SB 309 — INSURANCE ULTRASOUND AUTHORIZATIONS

SENATE BILL 309 TH LEGISLATURE - STATEOFNEWMEXICO- FIRST SESSION, 2019 INTRODUCED BY Elizabeth “Liz” Stefanics and Melanie A.

Stansbury Pursuant to House Rule 24-1, this document incorporates amendments that have been adopted prior to consideration of this measure by the House.

It is a tool to show the amendments in context and is not to be used for the purpose of amendments.

PROHIBITING PRIOR AUTHORIZATION h FOR GYNECOLOGICAL OR OBSTETRICAL ULTRASOUNDS;

DECLARING AN g o t hr EMERGENCY.

g6 e i k h r i s BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF NEW MEXICO:

h , t, e u g SECTION 1.

A new section of the Health Care Purchasing e b l e e h Act is enacted to read:

n"PRIOR d d i = = o h "[NEW MATERIAL ] PRIOR AUTHORIZATION FOR GYNECOLOGICAL OR l ] b ,d i a º e OBSTETRICAL ULTRASOUNDS PROHIBITED.-- r i = r t e w d m a n o A.

Group health coverage, including any form of dself-insurance, moffered, :issued or renewed under the Health Care Purchasing Act that provides coverage for gynecological or obstetrical ultrasounds shall not require prior authorization for gynecological or obstetrical ultrasounds.

bB. e d s º o t n = .211869.1 s k m e e a n e d r e l u [ A d self-insurance, offered, issued or renewed under the Health Care Purchasing Act that provides coverage for gynecological or obstetrical ultrasounds shall not require prior authorization for gynecological or obstetrical ultrasounds.

SPACº B.

or (2) a covered benefit.»SPACbenefit. SPACºB.

C.»SPACC. As used in this section, "prior authorization" means advance approval that is required as a condition precedent to payment for medical care or related benefits rendered to a covered person, including prospective or utilization review conducted prior to the provision of covered medical care or related benefits." SECTION 2.

AAs newused sectionin ofthis thesection, Public"prior Assistanceauthorization" Actmeans advance approval that is hrequired enactedas a condition precedent to read:payment for medical care or related benefits rendered to a covered person, including prospective or SB 309 utilization review conducted prior to the provision of Page 1 covered medical care or related benefits." SECTION 2.

gA onew tsection hrof "[NEWthe MATERIAL]Public PRIORAssistance AUTHORIZATIONAct FORis GYNECOLOGICALenacted ORto gread: e i k OBSTETRICAL ULTRASOUNDS PROHIBITED.-- h r i s A.

The"PRIOR departmentAUTHORIZATION shallFOR prohibitGYNECOLOGICAL itsOR medicaidOBSTETRICAL hULTRASOUNDS ,PROHIBITED.-- t,A. e u g managed care and fee-for-service contractors from requiring e b l e e h prior authorization for gynecological or obstetrical n d d i = = o h ultrasounds.

lThe ]department bshall ,dprohibit iits amedicaid ºmanaged ecare rand ifee-for-service =contractors rfrom SPACºrequiring B.prior authorization for gynecological or obstetrical ultrasounds.

NothingB. in this section shall be construed t e w d m a n o to require payment for a gynecological or obstetrical d m :

bNothing ein dthis ssection ºshall obe tconstrued nto =require .211869.1payment sfor k m e - 2 - e a ngynecological eor dobstetrical r e l u [ A d ultrasound that is not:

or (2) a covered benefit.»SPACbenefit. SPACºB.

C.»SPACC. As used in this section, "prior authorization" means advance approval that is required as a condition precedent to payment for medical care or related benefits rendered to a covered person, including prospective or utilization review conducted prior to the provision of covered medical care or related benefits." SECTION 3.

AAs newused sectionin ofthis Chaptersection, 59A,"prior Articleauthorization" 22means NMSAadvance approval that is enactedrequired as a condition precedent to read:payment for medical care or related benefits rendered to a covered person, including prospective or utilization review conducted prior to the provision of covered medical care or related benefits." SECTION 3.

"[NEWA MATERIAL]new PRIORsection AUTHORIZATIONof FORChapter GYNECOLOGICAL59A, ORArticle OBSTETRICAL22 ULTRASOUNDSNMSA PROHIBITED.--1978 A.is enacted to read:

An"PRIOR individualAUTHORIZATION orFOR groupGYNECOLOGICAL healthOR insuranceOBSTETRICAL policy,ULTRASOUNDS healthPROHIBITED.-- careA. plan or certificate of insurance that is delivered, issued for delivery or renewed in this state and that provides h coverage for gynecological or obstetrical ultrasounds shall not g o t hr require prior authorization for gynecological or obstetrical g e i k ultrasounds.

hAn rindividual ior sgroup SPACºhealth B.insurance policy, SB 309 Page 2 health care plan or certificate of insurance that is delivered, issued for delivery or renewed in this state and that provides coverage for gynecological or obstetrical ultrasounds shall not require prior authorization for gynecological or obstetrical ultrasounds.

NothingB. in this section shall be construed h , t, e u g to require payment for a gynecological or obstetrical e b l e e h ultrasound that is not:

nNothing din dthis isection =shall =be oconstrued hto (1)require medicallypayment necessary;for a gynecological or obstetrical ultrasound that is not:

or(1) lmedically ]necessary; b ,d i a º e r i = r (2) a covered benefit.»SPAC t e w d m a n o SPACºB.

C.»SPACor As(2) useda incovered thisbenefit. section, "prior d m :

bC. e d s º o t n = .211869.1 s k m e - 3 - e a n e d r e l u [ A d authorization" means advance approval that is required by a health insurance policy, health care plan or certificate of insurance as a condition precedent to payment for medical care or related benefits rendered to a covered person, including prospective or utilization review conducted prior to the provision of covered medical care or related benefits." SECTION 4.

AAs newused sectionin ofthis Chaptersection, 59A,"prior Articleauthorization" 23means NMSAadvance approval that is enactedrequired by a health insurance policy, health care plan or certificate of insurance as a condition precedent to read:payment for medical care or related benefits rendered to a covered person, including prospective or utilization review conducted prior to the provision of covered medical care or related benefits." SECTION 4.

"[NEWA MATERIALnew ]section PRIORof AUTHORIZATIONChapter FOR59A, GYNECOLOGICALArticle OR23 OBSTETRICALNMSA ULTRASOUNDS1978 PROHIBITED.--is A.enacted to read:

A"PRIOR blanketAUTHORIZATION orFOR groupGYNECOLOGICAL healthOR insuranceOBSTETRICAL policyULTRASOUNDS orPROHIBITED.-- contractA. that is delivered, issued for delivery or renewed in this state and that provides coverage for gynecological or obstetrical ultrasounds shall not require prior authorization for gynecological or obstetrical ultrasounds.

SPACºA B.blanket or group health insurance policy or contract that is delivered, issued for delivery or renewed in this state and that provides coverage for gynecological or obstetrical ultrasounds shall not require prior authorization SB 309 Page 3 for gynecological or obstetrical ultrasounds.

NothingB. in this section shall be construed h to require payment for a gynecological or obstetrical u » r ultrasound that is not:

tNothing hin gthis esection lshall ibe (1)construed medicallyto necessary;require payment for a gynecological or obstetrical ultrasound that is not:

or(1) hmedically rnecessary; i s (2) a covered benefit.»SPAC h , e h SPACºB.

C.»SPAC As used in this section, "prior t u g e b l e e , gh authorization" means advance approval that is required by n d d i = = o h blanket or group(2) health insurance policy or contract as a l ] b ,d i a º r condition precedent to payment for medical care or related e r = t e w d m a n o benefits rendered to a covered person,benefit. including prospective or d m :

bC. r e t º o t n = .211869.1 s k m e - 4 - e a n e d r e l u [ A d utilization review conducted prior to the provision of covered medical care or related benefits." SECTION 5.