SB 120 — NO BEHAVIORAL HEALTH COST SHARING

SENATEAN HEALTHACT ANDRELATING PUBLICTO AFFAIRSHEALTH; COMMITTEE SUBSTITUTE FOR SENATE BILL 120 57TH LEGISLATURE - STATE OF NEW MEXICO - FIRST SESSION, 2025 This document may incorporate amendments proposed by a committee, but not yet adopted, as well as amendments that have been adopted during the current legislative session.

TheAMENDING documentSECTIONS isOF aTHE toolHEALTH toCARE showPURCHASING amendmentsACT inAND contextNEW andMEXICO cannotINSURANCE beCODE usedTO forADD theAN purposeEXEMPTION ofFROM addingTHE amendmentsPROHIBITION toON legislation.COST SHARING FOR BEHAVIORAL HEALTH SERVICES FOR CERTAIN PLANS.

h7 ANBE ACTIT gENACTED oBY RELATINGTHE TOLEGISLATURE HEALTH;OF THE STATE OF NEW MEXICO:

AMENDINGSECTION SECTIONS1. OF THE HEALTH CARE t hr g e i k PURCHASING ACT AND NEW MEXICO INSURANCE CODE TO SFCº PERMANENTLY h r i s ELIMINATE BEHAVIORAL HEALTH SERVICES COST SHARING»SFC SFCºADD h , t, AN EXEMPTION FROM THE PROHIBITION ON COST SHARING FOR e u g e b l e e h BEHAVIORAL HEALTH SERVICES FOR CERTAIN PLANS»SFC .

nSection d13-7-26 dNMSA i1978 =(being =Laws o2021, hChapter l136, ]Section b3) ,dis iamended ato ºread: e BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF NEW MEXICO:

r i = r t e w d m a n o SECTION 1.

Section 13-7-26 NMSA 1978 (being Laws 2021, d m :

b e d s º o t n = .231379.1AIC March 13, 2025 (2:55pm) s k m e e a n e d r e l u [ A d SHPAC/SB 120 Chapter 136, Section 3) is amended to read:

[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 SFCº in network»SFCnetwork. .

(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 h therapy, outpatient therapy SFCº, emergency department visits, g o t hr urgent care visits»SFC and all medications, including brand-brand-name g e i k name pharmacy drugs when generics are unavailable;

hSHPAC/SB r120 iPage s1 (2) "coinsurance" means a cost-sharing method h , t, that requires an enrollee to pay a stated percentage of medical e u g e b l e e h expenses after any deductible amount is paid;

provided that n d d i = = o h coinsurance rates may differ for different types of services l ] b ,d i a º e under the same group health plan;

r(3) i"copayment" =means ra tcost-sharing emethod wthat drequires man enrollee to pay a nfixed odollar (3)amount "copayment"when meanshealth acare cost-sharingservices methodare dreceived, mwith :the plan administrator paying the balance of the allowable amount;

b e d s º o t n = .231379.1AIC March 13, 2025 (2:55pm) s k m e - 2 - e a n e d r e l u [ A d SHPAC/SB 120 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;

Section 59A-22-57 NMSA 1978 (being LawsSHPAC/SB 2021,120 hPage u2 »Laws r2021, Chapter 136, Section 6) is amended to read:

t h g e "59A-22-57.

BEHAVIORAL HEALTH SERVICES--ELIMINATION OF l i h r COST SHARING.-- i s h , e h A.

[Until January 1, 2027 ] An individual or group t u g e b l health insurance policy, health care plan or certificate of e e , gh n d d i health insurance that is delivered, issued for delivery or = = o h l ] b ,d i a º r renewed in this state that offers coverage of behavioral health e r = t e w d services shall not impose cost sharing on those behavioral mhealth aservices. n o d m :

b r e t º o t n = .231379.1AIC March 13, 2025 (2:55pm) s k m e - 3 - e a n e d r e l u [ A d SHPAC/SB 120 health services.

(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 therapy SFCº, emergency department visits, urgent care visits»SFC and all medications, including brand-brand-name name pharmacy drugs when generics are unavailable;

provided that coinsurance rates may differ for different types of services under the same individual or group health insurance policy, h health care plan or certificate of health insurance;

u » r (3) "copayment" means a cost-sharing method tSHPAC/SB h120 gPage e3 that requires the insured to pay a fixed dollar amount when l i h r i s health care services are received, with the insurer paying the h , e h balance of the allowable amount;

provided that there may be t u g e b l different copayment requirements for different types of e e , gh n d d i = = o h services under the same individual or group health insurance l ] b ,d i a º r policy, health care plan or certificate of health insurance;

eand r(4) ="cost tsharing" emeans wa dcopayment, andcoinsurance, mdeductible or any other form of financial obligation of the insured other than a npremium oor da mshare :of a premium, or any combination of any of these financial obligations, as defined by the terms of an individual or group health insurance policy, health care plan or certificate of health insurance.

b r e t º o t n = .231379.1AIC March 13, 2025 (2:55pm) s k m e - 4 - e a n e d r e l u [ A d SHPAC/SB 120 (4) "cost sharing" means a copayment, coinsurance, deductible or any other form of financial obligation of the insured 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 an individual or group health insurance policy, health care plan or certificate of health insurance.

BEHAVIORAL HEALTH SERVICES--ELIMINATION OF h COST SHARING.-- gSHPAC/SB o120 Page 4 A.

[Until January 1, 2027 ] A group or blanket t hr g e health insurance policy, health care plan or certificate of i k h r i s health insurance that is delivered, issued for delivery or h , t, renewed in this state that offers coverage of behavioral health e u g e b l services shall not impose cost sharing on those behavioral e e h n d d i health services SFCº in network»SFCnetwork. .

= = o h l ] b ,d i a º e B.

r(1) i"behavioral =health rservices" tmeans eprofessional wand dancillary (1)services "behavioralfor healththe services"treatment, meanshabilitation, mprevention aand nidentification oof dmental millnesses, :substance abuse disorders and trauma spectrum disorders, including inpatient, detoxification, residential treatment and partial hospitalization, intensive outpatient therapy, outpatient therapy and all medications, including brand-name pharmacy drugs when generics are unavailable;

b e d s º o t n = .231379.1AIC March 13, 2025 (2:55pm) s k m e - 5 - e a n e d r e l u [ A d SHPAC/SB 120 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 therapy SFCº, emergency department visits, urgent care visits»SFC and all medications, including brand- name pharmacy drugs when generics are unavailable;

(3) "copayment" means a cost-sharing method that requires a covered person to pay a fixed dollar amount h when health care services are received, with the insurer payingSHPAC/SB u120 »Page r5 paying the balance of the allowable amount;

provided that there may be t h g e different copayment requirements for different types of l i h r i s services under the same group or blanket health insurance h , e h policy, health care plan or certificate of health insurance;

tand u(4) g"cost esharing" bmeans la andcopayment, ecoinsurance, edeductible ,or ghany nother dform dof ifinancial =obligation =of oa hcovered (4)person "costother sharing"than means a copayment,premium lor ]a bshare ,dof i a ºpremium, r coinsurance, deductible or any othercombination form of financialany eof rthese =financial tobligations, eas wdefined dby obligationthe terms of a coveredgroup personor otherblanket thanhealth ainsurance premiumpolicy, orhealth acare shareplan mor acertificate nof ohealth dinsurance. m :

b r e t º o t n = .231379.1AIC March 13, 2025 (2:55pm) s k m e - 6 - e a n e d r e l u [ A d SHPAC/SB 120 of a premium, or any combination of any of these financial obligations, as defined by the terms of a group or blanket health insurance policy, health care plan or certificate of health insurance.

[Until January 1, 2027 ] An individual or group h health maintenance organization contract that is delivered, g o issued for delivery SHPAC/SB 120 Page 6 or renewed in this state that offers t hr g e coverage of behavioral health services shall not impose cost i k h r i s sharing on those behavioral health services SFCº in hnetwork. , t, network»SFC .

e u g e b l B.

e e h n d d i (1) "behavioral health services" means =professional =and oancillary hservices lfor ]the btreatment, ,dhabilitation, iprevention aand ºidentification eof professionalmental illnesses, substance abuse disorders and ancillarytrauma servicesspectrum fordisorders, theincluding treatment,inpatient, rdetoxification, iresidential =treatment rand tpartial ehospitalization, wintensive doutpatient habilitation,therapy, preventionoutpatient therapy and identificationall ofmedications, mentalincluding mbrand-name apharmacy ndrugs owhen dgenerics mare :unavailable;

b e d s º o t n = .231379.1AIC March 13, 2025 (2:55pm) s k m e - 7 - e a n e d r e l u [ A d SHPAC/SB 120 illnesses, substance abuse disorders and trauma spectrum disorders, including inpatient, detoxification, residential treatment and partial hospitalization, intensive outpatient therapy, outpatient therapy SFCº, emergency department visits, urgent care visits»SFC and all medications, including brand- name pharmacy drugs when generics are unavailable;

provided that there may be h different copayment requirements for different types of u » r services under the same individual or group health maintenance t h g e organization contract;

and lSHPAC/SB i120 hPage r7 i s (4) "cost sharing" means a copayment, h , e h coinsurance, deductible or any other form of financial t u g e b l obligation of an enrollee other than a premium or a share of a e e , gh n d d i = = o h premium, or any combination of any of these financial l ] b ,d i a º r obligations, as defined by the terms of an individual or group e r = t e w d health maintenance organization contract.