46th legislature - STATE OF NEW MEXICO - first session, 2003

REQUESTING A REVIEW OF CERTAIN MEDICAID PROGRAM REIMBURSEMENT POLICIES BY THE DEPARTMENT OF HEALTH, THE HUMAN SERVICES DEPARTMENT AND THE OFFICE OF THE ATTORNEY GENERAL.

WHEREAS, costs of providing services under the medicaid program of the state of New Mexico are projected to rise in the current and future fiscal years; and

WHEREAS, the department of health and the human services department each administer significant portions of the medicaid program; and

WHEREAS, the department of health and the human services department, as well as the medicaid fraud control unit of the office of the attorney general, each participate in medicaid fraud detection efforts; and

WHEREAS, current rules, procedures or reporting requirements pertaining to reimbursement of medicaid service providers may inadvertently permit billing for services neither necessary nor rendered; and

WHEREAS, addition of software program edits to the claims and reimbursement information systems can reduce or eliminate excessive medicaid program payments; and

WHEREAS, timely sharing of medicaid reimbursement data, along with any available statistical analysis, with appropriate agencies may assist in the early detection of medicaid program overpayments to providers; and

WHEREAS, a review of medicaid program reimbursement methodology will lead to suggestions for improved delivery of services to medicaid recipients, while reducing unnecessary program payments;

NOW, THEREFORE, BE IT RESOLVED BY THE LEGISLATURE OF THE STATE OF NEW MEXICO that the department of health and the human services department be encouraged to conduct a systematic and comprehensive review of their respective rules, policies, instructions, reporting requirements and procedures for reimbursement to medicaid providers for non-emergency transportation services, personal care option program services, developmentally disabled residential facilities and outpatient prescription drugs; and

BE IT FURTHER RESOLVED that these departments give a joint report on their respective reviews and any legislative recommendations to the legislative finance committee at its October 2003 meeting; and

BE IT FURTHER RESOLVED that copies of this memorial be transmitted to the governor, the secretary of health, the secretary of human services and the medicaid fraud control unit of the office of the attorney general.