HB0174

HOUSE BILL 174

55th legislature - STATE OF NEW MEXICO - second session, 2022

INTRODUCED BY

Christine Trujillo

AN ACT

AMENDING CERTAIN SECTIONS OF THE NEW MEXICO INSURANCE CODE AND THE HEALTH CARE PURCHASING ACT TO REQUIRE HEARING AID COVERAGE FOR CERTAIN PERSONS; AMENDING CERTAIN SECTIONS OF THE NEW MEXICO INSURANCE CODE AND THE HEALTH CARE PURCHASING ACT TO REQUIRE EXPANDED HEARING AID COVERAGE.

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

SECTION 1. Section 13-7-10 NMSA 1978 (being Laws 2007, Chapter 356, Section 1) is amended to read:

"13-7-10. HEARING AID COVERAGE [FOR CHILDREN] REQUIRED.--

A. Group health care coverage, including any form of self-insurance, offered, issued or renewed under the Health Care Purchasing Act shall provide coverage for [a] hearing [aid and any related service for] aids. Such hearing aids shall be prescribed by a physician or a person licensed by the state to prescribe hearing aids and shall be considered durable medical equipment under the policy. The policy shall limit the hearing aid benefit to one hearing aid per ear within a twenty-four month period. The hearing aid coverage shall cover the full cost of one hearing aid per hearing-impaired ear [up to] in an amount no less than two thousand two hundred dollars ($2,200) [every thirty-six months for hearing aids for insured children under eighteen years of age or under twenty-one years of age if still attending high school]. The insured may choose a higher priced hearing aid and may pay the difference in cost above the two-thousand-two-hundred-dollar ($2,200) limit as provided in this subsection without financial or contractual penalty to the insured or to the provider of the hearing aids.

B. Each insurer that delivers, issues for delivery or renews under the Health Care Purchasing Act any group health care coverage, including any form of self-insurance, may make available to the policyholder the option of purchasing additional hearing aid coverage that exceeds the services described in this section.

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

E. Coverage for hearing aids may be subject to deductibles and coinsurance consistent with those imposed on other benefits under the same group health care coverage, including any form of self-insurance.

F. For the purposes of this section, "hearing aid" means durable medical equipment that is of a design and circuitry to optimize audibility and listening skills in the environment commonly experienced by [children] the insured."

SECTION 2. Section 59A-22-34.5 NMSA 1978 (being Laws 2007, Chapter 356, Section 2) is amended to read:

"59A-22-34.5. HEARING AID COVERAGE [FOR CHILDREN] REQUIRED.--

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 this state shall provide coverage for [a] hearing [aid and any related service for] aids. Such hearing aids shall be prescribed by a physician or a person licensed by the state to prescribe hearing aids and shall be considered durable medical equipment under the group health insurance policy, health care plan or certificate of health insurance. The group health insurance policy, health care plan or certificate of health insurance shall limit the hearing aid benefit to one hearing aid per ear within a twenty-four month period. The hearing aid coverage shall cover the full cost of one hearing aid per hearing-impaired ear [up to] in an amount no less than two thousand two hundred dollars ($2,200) [every thirty-six months for hearing aids for insured children under eighteen years of age or under twenty-one years of age if still attending high school]. The insured may choose a higher priced hearing aid and may pay the difference in cost above the two-thousand-two-hundred-dollar ($2,200) limit as provided in this subsection without financial or contractual penalty to the insured or to the provider of the hearing aid.

B. An insurer that delivers, issues for delivery or renews in this state an individual or group health insurance policy, health care plan or certificate of health insurance may make available to the policyholder the option of purchasing additional hearing aid coverage that exceeds the services described in this section.

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

E. Coverage for hearing aids may be subject to deductibles and coinsurance consistent with those imposed on other benefits under the same policy, plan or certificate.

SECTION 3. Section 59A-23-7.8 NMSA 1978 (being Laws 2007, Chapter 356, Section 3) is amended to read:

"59A-23-7.8. HEARING AID COVERAGE [FOR CHILDREN] REQUIRED.--

A. A blanket or group health insurance policy, health care plan or certificate of health insurance that is delivered, issued for delivery or renewed in this state shall provide coverage for [a] hearing [aid and any related service for] aids. Such hearing aids shall be prescribed by a physician or a person licensed by the state to prescribe hearing aids and shall be considered durable medical equipment under the group health insurance policy, health care plan or certificate of health insurance. The group health insurance policy, health care plan or certificate of health insurance shall limit the hearing aid benefit to one hearing aid per ear within a twenty-four month period. The hearing aid coverage shall cover the full cost of one hearing aid per hearing-impaired ear [up to] in an amount no less than two thousand two hundred dollars ($2,200) [every thirty-six months for hearing aids for insured children under eighteen years of age or under twenty-one years of age if still attending high school]. The insured may choose a higher priced hearing aid and may pay the difference in cost above the two-thousand-two-hundred-dollar ($2,200) limit as provided in this subsection without financial or contractual penalty to the insured or to the provider of the hearing aid.

B. An insurer that delivers, issues for delivery or renews in this state a blanket or group health insurance policy, health care plan or certificate of health insurance may make available to the policyholder the option of purchasing additional hearing aid coverage that exceeds the services described in this section.

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

E. Coverage for hearing aids may be subject to deductibles and coinsurance consistent with those imposed on other benefits under the same policy, plan or certificate.

SECTION 4. Section 59A-46-38.5 NMSA 1978 (being Laws 2007, Chapter 356, Section 4) is amended to read:

"59A-46-38.5. HEARING AID COVERAGE [FOR CHILDREN] REQUIRED.--

A. An individual or group health maintenance organization contract delivered, issued for delivery or renewed in this state shall provide coverage for [a] hearing [aid and any related service for] aids. Such hearing aids shall be prescribed by a physician or a person licensed by the state to prescribe hearing aids and shall be considered durable medical equipment under the contract. The contract shall limit the hearing aid benefit to one hearing aid per ear within a twenty-four month period. The hearing aid coverage shall cover the full cost of one hearing aid per hearing-impaired ear [up to] in an amount no less than two thousand two hundred dollars ($2,200) [every thirty-six months for hearing aids for insured children under eighteen years of age or under twenty-one years of age if still attending high school]. The insured may choose a higher priced hearing aid and may pay the difference in cost above the two-thousand-two-hundred-dollar ($2,200) limit as provided in this subsection without financial or contractual penalty to the insured or to the provider of the hearing aid.

B. An insurer that delivers, issues for delivery or renews in this state an individual or group health maintenance organization contract may make available to the policyholder the option of purchasing additional hearing aid coverage that exceeds the services described in this section.

C. Hearing aid coverage offered shall include fitting and dispensing services, including providing ear molds as necessary to maintain optimal fit, provided by an audiologist, a hearing aid dispenser or a physician, licensed in New Mexico. A health maintenance organization has the discretion to determine the provider of hearing aids with which it contracts. Nothing in this section shall be construed to preclude a health maintenance organization from conducting medical necessity or utilization review for hearing aids and related services.

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

E. Coverage for hearing aids may be subject to deductibles and coinsurance consistent with those imposed on other benefits under the same policy, plan or certificate.

SECTION 5. Section 59A-47-37.1 NMSA 1978 (being Laws 2007, Chapter 356, Section 5) is amended to read:

"59A-47-37.1. HEARING AID COVERAGE [FOR CHILDREN] REQUIRED.--

A. An individual or group health insurance policy, health care plan or certificate of health insurance delivered or issued for delivery in this state shall provide coverage for [a] hearing [aid and any related service for] aids. Such hearing aids shall be prescribed by a physician or a person licensed by the state to prescribe hearing aids and shall be considered durable medical equipment under the group health insurance policy, health care plan or certificate of health insurance. The group health insurance policy, health care plan or certificate of health insurance shall limit the hearing aid benefit to one hearing aid per ear within a twenty-four-month period. The hearing aid coverage shall cover the full cost of one hearing aid per hearing-impaired ear [up to] in an amount no less than two thousand two hundred dollars ($2,200) [every thirty-six months for hearing aids for insured children under eighteen years of age or under twenty-one years of age if still attending high school]. The insured may choose a higher priced hearing aid and may pay the difference in cost above the two-thousand-two-hundred-dollar ($2,200) limit as provided in this subsection without financial or contractual penalty to the insured or to the provider of the hearing aid.

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

E. Coverage for hearing aids may be subject to deductibles and coinsurance consistent with those imposed on other benefits under the same policy, plan or certificate.

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