New Mexico 2025 Regular Session

New Mexico House Bill HB570 Compare Versions

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

Old	New	Differences
1	1	underscored material = new
2	2	[bracketed material] = delete
3	3	1
4	4	2
5	5	3
6	6	4
7	7	5
8	8	6
9	9	7
10	10	8
11	11	9
12	12	10
13	13	11
14	14	12
15	15	13
16	16	14
17	17	15
18	18	16
19	19	17
20	20	18
21	21	19
22	22	20
23	23	21
24	24	22
25	25	23
26	26	24
27	27	25
28	28	HOUSE BILL 570
29	29	57
30	30	TH LEGISLATURE
31	31	-
32	32
33	33	STATE
34	34
35	35	OF
36	36
37	37	NEW
38	38
39	39	MEXICO
40	40
41	41	-
42	42	FIRST SESSION
43	43	,
44	44
45	45	2025
46	46	INTRODUCED BY
47	47	Jenifer Jones and Elizabeth "Liz" Thomson
48	48	and Joshua N. Hernandez
49	49	AN ACT
50	50	RELATING TO INSURANCE; AMENDING AND ENACTING SECTIONS OF THE
51	51	PRIOR AUTHORIZATION ACT TO PROHIBIT THE IMPOSITION OF PRIOR
52	52	AUTHORIZATION REQUIREMENTS FOR CERTAIN COVERED SERVICES AND
53	53	PRESCRIPTION MEDICATION.
54	54	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF NEW MEXICO:
55	55	SECTION 1. Section 59A-22B-1 NMSA 1978 (being Laws 2019,
56	56	Chapter 187, Section 3) is amended to read:
57	57	"59A-22B-1. SHORT TITLE.--[Sections 3 through 7 of this
58	58	act] Chapter 59A, Article 22B NMSA 1978 may be cited as the
59	59	"Prior Authorization Act"."
60	60	SECTION 2. A new section of the Prior Authorization Act
61	61	is enacted to read:
62	62	"[NEW MATERIAL] PRIOR AUTHORIZATION FOR CHEMOTHERAPY
63	63	SERVICES PROHIBITED.--
64	64	.229604.1 underscored material = new
65	65	[bracketed material] = delete
66	66	1
67	67	2
68	68	3
69	69	4
70	70	5
71	71	6
72	72	7
73	73	8
74	74	9
75	75	10
76	76	11
77	77	12
78	78	13
79	79	14
80	80	15
81	81	16
82	82	17
83	83	18
84	84	19
85	85	20
86	86	21
87	87	22
88	88	23
89	89	24
90	90	25
91	91	A. A health insurer shall not require prior
92	92	authorization for covered chemotherapy services.
93	93	B. A health insurer may require a health care
94	94	provider to provide notification to the health insurer after
95	95	the initiation of chemotherapy services.
96	96	C. A health insurer may require a health care
97	97	provider to develop and submit a treatment plan for a covered
98	98	person receiving chemotherapy services in a manner that is
99	99	compliant with federal law."
100	100	SECTION 3. A new section of the Prior Authorization Act
101	101	is enacted to read:
102	102	"[NEW MATERIAL] PRIOR AUTHORIZATION FOR DIALYSIS SERVICES
103	103	PROHIBITED.--
104	104	A. A health insurer shall not require prior
105	105	authorization for covered dialysis services.
106	106	B. A health insurer may require a health care
107	107	provider to provide notification to the health insurer after
108	108	the initiation of dialysis services.
109	109	C. A health insurer may require a health care
110	110	provider to develop and submit a treatment plan for a covered
111	111	person receiving dialysis services in a manner that is
112	112	compliant with federal law."
113	113	SECTION 4. A new section of the Prior Authorization Act
114	114	is enacted to read:
115	115	"[NEW MATERIAL] PRIOR AUTHORIZATION FOR ELDER CARE
116	116	.229604.1
117	117	- 2 - underscored material = new
118	118	[bracketed material] = delete
119	119	1
120	120	2
121	121	3
122	122	4
123	123	5
124	124	6
125	125	7
126	126	8
127	127	9
128	128	10
129	129	11
130	130	12
131	131	13
132	132	14
133	133	15
134	134	16
135	135	17
136	136	18
137	137	19
138	138	20
139	139	21
140	140	22
141	141	23
142	142	24
143	143	25
144	144	SERVICES PROHIBITED.--
145	145	A. A health insurer shall not require prior
146	146	authorization for covered elder care services.
147	147	B. A health insurer may require a health care
148	148	provider to provide notification to the health insurer after
149	149	the initiation of elder care services.
150	150	C. A health insurer may require a health care
151	151	provider to develop and submit a treatment plan for a covered
152	152	person receiving elder care services in a manner that is
153	153	compliant with federal law."
154	154	SECTION 5. A new section of the Prior Authorization Act
155	155	is enacted to read:
156	156	"[NEW MATERIAL] PRIOR AUTHORIZATION FOR HOME HEALTH CARE
157	157	SERVICES PROHIBITED.--
158	158	A. A health insurer shall not require prior
159	159	authorization for covered home health care services.
160	160	B. A health insurer may require a health care
161	161	provider to provide notification to the health insurer after
162	162	the initiation of home health care services.
163	163	C. A health insurer may require a health care
164	164	provider to develop and submit a treatment plan for a covered
165	165	person receiving home health care services in a manner that is
166	166	compliant with federal law."
167	167	SECTION 6. Section 59A-22B-8 NMSA 1978 (being Laws 2023,
168	168	Chapter 114, Section 13, as amended) is amended to read:
169	169	.229604.1
170	170	- 3 - underscored material = new
171	171	[bracketed material] = delete
172	172	1
173	173	2
174	174	3
175	175	4
176	176	5
177	177	6
178	178	7
179	179	8
180	180	9
181	181	10
182	182	11
183	183	12
184	184	13
185	185	14
186	186	15
187	187	16
188	188	17
189	189	18
190	190	19
191	191	20
192	192	21
193	193	22
194	194	23
195	195	24
196	196	25
197	197	"59A-22B-8. PRIOR AUTHORIZATION FOR PRESCRIPTION DRUGS OR
198	198	STEP THERAPY FOR CERTAIN CONDITIONS PROHIBITED.--
199	199	A. Coverage for medication approved by the federal
200	200	food and drug administration that is prescribed for the
201	201	treatment of an autoimmune disorder, cancer, diabetes, high
202	202	blood pressure or a substance use disorder, pursuant to a
203	203	medical necessity determination, shall not be subject to prior
204	204	authorization, except in cases in which a biosimilar,
205	205	interchangeable biologic or generic version is available.
206	206	B. A health insurer shall not impose step therapy
207	207	requirements before authorizing coverage for medication
208	208	approved by the federal food and drug administration that is
209	209	prescribed for the treatment of an autoimmune disorder, cancer,
210	210	diabetes, high blood pressure or a substance use disorder,
211	211	pursuant to a medical necessity determination, except in cases
212	212	in which a biosimilar, interchangeable biologic or generic
213	213	version is available."
214	214	- 4 -
215	215	.229604.1