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F I S C A L I M P A C T R E P O R T





SPONSOR: SPAC DATE TYPED: 02/04/00 HB
SHORT TITLE: Home Health Care & Hospice Services SB 77/SPACS
ANALYST: Carrillo


APPROPRIATION



Appropriation Contained
Estimated Additional Impact
Recurring

or Non-Rec

Fund

Affected

FY00 FY01 FY00 FY01
See Narrative



(Parenthesis ( ) Indicate Expenditure Decreases)



Duplicates/Conflicts with/Companion to/Relates to



SOURCES OF INFORMATION



Health Policy Commission

Board of Medical Examiners

Board of Nursing

Department of Health



SUMMARY



Synopsis of Bill



Senate Bill 77 as substituted by the Senate Public Affairs Committee proposes to amend Section 61-6-17 NMSA 1978 (Medical Practice Act) to exempt physicians licensed in another state to treat and order home health or hospice services for a resident of New Mexico delivered by a New Mexico licensed home and community support services agency. Any change in the patients condition is to be physically re-evaluated by that treating physician in their jurisdiction or by a licensed new Mexico physician.



Significant Issues



The Board of Nursing staff indicates nurses working in home care and hospice setting have been unable to carry out the orders of physicians licensed in states other than New Mexico because it was not permitted by the Medical Practice Act. This bill would allow home health agency nurses and nurses providing hospice care services to follow the orders of a physician licensed in another state.



Staff from the Department of Health comment the bill would allow New Mexicans who are patients of physicians licensed in adjacent states to have home health agency prescriptions written by the patient's treating out-of-state physician which can then be carried out by New Mexico home health or hospice agencies.



OTHER SUBSTANTIVE ISSUES



The Board of Nursing staff comments the Nursing Practice Act was amended several years ago to deal with a concern raised by nurses that patients were traveling to other state to obtain medical services. The reason for this phenomena varied and included mechanisms for payment of services, availability of services and availability of physicians to name a few. Section 71-3-3(J) NMSA 1978 (Nursing Practice Act) allows nurses licensed in New Mexico to administer medications and perform treatments prescribed by a person authorized in this state or in any other state in the United States to prescribe those medications and treatments. The change proposed by SB77/SPAC is consistent with the Nursing Practice Act and would solve the most pressing problem, as reported to the Board of Nursing, with is the current dilemma faced by home health agency nurses and nurses providing hospice care services. Nurses working in these settings have been unable to carry out the orders of physicians licensed in a state other than New Mexico because it was not permitted by the Medical Practice Act. This bill will resolve in part the conflict between the Medical Practice Act and Nursing Practice Act. However, the language in the Nursing Practice Act remains broader, allowing nurses to accept orders from a person authorized in any state for any type of service and in any type of setting.



According to staff from the Department of Health, there are many border areas of new Mexico where New Mexicans routinely obtain medical services in; an adjacent state. The treating physician may lawfully write medication prescriptions for their New Mexico patients and the patient can have the prescription filled at their local New Mexico pharmacy. For many years, treating physicians could also write a prescription for home health or hospice services for their New Mexico patients and such prescriptions would be honored.



Additionally the Department of Health staff writes that recently the Board of Medical Examiners interpreted the Medical Practice Act to proscribe such orders as the "unlicenced practice of medicine." Thus nurses licensed in New Mexico could not honor the orders for home health care or hospice care for their New Mexico patients if the order was written by the patient's treating physician practicing in an adjacent state, even though the physician's order was lawful in the state where it was written. This results in harm and expense to the New Mexico patients.



Lastly, the Department of Health notes hospice and home health agencies are experiencing difficulty securing Medicare reimbursement for service when they are ordered by an out-of-state physician based on the scope of practice in the Medical Practice Act. This legislation would remove barriers to accessing necessary services by individuals who elect to have a physician in a border area. In-home services are the most cost effective way to meet the needs of individuals who would otherwise be hospitalized or institutionalized.



The following comments are from the Health Policy Commission staff:

WJC/njw