AN ACT
RELATING TO HEALTH INSURANCE;
REQUIRING COVERAGE FOR MEDICAL DIETS REQUIRED TO CONTROL GENETIC INBORN ERRORS
OF METABOLISM; ENACTING SECTIONS OF THE NMSA 1978.
BE IT ENACTED BY THE LEGISLATURE OF
THE STATE OF NEW MEXICO:
Section 1. A new section of Chapter 59A, Article 22 NMSA
1978 is enacted to read:
"COVERAGE FOR MEDICAL
DIETS FOR GENETIC INBORN ERRORS OF METABOLISM.--
A. As of July 1, 2003, each individual and group
health insurance policy, health care plan, certificate of health insurance and
managed health care plan delivered, issued for delivery, renewed, extended or
modified in this state shall provide coverage for the treatment of genetic
inborn errors of metabolism that involve amino acid, carbohydrate and fat
metabolism and for which medically standard methods of diagnosis, treatment and
monitoring exist.
B. Coverage shall include expenses of
diagnosing, monitoring and controlling disorders by nutritional and medical
assessment, including clinical services, biochemical analysis, medical
supplies, prescription drugs, corrective lenses for conditions related to the
genetic inborn error of metabolism, nutritional management and special medical
foods used in treatment to compensate for the metabolic abnormality and to
maintain adequate nutritional status.
C. Services required to be covered pursuant to
this section are subject to the terms and conditions of the applicable
individual or group policy or plan that establishes durational limits, dollar
limits, deductibles and co-payments as long as the terms are not less favorable
than for physical illness generally.
D. As used in this section:
(1) "genetic inborn error of
metabolism" means a rare, inherited disorder that:
(a) is present at birth;
(b) if untreated, results in mental
retardation or death; and
(c) causes the necessity for consumption of
special medical foods;
(2) "special medical foods" means
nutritional substances in any form that are:
(a) formulated to be consumed or administered
internally under the supervision of a physician;
(b) specifically processed or formulated to be
distinct in one or more nutrients present in natural food;
(c) intended for the medical and nutritional
management of patients with limited capacity to metabolize ordinary foodstuffs
or certain nutrients contained in ordinary foodstuffs or who have other
specific nutrient requirements as established by medical evaluation; and
(d) essential to optimize growth, health and
metabolic homeostasis; and
(3) "treatment" means medical services
provided by licensed health care professionals, including physicians,
dieticians and nutritionists, with specific training in managing patients
diagnosed with genetic inborn errors of metabolism."
Section 2. A new section of Chapter 59A, Article 46 NMSA
1978 is enacted to read:
"COVERAGE FOR MEDICAL
DIETS FOR GENETIC INBORN ERRORS OF METABOLISM.--As of July 1, 2003, each health
maintenance organization that delivers or issues for delivery in the state an
individual or group contract shall provide coverage for the treatment of
genetic inborn errors of metabolism as set forth in Chapter 59A, Article 22
NMSA 1978."
Section 3. A new section of Chapter 59A, Article 47 NMSA
1978 is enacted to read:
"COVERAGE FOR MEDICAL
DIETS FOR GENETIC INBORN ERRORS OF METABOLISM.--As of July 1, 2003, subscriber
contracts of a health care plan shall also be subject to coverage for special
medical diets for genetic inborn errors of metabolism as required of health
insurers in Chapter 59A, Article 22 NMSA 1978."