SB 3 — IMMUNIZATION RULES & RECOMMENDATIONS

u [ (2) invoice each health insurer and group .232474.3SA - 6 - health plan to reimburse the department for the cost of vaccines provided directly or indirectly by the department to such health insurer's or group health plan's insured children;

(5) report the failure of a health insurer or group health plan to reimburse the department within thirty days of the date of the invoice to the [office of the attorney general] state department of justice for collection;

and (6) credit all receipts collected from health insurers and group health plans pursuant to the Vaccine e t 17 Purchasing Act to the fund.

w l n d 18 C.

No later than July 1, 2015 and July 1 of each = = 19 a l year thereafter, the department shall estimate the amount to be i a e r 20 expended annually by the department to purchase, store and a t m m 21 distribute vaccines recommended by the [advisory committee on d r e 22 immunization practices] department pursuant to SectionSB 24-5-13 cPage e6 sSection k24-5-1 23 NMSA 1978 to all insured children in the state, including a e a n b 24 reserve of ten percent of the amount estimated.

u [ D.

No later than September 1, 2015 and each quarter .232474.3SA - 7 - thereafter, the department shall invoice each health insurer and each group health plan for one-fourth of its proportionate share of the estimated amount and reserve pursuant to Subsection C of this section, calculated pursuant to Subsection B of Section [6 of the Vaccine Purchasing Act] 24-5A-6 NMSA 1978.

AUTHORIZED USES OF THE VACCINE PURCHASING e t 17 FUND.-- w l n d 18 A.

The fund shall be used for the purchase, storage = = 19 a l and distribution of vaccines, as recommended by the [advisory i a e r 20 committee on immunization practices] department pursuant to a t m m 21 Section 24-5-1 NMSA 1978, for insured children who are not d r e 22 eligible for the vaccines for children program.

cSB e3 sPage k7 23 B.

The department shall credit any balance e a n b 24 remaining in the fund at the end of the fiscal year toward the u [ department's purchase of vaccines the following year;

provided .232474.3SA - 8 - that the department maintains a reserve of ten percent of the amount estimated to be expended in the following year.

A small group health plan and a health insurance e t 17 issuer or multiple employer welfare arrangement offering a w l n d 18 small group or individual health insurance plan that provides = = 19 a l benefits other than excepted benefits shall:

i a e r 20 (1) provide the essential health benefits aSB t3 mPage m8 21 defined by the superintendent under Subsection B of this d r e 22 section;

c e s k 23 (2) limit cost sharing for such coverage in e a n b 24 accordance with Subsection D of this section;

and u [ (3) provide coverage without cost sharing for .232474.3SA - 9 - preventive benefits in accordance with Subsection E of this section.

e t 17 (9) preventive and wellness services and w l n d 18 chronic disease management;

and = = 19 a l (10) pediatric services, including oral and i a e r 20 vision care.

aSB t3 mPage m9 21 C.

In defining the essential health benefits d r e 22 pursuant to Subsection B of this section, the superintendent c e s k 23 shall:

e a n b 24 (1) ensure that such essential health benefits u [ reflect an appropriate balance among the categories described .232474.3SA - 10 - in that subsection, so that benefits are not unduly weighted toward any category;

(5) provide that if a plan is offered through the New Mexico health insurance exchange, another health e t 17 insurance plan offered through the New Mexico health insurance w l n d 18 exchange shall not fail to be treated as a qualified health = = 19 a l plan solely because the plan does not offer coverage of i a e r 20 benefits offered through the standalone plan that areSB otherwise3 aPage t10 mare motherwise 21 required;

and d r e 22 (6) periodically update the essential health c e s k 23 benefits under Subsection B of this section to address any gaps e a n b 24 in access to coverage or changes in the evidence base u [ identified by the superintendent.

.232474.3SA - 11 - D.

The superintendent shall adopt and promulgate rules specifying the maximum cost-sharing amounts for which an insured may be held liable for payment of covered benefits under any health insurance plan that provides benefits other than excepted benefits, including deductibles, coinsurance, e t 17 copayments or similar charge, and any other expenditure w l n d 18 required of an insured individual with respect to essential = = 19 a l health benefits covered under the plan, but not including iSB a3 ePage r11 20 premiums, balance billing amounts for non-network providers or a t m m 21 spending for non-covered services.

d r e 22 F.

Any rules that the office of superintendent of c e s k 23 insurance intends to adopt and promulgate pursuant to this e a n b 24 section shall be adopted no later than the first day of u [ February of the year prior to the first plan year for which the .232474.3SA - 12 - rules would be effective.

(2) immunizations that have in effect a recommendation from the [advisory committee on immunization practices of the federal centers for disease control and prevention] department of health, with respect to the insured for which immunization is considered;

(3) with respect to infants, children and adolescents, preventive care and screenings provided for in the e t 17 comprehensive guidelines supported by the health resources and w l n d 18 services administration of the United States department of = = 19 a l health and human services;

and i a e r 20 (4) with respect to women, additional a t m m 21 preventive care and screenings to those described in ParagraphSB d3 rPage e12 22Paragraph (1) of this subsection, as provided for in comprehensive c e s k 23 guidelines supported by the health resources and services e a n b 24 administration of the United States department of health and u [ human services.

.232474.3SA - 13 - H.

If a health insurance plan is offered as a e t 17 qualified health plan through the New Mexico health insurance w l n d 18 exchange, the insurer offering the qualified health plan shall = = 19 a l also offer that plan through the health insurance exchange as a i a e r 20 plan that restricts enrollment to individuals SB 3 Page 13 who, as of the a t m m 21 beginning of a plan year, have not attained the age of twenty-twenty-one d r e 22 one years.

c e s k 23 J.

e a n b 24 (1) to define terms used regarding forms, u [ rates, reviews and blocks of business that an insurer or health .232474.3SA - 14 - care plan submits in filing matters;

e t 17 (1) coverage-only accident or disability w l n d 18 income insurance;

= = 19 a l (2) coverage issued as a supplement to i a e r 20 liability insurance;

aSB t3 mPage m14 21 (3) liability insurance;

d r e 22 (4) workers' compensation or similar c e s k 23 insurance;

e a n b 24 (5) automobile medical payment insurance;

u [ (6) credit-only insurance;

.232474.3SA - 15 - (7) coverage for on-site medical clinics;

(a) coverage only for a specified e t 17 disease or illness;

or w l n d 18 (b) hospital indemnity or other fixed = = 19 a l indemnity insurance;

and i a e r 20 (11) the following benefits if offered as a aSB t3 mPage m15 21 separate insurance policy:

d r e 22 (a) medicare supplemental health c e s k 23 insurance as defined pursuant to Section 1882(g)(1) of the e a n b 24 federal Social Security Act;

and u [ (b) coverage supplemental to the .232474.3SA - 16 - coverage provided pursuant to Chapter 55 of Title 10 USCA and similar supplemental coverage provided to coverage pursuant to a group health plan." SECTION 8.

[NEW MATERIAL] IMMUNIZATION REGULATIONS.--The public health division of the department of health shall, after consultation with the public education department, promulgate rules governing the immunization against diseases deemed to be dangerous to the public health, to be required of children attending public, private, home or parochial schools in the state.

The immunizations required and the manner and frequency of their administration shall conform to recommendations of the advisory committee on immunization practices of the United States department of health and human services and the American e t 17 academy of pediatrics.

The public health division shall w l n d 18 supervise and secure the enforcement of the required = = 19 a l immunization program." iSB a3 ePage r16 20 SECTION 9.

Section 24-5-2 NMSA 1978 (being Laws 1959, a t m m 21 Chapter 329, Section 2, as amended by Section 2 of this act) is d r e 22 repealed and a new Section 24-5-2 NMSA 1978 is enacted to read:

c e s k 23 "24-5-2.

[NEW MATERIAL] UNLAWFUL TO ENROLL IN SCHOOL eUNIMMUNIZED-- aUNLAWFUL n b 24 UNIMMUNIZED--UNLAWFUL TO REFUSE TO PERMIT IMMUNIZATION.--It is u [ unlawful for any student to enroll in school unless the student .232474.3SA - 17 - has been immunized as required under the rules of the public health division of the department of health and can provide satisfactory evidence of such immunization;

[NEW MATERIAL] DEFINITIONS.--As used in the Vaccine Purchasing Act:

e t 17 A.

"advisory committee on immunization practices" w l n d 18 means the group of medical and public health experts that =SB =3 19Page a17 l develops recommendations on how to use vaccines to control i a e r 20 diseases in the United States, established under Section 222 of a t m m 21 the federal Public Health Service Act;

d r e 22 B.

c e s k 23 C.

e a n b 24 D.

"group health plan" means an employee welfare u [ benefit plan to the extent that the plan provides medical care .232474.3SA - 18 - to employees or their dependents under the federal Employee Retirement Income Security Act of 1974 directly or through insurance, reimbursement or other means;

or (3) otherwise provides a plan of health e t 17 insurance or health benefits;

w l n d 18 G.

"insured child" means a child under the age of =SB =3 19Page a18 l nineteen who is eligible to receive health insurance coverage i a e r 20 from a health insurer or medical care pursuant to a group a t m m 21 health plan;

d r e 22 H.

"office of superintendent" means the office of c e s k 23 superintendent of insurance;

e a n b 24 I.

"policy" means any contract of health insurance u [ between a health insurer and the insured and all clauses, .232474.3SA - 19 - riders, endorsements and parts thereof;

[NEW MATERIAL] STATEWIDE VACCINE PURCHASING PROGRAM.-- A.

e t 17 (1) expand access to childhood immunizations w l n d 18 recommended by the advisory committee on immunization = = 19 a l practices;

iSB a3 ePage r19 20 (2) maintain and improve immunization rates;

a t m m 21 (3) facilitate the acquisition by providers of d r e 22 vaccines for childhood immunizations recommended by the c e s k 23 advisory committee on immunization practices;

and e a n b 24 (4) leverage public and private funding and u [ resources for the purchase, storage and distribution of .232474.3SA - 20 - vaccines for childhood immunizations recommended by the advisory committee on immunization practices.

(4) report the failure of a health insurer to reimburse the department within thirty days of the date of the e t 17 invoice to the office of superintendent;

w l n d 18 (5) report the failure of a health insurer orSB =3 =Page 1920 aor l group health plan to reimburse the department within thirty i a e r 20 days of the date of the invoice to the state department of a t m m 21 justice for collection;

and d r e 22 (6) credit all receipts collected from health c e s k 23 insurers and group health plans pursuant to the Vaccine e a n b 24 Purchasing Act to the fund.

u [ C.

No later than July 1, 2015 and July 1 of each .232474.3SA - 21 - year thereafter, the department shall estimate the amount to be expended annually by the department to purchase, store and distribute vaccines recommended by the advisory committee on immunization practices to all insured children in the state, including a reserve of ten percent of the amount estimated.

The department may update its estimated amount to be expended annually and its reserve to take into account increases or decreases in the cost of vaccines or the costs of additional vaccines that the department determines should be included in the statewide vaccine purchasing program and adjust e t 17 the amount invoiced to each health insurer and group health w l n d 18 plan the following quarter." =SB =3 19Page a21 l SECTION 12.

Section 24-5A-5 NMSA 1978 (being Laws 2015, i a e r 20 Chapter 5, Section 5, as amended by Section 6 of this act) is a t m m 21 repealed and a new Section 24-5A-5 NMSA 1978 is enacted to d r e 22 read:

c e s k 23 "24-5A-5.

[NEW MATERIAL] AUTHORIZED USES OF THE VACCINE e a n b 24 PURCHASING FUND.-- u [ A.

The fund shall be used for the purchase, storage .232474.3SA - 22 - and distribution of vaccines, as recommended by the advisory committee on immunization practices, for insured children who are not eligible for the vaccines for children program.

1396s." eSB t3 17Page 22 SECTION 13.

Section 59A-18-16.2 NMSA 1978 (being Laws w l n d 18 2011, Chapter 144, Section 12, as amended by Section 7 of this = = 19 a l act) is repealed and a new Section 59A-18-16.2 NMSA 1978 is i a e r 20 enacted to read:

a t m m 21 "59A-18-16.2.

[NEW MATERIAL] HEALTH INSURANCE OR HEALTH d r e 22 PLAN FORM AND RATE FILINGS--SUPERINTENDENT--RULEMAKING--FILINGS--SUPERINTENDENT--RULEMAKING--COMPLIANCE c e s k 23 COMPLIANCE WITH FEDERAL LAW.-- e a n b 24 A.

A small group health plan and a health insurance u [ issuer or multiple employer welfare arrangement offering a .232474.3SA - 23 - small group or individual health insurance plan that provides benefits other than excepted benefits shall:

eSB t3 17Page 23 (3) hospitalization;

w l n d 18 (4) maternity and newborn care;

= = 19 a l (5) mental health and substance use disorder i a e r 20 services, including behavioral health treatment;

a t m m 21 (6) prescription drugs;

d r e 22 (7) rehabilitative and habilitative services c e s k 23 and devices;

e a n b 24 (8) laboratory services;

u [ (9) preventive and wellness services and .232474.3SA - 24 - chronic disease management;

(3) take into account the health care needs of diverse segments of the population, including women, children,SB e3 tPage 1724 children, persons with disabilities and other groups;

w l n d 18 (4) ensure that health benefits established as = = 19 a l essential not be subject to denial to individuals against their i a e r 20 wishes on the basis of the individual's age or expected length a t m m 21 of life or of the individual's present or predicted disability, d r e 22 degree of medical dependency or quality of life;

c e s k 23 (5) provide that if a plan is offered through e a n b 24 the New Mexico health insurance exchange, another health u [ insurance plan offered through the New Mexico health insurance .232474.3SA - 25 - exchange shall not fail to be treated as a qualified health plan solely because the plan does not offer coverage of benefits offered through the standalone plan that are otherwise required;

The provisions of this subsection shall not be construed to prevent a group health plan or health insurance plan from SB 3 Page 25 placing annual or lifetime e t 17 per-beneficiary limits on specific covered benefits that are w l n d 18 not essential health benefits, to the extent that these limits = = 19 a l are otherwise permitted under federal or state law.

i a e r 20 E.

The superintendent shall adopt and promulgate a t m m 21 rules specifying the maximum cost-sharing amounts for which an d r e 22 insured may be held liable for payment of covered benefits c e s k 23 under any health insurance plan that provides benefits other e a n b 24 than excepted benefits, including deductibles, coinsurance, u [ copayments or similar charge, and any other expenditure .232474.3SA - 26 - required of an insured individual with respect to essential health benefits covered under the plan, but not including premiums, balance billing amounts for non-network providers or spending for non-covered services.

(1) items or services that have in effect a SB 3 Page 26 rating of "A" or "B" in the current recommendations of the e t 17 United States preventive services task force;

w l n d 18 (2) immunizations that have in effect a = = 19 a l recommendation from the advisory committee on immunization i a e r 20 practices of the federal centers for disease control and a t m m 21 prevention, with respect to the insured for which immunization d r e 22 is considered;

c e s k 23 (3) with respect to infants, children and e a n b 24 adolescents, preventive care and screenings provided for in the u [ comprehensive guidelines supported by the health resources and .232474.3SA - 27 - services administration of the United States department of health and human services;

The superintendent shall establish by rule a minimum interval SB 3 Page 27 between the date on which a recommendation described in Paragraphs (1) and (2) of e t 17 Subsection G of this section or a guideline under Paragraph (3) w l n d 18 of Subsection G of this section is issued and the plan year = = 19 a l with respect to which the requirement described in Subsection G i a e r 20 of this section is effective with respect to the service a t m m 21 described in such recommendation or guideline;

provided that d r e 22 the interval shall not be less than one year from the date the c e s k 23 federal recommendation or guideline is published.

e a n b 24 I.

If a health insurance plan is offered as a u [ qualified health plan through the New Mexico health insurance .232474.3SA - 28 - exchange, the insurer offering the qualified health plan shall also offer that plan through the health insurance exchange as a plan that restricts enrollment to individuals who, as of the beginning of a plan year, have not attained the age of twenty-twenty-one one years.

(4) to meet criteria for review in SB 3 Page 28 accordance with federal law;

and (5) that the superintendent deems appropriate e t 17 to carry out the provisions of Chapter 59A, Article 18 NMSA w l n d 18 1978.

= = 19 a l K.

Except as provided by state or federal rule or i a e r 20 law, nothing in this section shall be construed to prohibit a a t m m 21 health insurance carrier from appropriately using reasonable d r e 22 health care cost management techniques.

c e s k 23 L.

As used in this section, "excepted benefits" e a n b 24 means benefits furnished pursuant to the following:

u [ (1) coverage-only accident or disability .232474.3SA - 29 - income insurance;

SB 3 Page 29 (a) limited scope dental or vision benefits;

e t 17 (b) benefits for long-term care, nursing w l n d 18 home care, home health care, community-based care or any = = 19 a l combination of those benefits;

and i a e r 20 (c) other similar limited benefits a t m m 21 specified in regulations;

d r e 22 (10) the following benefits, offered as c e s k 23 independent noncoordinated benefits:

e a n b 24 (a) coverage only for a specified u [ disease or illness;

or .232474.3SA - 30 - (b) hospital indemnity or other fixed indemnity insurance;

SECTIONSB 15.3 Page 30

EMERGENCY.--It is necessary for the public peace, health and safety that this act take effect immediately.

- 31 - e t 17 w l n d 18 = = 19 a l i a e r 20 a t m m 21 d r e 22 c e s k 23 e a n b 24 u [ .232474.3SA