A2161

An Act concerning federally qualified health centers, supplementing Title 26 of the Revised Statutes, and amending P.L.2005, c.222.

Be It Enacted by the Senate and General Assembly of the State of New Jersey:

1. (New section) As a condition of receiving State funds pursuant to section 12 of P.L.1992, c.160 (C.26:2H-18.62) or any other law that provides for the compensation of federally qualified health centers for health care services provided to uninsured patients, a federally qualified health center shall:

a. Provide health care services at such times and locations as will ensure that services are available and accessible in the catchment area of the center promptly and in a manner that assures continuity, as determined by the Commissioner of Health;

b. Provide emergency medical services, including provision, through clearly defined arrangements, for access of users of the center to health care for medical emergencies during and after the center’s regularly scheduled hours of operation. These arrangements shall require that the center ensure the availability at all times of a physician or advanced practice nurse who has access to the federally qualified center’s records, so that relevant medical information can be shared with another provider of emergency medical services to which the center has referred or directed a patient;

c. Establish a collaborative agreement with a local hospital to provide behavioral, mental health, and substance abuse services through telemedicine at times that the services are not available at the center. Any such contract shall specify the manner in which reimbursements for services shall be divided between the federally qualified health center and the hospital;

d. Prepare an emergency plan, which shall be subject to the approval of the Commissioner of Health. The emergency plan shall include, but need not be limited to, the center’s plans to ensure continuity of operation of facilities, staffing responsibilities, and power generation;

e. Submit annually to the Division of Medical Assistance and Health Services in the Department of Human Services all information that would be submitted by a hospital on an annual Medicaid cost report; and

f. Conduct, at least annually, a public meeting to discuss issues relating to the operation of the center and concerns of the community with respect to the delivery of services at the center. The center shall ensure that:

(1) at a minimum, the director of the center and at least 25 percent of the members of the governing board are present at the meeting and available to respond to questions from members of the public;

(2) the meeting is open to members of the public and organized so as to provide the community served by the center with information about the operation of the center, and to provide an opportunity for members of the public to ask questions and raise issues of concern to them;

(3) public notice of the meeting is provided at least 14 days prior to the date of the meeting by posting written notice in the center in a conspicuous location that is available to the public, and by publishing the notice in a daily or weekly newspaper of general circulation in the service area of the center, and at least 30 days prior to the date of the meeting by posting notice on the center’s Internet website; and

(4) notice of the meeting is provided to the Department of Health at least 30 days prior to the date of the meeting.

2. Section 2 of P.L.2005, c.222 (C.26:13-2) is amended to read as follows:

2. As used in this act:

"Biological agent" means any microorganism, virus, bacterium, rickettsiae, fungus, toxin, infectious substance, or biological product that may be naturally occurring or engineered as a result of biotechnology, or any naturally occurring or bioengineered component of any such microorganism, virus, bacterium, rickettsiae, fungus, infectious substance, or biological product, capable of causing death, disease, or other biological malfunction in a human, an animal, a plant, or another living organism.

"Bioterrorism" means the intentional use or threat of use of any biological agent[,] to cause death, disease, or other biological malfunction in a human, animal, plant, or other living organism, or degrade the quality and safety of the food, air, or water supply.

"Chemical weapon" means a toxic chemical and its precursors, except where intended for a lawful purpose as long as the type and quantity is consistent with such a purpose. Chemical weapon includes, but is not limited to: nerve agents, choking agents, blood agents, and incapacitating agents.

"Commissioner" means the Commissioner of Health, or the commissioner's designee.

"Contagious disease" means an infectious disease that can be transmitted from person to person.

"Department" means the Department of Health.

"Health care facility" means any non-federal institution, building or agency, or portion thereof, whether public or private for profit or nonprofit, that is used, operated, or designed to provide health services, medical or dental treatment, or nursing, rehabilitative, or preventive care to any person. Health care facility includes, but is not limited to: an ambulatory surgical facility, federally qualified health center, home health agency, hospice, hospital, infirmary, intermediate care facility, dialysis center, long-term care facility, medical assistance facility, mental health center, paid and volunteer emergency medical services, outpatient facility, public health center, rehabilitation facility, residential treatment facility, skilled nursing facility, and adult day care center. Health care facility also includes, but is not limited to, the following related property when used for or in connection with the foregoing: a laboratory, research facility, pharmacy, laundry facility, health personnel training and lodging facility, patient, guest, and health personnel food service facility, and the portion of an office or office building used by persons engaged in health care professions or services.

"Health care provider" means any person or entity [who] that provides health care services including, but not limited to: a health care facility, bioanalytical laboratory director, perfusionist, physician, physician assistant, pharmacist, dentist, nurse, paramedic, respiratory care practitioner, medical or laboratory technician, and ambulance and emergency medical workers.

"Infectious disease" means a disease caused by a living organism or other pathogen, including a fungus, bacteria, parasite, protozoan, virus, or prion. An infectious disease may, or may not, be transmissible from person to person, animal to person, or insect to person.

"Isolation" means the physical separation and confinement of an individual or groups of individuals who are infected or reasonably believed to be infected, on the basis of signs, symptoms, or laboratory analysis, with a contagious or possibly contagious disease from non-isolated individuals, to prevent or limit the transmission of the disease to non-isolated individuals.

"Local health agency" means a county, regional, municipal, or other governmental agency organized for the purpose of providing health services, administered by a full-time health officer and conducting a public health program pursuant to law.

"Local Information Network and Communications System Agency" or " LINCS agency" means the lead local public health agency in each county or identified city, as designated and determined by the commissioner pursuant to section 21 of this act, responsible for providing central planning, coordination, and delivery of specialized services within the designated county or city, in partnership with the other local health agencies within that jurisdiction, in order to prepare for and respond to acts of bioterrorism and other forms of terrorism or other public health emergencies or threats, and to discharge the activities as specified under this act.

"Microorganism" includes, but is not limited to, bacteria, viruses, fungi, rickettsiae, or protozoa.

"Nuclear or radiological device" means: any nuclear device which is an explosive device designed to cause a nuclear yield; an explosive radiological dispersal device used directly or indirectly to spread radioactive material; or a simple radiological dispersal device which is any act, container, or any other device used to release radiological material for use as a weapon.

"Overlap agent or toxin" means: any microorganism or toxin that poses a risk to both human and animal health and includes:

Anthrax - Bacillus anthracis;

Botulism - Clostridium botulinum toxin, [Botulinum] botulinum neurotoxins, [Botulinum] and botulinum neurotoxin producing species of Clostridium;

Plague - Yersinia pestis;

Tularemia - Francisella tularensis;

Viral Hemorrhagic Fevers - Ebola, Marburg, Lassa, and Machupo;

Brucellosis- [Brucellosis] Brucella species;

Glanders - Burkholderia mallei;

Melioidosis - Burkholderia pseudomallei;

Psittacosis - Chlamydophila psittaci;

Coccidiodomycosis - Coccidiodes immitis;

Q Fever - Coxiella burnetii;

Typhus Fever - Rickettsia prowazekii;

Viral Encephalitis - VEE (Venezuelan equine encephalitis virus), EEE (Eastern equine encephalitis), WEE (Western equine encephalitis);

Toxins - Ricinus communis, Clostridium perfringens, [Staph. Aureus] Staphylococcus aureus, [Staphylococcal] staphylococcal enterotoxins, T-2 toxin, [Shigatoxin] and Shiga toxin;

Nipah - Nipah virus;

Hantavirus - Hantavirus;

West Nile Fever - West Nile virus;

Hendra - Hendra virus;

Rift Valley Fever - Rift Valley Fever virus; and

Highly Pathogenic Avian Influenza.

"Public health emergency" means an occurrence or imminent threat of an occurrence that:

a. is caused or is reasonably believed to be caused by any of the following: (1) bioterrorism or an accidental release of one or more biological agents; (2) the appearance of a novel or previously controlled or eradicated biological agent; (3) a natural disaster; (4) a chemical attack or accidental release of toxic chemicals; or (5) a nuclear attack or nuclear accident; and

b. poses a high probability of any of the following harms: (1) a large number of deaths, illness, or injury in the affected population; (2) a large number of serious or long-term impairments in the affected population; or (3) exposure to a biological agent or chemical that poses a significant risk of substantial future harm to a large number of people in the affected population.

"Quarantine" means the physical separation and confinement of an individual or groups of individuals, who are or may have been exposed to a contagious or possibly contagious disease and who do not show signs or symptoms of a contagious disease, from non-quarantined individuals, to prevent or limit the transmission of the disease to non-quarantined individuals.

"Toxin" means the toxic material of plants, animals, microorganisms, viruses, fungi, or infectious substances, or a recombinant molecule, whatever its origin or method of production, including:

a. any poisonous substance or biological product that may be engineered as a result of biotechnology or produced by a living organism; or

b. any poisonous isomer or biological product, homolog, or derivative of such a substance.

(cf: P.L.2012, c.17, s.356)

3. This act shall take effect on the first day of the seventh month next following the date of enactment.

STATEMENT

This bill supplements and amends current laws concerning federally qualified health centers (FQHCs) to make their services more available and accessible to the public.

Specifically, the bill codifies into State law provisions of federal law that require FQHCs to provide services at times and locations to ensure availability and accessibility, provide emergency medical services, and establish arrangements with other providers for emergency care when the FQHC is closed. The bill expands upon these provisions to require that FQHCs ensure the availability at all times of a physician or advanced practice nurse who has access to the health center’s records, so that relevant medical information can be shared with other providers; and establish a collaborative agreement with a local hospital to provide behavioral, mental health, and substance abuse services through telemedicine at times that the services are not available at the center.

The bill also imposes new requirements on FQHCs that resemble the requirements for hospitals. Specifically, FQHCs would be required to conduct annual public meetings to discuss issues relating to the operation of the FQHC and concerns of the community with respect to the delivery of services at the FQHC; and submit annually to the Division of Medical Assistance and Health Services in the Department of Human Services all information that would be submitted by a hospital on an annual Medicaid cost report.

The bill requires an FQHC to prepare an emergency plan, subject to the approval of the Commissioner of Health, which is to include the center’s plans to ensure continuity of operation of facilities, staffing responsibilities, and power generation.

Finally, the bill amends the “Emergency Health Powers Act” to stipulate that FQHCs are health care facilities, which clarifies that the Commissioner of Health has authority to direct FQHCs in the case of a public health emergency, such as a natural disaster.