New Mexico Family Infant Toddler Program Private Health

New Mexico Family Infant Toddler Program Private Health Insurance Legislation New Mexico - Private Insuranace Legislation

Background l NM Primary funding sources l l l 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 2

Funding challenge l l l 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 3

Initial steps l l 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 4

Joint Memorial results l l l 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 5

NM’s Insurance Statute l l l 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 6

Features of legislation l l l 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 7

Implementation l l l 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 8

Decisions / agreements l l l 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 01 st New Mexico - Private Insuranace Legislation 9

Work ahead l l 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 $$$!!! New Mexico - Private Insuranace Legislation 10