HOUSE BILL 570

57th legislature - STATE OF NEW MEXICO - first session, 2025

INTRODUCED BY

Jenifer Jones and Elizabeth "Liz" Thomson

and Joshua N. Hernandez

 

 

 

 

AN ACT

RELATING TO INSURANCE; AMENDING AND ENACTING SECTIONS OF THE PRIOR AUTHORIZATION ACT TO PROHIBIT THE IMPOSITION OF PRIOR AUTHORIZATION REQUIREMENTS FOR CERTAIN COVERED SERVICES AND PRESCRIPTION MEDICATION.

 

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF NEW MEXICO:

     SECTION 1. Section 59A-22B-1 NMSA 1978 (being Laws 2019, Chapter 187, Section 3) is amended to read:

     "59A-22B-1. SHORT TITLE.--[Sections 3 through 7 of this act] Chapter 59A, Article 22B NMSA 1978 may be cited as the "Prior Authorization Act"."

     SECTION 2. A new section of the Prior Authorization Act is enacted to read:

     "[NEW MATERIAL] PRIOR AUTHORIZATION FOR CHEMOTHERAPY SERVICES PROHIBITED.--

          A. A health insurer shall not require prior authorization for covered chemotherapy services.

          B. A health insurer may require a health care provider to provide notification to the health insurer after the initiation of chemotherapy services.

          C. A health insurer may require a health care provider to develop and submit a treatment plan for a covered person receiving chemotherapy services in a manner that is compliant with federal law."

     SECTION 3. A new section of the Prior Authorization Act is enacted to read:

     "[NEW MATERIAL] PRIOR AUTHORIZATION FOR DIALYSIS SERVICES PROHIBITED.--

          A. A health insurer shall not require prior authorization for covered dialysis services.

          B. A health insurer may require a health care provider to provide notification to the health insurer after the initiation of dialysis services.

          C. A health insurer may require a health care provider to develop and submit a treatment plan for a covered person receiving dialysis services in a manner that is compliant with federal law."

     SECTION 4. A new section of the Prior Authorization Act is enacted to read:

     "[NEW MATERIAL] PRIOR AUTHORIZATION FOR ELDER CARE SERVICES PROHIBITED.--

          A. A health insurer shall not require prior authorization for covered elder care services.

          B. A health insurer may require a health care provider to provide notification to the health insurer after the initiation of elder care services.

          C. A health insurer may require a health care provider to develop and submit a treatment plan for a covered person receiving elder care services in a manner that is compliant with federal law."

     SECTION 5. A new section of the Prior Authorization Act is enacted to read:

     "[NEW MATERIAL] PRIOR AUTHORIZATION FOR HOME HEALTH CARE SERVICES PROHIBITED.--

          A. A health insurer shall not require prior authorization for covered home health care services.                 B. A health insurer may require a health care provider to provide notification to the health insurer after the initiation of home health care services.

          C. A health insurer may require a health care provider to develop and submit a treatment plan for a covered person receiving home health care services in a manner that is compliant with federal law."

     SECTION 6. Section 59A-22B-8 NMSA 1978 (being Laws 2023, Chapter 114, Section 13, as amended) is amended to read:

     "59A-22B-8. PRIOR AUTHORIZATION FOR PRESCRIPTION DRUGS OR STEP THERAPY FOR CERTAIN CONDITIONS PROHIBITED.--

          A. Coverage for medication approved by the federal food and drug administration that is prescribed for the treatment of an autoimmune disorder, cancer, diabetes, high blood pressure or a substance use disorder, pursuant to a medical necessity determination, shall not be subject to prior authorization, except in cases in which a biosimilar, interchangeable biologic or generic version is available.

          B. A health insurer shall not impose step therapy requirements before authorizing coverage for medication approved by the federal food and drug administration that is prescribed for the treatment of an autoimmune disorder, cancer, diabetes, high blood pressure or a substance use disorder, pursuant to a medical necessity determination, except in cases in which a biosimilar, interchangeable biologic or generic version is available."

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