44TH LEGISLATURE - STATE OF NEW MEXICO - FIRST SESSION, 1999

RELATING TO MEDICAID; PROVIDING THAT THE COST PER MEDICAID RECIPIENT PURSUANT TO MANAGED CARE CONTRACTS CANNOT EXCEED A CERTAIN RATE OF INCREASE.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF NEW MEXICO:

Section 1. Section 27-2-12.6 NMSA 1978 (being Laws 1994, Chapter 62, Section 22) is amended to read:

"27-2-12.6. MEDICAID PAYMENTS--MANAGED CARE.--

A. The department shall provide for a statewide, managed care system to provide cost-efficient, preventive, primary and acute care for medicaid recipients by July 1, 1995.

B. The managed care system shall ensure:

(1) access to medically necessary services, particularly for medicaid recipients with chronic health problems;

(2) to the extent practicable, maintenance of the rural primary care delivery infrastructure;

(3) that the department's approach is consistent with national and state health care reform principles; and

(4) to the maximum extent possible, that medicaid-eligible individuals are not identified as such except as necessary for billing purposes.

C. The department may exclude nursing homes, intermediate care facilities for the mentally retarded, medicaid in-home and community-based waiver services and residential and community-based mental health services for children with serious emotional disorders from the provisions of this section.

D. Each contract for a managed care system entered into by the department pursuant to this section shall provide that the increase in the cost per medicaid recipient from one contract year to the next shall not exceed the average rate of increase in nationwide health insurance costs for the previous calendar year, as calculated by the superintendent of insurance using accepted national indices. The superintendent of insurance shall, by February 1 of each year, notify the department of the rate that health insurance costs increased in the previous calendar year. The limitation on the increase in cost provided in this subsection shall be exclusive of any expanded coverage of the medicaid program."