Current through Reg. 49, No. 38; September 20, 2024
(a) Purpose. This section implements Subtitle
C, Title 2, Health and Safety Code, Chapter 75, Subchapter E, which authorizes
the Health and Human Services Commission to implement a competitive grant
program to support the initial establishment and operation of one or more
regional or local health care programs for employees of small
employers.
(b) Grant objectives.
The grant or grants awarded under this section are intended to assist with the
establishment or operation of regional and local health care programs created
to:
(1) Improve the health of employees of
small employers and their families by improving the employees' access to health
care and by reducing the number of those employees who are uninsured;
(2) Reduce the likelihood that those
employees and their families will require services from publicly-funded
programs such as Medicaid and CHIP;
(3) Contribute to economic development by
helping small businesses remain competitive with a healthy workforce and health
care benefits that will attract employees; and
(4) Encourage innovative solutions for
providing and funding health care services and benefits.
(c) Definitions. The following definitions
are used throughout this section.
(1)
Commission--The Health and Human Services Commission.
(2) Employee--An individual employed by an
employer. The term includes a partner of a partnership and the proprietor of a
sole proprietorship.
(3) Grantee--A
recipient of a grant awarded under this section.
(4) Local health care program--A program
operating in one county and established to provide health care services or
benefits to employees of participating small employers under Health and Safety
Code, Chapter 75, Subchapter B, Regional or Local Health Care
Program.
(5) Regional health care
program--A program operating in two or more counties and established to provide
health care services or benefits to employees of participating small employers
under Health and Safety Code, Chapter 75, Subchapter B, Regional or Local
Health Care Program.
(6) Small
Employer--A person who employed an average of at least two employees, but not
more than 50 employees, on business days during the preceding calendar year and
who employs at least two employees on the first day of the plan year.
(d) General conditions of the
grant. The grants awarded under this section, and any extension, continuation,
or addition to such grants, are subject to:
(1) The availability of appropriated state
funds. A grant may be cancelled either before or after the Commission awards a
grant if funding for the grant is terminated, withdrawn, or if sufficient funds
are not appropriated to the Commission;
(2) A competitive award process established
by the Commission;
(3) The
requirements of the contract executed by the Commission with the grantee as
required under subsection (j) of this section; and
(4) The grant award period specified in the
requests for proposals or other notice of potential grant awards issued by the
Commission.
(e) Eligible
applicants. The following entities are eligible to apply for grant funds:
(1) The Commissioners court or courts of the
county or counties participating in a local or regional health care
program;
(2) The healthcare system
or hospital district of the county, or counties, participating in a regional or
local health care program;
(3) A
nonprofit organization or such other entity as is described in the requests for
proposals or other notice of potential grant award issued by the Commission
that:
(A) Plans or operates the program under
a contract with the commissioners court or courts, as applicable; or
(B) Is an entity in which the county or
counties, or a program affiliated with the county or counties, participate or
that is established or designated by the commissioners court or courts, as
applicable, to plan or operate the program.
(f) Eligible expenditures. Grant applications
must meet the requirements and specifications set forth in requests for
proposals issued by the Commission. Projects eligible for grant funding may
include:
(1) Identifying the target
population of small employers for participating in the program;
(2) Designing the service or benefit
structure and delivery mechanisms;
(3) Designing and implementing wellness and
educational programs to improve the general health of the targeted
population;
(4) Conducting
actuarial analysis;
(5) Conducting
related surveys or focus groups;
(6) Developing and maintaining a provider
network;
(7) Provider
contracting;
(8) Marketing to small
employers and employees;
(9)
Administrative costs for the initial operation of regional or local health care
programs; and
(10) Other functions
determined by the Commission to support the initial establishment or operation
of a regional or local health care program that accomplishes the objectives in
subsection (b) of this section.
(g) Application and selection process. An
applicant must submit its application for a grant directly to the Commission in
the time and manner specified by the Commission. An application received after
the deadline will not be considered. A panel selected by the Commission will
review and evaluate eligible, complete, and timely applications in accordance
with the evaluation methodology published in the request for proposal or other
notice of potential grant award issued by the Commission.
(h) Selection criteria. In selecting grant
recipients, the Commission shall consider:
(1) The extent to which the regional or local
health care program proposed by the applicant accomplishes the purposes
established by Chapter 75 of the Health and Safety Code;
(2) The extent to which the regional or local
health care program meets the objectives established by §
RSA
75.101 Health and Safety Code; and
(3) Other criteria established by the
Commission as described in the specific request for proposal or other notice of
potential grant awards issued by the Commission.
(i) Performance objectives. Grantees will be
required to meet performance objectives established by the
Commission.
(j) Contract execution.
Grantees will be required to execute a contract with the Commission on mutually
agreeable terms and conditions in the manner and format prescribed by the
Commission. Grant funds may not be distributed to a grantee before the
execution of a contract with the Commission. The contract will require that the
grantee comply with:
(1) The performance
objectives established by the Commission and monitored through progress
reports;
(2) Any financial and
reporting requirements established by the Commission;
(3) All applicable policies and procedures;
and
(4) All applicable federal and
state laws and their implementing regulations.
(k) Project review and evaluation report. The
Commission will review all grant projects before September 1, 2008. Grantees
must participate in this review in the manner prescribed by the Commission,
which may include on-site visits and the submission of data, documents, and
reports. The Commission will submit a report by December 1, 2008, to the
Governor, Lieutenant Governor, and speaker of the House of Representatives that
includes:
(1) An evaluation of the success of
regional and local health care programs in accomplishing the purposes of Health
and Safety Code, Chapter 75, Subchapter E; and
(2) The Commission's recommendations for any
legislation needed to facilitate or improve regional and local health care
programs.
(l)
Expiration. This rule expires September 1, 2009.
