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|
SPONSOR: |
J.P. Taylor |
DATE TYPED: |
|
HB |
417 |
||
|
SHORT TITLE: |
Medicaid for the Medically Ill |
SB |
|
||||
|
|
ANALYST: |
Weber |
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APPROPRIATION
|
Appropriation
Contained |
Estimated
Additional Impact |
Recurring or
Non-Rec |
Fund Affected |
||
|
FY03 |
FY04 |
FY03 |
FY04 |
|
|
|
$250.0 |
|
|
|
Recurring |
General
Fund |
(Parenthesis
( ) Indicate Expenditure Decreases)
REVENUE
|
Estimated Revenue |
Subsequent Years Impact |
Recurring or
Non-Rec |
Fund Affected |
|
|
FY03 |
FY04 |
|
|
|
|
$741.3 |
|
|
Recurring |
Federal
Funds |
(Parenthesis ( ) Indicate Revenue Decreases)
Responses Received From
Human Services Department
SUMMARY
Synopsis of Bill
House Bill 417
appropriates $250,000 from the General Fund to the Human Services Department (HSD) to develop a
Medicaid waiver for the purpose of creating a pilot Assertive Community
Treatment (ACT) program in
Significant Issues
The
Human Services Department reports that HB 417 proposes to pilot an ACT program
through a Medicaid Waiver that would serve 100 adult individuals in
The majority of
current Medicaid expenditures for adults with both mental illness and
co-occurring alcohol or drug use are for hospitalizations and medications that
are not taken, or not taken as prescribed.
The Medicaid program currently offers case management for the
chronically mentally ill, psychological and psychiatric evaluations, and
outpatient therapeutic interventions/counseling as general benefits. Under the Psychosocial Rehabilitation (PSR) benefit,
case management, high complexity assessment, therapeutic interventions,
psychiatric and psychological evaluations, medication management, and crisis
intervention are offered. The majority
of mental health/behavioral health services are provided by local community
mental health centers (CMHC).
Individuals whose needs would be addressed by an ACT team are not likely
to access their local CMHC for services on their own.
HB 417 requires HSD
to offer acupuncture and nutrition services as part of the ACT program. It is not clear how acupuncture and nutrition
services will fit in with the type of services traditionally offered by ACT
teams. Nutrition services for adults who
are not pregnant and acupuncture services are not current benefits of the
Medicaid program.
FISCAL IMPLICATIONS
The appropriation of $250.0 contained in this
bill is a recurring expense to the General Fund. Any unexpended or unencumbered
balance remaining at the end of Fiscal Year 2004 shall revert to the General
Fund.
Because
of the length of time it takes to receive approval for a waiver, the funding
would most likely not be used until FY04.
If a waiver were approved, the federal match would bring the total
funding for the program to $991,300. The
Department of Health (DOH) estimates it would cost approximately $6,000 per person
per year to provide ACT team services.
According to DOH, this amount is based on national figures from other
ACT programs. This estimate may be low
compared to New Mexico Medicaid expenditures for mental health services.
HB
417 requires HSD to contract with DOH for the design, development and operation
of the Waiver. There is no additional
appropriation for contracting with DOH.
ADMINISTRATIVE
IMPLICATIONS
The Human Service Department report that developing
a Medicaid Waiver application to the Centers for Medicare and Medicaid Services
(CMS) is extremely onerous and time consuming. It would require additional staff to perform
the necessary analysis and cost projections and to write the application. Staff will be required to implement and
oversee the waiver if approved. HB 417
also requires HSD to contract with DOH for the design, development and
operation of the Waiver program. Federal
law does not allow the Single State Medicaid Agency to delegate its authority
to another agency. HSD must maintain
responsibility for the waiver. HSD would
initiate a Joint Powers Agreement (JPA) with DOH to administer certain
functions of the Waiver. Staff would
have to be devoted to working with DOH on this program.
OTHER SUBSTANTIVE
ISSUES
A
Medicaid waiver allows the state to target services to a narrowly defined
population and to limit the numbers of persons served, in this case 100
persons. However, experience with
Medicaid waivers has shown that waiting lists often lead to frustration.
It
is difficult to actually estimate the cost of providing services under an ACT
program. The
clients
are frequently difficult to reach.
Implementation of a new program of this nature may require considerable
expense for locating clients, out-reach and treatment engagement.
There
is significant support in the literature for the efficacy of ACT programs,
especially for
persons with schizophrenia. The Substance Abuse and Mental Health
Services Administration (SAMHSA) has recognized ACT as a quality indicator for
state mental health programs. In 1999,
the Surgeon General endorsed ACT. On
MW/yr