SB 453 — PUBLICLY FUNDED HEALTH AGENCY PURCHASING

SENATE HEALTH AND PUBLIC AFFAIRS COMMITTEE SUBSTITUTE FOR SENATE BILL 453 56TH LEGISLATURE -STATEOFNEWMEXICO-- STATEOFNEWMEXICO- FIRST SESSION, 2023 4This 6document 8may 10incorporate ANamendments ACTproposed RELATINGby TOa PUBLICLYcommittee, FUNDEDbut HEALTHnot CAREyet PROGRAMS;adopted, as well as amendments that have been adopted during the current legislative session.

AMENDINGThe THEdocument HEALTHis CAREa PURCHASINGtool ACTto TOshow UPDATEamendments PUBLICLYin FUNDEDcontext HEALTHand CAREcannot AGENCYbe OBLIGATIONS.used for the purpose of adding amendments to legislation.

15h BEAN ITACT ENACTEDg BYo THERELATING LEGISLATURETO OFPUBLICLY THEFUNDED STATEHEALTH OFCARE NEWPROGRAMS; MEXICO:

SECTIONAMENDING 1.THE t hr g e i k HEALTH CARE PURCHASING ACT TO UPDATE PUBLICLY FUNDED HEALTH h r i s CARE AGENCY OBLIGATIONS.

Sectionh 13-7-4, NMSAt, 1978e (beingu Lawsg 1997,e b l e te 17h ChapterBE 74,IT SectionENACTED 4)BY isTHE amendedLEGISLATURE toOF read:THE STATE OF NEW MEXICO:

w l n d 18d "13-7-4.i = = o h SECTION 1.

MANDATORYSection CONSOLIDATED13-7-4 PURCHASING.--NMSA =1978 =(being 19Laws a1997, l A.] b ,d i a º e Chapter 74, Section 4) is amended to read:

Ther publicly funded health care agencies shall i a= e r 20 enter into a cooperative consolidated purchasing effort to a t me mw 21 provide plans of health care benefits for the benefit of d rm ea 22n eligibleo participants"13-7-4. of the respective agencies.

TheMANDATORY requestCONSOLIDATED cPURCHASING.-- ed sm k: 23 for [proposal] proposals shall set forth one or more plans of e a n b 24 health care benefits and shall include accommodation of fully u [ funded arrangements as well as varying degrees of self-funded .225684.2 SHPAC/SB 453 pool options.

b e d s º o t n = .225684.2AIC March 9, 2023 (4:50pm) s k m e e a n e d r e l u [ A d SHPAC/SB 453 A.

The publicly funded health care agencies shall enter into a cooperative consolidated purchasing effort to provide plans of health care benefits for the benefit of eligible participants of the respective agencies.

The request for [proposal ] proposals shall set forth one or more plans of health care benefits and shall include accommodation of fully funded arrangements as well as varying degrees of self-funded pool options.

All requests for proposals issued as part of the consolidated purchasing shall include at least one distinct h service area consisting of the Albuquerque metropolitan area.

g o Proposals on a distinct service area shall be evaluated t hr g e i k separately.

h r i s D.

All requests for proposals issued as part of the h , t, consolidated purchasing for commercial plans shall include e u g e b l e e h requests for self-insured and fully insured proposals for n d d i = = o h health care benefits.

SFCºThe requirements of this subsection l ] b ,d i a º e do not apply to the retiree health care authority.»SFC r i = r t 17e w d m a n o E.

Any contract for the consolidated purchasing of w l n d 18m health: care benefits entered into on or after July 1, 2023, but = = 19 before January 1, 2024, shall be for a duration of no longer a l i a e r 20 than one calendar year.

ab e d s º o t mn = .225684.2AIC March 9, 2023 (4:50pm) s k m 21e F.- 2 - e a n e d r e l u [ A d SHPAC/SB 453 health care benefits entered into on or after July 1, 2023, but before January 1, 2024, shall be for a duration of no longer than one calendar year.

AnySFCºThe contractrequirements forof thethis consolidatedsubsection purchasingdo ofnot dapply rto ethe 22retiree health care benefitsauthority.»SFC enteredF. into on or after July 1, 2024 c e s k 23 shall include requirements that providers be reimbursed through e a n b 24 medicare reference-based pricing.

uAny [contract G.for the consolidated purchasing of health care benefits entered into on or after July 1, 2024 shall include requirements that providers be reimbursed through medicare reference-based pricing.

ForSFCºThe therequirements purposes of this section,subsection "medicaredo .225684.2not -apply 2to -the SHPAC/SBretiree 453 reference-based pricing" means a reimbursement rate for health care servicesauthority.»SFC thatG. is based off of the medicare reimbursement rates established by the centers for medicare and medicaid services." SECTION 2.

For the purposes of this section, "medicare reference-based pricing" means a reimbursement rate for health care services that is based off of the medicare reimbursement rates established by the centers for medicare and medicaid services." SECTION 2.

h u » r "13-7-7.

CONSOLIDATED ADMINISTRATIVE FUNCTIONS-- t h g e BENEFIT.-- l i h r A.

The publicly funded health care agencies i s h , e h [political subdivisions and other persons participating in the t u g e b l consolidated purchasing single process pursuant to the Health e e , gh n d d i Care Purchasing Act may] SFCº, excluding the retiree health = = o h l ] b ,d i a º r care authority,»SFC shall enter into a joint powers agreement e r = t e w d pursuant to the Joint Powers Agreements Act.

[with the publiclym fundeda health care agencies and political subdivisions to determine assessments or provisions of resources to consolidate, standardize and administer the e t 17 consolidated purchasing single process and subsequent w l n o d 18m activities: pursuant to the Health Care Purchasing Act.

Theb =r = 19 publicly funded health care agencies, political subdivisions a l i a e rt 20º ando other persons participating in the consolidated purchasing a t mn m= 21.225684.2AIC singleMarch process9, pursuant2023 to(4:50pm) the Health Care Purchasing Act may d r e 22 enter into contracts with nonpublic persons to provide the c e s k 23m servicee of- determining3 assessments- or provision of resources e a n be 24d forr consolidation,e standardizationl and administrative u [ activities.]A Thed SHPAC/SB 453 publicly funded health care agencies shalland .225684.2political -subdivisions 3to -determine SHPAC/SBassessments 453or agreeprovisions toof andresources submitto aconsolidate, proposedstandardize jointand powersadminister agreement to the departmentconsolidated ofpurchasing financesingle andprocess administration and thesubsequent legislativeactivities financepursuant committeeto forthe approvalHealth noCare laterPurchasing thanAct. July 1, 2023.

PoliticalThe publicly funded health care agencies, political subdivisions and other persons participating in the consolidated purchasing single process pursuant to the Health Care Purchasing Act may enter into thecontracts jointwith powersnonpublic agreementpersons createdto byprovide the service of determining assessments or provision of resources for consolidation, standardization and administrative activities.] The publicly funded health care agencies.agencies SFCº, excluding the retiree health care authority,»SFC shall agree to and submit a proposed joint powers agreement to the department of finance and administration and the legislative finance committee for approval no later than July 1, 2023.

B.SFCºPolitical»SFC h SFCº The retiree health care authority, political»SFC u » r subdivisions and other persons participating in the t h g e l i consolidated purchasing single process may enter into the joint h r i s powers agreement SFCºcreated by the publicly funded health care h , e h agencies»SFC .

Eacht agencyu shallg retaine itsb responsibilityl toe determinee policy, directiongh ofB. the benefit plans, plan development, training and coordination with respect to participants and its benefits staff, as well as to respond to benefits eligibility inquiries and establish and enforce eligibility rules.

Each agency shall retain its responsibility to n d d i = = o h determine policy direction of the benefit plans, plan l ] b ,d i a º r development, training and coordination with respect to e r = t e w d m a n o participants and its benefits staff, as well as to respond to d m :

b r e t º o t n = .225684.2AIC March 9, 2023 (4:50pm) s k m e - 4 - e a n e d r e l u [ A d SHPAC/SB 453 benefits eligibility inquiries and establish and enforce eligibility rules.

Notwithstanding Subsection B of this section, publicly funded health care agencies, political subdivisions and other persons participating in the consolidated purchasing e t 17 single process pursuant to the Health Care Purchasing Act shall w l n d 18 provide coverage for children, from birth through three years = = 19 of age, for or under the family, infant, toddler program a l i a e r 20 administered by the early childhood education and care a t m m 21 department, provided eligibility criteria are met, for a d r e 22 maximum benefit of three thousand five hundred dollars ($3,500) c e s k 23 annually for medically necessary early intervention services e a n b 24 provided as part of an individualized family service plan and u [ delivered by certified and licensed personnel who are working .225684.2 - 4 - SHPAC/SB 453 in early intervention programs approved by the early childhood education and care department.

No payment under this subsection shall be applied against any maximum lifetime or h u » r annual limits specified in the policy, health benefits plan or t h g e contract.

l i h r D.

Each publicly funded health care agency shall i s h , e h provide an annual open and public enrollment period for all t u g e b l plan participants.

SFCºThe requirements of this subsection do e e , gh n d d i not apply to the retiree health care authority.»SFC = = o h l ] b ,d i a º r E.

Each publicly funded health care agency shall conducte claimsr recovery= auditst thate annuallyw auditd medicalconduct and pharmaceutical claims torecovery ensureaudits that claimsannually areaudit paidmedical for properly and accurately." - 5 - 15 e t 17 w l n d 18 = = 19 a l i a e r 20 a t m m 21 d r e 22 c e s k 23 e a n bo 24d um [: .225684.2

b r e t º o t n = .225684.2AIC March 9, 2023 (4:50pm) s k m e - 5 - e a n e d r e l u [ A d SHPAC/SB 453 pharmaceutical claims to ensure that claims are paid for properly and accurately.