New Mexico 2025 Regular Session

New Mexico House Bill HB279 Compare Versions

Only one version of the bill is available at this time.

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28	28	HOUSE BILL 279
29	29	57TH LEGISLATURE - STATE OF NEW MEXICO - FIRST SESSION, 2025
30	30	INTRODUCED BY
31	31	Nicole Chavez and Gail Armstrong and Elaine Sena Cortez
32	32	AN ACT
33	33	RELATING TO HEALTH CARE; CREATING AN OPTIONAL PROCESS FOR
34	34	ACTUARIAL REVIEWS OF PROPOSED LEGISLATION THAT MAY CHANGE THE
35	35	COVERAGE REQUIREMENTS FOR HEALTH INSURERS; REQUIRING THE
36	36	LEGISLATIVE COUNCIL SERVICE TO RETAIN CONTRACTORS WHO PERFORM
37	37	ACTUARIAL REVIEWS OF LEGISLATIVE PROPOSALS; MAKING AN
38	38	APPROPRIATION.
39	39	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF NEW MEXICO:
40	40	SECTION 1. A new section of Chapter 2, Article 3 NMSA
41	41	1978 is enacted to read:
42	42	"[NEW MATERIAL] ACTUARIAL REVIEWS OF PROPOSED HEALTH CARE
43	43	LEGISLATION.--
44	44	A. On or before September 1, 2025, the legislative
45	45	council service shall retain at least one contractor that is
46	46	capable of performing actuarial reviews of legislative
47	47	.228630.3 underscored material = new
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74	74	proposals that may change the health insurance or health plan
75	75	coverage or compliance requirements. A contractor retained by
76	76	the legislative council service shall have experience in
77	77	conducting actuarial reviews on health care policy and health
78	78	insurance premiums.
79	79	B. Every year, each member of the legislature may
80	80	request the legislative council service to perform an actuarial
81	81	review of one piece of legislation that may change the coverage
82	82	requirements for health insurers. For each regular legislative
83	83	session, the legislative council service shall provide
84	84	actuarial reviews of proposed legislation for:
85	85	(1) up to two members of the majority party of
86	86	the house of representatives. If more than two members of the
87	87	majority party of the house of representatives submit an
88	88	actuarial review request to the legislative council service,
89	89	the director of the legislative council service shall notify
90	90	the speaker of the house of representatives, who shall select
91	91	two legislative proposals to be actuarially reviewed;
92	92	(2) up to two members of the minority party of
93	93	the house of representatives. If more than two members of the
94	94	minority party of the house of representatives submit an
95	95	actuarial review request to the legislative council service,
96	96	the director of the legislative council service shall notify
97	97	the minority floor leader of the house of representatives, who
98	98	shall select two legislative proposals to be actuarially
99	99	.228630.3
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127	127	reviewed;
128	128	(3) up to two members of the majority party of
129	129	the senate. If more than two members of the majority party of
130	130	the senate submit an actuarial review request to the
131	131	legislative council service, the director of the legislative
132	132	council service shall notify the president pro tempore of the
133	133	senate, who shall select two legislative proposals to be
134	134	actuarially reviewed; and
135	135	(4) up to two members of the minority party of
136	136	the senate. If more than two members of the minority party of
137	137	the senate submit an actuarial review request to the
138	138	legislative council service, the director of the legislative
139	139	council service shall notify the minority floor leader of the
140	140	senate, who shall select two legislative proposals to be
141	141	actuarially reviewed.
142	142	C. A legislative proposal shall only be eligible
143	143	for actuarial review if the proposal is submitted to the
144	144	legislative council service by October 1 of a given year.
145	145	D. An actuarial review performed by a contractor
146	146	shall provide, at a minimum:
147	147	(1) an estimate of the number of New Mexico
148	148	residents who will be directly affected by the legislative
149	149	proposal;
150	150	(2) estimates of changes in the rates of
151	151	utilization of specific health care services that may result
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180	180	from the legislative proposal;
181	181	(3) estimates concerning any changes in
182	182	consumer cost sharing that would result from the legislative
183	183	proposal;
184	184	(4) estimates of any increases or decreases in
185	185	health insurance premiums;
186	186	(5) an estimate of the out-of-pocket health
187	187	care cost changes associated with the legislative proposal;
188	188	(6) an estimate of the potential long-term
189	189	health care cost changes associated with the legislative
190	190	proposal;
191	191	(7) identification of potential health
192	192	benefits for individuals or communities that would result from
193	193	the legislative proposal;
194	194	(8) to the extent practicable, the social and
195	195	economic impacts of the legislative proposal, including
196	196	potential impacts to health care providers, provider networks
197	197	and other health insurance markets;
198	198	(9) an estimate of the impact on state
199	199	spending related to programs administrated pursuant to the
200	200	Health Care Purchasing Act and the Public Assistance Act;
201	201	(10) an evaluation of whether coverage for any
202	202	health care services included in the legislative proposal is or
203	203	could be available without passage of the legislative proposal;
204	204	and
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233	233	(11) an analysis on whether the legislative
234	234	proposal is supported by:
235	235	(a) determinations made by the United
236	236	States food and drug administration;
237	237	(b) coverage determinations made by the
238	238	federal centers for medicare and medicaid services;
239	239	(c) determinations made by the United
240	240	States preventive services task force; and
241	241	(d) nationally recognized clinical
242	242	practice guidelines.
243	243	E. If an actuarial review performed by a contractor
244	244	requires the analysis of health data, the actuarial review
245	245	shall rely on health data collected pursuant to the Health
246	246	Information System Act whenever practicable.
247	247	F. No later than January 1 of each year, the
248	248	legislative council service shall prepare a written report
249	249	containing the results of the actuarial reviews conducted
250	250	pursuant to this section and shall:
251	251	(1) deliver the report to the New Mexico
252	252	legislative council;
253	253	(2) deliver the report to the legislative
254	254	finance committee; and
255	255	(3) make the report available on the
256	256	legislature's website.
257	257	G. For the purposes of this section:
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286	286	(1) "contractor" means an entity retained by
287	287	the legislative council service for the purpose of providing
288	288	actuarial reviews of legislative proposals that may change the
289	289	coverage requirements for health insurers;
290	290	(2) "health insurer" means a health
291	291	maintenance organization, nonprofit health care plan, provider
292	292	service network, medicaid managed care organization or third-
293	293	party payer or its agent;
294	294	(3) "legislative proposal" means a proposal
295	295	that would statutorily require a health insurer to:
296	296	(a) provide coverage or increase the
297	297	amount of coverage for the treatment of a particular disease,
298	298	condition or health care need;
299	299	(b) provide coverage or increase the
300	300	amount of coverage for a particular type of health care
301	301	treatment or service or equipment, supply or prescription drug
302	302	used in connection with a health care treatment or service;
303	303	(c) provide coverage for care delivered
304	304	by a specific health care provider;
305	305	(d) follow a particular benefit design
306	306	or cost-sharing requirement for: 1) the treatment of a
307	307	particular disease, condition or health care need; 2) a
308	308	particular type of health care treatment or service; or 3) the
309	309	provision of medical equipment, supplies or prescription drugs
310	310	used in connection with treating a particular disease,
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339	339	condition or health care need; or
340	340	(e) impose limits or conditions on a
341	341	contract between a health insurer and health care provider; and
342	342	(4) "legislative proposal" does not mean a
343	343	proposal that would:
344	344	(a) amend the scope of practice of a
345	345	licensed health care professional; or
346	346	(b) make state law consistent with
347	347	federal law."
348	348	SECTION 2. APPROPRIATION.--One hundred thousand dollars
349	349	($100,000) is appropriated from the general fund to the
350	350	legislative council service for expenditure in fiscal year 2026
351	351	to procure contractors to perform actuarial reviews of
352	352	legislative proposals that may change the coverage requirements
353	353	for health insurance plans. Any unexpended or unencumbered
354	354	balance remaining at the end of fiscal year 2026 shall revert
355	355	to the general fund.
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357	357	.228630.3