STATEMENT OF PURPOSE RS24760C2 This proposal establishes a two year cooperative grant program through the Department of Health and Welfare to the Community Health Center Network of Idaho. The purpose of the grant program is 1) to collect demographic and health data on the Idaho gap population (persons under 100% of the federal poverty guidelines), and 2) to provide outreach to and augmentation of primary health care services to the gap population provided through federally qualified health centers throughout the state. The data and augmented service will provide a bridge to recommendations expected to be made by a legislative interim committee to be established to study and make recommendations regarding long term provision of health care to the gap population. FISCAL NOTE The cost of the grants would be $400,000 from the general fund in fiscal year 2017 for the two years of data collection and final report, plus an anticipated $$ million for each of fiscal years 2017 ‘and 2018 anticipated to come from the Millennium Income Fund. Contact: Representative John Vander Woude (208) 332-1000 Representative Lynn M. Luker (208) 332-1000 Statement of Purpose / Fiscal Note #billnum10 1 n 8 " 8 8 7 1% 2 2 2 2 2B 7 28 20 3t 2 33 4 35 37 38 40 RS24760C3 oh LEGISLATURE OF THE STATE OF IDAHO 0800 sixty-third Legislature Second Regular Session - 2016 IN PRE BILL NO. By AN ACT RELATING TO HEALTH CARE; AMENDING CHAPTER 10, TITLE 56, IDAHO CODE, BY THE ADDITION OF A NEW SECTION 56-1055, IDAHO CODE, TO CREATE THE HEALTH GRANT PROGRAM FOR THE MEDICALLY UNDERSERVED, TO DEFINE TERMS, TO PRO- VIDE FOR THE AWARD OF A CERTAIN GRANT, TO REQUIRE A CERTAIN REPORT, 70 PROVIDE FOR ADDITIONAL GRANT AWARDS AND REPORTS, TO PROVIDE THAT A GRANT AWARD IS CONDITIONAL AND TO PROVIDE LEGISLATIVE INTENT; AND PROVIDING A SUNSET DATE. Be Tt Enacted by the Legislature of the State of Idsho: SECTION 1. That Chapter 10, Title 56, Idaho Code, be, and the same is hereby amended by the addition thereto of a NEW SECTION, to be known and des- ignated as Section 56-1055, Idaho Code, and to read as follow: 56-1055. HEALTH GRANT PROGRAM FOR THE MEDICALLY UNDERSERVED. (1) here is hereby created in the department a health grant program for the medically underserved, which program shall award the grants created by sub~ sections (3) and (5) of this section. (2) As used in this section: (a) "Community health center network of Idaho" or "network" means the association of federally qualified health centers in Idaho, which asso- ciation was created on May 14, 2012. (b) "Federally qualified health center" means a health care entity thet receives grants pursuant to 42 U.S.C. 254b (ce) “Low-income person" means a person eighteen (18) years of age or older with an income lower than one hundred percent (100%) of the fed- eral poverty level. (a) "Medically underserved" means a low-income person without health care insurance and not enrolled in or known to be eligible for the state medicaid plan or medicare. (3) Subject to appropriation, the director shall award a grant to the community health center network of Idaho by August 1, 2016. The purpose of the grant is to allow for the collection and analysis of data reported pur- suant to subsection (4) of this section. (4). By March 15, 2018, the network shall submit a report to the direc- tor, the governor and the senate and house of representatives health and wel- fare committees. The focus of the report shall be to identify the number of medically underserved persons and the prevalence of various chronic di- Aagnoses for which medical services are both needed and provided within the state, and shall include: (a) The number of medically underserved patients treated annually by the federally qualified health centers in the network;BBRR® SSSBSegeeses 2 a “4 “© 46 ” 0 RS24760C3 SEB (b) The number of low-income persons who were treated annually and had health insurance or were enrolled in or known to be eligible for medic- aid or medicare; (c) The number of visits made annually by medically underserved pa- tients; (d) Demographic information about medically underserved patients, in- cluding age and gender; (e) Clinical diagnoses made regarding medically underserved patients, and the services provided to them; (€) Quality of care indicators for medically underserved patients, in- cluding: (4) Adult weight screening and follow-up; (ii) Asthma pharmacological therapy: (444) Cervical cancer screening, (iv) Colorectal cancer screening; (v) Coronary artery disease lipid therapy; (vi) Depression and mental health screening and follow-up; (vii) Diabetes screening and follow-up; (viii) Ischemic vascular disease aspirin or antithrombotic ther- apy? (ix) Referral for treatment for human immunodeficiency virus; (x) Tobacco use screening and cessation intervention; and (ci) Any other quality of care indicators for medically under- served patients deemed relevant by the network; and (g) Health outcome indicators when available. (5) In addition to the grant awarded by subsection (3) of this section, the director shall award, subject to appropriation and the network's accep- tance, one (1) grant for fiscal year 2017 and one (1) grant for fiscal year 2018 for outreach and health care by the network to medically underserved Idahoans. The grant shall be distributed by August 1 of the respective fis- cal years. If a grant is awarded and accepted pursuant to this subsection, the network shall submit a report on how the grant moneys were used to the director and the legislature by August 15 following the close of the fiscal year for which the grant was awarded. Rural health clinics that serve unin- sured individuals and offer a sliding fee based on income are also eligible to apply to the director for grant funding to provide outreach and health care to the medically underserved under this subsection, subject to appro- priation. Any rural health clinic awarded a grant by the director shall sub- mit a report on how the grant moneys were used to the director and the legis- lature by August 15 following the close of the fiscal year for which the grant was awarded, (6) Grants awarded pursuant to this section shall be conditioned on the provision of the reports required by this section. Grant moneys that are not used in accordance with this section may be recovered by the director. (7) In creating thie program, the legislature intends to collect data related to medical care and health outcomes for medically underserved per~ sons in order to evaluate additional options for providing access to medical care and preventive management for the medically underserved. SECTION 2, The provisions of this act shall be null, void and of no force and effect on and after July 1, 2018STATEMENT OF PURPOSE RS24759C2 ‘This concurrent resolution would establish a legislative interim committee to study and make recommendations regarding health care for the gap population (persons under 100% of the federal poverty guidelines). FISCAL NOTE ‘The cost of the committee is not expected 10 exceed $10,000 per year that the committee is convened. The expenses will be paid out of the legislative account Contact: Representative John Vander Woude (208) 332-1000 Representative Lynn M. Luker (208) 332-1000 Statement of Purpose / Fiscal Note #billnumRS24759C2 os LEGISLATURE OF THE STATE OF IDAHO ama Sixty-third Legislature Second Regular Session - 2016 IN THE HOUSE OF REPRESENTATIVES HOUSE CONCURRENT RESOLUTION NO. By A CONCURRENT RESOLUTION STATING FINDINGS OF THE LEGISLATURE AND AUTHORIZING THE LEGISLATIVE COUNCIL "TO APPOINT A COMMITTEE TO UNDERTAKE AND PREPARE A MEDICAID WAIVER APPLI~ CATION. Be It Resolved by the Legislature of the State of Idaho: WHEREAS, a significant number of Idahoans earning less than 1008 of the federal poverty guideline (gap population) are medically underserved, in that their annual income is too high to qualify for Medicaid but too low to qualify for tax credits that would enable them to purchase private health insurance; and WHEREAS, the existing state systen to provide health care to the medi- cally underserved is in many ways inefficient and requires a review of the continuing benefit and viability of the county indigent and CAT fund pro- grams; and WHEREAS, expanding access to health care to medically underserved Ida- hoans would improve their health and potentially save lives; and WHEREAS, the Idaho Department of Health and Welfare is working on tran~ sitioning the state Medicaid plan by 2020 to a managed care model, which will yesult in cost savings to the state and better health outcomes for Medicaid patients; and WHEREAS, it is the belief of the Legislature that providing health care access to medically underserved Idahoans would best be accomplished through & state-driven managed care model using managed care experience and tools developed from the Nedicaid transition to managed care; and WHEREAS, expansion of traditional Medicaid is not acceptable to the Legislature due to cost, service and outcome inefficiencies, but Medicaid waiver options to use a state-driven managed care option should be explored to evaluate both the availability and benefit of federal funds to provide care to the gap population; and WHEREAS, it is further the belief of the Legislature that partnerships between the state and health care providers, including community health cen~ ters and hospitals, should be explored in order to facilitate the success of a state-driven managed care model using data, resources and delivery systems available through those partnerships; and WHEREAS, the Legislature would benefit froma detailed study and anal- ysis conducted by its own members in order to craft a state-driven solution for providing effective medical care for the gap population. NOW, THEREFORE, BE IT RESOLVED by the members of the Second Regular Session of the Sixty-third Idaho Legislature, the House of Representatives and the Senate concurring therein, that the Legislative Council is eutho— rized to appoint a committee to undertake and prepare a Medicaid waiver application for a state-driven plan for delivering health care to the gap population, utilizing a community care organization approach to managed0 12 13 4 15 16 7 18 19 21 23 2 25 26 28 20 30 RS24759C2 frost) care, The conmittee shall work with the Department of Health and Welfare to develop a state waiver that clearly articulates best practices for comuy nity-based coordinated care, emphasizing outcomes and elimination of the fee, for_service model and using Idaho-based evidence for population manage- ment. Specifically, the committee and the department shall look to the out- Gome-based models for primary care medical hones as currently being demon” strated to improve utilization patterns and outcomes. The conmittee and the Gepartment shall use the best aggregate data available for Idaho's gap por” Uletion from Idaho's community health centers, current health and welfare Gata, and data available from the state health innovation plan. Further, the ceiver shall clearly articulate accountability for benefit recipients and providers. Using Tdaho-based best practices, the waiver application shalt Piearly articulate risk-bearing, outcome-based incentives for community Gare organizations to ensure that every effort is made to link Idahoans with primary caze providers and reduce inefficient care. Finally, the waiver Rhall clearly articulate best practices for population managenent being en- ployed in Taaho community health centers and in coordination with the find {ngs of the state health innovation plan. Care shall be coordinated between primary medical, specialty medical and mental health resources through an ve teone-based primary care medical home. The committee shall also make rec- Gmnendations for actions necessary to eliminate the county medical indigent ony CAT fund programs. The Legislative Council shall determine the number av ogislators and membership from each house appointed to the committee and Shall authorize the committee to receive input, advice and assistance from interested and affected parties who are not menbers of the Legislature. BE I? FURTHER RESOLVED that the committee shall report its findings, reconmendations and proposed legislation, if any, or a request for reautho= Tisation, if necessary, to the First Regular Session of the Sixty-fourth Taaho Legislature. A waiver application shall not be submitted to the Cen- ters for Medicare and Medicaid Services without legislative approval.