Senate Bill 278

SENATE BILL 278

57th legislature - STATE OF NEW MEXICO - first session, 2025

INTRODUCED BY

Martin Hickey

 

 

 

 

 

AN ACT

RELATING TO INSURANCE; AMENDING THE HEALTH CARE PURCHASING ACT, THE PUBLIC ASSISTANCE ACT AND SECTIONS OF THE NEW MEXICO INSURANCE CODE TO PROHIBIT COST SHARING FOR CORONARY ARTERY CALCIUM SCREENING; BROADENING ELIGIBILITY FOR CORONARY ARTERY CALCIUM SCREENING.

 

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF NEW MEXICO:

     SECTION 1. Section 13-7-24 NMSA 1978 (being Laws 2020, Chapter 79, Section 1) is amended to read:

     "13-7-24. [HEART] CORONARY ARTERY CALCIUM [SCAN] SCREENING COVERAGE.--

          A. Group health coverage, including any form of self-insurance, offered, issued or renewed under the Health Care Purchasing Act shall provide coverage for eligible insureds to receive a [heart] coronary artery calcium [scan] screening.

          B. Coverage provided pursuant to this section shall:

                (1) be limited to the provision of a [heart] coronary artery calcium [scan] screening to an eligible insured at the discretion of a health care provider to be used as a clinical management tool;

                (2) be provided every [five] four years if an eligible insured has previously received a [heart] coronary artery calcium score of zero; [and]

                (3) not be required for future [heart] coronary artery calcium [scans] screenings if an eligible insured receives a [heart] coronary artery calcium score greater than zero; and

                (4) not impose cost sharing on eligible insureds.

          C. [At its discretion or as required by law] An insurer [may] shall offer [or refuse] coverage for further cardiac testing or procedures for eligible insureds based upon the results of a [heart] coronary artery calcium [scan] screening.

          D. The provisions of this section shall not apply to short-term travel, accident-only or limited or specified-disease policies, plans or certificates of health insurance.

          E. As used in this section:

                [(1) "eligible insured" means an insured who:

                     (a) is a person between the ages of forty-five and sixty-five; and

                     (b) has an intermediate risk of developing coronary heart disease as determined by a health care provider based upon a score calculated from an evidence-based algorithm widely used in the medical community to assess a person's ten-year cardiovascular disease risk, including a score calculated using a pooled cohort equation;

                (2) "health care provider" means a physician, physician assistant, nurse practitioner or other health care professional authorized to furnish health care services within the scope of the professional's license; and

                (3) "heart] (1) "coronary artery calcium [scan] screening" means a computed tomography scan measuring coronary artery calcium for atherosclerosis and abnormal artery structure and function;

                (2) "cost sharing" means deductibles, copayments or coinsurance; and

                (3) "health care provider" means a physician, physician assistant, nurse practitioner or other health care professional authorized to furnish health care services within the scope of the professional's license."

     SECTION 2. Section 27-2-12.31 NMSA 1978 (being Laws 2020, Chapter 79, Section 2) is amended to read:

     "27-2-12.31. [HEART] CORONARY ARTERY CALCIUM [SCAN] SCREENING COVERAGE.--

          A. In accordance with federal law, the secretary shall adopt and promulgate rules that provide medical assistance coverage for eligible enrollees to receive a [heart] coronary artery calcium [scan] screening.

          B. Medical assistance coverage provided pursuant to this section shall:

                (1) be limited to the provision of a [heart] coronary artery calcium [scan] screening to an eligible enrollee at the discretion of a health care provider to be used as a clinical management tool;

                (2) be provided every [five] four years if an eligible enrollee has previously received a [heart] coronary artery calcium score of zero; [and]

                (3) not be required for future [heart] coronary artery calcium [scans] screenings if an eligible enrollee receives a [heart] coronary artery calcium score greater than zero; and

                (4) not impose cost sharing on eligible enrollees.

          [C. At its discretion or as required by law, a managed care organization providing medical assistance may offer or refuse coverage for further cardiac testing or procedures for eligible enrollees based upon the results of a heart artery calcium scan.

          D.] C. The provisions of this section shall not apply to short-term travel, accident-only or limited or specified-disease policies, plans or certificates of health insurance.

          [E.] D. As used in this section:

                [(1) "eligible enrollee" means an enrollee who:

                     (a) is a person between the ages of forty-five and sixty-five; and

                     (b) has an intermediate risk of developing coronary heart disease as determined by a health care provider based upon a score calculated from an evidence-based algorithm widely used in the medical community to assess a person's ten-year cardiovascular disease risk, including a score calculated using a pooled cohort equation;

                (2) "health care provider" means a physician, physician assistant, nurse practitioner or other health care professional authorized to furnish health care services within the scope of the professional's license; and

                (3) "heart] (1) "coronary artery calcium [scan] screening" means a computed tomography scan measuring coronary artery calcium for atherosclerosis and abnormal artery structure and function;

                (2) "cost sharing" means deductibles, copayments or coinsurance; and

                (3) "health care provider" means a physician, physician assistant, nurse practitioner or other health care professional authorized to furnish health care services within the scope of the professional's license."

     SECTION 3. Section 59A-23-7.16 NMSA 1978 (being Laws 2020, Chapter 79, Section 3) is amended to read:

     "59A-23-7.16. [HEART] CORONARY ARTERY CALCIUM [SCAN] SCREENING COVERAGE.--

          A. A group health plan, other than a small group health plan or a blanket health insurance policy or contract that is delivered, issued for delivery or renewed in this state shall provide coverage for eligible insureds to receive a [heart] coronary artery calcium [scan] screening.

          B. Coverage provided pursuant to this section shall:

                (1) be limited to the provision of a [heart] coronary artery calcium [scan] screening to an eligible insured at the discretion of a health care provider to be used as a clinical management tool;

                (2) be provided every [five] four years if an eligible insured has previously received a [heart] coronary artery calcium score of zero; [and]

                (3) not be required for future [heart] coronary artery calcium [scans] screenings if an eligible insured receives a [heart] coronary artery calcium score greater than zero; and

                (4) not impose cost sharing on eligible insureds.

          [C. At its discretion or as required by law, an insurer may offer or refuse coverage for further cardiac testing or procedures for eligible insureds based upon the results of a heart artery calcium scan.

          D.] C. The provisions of this section do not apply to short-term travel, accident-only or limited or specified-disease policies, plans or certificates of health insurance.

          [E.] D. As used in this section:

                [(1) "eligible insured" means an insured who:

                     (a) is a person between the ages of forty-five and sixty-five; and

                     (b) has an intermediate risk of developing coronary heart disease as determined by a health care provider based upon a score calculated from an evidence-based algorithm widely used in the medical community to assess a person's ten-year cardiovascular disease risk, including a score calculated using a pooled cohort equation;

                (2) "health care provider" means a physician, physician assistant, nurse practitioner or other health care professional authorized to furnish health care services within the scope of the professional's license; and

                (3) "heart] (1) "coronary artery calcium [scan] screening" means a computed tomography scan measuring coronary artery calcium for atherosclerosis and abnormal artery structure and function;

                (2) "cost sharing" means deductibles, copayments or coinsurance; and

                (3) "health care provider" means a physician, physician assistant, nurse practitioner or other health care professional authorized to furnish health care services within the scope of the professional's license."

     SECTION 4. Section 59A-46-50.5 NMSA 1978 (being Laws 2020, Chapter 79, Section 4) is amended to read:

     "59A-46-50.5. [HEART] CORONARY ARTERY CALCIUM [SCAN] SCREENING COVERAGE.--

          A. A group health maintenance organization contract, other than a small group health maintenance organization contract, that is delivered, issued for delivery or renewed in this state shall provide coverage for eligible enrollees to receive a [heart] coronary artery calcium [scan] screening.

          B. Coverage provided pursuant to this section shall:

                (1) be limited to the provision of a [heart] coronary artery calcium [scan] screening to an eligible enrollee at the discretion of a health care provider to be used as a clinical management tool;

                (2) be provided every [five] four years if an eligible enrollee has previously received a [heart] coronary artery calcium score of zero; [and]

                (3) not be required for future [heart] coronary artery calcium [scans] screenings if an eligible enrollee receives a [heart] coronary artery calcium score greater than zero; and

                (4) not impose cost sharing on eligible enrollees.

          [C. At its discretion or as required by law, a carrier may offer or refuse coverage for further cardiac testing or procedures for eligible enrollees based upon the results of a heart artery calcium scan.

          D.] C. The provisions of this section do not apply to short-term travel, accident-only or limited or specified-disease policies, plans or certificates of health insurance.

          [E.] D. As used in this section:

                [(1) "eligible enrollee" means an enrollee who:

                     (a) is a person between the ages of forty-five and sixty-five; and

                     (b) has an intermediate risk of developing coronary heart disease as determined by a health care provider based upon a score calculated from an evidence-based algorithm widely used in the medical community to assess a person's ten-year cardiovascular disease risk, including a score calculated using a pooled cohort equation;

                (2) "health care provider" means a physician, physician assistant, nurse practitioner or other health care professional authorized to furnish health care services within the scope of the professional's license; and

                (3) heart] (1) "coronary artery calcium [scan] screening" means a computed tomography scan measuring coronary artery calcium for atherosclerosis and abnormal artery structure and function;

                (2) "cost sharing" means deductibles, copayments or coinsurance; and

                (3) "health care provider" means a physician, physician assistant, nurse practitioner or other health care professional authorized to furnish health care services within the scope of the professional's license."

     SECTION 5. Section 59A-47-45.7 NMSA 1978 (being Laws 2020, Chapter 79, Section 5) is amended to read:

     "59A-47-45.7. [HEART] CORONARY ARTERY CALCIUM [SCAN] SCREENING COVERAGE.--

          A. A group health care plan, other than a small group health care plan, that is delivered, issued for delivery or renewed in this state shall provide coverage for eligible subscribers to receive a [heart] coronary artery calcium [scan] screening.

          B. Coverage provided pursuant to this section shall:

                (1) be limited to the provision of a [heart] coronary artery calcium [scan] screening to an eligible subscriber at the discretion of a health care provider to be used as a clinical management tool;

                (2) be provided every [five] four years if an eligible subscriber has previously received a [heart] coronary artery calcium score of zero; [and]

                (3) not be required for future [heart] coronary artery calcium [scans] screenings if an eligible subscriber receives a [heart] coronary artery calcium score greater than zero; and

                (4) not impose cost sharing on eligible subscribers.

          [C. At its discretion or as required by law, a health care plan may offer or refuse coverage for further cardiac testing or procedures for eligible subscribers based upon the results of a heart artery calcium scan.

          D.] C. The provisions of this section do not apply to short-term travel, accident-only or limited or specified-disease policies, plans or certificates of health insurance.

          [E.] D. As used in this section:

                [(1) "eligible subscriber" means a subscriber who:

                     (a) is a person between the ages of forty-five and sixty-five; and

                     (b) has an intermediate risk of developing coronary heart disease as determined by a health care provider based upon a score calculated from an evidence-based algorithm widely used in the medical community to assess a person's ten-year cardiovascular disease risk, including a score calculated using a pooled cohort equation;

                (2) "health care provider" means a physician, physician assistant, nurse practitioner or other health care professional authorized to furnish health care services within the scope of the professional's license; and

                (3) "heart] (1) "coronary artery calcium [scan] screening" means a computed tomography scan measuring coronary artery calcium for atherosclerosis and abnormal artery structure and function;

                (2) "cost sharing" means deductibles, copayments or coinsurance; and

                (3) "health care provider" means a physician, physician assistant, nurse practitioner or other health care professional authorized to furnish health care services within the scope of the professional's license."

     SECTION 6. APPLICABILITY.--The provisions of this act are applicable to group health insurance policies, health care plans or certificates of health insurance that are delivered, issued for delivery or renewed in this state on or after January 1, 2026.

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