New Mexico 2019 Regular Session Status: Passed House 1 D cosponsors

HB 70 — INSURANCE COVERAGE FOR PROSTHETICS

Last action — action postponed indefinitely

Track this bill free

No card. One bill, free forever — alerts when it moves.

  1. ✓
    Introduced
  2. ✓
    In Committee
  3. 3
    Passed House
  4. 4
    Passed Senate
  5. 5
    To Executive
  6. 6
    Enacted

This bill died with 2019 Regular Session. It reached “Passed House” and never advanced before the session ended, so it can no longer move — a new version would have to be reintroduced in the current session.

This bill is no longer active — its legislative session has ended, so there is no live prognosis. It would have to be reintroduced in the current session to move again.

Bill Text

What changed in the latest version

373 added · 294 removed

Plain-language change summary

The recent amendments to House Bill 70 clarify that it requires health care coverage for expenses related to prosthetics and custom orthotic devices. This change is important because it helps ensure that individuals who need these medical devices receive financial support, which can significantly improve their quality of life and mobility. The new language of the bill emphasizes the commitment to enhancing health care accessibility for those in need of specialized medical equipment.

→
Previous
Latest
HOUSE BILL 70 54TH LEGISLATURE - STATEOFNEWMEXICO- FIRST SESSIO, 2019 INTRODUCED BY Elizabeth "Liz" Thomson 6 8 FOR THE LEGISLATIVE HEALTH AND HUMAN SERVICES COMMITTEE 10 AN ACT RELATING TO HEALTH CARE COVERAGE;
HOUSE BILL 70 TH LEGISLATURE - STATEOFNEWMEXICO- FIRST SESSION, 2019 INTRODUCED BY Elizabeth "Liz" Thomson Pursuant to House Rule 24-1, this document incorporates amendments that have been adopted prior to consideration of this measure by the House.
ENACTING NEW SECTIONS OF THE HEALTH CARE PURCHASING ACT AND THE NEW MEXICO INSURANCE CODE TO REQUIRE COVERAGE FOR EXPENSES RELATED TO PROSTHETICS AND CUSTOM 14 ORTHOTIC DEVICES.
It is a tool to show the amendments in context and is not to be used for the purpose of amendments.
16 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF NEW MEXICO:
FOR THE LEGISLATIVE HEALTH AND HUMAN SERVICES COMMITTEE AN ACT RELATING TO HEALTH CARE COVERAGE;
e t 17 SECTION 1.
ENACTING NEW SECTIONS OF THE h HEALTH CARE PURCHASING ACT AND THE NEW MEXICO INSURANCE CODE TO g o REQUIRE COVERAGE FOR EXPENSES RELATED TO PROSTHETICS AND CUSTOM t hr g e i k ORTHOTIC DEVICES.
A new section of the Health Care Purchasing w l n d 18 Act is enacted to read:
h r i s h , t, BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF NEW MEXICO:
= = 19 "[NEW MATERIAL] PROSTHETIC DEVICES--CUSTOM ORTHOTIC a l i a e r 20 DEVICES--MINIMUM COVERAGE.-- a t m m 21 A.
e u g e b l e e h SECTION 1.
Group health coverage, including any form of d r e 22 self-insurance, offered, issued or renewed under the Health c e s k 23 Care Purchasing Act, shall provide coverage for prosthetics and e a n b 24 custom orthotics that is at least equivalent to that coverage u [ currently provided by the federal medicare program and no less .211258.2 favorable than the terms and conditions that the group health plan offers for medical and surgical benefits.
A new section of the Health Care Purchasing n d d i = = o h Act is enacted to read:
l ] b ,d i a º e "[NEW MATERIAL ] PROSTHETIC DEVICES--CUSTOM ORTHOTIC r i = r t e w d m a n o DEVICES--MINIMUM COVERAGE.-- d m :
b e d s º o t n = .211258.2 s k m e e a n e d r e l u [ A d A.
Group health coverage, including any form of self-insurance, offered, issued or renewed under the Health Care Purchasing Act, shall provide coverage for prosthetics and custom orthotics that is at least equivalent to that coverage currently provided by the federal medicare program and no less favorable than the terms and conditions that the group health plan offers for medical and surgical benefits.
A group health plan shall cover the most appropriate prosthetic or custom orthotic device determined to be medically necessary by the enrollee's treating physician and associated medical providers to restore functionality to optimal levels.
A group health plan shall cover the most appropriate prosthetic or custom orthotic device determined to be medically necessary by the enrollee's treating physician and associated medical providers to restore functionality to optimal levels HCEDCº for that enrollee»HCEDC.
(1) formulation of the device's design, fabrication, material and component selection, measurements, fittings and static and dynamic alignments;
(1) formulation of the device's design, h fabrication, material and component selection, measurements, u » r fittings and static and dynamic alignments;
(2) all materials and components necessary to use the device;
t h g e l i (2) all materials and components necessary to h r i s use the device;
and (3) instructing the enrollee in the use of the device.
and h , e h (3) instructing the enrollee in the use of the t u g e b l e e , gh device.
e e 17 C.
n d d i = = o h C.
A group health plan's reimbursement rate for e e n d 18 prosthetic and custom orthotic devices shall be at least = = l ] 19 equivalent to that currently provided by the federal medicare a l r i 20 program and no more restrictive than other coverage under the t e a t group health plan.
A group health plan's reimbursement rate for l ] b ,d i a º r prosthetic and custom orthotic devices shall be at least e r = t e w d m a n o equivalent to that currently provided by the federal medicare d m :
m m 21 e d r e 22 D.
b r e t º o t n = .211258.2 s k m e - 2 - e a n e d r e l u [ A d program and no more restrictive than other coverage under the group health plan.
Prosthetic and custom orthotic device coverage c e r c 23 shall be comparable to coverage for other medical and surgical e a n b 24 benefits under the health plan, including restorative internal u [ devices such as internal prosthetic devices, and shall not be .211258.2 - 2 - subject to spending limits or lifetime restrictions.
D.
Prosthetic and custom orthotic device coverage shall be comparable to coverage for other medical and surgical benefits under the health plan, including restorative internal devices such as internal prosthetic devices, and shall not be subject to spending limits or lifetime restrictions.
A group health plan may impose cost sharing on prosthetic or custom orthotic devices;
A group h health plan may impose cost sharing on prosthetic or custom u » r orthotic devices;
provided that any cost-sharing requirements shall not be more restrictive than the cost-sharing requirements applicable to the plan's medical and surgical benefits, including those for internal devices.
provided that any cost-sharing requirements t h g e l i shall not be more restrictive than the cost-sharing h r i s requirements applicable to the plan's medical and surgical h , e h benefits, including those for internal devices.
G.
t u g e b l e e , gh G.
A group health plan may limit the coverage for, e e 17 or alter the cost-sharing requirements for, out-of-network e e n d 18 coverage of prosthetic and custom orthotic devices;
A group health plan may limit the coverage for, n d d i = = o h or alter the cost-sharing requirements for, out-of-network l ] b ,d i a º r coverage of prosthetic and custom orthotic devices;
provided = = l ] 19 that the restrictions and cost-sharing requirements applicable a l r i 20 to prosthetic or custom orthotic devices shall not be more t e a t restrictive than the restrictions and requirements applicable m m 21 e d r e 22 to the out-of-network coverage for a group health plan's c e r c 23 medical and surgical coverage.
provided e r = t e w d m a n o that the restrictions and cost-sharing requirements applicable d m :
e a n b 24 H.
b r e t º o t n = .211258.2 s k m e - 3 - e a n e d r e l u [ A d to prosthetic or custom orthotic devices shall not be more restrictive than the restrictions and requirements applicable to the out-of-network coverage for a group health plan's medical and surgical coverage.
The requirements of this section shall apply u [ separately with respect to coverage benefits provided under a .211258.2 - 3 - group health plan on an in-network basis and benefits provided under that group health plan on an out-of-network basis.
H.
The requirements of this section shall apply separately with respect to coverage benefits provided under a group health plan on an in-network basis and benefits provided under that group health plan on an out-of-network basis.
If coverage is provided through a managed care plan, an enrollee shall have access to medically necessary clinical care and to prosthetic and custom orthotic devices and technology from not less than two distinct prosthetic and custom orthotic providers in the managed care plan's provider network, which providers shall be located in the state.
If coverage is provided through a managed care plan, an enrollee shall have access to medically necessary clinical care and to prosthetic and custom orthotic devices and h technology from not less than two distinct prosthetic and u » r custom orthotic providers in the managed care plan's provider t h g e l i network, which providers shall be located in the state.
K.
h r i s HCEDCº K.
As used in this section, "medicare" means the federal health coverage offered pursuant to the federal Health Insurance for the Aged Act, Title XVIII of the Social Security e e 17 Amendments of 1965, as then constituted or later amended." e e n d 18 SECTION 2.
Coverage for prosthetics and custom h , e h orthotic devices shall be considered habilitative or t u g e b l e e , gh rehabilitative benefits for purposes of any state or federal n d d i = = o h requirement for coverage of essential health benefits, l ] b ,d i a º r including habilitative and rehabilitative benefits.»HCEDC e r = t e w d m a n o HCEDCºK.
A new section of the New Mexico Insurance Code = = l ] 19 is enacted to read:
L.»HCEDC As used in this section, d m :
a l r i 20 "[NEW MATERIAL] PROSTHETIC DEVICES--CUSTOM ORTHOTIC t e a t DEVICES--MINIMUM COVERAGE.-- m m 21 e d r e 22 A.
b r e t º o t n = .211258.2 s k m e - 4 - e a n e d r e l u [ A d "medicare" means the federal health coverage offered pursuant to the federal Health Insurance for the Aged Act, Title XVIII of the Social Security Amendments of 1965, as then constituted or later amended." SECTION 2.
A health plan shall provide coverage for c e r c 23 prosthetic and custom orthotic devices that is at least e a n b 24 equivalent to that currently provided by the federal medicare u [ program and no less favorable than the terms and conditions .211258.2 - 4 - that the health plan offers for medical and surgical benefits.
A new section of the New Mexico Insurance Code is enacted to read:
"[NEW MATERIAL ] PROSTHETIC DEVICES--CUSTOM ORTHOTIC DEVICES--MINIMUM COVERAGE.-- A.
A health plan shall provide coverage for prosthetic and custom orthotic devices that is at least equivalent to that currently provided by the federal medicare program and no less favorable than the terms and conditions that the health plan offers for medical and surgical benefits.
A health plan shall cover the most appropriate prosthetic or custom orthotic device determined to be medically necessary by the enrollee's treating physician and associated medical providers to restore functionality to optimal levels.
A health plan shall cover the most appropriate prosthetic or custom orthotic device determined to be medically necessary by the enrollee's treating physician and associated h medical providers to restore functionality to optimal levels u » r HCEDCº for that enrollee»HCEDC.
This coverage shall include all services and supplies necessary for the effective use of a prosthetic or custom orthotic device, including:
This coverage shall include t h g e l i all services and supplies necessary for the effective use of a h r i s prosthetic or custom orthotic device, including:
(1) formulation of the device's design, fabrication, material and component selection, measurements, fittings and static and dynamic alignments;
h , e h (1) formulation of the device's design, t u g e b l e e , gh fabrication, material and component selection, measurements, n d d i = = o h fittings and static and dynamic alignments;
(2) all materials and components necessary to use the device;
l ] b ,d i a º r (2) all materials and components necessary to e r = t e w d m a n o use the device;
and (3) instructing the enrollee in the use of the device.
and d m :
Show all 71 changed rows (31 more)
Previous
Latest
b r e t º o t n = .211258.2 s k m e - 5 - e a n e d r e l u [ A d (3) instructing the enrollee in the use of the device.
A health plan's reimbursement rate for e e 17 prosthetic and custom orthotic devices shall be at least e e n d 18 equivalent to that currently provided by the federal medicare = = l ] 19 program and no more restrictive than other coverage under the a l r i 20 health plan.
A health plan's reimbursement rate for prosthetic and custom orthotic devices shall be at least equivalent to that currently provided by the federal medicare program and no more restrictive than other coverage under the health plan.
t e a t D.
D.
Coverage for prosthetic and custom orthotic m m 21 e d r e 22 devices shall be comparable to coverage for other medical and c e r c 23 surgical benefits under the health plan, including restorative e a n b 24 internal devices such as internal prosthetic devices, and shall u [ not be subject to spending limits or lifetime restrictions.
Coverage for prosthetic and custom orthotic devices shall be comparable to coverage for other medical and surgical benefits under the health plan, including restorative internal devices such as internal prosthetic devices, and shall not be subject to spending limits or lifetime restrictions.
.211258.2 - 5 - E.
E.
Prosthetic and custom orthotic device coverage shall include coverage for repair or replacement of a prosthetic or custom orthotic device that is determined medically necessary to restore or maintain the ability to complete activities of daily living or essential job-related activities and that is not solely for comfort or convenience.
Prosthetic and custom orthotic device coverage shall include coverage for repair or replacement of a prosthetic or custom orthotic device that is determined medically necessary to restore or maintain the ability to h complete activities of daily living or essential job-related u » r activities and that is not solely for comfort or convenience.
F.
t h g e l i F.
Prosthetic and custom orthotic device coverage shall not be subject to separate financial requirements that are applicable only with respect to that coverage.
Prosthetic and custom orthotic device coverage h r i s shall not be subject to separate financial requirements that h , e h are applicable only with respect to that coverage.
A health plan may impose cost sharing on prosthetic or custom orthotic devices;
A health t u g e b l e e , gh plan may impose cost sharing on prosthetic or custom orthotic n d d i = = o h devices;
provided that any cost-sharing requirements shall not be more restrictive than the cost-sharing requirements applicable to the plan's medical and surgical benefits, including those for internal devices.
provided that any cost-sharing requirements shall not l ] b ,d i a º r be more restrictive than the cost-sharing requirements e r = t e w d m a n o applicable to the plan's medical and surgical benefits, d m :
b r e t º o t n = .211258.2 s k m e - 6 - e a n e d r e l u [ A d including those for internal devices.
A health plan may limit the coverage for or alter the cost-sharing requirements for out-of-network coverage e e 17 of prosthetic and custom orthotic devices;
A health plan may limit the coverage for or alter the cost-sharing requirements for out-of-network coverage of prosthetic and custom orthotic devices;
provided that the e e n d 18 restrictions and requirements applicable to prosthetic or = = l ] 19 custom orthotic devices shall not be more restrictive than the a l r i 20 restrictions and requirements applicable to the out-of-network t e a t coverage for a health plan's medical and surgical coverage.
provided that the restrictions and requirements applicable to prosthetic or custom orthotic devices shall not be more restrictive than the restrictions and requirements applicable to the out-of-network coverage for a health plan's medical and surgical coverage.
m m 21 e d r e 22 H.
H.
The requirements of this section shall apply c e r c 23 separately with respect to coverage benefits provided under a e a n b 24 group health plan on an in-network basis and benefits provided u [ under that health plan on an out-of-network basis.
The requirements of this section shall apply separately with respect to coverage benefits provided under a group health plan on an in-network basis and benefits provided under that health plan on an out-of-network basis.
.211258.2 - 6 - I.
I.
A health plan shall not impose any annual or lifetime dollar maximum on coverage for prosthetic or custom orthotic devices other than an annual or lifetime dollar maximum that applies in the aggregate to all terms and services covered under the health plan.
A health plan shall not impose any annual or lifetime dollar maximum on coverage for prosthetic or custom orthotic devices other than an annual or lifetime dollar maximum that applies in the aggregate to all terms and services h covered under the health plan.
J.
u » r J.
If coverage is provided through a managed care plan or health maintenance organization, an enrollee shall have access to medically necessary clinical care and to prosthetic and custom orthotic devices and technology from not less than two distinct prosthetic and custom orthotic providers in the managed care plan's or health maintenance organization's provider network, which providers shall be located in the state.
If coverage is provided through a managed care t h g e l i plan or health maintenance organization, an enrollee shall have h r i s access to medically necessary clinical care and to prosthetic h , e h and custom orthotic devices and technology from not less than t u g e b l e e , gh two distinct prosthetic and custom orthotic providers in the n d d i = = o h managed care plan's or health maintenance organization's l ] b ,d i a º r provider network, which providers shall be located in the e r = t e w d m a n o state.
K.
d m :
As used in this section:
b r e t º o t n = .211258.2 s k m e - 7 - e a n e d r e l u [ A d HCEDCºK.
Coverage for prosthetics and custom orthotic devices shall be considered habilitative or rehabilitative benefits for purposes of any state or federal requirement for coverage of essential health benefits, including habilitative and rehabilitative benefits.»HCEDC HCEDCºK.
L.»HCEDC As used in this section:
(a) means the following types of major e e 17 medical coverage:
(a) means the following types of major medical coverage:
1) an individual or group health insurance e e n d 18 policy, health care plan or certificate of health insurance = = l ] 19 subject to the provisions of Article 22 or Article 23 of the a l r i 20 Insurance Code that is delivered, issued for delivery or t e a t renewed in this state;
1) an individual or group health insurance policy, health care plan or certificate of health insurance subject to the provisions of Article 22 or Article 23 of the Insurance Code that is delivered, issued for delivery or renewed in this state;
2) an individual or group health m m 21 e d r e 22 maintenance organization contract subject to the Health c e r c 23 Maintenance Organization Law that is delivered, issued for e a n b 24 delivery or renewed in this state;
2) an individual or group health maintenance organization contract subject to the Health Maintenance Organization Law that is delivered, issued for delivery or renewed in this state;
and 3) an individual or u [ group health care plan subject to the provisions of the .211258.2 - 7 - Nonprofit Health Care Plan Law that is delivered, issued for delivery or renewed in this state;
and 3) an individual or h group health care plan subject to the provisions of the u » r Nonprofit Health Care Plan Law that is delivered, issued for t h g e l i delivery or renewed in this state;
and (b) does not mean a health insurance or health coverage policy, plan or certificate of coverage that is intended to supplement major medical group-type coverage, such as medicare supplement, long-term care, disability income, specified disease, accident only, hospital indemnity or any other limited-benefit health insurance policy;
and h r i s (b) does not mean a health insurance or h , e h health coverage policy, plan or certificate of coverage that is t u g e b l e e , gh intended to supplement major medical group-type coverage, such n d d i = = o h as medicare supplement, long-term care, disability income, l ] b ,d i a º r specified disease, accident only, hospital indemnity or any e r = t e w d m a n o other limited-benefit health insurance policy;
and (2) "medicare" means the federal health coverage offered pursuant to the federal Health Insurance for the Aged Act, Title XVIII of the Social Security Amendments of 1965, as then constituted or later amended." - 8 - 15 e e 17 e e n d 18 = = l ] 19 a l r i 20 t e a t m m 21 e d r e 22 c e r c 23 e a n b 24 u [ .211258.2
and d m :
b r e t º o t n = .211258.2 s k m e - 8 - e a n e d r e l u [ A d (2) "medicare" means the federal health coverage offered pursuant to the federal Health Insurance for the Aged Act, Title XVIII of the Social Security Amendments of 1965, as then constituted or later amended." - 9 - » g o » r h t i k l i g t h s , e h t l i w l b l e e , g n d l h = = b , a l º d i a r e r = , a t e d m a n o d m :
b r e t º o t n = .211258.2 s k em e e a n e d r e l u [ A d
⬇ Download PDF
View plain text versions (2)

Action History

  1. action postponed indefinitely

  2. Sent to Senate Public Affairs Committee & Senate Corporations and Transportation Committee

  3. passed House

  4. DO PASS, as amended, committee report adopted

  5. DO PASS committee report adopted

  6. Sent to House Health & Human Services Committee & House Commerce & Economic Development Committee

  7. Sent to House Pre-file

Sponsors

Sponsorship breakdown

Export CSV (upgrade) →

1 sponsors · 0 co-sponsors · 111 not signed on

Sponsors (1)

Co-sponsors (0)

None.

Not signed on (111)

111 members have not signed on to this bill.

Show all 111 →

"Not signed on" means a member has not sponsored or co-sponsored this bill — it does not imply opposition. Members flagged Voted No have a recorded No vote on this bill.

Whip count is in markup. Polling the chamber and every recorded vote this session. Only the first open is slow. It’s instant for you after this. Calling the roll · Tallying · Engrossing

Subjects

healthcare health-insurance
Cross-referencing the record. Reading this bill against every other bill in the corpus by meaning, not keywords. Only the first open is slow. It’s instant for you after this. Matching · Ranking · Engrossing

Frequently asked questions

Who sponsors HB 70?
HB 70 is sponsored by Elizabeth "Liz" Thomson (Democrat).
What is the current status of HB 70?
This bill died with 2019 Regular Session. It reached “Passed House” and never advanced before the session ended, so it can no longer move — a new version would have to be reintroduced in the current session.
Where can I track HB 70?
Track HB 70 free on One Click Politics — get push/email alerts when it moves.

Make your voice heard on HB 70

Find the representatives who decide this bill and tell them where you stand — for yourself, or mobilize your whole list in one click with One Click Politics advocacy software.

Find my representatives → Run a campaign

Stay ahead of HB 70

Last checked for changes 3 months ago · updated continuously

One Click Politics tracks every bill in Congress and all 50 states.

Track this bill →