SENATE BILL 1173
48th legislature - STATE OF NEW MEXICO - first session, 2007
INTRODUCED BY
Steve Komadina
AN ACT
RELATING TO HEALTH CARE REFORM; REQUIRING PROCEEDS FROM THE TOBACCO SETTLEMENT PROGRAM FUND TO BE USED SOLELY FOR TOBACCO RESEARCH AND CESSATION PROGRAMS; PROVIDING FOR AN INCOME TAX DEDUCTION FOR THE PURCHASE OF LONG-TERM CARE INSURANCE; REQUIRING HIGH SCHOOL PHYSICAL EDUCATION REQUIREMENTS TO EMPHASIZE NUTRITION AND EXERCISE; REQUIRING THE ELECTRONIC SUBMISSION OF HEALTH CARE CLAIMS AND ASSOCIATED DATA; PROVIDING FOR INSURANCE RATING FACTORS FOR QUALIFIED WELLNESS PROGRAMS; RECONCILING MULTIPLE AMENDMENTS TO THE SAME SECTION OF LAW IN LAWS 2005.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF NEW MEXICO:
Section 1. Section 6-4-10 NMSA 1978 (being Laws 1999, Chapter 207, Section 2, as amended) is amended to read:
"6-4-10. TOBACCO SETTLEMENT PROGRAM FUND CREATED--PURPOSE.--
A. The "tobacco settlement program fund" is created in the state treasury and shall consist of distributions made to the fund from the tobacco settlement permanent fund. Income from investment of the tobacco settlement program fund shall be credited to the fund. Beginning in fiscal year 2002, money in the tobacco settlement program fund may be appropriated by the legislature for any of the purposes specified in Subsection B of this section and after receiving the recommendations of the tobacco settlement revenue oversight committee. Balances in the tobacco settlement program fund at the end of any fiscal year shall remain in the fund.
B. Money may be appropriated from the tobacco settlement program fund for [health and educational purposes, including:
(1) support of additional public school programs, including extracurricular and after-school programs designed to involve students in athletic, academic, musical, cultural, civic, mentoring and similar types of activities;
(2) any health or health care program or service for prevention or treatment of disease or illness;
(3)] basic and applied research conducted by higher educational institutions or state agencies addressing the impact of smoking [or other behavior] on health and disease
[(4) public health programs and needs] and for
[(5)] tobacco use cessation and prevention programs, including statewide public information, education and media campaigns."
Section 2. A new section of the Income Tax Act is enacted to read:
"[NEW MATERIAL] DEDUCTION--UNREIMBURSED OR UNCOMPENSATED MEDICAL CARE EXPENSES.--
A. A taxpayer may claim a deduction from net income in an amount equal to the premiums for a long-term care insurance contract paid by the taxpayer during the taxable year if the premiums have not been included in the taxpayer's itemized deductions, as defined in Section 63 of the Internal Revenue Code, for the taxable year.
B. As used in this section, "long-term care insurance contract" means a qualified long-term care insurance contract as defined in Section 7702B(b) of the Internal Revenue Code.
C. A husband and wife who file separate returns for a taxable year in which they could have filed a joint return may each claim only one-half of the deduction pursuant to this section that would have been allowed on a joint return.
D. The provisions of this act apply to taxable years beginning on or after January 1, 2008."
Section 3. Section 22-13-1.1 NMSA 1978 (being Laws 1986, Chapter 33, Section 5, as amended by Laws 2005, Chapter 314, Section 1 and by Laws 2005, Chapter 315, Section 10) is amended to read:
"22-13-1.1. GRADUATION REQUIREMENTS.--
A. At the end of grades eight through eleven, each student shall prepare an interim next-step plan that sets forth the coursework for the grades remaining until high school graduation. Each year's plan shall explain any differences from previous interim next-step plans, shall be filed with the principal of the student's high school and shall be signed by the student, the student's parent and the student's guidance counselor or other school official charged with coursework planning for the student.
B. Each student must complete a final next-step plan during the senior year and prior to graduation. The plan shall be filed with the principal of the student's high school and shall be signed by the student, the student's parent and the student's guidance counselor or other school official charged with coursework planning for the student.
C. An individualized education program that meets the requirements of Subsections A and B of this section and that meets all applicable transition and procedural requirements of the federal Individuals with Disabilities Education Act for a student with a disability shall satisfy the next-step plan requirements of this section for that student.
D. A local school board shall ensure that each high school student has the opportunity to develop a next-step plan and is reasonably informed about:
(1) curricular and course options;
(2) opportunities available that lead to different post-high-school options; and
(3) alternative opportunities available if the student does not finish a planned curriculum.
E. The secretary shall:
(1) establish specific accountability standards for administrators, counselors, teachers and school district staff to ensure that every student has the opportunity to develop a next-step plan;
(2) promulgate rules for accredited private schools in order to ensure substantial compliance with the provisions of this section;
(3) monitor compliance with the requirements of this section; and
(4) compile such information as is necessary to evaluate the success of next-step plans and report annually, by December 15, to the legislative education study committee and the governor.
F. Successful completion of a minimum of twenty-three units aligned to the state academic content and performance standards shall be required for graduation. These units shall be as follows:
(1) four units in English, with major emphasis on grammar and literature;
(2) three units in mathematics, at least one of which is equivalent to the algebra 1 level or higher;
(3) two units in science, one of which shall have a laboratory component; provided, however, that with students entering the ninth grade beginning in the 2005-2006 school year, three units in science shall be required, one of which shall have a laboratory component;
(4) three units in social science, which shall include United States history and geography, world history and geography and government and economics;
(5) one unit in physical education, with a major emphasis on the long-range benefits of proper nutrition and exercise;
(6) one unit in communication skills or business education, with a major emphasis on writing and speaking and that may include a language other than English;
(7) one-half unit in New Mexico history for students entering the ninth grade beginning in the 2005-2006 school year; and
(8) nine elective units and seven and one-half elective units for students entering the ninth grade in the 2005-2006 school year that meet department content and performance standards. Student service learning shall be offered as an elective.
G. The department shall establish a procedure for students to be awarded credit through completion of specified career technical education courses for certain graduation requirements.
H. Final examinations shall be administered to all students in all classes offered for credit.
I. A student [shall not receive a high school diploma] who has not passed a state graduation examination in the subject areas of reading, English, mathematics, writing, science and social science shall not receive a high school diploma. The state graduation examination on social science shall include a section on the constitution of the United States and the constitution of New Mexico. If a student exits from the school system at the end of grade twelve without having passed a state graduation examination, the student shall receive an appropriate state certificate indicating the number of credits earned and the grade completed. If within five years after a student exits from the school system the student takes and passes the state graduation examination, the student may receive a high school diploma.
J. As used in this section:
(1) "final next-step plan" means a next-step plan that shows that the student has committed or intends to commit in the near future to a four-year college or university, a two-year college, a trade or vocational program, an internship or apprenticeship, military service or a job;
(2) "interim next-step plan" means an annual next-step plan in which the student specifies post-high-school goals and sets forth the coursework that will allow the student to achieve those goals; and
(3) "next-step plan" means an annual personal written plan of studies developed by a student in a public school or other state-supported school or institution in consultation with the student's parent and school counselor or other school official charged with coursework planning for the student.
K. The secretary may establish a policy to provide for administrative interpretations to clarify curricular and testing provisions of the Public School Code."
Section 4. A new section of Chapter 59A, Article 2 NMSA 1978 is enacted to read:
"[NEW MATERIAL] ELECTRONIC SUBMISSION OF CLAIMS AND ASSOCIATED DATA.--The superintendent, in consultation with the New Mexico health policy commission and pursuant to the Health Information System Act, shall adopt and promulgate rules by January 1, 2009 to require health insurers, health maintenance organizations, other health coverage payers, third-party administrators and individual and institutional health care providers to transmit electronically all claims, referrals, medical records, appeals, eligibility information, inquiries, reimbursements and other data and information associated with the submission, processing and payment of health care claims. The superintendent shall seek ways to establish loans, grants and other public or private funding to facilitate implementation of this requirement. Electronic transmission of information pursuant to this section shall comply with the electronic code standards and the privacy and confidentiality standards of the federal Health Insurance Portability and Accountability Act of 1996."
Section 5. Section 59A-18-13.1 NMSA 1978 (being Laws 1994, Chapter 75, Section 26, as amended) is amended to read:
"59A-18-13.1. ADJUSTED COMMUNITY RATING.--
A. Every insurer, fraternal benefit society, health maintenance organization or nonprofit health care plan that provides primary health insurance or health care coverage insuring or covering major medical expenses shall, in determining the initial year's premium charged for an individual, use only the rating factors of age, gender, geographic area of the place of employment and smoking practices, except that for individual policies the rating factor of the individual's place of residence may be used instead of the geographic area of the individual's place of employment.
B. In determining the initial and any subsequent year's rate, the difference in rates in any one age group that may be charged on the basis of a person's gender shall not exceed another person's rates in the age group by more than twenty percent of the lower rate, and no person's rate shall exceed the rate of any other person with similar family composition by more than two hundred fifty percent of the lower rate, except that the rates for children under the age of nineteen or children aged nineteen to twenty-five who are full-time students may be lower than the bottom rates in the two hundred fifty percent band. The rating factor restrictions shall not prohibit an insurer, fraternal benefit society, health maintenance organization or nonprofit health care plan from offering rates that differ depending upon family composition.
C. An insurer, fraternal benefit society, health maintenance organization or nonprofit health care plan that provides a qualified wellness program may use a rating factor that reflects the expected level of participation in the program and the anticipated effect the program will have on utilization or medical claim costs. A qualified wellness program shall:
(1) meet the requirements of the federal Health Insurance Portability and Accountability Act of 1996 for bona fide wellness programs;
(2) provide financial incentives to covered employees or individuals for participating in the program; and
(3) provide to covered employees or individuals for whom it is unreasonably difficult to satisfy the program's applicable standards reasonable alternative methods for achieving program participation.
D. The methodology proposed by the insurer, fraternal benefit society, health maintenance organization or nonprofit health care plan for establishing rating factors for a qualified wellness program may take into consideration:
(1) the anticipated average percentage of employees or individuals eligible to participate in the program;
(2) the anticipated efficacy of the financial incentives in producing high levels of program participation;
(3) the level of program participation achieved in prior coverage periods;
(4) the expected success rate for program participants;
(5) clinical studies; and
(6) the insurer's experience in the use of the program.
[C.] E. The provisions of this section do not preclude an insurer, fraternal benefit society, health maintenance organization or nonprofit health care plan from using health status or occupational or industry classification in establishing:
(1) rates for individual policies; or
(2) the amount an employer may be charged for coverage under the group health plan.
[D.] F. As used in Subsection [C] E of this section, "health status" does not include genetic information.
[E.] G. The superintendent shall adopt [regulations] rules to implement the provisions of this section."
Section 6. Section 59A-23B-6 NMSA 1978 (being Laws 1991, Chapter 111, Section 6, as amended) is amended to read:
"59A-23B-6. FORMS AND RATES--APPROVAL OF THE SUPERINTENDENT--ADJUSTED COMMUNITY RATING.--
A. All policy or plan forms, including applications, enrollment forms, policies, plans, certificates, evidences of coverage, riders, amendments, endorsements and disclosure forms, shall be submitted to the superintendent for approval prior to use.
B. No policy or plan may be issued in the state unless the rates have first been filed with and approved by the superintendent. This subsection shall not apply to policies or plans subject to the Small Group Rate and Renewability Act.
C. In determining the initial year's premium or rate charged for coverage under a policy or plan, the only rating factors that may be used are age, gender, geographic area of the place of employment and smoking practices, except that for individual policies the rating factor of the individual's place of residence may be used instead of the geographic area of the individual's place of employment. In determining the initial and any subsequent year's rate, the difference in rates in any one age group that may be charged on the basis of a person's gender shall not exceed another person's rate in the age group by more than twenty percent of the lower rate, and no person's rate shall exceed the rate of any other person with similar family composition by more than two hundred fifty percent of the lower rate, except that the rates for children under the age of nineteen or children aged nineteen to twenty-five who are full-time students may be lower than the bottom rates in the two hundred fifty percent band. The rating factor restrictions shall not prohibit an insurer, fraternal benefit society, health maintenance organization or nonprofit healthcare plan from offering rates that differ depending upon family composition.
D. An insurer, fraternal benefit society, health maintenance organization or nonprofit healthcare plan that provides a qualified wellness program may use a rating factor that reflects the expected level of participation in the program and the anticipated effect the program will have on utilization or medical claim costs. A qualified wellness program shall:
(1) meet the requirements of the federal Health Insurance Portability and Accountability Act of 1996 for bona fide wellness programs;
(2) provide financial incentives to covered employees or individuals for participating in the program; and
(3) provide to covered employees or individuals for whom it is unreasonably difficult to satisfy the program's applicable standards reasonable alternative methods for achieving program participation.
E. The methodology proposed by the insurer, fraternal benefit society, health maintenance organization or nonprofit healthcare plan for establishing rating factors for a qualified wellness program may take into consideration:
(1) the anticipated average percentage of employees or individuals eligible to participate in the program;
(2) the anticipated efficacy of the financial incentives in producing high levels of program participation;
(3) the level of program participation achieved in prior coverage periods;
(4) the expected success rate for program participants;
(5) clinical studies; and
(6) the insurer's experience in the use of the program.
[D.] F. The provisions of this section do not preclude an insurer, fraternal benefit society, health maintenance organization or nonprofit healthcare plan from using health status or occupational or industry classification in establishing:
(1) rates for individual policies; or
(2) the amount an employer may be charged for coverage under a group health plan.
[E.] G. As used in Subsection [D] F of this section, "health status" does not include genetic information.
[F.] H. The superintendent shall adopt [regulations] rules to implement the provisions of this section."
Section 7. Section 59A-23C-5.1 NMSA 1978 (being Laws 1994, Chapter 75, Section 33, as amended) is amended to read:
"59A-23C-5.1. ADJUSTED COMMUNITY RATING.--
A. A health benefit plan that is offered by a carrier to a small employer shall be offered without regard to the health status of any individual in the group, except as provided in the Small Group Rate and Renewability Act. The only rating factors that may be used to determine the initial year's premium charged a group, subject to the maximum rate variation provided in this section for all rating factors, are the group members':
(1) ages;
(2) genders;
(3) geographic areas of the place of employment; or
(4) smoking practices.
B. In determining the initial and any subsequent year's rate, the difference in rates in any one age group that may be charged on the basis of a person's gender shall not exceed another person's rate in the age group by more than twenty percent of the lower rate, and no person's rate shall exceed the rate of any other person with similar family composition by more than two hundred fifty percent of the lower rate, except that the rates for children under the age of nineteen or children aged nineteen to twenty-five who are full-time students may be lower than the bottom rates in the two hundred fifty percent band. The rating factor restrictions shall not prohibit a carrier from offering rates that differ depending upon family composition.
C. A carrier that provides a qualified wellness program may use a rating factor that reflects the expected level of participation in the program and the anticipated effect the program will have on utilization or medical claim costs. A qualified wellness program shall:
(1) meet the requirements of the federal Health Insurance Portability and Accountability Act of 1996 for bona fide wellness programs;
(2) provide financial incentives to covered employees or individuals for participating in the program; and
(3) provide to covered employees or individuals for whom it is unreasonably difficult to satisfy the program's applicable standards reasonable alternative methods for achieving program participation.
D. The methodology proposed by the carrier for establishing rating factors for a qualified wellness program may take into consideration:
(1) the anticipated average percentage of employees or individuals eligible to participate in the program;
(2) the anticipated efficacy of the financial incentives in producing high levels of program participation;
(3) the level of program participation achieved in prior coverage periods;
(4) the expected success rate for program participants;
(5) clinical studies; and
(6) the insurer's experience in the use of the program.
[C.] E. The provisions of this section do not preclude a carrier from using health status or occupational or industry classification in establishing the amount an employer may be charged for coverage under a group health plan.
[D.] F. As used in Subsection [C] E of this section, "health status" does not include genetic information.
[E.] G. The superintendent shall adopt [regulations] rules to implement the provisions of this section."
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