HOUSE BILL 27
56th legislature - STATE OF NEW MEXICO - first session, 2023
INTRODUCED BY
Christine Chandler and Elizabeth "Liz" Stefanics and
Elizabeth "Liz" Thomson
AN ACT
RELATING TO HEALTH INSURANCE 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 REQUIRE COVERAGE OF DIAGNOSTIC AND SUPPLEMENTAL BREAST EXAMINATIONS.
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] DIAGNOSTIC AND SUPPLEMENTAL BREAST EXAMINATIONS.--
A. Group health coverage, including self-insurance, offered, issued, amended, delivered or renewed under the Health Care Purchasing Act shall provide coverage for eligible insureds to receive diagnostic and supplemental breast examinations.
B. An insurer providing coverage for diagnostic and supplemental breast examinations pursuant to this section shall ensure that coverage is provided in a manner that does not limit benefits otherwise allowable under a similar policy, plan or certificate.
C. Coverage for diagnostic and supplemental breast examinations provided pursuant to this section shall not be subject to cost sharing.
D. As used in this section:
(1) "cost sharing" means a deductible, coinsurance, copayment and any maximum limitation on the application of such a deductible, coinsurance, copayment or similar out-of-pocket expense;
(2) "diagnostic breast examination" means a medically necessary and appropriate examination of the breast using diagnostic mammography, breast magnetic resonance imaging or breast ultrasound that evaluates an abnormality:
(a) seen or suspected from a screening examination for breast cancer; or
(b) detected by another means of examination; and
(3) "supplemental breast examination" means a medically necessary and appropriate examination of the breast using breast magnetic resonance imaging or breast ultrasound that is:
(a) used to screen for breast cancer when there is no abnormality seen or suspected; and
(b) based on personal or family medical history or additional factors that may increase the individual's risk of breast cancer."
SECTION 2. A new section of Chapter 59A, Article 22 NMSA 1978 is enacted to read:
"[NEW MATERIAL] DIAGNOSTIC AND SUPPLEMENTAL BREAST
EXAMINATIONS.--
A. An individual or group health insurance policy, health care plan or certificate of insurance that is delivered, issued for delivery or renewed in this state shall provide coverage for eligible insureds to receive diagnostic and supplemental breast examinations.
B. An individual or group health insurance policy,
health care plan or certificate of health insurance providing
coverage pursuant to this section shall ensure that coverage is
provided in a manner that does not limit benefits otherwise
allowable as a medical assistance plan otherwise provided to
insureds.
C. Coverage for diagnostic and supplemental breast
examinations provided pursuant to this section shall not be
subject to cost sharing.
D. As used in this section:
(1) "cost sharing" means a deductible,
coinsurance, copayment and any maximum limitation on the
application of such a deductible, coinsurance, copayment or
similar out-of-pocket expense;
(2) "diagnostic breast examination" means a
medically necessary and appropriate examination of the breast using diagnostic mammography, breast magnetic resonance imaging or breast ultrasound that evaluates an abnormality:
(a) seen or suspected from a screening examination for breast cancer; or
(b) detected by another means of examination; and
(3) "supplemental breast examination" means a
medically necessary and appropriate examination of the breast using breast magnetic resonance imaging or breast ultrasound that is:
(a) used to screen for breast cancer when there is no abnormality seen or suspected; and
(b) based on personal or family medical
history or additional factors that may increase the individual's risk of breast cancer."
SECTION 3. A new section of Chapter 59A, Article 22 NMSA 1978 is enacted to read:
"[NEW MATERIAL] COVERAGE EXCLUSION.--Coverage of diagnostic and supplemental breast examinations provided pursuant to Section 2 of this 2023 act is excluded for high- deductible individual and group health insurance policies, health care plans or certificates of insurance with health savings accounts delivered or issued for delivery in this state until an insured's deductible has been met."
SECTION 4. A new section of Chapter 59A, Article 23 NMSA 1978 is enacted to read:
"[NEW MATERIAL] DIAGNOSTIC AND SUPPLEMENTAL BREAST EXAMINATIONS.--
A. A blanket 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 eligible insureds to receive diagnostic and supplemental breast examinations.
B. A blanket or group health insurance policy, health care plan or certificate of health insurance providing coverage pursuant to this section shall ensure that coverage is provided in a manner that does not limit benefits otherwise allowable as a medical assistance plan otherwise provided to insureds.
C. Coverage for diagnostic and supplemental breast examinations provided pursuant to this section shall not be subject to cost sharing.
D. As used in this section:
(1) "cost sharing" means a deductible, coinsurance, copayment and any maximum limitation on the application of such a deductible, coinsurance, copayment or similar out-of-pocket expense;
(2) "diagnostic breast examination" means a medically necessary and appropriate examination of the breast using diagnostic mammography, breast magnetic resonance imaging or breast ultrasound that evaluates an abnormality:
(a) seen or suspected from a screening examination for breast cancer; or
(b) detected by another means of examination; and
(3) "supplemental breast examination" means a medically necessary and appropriate examination of the breast using breast magnetic resonance imaging or breast ultrasound that is:
(a) used to screen for breast cancer when there is no abnormality seen or suspected; and
(b) based on personal or family medical history or additional factors that may increase the individual's risk of breast cancer."
SECTION 5. A new section of Chapter 59A, Article 23 NMSA 1978 is enacted to read:
"[NEW MATERIAL] COVERAGE EXCLUSION.--Coverage of diagnostic and supplemental breast examinations provided pursuant to Section 4 of this 2023 act is excluded for high-deductible individual or group health insurance policies, health care plans or certificates of insurance with health savings accounts delivered or issued for delivery in this state until an insured's deductible has been met."
SECTION 6. A new section of the Health Maintenance Organization Law is enacted to read:
"[NEW MATERIAL] DIAGNOSTIC AND SUPPLEMENTAL BREAST EXAMINATIONS.--
A. An individual or group health maintenance organization contract that is delivered, issued for delivery or renewed in this state shall provide coverage for eligible enrollees to receive diagnostic and supplemental breast examinations.
B. A health maintenance organization contract pursuant to this section shall ensure that coverage is provided in a manner that does not limit benefits otherwise allowable as a medical assistance plan otherwise provided to enrollees.
C. Coverage for diagnostic and supplemental breast examinations provided pursuant to this section shall not be subject to cost sharing.
D. As used in this section:
(1) "cost sharing" means a deductible, coinsurance, copayment and any maximum limitation on the application of such a deductible, coinsurance, copayment or similar out-of-pocket expense;
(2) "diagnostic breast examination" means a medically necessary and appropriate examination of the breast using diagnostic mammography, breast magnetic resonance imaging or breast ultrasound that evaluates an abnormality:
(a) seen or suspected from a screening examination for breast cancer; or
(b) detected by another means of examination; and
(3) "supplemental breast examination" means a medically necessary and appropriate examination of the breast using breast magnetic resonance imaging or breast ultrasound that is:
(a) used to screen for breast cancer when there is no abnormality seen or suspected; and
(b) based on personal or family medical history or additional factors that may increase the individual's risk of breast cancer."
SECTION 7. A new section of the Health Maintenance Organization Law is enacted to read:
"[NEW MATERIAL] COVERAGE EXCLUSION.--Coverage of diagnostic and supplemental breast examinations provided pursuant to Section 6 of this 2023 act is excluded for high- deductible individual or group health maintenance organization contracts with health savings accounts delivered or issued for delivery in this state until an enrollee's deductible has been met."
SECTION 8. A new section of the Nonprofit Health Care
Plan Law is enacted to read:
"[NEW MATERIAL] DIAGNOSTIC AND SUPPLEMENTAL BREAST EXAMINATIONS.--
A. An individual or group health care plan that is delivered, issued for delivery or renewed in this state shall provide coverage for eligible subscribers to receive diagnostic and supplemental breast examinations.
B. An individual or group health plan providing coverage pursuant to this section shall ensure that coverage is provided in a manner that does not limit benefits otherwise allowable as a medical assistance plan otherwise provided to subscribers.
C. Coverage for diagnostic and supplemental breast examinations provided pursuant to this section shall not be subject to cost sharing.
D. As used in this section:
(1) "cost sharing" means a deductible, coinsurance, copayment and any maximum limitation on the application of such a deductible, coinsurance, copayment or similar out-of-pocket expense;
(2) "diagnostic breast examination" means a medically necessary and appropriate examination of the breast using diagnostic mammography, breast magnetic resonance imaging or breast ultrasound that evaluates an abnormality:
(a) seen or suspected from a screening examination for breast cancer; or
(b) detected by another means of examination; and
(3) "supplemental breast examination" means a medically necessary and appropriate examination of the breast using breast magnetic resonance imaging or breast ultrasound that is:
(a) used to screen for breast cancer when there is no abnormality seen or suspected; and
(b) based on personal or family medical history or additional factors that may increase the individual's risk of breast cancer."
SECTION 9. A new section of the Nonprofit Health Care Plan Law is enacted to read:
"[NEW MATERIAL] COVERAGE EXCLUSION.--Coverage of diagnostic and supplemental breast examinations provided pursuant to Section 8 of this 2023 act is excluded for high- deductible health care plans with health savings accounts until a covered person's deductible has been met."
SECTION 10. APPLICABILITY.--The provisions of this act
apply to health insurance policies, health care plans,
certificates of health insurance or health maintenance
organization contracts that are delivered, issued for delivery
or renewed in this state on or after January 1, 2024.
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