SHPAC/SB 120
Page 1
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
AN ACT
RELATING TO HEALTH; AMENDING SECTIONS OF THE HEALTH CARE
PURCHASING ACT AND NEW MEXICO INSURANCE CODE TO ADD AN
EXEMPTION FROM THE PROHIBITION ON COST SHARING FOR BEHAVIORAL
HEALTH SERVICES FOR CERTAIN PLANS.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF NEW MEXICO:
SECTION 1. Section 13-7-26 NMSA 1978 (being Laws 2021,
Chapter 136, Section 3) is amended to read:
"13-7-26. BEHAVIORAL HEALTH SERVICES--ELIMINATION OF
COST SHARING.--
A. Group health coverage, including any form of
self-insurance, offered, issued or renewed under the Health
Care Purchasing Act that offers coverage of behavioral health
services shall not impose cost sharing on those behavioral
health services in network.
B. For the purposes of this section:
(1) "behavioral health services" means
professional and ancillary services for the treatment,
habilitation, prevention and identification of mental
illnesses, substance abuse disorders and trauma spectrum
disorders, including inpatient, detoxification, residential
treatment and partial hospitalization, intensive outpatient
therapy, outpatient therapy and all medications, including
brand-name pharmacy drugs when generics are unavailable; SHPAC/SB 120
Page 2
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
(2) "coinsurance" means a cost-sharing
method that requires an enrollee to pay a stated percentage
of medical expenses after any deductible amount is paid;
provided that coinsurance rates may differ for different
types of services under the same group health plan;
(3) "copayment" means a cost-sharing method
that requires an enrollee to pay a fixed dollar amount
when health care services are received, with the plan
administrator paying the balance of the allowable amount;
provided that there may be different copayment requirements
for different types of services under the same group health
plan; and
(4) "cost sharing" means a copayment,
coinsurance, deductible or any other form of financial
obligation of an enrollee other than a premium or a share of
a premium, or any combination of any of these financial
obligations, as defined by the terms of a group health plan.
C. The provisions of this section do not apply to
excepted benefit plans as provided under the Short-Term
Health Plan and Excepted Benefit Act, catastrophic plans as
defined under 42 USCA Section 18022(e) or high-deductible
health plans with health savings accounts until an enrollee's
deductible has been met, unless otherwise permitted by
federal law."
SECTION 2. Section 59A-22-57 NMSA 1978 (being SHPAC/SB 120
Page 3
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Laws 2021, Chapter 136, Section 6) is amended to read:
"59A-22-57. BEHAVIORAL HEALTH SERVICES--ELIMINATION OF
COST SHARING.--
A. An individual or group health insurance policy,
health care plan or certificate of health insurance that is
delivered, issued for delivery or renewed in this state that
offers coverage of behavioral health services shall not
impose cost sharing on those behavioral health services.
B. For the purposes of this section:
(1) "behavioral health services" means
professional and ancillary services for the treatment,
habilitation, prevention and identification of mental
illnesses, substance abuse disorders and trauma spectrum
disorders, including inpatient, detoxification, residential
treatment and partial hospitalization, intensive outpatient
therapy, outpatient therapy and all medications, including
brand-name pharmacy drugs when generics are unavailable;
(2) "coinsurance" means a cost-sharing
method that requires the insured to pay a stated percentage
of medical expenses after any deductible amount is paid;
provided that coinsurance rates may differ for different
types of services under the same individual or group health
insurance policy, health care plan or certificate of health
insurance;
(3) "copayment" means a cost-sharing method SHPAC/SB 120
Page 4
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
that requires the insured to pay a fixed dollar amount when
health care services are received, with the insurer paying
the balance of the allowable amount; provided that there may
be different copayment requirements for different types of
services under the same individual or group health insurance
policy, health care plan or certificate of health insurance;
and
(4) "cost sharing" means a copayment,
coinsurance, deductible or any other form of financial
obligation of the insured other than a premium or a share
of a premium, or any combination of any of these financial
obligations, as defined by the terms of an individual or
group health insurance policy, health care plan or
certificate of health insurance.
C. The provisions of this section do not apply
to excepted benefit plans as provided under the Short-Term
Health Plan and Excepted Benefit Act, catastrophic plans as
defined under 42 USCA Section 18022(e) or high-deductible
health plans with health savings accounts until an insured's
deductible has been met, unless otherwise permitted by
federal law."
SECTION 3. Section 59A-23-16 NMSA 1978 (being
Laws 2021, Chapter 136, Section 7) is amended to read:
"59A-23-16. BEHAVIORAL HEALTH SERVICES--ELIMINATION OF
COST SHARING.-- SHPAC/SB 120
Page 5
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
A. A group or blanket health insurance policy,
health care plan or certificate of health insurance that is
delivered, issued for delivery or renewed in this state that
offers coverage of behavioral health services shall not
impose cost sharing on those behavioral health services in
network.
B. For the purposes of this section:
(1) "behavioral health services" means
professional and ancillary services for the treatment,
habilitation, prevention and identification of mental
illnesses, substance abuse disorders and trauma spectrum
disorders, including inpatient, detoxification, residential
treatment and partial hospitalization, intensive outpatient
therapy, outpatient therapy and all medications, including
brand-name pharmacy drugs when generics are unavailable;
(2) "coinsurance" means a cost-sharing
method that requires a covered person to pay a stated
percentage of medical expenses after any deductible amount
is paid; provided that coinsurance rates may differ for
different types of services under the same group or blanket
health insurance policy, health care plan or certificate of
health insurance;
(3) "copayment" means a cost-sharing method
that requires a covered person to pay a fixed dollar amount
when health care services are received, with the insurer SHPAC/SB 120
Page 6
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
paying the balance of the allowable amount; provided that
there may be different copayment requirements for different
types of services under the same group or blanket health
insurance policy, health care plan or certificate of health
insurance; and
(4) "cost sharing" means a copayment,
coinsurance, deductible or any other form of financial
obligation of a covered person other than a premium or a
share of a premium, or any combination of any of these
financial obligations, as defined by the terms of a group
or blanket health insurance policy, health care plan or
certificate of health insurance.
C. The provisions of this section do not apply
to excepted benefit plans as provided under the Short-Term
Health Plan and Excepted Benefit Act, catastrophic plans as
defined under 42 USCA Section 18022(e) or high-deductible
health plans with health savings accounts until a covered
person's deductible has been met, unless otherwise permitted
by federal law."
SECTION 4. Section 59A-46-57 NMSA 1978 (being
Laws 2021, Chapter 136, Section 8) is amended to read:
"59A-46-57. BEHAVIORAL HEALTH SERVICES--ELIMINATION OF
COST SHARING.--
A. An individual or group health maintenance
organization contract that is delivered, issued for delivery SHPAC/SB 120
Page 7
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
or renewed in this state that offers coverage of behavioral
health services shall not impose cost sharing on those
behavioral health services in network.
B. For the purposes of this section:
(1) "behavioral health services" means
professional and ancillary services for the treatment,
habilitation, prevention and identification of mental
illnesses, substance abuse disorders and trauma spectrum
disorders, including inpatient, detoxification, residential
treatment and partial hospitalization, intensive outpatient
therapy, outpatient therapy and all medications, including
brand-name pharmacy drugs when generics are unavailable;
(2) "coinsurance" means a cost-sharing
method that requires an enrollee to pay a stated percentage
of medical expenses after any deductible amount is paid;
provided that coinsurance rates may differ for different
types of services under the same individual or group health
maintenance organization contract;
(3) "copayment" means a cost-sharing method
that requires an enrollee to pay a fixed dollar amount when
health care services are received, with the carrier paying
the balance of the allowable amount; provided that there
may be different copayment requirements for different types
of services under the same individual or group health
maintenance organization contract; and SHPAC/SB 120
Page 8
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
(4) "cost sharing" means a copayment,
coinsurance, deductible or any other form of financial
obligation of an enrollee other than a premium or a share of
a premium, or any combination of any of these financial
obligations, as defined by the terms of an individual or
group health maintenance organization contract.
C. The provisions of this section do not apply
to excepted benefit plans as provided under the Short-Term
Health Plan and Excepted Benefit Act, catastrophic plans as
defined under 42 USCA Section 18022(e) or high-deductible
health plans with health savings accounts until an enrollee's
deductible has been met, unless otherwise permitted by
federal law."
SECTION 5. Section 59A-47-51 NMSA 1978 (being
Laws 2021, Chapter 136, Section 9) is amended to read:
"59A-47-51. BEHAVIORAL HEALTH SERVICES--ELIMINATION OF
COST SHARING.--
A. An individual or group health care plan that is
delivered, issued for delivery or renewed in this state that
offers coverage of behavioral health services shall not
impose cost sharing on those behavioral health services in
network.
B. For the purposes of this section:
(1) "behavioral health services" means
professional and ancillary services for the treatment, SHPAC/SB 120
Page 9
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
habilitation, prevention and identification of mental
illnesses, substance abuse disorders and trauma spectrum
disorders, including inpatient, detoxification, residential
treatment and partial hospitalization, intensive outpatient
therapy, outpatient therapy and all medications, including
brand-name pharmacy drugs when generics are unavailable;
(2) "coinsurance" means a cost-sharing
method that requires a subscriber to pay a stated percentage
of medical expenses after any deductible amount is paid;
provided that coinsurance rates may differ for different
types of services under the same individual or group health
care plan;
(3) "copayment" means a cost-sharing method
that requires a subscriber to pay a fixed dollar amount when
health care services are received, with the health care plan
paying the balance of the allowable amount; provided that
there may be different copayment requirements for different
types of services under the same individual or group health
care plan; and
(4) "cost sharing" means a copayment,
coinsurance, deductible or any other form of financial
obligation of a subscriber other than a premium or a share
of a premium, or any combination of any of these financial
obligations, as defined by the terms of an individual or
group health care plan. SHPAC/SB 120
Page 10
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
C. The provisions of this section do not apply
to excepted benefit plans as provided under the Short-Term
Health Plan and Excepted Benefit Act, catastrophic plans as
defined under 42 USCA Section 18022(e) or high-deductible
health plans with health savings accounts until a
subscriber's deductible has been met, unless otherwise
permitted by federal law."
SECTION 6. EFFECTIVE DATE.--The effective date of the
provisions of this act is January 1, 2026.