New Mexico 2025 Regular Session

New Mexico House Bill HB233 Compare Versions

Version 1 (Old)

Version 2 (New)

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1		-	~~HB 233/a~~
2		-	~~Page 1~~
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	28	+	HOUSE BILL 233
	29	+	57
	30	+	TH LEGISLATURE
	31	+	-
	32	+
	33	+	STATE
	34	+
	35	+	OF
	36	+
	37	+	NEW
	38	+
	39	+	MEXICO
	40	+
	41	+	-
	42	+	FIRST SESSION
	43	+	,
	44	+
	45	+	2025
	46	+	INTRODUCED BY
	47	+	Joshua N. Hernandez and Elizabeth "Liz" Thomson
	48	+	and Eleanor Chávez
28	49		AN ACT
29	50		RELATING TO INSURANCE; AMENDING SECTIONS OF THE NEW MEXICO
30		-	INSURANCE CODE, THE HEALTH MAINTENANCE ORGANIZATION LAW AND
31		-	~~THE~~ NONPROFIT HEALTH CARE PLAN LAW TO REQUIRE COVERAGE FOR
32		-	~~CERTAIN~~ DURABLE MEDICAL EQUIPMENT FOR THE TREATMENT OF ACTIVE
33		-	~~DIABETIC~~ FOOT ULCERS.
	51	+	INSURANCE CODE, THE HEALTH MAINTENANCE ORGANIZATION LAW AND THE
	52	+	NONPROFIT HEALTH CARE PLAN LAW TO REQUIRE COVERAGE FOR CERTAIN
	53	+	DURABLE MEDICAL EQUIPMENT FOR THE TREATMENT OF ACTIVE DIABETIC
	54	+	FOOT ULCERS.
34	55		BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF NEW MEXICO:
35		-	SECTION 1. Section 59A-22-41 NMSA 1978 (being Laws
36		-	~~1997,~~ Chapter 7, Section 1 and Laws 1997, Chapter 255,
37		-	~~Section 1, as~~ amended) is amended to read:
	56	+	SECTION 1. Section 59A-22-41 NMSA 1978 (being Laws 1997,
	57	+	Chapter 7, Section 1 and Laws 1997, Chapter 255, Section 1, as
	58	+	amended) is amended to read:
38	59		"59A-22-41. COVERAGE FOR INDIVIDUALS WITH DIABETES.--
39	60		A. Each individual and group health insurance
40	61		policy, health care plan, certificate of health insurance and
41	62		managed health care plan delivered or issued for delivery in
42		-	this state shall provide coverage for individuals with
43		-	insulin-using diabetes, with non-insulin-using diabetes and
44		-	with elevated blood glucose levels induced by pregnancy.
45		-	This coverage shall be a basic health care benefit and shall
46		-	entitle each individual to the medically accepted standard of
47		-	medical care for diabetes and benefits for diabetes treatment
48		-	as well as diabetes supplies, and this coverage shall not be
49		-	reduced or eliminated.
50		-	B. Except as otherwise provided in this
51		-	subsection, coverage for individuals with diabetes may be HB 233/a
52		-	Page 2
	63	+	this state shall provide coverage for individuals with insulin-
	64	+	.229151.1 underscored material = new
	65	+	[bracketed material] = delete
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78		-	subject to deductibles and coinsurance consistent with those
79		-	imposed on other benefits under the same policy, plan or
80		-	certificate, as long as the annual deductibles or coinsurance
81		-	for benefits are no greater than the annual deductibles or
82		-	coinsurance established for similar benefits within a given
83		-	policy. The amount an individual with diabetes is required
84		-	to pay for a preferred formulary prescription insulin drug or
85		-	a medically necessary alternative is an amount not to exceed
86		-	a total of twenty-five dollars ($25.00) per thirty-day
87		-	supply.
	91	+	using diabetes, with non-insulin-using diabetes and with
	92	+	elevated blood glucose levels induced by pregnancy. This
	93	+	coverage shall be a basic health care benefit and shall entitle
	94	+	each individual to the medically accepted standard of medical
	95	+	care for diabetes and benefits for diabetes treatment as well
	96	+	as diabetes supplies, and this coverage shall not be reduced or
	97	+	eliminated.
	98	+	B. Except as otherwise provided in this subsection,
	99	+	coverage for individuals with diabetes may be subject to
	100	+	deductibles and coinsurance consistent with those imposed on
	101	+	other benefits under the same policy, plan or certificate, as
	102	+	long as the annual deductibles or coinsurance for benefits are
	103	+	no greater than the annual deductibles or coinsurance
	104	+	established for similar benefits within a given policy. The
	105	+	amount an individual with diabetes is required to pay for a
	106	+	preferred formulary prescription insulin drug or a medically
	107	+	necessary alternative is an amount not to exceed a total of
	108	+	twenty-five dollars ($25.00) per thirty-day supply.
88	109		C. When prescribed or diagnosed by a health care
89	110		practitioner with prescribing authority, all individuals with
90		-	diabetes as described in Subsection A of this section
91		-	~~enrolled~~ in health policies described in that subsection
92		-	~~shall be~~ entitled to the following equipment, supplies and
93		-	~~appliances to~~ treat diabetes:
	111	+	diabetes as described in Subsection A of this section enrolled
	112	+	in health policies described in that subsection shall be
	113	+	entitled to the following equipment, supplies and appliances to
	114	+	treat diabetes:
94	115		(1) blood glucose monitors, including those
95		-	for individuals with disabilities, including the legally
96		-	blind;
97		-	(2) test strips for blood glucose monitors;
98		-	(3) visual reading urine and ketone strips;
99		-	(4) lancets and lancet devices;
100		-	(5) insulin;
101		-	(6) injection aids, including those
102		-	adaptable to meet the needs of individuals with disabilities, HB 233/a
103		-	Page 3
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129		-	including the legally blind;
	144	+	for individuals with disabilities, including the legally blind;
	145	+	(2) test strips for blood glucose monitors;
	146	+	(3) visual reading urine and ketone strips;
	147	+	(4) lancets and lancet devices;
	148	+	(5) insulin;
	149	+	(6) injection aids, including those adaptable
	150	+	to meet the needs of individuals with disabilities, including
	151	+	the legally blind;
130	152		(7) syringes;
131	153		(8) prescriptive oral agents for controlling
132	154		blood sugar levels;
133		-	(9) medically necessary podiatric appliances
134		-	for prevention of feet complications associated with
135		-	diabetes, including therapeutic molded or depth-inlay shoes,
136		-	functional orthotics, custom molded inserts, replacement
137		-	inserts, preventive devices and shoe modifications for
138		-	prevention and treatment; and
	155	+	(9) medically necessary:
	156	+	(a) podiatric appliances for prevention
	157	+	of feet complications associated with diabetes, including
	158	+	therapeutic molded or depth-inlay shoes, functional orthotics,
	159	+	custom molded inserts, replacement inserts, preventive devices
	160	+	and shoe modifications for prevention and treatment; and
	161	+	(b) durable medical equipment for the
	162	+	treatment of active diabetic foot ulcers, including topical
	163	+	oxygen therapy; and
139	164		(10) glucagon emergency kits.
140	165		D. When prescribed or diagnosed by a health care
141	166		practitioner with prescribing authority, all individuals with
142		-	diabetes as described in Subsection A of this section
143		-	enrolled in health policies described in that subsection
144		-	shall be entitled to the following basic health care
145		-	benefits:
146		-	(1) diabetes self-management training that
147		-	shall be provided by a certified, registered or licensed
148		-	health care professional with recent education in diabetes
149		-	management, which shall be limited to:
150		-	(a) medically necessary visits upon the
151		-	diagnosis of diabetes;
152		-	(b) visits following a diagnosis from a
153		-	health care practitioner that represents a significant change HB 233/a
154		-	Page 4
	167	+	diabetes as described in Subsection A of this section enrolled
	168	+	in health policies described in that subsection shall be
	169	+	.229151.1
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180		-	in the patient's symptoms or condition that warrants changes
181		-	in the patient's self-management; and
	197	+	entitled to the following basic health care benefits:
	198	+	(1) diabetes self-management training that
	199	+	shall be provided by a certified, registered or licensed health
	200	+	care professional with recent education in diabetes management,
	201	+	which shall be limited to:
	202	+	(a) medically necessary visits upon the
	203	+	diagnosis of diabetes;
	204	+	(b) visits following a diagnosis from a
	205	+	health care practitioner that represents a significant change
	206	+	in the patient's symptoms or condition that warrants changes in
	207	+	the patient's self-management; and
182	208		(c) visits when re-education or
183		-	refresher training is prescribed by a health care
184		-	~~practitioner~~ with prescribing authority;
	209	+	refresher training is prescribed by a health care practitioner
	210	+	with prescribing authority; and
185	211		(2) medical nutrition therapy related to
186		-	diabetes management; and
187		-	(3) medically necessary treatment of active
188		-	diabetic foot ulcers, including topical oxygen therapy.
	212	+	diabetes management.
189	213		E. When new or improved equipment, appliances,
190	214		prescription drugs for the treatment of diabetes, insulin or
191	215		supplies for the treatment of diabetes are approved by the
192	216		federal food and drug administration, all individual or group
193		-	health insurance policies as described in Subsection A of
194		-	~~this~~ section shall:
195		-	(1) maintain an adequate formulary to
196		-	~~provide~~ those resources to individuals with diabetes; and
	217	+	health insurance policies as described in Subsection A of this
	218	+	section shall:
	219	+	(1) maintain an adequate formulary to provide
	220	+	those resources to individuals with diabetes; and
197	221		(2) guarantee reimbursement or coverage for
198		-	the equipment, appliances, prescription drug, insulin or
199		-	supplies described in this subsection within the limits of
200		-	the health care plan, policy or certificate.
201		-	F. An insurer that requires a covered person to
202		-	use a specific network provider or to purchase equipment,
203		-	appliances, supplies or insulin or prescription drugs for the
204		-	treatment or management of diabetes from a specific durable HB 233/a
205		-	Page 5
	222	+	.229151.1
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231		-	medical equipment supplier or other supplier as a condition
232		-	of coverage, payment or reimbursement shall:
	250	+	the equipment, appliances, prescription drug, insulin or
	251	+	supplies described in this subsection within the limits of the
	252	+	health care plan, policy or certificate.
	253	+	F. An insurer that requires a covered person to use
	254	+	a specific network provider or to purchase equipment,
	255	+	appliances, supplies or insulin or prescription drugs for the
	256	+	treatment or management of diabetes from a specific durable
	257	+	medical equipment supplier or other supplier as a condition of
	258	+	coverage, payment or reimbursement shall:
233	259		(1) maintain an adequate network of durable
234	260		medical equipment suppliers and other suppliers to provide
235	261		covered persons with medically necessary diabetes resources,
236		-	whether covered under the health policy's prescription drug
237		-	or medical benefit;
	262	+	whether covered under the health policy's prescription drug or
	263	+	medical benefit;
238	264		(2) have network contracts in place for the
239		-	entire policy or plan period and shall not allow contracts
240		-	with network providers, durable medical equipment suppliers
241		-	and other suppliers to lapse or terminate without ensuring
242		-	the availability of a replacement and continuity of care;
243		-	provided that single-case agreements do not satisfy the
244		-	requirements of Paragraph (1) of this subsection or this
245		-	paragraph;
246		-	(3) monitor network providers, durable
247		-	medical equipment suppliers and other network suppliers to
248		-	ensure that medically necessary equipment, appliances,
249		-	supplies and insulin or other prescription drugs are being
250		-	delivered to a covered person in a timely manner and when
251		-	needed by the covered person;
252		-	(4) guarantee reimbursement to a covered
253		-	person within thirty days following receipt of a written
254		-	demand from the covered person who pays out of pocket for
255		-	necessary equipment, appliances, supplies and insulin or HB 233/a
256		-	Page 6
	265	+	entire policy or plan period and shall not allow contracts with
	266	+	network providers, durable medical equipment suppliers and
	267	+	other suppliers to lapse or terminate without ensuring the
	268	+	availability of a replacement and continuity of care; provided
	269	+	that single-case agreements do not satisfy the requirements of
	270	+	Paragraph (1) of this subsection or this paragraph;
	271	+	(3) monitor network providers, durable medical
	272	+	equipment suppliers and other network suppliers to ensure that
	273	+	medically necessary equipment, appliances, supplies and insulin
	274	+	or other prescription drugs are being delivered to a covered
	275	+	.229151.1
	276	+	- 5 - underscored material = new
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282		-	other prescription drugs described in this section that are
283		-	not delivered timely to the covered person, and the portion
284		-	of payment for which the patient is responsible shall not
285		-	exceed the amount for the same covered benefit obtained from
286		-	a contracted supplier;
	303	+	person in a timely manner and when needed by the covered
	304	+	person;
	305	+	(4) guarantee reimbursement to a covered
	306	+	person within thirty days following receipt of a written demand
	307	+	from the covered person who pays out of pocket for necessary
	308	+	equipment, appliances, supplies and insulin or other
	309	+	prescription drugs described in this section that are not
	310	+	delivered timely to the covered person, and the portion of
	311	+	payment for which the patient is responsible shall not exceed
	312	+	the amount for the same covered benefit obtained from a
	313	+	contracted supplier;
287	314		(5) pay interest at the rate of eighteen
288	315		percent per year on the amount of reimbursement due to a
289	316		covered person if not paid within thirty days as required by
290	317		Paragraph (4) of this subsection;
291	318		(6) beginning on April 1, 2024, submit a
292	319		written report each quarter to the superintendent for the
293	320		previous quarter on the following metrics:
294	321		(a) the number of written demands for
295	322		reimbursement of out-of-pocket expenses from covered persons
296	323		received by the health care insurer;
297	324		(b) the number of out-of-pocket claims
298	325		for reimbursement paid and the aggregate amount of claims
299		-	reimbursed by the health care insurer within the time
300		-	required by Paragraph (4) of this subsection;
301		-	(c) the number of out-of-pocket claims
302		-	for reimbursement paid more than thirty days following
303		-	receipt of a written demand and the aggregate amount of these
304		-	payments, excluding interest; and
305		-	(d) the aggregate amount of interest
306		-	paid by the health care insurer pursuant to Paragraph (5) of HB 233/a
307		-	Page 7
	326	+	reimbursed by the health care insurer within the time required
	327	+	by Paragraph (4) of this subsection;
	328	+	.229151.1
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	356	+	(c) the number of out-of-pocket claims
	357	+	for reimbursement paid more than thirty days following receipt
	358	+	of a written demand and the aggregate amount of these payments,
	359	+	excluding interest; and
	360	+	(d) the aggregate amount of interest
	361	+	paid by the health care insurer pursuant to Paragraph (5) of
333	362		this subsection; and
334	363		(7) beginning on April 1, 2024, submit a
335	364		written report each quarter for the previous quarter to the
336		-	superintendent with the following information for each
337		-	~~durable~~ medical equipment supplier or other supplier that was
338		-	~~under~~ contract with the health care insurer or its agent
339		-	~~during the~~ previous quarter:
	365	+	superintendent with the following information for each durable
	366	+	medical equipment supplier or other supplier that was under
	367	+	contract with the health care insurer or its agent during the
	368	+	previous quarter:
340	369		(a) the name, address and telephone
341	370		number of each supplier and, if applicable, the corresponding
342	371		date upon which the respective supplier's contract expired,
343	372		lapsed or was terminated during the previous quarter;
344	373		(b) the percentage of total deliveries,
345	374		by description of item, that did not meet the delivery
346		-	requirements specified in Paragraph (3) of this subsection;
347		-	and
348		-	(c) the number of complaints received
349		-	by the health care insurer or its agent during the previous
	375	+	requirements specified in Paragraph (3) of this subsection; and
	376	+	(c) the number of complaints received by
	377	+	the health care insurer or its agent during the previous
350	378		quarter related to late deliveries, incomplete orders or
351	379		incorrect orders, respectively.
352	380		G. The superintendent shall annually audit all
353		-	health insurers offering policies, plans or certificates as
354		-	described in Subsection A of this section for compliance with
355		-	the requirements of this section. If the superintendent
356		-	determines that a health care insurer has not complied with
357		-	the requirements of this section, the superintendent shall HB 233/a
358		-	Page 8
	381	+	.229151.1
	382	+	- 7 - underscored material = new
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384		-	impose corrective action or use any other enforcement
385		-	mechanism available to the superintendent to obtain the
386		-	health care insurer's compliance with this section.
	409	+	health insurers offering policies, plans or certificates as
	410	+	described in Subsection A of this section for compliance with
	411	+	the requirements of this section. If the superintendent
	412	+	determines that a health care insurer has not complied with the
	413	+	requirements of this section, the superintendent shall impose
	414	+	corrective action or use any other enforcement mechanism
	415	+	available to the superintendent to obtain the health care
	416	+	insurer's compliance with this section.
387	417		H. Absent a change in diagnosis or in a covered
388	418		person's management or treatment of diabetes or its
389	419		complications, a health care insurer shall not require more
390	420		than one prior authorization per policy period for any single
391	421		drug or category of item enumerated in this section if
392	422		prescribed as medically necessary by the covered person's
393		-	health care practitioner. Changes in the prescribed dose of
394		-	a drug; quantities of supplies needed to administer a
395		-	prescribed drug; quantities of blood glucose self-testing
396		-	equipment and supplies; or quantities of supplies needed to
397		-	use or operate devices for which a covered person has
398		-	received prior authorization during the policy year shall not
399		-	be subject to additional prior authorization requirements in
400		-	the same policy year if prescribed as medically necessary by
401		-	the covered person's health care practitioner. Nothing in
402		-	this subsection shall be construed to require payment for
403		-	diabetes resources that are not covered benefits.
404		-	I. The provisions of this section do not apply to
405		-	short-term travel, accident-only or limited or specified
406		-	disease policies.
407		-	J. For purposes of this section:
408		-	(1) "basic health care benefits": HB 233/a
409		-	Page 9
	423	+	health care practitioner. Changes in the prescribed dose of a
	424	+	drug; quantities of supplies needed to administer a prescribed
	425	+	drug; quantities of blood glucose self-testing equipment and
	426	+	supplies; or quantities of supplies needed to use or operate
	427	+	devices for which a covered person has received prior
	428	+	authorization during the policy year shall not be subject to
	429	+	additional prior authorization requirements in the same policy
	430	+	year if prescribed as medically necessary by the covered
	431	+	person's health care practitioner. Nothing in this subsection
	432	+	shall be construed to require payment for diabetes resources
	433	+	that are not covered benefits.
	434	+	.229151.1
	435	+	- 8 - underscored material = new
	436	+	[bracketed material] = delete
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	462	+	I. The provisions of this section do not apply to
	463	+	short-term travel, accident-only or limited or specified
	464	+	disease policies.
	465	+	J. For purposes of this section:
	466	+	(1) "basic health care benefits":
435	467		(a) means benefits for medically
436	468		necessary services consisting of preventive care, emergency
437	469		care, inpatient and outpatient hospital and physician care,
438	470		diagnostic laboratory and diagnostic and therapeutic
439	471		radiological services; and
440	472		(b) does not include services for
441	473		alcohol or drug abuse, dental or long-term rehabilitation
442	474		treatment; and
443		-	(2) "managed health care plan" means a
444		-	~~health~~ benefit plan offered by a health care insurer that
445		-	~~provides for~~ the delivery of comprehensive basic health care
446		-	~~services and~~ medically necessary services to individuals
447		-	~~enrolled in the~~ plan through its own employed health care
448		-	~~providers or by~~ contracting with selected or participating
449		-	~~health care~~ providers. A managed health care plan includes
450		-	~~only those~~ plans that provide comprehensive basic health care
451		-	~~services to~~ enrollees on a prepaid, capitated basis,
452		-	~~including the~~ following:
	475	+	(2) "managed health care plan" means a health
	476	+	benefit plan offered by a health care insurer that provides for
	477	+	the delivery of comprehensive basic health care services and
	478	+	medically necessary services to individuals enrolled in the
	479	+	plan through its own employed health care providers or by
	480	+	contracting with selected or participating health care
	481	+	providers. A managed health care plan includes only those
	482	+	plans that provide comprehensive basic health care services to
	483	+	enrollees on a prepaid, capitated basis, including the
	484	+	following:
453	485		(a) health maintenance organizations;
454	486		(b) preferred provider organizations;
455		-	(c) individual practice associations;
456		-	(d) competitive medical plans;
457		-	(e) exclusive provider organizations;
458		-	(f) integrated delivery systems;
459		-	(g) independent physician-provider HB 233/a
460		-	Page 10
	487	+	.229151.1
	488	+	- 9 - underscored material = new
	489	+	[bracketed material] = delete
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	515	+	(c) individual practice associations;
	516	+	(d) competitive medical plans;
	517	+	(e) exclusive provider organizations;
	518	+	(f) integrated delivery systems;
	519	+	(g) independent physician-provider
486	520		organizations;
487	521		(h) physician hospital-provider
488	522		organizations; and
489	523		(i) managed care services
490	524		organizations."
491	525		SECTION 2. Section 59A-23-7.17 NMSA 1978 (being Laws
492	526		2023, Chapter 50, Section 3) is amended to read:
493	527		"59A-23-7.17. COVERAGE FOR INDIVIDUALS WITH DIABETES.--
494		-	A. Each group health insurance contract and
495		-	blanket health insurance contract delivered or issued for
496		-	delivery in this state shall provide coverage for individuals
497		-	with diabetes who use insulin, individuals with diabetes who
498		-	do not use insulin and with elevated blood glucose levels
499		-	induced by pregnancy. This coverage shall be a basic health
500		-	care benefit and shall entitle each individual to the
501		-	medically accepted standard of medical care for diabetes and
502		-	benefits for diabetes treatment as well as diabetes supplies,
503		-	and this coverage shall not be reduced or eliminated.
504		-	B. Except as otherwise provided in this
505		-	subsection, coverage for individuals with diabetes may be
506		-	subject to deductibles and coinsurance consistent with those
507		-	imposed on other benefits under the same policy, as long as
508		-	the annual deductibles or coinsurance for benefits are no
509		-	greater than the annual deductibles or coinsurance
510		-	established for similar benefits within a given policy. The HB 233/a
511		-	Page 11
	528	+	A. Each group health insurance contract and blanket
	529	+	health insurance contract delivered or issued for delivery in
	530	+	this state shall provide coverage for individuals with diabetes
	531	+	who use insulin, individuals with diabetes who do not use
	532	+	insulin and with elevated blood glucose levels induced by
	533	+	pregnancy. This coverage shall be a basic health care benefit
	534	+	and shall entitle each individual to the medically accepted
	535	+	standard of medical care for diabetes and benefits for diabetes
	536	+	treatment as well as diabetes supplies, and this coverage shall
	537	+	not be reduced or eliminated.
	538	+	B. Except as otherwise provided in this subsection,
	539	+	coverage for individuals with diabetes may be subject to
	540	+	.229151.1
	541	+	- 10 - underscored material = new
	542	+	[bracketed material] = delete
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537		-	amount an individual with diabetes is required to pay for a
538		-	preferred formulary prescription insulin drug or a medically
539		-	necessary alternative is an amount not to exceed a total of
540		-	twenty-five dollars ($25.00) per thirty-day supply.
	568	+	deductibles and coinsurance consistent with those imposed on
	569	+	other benefits under the same policy, as long as the annual
	570	+	deductibles or coinsurance for benefits are no greater than the
	571	+	annual deductibles or coinsurance established for similar
	572	+	benefits within a given policy. The amount an individual with
	573	+	diabetes is required to pay for a preferred formulary
	574	+	prescription insulin drug or a medically necessary alternative
	575	+	is an amount not to exceed a total of twenty-five dollars
	576	+	($25.00) per thirty-day supply.
541	577		C. When prescribed or diagnosed by a health care
542	578		practitioner with prescribing authority, all individuals with
543		-	diabetes as described in Subsection A of this section
544		-	~~enrolled~~ in health policies described in that subsection
545		-	~~shall be~~ entitled to the following equipment, supplies and
546		-	~~appliances to~~ treat diabetes:
	579	+	diabetes as described in Subsection A of this section enrolled
	580	+	in health policies described in that subsection shall be
	581	+	entitled to the following equipment, supplies and appliances to
	582	+	treat diabetes:
547	583		(1) blood glucose monitors, including those
548	584		for persons with disabilities, including the legally blind;
549	585		(2) test strips for blood glucose monitors;
550	586		(3) visual reading urine and ketone strips;
551	587		(4) lancets and lancet devices;
552	588		(5) insulin;
553		-	(6) injection aids, including those
554		-	~~adaptable~~ to meet the needs of persons with disabilities,
555		-	~~including the~~ legally blind;
	589	+	(6) injection aids, including those adaptable
	590	+	to meet the needs of persons with disabilities, including the
	591	+	legally blind;
556	592		(7) syringes;
557		-	(8) prescriptive oral agents for controlling
558		-	blood sugar levels;
559		-	(9) medically necessary podiatric appliances
560		-	for prevention of feet complications associated with
561		-	diabetes, including therapeutic molded or depth-inlay shoes, HB 233/a
562		-	Page 12
	593	+	.229151.1
	594	+	- 11 - underscored material = new
	595	+	[bracketed material] = delete
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588		-	functional orthotics, custom molded inserts, replacement
589		-	inserts, preventive devices and shoe modifications for
590		-	prevention and treatment; and
	621	+	(8) prescriptive oral agents for controlling
	622	+	blood sugar levels;
	623	+	(9) medically necessary:
	624	+	(a) podiatric appliances for prevention
	625	+	of feet complications associated with diabetes, including
	626	+	therapeutic molded or depth-inlay shoes, functional orthotics,
	627	+	custom molded inserts, replacement inserts, preventive devices
	628	+	and shoe modifications for prevention and treatment; and
	629	+	(b) durable medical equipment for the
	630	+	treatment of active diabetic foot ulcers, including topical
	631	+	oxygen therapy; and
591	632		(10) glucagon emergency kits.
592	633		D. When prescribed or diagnosed by a health care
593	634		practitioner with prescribing authority, all individuals with
594		-	diabetes as described in Subsection A of this section
595		-	enrolled in health policies described in that subsection
596		-	shall be entitled to the following basic health care
597		-	benefits:
	635	+	diabetes as described in Subsection A of this section enrolled
	636	+	in health policies described in that subsection shall be
	637	+	entitled to the following basic health care benefits:
598	638		(1) diabetes self-management training that
599		-	shall be provided by a certified, registered or licensed
600		-	~~health~~ care professional with recent education in diabetes
601		-	~~management,~~ which shall be limited to:
	639	+	shall be provided by a certified, registered or licensed health
	640	+	care professional with recent education in diabetes management,
	641	+	which shall be limited to:
602	642		(a) medically necessary visits upon the
603	643		diagnosis of diabetes;
604	644		(b) visits following a diagnosis from a
605	645		health care practitioner that represents a significant change
606		-	in the patient's symptoms or condition that warrants changes
607		-	in the patient's self-management; and
608		-	(c) visits when re-education or
609		-	refresher training is prescribed by a health care
610		-	practitioner with prescribing authority;
611		-	(2) medical nutrition therapy related to
612		-	diabetes management; and HB 233/a
613		-	Page 13
	646	+	.229151.1
	647	+	- 12 - underscored material = new
	648	+	[bracketed material] = delete
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639		-	(3) medically necessary treatment of active
640		-	diabetic foot ulcers, including topical oxygen therapy.
	674	+	in the patient's symptoms or condition that warrants changes in
	675	+	the patient's self-management; and
	676	+	(c) visits when re-education or
	677	+	refresher training is prescribed by a health care practitioner
	678	+	with prescribing authority; and
	679	+	(2) medical nutrition therapy related to
	680	+	diabetes management.
641	681		E. When new or improved equipment, appliances,
642	682		prescription drugs for the treatment of diabetes, insulin or
643	683		supplies for the treatment of diabetes are approved by the
644	684		federal food and drug administration, all individual or group
645		-	health insurance policies as described in Subsection A of
646		-	~~this~~ section shall:
647		-	(1) maintain an adequate formulary to
648		-	~~provide~~ those resources to individuals with diabetes; and
	685	+	health insurance policies as described in Subsection A of this
	686	+	section shall:
	687	+	(1) maintain an adequate formulary to provide
	688	+	those resources to individuals with diabetes; and
649	689		(2) guarantee reimbursement or coverage for
650	690		the equipment, appliances, prescription drugs, insulin or
651		-	supplies described in this subsection within the limits of
652		-	~~the~~ health care plan, policy or certificate.
653		-	F. An insurer that requires a covered person to
654		-	~~use~~ a specific network provider or to purchase equipment,
	691	+	supplies described in this subsection within the limits of the
	692	+	health care plan, policy or certificate.
	693	+	F. An insurer that requires a covered person to use
	694	+	a specific network provider or to purchase equipment,
655	695		appliances, supplies or insulin or prescription drugs for the
656	696		treatment or management of diabetes from a specific durable
657		-	medical equipment supplier or other supplier as a condition
658		-	of coverage, payment or reimbursement shall:
659		-	(1) maintain an adequate network of durable
660		-	medical equipment suppliers and other suppliers to provide
661		-	covered persons with medically necessary diabetes resources
662		-	whether covered under the health policy's prescription drug
663		-	or medical benefit; HB 233/a
664		-	Page 14
	697	+	medical equipment supplier or other supplier as a condition of
	698	+	coverage, payment or reimbursement shall:
	699	+	.229151.1
	700	+	- 13 - underscored material = new
	701	+	[bracketed material] = delete
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	727	+	(1) maintain an adequate network of durable
	728	+	medical equipment suppliers and other suppliers to provide
	729	+	covered persons with medically necessary diabetes resources
	730	+	whether covered under the health policy's prescription drug or
	731	+	medical benefit;
690	732		(2) have network contracts in place for the
691		-	entire policy or plan period and shall not allow contracts
692		-	with network providers, durable medical equipment suppliers
693		-	and other suppliers to lapse or terminate without ensuring
694		-	the availability of a replacement and continuity of care;
695		-	provided that single-case agreements do not satisfy the
696		-	requirements of Paragraph (1) of this subsection or this
697		-	paragraph;
698		-	(3) monitor network providers, durable
699		-	medical equipment suppliers and other network suppliers to
700		-	ensure that medically necessary equipment, appliances,
701		-	supplies and insulin or other prescription drugs are being
702		-	delivered to a covered person in a timely manner and when
703		-	needed by the covered person;
	733	+	entire policy or plan period and shall not allow contracts with
	734	+	network providers, durable medical equipment suppliers and
	735	+	other suppliers to lapse or terminate without ensuring the
	736	+	availability of a replacement and continuity of care; provided
	737	+	that single-case agreements do not satisfy the requirements of
	738	+	Paragraph (1) of this subsection or this paragraph;
	739	+	(3) monitor network providers, durable medical
	740	+	equipment suppliers and other network suppliers to ensure that
	741	+	medically necessary equipment, appliances, supplies and insulin
	742	+	or other prescription drugs are being delivered to a covered
	743	+	person in a timely manner and when needed by the covered
	744	+	person;
704	745		(4) guarantee reimbursement to a covered
705		-	person within thirty days following receipt of a written
706		-	demand from the covered person who pays out of pocket for
707		-	necessary equipment, appliances, supplies and insulin or
708		-	other prescription drugs described in this section that are
709		-	not delivered in a timely manner to the covered person, and
710		-	the portion of payment for which the patient is responsible
711		-	shall not exceed the amount for the same covered benefit
712		-	obtained from a contracted supplier;
713		-	(5) pay interest at the rate of eighteen
714		-	percent per year on the amount of reimbursement due to a HB 233/a
715		-	Page 15
	746	+	person within thirty days following receipt of a written demand
	747	+	from the covered person who pays out of pocket for necessary
	748	+	equipment, appliances, supplies and insulin or other
	749	+	prescription drugs described in this section that are not
	750	+	delivered in a timely manner to the covered person and the
	751	+	portion of payment for which the patient is responsible shall
	752	+	.229151.1
	753	+	- 14 - underscored material = new
	754	+	[bracketed material] = delete
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	780	+	not exceed the amount for the same covered benefit obtained
	781	+	from a contracted supplier;
	782	+	(5) pay interest at the rate of eighteen
	783	+	percent per year on the amount of reimbursement due to a
741	784		covered person if not paid within thirty days as required by
742	785		Paragraph (4) of this subsection;
743	786		(6) beginning on April 1, 2024, submit a
744	787		written report each quarter to the superintendent for the
745	788		previous quarter on the following metrics:
746	789		(a) the number of written demands for
747	790		reimbursement of out-of-pocket expenses from covered persons
748	791		received by the health care insurer;
749	792		(b) the number of out-of-pocket claims
750	793		for reimbursement paid and the aggregate amount of claims
751		-	reimbursed by the health care insurer within the time
752		-	~~required~~ by Paragraph (4) of this subsection;
	794	+	reimbursed by the health care insurer within the time required
	795	+	by Paragraph (4) of this subsection;
753	796		(c) the number of out-of-pocket claims
754		-	for reimbursement paid more than thirty days following
755		-	~~receipt~~ of a written demand and the aggregate amount of these
756		-	~~payments,~~ excluding interest; and
	797	+	for reimbursement paid more than thirty days following receipt
	798	+	of a written demand and the aggregate amount of these payments,
	799	+	excluding interest; and
757	800		(d) the aggregate amount of interest
758	801		paid by the health care insurer pursuant to Paragraph (5) of
759	802		this subsection; and
760	803		(7) beginning on April 1, 2024, submit a
761	804		written report each quarter for the previous quarter to the
762		-	superintendent with the following information for each
763		-	durable medical equipment supplier or other supplier that was
764		-	under contract with the health care insurer or its agent
765		-	during the previous quarter: HB 233/a
766		-	Page 16
	805	+	.229151.1
	806	+	- 15 - underscored material = new
	807	+	[bracketed material] = delete
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	833	+	superintendent with the following information for each durable
	834	+	medical equipment supplier or other supplier that was under
	835	+	contract with the health care insurer or its agent during the
	836	+	previous quarter:
792	837		(a) the name, address and telephone
793	838		number of each supplier and, if applicable, the corresponding
794	839		date upon which the respective supplier's contract expired,
795	840		lapsed or was terminated during the previous quarter;
796	841		(b) the percentage of total deliveries,
797	842		by description of item, that did not meet the delivery
798		-	requirements specified in Paragraph (3) of this subsection;
799		-	and
800		-	(c) the number of complaints received
801		-	by the health care insurer or its agent during the previous
	843	+	requirements specified in Paragraph (3) of this subsection; and
	844	+	(c) the number of complaints received by
	845	+	the health care insurer or its agent during the previous
802	846		quarter related to late deliveries, incomplete orders or
803	847		incorrect orders, respectively.
804	848		G. The superintendent shall annually audit all
805	849		health insurers offering policies, plans or certificates as
806	850		described in Subsection A of this section for compliance with
807	851		the requirements of this section. If the superintendent
808		-	determines that a health care insurer has not complied with
809		-	~~the~~ requirements of this section, the superintendent shall
810		-	~~impose~~ corrective action or use any other enforcement
811		-	~~mechanism~~ available to the superintendent to obtain the
812		-	~~health care~~ insurer's compliance with this section.
	852	+	determines that a health care insurer has not complied with the
	853	+	requirements of this section, the superintendent shall impose
	854	+	corrective action or use any other enforcement mechanism
	855	+	available to the superintendent to obtain the health care
	856	+	insurer's compliance with this section.
813	857		H. Absent a change in diagnosis or in a covered
814		-	person's management or treatment of diabetes or its
815		-	complications, a health care insurer shall not require more
816		-	than one prior authorization per policy period for any single HB 233/a
817		-	Page 17
	858	+	.229151.1
	859	+	- 16 - underscored material = new
	860	+	[bracketed material] = delete
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	886	+	person's management or treatment of diabetes or its
	887	+	complications, a health care insurer shall not require more
	888	+	than one prior authorization per policy period for any single
843	889		drug or category of item enumerated in this section if
844	890		prescribed as medically necessary by the covered person's
845		-	health care practitioner. Changes in the prescribed dose of
846		-	a drug; quantities of supplies needed to administer a
847		-	~~prescribed~~ drug; quantities of blood glucose self-testing
848		-	~~equipment and~~ supplies; or quantities of supplies needed to
849		-	~~use or operate~~ devices for which a covered person has
850		-	~~received prior~~ authorization during the policy year shall not
851		-	~~be subject to~~ additional prior authorization requirements in
852		-	~~the same policy~~ year if prescribed as medically necessary by
853		-	~~the covered~~ person's health care practitioner. Nothing in
854		-	~~this subsection~~ shall be construed to require payment for
855		-	~~diabetes resources~~ that are not covered benefits.
	891	+	health care practitioner. Changes in the prescribed dose of a
	892	+	drug; quantities of supplies needed to administer a prescribed
	893	+	drug; quantities of blood glucose self-testing equipment and
	894	+	supplies; or quantities of supplies needed to use or operate
	895	+	devices for which a covered person has received prior
	896	+	authorization during the policy year shall not be subject to
	897	+	additional prior authorization requirements in the same policy
	898	+	year if prescribed as medically necessary by the covered
	899	+	person's health care practitioner. Nothing in this subsection
	900	+	shall be construed to require payment for diabetes resources
	901	+	that are not covered benefits.
856	902		I. The provisions of this section do not apply to
857	903		short-term travel, accident-only or limited or specified
858	904		disease policies.
859		-	J. For purposes of this section, "basic health
860		-	~~care~~ benefits":
	905	+	J. For purposes of this section, "basic health care
	906	+	benefits":
861	907		(1) means benefits for medically necessary
862	908		services consisting of preventive care, emergency care,
863	909		inpatient and outpatient hospital and physician care,
864	910		diagnostic laboratory and diagnostic and therapeutic
865		-	radiological services; and
866		-	(2) does not include services for alcohol or
867		-	drug abuse, dental or long-term rehabilitation treatment." HB 233/a
868		-	Page 18
	911	+	.229151.1
	912	+	- 17 - underscored material = new
	913	+	[bracketed material] = delete
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894		-	SECTION 3. Section 59A-46-43 NMSA 1978 (being Laws
895		-	1997, Chapter 7, Section 3 and Laws 1997, Chapter 255,
896		-	Section 3, as amended) is amended to read:
	939	+	radiological services; and
	940	+	(2) does not include services for alcohol or
	941	+	drug abuse, dental or long-term rehabilitation treatment."
	942	+	SECTION 3. Section 59A-46-43 NMSA 1978 (being Laws 1997,
	943	+	Chapter 7, Section 3 and Laws 1997, Chapter 255, Section 3, as
	944	+	amended) is amended to read:
897	945		"59A-46-43. COVERAGE FOR INDIVIDUALS WITH DIABETES.--
898	946		A. Each individual and group health maintenance
899		-	organization contract delivered or issued for delivery in
900		-	~~this~~ state shall provide coverage for individuals with
901		-	~~insulin-using~~ diabetes, with non-insulin-using diabetes and
902		-	~~with elevated~~ blood glucose levels induced by pregnancy.
903		-	~~This coverage shall~~ be a basic health care service and shall
904		-	~~entitle each~~ individual to the medically accepted standard of
905		-	~~medical care~~ for diabetes and benefits for diabetes treatment
906		-	~~as well as~~ diabetes supplies, and this coverage shall not be
907		-	~~reduced or~~ eliminated.
	947	+	organization contract delivered or issued for delivery in this
	948	+	state shall provide coverage for individuals with insulin-using
	949	+	diabetes, with non-insulin-using diabetes and with elevated
	950	+	blood glucose levels induced by pregnancy. This coverage shall
	951	+	be a basic health care service and shall entitle each
	952	+	individual to the medically accepted standard of medical care
	953	+	for diabetes and benefits for diabetes treatment as well as
	954	+	diabetes supplies, and this coverage shall not be reduced or
	955	+	eliminated.
908	956		B. Except as provided in this subsection, coverage
909		-	for individuals with diabetes may be subject to deductibles
910		-	and coinsurance consistent with those imposed on other
911		-	benefits under the same contract, as long as the annual
912		-	deductibles or coinsurance for benefits are no greater than
913		-	the annual deductibles or coinsurance established for similar
914		-	benefits within a given contract. The amount an individual
915		-	with diabetes is required to pay for a preferred formulary
916		-	prescription insulin drug or a medically necessary
917		-	alternative is an amount not to exceed a total of twenty-five
918		-	dollars ($25.00) per thirty-day supply. HB 233/a
919		-	Page 19
	957	+	for individuals with diabetes may be subject to deductibles and
	958	+	coinsurance consistent with those imposed on other benefits
	959	+	under the same contract, as long as the annual deductibles or
	960	+	coinsurance for benefits are no greater than the annual
	961	+	deductibles or coinsurance established for similar benefits
	962	+	within a given contract. The amount an individual with
	963	+	diabetes is required to pay for a preferred formulary
	964	+	.229151.1
	965	+	- 18 - underscored material = new
	966	+	[bracketed material] = delete
920	967		1
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941	988		22
942	989		23
943	990		24
944	991		25
	992	+	prescription insulin drug or a medically necessary alternative
	993	+	is an amount not to exceed a total of twenty-five dollars
	994	+	($25.00) per thirty-day supply.
945	995		C. When prescribed or diagnosed by a health care
946	996		practitioner with prescribing authority, all individuals with
947		-	diabetes as described in Subsection A of this section
948		-	~~enrolled~~ under an individual or group health maintenance
949		-	~~organization~~ contract shall be entitled to the following
950		-	~~equipment, supplies~~ and appliances to treat diabetes:
	997	+	diabetes as described in Subsection A of this section enrolled
	998	+	under an individual or group health maintenance organization
	999	+	contract shall be entitled to the following equipment, supplies
	1000	+	and appliances to treat diabetes:
951	1001		(1) blood glucose monitors, including those
952		-	for individuals with disabilities, including the legally
953		-	blind;
	1002	+	for individuals with disabilities, including the legally blind;
954	1003		(2) test strips for blood glucose monitors;
955	1004		(3) visual reading urine and ketone strips;
956	1005		(4) lancets and lancet devices;
957	1006		(5) insulin;
958		-	(6) injection aids, including those
959		-	~~adaptable~~ to meet the needs of individuals with disabilities,
960		-	~~including~~ the legally blind;
	1007	+	(6) injection aids, including those adaptable
	1008	+	to meet the needs of individuals with disabilities, including
	1009	+	the legally blind;
961	1010		(7) syringes;
962	1011		(8) prescriptive oral agents for controlling
963	1012		blood sugar levels;
964		-	(9) medically necessary ~~podiatric appliances~~
965		-	for prevention ~~of feet complications associated with~~
966		-	diabetes, including ~~therapeutic molded or depth-inlay shoes,~~
967		-	functional orthotics, ~~custom molded inserts, replacement~~
968		-	~~inserts, preventive devices and shoe modifications for~~
969		-	~~prevention and treatment;~~ ~~and HB 233/a~~
970		-	~~Page 20~~
	1013	+	(9) medically necessary:
	1014	+	(a) podiatric appliances for prevention
	1015	+	of feet complications associated with diabetes, including
	1016	+	therapeutic molded or depth-inlay shoes, functional orthotics,
	1017	+	.229151.1
	1018	+	- 19 - underscored material = new
	1019	+	[bracketed material] = delete
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993	1042		23
994	1043		24
995	1044		25
	1045	+	custom molded inserts, replacement inserts, preventive devices
	1046	+	and shoe modifications for prevention and treatment; and
	1047	+	(b) durable medical equipment for the
	1048	+	treatment of active diabetic foot ulcers, including topical
	1049	+	oxygen therapy; and
996	1050		(10) glucagon emergency kits.
997	1051		D. When prescribed or diagnosed by a health care
998	1052		practitioner with prescribing authority, all individuals with
999		-	diabetes as described in Subsection A of this section
1000		-	enrolled under an individual or group health maintenance
1001		-	contract shall be entitled to the following basic health care
1002		-	services:
	1053	+	diabetes as described in Subsection A of this section enrolled
	1054	+	under an individual or group health maintenance contract shall
	1055	+	be entitled to the following basic health care services:
1003	1056		(1) diabetes self-management training that
1004		-	shall be provided by a certified, registered or licensed
1005		-	~~health~~ care professional with recent education in diabetes
1006		-	~~management,~~ which shall be limited to:
	1057	+	shall be provided by a certified, registered or licensed health
	1058	+	care professional with recent education in diabetes management,
	1059	+	which shall be limited to:
1007	1060		(a) medically necessary visits upon the
1008	1061		diagnosis of diabetes;
1009	1062		(b) visits following a diagnosis from a
1010	1063		health care practitioner that represents a significant change
1011		-	in the patient's symptoms or condition that warrants changes
1012		-	in the patient's self-management; and
	1064	+	in the patient's symptoms or condition that warrants changes in
	1065	+	the patient's self-management; and
1013	1066		(c) visits when re-education or
1014		-	refresher training is prescribed by a health care
1015		-	~~practitioner~~ with prescribing authority; and
	1067	+	refresher training is prescribed by a health care practitioner
	1068	+	with prescribing authority; and
1016	1069		(2) medical nutrition therapy related to
1017		-	diabetes management.
1018		-	E. When new or improved equipment, appliances,
1019		-	prescription drugs for the treatment of diabetes, insulin or
1020		-	supplies for the treatment of diabetes are approved by the HB 233/a
1021		-	Page 21
	1070	+	.229151.1
	1071	+	- 20 - underscored material = new
	1072	+	[bracketed material] = delete
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1042	1093		21
1043	1094		22
1044	1095		23
1045	1096		24
1046	1097		25
1047		-	federal food and drug administration, each individual or
1048		-	group health maintenance organization contract shall:
1049		-	(1) maintain an adequate formulary to
1050		-	provide these resources to individuals with diabetes; and
	1098	+	diabetes management.
	1099	+	E. When new or improved equipment, appliances,
	1100	+	prescription drugs for the treatment of diabetes, insulin or
	1101	+	supplies for the treatment of diabetes are approved by the
	1102	+	federal food and drug administration, each individual or group
	1103	+	health maintenance organization contract shall:
	1104	+	(1) maintain an adequate formulary to provide
	1105	+	these resources to individuals with diabetes; and
1051	1106		(2) guarantee reimbursement or coverage for
1052	1107		the equipment, appliances, prescription drug, insulin or
1053		-	supplies described in this subsection within the limits of
1054		-	~~the~~ health care plan, policy or certificate.
	1108	+	supplies described in this subsection within the limits of the
	1109	+	health care plan, policy or certificate.
1055	1110		F. A health maintenance organization that requires
1056	1111		an enrollee to use a specific network provider or to purchase
1057	1112		equipment, appliances, supplies or insulin or prescription
1058	1113		drugs for the treatment or management of diabetes from a
1059	1114		specific durable medical equipment supplier or other supplier
1060	1115		as a condition of coverage, payment or reimbursement shall:
1061	1116		(1) maintain an adequate network of durable
1062	1117		medical equipment suppliers and other suppliers to provide
1063	1118		covered persons with medically necessary diabetes resources
1064	1119		whether covered under the health maintenance organization
1065	1120		contract's prescription drug or medical benefit;
1066	1121		(2) have network contracts in place for the
1067	1122		entire contract period and shall not allow contracts with
1068		-	network providers, durable medical equipment suppliers and
1069		-	other suppliers to lapse or terminate without ensuring the
1070		-	availability of a replacement and continuity of care;
1071		-	provided that single-case agreements do not satisfy the HB 233/a
1072		-	Page 22
	1123	+	.229151.1
	1124	+	- 21 - underscored material = new
	1125	+	[bracketed material] = delete
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1074	1127		2
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1093	1146		21
1094	1147		22
1095	1148		23
1096	1149		24
1097	1150		25
1098		-	requirements of Paragraph (1) of this subsection or this
1099		-	paragraph;
1100		-	(3) monitor network providers, durable
1101		-	medical equipment suppliers and other network suppliers to
1102		-	ensure that medically necessary equipment, appliances,
1103		-	supplies and insulin or other prescription drugs are being
1104		-	delivered to an enrollee in a timely manner and when needed
1105		-	by the enrollee;
	1151	+	network providers, durable medical equipment suppliers and
	1152	+	other suppliers to lapse or terminate without ensuring the
	1153	+	availability of a replacement and continuity of care; provided
	1154	+	that single-case agreements do not satisfy the requirements of
	1155	+	Paragraph (1) of this subsection or this paragraph;
	1156	+	(3) monitor network providers, durable medical
	1157	+	equipment suppliers and other network suppliers to ensure that
	1158	+	medically necessary equipment, appliances, supplies and insulin
	1159	+	or other prescription drugs are being delivered to an enrollee
	1160	+	in a timely manner and when needed by the enrollee;
1106	1161		(4) guarantee reimbursement to an enrollee
1107	1162		within thirty days following receipt of a written demand from
1108	1163		the enrollee who pays out of pocket for necessary equipment,
1109	1164		appliances, supplies and insulin or other prescription drugs
1110		-	described in this section that are not delivered timely to
1111		-	~~the~~ enrollee, and the portion of payment for which the
1112		-	~~patient is~~ responsible shall not exceed the amount for the
1113		-	~~same covered~~ benefit obtained from a contracted supplier;
	1165	+	described in this section that are not delivered timely to the
	1166	+	enrollee and the portion of payment for which the patient is
	1167	+	responsible shall not exceed the amount for the same covered
	1168	+	benefit obtained from a contracted supplier;
1114	1169		(5) pay interest at the rate of eighteen
1115	1170		percent per year on the amount of reimbursement due to an
1116	1171		enrollee if not paid within thirty days as required by
1117	1172		Paragraph (4) of this subsection;
1118	1173		(6) beginning on April 1, 2024, submit a
1119	1174		written report each quarter to the superintendent for the
1120	1175		previous quarter on the following metrics:
1121		-	~~(a) the number of written demands for~~
1122		-	~~reimbursement of out-of-pocket~~ ~~expenses from enrollees HB 233/a~~
1123		-	~~Page 23~~
	1176	+	.229151.1
	1177	+	- 22 - underscored material = new
	1178	+	[bracketed material] = delete
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1145	1200		22
1146	1201		23
1147	1202		24
1148	1203		25
1149		-	received by the health maintenance organization;
	1204	+	(a) the number of written demands for
	1205	+	reimbursement of out-of-pocket expenses from enrollees received
	1206	+	by the health maintenance organization;
1150	1207		(b) the number of out-of-pocket claims
1151	1208		for reimbursement paid and the aggregate amount of claims
1152	1209		reimbursed by the health maintenance organization within the
1153	1210		time required by Paragraph (4) of this subsection;
1154	1211		(c) the number of out-of-pocket claims
1155		-	for reimbursement paid more than thirty days following
1156		-	~~receipt~~ of a written demand and the aggregate amount of these
1157		-	~~payments,~~ excluding interest; and
	1212	+	for reimbursement paid more than thirty days following receipt
	1213	+	of a written demand and the aggregate amount of these payments,
	1214	+	excluding interest; and
1158	1215		(d) the aggregate amount of interest
1159	1216		paid by the health maintenance organization pursuant to
1160	1217		Paragraph (5) of this subsection; and
1161	1218		(7) beginning on April 1, 2024, submit a
1162	1219		written report each quarter for the previous quarter to the
1163		-	superintendent with the following information for each
1164		-	~~durable~~ medical equipment supplier or other supplier that was
1165		-	~~under~~ contract with the health maintenance organization or
1166		-	~~its agent~~ during the previous quarter:
	1220	+	superintendent with the following information for each durable
	1221	+	medical equipment supplier or other supplier that was under
	1222	+	contract with the health maintenance organization or its agent
	1223	+	during the previous quarter:
1167	1224		(a) the name, address and telephone
1168	1225		number of each supplier and, if applicable, the corresponding
1169	1226		date upon which the respective supplier's contract expired,
1170	1227		lapsed or was terminated during the previous quarter;
1171	1228		(b) the percentage of total deliveries,
1172		-	~~by description of item, that did not meet the delivery~~
1173		-	~~requirements specified in Paragraph (3) of this subsection; HB 233/a~~
1174		-	~~Page 24~~
	1229	+	.229151.1
	1230	+	- 23 - underscored material = new
	1231	+	[bracketed material] = delete
1175	1232		1
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1199	1256		25
1200		-	and
1201		-	(c) the number of complaints received
1202		-	by the health maintenance organization or its agent during
1203		-	the previous quarter related to late deliveries, incomplete
1204		-	orders or incorrect orders, respectively.
	1257	+	by description of item, that did not meet the delivery
	1258	+	requirements specified in Paragraph (3) of this subsection; and
	1259	+	(c) the number of complaints received by
	1260	+	the health maintenance organization or its agent during the
	1261	+	previous quarter related to late deliveries, incomplete orders
	1262	+	or incorrect orders, respectively.
1205	1263		G. The superintendent shall annually audit all
1206	1264		health maintenance organizations offering contracts as
1207	1265		described in Subsection A of this section for compliance with
1208	1266		the requirements of this section. If the superintendent
1209	1267		determines that a health maintenance organization has not
1210	1268		complied with the requirements of this section, the
1211		-	superintendent shall impose corrective action or use any
1212		-	other enforcement mechanism available to the superintendent
1213		-	to obtain the health maintenance organization's compliance
1214		-	with this section.
1215		-	H. Absent a change in diagnosis or in an
1216		-	enrollee's management or treatment of diabetes or its
1217		-	complications, a health maintenance organization shall not
1218		-	require more than one prior authorization per policy period
1219		-	for any single drug or category of item enumerated in this
1220		-	section if prescribed as medically necessary by the
1221		-	enrollee's health care practitioner. Changes in the
1222		-	prescribed dose of a drug; quantities of supplies needed to
1223		-	administer a prescribed drug; quantities of blood glucose
1224		-	self-testing equipment and supplies; or quantities of HB 233/a
1225		-	Page 25
	1269	+	superintendent shall impose corrective action or use any other
	1270	+	enforcement mechanism available to the superintendent to obtain
	1271	+	the health maintenance organization's compliance with this
	1272	+	section.
	1273	+	H. Absent a change in diagnosis or in an enrollee's
	1274	+	management or treatment of diabetes or its complications, a
	1275	+	health maintenance organization shall not require more than one
	1276	+	prior authorization per policy period for any single drug or
	1277	+	category of item enumerated in this section if prescribed as
	1278	+	medically necessary by the enrollee's health care practitioner.
	1279	+	Changes in the prescribed dose of a drug; quantities of
	1280	+	supplies needed to administer a prescribed drug; quantities of
	1281	+	blood glucose self-testing equipment and supplies; or
	1282	+	.229151.1
	1283	+	- 24 - underscored material = new
	1284	+	[bracketed material] = delete
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1251		-	supplies needed to use or operate devices for ~~which an~~
1252		-	enrollee has received prior authorization during the ~~policy~~
1253		-	year shall not be subject to additional prior ~~authorization~~
1254		-	requirements in the same policy year if ~~prescribed as~~
1255		-	medically necessary by the enrollee's health care
1256		-	practitioner. Nothing in this subsection shall be construed
1257		-	to require payment for diabetes resources that are not a
1258		-	~~covered~~ benefit.
	1310	+	quantities of supplies needed to use or operate devices for
	1311	+	which an enrollee has received prior authorization during the
	1312	+	policy year shall not be subject to additional prior
	1313	+	authorization requirements in the same policy year if
	1314	+	prescribed as medically necessary by the enrollee's health care
	1315	+	practitioner. Nothing in this subsection shall be construed to
	1316	+	require payment for diabetes resources that are not a covered
	1317	+	benefit.
1259	1318		I. The provisions of this section do not apply to
1260	1319		short-term travel, accident-only or limited or specified
1261	1320		disease policies.
1262		-	J. For purposes of this section, "basic health
1263		-	~~care~~ benefits":
	1321	+	J. For purposes of this section, "basic health care
	1322	+	benefits":
1264	1323		(1) means benefits for medically necessary
1265	1324		services consisting of preventive care, emergency care,
1266	1325		inpatient and outpatient hospital and physician care,
1267	1326		diagnostic laboratory and diagnostic and therapeutic
1268	1327		radiological services; and
1269	1328		(2) does not include services for alcohol or
1270	1329		drug abuse, dental or long-term rehabilitation treatment."
1271	1330		SECTION 4. Section 59A-47-45.8 NMSA 1978 (being Laws
1272	1331		2023, Chapter 50, Section 5) is amended to read:
1273	1332		"59A-47-45.8. COVERAGE FOR INDIVIDUALS WITH DIABETES.--
1274	1333		A. Each health care plan delivered or issued for
1275		-	delivery in this state shall provide coverage for individuals HB 233/a
1276		-	Page 26
	1334	+	delivery in this state shall provide coverage for individuals
	1335	+	.229151.1
	1336	+	- 25 - underscored material = new
	1337	+	[bracketed material] = delete
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1300	1361		24
1301	1362		25
1302		-	with diabetes who use insulin, individuals with diabetes who
1303		-	do not use insulin and with elevated blood glucose levels
1304		-	~~induced~~ by pregnancy. This coverage shall be a basic health
1305		-	~~care~~ benefit and shall entitle each individual to the
1306		-	~~medically~~ accepted standard of medical care for diabetes and
1307		-	~~benefits for~~ diabetes treatment as well as diabetes supplies,
1308		-	~~and this~~ coverage shall not be reduced or eliminated.
1309		-	B. Except as otherwise provided in this
1310		-	~~subsection,~~ coverage for individuals with diabetes may be
1311		-	~~subject to~~ deductibles and coinsurance consistent with those
1312		-	~~imposed on~~ other benefits under the same plan as long as the
1313		-	~~annual~~ deductibles or coinsurance for benefits are no greater
1314		-	~~than the~~ annual deductibles or coinsurance established for
1315		-	~~similar~~ benefits within a given plan. The amount an
1316		-	~~individual with~~ diabetes is required to pay for a preferred
1317		-	~~formulary~~ prescription insulin drug or a medically necessary
1318		-	~~alternative~~ is an amount not to exceed a total of twenty-five
1319		-	~~dollars~~ ($25.00) per thirty-day supply.
	1363	+	with diabetes who use insulin, individuals with diabetes who do
	1364	+	not use insulin and with elevated blood glucose levels induced
	1365	+	by pregnancy. This coverage shall be a basic health care
	1366	+	benefit and shall entitle each individual to the medically
	1367	+	accepted standard of medical care for diabetes and benefits for
	1368	+	diabetes treatment as well as diabetes supplies, and this
	1369	+	coverage shall not be reduced or eliminated.
	1370	+	B. Except as otherwise provided in this subsection,
	1371	+	coverage for individuals with diabetes may be subject to
	1372	+	deductibles and coinsurance consistent with those imposed on
	1373	+	other benefits under the same plan as long as the annual
	1374	+	deductibles or coinsurance for benefits are no greater than the
	1375	+	annual deductibles or coinsurance established for similar
	1376	+	benefits within a given plan. The amount an individual with
	1377	+	diabetes is required to pay for a preferred formulary
	1378	+	prescription insulin drug or a medically necessary alternative
	1379	+	is an amount not to exceed a total of twenty-five dollars
	1380	+	($25.00) per thirty-day supply.
1320	1381		C. When prescribed or diagnosed by a health care
1321	1382		practitioner with prescribing authority, all individuals with
1322		-	diabetes as described in Subsection A of this section
1323		-	enrolled in health care plans described in that subsection
1324		-	shall be entitled to the following equipment, supplies and
1325		-	appliances to treat diabetes:
1326		-	(1) blood glucose monitors, including those HB 233/a
1327		-	Page 27
	1383	+	diabetes as described in Subsection A of this section enrolled
	1384	+	in health care plans described in that subsection shall be
	1385	+	entitled to the following equipment, supplies and appliances to
	1386	+	treat diabetes:
	1387	+	(1) blood glucose monitors, including those
	1388	+	.229151.1
	1389	+	- 26 - underscored material = new
	1390	+	[bracketed material] = delete
1328	1391		1
1329	1392		2
1330	1393		3
1331	1394		4
1332	1395		5
1333	1396		6
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1350	1413		23
1351	1414		24
1352	1415		25
1353	1416		for persons with disabilities, including the legally blind;
1354	1417		(2) test strips for blood glucose monitors;
1355	1418		(3) visual reading urine and ketone strips;
1356	1419		(4) lancets and lancet devices;
1357	1420		(5) insulin;
1358		-	(6) injection aids, including those
1359		-	~~adaptable~~ to meet the needs of persons with disabilities,
1360		-	~~including the~~ legally blind;
	1421	+	(6) injection aids, including those adaptable
	1422	+	to meet the needs of persons with disabilities, including the
	1423	+	legally blind;
1361	1424		(7) syringes;
1362	1425		(8) prescriptive oral agents for controlling
1363	1426		blood sugar levels;
1364		-	(9) medically necessary podiatric appliances
1365		-	for prevention of feet complications associated with
1366		-	diabetes, including therapeutic molded or depth-inlay shoes,
1367		-	functional orthotics, custom molded inserts, replacement
1368		-	inserts, preventive devices and shoe modifications for
1369		-	prevention and treatment; and
	1427	+	(9) medically necessary:
	1428	+	(a) podiatric appliances for prevention
	1429	+	of feet complications associated with diabetes, including
	1430	+	therapeutic molded or depth-inlay shoes, functional orthotics,
	1431	+	custom molded inserts, replacement inserts, preventive devices
	1432	+	and shoe modifications for prevention and treatment; and
	1433	+	(b) durable medical equipment for the
	1434	+	treatment of active diabetic foot ulcers, including topical
	1435	+	oxygen therapy; and
1370	1436		(10) glucagon emergency kits.
1371	1437		D. When prescribed or diagnosed by a health care
1372	1438		practitioner with prescribing authority, all individuals with
1373		-	diabetes as described in Subsection A of this section
1374		-	enrolled in health care plans described in that subsection
1375		-	shall be entitled to the following basic health care
1376		-	benefits:
1377		-	(1) diabetes self-management training that HB 233/a
1378		-	Page 28
	1439	+	diabetes as described in Subsection A of this section enrolled
	1440	+	in health care plans described in that subsection shall be
	1441	+	.229151.1
	1442	+	- 27 - underscored material = new
	1443	+	[bracketed material] = delete
1379	1444		1
1380	1445		2
1381	1446		3
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1399	1464		21
1400	1465		22
1401	1466		23
1402	1467		24
1403	1468		25
1404		-	shall be provided by a certified, registered or licensed
1405		-	health care professional with recent education in diabetes
1406		-	management, which shall be limited to:
	1469	+	entitled to the following basic health care benefits:
	1470	+	(1) diabetes self-management training that
	1471	+	shall be provided by a certified, registered or licensed health
	1472	+	care professional with recent education in diabetes management,
	1473	+	which shall be limited to:
1407	1474		(a) medically necessary visits upon the
1408	1475		diagnosis of diabetes;
1409	1476		(b) visits following a diagnosis from a
1410	1477		health care practitioner that represents a significant change
1411		-	in the patient's symptoms or condition that warrants changes
1412		-	in the patient's self-management; and
	1478	+	in the patient's symptoms or condition that warrants changes in
	1479	+	the patient's self-management; and
1413	1480		(c) visits when re-education or
1414		-	refresher training is prescribed by a health care
1415		-	~~practitioner~~ with prescribing authority;
	1481	+	refresher training is prescribed by a health care practitioner
	1482	+	with prescribing authority; and
1416	1483		(2) medical nutrition therapy related to
1417		-	diabetes management; and
1418		-	(3) medically necessary treatment of active
1419		-	diabetic foot ulcers, including topical oxygen therapy.
	1484	+	diabetes management.
1420	1485		E. When new or improved equipment, appliances,
1421	1486		prescription drugs for the treatment of diabetes, insulin or
1422	1487		supplies for the treatment of diabetes are approved by the
1423		-	federal food and drug administration, all health care plans
1424		-	as described in Subsection A of this section shall:
1425		-	(1) maintain an adequate formulary to
1426		-	~~provide~~ those resources to individuals with diabetes; and
	1488	+	federal food and drug administration, all health care plans as
	1489	+	described in Subsection A of this section shall:
	1490	+	(1) maintain an adequate formulary to provide
	1491	+	those resources to individuals with diabetes; and
1427	1492		(2) guarantee reimbursement or coverage for
1428		-	the equipment, appliances, prescription drugs, insulin or HB 233/a
1429		-	Page 29
	1493	+	the equipment, appliances, prescription drugs, insulin or
	1494	+	.229151.1
	1495	+	- 28 - underscored material = new
	1496	+	[bracketed material] = delete
1430	1497		1
1431	1498		2
1432	1499		3
1433	1500		4
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1450	1517		21
1451	1518		22
1452	1519		23
1453	1520		24
1454	1521		25
1455		-	supplies described in this subsection within the limits of
1456		-	~~the~~ health care plan.
1457		-	F. A health care plan that requires a subscriber
1458		-	to use a specific network provider or to purchase equipment,
	1522	+	supplies described in this subsection within the limits of the
	1523	+	health care plan.
	1524	+	F. A health care plan that requires a subscriber to
	1525	+	use a specific network provider or to purchase equipment,
1459	1526		appliances, supplies or insulin or prescription drugs for the
1460	1527		treatment or management of diabetes from a specific durable
1461		-	medical equipment supplier or other supplier as a condition
1462		-	of coverage, payment or reimbursement shall:
	1528	+	medical equipment supplier or other supplier as a condition of
	1529	+	coverage, payment or reimbursement shall:
1463	1530		(1) maintain an adequate network of durable
1464	1531		medical equipment suppliers and other suppliers to provide
1465		-	subscribers with medically necessary diabetes resources
1466		-	~~whether~~ covered under the health care plan's prescription
1467		-	~~drug or~~ medical benefit;
	1532	+	subscribers with medically necessary diabetes resources whether
	1533	+	covered under the health care plan's prescription drug or
	1534	+	medical benefit;
1468	1535		(2) have network contracts in place for the
1469	1536		entire plan period and shall not allow contracts with network
1470	1537		providers, durable medical equipment suppliers and other
1471	1538		suppliers to lapse or terminate without ensuring the
1472		-	availability of a replacement and continuity of care;
1473		-	provided that single-case agreements do not satisfy the
1474		-	requirements of Paragraph (1) of this subsection or this
1475		-	paragraph;
1476		-	(3) monitor network providers, durable
1477		-	medical equipment suppliers and other network suppliers to
1478		-	ensure that medically necessary equipment, appliances,
1479		-	supplies and insulin or other prescription drugs are being HB 233/a
1480		-	Page 30
	1539	+	availability of a replacement and continuity of care; provided
	1540	+	that single-case agreements do not satisfy the requirements of
	1541	+	Paragraph (1) of this subsection or this paragraph;
	1542	+	(3) monitor network providers, durable medical
	1543	+	equipment suppliers and other network suppliers to ensure that
	1544	+	medically necessary equipment, appliances, supplies and insulin
	1545	+	or other prescription drugs are being delivered to a subscriber
	1546	+	in a timely manner and when needed by the subscriber;
	1547	+	.229151.1
	1548	+	- 29 - underscored material = new
	1549	+	[bracketed material] = delete
1481	1550		1
1482	1551		2
1483	1552		3
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1485	1554		5
1486	1555		6
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1502	1571		22
1503	1572		23
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1505	1574		25
1506		-	delivered to a subscriber in a timely manner and when needed
1507		-	by the subscriber;
1508	1575		(4) guarantee reimbursement to a subscriber
1509	1576		within thirty days following receipt of a written demand from
1510		-	the subscriber who pays out of pocket for necessary
1511		-	equipment, appliances, supplies and insulin or other
1512		-	prescription drugs described in this section that are not
1513		-	delivered timely to the subscriber and the portion of payment
1514		-	for which the patient is responsible shall not exceed the
1515		-	amount for the same covered benefit obtained from a
1516		-	contracted supplier;
	1577	+	the subscriber who pays out of pocket for necessary equipment,
	1578	+	appliances, supplies and insulin or other prescription drugs
	1579	+	described in this section that are not delivered timely to the
	1580	+	subscriber and the portion of payment for which the patient is
	1581	+	responsible shall not exceed the amount for the same covered
	1582	+	benefit obtained from a contracted supplier;
1517	1583		(5) pay interest at the rate of eighteen
1518	1584		percent per year on the amount of reimbursement due to a
1519	1585		subscriber if not paid within thirty days as required by
1520	1586		Paragraph (4) of this subsection;
1521	1587		(6) beginning on April 1, 2024, submit a
1522	1588		written report each quarter to the superintendent for the
1523	1589		previous quarter on the following metrics:
1524	1590		(a) the number of written demands for
1525	1591		reimbursement of out-of-pocket expenses from subscribers
1526	1592		received by the health care plan;
1527	1593		(b) the number of out-of-pocket claims
1528	1594		for reimbursement paid and the aggregate amount of claims
1529		-	reimbursed by the health care plan within the time required
1530		-	by Paragraph (4) of this subsection; HB 233/a
1531		-	Page 31
	1595	+	reimbursed by the health care plan within the time required by
	1596	+	Paragraph (4) of this subsection;
	1597	+	(c) the number of out-of-pocket claims
	1598	+	for reimbursement paid more than thirty days following receipt
	1599	+	of a written demand and the aggregate amount of these payments,
	1600	+	.229151.1
	1601	+	- 30 - underscored material = new
	1602	+	[bracketed material] = delete
1532	1603		1
1533	1604		2
1534	1605		3
1535	1606		4
1536	1607		5
1537	1608		6
1538	1609		7
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1554	1625		23
1555	1626		24
1556	1627		25
1557		-	(c) the number of out-of-pocket claims
1558		-	for reimbursement paid more than thirty days following
1559		-	receipt of a written demand and the aggregate amount of these
1560		-	payments, excluding interest; and
	1628	+	excluding interest; and
1561	1629		(d) the aggregate amount of interest
1562		-	paid by the health care plan pursuant to Paragraph (5) of
1563		-	~~this~~ subsection; and
	1630	+	paid by the health care plan pursuant to Paragraph (5) of this
	1631	+	subsection; and
1564	1632		(7) beginning on April 1, 2024, submit a
1565	1633		written report each quarter for the previous quarter to the
1566		-	superintendent with the following information for each
1567		-	~~durable~~ medical equipment supplier or other supplier that was
1568		-	~~under~~ contract with the health care plan or its agent during
1569		-	~~the~~ previous quarter:
	1634	+	superintendent with the following information for each durable
	1635	+	medical equipment supplier or other supplier that was under
	1636	+	contract with the health care plan or its agent during the
	1637	+	previous quarter:
1570	1638		(a) the name, address and telephone
1571	1639		number of each supplier and, if applicable, the corresponding
1572	1640		date upon which the respective supplier's contract expired,
1573	1641		lapsed or was terminated during the previous quarter;
1574	1642		(b) the percentage of total deliveries,
1575	1643		by description of item, that did not meet the delivery
1576		-	requirements specified in Paragraph (3) of this subsection;
1577		-	and
1578		-	(c) the number of complaints received
1579		-	by the health care plan or its agent during the previous
1580		-	quarter related to late deliveries, incomplete orders or
1581		-	incorrect orders, respectively. HB 233/a
1582		-	Page 32
	1644	+	requirements specified in Paragraph (3) of this subsection; and
	1645	+	(c) the number of complaints received by
	1646	+	the health care plan or its agent during the previous quarter
	1647	+	related to late deliveries, incomplete orders or incorrect
	1648	+	orders, respectively.
	1649	+	G. The superintendent shall annually audit all
	1650	+	health care plans as described in Subsection A of this section
	1651	+	for compliance with the requirements of this section. If the
	1652	+	superintendent determines that a health care plan has not
	1653	+	.229151.1
	1654	+	- 31 - underscored material = new
	1655	+	[bracketed material] = delete
1583	1656		1
1584	1657		2
1585	1658		3
1586	1659		4
1587	1660		5
1588	1661		6
1589	1662		7
1590	1663		8
1591	1664		9
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1593	1666		11
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1599	1672		17
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1605	1678		23
1606	1679		24
1607	1680		25
1608		-	G. The superintendent shall annually audit all
1609		-	health care plans as described in Subsection A of this
1610		-	section for compliance with the requirements of this section.
1611		-	If the superintendent determines that a health care plan has
1612		-	not complied with the requirements of this section, the
1613		-	superintendent shall impose corrective action or use any
1614		-	other enforcement mechanism available to the superintendent
1615		-	to obtain the health care plan's compliance with this
1616		-	section.
	1681	+	complied with the requirements of this section, the
	1682	+	superintendent shall impose corrective action or use any other
	1683	+	enforcement mechanism available to the superintendent to obtain
	1684	+	the health care plan's compliance with this section.
1617	1685		H. Absent a change in diagnosis or in a
1618	1686		subscriber's management or treatment of diabetes or its
1619	1687		complications, a health care plan shall not require more than
1620		-	one prior authorization per plan period for any single drug
1621		-	or category of item enumerated in this section if prescribed
	1688	+	one prior authorization per plan period for any single drug or
	1689	+	category of item enumerated in this section if prescribed as
	1690	+	medically necessary by the subscriber's health care
	1691	+	practitioner. Changes in the prescribed dose of a drug;
	1692	+	quantities of supplies needed to administer a prescribed drug;
	1693	+	quantities of blood glucose self-testing equipment and
	1694	+	supplies; or quantities of supplies needed to use or operate
	1695	+	devices for which a subscriber has received prior authorization
	1696	+	during the plan year shall not be subject to additional prior
	1697	+	authorization requirements in the same plan year if prescribed
1622	1698		as medically necessary by the subscriber's health care
1623		-	practitioner. Changes in the prescribed dose of a drug;
1624		-	quantities of supplies needed to administer a prescribed
1625		-	drug; quantities of blood glucose self-testing equipment and
1626		-	supplies; or quantities of supplies needed to use or operate
1627		-	devices for which a subscriber has received prior
1628		-	authorization during the plan year shall not be subject to
1629		-	additional prior authorization requirements in the same plan
1630		-	year if prescribed as medically necessary by the subscriber's
1631		-	health care practitioner. Nothing in this subsection shall
1632		-	be construed to require payment for diabetes resources that HB 233/a
1633		-	Page 33
	1699	+	practitioner. Nothing in this subsection shall be construed to
	1700	+	require payment for diabetes resources that are not covered
	1701	+	benefits.
	1702	+	I. The provisions of this section do not apply to:
	1703	+	(1) a short-term health care plan;
	1704	+	(2) an excepted benefit health care plan
	1705	+	intended to supplement major medical coverage, including
	1706	+	.229151.1
	1707	+	- 32 - underscored material = new
	1708	+	[bracketed material] = delete
1634	1709		1
1635	1710		2
1636	1711		3
1637	1712		4
1638	1713		5
1639	1714		6
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1653	1728		20
1654	1729		21
1655	1730		22
1656	1731		23
1657	1732		24
1658	1733		25
1659		-	are not covered benefits.
1660		-	I. The provisions of this section do not apply to:
1661		-	(1) a short-term health care plan;
1662		-	(2) an excepted benefit health care plan
1663		-	intended to supplement major medical coverage, including
1664	1734		medicare supplement, vision, dental, disease-specific,
1665	1735		accident-only or hospital indemnity-only insurance policies;
1666	1736		(3) a policy or plan for long-term care or
1667	1737		disability income; or
1668	1738		(4) short-term travel policy or plan.
1669		-	J. For purposes of this section, "basic health
1670		-	~~care~~ benefits":
	1739	+	J. For purposes of this section, "basic health care
	1740	+	benefits":
1671	1741		(1) means benefits for medically necessary
1672	1742		services consisting of preventive care, emergency care,
1673	1743		inpatient and outpatient hospital and physician care,
1674	1744		diagnostic laboratory and diagnostic and therapeutic
1675	1745		radiological services; and
1676	1746		(2) does not include services for alcohol or
1677	1747		drug abuse, dental or long-term rehabilitation treatment."
1678		-	SECTION 5. EFFECTIVE DATE.--The effective date of the
1679		-	provisions of this act is January 1, 2026.
	1748	+	SECTION 5. APPLICABILITY.--The provisions of this act
	1749	+	apply to self-insurance provided pursuant to the Health Care
	1750	+	Purchasing Act, individual and group health insurance policies,
	1751	+	health care plans, certificates of health insurance, managed
	1752	+	health care plans, contracts of health insurance, group health
	1753	+	plans provided through a cooperative, individual and group
	1754	+	health maintenance organization contracts, health benefit plans
	1755	+	and group health coverage that are offered, delivered or issued
	1756	+	for delivery, renewed, extended or amended in New Mexico on or
	1757	+	after January 1, 2026.
	1758	+	- 33 -
	1759	+	.229151.1