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SENATE BILL 297
57
TH LEGISLATURE
-
STATE
OF
NEW
MEXICO
-
FIRST SESSION
,
2025
INTRODUCED BY
Nicole Tobiassen and Jay C. Block and Katy M. Duhigg
and Linda M. López
AN ACT
RELATING TO HEALTH CARE; REQUIRING THE HEALTH CARE AUTHORITY TO
CONDUCT REGIONAL COMMERCIAL INSURANCE MARKET ASSESSMENTS;
REQUIRING INCREASED MEDICAID REIMBURSEMENT FOR HEALTH CARE
SERVICES.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF NEW MEXICO:
SECTION 1. A new section of the Public Assistance Act is
enacted to read:
"[NEW MATERIAL] MARKET ASSESSMENTS REQUIRED.--
A. By July 1, 2026 and every two years thereafter,
the authority shall conduct a market assessment to determine
the regional average commercial insurance reimbursement rate
for all health care services provided in Arizona, Colorado,
Utah, Oklahoma and Texas that are covered by the New Mexico
medicaid program.
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B. The medicaid reimbursement rate for all health
care services that are covered by the New Mexico medicaid
program shall be the greater of:
(1) two hundred percent of the medicare
reimbursement rate for the equivalent service; or
(2) the regional average commercial insurance
reimbursement rate for the service.
C. Using the medicaid reimbursement rate for each
health care service as of July 1, 2024 as a baseline for
comparison, all health care entities that receive increases in
medicaid reimbursement pursuant to this section shall ensure
that at least seventy-five percent of the increase in
reimbursement revenue is used to:
(1) provide increased compensation to health
care workers and other employees who interact directly with
patients; or
(2) hire additional health care workers and
other employees who interact directly with patients.
D. For the purposes of this section:
(1) "health care entity" means an entity,
other than an individual, that is licensed to provide any form
of health care in the state, including a hospital, clinic,
hospice agency, home health agency, long-term care agency,
pharmacy, group medical practice, medical home or any similar
entity;
.229810.3
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(2) "medicaid" means the federal-state program
administered by the authority pursuant to Title 19 or Title 21
of the federal Social Security Act; and
(3) "medicare" means coverage provided
pursuant to part A or part B of Title 18 of the federal Social
Security Act, as amended."
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