A. Until January 1, 2027, group health coverage, including any form of self-insurance, offered, issued or renewed under the Health Care Purchasing Act that offers coverage of behavioral health services shall not impose cost sharing on those behavioral health services.
B. For the purposes of this section:
(1) "behavioral health services" means professional and ancillary services for the treatment, habilitation, prevention and identification of mental illnesses, substance abuse disorders and trauma spectrum disorders, including inpatient, detoxification, residential treatment and partial hospitalization, intensive outpatient therapy, outpatient and all medications, including brand-name pharmacy drugs when generics are unavailable;
(2) "coinsurance" means a cost-sharing method that requires an enrollee to pay a stated percentage of medical expenses after any deductible amount is paid; provided that coinsurance rates may differ for different types of services under the same group health plan;
(3) "copayment" means a cost-sharing method that requires an enrollee to pay a fixed dollar amount when health care services are received, with the plan administrator paying the balance of the allowable amount; provided that there may be different copayment requirements for different types of services under the same group health plan; and
(4) "cost sharing" means a copayment, coinsurance, deductible or any other form of financial obligation of an enrollee other than a premium or a share of a premium, or any combination of any of these financial obligations, as defined by the terms of a group health plan.
History: Laws 2021, ch. 136, § 3.
Effective dates. — Laws 2021, ch. 136, § 11 made Laws 2021, ch. 136, § 3 effective January 1, 2022.
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.