New Mexico Releases Medicaid Managed Care RFP For Turquoise Care

By OPEN MINDS Circle

On September 30, 2022, the New Mexico Human Services Department (HSD) released a request for proposals (RFP) for Medicaid managed care organizations (MCOs) for its upcoming Turquoise Care program, which will build on the current Centennial Care 2.0 managed care program. The Turquoise Care MCOs will provide physical health, behavioral health, and long-term care (LTC) services to approximately 800,000 Medicaid managed care members, about 83% of the state’s Medicaid population. The state intends to contract with three MCOs. One of the MCOs will be awarded a separate statewide contract to cover children in the state’s foster care system. Enrollment will be mandatory for most children in state custody. Enrollment will be voluntary for Native American children in state custody.

The Centennial Care 2.0 contracts expire at the end of 2023. The incumbents are Blue Cross Blue Shield of New Mexico, Presbyterian Health Plan, and Western Sky Community Care.

People fully eligible for both Medicare and Medicaid will be required to enroll in a Turquoise Care MCO. People receiving services through the Developmental Disabilities 1915(c) Waiver or the Medically Fragile 1915(c) Waiver will continue to receive home and community-based services (HCBS) through those waivers but are required to enroll with an MCO for all non-HCBS. The following populations are exempted from mandatory enrollment in a Turquoise Care MCO:

Native American members not in need of LTC
Residents of an intermediate care facility for individuals with intellectual disabilities
Individuals enrolled in Qualified Medicare Beneficiary (QMB), Specified Low-Income Medicare Beneficiary (SLIMB), or Qualified Individuals program
Individuals covered only under the Medicaid Family Planning program
Individuals enrolled in the Program of All-Inclusive Care for the Elderly (PACE)
Individuals covered pursuant to Emergency Medical Services for Non-Citizens (EMSNC)

Proposals are due by December 2, 2022, and the initial contract term will run from January 1, 2024, through December 31, 2026, with optional one-year renewals up to eight years total. Through the new contracts, HSD seeks to ensure that Medicaid beneficiaries will have access to integrated person-centered care. There are three broad goals:

Build a New Mexico health care delivery system where every Medicaid member has a dedicated health care team that is accessible for both preventive and emergency care that supports the whole person – their physical, behavioral, and social drivers of health.
Strengthen the New Mexico health care delivery system through the expansion and implementation of innovative payment reforms and value-based initiatives.
Identify groups that have been historically and intentionally disenfranchised and address health disparities through strategic program changes to enable an equitable chance at living healthy lives.

Within these three goals, the state intends to focus on population health of five populations to improve health outcomes and member satisfaction. The MCOs will be responsible for implementing various changes to benefit each population.

Prenatal, postpartum, and members parenting children, including children in state custody: The key responsibilities are as follows:

Identify members and apply population health strategies.
Emphasize early and periodic screening, diagnosis, and referral to treatment.
Expand services delivered in school-based health centers.
Promote Medicaid home visiting for pregnant and postpartum members.
Provide comprehensive lactation support services and breastfeeding equipment with no prior authorization requirements.
Customize care coordination for children in state custody in collaboration with the state Children, Youth, and Families Department and with the Behavioral Health Collaborative.

Seniors and members with long-term services and supports (LTSS) needs: The key responsibilities are as follows:

Identify members and apply population health strategies.
Annually increase value-based purchasing targets related to long-term services and supports provider organizations.
Provide default enrollment for members eligible for both Medicare and Medicaid into the MCO’s Dual Eligible Special Needs Plan.
Offer a tiered payment system for assisted living that offers reimbursement that is aligned with the level of care delivered.

Members with behavioral health conditions: The key responsibilities are as follows:

Identify members and apply population health strategies.
Expand the behavioral health crisis continuum for members and their families experiencing a crisis.
Add Certified Community Behavioral Health Clinics (CCHBCs) to the MCO provider organization network.
Promote effective community-based alternatives to out of home services.
Expand availability of in-state behavioral health residential facilities through community reinvestment to avoid the need for out-of-state placements.
Enhance reporting and monitoring to ensure that members have parity in accessing and coverage of behavioral health services.

Native American members: The key responsibilities are as follows:

Identify members and apply population health strategies.
Ensure that health disparities and social determinants of health are identified and addressed.
Offer Native American children in state custody the option receive services through the MCO selected to implement a health care program customized to address the unique needs of youth in this population.
Support the Indian Health Service, Tribal Health Providers, and Urban Indian Providers serving MCO members by providing training about the covered services and benefits available to members and providing technical assistance for billing and claims matters.

Justice-involved individuals: The key responsibilities are as follows:

Identify members and apply population health strategies.
Suspend, rather than terminate Medicaid Identify members and apply population health strategies. eligibility to promote seamless reentry following incarceration or detention.
Offer circumstances to provide medication assisted treatment for addiction treatment within the facility.
Designate an MCO liaison responsible for justice involved care coordination and transitions.

The Turquoise Care contracts feature the following new provisions to strengthen the Medicaid health care delivery system:

Identification and remediation of cultural and linguistic health care disparities.
Focus on identifying and addressing social determinants of health.
Emphasis on care coordination delivered by community-based individuals and entities.
Enhanced MCO staffing requirements qualifications, staffing levels, and training.
Implementation of a Uniform Prescription Drug List and supplemental rebate program.
More stringent provider network requirements, including appointment availability standards, provider training, and accuracy of provider directory information.
Minimum reimbursement rate for contract providers at or above the State Plan approved fee schedule.
Provider organization requested, peer to peer reviews of adverse MCO utilization management decisions.
Expanded MCO reporting and monetary penalties for noncompliance.
Medical Loss Ratio of 90%.

For more information about the RFP, contact: Charles Canada, Procurement Manager, New Mexico Human Services Department, Post Office Box 2348, Santa Fe, New Mexico 87504; Email: TurquoiseCare.rfp@state.nm.us; Website: https://www.hsd.state.nm.us/2022-turquoise-care-mco-rfp-procurement-library/

For more information, about Centennial Care 2.0 and HSD’s plans for the 1115 waiver contact: Marina Pina, Director, Communications, New Mexico Human Services Department, Post Office Box 2348, Santa Fe, New Mexico 87504; 505-476-7203; Email: marina.pina@state.nm.us; Website: https://www.hsd.state.nm.us/default.aspx