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H0246......................................................by STATE AFFAIRS
RURAL HEALTH CARE ACCESS PROGRAM - Amends existing law to change the Rural
Health Care Access Program to the Primary Health Care Access Program; to
provide primary care system grants and primary care service grants; to
govern the amount and use of the grant funds; to increase the membership of
the Primary Health Care Access Grant Program Board; to define the scope and
use of grants and specify categories of grants; to provide conditions
governing the eligibility for grants; to provide deadlines; and to revise
award criteria.
02/18 House intro - 1st rdg - to printing
02/21 Rpt prt - to Health/Wel
]]]] LEGISLATURE OF THE STATE OF IDAHO ]]]]
Fifty-eighth Legislature First Regular Session - 2005
IN THE HOUSE OF REPRESENTATIVES
HOUSE BILL NO. 246
BY STATE AFFAIRS COMMITTEE
1 AN ACT
2 RELATING TO THE RURAL HEALTH CARE ACCESS PROGRAM; AMENDING SECTION 39-5901,
3 IDAHO CODE, TO CHANGE THE RURAL HEALTH CARE ACCESS PROGRAM TO THE PRIMARY
4 HEALTH CARE ACCESS PROGRAM; AMENDING SECTION 39-5902, IDAHO CODE, TO PRO-
5 VIDE PRIMARY CARE SYSTEM GRANTS AND PRIMARY CARE SERVICE GRANTS AND TO
6 GOVERN THE AMOUNT AND USE OF THE GRANT FUNDS; AMENDING SECTION 39-5903,
7 IDAHO CODE, TO FURTHER DEFINE TERMS; AMENDING SECTION 39-5904, IDAHO CODE,
8 TO SPECIFY MEMBERSHIP OF THE PRIMARY HEALTH CARE ACCESS PROGRAM REVIEW
9 BOARD; AMENDING SECTION 39-5905, IDAHO CODE, TO DEFINE THE SCOPE AND USE
10 OF GRANTS; AMENDING SECTION 39-5906, IDAHO CODE, TO SPECIFY CATEGORIES OF
11 GRANTS; AMENDING SECTION 39-5907, IDAHO CODE, TO PROVIDE CONDITIONS GOV-
12 ERNING ELIGIBILITY FOR GRANTS; AMENDING SECTION 39-5908, IDAHO CODE, TO
13 PROVIDE REQUIRED CONTENT OF APPLICATIONS; AMENDING SECTION 39-5909, IDAHO
14 CODE, TO PROVIDE CORRECT TERMINOLOGY AND TO PROVIDE DEADLINES; AMENDING
15 SECTION 39-5910, IDAHO CODE, TO REVISE AWARD CRITERIA AND TO MAKE A TECH-
16 NICAL CORRECTION; AMENDING SECTION 39-5911, IDAHO CODE, TO DELETE A TIME
17 LIMIT; AND AMENDING SECTION 39-5912, IDAHO CODE, TO PROVIDE CORRECT TERMI-
18 NOLOGY.
19 Be It Enacted by the Legislature of the State of Idaho:
20 SECTION 1. That Section 39-5901, Idaho Code, be, and the same is hereby
21 amended to read as follows:
22 39-5901. SHORT TITLE. This act shall be known and cited as the "Idaho
23 Rural Primary Health Care Access Program."
24 SECTION 2. That Section 39-5902, Idaho Code, be, and the same is hereby
25 amended to read as follows:
26 39-5902. RURAL PRIMARY HEALTH CARE ACCESS FUND. (1) There is hereby cre-
27 ated in the state treasury a fund known as the "RuralPrimary Health Care
28 Access Fund." Subject to appropriation by the legislature, moneys in the fund
29 shall be used exclusively for the purpose of grants for improving access to
30 primary care medical and dental services in areas designated as primary care
31 health professional shortage areas and medically underserved areas and their
32 administration pursuant to this chapter. Moneys in the fund may consist of
33 appropriations, contributions, grants, gifts, bequests or other sources
34 received. Any unexpended balance in the fund at the end of each fiscal year
35 shall remain in the fund. Funds will be set aside for the following purposes:
36 (1) Primary care system grants consisting of:
37 (a) Recruitment and retention of primary care providers. Grant funds may
38 be used for loan repayment for primary care providers, recruitment incen-
39 tive, and/or reimbursement of relocation expenses for primary care
40 providers.
41 (b) Community development projects. Grant funds may be used for health
2
1 needs assessments, marketplace analysis, financial analysis and strategic
2 planning activities.
3 (c) Telehealth projects. Grant funds may be used for projects that
4 involve the use of telecommunications technologies for distance learning
5 and for projects to improve access to care for rural communities.
6 (d) Other. Communities may choose to apply for funds for activities that
7 they have identified and determined will help to improve access to primary
8 care.
9 (2) Primary care service grants to Idaho qualified health centers, free
10 clinics or Idaho family medicine residency program clinics for their use in
11 providing care and improving access to uninsured or medically indigent
12 patients in Idaho.
13 (3) Payment of program administrative costs which are reasonably incurred
14 by the department or the program board; provided however, in no event shall
15 more than one and one-half percent (1.5%) or less than forty-five thousand
16 dollars ($45,000) annually be used to administer this program.
17 SECTION 3. That Section 39-5903, Idaho Code, be, and the same is hereby
18 amended to read as follows:
19 39-5903. DEFINITIONS. As used in this chapter:
20 (1) "Applicant" means an entity submitting documents required by the
21 rural primary health care access program for the purpose of requesting a grant
22 from the rural primary health care access fund.
23 (2) "Application period" means the time period from January 15 to April
24 15 prior to the state fiscal year for which funding is requested.
25 (3) "Approval" means written notification that the application will be
26 awarded funding through the rural funding request submitted by the applicant
27 has been favorably supported by the board to receive payment from the primary
28 health care access fund.
29 (4) "Board" means the rural primary health care access program review
30 board.
31 (5) "Dental health professional shortage area" means a geographic area or
32 population group or facility which the U.S. secretary of health and human ser-
33 vices has determined is underserved by dental health care professionals.
34 (6) "Department" means the department of health and welfare.
35 (67) "Director" means the director of the department of health and wel-
36 fare.
37 (8) "Free medical clinic" means a facility, other than a hospital or
38 health care provider's office, which is an organized, community-based program
39 registered with the department of health and welfare, at which primary medical
40 care is provided without charge to individuals unable to pay for it and at
41 which the care provided does not include the use of general anesthesia or
42 require an overnight stay in a health care facility.
43 (79) "Grant period" means the time immediately following the application
44 period from July 1 through June 30 (state fiscal year) for which funding is
45 granted.
46 (10) "Idaho qualified health center" or "qualified health center" means an
47 entity that provides primary care services and that:
48 (a) Is a PHS section 330 federally funded community or migrant health
49 center (CMHC);
50 (b) Accepts all patients without regard to a patient's ability to pay,
51 including medicaid and medicare recipients, and uses a sliding fee sched-
52 ule for payments, which is visibly posted;
53 (c) Has a consumer majority board of directors;
3
1 (d) Is a 501(c)(3) not-for-profit or governmental entity;
2 (e) Serves a medically underserved area or medically underserved popula-
3 tion; and
4 (f) Provides or arranges for the provision of primary care services to
5 persons of all ages.
6 (11) "Idaho family medicine residency program clinics" means the outpa-
7 tient primary care clinics of Idaho's two (2) family medicine training pro-
8 grams which:
9 (a) Are ACGME accredited residency programs with a mission to train fam-
10 ily medicine residents;
11 (b) Accept all patients without regard to a patient's ability to pay,
12 including medicaid and medicare recipients;
13 (c) Provide free care to those unable to pay and/or use a sliding fee
14 scale and/or assist uninsured patients in getting access to county funds;
15 (d) Are governed by a board that acts as a graduate medical education
16 committee consistent with ACGME requirements;
17 (e) Serve the underserved inner city indigent patients in Boise and Poca-
18 tello;
19 (f) Provide for the provision of primary care services to persons of all
20 ages;
21 (g) Are eligible for and receive graduate medical education funds through
22 their hospital cost reports; and
23 (h) Enroll and assist patients without funds into the indigent medication
24 program to ensure access to medication.
25 (12) "Medically underserved area" may be a whole county or a group of con-
26 tiguous counties, a group of county or civil divisions or a group of urban
27 census tracts in which the U.S. secretary of health and human services has
28 determined that the residents have a shortage of personal health services.
29 (13) "Medically underserved population" means groups of persons who the
30 U.S. secretary of health and human services has determined face economic, cul-
31 tural or linguistic barriers to health care.
32 (814) "Nurse practitioner" means a health care provider licensed pursuant
33 to chapter 14, title 54, Idaho Code.
34 (915) "Oral health care provider" means a dentist or dental hygienist
35 licensed pursuant to chapter 9, title 54, Idaho Code.
36 (106) "Physician assistant" means a health care provider licensed pursuant
37 to chapter 18, title 54, Idaho Code.
38 (117) "Primary care services" means the provision of professional compre-
39 hensive health services, including oral health care services, that includes
40 health education and disease prevention, initial assessment of health prob-
41 lems, treatment of acute care and chronic health problems, and the overall
42 management of an individual's or family's health care, including prenatal
43 care, child and adult preventive services and coordination and follow-up care
44 from hospitalizations provided by physicians, physician assistants and nurse
45 practitioners. Primary care may also include, but is not limited to, develop-
46 mental and diagnostic services for infants and children; diagnostic laboratory
47 and radiology services; emergency care for minor trauma; and pharmaceutical
48 services.
49 (18) "Primary care providers" means services as provided by an Idaho
50 licensed internist, obstetrician, gynecologist, pediatrician, family practi-
51 tioner, general practitioner, dentist, dental hygienist, nurse practitioner,
52 or physician assistant or certified nurse midwife. It provides the initial
53 contact for health services and referral for secondary and tertiary care.
54 (129) "Primary care health professional shortage area" means a geographic
55 area or population group which the U.S. secretary of health and human services
4
1 has determined is underserved by primary care health professional(s).
2 (13) "Medically underserved area" means a geographic area which the U.S.
3 secretary of health and human services has determined is underserved by pri-
4 mary care health professional(s).
5 (1420) "Rural health "Primary care access system grant," hereinafter
6 referred to as a "system grant" means a grant awarded pursuant to this chapter
7 for recruitment and retention, community development, telehealth or other pro-
8 grams to improve access to primary care.
9 (21) "Primary care service grant," hereinafter referred to as a "service
10 grant" means a grant awarded pursuant to this chapter by the department to an
11 Idaho qualified health center, free clinic or Idaho family medicine residency
12 program clinic in accordance with this chapter.
13 (1522) "Rural "Primary health care access program" means the program that
14 administers the rural primary health care access fund.
15 (23) "Sliding fee schedule" means a schedule of patient fees that is
16 adjusted according to the patient's income according to the federal poverty
17 level. A fee schedule must be established that is consistent with local pre-
18 vailing rates or charges. The fee schedule must provide for a full discount to
19 individuals and families with annual incomes at or below one hundred percent
20 (100%) of the federal poverty level as set forth in the most recent poverty
21 guidelines, except that nominal fees may be charged to the patient for ser-
22 vices. No discount shall be offered to individuals and families with annual
23 incomes greater than two hundred percent (200%) of the federal poverty level.
24 (24) "Uninsured or medically indigent patient" means a patient receiving
25 services from an Idaho qualified health center, free clinic or Idaho family
26 medicine residency program clinic and:
27 (a) Who is not insured for primary health care costs; and
28 (b) Whose household income, as defined in section 63-701, Idaho Code, is
29 at or below two hundred percent (200%) of the federal poverty level.
30 SECTION 4. That Section 39-5904, Idaho Code, be, and the same is hereby
31 amended to read as follows:
32 39-5904. RURAL PRIMARY HEALTH CARE ACCESS GRANT PROGRAM REVIEW BOARD. (1)
33 The director shall appoint the members of a board to be known as the rural
34 primary health care access grant program review board, who shall serve at the
35 pleasure of the director. Board members shall not be compensated, but shall be
36 reimbursed for travel expenses incurred for attendance at board meetings.
37 (2) The board shall meet at least annually, for the purposes described in
38 this chapter.
39 (3) The board shall be composed of the following: a representative from
40 the Idaho academy of family physicians, a representative from the nurse prac-
41 titioner conference group, a rural hospital administrator, a representative
42 from the physician assistant association, the health resources section super-
43 visor from the division of health, a faculty member from one (1) of the Idaho
44 family residency programs, an Idaho medical association representative, an
45 Idaho hospital association representative, and an Idaho primary care associa-
46 tion representative, one (1) representative of an Idaho qualified health cen-
47 ter, one (1) representative of a free clinic, one (1) private practice physi-
48 cian, with consideration given to physicians who have training and expertise
49 in providing primary care service, one (1) dentist, and one (1) individual who
50 has received health care services from an Idaho qualified health center, free
51 clinic or Idaho family medicine residency program clinic.
52 (4) Appointments to the board shall be for three (3) years. Board members
53 may be reappointed at the end of each three (3) year period. Initial appoint-
5
1 ments shall be staggered in such a manner that approximately one-third (1/3)
2 are appointed for one (1) year, one-third (1/3) are appointed for two (2)
3 years, and one-third (1/3) are appointed for three (3) years.
4 (5) A majority of the board members constitutes a quorum for the transac-
5 tion of business. A majority vote is required by the quorum in finalizing
6 decisions.
7 SECTION 5. That Section 39-5905, Idaho Code, be, and the same is hereby
8 amended to read as follows:
9 39-5905. SCOPE OF GRANT SUPPORT. The legislature may appropriate at least
10 two hundred fifty thousand dollars ($250,000) annually for the purpose of
11 awarding system grants. Additional funds above this amount shall be appropri-
12 ated to service grants. The board may award grants, in accordance with the
13 procedures and criteria in this chapter,.
14 (1) System grants will be awarded to governmental and nonprofit entities
15 which serve health professional shortage areas, dental health professional
16 shortage areas or medically underserved areas or populations, for the purpose
17 of improving access to the system of primary health care services to rural and
18 care delivery to underserved areas.
19 (1a) Individual grant awards will be limited to a total of thirty-five
20 thousand dollars ($35,000), direct and indirect costs, per year.
21 (2b) Applicants may propose projects for funding for up to three (3)
22 years.
23 (ac) Continued funding for projects beyond the first grant year, years
24 two (2) and three (3), shall be subject to the appropriation of funds and
25 grantee performance.
26 (bd) No project may be funded for more than a total of three (3) years.
27 (ce) Any unused grant funds shall be returned to the rural primary health
28 care access fund by the applicant no later than June May 10 of the grant
29 period.
30 (2) Service grants shall be awarded to Idaho qualified health centers,
31 free clinics or Idaho family medicine residency program clinics for the pur-
32 pose of:
33 (a) Increasing access to primary care services to uninsured or medically
34 indigent patients who are not otherwise served; or
35 (b) Creating new services or augmenting existing services provided to
36 uninsured or medically indigent patients.
37 (3) Grants shall be awarded to Idaho qualified health centers, free clin-
38 ics or Idaho family medicine residency program clinics, such that no more than
39 ten percent (10%) of the total service grant funds shall be awarded annually
40 to any single grantee.
41 (4) No funds awarded under a grant may be used for purchase, construc-
42 tion, renovation or improvement of real property or for projects which are
43 solely or predominantly designed for the purchase of equipment. Use of funds
44 for the purchase of equipment may be allowed when such equipment is an essen-
45 tial component of a program. However, the purchase of equipment may not repre-
46 sent more than forty percent (40%) of the total annual share of a proposal.
47 Indirect costs shall not exceed fifteen percent (15%) of the total project.
48 (5) Grants received by Idaho qualified health centers, free clinics or
49 Idaho family medicine residency program clinics pursuant to this chapter shall
50 not be used:
51 (a) To replace federal funds traditionally received by such centers;
52 (b) To finance or satisfy any existing debt; or
53 (c) To compete with the services of existing private practitioners.
6
1 (6) No later than May 10 of each year, an Idaho qualified health center,
2 free clinic or Idaho family medicine residency program clinic receiving a ser-
3 vice grant shall provide an annual report to the board and to the department
4 which details the number of additional uninsured and medically indigent
5 patients that are cared for and the types of services that are provided.
6 SECTION 6. That Section 39-5906, Idaho Code, be, and the same is hereby
7 amended to read as follows:
8 39-5906. CATEGORIES OF GRANTS. There are four (4) two (2) categories of
9 grant assistance for the primary health care access program:
10 (1) System grants awarded to governmental and nonprofit entities which
11 serve health professional shortage areas, dental health professional shortage
12 areas or medically underserved areas or populations, for the purpose of
13 improving the system of primary care delivery to underserved areas.
14 (a) Recruitment and retention of primary care providers -- Grant funds
15 may be used for loan repayment for primary care providers, recruitment
16 incentive, and/or reimbursement of relocation expenses for primary care
17 providers.
18 (2b) Telehealth projects -- Grant funds may be used for projects that
19 involve the use of telecommunications technologies for distance learning
20 and for projects to improve access to care for rural communities.
21 (3c) Community development projects -- Grant funds may be used for health
22 needs assessments, marketplace analysis, financial analysis and strategic
23 planning activities.
24 (4d) Other -- Communities may choose to apply for funds for activities
25 that they have identified and determined will help to improve access to
26 primary care in rural areas.
27 (2) Service grants awarded to Idaho qualified health centers, free clin-
28 ics and Idaho family medicine residency program clinics to:
29 (a) Increase access to primary care services to uninsured or medically
30 indigent patients who are not otherwise served; or
31 (b) Create new services or augment existing services provided to unin-
32 sured or medically indigent patients.
33 SECTION 7. That Section 39-5907, Idaho Code, be, and the same is hereby
34 amended to read as follows:
35 39-5907. ELIGIBILITY FOR GRANTS. (1) System grant aApplicants must meet
36 the following requirements:
37 (1a) The geographical area to be benefitted must be located in a current
38 designated primary care or dental health professional shortage area or a
39 medically underserved area or population.
40 (2b) Applicant must be a governmental entity or a nonprofit entity regis-
41 tered with the Idaho secretary of state.
42 (2) Service grant applicants must be:
43 (a) An Idaho qualified health center;
44 (b) A free clinic; or
45 (c) An Idaho family medicine residency program clinic.
46 SECTION 8. That Section 39-5908, Idaho Code, be, and the same is hereby
47 amended to read as follows:
48 39-5908. APPLICATION REQUIRED. (1) A completed rural primary health care
49 access grant application must be submitted by the applicant for the purpose
7
1 of requesting a grant, on or before the conclusion of the application period
2 specified for the appropriate grant cycle.
3 (2) Each system and service grant application shall include:
4 (a) Geographical area of need;
5 (b) Individual or entity requesting funds;
6 (c) Narrative description of the methods to be used to address needs and
7 demonstrate the potential of the project to improve access to health care
8 services in the community;
9 (d) Identification of measurable goals, objectives to be used to reach
10 the goals, and the resources necessary to complete each activity;
11 (e) Estimation of how long it will take to accomplish the individual
12 activities of the project;
13 (f) Demonstrated community and organizational support for the project;
14 (g) County or local governmental endorsement;
15 (h) Operating budget including:
16 (i) Proportion of operating budget, if any, the applicant proposes
17 to match with the rural primary health care access grant funds;
18 (ii) Documentation of one (1) or more vendor price quotes for all
19 proposed equipment purchases;
20 (iii) Contact person for verification of fiscal information;
21 (i) Federal tax identification number; and
22 (j) Other information required by the board.
23 (3) The primary health care access program board shall:
24 (a) Develop a plan to ensure that service grants are distributed to eli-
25 gible qualified health centers, free clinics, or Idaho family medicine
26 residency program clinics; and
27 (b) In cooperation with the department, prepare and submit to the legis-
28 lature an annual report describing the program's effectiveness in increas-
29 ing access and expanding care to health care services for medically
30 underserved and uninsured patients in Idaho.
31 (4) All applications must include the required information.
32 (45) The grant application and any attachments submitted by the applicant
33 shall be the primary source of information for awarding a grant. Additionally,
34 the board may request and/or use other information known to them in making
35 their decision.
36 SECTION 9. That Section 39-5909, Idaho Code, be, and the same is hereby
37 amended to read as follows:
38 39-5909. GRANT AWARD SCHEDULE. The board shall conduct the grant process
39 in accordance with the following schedule:
40 (1) The rural primary health care access director will generate, and make
41 available, a list of areas eligible for potential grant assistance no later
42 than November 15 prior to the application period.
43 (2) The rural primary health care access director shall develop an appli-
44 cation form and make guidance available no later than January 15 which shall
45 initiate the application period prior to the grant period.
46 (3) The completed application shall be submitted no later than the close
47 of business on April 15 of the application period.
48 (4) The board department shall issue notification to every applicant
49 regarding the disposition of their grant request by June 15 prior to the grant
50 period.
51 (5) Funds for approved grants shall be disbursed during July of that
52 grant period or over the course of the current grant year as funds become
53 available.
8
1 SECTION 10. That Section 39-5910, Idaho Code, be, and the same is hereby
2 amended to read as follows:
3 39-5910. AWARD CRITERIA. The board shall award grants based on the fol-
4 lowing weighted criteria:
5 (1) Background of bidding organization. The applicant must show adequate
6 experience, knowledge, and qualifications to adequately perform the scope of
7 work: weight = 10%;
8 (2) Community and organizational support. The applicant must demonstrate
9 community and organizational support for the project: weight = 15%;
10 (3) Specificity and clarity of scope of project. The proposal will be
11 evaluated based on the extent to which the goals and objectives are specific,
12 measurable, and relevant to the purpose of the proposal and the activities
13 planned to accomplish those objectives are germane. and can be sustained
14 beyond the grant time frame. Additionally, there must be a demonstrated need
15 for and lack of availability of funds from other sources to address the pri-
16 mary health care needs of the defined area of service: weight = 35%;
17 (4) Monitoring and evaluation. The proposal will be evaluated based on
18 the extent to which the monitoring and evaluation system will document program
19 or activity progress and measure effectiveness: weight = 15%;
20 (5) Budget. The proposal will be evaluated based on the extent to which a
21 detailed itemized budget and justification are consistent with stated objec-
22 tives and planned program activities: weight = 25%;.
23 SECTION 11. That Section 39-5911, Idaho Code, be, and the same is hereby
24 amended to read as follows:
25 39-5911. NEGOTIATION. The board shall have the authority to negotiate the
26 amount of the grant award and any potential continuation, not to exceed a
27 total of three (3) years.
28 SECTION 12. That Section 39-5912, Idaho Code, be, and the same is hereby
29 amended to read as follows:
30 39-5912. FRAUDULENT INFORMATION ON GRANT APPLICATION. Providing false
31 information on any application or document submitted under this statute is a
32 misdemeanor and grounds for declaring the applicant ineligible. Any and all
33 funds determined to have been acquired on the basis of fraudulent information
34 must be returned to the rural primary health care access fund. This section
35 shall not limit other remedies which may be available for the filing of false
36 or fraudulent applications.
STATEMENT OF PURPOSE
RS 14787C1
Amends Idaho Code 39, Chapter 59, the Idaho Rural Health Care
Access Program, by changing the title to the Idaho Primary Health Care
Access Program. This legislation also separates grants into two (2)
categories, system grants and service grants, and allows funding for
both types. System grants will be defined as funds awarded for the
purpose of recruiting primary care providers, telehealth projects,
community development, and other activities determined to improve
primary care in under-served areas or populations. Service grants
will be defined as grants awarded to increase access to primary care
services or to create or augment existing services to uninsured or
medically indigent patients.
The amendments will allow uninsured and medically indigent
patients to receive ongoing community based care, delaying or avoiding
use of emergency room care, hospitalization or increased Medicaid
services.
FISCAL NOTE
Equal to any amount acquired from a state appropriation ranging
up to $4,000,000, which serves approximately 11,000 patients and
finances 40,000 visits.
Contact
Name: Bill Foxcroft, Idaho Primary Care Association
Phone: 208-345-2335
Names: Representative Bill Deal, Representative Max Black,
Representative Bob Ring and Representative Kathie Garrett
STATEMENT OF PURPOSE/FISCAL NOTE H 246