46th legislature - STATE OF NEW MEXICO - first session, 2003

RELATING TO HEALTH CARE; EXCLUDING MEDICAID BEHAVIORAL HEALTH SERVICES FROM MEDICAID MANAGED CARE PROGRAMS; AMENDING AND ENACTING SECTIONS OF THE NMSA 1978; DECLARING AN EMERGENCY.

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

Section 1. [NEW MATERIAL] SHORT TITLE.--Sections 1 through 5 of this act may be cited as the "Medicaid Behavioral Health Program Act".

Section 2. [NEW MATERIAL] DEFINITION.--As used in the Medicaid Behavioral Health Program Act, "department" means the human services department.

Section 3. [NEW MATERIAL] DEPARTMENT DUTIES.--

A. The department shall establish a medicaid behavioral health program to provide behavioral health services to medicaid recipients and begin providing services pursuant to that program no later than July 1, 2004.

B. The program established by the department pursuant to Subsection A of this section shall have its own dedicated budget that shall be expended solely to provide behavioral health services to medicaid recipients.

C. The department or its designee with experience in provision of services for behavioral health clients and knowledge of the management of behavioral health services shall provide services pursuant to the Medicaid Behavioral Health Program Act.

Section 4. [NEW MATERIAL] OPEN PLANNING PROCESS.--The department shall begin a planning process involving a

cross-section of people involved in receiving or providing behavioral health services. The process shall be designed to advise the department on the structure and services to be provided by the medicaid behavioral health program and convene meetings of a medicaid behavioral health planning group, including at least:

A. representatives of medicaid recipients;

B. consumers of medicaid-funded behavioral health services;

C. family members of consumers of medicaid-funded behavioral health services;

D. providers of medicaid-funded behavioral health services;

E. advocates for consumers of medicaid-funded behavioral health services;

F. mental health professionals;

G. representatives of a hospital association;

H. representatives of medicaid managed care providers;

I. representatives of the health care agencies of governments of the Indian nations, tribes or pueblos located wholly or partially within New Mexico; and

J. representatives of state agencies involved in the delivery of behavioral health services or populations requiring behavioral health services, including the state agency on aging, the children, youth and families department, the corrections department, the department of health and the state department of public education.

Section 5. [NEW MATERIAL] MEDICAID BEHAVIORAL HEALTH PROGRAM--SERVICES.--

A. The services provided by the medicaid behavioral health program shall be delivered on the assumption that recovery is possible for all people who suffer from adverse behavioral health conditions.

B. The medicaid behavioral health program shall:

(1) deliver a full range of behavioral health services including prevention, early intervention, recovery services, community-based services, in-home services, residential treatment, day services, inpatient services, non-residential intensive services, case management and care coordination services;

(2) be designed so that the complement of services delivered to each individual medicaid recipient accommodates the special needs of the recipient;

(3) address the special needs that arise due to the location of a medicaid recipient in an urban or rural community or the special needs that exist due to the recipient residing in a community near the international border of New Mexico and Mexico;

(4) be designed so that the greatest amount of funding feasible is expended on the delivery of direct services; and

(5) provide effective monitoring and accountability of the funds and services provided.

Section 6. 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. 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 and 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 all behavioral health services for children and adults from the provisions of this section."

Section 7. EMERGENCY.--It is necessary for the public peace, health and safety that this act take effect immediately.