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NMBHPA: WE ARE STRONGER TOGETHER

MAY 16, 2024

INVESTING FOR TOMORROW, DELIVERING TODAY.

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BEFORE WE START...

On behalf of all colleagues at the Health Care Authority, we humbly acknowledge we are on the unceded ancestral lands of the original peoples of the Pueblo, Apache, and Diné past, present, and future.

With gratitude we pay our respects to the land, the people and the communities that contribute to what today is known as the State of New Mexico.

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Evening drive through Corrales, NM in October 2021.

By HCA Employee, Marisa Vigil

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DISCUSSION TOPICS

  • Stronger Together: New Mexico Health Care Authority (HCA)
  • Turquoise Care
    • Benefits
    • Open enrollment
    • Medicaid Managed Care Organizations (MCOs) Accountability
  • Rebuilding Behavioral Health in NM
  • Additional HCA State Fiscal Year 2025 Initiatives

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NEW MEXICO HAS THE HIGHEST DEGREE OF SOCIAL VULNERABILITY IN THE U.S.

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Source: https://www.atsdr.cdc.gov/placeandhealth/svi/index.html

U.S. Social Vulnerability by County, 2020

Darker color shows higher vulnerability

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STRONGER TOGETHER: HCA WILL SERVE 50% OF NEW MEXICANS BEGINNING JULY 1

  • HCA will serve all 981,610 HSD customers and:
    • 123,000 New Mexicans enrolled in public school or retiree health plans;
    • 70,000 New Mexicans who receive coverage assistance through the Health Care Affordability Fund;
    • 57,375 New Mexicans enrolled in a state employee or local public body health plans;
    • 7,319 New Mexicans enrolled in a Medicaid Developmental Disability waiver program; and,
    • New Mexicans who receive care at a licensed health facility.

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Map Source: https://www.usnews.com/news/best-states/articles/food-stamp-benefits-by-statehttps://www.usnews.com/news/best-states/articles/food-stamp-benefits-by-state

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HCA IS POSITIONED TO LEAD IN HEALTH CARE PURCHASING, HEALTH EQUITY, AND ACCESS

  • HCA demonstrates Governor’s commitment to prioritize health and well-being by creating single agency for health care purchasing, policy, and regulation.
  • HCA will transform how NM purchases health care, using Medicaid’s purchasing power to improve cost, quality, and outcomes.
  • HCA will leverage financing, policies, programs, and data to address structural determinants of health.

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FY24 Medicaid Provider Rate Increases (Millions) By County

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HCA WILL BUILD ON HSD’S SUCCESS

Since 2019, HSD has worked tirelessly and:

  • Designed Medicaid 1115 waiver application with 20+ initiatives to redesign and enhance healthcare delivery.
  • Executed Medicaid Turquoise Care MCO contracts with more stringent accountability requirements and tailored plan designs to better serve New Mexicans. 
  • Invested $2.5B in Medicaid reimbursement and increases. 
  • Launched 988, reaching 39,091 New Mexicans in first year including 700+ New Mexicans at risk of suicide.
  • Provided safety net services to New Mexicans during pandemic, including to 319,479 new SNAP customers.
  • Provided additional $7M to children through a modernized Child Support program.
  • Is on track to provide $80M to rural providers via Rural Health Care Delivery Fund.

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STRONGER TOGETHER: BHSD AND MEDICAID

  • Medicaid is largest payer of BH services in NM and largest insurer (43%+ of New Mexicans enrolled).
    • BHSD is NM’s Mental Health and Substance Use Single State Authority, addressing BH needs, services, planning, monitoring and continuous quality improvement.
    • HCA enables BHSD and Medicaid to be stronger together by:
        • Working towards same goals, improving provider and patient experiences;
        • Aligning federal discretionary and state funds to address gaps in Medicaid services and non-Medicaid populations;
        • Improving provider TA, coordination, and communications;
        • Working with MCOs for single credentialing;
        • Streamlining MCO monitoring and oversight;
        • Integrating physical and BH at MCO and provider levels; and,
        • Using joint purchasing power to expand service access and availability.

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Source: https://sites.google.com/view/nmhsdscorecard/goal-1/mco-behavioral-health

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MEDICAID TURQUOISE CARE COMING JULY 1, 2024

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Vision: Every New Mexico Medicaid member has high-quality, well-integrated, person-centered care to achieve their personally defined health and wellness goals.

Goal 2

Goal 3

Build a New Mexico health care delivery system where every Medicaid member has a dedicated health care team that is accessible for both preventive and emergency care that supports the whole person – their physical, behavioral, and social drivers of health.

Strengthen the New Mexico health care delivery system through the expansion and implementation of innovative payment reforms and �value-based initiatives.

Identify groups that have been historically and intentionally disenfranchised and address health disparities through strategic program changes to enable an equitable chance at living healthy lives.

Goal 1

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TURQUOISE CARE OPEN ENROLLMENT THROUGH MAY 31

  • Medicaid customers currently enrolled with Presbyterian and BlueCross BlueShield will be automatically re-enrolled in their existing plans if they do not select an MCO.
  • Customers with Western Sky will be assigned to another MCO if they don’t choose a new health plan, ensuring a seamless transition.
  • Presbyterian Healthcare selected as MCO to serve most Children in State Custody.
  • Starting this April, Medicaid MCO customers received detailed open enrollment information in a yellow envelope.

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NEW TURQUOISE CARE BENEFITS

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Continuous eligibility for children up to age 6)

Expanded Access to Supportive Housing

Addition of Chiropractic Services

Additional Community Benefit slots

Home Visiting Benefit for new mothers

Dialectical Behavior Therapy  

Eye Movement Desensitization & Reprocessing

Mobile Crisis Intervention Service

Trauma Focused Cognitive Behavioral Therapy

Functional Family Therapy

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TURQUOISE CARE MCO ACCOUNTABILITY

Main Categories of MCO Oversight

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Financial Accountability, Expanded Reporting, and Penalties

Specific Accountability for Underserved Populations

Enhanced Operational Requirements �(e.g., MCO staffing, Care Coordination)

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MCO CONTRACT IMPROVEMENTS

Centennial Care 2.0 vs Turquoise Care

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Area of Accountability

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Provider Reimbursement

Limited specificity on how providers should be reimbursed

Required reimbursement at or above Medicaid fee schedule

Provider Network

Specifications for member accessibility to defined providers and services

  • Increased emphasis on community-based models (CCBHC, HFW), appointment availability standards, provider training, and accuracy of provider directory information
  • More frequent secret shopper evaluations

Community Reinvestment

Minimal requirements

  • MCOs must contribute 5% of after-tax underwriting margin (profit) to BH-focused community reinvestments

New and Expanded Services

Opportunity to expand and enhance service offerings and emphasis on connecting members to existing programs

Home Visiting program, BH Crisis continuum, school-based services, postpartum support services, EPSDT and CCBHCs

Health Equity

None

  • MCOs required to apply population health strategies to improve outcomes
  • Requirement for peer and family supports
  • Health information exchange requirements to better support member care and communication amongst providers
  • Care coordination focusing on high cost and high-needs individuals

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REBUILDING BEHAVIORAL HEALTH IN NEW MEXICO

  • 104% growth in Medicaid psychiatric providers and 73% increase in core professionals.
    • 2.2+ M BH visits for Medicaid members in 2022, 68% increase since 2018.
  • Raising BH Medicaid reimbursement rates, reaching up to 150% of Medicare rates by January 2025.
  • Telehealth expansion for most BH services during pandemic resulted in a 133% increase in service utilization in 2020.
  • Expanding Mobile Crisis Teams and Crisis Triage Centers.
  • Medicaid-funded CARA care coordinators in hospitals; requiring MCOs to contact every pregnant member after positive test. 
  • 12 months postpartum coverage extension.

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1 Core behavioral health providers include: Licensed Master’s of Social Worker (LMSW), Licensed Mental Health Counselor (LMHC), Licensed Professional Clinical Counselor (LPCC), Psychologists (non-prescribing), Licensed Alcohol and Drug Abuse Counselor (LADAC), Licensed Clinical Social Worker (LCSW)

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REBUILDING BEHAVIORAL HEALTH IN NEW MEXICO

  • Supporting primary care and psychiatry residency expansion, doubling number of accredited programs to 16 by 2025.
    • Residents in training will increase from 142 to 264 (86% increase) in 2025. 74% remain in NM post-residency.
  • Launching Certified Community Behavioral Health Clinics in 2025; 6 CCBHCs provisionally certified.
  • Pursuing federal approval to offer Medicaid services 30 days before release from correctional settings.
  • Participating in national initiative to align housing programs for New Mexicans with complex BH needs.
  • Bridging gaps in services and ensuring coordination among healthcare and social service providers by launching a statewide Closed-Loop Referral Service.
  • Providing millions in funding to rural BH providers via Rural Health Care Delivery Fund.

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HCA FY25 BUDGET ADDRESSES ROOT CAUSES OF INTERGENERATIONAL POVERTY

  1. Medicaid coverage and workforce innovations:
    • Raise primary care, behavioral health, and maternal/child reimbursement rates from 120% to 150% Medicare beginning 1/1/25.
      • All other FY24 rate increases to 100% of Medicare sustained.
      • Rates that did not get FY24 increase will be raised to 100% Medicare.
    • Add’l $46M for Rural Health Care Delivery Fund.
  2. Create a more effective safety net:
    • Supportive housing expansion for people with substance use disorder and/or mental illness.
    • Eliminated fees charged to child support families.
    • SNAP eligibility expanded from 165% to 200% FPL.
    • SNAP monthly supplemental for older adults and people with disabilities raised from $25 to $100.

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Key Drivers of Long-Term, Intergenerational Poverty

Disparities

Child’s Education

Child & Parental Health

Child’s Family Income, Wealth & Parental Employment

Child’s Family Structure

Child’s Housing & Neighborhood

Neighborhood Crime & Criminal Justice System

Child Maltreatment

Drivers HCA will address

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INVESTING FOR TOMORROW, DELIVERING TODAY.

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APPENDIX

INVESTING FOR TOMORROW, DELIVERING TODAY.

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TURQUOISE CARE AND HEALTH CARE AUTHORITY

Turquoise Care Links:

Health Care Authority Link:

  • https://www.hsd.state.nm.us/
  • Frequently asked questions about the Health Care Authority: HCA FAQs

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STAYING CONNECTED WITH HEALTH CARE AUTHORITY

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MCO CONTRACT IMPROVEMENTS

Centennial Care 2.0 vs Turquoise Care

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Area of Accountability

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Performance Penalties

  • Failure to meet Performance Measures = 2% of annual capitation.
  • Performance measures based on regional averages.
  • Failure to meet Delivery System Improvement Performance Targets = penalty 1.5% annual capitation.
  • Failure to meet Performance Measure targets = 3% of annual capitation
  • Targets based on national averages.
  • Failure to meet Delivery System Improvement Performance Targets = penalty of 2% of annual capitation.

Care Coordination

  • Emphasis on care coordination performed by the MCO
  • Care Coordination levels primarily defined by medical complexity or functional impairment
  • Emphasis on care coordination delivered by community-based individuals and entities
  • Care Coordination levels defined by high cost/high need, medical complexity or population vulnerability (i.e., pregnant women, justice-involved, CARA)
  • Additional reporting including emphasis on vulnerable populations and member outcomes

MCO Staffing Requirements

Additional dedicated MCO staff needed to liaise and direct expanding programs

Enhanced MCO staffing requirements – qualifications, staffing levels, and training

Community Reinvestment

Minimal requirements

MCOs must contribute 5% of after-tax underwriting margin (profit) to BH-focused community reinvestments

Children in State Custody

Opportunity to centralize benefits and coordination for Children in State Custody

Specialized plan for Children in State Custody

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