SENATE BILL 271

48th legislature - STATE OF NEW MEXICO - first session, 2007

INTRODUCED BY

Bernadette M. Sanchez

AN ACT

RELATING TO HEALTH; REQUIRING FUNDING FOR SUBSTANCE ABUSE TREATMENT FOR CERTAIN MEDICAID-ELIGIBLE CLIENTS.

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

     Section 1. SHORT TITLE.--This act may be cited as the "Addiction Recovery Act".

     Section 2. DEFINITIONS.--As used in the Addiction Recovery Act:

          A. "department" means the department of health insofar as it licenses facilities and the human services department insofar as it administers or contracts for behavioral health services; 

          B. "detoxification" means the process whereby a substance-intoxicated or -dependent person is assisted to eliminate the substance as determined by a licensed physician while keeping the physiological risk to the patient at a minimum;

          C. "facility" means a hospital licensed by the department or a nonhospital residential care environment licensed by the department to conduct a substance abuse treatment program;

          D. "inpatient care" means medical, nursing, counseling or therapeutic care twenty-four hours a day in a facility, according to an individualized treatment plan; 

          E. "medical assistance recipient" means a person who is eligible for medicaid and who suffers from substance abuse; 

          F. "nonhospital residential care" means medical, nursing, counseling or therapeutic services provided in a residential setting according to an individualized treatment plan;

          G. "outpatient care" means medical, nursing, counseling or therapeutic services on a regular and predetermined schedule, according to an individualized treatment plan;

          H. "partial hospitalization or intensive outpatient care" means a substance abuse treatment program of medical, nursing, counseling or therapeutic service on a fixed schedule in a facility or nonhospital residential care environment on a more intensive basis than that available in an outpatient care setting;

          I. "substance abuse" means the use of alcohol or another drug causing impairment in social or occupational functioning or producing physiological dependency evidenced by physical tolerance or withdrawal; and

          J. "treatment plan" means a periodically updated written guide to treatment, based on assessments, that includes the medical assistance recipient's goals, activities designed to help the recipient meet those goals, evaluation criteria and a timeline.

     Section 3. SUBSTANCE ABUSE TREATMENT THERAPIES INCLUDED IN COVERAGE.--

          A. A medical assistance recipient shall receive the following services as a minimum covered benefit under the Addiction Recovery Act: 

                (1) assessment, screening and treatment plan development and review;

                (2) physician, psychologist, nurse and licensed counselor services;

                (3) psychiatric, psychological and medical laboratory tests; and

                (4) prescription drugs, medicines, equipment use and supplies.

          B. In addition to the covered benefit required under Subsection A of this section, a medical assistance recipient shall be eligible to receive as a covered benefit according to the medical assistance recipient's treatment plan:

                (1) inpatient care for detoxification;

                (2) long-term or short-term nonhospital residential care, partial hospitalization or intensive outpatient care;

                (3) outpatient substance abuse treatment, case management and crisis intervention; and 

                (4) individual and family counseling and intervention.

     Section 4. TIME LIMITS FOR BENEFITS COVERAGE.--Each covered benefit shall be offered for the minimum amount of time established by current evidence-based practices and research.

     Section 5. PARITY REQUIRED.--Notwithstanding any other provision in the Addiction Recovery Act, drug treatment coverage under state medical assistance shall not be less, in any respect, than coverage required by the state in the policies of health insurance companies or health maintenance organizations.

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