LEGISLATIVE HEALTH AND HUMAN SERVICES COMMITTEE 2014 INTERIM FINAL REPORT New Mexico Legislative Council Service Santa Fe, New Mexico January 2015 2014 INTERIM REPORT LEGISLATIVE HEALTH AND HUMAN SERVICES COMMITTEE INCLUDING THE DISABILITIES CONCERNS SUBCOMMITTEE AND THE BEHAVIORAL HEALTH SUBCOMMITTEE CONTENTS • Executive Summary • Work Plan and Meeting Schedule • Legislative Health and Human Services Committee Agendas • Behavioral Health Subcommittee Agendas • Disabilities Concerns Subcommittee Agendas • Legislative Health and Human Services Committee Minutes • Behavioral Health Subcommittee Minutes • Disabilities Concerns Subcommittee Minutes • Endorsed Legislation EXECUTIVE SUMMARY LEGISLATIVE HEALTH AND HUMAN SERVICES COMMITTEE 2014 SUMMARY Appointments — Meetings The New Mexico Legislative Council reappointed Representative James Roger Madalena as chair and Senator Gerald Ortiz y Pino as vice chair of the Legislative Health and Human Services Committee (LHHS) for the 2014 interim. Representative Doreen Y. Gallegos was appointed chair, and Senator Nancy Rodriguez was appointed vice chair, of the Disabilities Concerns Subcommittee. The New Mexico Legislative Council elected to re-create for the 2014 interim the Behavioral Health Subcommittee, appointing Representative Elizabeth "Liz" Thomson as chair and Senator Benny Shendo, Jr., as vice chair. The LHHS held meetings in Albuquerque, Elephant Butte, Las Cruces, the Pueblo of Santa Clara, the Pueblo of Taos, Santa Fe and Silver City this interim. Committee Review Children and Families The well-being of children and families was under review by the LHHS throughout this interim. The committee heard testimony from the Children, Youth and Families Department (CYFD) and local and national experts on children's health care and children's services related to state intervention in abuse and neglect cases, including evidence-based intervention, foster care rules, child trauma treatment, obesity and psychotropic medications. At two meetings, in Las Cruces and in Santa Fe, the LHHS heard recommendations from state government and community stakeholders related to changing the statutory and programmatic structure for the state's substitute care review system. The LHHS held hearings about CYFD rulemaking related to child care center reimbursement and accreditation. It heard recommendations from the J. Paul Taylor Early Childhood Task Force on children's well-being statewide, from a group of grandparents raising grandchildren and from experts on child obesity. The LHHS also heard recommendations from experts and stakeholders relating to workplace accommodations for pregnancy and parental leave. Medical Assistance The LHHS held several hearings related to the state's Medicaid program and the first months of the implementation of a new Medicaid waiver program called Centennial Care. These included testimony relating to care coordination, Native American services and enrollment, long- term care, nursing facility reimbursement, a pediatric dental services pilot proposal and enrollment of individuals who have been incarcerated. The LHHS heard testimony from the Human Services Department (HSD), its contractors and public assistance stakeholders, experts and advocates. Matters relating to the HSD's referral of behavioral health provider agencies for investigation and possible prosecution for credible allegations of fraud were an ongoing discussion before the LHHS this interim. The committee also heard an update relating to federally and state-sponsored coverage under the Basic Health Program authorized under the federal Patient Protection and Affordable Care Act. Human Services The LHHS heard testimony from the HSD, experts and stakeholders on proposed changes to the state's Supplemental Nutrition Assistance Program, also known as "SNAP" and formerly known as "Food Stamps". The proposed changes would add greater participation requirements for work and training programming through SNAP. A hearing on the Temporary Assistance for Needy Families (TANF) Program included testimony from advocates and the HSD about TANF enrollment and work and training program changes. The Human Trafficking Task Force provided testimony pursuant to 2014's House Memorial 16, which called for a study of the services needed for victims of human trafficking — recently classified as a felony in New Mexico — especially for minors who are being exploited. Corrections and Justice Joint Meeting The LHHS held a joint meeting with the Courts, Corrections and Justice Committee in Albuquerque in August. The Corrections Department, the HSD, experts and stakeholders appeared before the LHHS to discuss health care and human services provided to incarcerated New Mexicans. They provided testimony related to health care access, quality and cost- effectiveness and human services aimed at preventing and addressing prison rape under the federal Prison Rape Elimination Act of 2003. As noted above, the LHHS continued its ongoing discussion relating to getting inmates access to Medicaid services through enrollment suspension or enrollment upon release. Health Care Infrastructure The HSD, the New Mexico Hospital Association and the New Mexico Association of Counties provided testimony relating to the first months of implementation of the "safety net care pool", a new funding system that replaces the former federal Medicaid sole community provider funding. The safety net care pool allows the state to use county assessments to match federal dollars for funding indigent care statewide. The Health Care Work Force Working Group provided testimony and recommendations for addressing the state's health care work force shortage, including some best practices in the field for recruiting and retaining health care professionals. The committee also heard testimony about facilities and infrastructure in Sierra County, as well as testimony about a Las Cruces clinic's health care integration model. - 2 - Health care experts and staff testified about the policy implications of health facilities' work to promote advance care planning to ensure that patients are accorded the care they want even if they are later incapacitated. The Department of Health provided testimony relating to the state's ability to respond to a public health crisis, such as the Ebola outbreak occurring in West Africa. The LHHS held further hearings on the feasibility of creating a liver transplant facility in the state. Representatives from the state's chiropractic physician community provided testimony both in favor of and against scope of practice changes proposed for their profession. The committee also heard testimony about the use of nurse advice lines among New Mexico health insurance carriers and medical assistance programs, with recommendations for ensuring the viability of a local nurse advice line. Health Care Coverage The New Mexico Health Insurance Exchange provided updates on exchange enrollment, policy changes, administration and funding at most of the LHHS's meetings this interim. This included testimony by board members and by the new chief executive officer, Amy Dowd, as well as the former acting chief executive officer, Mike Nunez. The committee also heard from the superintendent of insurance and his staff as well as experts and stakeholders on matters relating to health coverage enrollment and affordability and provider network adequacy. The committee held a hearing with respect to managed health care credentialing of health care providers, including a legislative proposal to mandate faster credentialing procedures. The Interagency Benefits Advisory Committee, made up of the Risk Management Division of the General Services Department, Albuquerque Public Schools, the Retiree Health Care Authority and the Public School Insurance Authority, provided an update to the committee on the committee's mission to consolidate health care purchasing wherever feasible and cost- effective. Behavioral Health The LHHS heard testimony from tribal officials, the HSD, advocates and stakeholders on the provision of behavioral health services to Native Americans in the state. It held a hearing on incarceration diversion for individuals living with mental illness and substance use disorders. The committee also heard from experts about assisted outpatient treatment programming and the prescribing of psychotropic medications to foster children. - 3 - The Behavioral Health Subcommittee met in Albuquerque, Española, Gallup and Silver City this interim. Throughout the interim, it worked to gauge the impact of the transition of most of the state's behavioral health services to new Arizona providers by seeking information from stakeholders from communities throughout the state and from the HSD. A working group convened by the subcommittee identified seven strategic and long-term initiatives to expand and improve consumer access to behavioral health services that included: supportive housing; the establishment of a behavioral health information clearinghouse; expansion of school-based health clinics; the University of New Mexico's Project ECHO's behavioral health training for rural clinics; FOCUS/Milagro work with addicted mothers and infants; increased psychiatric nurse slots at New Mexico State University; and supplemental funding for an adolescent transitional living and recovery center. Appropriations for these proposals were endorsed by the LHHS. Disabilities Concerns Subcommittee Focus on the Developmental Disabilities Waiver Program and the use of the Supports Intensity Scale to evaluate