HOUSE HEALTH AND GOVERNMENT AFFAIRS COMMITTEE SUBSTITUTE FOR

HOUSE BILL 365

49th legislature - STATE OF NEW MEXICO - first session, 2009

AN ACT

RELATING TO HEALTH INSURANCE; MANDATING THAT PRIVATE AND PUBLIC HEALTH INSURANCE INCLUDE COVERAGE FOR ANY CANCER THERAPIES FOR CHILDREN.

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

     Section 1. A new section of the Health Care Purchasing Act is enacted to read:

     "[NEW MATERIAL] CANCER COVERAGE FOR CHILDREN.--

          A. Group health care coverage, including any form of self-insurance, offered, issued or renewed under the Health Care Purchasing Act shall provide coverage for any cancer therapy approved by the federal food and drug administration or any cancer therapy subject to a federal food and drug administration investigational new drug application that is prescribed for individuals from birth to nineteen years of age, without regard to:

                (1) its inclusion on any formulary; or

                (2) any other limiting factor for therapies provided in accordance with the prescribing physician's best medical judgment and meeting reasonable standards of quality of care consistent with prevailing professionally recognized standards of medical practice.

          B. This section applies to any therapy prescribed to cancer patients, whether to treat the cancer itself, to treat its side effects, to treat the side effects of the treatment itself or to improve the likelihood of treatment success.

          C. The provisions of this section shall not apply to short-term travel, accident-only or limited or specified disease policies."

     Section 2. A new section of the Public Assistance Act is enacted to read:

     "[NEW MATERIAL] CANCER COVERAGE FOR CHILDREN.--

          A. The department shall promulgate rules for coverage for any cancer therapy approved by the federal food and drug administration or any cancer therapy subject to a federal food and drug administration investigational new drug application that is prescribed for medicaid recipients from birth to nineteen years of age without regard to:

                (1) its inclusion on any formulary; or

HHGAC/HB 365

                (2) any other limiting factor for therapies provided in accordance with the prescribing physician's best medical judgment and meeting reasonable standards of quality of care consistent with prevailing professionally recognized standards of medical practice.

          B. This section applies to any therapy prescribed to cancer patients, whether to treat the cancer itself, to treat its side effects, to treat the side effects of the treatment itself or to improve the likelihood of treatment success.

          C. The department shall ensure that the cancer therapy coverage described in Subsections A and B of this section is in compliance with federal requirements and shall apply for any waivers or medicaid state plan amendments that the federal department of health and human services or the federal Social Security Act requires to institute that cancer therapy coverage.

          D. Nothing in this section shall require the department to expend state funds for cancer therapies when the secretary does not reasonably expect to receive federal matching funds for those expenditures.

          E. The department shall make every effort to obtain from pharmaceutical manufacturers any medications prescribed for cancer patients free of charge when federal matching funds are unavailable. 

          F. The department shall quarterly publish in a publicly accessible and prominent manner on its web site a list of pharmaceutical manufacturers that agree to provide medications prescribed for cancer patients free of charge and a list of those pharmaceutical manufacturers that refuse to supply those medications free of charge."

     Section 3. A new section of Chapter 59A, Article 22 NMSA 1978 is enacted to read:

     "[NEW MATERIAL] CANCER COVERAGE FOR CHILDREN.--

          A. An individual or group health insurance policy, health care plan or certificate of health insurance that is delivered, issued for delivery or renewed in this state shall provide coverage for any cancer therapy approved by the federal food and drug administration or any cancer therapy subject to a federal food and drug administration investigational new drug application that is prescribed for individuals from birth to nineteen years of age without regard to:

                (1) its inclusion on any formulary; or

                (2) any other limiting factor for therapies provided in accordance with the prescribing physician's best medical judgment and meeting reasonable standards of quality of care consistent with prevailing professionally recognized standards of medical practice.

          B. This section applies to any therapy prescribed to cancer patients, whether to treat the cancer itself, to

                                                   HHGAC/HB 365

treat its side effects, to treat the side effects of the treatment itself or to improve the likelihood of treatment success.

          C. The provisions of this section shall not apply to short-term travel, accident-only or limited or specified disease policies."  

     Section 4. A new section of Chapter 59A, Article 23 NMSA 1978 is enacted to read:

     "[NEW MATERIAL] CANCER COVERAGE FOR CHILDREN.--

          A. A blanket or group health insurance policy or contract that is delivered, issued for delivery or renewed in this state shall provide coverage for any cancer therapy approved by the federal food and drug administration or any cancer therapy subject to a federal food and drug administration investigational new drug application that is prescribed for individuals from birth to nineteen years of age without regard to:

                (1) its inclusion on any formulary; or

                (2) any other limiting factor for therapies provided in accordance with the prescribing physician's best medical judgment and meeting reasonable standards of quality of care consistent with prevailing professionally recognized standards of medical practice.

          B. This section applies to any therapy prescribed to cancer patients, whether to treat the cancer itself, to treat its side effects, to treat the side effects of the treatment itself or to improve the likelihood of treatment success.

          C. The provisions of this section shall not apply to short-term travel, accident-only or limited or specified disease policies."

     Section 5. A new section of Chapter 59A, Article 46 NMSA 1978 is enacted to read:

     "[NEW MATERIAL] CANCER COVERAGE FOR CHILDREN.--

          A. An individual or group health maintenance contract that is delivered, issued for delivery or renewed in this state shall provide coverage for any cancer therapy approved by the federal food and drug administration or any cancer therapy subject to a federal food and drug administration investigational new drug application that is prescribed for individuals from birth to nineteen years of age without regard to:

                (1) its inclusion on any formulary; or

                (2) any other limiting factor for therapies provided in accordance with the prescribing physician's best medical judgment and meeting reasonable standards of quality of care consistent with prevailing professionally recognized standards of medical practice.

          B. This section applies to any therapy prescribed to cancer patients, whether to treat the cancer itself, to

HHGAC/HB 365

treat its side effects, to treat the side effects of the treatment itself or to improve the likelihood of treatment success.

          C. The provisions of this section shall not apply to short-term travel, accident-only or limited or specified disease policies."

     Section 6. A new section of Chapter 59A, Article 47 NMSA 1978 is enacted to read:

     "[NEW MATERIAL] CANCER COVERAGE FOR CHILDREN.--

          A. An individual or group health insurance policy, health care plan or certificate of health insurance that is delivered, issued for delivery or renewed in the state shall provide coverage for any cancer therapy approved by the federal food and drug administration or any cancer therapy subject to a federal food and drug administration investigational new drug application that is prescribed for individuals from birth to nineteen years of age, without regard to:

                (1) its inclusion on any formulary; or

                (2) any other limiting factor for therapies provided in accordance with the prescribing physician's best medical judgment and meeting reasonable standards of quality of care consistent with prevailing professionally recognized standards of medical practice.

          B. This section applies to any therapy prescribed to cancer patients, whether to treat the cancer itself, to treat its side effects, to treat the side effects of the treatment itself or to improve the likelihood of treatment success.

          C. The provisions of this section shall not apply to short-term travel, accident-only or limited or specified disease policies."

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