New Mexico Statutes
Article 2 - Public Assistance Act
Section 27-2-12.6 - Medicaid payments; managed care.

A. The department shall provide for a statewide, managed care system to provide cost-efficient, preventive, primary and acute care for medicaid recipients by July 1, 1995.
B. The managed care system shall ensure:
(1) access to medically necessary services, particularly for medicaid recipients with chronic health problems;
(2) to the extent practicable, maintenance of the rural primary care delivery infrastructure;
(3) that the department's approach is consistent with national and state health care reform principles; and
(4) to the maximum extent possible that medicaid-eligible individuals are not identified as such except as necessary for billing purposes.
C. The department may exclude nursing homes, intermediate care facilities for the mentally retarded, medicaid in-home and community-based waiver services and residential and community-based mental health services for children with serious emotional disorders from the provisions of this section.
History: Laws 1994, ch. 62, § 22.
Cross references. — For Money Follows the Person in New Mexico Act, see 27-15-1 NMSA 1978.
Subsection B of Section 27-1-16 does not apply to New Mexico's managed health care system or managed care organizations. Starko, Inc. v. N.M. Human Servs. Dep't, 2014-NMSC-033, rev'g 2012-NMCA-053, 276 P.3d 252.

Structure New Mexico Statutes

New Mexico Statutes

Chapter 27 - Public Assistance

Article 2 - Public Assistance Act

Section 27-2-1 - Short title.

Section 27-2-2 - Definitions.

Section 27-2-3 - Standard of need; income determination.

Section 27-2-4 - Eligibility requirements.

Section 27-2-6 - Repealed.

Section 27-2-6.1 - Supplemental postnatal assistance.

Section 27-2-6.2 - Repealed.

Section 27-2-7 - General assistance program; qualifications and payments.

Section 27-2-7.1 - Eligible person entitled to information.

Section 27-2-8 - Repealed.

Section 27-2-9 - Payment for hospital care.

Section 27-2-9.1 - Administration of shelter care supplement.

Section 27-2-10 - Food stamp program.

Section 27-2-11 - Scope of assistance programs.

Section 27-2-12 - Medical assistance programs.

Section 27-2-12.1 - Repealed.

Section 27-2-12.2 - Medical assistance program; eligibility of married individuals.

Section 27-2-12.3 - Medicaid reimbursement; equal pay for equal physicians', dentists', optometrists', podiatrists' and psychologists' services.

Section 27-2-12.4 - Long-term care facilities; noncompliance with standards and conditions; sanctions.

Section 27-2-12.5 - Medicaid-certified nursing facilities; retroactive eligibility; refunds; penalty.

Section 27-2-12.6 - Medicaid payments; managed care.

Section 27-2-12.7 - Medicaid; human services department employees; standards of conduct; enforcement.

Section 27-2-12.8 - Mammograms for medicaid recipients.

Section 27-2-12.9 - Medicaid; personal spending allowances; increases.

Section 27-2-12.10 - Clinical nurse specialists.

Section 27-2-12.11 - Prescription drug waiver program; purpose; eligibility.

Section 27-2-12.12 - Human services department; managed care contract credentialing provisions.

Section 27-2-12.13 - Medicaid reform; program changes.

Section 27-2-12.14 - Brain injury; services authorized.

Section 27-2-12.15 - Medicaid, state children's health insurance program and state coverage initiative program medical home waiver; rulemaking; application for waiver or state plan amendment.

Section 27-2-12.16 - Medicaid recipients; cost-sharing payments for emergency medical services when non-emergency services are indicated.

Section 27-2-12.17 - Qualified state long-term care insurance partnership program; establishment; rulemaking.

Section 27-2-12.18 - Medical assistance; prescription drugs; prior authorization request form; prior authorization protocols.

Section 27-2-12.19 - Former foster-care recipients; medical assistance coverage until age twenty-six.

Section 27-2-12.20 - Crisis triage center; medical assistance reimbursement.

Section 27-2-12.21 - Medical assistance; pharmacy benefits; prescription synchronization.

Section 27-2-12.22 - Incarcerated individuals; medicaid eligibility; county jail technical assistance; presumptive eligibility determiner training and certification.

Section 27-2-12.23 - Medical assistance; prescription drug coverage; step therapy protocols; clinical review criteria; exceptions.

Section 27-2-12.24 - Medical assistance; plan of care; participation required.

Section 27-2-12.25 - Prior authorization for gynecological or obstetrical ultrasounds prohibited.

Section 27-2-12.26 - Qualified medicare beneficiary recipients; medicare part B coverage automatic enrollment.

Section 27-2-12.27 - Medical assistance; managed care organization contracts; applicability of Prior Authorization Act.

Section 27-2-12.28 - Medical assistance; autism spectrum disorder.

Section 27-2-12.29 - Medical assistance; reimbursement for a one-year supply of covered prescription contraceptive drugs or devices.

Section 27-2-12.30 - Pharmacist prescriptive authority services; reimbursement parity.

Section 27-2-12.31 - Heart artery calcium scan coverage.

Section 27-2-13 - Conflict in federal and state laws.

Section 27-2-14 - Continuing effect of regulations and standards.

Section 27-2-15 - Cooperation with United States.

Section 27-2-16 - Compliance with federal law.

Section 27-2-17 - Custodian of funds.

Section 27-2-18 to 27-2-20 - Repealed.

Section 27-2-21 - Assistance not assignable.

Section 27-2-22 - Repealed.

Section 27-2-23 - Third party liability.

Section 27-2-23.1 - Employee Retirement Income Security Act employee health benefit plans; clauses to exclude medicaid coverage prohibited.

Section 27-2-24 - [Federal government entitled to share recovery.]

Section 27-2-25 - Funeral expenses.

Section 27-2-26 - Money received from other sources; duty and liability of funeral director.

Section 27-2-27 - Single state agency; powers and duties.

Section 27-2-28 - Liability for repayment of public assistance.

Section 27-2-29 - Repealed.

Section 27-2-29.1 - Compensation under contingent fee contracts; suspense fund created.

Section 27-2-30 - [Enforcement of support;] orders.

Section 27-2-31 - Judgments and proceeds.

Section 27-2-32 - Duty of agencies to cooperate.

Section 27-2-33 - Repealed.

Section 27-2-34 - Limitations of act.

Section 27-2-35 to 27-2-40 - Repealed.

Section 27-2-41 - Short title.

Section 27-2-42 - Legislative findings; purpose.

Section 27-2-43 - Definitions.

Section 27-2-44 - Indigent catastrophic illness hospital fund created.

Section 27-2-45 - Hospitals; claims for payment.

Section 27-2-46 - Medically indigent patient deductible.

Section 27-2-47 - Department; regulations.