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