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Fourth Substitute H.B. 131

This document includes Senate 3rd Reading Floor Amendments incorporated into the bill on Tue, Mar 4, 2008 at 2:37 PM by rday. -->

Senator Scott D. McCoy proposes the following substitute bill:


             1     
COMMUNITY BASED SELF SUFFICIENCY

             2     
PROGRAM

             3     
2008 GENERAL SESSION

             4     
STATE OF UTAH

             5     
Chief Sponsor: Jennifer M. Seelig

             6     
Senate Sponsor: Scott D. McCoy

             7     
             8      LONG TITLE
             9      General Description:
             10          This bill amends the Access to Health Care part of the Medical Assistance Act in the
             11      Health Code.
             12      Highlighted Provisions:
             13          This bill:
             14          .    authorizes the Department of Health to spend funds from the interest earnings on
             15      the Medicaid Restricted Account to contract with private entities for community
             16      based services for low income individuals and individuals who are underserved in
             17      health care to assist them with prudent and appropriate use of health care resources;
             18          .    establishes the purposes of the contracts;
             19          .    amends definitions;
             20          .    directs the department to maximize federal matching dollars for the purpose of
             21      funding additional contracts for services;
             22          .    establishes the criteria for awarding the contract; and
             23          .    establishes a pilot program for the contract for S. [ service for the 2008-09 fiscal year ]
             23a      services .S .
             24      Monies Appropriated in this Bill:
             25          This bill appropriates:


             26           . S. [$250,000 from the Medicaid Restricted Account] $175,000 from the General Fund .S for
             26a      fiscal year 2008-09 only, to
             27      fund the pilot program for community based services.
             28      Other Special Clauses:
             29          None
             30      Utah Code Sections Affected:
             31      AMENDS:
             32          26-18-301, as enacted by Laws of Utah 1993, Chapter 255
             33          26-18-302, as enacted by Laws of Utah 1993, Chapter 255
             34          26-18-304, as enacted by Laws of Utah 1993, Chapter 255
             35     
             36      Be it enacted by the Legislature of the state of Utah:
             37          Section 1. Section 26-18-301 is amended to read:
             38           26-18-301. Definitions.
             39          As used in this part:
             40          (1) "Community based organization":
             41          (a) means a private entity; and
             42          (b) includes for profit and not for profit entities.
             43          (2) "Cultural competence" means a set of congruent behaviors, attitudes, and policies
             44      that come together in a system, agency, or profession and enables that system, agency, or
             45      profession to work effectively in cross-cultural situations.
             46          (3) "Health literacy" means the degree to which an individual has the capacity to
             47      obtain, process, and understand health information and services needed to make appropriate
             48      health decisions.
             49          (4) " Institutional capacity" means the ability of a community based organization to
             50      implement public and private contracts.
             51          [(1)] (5) "Medically underserved population" means the population of an urban or rural
             52      area or a population group designated by the department as having a shortage of primary health
             53      care services.
             54          [(2)] (6) "Primary health care" means:
             55          (a) basic and general health care services given when a person seeks assistance to
             56      screen for or to prevent illness and disease, or for simple and common illnesses and injuries;


             57      and
             58          (b) care given for the management of chronic diseases.
             59          [(3)] (7) "Primary health care services" include, but are not limited to:
             60          (a) services of physicians, [all] nurses, physician's assistants, and dentists licensed to
             61      practice in this state under Title 58, Occupations and Professions;
             62          (b) diagnostic and radiologic services;
             63          (c) preventive health services including, but not limited to, perinatal services,
             64      well-child services, and other services that seek to prevent disease or its consequences;
             65          (d) emergency medical services;
             66          (e) preventive dental services; and
             67          (f) pharmaceutical services.
             68          Section 2. Section 26-18-302 is amended to read:
             69           26-18-302. Department to award grants and contracts -- Applications.
             70          (1) (a) Within appropriations specified by the Legislature for this purpose, the
             71      department may make grants to public and nonprofit entities for the cost of operation of
             72      providing primary health care services to medically underserved populations.
             73          (b) S. [ Within appropriations specified by the Legislature, the ] The .S department may
             73a      S. , as funding permits, .S contract
             74      with community based organizations for the purpose of developing culturally and linguistically
             75      appropriate programs and services for low income and medically underserved populations
             76      through a pilot program to accomplish one or more of the following:
             77          (i) to educate individuals:
             78          (A) to use private and public health care coverage programs, products, services, and
             79      resources in a timely, effective, and responsible manner;
             80          (B) to make prudent use of private and public health care resources;
             81          (C) to pursue preventive health care, health screenings, and disease management;
             82          (D) to locate health care programs and services;
             83          (ii) to assist individuals to develop:
             84          (A) personal health management;
             85          (B) self-sufficiency in daily care; and
             86          (C) life and disease management skills;
             87          (iii) to support translation of health materials and information;


             88          (iv) to facilitate an individual's access to primary care services and providers, including
             89      mental health services; and
             90          (v) to measure and report empirical results of the pilot project.
             91          (2) (a) Grants by the department shall be awarded based on:
             92          (i) applications submitted to the department in the manner and form prescribed by the
             93      department; and [by]
             94          (ii) the criteria established in Section 26-18-303 .
             95          (b) The application for a grant under Subsection (2)(a) shall contain:
             96          (i) a requested award amount[,];
             97          (ii) a budget[,]; and
             98          (iii) a narrative plan of the manner in which the applicant intends to provide the
             99      primary health care services described in [this chapter.] Subsection 26-18-301 (7).
             100          (c) A contract bid for a service under Subsection (1)(b):
             101          (i) shall be awarded in accordance with Title 63, Chapter 56, Utah Procurement Code;
             102          (ii) must include the information described in Section 28-18-303 ; and
             103          (iii) is subject to Subsection (3) of this section .
             104          (3) [Applicants] (a) An applicant under this chapter must demonstrate to the
             105      department that [they will operate in a manner such that no person shall be denied service by
             106      reason of his inability to pay. This] the applicant will not deny services to a person because of
             107      the person's inability to pay for the services.
             108          (b) Subsection (3)(a) does not preclude [the] an applicant from seeking payment from
             109      the [patient] person receiving services, a third party, or a government agency [that is authorized
             110      or that] if:
             111          (i) the applicant is authorized to charge for the services; and
             112          (ii) the person, third party, or government agency is under legal obligation to pay
             113      [such] the charges.
             114          (4) The department shall maximize the use of federal matching funds received for
             115      services under Subsection (1)(b) to fund additional contracts under Subsection (1)(b).
             116          Section 3. Section 26-18-304 is amended to read:
             117           26-18-304. Process and criteria for awarding grants and contracts.
             118          (1) The department shall establish rules in accordance with Title 63, Chapter 46a, Utah


             119      Administrative Rulemaking Act, governing the application form, process, and criteria it will
             120      use in awarding grants and contracts under this chapter. [In awarding grants,]
             121          (2) When awarding a primary care grant under Subsection 26-18-302 (1)(a), the
             122      department shall consider the extent to which the applicant:
             123          [(1)] (a) demonstrates that the area or a population group to be served under the
             124      application has a shortage of primary health care and that the services will be located so that
             125      they will provide assistance to the greatest number of persons residing in [such] the area or
             126      included in [such] the population group;
             127          [(2)] (b) utilizes other sources of funding, including private funding, to provide primary
             128      health care;
             129          [(3)] (c) demonstrates the ability and expertise to serve traditionally medically
             130      underserved populations including persons of limited English-speaking ability, single heads of
             131      households, the elderly, persons with low incomes, and persons with chronic diseases;
             132          [(4)] (d) demonstrates that it will assume financial risk for a specified number of
             133      medically underserved persons within its catchment area for a predetermined level of care on a
             134      prepaid capitation basis; and
             135          [(5)] (e) meets other criteria determined by the department.
             136          (3) When awarding a contract for community based services under Subsection
             137      26-18-302 (1)(b), the department shall:
             138          (a) consider the extent to which the applicant:
             139          (i) demonstrates that the area or a population group to be served under the application
             140      is a medically underserved area or population and that the services will be located so that they
             141      will provide assistance to the greatest number of persons residing in the area or included in the
             142      population group;
             143          (ii) utilizes other sources of funding, including private funding, to provide the services
             144      described in Subsection 26-18-302 (1)(b);
             145          (iii) demonstrates the ability and expertise to serve traditionally medically underserved
             146      populations including persons of limited English-speaking ability, single heads of households,
             147      the elderly, persons with low incomes, and persons with chronic diseases;
             148          (iv) meets other criteria determined by the department; and
             149          (v) demonstrates the ability to empirically measure and report the results of all contract


             150      supported activities;
             151          (b) consider the extent to which the contract increases the applicant's institutional
             152      capacity;
             153          (c) consult with the state's:
             154          (i) Medicaid program;
             155          (ii) Children's Health Insurance Program; and
             156          (iii) other assistance programs within the Department of Workforce Services and the
             157      Department of Human Services; and
             158          (d) S. [ for fiscal year 2008-09 ] as funding permits .S , implement the community based
             158a      service contract as a pilot
             159      program for which the department shall enter into contracts for services as follows:
             160          (i) two contracts in the amount of $50,000 each to be awarded to experienced and
             161      established applicants; and
             162          (ii) S. [ four ] three .S contracts in the amount of $30,000 each to be awarded to
             162a      applicants that:
             163          (A) are not as established or experienced as the applicants under Subsection (3)(c)(i);
             164      or
             165          (B) represent smaller community based approaches than the applicants described in
             166      Subsection (3)(c)(i) .
             167          (4) Once a contract has been awarded under Subsection (3), the department shall
             168      provide technical assistance to the contractee to familiarize the contractee with public and
             169      private resources available to support wellness, health promotion, and disease management.
             170          Section 4. Appropriation.
             171          There is appropriated from the S. [ interest on the Medicaid Restricted Account ] General
             171a      Fund .S for fiscal
             172      year 2008-09 only, S. [ $250,000 ] $175,000 .S to the Department of Health to fund the contracts
             172a      for services
             173      authorized by Chapter 18, Part 3, Access to Health Care.


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