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(Parenthesis ( ) Indicate Expenditure Decreases)

Duplicates/Conflicts with/Companion to/Relates to

SUMMARY

Synopsis of Bill

Senate Bill 725 adds a new section to the Medicaid Provider Act and declares that medical doctors and other health care professionals employed by or under contract to the Indian Health Service, Tribally operated health facilities and urban Indian health clinics to be primary care physicians for all health care organizations or managed care organizations contracting with the state to provide medicaid services in New Mexico. The bill contains an emergency clause.

Significant Issues

Native Americans are utilizing Indian Health Services facilities, Tribal facilities and urban Indian clinics and health care providers and at the same time are enrolled in managed care portion of medicaid. The managed care organization is receiving capitation fees and, in some cases, the federally funded or tribal funded provider is providing the service and receiving no compensation from medicaid. In addition, some Native Americans have not been able to utilize the managed care services because of the confusion and misunderstanding of the complex and confusing managed care requirements. The result is a lack of necessary care and the payment of fees that are not warranted. Allowing the above mentioned providers to act as the primary care provider under medicaid will insure that Native Americans will have the proper services and that they will be followed to insure the treatment of their illness is accomplished in the most efficient and medically correct manner.

FISCAL IMPLICATIONS

Payment of capitation fees to the managed care organization without the provision of needed services is costing the Medicaid program significant amounts of money. Native Americans who need medical services are not always receiving the services they are entitled to.

ADMINISTRATIVE IMPLICATIONS

Administration of the additions of the new primary care providers that are contemplated under this act will not cause significant increases in administrative costs.

MB/njw