SENATE JOINT MEMORIAL 4

51st legislature - STATE OF NEW MEXICO - first session, 2013

INTRODUCED BY

Gerald Ortiz y Pino

FOR THE LEGISLATIVE HEALTH AND HUMAN SERVICES COMMITTEE

A JOINT MEMORIAL

REQUESTING THE HUMAN SERVICES DEPARTMENT TO REQUIRE MEDICAID MANAGED CARE ORGANIZATIONS TO PROVIDE MEDICAID RECIPIENTS WITH MONTHLY EXPLANATIONS OF BENEFITS TO ENCOURAGE PERSONAL RESPONSIBILITY AND TO COMBAT FRAUD AND ABUSE IN THE MEDICAID PROGRAM.

     WHEREAS, nearly half a million New Mexicans receive medicaid benefits, with medicaid enrollment at its highest point in the state's history; and

     WHEREAS, medicaid expenditures were approximately four billion dollars ($4,000,000,000) in fiscal year 2011; and

     WHEREAS, the medical assistance division of the human services department oversees the state's medicaid program; and

     WHEREAS, the human services department contracts with managed care organizations to manage health care services paid for by medicaid; and

     WHEREAS, federal law requires a state's medicaid agency to verify that services billed to medicaid by providers were in fact received by medicaid recipients; and

     WHEREAS, verification of services is a valuable tool used by many states to detect medicaid fraud and abuse; and

     WHEREAS, Texas requires a medicaid explanation of benefits for the purpose of informing recipients of the medicaid services paid for by the state's medicaid program on their behalf; in turn, recipients are encouraged to inform the state's medicaid agency if any of the services were incorrectly recorded or not received; and

     WHEREAS, Nevada verifies services paid for by its medicaid program with monthly mailings to medicaid recipients of a summary of medicaid claims or explanation of benefits for the month preceding the mailing, with stamped self-addressed envelopes for recipients who wish to notify its medicaid agency of incorrect billings; and

     WHEREAS, while one of the four guiding principles of New Mexico's centennial care medicaid program is "personal responsibility" and a stated goal of centennial care is to "engage recipients in their personal health decisions", the human services department does not require its medicaid managed care contractors to provide medicaid recipients with an explanation of benefits;

     NOW, THEREFORE, BE IT RESOLVED BY THE LEGISLATURE OF THE STATE OF NEW MEXICO that the human services department be requested to require its medicaid managed care contractors to provide medicaid recipients with regular and periodic explanations of benefits to encourage personal responsibility and as a tool to detect fraud and abuse in the medicaid program; and

     BE IT FURTHER RESOLVED that copies of this memorial be transmitted to the governor, the secretary of human services and the director of the medical assistance division.

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