HB 81 — PHYSICAL REHAB COST SHARING LIMITS

HOUSE BILL 81 TH LEGISLATURE - STATEOFNEWMEXICO- FIRST SESSION, 2019 INTRODUCED BY Eliseo Lee Alcon 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.

ENACTING SECTIONS OF THE HEALTH h CARE PURCHASING ACT, THE NEW MEXICO INSURANCE CODE, THE HEALTH g o MAINTENANCE ORGANIZATION LAW AND THE NONPROFIT HEALTH CARE PLAN t hr g e i k LAW TO ESTABLISH LIMITS ON COST SHARING FOR PHYSICAL h r i s REHABILITATION SERVICES.

h8 , t, e u g e b l e e h BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF NEW MEXICO:

n d d i = = o h SECTION 1.

A new section of the Health Care Purchasing l ] b ,d i a º e Act is enacted to read:

r"PHYSICAL i = r t e w d m a n o "[NEW MATERIAL ] PHYSICAL REHABILITATION SERVICES--LIMITS dON mCOST :SHARING.-- A.

b e d s º o t n = .211805.2 s k m e e a n e d r e l u [ A d ON COST SHARING.-- A.

(1) "physical rehabilitation services" means services aimed at maximizing an individual's level of function, returning to a prior level of function or maintaining or slowing the decline of function, which HB 81/a Page 1 services are provided by or under the direction of a licensed physical therapist, occupational therapist or speech therapist;

and h (2) "primary care services" means the first u » r level of basic or general health care for a person's health t h g e l i needs, including diagnostic and treatment services, initiation h r i s of referrals for other health care services and maintenance of h , e h the continuity of care when appropriate." t u g e b l e e , gh SECTION 2.

A new section of Chapter 59A, Article 22 NMSA n d d i = = o h 1978 is enacted to read:

l"PHYSICAL ] b ,d i a º r "[NEW MATERIAL ] PHYSICAL REHABILITATION SERVICES--LIMITS e r = t e w d m a n o ON COST SHARING.-- dA. m :

b r e t º o t n = .211805.2 s k m e - 2 - e a n e d r e l u [ A d A.

(1) "physical rehabilitation services" means services aimed at maximizing an individual's level of function, returning to a prior level of function or maintaining or slowing the decline of function, which services are provided by or under the direction of a licensed HB 81/a Page 2 physical therapist, occupational therapist or speech therapist;

and (2) "primary care services" means the first level of basic or general health care for a person's health h needs, including diagnostic and treatment services, initiation u » r of referrals for other health care services and maintenance of t h g e l i the continuity of care when appropriate." h r i s SECTION 3.

A new section of Chapter 59A, Article 23 NMSA h , e h 1978 is enacted to read:

t"PHYSICAL u g e b l e e , gh "[NEW MATERIAL ] PHYSICAL REHABILITATION SERVICES--LIMITS n d d i = = o h ON COST SHARING.-- l ] b ,d i a º r A.

A group or blanket health insurance policy, ehealth rcare =plan tor ecertificate wof dhealth minsurance athat nis odelivered, healthissued carefor plandelivery or certificaterenewed ofin healththis insurancestate shall not impose a member cost share for physical rehabilitation services that is dgreater mthan :that for primary care services on a coinsurance percentage basis when coinsurance is applied or on an absolute dollar amount when a copay is applied.

b r e t º o t n = .211805.2 s k m e - 3 - e a n e d r e l u [ A d delivered, issued for delivery or renewed in this state shall not impose a member cost share for physical rehabilitation services that is greater than that for primary care services on a coinsurance percentage basis when coinsurance is applied or on an absolute dollar amount when a copay is applied.

(1) "physical rehabilitation services" means services aimed at maximizing an individual's level of function, returning to a prior level of function or maintaining or slowing the decline of function, which services are provided by or under the direction of a licensed physical therapist, occupational therapist or speech HB 81/a Page 3 therapist;

and (2) "primary care services" means the first level of basic or general health care for a person's health needs, including diagnostic and treatment services, initiation of referrals for other health care services and maintenance of the continuity of care when appropriate." SECTION 4.

A new section of the Health Maintenance Organization Law is enacted to read:

"PHYSICAL REHABILITATION SERVICES--LIMITS ON COST SHARING.-- A.

An individual or group health maintenance contract that is delivered, issued for delivery or renewed in this state shall not impose a member cost share for physical rehabilitation services that is greater than that for primary care services on a coinsurance percentage basis when coinsurance is applied or on an absolute dollar amount when a copay is applied.

B.

As used in this section:

and HB 81/a Page 4 (2) "primary care services" means the first level of basic or general health care for a person's health needs, including diagnostic and treatment services, initiation of referrals for other health care services and maintenance of h the continuity of care when appropriate." u » r SECTION 4.5.

A new section of the Nonprofit Health MaintenanceCare tPlan h g e l i Organization Law is enacted to read:

h"PHYSICAL r i s "[NEW MATERIAL ] PHYSICAL REHABILITATION SERVICES--LIMITS h , e h ON COST SHARING.-- t u g e b l e e , gh A.

An individual or group health maintenancecare nplan d d i = = o h contract that is delivered, issued for delivery or renewed in l ] b ,d i a º r this state shall not impose a member cost share for physical erehabilitation rservices =that tis egreater wthan dthat mfor primary care services on a ncoinsurance opercentage rehabilitationbasis serviceswhen thatcoinsurance is greaterapplied thanor thaton foran primaryabsolute ddollar mamount :when a copay is applied.

b r e t º o t n = .211805.2 s k m e - 4 - e a n e d r e l u [ A d care services on a coinsurance percentage basis when coinsurance is applied or on an absolute dollar amount when a copay is applied.

(1) "physical rehabilitation services" means Hflº ,»Hfl services aimed at maximizing an individual's level of function, returning to a prior level of function or maintaining or slowing the decline of function, which services are provided by or under the direction of a licensed physical therapist, occupational therapist or speech therapist;

and (2) "primary care services" means the first level of basic or general health care for a person's health HB 81/a Page 5 needs, including diagnostic and treatment services, initiation of referrals for other health care services and maintenance of the continuity of care when appropriate." SECTION 5.6.

AEFFECTIVE newDATE.--The sectioneffective date of the Nonprofitprovisions Healthof Carethis hact Planis LawJanuary is1, enacted2020." toHB read:81/a Page 6 7 9 25

u » r "[NEW MATERIAL ] PHYSICAL REHABILITATION SERVICES--LIMITS t h g e l i ON COST SHARING.-- h r i s A.

An individual or group health care plan that is h , e h delivered, issued for delivery or renewed in this state shall t u g e b l e e , gh not impose a member cost share for physical rehabilitation n d d i = = o h services that is greater than that for primary care services l ] b ,d i a º r on a coinsurance percentage basis when coinsurance is applied e r = t e w d m a n o or on an absolute dollar amount when a copay is applied.

d m :

b r e t º o t n = .211805.2 s k m e - 5 - e a n e d r e l u [ A d B.

As used in this section:

(1) "physical rehabilitation services" means Hflº ,»Hfl services aimed at maximizing an individual's level of function, returning to a prior level of function or maintaining or slowing the decline of function, which services are provided by or under the direction of a licensed physical therapist, occupational therapist or speech therapist;