The bill amends the New Mexico Insurance Code, the Health Maintenance Organization Law, and the Nonprofit Health Care Plan Law to require comprehensive coverage for durable medical equipment necessary for the treatment of active diabetic foot ulcers. It mandates that all individual and group health insurance policies provide coverage for individuals with diabetes, including those who use insulin, those who do not, and those with elevated blood glucose levels due to pregnancy. This coverage is classified as a basic health care benefit and includes essential medical supplies such as blood glucose monitors and insulin. The bill also sets forth requirements for insurers to maintain an adequate network of durable medical equipment suppliers, ensure timely delivery of supplies, and reimburse out-of-pocket expenses within thirty days. Additionally, it limits prior authorization for diabetes-related items to one per policy period.

Moreover, the bill specifies exclusions from coverage under health care plans, detailing that certain plans, such as short-term health care plans and long-term care policies, are not considered covered benefits. It defines "basic health care benefits" to include medically necessary services like preventive care and emergency care, while explicitly excluding services related to alcohol or drug abuse, dental care, and long-term rehabilitation treatment. The provisions of this act are set to take effect on January 1, 2026, ensuring that individuals managing diabetes have improved access to necessary care and resources.

Statutes affected:
introduced version: 59A-22-41, 59A-23-7.17, 59A-46-43, 59A-47-45.8
Final Version: 59A-22-41, 59A-23-7.17, 59A-46-43, 59A-47-45.8