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 using insulin, those not using insulin, and those with elevated blood glucose levels due to pregnancy. This coverage is classified as a basic health care benefit, ensuring that essential diabetes supplies and treatment options are accessible without reduction or elimination. The bill also establishes specific requirements for insurers, including maintaining an adequate network of suppliers, ensuring timely delivery of supplies, and guaranteeing reimbursement for out-of-pocket expenses within a specified timeframe.

Additionally, the bill outlines exclusions from coverage for certain health care plans, such as short-term health care plans and long-term care policies, while defining "basic health care benefits" to include medically necessary services like preventive care and emergency care, but excluding services related to alcohol or drug abuse, dental care, or long-term rehabilitation treatment. The legislation also limits prior authorization for diabetes-related medications and supplies, ensuring that changes in a patient's condition do not require additional approvals within the same policy year. The provisions of this act 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