In the current legislative term, New Mexico has renewed its efforts in establishing an All-Payer Claims Database (APCD) by introducing SB 191, which would appropriate funds to the Department of Health to fund planning for an APCD. A bill to create a task force to study and issue recommendations for the creation of an APCD was passed by the New Mexico legislature in 2013, but was killed by a pocket veto from Republican Governor Susana Martinez.
New Mexico’s healthcare system is currently facing access issues as 1 in 3 residents is enrolled in Medicaid, the highest rate in the country. In 2014, Think New Mexico, a bipartisan group based out of Santa Fe, launched an initiative to support transparency in healthcare, proposing a law that would require hospitals to create a single pricelist for all payers and to forbid insurers from including price gag clauses in contracts with providers.
New Mexico’s current regular legislative session runs from 1/6/2018 – 2/15/2018.
Recent Legislative Developments
|2018||SB 191||AN ACT TO FUND PLANNING FOR AN ALL-PAYER CLAIMS DATABASE: Five hundred thousand dollars ($500,000) is appropriated from the general fund to the department of health for expenditure in fiscal year 2019 to fund planning for an all-payer claims database.||Active – Referred to Senate Finance|
|2015-2016||SB578||AN ACT ESTABLISHING AN ALL-PAYER CLAIMS DATABASE (APCD): would require the superintendent of insurance to establish an APCD. Reporting entities would include: health insurers, nonprofit heath service providers, health maintenance organizations, managed care organizations, fraternal benefit societies, provider service organizations, insurance administrators, pharmacy benefit managers, fiscal intermediaries, other person who are legally responsible for payment of a claim for a health care item or service, the state Medicaid program, and any person that provides coverage pursuant to Part C of the Social Security Act.
The superintendent would be required to establish reasonable user fees to cover the cost of administering the database. The bill would also appropriate $100,000 to cover the costs of establishing the database.
|Inactive — Died.|
|SB295||SMALL GROUP RATE TRANSPARENCY: would require the superintendent of insurance to adopt and promulgate rules that require a carrier that provides a quote for a health benefit plan to a small employer disclose the history of rate changes over the preceding 5 years for the type of health benefit plan being considered.||Inactive — Died.|
|2018||SB 8||AN ACT ESTABLISHING THE INTERAGENCY PHARMACEUTICALS PURCHASING COUNCIL: Would establish the interagency pharmaceuticals purchasing council that would use existing constituent agency resources to review and coordinate cost-containment strategies for the procurement of pharmaceuticals and pharmacy benefits and the pooling of risk for pharmacy services by the constituent agencies.||Active – Referred to Senate Committees’ Committee|
|SB295||RELATING TO STEP THERAPY FOR PRESCRIPTION DRUG COVERAGE: When a group health plan restricts coverage of a prescription drug for the treatment of any medical condition through the use of a step therapy protocol, an enrollee and the practitioner prescribing the prescription drug shall have access to a clear, readily accessible and convenient process to request a step therapy exception determination. A group health plan shall expeditiously grant an exception to the group health plan’s step therapy protocol, based on medical necessity and a clinically valid explanation from the patient’s prescribing practitioner as to why a drug on the plan’s formulary that is therapeutically equivalent to the prescribed drug should not be substituted for the prescribed drug, if certain criteria are met.||Passed – Signed by Governor (Chapter 9)|
- None identified.
We compile state statutes relate to healthcare price and competition, including healthcare transparency, markets, and costs. For a complete listing of all health related statutes visit the State Health Practice Database for Research.
Transparency in Healthcare
- M. Stat. §§ 24-14A-3 et seq., the “Health Information System Act,” creates a health information system for the purpose of facilitating the collection, analysis and dissemination of health information to assist in health planning, policymaking, and to assist consumer in making informed healthcare decisions. Specifically, administrators must “collect health data sufficient for consumers to be able to evaluate health care services, plans, providers and payers and to make informed decisions regarding quality, cost and outcome of care across the spectrum of health care services, providers and payers.” The system has been implemented within the Department of Health as the New Mexico Indicator-Based Information System (NM-IBIS).
- M. Stat. § 59A-19-1 through 7, the “Policy Language Simplification Law,” forbids policy forms from being issued for delivery without meeting the minimum standard of readability.
- M. Stat. § 59A-46-35 prohibits health maintenance organizations (HMO) from discriminating against providers and ensures competition by preventing an HMO from excluding a provider willing to meet the terms and conditions offered by that HMO to contract for healthcare services.
- M. Stat. § 59A-22A-5 permits health care insurers to issue benefit plans which provide an incentive for covered persons to seek health care services from preferred providers; however, differences in benefit levels between non-preferred providers and preferred providers shall be no greater than necessary to provide a reasonable incentive for covered persons to use the preferred provider.
- M. Stat. Ann. §§ 59A-18-12 mandates that a health care plan may not be delivered or issued for delivery until a copy of the form and the classification of risks pertaining to that health care plan have been filed with and approved by the superintendent of insurance.
- M. Stat. § 59A-18-13.2 requires prior approval for health insurance rates. An insurer may request an exemption from disclosure of any part of the filing requirements pursuant to this section if the disclosure would reveal proprietary information that would harm competition.
FY 2018 BUDGET
New Mexico’s fiscal year begins on July 1 and ends on June 30. New Mexico enacted its FY 2018 Budget during the regular legislative session. To view New Mexico’s FY 2018 Budget, click here.
- We have our eye on New Mexico because it was one of 16 states to file an amicus brief in the Ninth Circuit case St. Luke’s Health Care Sys. v. FTC, No. 14-35173 (March 7, 2014), explaining that the acceleration of health care costs due to the growth of large health care provider systems has become a matter of grave concern for the States.