New Mexico Family Infant Toddler Program

1. New MexicoFamily Infant Toddler Program Private Health Insurance Legislation

2. Background • NM Primary funding sources • 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

3. Funding challenge • 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

4. Initial steps • 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

5. Joint Memorial results • 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

6. NM’s Insurance Statute • 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

7. Features of legislation • 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

8. Implementation • 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

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

10. Work ahead • 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