45th legislature - STATE OF NEW MEXICO - first session, 2001

RELATING TO HEALTH; PROVIDING FOR NEGOTIATION WITH MANAGED CARE ENTITIES; PROVIDING FOR NOTIFICATION OF NEGOTIATED MANAGED CARE FEES BY JANUARY 1 OF EACH YEAR; AMENDING A SECTION OF THE NMSA 1978.

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. The department shall establish procedures whereby rates and amounts, including those under contract, payable to or through a managed care entity or its contractor or subcontractor under the managed care system, are negotiated and made available to the legislative finance committee by January 1 of each year for implementation in the subsequent fiscal year."