House Bill 2688*-Second Edition

GENERAL ASSEMBLY OF NORTH CAROLINA

SESSION 2007

H 2

HOUSE BILL 2688*

Committee Substitute Favorable 7/9/08

Short Title: NCIOM- Access to Health Care Study Group.		(Public)
Sponsors:
Referred to:

May 28, 2008

A BILL TO BE ENTITLED

AN ACT TO direct the North carolina Institute of Medicine to continue to study issues relating to access to health care by establishing the Access to health care study group.

The General Assembly of North Carolina enacts:

SECTION 1. Chapter 143 of the General Statutes is amended by adding the following new Article to read:

"Article 80.

"Access to Health Care Study Group.

"§ 143‑750. Study group established; purpose; findings.

(a) The North Carolina Institute of Medicine shall continue to study the issue of access to health care. In order to assist with this work, there is established the Access to Health Care Study Group (Study Group). The Study Group shall be housed in the Department of Health and Human Services for budgetary purposes only.

(b) The purpose of the Study Group is to make recommendations to the General Assembly and the Governor for improvements in health care policy with the goal of expanding access to appropriate and affordable health care on a regular basis to all North Carolinians. The intent of the General Assembly is to move to an integrated system of public and private health care services that would serve all North Carolinians.

(1) More than 1,300,000 nonelderly people in the State lacked health insurance coverage in 2004. This is more than one‑sixth of the State's population. The percentage of State residents who lack health insurance for a full year has risen from fifteen and three‑tenths percent (15.3%) in 2000 to seventeen and two‑tenths percent (17.2%) in 2005. The percentage of the State's population without health insurance is growing more rapidly in North Carolina than in most of the rest of the country.

(2) Access to health care is essential to ensure the sustained development of a healthy, educated, and productive workforce. Such a workforce is necessary to support North Carolina's ability to compete in a diverse, global marketplace.

(3) Many areas of North Carolina are currently experiencing provider shortages. Rural North Carolina suffers disproportionately from these shortages and lack of access. If nothing is done to improve growth in provider supply in North Carolina, the ratio of physicians to population is expected to drop eight percent (8%) by 2020 and twenty‑one percent (21%) by 2030.

(4) Efforts to improve access to health care have been made by the State as far back as the 1940s under Governor Broughton's 'Good Health Plan.' Although the State has made significant progress, these and more recent efforts have not fully addressed the aspects of health care access necessary to ensure a healthy citizenry and to contribute to a vital economy.

(5) The most efficient and effective method to deliver health care services is through a medical home. Introduced by the American Academy of Pediatrics in 1967, a patient‑centered medical home is an approach to providing comprehensive primary care for people of all ages and medical conditions. It is a way for a physician‑led medical practice, chosen by the patient, to integrate health care services for that patient who confronts a complex and confusing health care system to achieve better health outcomes.

(6) Health care policy should be guided by the following principles:

a. Continuous review of health care system strengths and weaknesses is essential to ensure access to appropriate and affordable health care.

b. Health care providers and clients should have a primary role in medical care decisions, taking into consideration evidence‑based care and cost of care. Medical care should be based on evidence of safety and effectiveness.

c. Appropriate and affordable comprehensive care includes dental care, vision care, and mental health, developmental disability, substance abuse, and addictive disease services.

d. Health care policy must recognize the value of prevention, early intervention, and wellness and should provide incentives to encourage healthy lifestyles and health protection.

e. Health care policy must recognize the value of public health services that contribute to the improved health of the individual and the community as a whole.

"§ 143‑751. Group membership; appointment; per diem.

(a) The Study Group shall consist of at least 36 members but not more than 45 members. The Study Group shall include the following:

(1) Five members of the North Carolina House of Representatives, appointed by the Speaker of the House of Representatives.

(2) Five members of the North Carolina Senate, appointed by the President Pro Tempore of the Senate.

(3) Other members, including employers, physicians, public health and other health care professionals, representatives of the hospital and insurance industry, safety net providers, consumers and other public members.

(b) The North Carolina Institute of Medicine shall appoint as cochairs one member of the North Carolina House of Representatives, one member of the North Carolina Senate, and one other non‑legislative member. In selecting Study Group members which shall include at least one attorney who specializes in defending medical malpractice claims, the North Carolina Institute of Medicine shall solicit recommendations from relevant organizations and shall have a membership that reflects the geographic and ethnic diversity of the State. Consideration shall also be given to gender, race, and persons with disabilities.

(c) Legislators appointed to the Study Group shall receive per diem and necessary travel and subsistence expenses in accordance with the provisions of G.S. 138‑5.

"§ 143‑752. Power, duties, and responsibilities of the Group.

(a) The Study Group shall:

(1) Review assessments of current health care access in North Carolina and the nation as a whole. The assessments shall include the following:

a. The demographics of the uninsured population of North Carolina. Such demographics shall include, if available, age, income, race, gender, and geographic locations of each population.

b. Quality, safety, and cost of health care in North Carolina; e.g., inpatient and outpatient hospital care; primary care; specialty care; long‑term care; and chronic disease care.

c. The policies, programs, and services for indigent, underserved, and racial and ethnic minority populations to reduce barriers to health care.

d. The State's ability to respond to small and large emergencies through the State's emergency response system.

e. The ability of rural and urban health care providers to obtain and utilize new technologies and the potential impact of new technologies on cost and quality of health care.

f. Increases in the cost to the delivery of health care associated with the practice of defensive medicine.

g. Other matters necessary for the Group to carry out its purpose.

(2) Convene public hearings across the State to solicit input from diverse members of the public with respect to issues related to health care access in North Carolina.

(3) Develop proposals that will help North Carolina move to an integrated system of health care that provides access to appropriate and affordable health care on a regular basis to all North Carolinians.

(4) Report annually to the General Assembly, the Joint Legislative Health Care Oversight Committee, and the Governor the results of its work. A written report shall be submitted to each session of the General Assembly upon its convening.

(b) The Group may recommend legislation, which shall be eligible in any regular session of the General Assembly.

"§ 143‑753. Study Group meetings; quorum.

The Study Group shall meet at least three times each calendar year and may meet at other times upon the call of the chairs. A majority of the members of the Study Group shall constitute a quorum for the transaction of business. The affirmative vote of a majority of the members present at meetings of the Study Group shall be necessary for action to be taken by the Study Group.

"§ 143‑754. Assistance from other agencies.

The Study Group may obtain information and data from all State officers, agents, agencies, and departments, while in the discharge of its duties, pursuant to G.S. 120‑19, as if it were a committee of the General Assembly.

"§ 143‑755. Group staff and meetings.

(a) The North Carolina Institute of Medicine ("NC IOM") shall provide staff and arrange for meeting places for the Study Group.

(b) The Study Group may, with the approval of the Legislative Services Commission, meet in the State Legislative Building or the Legislative Office Building."

SECTION 2. The Access to Health Care Study Group shall convene its first meeting not later than September 1, 2009.

SECTION 3. Of funds appropriated to the Department of Health and Human Services in the 2008‑2009 fiscal year, the sum of three hundred thousand dollars ($300,000) shall be allocated by the Department to the North Carolina Institute of Medicine for the expenses of the Access to Health Care Study Group established under Section 1 of this act.

SECTION 4. Section 3 of this act becomes effective July 1, 2008. The remainder of this act is effective when it becomes law.