0001| HOUSE BILL 1305 | 0002| 43rd legislature - STATE OF NEW MEXICO - first session, 1997 | 0003| INTRODUCED BY | 0004| DANICE PICRAUX | 0005| | 0006| | 0007| | 0008| | 0009| | 0010| AN ACT | 0011| RELATING TO PUBLIC EDUCATION; ENACTING A SECTION OF THE PUBLIC | 0012| ASSISTANCE ACT TO PROVIDE FOR MEDICAID REIMBURSEMENTS TO SCHOOL | 0013| DISTRICTS PURSUANT TO THE FEDERAL INDIVIDUALS WITH DISABILITIES | 0014| EDUCATION ACT. | 0015| | 0016| BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF NEW MEXICO: | 0017| Section 1. A new section of the Public Assistance Act is | 0018| enacted to read: | 0019| "[NEW MATERIAL] MEDICAID IN THE SCHOOLS PROGRAM--HUMAN | 0020| SERVICES DEPARTMENT--PUBLIC SCHOOL DISTRICTS--POWERS AND | 0021| DUTIES--COVERED SERVICES--PROCESSING OF CLAIMS.-- | 0022| A. School districts may enroll in the medicaid in | 0023| the schools program to receive federal funds under the medicaid | 0024| program pursuant to Title 19 of the federal Social Security Act | 0025| and the federal Individuals with Disabilities Education Act. | 0001| B. In order to maximize receipt of federal funds, | 0002| the medical assistance division of the department shall furnish | 0003| services and promptly reimburse school districts and recipients | 0004| within sixty days of receipt of a claim for reimbursement. No | 0005| state regulation or procedure affecting the medicaid in the | 0006| schools program shall be more restrictive than those | 0007| established by federal law or regulation. | 0008| C. The department may deduct an amount equal to | 0009| five percent of the total federal reimbursement available from | 0010| each medicaid claim filed under the program and shall convey | 0011| the remaining ninety-five percent to the school districts. The | 0012| department shall maintain a mechanized claims processing and | 0013| information retrieval system for processing reimbursable claims | 0014| filed under the program. | 0015| D. The following services shall be eligible for | 0016| reimbursement by the medicaid in the schools program and do not | 0017| need prior authorization: | 0018| (1) speech, language and hearing service and | 0019| evaluation; | 0020| (2) occupational therapy and evaluation; | 0021| (3) physical therapy and evaluation; | 0022| (4) nursing services; | 0023| (5) psychological, counseling and social work | 0024| services; | 0025| (6) developmental testing; | 0001| (7) Individuals with Disabilities Education | 0002| Act assessment; | 0003| (8) case management; and | 0004| (9) transportation for individuals whose | 0005| medical needs require accommodation for transport in order to | 0006| receive covered services. | 0007| E. The services described in Subsection D of this | 0008| section are medically necessary if the service: | 0009| (1) addresses a medical or mental disability; | 0010| (2) assists the person to benefit from special | 0011| education; and | 0012| (3) is provided to a student identified in an | 0013| individualized education program or individual family service | 0014| plan. | 0015| F. The department shall permit the submission of | 0016| retroactive claims no later than twelve months from the date of | 0017| service. The department shall pay claims within thirty days of | 0018| the date of receipt. | 0019| G. Administrative claims are allowed for | 0020| reimbursement of costs incurred for persons under twenty-one | 0021| years of age by school districts acting in compliance with the | 0022| early and periodic screening, diagnosis and treatment services | 0023| program pursuant to 42 CFR Part 441 (B). The services include | 0024| actions by the department or school districts to assure | 0025| families are informed about the program and are assisted to | 0001| seek the services from health care providers. Health care | 0002| administrative services include: | 0003| (1) program management; | 0004| (2) training and supervision of service | 0005| providers; | 0006| (3) directing recipients to preventative | 0007| services; | 0008| (4) informing eligible recipients under Title | 0009| 19 of early and periodic screening, diagnosis and treatment | 0010| services; | 0011| (5) assistance to children and their families | 0012| in determining their eligibility; | 0013| (6) assuring that screening, diagnosis and | 0014| treatment are appropriate and timely; and | 0015| (7) assuring that services are of sufficient | 0016| amount, duration and scope to correct or ameliorate the | 0017| conditions for which they were determined to be necessary. | 0018| H. The department shall adopt regulations to carry | 0019| out the provisions of this section pursuant to the federal | 0020| office of management and budget circular A-87, as amended, and | 0021| shall include requirements that: | 0022| (1) school districts submit claims quarterly | 0023| to the department no later than the forty-fifth calendar day | 0024| after the end of the calendar quarter; | 0025| (2) the financial data used to calculate the | 0001| claim shall be based on actual expenditure reports including | 0002| other costs and obtained directly from school districts' | 0003| financial accounting systems; | 0004| (3) the use by school districts of generally | 0005| acceptable governmental accounting standards certified by an | 0006| independent professional service; | 0007| (4) use of a time allocation methodology shall | 0008| be applied to determine the appropriate distribution of time | 0009| toward the medicaid services during each quarter; and | 0010| (5) a statistically valid, stratified, random | 0011| sample of the school districts' personnel who directly perform | 0012| the services shall be selected to participate in the time study | 0013| for a segment of time during each quarter for representation of | 0014| all eligible participants." | 0015|  | 0016| State of New Mexico | 0017| House of Representatives | 0018| | 0019| FORTY-THIRD LEGISLATURE | 0020| FIRST SESSION, 1997 | 0021| | 0022| | 0023| March 12, 1997 | 0024| | 0025| | 0001| Mr. Speaker: | 0002| | 0003| Your EDUCATION COMMITTEE, to whom has been referred | 0004| | 0005| HOUSE BILL 1305 | 0006| | 0007| has had it under consideration and reports same with | 0008| recommendation that it DO PASS, amended as follows: | 0009| | 0010| 1. On page 2, line 25, strike "developmental" and insert in | 0011| lieu thereof "diagnostic". | 0012| | 0013| 2. On page 3, line 9, after "medical" insert "need". | 0014| | 0015| 3. On page 3, line 17, strike "thirty" and insert in lieu | 0016| thereof "sixty"., | 0017| | 0018| and thence referred to the CONSUMER AND PUBLIC AFFAIRS | 0019| COMMITTEE. | 0020| | 0021| Respectfully submitted, | 0022| | 0023| | 0024| | 0025| | 0001| | 0002| Samuel F. Vigil, Chairman | 0003| | 0004| | 0005| Adopted Not Adopted | 0006| | 0007| (Chief Clerk) (Chief Clerk) | 0008| | 0009| Date | 0010| | 0011| The roll call vote was 9 For 0 Against | 0012| Yes: 9 | 0013| Excused: Beam, McSherry, Nicely, Wright | 0014| Absent: None | 0015| | 0016| | 0017| .118344.1 | 0018| G:\BILLTEXT\BILLW_97\H1305 State of New Mexico | 0019| House of Representatives | 0020| | 0021| FORTY-THIRD LEGISLATURE | 0022| FIRST SESSION, 1997 | 0023| | 0024| | 0025| March 13, 1997 | 0001| | 0002| | 0003| Mr. Speaker: | 0004| | 0005| Your CONSUMER AND PUBLIC AFFAIRS COMMITTEE, to | 0006| whom has been referred | 0007| | 0008| HOUSE BILL 1305, as amended | 0009| | 0010| has had it under consideration and reports same with | 0011| recommendation that it DO PASS. | 0012| | 0013| Respectfully submitted, | 0014| | 0015| | 0016| | 0017| | 0018| | 0019| Gary King, Chairman | 0020| | 0021| | 0022| Adopted Not Adopted | 0023| | 0024| (Chief Clerk) (Chief Clerk) | 0025| | 0001| Date | 0002| | 0003| The roll call vote was 6 For 0 Against | 0004| Yes: 6 | 0005| Excused: Dana, Rios, Sandel, Vigil | 0006| Absent: None | 0007| | 0008| | 0009| G:\BILLTEXT\BILLW_97\H1305 |