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SPONSOR: |
Madalena |
DATE TYPED: |
1/30/02 |
HB |
HJM 19 |
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SHORT TITLE: |
NM Tribal Health Care Alliance |
SB |
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ANALYST: |
Dunbar |
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APPROPRIATION
|
Appropriation
Contained |
Estimated
Additional Impact |
Recurring or Non-Rec |
Fund Affected |
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FY02 |
FY03 |
FY02 |
FY03 |
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|
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$0.1
See Fiscal Narrative |
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(Parenthesis
( ) Indicate Expenditure Decreases)
Human Services Department (HSD)
Public Regulations Commission (PRC)
SUMMARY
Synopsis
of Bill
House Joint Memorial
19 requests the Human Services Department (HSD), the Insurance Division of the
Public Regulation Commission and other state agencies to support and expedite establishment
of the New Mexico Tribal Health Care Alliance as a licensed Managed Care
Organization (MCO) for the delivery of quality health care to American Indians
eligible for Medicaid services.
Significant
Issues
HSD states that the process for licensure of the alliance as an MCO is already underway, wherein HSD has supported and assisted the alliance in its effort to become an MCO.
The PRC reports that is not clear whether the Alliance is a non-profit of for-profit entity and that the Insurance Division cannot "negotiate" a license. Applicants for a license must meet all statutory requirements of the Insurance Code.
FISCAL IMPLICATIONS
The bill does
not contain an appropriation. However,
if the alliance is successful in becoming a MCO, it is unknown what this would
do in terms of costs to the Medicaid program.
It is possible that the addition of this MCO could be cost-neutral, in
that HSD already covers health services to these American Indian clients either
through the departments MCO program or through the Medicaid fee-for-service program.
ADMINISTRATIVE IMPLICATIONS
Several
members of HSD staff have been working with alliance staff and representatives
since the spring of 2001 in an effort to assist the alliance in becoming an
MCO. This has required HSD staff
attendance at meetings, technical assistance, arranging for alliance receipt,
review of Salud related documents and compiling data for the alliance and its
actuaries. This level of staff assistance
would be expected to increase, as much as a .25 Full Time Equivalent (FTE),
when the alliance moves toward licensure as an MCO.
PRC states that the Insurance Division may be called upon to assist the Alliance at a level not ordinarily offered to applicants for license as an insurer.
The memorial does not provide for a “feed back” mechanism to the legislature on progress achieved towards the licensure of the alliance as an MCO.
OTHER SUBSTANTIVE ISSUES
There
was concern expressed by HSD pertaining to the reference in HJM 19 to “Salud
Medicaid
Program
mandates specific to the American Indian population of New Mexico”. HSD explains that
Managed
care contracted organizations must meet significant requirements that are
specific to all
Medicaid
clients, which includes Native American clients.
POSSIBLE QUESTIONS
What progress has been
achieved towards the licensure of the alliance as an MCO?
Has a time frame been
established?
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