SENATE BILL 359

52nd legislature - STATE OF NEW MEXICO - first session, 2015

INTRODUCED BY

Bill B. O'Neill

AN ACT

RELATING TO HEALTH COVERAGE; ENACTING SECTIONS OF THE HEALTH CARE PURCHASING ACT, THE NEW MEXICO INSURANCE CODE, THE HEALTH MAINTENANCE ORGANIZATION LAW AND THE NONPROFIT HEALTH CARE PLAN LAW TO ESTABLISH LIMITS ON COST SHARING FOR PHYSICAL REHABILITATION SERVICES.

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] PHYSICAL REHABILITATION SERVICES--LIMITS ON COST SHARING.--

          A. Group health coverage, including any form of self-insurance, offered, issued or renewed under the Health Care Purchasing Act that offers coverage of physical rehabilitation services shall not impose a copayment or coinsurance on those physical rehabilitation services that exceeds the lesser of:

                (1) the copayment or coinsurance imposed for specialist services; or

                (2) one hundred twenty percent of the copayment or coinsurance amount imposed for primary care services.

          B. As used in this section:

                (1) "physical rehabilitation services" means services aimed at maximizing an individual's level of function or returning to a prior level of function that are provided by a licensed physical therapist, occupational therapist or chiropractic physician or other person licensed to provide the services; and

                (2) "primary care services" means the first level of basic or general health care for a person's health needs, including diagnostic and treatment services, initiation of referrals for other health care services and maintenance of the continuity of care when appropriate."

     SECTION 2. A new section of Chapter 59A, Article 22 NMSA 1978 is enacted to read:

     "[NEW MATERIAL] PHYSICAL REHABILITATION SERVICES--LIMITS ON COST SHARING.--

          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 that offers coverage of physical rehabilitation services shall not impose a copayment or coinsurance on those physical rehabilitation services that exceeds the lesser of:

                (1) the copayment or coinsurance imposed for specialist services; or

                (2) one hundred twenty percent of the copayment or coinsurance amount imposed for primary care services.

          B. As used in this section:

                (1) "physical rehabilitation services" means services aimed at maximizing an individual's level of function or returning to a prior level of function that are provided by a licensed physical therapist, occupational therapist or chiropractic physician or other person licensed to provide the services; and

                (2) "primary care services" means the first level of basic or general health care for a person's health needs, including diagnostic and treatment services, initiation of referrals for other health care services and maintenance of the continuity of care when appropriate."

     SECTION 3. A new section of Chapter 59A, Article 23 NMSA 1978 is enacted to read:

     "[NEW MATERIAL] PHYSICAL REHABILITATION SERVICES--LIMITS ON COST SHARING.--

          A. A group or blanket health insurance policy, health care plan or certificate of health insurance that is delivered, issued for delivery or renewed in this state that offers coverage of physical rehabilitation services shall not impose a copayment or coinsurance on those physical rehabilitation services that exceeds the lesser of:

                (1) the copayment or coinsurance imposed for specialist services; or

                (2) one hundred twenty percent of the copayment or coinsurance amount imposed for primary care services.

          B. As used in this section:

                (1) "physical rehabilitation services" means services aimed at maximizing an individual's level of function or returning to a prior level of function that are provided by a licensed physical therapist, occupational therapist or chiropractic physician or other person licensed to provide the services; and

                (2) "primary care services" means the first level of basic or general health care for a person's health needs, including diagnostic and treatment services, initiation of referrals for other health care services and maintenance of the continuity of care when appropriate."

     SECTION 4. A new section of the Health Maintenance Organization Law is enacted to read:

     "[NEW MATERIAL] PHYSICAL REHABILITATION SERVICES--LIMITS ON COST SHARING.--

          A. An individual or group health maintenance contract that is delivered, issued for delivery or renewed in this state that offers coverage of physical rehabilitation services shall not impose a copayment or coinsurance on those physical rehabilitation services that exceeds the lesser of:

                (1) the copayment or coinsurance imposed for specialist services; or

                (2) one hundred twenty percent of the copayment or coinsurance amount imposed for primary care services.

          B. As used in this section:

                (1) "physical rehabilitation services" means services aimed at maximizing an individual's level of function or returning to a prior level of function that are provided by a licensed physical therapist, occupational therapist or chiropractic physician or other person licensed to provide the services; and

                (2) "primary care services" means the first level of basic or general health care for a person's health needs, including diagnostic and treatment services, initiation of referrals for other health care services and maintenance of the continuity of care when appropriate."

     SECTION 5. A new section of the Nonprofit Health Care Plan Law is enacted to read:

     "[NEW MATERIAL] PHYSICAL REHABILITATION SERVICES--LIMITS ON COST SHARING.--

          A. An individual or group health care plan that is delivered, issued for delivery or renewed in this state that offers coverage of physical rehabilitation services shall not impose a copayment or coinsurance on those physical rehabilitation services that exceeds the lesser of:

                (1) the copayment or coinsurance imposed for specialist services; or

                (2) one hundred twenty percent of the copayment or coinsurance amount imposed for primary care services.

          B. As used in this section:

                (1) "physical rehabilitation services" means services aimed at maximizing an individual's level of function or returning to a prior level of function that are provided by a licensed physical therapist, occupational therapist or chiropractic physician or other person licensed to provide the services; and

                (2) "primary care services" means the first level of basic or general health care for a person's health needs, including diagnostic and treatment services, initiation of referrals for other health care services and maintenance of the continuity of care when appropriate."