0001|                       HOUSE JOINT MEMORIAL 49
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0002|     43RD LEGISLATURE - STATE OF NEW MEXICO - SECOND SESSION, 1998
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0003|                            INTRODUCED BY
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0004|                           LYNDA M. LOVEJOY
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0005|     
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0006|                                   
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0007|     
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0008|             FOR THE HEALTH AND WELFARE REFORM COMMITTEE
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0009|     
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0010|                           A JOINT MEMORIAL
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0011|     REQUESTING THE HUMAN SERVICES DEPARTMENT TO ESTABLISH
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0012|     LIMITATIONS ON NETWORK PROVIDERS REFERRING MEDICAID MANAGED
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0013|     CARE PATIENTS TO THEMSELVES.
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0014|     
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0015|          WHEREAS, the medicaid program is under a managed care
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0016|     system and the human services department has contracts with
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0017|     three managed care organizations to implement that program;
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0018|     and
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0019|          WHEREAS, the contracted organizations subcontract for the
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0020|     provision of services under the medicaid program; and
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0021|          WHEREAS, some subcontractors further contract with
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0022|     network providers to identify and establish an adequate number
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0023|     of physicians and allied health care providers to deliver
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0024|     services to medicaid patients; and
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0025|          WHEREAS, network providers have an inherent potential
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0001|     conflict of interest since they have an incentive to refer
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0002|     medicaid patients to themselves to provide services; and
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0003|          WHEREAS, there are community-based and free-standing
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0004|     health care providers in communities that also have contracts
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0005|     with managed care organizations, and that are ready and
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0006|     willing to serve medicaid beneficiaries; and
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0007|          WHEREAS, the survival of these providers is threatened by
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0008|     network providers who do not refer medicaid patients to them;
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0009|     and 
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0010|          WHEREAS, medicaid patients may have continuity of care
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0011|     interrupted with providers who have served their needs for a
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0012|     long time if network providers insist on referring these
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0013|     patients to themselves; and
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0014|          WHEREAS, medicaid patients are entitled to free choice of
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0015|     providers represented by a contract with their chosen managed
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0016|     care organization;
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0017|          NOW, THEREFORE, BE IT RESOLVED BY THE LEGISLATURE OF THE
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0018|     STATE OF NEW MEXICO that the human services department be
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0019|     requested to limit or eliminate the ability of network
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0020|     providers to refer medicaid managed care patients to
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0021|     themselves; and
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0022|          BE IT FURTHER RESOLVED that the department monitor this
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0023|     activity through contract oversight; and
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0024|          BE IT FURTHER RESOLVED that the use of network providers
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0025|     be curtailed and that their use be expressly prohibited when
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0001|     and if contracts with managed care organizations are renewed
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0002|     or revised; and
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0003|          BE IT FURTHER RESOLVED that a copy of this memorial be
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0004|     sent to the secretary of human services and to each of the
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0005|     three primary SALUD contractors.
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0006|                            - 3 -
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