0001| HOUSE BILL 208
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0002| 43RD LEGISLATURE - STATE OF NEW MEXICO - SECOND SESSION, 1998
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0003| INTRODUCED BY
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0004| LUCIANO "LUCKY" VARELA
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0005|
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0006|
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0007| FOR THE LEGISLATIVE FINANCE COMMITTEE AND
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0008| THE HEALTH AND WELFARE REFORM COMMITTEE
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0009|
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0010| AN ACT
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0011| RELATING TO HEALTH; ENACTING THE CHILD HEALTH ACT; CREATING
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0012| THE HEALTHY KIDS PROGRAM; AMENDING, REPEALING AND ENACTING
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0013| SECTIONS OF THE NMSA 1978; MAKING AN APPROPRIATION; DECLARING
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0014| AN EMERGENCY.
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0015|
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0016| BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF NEW MEXICO:
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0017| Section 1. [NEW MATERIAL] SHORT TITLE.--Sections 1
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0018| through 7 of this act may be cited as the "Child Health Act".
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0019| Section 2. [NEW MATERIAL] DEFINITIONS.--As used in the
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0020| Child Health Act:
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0021| A. "child" means a natural person who has not
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0022| reached his nineteenth birthday;
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0023| B. "department" means the human services
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0024| department;
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0025| C. "low-income family" means a family with income
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0001| at or below the level specified in Section 5 of the Child
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0002| Health Act; and
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0003| D. "secretary" means the secretary of human
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0004| services.
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0005| Section 3. [NEW MATERIAL] HEALTHY KIDS PROGRAM
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0006| CREATED.--After consultation with the secretary of health and
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0007| the secretary of children, youth and families, the secretary is
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0008| directed to design and implement a program to provide health
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0009| services to children and adults in low-income families in
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0010| accordance with the provisions of the Child Health Act. The
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0011| program shall be known as "healthy kids". It shall meet the
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0012| requirements for obtaining allotted federal funds pursuant to
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0013| the provisions of Title 21 of the federal Social Security Act.
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0014| In accordance with those requirements and the requirements of
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0015| the Child Health Act, the secretary shall prepare and submit a
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0016| child health plan to the secretary of health and human
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0017| services. Healthy kids shall be administered by the
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0018| department.
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0019| Section 4. [NEW MATERIAL] PROGRAM OBJECTIVES--
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0020| DEVELOPMENT OF PLAN AND ADOPTION OF RULES.--
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0021| A. The child health plan and healthy kids shall be
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0022| designed to achieve the following objectives:
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0023| (1) expand access to and coverage for full or
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0024| partial payment for a comprehensive array of personal health
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0025| services for children and adults in low-income families that do
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0001| not have those services at present;
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0002| (2) increase measurably the quality of life
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0003| and well-being for the state's citizens by ensuring the good
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0004| health of children and adults in low-income families;
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0005| (3) reduce substantially the occurrence rates
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0006| of preventable illness and disease, morbidity and mortality in
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0007| the state's population;
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0008| (4) increase positively the benefit-to-cost
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0009| ratios of health services provided in the state to the
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0010| population as a whole while at the same time improving the
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0011| quality of service when measured by both scientifically
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0012| objective and beneficiary-perceived criteria;
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0013| (5) retard escalation of health care costs in
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0014| all segments of the health care industry; and
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0015| (6) provide through experimentation and
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0016| demonstration projects, coupled with any necessary and
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0017| appropriate federal waivers of conditions for expenditure
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0018| approval, innovative and imaginative methods of providing
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0019| health care to all segments of the state's population.
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0020| B. Implementation of an approved child health plan
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0021| shall be in accordance with rules adopted by the secretary.
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0022| The rules shall be designed to achieve and be consistent with
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0023| the objectives specified in Subsection A of this section.
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0024| Those objectives are stated as mandatory standards by which the
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0025| validity of proposed rules shall be tested. Additionally, the
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0001| rules must be consistent with those provisions of the Child
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0002| Health Act that mandate program requirements.
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0003| Section 5. [NEW MATERIAL] PLAN CONTENT--REQUIRED
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0004| ELEMENTS.--The child health plan and the program of services to
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0005| be provided by it shall include:
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0006| A. a one-year period measured from the date of
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0007| federal approval of the child health plan to be known as "phase
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0008| one", during which the following shall occur:
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0009| (1) the family income eligibility requirement
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0010| for participation of children in healthy kids shall be
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0011| established at two hundred thirty-five percent of the federal
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0012| poverty level;
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0013| (2) presumptive eligibility procedures shall
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0014| be established and initiated;
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0015| (3) a simplified application process shall be
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0016| established and implemented;
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0017| (4) the locations of eligibility workers shall
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0018| be diversified;
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0019| (5) training for health care providers to
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0020| enable them to assist families in filling out application forms
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0021| shall be developed and implemented; and
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0022| (6) specific outreach procedures shall be
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0023| developed, including within those procedures ways to recognize
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0024| and accommodate cultural diversity, to involve families of
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0025| children likely to be eligible for healthy kids or other public
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0001| or private health coverage programs and to inform these
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0002| families of the availability of and assist them in enrolling in
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0003| those programs;
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0004| B. a two-year period measured from the date of
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0005| federal approval of the child health plan to be known as "phase
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0006| two", during which the following shall occur:
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0007| (1) a continuum of prevention and intervention
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0008| services shall be developed and implemented consisting of at
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0009| least the following, including applications for any federal
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0010| waivers of conditions that are necessary:
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0011| (a) implementation of a universal home
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0012| visiting program for mothers having their first child,
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0013| beginning during pregnancy and extending for two years, with a
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0014| frequency of use as both desired and medically indicated;
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0015| (b) creation of a program of early
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0016| intervention developmental services;
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0017| (c) provision of a behavioral health
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0018| identification, assessment and management system;
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0019| (d) expansion of school-based health
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0020| services into the network of health care programs;
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0021| (e) expansion of the healthier kids fund
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0022| administered by the department of health to enable children to
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0023| have effective access to health care; and
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0024| (f) development of ways to increase
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0025| children's dental services; and
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0001| (2) development of a plan to provide health
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0002| services to uninsured parents of children eligible for healthy
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0003| kids;
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0004| C. twelve months of continuous coverage for healthy
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0005| kids beneficiaries;
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0006| D. a requirement that no asset test be imposed as a
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0007| condition of eligibility for children;
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0008| E. provisions for inhibiting or preventing both
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0009| employer crowd-out and employee crowd-out;
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0010| F. requirements that in its development and
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0011| implementation interests of Native American children are
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0012| identified and that appropriate provisions for their enrollment
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0013| are made with recognition that the application process and the
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0014| delivery of services with respect to those children present
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0015| special cultural and other considerations;
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0016| G. provisions for the coordination of the
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0017| administration of healthy kids with other public and private
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0018| health programs;
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0019| H. identification and implementation of methods,
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0020| including monitoring, used to ensure the quality and
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0021| appropriateness of care, particularly with respect to well-baby
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0022| care, well-child care and immunizations provided under the plan
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0023| and to ensure access to covered services, including emergency
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0024| services;
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0025| I. methods by which the state will collect data,
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0001| maintain the records and furnish required reports to the
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0002| secretary of health and human services; and
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0003| J. specific requirements for and description of the
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0004| means to be used to ensure that members of the public will be
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0005| involved in the design and implementation of the plan and a
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0006| description of a method to ensure ongoing public involvement.
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0007| Section 6. [NEW MATERIAL] CREATION OF LEGISLATIVE
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0008| OVERSIGHT COMMITTEE--AUTHORITY AND DUTIES.--
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0009| A. There is created a joint interim legislative
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0010| committee, which shall be known as the "healthy kids oversight
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0011| committee".
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0012| B. The committee shall be composed of eight
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0013| members. Four members of the house of representatives shall be
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0014| appointed by the speaker of the house of representatives and
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0015| four members of the senate shall be appointed by the
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0016| committees' committee of the senate or, if the senate
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0017| appointments are made in the interim, by the president pro
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0018| tempore of the senate after consultation with and agreement of
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0019| a majority of the members of the committees' committee. Members
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0020| shall be appointed so that there is a member from each of the
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0021| major political parties from each house. No member who has a
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0022| financial interest in an insurance company or health care
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0023| provider shall be appointed to the committee.
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0024| C. The healthy kids oversight committee shall
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0025| oversee the development and operations of healthy kids created
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0001| pursuant to the Child Health Act. It shall fulfill any
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0002| responsibilities delegated to it pursuant to that act.
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0003| D. The committee shall report annually its findings
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0004| and recommendations regarding healthy kids to each regular
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0005| session of the legislature and shall include in that report any
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0006| recommendations for changes in the laws pertaining to the
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0007| program.
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0008| Section 7. [NEW MATERIAL] CREATION OF HEALTHY KIDS FUND.-
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0009| -
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0010| The "healthy kids fund" is created in the state treasury.
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0011| Revenue consisting of all amounts shall be deposited in the fund.
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0012| Interest earned by investment of the fund shall be deposited in
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0013| the fund. Balances of the fund shall not revert to the general
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0014| fund at the close of any fiscal year. Expenditures from the fund
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0015| shall be made pursuant to warrants drawn by the department of
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0016| finance and administration upon vouchers submitted by the
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0017| secretary of human services for the purpose of providing state
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0018| funds needed to match federal funds for payment of the costs of
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0019| healthy kids operated by the human services department pursuant
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0020| to the Child Health Act.
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0021| Section 8. Section 27-2-1 NMSA 1978 (being Laws 1973,
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0022| Chapter 376, Section 1) is amended to read:
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0023| "27-2-1. SHORT TITLE.--Sections [1 through 20 of this act
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and Sections 13-1-9, 13-1-10, 13-1-12, 13-1-13, 13-1-17,
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13-1-18, 13-1-18.1, 13-1-19, 13-1-20, 13-1-20.1, 13-1-21,
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13-1-22, 13-1-27, 13-1-27.2, 13-1-27.3, 13-1-27.4, 13-1-28,
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13-1-28.6, 13-1-29, 13-1-30, 13-1-34, 13-1-35, 13-1-37, 13-1-39,
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13-1-40, 13-1-41 and 13-1-42 NMSA 1953] 27-2-1 through 27-2-36
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0004| NMSA 1978 may be cited as the "Public Assistance Act"."
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0005| Section 9. Section 27-2-12 NMSA 1978 (being Laws 1973,
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0006| Chapter 376, Section 16, as amended) is amended to read:
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0007| "27-2-12. MEDICAL ASSISTANCE [PROGRAMS] PROGRAM--
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0008| MEDICAID.--Consistent with the federal act and subject to the
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0009| appropriation and availability of federal and state funds, the
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0010| medical assistance division of the human services department may
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0011| by [regulation] rule provide medical assistance [including
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the services of licensed doctors of oriental medicine and
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licensed chiropractors, to persons eligible for public assistance
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programs under the federal act] pursuant to a state plan
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0015| approved by the federal health and human services department in
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0016| accordance with Title 19 of the federal act. This medical
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0017| assistance program shall be known as "medicaid"."
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0018| Section 10. Section 27-2-12.2 NMSA 1978 (being Laws 1987,
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0019| Chapter 16, Section 1, as amended) is amended to read:
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0020| "27-2-12.2. [MEDICAL ASSISTANCE PROGRAM] MEDICAID--
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0021| ELIGIBILITY OF MARRIED INDIVIDUALS.--For the purpose of
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0022| determining [medical assistance] medicaid eligibility for
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0023| the institutional care program [eligibility under the Public
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Assistance Act], the community spouse resource allowance for a
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0025| community spouse as defined and authorized by the federal
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0001| Medicare Catastrophic Coverage Act of 1988 shall be a minimum of
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0002| thirty thousand dollars ($30,000)."
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0003| Section 11. Section 27-2-12.3 NMSA 1978 (being Laws 1987,
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0004| Chapter 269, Section 1, as amended) is amended to read:
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0005| "27-2-12.3. MEDICAID REIMBURSEMENT--EQUAL PAY FOR EQUAL
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0006| PHYSICIANS', DENTISTS', OPTOMETRISTS', PODIATRISTS' AND
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0007| PSYCHOLOGISTS' SERVICES.--The [human services] department shall
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0008| establish a rate for the reimbursement of physicians, dentists,
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0009| optometrists, podiatrists and psychologists for services rendered
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0010| to medicaid patients that provides equal reimbursement for the
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0011| same or similar services rendered without respect to the date on
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0012| which such physician, dentist, optometrist, podiatrist or
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0013| psychologist entered into practice in New Mexico; the date on
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0014| which the physician, dentist, optometrist, podiatrist or
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0015| psychologist entered into an agreement or contract to provide
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0016| such services; or the location in which such services are to be
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0017| provided in the state; provided, however, that the requirements
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0018| of this section shall not apply when the [human services]
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0019| department contracts with entities pursuant to Section 27-2-12.6
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0020| NMSA 1978 to negotiate a rate for the reimbursement for services
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0021| rendered to medicaid patients in the medicaid managed care
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0022| system."
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0023| Section 12. Section 27-2-12.4 NMSA 1978 (being Laws 1987,
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0024| Chapter 214, Section 1) is amended to read:
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0025| "27-2-12.4. LONG-TERM CARE FACILITIES--NONCOMPLIANCE WITH
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0001| STANDARDS AND CONDITIONS--SANCTIONS.--
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0002| A. In addition to any other actions required or
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0003| permitted by federal law or regulation, the [human services]
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0004| department shall impose a hold on [state] medicaid payments to
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0005| a long-term care facility thirty days after the department of
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0006| health [and environment department] notifies the [human
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services] department in writing pursuant to an on-site visit
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0008| that the long-term care facility is not in substantial compliance
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0009| with the standards or conditions of participation promulgated by
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0010| the federal department of health and human services pursuant to
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0011| which the facility is a party to a medicaid provider agreement,
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0012| unless the substantial noncompliance has been corrected within
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0013| that thirty-day period or the facility's medicaid provider
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0014| agreement is terminated or not renewed based in whole or in part
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0015| on the noncompliance. The written notice shall cite the specific
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0016| deficiencies that constitute noncompliance.
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0017| B. The [human services] department shall remove the
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0018| payment hold imposed under Subsection A of this section when the
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0019| department of health [and environment department], pursuant
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0020| to an on-site visit, certifies in writing to the [human
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services] department that the long-term care facility is in
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0022| substantial compliance with the standards or conditions of
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0023| participation pursuant to which the facility is a party to a
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0024| medicaid provider agreement.
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0025| C. The [human services] department shall not
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0001| reimburse any long-term care facility during the payment hold
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0002| period imposed pursuant to Subsection A of this section for any
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0003| medicaid [recipient-patients] patients who are new admissions
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0004| and who are admitted on or after the day the hold is imposed and
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0005| prior to the day the hold is removed.
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0006| D. If a long-term care facility is certified in
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0007| writing to be in noncompliance pursuant to Subsection A of this
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0008| section for the second time in any twelve-month period, the
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0009| [human services] department shall cancel or refuse to execute
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0010| the long-term care facility's medicaid provider agreement for a
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0011| two-month period, unless it can be demonstrated that harm to the
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0012| patients would result from this action or that good cause exists
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0013| to allow the facility to continue to participate in [the]
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0014| medicaid [program]. The provisions of this subsection are
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0015| subject to appeal procedures set forth in federal regulations for
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0016| nonrenewal or termination of a medicaid provider agreement.
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0017| E. A long-term care facility shall not charge
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0018| medicaid [recipient-patients] beneficiaries, their families
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0019| or their responsible parties to recoup [any] payments not
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0020| received because of a hold on medicaid payments imposed pursuant
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0021| to this section.
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0022| F. This section [shall not be construed to] does
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0023| not affect any other provisions for medicaid provider agreement
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0024| termination, nonrenewal, due process and appeal pursuant to
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0025| federal law or regulation.
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0001| G. As used in this section:
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0002| (1) "day" means a twenty-four hour period
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0003| beginning at midnight and ending one second before midnight;
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0004| (2) "long-term care facility" means any
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0005| intermediate care facility or skilled nursing facility [which]
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0006| that is licensed by the department of health [and
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environment department] and [which] is medicaid certified;
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0008| (3) "new admissions" means medicaid
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0009| [recipients] patients who have never been in the long-term
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0010| care facility or, if previously admitted, had been discharged or
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0011| had voluntarily left the facility, but the term does not include:
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0012| (a) individuals who were in the long-term
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0013| care facility before the effective date of the hold on medicaid
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0014| payments and became eligible for medicaid after that date; and
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0015| (b) individuals who, after a temporary
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0016| absence from the facility, are readmitted to beds reserved for
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0017| them in accordance with federal regulations; and
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0018| (4) "substantial compliance" means the condition
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0019| of having no cited deficiencies or having only those cited
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0020| deficiencies [which] that:
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0021| (a) are not inconsistent with any federal
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0022| statutory requirement;
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0023| (b) do not interfere with adequate patient
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0024| care;
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0025| (c) do not represent a hazard to the
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0001| patients' health or safety;
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0002| (d) are capable of correction within a
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0003| reasonable period of time; and
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0004| (e) are [ones which] deficiencies the
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0005| long-term care facility is making reasonable plans to correct."
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0006| Section 13. Section 27-2-12.5 NMSA 1978 (being Laws 1989,
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0007| Chapter 83, Section 1, as amended) is amended to read:
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0008| "27-2-12.5. MEDICAID-CERTIFIED NURSING FACILITIES--
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0009| RETROACTIVE ELIGIBILITY--REFUNDS--PENALTY.--
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0010| A. Medicaid payment for a medicaid-eligible patient
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0011| shall be accepted by a medicaid-certified nursing facility from
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0012| the first month of medicaid eligibility, regardless of whether
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0013| the eligibility is retroactive. The nursing facility shall
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0014| refund to the patient or responsible party all out-of-pocket
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0015| money except for required medical-care credits paid to the
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0016| nursing facility for that patient's care on and after the date of
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0017| medicaid eligibility for services covered by the medicaid
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0018| program. Within thirty days after notification by the [human
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services] department of the patient's medicaid eligibility, the
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0020| nursing facility shall make any necessary refund to the patient
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0021| or responsible party required under this section.
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0022| B. In any [cause of action] lawsuit brought
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0023| against a nursing facility because of its failure to make a
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0024| refund to the patient or responsible party as required under
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0025| Subsection A of this section, the patient or responsible party
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0001| may be awarded damages equal to triple the amount of the money
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0002| not refunded or three hundred dollars ($300), whichever is
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0003| greater, [and] reasonable [attorneys'] attorney fees and
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0004| [court] costs."
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0005| Section 14. Section 27-2-12.6 NMSA 1978 (being Laws 1994,
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0006| Chapter 62, Section 22) is amended to read:
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0007| "27-2-12.6. MEDICAID PAYMENTS--MANAGED CARE.--
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0008| A. The department shall provide for a statewide
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0009| managed care system to provide cost-efficient, preventive,
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0010| primary and acute health care for medicaid [recipients by July
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1, 1995] beneficiaries.
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0012| B. The managed care system shall ensure:
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0013| (1) access to medically necessary services,
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0014| particularly for medicaid [recipients] beneficiaries with
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0015| chronic health problems;
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0016| (2) to the extent practicable, maintenance of
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0017| the rural primary care delivery infrastructure;
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0018| (3) that the department's approach is consistent
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0019| with national and state health care reform principles; and
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0020| (4) to the maximum extent possible, that
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0021| [medicaid-eligible individuals] beneficiaries are not
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0022| identified as such except as necessary for billing purposes.
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0023| C. The department may exclude nursing homes,
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0024| intermediate care facilities for the mentally retarded, medicaid
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0025| in-home and community-based waiver services and residential and
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0001| community-based mental health services for children with serious
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0002| emotional disorders from the provisions of this section."
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0003| Section 15. Section 27-2-12.7 NMSA 1978 (being Laws 1980,
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0004| Chapter 86, Section 1) is amended to read:
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0005| "27-2-12.7. MEDICAID--HUMAN SERVICES DEPARTMENT EMPLOYEES--
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0006| STANDARDS OF CONDUCT--ENFORCEMENT.--
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0007| A. As used in this section:
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0008| (1) "business" means a corporation, partnership,
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0009| sole proprietorship, firm, organization or individual carrying on
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0010| a business;
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0011| [(2) "department" means the human services
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department;
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(3)] (2) "employee" means [any] a person
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0014| who has been appointed to or hired for [any] a department
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0015| office connected with the administration of medicaid funds and
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0016| who receives compensation in the form of salary;
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0017| [(4)] (3) "employee with responsibility"
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0018| means an employee who is directly involved in or has a
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0019| significant part in the medicaid decision-making, regulatory,
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0020| procurement or contracting process; and
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0021| [(5)] (4) "financial interest" means an
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0022| interest held by an individual, his spouse or minor child
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0023| [which] that is:
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0024| (a) an ownership interest in business; or
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0025| (b) [any] an employment or prospective
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0001| employment for which negotiations have already begun.
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0002| B. No employee with responsibility shall, for twenty-
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0003| four months following the date on which he ceases to be an
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0004| employee, act as agent or attorney for [any other] another
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0005| person or business in connection with a judicial or
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0006| administrative proceeding, application, ruling, contract, claim
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0007| or other matter relating to the medicaid program with respect to
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0008| which the employee made an investigation, rendered [any] a
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0009| ruling or was otherwise substantially and directly involved
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0010| during the last year he was an employee and [which] that was
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0011| actually pending under his responsibility within that period.
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0012| C. No [department] secretary of human services,
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0013| income support division director or medical assistance bureau
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0014| chief or their deputies shall, for twelve months following the
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0015| date on which he ceases to be an employee, participate [in any
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manner] with respect to a judicial or administrative proceeding,
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0017| application, ruling, contract, claim or other matter relating to
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0018| the medicaid program and pending before the department.
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0019| D. No employee with responsibility shall participate
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0020| [in any manner] with respect to a judicial or administrative
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0021| proceeding, application, ruling, contract, claim or other matter
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0022| relating to the medicaid program and involving his spouse, minor
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0023| child or [any] a business in which he has a financial
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0024| interest unless prior to [such] the participation:
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0025| (1) full disclosure of his relationship or
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0001| financial interest is made in writing to the secretary of [the
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department] human services; and
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0003| (2) a written determination is made by the
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0004| secretary of human services that the disclosed relationship or
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0005| financial interest is too remote or inconsequential to affect the
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0006| integrity of the services of the employee.
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0007| E. Violation of any of the provisions of this section
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0008| by an employee is grounds for dismissal, demotion or suspension.
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0009| A former employee who violates [any of the provisions] a
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0010| provision of this section [shall be] is subject to
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0011| assessment by the department of a civil money penalty of two
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0012| hundred fifty dollars ($250) for each violation. The department
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0013| shall promulgate [regulations] rules to provide for an
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0014| administrative appeal of any assessment imposed."
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0015| Section 16. Section 27-2-12.8 (being Laws 1997, Chapter
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0016| 264, Section 1) is amended to read:
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0017| "27-2-12.8 MAMMOGRAMS FOR MEDICAID [RECIPIENTS]
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0018| BENEFICIARIES.--In providing coverage for mammograms under the
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0019| medicaid program, the department shall ensure that:
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0020| A. patients will not be routinely solicited for
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0021| mammograms and that mammograms will only be performed based on
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0022| nationally recognized standards; and
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0023| B. any fee for service payment that [shall be] is
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0024| made on behalf of [the] medicaid [program] for a mammogram of
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0025| a medicaid [recipient] beneficiary shall be consistent with
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0001| and not exceed the usual and customary charge that reflects the
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0002| reasonable fair market value of the cost of a mammogram."
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0003| Section 17. Section 27-2-13 NMSA 1978 (being Laws 1973,
|
0004| Chapter 376, Section 17) is amended to read:
|
0005| "27-2-13. CONFLICT IN FEDERAL AND STATE LAWS.--Any section
|
0006| of the NMSA [1953] 1978 [relating to] authorizing public
|
0007| assistance [which] that is in conflict with the provisions of
|
0008| the federal act, [or] the federal Food Stamp Act, [as may be
|
amended from time to time, and] or federal regulations issued
|
0010| pursuant [thereto] to those acts shall be suspended in its
|
0011| operation if the attorney general certifies that [such] the
|
0012| conflict exists."
|
0013| Section 18. Section 27-2-15 NMSA 1978 (being Laws 1937,
|
0014| Chapter 18, Section 9) is amended to read:
|
0015| "27-2-15. COOPERATION WITH THE UNITED STATES.--
|
0016| A. The [State] department is [hereby]
|
0017| designated as the state agency to cooperate with the federal
|
0018| government in the administration of the provisions of [Title 1,
|
Title 4, part 2 and 3 of Title 5 and Title 10] Titles 4 and 19
|
0020| of the federal [Social Security Act. The State Board is hereby
|
authorized and directed to cooperate with the proper departments
|
of the federal government and with all other departments of the
|
state and local governments in the enforcement and administration
|
of such provisions of the federal Social Security Act, and any
|
amendments thereto and the rules and regulations issued
|
- 19 -
thereunder, and in compliance therewith in the manner prescribed
|
in this act or as otherwise provided by law] act.
|
0003| B. The department shall [also] make reports in
|
0004| [such] the form and containing [such] the information
|
0005| [as any] required by an agency or instrumentality of the
|
0006| United States with which it is cooperating [may from time to
|
time require], and shall comply with [such] those provisions
|
0008| [as any such] a federal agency or instrumentality may [from
|
time to time] find necessary to assure the correctness and
|
0010| verification of [such] the reports."
|
0011| Section 19. Section 27-2-17 NMSA 1978 (being Laws 1937,
|
0012| Chapter 18, Section 10) is amended to read:
|
0013| "27-2-17. CUSTODIAN OF FUNDS.--The [State] department is
|
0014| [hereby] designated as the custodian, subject to the provisions
|
0015| of Section [21 of this Act] 27-2-33 NMSA 1978, of [any and]
|
0016| all [monies which may be] money received by the state [of
|
New Mexico which] that the [State Board of Public Welfare]
|
0018| department is authorized to administer pursuant to the Public
|
0019| Assistance Act, from any appropriations made by the congress of
|
0020| the United States for the purpose of cooperating with the several
|
0021| states in the enforcement and administration of the provisions of
|
0022| the federal [Social Security] act referred to in Section [9]
|
0023| 27-2-15 NMSA 1978 and all [monies] money received from any
|
0024| other source for [the] purposes [set forth in this Act]
|
0025| authorized by the Public Assistance Act. The [State]
|
- 20 -
0001| department is [hereby] authorized to receive such [monies]
|
0002| money, provide for [the] its proper custody [thereof] and
|
0003| [to] make disbursements [therefrom] of it under such rules
|
0004| [and regulations] as the [State Board] department may
|
0005| prescribe."
|
0006| Section 20. Section 27-2-23 NMSA 1978 (being Laws 1969,
|
0007| Chapter 232, Section 1) is amended to read:
|
0008| "27-2-23. THIRD PARTY LIABILITY FOR MEDICAID
|
0009| EXPENDITURES.--
|
0010| A. The [health and social services] department
|
0011| shall make reasonable efforts to ascertain [any] legal
|
0012| liability of third parties who are or may be liable to pay all or
|
0013| part of the medical cost of injury, disease or disability of an
|
0014| applicant for or recipient of [medical assistance]
|
0015| medicaid.
|
0016| B. When the department makes [medical assistance]
|
0017| medicaid payments [in behalf of a recipient] for a medicaid
|
0018| beneficiary, the department is subrogated to any right of the
|
0019| [recipient] beneficiary against a third party for recovery of
|
0020| medical expenses to the extent that the department has made
|
0021| payment."
|
0022| Section 21. Section 27-2-23.1 NMSA 1978 (being Laws 1989,
|
0023| Chapter 184, Section 1) is amended to read:
|
0024| "27-2-23.1. EMPLOYEE RETIREMENT INCOME SECURITY ACT OF
|
0025| 1974--EMPLOYEE HEALTH BENEFIT PLANS--CLAUSES TO EXCLUDE MEDICAID
|
- 21 -
0001| COVERAGE PROHIBITED.--No employee health benefit plan established
|
0002| under the Employee Retirement Income Security Act of 1974, 29
|
0003| U.S.C. 1144 that provides payments for health care on behalf of
|
0004| individuals residing in the state shall contain any provisions
|
0005| excluding or limiting coverage or payment for any health care for
|
0006| an individual who would otherwise be covered or entitled to
|
0007| benefits or services under the terms of the employee health
|
0008| benefit plan because that individual is provided or is eligible
|
0009| for benefits [under the] pursuant to medicaid [program of
|
this state pursuant to Title XIX of the federal Social Security
|
Act, 42 U.S.C. 1396, et seq.]."
|
0012| Section 22. Section 27-2-33 NMSA 1978 (being Laws 1937,
|
0013| Chapter 18, Section 21) is amended to read:
|
0014| "27-2-33. METHOD OF HANDLING FUNDS.--
|
0015| A. All [monies] money received from the federal
|
0016| government for carrying out [of] any of the purposes of [this
|
Act] Chapter 27 NMSA 1978 and all other funds received by the
|
0018| [State] department under the provisions of [this Act] that
|
0019| chapter shall be [by it] paid [over] to the state treasurer
|
0020| and [shall be by him] kept in a separate fund known as the
|
0021| "social security fund" [and]. All [monies] money in
|
0022| [such] the fund [are hereby] is appropriated to the
|
0023| [State Board] department for [the] carrying out [of] the
|
0024| purposes of [this Act] Chapter 27 NMSA 1978, provided that
|
0025| all [monies] money received from the federal government shall
|
- 22 -
0001| be spent solely for the purposes for which [said] the funds
|
0002| were granted.
|
0003| B. [By resolution of the State Board requisitions
|
shall be made from time to time] The department shall request
|
0005| from the state treasurer [for] the funds needed [for the
|
carrying] to carry out [of any of] the purposes of [this
|
Act, and] Chapter 27 NMSA 1978. The funds [so
|
requisitioned] shall be disbursed under rules [and
|
regulations] of the [State Board provided, however, that the
|
State Board] department, but it shall not [requisition]
|
0011| request at any one time [and] or have on hand more than
|
0012| sufficient [monies] money to meet its estimated needs for a
|
0013| period of sixty days.
|
0014| C. The [State Board] department shall be
|
0015| subject at all times to audit by the state [Comptroller or any
|
other] auditor, an agency provided by law [provided that an
|
audit by any] or a private auditor approved by the state
|
0018| [Comptroller may be accepted by him] auditor. The [State
|
Board] department may, with the approval of the state
|
0020| [Comptroller] auditor, provide for a continuous audit of its
|
0021| transactions."
|
0022| Section 23. APPROPRIATION.--Two million nine hundred
|
0023| thousand dollars ($2,900,000) is appropriated from the general
|
0024| fund to the healthy kids fund for expenditure by the human
|
0025| services department in fiscal years 1998 and 1999 to implement
|
- 23 -
0001| the healthy kids program as authorized by the Child Health Act.
|
0002| Any unexpended or unencumbered balance remaining in the fund at
|
0003| the end of fiscal year 1999 shall revert to the general fund.
|
0004| Section 24. REPEAL.--Sections 27-2-16 and 27-2-36 NMSA 1978
|
0005| (being Laws 1974, Chapter 31, Section 1 and Laws 1921, Chapter
|
0006| 117, Section 9, as amended) are repealed.
|
0007| Section 25. EMERGENCY.--It is necessary for the public
|
0008| peace, health and safety that this act take effect immediately.
|
0009|
|