HOUSE BILL 58

54th legislature - STATE OF NEW MEXICO - first session, 2019

INTRODUCED BY

Christine Trujillo

FOR THE LEGISLATIVE HEALTH AND HUMAN SERVICES COMMITTEE

AN ACT

RELATING TO HEALTH COVERAGE; ENACTING SECTIONS OF THE HEALTH CARE PURCHASING ACT, THE PUBLIC ASSISTANCE ACT AND THE NEW MEXICO INSURANCE CODE TO REQUIRE COVERAGE OF ARTERY CALCIFICATION SCREENING FOR EARLY DETECTION OF CARDIOVASCULAR DISEASE IN CERTAIN INDIVIDUALS.

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] ARTERY CALCIFICATION SCREENING COVERAGE.--

          A. Group health coverage, including any form of self-insurance, offered, issued or renewed under the Health Care Purchasing Act shall provide coverage for eligible enrollees to receive artery calcification screening.

          B. Coverage provided pursuant to this section shall:

                (1) be limited to the provision of an artery calcification screening to an eligible enrollee once every five years; and

                (2) not be subject to a deductible.

          C. The provisions of this section shall not apply to short-term travel, accident-only or limited or specified-disease policies, plans or certificates of health insurance.

D. As used in this section:

                (1) "artery calcification screening" means a computed tomography scan measuring coronary artery calcification for atheroscleroris and abnormal artery structure and function; and

                (2) "eligible enrollee" means an enrollee who:

                     (a) is: 1) a male older than thirty years of age and younger than seventy-six years of age; or 2) a female older than forty years of age and younger than seventy-six years of age; and

                     (b) has a risk of developing coronary heart disease based on at least one of the following: hypertension, hyperlipidemia, diabetes, smoking or family history of heart disease."

     SECTION 2. A new section of the Public Assistance Act is enacted to read:

     "[NEW MATERIAL] ARTERY CALCIFICATION SCREENING COVERAGE.--

          A. By January 1, 2020 and in accordance with federal law, the secretary shall adopt and promulgate rules that provide medicaid coverage for eligible recipients to receive artery calcification screening.

          B. Medicaid coverage provided pursuant to this section shall be limited to the provision of an artery calcification screening to an eligible recipient once every five years.

          C. As used in this section:

                (1) "artery calcification screening" means a computed tomography scan measuring coronary artery calcification for atheroscleroris and abnormal artery structure and function; and

                (2) "eligible recipient" means a recipient who:

                     (a) is: 1) a male older than thirty years of age and younger than seventy-six years of age; or 2) a female older than forty years of age and younger than seventy-six years of age; and

                     (b) has a risk of developing coronary heart disease based on at least one of the following: hypertension, hyperlipidemia, diabetes, smoking or family history of heart disease."

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

     "[NEW MATERIAL] ARTERY CALCIFICATION SCREENING COVERAGE.--

          A. An individual or group health insurance policy, health care plan and certificate of health insurance delivered or issued for delivery in this state shall provide coverage for eligible insureds to receive artery calcification screening.

          B. Coverage provided pursuant to this section shall:

                (1) be limited to the provision of an artery calcification screening to an eligible insured once every five years; and

                (2) not be subject to a deductible.

          C. The provisions of this section apply to the following types of health benefit plans delivered or issued for delivery after January 1, 2020:

                (1) an individual or group health insurance policy or plan or certificate of health insurance regulated in accordance with the provisions of Chapter 59A, Article 22 or 23 NMSA 1978;

                (2) a health maintenance organization contract regulated in accordance with the provisions of the Health Maintenance Organization Law; and

                (3) a nonprofit health care plan regulated in accordance with the provisions of the Nonprofit Health Care Plan Law.

          D. The provisions of this section do not apply to short-term travel, accident-only or limited or specified-disease policies, plans or certificates of health insurance.

          E. As used in this section:

                (1) "artery calcification screening" means a computed tomography scan measuring coronary artery calcification for atheroscleroris and abnormal artery structure and function;

                (2) "eligible insured" means an insured who:

                     (a) is: 1) a male older than thirty years of age and younger than seventy-six years of age; or 2) a female older than forty years of age and younger than seventy-six years of age; and

                     (b) has a risk of developing coronary heart disease based on at least one of the following: hypertension, hyperlipidemia, diabetes, smoking or family history of heart disease; and

                (3) "health benefit plan" means a health insurance policy, health care plan, certificate of health insurance, health maintenance organization contract or nonprofit health care plan contract delivered or issued for delivery in this state."

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