New Mexico

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Managed LTSS Program

In August 2012, the state submitted its Centennial Care §1115 Demonstration Waiver Proposal. Under the demonstration, the state is consolidating its §1915(b) and 1915(c) waivers to create a comprehensive managed care delivery system. Centennial Care's contracted health plans offer acute; behavioral health; institutional; and community-based LTSS. The system features expanded care coordination; a beneficiary reward program to incentivize beneficiaries to pursue healthy behaviors; and a Safety Net Care Pool. Native American Medicaid beneficiaries can voluntarily opt-in; and the state auto-enrolls dually-eligible Native American beneficiaries and those who meet nursing facility level-of-care. (Source: State Centennial Care website; Centennial Care FAQs, 6/19/13)
Waiver application, link no longer available (8/17/2012)

In July 2013, CMS approved the demonstration proposal; and effective January 1, 2014, Centennial Care replaced New Mexico’s previous Medicaid managed care programs, CoLTS and Salud!. The demonstration will be implemented through December 31, 2018. (Source: State Centennial Care website; Centennial Care FAQs, 7/2/2013; Approval Letter, 7/12/2013)

The New Mexico Human Services Department (HSD) has released a procurement schedule for MCOs to serve in the Centennial Care Medicaid managed care program, which includes MLTSS. The state proposes the following timeline, but HSD notes that all dates are subject to its discretion:

  • Release of RFP – September 1, 2017;
  • Proposals due – November 15, 2017;
  • Contract award date – March 15, 2018;
  • Program start date – January 1, 2019.

(Source: Procurement Schedule 6/1/2017)  

On May 19, 2017, the New Mexico Human Services Department (HSD) released a section 1115 waiver demonstration concept paper for the state’s Centennial Care program. First approved in 2014, HSD notes some of the advances that Centennial Care has made in the Medicaid program, including:

  • Streamlined administration;
  • Created a care coordination infrastructure;
  • Increased access to LTSS for individuals residing in the community;
  • Advanced value-based purchasing (VBP) initiatives; and
  • Reduced per capita costs.

For the next iteration of the program, referred to as Centennial Care 2.0, the state hopes to make the following targeted improvements regarding LTSS: 

  • Streamline services between the agency-based community benefit (ABCD) and self-directed community benefit (SDCB) program options; 
  • Create an allowance for start-up goods for when members transition between the ABCD and SDCB programs; 
  • Increase the number of hours available for caregiver respite; 
  • Limit the costs of certain services in the SDCB model; 
  • Establish automatic nursing facility (NF) level of care (LOC) approval for individuals with specific criteria and whose condition is not expected to change; and 
  • Include nursing facilities in VBP initiatives. (Source: Concept Paper 5/19/2017) 

On September 1, 2017, the New Mexico Human Services Department (HSD) released a request for proposals (RFP) to procure MCOs for Centennial Care 2.0, which is the state’s comprehensive Medicaid managed care program that includes LTSS. A concept paper on Centennial Care 2.0 was examined in the August edition of the State Medicaid Integration Tracker©. HSD expects that Centennial Care 2.0 will cover approximately 700,000 Medicaid beneficiaries, but will continue to exclude the following populations from Medicaid managed care: 

  • Native American individuals who do not need LTSS and have previously opted out of managed care;
  • Individuals residing in an Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF-IDD);
  • Partial benefits individuals;
  • Beneficiaries participating in the Program of All Inclusive Care for the Elderly (PACE); and
  • Individuals enrolled in a 1915(c) waiver for individuals with IDD—this population will receive acute care benefits only through Centennial Care.

Centennial Care 2.0 does not contain major programmatic changes, but instead builds on program successes, including with rebalancing the state’s LTSS system away from institutions and towards community-based care. HSD intends to award contracts to between three and five MCOs, for an initial five-year period with opportunities to renew. Implementation of the new contracts is scheduled for January 1, 2019. (Source: RFP 9/1/2017; August State Medicaid Integration Tracker   8/4/2017) 

On December 6, 2017, the New Mexico Human Services Department formally submitted its application to renew the state’s comprehensive section 1115 demonstration waiver, Centennial Care 2.0, which includes LTSS. The August edition of the State Medicaid Integration Tracker details the programmatic changes and updates the state intends to pursue with the renewal, including streamlined administration and increased access to community-based LTSS. (Source: 1115 Renewal Application 12/6/2017;  State Medicaid Integration Tracker 8/4/2017)

On January 19, 2018, the Santa Fe New Mexican reported that the New Mexico Human Services Department (HSD) announced the MCOs selected to serve in the state’s re-procured Centennial Care Medicaid managed care program. The incumbent plans selected are Presbyterian Health Plan and Blue Cross Blue Shield of New Mexico; two other incumbents, Molina Healthcare of New Mexico and United Healthcare, will not have their contracts renewed. HSD instead selected a new MCO, Western Sky Community Care, which is a subsidiary of Centene Corporation. (Source: Sante Fe New Mexican 1/19/2018)

On January 31, 2018, The New Mexican reported that Molina Healthcare filed a suit against the New Mexico Human Services Department (HSD) overall alleged irregularities in the reprocurement of the state’s Medicaid managed care program, Centennial Care. Molina is one of two incumbent MCOs that was not selected for contractual renewal starting in 2019; the other is UnitedHealthcare. At issue is alleged changes to evaluation factors for contracts, and alterations to the timeline. The suit also alleges that the state may have been influenced by a consultant that it has used to assist with evaluating MCO bids. (Source: The New Mexican 1/31/2018)

On February 16, 2018, The New Mexican reported on the response from the New Mexico HSD regarding any irregularities or issues with the state’s recent reprocurement of its Medicaid managed care contracts. In addition to the lawsuit filed by Molina, both Molina and UnitedHealthcare have filed administrative protests with the HSD. The state, in its court filings and public statements, defends its process and the results of the reprocurement. (Source: The New Mexican 2/16/2018) 

On February 26, 2018, a District judge dismissed Molina’s lawsuit, stating it was inappropriate at this time given that the company’s administrative protest was still being reviewed. If the company’s protest is denied, a new lawsuit is considered likely. (Source: The New Mexican 2/26/2018) 

 

State Demonstration to Integrate Care for Dual Eligible Individuals (Withdrawn)

In August 2012, the state withdrew its demonstration proposal. Under the proposed demonstration, dually-eligibles receiving services through the state’s Developmental Disabilities Waiver would have received regular medical benefits; but LTSS would have remained fee-for-service and carved out of managed care. (Source: Withdrawal Letter to CMS, 8/17/2012; Demonstration Proposal, 5/2012)

Health Homes

CMS has approved the state’s Heath Home Planning Request. (Source: CMS State Health Home Proposal Status website, 6/2014) New Mexico is working under a §2703 planning grant to design a SPA establishing Behavioral Health Homes within Core Service Agencies statewide, coordinating the BHHs with MCOs established under the Centennial Care §1115 demonstration waiver. Once a recipient enrolls in a BHH, MCOs will delegate care management and care coordination responsibilities to the BHH. Over time, the state intends to establish Health Homes for other chronic conditions through the SPA process, continuing to coordinate the Health Homes models with Centennial Care to ensure care integration at all levels. (Source: Centennial Care §1115 Demonstration Waiver Application, link no longer available)

On March 21, 2016, CMS formally approved New Mexico’s Medicaid health home state plan amendment (SPA), which became effective April 1, 2016. The health home initiative will be known as CareLink NM, and will serve adults with serious persistent mental illness, and children with serious emotional disturbance in San Juan County and Curry County. Health homes receive an enhanced per-member per-month (PMPM) payment in order to cover the costs of health home services. (Source: SPA 3/21/2016; NASHP 4/12/2016)