SENATE BILL 334
53rd legislature - STATE OF NEW MEXICO - first session, 2017
INTRODUCED BY
Mimi Stewart
AN ACT
RELATING TO PUBLIC EMPLOYEES AND RETIREES; AMENDING SECTIONS OF THE HEALTH CARE PURCHASING ACT TO REQUIRE CERTAIN DISCLOSURES.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF NEW MEXICO:
SECTION 1. Section 13-7-4 NMSA 1978 (being Laws 1997, Chapter 74, Section 4) is amended to read:
"13-7-4. MANDATORY CONSOLIDATED PURCHASING.--
A. The publicly funded health care agencies shall enter into a cooperative consolidated purchasing effort to provide plans of health care benefits for the benefit of eligible participants of the respective agencies. The single request for [proposal] proposals shall set forth one or more plans of health care benefits and shall include accommodation of fully funded arrangements as well as varying degrees of self-funded pool options.
B. A consolidated purchasing request for proposals for all health care benefits by the publicly funded health care agencies shall be issued on or before July 1, 1999 and any contracts for health care benefits renewed or issued on or after July 1, 2000 shall be the result of consolidated purchasing.
C. [All requests] The request for proposals issued as part of the consolidated purchasing shall include at least one distinct service area consisting of the Albuquerque metropolitan area. Proposals on a distinct service area shall be evaluated separately."
SECTION 2. Section 13-7-7 NMSA 1978 (being Laws 2001, Chapter 351, Section 3, as amended) is amended to read:
"13-7-7. CONSOLIDATED ADMINISTRATIVE FUNCTIONS--BENEFIT--DISCLOSURES--PENALTIES.--
A. By December 1, [2001] 2017, the publicly funded health care agencies, political subdivisions and other persons participating in the consolidated purchasing single process pursuant to the Health Care Purchasing Act shall cooperatively study and provide a status report on the consolidation of administrative functions to the legislative health and human services committee and the governor.
B. By December 31, 2003, the publicly funded health care agencies, political subdivisions and other persons participating in the consolidated purchasing single process pursuant to the Health Care Purchasing Act shall consolidate, standardize and administer the administrative functions that those entities can effectively and efficiently administer as reflected in the study.
C. The publicly funded health care agencies, political subdivisions and other persons participating in the consolidated purchasing single process pursuant to the Health Care Purchasing Act may enter into a joint powers agreement pursuant to the Joint Powers Agreements Act with the publicly funded health care agencies and political subdivisions to determine assessments or provisions of resources to consolidate, standardize and administer the consolidated purchasing single process and subsequent activities pursuant to the Health Care Purchasing Act. The publicly funded health care agencies, political subdivisions and other persons participating in the consolidated purchasing single process pursuant to the Health Care Purchasing Act may enter into contracts with nonpublic persons to provide the service of determining assessments or provision of resources for consolidation, standardization and administrative activities.
D. Each agency will retain its responsibility to determine policy direction of the benefit plans, plan development, training and coordination with respect to participants and its benefits staff, as well as to respond to benefits eligibility inquiries and establish and enforce eligibility rules.
E. Notwithstanding Subsection D of this section, publicly funded health care agencies, political subdivisions and other persons participating in the consolidated purchasing single process pursuant to the Health Care Purchasing Act shall provide coverage for children, from birth through three years of age, for or under the family, infant, toddler program administered by the department of health; provided that eligibility criteria are met, for a maximum benefit of three thousand five hundred dollars ($3,500) annually for medically necessary early intervention services provided as part of an individualized family service plan and delivered by certified and licensed personnel as defined in [7.30.8 NMAC who are working in early intervention programs approved by the] department of health rules. No payment under this subsection shall be applied against any maximum lifetime or annual limits specified in the policy, health benefits plan or contract.
F. The publicly funded health care agencies, political subdivisions and other persons participating in the consolidated purchasing single process pursuant to the Health Care Purchasing Act shall ensure that enrollees are informed on a readily accessible website and are individually notified in writing of all premiums, deductibles, copayments, coinsurance and other cost-sharing associated with each group health plan offered in a side-by-side comparison pursuant to the Health Care Purchasing Act.
G. Each publicly funded health care agency shall conduct a full and open annual enrollment period. Regardless of whether an eligible participant is newly enrolling in group health coverage or is seeking to re-enroll in group health coverage, each eligible participant shall be provided with thorough written, verbal and web-based education relating to each group health plan, including the side-by-side comparison required pursuant to Subsection F of this section.
H. Any violation of the provisions of Subsection F of this section shall entitle an enrollee to rescission of that enrollee's enrollment in a group health plan and eligibility to enroll in another group health plan for the same plan year.
I. The provisions of this section shall be applicable to a new open enrollment period for all publicly funded health care agencies that shall begin on or after July 1, 2017."
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