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SENATE BILL 512
57
TH LEGISLATURE
-
STATE
OF
NEW
MEXICO
-
FIRST SESSION
,
2025
INTRODUCED BY
Linda M. López
AN ACT
RELATING TO INSURANCE; AMENDING THE SURPRISE BILLING PROTECTION
ACT TO CHANGE THE METHOD FOR CALCULATING HEALTH CARE PROVIDER
REIMBURSEMENT.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF NEW MEXICO:
SECTION 1. Section 59A-57A-13 NMSA 1978 (being Laws 2019,
Chapter 227, Section 13) is amended to read:
"59A-57A-13. PROVIDERS--REIMBURSEMENT FOR A SURPRISE
BILL.--
A. For services provided pursuant to Section [3 or
4 of the Surprise Billing Protection Act ] 59A-57A-3 or
59A-57A-4 NMSA 1978, a health insurance carrier shall directly
reimburse a nonparticipating provider for care rendered the
surprise bill reimbursement rate for services.
B. The surprise bill reimbursement rate [shall be
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[bracketed material] = delete
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calculated using claims data reflecting the allowed amounts
paid for claims paid in the 2017 plan year ] related to a
specified service shall be determined based on claims data that
reflects the reimbursement amount for that service in the
calendar year that is two years prior to the year in which the
service was provided.
C. As used in this section, "surprise bill
reimbursement rate" means the sixtieth percentile of the
allowed commercial reimbursement rate for the particular health
care service performed by a provider in the same or similar
specialty in the same geographic area, as reported in a
benchmarking database [maintained by a nonprofit organization ]
specified by the superintendent after consultation with health
care sector stakeholders; provided that no surprise bill
reimbursement rate shall be paid at less than one hundred fifty
percent of the [2017] approved and published medicare
reimbursement rate for the applicable health care service
provided [D. The nonprofit organization shall be conflict-free
and unaffiliated with any stakeholder in the health care
sector] in the calendar year prior to the year the service was
provided."
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