New Mexico Administrative Code
Title 7 - HEALTH
Chapter 29 - PRIMARY AND RURAL HEALTH CARE SERVICES
Part 3 - RURAL PRIMARY HEALTH CARE ACT
Section 7.29.3.8 - FUND DISTRIBUTION
Universal Citation: 7 NM Admin Code 7.29.3.8
Current through Register Vol. 35, No. 18, September 24, 2024
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.
Disclaimer: These regulations may not be the most recent version. New Mexico may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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