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F I S C A L   I M P A C T   R E P O R T

 

 

 

SPONSOR:

Tsosie

 

DATE TYPED:

2/5/02

 

HB

 

 

SHORT TITLE:

NM Tribal Health Care Alliance

 

SB

SJM50

 

 

ANALYST:

Dunbar

 

APPROPRIATION

 

Appropriation Contained

Estimated Additional Impact

Recurring

or Non-Rec

Fund

Affected

FY02

FY03

FY02

FY03

 

 

 

 

$0.1 See Fiscal Narrative

 

 

 

 

 

 

 

 

(Parenthesis ( ) Indicate Expenditure Decreases)

 

SOURCES OF INFORMATION

 

Responses Received From

    

Human Services Department (HSD)

Public Regulations Commission (PRC)

 

SUMMARY

 

     Synopsis of Bill

 

Senate Joint Memorial 50 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 or 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 Native American 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.  

 

TECHNICAL ISSUES

 

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 SJM 50 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.  These requirements include 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?

 

BD/njw

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