SENATE BILL 463

56th legislature - STATE OF NEW MEXICO - first session, 2023

INTRODUCED BY

Pete Campos and Stuart Ingle

AN ACT

RELATING TO EMERGENCY MEDICAL SERVICES; ESTABLISHING A MEDICAID COST-BASED SUPPLEMENTAL REIMBURSEMENT PROGRAM FOR ELIGIBLE PUBLIC EMERGENCY MEDICAL SERVICES PROVIDERS; CREATING AN ALTERNATIVE MEDICAID UPPER PAYMENT LIMIT REIMBURSEMENT PROGRAM FOR PRIVATE EMERGENCY MEDICAL SERVICES PROVIDERS; MAKING AN APPROPRIATION.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF NEW MEXICO:

     SECTION 1. [NEW MATERIAL] MEDICAID COST-BASED SUPPLEMENTAL REIMBURSEMENT PROGRAM FOR ELIGIBLE PUBLIC EMERGENCY MEDICAL SERVICES PROVIDERS.--

          A. An eligible public emergency medical services provider shall receive cost-based supplemental medicaid reimbursement, to the extent provided by law, in addition to the rate of payment that the provider would otherwise receive from medicaid for ground emergency medical transportation services.

          B. An eligible public emergency medical services provider's supplemental reimbursement pursuant to this section shall be subject to the following conditions:

                (1) the supplemental reimbursement shall be equal to the amount of federal financial participation based on claims and emergency medical services costs;

                (2) eligible public emergency medical services providers shall not be reimbursed for more than one hundred percent of the eligible public emergency medical services provider's actual costs;

                (3) the supplemental reimbursement shall apply to the emergency medical services transportation costs that are reimbursed by medicaid fee-for-service and medicaid-managed care programs;

                (4) the supplemental reimbursement shall be distributed to eligible public emergency medical services providers through a federally permissible cost-basis methodology, which includes the per-transport cost-basis;

                (5) as a condition of receiving supplemental medicaid reimbursement pursuant to this section, each eligible public emergency medical services provider shall enter into an agreement with the human services department to reimburse the department for administrative costs related to providing supplemental reimbursement pursuant to this section; and

                (6) each eligible public emergency medical services provider shall reimburse the state for any additional costs incurred due to the provision of supplemental reimbursement to the eligible public emergency medical services provider.

          C. Participation in the cost-based supplemental medicaid reimbursement program provided for in this section is voluntary for eligible public emergency medical services providers.

          D. For the purposes of this section, "eligible public emergency medical services provider" means an entity that:

                (1) provides ground emergency medical transportation services to medicaid beneficiaries;

                (2) is enrolled as a medicaid provider for the period for which reimbursement is claimed; and

                (3) is owned or operated by the state or a political subdivision of the state and employs or contracts with persons who are licensed to provide emergency medical services pursuant to the Emergency Medical Services Act.

     SECTION 2. [NEW MATERIAL] ALTERNATIVE MEDICAID UPPER PAYMENT LIMIT REIMBURSEMENT PROGRAM FOR PRIVATE EMERGENCY MEDICAL SERVICES PROVIDERS.--The human services department shall establish a medicaid upper payment limit reimbursement program for private emergency medical services providers. The human services department may implement the upper payment limit reimbursement program through any lawful method that enables the department to enhance medicaid reimbursement for private emergency medical services providers.

     SECTION 3. TEMPORARY PROVISION.--The human services department shall promptly seek necessary federal approvals for the implementation of this act.

     SECTION 4. APPROPRIATION.--Seventy-five thousand dollars ($75,000) is appropriated from the general fund to the human services department for expenditure in fiscal year 2024 to carry out the purposes of this act. Any unexpended or unencumbered balance remaining at the end of fiscal year 2024 shall revert to the general fund.

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