The bill amends the Health Care Purchasing Act and the New Mexico Insurance Code to require group health plans to cover complex rehabilitation technology devices, prosthetic devices, and custom orthotic devices. Coverage must be at least equivalent to that provided by Medicare and cannot impose annual or lifetime dollar maximums. The legislation allows for multiple devices per affected limb when medically necessary and includes provisions for replacement devices after three years if they no longer meet the enrollee's needs. It also mandates that coverage for these devices be comparable to other medical benefits and prohibits more restrictive financial requirements.

Additionally, the bill defines certain practices as unfair and deceptive, particularly regarding coverage denial based on disability, and requires insurers to apply the latest treatment criteria when reviewing coverage requests. It ensures access to necessary clinical care and devices from multiple providers within the insurer's network and mandates clear communication regarding coverage denials. The bill emphasizes equitable treatment for individuals with disabilities and outlines comprehensive services that must be included in coverage, such as fitting and repairs. These provisions will take effect for policies issued or renewed in the state starting January 1, 2027.

Statutes affected:
introduced version: 13-7-46, 59A-16-21.4, 59A-22-62, 59A-23-32, 59A-46-72, 59A-47-66
HC substitute: 13-7-46, 59A-16-21.4, 59A-22-62, 59A-23-32, 59A-46-72, 59A-47-66
Final Version: 13-7-46, 59A-16-21.4, 59A-22-62, 59A-23-32, 59A-46-72, 59A-47-66