HOUSE BILL 544

49th legislature - STATE OF NEW MEXICO - first session, 2009

INTRODUCED BY

Danice Picraux

AN ACT

RELATING TO HEALTH CARE; ENACTING THE HEALTH CARE COVERAGE ACCOUNTABILITY AND TRANSPARENCY ACT.

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

     Section 1. SHORT TITLE.--This act may be cited as the "Health Care Coverage Accountability and Transparency Act".

     Section 2. DEFINITIONS.--As used in the Health Care Coverage Accountability and Transparency Act:

          A. "department" means the human services department;

          B. "medical assistance program" means health care coverage or assistance that the department provides pursuant to the Public Assistance Act; and

          C. "report" means to post prominently and make easily accessible on the department's internet web site.

     Section 3. REQUIRED REPORTING.--

          A. The department shall report within thirty days of filing any plans, state plan amendments, waiver proposals or amendments, reports, reviews it has filed and any documentation of any public input that was obtained as required by the United States department of health and human services centers for medicare and medicaid services for any medical assistance program. The department shall also report any correspondence with the centers for medicare and medicaid services that the director of the medical assistance division of the department deems to have a significant impact on any medical assistance program.

          B. The department shall report annually and within thirty days of any change in the per-member per-month capitation rate by category of eligibility and rate cohort for each contract that the department enters into to provide medical assistance pursuant to the Public Assistance Act. When the individual contracts that the department enters into offer rates that differ from each other, the average capitation shall be reported for each category of eligibility and rate cohort and not the rates pursuant to each of the individual contracts. The department shall report annually the average per-member per-month expenditure by category of eligibility for medical assistance programs directly administered by the department. The department shall report annually for each medical assistance program the percentage of total expenditures that the department and the person with whom it contracts spend on administrative expenses, exclusive of health care services provided to individual members. The department shall define "administrative expenses" when reporting on administrative expenses.

          C. The department shall report on a monthly basis:

                (1) enrollment and demographic data on individuals in each medical assistance program, including age, sex, ethnicity, income level, employment status, marital status and parental status; and

                (2) data on employer involvement in medical assistance, where applicable, including the number of participating employers, their size by number of employees, their geographic location by county and their financial contributions.

          D. The department shall report on a quarterly basis budget projections and actual expenditures by program and category of eligibility and all actuarial analyses related to medical assistance programs.

          E. The department shall report annually all information that is currently provided to the department or routinely collected on utilization, quality and performance data for each medical assistance program.

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