0001| SENATE BILL 682 | 0002| 43rd legislature - STATE OF NEW MEXICO - first session, 1997 | 0003| INTRODUCED BY | 0004| BEN D. ALTAMIRANO | 0005| | 0006| | 0007| | 0008| | 0009| | 0010| AN ACT | 0011| RELATING TO HEALTH INSURANCE; REQUIRING COVERAGE FOR | 0012| INDIVIDUALS WITH DIABETES; AMENDING AND ENACTING SECTIONS OF | 0013| THE NMSA 1978. | 0014| | 0015| BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF NEW MEXICO: | 0016| Section 1. A new section of the New Mexico Insurance | 0017| Code, Section 59A-22-41 NMSA 1978, is enacted to read: | 0018| "59A-22-41. [NEW MATERIAL] COVERAGE FOR INDIVIDUALS | 0019| WITH DIABETES.-- | 0020| A. Each individual and group health insurance | 0021| policy, health care plan, certificate of health insurance and | 0022| managed health care plan delivered or issued for delivery in | 0023| this state shall provide coverage for individuals with | 0024| insulin-using diabetes, with non-insulin-using diabetes and | 0025| with elevated blood glucose levels induced by pregnancy. This | 0001| coverage shall be a basic health care benefit and shall entitle | 0002| each individual to the medically accepted standard of medical | 0003| care for diabetes and benefits for diabetes treatment as well | 0004| as diabetes supplies, and this coverage shall not be reduced or | 0005| eliminated. | 0006| B. Coverage for individuals with diabetes may be | 0007| subject to deductibles and coinsurance consistent with those | 0008| imposed on other benefits under the same policy, plan or | 0009| certificate, as long as the annual deductibles or coinsurance | 0010| for benefits are no greater than the annual deductibles or | 0011| coinsurance established for similar benefits within a given | 0012| policy. | 0013| C. When prescribed or diagnosed by a health care | 0014| practitioner with prescribing authority, all individuals with | 0015| diabetes as described in Subsection A of this section enrolled | 0016| in health policies described in that subsection shall be | 0017| entitled to the following equipment, supplies and appliances to | 0018| treat diabetes: | 0019| (1) blood glucose monitors, including those | 0020| for the legally blind; | 0021| (2) test strips for blood glucose monitors; | 0022| (3) visual reading urine and ketone strips; | 0023| (4) lancets and lancet devices; | 0024| (5) insulin; | 0025| (6) injection aids, including those adaptable | 0001| to meet the needs of the legally blind; | 0002| (7) syringes; | 0003| (8) prescriptive oral agents for controlling | 0004| blood sugar levels; | 0005| (9) podiatric appliances for prevention of | 0006| feet complications associated with diabetes, including | 0007| therapeutic molded or depth-inlay shoes, functional orthotics, | 0008| custom molded inserts, replacement inserts, preventive devices | 0009| and shoe modifications for prevention and treatment; and | 0010| (10) glucagon emergency kits. | 0011| D. When prescribed or diagnosed by a health care | 0012| practitioner with prescribing authority, all individuals with | 0013| diabetes as described in Subsection A of this section enrolled | 0014| in health policies described in that subsection shall be | 0015| entitled to the following basic health care benefits: | 0016| (1) diabetes self-management training that | 0017| shall be provided by a certified, registered or licensed health | 0018| care professional with recent education in diabetes management, | 0019| which shall be limited to: | 0020| (a) medically necessary visits upon the | 0021| diagnosis of diabetes; | 0022| (b) visits following a physician | 0023| diagnosis that represents a significant change in the patient's | 0024| symptoms or condition that warrants changes in the patient's | 0025| self-management; and | 0001| (c) visits when re-education or | 0002| refresher training is prescribed by a health care practitioner | 0003| with prescribing authority; and | 0004| (2) medical nutrition therapy related to | 0005| diabetes management. | 0006| E. When new or improved equipment, appliances, | 0007| prescription drugs for the treatment of diabetes, insulin or | 0008| supplies for the treatment of diabetes are approved by the food | 0009| and drug administration, all individual or group health | 0010| insurance policies as described in Subsection A of this section | 0011| shall: | 0012| (1) maintain an adequate formulary to provide | 0013| these resources to individuals with diabetes; and | 0014| (2) guarantee reimbursement or coverage for | 0015| the equipment, appliances, prescription drug, insulin or | 0016| supplies described in this subsection within the limits of the | 0017| health care plan, policy or certificate. | 0018| F. The provisions of Subsections A through E of | 0019| this section shall be enforced by the superintendent. | 0020| G. The provisions of this section shall not apply | 0021| to short-term travel, accident-only or limited or specified | 0022| disease policies. | 0023| H. For purposes of this section: | 0024| (1) "basic health care benefits": | 0025| (a) means benefits for medically | 0001| necessary services consisting of preventive care, emergency | 0002| care, inpatient and outpatient hospital and physician care, | 0003| diagnostic laboratory and diagnostic and therapeutic | 0004| radiological services; and | 0005| (b) does not include mental health | 0006| services or services for alcohol or drug abuse, dental or | 0007| vision services or long-term rehabilitation treatment; and | 0008| (2) "managed health care plan" means a health | 0009| benefit plan offered by a health care insurer that provides for | 0010| the delivery of comprehensive basic health care services and | 0011| medically necessary services to individuals enrolled in the | 0012| plan through its own employed health care providers or by | 0013| contracting with selected or participating health care | 0014| providers. A managed health care plan includes only those | 0015| plans that provide comprehensive basic health care services to | 0016| enrollees on a prepaid, capitated basis, including the | 0017| following: | 0018| (a) health maintenance organizations; | 0019| (b) preferred provider organizations; | 0020| (c) individual practice associations; | 0021| (d) competitive medical plans; | 0022| (e) exclusive provider organizations; | 0023| (f) integrated delivery systems; | 0024| (g) independent physician-provider | 0025| organizations; | 0001| (h) physician hospital-provider | 0002| organizations; and | 0003| (i) managed care services | 0004| organizations." Section 2. Section 59A-23-4 NMSA 1978 | 0005| (being Laws 1984, Chapter 127, Section 463, as amended) is | 0006| amended to read: | 0007| "59A-23-4. OTHER PROVISIONS APPLICABLE.-- | 0008| A. No blanket or group health insurance policy or | 0009| contract shall contain any provision relative to notice or | 0010| proof of loss or the time for paying benefits or the time | 0011| within which suit may be brought upon the policy that in the | 0012| superintendent's opinion is less favorable to the insured than | 0013| would be permitted in the required or optional provisions for | 0014| individual health insurance policies as set forth in Chapter | 0015| 59A, Article 22 NMSA 1978. | 0016| B. The following provisions of Chapter 59A, Article | 0017| 22 NMSA 1978 shall also apply as to Chapter 59A, Article 23 | 0018| NMSA 1978 and blanket and group health insurance contracts: | 0019| (1) Section 59A-22-1 NMSA 1978, except | 0020| Subsection C [thereof] of that section; and | 0021| (2) Section 59A-22-32 NMSA 1978. | 0022| C. The following provisions of Chapter 59A, Article | 0023| 22 NMSA 1978 shall also apply as to group health insurance | 0024| contracts: | 0025| (1) Section 59A-22-33 NMSA 1978; | 0001| (2) Section 59A-22-34 NMSA 1978; | 0002| (3) Section 59A-22-34.1 NMSA 1978; | 0003| (4) Section 59A-22-35 NMSA 1978; | 0004| (5) Section 59A-22-36 NMSA 1978; | 0005| (6) Section 59A-22-39 NMSA 1978; [and] | 0006| (7) Section 59A-22-40 NMSA 1978; and | 0007| (8) Section 59A-22-41 NMSA 1978." | 0008| Section 3. A new section of the Health Maintenance | 0009| Organization Law, Section 59A-46-43 NMSA 1978, is enacted to | 0010| read: | 0011| "59A-46-43. [NEW MATERIAL] COVERAGE FOR INDIVIDUALS | 0012| WITH DIABETES.-- | 0013| A. Each individual and group health maintenance | 0014| organization contract delivered or issued for delivery in this | 0015| state shall provide coverage for individuals with insulin-using | 0016| diabetes, with non-insulin-using diabetes and with elevated | 0017| blood glucose levels induced by pregnancy. This coverage shall | 0018| be a basic health care service and shall entitle each | 0019| individual to the medically accepted standard of medical care | 0020| for diabetes and benefits for diabetes treatment as well as | 0021| diabetes supplies, and this coverage shall not be reduced or | 0022| eliminated. | 0023| B. Coverage for individuals with diabetes may be | 0024| subject to deductibles and coinsurance consistent with those | 0025| imposed on other benefits under the same contract, as long as | 0001| the annual deductibles or coinsurance for benefits are no | 0002| greater than the annual deductibles or coinsurance established | 0003| for similar benefits within a given contract. | 0004| C. When prescribed or diagnosed by a health care | 0005| practitioner with prescribing authority, all individuals with | 0006| diabetes as described in Subsection A of this section enrolled | 0007| under an individual or group health maintenance organization | 0008| contract shall be entitled to the following equipment, supplies | 0009| and appliances to treat diabetes: | 0010| (1) blood glucose monitors, including those | 0011| for the legally blind; | 0012| (2) test strips for blood glucose monitors; | 0013| (3) visual reading urine and ketone strips; | 0014| (4) lancets and lancet devices; | 0015| (5) insulin; | 0016| (6) injection aids, including those adaptable | 0017| to meet the needs of the legally blind; | 0018| (7) syringes; | 0019| (8) prescriptive oral agents for controlling | 0020| blood sugar levels; | 0021| (9) podiatric appliances for prevention of | 0022| feet complications associated with diabetes, including | 0023| therapeutic molded or depth-inlay shoes, functional orthotics, | 0024| custom molded inserts, replacement inserts, preventive devices | 0025| and shoe modifications for prevention and treatment; and | 0001| (10) glucagon emergency kits. | 0002| D. When prescribed or diagnosed by a health care | 0003| practitioner with prescribing authority, all individuals with | 0004| diabetes as described in Subsection A of this section enrolled | 0005| under an individual or group health maintenance contract shall | 0006| be entitled to the following basic health care services: | 0007| (1) diabetes self-management training that | 0008| shall be provided by a certified, registered or licensed health | 0009| care professional with recent education in diabetes management, | 0010| which shall be limited to: | 0011| (a) medically necessary visits upon the | 0012| diagnosis of diabetes; | 0013| (b) visits following a physician | 0014| diagnosis that represents a significant change in the patient's | 0015| symptoms or condition that warrants changes in the patient's | 0016| self-management; and | 0017| (c) visits when re-education or | 0018| refresher training is prescribed by a health care practitioner | 0019| with prescribing authority; and | 0020| (2) medical nutrition therapy related to | 0021| diabetes management. | 0022| E. When new or improved equipment, appliances, | 0023| prescription drugs for the treatment of diabetes, insulin or | 0024| supplies for the treatment of diabetes are approved by the food | 0025| and drug administration, each individual or group health | 0001| maintenance organization contract shall: | 0002| (1) maintain an adequate formulary to provide | 0003| these resources to individuals with diabetes; and | 0004| (2) guarantee reimbursement or coverage for | 0005| the equipment, appliances, prescription drug, insulin or | 0006| supplies described in this subsection within the limits of the | 0007| health care plan, policy or certificate. | 0008| F. The provisions of Subsections A through E of | 0009| this section shall be enforced by the superintendent. | 0010| G. The provisions of this section shall not apply | 0011| to short-term travel, accident-only or limited or specified | 0012| disease policies." | 0013| Section 4. Section 59A-47-33 NMSA 1978 (being Laws 1984, | 0014| Chapter 127, Section 879.32, as amended by Laws 1994, Chapter | 0015| 64, Section 10 and also by Laws 1994, Chapter 75, Section 34) | 0016| is amended to read: | 0017| "59A-47-33. OTHER PROVISIONS APPLICABLE.--The provisions | 0018| of the Insurance Code other than Chapter 59A, Article 47 NMSA | 0019| 1978 shall not apply to health care plans except as expressly | 0020| provided in the Insurance Code and that article. To the extent | 0021| reasonable and not inconsistent with the provisions of that | 0022| article, the following articles and provisions of the Insurance | 0023| Code shall also apply to health care plans, their promoters, | 0024| sponsors, directors, officers, employees, agents, solicitors | 0025| and other representatives; and, for the purposes of such | 0001| applicability, a health care plan may therein be referred to as | 0002| an "insurer": | 0003| A. Chapter 59A, Article 1 NMSA 1978; | 0004| B. Chapter 59A, Article 2 NMSA 1978; | 0005| C. Chapter 59A, Article 4 NMSA 1978; | 0006| D. Subsection C of Section 59A-5-22 NMSA 1978; | 0007| E. Sections 59A-6-2 through 59A-6-4 and | 0008| 59A-6-6 NMSA 1978; | 0009| F. Section 59A-7-11 NMSA 1978; | 0010| G. Chapter 59A, Article 8 NMSA 1978; | 0011| H. Chapter 59A, Article 10 NMSA 1978; | 0012| I. Section 59A-12-22 NMSA 1978; | 0013| J. Chapter 59A, Article 16 NMSA 1978; | 0014| K. Chapter 59A, Article 18 NMSA 1978; | 0015| L. Chapter 59A, Article 19 NMSA 1978; | 0016| M. Subsections B through E of Section | 0017| 59A-22-5 NMSA 1978; | 0018| N. Section 59A-22-34.1 NMSA 1978; | 0019| O. Section 59A-22-39 NMSA 1978; | 0020| P. Section 59A-22-40 NMSA 1978; | 0021| Q. Section 59A-22-41 NMSA 1978; | 0022| [Q.] R. Sections 59A-34-9 through 59A-34-13 | 0023| [NMSA 1978] and [Section] 59A-34-23 NMSA 1978; | 0024| [R.] S. Chapter 59A, Article 37 NMSA 1978, | 0025| except Section 59A-37-7 NMSA 1978; and | 0001| [S.] T. Section 59A-46-15 NMSA 1978." | 0002| Section 5. EFFECTIVE DATE.--The effective date of the | 0003| provisions of this act is January 1, 1998. | 0004| - 11 - | 0005| | 0006| FORTY-THIRD LEGISLATURE | 0007| FIRST SESSION, 1997 | 0008| | 0009| | 0010| February 18, 1997 | 0011| | 0012| Mr. President: | 0013| | 0014| Your CORPORATIONS & TRANSPORTATION COMMITTEE, to | 0015| whom has been referred | 0016| | 0017| SENATE BILL 682 | 0018| | 0019| has had it under consideration and reports same with | 0020| recommendation that it DO PASS, and thence referred to the | 0021| FINANCE COMMITTEE. | 0022| | 0023| Respectfully submitted, | 0024| | 0025| | 0001| | 0002| | 0003| __________________________________ | 0004| Roman M. Maes, III, Chairman | 0005| | 0006| | 0007| | 0008| Adopted_______________________ Not | 0009| Adopted_______________________ | 0010| (Chief Clerk) (Chief Clerk) | 0011| | 0012| | 0013| Date ________________________ | 0014| | 0015| | 0016| The roll call vote was 7 For 0 Against | 0017| Yes: 7 | 0018| No: 0 | 0019| Excused: Fidel, Griego, Robinson | 0020| Absent: None | 0021| | 0022| | 0023| S0682CT1 | 0024| | 0025| FORTY-THIRD LEGISLATURE | 0001| FIRST SESSION | 0002| | 0003| | 0004| February 20, 1997 | 0005| | 0006| | 0007| SENATE FLOOR AMENDMENT number _______ to SENATE BILL 682 | 0008| | 0009| Amendment sponsored by Senator Altamirano | 0010| | 0011| | 0012| 1. On page 3, line 4, after "(9)" insert "medically | 0013| necessary". | 0014| | 0015| 2. On page 8, line 17, after "(9)" insert "medically | 0016| necessary". | 0017| | 0018| | 0019| | 0020| | 0021| __________________________ | 0022| Ben D. Altamirano | 0023| | 0024| | 0025| | 0001| Adopted ___________________ Not Adopted _______________________ | 0002| (Chief Clerk) (Chief Clerk) | 0003| | 0004| | 0005| Date _________________ | 0006| State of New Mexico | 0007| House of Representatives | 0008| | 0009| FORTY-THIRD LEGISLATURE | 0010| FIRST SESSION, 1997 | 0011| | 0012| | 0013| March 11, 1997 | 0014| | 0015| | 0016| Mr. Speaker: | 0017| | 0018| Your BUSINESS AND INDUSTRY COMMITTEE, to whom has | 0019| been referred | 0020| | 0021| SENATE BILL 682, as amended | 0022| | 0023| has had it under consideration and reports same with | 0024| recommendation that it DO PASS, and thence referred to the | 0025| CONSUMER AND PUBLIC AFFAIRS COMMITTEE. | 0001| | 0002| Respectfully submitted, | 0003| | 0004| | 0005| | 0006| | 0007| Fred Luna, Chairman | 0008| | 0009| | 0010| Adopted Not Adopted | 0011| | 0012| (Chief Clerk) | 0013| (Chief Clerk) | 0014| | 0015| Date | 0016| | 0017| The roll call vote was 10 For 0 Against | 0018| Yes: 10 | 0019| Excused: Alwin, Getty, Olguin | 0020| Absent: None | 0021| | 0022| | 0023| | 0024| G:\BILLTEXT\BILLW_97\S0682 State of New Mexico | 0025| House of Representatives | 0001| | 0002| FORTY-THIRD LEGISLATURE | 0003| FIRST SESSION, 1997 | 0004| | 0005| | 0006| March 21, 1997 | 0007| | 0008| | 0009| Mr. Speaker: | 0010| | 0011| Your CONSUMER AND PUBLIC AFFAIRS COMMITTEE, to | 0012| whom has been referred | 0013| | 0014| SENATE BILL 682, as amended | 0015| | 0016| has had it under consideration and reports same with | 0017| recommendation that it DO PASS. | 0018| | 0019| Respectfully submitted, | 0020| | 0021| | 0022| | 0023| | 0024| Gary King, Chairman | 0025| | 0001| | 0002| Adopted Not Adopted | 0003| | 0004| (Chief Clerk) | 0005| (Chief Clerk) | 0006| | 0007| Date | 0008| | 0009| The roll call vote was 6 For 0 Against | 0010| Yes: 6 | 0011| Excused: Dana, Rios, Sandel, Trujillo | 0012| Absent: None | 0013| | 0014| | 0015| G:\BILLTEXT\BILLW_97\S0682 |