New Mexico Approved For Centennial Care 2.0

HSD News:
SANTA FE — The New Mexico Human Services Department announced Friday that the Centers for Medicare and Medicaid Services (CMS) approved its Section 1115 waiver renewal that authorizes the Medicaid managed care program, known as Centennial Care.
The renewal, effective Jan. 1, 2019 through Dec. 31, 2023, builds on the program’s accomplishments and maximizes opportunities for targeted improvements and other modifications in the following key areas: care coordination, benefit and delivery system refinements, payment reform, member engagement, cost sharing responsibilities, and administrative simplification.

The program improvements and modifications include:

  • Refining care coordination to better meet the needs of high-cost, high-need members, especially during transitions in their setting of care;
  • Expanding substance use disorder services, including allowing treatment for adults in accredited residential centers and allowing inpatient services in Institutes for Mental Disorders, which were previously not permitted by federal rule;
  • Improving the integration of behavioral and physical health services, with greater emphasis on social determinants of health, including supportive housing services;
  • Piloting home visiting program that focuses on pre-natal, post-partum and early childhood development services;
  • Expanding payment reform initiatives through value-based purchasing arrangements to achieve improved quality and better health outcomes;
  • Continuing safety net care hospital funding of $68 million in the first year and $12 million per year for three years for the hospital quality improvement initiative;
  • Building upon policies that seek to enhance beneficiaries’ ability to become more active participants in their own health care, including the introduction of modest premiums for Medicaid expansion adults with higher income and two new copayments ($8/each)—one for the use of the emergency room when it is not emergency and another when choosing a non-preferred prescription drug when an equivalent, preferred prescription drug is available;
  • Improving continuity of coverage and encouraging Medicaid-eligible adults to obtain health coverage as soon as possible upon accessing services by phasing out retroactive eligibility; and
  • Further simplifying administrative complexities by designing the family planning program to cover men and women through the age of 50.
Over the course of Centennial Care 2.0, New Mexico will continue to introduce progressive quality goals focused on improving health outcomes, implement pilot projects to advance program goals, and challenge its MCO partners to work cooperatively with the provider community to achieve a health care delivery system that is efficient and value-driven, while reducing health disparities across all populations.
The Medicaid managed care organizations that were selected through a competitive procurement by the Department to administer the Centennial Care program are Blue Cross/Blue Shield of New Mexico, Presbyterian Health Plan and Western Sky Community Care.
For more information about Centennial Care 2.0, visit the Department’s website at