2001 Legislation
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SENATE BILL NO. 1183 – Preventive health care program

SENATE BILL NO. 1183

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S1183................................................by JUDICIARY AND RULES
PREVENTIVE CARE PROGRAM - Adds to existing law to define terms; to
establish the Idaho Primary and Preventive Care Grant Program; to provide
for service grant applications and awards, and use of service grant moneys;
to provide for reports; to provide for a program board and duties of the
board and the Department of Health and Welfare; and to create the Primary
and Preventive Care Fund.
                                                                        
02/27    Senate intro - 1st rdg - to printing
02/28    Rpt prt - to Health/Wel

Bill Text


                                                                        
                                                                        
  ||||              LEGISLATURE OF THE STATE OF IDAHO             ||||
 Fifty-sixth Legislature                  First Regular Session - 2001
                                                                        
                                                                        
                                       IN THE SENATE
                                                                        
                                    SENATE BILL NO. 1183
                                                                        
                              BY JUDICIARY AND RULES COMMITTEE
                                                                        
  1                                        AN ACT
  2    RELATING TO THE PRIMARY AND PREVENTIVE CARE GRANT PROGRAM; AMENDING TITLE  39,
  3        IDAHO  CODE, BY THE ADDITION OF A NEW CHAPTER 82, TITLE 39, IDAHO CODE, TO
  4        DEFINE TERMS, TO ESTABLISH THE IDAHO PRIMARY  AND  PREVENTIVE  CARE  GRANT
  5        PROGRAM, TO PROVIDE FOR SERVICE GRANT APPLICATIONS AND AWARDS, PERMISSIBLE
  6        USES OF SERVICE GRANT MONEYS AND TO PROVIDE FOR ANNUAL REPORTS, TO PROVIDE
  7        FOR  A  PROGRAM BOARD, TO PROVIDE FOR THE CREATION OF THE PRIMARY AND PRE-
  8        VENTIVE CARE FUND AND TO PROVIDE FOR DUTIES OF THE PROGRAM BOARD  AND  THE
  9        DEPARTMENT OF HEALTH AND WELFARE.
                                                                        
 10    Be It Enacted by the Legislature of the State of Idaho:
                                                                        
 11        SECTION  1.  That Title 39, Idaho Code, be, and the same is hereby amended
 12    by the addition thereto of a NEW CHAPTER, to be known and designated as  Chap-
 13    ter 82, Title 39, Idaho Code, and to read as follows:
                                                                        
 14                                      CHAPTER 82
 15                   IDAHO PRIMARY AND PREVENTIVE CARE GRANT PROGRAM
                                                                        
 16        39-8201.  DEFINITIONS. As used in this chapter:
 17        (1)  "Department" means the Idaho department of health and welfare.
 18        (2)  "Free  clinic" means a health clinic which provides primary care ser-
 19    vices without charge to uninsured or medically indigent patients and which:
 20        (a)  Has a community board of directors that includes  at  least  one  (1)
 21        individual representing patients who use free clinics; and
 22        (b)  Serves a designated medically underserved area or population, as pro-
 23        vided  in  section  330(b)  of  the  federal public health service act, 42
 24        U.S.C. section 254b.
 25        (3)  "Idaho qualified health center" or "qualified health center" means an
 26    entity which provides primary care services and which:
 27        (a)  Accepts all patients without regard to a patient's ability to pay;
 28        (b)  Uses a sliding fee schedule for payments;
 29        (c)  Has a community board of directors that includes  at  least  two  (2)
 30        individuals who represent patients who use such centers;
 31        (d)  Serves a designated medically underserved area or population, as pro-
 32        vided  in  section  330(b)  of  the  federal public health service act, 42
 33        U.S.C. section 254b; and
 34        (e)  Provides or arranges for the provision of primary  care  services  to
 35        persons of all ages.
 36        (4)  "Medically  underserved  area" means an area designated by the secre-
 37    tary of the United States department of health and human services as  an  area
 38    with a shortage of health care professionals or health services.
 39        (5)  "Medically  underserved  population"  means a population group desig-
 40    nated by the secretary of the United States department  of  health  and  human
 41    services as having a shortage of health care professionals or health services.
 42        (6)  "Primary care" means the basic entry level of health care provided by
                                                                        
                                           2
                                                                        
  1    health  care  practitioners  which is generally provided in an outpatient set-
  2    ting. Primary care includes, but is not limited to, providing or arranging for
  3    the provision of the following services:  primary health  care;  dental  care;
  4    maternity  care,  including prenatal care; preventive, developmental and diag-
  5    nostic services for infants and children; adult preventive services;  diagnos-
  6    tic  laboratory and radiology services; emergency care for minor trauma; phar-
  7    maceutical services; and coordination and follow-up for hospital care. Primary
  8    care may also include optional services based on a patient's needs.
  9        (7)  "Program" means the Idaho primary and preventive care  grant  program
 10    as provided for in this chapter.
 11        (8)  "Service grant" means a grant by the department to an Idaho qualified
 12    health center or free clinic in accordance with this chapter.
 13        (9)  "Sliding  fee  schedule"  means  a  schedule  of patient fees that is
 14    adjusted according to the patient's income. A fee schedule must be established
 15    that is consistent with local prevailing rates or charges.  The  fee  schedule
 16    must  provide  for  a  full  discount  to individuals and families with annual
 17    incomes at or below one hundred percent (100%) of the federal poverty level as
 18    set forth in the most recent poverty income guidelines,  except  that  nominal
 19    fees  may  be  collected  from  the patient for services. No discount shall be
 20    offered to individuals and families with annual incomes greater than two  hun-
 21    dred  percent  (200%)  of  the federal poverty level. Individuals and families
 22    with annual incomes between one hundred fifty percent (150%) and  two  hundred
 23    percent  (200%) of the federal poverty level will be charged at least seventy-
 24    five percent (75%) of local prevailing rates or charges.
 25        (10) "Uninsured or medically indigent patient" means a  patient  receiving
 26    services from an Idaho qualified health center or free clinic:
 27        (a)  Who  is not eligible for medicaid, medicare or any other type of gov-
 28        ernmental health insurance;
 29        (b)  Who is not receiving third-party payments  through  an  employer  for
 30        health care costs; and
 31        (c)  Whose  household income, as defined in section 63-701, Idaho Code, is
 32        at or below two hundred percent (200%) of the federal poverty level.
                                                                        
 33        39-8202.  IDAHO PRIMARY AND PREVENTIVE CARE GRANT PROGRAM ESTABLISHED. The
 34    "Idaho Primary and Preventive Care Grant Program" is hereby established, under
 35    the direction and administration of the department, for the purpose of  making
 36    service  grants  to  Idaho qualified health centers and free clinics for their
 37    use in providing care to uninsured or medically indigent  patients  in  Idaho.
 38    The  program shall be established with such state funds as may be appropriated
 39    annually by the legislature.
                                                                        
 40        39-8203.  SERVICE GRANT APPLICATIONS AND AWARDS -- USES OF  SERVICE  GRANT
 41    MONEYS  --  ANNUAL  REPORTS.  (1)  Any  Idaho  qualified health center or free
 42    clinic, as defined in section 39-8201, Idaho Code, desiring to participate  in
 43    the  program shall make application for a service grant to the department in a
 44    form prescribed by the department. All applications  shall  be  submitted  and
 45    reviewed  in  accordance with the provisions of grant procedures, criteria and
 46    standards promulgated by rule by the department. All service grants  shall  be
 47    awarded within thirty (30) days after approval by the department.
 48        (2)  Service  grants  awarded  to  Idaho qualified health centers and free
 49    clinics shall only be used by such centers to:
 50        (a)  Increase access to primary care services to  uninsured  or  medically
 51        indigent patients who are not otherwise served;
 52        (b)  Create  new  services  or augment existing services provided to unin-
 53        sured or medically indigent patients; or
                                                                        
                                           3
                                                                        
  1        (c)  Establish new center sites that offer primary care services in  medi-
  2        cally  underserved  areas of the state or to medically underserved popula-
  3        tions.
  4        (3)  Grants received by Idaho qualified health centers  and  free  clinics
  5    pursuant to this chapter shall not be used:
  6        (a)  To  replace federal funds traditionally received by such centers, but
  7        may be used to supplement such federal funds;
  8        (b)  For land or real estate investment;
  9        (c)  To finance or satisfy any existing debt; or
 10        (d)  To supplant the services of existing practitioners.
 11        (4)  No later than December 15 of each year,  an  Idaho  qualified  health
 12    center or free clinic receiving a service grant shall provide an annual report
 13    to  the  board  and  to  the department which details the number of additional
 14    uninsured and medically indigent patients that are cared for and the types  of
 15    services that are provided.
                                                                        
 16        39-8204.  PRIMARY AND PREVENTIVE CARE GRANT PROGRAM BOARD. (1) The primary
 17    and  preventive  care grant program board (hereinafter referred to as "program
 18    board") is hereby established to manage the program, review and award  service
 19    grants,  and assess grantee effectiveness. The program board shall be composed
 20    of the following nine (9) members:
 21        (a)  One (1) member of the house  of  representatives,  appointed  by  and
 22        serving at the pleasure of the speaker of the house of representatives;
 23        (b)  One  (1) member of the senate, appointed by and serving at the pleas-
 24        ure of the president pro tempore of the senate;
 25        (c)  One (1) employee of the department who is  knowledgeable  in  primary
 26        and preventive health care issues;
 27        (d)  One  (1) representative of a nonprofit organization representing pri-
 28        mary health care providers serving uninsured, medically indigent Idahoans;
 29        (e)  One (1) representative of an Idaho qualified health center;
 30        (f)  Two (2) physicians, with consideration given to physicians  who  have
 31        training  and  expertise  in  providing primary care services to medically
 32        underserved populations;
 33        (g)  One (1) individual who has received  health  care  services  from  an
 34        Idaho qualified health center or free clinic; and
 35        (h)  One (1) rural hospital administrator.
 36        (2)  The  director  of the department shall appoint nonlegislative members
 37    of the board after consultation with applicable  organizations  in  the  state
 38    and, in making such appointments, shall give consideration for geographic rep-
 39    resentation of the state.
 40        (3)  Appointments  of nonlegislative members to the program board shall be
 41    for terms of three (3) years;  provided  however,  that  initial  appointments
 42    shall  be  staggered  in  such a manner that approximately one-third (1/3) are
 43    appointed for one (1) year, one-third (1/3) are appointed for two  (2)  years,
 44    and  one-third  (1/3) are appointed for three (3) years. Program board members
 45    may be reappointed at the end of each three (3) year period.
 46        (4)  A majority of the program board members constitutes a quorum for  the
 47    transaction of business. A majority vote is required by the quorum in finaliz-
 48    ing decisions relating to the program.
 49        (5)  Members  of the program board shall serve and shall be compensated as
 50    provided by section 59-509(b), Idaho Code.
                                                                        
 51        39-8205.  IDAHO PRIMARY AND PREVENTIVE CARE FUND  CREATED.  (1)  There  is
 52    hereby  created in the state treasury a fund to be known as the "Idaho Primary
 53    and Preventive Care Fund." Moneys in the fund  may  be  expended  pursuant  to
                                                                        
                                           4
                                                                        
  1    appropriation  by  the legislature, and may be utilized for service grants and
  2    for the payment of program administrative costs which are reasonably  incurred
  3    by  the  department  or the program board; provided however, in no event shall
  4    more than one and one-half  percent  (1.5%)  or  forty-five  thousand  dollars
  5    ($45,000)  annually,  whichever is less, be used to administer the program and
  6    pay expenses incurred by the program board.
  7        (2)  Moneys in the fund  may  consist  of  appropriations,  contributions,
  8    grants,  gifts,  bequests  or  other  sources received. All interest from idle
  9    moneys in the fund shall be returned to the fund. Any  unexpended  balance  in
 10    the fund at the end of each fiscal year shall remain in the fund.
                                                                        
 11        39-8206.  DUTIES OF THE PROGRAM BOARD. The program board shall:
 12        (1)  Develop  assessment  criteria  for the awarding of grants. Assessment
 13    criteria shall include, but not be limited to:
 14        (a)  A demonstrated need for expanded access or services;
 15        (b)  A description of the program's effect on other practitioners  in  the
 16        applicable community;
 17        (c)  A demonstrated community support for the program;
 18        (d)  A demonstrated support from providers of primary care services;
 19        (e)  A demonstrated record of providing cost-effective health care;
 20        (f)  A program operating budget; and
 21        (g)  A  description of measures that will be used to assess the effective-
 22        ness of the program.
 23        (2)  Consider the need  for  geographic  expansion  based  upon  medically
 24    underserved areas or populations;
 25        (3)  Develop  a  plan  to  ensure that grants are equitably distributed to
 26    eligible qualified health centers and free clinics; and
 27        (4)  In cooperation with the department, prepare and submit to the  legis-
 28    lature  an  annual report describing the program's effectiveness in increasing
 29    access to health care services for medically uninsured patients in Idaho.
                                                                        
 30        39-8207.  DUTIES OF THE DEPARTMENT. The department shall:
 31        (1)  Promulgate rules and forms to govern grant applications  and  awards;
 32    and
 33        (2)  Develop  a  reporting process to assure that grant moneys are used to
 34    provide and expand care to uninsured and medically indigent patients.

Statement of Purpose / Fiscal Impact


                       STATEMENT OF PURPOSE

                         RS 11195

This legislation would create the Idaho Primary and Preventive Care
Grant Program that would provide money to Idaho qualified health 
centers located in medically underserved areas to treat uninsured 
patients.  Approximately 160,000 Idahoans will go without health 
insurance this year because they cannot afford it.  The service 
grants could be used to 1) increase access to primary care services 
for uninsured people, 2) create new services or augment existing 
services provided to uninsured patients, and 3) establish new center
sites that offer primary care services in medically underserved areas
of the state or to medically underserved populations.

The grant program would be administratively housed in the Idaho 
Department of Health & Welfare.  The legislation creates a Program 
Board to manage the program, review and award service grants, and 
assess effectiveness.  In addition, the legislation provides for  
annual reporting of grant expenditures which details the number of
 additional uninsured patients who are cared for and the types of 
services provided.
                                        
                       FISCAL IMPACT
If the legislation passes both houses, a request for an appropriation 
would be heard by JFAC.  Each appropriation of $1 million from the 
state general fund would provide approximately 12,500 primary care 
visits to 4,167 Idahoans.  It would be desirable to have an 
appropriation of $2 million to $4 million in order to significantly 
expand service to the uninsured.

The use of Idaho qualified health centers as medical homes for these
patients could reduce the impact on both the county indigent programs 
and the Catastrophic Health Care Fund for treatment of the chronically 
ill.

The estimated cost of the semi-annual board meetings is $2,000 and 
will be included in the administrative costs of the department, which 
are limited to 1.5% of the appropriation or $45,000, whichever is less.


CONTACT:  Rep. Max Black                     332-1139
          Bill Foxcroft/Sarah LaPlante
          Idaho Primary Care Association     345-2335
     


STATEMENT OF PURPOSE/FISCAL NOTE                S 1183