N.M. Stat. § 24A-8-5
Health care delivery and access medicaid-directed
payment program.
A. The "health care delivery and access medicaid-directed payment program" is
created in the authority pursuant to the provisions of this section, to be approved by the
centers for medicare and medicaid services.
B. The authority shall:
(1)
determine the amount of funds required for disproportionate share hospital
payments but for the impact of the medicaid-directed payment program on the limit
established by Section 1923(g) of the federal Social Security Act and direct a like
amount of funds otherwise appropriated for the New Mexico medicaid program to fund
the medicaid-directed payment program;
(2)
determine the total funding for the medicaid-directed payment program,
including the amount pursuant to Paragraph (1) of this subsection, and the associated
matching federal funds;
(3)
set aside forty percent of the medicaid-directed payment program funding
for quality incentive payments for eligible hospitals, to replace the targeted access fee-
for-service supplemental payment program and the hospital value-based directed
payment program, including the hospital access payment program and the hospital
quality improvement initiative;
(4)
establish quality measurements and performance evaluation criteria based
on hospital grouping classifications, after soliciting input from key stakeholders of the
New Mexico hospital industry, for eligible hospitals using quality measurements and
performance evaluation criteria:
(a) that have been endorsed by a nationally recognized quality organization;
(b) that align with the New Mexico medicaid strategic plan; or
(c) that align with the department of health's state health improvement plan;
(5)
ensure that a quality incentive payment made to an eligible general acute
care hospital:
(a) prior to calendar year 2026, is distributed based only on quality
measurements and not performance evaluation; and
(b) for calendar year 2026 and subsequent years, is distributed based on
quality measurements and performance evaluation;
(6)
ensure that a quality incentive payment made to an eligible special
hospital:
(a) prior to calendar year 2027, is distributed based only on quality
measurements and not performance evaluation; and
(b) for calendar year 2027 and subsequent years, is distributed based on
quality measurements and performance evaluation;
(7)
after soliciting input from key stakeholders of New Mexico's hospital
industry, structure payments to hospitals for the portion of the funding not used for the
quality incentive payments as a uniform rate increase, to be paid to eligible hospitals
through medicaid managed care organizations separately and in addition to capitation
payments made to such organizations; and
(8)
to the extent permitted by federal law, require, no more frequently than
annually, that each eligible hospital submit to the authority, upon request, a report
demonstrating that the increase in payment for medicaid managed care patients
provided through the medicaid-directed payment program has enabled it to invest an
amount equal to at least seventy-five percent of its net new funding into the delivery of
and access to health care services in New Mexico, including investments in hospital
operational costs, workforce recruitment and retention, staff and provider compensation
increases, on-call physician coverage, precepting incentives, creation or expansion of
services, community benefit activities or capital investments.