New Mexico Human Services Department Cancels Procurement for Medicaid MCOs
The current contracts in place will continue until a new RFP is issued
By: Catie Hillard
January 31, 2023 – The New Mexico Human Services Department (HSD) recently announced it is canceling the procurement process for the selection of managed care organizations to deliver services to Medicaid Centennial Care members in the state. Currently, there are over 800,000 Medicaid Centennial Care members.
The original RFP for managed care organizations to deliver services to Medicaid Centennial Care members in New Mexico was announced in October 2022. It set forth HSD’s process for managed care organization procurement with the following included:
- Creating a specialized plan for children in state custody under the Children, Youth and Families Department
- Implementing a uniform prescription drug list and supplemental rebate program
- Providing a minimum reimbursement rate for contract providers at or above the state plan approved fee schedule
- Developing more stringent provider network requirements, including appointment availability standards, provider training, and greater accuracy of provider directory information
- Expanding MCO reporting and monetary penalties for non-compliance
- Requiring that 90 percent of capitation go to payment for delivery of services and efforts to improve quality of care
- Creating direction to use a single centralized vendor to process applications for credentialing perform primary source verifications
- Taking a population health approach to improve health outcomes and member satisfaction
- Identifying and remediating cultural and linguistic health care disparities
- Focusing on identifying and addressing social determinants of health
- Putting an emphasis on care coordination delivered by community-based individuals and entities
- Enhancing MCO staffing requirements, including qualifications, staffing levels, and training
Despite the state’s goal to provide quality care, the current RFP is being canceled so the agency’s new leadership can assess the procurement design. Both Secretary David Scrase and the Medicaid Director Nicole Comeaux are planning to depart HSD. This cancellation allows the agency’s new leadership to ensure the RFP aligns with new goals.
The state has current managed care organization contracts in place that will expire at the end of 2023. Those contracts will remain in place until HSD issues a new expedited request for proposal (RFP).
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