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HOUSE BILL 570
57
TH LEGISLATURE
-
STATE
OF
NEW
MEXICO
-
FIRST SESSION
,
2025
INTRODUCED BY
Jenifer Jones and Elizabeth "Liz" Thomson
and Joshua N. Hernandez
AN ACT
RELATING TO INSURANCE; AMENDING AND ENACTING SECTIONS OF THE
PRIOR AUTHORIZATION ACT TO PROHIBIT THE IMPOSITION OF PRIOR
AUTHORIZATION REQUIREMENTS FOR CERTAIN COVERED SERVICES AND
PRESCRIPTION MEDICATION.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF NEW MEXICO:
SECTION 1. Section 59A-22B-1 NMSA 1978 (being Laws 2019,
Chapter 187, Section 3) is amended to read:
"59A-22B-1. SHORT TITLE.--[Sections 3 through 7 of this
act] Chapter 59A, Article 22B NMSA 1978 may be cited as the
"Prior Authorization Act"."
SECTION 2. A new section of the Prior Authorization Act
is enacted to read:
"[NEW MATERIAL] PRIOR AUTHORIZATION FOR CHEMOTHERAPY
SERVICES PROHIBITED.--
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A. A health insurer shall not require prior
authorization for covered chemotherapy services.
B. A health insurer may require a health care
provider to provide notification to the health insurer after
the initiation of chemotherapy services.
C. A health insurer may require a health care
provider to develop and submit a treatment plan for a covered
person receiving chemotherapy services in a manner that is
compliant with federal law."
SECTION 3. A new section of the Prior Authorization Act
is enacted to read:
"[NEW MATERIAL] PRIOR AUTHORIZATION FOR DIALYSIS SERVICES
PROHIBITED.--
A. A health insurer shall not require prior
authorization for covered dialysis services.
B. A health insurer may require a health care
provider to provide notification to the health insurer after
the initiation of dialysis services.
C. A health insurer may require a health care
provider to develop and submit a treatment plan for a covered
person receiving dialysis services in a manner that is
compliant with federal law."
SECTION 4. A new section of the Prior Authorization Act
is enacted to read:
"[NEW MATERIAL] PRIOR AUTHORIZATION FOR ELDER CARE
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SERVICES PROHIBITED.--
A. A health insurer shall not require prior
authorization for covered elder care services.
B. A health insurer may require a health care
provider to provide notification to the health insurer after
the initiation of elder care services.
C. A health insurer may require a health care
provider to develop and submit a treatment plan for a covered
person receiving elder care services in a manner that is
compliant with federal law."
SECTION 5. A new section of the Prior Authorization Act
is enacted to read:
"[NEW MATERIAL] PRIOR AUTHORIZATION FOR HOME HEALTH CARE
SERVICES PROHIBITED.--
A. A health insurer shall not require prior
authorization for covered home health care services.
B. A health insurer may require a health care
provider to provide notification to the health insurer after
the initiation of home health care services.
C. A health insurer may require a health care
provider to develop and submit a treatment plan for a covered
person receiving home health care services in a manner that is
compliant with federal law."
SECTION 6. Section 59A-22B-8 NMSA 1978 (being Laws 2023,
Chapter 114, Section 13, as amended) is amended to read:
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"59A-22B-8. PRIOR AUTHORIZATION FOR PRESCRIPTION DRUGS OR
STEP THERAPY FOR CERTAIN CONDITIONS PROHIBITED.--
A. Coverage for medication approved by the federal
food and drug administration that is prescribed for the
treatment of an autoimmune disorder, cancer, diabetes, high
blood pressure or a substance use disorder, pursuant to a
medical necessity determination, shall not be subject to prior
authorization, except in cases in which a biosimilar,
interchangeable biologic or generic version is available.
B. A health insurer shall not impose step therapy
requirements before authorizing coverage for medication
approved by the federal food and drug administration that is
prescribed for the treatment of an autoimmune disorder, cancer,
diabetes, high blood pressure or a substance use disorder,
pursuant to a medical necessity determination, except in cases
in which a biosimilar, interchangeable biologic or generic
version is available."
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