New Mexico § 27-2-12.15 - Medicaid, state children's health insurance program and state coverage initiative program medical home waiver; rulemaking; application for waiver or state plan amendment

§ 27-2-12.15. Medicaid, state children's health insurance program and state coverage initiative program medical home waiver; rulemaking; application for waiver or state plan amendment

A. Subject to the availability of state funds and consistent with the federal Social

Security Act, the department shall work with its contractors that administer the state's

approved waiver programs to promote and, if practicable, develop a program called

the “medical home program”. The “ medical home ” is an integrated care management model that emphasizes primary medical care that

is continuous, comprehensive, coordinated, accessible, compassionate and culturally

appropriate. Care within the medical home includes primary care, preventive care and care management

services and uses quality improvement techniques and information technology for clinical

decision support. Components of the medical home model may include: (1) assignment of recipients to a primary care provider, clinic or practice that will

serve as a medical home; (2) promotion of the health commons model of service delivery, whereby the medical

home tracks recipients' primary care, specialty, behavioral health, dental health

and social services needs as much as practicable; (3) health education, health promotion, peer support and other services that may integrate

with health care services to promote overall health; (4) health risk or functional needs assessments for recipients; (5) a method for reporting on the effectiveness of the medical home model and its

effect upon recipients' utilization of health care services and the associated cost

of utilization of those services; (6) mechanisms to reduce inappropriate emergency department utilization by recipients; (7) financial incentives for the provision of after-hours primary care; (8) mechanisms that ensure a robust system of care coordination for assessing, planning,

coordinating and monitoring recipients with complex, chronic or high-cost health care

or social support needs, including attendant care and other services needed to remain

in the community; (9) implementation of a comprehensive, community-based initiative to educate recipients

about effective use of the health care delivery system, including the use of community

health workers or promotoras; (10) strategies to prevent or delay institutionalization of recipients through the

effective utilization of home- and community-based support services; (11) a primary care provider for each recipient, who advocates for and provides ongoing

support, oversight and guidance to implement an integrated, coherent, cross-disciplinary

plan for ongoing health care developed in partnership with the recipient and including

all other health care providers furnishing care to the recipient; (12) implementation of evidence-based medicine and clinical decision support tools

to guide decision-making at the point-of-care based upon recipient-specific factors; (13) use of comparative effectiveness to make a cost-benefit analysis of health care

practices; (14) use of health information technology, including remote supervision, recipient

monitoring and recipient registries, to monitor and track the health status of recipients; (15) development and use of safe and secure health information technology to promote

convenient recipient access to personal health information, health services and web

sites with tools for patient self-management; (16) implementation of training programs for personnel involved in the coordination

of care for recipients; (17) implementation of equitable financial incentive and compensation systems for

primary care providers and other staff engaged in care management and the medical

home model; and (18) any other components that the secretary determines will improve a recipient's

health outcome and that are cost-effective. B. For the purposes of this section, “ primary care provider ” means a medical doctor or physician assistant licensed under the Medical Practice

Act 1 to practice medicine in New Mexico, an osteopathic physician licensed pursuant to Chapter 61, Article 10 NMSA 1978 , an osteopathic physician's assistant licensed pursuant to the Osteopathic Physicians'

Assistants Act 2 , a pharmacist clinician licensed or certified to prescribe and administer drugs that

are subject to the New Mexico Drug, Device and Cosmetic Act 3 ; or a certified nurse practitioner as defined in the Nursing Practice Act 4 who provides first contact and continuous care and who has the staff and resources

to manage the comprehensive and coordinated health care of each individual under the

primary care provider's care. 1

NMSA 1978, § 61-6-1 et seq. 2

NMSA 1978, § 61-10A-1 et seq. 3

NMSA 1978, § 26-1-1 et seq. 4

NMSA 1978, § 61-3-1 et seq.