TITLE 7 HEALTH
CHAPTER 29 PRIMARY AND RURAL HEALTH CARE SERVICES
PART 3 RURAL
PRIMARY HEALTH CARE ACT
7.29.3.1 ISSUING AGENCY: New Mexico Department of Health.
[7.29.3.1
NMAC - Rp, 7 NMAC 29.3.1, 10/16/06]
7.29.3.2 SCOPE: Rural Primary Health Care Act rules shall
apply to the use of the funds by eligible programs available pursuant to the
Rural Primary Health Care Act, Sections 24-1A-1 to 24-1A-4 NMSA 1978.
[7.29.3.2
NMAC - Rp, 7 NMAC 29.3.2, 10/16/06]
7.29.3.3 STATUTORY AUTHORITY: The Rural Primary Health Care Act, Sections
9-7-6(F) and 24-1A-4 NMSA 1978, as amended.
[7.29.3.3
NMAC - Rp, 7 NMAC 29.3.3, 10/16/06]
7.29.3.4 DURATION: Permanent.
[7.29.3.2
NMAC - Rp, 10/16/06]
7.29.3.5 EFFECTIVE DATE: October 16, 2006, unless a later date is cited
at the end of a section.
[7.29.3.5
NMAC - Rp, 7 NMAC 29.3.5, 10/16/06]
7.29.3.6 OBJECTIVE: The objective of 7.29.3 NMAC is to establish
standards and procedures for regulating programs under the Rural Primary Health
Care Act. The purpose of the Rural
Primary Health Care Act is to assist in the provision of primary health care
services in underserved areas of the state in order to better serve the health
care needs of the public. This purpose
will be accomplished through, but not limited to, the following activities:
A. assist communities in the
recruitment, placement, and retention of health care personnel in underserved
areas of the state which includes the coordination of such effort with health
professional education programs at post-secondary schools and other
institutions involved in the training of health professional personnel;
B. develop plans and encourage
coordination between publicly supported programs, and between public and
private sector providers;
C. provide technical assistance;
D. distribute financial assistance to
eligible programs in order to sustain or provide a minimum level of primary
health care services; and which assist in the provision of primary health care
services in underserved areas in order to better serve the health needs of the
public; and
E. provide a program for enabling the
development of new primary health care services and facilities.
[7.29.3.6
NMAC - Rp, 7 NMAC 29.3.6, 10/16/06]
7.29.3.7 DEFINITIONS:
A. "Act" means the Rural
Primary Health Care Act, Sections 24-1A-1 to 24-1A-4 NMSA 1978.
B. "Department" means
the department of health.
C. "Eligible programs"
means nonprofit community based entities that provide or commit to provide
primary health care services for residents of health care underserved areas and
include rural health facilities and those serving primarily low income
populations.
D. "Health care personnel"
means health care professionals who contribute to ensuring adequate
availability of primary health care services including but not limited to:
licensed practical nurses, registered nurses, pharmacists, physician
assistants, nurse practitioners, certified nurse midwives, primary care
physicians (family practice, general practice, pediatrics, obstetrics and gynecology,
and internal medicine), dentists and dental hygienists.
E. "Health care underserved
areas" (HCUA) means geographic areas where it has been determined by
the department of health, through the use of indices and other standards set by
the department, that sufficient primary health care is not being provided to
the citizens of that area. These
designations may recognize need for either general or special health care
services. HCUA designations may give
consideration to federally designated health professional shortage areas (HPSA)
and medically underserved areas (MUA).
F. "Medically indigent"
means individuals who are unable to afford all medical care that they
require. This includes both those
individuals below the federal poverty level not covered by medicaid, medicare
or other third party health care insurance and those individuals between 100
percent and 200 percent of federal poverty levels who are not covered by any
third party health insurance. Medically
indigent individuals are usually expected to pay for some portion of the cost
of their health care based upon the level of their income.
G. "Minimum level of primary
health care services" means basic primary health care services
provided to the general population by health care personnel.
H. "Nonprofit community based
entities" means nonprofit organizations with an internal revenue
service 501c(3) tax exempt status which have a governing board whose membership
is broadly representative of the area served including consumer representatives. Nonprofit community based entities also
include local governments and tribal governments. Nonprofit community based entities which are
local governments, tribal governments and/or are multi-purpose or provide
services in more than one HCUA, shall have local or regional primary health
care advisory boards whose membership is generally representative of the area
served.
I. "Patient collections"
means receipts generated from patient encounters for primary health care
services. Patient collections include
revenues from medicaid, medicare, private insurance, Title XX, other third
party sources or self pay.
J. "Primary health care
advisory board" means a board, advisory to an organization's governing
board, which has responsibility for consideration of and input into matters
related to the provision of primary health care services in a local HCUA or
regional combination of HCUA(s) being served.
A majority of the advisory board shall be consumers of primary health
care services.
K. "Primary health care services"
are those provided at the first level of basic or general health care for an
individual's health needs, including medical, dental and behavioral health
diagnostic and treatment services and supportive services. Any dental or behavioral health services
shall be provided in conjunction with primary medical services. Primary health care services are those
provided as part of either general practice, family practice, obstetrics,
gynecology, pediatrics or general internal medicine.
L. "Total revenues" means
all receipts collected in support of primary health care services. Includes but not limited to: patient
collections; Section 329, 330 and 340 Federal Funds, P.L. 93-638 or IHS
support; Title V, X and WIC programs; other federal grants; other state grants/contracts;
and local income, including city, county or other unit of government, direct
grant or value of donated property or facilities. In addition, other revenues including but not
limited to: gifts, cash donations or grants from private foundations, church
organizations, or other sources, general operating revenues from clinic
services and interest, dividends, and other income derived from certificates of
deposit, saving accounts and other investments.
[7.29.3.7
NMAC - Rp, 7 NMAC 29.3.7, 10/16/06]
7.29.3.8 FUND DISTRIBUTION:
A. Duty of the department: To the extent funds are made available for
the purposes of the act Section 24-1A-3.1D NMSA 1978, the department, in
accordance with applicable procurement procedures, shall provide for the distribution
of financial assistance to eligible programs which have applied for and
demonstrated a need for assistance in order to sustain the delivery of a
minimum level of primary health care services.
B. Eligibility: To receive financial assistance through
Section 24-1A-3.1D NMSA 1978, of the act, an eligible program shall:
(1) be a New Mexico nonprofit community based
entity with federal internal revenue service 501c(3) tax exempt status, a local
government or a tribal government which provide or commits to provide primary
health care services to residents of an health care underserved area (HCUA)
designated for primary health care needs;
(2) have a governing board whose membership is
generally representative of the HCUA(s) it serves, including consumers of the
primary health care services it provides;
an eligible program which is a local government or tribal government
and/or is multi-purpose or provides services in more than one HCUA shall have a
local or regional primary health care advisory board whose membership is
generally representative of the HCUA(s) being served; a majority of the
advisory board shall be consumers of the primary health care services; the
local or regional primary health care advisory board shall have opportunity for
consideration of and input into the decisions regarding budgets, scope of
services, payment policies and procedures, hours of operation and staffing; the
eligible program shall be able to demonstrate the ability to meet the governing
board and/or the advisory board requirements or have a practical plan for its
establishment and implementation;
(3) have as its purpose to sustain or provide
a minimum level of primary health care services as defined in Subsection D of
7.29.3.6 NMAC; services may additionally include medical support, diagnostic
and treatment services, pharmacy, laboratory, radiology, preventive health
services, behavioral health services, patient follow-up and/or dental and
dental support services; any dental and/or behavioral health services shall be
provided in conjunction with primary medical care services;
(4) have policies and procedures which assure
that no person will be denied primary health care services they require because
of inability to pay; these policies and procedures should address medically
indigent persons below poverty not covered by third party payors and those
between 100 percent and 200 percent of poverty without third party coverage; the
eligible program should be able to demonstrate either the successful impact of
these policies and procedures, or have a practical plan for their
implementation;
(5) have billing policies and procedures which
maximize patient collections, except where federal rules or contractual
obligations prohibit the use of such measures; the program should be able to
demonstrate either the successful impact of these policies and procedures, or
have a practical plan for their implementation;
(6) have viable systems and infrastructure to
deliver primary health care services including facility, staff and financial
management systems;
(7) have comprehensive policies and procedures
governing the primary health care operations which assure the delivery of
effective, efficient and quality care; and
(8) meet other requirements as determined by
the department.
C. Eligible items/uses of
expenditures: Funds made available under
Section 24-1A-3.1D NMSA of the act may be used for the following types of
expenditures:
(1) salaries and benefits for the employees of
contractor in support of the provision of primary health care services;
(2) purchase, repair and/or maintenance of
necessary medical and dental equipment;
(3) purchase of office, medical, and/or dental
supplies;
(4) in-state travel to obtain training or
improve coordination in order to better support or provide primary health care
services;
(5) general operating expenses;
(6) programs or plans to improve the
coordination, effectiveness or efficiency of the delivery of primary health care
services; and
(7) contracts for medical and dental personnel
services.
D. Ineligible item/uses of
expenditures: Costs which are not
eligible for funding under Section 24.1A-3.1.D., NMSA 1978, of the act include:
(1) land acquisition;
(2) building, construction, renovation;
(3) debt amortization;
(4) emergency medical services (EMS) including
stand-by, dispatch, transport, ambulance runs, equipment and salary, fringe
benefits and other costs associated with personnel to provide emergency medical
services;
(5) home health care or visiting nurses
services;
(6) school nurse programs;
(7) in-patient care;
(8) non-primary health care specialty care
including but not limited to surgery, outpatient specialty care and long term
care;
(9) freestanding services not otherwise meeting
the definition of primary health care;
(10) political activity; and
(11) lobbying.
E. Distribution of financial
assistance: In any state fiscal year,
the distribution of financial assistance to eligible programs selected pursuant
to these rules shall be determined according to the following guidelines.
(1) The award amount will be set by the
department reflecting the demonstrated need of the eligible program in its
proposal. The demonstrated need of an
applicant will be established by the department based upon information
contained in the proposal. The
department reserves the right to award an amount less than the full amount of
demonstrated need.
(2) In any state fiscal year, a maximum award
to an eligible program for use in a single HCUA designated for primary health
care needs shall not exceed an amount greater than 10 percent of the funds made
available by the department for the purposes of distribution of financial
assistance under Subsection D of 7.29.3.6 NMAC of these rules, except that
eligible programs which are found to have exceptional need may be funded in an
amount not to exceed 15 percent of the funds available.
(3) The relative need of an eligible program
for financial assistance as demonstrated in the proposal.
(4) The relative need for primary health care
services of the HCUA served by the eligible program as reflected in the
proposal or other department documents which demonstrate the relative need for
primary health care services.
Consideration will be given by the department to avoiding the funding of
duplicative services and to sustain the provision of a minimum level of primary
health care services by eligible organizations which demonstrate the ability to
deliver and maintain quality, effective, efficient and appropriate primary
health care services.
(5) The degree to which the eligible program
has adequate structures and procedures to administer and deliver primary health
care services, including but not limited to staffing, the ability to administer
effective and appropriate primary health care services, effective and
appropriate financial management systems and adequate systems to maximize
patient revenues.
(6) The priority given by the department for
the proposed use of the funds.
(7) Other guidelines as determined by the
department.
F. Evaluation of proposals: Each proposal will be evaluated and ranked
with consideration given to the following factors:
(1) the relative need of an eligible program
for financial assistance to sustain or provide primary health care services in
a HCUA designated for primary health care needs as demonstrated in the proposal
process. Financial need will be evaluated based on several factors, including
but not limited to:
(a) the applicant's dependence upon patient
collections as a percentage of total revenues available to the applicant for
primary health care services;
(b) the extent to which
write-offs and adjustments to charges, based on appropriate sliding fee scale
implementation, affect the ability of the eligible program to sustain the
delivery of primary health care services to an HCUA designated for primary
health care needs, as demonstrated in the proposal;
(c) the existence of fund balances which may
be used by the applicant to sustain or provide a minimum level of primary
health care services in an HCUA designated for primary health care needs;
(d) the projected
deficit as demonstrated in the proposal which will impact the ability to
sustain or provide a minimum level of primary health care services in an HCUA
designated for primary health care needs;
(e) the probable impact
which any projected deficit as demonstrated in the proposal will have on the
provision of primary health care in an HCUA; and
(f) other need criteria
developed by the department.
(2) the relative need of the HCUA served by
the applicant for primary health care services, as reflected in the proposal
and measured by, including but not limited to:
(a) the severity of
need within the HCUA as indicated in department documents or demonstrated in
the proposal;
(b) the number and/or
percentage of medically indigent population residing in the HCUA; and
(c) other need criteria
developed by the department;
(3) the degree to which the applicant has
adequate structure and procedures to administer and deliver primary health care
services including, but not limited to, staffing, ability to administer
effective and appropriate primary health care services, effective and
appropriate financial management systems and adequate systems to maximize
patient revenues;
(4) the priority given by the department will
be for application proposals which have shown need under Subsection E of
7.29.3.9 NMAC of these rules and will be evaluated based on the following
criteria, including but not limited to:
(a) proposals where
state funds are critical in assuring that any basic primary health care
services can be provided in an HCUA designated for primary health care
needs. This could include, but not be
limited to, support for compensation of providers which is needed for their
recruitment and/or retention;
(b) proposals where state funds will be used to
supplement the quality/quantity of basic primary health care services in an
HCUA designated for primary health care needs.
This could include, but not be limited to, support for compensation of
providers which is needed for their recruitment and/or retention;
(c) proposals which
demonstrate coordination and/or innovative relationships with those funded by
the department including, but not limited to, local public health division
offices, mental health programs, and substance abuse program and/or other
health care services;
(d) proposals where
state funds will be used to maintain or expand the comprehensiveness of
services beyond basic primary medical services in an HCUA designated for
primary health care needs. This could
include, but not be limited to, support for compensation of providers which is
needed for their recruitment and/or retention; and
(e) other priorities as
established by the department.
(5) other factors established by the
department.
G. Reports: The department will monitor the performance
of the contractor(s) to ensure compliance with the intent of the act.
H. Award of contracts: The department will award contracts in
accordance with the New Mexico Procurement Code and applicable department
rules.
I. Protest procedure: Any offeror or contractor who is aggrieved in
connection with the award process may use the protest procedure established by
the New Mexico Procurement Code and applicable department rules.
[7.29.3.8
NMAC - Rp, 7 NMAC 29.3.9, 10/16/06]
7.29.3.9 NEW PRIMARY HEALTH CARE SERVICES/FACILITIES:
A. Duty of the department: To the extent funds are made available for
the purposes of the act, Section 24-1A.3.1E NMSA 1978, the department shall
provide a program for enabling the development of new primary health care
services or facilities. The department
in establishing the program for new primary health care services or facilities
will give consideration to proposals for planning as well as for
implementation.
B. Eligibility: To be eligible to receive funds to assist in
planning for the development of primary health care services or facilities in
HCUA(s) designated for primary health care needs, eligible program(s) shall:
(1) be a New Mexico nonprofit community based
entity with Federal Internal Revenue Service 501c(3) tax exempt status, local
government or tribal government;
(2) have a local or regional primary health
care advisory board whose membership is generally representative of the HCUA(s)
for which it is developing the primary health care plan; and
(3) meet other requirements as determined by
the department.
[7.29.3.9
NMAC - Rp, 7 NMAC 29.3.10, 10/16/06]
7.29.3.10 PERSONNEL RECRUITMENT:
A. Duty of the department: To the extent funds are made available for
the purposes of the act, Section 24-1A-3.1A NMSA 1978, the department may
contract, in accordance with applicable procurement procedures, with New Mexico
nonprofit entities to assist communities in the recruitment, placement, and
retention of health care personnel in health care underserved areas of the
state and to coordinate such effort with health professional education
programs. Such efforts shall be
consistent with priorities set out by the department. The department will monitor the performance
of the contractor to ensure compliance with the intent of the act.
B. Eligibility: In order to contract pursuant to this part of
the rules, the entity shall meet the following requirements:
(1) be a New Mexico nonprofit entity which has
obtained and maintains a federal internal revenue service 501c(3) tax exempt
status;
(2) have a governing board of directors which
is representative of the geographic areas and ethnic populations in New Mexico
and is comprised of both health care providers and consumers;
(3) have the capability to carry out the
purposes of Subsection A of 7.29.3.8 NMAC of these rules, including qualified
professional staff;
(4) not be a health care provider or
association of health care providers; and
(5) meet other requirements as determined by
the department.
C. Reports: The department will monitor the performance
of the contractor(s) to ensure compliance with the intent of the act. The contractor shall submit to the department
all financial and program reports required by the contract.
D. Selection of candidates: The contractor shall conduct all recruitment
activities based upon the following considerations:
(1) all candidates shall be considered on an
equal opportunity basis without regards to race, age, color, national origin,
gender, sexual orientation, handicap or disability or religion or ethnicity;
and
(2) whenever possible, emphasis will be placed
upon assisting native New Mexicans, New Mexico residents and graduates from New
Mexico health professional education programs in relocating to health care
underserved areas.
[7.29.3.10
NMAC - Rp, 7 NMAC 29.3.8, 10/16/06]
HISTORY
OF 7.29.3 NMAC:
Pre-NMAC History: Material in this part was derived from that previously filed with the commission of public records - state records center and archives as:
HED 81-3 (HSD), Rural Primary Health Care Act Regulations, filed 7/2/1981.
HED 81-5 (HSD), Rural Primary Health Care Act Regulations, filed 7/28/1981.
HED 82-8 (HPDD), Rural Primary Health Care Act Regulations, filed 8/11/1982.
HED 84-3 (HSD), Rural Primary Health Care Regulations, filed 8/13/1984.
HED 86-2 (HSD), Rural Primary Health Care Regulations, filed 3/12/1986.
DOH 93-5 (PHD), Regulations Governing the Rural Primary Health Care Act, filed 4/13/1993.
History of Repealed Material: 7 NMAC 29.3, Rural Primary Health Care Act (filed 11/26/96) repealed 10/16/06.
Other History: DOH 93-5(PHD), Regulations Governing the Rural Primary Health Care Act (filed 4/13/93) renumbered, reformatted and replaced by 7 NMAC 29.3, Rural Primary Health Care Act, effective 1/01/97.
7 NMAC 29.3, Rural Primary Health Care Act (filed 11/26/96) renumbered, reformatted and replaced by 7.29.3 NMAC, Rural Primary Health Care Act, effective 10/16/06.