44th legislature - STATE OF NEW MEXICO - second session, 2000

RELATING TO HEALTH; REQUIRING CERTAIN FORMS, STANDARDS AND PROCEDURES IN MEDICAID MANAGED CARE; MAKING AN APPROPRIATION.

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

Section 1. Section 27-2-1 NMSA 1978 (being Laws 1973, Chapter 376, Section 1) is amended to read:

"27-2-1. SHORT TITLE.--Sections [1 through 20 of this act and Sections 13-1-9, 13-1-10, 13-1-12, 13-1-13, 13-1-17,

13-1-18, 13-1-18.1, 13-1-19, 13-1-20, 13-1-20.1, 13-1-21,

13-1-22, 13-1-27, 13-1-27.2, 13-1-27.3, 13-1-27.4, 13-1-28,

13-1-28.6, 13-1-29, 13-1-30, 13-1-34, 13-1-35, 13-1-37, 13-1-39, 13-1-40, 13-1-41 and 13-1-42 NMSA 1953] 27-2-1 through 27-2-34 NMSA 1978 may be cited as the "Public Assistance Act"."

Section 2. A new section of the Public Assistance Act, Section 27-2-12.9 NMSA 1978, is enacted to read:

"27-2-12.9. [NEW MATERIAL] MEDICAID MANAGED CARE SYSTEM--CLAIMS FOR PAYMENT--STANDARD FORMS.--By July 1, 2000 medicaid managed-care contracts shall require the use of a standard claims form for all medical, surgical and behavioral health claims for payment for services. The form shall be used by all providers seeking payment for services provided pursuant to the medicaid managed care program. The form shall be usable in printed or electronic format. In designing the claims form, the department shall consult with the department of health, the insurance division of the public regulation commission, the New Mexico health policy commission, all organizations currently providing services pursuant to the medicaid managed care program, organizations of health professionals, health consumer advocates and other interested persons."

Section 3. A new section of the Public Assistance Act, Section 27-2-12.10 NMSA 1978, is enacted to read:

"27-2-12.10. [NEW MATERIAL] MEDICAID MANAGED CARE SYSTEM--BEHAVIORAL HEALTH CARE AUTHORIZATIONS--DURATION--FREQUENCY--PRESUMPTION OF APPROVAL.--

A. Managed care authorizations for behavioral health care treatment for initial visits to or treatment by providers under medicaid managed care shall be valid for not less than sixty days from the initial date of approval by the managed care organization.

B. Evaluations for re-authorization for continued behavioral health care treatment shall be required no more frequently than every thirty days subsequent to the initial sixty-day course of treatment.

C. Authorizations and re-authorizations for behavioral health care under medicaid managed care for visits to or treatment by providers required by medicaid managed-care organizations and requested by an insured or a provider organization shall be considered approved and the behavioral health organization liable for payment for the treatment or visits if the behavioral health organization does not communicate disapproval of the request for authorization or re-authorization to the insured or to the person or organization providing the services within forty-eight hours of the request.

D. For purposes of this section, "insured" means a person enrolled in the state's medicaid managed care program."

Section 4. A new section of the Public Assistance Act, Section 27-2-12.11 NMSA 1978, is enacted to read:

"27-2-12.11. [NEW MATERIAL] BEHAVIORAL HEALTH ORGANIZATIONS--DIRECT CARE EXPENSES MINIMUM.--In providing behavioral health services to medicaid clients, regardless of whether such services are provided directly or through subcontracts with other behavioral health or provider organizations, no behavioral health organization shall expend less than eighty-five percent of its gross income received for such purposes on direct client care."

Section 5. APPROPRIATION--BEHAVIORAL HEALTH SERVICES.--Five hundred thousand dollars ($500,000) is appropriated from the general fund to the human services department for expenditure in fiscal year 2001 to expand availability of behavioral health services through medicaid managed care. Any unexpended or unencumbered balance remaining at the end of fiscal year 2001 shall revert to the general fund.