The proposed bill amends New Mexico's insurance laws to require coverage for coronary artery calcium screening without cost sharing for individuals over the age of forty-nine. It mandates that group health coverage, medical assistance, and health maintenance organization contracts provide this screening at the discretion of healthcare providers. Eligible insured individuals can receive the screening every five years if their previous calcium score is zero, and further screenings are not necessary if the score exceeds zero. The bill also introduces definitions for key terms, including "cost sharing," which encompasses deductibles, copayments, or coinsurance, and specifies that these provisions do not apply to certain insurance plans, such as short-term travel or high-deductible health plans until deductibles are met.

Additionally, the bill removes previous age and risk criteria for eligibility, which required individuals to be between the ages of forty-five and sixty-five and have an intermediate risk of developing coronary heart disease. It defines "coronary artery calcium screening" as a computed tomography scan that measures coronary artery calcium for assessing atherosclerosis and abnormal artery structure and function. The definition of "health care provider" is reaffirmed to include various licensed professionals authorized to provide health care services. The provisions of this act will apply to group health insurance policies and health care plans delivered, issued for delivery, or renewed in the state on or after January 1, 2026.

Statutes affected:
introduced version: 13-7-24, 27-2-12.31, 59A-23-7.16, 59A-46-50.5, 59A-47-45.7
CT substitute: 13-7-24, 27-2-12.31, 59A-23-7.16, 59A-46-50.5, 59A-47-45.7