HOUSE JUDICIARY COMMITTEE SUBSTITUTE FOR

HOUSE BILL 27

56th legislature - STATE OF NEW MEXICO - first session, 2023

 

 

 

 

 

 

 

AN ACT

RELATING TO HEALTH INSURANCE COVERAGE; AMENDING AND ENACTING SECTIONS OF THE HEALTH CARE PURCHASING ACT, THE NEW MEXICO INSURANCE CODE, THE HEALTH MAINTENANCE ORGANIZATION LAW AND THE NONPROFIT HEALTH CARE PLAN LAW TO ELIMINATE COST SHARING FOR INSURERS THAT PROVIDE COVERAGE OF DIAGNOSTIC AND SUPPLEMENTAL BREAST EXAMINATIONS.

 

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF NEW MEXICO:

     SECTION 1. A new section of the Health Care Purchasing Act is enacted to read:

     "[NEW MATERIAL] DIAGNOSTIC AND SUPPLEMENTAL BREAST

EXAMINATIONS.--

          A. Group health coverage, including self-insurance,

offered, issued, amended, delivered or renewed under the Health

Care Purchasing Act that provides coverage for diagnostic and supplemental breast examinations shall not impose cost sharing

for diagnostic and supplemental breast examinations. 

          B. The provisions of this section do not apply to excepted benefit plans as provided pursuant to the Short-Term Health Plan and Excepted Benefit Act, catastrophic plans as defined pursuant to 42 USCA Section 18022(e) or tax-favored plans as defined pursuant to 26 USC Section 223(c)(2).

          C. As used in this section:

                (1) "cost sharing" means a deductible,

coinsurance, copayment and any maximum limitation on the application of such a deductible, coinsurance, copayment or

similar out-of-pocket expense;

                (2) "diagnostic breast examination" means a

medically necessary and clinically appropriate examination of

the breast using diagnostic mammography, breast magnetic

resonance imaging or breast ultrasound that evaluates an

abnormality:

                     (a) seen or suspected from a screening

examination for breast cancer; or

                     (b) detected by another means of

examination; and

                (3) "supplemental breast examination" means a

medically necessary and clinically appropriate examination of

the breast using breast magnetic resonance imaging or breast

ultrasound that is:

                     (a) used to screen for breast cancer when there is no abnormality seen or suspected; and

                     (b) based on personal or family medical

history or additional factors that may increase the individual's risk of breast cancer."

     SECTION 2. A new section of Chapter 59A, Article 22 NMSA 1978 is enacted to read:

     "[NEW MATERIAL] DIAGNOSTIC AND SUPPLEMENTAL BREAST

EXAMINATIONS.--

          A. An individual or group health insurance policy,

health care plan or certificate of insurance that is delivered,

issued for delivery or renewed in this state that provides

coverage for diagnostic and supplemental breast examinations

shall not impose cost sharing for diagnostic and supplemental

breast examinations.

          B. The provisions of this section do not apply to excepted benefit plans as provided pursuant to the Short-Term Health Plan and Excepted Benefit Act, catastrophic plans as defined pursuant to 42 USCA Section 18022(e) or tax-favored plans as defined pursuant to 26 USC Section 223(c)(2).

          C. As used in this section:

                (1) "cost sharing" means a deductible,

coinsurance, copayment and any maximum limitation on the application of such a deductible, coinsurance, copayment or

similar out-of-pocket expense;

                (2) "diagnostic breast examination" means a

medically necessary and clinically appropriate examination of

the breast using diagnostic mammography, breast magnetic

resonance imaging or breast ultrasound that evaluates an

abnormality:

                     (a) seen or suspected from a screening

examination for breast cancer; or

                     (b) detected by another means of

examination; and

                (3) "supplemental breast examination" means a

medically necessary and clinically appropriate examination of

the breast using breast magnetic resonance imaging or breast

ultrasound that is:

                     (a) used to screen for breast cancer when there is no abnormality seen or suspected; and

                     (b) based on personal or family medical

history or additional factors that may increase the individual's risk of breast cancer." 

     SECTION 3. A new section of Chapter 59A, Article 23 NMSA 1978 is enacted to read:

     "[NEW MATERIAL] DIAGNOSTIC AND SUPPLEMENTAL BREAST

EXAMINATIONS.--

          A. A blanket 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 provides coverage for diagnostic and supplemental breast examinations shall not impose cost sharing for diagnostic and supplemental breast examinations.

          B. The provisions of this section do not apply to excepted benefit plans as provided pursuant to the Short-Term Health Plan and Excepted Benefit Act, catastrophic plans as defined pursuant to 42 USCA Section 18022(e) or tax-favored plans as defined pursuant to 26 USC Section 223(c)(2).

          C. As used in this section:

                (1) "cost sharing" means a deductible,

coinsurance, copayment and any maximum limitation on the application of such a deductible, coinsurance, copayment or

similar out-of-pocket expense;

                (2) "diagnostic breast examination" means a

medically necessary and clinically appropriate examination of

the breast using diagnostic mammography, breast magnetic

resonance imaging or breast ultrasound that evaluates an

abnormality:

                     (a) seen or suspected from a screening

examination for breast cancer; or

                     (b) detected by another means of

examination; and

                (3) "supplemental breast examination" means a

medically necessary and clinically appropriate examination of

the breast using breast magnetic resonance imaging or breast

ultrasound that is:

                     (a) used to screen for breast cancer when there is no abnormality seen or suspected; and

                     (b) based on personal or family medical

history or additional factors that may increase the individual's risk of breast cancer."

     SECTION 4. A new section of the Health Maintenance Organization Law is enacted to read:

     "[NEW MATERIAL] DIAGNOSTIC AND SUPPLEMENTAL BREAST

EXAMINATIONS.--

          A. An individual or group health maintenance

organization contract that is delivered, issued for delivery or

renewed in this state that provides coverage for diagnostic and

supplemental breast examinations shall not impose cost sharing

for diagnostic and supplemental breast examinations.

          B. The provisions of this section do not apply to excepted benefit plans as provided pursuant to the Short-Term Health Plan and Excepted Benefit Act, catastrophic plans as defined pursuant to 42 USCA Section 18022(e) or tax-favored plans as defined pursuant to 26 USC Section 223(c)(2).

          C. As used in this section:

                (1) "cost sharing" means a deductible,

coinsurance, copayment and any maximum limitation on the application of such a deductible, coinsurance, copayment or

similar out-of-pocket expense;

                (2) "diagnostic breast examination" means a

medically necessary and clinically appropriate examination of

the breast using diagnostic mammography, breast magnetic

resonance imaging or breast ultrasound that evaluates an

abnormality:

                     (a) seen or suspected from a screening

examination for breast cancer; or

                     (b) detected by another means of

examination; and

                (3) "supplemental breast examination" means a

medically necessary and clinically appropriate examination of

the breast using breast magnetic resonance imaging or breast

ultrasound that is:

                     (a) used to screen for breast cancer when there is no abnormality seen or suspected; and

                     (b) based on personal or family medical

history or additional factors that may increase the individual's risk of breast cancer."

     SECTION 5. A new section of the Nonprofit Health Care Plan Law is enacted to read:

     "[NEW MATERIAL] DIAGNOSTIC AND SUPPLEMENTAL BREAST

EXAMINATIONS.--

          A. An individual or group health care plan that is

delivered, issued for delivery or renewed in this state that

provides coverage for diagnostic and supplemental breast

examinations shall not impose cost sharing for diagnostic and

supplemental breast examinations.

          B. The provisions of this section do not apply to excepted benefit plans as provided pursuant to the Short-Term Health Plan and Excepted Benefit Act, catastrophic plans as defined pursuant to 42 USCA Section 18022(e) or tax-favored plans as defined pursuant to 26 USC Section 223(c)(2).

          C. As used in this section:

                (1) "cost sharing" means a deductible,

coinsurance, copayment and any maximum limitation on the application of such a deductible, coinsurance, copayment or

similar out-of-pocket expense;

                (2) "diagnostic breast examination" means a

medically necessary and clinically appropriate examination of

the breast using diagnostic mammography, breast magnetic

resonance imaging or breast ultrasound that evaluates an

abnormality:

                     (a) seen or suspected from a screening

examination for breast cancer; or

                     (b) detected by another means of

examination; and

                (3) "supplemental breast examination" means a

medically necessary and clinically appropriate examination of

the breast using breast magnetic resonance imaging or breast

ultrasound that is:

                     (a) used to screen