New Medicaid fee schedule effective December 15, 2009
On November 19, 2009, the Director of the Medical Assistance Division of the New Mexico Human Services Department issued a Medical Assistance Program Manual Supplement (Notice) requiring Medicaid Managed Care Organizations contracted for the SALUD!, Behavioral Health Statewide Entity (BH SE), Coordination of Long-Term Services (CoLTS), and State Coverage Insurance (SCI) programs, including BCBSNM, to reduce reimbursement levels.

The Notice attributes the need for the reduction to a shortfall in state revenues. As a result, budgets for many state programs are either being reduced or not sufficiently increased to cover current program costs. The New Mexico Medicaid program budget is being reduced as part of those reductions. You may read the Notice here.

The Notice requires:

1. Practitioner providers’ rates must be reduced by 3 percent.
2. Anesthesia services will not be affected at this time, but the State will provide direction on these services at a later time.
   
3. The reduction will not be applied to the Early Periodic Screening, Diagnostic, and Treatment (EPSDT) screening rates for children; EPSDT person care; EPSDT private duty nursing; early intervention services (FIT); day treatment, multisystemic treatment, assertive community treatment (ACT); or to home and community based services waivers.
   
4. The reduction will not be applied to payment rates for cost-based encounters: Federally qualified health centers and rural health clinics, or federal Office of Management and Budget (OMB) rates (Indian Health Services and 638-compact facility services paid at OMB rates).
   
5. The reduction will also not be applied to payment rates that are determined at the federal level (hospice, clinical laboratory, prosthetics, orthotics, and oxygen), to cost-based/cost-settled provider rates (home health agencies), to items and services for which payment is based on invoice costs (hearing aids, glasses, frames, IV infusions), or to items that are paid at cost plus a percentage (medical supplies).