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 artery calcium scan.
B. Medical assistance coverage provided pursuant to this section shall:
(1) be limited to the provision of a heart artery calcium scan to an eligible enrollee to be used as a clinical management tool;
(2) be provided every five years if an eligible enrollee has previously received a heart artery calcium score of zero; and
(3) not be required for future heart artery calcium scans if an eligible enrollee receives a heart artery calcium score greater than zero.
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. 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 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 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, § 2.
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 27 - Public Assistance
Article 2 - Public Assistance Act
Section 27-2-3 - Standard of need; income determination.
Section 27-2-4 - Eligibility requirements.
Section 27-2-6.1 - Supplemental postnatal assistance.
Section 27-2-7 - General assistance program; qualifications and payments.
Section 27-2-7.1 - Eligible person entitled to information.
Section 27-2-9 - Payment for hospital care.
Section 27-2-9.1 - Administration of shelter care supplement.
Section 27-2-10 - Food stamp program.
Section 27-2-11 - Scope of assistance programs.
Section 27-2-12 - Medical assistance programs.
Section 27-2-12.2 - Medical assistance program; eligibility of married individuals.
Section 27-2-12.6 - Medicaid payments; managed care.
Section 27-2-12.8 - Mammograms for medicaid recipients.
Section 27-2-12.9 - Medicaid; personal spending allowances; increases.
Section 27-2-12.10 - Clinical nurse specialists.
Section 27-2-12.11 - Prescription drug waiver program; purpose; eligibility.
Section 27-2-12.12 - Human services department; managed care contract credentialing provisions.
Section 27-2-12.13 - Medicaid reform; program changes.
Section 27-2-12.14 - Brain injury; services authorized.
Section 27-2-12.20 - Crisis triage center; medical assistance reimbursement.
Section 27-2-12.21 - Medical assistance; pharmacy benefits; prescription synchronization.
Section 27-2-12.24 - Medical assistance; plan of care; participation required.
Section 27-2-12.25 - Prior authorization for gynecological or obstetrical ultrasounds prohibited.
Section 27-2-12.28 - Medical assistance; autism spectrum disorder.
Section 27-2-12.30 - Pharmacist prescriptive authority services; reimbursement parity.
Section 27-2-12.31 - Heart artery calcium scan coverage.
Section 27-2-13 - Conflict in federal and state laws.
Section 27-2-14 - Continuing effect of regulations and standards.
Section 27-2-15 - Cooperation with United States.
Section 27-2-16 - Compliance with federal law.
Section 27-2-17 - Custodian of funds.
Section 27-2-18 to 27-2-20 - Repealed.
Section 27-2-21 - Assistance not assignable.
Section 27-2-23 - Third party liability.
Section 27-2-24 - [Federal government entitled to share recovery.]
Section 27-2-25 - Funeral expenses.
Section 27-2-26 - Money received from other sources; duty and liability of funeral director.
Section 27-2-27 - Single state agency; powers and duties.
Section 27-2-28 - Liability for repayment of public assistance.
Section 27-2-29.1 - Compensation under contingent fee contracts; suspense fund created.
Section 27-2-30 - [Enforcement of support;] orders.
Section 27-2-31 - Judgments and proceeds.
Section 27-2-32 - Duty of agencies to cooperate.
Section 27-2-34 - Limitations of act.
Section 27-2-35 to 27-2-40 - Repealed.
Section 27-2-41 - Short title.
Section 27-2-42 - Legislative findings; purpose.
Section 27-2-43 - Definitions.
Section 27-2-44 - Indigent catastrophic illness hospital fund created.
Section 27-2-45 - Hospitals; claims for payment.