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November
21, 2007
TO: New Mexico Chiropractors
FROM: Linda Siegle, Lobbyist
RE: Latest Governor’s Health Insurance Reform Plan (released 11/19/07)
Highlights:Insurance
Reform:
Require 85% of premiums to be sent on direct services.
Guarantee issue of coverage without exclusion effective 1/1/09.
Require all practitioners
to accept Medicaid and other
public sources of payment.
Allow HIS and tribal 638 providers be part of a carrier’s provider
network.
Allow partners of retirees to be covered in the state retiree system.
Require unduplicated, common data reporting from all insurance companies
and practitioners.
Impose a moratorium on any
insurance benefit mandates until after 12/31/10.
Coverage Mechanisms:
Require individuals to show proof of insurance coverage beginning 1/1/10.
Require employers to contribute to a Health NM Workforce Fund by January
2009.
Require employers to offer a pre-tax health coverage option to employees
whether the employer contributes to that option or not.
Require employers to collect information about coverage from employee.
Expand buy-in to existing public pools like Medicaid or state employee
pool.
Health Coverage Authority:
Set standards for benefits
(including preventive services) and plan choices that will count as coverage.
Control costs by:
1. addressing cost drivers;
2. paying for performance programs and quality standards;
3. developing prevention programs, disease management and wellness programs;
4. mandating cost effective pharmaceuticals;
5. practitioner recruitment
and retention activities and incentives;
6. quality data posted on a public website;
7. reasonable and appropriate ranges for
provider rates; and
8. opportunities for collaborative purchasing of health care delivery
supplies, pharmaceuticals and administrative services.
Manage and consolidate all public sector pools and programs like Retiree
Health Care, state employees, APS and public school systems, Health Policy
Commission and Medicaid.
Conduct studies and analyses of health care.
Make recommendations to Governor, Legislature, etc.
Educate the public.
Create five standing policy advisory councils:
1. Native American Health Care; 2. Delivery
System (probably practitioners); 3. Cost Containment and
Finance; 4. Benefits and Services; and 5. Federal Issues.
Electronic Health
Transaction
Require electronic claims submission and
remittance.
Require use and exchange of electronic medical
records.
Protect patients’ privacy.
BUDGET So FAR:
|
Provider retention and recruitment |
$1.8
million |
| Expansion
of PTSD for Veterans |
$1.5
million |
| Information
Technology |
$800,000 |
| Start
Up Costs for Authority |
$1.3
million |
|
Medicaid ? but request has been |
$147
million |
|
