HOUSE BILL 158

52nd legislature - STATE OF NEW MEXICO - second session, 2016

INTRODUCED BY

Deborah A. Armstrong

AN ACT

RELATING TO PUBLIC ASSISTANCE; ENACTING A NEW SECTION OF THE PUBLIC ASSISTANCE ACT TO PROVIDE FOR CERTAIN MEDICAID COVERAGES.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF NEW MEXICO:

     SECTION 1. A new section of the Public Assistance Act is enacted to read:

     "[NEW MATERIAL] MEDICAID--ELIGIBILITY FOR FAMILY PLANNING SERVICES--ACCESS TO FAMILY PLANNING SERVICES--OBSTETRICAL SERVICES--GYNECOLOGICAL SERVICES--COVERAGE FOR PRESCRIPTION CONTRACEPTIVE DRUGS OR DEVICES.--The secretary shall adopt and promulgate rules, in accordance with federal law, to ensure that:

          A. family planning medicaid coverage is provided to applicants and reapplicants who:

                (1) are eligible on the basis of household income as determined in accordance with the same financial eligibility criteria as those eligibility criteria promulgated for medicaid pregnancy services coverage;

                (2) are otherwise eligible for family planning medicaid coverage in accordance with federal law; and

                (3) comply with procedures for applying and maintaining eligibility in accordance with department rules;

          B. medicaid coverage includes coverage to female recipients for all of the following gynecological and obstetrical services and contraceptive methods:

                (1) all contraceptive drugs, devices and other products approved by the federal food and drug administration, including any contraceptive drug, device or other product prescribed by a recipient's health care provider, regardless of whether the drug, device or other product is available over the counter or by prescription only; provided that:

                     (a) if the federal food and drug administration has approved one or more therapeutically equivalent versions of a contraceptive drug, device or product, a group health plan shall not be required to cover all of the therapeutically equivalent versions, so long as at least one drug, device or product in its class is included and covered without cost-sharing; and

                     (b) if the covered therapeutically equivalent versions of a drug, device or product are not available or are deemed medically contraindicated by the recipient's health care provider, a group health plan shall provide coverage for an alternative therapeutically equivalent version of the contraceptive drug, device or product without cost-sharing;

                (2) patient education and counseling on contraception;

                (3) voluntary sterilization procedures;

                (4) breast and cervical cancer screening;

                (5) diagnostic and treatment services relating to the female reproductive system, including annual pelvic exams and pap smears, follow-up care and outpatient treatment of abnormal findings and diagnosis pursuant to those exams and pap smears;

                (6) prenatal care, including regular checkups for pregnant women with diagnosis and treatment of any health challenges that arise during pregnancy while promoting healthy lifestyles in accordance with nationally recognized standards;

                (7) pregnancy-related services, including care and treatment of women in childbirth, during the period before and after delivery, and other services related to or arising out of pregnancy; and

                (8) follow-up services related to the drugs, devices, products and procedures covered pursuant to this subsection, including management of side effects, counseling for continued adherence, social services, education related to reproductive health and device insertion and removal;

          C. drugs, devices, products or services covered pursuant to Subsection B of this section shall not be subject to any prior authorization or step therapy requirement;

          D. medicaid coverage includes coverage for screening, diagnosis and treatment of sexually transmitted infections and human immunodeficiency virus for all recipients, and counseling services for those recipients whom a health care provider deems to be at increased risk of infection; and

          E. medicaid does not impose a deductible, coinsurance, copayment or any other cost-sharing on the following coverages provided pursuant to this section:

                (1) contraceptive drugs, devices or products;

                (2) breast or cervical cancer screening;

                (3) prenatal care; or

                (4) sexually transmitted infection screening and counseling."

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