House Bill 70

     SECTION 1. [NEW MATERIAL] SHORT TITLE.--This act may be cited as the "Behavioral Health Medicaid Waiver Act".

     SECTION 2. [NEW MATERIAL] DEFINITIONS.--As used in the Behavioral Health Medicaid Waiver Act:

          A. "behavioral health condition" means serious mental illness, serious emotional disturbance, substance use disorder or brain injury whenever that condition:

                (1) substantially impairs a person's ability to manage the person's own affairs; or

                (2) makes a person eligible to receive disability benefits from New Mexico or the federal government;

          B. "brain injury" means an injury to the brain of traumatic or acquired origin, including an open or closed head injury, caused by:

                (1) an insult to the brain from an outside physical force;

                (2) anoxia;

                (3) an electrical shock;

                (4) shaken baby syndrome;

                (5) a toxic or chemical substance;

                (6) a near-drowning;

                (7) an infection;

                (8) a tumor;

                (9) a vascular lesion; or

                (10) an event that results in either temporary or permanent, partial or total impairment in one or more areas of the brain that results in total or partial functional disability, including:

                     (a) cognition;

                     (b) language;

                     (c) memory;

                     (d) attention;

                     (e) reasoning;

                     (f) abstract thinking;

                     (g) judgment;

                     (h) problem solving;

                     (i) sensory perception and motor abilities;

                     (j) psychosocial behavior;

                     (k) physical functions;

                     (l) information processing; or

                     (m) speech;

          C. "eligible person" means a person that the health care authority has determined is eligible to receive support and services to treat the person's behavioral health condition;

          D. "serious emotional disturbance" means a diagnosable mental, behavioral or emotional disorder in a person under the age of eighteen years and of sufficient duration to meet diagnostic criteria that results in functional impairment that substantially interferes with or limits the person's role or functioning in family, school or community activities;

          E. "serious mental illness" means a diagnosable mental, behavioral or emotional disorder in a person eighteen years of age or older of sufficient duration to meet diagnostic criteria that results in functional impairment that substantially interferes with or limits one or more major life activities; and

          F. "substance use disorder" means dependence on or misuse of alcohol, illicit drugs or psychotherapeutics, including prescription pain relievers, sedatives, tranquilizers or stimulants, within the past twelve months based on assessments of individual diagnostic criteria from the current edition of the Diagnostic and Statistical Manual of Mental Disorders published by the American psychiatric association.

     SECTION 3. [NEW MATERIAL] HEALTH CARE AUTHORITY DUTIES--PERSONS WITH BEHAVIORAL HEALTH CONDITIONS.--

          A. Subject to approval by the federal centers for medicare and medicaid services and the availability of appropriations provided expressly for this purpose, the health care authority shall:

                (1) acquire, provide or coordinate support and services for persons with behavioral health conditions through a medicaid waiver program that provides home- and community-based services and supports;

                (2) enter into contracts and provider agreements with agencies and persons capable of providing support and services to eligible persons with behavioral health conditions; and

                (3) establish advisory councils and task forces as necessary to guide the development of and to review the operation of support and services to eligible persons with behavioral health conditions.

          B. Support and services shall be provided to eligible persons with behavioral health conditions based on individual support and service plans developed by an interdisciplinary team. The team is responsible for collectively evaluating a person's behavioral health needs and developing an individual support and service plan to meet the needs.

          C. The health care authority shall:

                (1) solicit the involvement of persons with behavioral health conditions and their family members, providers, parents, professional organizations and other governmental organizations prior to the adoption or revision of rules concerning the provision of support, services, standards or funding systems; provided that participants shall be selected in a manner that reflects geographical, cultural, organizational and professional representation across New Mexico; and

                (2) develop rules that:

                     (a) to the extent possible, promote uniformity in reimbursement and quality assurance systems regardless of the source of funding;

                     (b) establish the types of supports and services that are provided to eligible persons with behavioral health conditions; and

                     (c) establish eligibility criteria for receiving support and services to treat behavioral health conditions.

     SECTION 4. [NEW MATERIAL] TEMPORARY PROVISION--DUTIES OF HEALTH CARE AUTHORITY--MEDICAID WAIVER PROGRAM.--

          A. Beginning July 2025, the health care authority shall conduct monthly meetings with persons with behavioral health conditions and their family members, providers of behavioral health services, the university of New Mexico, advocates for persons with behavioral health conditions and county and municipal officials who are serving persons with behavioral health conditions to develop an application to be submitted to the federal centers for medicare and medicaid services for authorization to operate a medicaid waiver program for persons with behavioral health conditions. The meetings shall:

                (1) be used to consider:

                     (a) the scope of services that will be available under the medicaid waiver program; and

                     (b) eligibility requirements for persons who apply to participate in the medicaid waiver program; and

                (2) continue until the health care authority has submitted an application to the federal centers for medicare and medicaid services for authorization to operate a medicaid waiver program for residents of New Mexico with behavioral health conditions.

          B. The health care authority may retain a consulting entity to assist the health care authority in the development of an application to the federal centers for medicare and medicaid services for authorization to operate a medicaid waiver program that provides home- and community-based services and supports for persons with behavioral health conditions.

          C. No later than July 1, 2026, the health care authority shall submit an application to the federal centers for medicare and medicaid services for authorization to operate a medicaid waiver program that provides home- and community-based services and supports.

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