HOUSE HEALTH, GOVERNMENT AND INDIAN AFFAIRS COMMITTEE

SUBSTITUTE FOR HOUSE BILL 376

51st legislature - STATE OF NEW MEXICO - first session, 2013

AN ACT

RELATING TO PUBLIC ASSISTANCE; AMENDING A SECTION OF THE PUBLIC ASSISTANCE ACT TO BAN MANDATORY ENROLLMENT OF NATIVE AMERICANS IN MEDICAID MANAGED CARE.

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--NATIVE AMERICANS OPTIONAL ENROLLMENT.--

          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 not require the enrollment in a managed care program of any recipient who self-identifies as a Native American.

          E. The department shall afford any recipient who self-identifies as a Native American the option of enrolling in a medicaid managed care program or a medicaid fee-for-service program for medical or behavioral health services. Upon determination of medicaid eligibility, a Native American may choose to enroll in a medicaid managed care program or a medicaid fee-for-service program.

          F. By not enrolling in a medicaid managed care program, a Native American recipient chooses not to participate in medicaid managed care and shall be covered through a medicaid fee-for-service program.

          G. The department shall provide a Native American recipient a monthly opportunity to enroll or disenroll in a medicaid managed care program or a medicaid fee-for-service program."

- 3 -