SENATE BILL 10

53rd legislature - STATE OF NEW MEXICO - first session, 2017

INTRODUCED BY

Gerald Ortiz y Pino

FOR THE LEGISLATIVE HEALTH AND HUMAN SERVICES COMMITTEE

AN ACT

RELATING TO HEALTH COVERAGE; ENACTING SECTIONS OF THE GROUP BENEFITS ACT, CHAPTER 59A, ARTICLE 22 NMSA 1978, CHAPTER 59A, ARTICLE 23 NMSA 1978, THE HEALTH MAINTENANCE ORGANIZATION LAW AND THE NONPROFIT HEALTH CARE PLAN LAW TO BAN DISCRIMINATION AGAINST ANY HEALTH CARE PRACTITIONER WORKING WITHIN THE SCOPE OF THAT PRACTITIONER'S LICENSE OR CERTIFICATION.

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

     SECTION 1. A new section of the Group Benefits Act is enacted to read:

     "[NEW MATERIAL] BAN ON HEALTH CARE PRACTITIONER DISCRIMINATION.--

          A. With respect to participation in a group health coverage plan, a group health plan shall not discriminate against any health care practitioner who is acting within the scope of that practitioner's license or certification.

          B. The provisions of this section shall not be construed to:

                (1) require a group health plan to contract with any health care practitioner willing to abide by the terms and conditions for participation established by the group health plan; or

                (2) prevent a group health plan from establishing varying reimbursement rates based on quality or performance measures.

          C. As used in this section, "health care practitioner" means any individual licensed or certified to provide health care in the ordinary course of business."

     SECTION 2. A new section of Chapter 59A, Article 22 NMSA 1978 is enacted to read:

     "[NEW MATERIAL] BAN ON HEALTH CARE PRACTITIONER DISCRIMINATION.--

          A. With respect to participation in health coverage pursuant to an individual health insurance plan, policy or certificate of insurance, an insurer shall not discriminate against any health care practitioner who is acting within the scope of that practitioner's license or certification.

          B. The provisions of this section shall not be construed to:

                (1) require an insurer to contract with any health care practitioner willing to abide by the terms and conditions for participation established by the insurer; or

                (2) prevent an insurer from establishing varying reimbursement rates based on quality or performance measures.

          C. As used in this section, "health care practitioner" means any individual licensed or certified to provide health care in the ordinary course of business."

     SECTION 3. A new section of Chapter 59A, Article 23 NMSA 1978 is enacted to read:

     "[NEW MATERIAL] BAN ON HEALTH CARE PRACTITIONER DISCRIMINATION.--

          A. With respect to participation in health coverage pursuant to a group or blanket health insurance plan, policy or certificate of insurance, an insurer shall not discriminate against any health care practitioner who is acting within the scope of that practitioner's license or certification.

          B. The provisions of this section shall not be construed to:

                (1) require an insurer to contract with any health care practitioner willing to abide by the terms and conditions for participation established by the insurer; or

                (2) prevent an insurer from establishing varying reimbursement rates based on quality or performance measures.

          C. As used in this section, "health care practitioner" means any individual licensed or certified to provide health care in the ordinary course of business."

     SECTION 4. A new section of the Health Maintenance Organization Law is enacted to read:

     "[NEW MATERIAL] BAN ON HEALTH CARE PRACTITIONER DISCRIMINATION.--

          A. With respect to participation in individual or group health coverage pursuant to a health maintenance organization contract, a carrier shall not discriminate against any health care practitioner who is acting within the scope of that health care practitioner's license or certification.

          B. The provisions of this section shall not be construed to:

                (1) require a carrier to contract with any health care practitioner willing to abide by the terms and conditions for participation established by the carrier; or

                (2) prevent a carrier from establishing varying reimbursement rates based on quality or performance measures.

          C. As used in this section, "health care practitioner" means any individual licensed or certified to provide health care in the ordinary course of business."

     SECTION 5. A new section of the Nonprofit Health Care Plan Law is enacted to read:

     "[NEW MATERIAL] BAN ON HEALTH CARE PRACTITIONER DISCRIMINATION.--

          A. With respect to participation in an individual or group health care plan, a health care plan shall not discriminate against any health care practitioner who is acting within the scope of that health care practitioner's license or certification.

          B. The provisions of this section shall not be construed to:

                (1) require a health care plan to contract with any health care practitioner willing to abide by the terms and conditions for participation established by the health care plan; or

                (2) prevent a health care plan from establishing varying reimbursement rates based on quality or performance measures.

          C. As used in this section, "health care practitioner" means any individual licensed or certified to provide health care in the ordinary course of business."

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