SENATE BILL 144

51st legislature - STATE OF NEW MEXICO - first session, 2013

INTRODUCED BY

Bill B. O'Neill

AN ACT

RELATING TO HEALTH INSURANCE; 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 COST-SHARING FOR CERTAIN HEALTH PRACTITIONERS AT RATES NO HIGHER THAN THE COST-SHARING RATES CHARGED FOR PRIMARY CARE PRACTITIONERS.

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] COST-SHARING LIMITS FOR CERTAIN SERVICES.--

          A. Group health coverage, including any form of self-insurance, offered, issued or renewed under the Health Care Purchasing Act that provides coverage for physical therapy, occupational therapy or chiropractic services shall require an enrollee to pay a copayment, co-insurance or deductible for those services in an amount that is no greater than the group health coverage requires the enrollee to pay for the services of a primary care provider.

          B. As used in this section, "primary care provider" means a health care practitioner acting within the scope of the practitioner's license who provides the first level of basic or general health care for a person's health needs, including diagnostic and treatment services, initiation of referrals to other health care practitioners 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] COST-SHARING LIMITS FOR CERTAIN SERVICES.--

          A. An individual health insurance policy, health care plan or certificate of health insurance that is delivered, issued for delivery or renewed in this state and that provides coverage for physical therapy, occupational therapy or chiropractic services shall require an insured to pay a copayment, co-insurance or deductible for those services in an amount that is no greater than the group health coverage requires the insured to pay for the services of a primary care provider.

          B. As used in this section, "primary care provider" means a health care practitioner acting within the scope of the practitioner's license who provides the first level of basic or general health care for a person's health needs, including diagnostic and treatment services, initiation of referrals to other health care practitioners 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] COST-SHARING LIMITS FOR CERTAIN SERVICES.--

          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 and that provides coverage for physical therapy, occupational therapy or chiropractic services shall require an insured to pay a copayment, co-insurance or deductible for those services in an amount that is no greater than the group health coverage requires the insured to pay for the services of a primary care provider.

          B. As used in this section, "primary care provider" means a health care practitioner acting within the scope of the practitioner's license who provides the first level of basic or general health care for a person's health needs, including diagnostic and treatment services, initiation of referrals to other health care practitioners 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] COST-SHARING LIMITS FOR CERTAIN SERVICES.--

          A. An individual or group health maintenance organization contract that is delivered, issued for delivery or renewed in this state and that provides coverage for physical therapy, occupational therapy or chiropractic services shall require a subscriber to pay a copayment, co-insurance or deductible for those services in an amount that is no greater than the group health coverage requires the subscriber to pay for the services of a primary care provider.

          B. As used in this section, "primary care provider" means a health care practitioner acting within the scope of the practitioner's license who provides the first level of basic or general health care for a person's health needs, including diagnostic and treatment services, initiation of referrals to other health care practitioners 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] COST-SHARING LIMITS FOR CERTAIN SERVICES.--

          A. An individual or group health care plan that is delivered, issued for delivery or renewed in this state and that provides coverage for physical therapy, occupational therapy or chiropractic services shall require a subscriber to pay a copayment, co-insurance or deductible for those services in an amount that is no greater than the group health coverage requires the subscriber to pay for the services of a primary care provider.

          B. As used in this section, "primary care provider" means a health care practitioner acting within the scope of the practitioner's license who provides the first level of basic or general health care for a person's health needs, including diagnostic and treatment services, initiation of referrals to other health care practitioners and maintenance of the continuity of care when appropriate."

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