SB0190

SENATE BILL 190

52nd legislature - STATE OF NEW MEXICO - first session, 2015

INTRODUCED BY

Mary Kay Papen

FOR THE LEGISLATIVE HEALTH AND HUMAN SERVICES COMMITTEE

AN ACT

RELATING TO HEALTH 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 PROVIDE THAT HEALTH COVERAGE CARRIERS SHALL NOT DISCRIMINATE AGAINST HEALTH CARE PROVIDERS WORKING WITHIN THEIR LEGAL SCOPES OF PRACTICE; AMENDING A SECTION OF CHAPTER 59A, ARTICLE 22 NMSA 1978; REPEALING SECTIONS OF THE NMSA 1978.

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] HEALTH CARE PROVIDERS--NONDISCRIMINATION.--

A. Group health coverage, including any form of self-insurance, offered, issued or renewed under the Health Care Purchasing Act shall not discriminate with respect to participation under the plan or coverage against any health care provider who is acting within the scope of that provider's license, certification or other legal authority to practice in the state.

B. This section shall not require that a group health plan contract with any health care provider willing to abide by the terms and conditions for participation established by the group health plan.

C. Nothing in this section shall be construed as preventing a group health plan from establishing varying reimbursement rates based on quality or performance measures.

D. As used in this section, "health care provider" means a person that is licensed, certified or otherwise authorized to provide services relating to physical or behavioral health care in the ordinary course of business in the state."

SECTION 2. Section 59A-22-32 NMSA 1978 (being Laws 1984, Chapter 127, Section 454, as amended) is amended to read:

"59A-22-32. FREEDOM OF CHOICE OF HOSPITAL [AND PRACTITIONER].--

A. Within the area and limits of coverage offered an insured and selected by the insured in the application for insurance, the right of a person to exercise full freedom of choice in the selection of a hospital for hospital care [or of a practitioner of the healing arts or optometrist, psychologist, podiatrist, physician assistant, certified nurse-midwife, registered lay midwife or registered nurse in expanded practice, as defined in Subsection B of this section] for treatment of an illness or injury [within that person's scope of practice] shall not be restricted under any [new] policy of health insurance, contract or health care plan [issued after June 30, 1967] in this state or in the processing of a claim thereunder. A person insured or claiming benefits under any [such] health insurance policy, contract or health care plan providing within its coverage for payment of service benefits or indemnity for hospital care [or treatment of persons for the cure or correction of any physical or mental condition] shall be deemed to have complied with the requirements of the policy, contract or health care plan as to submission of proof of loss upon submitting written proof supported by the certificate of any hospital currently licensed by the department of health [or any practitioner of the healing arts or optometrist, psychologist, podiatrist, physician assistant, certified nurse-midwife, registered lay midwife or registered nurse in expanded practice].

B. As used in this section, [(1)] "hospital care" means hospital service provided through a hospital that is maintained by the state or a political subdivision of the state or a place that is currently licensed as a hospital by the department of health and has accommodations for resident bed patients, a licensed professional registered nurse always on duty or call, a laboratory and an operating room where surgical operations are performed, but "hospital care" does not include a convalescent or nursing or rest home

[(2) "practitioner of the healing arts" means a person holding a license or certificate authorizing the licensee to offer or undertake to diagnose, treat, operate on or prescribe for any human pain, injury, disease, deformity or physical or mental condition pursuant to:

(a) the Chiropractic Physician Practice Act;

(b) the Dental Health Care Act;

(d) Chapter 61, Article 10 NMSA 1978; and

(e) the Acupuncture and Oriental Medicine Practice Act;

(3) "optometrist" means a person holding a license provided for in the Optometry Act;

(4) "podiatrist" means a person holding a license provided for in the Podiatry Act;

(5) "psychologist" means a person who is duly licensed or certified in the state where the service is rendered and has a doctoral degree in psychology and has had at least two years of clinical experience in a recognized health setting or has met the standards of the national register of health service providers in psychology;

(6) "physician assistant" means a person who is licensed by the New Mexico medical board to practice as a physician assistant and who provides services to patients under the supervision and direction of a licensed physician;

(7) "certified nurse-midwife" means a person licensed by the board of nursing as a registered nurse and who is registered with the public health division of the department of health as a certified nurse-midwife;

(8) "registered lay midwife" means a person who practices lay midwifery and is registered as a registered lay midwife by the public health division of the department of health; and

(9) "registered nurse in expanded practice" means a person licensed by the board of nursing as a registered nurse approved for expanded practice pursuant to the Nursing Practice Act as a certified nurse practitioner, certified registered nurse anesthetist, certified clinical nurse specialist in psychiatric mental health nursing or clinical nurse specialist in private practice and who has a master's degree or doctorate in a defined clinical nursing speciality and is certified by a national nursing organization.

C. This section shall apply to any such policy that is delivered or issued for delivery in this state on or after July 1, 1979 and to any existing group policy or plan on its anniversary or renewal date after June 30, 1979 or at expiration of the applicable collective bargaining contract, if any, whichever is later]."

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

"[NEW MATERIAL] HEALTH CARE PROVIDERS--NONDISCRIMINATION.--

A. An individual or group health insurance policy,

health care plan or certificate of health insurance that is

delivered, issued for delivery or renewed in the state shall not discriminate with respect to participation under the policy, plan or certificate against any health care provider who is acting within the scope of that provider's license, certification or other legal authority to practice in the state.

B. This section shall not require that a health insurer contract with any health care provider willing to abide by the terms and conditions for participation established by the health insurance policy, health care plan or certificate of health insurance.

C. Nothing in this section shall be construed as preventing a health insurer from establishing varying reimbursement rates based on quality or performance measures.

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

"[NEW MATERIAL] HEALTH CARE PROVIDERS--NONDISCRIMINATION.--

A. A group health insurance policy, health care plan or certificate of health insurance that is delivered, issued for delivery or renewed in the state shall not discriminate with respect to participation under the policy, plan or certificate against any health care provider who is acting within the scope of that provider's license, certification or other legal authority to practice in the state.

C. Nothing in this section shall be construed as preventing a health insurer from establishing varying reimbursement rates based on quality or performance measures.

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

"[NEW MATERIAL] HEALTH CARE PROVIDERS--NONDISCRIMINATION.--

A. An individual or group health maintenance contract that is delivered, issued for delivery or renewed in the state shall not discriminate with respect to participation pursuant to that contract against any health care provider who is acting within the scope of that provider's license, certification or other legal authority to practice in the state.

B. This section shall not require that a health maintenance organization contract with any health care provider willing to abide by the terms and conditions for participation established by the health maintenance contract.

C. Nothing in this section shall be construed as preventing a health maintenance organization from establishing varying reimbursement rates based on quality or performance measures.

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

"[NEW MATERIAL] HEALTH CARE PROVIDERS--NONDISCRIMINATION.--

A. An individual or group health care plan that is delivered, issued for delivery or renewed in the state shall not discriminate with respect to participation under the plan or coverage against any health care provider who is acting within the scope of that provider's license, certification or other legal authority to practice in the state.

B. This section shall not require that a health plan contract with any health care provider willing to abide by the terms and conditions for participation established by the health plan.

C. Nothing in this section shall be construed as preventing a health insurer from establishing varying reimbursement rates based on quality or performance measures.

SECTION 7. REPEAL.--Sections 59A-46-35, 59A-46-36, 59A-47-28.2 and 59A-47-28.3 NMSA 1978 (being Laws 1987, Chapter 335, Section 1, Laws 1989, Chapter 96, Section 2, Laws 1991, Chapter 145, Section 1 and Laws 1998, Chapter 39, Section 2, as amended) are repealed.

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