HOUSE BILL 35

50th legislature - STATE OF NEW MEXICO - first session, 2011

INTRODUCED BY

Danice Picraux and Dede Feldman

FOR THE LEGISLATIVE HEALTH AND HUMAN SERVICES COMMITTEE

AN ACT

RELATING TO PUBLIC ASSISTANCE; DIRECTING THE SECRETARY OF HUMAN SERVICES TO ESTABLISH AN "ACCOUNTABLE CARE ORGANIZATION DEMONSTRATION PROJECT TASK FORCE" TO STUDY THE FEASIBILITY AND PARAMETERS OF AN ACCOUNTABLE CARE ORGANIZATION DEMONSTRATION PROJECT FOR MEDICAID, STATE CHILDREN'S HEALTH INSURANCE PROGRAM AND STATE COVERAGE INSURANCE PROGRAM RECIPIENTS IN HIDALGO COUNTY.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF NEW MEXICO:

     SECTION 1. TEMPORARY PROVISION--ACCOUNTABLE CARE ORGANIZATION DEMONSTRATION PROJECT TASK FORCE.--

          A. By July 1, 2011, the secretary of human services or the secretary's successor in interest shall convene an "accountable care organization demonstration project task force" and work with representatives from the human services department, the New Mexico health policy commission, the university of New Mexico health sciences center, managed care contractors, a nonprofit primary care organization and others as the secretary deems necessary to devise a strategic plan for implementing an accountable care organization demonstration project in Hidalgo county pursuant to a prospective federal waiver. The task force shall devise a two-year strategic plan and report on the plan to the legislative health and human services committee and the legislative finance committee by August 1, 2012. The strategic plan shall contain recommendations regarding:

                (1) the feasibility of implementing a financial model for an accountable care organization in Hidalgo county that provides incentives to improve health outcomes and reduce per capita costs in the accountable care organization;

                (2) the parameters of risk in a regional or community-based accountable care organization in Hidalgo county;

                (3) the role of managed care contractors in providing administrative and other services to successfully implement the demonstration project;

                (4) the utilization of care and case management, whereby the demonstration project incorporates the following:

                     (a) incentives for the promotion of a comprehensive health care system in which a recipient has a primary health care or social service provider who advocates for and provides ongoing support, oversight and guidance to implement an integrated, coherent, cross-discipline plan for ongoing health care and service delivery that is developed in partnership with the recipient and that includes all other health care and social service providers furnishing care to the recipient;

                     (b) health system utilization management that is designed to assure appropriate access and utilization of services, including specialty and hospital care and utilization of prescription drugs;

                     (c) health risk or functional needs assessments for recipients;

                     (d) a method for reporting on the effectiveness of the demonstration project and its effect upon recipients' utilization of health care services and the associated costs of utilization of those services;

                     (e) mechanisms to reduce inappropriate emergency department utilization by recipients;

                     (f) mechanisms that ensure a robust system of care coordination for assessing, planning, coordinating and monitoring recipients with complex, chronic or high-cost health care or social support needs, including attendant care and other services needed to enable recipients to remain in the community;

                     (g) a comprehensive, community-based initiative to educate recipients about effective use of the health care delivery system, including the use of community health workers or promotoras;

                     (h) strategies to prevent or delay institutionalization of recipients through the effective utilization of home- and community-based support services; and

                     (i) any other components that the task force determines will improve a recipient's health outcome and that are cost-effective;

                (5) promotion of the health commons model of integrated primary care, specialty, behavioral and dental health care services, including telehealth services;

                (6) incentives for encouraging longer hours for primary care services, including weekend and evening hours; and

                (7) recommendations for designing and implementing a comprehensive incentive and risk system whereby providers of care in an accountable care organization in Hidalgo county receive financial incentives for measurable improvements in the health of their patients, including recommendations for quality evaluation and measurement protocols and for increasing community support for improving health care outcomes while addressing the social determinants of health.

          B. For fiscal year 2012, the human services department shall specify in its contract with each managed care contractor that the contractor allocate funds for the operation of the task force pursuant to Subsection A of this section.

          C. For the purposes of this section:

                (1) "accountable care organization" means a set of providers associated with a defined population of patients that is accountable for the quality and cost of care delivered to that population;

                (2) "managed care contractor" means a managed care organization that provides the health care benefits, items and services to recipients in Hidalgo county under the state's medicaid program, state children's health insurance program or state coverage insurance program;

                (3) "primary care provider" means a nonprofit community-based entity that provides, or commits to provide, comprehensive primary health care services for residents of Hidalgo county, including a federally qualified health center or a facility serving primarily low-income populations; and

                (4) "recipient" means a person who is receiving medical assistance under the Public Assistance Act.

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