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 artery calcium scan.
B. Coverage provided pursuant to this section shall:
(1) be limited to the provision of a heart artery calcium scan to an eligible insured to be used as a clinical management tool;
(2) be provided every five years if an eligible insured has previously received a heart artery calcium score of zero; and
(3) not be required for future heart artery calcium scans if an eligible insured receives a heart artery calcium score greater than zero.
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. 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 artery calcium scan" means a computed tomography scan measuring coronary artery calcium for atherosclerosis and abnormal artery structure and function.
History: Laws 2020, ch. 79, § 1.
Effective dates. — Laws 2020, ch. 79 contained no effective date provision, but, pursuant to N.M. Const., art. IV, § 23, was effective May 20, 2020, 90 days after adjournment of the legislature.
Applicability. — Laws 2020, ch. 79, § 6 provided that the provisions of Laws 2020, ch. 79, are applicable to group health insurance policies, health care plans or certificates of health insurance, other than small group health plans, that are delivered, issued for delivery or renewed in this state on or after January 1, 2021.
Structure New Mexico Statutes
Chapter 13 - Public Purchases and Property
Article 7 - Health Care Purchasing
Section 13-7-2 - Purpose of act.
Section 13-7-4 - Mandatory consolidated purchasing.
Section 13-7-5 - Consolidated purchasing for other persons.
Section 13-7-6 - Use of social security numbers.
Section 13-7-7 - Consolidated administrative functions; benefit.
Section 13-7-8 - Maximum age of dependent.
Section 13-7-9 - General anesthesia and hospitalization for dental surgery.
Section 13-7-10 - Hearing aid coverage for children required.
Section 13-7-11 - Required coverage of patient costs incurred in cancer clinical trials.
Section 13-7-12 - Coverage for orally administered anticancer medications; limits on patient costs.
Section 13-7-13 - Coverage of prescription eye drop refills.
Section 13-7-14 - Coverage for telemedicine services.
Section 13-7-15 - Prescription drugs; prohibited formulary changes; notice requirements.
Section 13-7-17 - Pharmacy benefits; prescription synchronization.
Section 13-7-19 - Prior authorization for gynecological or obstetrical ultrasounds prohibited.
Section 13-7-20 - Prior Authorization Act.
Section 13-7-21 - Physical rehabilitation services; limits on cost sharing.
Section 13-7-22 - Coverage for contraception.
Section 13-7-23 - Pharmacist prescriptive authority services; reimbursement parity.
Section 13-7-24 - Heart artery calcium scan coverage.