0001| AN ACT | 0002| RELATING TO HEALTH CARE; ENACTING THE MEDICAID REVIEW ACT; | 0003| REQUIRING REVIEW OF THE SERVICES AND MEDICAL BENEFITS PROVIDED IN | 0004| THE MEDICAID PROGRAM. | 0005| | 0006| BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF NEW MEXICO: | 0007| Section 1. SHORT TITLE.--Sections 1 through 4 of this act may be cited as the | 0008| "Medicaid Review Act". | 0009| Section 2. PURPOSE OF ACT.--The purpose of the Medicaid Review Act is to ensure | 0010| that the human services department reviews, with full public involvement, the medicaid program | 0011| and the full array of services and medical benefits provided in the medicaid program and seeks | 0012| appropriate legislative approval for significant changes in services, medical benefits or eligibility | 0013| criteria made to the program. | 0014| Section 3. HUMAN SERVICES DEPARTMENT REVIEW OF MEDICAID | 0015| BENEFITS AND SERVICES.-- | 0016| A. The human services department, in consultation with other state agencies | 0017| using medicaid funds, shall conduct a review that considers the full array of services and medical | 0018| benefits provided in the medicaid program. The public review process provided in the Medicaid | 0019| Review Act shall be used by the department to assist it in planning the medicaid program and in | 0020| developing recommendations for funding to the state legislature. | 0021| B. In conducting the review, the department shall seek to develop through a | 0022| broad-based public process a consensus on values to guide medicaid spending and medicaid | 0023| resource allocation. The review shall consider all medicaid services, including: | 0024| (1) medical benefits; | 0025| (2) nursing facilities and home- and community-based services; | 0001| (3) institutional, home- and community-based care for the | 0002| developmentally disabled, the chronically mentally ill or emotionally disturbed and the treatment | 0003| of alcohol- and drug-dependent persons; and | 0004| (4) other categories of service. | 0005| C. In conducting the review, the department shall analyze the impact to other | 0006| health services of recommended changes to the medicaid program including: | 0007| (1) costs incurred by the state, county indigent funds and private | 0008| insurance providers and policyholders; | 0009| (2) costs of uncompensated care incurred by providers; | 0010| (3) use of emergency care; | 0011| (4) care received by persons affected by proposed changes in services, | 0012| eligibility criteria or the imposition of co-payment requirements; | 0013| (5) care received by special needs populations and persons with terminal | 0014| or progressive illnesses; and | 0015| (6) rural health care infrastructure and provider participation in the | 0016| medicaid program. | 0017| D. The review of the medicaid program by the department shall include | 0018| consideration of options to contain health care costs and expand medicaid coverage to persons | 0019| without health insurance. | 0020| E. The public review process shall include a series of public hearings and seek | 0021| testimony and information from a wide range of interested persons, including legislative and | 0022| executive representatives, advocates for seniors, handicapped persons, mental health consumers, | 0023| low-income individuals and providers of services or potential services for the medicaid program. | 0024| F. Unless otherwise provided in the Medicaid Review Act, the human services | 0025| department may establish committees or advisory groups as it deems necessary or appropriate to | 0001| conduct the review required by this section and make recommendations to the department; | 0002| provided that the membership of any such committee or advisory group shall reflect the ethnic, | 0003| economic and geographic diversity of New Mexico. | 0004| G. The human services department shall work with the New Mexico health | 0005| policy commission to establish a subcommittee to review medical benefits for the medicaid | 0006| program. The New Mexico health policy commission shall administer and oversee the work of | 0007| the subcommittee. The subcommittee shall participate in the public review process and shall: | 0008| (1) recommend to the human services department the array of medical | 0009| benefits for the medicaid program. The subcommittee shall accord priority attention to | 0010| providing basic preventive and primary care medical benefits to all persons eligible for medicaid | 0011| assistance, taking into account special needs populations and persons with terminal illness. The | 0012| advantages of each medical benefit to the population to be served by the medicaid program shall | 0013| be described; | 0014| (2) consider eligibility criteria for medical benefits for medicaid | 0015| recipients; and | 0016| (3) consider patient co-payments and appropriate reimbursement rates for | 0017| medical benefits for providers and plans that serve medicaid recipients. | 0018| H. The human services department shall consider opinions expressed in the | 0019| public review process required in the Medicaid Review Act and recommendations of | 0020| committees, advisory groups and the medical benefits subcommittee prior to issuing proposed | 0021| regulations to revise the medicaid program or seeking legislative approval for significant | 0022| changes in services, medical benefits or eligibility in the medicaid program. | 0023| I. In conducting its review, the human services department shall adopt interim | 0024| revisions to the medicaid program if necessary to comply with federal law requirements imposed | 0025| for calendar year 1996; provided the department shall seek, to the maximum extent practicable, | 0001| to include public participation and comment prior to the adoption of interim regulations for | 0002| 1996. The department shall complete its review of the medicaid program by October 1, 1997, | 0003| and shall revise that review by October 1, 1998, in accordance with the provisions of the | 0004| Medicaid Review Act. | 0005| J. The human services department shall submit a report to the appropriate interim | 0006| legislative committee by October 1, 1997, and revise the report by October 1, 1998, of the | 0007| department's review of and recommendations concerning services and the allocation of funds for | 0008| the medicaid program. | 0009| Section 4. AUTHORIZATION FOR CONTRACTS--NOTICE TO PROVIDERS.-- | 0010| A. The New Mexico health policy commission and the human services | 0011| department may enter into contracts to hire actuaries, consultants and experts as they deem | 0012| necessary or appropriate to fulfill the duties of the Medicaid Review Act. | 0013| B. Providers of services under medicaid and health plans contracting with the | 0014| human services department for medicaid services shall be given no less than thirty days' written | 0015| notice prior to a reduction in reimbursement payments or services taking effect. | 0016| Section 5. DELAYED REPEAL.--The Medicaid Review Act is repealed effective | 0017| October 1, 1998. | 0018| |