[{"_1":2,"_88":-5,"_89":-5},"loaderData",{"_3":4,"_26":27},"root",{"_5":6,"_17":10,"_18":19,"_20":21,"_22":10,"_23":-5,"_24":-5,"_25":10},"user",{"_7":8,"_9":10,"_11":10,"_12":-5,"_13":-5,"_14":15,"_16":-5},"roles",[],"isAuthenticated",false,"isPremium","planName","subscriptionStatus","featureFlags",{},"insightsBudget","isDevelopmentHost","userPreferences",{},"recaptchaSiteKey","6LcvOJcUAAAAAHsB-gPGfGktcRlKpH7OTIU_dMTD","isImpersonating","impersonation","affiliateStatus","isFreedomPortal","routes/v2/article/layout",{"_28":29,"_30":31},"notFound",true,"relatedArticles",[32,76],{"_33":34,"_35":36,"_37":38,"_39":40,"_41":42,"_43":44,"_45":46,"_47":48,"_49":50,"_51":52,"_53":54,"_55":56,"_57":58,"_59":60,"_61":62,"_63":64,"_65":66,"_67":68,"_69":70,"_71":72,"_73":74,"_75":74},"mediaId",6131868,"mediaKeyId","5727761-467263d70b5ae7bb98bf41d20523fba8","parentId",5727761,"title","Gallup coalition renews call for higher alcohol taxes and dedicated funds after local detox data","audioSeconds",1120,"startMs",3840000,"endMs",4960000,"viewUrl","/Search/View?dp=1&key=5727761-467263d70b5ae7bb98bf41d20523fba8&start=3840&end=4960","thumbnailUrl","https://assets.pipeline.soar.com/5727761-467263d70b5ae7bb98bf41d20523fba8/thumbnail_3840000.jpg","articleUrl","/articles/6131868/New-Mexico/Gallup-coalition-renews-call-for-higher-alcohol-taxes-and-dedicated-funds-after-local-detox-data","mediaUrl","https://secure.pipeline.soar.com/6131868-6bcbe7040ae2736b09b5bc374281156a/orig.mp4?Expires=1770809272&Signature=RtSkS8G0muo3EkuxibiJSHHoit55UnPpgxArqLaYdQE93CORikoMylY~JPnekw4ze0UMEJMb7j57UyVvBMgqZvDJ-AAz-ZKmN51FlfR-ZTMYFml~ZOBj5X6RefJUbZCBy2610rzuKuVLQj8ppLGlmY9VoUdhvIPO7o4CHy~ti0Ai9oYNRxj-VrHxQNC2u9cJanyNg~J8PF7eKxqj2CdS-fXR3y8ErQuWYALM2y3Mrimu~AK9fs2xKEWqjbxP6oAYh7NndeqrnMHHhiR1grxSuDmJ9dkVBXbuGmPwfzgXKsDjvI4FFr5Y2KyMzAwGV1jmSz9GV7XrW-o62D0jgfLJ~A__&Key-Pair-Id=KUT5TJCACFTXG","author","New Mexico Legislature","date","2025-08-19T00:00:00Z","article","Representatives and coalition members told the Legislative Health & Human Services Committee that alcohol‑related harm remains a major public‑health problem in New Mexico and presented local data and a funding proposal aimed at prevention, treatment and tribal investments.

Why it matters: presenters and committee members framed higher excise taxes and a stable funding stream as tools to reduce youth initiation, finance prevention and treatment services statewide, and target funds to tribal communities that experience disproportionate alcohol‑related mortality.

Presentation summary and recommendations
Representative Ferrari and Senator Pinto introduced the Alcohol Harms Alleviation Coalition’s briefing. Coalition members cited national and state statistics showing increasing alcohol‑related mortality in New Mexico, with a peak of about 2,274 alcohol‑related deaths in 2021 and current annual totals near 2,000. The coalition presented economic estimates that excessive alcohol consumption cost New Mexico about $2.2 billion in 2010 and an inflation‑adjusted estimate of $3.1 billion in 2023 (about $3.93 per standard drink).

The coalition advocated a package of tax changes presented in prior sessions: a 25¢‑per‑drink excise increase and an additional sales or surtax mechanism intended to produce recurring revenue. Sponsors said a 6% sales surtax scenario had been projected to yield about $150–$200 million annually; a tribal allocation of roughly $50 million was proposed in earlier drafts to support tribally led programs.

Local Gallup data and service gaps
Deborah Martinez of the Gallup coalition described local service volume and funding. She said Gallup’s social detox program handled about 19,331 admissions in 2024; 10,575 were admitted under the detox‑reform intake standard because they were unable to care for themselves. Martinez said the city uses local liquor excise tax revenue (about $835,000 cited) to support services and that local law enforcement responds to about 52,424 calls per year.

Coalition members highlighted what they called the “alcohol harms paradox”: some disadvantaged groups, particularly American Indian and Alaska Native people, display lower reported average consumption but far higher alcohol‑related mortality and harms. Presenters urged that any statewide funding formula include direct tribal allocations and culturally grounded, tribally led solutions.

Questions and policy context raised by legislators
Committee members asked for implementation details and the reasons prior bills did not pass. Counsel and sponsors explained negotiations last session combined excise and surtax proposals and that revenue and tax structure were key sticking points in the tax committee. Legislators suggested additional outreach to insurers, behavioral‑health providers and DWI task forces, and recommended explicitly including tribal representatives in fund design.

What the coalition did not establish
Presenters acknowledged uncertainty about long‑term effects of legalization of cannabis products and possible substitution/combination effects with alcohol. They also noted that certain local changes (for example, closing small liquor miniature sales) had mixed economic impacts and sometimes led vendors to substitute other product sizes.

Bottom line
The coalition urged the committee to reintroduce a funding mechanism that raises excise or sales taxes on alcohol and dedicates revenue to prevention, treatment, tribal programs and local DWI resources. Gallup officials asked the committee to consider stable statewide funding to expand local detox, residential and housing supports and reduce alcohol‑related harms, especially among youth and tribal populations.","mediaType","Video","parentTitle","Legislative Health and Human Services Committee Aug 19, 2025 9:20 AM - 11:55 AM","oneSentenceSummary","Members of the Alcohol Harms Alleviation Coalition and Gallup officials briefed the committee on rising alcohol‑related harms in New Mexico, presented local detox and service data, and urged a statewide excise/sales tax package to fund prevention, treatment and tribal allocations.","taxTitle","Legislative Health & Human Services, Interim, Committees, Legislative, New Mexico","taxId",65389,"location","New Mexico","headline","","shortSummary",{"_33":77,"_35":36,"_37":38,"_39":78,"_41":79,"_43":80,"_45":81,"_47":82,"_49":83,"_51":84,"_53":85,"_55":56,"_57":58,"_59":86,"_61":62,"_63":64,"_65":87,"_67":68,"_69":70,"_71":72,"_73":74,"_75":74},6131872,"UNM study: prior authorization, denials and code churn consume clinicians’ time, frustrate rural providers",1695,34000,1729000,"/Search/View?dp=1&key=5727761-467263d70b5ae7bb98bf41d20523fba8&start=34&end=1729","https://assets.pipeline.soar.com/5727761-467263d70b5ae7bb98bf41d20523fba8/thumbnail_34000.jpg","/articles/6131872/New-Mexico/UNM-study-prior-authorization-denials-and-code-churn-consume-clinicians-time-frustrate-rural-providers","https://secure.pipeline.soar.com/6131872-375f73fbe2ce0c3f4b11335e6fcb7ac8/orig.mp4?Expires=1770809272&Signature=kA23NUo1WBm4Lv2tFfrUsCO9afcuV0jTw5tq01iAbf99pgtF-AWynUNGAtK7Istltkevgqx-eGtd1V-Objab6~nqSQqoTi0WJ5WX9hz2GqcZyvm5kxg1YuwyQYqsjTC-TBeE2aKUiSb0nE71Q5sByG-E5OJBEqWfK6J7EbZTfarx1qKiMxjOLxeQTyv9F~cLtbv-s6TtBxHef001ioL~XxQaXSXIDubaIWlBhQh~5HAdAgnvjzIH7276Bvgi9Jva9w7resKsSyeg-g-YXl3FdM2yDPjXbWBNgbpH7tHLChWnrbJdf8zY4XCf2Yb60LkXBDkdeOdpfMo4sT8uIbGwQg__&Key-Pair-Id=KUT5TJCACFTXG","Good morning: Melanie Sontak, a research assistant professor at the University of New Mexico’s Center for Social Policy, presented results from a small qualitative study the center conducted on medical billing, coding and claims in New Mexico. The study, commissioned by the Legislative Council Service and funded with GROW dollars, interviewed 31 health‑care workers (28 in focus groups and three by interview) from a mix of hospitals and smaller clinics across multiple counties.

The research sought to measure how much time staff spend at each step of the revenue cycle, what staffing and infrastructure are available, how practices vary by payer, and how the current system affects patient care and clinician well‑being. The study found substantial administrative burden across the revenue cycle and repeated examples of prior authorization, claim denials and frequent coding or formulary updates that remove time from patient care.

Why it matters: the committee heard that New Mexico clinicians already operate under tight capacity and that the added administrative tasks — especially for prior authorization and appeals — contribute to clinician burnout, delays in care and financial strain for facilities serving high shares of Medicaid patients.

Study methods and scope
Sontak told the committee the research was qualitative and limited in scale: 31 total participants working in billing, coding, claims and clinical roles were recruited from urban and rural facilities in Bernalillo, Chavez, Doña Ana, Los Alamos, Sandoval, San Juan, San Miguel and Santa Fe counties. Participants included clinicians, billing/claims professionals and administrators with routine billing responsibilities. The presenter cautioned the focus‑group approach documents experience and perceptions rather than producing statewide statistical estimates.

Main findings
- Time burden: clinicians reported about 3–4 hours per week spent on billing and insurance tasks (Sontak called this likely an underestimate). Nurses reported prior authorization work consuming roughly 2 hours a day in many clinics; some staff said they had spent up to 4 hours a day for multiple days straight trying to secure prior authorization. Prior authorization timelines varied; participants described typical turnarounds of 7–14 business days when a request passes on first submission, and noted some cases take months when modifications or appeals are required.

- During and after encounters: clinicians described documentation demands that shrink face‑to‑face time. One focus‑group clinician said a 30‑minute encounter often left 10–15 minutes for documentation. Billing staff also reported “backtracking” to correct denials tied to claims as old as nine to 12 months — and in some examples, up to two years — which requires substantial staff time to reconcile.

- Coding and rule churn: participants listed the International Classification of Diseases (ICD), Healthcare Common Procedure Coding System (HCPCS), Current Procedural Terminology (CPT) and payers’ formularies as multiple, frequently updated rule sets they must follow. Sontak said HCPCS, CPT and formulary updates are commonly annual but can effectively change more frequently, increasing training and implementation burden.

- Payer differences and reimbursement pressure: while frustrations were reported across public and private payers, participants singled out low Medicaid reimbursement as a financial strain for safety‑net providers. One study participant estimated Medicaid reimburses as little as 25% of billed charges in some cases (example given: a $40,000 claim yielding $10,000 reimbursement).

- Staffing and infrastructure: almost all participants said billing and coding departments lack adequate staffing or training to manage workloads effectively. High turnover among billers and coders was reported; respondents said credential programs do not always cover key practical tasks such as navigating denials and appeals. Participants described outsourcing billing as commonly disappointing, while early AI tools had mixed but sometimes positive reception.

- Rural impact and access: rural respondents described network gaps such as no in‑network lab nearby, forcing patients to pay out of pocket or travel long distances. Participants said rural clinics with high Medicaid populations are especially vulnerable to low reimbursement and workforce drain.

Examples quoted from participants
- A focus‑group clinician said, “Clinical decision‑making is driven by insurance formulary, not individualized patient care.”
- Sontak summarized: clinicians and billers “spend a large amount of time on billing and insurance related tasks that interfere with time spent with patients.”

Discussion and next steps raised in committee
Committee members and the presenter debated scope and next steps. Several legislators asked for additional, larger studies and for follow‑up briefings with insurers and the Legislative Finance Committee. Sontak and committee members agreed to share the final report with staff (the presenter said she would provide the completed report to the committee’s staffer, Xander) and to consider broader studies on algorithmic denials, malpractice and financing models.

What this study does not show
Sontak emphasized the study documents workers’ experiences rather than proving causal relationships or estimating statewide prevalence. The committee heard repeatedly that larger, quantitative, and payer‑side data would be needed to quantify how much each factor (CMS rules, individual insurer practices, formulary decisions) contributes to delays or denials.

Bottom line
The UNM Center for Social Policy’s focused study presented qualitative evidence that prior authorization, claim denials, frequent coding and formulary changes, and staffing shortages combine to consume clinician and billing staff time, contribute to burnout and complicate access to specialized care — with rural providers especially exposed to access and financial risk. Committee members suggested follow‑up with payers, larger studies, and targeted policy work on prior authorization and algorithmic denials.

","A small UNM-commissioned study of billing, coding and claims work in New Mexico found clinicians and billers spend substantial time on prior authorization and denials, that frequent coding and formulary changes add extra work, and that rural facilities face steeper access and reimbursement pressures.","actionData","errors"]

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Gallup coalition renews call for higher alcohol taxes and dedicated funds after local detox data

UNM study: prior authorization, denials and code churn consume clinicians’ time, frustrate rural providers