new mexico family infant toddler program private health insurance legislation
TRANSCRIPT
New MexicoFamily Infant Toddler
Program
Private Health Insurance
Legislation
New Mexico - Private Insuranace Legislation 2
Background
NM Primary funding sources State General Funds Medicaid IDEA Part C grant
Sporadic use of family fees Historic billing of Health Plans – but most
providers had given up
New Mexico - Private Insuranace Legislation 3
Funding challenge
Over ~100% growth in children / families served in 5 years (2000 – 2005)
Average annual growth of ~16% Flat Federal Part C funding Rate study in 2003 recommended increase to
rates to meet costs Challenge to access State General Funds to
match growth
New Mexico - Private Insuranace Legislation 4
Initial steps
Decision by ICC to look for other sources of funding
2004 Legislature passed a Joint Memorial to study the feasibility of billing private health insurance
HJM 38 Committee included parents, providers, 3 major health plans, Insurance Division; Dept of Health and Medicaid
Input from two other States – Massachusetts and Connecticut
New Mexico - Private Insuranace Legislation 5
Joint Memorial results Brought health plans to the table Various options considered Report presented to Health & Human
Services Committee Report identified potential for ~$3 million
revenue Health plans recognized the minimal impact
to premiums Health plans saw “writing on the wall” for
legislation and got behind the idea of an annual cap
New Mexico - Private Insuranace Legislation 6
NM’s Insurance Statute
Introduced by Legislator (who’s on the ICC) Language for bill submitted by ICC members Testimony provided by families & providers Recommendations of the HJM utilized in
testimony Passed the first session it was introduced!
New Mexico - Private Insuranace Legislation 7
Features of legislation
Early Intervention must be provided by provider agencies certified by the Dept. of Health
IFSP is considered plan of care Can not effect the families lifetime benefit cap $3,500 annual cap (after which the
Department of Health picks up all costs) Applied to several types of health plan
New Mexico - Private Insuranace Legislation 8
Implementation
Consultation from Massachusetts Initial meeting with health plans, Insurance
Division, EI provider agencies, families Monthly meetings with 3 major health Plans Collecting health insurance information from
families Contract with billing agent to process third
party claims
New Mexico - Private Insuranace Legislation 9
Decisions / agreements Department of Health will submit claims
(rather than 33 providers) Contracted agency will submit claims Health
plans will not charge co-pays or deductibles Health plans will not have certify FIT Provider
agencies Health plans will not conduct prior auth. Health plans will allow back billing to July 01st
New Mexico - Private Insuranace Legislation 10
Work ahead
Decide whether to require families to allow access to the insurance plan and if they choose not to whether to levy a fee
Develop MOUs with health plans that would cover issues like no co-pays or deductibles
Clean-up legislation that clarifies that this benefit does not apply to specific plans (dental, vision, long term care ins. etc.)
Collect the $$$!!!