44TH LEGISLATURE - STATE OF NEW MEXICO - FIRST SESSION, 1999

RELATING TO HEALTH; EXEMPTING CLEFT LIP AND PALATE SERVICES FOR CHILDREN FROM MANAGED CARE; AUTHORIZING SERVICES AND REIMBURSEMENT; MAKING APPROPRIATIONS.

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

Section 1. A new Section of the Public Assistance Act is enacted to read:

"[NEW MATERIAL] CLEFT PALATE PROGRAM AUTHORIZED-- EXEMPTION.--The human services department, in cooperation with the department of health, shall, subject to appropriation and availability of state and federal funds, develop and implement a program to provide cleft lip and palate services to children eligible for medicaid. The program shall include dental, orthodontia and oral-plastic surgery services, and the department shall establish reimbursement for the respective professional services provided at a rate not to exceed seventy-two percent of the usual and customary charges. The cleft lip and palate program shall be excluded from the managed care system authorized by Section 27-2-12.6 NMSA 1978."

Section 2. Section 27-2-12.6 NMSA 1978 (being Laws 1994, Chapter 62, Section 22) is amended to read:

"27-2-12.6. MEDICAID PAYMENTS--MANAGED CARE.--

A. Except as provided in Subsection D of this section, the department shall provide for a statewide, managed care system to provide cost-efficient, preventive, primary and acute care for medicaid recipients by July 1, 1995.

B. The managed care system shall ensure:

(1) access to medically necessary services, particularly for medicaid recipients with chronic health problems;

(2) to the extent practicable, maintenance of the rural primary care delivery infrastructure;

(3) that the department's approach is consistent with national and state health care reform principles; and

(4) to the maximum extent possible, that medicaid-eligible individuals are not identified as such except as necessary for billing purposes.

C. The department may exclude nursing homes, intermediate care facilities for the mentally retarded, medicaid in-home and community-based waiver services and residential and community-based mental health services for children with serious emotional disorders from the provisions of this section.

D. The department shall exclude from the provisions of this section a cleft lip and palate program of dental, orthodontia and oral-plastic surgery services for children eligible for medicaid."

Section 3. APPROPRIATIONS.--

A. One million four hundred thirty thousand dollars ($1,430,000) is appropriated from the general fund to the human services department for expenditure in fiscal year 2000 for the purpose of providing orthodontia and oral-plastic surgery service reimbursements under a cleft lip and palate program exempt from managed care for medicaid eligible children.

B. Seven hundred fifteen thousand dollars ($715,000) is appropriated from the general fund to the department of health for expenditure in fiscal year 2000 for the purpose of providing orthodontia and oral-plastic surgery cleft lip and palate services to low-income children not eligible for medicaid.

C. Any unexpended or unencumbered balance remaining at the end of fiscal year 2000 from the appropriations made in this section shall revert to the general fund.