HB 233 — DIABETIC FOOT ULCER EQUIPMENT COVERAGE

If the superintendent determines that a health care insurer has not complied with the requirements of this section, the superintendent shall HB 233/a Page 7 impose corrective action or use any other enforcement mechanism available to the superintendent to obtain the health care h insurer's compliance with this section.

u » r H.

Absent a change in diagnosis or in a covered t h g e l i person's management or treatment of diabetes or its h r i s complications, a health care insurer shall not require more h , e h than one prior authorization per policy period for any single t u g e b l e e , gh drug or category of item enumerated in this section if n d d i = = o h prescribed as medically necessary by the covered person's l ] b ,d i a º r health care practitioner.

Changes in the prescribed dose of a e r = t e w d m a n o drug;

quantities of supplies needed to administer a prescribed ddrug; m :

b r e t º o t n = .229151.1AIC March 1, 2025 (9:52pm) s k m e - 8 - e a n e d r e l u [ A d drug;

HB 233/a Page 8 (a) means benefits for medically necessary services consisting of preventive care, emergency h care, inpatient and outpatient hospital and physician care, u » r diagnostic laboratory and diagnostic and therapeutic t h g e l i radiological services;

and h r i s (b) does not include services for h , e h alcohol or drug abuse, dental or long-term rehabilitation t u g e b l e e , gh treatment;

and n d d i = = o h (2) "managed health care plan" means a health l ] b ,d i a º r benefit plan offered by a health care insurer that provides for ethe rdelivery =of tcomprehensive ebasic whealth dcare mservices aand nmedically onecessary services to individuals enrolled in the deliveryplan ofthrough comprehensiveits basicown employed health care servicesproviders andor dby mcontracting :with selected or participating health care providers.

b r e t º o t n = .229151.1AIC March 1, 2025 (9:52pm) s k m e - 9 - e a n e d r e l u [ A d medically necessary services to individuals enrolled in the plan through its own employed health care providers or by contracting with selected or participating health care providers.

(g) independent physician-provider HB 233/a Page 9 organizations;

(h) physician hospital-provider h organizations;

and g o t hr (i) managed care services g e i k organizations." h r i s SECTION 2.

Section 59A-23-7.17 NMSA 1978 (being Laws h , t, 2023, Chapter 50, Section 3) is amended to read:

e u g e b l e e h "59A-23-7.17.

COVERAGE FOR INDIVIDUALS WITH DIABETES.-- n d d i = = o h A.

Each group health insurance contract and blanket l ] b ,d i a º e health insurance contract delivered or issued for delivery in rthis istate =shall rprovide tcoverage efor windividuals dwith mdiabetes awho nuse oinsulin, thisindividuals statewith shalldiabetes providewho coveragedo fornot individualsuse insulin and with diabeteselevated dblood mglucose :levels induced by pregnancy.

b e d s º o t n = .229151.1AIC March 1, 2025 (9:52pm) s k m e - 10 - e a n e d r e l u [ A d who use insulin, individuals with diabetes who do not use insulin and with elevated blood glucose levels induced by pregnancy.

The HB 233/a Page 10 amount an individual with diabetes is required to pay for a preferred formulary prescription insulin drug or a medically necessary alternative h is an amount not to exceed a total of twenty-five dollars u » r ($25.00) per thirty-day supply.

t h g e l i C.

When prescribed or diagnosed by a health care h r i s practitioner with prescribing authority, all individuals with h , e h diabetes as described in Subsection A of this section enrolled t u g e b l e e , gh in health policies described in that subsection shall be n d d i = = o h entitled to the following equipment, supplies and appliances to l ] b ,d i a º r treat diabetes:

e r = t e w d m a n o (1) blood glucose monitors, including those dfor mpersons :with disabilities, including the legally blind;

b r e t º o t n = .229151.1AIC March 1, 2025 (9:52pm) s k m e - 11 - e a n e d r e l u [ A d for persons with disabilities, including the legally blind;

(9) medically necessary HHHCºpodiatric :appliances for prevention of feet complications associated with diabetes, including therapeutic molded or depth-inlay shoes, HB 233/a Page 11 functional orthotics, custom molded inserts, replacement inserts, preventive devices and shoe modifications for prevention and treatment;

(a)»HHHC podiatric appliances for prevention of feet complications associated with diabetes, including therapeutic molded or depth-inlay shoes, functional orthotics, custom molded inserts, replacement inserts, h preventive devices and shoe(10) modificationsglucagon foremergency preventionkits. and g o t hr treatment;

andD. g e i k HHHCº(b) durable medical equipment for h r i s the treatment of active diabetic foot ulcers, including topical h , t, e u g oxygen therapy;

and»HHHCWhen eprescribed bor ldiagnosed eby ea hhealth (10)care glucagonpractitioner emergencywith kits.prescribing authority, all individuals with diabetes as described in Subsection A of this section enrolled in health policies described in that subsection shall be entitled to the following basic health care benefits:

n d d i = = o h D.

When prescribed or diagnosed by a health care l ] b ,d i a º e practitioner with prescribing authority, all individuals with r i = r t e w d m a n o diabetes as described in Subsection A of this section enrolled d m :

b e d s º o t n = .229151.1AIC March 1, 2025 (9:52pm) s k m e - 12 - e a n e d r e l u [ A d in health policies described in that subsection shall be entitled to the following basic health care benefits:

HHHCº and»HHHC (2) medical nutrition therapy related to h diabetes managementmanagement; HHHCº;

and gHB o233/a tPage hr12 (3) medically necessary treatment of active g e i k diabetic foot ulcers, including topical oxygen therapy»HHHCtherapy. .

h r i s E.

When new or improved equipment, appliances, h , t, e u g prescription drugs for the treatment of diabetes, insulin or e b l e e h supplies for the treatment of diabetes are approved by the n d d i = = o h federal food and drug administration, all individual or group l ] b ,d i a º e health insurance policies as described in Subsection A of this r i = r t e w d m a n o section shall:

d(1) mmaintain :an adequate formulary to provide those resources to individuals with diabetes;

b e d s º o t n = .229151.1AIC March 1, 2025 (9:52pm) s k m e - 13 - e a n e d r e l u [ A d (1) maintain an adequate formulary to provide those resources to individuals with diabetes;

(1) maintain an adequate network of durable medical equipment suppliers and other suppliers to provide covered persons with medically necessary diabetes resources whether covered under the health policy's prescription drug or h medical benefit;

uHB »233/a rPage 13 (2) have network contracts in place for the t h g e l i entire policy or plan period and shall not allow contracts with h r i s network providers, durable medical equipment suppliers and h , e h other suppliers to lapse or terminate without ensuring the t u g e b l e e , gh availability of a replacement and continuity of care;

provided n d d i = = o h that single-case agreements do not satisfy the requirements of l ] b ,d i a º r Paragraph (1) of this subsection or this paragraph;

e(3) rmonitor =network tproviders, edurable wmedical dequipment msuppliers and other network suppliers to ensure that medically necessary equipment, appliances, supplies and insulin or other prescription drugs are being delivered to a ncovered operson (3)in monitora networktimely providers,manner durableand medicalwhen dneeded mby :the covered person;

b(4) rguarantee ereimbursement tto ºa ocovered tperson nwithin =thirty .229151.1AICdays Marchfollowing 1,receipt 2025of (9:52pm)a swritten kdemand mfrom ethe -covered 14person -who epays aout nof epocket dfor rnecessary eequipment, lappliances, usupplies [and Ainsulin dor equipmentother suppliersprescription anddrugs otherdescribed networkin suppliersthis tosection ensure that medicallyare necessarynot equipment,delivered appliances,in suppliesa andtimely insulinmanner orto otherthe prescriptioncovered drugsperson, areand beingthe deliveredportion toof apayment coveredfor personwhich inthe apatient timelyis mannerresponsible andshall whennot neededexceed bythe amount for the same covered person;benefit obtained from a contracted supplier;

(4)(5) guaranteepay reimbursementinterest toat athe coveredrate person within thirty days following receipt of aeighteen writtenpercent demandper fromyear on the coveredamount person who pays out of pocketreimbursement fordue necessaryto equipment, appliances, supplies and insulin or other prescription drugs described in this section that are not delivered in a timelyHB manner233/a toPage the14 covered person andif the portion of payment for which the patient is responsible shall not exceedpaid thewithin amountthirty fordays theas samerequired coveredby benefitParagraph obtained(4) fromof athis contractedsubsection; supplier;

(5)(6) paybeginning interest at the rate of eighteen percent per year on theApril amount1, of2024, reimbursementsubmit due to a hwritten coveredreport personeach ifquarter notto paidthe withinsuperintendent thirtyfor daysthe asprevious requiredquarter byon uthe »following rmetrics: Paragraph (4) of this subsection;

t(a) hthe gnumber eof l i (6) beginning on April 1, 2024, submit a h r i s written reportdemands each quarter to the superintendent for thereimbursement hof ,out-of-pocket eexpenses hfrom previouscovered quarterpersons onreceived by the followinghealth metrics:care insurer;

t(b) u g e b l e e , gh (a) the number of writtenout-of-pocket demandsclaims for nreimbursement dpaid dand ithe =aggregate =amount o h reimbursement of out-of-pocketclaims expensesreimbursed fromby coveredthe personshealth lcare ]insurer bwithin ,dthe itime arequired º r received by theParagraph health(4) careof insurer;this subsection;

e r = t e w d m a n o (b) the number of out-of-pocket claims d m :

b r e t º o t n = .229151.1AIC March 1, 2025 (9:52pm) s k m e - 15 - e a n e d r e l u [ A d for reimbursement paid and the aggregate amount of claims reimbursed by the health care insurer within the time required by Paragraph (4) of this subsection;

hHB 233/a Page 15 (a) the name, address and telephone u » r number of each supplier and, if applicable, the corresponding t h g e l i date upon which the respective supplier's contract expired, h r i s lapsed or was terminated during the previous quarter;

h , e h (b) the percentage of total deliveries, t u g e b l e e , gh by description of item, that did not meet the delivery n d d i = = o h requirements specified in Paragraph (3) of this subsection;

and l ] b ,d i a º r (c) the number of complaints received by e r = t e w d m a n o the health care insurer or its agent during the previous dquarter mrelated :to late deliveries, incomplete orders or incorrect orders, respectively.

b r e t º o t n = .229151.1AIC March 1, 2025 (9:52pm) s k m e - 16 - e a n e d r e l u [ A d quarter related to late deliveries, incomplete orders or incorrect orders, respectively.

Absent a change in diagnosis or in a covered person's management or treatment of diabetes or its complications, a health care insurer shall not require more than one prior authorization per policy period for any single HB 233/a Page 16 drug or category of item enumerated in this section if h prescribed as medically necessary by the covered person's u » r health care practitioner.

Changes in the prescribed dose of a t h g e l i drug;

quantities of supplies needed to administer a prescribed h r i s drug;

quantities of blood glucose self-testing equipment and h , e h supplies;

or quantities of supplies needed to use or operate t u g e b l e e , gh devices for which a covered person has received prior n d d i = = o h authorization during the policy year shall not be subject to l ] b ,d i a º r additional prior authorization requirements in the same policy e r = t e w d m a n o year if prescribed as medically necessary by the covered dperson's mhealth :care practitioner.

b r e t º o t n = .229151.1AIC March 1, 2025 (9:52pm) s k m e - 17 - e a n e d r e l u [ A d person's health care practitioner.

and (2) does not include services for alcohol or drug abuse, dental or long-term rehabilitation treatment." HB 233/a Page 17 SECTION 3.

Section 59A-46-43 NMSA 1978 (being Laws 1997, h Chapter 7, Section 3 and Laws 1997, Chapter 255, Section 3, as g o t hr amended) is amended to read:

g e i k "59A-46-43.

COVERAGE FOR INDIVIDUALS WITH DIABETES.-- h r i s A.

Each individual and group health maintenance h , t, organization contract delivered or issued for delivery in this e u g e b l e e h state shall provide coverage for individuals with insulin-using n d d i = = o h diabetes, with non-insulin-using diabetes and with elevated l ] b ,d i a º e blood glucose levels induced by pregnancy.

This coverage shall rbe ia =basic rhealth tcare eservice wand dshall mentitle aeach nindividual oto bethe amedically basicaccepted healthstandard of medical care servicefor diabetes and benefits for diabetes treatment as well as diabetes supplies, and this coverage shall entitlenot eachbe dreduced mor :eliminated.

b e d s º o t n = .229151.1AIC March 1, 2025 (9:52pm) s k m e - 18 - e a n e d r e l u [ A d individual to the medically accepted standard of medical care for diabetes and benefits for diabetes treatment as well as diabetes supplies, and this coverage shall not be reduced or eliminated.

HB 233/a Page 18 C.

When prescribed or diagnosed by a health care h practitioner with prescribing authority, all individuals with u » r diabetes as described in Subsection A of this section enrolled t h g e l i under an individual or group health maintenance organization h r i s contract shall be entitled to the following equipment, supplies h , e h and appliances to treat diabetes:

t u g e b l e e , gh (1) blood glucose monitors, including those n d d i = = o h for individuals with disabilities, including the legally blind;

l ] b ,d i a º r (2) test strips for blood glucose monitors;

e r = t e w d m a n o (3) visual reading urine and ketone strips;

d(4) mlancets :and lancet devices;

b r e t º o t n = .229151.1AIC March 1, 2025 (9:52pm) s k m e - 19 - e a n e d r e l u [ A d (4) lancets and lancet devices;

(9) medically necessary HHHCºpodiatric :appliances for prevention of feet complications associated with diabetes, including therapeutic molded or depth-inlay shoes, functional orthotics, custom molded inserts, replacement inserts, preventive devices and shoe modifications for prevention and treatment;

(a)»HHHCand podiatricHB appliances233/a forPage prevention19 of(10) feetglucagon complicationsemergency associatedkits. with diabetes, including therapeutic molded or depth-inlay shoes, functional orthotics, custom molded inserts, replacement inserts, preventive devices and shoe modifications for prevention and treatment;

andD. HHHCº(b) durable medical equipment for h the treatment of active diabetic foot ulcers, including topical g o t hr oxygen therapy;

and»HHHCWhen gprescribed eor idiagnosed kby (10)a glucagonhealth emergencycare kits.practitioner with prescribing authority, all individuals with diabetes as described in Subsection A of this section enrolled under an individual or group health maintenance contract shall be entitled to the following basic health care services:

h(1) rdiabetes iself-management straining D.that shall be provided by a certified, registered or licensed health care professional with recent education in diabetes management, which shall be limited to:

When prescribed or diagnosed by a health care h , t, e u g practitioner with prescribing authority, all individuals with e b l e e h diabetes as described in Subsection A of this section enrolled n d d i = = o h under an individual or group health maintenance contract shall l ] b ,d i a º e be entitled to the following basic health care services:

r i = r t e w d m a n o (1) diabetes self-management training that d m :

b e d s º o t n = .229151.1AIC March 1, 2025 (9:52pm) s k m e - 20 - e a n e d r e l u [ A d shall be provided by a certified, registered or licensed health care professional with recent education in diabetes management, which shall be limited to:

When new or improved equipment, appliances, prescription drugs for the treatment of diabetes, insulin or h supplies for the treatment of diabetes are approved by the uHB »233/a rPage 20 federal food and drug administration, each individual or group t h g e l i health maintenance organization contract shall:

h r i s (1) maintain an adequate formulary to provide h , e h these resources to individuals with diabetes;

and t u g e b l e e , gh (2) guarantee reimbursement or coverage for n d d i = = o h the equipment, appliances, prescription drug, insulin or l ] b ,d i a º r supplies described in this subsection within the limits of the e r = t e w d m a n o health care plan, policy or certificate.

dF. m :

b r e t º o t n = .229151.1AIC March 1, 2025 (9:52pm) s k m e - 21 - e a n e d r e l u [ A d F.

provided h that single-case agreements do not satisfy the requirementsHB of233/a uPage »21 rrequirements of Paragraph (1) of this subsection or this paragraph;

t h g e l i (3) monitor network providers, durable medical h r i s equipment suppliers and other network suppliers to ensure that h , e h medically necessary equipment, appliances, supplies and insulin t u g e b l e e , gh or other prescription drugs are being delivered to an enrollee n d d i = = o h in a timely manner and when needed by the enrollee;

l(4) ]guarantee breimbursement ,dto ian aenrollee ºwithin rthirty (4)days guaranteefollowing reimbursementreceipt toof ana written demand from the enrollee ewho rpays =out tof epocket wfor dnecessary mequipment, aappliances, nsupplies oand withininsulin thirtyor daysother followingprescription receiptdrugs described in this section that are not delivered timely to the enrollee, and the portion of apayment writtenfor demandwhich the patient is responsible shall not exceed the amount for the same covered benefit obtained from da mcontracted :supplier;

b r e t º o t n = .229151.1AIC March 1, 2025 (9:52pm) s k m e - 22 - e a n e d r e l u [ A d the enrollee who pays out of pocket for necessary equipment, appliances, supplies and insulin or other prescription drugs described in this section that are not delivered timely to the enrollee and the portion of payment for which the patient is responsible shall not exceed the amount for the same covered benefit obtained from a contracted supplier;

(a) the number of written demands for reimbursement of out-of-pocket expenses from enrollees HB 233/a Page 22 received by the health maintenance organization;

h (b) the number of out-of-pocket claims u » r for reimbursement paid and the aggregate amount of claims t h g e l i reimbursed by the health maintenance organization within the h r i s time required by Paragraph (4) of this subsection;

h , e h (c) the number of out-of-pocket claims t u g e b l e e , gh for reimbursement paid more than thirty days following receipt n d d i = = o h of a written demand and the aggregate amount of these payments, l ] b ,d i a º r excluding interest;

and e(d) rthe =aggregate tamount eof winterest dpaid mby athe nhealth omaintenance (d)organization thepursuant aggregateto amountParagraph (5) of interestthis dsubsection; m :

b r e t º o t n = .229151.1AIC March 1, 2025 (9:52pm) s k m e - 23 - e a n e d r e l u [ A d paid by the health maintenance organization pursuant to Paragraph (5) of this subsection;

HB 233/a Page 23 and (c) the number of complaints received by h the health maintenance organization or its agent during the u » r previous quarter related to late deliveries, incomplete orders t h g e l i or incorrect orders, respectively.

h r i s G.

The superintendent shall annually audit all h , e h health maintenance organizations offering contracts as t u g e b l e e , gh described in Subsection A of this section for compliance with n d d i = = o h the requirements of this section.

If the superintendent l ] b ,d i a º r determines that a health maintenance organization has not ecomplied rwith =the trequirements eof wthis dsection, mthe asuperintendent nshall oimpose compliedcorrective withaction theor requirementsuse ofany thisother section,enforcement mechanism available to the dsuperintendent mto :obtain the health maintenance organization's compliance with this section.

b r e t º o t n = .229151.1AIC March 1, 2025 (9:52pm) s k m e - 24 - e a n e d r e l u [ A d superintendent shall impose corrective action or use any other enforcement mechanism available to the superintendent to obtain the health maintenance organization's compliance with this section.

or quantities of HB 233/a Page 24 supplies needed to use or operate devices for which an enrollee has received prior authorization during the policy year shall not be subject to additional prior h authorization requirements in the same policy year if u » r prescribed as medically necessary by the enrollee's health care t h g e l i practitioner.

Nothing in this subsection shall be construed to h r i s require payment for diabetes resources that are not a covered h , e h benefit.

t u g e b l e e , gh I.

The provisions of this section do not apply to n d d i = = o h short-term travel, accident-only or limited or specified l ] b ,d i a º r disease policies.

e r = t e w d m a n o J.

For purposes of this section, "basic health care dbenefits": m :

b r e t º o t n = .229151.1AIC March 1, 2025 (9:52pm) s k m e - 25 - e a n e d r e l u [ A d benefits":

Each health care plan delivered or issued for delivery in this state shall provide coverage for individuals HB 233/a Page 25 with diabetes who use insulin, individuals with diabetes who do not use insulin and with elevated blood glucose levels induced by pregnancy.

This coverage shall be a basic health care h benefit and shall entitle each individual to the medically u » r accepted standard of medical care for diabetes and benefits for t h g e l i diabetes treatment as well as diabetes supplies, and this h r i s coverage shall not be reduced or eliminated.

h , e h B.

Except as otherwise provided in this subsection, t u g e b l e e , gh coverage for individuals with diabetes may be subject to n d d i = = o h deductibles and coinsurance consistent with those imposed on l ] b ,d i a º r other benefits under the same plan as long as the annual edeductibles ror =coinsurance tfor ebenefits ware dno mgreater athan nthe oannual deductibles or coinsurance established for similar benefits arewithin noa greatergiven thanplan. the d m :

b r e t º o t n = .229151.1AIC March 1, 2025 (9:52pm) s k m e - 26 - e a n e d r e l u [ A d annual deductibles or coinsurance established for similar benefits within a given plan.

(1) blood glucose monitors, including those HB 233/a Page 26 for persons with disabilities, including the legally blind;

h (4) lancets and lancet devices;

g o t hr (5) insulin;

g e i k (6) injection aids, including those adaptable h r i s to meet the needs of persons with disabilities, including the h , t, legally blind;

e u g e b l e e h (7) syringes;

n d d i = = o h (8) prescriptive oral agents for controlling l ] b ,d i a º e blood sugar levels;

r(9) imedically =necessary rpodiatric tappliances efor wprevention dof mfeet acomplications nassociated owith (9)diabetes, medicallyincluding necessarytherapeutic HHHCºmolded :or depth-inlay shoes, functional orthotics, custom molded inserts, replacement inserts, preventive devices and shoe modifications for prevention and treatment;

dand m(10) :glucagon emergency kits.

b e d s º o t n = .229151.1AIC March 1, 2025 (9:52pm) s k m e - 27 - e a n e d r e l u [ A d (a)»HHHC podiatric appliances for prevention of feet complications associated with diabetes, including therapeutic molded or depth-inlay shoes, functional orthotics, custom molded inserts, replacement inserts, preventive devices and shoe modifications for prevention and treatment;

and HHHCº(b) durable medical equipment for the treatment of active diabetic foot ulcers, including topical oxygen therapy;

and»HHHC (10) glucagon emergency kits.

(1) diabetes self-management training that hHB 233/a Page 27 shall be provided by a certified, registered or licensed health u » r care professional with recent education in diabetes management, t h g e l i which shall be limited to:

h r i s (a) medically necessary visits upon the h , e h diagnosis of diabetes;

t u g e b l e e , gh (b) visits following a diagnosis from a n d d i = = o h health care practitioner that represents a significant change l ] b ,d i a º r in the patient's symptoms or condition that warrants changes in e r = t e w d m a n o the patient's self-management;

and d(c) mvisits :when re-education or refresher training is prescribed by a health care practitioner with prescribing authority;

b(2) rmedical enutrition ttherapy ºrelated oto tdiabetes nmanagement; = .229151.1AIC March 1, 2025 (9:52pm) s k m e - 28 - e a n e d r e l u [ A d (c) visits when re-education or refresher training is prescribed by a health care practitioner with prescribing authority;

HHHCºand and»HHHC(3) (2)medically medicalnecessary nutritiontreatment therapyof relatedactive todiabetic diabetesfoot managementulcers, HHHCº;including topical oxygen therapy.

and (3) medically necessary treatment of active diabetic foot ulcers, including topical oxygen therapy»HHHC .

and (2) guarantee reimbursement or coverage for the equipment, appliances, prescription drugs, insulin or hHB 233/a Page 28 supplies described in this subsection within the limits of the g o t hr health care plan.

g e i k F.

A health care plan that requires a subscriber to h r i s use a specific network provider or to purchase equipment, h , t, e u g appliances, supplies or insulin or prescription drugs for the e b l e e h treatment or management of diabetes from a specific durable n d d i = = o h medical equipment supplier or other supplier as a condition of l ] b ,d i a º e coverage, payment or reimbursement shall:

r(1) imaintain =an radequate tnetwork eof wdurable dmedical mequipment asuppliers nand oother (1)suppliers maintainto anprovide adequatesubscribers networkwith ofmedically durablenecessary ddiabetes mresources :whether covered under the health care plan's prescription drug or medical benefit;

b e d s º o t n = .229151.1AIC March 1, 2025 (9:52pm) s k m e - 29 - e a n e d r e l u [ A d medical equipment suppliers and other suppliers to provide subscribers with medically necessary diabetes resources whether covered under the health care plan's prescription drug or medical benefit;

(3) monitor network providers, durable medical equipment suppliers and other network suppliers to ensure that medically necessary equipment, appliances, supplies and insulin or other prescription drugs are being HB 233/a Page 29 delivered to a subscriber in a timely manner and when needed by the subscriber;

h (4) guarantee reimbursement to a subscriber u » r within thirty days following receipt of a written demand from t h g e l i the subscriber who pays out of pocket for necessary equipment, h r i s appliances, supplies and insulin or other prescription drugs h , e h described in this section that are not delivered timely to the t u g e b l e e , gh subscriber and the portion of payment for which the patient is n d d i = = o h responsible shall not exceed the amount for the same covered l ] b ,d i a º r benefit obtained from a contracted supplier;

e(5) rpay =interest tat ethe wrate dof meighteen percent per year on the amount of reimbursement due to a nsubscriber oif (5)not paypaid interestwithin atthirty thedays rateas ofrequired eighteenby dParagraph m(4) :of this subsection;

b r e t º o t n = .229151.1AIC March 1, 2025 (9:52pm) s k m e - 30 - e a n e d r e l u [ A d percent per year on the amount of reimbursement due to a subscriber if not paid within thirty days as required by Paragraph (4) of this subsection;

HB 233/a Page 30 (c) the number of out-of-pocket claims for reimbursement paid more than thirty days following receipt of a written demand and the aggregate amount of these payments, h excluding interest;

and u » r (d) the aggregate amount of interest t h g e l i paid by the health care plan pursuant to Paragraph (5) of this h r i s subsection;

and h , e h (7) beginning on April 1, 2024, submit a t u g e b l e e , gh written report each quarter for the previous quarter to the n d d i = = o h superintendent with the following information for each durable l ] b ,d i a º r medical equipment supplier or other supplier that was under e r = t e w d m a n o contract with the health care plan or its agent during the dprevious mquarter: :

b r e t º o t n = .229151.1AIC March 1, 2025 (9:52pm) s k m e - 31 - e a n e d r e l u [ A d previous quarter:

HB 233/a Page 31 G.

If the superintendent determines that a health care plan has not h complied with the requirements of this section, the u » r superintendent shall impose corrective action or use any other t h g e l i enforcement mechanism available to the superintendent to obtain h r i s the health care plan's compliance with this section.

h , e h H.

Absent a change in diagnosis or in a t u g e b l e e , gh subscriber's management or treatment of diabetes or its n d d i = = o h complications, a health care plan shall not require more than l ] b ,d i a º r one prior authorization per plan period for any single drug or e r = t e w d m a n o category of item enumerated in this section if prescribed as dmedically mnecessary :by the subscriber's health care practitioner.

b r e t º o t n = .229151.1AIC March 1, 2025 (9:52pm) s k m e - 32 - e a n e d r e l u [ A d medically necessary by the subscriber's health care practitioner.

Nothing in this subsection shall be construed to require payment for diabetes resources that HB 233/a Page 32 are not covered benefits.

(2) an excepted benefit health care plan intended to supplement major medical coverage, including h medicare supplement, vision, dental, disease-specific, g o t hr accident-only or hospital indemnity-only insurance policies;

g e i k (3) a policy or plan for long-term care or h r i s disability income;

or h , t, (4) short-term travel policy or plan.

e u g e b l e e h J.

For purposes of this section, "basic health care n d d i = = o h benefits":

l ] b ,d i a º e (1) means benefits for medically necessary rservices iconsisting =of rpreventive tcare, eemergency wcare, dinpatient mand aoutpatient nhospital oand servicesphysician consistingcare, ofdiagnostic preventivelaboratory care,and emergencydiagnostic care,and dtherapeutic mradiological :services;

band e(2) ddoes snot ºinclude oservices tfor nalcohol =or .229151.1AICdrug Marchabuse, 1,dental 2025or (9:52pm)long-term srehabilitation ktreatment." mSECTION e5. - 33 - e a n e d r e l u [ A d inpatient and outpatient hospital and physician care, diagnostic laboratory and diagnostic and therapeutic radiological services;

andEFFECTIVE (2)DATE.--The doeseffective notdate includeof servicesthe forprovisions alcoholof orthis drugact abuse,is dentalJanuary or1, long-term2026. rehabilitation treatment." HCEDCº SECTION 5.

APPLICABILITY.--TheHB provisions233/a ofPage this33 act25 apply to self-insurance provided pursuant to the Health Care Purchasing Act, individual and group health insurance policies, health care plans, certificates of health insurance, managed health care plans, contracts of health insurance, group health plans provided through a cooperative, individual and group health maintenance organization contracts, health benefit plans and group health coverage that are offered, delivered or issued for delivery, renewed, extended or amended in New Mexico on or after January 1, 2026.»HCEDC HCEDCºSECTION 5.

EFFECTIVE DATE.--The effective date of h the provisions of this act is January 1, 2026.»HCEDC u » r t h - 34 - g e l i h r i s h , e h t u g e b l e e , gh n d d i = = o h l ] b ,d i a º r e r = t e w d m a n o d m :

b r e t º o t n = .229151.1AIC March 1, 2025 (9:52pm) s k m e e a n e d r e l u [ A d