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SENATE BILL 390
57
TH LEGISLATURE
-
STATE
OF
NEW
MEXICO
-
FIRST SESSION
,
2025
INTRODUCED BY
Katy M. Duhigg
AN ACT
RELATING TO INSURANCE; REQUIRING BEHAVIORAL AND MENTAL HEALTH
CARE PROVIDERS TO BE REIMBURSED FOR ALL NECESSARY SERVICES THAT
THEY PROVIDE.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF NEW MEXICO:
SECTION 1. Section 13-7-32 NMSA 1978 (being Laws 2023,
Chapter 114, Section 3) is amended to read:
"13-7-32. PARITY FOR COVERAGE OF MENTAL HEALTH AND
SUBSTANCE USE DISORDER SERVICES--PARITY FOR REIMBURSEMENT .--
A. The office of superintendent of insurance shall
ensure that an insurer complies with federal and state laws,
rules and regulations applicable to coverage for mental health
or substance use disorder services.
B. An insurer shall not impose quantitative
treatment limitations, financial restrictions, limitations or
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requirements on the provision of mental health or substance use
disorder services that are more restrictive than the
predominant restrictions, limitations or requirements that are
imposed on substantially all of the coverage of benefits for
other conditions.
C. An insurer shall not impose non-quantitative
treatment limitations for the treatment of mental health or
substance use disorders or conditions unless factors, including
the processes, strategies or evidentiary standards used in
applying the non-quantitative treatment limitation, as written
and in operation, are comparable to and are applied no more
restrictively than the factors used in applying the limitation
to medical or surgical benefits in the classification.
D. An insurer shall pay or reimburse a behavioral
or mental health care provider for all medically necessary
services that the health care provider performs, regardless of
the health care provider's designation as a behavioral or
mental health care provider; provided that the service is
within the scope and limitations of the provider's license. "
SECTION 2. A new section of Chapter 59A, Article 22 NMSA
1978 is enacted to read:
"[NEW MATERIAL] PARITY FOR REIMBURSEMENT TO BEHAVIORAL AND
MENTAL HEALTH CARE PROVIDERS.--An insurer shall pay or
reimburse a behavioral or mental health care provider for all
medically necessary services that the health care provider
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performs, regardless of the health care provider's designation
as a behavioral or mental health care provider; provided that
the service is within the scope and limitations of the
provider's license."
SECTION 3. Section 59A-23-24 NMSA 1978 (being Laws 2023,
Chapter 114, Section 16) is amended to read:
"59A-23-24. PARITY FOR COVERAGE OF MENTAL HEALTH OR
SUBSTANCE USE DISORDER SERVICES--PARITY FOR REIMBURSEMENT .--
A. The office of superintendent of insurance shall
ensure that an insurer complies with federal and state laws,
rules and regulations applicable to coverage for mental health
or substance use disorder services.
B. An insurer shall not impose quantitative
treatment limitations, financial restrictions, limitations or
requirements on the provision of mental health or substance use
disorder services that are more restrictive than the
predominant restrictions, limitations or requirements that are
imposed on substantially all of the coverage of benefits for
other conditions.
C. An insurer shall not impose non-quantitative
treatment limitations for the treatment of mental health or
substance use disorders or conditions unless factors, including
the processes, strategies or evidentiary standards used in
applying the non-quantitative treatment limitation, as written
and in operation, are comparable to and are applied no more
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restrictively than the factors used in applying the limitation
with respect to medical or surgical benefits in the
classification.
D. An insurer shall pay or reimburse a behavioral
or mental health care provider for all medically necessary
services that the health care provider performs, regardless of
the health care provider's designation as a behavioral or
mental health care provider; provided that the service is
within the scope and limitations of the provider's license. "
SECTION 4. Section 59A-46-63 NMSA 1978 (being Laws 2023,
Chapter 114, Section 27) is amended to read:
"59A-46-63. PARITY FOR COVERAGE OF MENTAL HEALTH OR
SUBSTANCE USE DISORDER SERVICES--PARITY FOR REIMBURSEMENT .--
A. The office of superintendent of insurance shall
ensure that a carrier complies with federal and state laws,
rules and regulations applicable to coverage for mental health
or substance use disorder services.
B. A carrier shall not impose quantitative
treatment limitations, financial restrictions, limitations or
requirements on the provision of mental health or substance use
disorder services that are more restrictive than the
predominant restrictions, limitations or requirements that are
imposed on substantially all of the coverage of benefits for
other conditions.
C. A carrier shall not impose non-quantitative
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treatment limitations for the treatment of mental health or
substance use disorders or conditions unless factors, including
the processes, strategies or evidentiary standards used in
applying the non-quantitative treatment limitation, as written
and in operation, are comparable to and are applied no more
restrictively than the factors used in applying the limitation
with respect to medical or surgical benefits in the
classification.
D. A carrier shall pay or reimburse a behavioral or
mental health care provider for all medically necessary
services that the health care provider performs, regardless of
the health care provider's designation as a behavioral or
mental health care provider; provided that the service is
within the scope and limitations of the provider's license. "
SECTION 5. Section 59A-47-58 NMSA 1978 (being Laws 2023,
Chapter 114, Section 37) is amended to read:
"59A-47-58. PARITY FOR COVERAGE OF MENTAL HEALTH OR
SUBSTANCE USE DISORDER SERVICES--PARITY FOR REIMBURSEMENT .--
A. The office of superintendent of insurance shall
ensure that a health care plan complies with federal and state
laws, rules and regulations applicable to coverage for mental
health or substance use disorder services.
B. A health care plan shall not impose quantitative
treatment limitations, financial restrictions, limitations or
requirements on the provision of mental health or substance use
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disorder services that are more restrictive than the
predominant restrictions, limitations or requirements that are
imposed on substantially all of the coverage of benefits for
other conditions.
C. A health care plan shall not impose non-
quantitative treatment limitations for the treatment of mental
health or substance use disorders or conditions unless factors,
including the processes, strategies or evidentiary standards
used in applying the non-quantitative treatment limitation, as
written and in operation, are comparable to and are applied no
more restrictively than the factors used in applying the
limitation with respect to medical or surgical benefits in the
classification.
D. A health care plan shall pay or reimburse a
behavioral or mental health care provider for all medically
necessary services that the health care provider performs,
regardless of the health care provider's designation as a
behavioral or mental health care provider; provided that the
service is within the scope and limitations of the provider's
license."
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