SENATE BILL 155
49th legislature - STATE OF NEW MEXICO - second session, 2010
INTRODUCED BY
Clinton D. Harden
AN ACT
RELATING TO PUBLICLY FUNDED HEALTH CARE; PROVIDING FOR THE PURCHASE OF PLANS WITH BENEFIT OPTIONS FOR PUBLIC SCHOOL EMPLOYEES, STATE AND LOCAL PUBLIC EMPLOYEES AND PUBLIC RETIREES; PROVIDING FOR DISPUTE RESOLUTION.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF NEW MEXICO:
Section 1. Section 13-7-4 NMSA 1978 (being Laws 1997, Chapter 74, Section 4) is amended to read:
"13-7-4. MANDATORY CONSOLIDATED PURCHASING.--
A. The publicly funded health care agencies shall enter into a cooperative consolidated purchasing effort to provide plans of health care benefits for the benefit of eligible participants of the respective agencies. The request for [proposal] proposals shall set forth one or more plans of health care benefits and shall include accommodation of fully funded arrangements as well as varying degrees of self-funded pool options. Any plan selected shall provide options for health care benefits among like populations of similar age, location or service needs across the publicly funded health care agencies, including options for:
(1) medicare supplement coverage;
(2) pregnancy and maternity benefits;
(3) high-risk or high-cost services;
(4) age-appropriate services;
(5) geographic considerations;
(6) coordination of benefits with other public or private coverage; or
(7) other unique services identified jointly by the agencies.
B. The insurers and administrators selected shall use common definitions of services and other common characteristics as determined by the governing bodies of the publicly funded health care agencies. Any plan selected may include different health care benefit options that include health coverage through a health maintenance organization, preferred provider organization, point-of-service product or other health coverage product; provided that the options are available to all eligible participants of the respective publicly funded health care agencies or other entities pursuant to Section 13-7-5 NMSA 1978. A publicly funded health care agency shall not select a plan for that agency's eligible participants that excludes an eligible participant from any of the other publicly funded health care agencies.
C. The publicly funded health care agencies shall develop consistency in member services functions for enrollment, premium collection and other activities. A public employee who transfers from one publicly funded health care agency to another shall be allowed to retain the same insurer or third-party administrator. The agencies shall select one person to provide actuarial analysis and information for any plan and its health coverage options across all agencies. To the extent practicable, the agencies shall select the same person to provide each agency with fund viability and solvency analysis and information; provided, however, that, if more than one person is selected, it shall be by consensus of the agencies.
[B.] D. A consolidated purchasing request for proposals for all health care benefits by the publicly funded health care agencies shall be issued on or before July 1, 1999 and any contracts for health care benefits renewed or issued on or after July 1, 2000 shall be the result of consolidated purchasing.
[C. All requests for proposals issued as part of the consolidated purchasing shall include at least one distinct service area consisting of the Albuquerque metropolitan area. Proposals on a distinct service area shall be evaluated separately.]"
Section 2. Section 13-7-5 NMSA 1978 (being Laws 2001, Chapter 351, Section 1) is amended to read:
"13-7-5. CONSOLIDATED PURCHASING FOR OTHER PERSONS.--
A. Counties, municipalities, state educational institutions and other political subdivisions that wish to use the consolidated purchasing single process for the procurement of health care benefits shall create or enter into an existing association, cooperative or other mutual alliance to create larger pools of eligible participants.
B. Counties, municipalities, state educational institutions and other political subdivisions that wish to use the consolidated purchasing single process shall, through their respective association, cooperative or mutual alliance, participate in the subsequent consolidated purchasing single process with the publicly funded health care agencies.
C. Counties, municipalities, state educational institutions and other political subdivisions that wish to use the consolidated purchasing single process shall use any plan selected by the publicly funded health care agencies and shall not use any plan not selected by those agencies."
Section 3. Section 13-7-7 NMSA 1978 (being Laws 2001, Chapter 351, Section 3, as amended) is amended to read:
"13-7-7. CONSOLIDATED ADMINISTRATIVE FUNCTIONS--BENEFIT.--
A. By December 1, 2001, the publicly funded health care agencies, political subdivisions and other persons participating in the consolidated purchasing single process pursuant to the Health Care Purchasing Act shall cooperatively study and provide a status report on the consolidation of administrative functions to the legislative health and human services committee and the governor.
B. By December 31, 2003, the publicly funded health care agencies, political subdivisions and other persons participating in the consolidated purchasing single process pursuant to the Health Care Purchasing Act shall consolidate, standardize and administer the administrative functions that those entities can effectively and efficiently administer as reflected in the study.
C. The publicly funded health care agencies, political subdivisions and other persons participating in the consolidated purchasing single process pursuant to the Health Care Purchasing Act may enter into a joint powers agreement pursuant to the Joint Powers Agreements Act with the publicly funded health care agencies and political subdivisions to determine assessments or provisions of resources to consolidate, standardize and administer the consolidated purchasing single process and subsequent activities pursuant to the Health Care Purchasing Act. The publicly funded health care agencies, political subdivisions and other persons participating in the consolidated purchasing single process pursuant to the Health Care Purchasing Act may enter into contracts with nonpublic persons to provide the service of determining assessments or provision of resources for consolidation, standardization and administrative activities.
D. Each agency will retain its responsibility to determine policy direction of the benefit plans, recommend plan development and provide training and coordination with respect to participants and its benefits staff, as well as to respond to benefits eligibility inquiries and establish and enforce eligibility rules. Each agency shall assess premiums or cost sharing in accordance with Section 10-7-4 NMSA 1978, the Group Benefits Act, the Retiree Health Care Act or the Public School Insurance Authority Act, as applicable.
E. Notwithstanding Subsection D of this section, publicly funded health care agencies, political subdivisions and other persons participating in the consolidated purchasing single process pursuant to the Health Care Purchasing Act shall provide coverage for children, from birth through three years of age, for or under the family, infant, toddler program administered by the department of health, provided eligibility criteria are met, for a maximum benefit of three thousand five hundred dollars ($3,500) annually for medically necessary early intervention services provided as part of an individualized family service plan and delivered by certified and licensed personnel as defined in 7.30.8 NMAC who are working in early intervention programs approved by the department of health. No payment under this subsection shall be applied against any maximum lifetime or annual limits specified in the policy, health benefits plan or contract."
Section 4. A new section of the Health Care Purchasing Act is enacted to read:
"[NEW MATERIAL] SCHOOL DISTRICTS WITH STUDENT ENROLLMENT IN EXCESS OF SIXTY THOUSAND STUDENTS--ACTUARIAL ANALYSIS REQUIRED--CONTINUED PARTICIPATION.--The superintendent of a school district with student enrollment in excess of sixty thousand students may have an actuarial analysis performed to obtain recommendations regarding the school district's continued participation in the interagency health care benefits consolidated purchasing effort pursuant to the Health Care Purchasing Act. In the event that the superintendent finds that the actuarial analysis obtained pursuant to this section indicates that the school district's participation in the interagency health care benefits consolidated purchasing effort is not actuarially sound, the school district may refer the matter of its continued participation in consolidated purchasing to alternative dispute resolution pursuant to Section 5 of this 2010 act."
Section 5. A new section of the Health Care Purchasing Act is enacted to read:
"[NEW MATERIAL] DISPUTE--MEDIATION--ARBITRATION.--If a dispute arises among the publicly funded health care agencies, the agencies shall resolve the dispute by mediation, arbitration or other procedure for alternative dispute resolution."
Section 6. APPLICABILITY.--The provisions of Section 1 of this act apply to consolidated purchasing beginning on or after July 1, 2011.
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