How New Mexico Dramatically Reduced Marketplace Deductibles At Zero Cost To The State

Centene to pay $13.7M to settle PBM allegations in New Mexico

HM 36

Hospital Charges for Uninsured. A memorial: requesting the legislative health and human services committee to hold a hearing on hospital charges for New Mexico’s uninsured patients and for the Human Services Department to report on New Mexico hospitals’ use of public funds and provisions for financial assistance for uninsured patients.

Healthcare Affordability State Policy Scorecard

Spotlight on State: New Mexico

This is part of a series of summaries that highlight notable legislation and initiatives in health policy and reform of all 50 states. Check back on The Source as we roll out additional states each week.

See New Mexico page.

New Mexico has made strides in healthcare price transparency and cost control. After a legislative mandate was enacted to establish an all-payer claims database, the state began its implementation with budget allotted in the 2019-2020 fiscal year. In recent terms, New Mexico also passed the Surprise Billing Protection Act, which requires a provider to refund to the covered person the amount paid in excess of the in-network cost-sharing amount within forty-five calendar days of receipt of payment. The consumer protection applies to both emergency and non-emergency services.

To increase healthcare access and reduce costs, New Mexico has enacted robust telehealth coverage laws that requires reimbursement, cost-sharing, and coverage parity for telehealth services. Additionally, the legislature enacted legislation that ensures insurance coverage for individuals with pre-existing conditions, regardless of mandates under the Affordable Care Act. In 2021, the state transitioned from the federal ACA exchange and launched its own-state run marketplace, beWellNM. The new state-based exchange offers plans from five insurers, more options than provided in most of the other states.

The state also proposed several health system reform initiatives to promote affordable access to care in the state, including a Medicaid buy-in public option proposal. Additionally, the legislature introduced a bill to establish a global hospital budgets task force to study global hospital budgets to determine prospective changes in health care quality outcomes and spending within rural hospitals that elect to participate in the demonstration project.

HB 67

House Bill 67 would establish an unpaid primary care council to advise state government and especially the Department of Human Services in finding means to increase New Mexicans’ access to health care while improving their health and controlling the costs of health care. The bill council would consist of members from the Department of Health, the Department of Human Services and the Office of the Superintendent of Insurance; from an organization representing federally qualified health care centers (FQHCs), and five members representing statewide primary care
provider organizations. There would be thirteen advisory non-voting members.

HB 107

Mail-Order Pharmacy Insurance Parity: House Bill 107 applies to each of the types of health insurance offered in New Mexico the same new requirement, repeated in each of the five sections of the bill, with the aim to increase parity among local pharmacies and mail-order pharmacies on price to consumers.

SB 317

Relating to health coverage; prohibiting imposition of cost sharing for behavioral health services under certain insurance coverage policies or plans; allowing plans exempt from regulation under the new mexico insurance code to eliminate cost sharing for behavioral health services; establishing reporting requirements.

HB 34

Podiatric Services Cost Sharing Limits. House Bill 34 would dictate that insurance products for sale in New Mexico could not impose a higher coinsurance percentage or copay amount on a consumer for services provided by a podiatrist than for primary care services, defined in each of the bill’s sections as “the first level of basic or general health care for a person’s health needs.”

HB 129

House Bill 129 would amend and add new subsections to Section 59A-61 NMSA 1978 (the Pharmacy Benefit Manager Regulation Act, part of the Insurance Code) to increase transparency of operations of pharmacy benefit managers (PBMs) operating in New Mexico.