HOUSE BILL 216

53rd legislature - STATE OF NEW MEXICO - first session, 2017

INTRODUCED BY

Christine Trujillo

AN ACT

RELATING TO HEALTH COVERAGE; ENACTING SECTIONS OF THE HEALTH CARE PURCHASING ACT, PUBLIC ASSISTANCE ACT, CHAPTER 59A, ARTICLES 22 AND 23 NMSA 1978, THE HEALTH MAINTENANCE ORGANIZATION LAW AND THE NONPROFIT HEALTH CARE PLAN LAW TO BAN DISCRIMINATION AGAINST PROFESSIONAL ART THERAPISTS.

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] PROFESSIONAL ART THERAPISTS--BAN ON DISCRIMINATION.-- 

          A. If a group health plan covers services that are within the scope of practice of professional art therapists, the group health plan shall not:

                (1) deny the right to participate in the group health plan's provider network to any professional art therapist who is willing to participate under the same terms and conditions as any other health care practitioner who provides the same services;

                (2) reimburse a professional art therapist at a lower rate than any other health care practitioner for the same service;

                (3) prevent an enrollee from selecting a professional art therapist to provide services within the professional art therapist's scope of practice under the same terms and conditions as those offered to any other health care practitioner; or

                (4) permit or mandate a difference in coverage or impose any different conditions or disincentives that would likely cause an enrollee to choose another type of health care practitioner over a professional art therapist for services that are covered under the group health plan.

          B. The provisions of this section shall not be construed to prevent a group health plan from establishing varying reimbursement rates among health care practitioners based on quality or performance measures.

          C. As used in this section:

                (1) "health care practitioner" means an individual licensed or certified to provide health care in the ordinary course of business; and

                (2) "professional art therapist" means an individual licensed as a professional art therapist pursuant to the Counseling and Therapy Practice Act."

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

     "[NEW MATERIAL] PROFESSIONAL ART THERAPISTS--BAN ON DISCRIMINATION.--

          A. The secretary shall ensure that a medical assistance plan that covers services that are within the scope of practice of professional art therapists does not:

                (1) deny the right to participate in the medical assistance plan's provider network to any professional art therapist who is willing to participate under the same terms and conditions as any other health care practitioner who provides the same services;

                (2) reimburse a professional art therapist at a lower rate than any other health care practitioner for the same service;

                (3) prevent a recipient from selecting a professional art therapist to provide services within the professional art therapist's scope of practice under the same terms and conditions as those offered to any other health care practitioner; or

                (4) permit or mandate a difference in coverage or impose any different conditions or disincentives that would likely cause a recipient to choose another type of health care practitioner over a professional art therapist for services that are covered under the medical assistance plan.

          B. The provisions of this section shall not be construed to prevent a medical assistance plan from establishing varying reimbursement rates among health care practitioners based on quality or performance measures.

          C. As used in this section:

                (1) "health care practitioner" means an individual licensed or certified to provide health care in the ordinary course of business; and

                (2) "professional art therapist" means an individual licensed as a professional art therapist pursuant to the Counseling and Therapy Practice Act."

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

     "[NEW MATERIAL] PROFESSIONAL ART THERAPISTS--BAN ON DISCRIMINATION.--

          A. An individual health insurance plan, policy or certificate of insurance that covers services that are within the scope of practice of professional art therapists shall not:

                (1) deny the right to participate in the plan's, policy's or certificate's provider network to any professional art therapist who is willing to participate under the same terms and conditions as any other health care practitioner who provides the same services;

                (2) reimburse a professional art therapist at a lower rate than any other health care practitioner for the same service;

                (3) prevent an insured from selecting a professional art therapist to provide services within the professional art therapist's scope of practice under the same terms and conditions as those offered to any other health care practitioner; or

                (4) permit or mandate a difference in coverage or impose any different conditions or disincentives that would likely cause an insured to choose another type of health care practitioner over a professional art therapist for services that are covered under the health insurance plan, policy or certificate of insurance.

          B. The provisions of this section shall not be construed to prevent an insurer from establishing varying reimbursement rates among health care practitioners based on quality or performance measures.

          C. As used in this section:

                (1) "health care practitioner" means an individual licensed or certified to provide health care in the ordinary course of business; and

                (2) "professional art therapist" means an individual licensed as a professional art therapist pursuant to the Counseling and Therapy Practice Act."

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

     "[NEW MATERIAL] PROFESSIONAL ART THERAPISTS--BAN ON DISCRIMINATION.--

          A. A group or blanket health insurance plan, policy or certificate of insurance that covers services that are within the scope of practice of professional art therapists shall not:

                (1) deny the right to participate in the plan's, policy's or certificate's provider network to any professional art therapist who is willing to participate under the same terms and conditions as any other health care practitioner who provides the same services;

                (2) reimburse a professional art therapist at a lower rate than any other health care practitioner for the same service;

                (3) prevent an insured from selecting a professional art therapist to provide services within the professional art therapist's scope of practice under the same terms and conditions as those offered to any other health care practitioner; or

                (4) permit or mandate a difference in coverage or impose any different conditions or disincentives that would likely cause an insured to choose another type of health care practitioner over a professional art therapist for services that are covered under the health insurance plan, policy or certificate of insurance.

          B. The provisions of this section shall not be construed to prevent an insurer from establishing varying reimbursement rates among health care practitioners based on quality or performance measures.

          C. As used in this section:

                (1) "health care practitioner" means an individual licensed or certified to provide health care in the ordinary course of business; and

                (2) "professional art therapist" means an individual licensed as a professional art therapist pursuant to the Counseling and Therapy Practice Act."

     SECTION 5. A new section of the Health Maintenance Organization Law is enacted to read:

     "[NEW MATERIAL] PROFESSIONAL ART THERAPISTS--BAN ON DISCRIMINATION.--

          A. Health coverage provided pursuant to an individual or group health maintenance organization contract that covers services that are within the scope of practice of professional art therapists shall not:

                (1) deny the right to participate in the health maintenance organization's provider network to any professional art therapist who is willing to participate under the same terms and conditions as any other health care practitioner who provides the same services;

                (2) reimburse a professional art therapist at a lower rate than any other health care practitioner for the same service;

                (3) prevent an enrollee from selecting a professional art therapist to provide services within the professional art therapist's scope of practice under the same terms and conditions as those offered to any other health care practitioner; or

                (4) permit or mandate a difference in coverage or impose any different conditions or disincentives that would likely cause an enrollee to choose another type of health care practitioner over a professional art therapist for services that are covered under the health maintenance organization contract.

          B. The provisions of this section shall not be construed to prevent a health maintenance organization from establishing varying reimbursement rates among health care practitioners based on quality or performance measures.

          C. As used in this section:

                (1) "health care practitioner" means an individual licensed or certified to provide health care in the ordinary course of business; and

                (2) "professional art therapist" means an individual licensed as a professional art therapist pursuant to the Counseling and Therapy Practice Act."

     SECTION 6. A new section of the Nonprofit Health Care Plan Law is enacted to read:

     "[NEW MATERIAL] PROFESSIONAL ART THERAPISTS--BAN ON DISCRIMINATION.--

          A. An individual or group nonprofit health care plan that covers services that are within the scope of practice of professional art therapists shall not:

                (1) deny the right to participate in the health care plan's provider network to any professional art therapist who is willing to participate under the same terms and conditions as any other health care practitioner who provides the same services;

                (2) reimburse a professional art therapist at a lower rate than any other health care practitioner for the same service;

                (3) prevent a subscriber from selecting a professional art therapist to provide services within the professional art therapist's scope of practice under the same terms and conditions as those offered to any other health care practitioner; or

                (4) permit or mandate a difference in coverage or impose any different conditions or disincentives that would likely cause a subscriber to choose another type of health care practitioner over a professional art therapist for services that are covered under the health care plan.

          B. The provisions of this section shall not be construed to prevent a health care plan from establishing varying reimbursement rates among health care practitioners based on quality or performance measures.

          C. As used in this section:

                (1) "health care practitioner" means an individual licensed or certified to provide health care in the ordinary course of business; and

                (2) "professional art therapist" means an individual licensed as a professional art therapist pursuant to the Counseling and Therapy Practice Act."

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