0001|                            HOUSE BILL 834
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0002|     43rd legislature - STATE OF NEW MEXICO - first session, 1997
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0003|                            INTRODUCED BY
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0004|                            JOHN A. HEATON
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0005|     
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0006|                                   
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0007|     
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0008|                                   
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0009|     
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0010|                                AN ACT
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0011|     RELATING TO HEALTH INSURANCE; IMPOSING PROHIBITIONS ON A
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0012|     MANAGED HEALTH CARE PLAN'S REQUIREMENTS AFFECTING HEALTH CARE
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0013|     PROVIDERS.
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0014|     
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0015|     BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF NEW MEXICO:
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0016|          Section 1.  A new section of the New Mexico Insurance Code
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0017|     is enacted to read:
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0018|          "[<u>NEW MATERIAL</u>]  MANAGED HEALTH CARE PLAN PROHIBITIONS
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0019|     AFFECTING PROVIDERS.--
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0020|               A.  No managed health care plan may enter into or
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0021|     continue in a contract with a health care provider that has
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0022|     been determined in a final, nonappealable decision issued by
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0023|     the provider's professional licensing board or state regulatory
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0024|     agency to be in current violation of a material provision of
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0025|     the licensing act that governs the provider's profession or
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0001|     business.
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0002|               B.  No managed health care plan may require a health
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0003|     care provider to act or refrain from acting in a manner that
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0004|     violates a professional standard, an ethical obligation or the
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0005|     professional judgment of the provider.  A managed health care
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0006|     plan that violates the provisions of this subsection shall be
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0007|     deemed to commit an act of professional malpractice and shall
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0008|     be liable for any resulting professional malpractice judgment
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0009|     imposed upon the plan or the affected health care provider.
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0010|               C.  For the purposes of this section:
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0011|                    (1)  "health care facility" means an
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0012|     institution providing health care services, including a
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0013|     hospital or other licensed inpatient center; an ambulatory
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0014|     surgical or treatment center; a skilled nursing center; a
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0015|     residential treatment center; a home health agency; a
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0016|     diagnostic, laboratory or imaging center; and a rehabilitation
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0017|     or other therapeutic health setting;
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0018|                    (2)  "health care insurer" means a person that
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0019|     has a valid certificate of authority in good standing under the
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0020|     New Mexico Insurance Code to act as an insurer, health
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0021|     maintenance organization, nonprofit health care plan or prepaid
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0022|     dental plan;
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0023|                    (3)  "health care professional" means a
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0024|     physician or other health care practitioner, including a
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0025|     pharmacist, who is licensed, certified or otherwise authorized
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0001|     by the state to provide health care services consistent with
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0002|     state law;
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0003|                    (4)  "health care provider" or "provider" means
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0004|     a person that is licensed or otherwise authorized by the state
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0005|     to furnish health care services and includes health care
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0006|     professionals and health care facilities;
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0007|                    (5)  "health care services" includes physical
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0008|     health services or community-based mental health or
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0009|     developmentally disabled services;
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0010|                    (6)  "managed health care plan" or "plan" means
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0011|     a health benefit plan of a health care insurer or a provider
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0012|     service network that either requires a covered person to use,
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0013|     or creates incentives, including financial incentives, for a
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0014|     covered person to use health care providers managed, owned,
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0015|     under contract with or employed by the health care insurer.  A
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0016|     managed health care plan includes a plan that provides health
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0017|     care services to enrollees on a prepaid, capitated basis and
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0018|     includes the health care services offered by a health
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0019|     maintenance organization, a preferred provider organization, an
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0020|     individual practice organization, a competitive medical plan,
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0021|     an exclusive provider organization, an integrated delivery
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0022|     system, an independent physician-provider organization, a
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0023|     physician hospital-provider organization or a managed care
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0024|     services organization.  "Managed health care plan" or "plan"
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0025|     does not include a traditional fee-for-service indemnity plan
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0001|     or a plan that covers only short-term travel, accident-only,
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0002|     limited benefit or specified disease policies; and
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0003|                    (7)  "person" means an individual or other
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0004|     legal entity."
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0005|                                                         State of New Mexico
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0006|                      House of Representatives
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0007|   
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0008|                      FORTY-THIRD LEGISLATURE
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0009|                        FIRST SESSION, 1997
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0010|   
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0011|   
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0012|                                               February 27, 1997
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0013|   
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0014|   
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0015|   Mr. Speaker:
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0016|   
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0017|        Your BUSINESS AND INDUSTRY COMMITTEE, to whom
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0018|   has been referred
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0019|   
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0020|                        HOUSE BILL 834
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0021|   
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0022|   has had it under consideration and reports same with
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0023|   recommendation that it DO PASS, amended as follows:
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0024|   
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0025|        1.  On page 1, line 20, after "provider" insert "if" and
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0001|   after "that" insert "provider".
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0002|   
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0003|        2.  On page 2, line 3, after "standard" strike the comma and
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0004|   insert in lieu thereof "or".
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0005|   
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0006|        3.  On page 2, lines 3 and 4, after "obligation" strike "or
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0007|   the professional judgment".
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0008|   
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0009|        4.  On page 2, strike line 6.
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0010|   
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0011|        5.  On page 3, line 14, after the period strike "A", strike
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0012|   all 
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0013|   of lines 15 through 22, and on line 23 strike "organization.".,
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0014|   
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0015|   and thence referred to the APPROPRIATIONS AND FINANCE
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0016|   COMMITTEE.
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0017|   
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0018|                                 Respectfully submitted,
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0019|   
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0020|   
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0021|   
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0022|                                 <u>                                
</u>    |
<u></u>0023| <u>  
</u>    |
<u></u>0024| <u>                                </u>                             Fred Luna, Chairman
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0025|   
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0001|   
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0002|   Adopted <u>                    </u>     Not Adopted <u>                    
</u>    |
<u></u>0003| <u>   </u>
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0004|             (Chief Clerk)                       (Chief Clerk)
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0005|   
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0006|                        Date <u>            </u>
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0007|   
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0008|   The roll call vote was<u> 9 </u> For<u> 0 </u> Against
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0009|   Yes:      9
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0010|             Excused:  Alwin, Lutz, Olguin
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0011|             Absent:   Getty
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0012|   
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0013|   
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0014|                                                        117859.1
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0015|   G:\BILLTEXT\BILLW_97\H0834  
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0016|   
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0017|                      FORTY-THIRD LEGISLATURE
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0018|                        FIRST SESSION, 1997
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0019|   
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0020|   
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0021|                                                  March 16, 1997
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0022|   
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0023|   Mr. President:
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0024|   
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0025|       Your PUBLIC AFFAIRS COMMITTEE, to whom has been
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0001|   referred
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0002|   
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0003|                     HOUSE BILL 834, as amended
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0004|   
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0005|   has had it under consideration and reports same with
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0006|   recommendation that it DO PASS.
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0007|   
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0008|                                Respectfully submitted,
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0009|   
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0010|   
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0011|   
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0012|                                
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0013|   __________________________________
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0014|                                Shannon Robinson, Chairman 
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0015|   
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0016|   
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0017|   
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0018|   Adopted_______________________   Not
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0019|   Adopted_______________________
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0020|             (Chief Clerk)                          (Chief Clerk)
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0021|   
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0022|   
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0023|   
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0024|                     Date ________________________
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0025|   
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0001|   
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0002|   The roll call vote was <u> 5 </u> For <u> 0 </u> Against
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0003|           Yes:    5
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0004|           No:     0
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0005|                Excused:     Adair, Boitano, Garcia, Vernon,
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0006|           Absent: None
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0007|   
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0008|   
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0009|   H0834PA1
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