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 treating 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 encompasses essential medical supplies and treatments, such as blood glucose monitors and insulin. Additionally, the bill stipulates that individuals with diabetes will only pay a maximum of $25 for a thirty-day supply of preferred formulary prescription insulin drugs.

The legislation also outlines specific requirements for insurers, including maintaining an adequate network of durable medical equipment suppliers, ensuring timely delivery of necessary supplies, and providing reimbursement for out-of-pocket expenses within a specified timeframe. It establishes reporting requirements for health plans to monitor compliance and mandates annual audits by the superintendent to ensure adherence to these regulations. Furthermore, the bill specifies exclusions from coverage for certain health care plans, such as short-term health care plans and long-term care policies, and defines "basic health care benefits" to include medically necessary services while excluding certain treatments. The provisions of the bill are set to take effect on January 1, 2026.

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