Bill > HB278

This bill establishes new requirements for how Medicaid, the joint federal-state health coverage program, reimburses independent reference laboratories for toxicology services, which are laboratory tests on biological specimens like urine or blood to detect drugs or alcohol. Specifically, the bill mandates that Medicaid reimbursement rates for these services be set at the average Medicaid fee-for-service rate for the specific billing codes used for definitive drug testing, provided the services are deemed medically necessary by a treating healthcare provider and follow evidence-based clinical protocols. The bill also directs the authority to create rules for these reimbursements, considering national guidelines for frequency of testing based on a patient's stage of substance use disorder treatment or recovery, while clarifying that it does not set mandatory minimums or maximums for testing frequency or restrict a provider's ability to order tests based on documented clinical necessity. An independent reference laboratory is defined as a state-based facility, certified and accredited under federal and professional standards, licensed by the authority, enrolled as a Medicaid provider, and not financially affiliated with hospitals, physician groups, managed care organizations, or insurers, among other criteria. Finally, the bill includes an appropriation of $100,000 for the health care authority to administer these new reimbursement requirements.

Health and Social Services

https://www.nmlegis.gov/Legislation/Legislation?chamber=H&legtype=B&legno=278&year=26