This bill amends the New Mexico Insurance Code, the Health Maintenance Organization Law, and the Nonprofit Health Care Plan Law to enhance coverage for individuals with diabetes, specifically mandating coverage for durable medical equipment necessary for the treatment of active diabetic foot ulcers. It ensures that health insurance policies include essential medical supplies such as podiatric appliances and topical oxygen therapy, emphasizing that this coverage is a basic health care benefit that cannot be reduced or eliminated. The bill also establishes requirements for health insurers regarding the timely delivery of diabetes-related supplies, including the creation of adequate supplier networks and reimbursement timelines, while mandating quarterly compliance reports to the superintendent of insurance.

Additionally, the bill limits health care insurers to one prior authorization per policy period for diabetes-related drugs or items deemed medically necessary, with no further authorizations required for changes in prescribed doses or quantities within the same policy year. It mandates that health care plans maintain an adequate formulary for diabetes resources and ensures timely delivery of necessary supplies, with annual audits by the superintendent to enforce compliance. The bill outlines specific exclusions for certain health care plans and defines "basic health care benefits," which will take effect for various health insurance policies in New Mexico starting January 1, 2026.

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