New Mexico 2025 Regular Session

New Mexico Senate Bill SB508 Compare Versions

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

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28	28	SENATE BILL 508
29	29	57
30	30	TH LEGISLATURE
31	31	-
32	32
33	33	STATE
34	34
35	35	OF
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37	37	NEW
38	38
39	39	MEXICO
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41	41	-
42	42	FIRST SESSION
43	43	,
44	44
45	45	2025
46	46	INTRODUCED BY
47	47	Heather Berghmans and Carrie Hamblen and Angel M. Charley
48	48	and Micaelita Debbie O’Malley and Mimi Stewart
49	49	AN ACT
50	50	RELATING TO INSURANCE; AMENDING AND ENACTING SECTIONS OF THE
51	51	HEALTH CARE PURCHASING ACT, THE PUBLIC ASSISTANCE ACT AND THE
52	52	NEW MEXICO INSURANCE CODE TO REQUIRE COVERAGE FOR CERTAIN
53	53	SEXUAL, REPRODUCTIVE AND GENDER-AFFIRMING HEALTH CARE SERVICES;
54	54	TO ELIMINATE COST SHARING FOR CERTAIN SEXUAL, REPRODUCTIVE AND
55	55	GENDER-AFFIRMING HEALTH CARE SERVICES; AND TO ELIMINATE PRIOR
56	56	AUTHORIZATION REQUIREMENTS FOR CERTAIN SEXUAL, REPRODUCTIVE AND
57	57	GENDER-AFFIRMING HEALTH CARE SERVICES.
58	58	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF NEW MEXICO:
59	59	SECTION 1. A new section of the Health Care Purchasing
60	60	Act is enacted to read:
61	61	"[NEW MATERIAL] PREVENTIVE BENEFITS--NO COST SHARING.--
62	62	Group health coverage, including any form of self-insurance,
63	63	offered, issued or renewed under the Health Care Purchasing Act
64	64	.229202.1 underscored material = new
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91	91	shall provide coverage for and shall not impose any
92	92	cost-sharing requirements for:
93	93	A. items or services that have in effect a rating
94	94	of "A" or "B" in the current recommendations of the United
95	95	States preventive services task force;
96	96	B. immunizations that have in effect a
97	97	recommendation from the advisory committee on immunization
98	98	practices of the federal centers for disease control and
99	99	prevention, with respect to the insured for which immunization
100	100	is considered;
101	101	C. with respect to infants, children and
102	102	adolescents, preventive care and screenings provided for in the
103	103	comprehensive guidelines supported by the health resources and
104	104	services administration of the United States department of
105	105	health and human services; and
106	106	D. with respect to women, additional preventive
107	107	care and screenings to those described in Subsection A of this
108	108	section, as provided for in comprehensive guidelines supported
109	109	by the health resources and services administration of the
110	110	United States department of health and human services."
111	111	SECTION 2. A new section of the Health Care Purchasing
112	112	Act is enacted to read:
113	113	"[NEW MATERIAL] ABORTION CARE--NO COST SHARING.--
114	114	A. Except as provided in Subsection C of this
115	115	section, all group health coverage, including self-insurance,
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144	144	offered, issued, amended, delivered or renewed under the Health
145	145	Care Purchasing Act shall provide coverage for the total cost
146	146	of abortion care.
147	147	B. The coverage shall not be subject to cost
148	148	sharing.
149	149	C. The provisions of this section shall not apply
150	150	to a high deductible health benefit plan issued or renewed in
151	151	this state until an eligible insured's deductible has been
152	152	met."
153	153	SECTION 3. A new section of the Health Care Purchasing
154	154	Act is enacted to read:
155	155	"[NEW MATERIAL] PREGNANCY--SPECIAL ENROLLMENT PERIOD.--
156	156	A. Group health coverage, including self-insurance,
157	157	offered, issued, amended, delivered or renewed under the Health
158	158	Care Purchasing Act shall establish a special enrollment period
159	159	to provide coverage to an uninsured person when the person
160	160	provides a certification from a health care provider to the
161	161	insurer that the person is pregnant.
162	162	B. Coverage shall be effective before the end of
163	163	the first month in which the uninsured person receives
164	164	certification of the pregnancy, unless the person elects to
165	165	have coverage effective on the first day of the month following
166	166	the date that the person makes a plan selection."
167	167	SECTION 4. A new section of the Health Care Purchasing
168	168	Act is enacted to read:
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197	197	"[NEW MATERIAL] COVERAGE FOR GENDER-AFFIRMING CARE.--
198	198	A. All group health coverage, including self-
199	199	insurance, offered, issued, amended, delivered or renewed under
200	200	the Health Care Purchasing Act shall provide coverage for
201	201	gender-affirming care.
202	202	B. As used in this section, "gender-affirming care"
203	203	means a procedure, service, drug, device or product that a
204	204	physical or behavioral health care provider prescribes to treat
205	205	an individual for incongruence between the individual's gender
206	206	identity and the individual's sex assignment at birth.
207	207	C. The provisions of Subsection A of this section
208	208	do not apply to a high deductible health benefit plan issued or
209	209	renewed in this state until an eligible insured's deductible
210	210	has been met, unless allowed pursuant to federal law."
211	211	SECTION 5. Section 13-7-22 NMSA 1978 (being Laws 2019,
212	212	Chapter 263, Section 1) is amended to read:
213	213	"13-7-22. COVERAGE FOR CONTRACEPTION.--
214	214	A. Group health coverage, including any form of
215	215	self-insurance, offered, issued or renewed under the Health
216	216	Care Purchasing Act that provides coverage for prescription
217	217	drugs shall provide, at a minimum, the following coverage:
218	218	(1) at least one product or form of
219	219	contraception in each of the contraceptive method categories
220	220	identified by the federal food and drug administration;
221	221	(2) a sufficient number and assortment of oral
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250	250	contraceptive pills to reflect the variety of oral
251	251	contraceptives approved by the federal food and drug
252	252	administration; and
253	253	(3) clinical services related to the provision
254	254	or use of contraception, including consultations, examinations,
255	255	procedures, ultrasound, anesthesia, patient education,
256	256	counseling, device insertion and removal, follow-up care and
257	257	side-effects management.
258	258	B. Except as provided in Subsection C of this
259	259	section, the coverage required pursuant to this section shall
260	260	not be subject to:
261	261	(1) enrollee cost sharing;
262	262	(2) utilization review;
263	263	(3) prior authorization or step therapy
264	264	requirements; or
265	265	(4) any other restrictions or delays on the
266	266	coverage.
267	267	C. A group health plan may discourage brand-name
268	268	pharmacy drugs or items by applying cost sharing to brand-name
269	269	drugs or items when at least one generic or therapeutic
270	270	equivalent is covered within the same method of contraception
271	271	without patient cost sharing; provided that when an enrollee's
272	272	health care provider determines that a particular drug or item
273	273	is medically necessary, the group health plan shall cover the
274	274	brand-name pharmacy drug or item without cost sharing. Medical
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303	303	necessity may include considerations such as severity of side
304	304	effects, differences in permanence or reversibility of
305	305	contraceptives and ability to adhere to the appropriate use of
306	306	the drug or item, as determined by the attending provider.
307	307	D. A group health plan administrator shall grant an
308	308	enrollee an expedited hearing to appeal any adverse
309	309	determination made relating to the provisions of this section.
310	310	The process for requesting an expedited hearing pursuant to
311	311	this subsection shall:
312	312	(1) be easily accessible, transparent,
313	313	sufficiently expedient and not unduly burdensome on an
314	314	enrollee, the enrollee's representative or the enrollee's
315	315	health care provider;
316	316	(2) defer to the determination of the
317	317	enrollee's health care provider; and
318	318	(3) provide for a determination of the claim
319	319	according to a time frame and in a manner that takes into
320	320	account the nature of the claim and the medical exigencies
321	321	involved for a claim involving an urgent health care need.
322	322	E. A group health plan shall not require a
323	323	prescription for any drug, item or service that is available
324	324	without a prescription.
325	325	F. A group health plan shall provide coverage and
326	326	shall reimburse a health care provider or dispensing entity on
327	327	a per-unit basis for dispensing [a six-month supply of
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356	356	contraceptives] contraception intended to last the enrollee for
357	357	a duration of twelve months, as permitted by the enrollee's
358	358	prescription, dispensed at one time; provided that the
359	359	contraceptives are prescribed and self-administered.
360	360	G. Nothing in this section shall be construed to:
361	361	(1) require a health care provider to
362	362	prescribe six months of contraceptives at one time; or
363	363	(2) permit a group health plan to limit
364	364	coverage or impose cost sharing for an alternate method of
365	365	contraception if an enrollee changes contraceptive methods
366	366	before exhausting a previously dispensed supply.
367	367	H. The provisions of this section shall not apply
368	368	to short-term travel, accident-only, hospital-indemnity-only,
369	369	limited-benefit or disease-specific group health plans.
370	370	I. For the purposes of this section:
371	371	(1) "contraceptive method categories
372	372	identified by the federal food and drug administration":
373	373	(a) means tubal ligation; sterilization
374	374	implant; copper intrauterine device; intrauterine device with
375	375	progestin; implantable rod; contraceptive shot or injection;
376	376	combined oral contraceptives; extended or continuous use oral
377	377	contraceptives; progestin-only oral contraceptives; patch;
378	378	vaginal ring; diaphragm with spermicide; sponge with
379	379	spermicide; cervical cap with spermicide; male and female
380	380	condoms; spermicide alone; vasectomy; ulipristal acetate;
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409	409	levonorgestrel emergency contraception; and any additional
410	410	method categories of contraception approved by the federal food
411	411	and drug administration; and
412	412	(b) does not mean a product that has
413	413	been recalled for safety reasons or withdrawn from the market;
414	414	(2) "cost sharing" means a deductible,
415	415	copayment or coinsurance that an enrollee is required to pay in
416	416	accordance with the terms of a group health plan; and
417	417	(3) "health care provider" means an individual
418	418	licensed to provide health care in the ordinary course of
419	419	business."
420	420	SECTION 6. Section 27-2-12.29 NMSA 1978 (being Laws 2019,
421	421	Chapter 263, Section 2) is amended to read:
422	422	"27-2-12.29. MEDICAL ASSISTANCE--REIMBURSEMENT FOR A ONE-
423	423	YEAR SUPPLY OF COVERED PRESCRIPTION CONTRACEPTIVE DRUGS OR
424	424	DEVICES.--
425	425	A. In providing coverage for family planning
426	426	services and supplies under the medical assistance program, the
427	427	[department] authority shall ensure that a recipient is
428	428	permitted to fill or refill a prescription for a one-year
429	429	supply of a covered, self-administered contraceptive at one
430	430	time, as prescribed.
431	431	B. Nothing in this section shall be construed to
432	432	limit a recipient's freedom to choose or change the method of
433	433	family planning to be used, regardless of whether the recipient
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462	462	has exhausted a previously dispensed supply of contraceptives.
463	463	C. Nothing in this section shall be construed to:
464	464	(1) require a health care provider to
465	465	prescribe twelve months of contraceptives at one time;
466	466	(2) permit the authority or a managed care
467	467	organization to impose any restrictions or delays on coverage,
468	468	including quantity or fill limits, if the practice would result
469	469	in a covered person receiving less than a twelve-months'
470	470	duration of contraception dispensed either at one time or, if
471	471	requested by the covered person at the point of dispensing,
472	472	over a twelve-month period;
473	473	(3) permit the authority or a managed care
474	474	organization to limit coverage or impose cost sharing for an
475	475	alternative method of contraception if a patient changes
476	476	contraceptive methods before exhausting a previously dispensed
477	477	supply of contraceptives;
478	478	(4) permit the authority or a managed care
479	479	organization to limit the quantity of contraceptive drugs or
480	480	devices dispensed; or
481	481	(5) permit the authority or a managed care
482	482	organization to deny coverage for the continuous use of
483	483	clinically appropriate contraception as determined by the
484	484	prescribing provider.
485	485	D. For the purposes of this section, "self-
486	486	administered contraceptive" means combined oral contraceptives;
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515	515	extended or continuous use oral contraceptives; progestin-only
516	516	oral contraceptives; patch; vaginal ring; diaphragm with
517	517	spermicide; sponge with spermicide; cervical cap with
518	518	spermicide; male and female condoms; spermicide alone;
519	519	ulipristal acetate; levonorgestrel emergency contraception; and
520	520	any other self-administered contraceptive method categories
521	521	approved by the federal food and drug administration. "
522	522	SECTION 7. A new section of the Public Assistance Act is
523	523	enacted to read:
524	524	"[NEW MATERIAL] FAMILY PLANNING AND RELATED SERVICES.--
525	525	A. When family planning services or family-
526	526	planning-related services are provided in accordance with the
527	527	Public Assistance Act, the authority shall authorize
528	528	reimbursement for services without quantity limitation,
529	529	utilization controls or prior authorization. The authority,
530	530	any intermediaries or any managed care organization shall
531	531	reimburse the provider of those services.
532	532	B. As used in this section:
533	533	(1) "family-planning-related services" means
534	534	any medical diagnosis, treatment or preventive service that is
535	535	routinely provided pursuant to a family planning visit,
536	536	including:
537	537	(a) abortion care;
538	538	(b) miscarriage management;
539	539	(c) medically necessary evaluations or
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568	568	preventive services, such as tobacco utilization screening,
569	569	counseling, testing, and cessation services;
570	570	(d) cervical cancer screening and
571	571	prevention;
572	572	(e) prevention, diagnosis or treatment
573	573	of a sexually transmitted infection or sexually transmitted
574	574	disease; and
575	575	(f) mental health screening and
576	576	referral; and
577	577	(2) "family planning services" means all
578	578	services covered by the federal Title X family planning
579	579	program, regardless of an individual's or a partner's age, sex
580	580	or gender identity, including:
581	581	(a) all contraceptive method categories
582	582	approved by the federal food and drug administration,
583	583	including: 1) tubal ligation; 2) sterilization implant; 3)
584	584	copper intrauterine device; 4) intrauterine device with
585	585	progestin; 5) implantable rod; 6) contraceptive injection; 7)
586	586	combined oral contraceptives; 8) extended or continuous use
587	587	oral contraceptives; 9) progestin-only oral contraceptives; 10)
588	588	patch; 11) vaginal ring; 12) diaphragm with spermicide; 13)
589	589	sponge with spermicide; 14) cervical cap with spermicide; 15)
590	590	male and female condoms; 16) spermicide alone; 17) vasectomy;
591	591	18) ulipristal acetate; and 19) levonorgestrel emergency
592	592	contraception;
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621	621	(b) health care and counseling services
622	622	focused on preventing, delaying or planning for a pregnancy;
623	623	(c) follow-up visits to evaluate or
624	624	manage problems associated with contraceptive methods; and
625	625	(d) basic fertility services.
626	626	C. A recipient shall be permitted to obtain family
627	627	planning services or family-planning-related services from any
628	628	licensed health care provider, including a doctor of medicine,
629	629	a doctor of osteopathy, a physician assistant, an advanced
630	630	practice registered nurse or a certified midwife. The
631	631	enrollment of a recipient in a managed care organization shall
632	632	not restrict a recipient's choice of the licensed provider from
633	633	whom the recipient may receive those services or restrict the
634	634	obligation of the managed care organization to reimburse the
635	635	provider of those services.
636	636	D. When abortion care services are provided in
637	637	accordance with the Public Assistance Act, the authority, any
638	638	intermediaries or any managed care organization shall reimburse
639	639	the provider of those services as distinct, non-bundled
640	640	procedural services and shall allow modifier codes, including
641	641	increased professional service, distinct procedural services
642	642	and separate structures, to reflect the increased time and
643	643	training required when applicable."
644	644	SECTION 8. A new section of the Public Assistance Act is
645	645	enacted to read:
646	646	.229202.1
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674	674	"[NEW MATERIAL] LACTATION SUPPORT.--
675	675	A. The authority shall ensure that medical
676	676	assistance coverage, including coverage provided by any managed
677	677	care organizations, provides coverage for lactation support,
678	678	including:
679	679	(1) prior to delivery, single user lactation
680	680	supplies and equipment; and
681	681	(2) comprehensive lactation support services
682	682	provided by a lactation care provider licensed pursuant to the
683	683	Lactation Care Provider Act.
684	684	B. Access to multi-user loaned breast pumps shall
685	685	be prioritized for persons with premature, medically fragile,
686	686	low birth weight infants or with lactation complications.
687	687	Access to multi-user loaned breast pumps shall be authorized by
688	688	a health care provider."
689	689	SECTION 9. A new section of the Public Assistance Act is
690	690	enacted to read:
691	691	"[NEW MATERIAL] GENDER-AFFIRMING CARE.--
692	692	A. The authority shall ensure that medical
693	693	assistance coverage, including coverage provided by any managed
694	694	care organizations, provides coverage for gender-affirming
695	695	care.
696	696	B. Coverage provided pursuant to this section:
697	697	(1) may be subject to other general exclusions
698	698	and limitations of medical assistance coverage, including
699	699	.229202.1
700	700	- 13 - underscored material = new
701	701	[bracketed material] = delete
702	702	1
703	703	2
704	704	3
705	705	4
706	706	5
707	707	6
708	708	7
709	709	8
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720	720	19
721	721	20
722	722	21
723	723	22
724	724	23
725	725	24
726	726	25
727	727	coordination of benefits, participating provider requirements
728	728	and restrictions on services provided by family or household
729	729	members; and
730	730	(2) shall not be subject to cost-sharing
731	731	provisions.
732	732	C. As used in this section, "gender-affirming care"
733	733	means a procedure, service, drug, device or product that a
734	734	physical or behavioral health care provider prescribes to treat
735	735	an individual for incongruence between the individual's gender
736	736	identity and the individual's sex assignment at birth."
737	737	SECTION 10. A new section of Chapter 59A, Article 22
738	738	NMSA 1978 is enacted to read:
739	739	"[NEW MATERIAL] ABORTION CARE--NO COST SHARING.--
740	740	A. An individual or group health insurance policy,
741	741	health care plan or certificate of health insurance that is
742	742	delivered, issued for delivery or renewed in this state shall
743	743	provide coverage for the total cost of abortion care.
744	744	B. The coverage shall not be subject to cost
745	745	sharing.
746	746	C. The provisions of this section shall not apply
747	747	to a high deductible health benefit plan issued or renewed in
748	748	this state until an eligible insured's deductible has been
749	749	met."
750	750	SECTION 11. Section 59A-22-42 NMSA 1978 (being Laws
751	751	2001, Chapter 14, Section 1, as amended) is amended to read:
752	752	.229202.1
753	753	- 14 - underscored material = new
754	754	[bracketed material] = delete
755	755	1
756	756	2
757	757	3
758	758	4
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773	773	19
774	774	20
775	775	21
776	776	22
777	777	23
778	778	24
779	779	25
780	780	"59A-22-42. COVERAGE FOR PRESCRIPTION CONTRACEPTIVE
781	781	DRUGS OR DEVICES.--
782	782	A. Each individual and group health insurance
783	783	policy, health care plan and certificate of health insurance
784	784	delivered or issued for delivery in this state that provides a
785	785	prescription drug benefit shall provide, at a minimum, the
786	786	following coverage:
787	787	(1) at least one product or form of
788	788	contraception in each of the contraceptive method categories
789	789	identified by the federal food and drug administration;
790	790	(2) a sufficient number and assortment of oral
791	791	contraceptive pills to reflect the variety of oral
792	792	contraceptives approved by the federal food and drug
793	793	administration; [and]
794	794	(3) clinical services related to the provision
795	795	or use of contraception, including consultations, examinations,
796	796	procedures, ultrasound, anesthesia, patient education,
797	797	counseling, device insertion and removal, follow-up care and
798	798	side-effects management;
799	799	(4) a sufficient quantity to allow for the
800	800	continuous use of clinically appropriate contraception as
801	801	determined by the prescribing provider; and
802	802	(5) United States food and drug
803	803	administration-approved, -cleared or -granted over-the-counter
804	804	contraception, including point-of-sale coverage for
805	805	.229202.1
806	806	- 15 - underscored material = new
807	807	[bracketed material] = delete
808	808	1
809	809	2
810	810	3
811	811	4
812	812	5
813	813	6
814	814	7
815	815	8
816	816	9
817	817	10
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819	819	12
820	820	13
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823	823	16
824	824	17
825	825	18
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827	827	20
828	828	21
829	829	22
830	830	23
831	831	24
832	832	25
833	833	over-the-counter contraception at in-network dispensing
834	834	entities without prior authorization, step therapy, utilization
835	835	management or cost sharing .
836	836	B. Except as provided in Subsection C of this
837	837	section, the coverage required pursuant to this section shall
838	838	not be subject to:
839	839	(1) cost sharing for insureds;
840	840	(2) utilization review;
841	841	(3) prior authorization or step-therapy
842	842	requirements; or
843	843	(4) any other restrictions or delays on the
844	844	coverage, including quantity or fill limits if the practice
845	845	would result in a covered person receiving less than a
846	846	twelve-months' duration of contraception dispensed either at
847	847	one time or, if requested by the covered person at the point of
848	848	dispensing, over a twelve-month period .
849	849	C. An insurer may discourage brand-name pharmacy
850	850	drugs or items by applying cost sharing to brand-name drugs or
851	851	items when at least one generic or therapeutic equivalent is
852	852	covered within the same method of contraception without patient
853	853	cost sharing; provided that when an insured's health care
854	854	provider determines that a particular drug or item is medically
855	855	necessary, the individual or group health insurance policy,
856	856	health care plan or certificate of insurance shall cover the
857	857	brand-name pharmacy drug or item without cost sharing. Medical
858	858	.229202.1
859	859	- 16 - underscored material = new
860	860	[bracketed material] = delete
861	861	1
862	862	2
863	863	3
864	864	4
865	865	5
866	866	6
867	867	7
868	868	8
869	869	9
870	870	10
871	871	11
872	872	12
873	873	13
874	874	14
875	875	15
876	876	16
877	877	17
878	878	18
879	879	19
880	880	20
881	881	21
882	882	22
883	883	23
884	884	24
885	885	25
886	886	necessity may include considerations such as severity of side
887	887	effects, differences in permanence or reversibility of
888	888	contraceptives and ability to adhere to the appropriate use of
889	889	the drug or item, as determined by the attending provider.
890	890	D. An insurer shall grant an insured an expedited
891	891	hearing to appeal any adverse determination made relating to
892	892	the provisions of this section. The process for requesting an
893	893	expedited hearing pursuant to this subsection shall:
894	894	(1) be easily accessible, transparent,
895	895	sufficiently expedient and not unduly burdensome on an insured,
896	896	the insured's representative or the insured's health care
897	897	provider;
898	898	(2) defer to the determination of the
899	899	insured's health care provider; and
900	900	(3) provide for a determination of the claim
901	901	according to a time frame and in a manner that takes into
902	902	account the nature of the claim and the medical exigencies
903	903	involved for a claim involving an urgent health care need.
904	904	E. An insurer shall not require a prescription for
905	905	any drug, item or service that is available without a
906	906	prescription.
907	907	F. An insurer shall provide coverage and shall
908	908	reimburse a health care provider or dispensing entity on a per-
909	909	unit basis for dispensing [a six-month supply of
910	910	contraceptives] contraception intended to last the covered
911	911	.229202.1
912	912	- 17 - underscored material = new
913	913	[bracketed material] = delete
914	914	1
915	915	2
916	916	3
917	917	4
918	918	5
919	919	6
920	920	7
921	921	8
922	922	9
923	923	10
924	924	11
925	925	12
926	926	13
927	927	14
928	928	15
929	929	16
930	930	17
931	931	18
932	932	19
933	933	20
934	934	21
935	935	22
936	936	23
937	937	24
938	938	25
939	939	person for a duration of twelve months, as permitted by the
940	940	covered person's prescription, dispensed at one time; provided
941	941	that the contraceptives are prescribed and self-administered.
942	942	G. Nothing in this section shall be construed to:
943	943	(1) require a health care provider to
944	944	prescribe [six] twelve months of contraceptives at one time;
945	945	[or]
946	946	(2) permit an insurer to limit coverage or
947	947	impose cost sharing for an alternate method of contraception if
948	948	an insured changes contraceptive methods before exhausting a
949	949	previously dispensed supply;
950	950	(3) permit an insurer to limit the quantity of
951	951	contraceptives dispensed based on the number of months left in
952	952	the plan year; or
953	953	(4) permit an insurer or pharmacy benefits
954	954	manager to deny coverage for the continuous use of clinically
955	955	appropriate contraception as determined by the prescribing
956	956	provider.
957	957	H. The provisions of this section shall not apply
958	958	to short-term travel, accident-only, hospital-indemnity-only,
959	959	limited-benefit or specified-disease policies.
960	960	I. The provisions of this section apply to
961	961	individual and group health insurance policies, health care
962	962	plans and certificates of insurance delivered or issued for
963	963	delivery after January 1, 2020.
964	964	.229202.1
965	965	- 18 - underscored material = new
966	966	[bracketed material] = delete
967	967	1
968	968	2
969	969	3
970	970	4
971	971	5
972	972	6
973	973	7
974	974	8
975	975	9
976	976	10
977	977	11
978	978	12
979	979	13
980	980	14
981	981	15
982	982	16
983	983	17
984	984	18
985	985	19
986	986	20
987	987	21
988	988	22
989	989	23
990	990	24
991	991	25
992	992	J. For the purposes of this section:
993	993	(1) "contraceptive method categories
994	994	identified by the federal food and drug administration":
995	995	(a) means tubal ligation; sterilization
996	996	implant; copper intrauterine device; intrauterine device with
997	997	progestin; implantable rod; contraceptive shot or injection;
998	998	combined oral contraceptives; extended or continuous use oral
999	999	contraceptives; progestin-only oral contraceptives; patch;
1000	1000	vaginal ring; diaphragm with spermicide; sponge with
1001	1001	spermicide; cervical cap with spermicide; male and female
1002	1002	condoms; spermicide alone; vasectomy; ulipristal acetate;
1003	1003	levonorgestrel emergency contraception; and any additional
1004	1004	contraceptive method categories approved by the federal food
1005	1005	and drug administration; and
1006	1006	(b) does not mean a product that has
1007	1007	been recalled for safety reasons or withdrawn from the market;
1008	1008	(2) "cost sharing" means a deductible,
1009	1009	copayment or coinsurance that an insured is required to pay in
1010	1010	accordance with the terms of an individual or group health
1011	1011	insurance policy, health care plan or certificate of insurance;
1012	1012	and
1013	1013	(3) "health care provider" means an individual
1014	1014	licensed to provide health care in the ordinary course of
1015	1015	business.
1016	1016	K. A religious entity purchasing individual or
1017	1017	.229202.1
1018	1018	- 19 - underscored material = new
1019	1019	[bracketed material] = delete
1020	1020	1
1021	1021	2
1022	1022	3
1023	1023	4
1024	1024	5
1025	1025	6
1026	1026	7
1027	1027	8
1028	1028	9
1029	1029	10
1030	1030	11
1031	1031	12
1032	1032	13
1033	1033	14
1034	1034	15
1035	1035	16
1036	1036	17
1037	1037	18
1038	1038	19
1039	1039	20
1040	1040	21
1041	1041	22
1042	1042	23
1043	1043	24
1044	1044	25
1045	1045	group health insurance coverage may elect to exclude
1046	1046	prescription contraceptive drugs or devices from the health
1047	1047	coverage purchased."
1048	1048	SECTION 12. A new section of Chapter 59A, Article 22
1049	1049	NMSA 1978 is enacted to read:
1050	1050	"[NEW MATERIAL] SPECIAL ENROLLMENT PERIOD--PREGNANCY.--
1051	1051	A. An individual or group health insurance policy,
1052	1052	health care plan or certificate of health insurance that is
1053	1053	delivered, issued for delivery or renewed in this state shall
1054	1054	establish a special enrollment period to provide coverage to an
1055	1055	uninsured person when the person provides a certification from
1056	1056	a health care provider to the insurer that the person is
1057	1057	pregnant.
1058	1058	B. Coverage shall be effective before the end of
1059	1059	the first month in which the person receives certification of
1060	1060	the pregnancy, unless the person elects to have coverage
1061	1061	effective on the first day of the month following the date that
1062	1062	the person makes a plan selection."
1063	1063	SECTION 13. A new section of Chapter 59A, Article 22
1064	1064	NMSA 1978 is enacted to read:
1065	1065	"[NEW MATERIAL] COVERAGE FOR GENDER-AFFIRMING CARE.--
1066	1066	A. An individual or group health insurance policy,
1067	1067	health care plan or certificate of health insurance that is
1068	1068	delivered, issued for delivery or renewed in this state shall
1069	1069	provide coverage for gender-affirming care.
1070	1070	.229202.1
1071	1071	- 20 - underscored material = new
1072	1072	[bracketed material] = delete
1073	1073	1
1074	1074	2
1075	1075	3
1076	1076	4
1077	1077	5
1078	1078	6
1079	1079	7
1080	1080	8
1081	1081	9
1082	1082	10
1083	1083	11
1084	1084	12
1085	1085	13
1086	1086	14
1087	1087	15
1088	1088	16
1089	1089	17
1090	1090	18
1091	1091	19
1092	1092	20
1093	1093	21
1094	1094	22
1095	1095	23
1096	1096	24
1097	1097	25
1098	1098	B. As used in this section, "gender-affirming care"
1099	1099	means a procedure, service, drug, device or product that a
1100	1100	physical or behavioral health care provider prescribes to treat
1101	1101	an individual for incongruence between the individual's gender
1102	1102	identity and the individual's sex assignment at birth.
1103	1103	C. The provisions of this section do not apply to a
1104	1104	high deductible health benefit plan issued or renewed in this
1105	1105	state until an eligible insured's deductible has been met."
1106	1106	SECTION 14. A new section of Chapter 59A, Article 23
1107	1107	NMSA 1978 is enacted to read:
1108	1108	"[NEW MATERIAL] ABORTION CARE--NO COST SHARING.--
1109	1109	A. A group or blanket health insurance policy,
1110	1110	health care plan or certificate of health insurance that is
1111	1111	delivered, issued for delivery or renewed in this state shall
1112	1112	provide coverage for the total cost of abortion care.
1113	1113	B. The coverage shall not be subject to cost
1114	1114	sharing.
1115	1115	C. The provisions of this section shall not apply
1116	1116	to a high deductible health benefit plan issued or renewed in
1117	1117	this state until an eligible insured's deductible has been
1118	1118	met."
1119	1119	SECTION 15. Section 59A-23-7.14 NMSA 1978 (being Laws
1120	1120	2019, Chapter 263, Section 5) is amended to read:
1121	1121	"59A-23-7.14. COVERAGE FOR CONTRACEPTION.--
1122	1122	A. [Each individual and group ] A group or blanket
1123	1123	.229202.1
1124	1124	- 21 - underscored material = new
1125	1125	[bracketed material] = delete
1126	1126	1
1127	1127	2
1128	1128	3
1129	1129	4
1130	1130	5
1131	1131	6
1132	1132	7
1133	1133	8
1134	1134	9
1135	1135	10
1136	1136	11
1137	1137	12
1138	1138	13
1139	1139	14
1140	1140	15
1141	1141	16
1142	1142	17
1143	1143	18
1144	1144	19
1145	1145	20
1146	1146	21
1147	1147	22
1148	1148	23
1149	1149	24
1150	1150	25
1151	1151	health insurance policy, health care plan [and ] or certificate
1152	1152	of health insurance that is delivered, [or] issued for delivery
1153	1153	or renewed in this state that provides a prescription drug
1154	1154	benefit shall provide, at a minimum, the following coverage:
1155	1155	(1) at least one product or form of
1156	1156	contraception in each of the contraceptive method categories
1157	1157	identified by the federal food and drug administration;
1158	1158	(2) a sufficient number and assortment of oral
1159	1159	contraceptive pills to reflect the variety of oral
1160	1160	contraceptives approved by the federal food and drug
1161	1161	administration; [and]
1162	1162	(3) clinical services related to the provision
1163	1163	or use of contraception, including consultations, examinations,
1164	1164	procedures, ultrasound, anesthesia, patient education,
1165	1165	counseling, device insertion and removal, follow-up care and
1166	1166	side-effects management;
1167	1167	(4) a sufficient quantity to allow for the
1168	1168	continuous use of clinically appropriate contraception as
1169	1169	determined by the prescribing provider; and
1170	1170	(5) United States food and drug
1171	1171	administration-approved, -cleared or -granted over-the-counter
1172	1172	contraception, including point-of-sale coverage for
1173	1173	over-the-counter contraception at in-network dispensing
1174	1174	entities without prior authorization, step therapy, utilization
1175	1175	management or cost sharing .
1176	1176	.229202.1
1177	1177	- 22 - underscored material = new
1178	1178	[bracketed material] = delete
1179	1179	1
1180	1180	2
1181	1181	3
1182	1182	4
1183	1183	5
1184	1184	6
1185	1185	7
1186	1186	8
1187	1187	9
1188	1188	10
1189	1189	11
1190	1190	12
1191	1191	13
1192	1192	14
1193	1193	15
1194	1194	16
1195	1195	17
1196	1196	18
1197	1197	19
1198	1198	20
1199	1199	21
1200	1200	22
1201	1201	23
1202	1202	24
1203	1203	25
1204	1204	B. [Except as provided in Subsection C of this
1205	1205	section] The coverage required pursuant to this section shall
1206	1206	not be subject to:
1207	1207	(1) cost sharing for insureds;
1208	1208	(2) utilization review;
1209	1209	(3) prior authorization or step-therapy
1210	1210	requirements; or
1211	1211	(4) any restrictions or delays on the
1212	1212	coverage.
1213	1213	C. An insurer may discourage brand-name pharmacy
1214	1214	drugs or items by applying cost sharing to brand-name drugs or
1215	1215	items when at least one generic or therapeutic equivalent is
1216	1216	covered within the same method category of contraception
1217	1217	without cost sharing by the insured; provided that when an
1218	1218	insured's health care provider determines that a particular
1219	1219	drug or item is medically necessary, the individual or group
1220	1220	health insurance policy, health care plan or certificate of
1221	1221	health insurance shall cover the brand-name pharmacy drug or
1222	1222	item without cost sharing. A determination of medical
1223	1223	necessity may include considerations such as severity of side
1224	1224	effects, differences in permanence or reversibility of
1225	1225	contraceptives and ability to adhere to the appropriate use of
1226	1226	the drug or item, as determined by the attending provider.
1227	1227	D. An insurer shall grant an insured an expedited
1228	1228	hearing to appeal any adverse determination made relating to
1229	1229	.229202.1
1230	1230	- 23 - underscored material = new
1231	1231	[bracketed material] = delete
1232	1232	1
1233	1233	2
1234	1234	3
1235	1235	4
1236	1236	5
1237	1237	6
1238	1238	7
1239	1239	8
1240	1240	9
1241	1241	10
1242	1242	11
1243	1243	12
1244	1244	13
1245	1245	14
1246	1246	15
1247	1247	16
1248	1248	17
1249	1249	18
1250	1250	19
1251	1251	20
1252	1252	21
1253	1253	22
1254	1254	23
1255	1255	24
1256	1256	25
1257	1257	the provisions of this section. The process for requesting an
1258	1258	expedited hearing pursuant to this subsection shall:
1259	1259	(1) be easily accessible, transparent,
1260	1260	sufficiently expedient and not unduly burdensome on an insured,
1261	1261	the insured's representative or the insured's health care
1262	1262	provider;
1263	1263	(2) defer to the determination of the
1264	1264	insured's health care provider; and
1265	1265	(3) provide for a determination of the claim
1266	1266	according to a time frame and in a manner that takes into
1267	1267	account the nature of the claim and the medical exigencies
1268	1268	involved for a claim involving an urgent health care need.
1269	1269	E. An insurer shall not require a prescription for
1270	1270	any drug, item or service that is available without a
1271	1271	prescription.
1272	1272	F. An individual or group health insurance policy,
1273	1273	health care plan or certificate of health insurance shall
1274	1274	provide coverage and shall reimburse a health care provider or
1275	1275	dispensing entity on a per unit basis for dispensing [a six-
1276	1276	month supply of contraceptives ] contraception intended to last
1277	1277	the covered person for a duration of twelve months, as
1278	1278	permitted by the covered person's prescription, dispensed at
1279	1279	one time; provided that the contraceptives are prescribed and
1280	1280	self-administered.
1281	1281	G. Nothing in this section shall be construed to:
1282	1282	.229202.1
1283	1283	- 24 - underscored material = new
1284	1284	[bracketed material] = delete
1285	1285	1
1286	1286	2
1287	1287	3
1288	1288	4
1289	1289	5
1290	1290	6
1291	1291	7
1292	1292	8
1293	1293	9
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1296	1296	12
1297	1297	13
1298	1298	14
1299	1299	15
1300	1300	16
1301	1301	17
1302	1302	18
1303	1303	19
1304	1304	20
1305	1305	21
1306	1306	22
1307	1307	23
1308	1308	24
1309	1309	25
1310	1310	(1) require a health care provider to
1311	1311	prescribe [six] twelve months of contraceptives at one time;
1312	1312	[or]
1313	1313	(2) permit an insurer to limit coverage or
1314	1314	impose cost sharing for an alternate method of contraception if
1315	1315	an insured changes contraceptive methods before exhausting a
1316	1316	previously dispensed supply;
1317	1317	(3) permit an insurer to limit the quantity of
1318	1318	contraceptives dispensed based on the number of months left in
1319	1319	the plan year; or
1320	1320	(4) permit an insurer to deny coverage for the
1321	1321	continuous use of clinically appropriate contraception as
1322	1322	determined by the prescribing provider .
1323	1323	H. The provisions of this section shall not apply
1324	1324	to short-term travel, accident-only, hospital-indemnity-only,
1325	1325	limited-benefit or specified-disease health benefits plans.
1326	1326	I. The provisions of this section apply to
1327	1327	individual or group health insurance policies, health care
1328	1328	plans or certificates of insurance delivered or issued for
1329	1329	delivery after January 1, 2020.
1330	1330	J. For the purposes of this section:
1331	1331	(1) "contraceptive method categories
1332	1332	identified by the federal food and drug administration":
1333	1333	(a) means tubal ligation; sterilization
1334	1334	implant; copper intrauterine device; intrauterine device with
1335	1335	.229202.1
1336	1336	- 25 - underscored material = new
1337	1337	[bracketed material] = delete
1338	1338	1
1339	1339	2
1340	1340	3
1341	1341	4
1342	1342	5
1343	1343	6
1344	1344	7
1345	1345	8
1346	1346	9
1347	1347	10
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1357	1357	20
1358	1358	21
1359	1359	22
1360	1360	23
1361	1361	24
1362	1362	25
1363	1363	progestin; implantable rod; contraceptive shot or injection;
1364	1364	combined oral contraceptives; extended or continuous use oral
1365	1365	contraceptives; progestin-only oral contraceptives; patch;
1366	1366	vaginal ring; diaphragm with spermicide; sponge with
1367	1367	spermicide; cervical cap with spermicide; male and female
1368	1368	condoms; spermicide alone; vasectomy; ulipristal acetate;
1369	1369	levonorgestrel emergency contraception; and any additional
1370	1370	contraceptive method categories approved by the federal food
1371	1371	and drug administration; and
1372	1372	(b) does not mean a product that has
1373	1373	been recalled for safety reasons or withdrawn from the market;
1374	1374	(2) "cost sharing" means a deductible,
1375	1375	copayment or coinsurance that an insured is required to pay in
1376	1376	accordance with the terms of an individual or group health
1377	1377	insurance policy, health care plan or certificate of insurance;
1378	1378	and
1379	1379	(3) "health care provider" means an individual
1380	1380	licensed to provide health care in the ordinary course of
1381	1381	business.
1382	1382	K. A religious entity purchasing individual or
1383	1383	group health insurance coverage may elect to exclude
1384	1384	prescription contraceptive drugs or items from the health
1385	1385	insurance coverage purchased."
1386	1386	SECTION 16. A new section of Chapter 59A, Article 23
1387	1387	NMSA 1978 is enacted to read:
1388	1388	.229202.1
1389	1389	- 26 - underscored material = new
1390	1390	[bracketed material] = delete
1391	1391	1
1392	1392	2
1393	1393	3
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1410	1410	20
1411	1411	21
1412	1412	22
1413	1413	23
1414	1414	24
1415	1415	25
1416	1416	"[NEW MATERIAL] SPECIAL ENROLLMENT PERIOD--PREGNANCY.--
1417	1417	A. A group or blanket health insurance policy,
1418	1418	health care plan or certificate of health insurance that is
1419	1419	delivered, issued for delivery or renewed in this state shall
1420	1420	establish a special enrollment period to provide coverage to an
1421	1421	uninsured person when the person provides a certification from
1422	1422	a health care provider to the insurer that the person is
1423	1423	pregnant.
1424	1424	B. Coverage shall be effective before the end of
1425	1425	the first month in which the uninsured person receives
1426	1426	certification of the pregnancy, unless the person elects to
1427	1427	have coverage effective on the first day of the month following
1428	1428	the date that the person makes a plan selection."
1429	1429	SECTION 17. A new section of Chapter 59A, Article 23
1430	1430	NMSA 1978 is enacted to read:
1431	1431	"[NEW MATERIAL] COVERAGE FOR GENDER-AFFIRMING CARE.--
1432	1432	A. A group or blanket health insurance policy,
1433	1433	health care plan or certificate of health insurance that is
1434	1434	delivered, issued for delivery or renewed in this state shall
1435	1435	provide coverage for gender-affirming care.
1436	1436	B. As used in this section, "gender-affirming care"
1437	1437	means a procedure, service, drug, device or product that a
1438	1438	physical or behavioral health care provider prescribes to treat
1439	1439	an individual for incongruence between the individual's gender
1440	1440	identity and the individual's sex assignment at birth.
1441	1441	.229202.1
1442	1442	- 27 - underscored material = new
1443	1443	[bracketed material] = delete
1444	1444	1
1445	1445	2
1446	1446	3
1447	1447	4
1448	1448	5
1449	1449	6
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1464	1464	21
1465	1465	22
1466	1466	23
1467	1467	24
1468	1468	25
1469	1469	C. The provisions of this section shall not apply
1470	1470	to a high deductible health benefit plans issued or renewed in
1471	1471	this state until an eligible insured's deductible has been
1472	1472	met."
1473	1473	SECTION 18. A new section of the Health Maintenance
1474	1474	Organization Law is enacted to read:
1475	1475	"[NEW MATERIAL] ABORTION CARE--NO COST SHARING.--
1476	1476	A. An individual or group health maintenance
1477	1477	organization contract that is delivered, issued for delivery or
1478	1478	renewed in this state shall provide coverage for the total cost
1479	1479	of abortion care.
1480	1480	B. The coverage shall not be subject to cost
1481	1481	sharing.
1482	1482	C. The provisions of this section shall not apply
1483	1483	to a high deductible health benefit plan issued or renewed in
1484	1484	this state until an eligible insured's deductible has been
1485	1485	met."
1486	1486	SECTION 19. Section 59A-46-44 NMSA 1978 (being Laws
1487	1487	2001, Chapter 14, Section 3, as amended) is amended to read:
1488	1488	"59A-46-44. COVERAGE FOR CONTRACEPTION.--
1489	1489	A. [Each] An individual and group health
1490	1490	maintenance organization contract delivered or issued for
1491	1491	delivery in this state that provides a prescription drug
1492	1492	benefit shall provide, at a minimum, the following coverage:
1493	1493	(1) at least one product or form of
1494	1494	.229202.1
1495	1495	- 28 - underscored material = new
1496	1496	[bracketed material] = delete
1497	1497	1
1498	1498	2
1499	1499	3
1500	1500	4
1501	1501	5
1502	1502	6
1503	1503	7
1504	1504	8
1505	1505	9
1506	1506	10
1507	1507	11
1508	1508	12
1509	1509	13
1510	1510	14
1511	1511	15
1512	1512	16
1513	1513	17
1514	1514	18
1515	1515	19
1516	1516	20
1517	1517	21
1518	1518	22
1519	1519	23
1520	1520	24
1521	1521	25
1522	1522	contraception in each of the contraceptive method categories
1523	1523	identified by the federal food and drug administration;
1524	1524	(2) a sufficient number and assortment of oral
1525	1525	contraceptive pills to reflect the variety of oral
1526	1526	contraceptives approved by the federal food and drug
1527	1527	administration; [and]
1528	1528	(3) clinical services related to the provision
1529	1529	or use of contraception, including consultations, examinations,
1530	1530	procedures, ultrasound, anesthesia, patient education,
1531	1531	counseling, device insertion and removal, follow-up care and
1532	1532	side-effects management;
1533	1533	(4) sufficient quantity to allow for the
1534	1534	continuous use of clinically appropriate contraception as
1535	1535	determined by the prescribing provider; and
1536	1536	(5) United States food and drug
1537	1537	administration-approved, -cleared or -granted over-the-counter
1538	1538	contraception, including point-of-sale coverage for
1539	1539	over-the-counter contraception at in-network dispensing
1540	1540	entities without prior authorization, step therapy, utilization
1541	1541	management or cost sharing .
1542	1542	B. Except as provided in Subsection C of this
1543	1543	section, the coverage required pursuant to this section shall
1544	1544	not be subject to:
1545	1545	(1) enrollee cost sharing;
1546	1546	(2) utilization review;
1547	1547	.229202.1
1548	1548	- 29 - underscored material = new
1549	1549	[bracketed material] = delete
1550	1550	1
1551	1551	2
1552	1552	3
1553	1553	4
1554	1554	5
1555	1555	6
1556	1556	7
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1565	1565	16
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1569	1569	20
1570	1570	21
1571	1571	22
1572	1572	23
1573	1573	24
1574	1574	25
1575	1575	(3) prior authorization or step-therapy
1576	1576	requirements; or
1577	1577	(4) any other restrictions or delays on the
1578	1578	coverage, including quantity or fill limits if the practice
1579	1579	would result in a covered person receiving less than a
1580	1580	twelve-months' duration of contraception dispensed either at
1581	1581	one time or, if requested by the covered person at the point of
1582	1582	dispensing, over a twelve-month period .
1583	1583	C. A health maintenance organization may discourage
1584	1584	brand-name pharmacy drugs or items by applying cost sharing to
1585	1585	brand-name drugs or items when at least one generic or
1586	1586	therapeutic equivalent is covered within the same method of
1587	1587	contraception without patient cost sharing; provided that when
1588	1588	an enrollee's health care provider determines that a particular
1589	1589	drug or item is medically necessary, the individual or group
1590	1590	health maintenance organization contract shall cover the brand-
1591	1591	name pharmacy drug or item without cost sharing. Medical
1592	1592	necessity may include considerations such as severity of side
1593	1593	effects, differences in permanence or reversibility of
1594	1594	contraceptives and ability to adhere to the appropriate use of
1595	1595	the drug or item, as determined by the attending provider.
1596	1596	D. An individual or group health maintenance
1597	1597	organization contract shall grant an enrollee an expedited
1598	1598	hearing to appeal any adverse determination made relating to
1599	1599	the provisions of this section. The process for requesting an
1600	1600	.229202.1
1601	1601	- 30 - underscored material = new
1602	1602	[bracketed material] = delete
1603	1603	1
1604	1604	2
1605	1605	3
1606	1606	4
1607	1607	5
1608	1608	6
1609	1609	7
1610	1610	8
1611	1611	9
1612	1612	10
1613	1613	11
1614	1614	12
1615	1615	13
1616	1616	14
1617	1617	15
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1621	1621	19
1622	1622	20
1623	1623	21
1624	1624	22
1625	1625	23
1626	1626	24
1627	1627	25
1628	1628	expedited hearing pursuant to this subsection shall:
1629	1629	(1) be easily accessible, transparent,
1630	1630	sufficiently expedient and not unduly burdensome on an
1631	1631	enrollee, the enrollee's representative or the enrollee's
1632	1632	health care provider;
1633	1633	(2) defer to the determination of the
1634	1634	enrollee's health care provider; and
1635	1635	(3) provide for a determination of the claim
1636	1636	according to a time frame and in a manner that takes into
1637	1637	account the nature of the claim and the medical exigencies
1638	1638	involved for a claim involving an urgent health care need.
1639	1639	E. An individual or group health maintenance
1640	1640	organization contract shall not require a prescription for any
1641	1641	drug, item or service that is available without a prescription.
1642	1642	F. An individual or group health maintenance
1643	1643	organization contract shall provide coverage and shall
1644	1644	reimburse a health care provider or dispensing entity on a per-
1645	1645	unit basis for dispensing a six-month supply of contraceptives
1646	1646	at one time; provided that the contraceptives are prescribed
1647	1647	and self-administered.
1648	1648	G. Nothing in this section shall be construed to:
1649	1649	(1) require a health care provider to
1650	1650	prescribe six months of contraceptives at one time; or
1651	1651	(2) permit an individual or group health
1652	1652	maintenance organization contract to limit coverage or impose
1653	1653	.229202.1
1654	1654	- 31 - underscored material = new
1655	1655	[bracketed material] = delete
1656	1656	1
1657	1657	2
1658	1658	3
1659	1659	4
1660	1660	5
1661	1661	6
1662	1662	7
1663	1663	8
1664	1664	9
1665	1665	10
1666	1666	11
1667	1667	12
1668	1668	13
1669	1669	14
1670	1670	15
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1674	1674	19
1675	1675	20
1676	1676	21
1677	1677	22
1678	1678	23
1679	1679	24
1680	1680	25
1681	1681	cost sharing for an alternate method of contraception if an
1682	1682	enrollee changes contraceptive methods before exhausting a
1683	1683	previously dispensed supply.
1684	1684	H. The provisions of this section shall not apply
1685	1685	to short-term travel, accident-only, hospital-indemnity-only,
1686	1686	limited-benefit or specified disease health benefits plans.
1687	1687	I. The provisions of this section apply to
1688	1688	individual or group health maintenance organization contracts
1689	1689	delivered or issued for delivery after January 1, 2020.
1690	1690	J. For the purposes of this section:
1691	1691	(1) "contraceptive method categories
1692	1692	identified by the federal food and drug administration":
1693	1693	(a) means tubal ligation; sterilization
1694	1694	implant; copper intrauterine device; intrauterine device with
1695	1695	progestin; implantable rod; contraceptive shot or injection;
1696	1696	combined oral contraceptives; extended or continuous use oral
1697	1697	contraceptives; progestin-only oral contraceptives; patch;
1698	1698	vaginal ring; diaphragm with spermicide; sponge with
1699	1699	spermicide; cervical cap with spermicide; male and female
1700	1700	condoms; spermicide alone; vasectomy; ulipristal acetate;
1701	1701	levonorgestrel emergency contraception; and any additional
1702	1702	contraceptive method categories approved by the federal food
1703	1703	and drug administration; and
1704	1704	(b) does not mean a product that has
1705	1705	been recalled for safety reasons or withdrawn from the market;
1706	1706	.229202.1
1707	1707	- 32 - underscored material = new
1708	1708	[bracketed material] = delete
1709	1709	1
1710	1710	2
1711	1711	3
1712	1712	4
1713	1713	5
1714	1714	6
1715	1715	7
1716	1716	8
1717	1717	9
1718	1718	10
1719	1719	11
1720	1720	12
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1722	1722	14
1723	1723	15
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1725	1725	17
1726	1726	18
1727	1727	19
1728	1728	20
1729	1729	21
1730	1730	22
1731	1731	23
1732	1732	24
1733	1733	25
1734	1734	(2) "cost sharing" means a deductible,
1735	1735	copayment or coinsurance that an enrollee is required to pay in
1736	1736	accordance with the terms of an individual or group health
1737	1737	maintenance organization contract; and
1738	1738	(3) "health care provider" means an individual
1739	1739	licensed to provide health care in the ordinary course of
1740	1740	business.
1741	1741	K. A religious entity purchasing individual or
1742	1742	group health maintenance organization coverage may elect to
1743	1743	exclude prescription contraceptive drugs or devices from the
1744	1744	health coverage purchased."
1745	1745	SECTION 20. A new section of the Health Maintenance
1746	1746	Organization Law is enacted to read:
1747	1747	"[NEW MATERIAL] SPECIAL ENROLLMENT PERIOD--PREGNANCY.--
1748	1748	A. An individual or group health maintenance
1749	1749	organization contract delivered or issued for delivery in this
1750	1750	state shall establish a special enrollment period to provide
1751	1751	coverage to an uninsured person when the person provides a
1752	1752	certification from a health care provider to the insurer that
1753	1753	the person is pregnant.
1754	1754	B. Coverage shall be effective before the end of
1755	1755	the first month in which the person receives certification of
1756	1756	the pregnancy, unless the person elects to have coverage
1757	1757	effective on the first day of the month following the date that
1758	1758	the person makes a plan selection."
1759	1759	.229202.1
1760	1760	- 33 - underscored material = new
1761	1761	[bracketed material] = delete
1762	1762	1
1763	1763	2
1764	1764	3
1765	1765	4
1766	1766	5
1767	1767	6
1768	1768	7
1769	1769	8
1770	1770	9
1771	1771	10
1772	1772	11
1773	1773	12
1774	1774	13
1775	1775	14
1776	1776	15
1777	1777	16
1778	1778	17
1779	1779	18
1780	1780	19
1781	1781	20
1782	1782	21
1783	1783	22
1784	1784	23
1785	1785	24
1786	1786	25
1787	1787	SECTION 21. A new section of the Health Maintenance
1788	1788	Organization Law is enacted to read:
1789	1789	"[NEW MATERIAL] COVERAGE FOR GENDER-AFFIRMING CARE.--
1790	1790	A. An individual or group health maintenance
1791	1791	organization contract delivered or issued for delivery in this
1792	1792	state shall provide coverage for gender-affirming care.
1793	1793	B. As used in this section, "gender-affirming care"
1794	1794	means a procedure, service, drug, device or product that a
1795	1795	physical or behavioral health care provider prescribes to treat
1796	1796	an individual for incongruence between the individual's gender
1797	1797	identity and the individual's sex assignment at birth.
1798	1798	C. The provisions of this section shall not apply
1799	1799	to a high deductible health benefit plan issued or renewed in
1800	1800	this state until an eligible enrollee's deductible has been
1801	1801	met."
1802	1802	SECTION 22. A new section of Nonprofit Health Care Plan
1803	1803	Law is enacted to read:
1804	1804	"[NEW MATERIAL] ABORTION CARE--NO COST SHARING.--
1805	1805	A. A health care plan delivered or issued for
1806	1806	delivery in this state shall provide coverage for the total
1807	1807	cost of abortion care.
1808	1808	B. The coverage shall not be subject to cost
1809	1809	sharing.
1810	1810	C. The provisions of this section shall not apply
1811	1811	to a high deductible health benefit plan issued or renewed in
1812	1812	.229202.1
1813	1813	- 34 - underscored material = new
1814	1814	[bracketed material] = delete
1815	1815	1
1816	1816	2
1817	1817	3
1818	1818	4
1819	1819	5
1820	1820	6
1821	1821	7
1822	1822	8
1823	1823	9
1824	1824	10
1825	1825	11
1826	1826	12
1827	1827	13
1828	1828	14
1829	1829	15
1830	1830	16
1831	1831	17
1832	1832	18
1833	1833	19
1834	1834	20
1835	1835	21
1836	1836	22
1837	1837	23
1838	1838	24
1839	1839	25
1840	1840	this state until an eligible insured's deductible has been
1841	1841	met."
1842	1842	SECTION 23. Section 59A-47-45.5 NMSA 1978 (being Laws
1843	1843	2019, Chapter 263, Section 9) is amended to read:
1844	1844	"59A-47-45.5. COVERAGE FOR CONTRACEPTION.--
1845	1845	A. A health care plan delivered or issued for
1846	1846	delivery in this state that provides a prescription drug
1847	1847	benefit shall provide, at a minimum, the following coverage:
1848	1848	(1) at least one product or form of
1849	1849	contraception in each of the contraceptive method categories
1850	1850	identified by the federal food and drug administration;
1851	1851	(2) a sufficient number and assortment of oral
1852	1852	contraceptive pills to reflect the variety of oral
1853	1853	contraceptives approved by the federal food and drug
1854	1854	administration; [and]
1855	1855	(3) clinical services related to the provision
1856	1856	or use of contraception, including consultations, examinations,
1857	1857	procedures, ultrasound, anesthesia, patient education,
1858	1858	counseling, device insertion and removal, follow-up care and
1859	1859	side-effects management;
1860	1860	(4) a sufficient quantity to allow for the
1861	1861	continuous use of clinically appropriate contraception as
1862	1862	determined by the prescribing provider; and
1863	1863	(5) United States food and drug administation-
1864	1864	approved, -cleared or -granted over-the-counter contraception,
1865	1865	.229202.1
1866	1866	- 35 - underscored material = new
1867	1867	[bracketed material] = delete
1868	1868	1
1869	1869	2
1870	1870	3
1871	1871	4
1872	1872	5
1873	1873	6
1874	1874	7
1875	1875	8
1876	1876	9
1877	1877	10
1878	1878	11
1879	1879	12
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1881	1881	14
1882	1882	15
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1885	1885	18
1886	1886	19
1887	1887	20
1888	1888	21
1889	1889	22
1890	1890	23
1891	1891	24
1892	1892	25
1893	1893	including point-of-sale coverage for over-the counter
1894	1894	contraception at in-network dispensing entities without prior
1895	1895	authorization, step therapy, utilization management or cost
1896	1896	sharing.
1897	1897	B. Except as provided in Subsection C of this
1898	1898	section, the coverage required pursuant to this section shall
1899	1899	not be subject to:
1900	1900	(1) cost sharing for subscribers;
1901	1901	(2) utilization review;
1902	1902	(3) prior authorization or step-therapy
1903	1903	requirements; or
1904	1904	(4) any restrictions or delays on the
1905	1905	coverage, including quantity or fill limits if the practice
1906	1906	would result in a covered person receiving less than a
1907	1907	twelve-months' duration of contraception dispensed either at
1908	1908	one time or, if requested by the covered person at the point of
1909	1909	dispensing, over a twelve-month period .
1910	1910	C. A health care plan may discourage brand-name
1911	1911	pharmacy drugs or items by applying cost sharing to brand-name
1912	1912	drugs or items when at least one generic or therapeutic
1913	1913	equivalent is covered within the same method category of
1914	1914	contraception without cost sharing by the subscriber; provided
1915	1915	that when a subscriber's health care provider determines that a
1916	1916	particular drug or item is medically necessary, the health care
1917	1917	plan shall cover the brand-name pharmacy drug or item without
1918	1918	.229202.1
1919	1919	- 36 - underscored material = new
1920	1920	[bracketed material] = delete
1921	1921	1
1922	1922	2
1923	1923	3
1924	1924	4
1925	1925	5
1926	1926	6
1927	1927	7
1928	1928	8
1929	1929	9
1930	1930	10
1931	1931	11
1932	1932	12
1933	1933	13
1934	1934	14
1935	1935	15
1936	1936	16
1937	1937	17
1938	1938	18
1939	1939	19
1940	1940	20
1941	1941	21
1942	1942	22
1943	1943	23
1944	1944	24
1945	1945	25
1946	1946	cost sharing. A determination of medical necessity may include
1947	1947	considerations such as severity of side effects, differences in
1948	1948	permanence or reversibility of contraceptives and ability to
1949	1949	adhere to the appropriate use of the drug or item, as
1950	1950	determined by the attending provider.
1951	1951	D. A health care plan shall grant a subscriber an
1952	1952	expedited hearing to appeal any adverse determination made
1953	1953	relating to the provisions of this section. The process for
1954	1954	requesting an expedited hearing pursuant to this subsection
1955	1955	shall:
1956	1956	(1) be easily accessible, transparent,
1957	1957	sufficiently expedient and not unduly burdensome on a
1958	1958	subscriber, the subscriber's representative or the subscriber's
1959	1959	health care provider;
1960	1960	(2) defer to the determination of the
1961	1961	subscriber's health care provider; and
1962	1962	(3) provide for a determination of the claim
1963	1963	according to a time frame and in a manner that takes into
1964	1964	account the nature of the claim and the medical exigencies
1965	1965	involved for a claim involving an urgent health care need.
1966	1966	E. A health care plan shall not require a
1967	1967	prescription for any drug, item or service that is available
1968	1968	without a prescription.
1969	1969	F. A health care plan shall provide coverage and
1970	1970	shall reimburse a health care provider or dispensing entity on
1971	1971	.229202.1
1972	1972	- 37 - underscored material = new
1973	1973	[bracketed material] = delete
1974	1974	1
1975	1975	2
1976	1976	3
1977	1977	4
1978	1978	5
1979	1979	6
1980	1980	7
1981	1981	8
1982	1982	9
1983	1983	10
1984	1984	11
1985	1985	12
1986	1986	13
1987	1987	14
1988	1988	15
1989	1989	16
1990	1990	17
1991	1991	18
1992	1992	19
1993	1993	20
1994	1994	21
1995	1995	22
1996	1996	23
1997	1997	24
1998	1998	25
1999	1999	a per unit basis for dispensing [a six-month supply of
2000	2000	contraceptives] contraception intended to last the covered
2001	2001	person for a duration of twelve months, as permitted by the
2002	2002	covered person's prescription, dispensed at one time ; provided
2003	2003	that the contraceptives are prescribed and self-administered.
2004	2004	G. Nothing in this section shall be construed to:
2005	2005	(1) require a health care provider to
2006	2006	prescribe [six] twelve months of contraceptives at one time;
2007	2007	[or]
2008	2008	(2) permit a health care plan to limit
2009	2009	coverage or impose cost sharing for an alternate method of
2010	2010	contraception if a subscriber changes contraceptive methods
2011	2011	before exhausting a previously dispensed supply;
2012	2012	(3) permit a plan or pharmacy benefits manager
2013	2013	to limit the quantity of contraceptives dispensed based on the
2014	2014	number of months left in the plan year; or
2015	2015	(4) permit a plan or pharmacy benefits manager
2016	2016	to deny coverage for the continuous use of clinically
2017	2017	appropriate contraception as determined by the prescribing
2018	2018	provider.
2019	2019	H. The provisions of this section shall not apply
2020	2020	to short-term travel, accident-only, hospital-indemnity-only,
2021	2021	limited-benefit or specified-disease health care plans.
2022	2022	I. The provisions of this section apply to health
2023	2023	care plans delivered or issued for delivery after January 1,
2024	2024	.229202.1
2025	2025	- 38 - underscored material = new
2026	2026	[bracketed material] = delete
2027	2027	1
2028	2028	2
2029	2029	3
2030	2030	4
2031	2031	5
2032	2032	6
2033	2033	7
2034	2034	8
2035	2035	9
2036	2036	10
2037	2037	11
2038	2038	12
2039	2039	13
2040	2040	14
2041	2041	15
2042	2042	16
2043	2043	17
2044	2044	18
2045	2045	19
2046	2046	20
2047	2047	21
2048	2048	22
2049	2049	23
2050	2050	24
2051	2051	25
2052	2052	2020.
2053	2053	J. For the purposes of this section:
2054	2054	(1) "contraceptive method categories
2055	2055	identified by the federal food and drug administration":
2056	2056	(a) means tubal ligation; sterilization
2057	2057	implant; copper intrauterine device; intrauterine device with
2058	2058	progestin; implantable rod; contraceptive shot or injection;
2059	2059	combined oral contraceptives; extended or continuous use oral
2060	2060	contraceptives; progestin-only oral contraceptives; patch;
2061	2061	vaginal ring; diaphragm with spermicide; sponge with
2062	2062	spermicide; cervical cap with spermicide; male and female
2063	2063	condoms; spermicide alone; vasectomy; ulipristal acetate;
2064	2064	levonorgestrel emergency contraception; and any additional
2065	2065	contraceptive method categories approved by the federal food
2066	2066	and drug administration; and
2067	2067	(b) does not mean a product that has
2068	2068	been recalled for safety reasons or withdrawn from the market;
2069	2069	(2) "cost sharing" means a deductible,
2070	2070	copayment or coinsurance that a subscriber is required to pay
2071	2071	in accordance with the terms of a health care plan; and
2072	2072	(3) "health care provider" means an individual
2073	2073	licensed to provide health care in the ordinary course of
2074	2074	business.
2075	2075	K. A religious entity purchasing individual or
2076	2076	group health care plan coverage may elect to exclude
2077	2077	.229202.1
2078	2078	- 39 - underscored material = new
2079	2079	[bracketed material] = delete
2080	2080	1
2081	2081	2
2082	2082	3
2083	2083	4
2084	2084	5
2085	2085	6
2086	2086	7
2087	2087	8
2088	2088	9
2089	2089	10
2090	2090	11
2091	2091	12
2092	2092	13
2093	2093	14
2094	2094	15
2095	2095	16
2096	2096	17
2097	2097	18
2098	2098	19
2099	2099	20
2100	2100	21
2101	2101	22
2102	2102	23
2103	2103	24
2104	2104	25
2105	2105	prescription contraceptive drugs or items from the health
2106	2106	insurance coverage purchased."
2107	2107	SECTION 24. A new section of the Nonprofit Health Care
2108	2108	Plan Law is enacted to read:
2109	2109	"[NEW MATERIAL] SPECIAL ENROLLMENT PERIOD--PREGNANCY.--
2110	2110	A. A health care plan delivered or issued for
2111	2111	delivery in this state shall establish a special enrollment
2112	2112	period to provide coverage to an uninsured person when the
2113	2113	person provides a certification from a health care provider to
2114	2114	the insurer that the person is pregnant.
2115	2115	B. Coverage shall be effective before the end of
2116	2116	the first month in which the uninsured person receives
2117	2117	certification of the pregnancy, unless the person elects to
2118	2118	have coverage effective on the first day of the month following
2119	2119	the date that the person makes a plan selection."
2120	2120	SECTION 25. A new section of section of the Nonprofit
2121	2121	Health Care Plan Law is enacted to read:
2122	2122	"[NEW MATERIAL] COVERAGE FOR GENDER-AFFIRMING CARE.--
2123	2123	A. A health care plan delivered or issued for
2124	2124	delivery in this state shall provide coverage for gender-
2125	2125	affirming care.
2126	2126	B. As used in this section, "gender-affirming care"
2127	2127	means a procedure, service, drug, device or product that a
2128	2128	physical or behavioral health care provider prescribes to treat
2129	2129	an individual for incongruence between the individual's gender
2130	2130	.229202.1
2131	2131	- 40 - underscored material = new
2132	2132	[bracketed material] = delete
2133	2133	1
2134	2134	2
2135	2135	3
2136	2136	4
2137	2137	5
2138	2138	6
2139	2139	7
2140	2140	8
2141	2141	9
2142	2142	10
2143	2143	11
2144	2144	12
2145	2145	13
2146	2146	14
2147	2147	15
2148	2148	16
2149	2149	17
2150	2150	18
2151	2151	19
2152	2152	20
2153	2153	21
2154	2154	22
2155	2155	23
2156	2156	24
2157	2157	25
2158	2158	identity and the individual's sex assignment at birth.
2159	2159	C. The provisions of this section shall not apply
2160	2160	to a high deductible health benefit plans issued or renewed in
2161	2161	this state until an eligible subscriber's deductible has been
2162	2162	met."
2163	2163	SECTION 26. EFFECTIVE DATE.--The effective date of the
2164	2164	provisions of this act is January 1, 2026.
2165	2165	- 41 -
2166	2166	.229202.1