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H0281.........................................................by STATE AFFAIRS
PRIMARY AND PREVENTIVE CARE GRANT 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 the 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.
02/20 House intro - 1st rdg - to printing
02/21 Rpt prt - to Bus
03/06 Rpt out - rec d/p - to 2nd rdg
03/07 2nd rdg - to 3rd rdg
03/11 3rd rdg - PASSED - 51-15-4
AYES -- Andersen, Barraclough, Bauer, Bieter, Black, Block, Boe, Bolz,
Bradford, Campbell, Cannon, Collins, Cuddy, Deal, Denney, Douglas,
Edmunson, Ellsworth, Field(18), Field(23), Gagner, Garrett, Henbest,
Jaquet, Jones, Kellogg, Lake, Langhorst(Wallace), Martinez, Meyer,
Miller, Mitchell, Naccarato, Nielsen, Raybould, Ridinger, Ring, Ringo,
Robison, Rydalch, Sayler, Schaefer, Shepherd, Shirley, Skippen,
Smith(30), Smylie, Snodgrass, Stevenson, Trail, Wills
NAYS -- Barrett, Bedke, Bell, Clark, Eberle, Harwood, Kulczyk, Langford,
McGeachin, McKague, Moyle, Roberts, Sali, Tilman, Wood
Absent and excused -- Crow, Eskridge, Smith(24), Mr. Speaker
Floor Sponsors - Deal & Black
Title apvd - to Senate
03/12 Senate intro - 1st rdg - to Fin
|||| LEGISLATURE OF THE STATE OF IDAHO ||||
Fifty-seventh Legislature First Regular Session - 2003
IN THE HOUSE OF REPRESENTATIVES
HOUSE BILL NO. 281
BY STATE AFFAIRS 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 84, 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 84, Title 39, Idaho Code, and to read as follows:
14 CHAPTER 84
15 IDAHO PRIMARY AND PREVENTIVE CARE GRANT PROGRAM
16 39-8401. DEFINITIONS. As used in this chapter:
17 (1) "Department" means the Idaho department of health and welfare.
18 (2) "Free clinic" means a health care facility, other than a hospital or
19 health care provider's office, which:
20 (a) Is an organized community-based program at which primary medical care
21 is provided without charge to individuals unable to pay for such care and
22 at which the care provided does not include the use of general anesthesia
23 and does not require an overnight stay in the health care facility;
24 (b) Has a community board of directors that includes at least one (1)
25 individual representing patients who use free clinics; and
26 (c) Demonstrates that it serves populations in areas with the greatest
27 need for services based on criteria established by the primary and preven-
28 tive care grant program board, as provided in section 39-8404, Idaho Code,
29 for the following three (3) indicators of need:
30 (i) Geographic barriers based on average travel time and distance
31 by the means most commonly used by the target population from the
32 home, shelter or camp to the nearest source of primary care that is
33 accessible to the target population, provided that a physician at
34 such primary care source is willing to accept new medicaid patients
35 and/or has a posted sliding fee schedule for people below two hundred
36 percent (200%) of the federal poverty level;
37 (ii) The percentage of individuals in the target population below
38 two hundred percent (200%) of the federal poverty level; and
39 (iii) The percentage of uninsured individuals in the target popula-
40 tion.
41 (3) "Idaho qualified health center" or "qualified health center" means an
42 entity which provides primary care services and which:
2
1 (a) Accepts all patients without regard to a patient's ability to pay;
2 (b) Uses a sliding fee schedule for payments which is visibly posted;
3 (c) Has a community board of directors that includes at least two (2)
4 individuals who represent patients who use such centers;
5 (d) Provides or arranges for the provision of primary care services to
6 persons of all ages; and
7 (e) Demonstrates that it serves populations in areas with the greatest
8 need for services based on criteria established by the primary and preven-
9 tive care grant program board, as provided in section 39-8404, Idaho Code,
10 for the following three (3) indicators of need:
11 (i) Geographic barriers based on average travel time and distance
12 by the means most commonly used by the target population from the
13 home, shelter or camp to the nearest source of primary care that is
14 accessible to the target population, provided that a physician at
15 such primary care source is willing to accept new Medicaid patients
16 and/or has a posted sliding fee schedule for people below two hundred
17 percent (200%) of the federal poverty level;
18 (ii) The percentage of individuals in the target population below
19 two hundred percent (200%) of the federal poverty level; and
20 (iii) The percentage of uninsured individuals in the target popula-
21 tion.
22 (4) "Primary care" means the basic entry level of health care provided by
23 health care practitioners which is generally provided in an outpatient set-
24 ting. Basic primary health care services must include health services related
25 to family medicine, internal medicine, pediatrics, obstetrics or gynecology,
26 including prenatal care, child and adult preventive services and coordination
27 and follow-up care from hospitalizations provided by physicians, physician
28 assistants, nurse practitioners or nurse-midwives. Primary care includes, but
29 is not limited to, providing or arranging for the provision of the following
30 services: primary health care; dental care; maternity care, including prenatal
31 care; preventive, developmental and diagnostic services for infants and chil-
32 dren; adult preventive services; diagnostic laboratory and radiology services;
33 emergency care for minor trauma; pharmaceutical services; and coordination and
34 follow-up for hospital care.
35 (5) "Program" means the Idaho primary and preventive care grant program
36 as provided for in this chapter.
37 (6) "Service grant" means a grant by the department to an Idaho qualified
38 health center or free clinic in accordance with this chapter.
39 (7) "Sliding fee schedule" means a schedule of patient fees that is
40 adjusted according to the patient's income. A fee schedule must be established
41 that is consistent with local prevailing rates or charges. The fee schedule
42 must provide for a full discount to individuals and families with annual
43 incomes at or below one hundred percent (100%) of the federal poverty level as
44 set forth in the most recent poverty income guidelines, except that nominal
45 fees may be collected from the patient for services. No discount shall be
46 offered to individuals and families with annual incomes greater than two hun-
47 dred percent (200%) of the federal poverty level.
48 (8) "Uninsured or medically indigent patient" means a patient receiving
49 services from an Idaho qualified health center or free clinic:
50 (a) Who is not insured through an employer or the United States veterans
51 administration for primary health care costs; and
52 (b) Whose household income, as defined in section 63-701, Idaho Code, is
53 at or below two hundred percent (200%) of the federal poverty level.
54 39-8402. IDAHO PRIMARY AND PREVENTIVE CARE GRANT PROGRAM ESTABLISHED. The
3
1 "Idaho Primary and Preventive Care Grant Program" is hereby established, under
2 the direction and administration of the department, for the purpose of making
3 service grants to Idaho qualified health centers and free clinics for their
4 use in providing care to uninsured or medically indigent patients in Idaho.
5 The program shall be established with such state funds as may be appropriated
6 annually by the legislature.
7 39-8403. SERVICE GRANT APPLICATIONS AND AWARDS -- USES OF SERVICE GRANT
8 MONEYS -- ANNUAL REPORTS. (1) Any Idaho qualified health center or free
9 clinic, as defined in section 39-8401, Idaho Code, desiring to participate in
10 the program shall make application for a service grant to the department in a
11 form prescribed by the department. All applications shall be submitted and
12 reviewed in accordance with the provisions of grant procedures, criteria and
13 standards promulgated by rule by the department. All service grants shall be
14 awarded within thirty (30) days after approval by the department.
15 (2) Service grants awarded to Idaho qualified health centers and free
16 clinics shall only be used by such centers to:
17 (a) Increase access to primary care services to uninsured or medically
18 indigent patients who are not otherwise served;
19 (b) Create new services or augment existing services provided to unin-
20 sured or medically indigent patients; or
21 (c) Establish new center or clinic sites that offer primary care services
22 that serve populations in areas with the greatest need for services.
23 (3) Grants received by Idaho qualified health centers and free clinics
24 pursuant to this chapter shall not be used:
25 (a) To replace federal funds traditionally received by such centers, but
26 may be used to supplement such federal funds;
27 (b) For land or real estate investment;
28 (c) To finance or satisfy any existing debt;
29 (d) To supplant the services of existing practitioners; or
30 (e) To provide abortions.
31 (4) No later than December 15 of each year, an Idaho qualified health
32 center or free clinic receiving a service grant shall provide an annual report
33 to the board and to the department which details the number of additional
34 uninsured and medically indigent patients that are cared for and the types of
35 services that are provided.
36 39-8404. PRIMARY AND PREVENTIVE CARE GRANT PROGRAM BOARD. (1) The primary
37 and preventive care grant program board (hereinafter referred to as "program
38 board") is hereby established to manage the program, review and award service
39 grants, and assess grantee effectiveness. The program board shall be composed
40 of the following ten (10) members:
41 (a) One (1) member of the house of representatives, appointed by and
42 serving at the pleasure of the speaker of the house of representatives;
43 (b) One (1) member of the senate, appointed by and serving at the pleas-
44 ure of the president pro tempore of the senate;
45 (c) One (1) employee of the department who is knowledgeable in primary
46 and preventive health care issues;
47 (d) One (1) representative of a nonprofit organization representing pri-
48 mary health care providers serving uninsured, medically indigent Idahoans;
49 (e) Two (2) representatives of an Idaho qualified health center or free
50 health clinic;
51 (f) Two (2) physicians, with consideration given to physicians who have
52 training and expertise in providing primary care services to medically
53 underserved populations;
4
1 (g) One (1) individual who has received health care services from an
2 Idaho qualified health center or free clinic; and
3 (h) One (1) rural hospital administrator.
4 (2) The director of the department shall appoint nonlegislative members
5 of the board after consultation with applicable organizations in the state
6 and, in making such appointments, shall give consideration for geographic rep-
7 resentation of the state.
8 (3) Appointments of nonlegislative members to the program board shall be
9 for terms of three (3) years; provided however, that initial appointments
10 shall be staggered in such a manner that approximately one-third (1/3) are
11 appointed for one (1) year, one-third (1/3) are appointed for two (2) years,
12 and one-third (1/3) are appointed for three (3) years. Program board members
13 may be reappointed at the end of each three (3) year period.
14 (4) A majority of the program board members constitutes a quorum for the
15 transaction of business. A majority vote is required by the quorum in finaliz-
16 ing decisions relating to the program.
17 (5) Members of the program board shall serve and shall be compensated as
18 provided by section 59-509(b), Idaho Code.
19 39-8405. IDAHO PRIMARY AND PREVENTIVE CARE FUND CREATED. (1) There is
20 hereby created in the state treasury a fund to be known as the "Idaho Primary
21 and Preventive Care Fund." Moneys in the fund may be expended pursuant to
22 appropriation by the legislature, and may be utilized for service grants and
23 for the payment of program administrative costs which are reasonably incurred
24 by the department or the program board; provided however, in no event shall
25 less than forty-five thousand dollars ($45,000) nor more than one and one-half
26 percent (1.5%) of the appropriation be used to administer the program and pay
27 expenses incurred by the program board.
28 (2) Moneys in the fund may consist of appropriations, contributions,
29 grants, gifts, bequests or other sources received. All interest from idle
30 moneys in the fund shall be returned to the fund. Any unexpended balance in
31 the fund at the end of each fiscal year shall remain in the fund.
32 39-8406. DUTIES OF THE PROGRAM BOARD. The program board shall:
33 (1) Develop assessment criteria for the awarding of grants. Assessment
34 criteria shall include, but not be limited to:
35 (a) A demonstrated need for expanded access or services;
36 (b) A description of the program's effect on other practitioners in the
37 applicable community;
38 (c) A demonstrated community support for the program;
39 (d) A demonstrated support from providers of primary care services;
40 (e) A demonstrated record of providing cost-effective health care;
41 (f) A program operating budget; and
42 (g) A description of measures that will be used to assess the effective-
43 ness of the program.
44 (2) Consider the need for geographic expansion based upon medically
45 underserved areas or populations as provided in section 330(b) of the federal
46 public health service act, 42 U.S.C. section 254b;
47 (3) Develop a plan to ensure that grants are equitably distributed to
48 eligible qualified health centers and free clinics; and
49 (4) In cooperation with the department, prepare and submit to the legis-
50 lature an annual report describing the program's effectiveness in increasing
51 access to health care services for medically uninsured patients in Idaho.
52 39-8407. DUTIES OF THE DEPARTMENT. The department shall:
5
1 (1) Promulgate rules and forms to govern grant applications and awards;
2 and
3 (2) Develop a reporting process to assure that grant moneys are used to
4 provide and expand care to uninsured and medically indigent patients.
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STATEMENT OF PURPOSE
RS 13002
This legislation would create the Idaho Primary & Preventative Care Grant
Program for Idaho qualified health centers and free clinics which care
for medically indigent populations. The Idaho State Planning Grant
estimates there are 196,800 Idahoans uninsured because they cannot afford
health insurance; 80% of these are in working families with 48,310
uninsured children. Failure to seek primary health care services results
in increased hospitalizations and poor quality of life. The service
grants would be used to: 1) increase access to primary care services for
both the uninsured and medically indigent; 2) expand services at existing
centers or clinics; or 3) establish new health centers or clinics that
offer primary health care services in areas with greatest need for
services.
Once established, pursuant to appropriation by the Legislature, the grant
program would be administered in the Idaho Department of Health and
Welfare. The legislation creates a Program board to manage the program,
review/award service grants, and assess effectiveness. In addition, the
legislation provides for annual reporting to the legislature describing
the program's effectiveness in increasing access to health care services
for uninsured or medically indigent patients.
FISCAL IMPACT
No fiscal impact for FY 2004. This bill will set up a mechanism to
create the Idaho Primary & Preventative Care Fund. The Idaho Primary &
Preventative Care Program will not be established until funding is
available, whether from state funds or from outside funding sources, such
as contributions or grants.
The use of Idaho qualified health centers and free clinics as medical
homes for patients with chronic illnesses could reduce the impact on both
the county indigent programs and Catastrophic Health Care Fund, which
have had significant increases in expenditures. According to the Bureau
of Primary Health Care Uniform Data Systems (UDS), Idaho Community Health
Centers saved Idaho approximately $3.4 million on Medicaid expenditures
in 2002.
Once established, the estimated cost of the semi-annual board meetings,
$2,000, will be included in the administrative costs of the department,
a minimum of $45,000 and no more than 1.5% of the appropriation.
Contact: Rep. Max Black/Rep. Bill Deal
(208) 332-1139
Bill Foxcroft, Idaho Primary Care Association
(208) 345-2335, ext. 12
STATEMENT OF PURPOSE/FISCAL NOTE H 281