Overview
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.
In 2024, New Mexico passed SB15, establishing a mandatory process for examining proposed acquisitions and changes in the control of hospitals as well as other health care mergers, acquisitions, and significant changes in control of health care entities, including health insurance entities. New Mexico also passed bills to address pharmaceutical issues, including HB33, which created new prescription drug price transparency requirements, and HB165 requiring Medicaid managed care organizations to reimburse community-based pharmacy providers for the full cost of prescription drugs plus a professional dispensing fee. The state also considered legislation that would have required county hospitals and contracting hospitals in New Mexico to accept all health benefit plans available through the New Mexico health insurance exchange, and legislation that would have created new transparency requirements for hospitals or providers of management services for hospitals, but these bills ultimately failed.
See below for an overview of existing New Mexico state mandates. Click on citation tab for detailed information of specific statutes (click link to download statute text).
State Action
Latest Legislative Session: 1/17/2023 - 3/18/2023 (2023 term). *Current session bill updates are ongoing. Check back weekly for updates.
SB 146 – New Mexico
Introduced: 2024 Status: In Process
An act relating to hospitals; enacting a new section of the hospital funding act to provide affordable payment plans to patients under certain circumstances.
SB 15 – New Mexico
Introduced: 2024 Status: In Process
Relating to insurance; enacting the health care consolidation oversight act; requiring review of proposed health care mergers, acquisitions and other material changes in control of health care entities, including health insurance entities; providing exceptions; granting …
SB 17 – New Mexico
Introduced: 2024 Status: In Process
Relating to health care; enacting the health care delivery and access act; imposing on certain hospitals the health care delivery and access assessment; creating the health care delivery and access fund; creating the health care …
SB 184 – New Mexico
Introduced: 2019 Status: Inactive / Dead
MEDICAID MANAGED CARE PHARMACEUTICAL BENEFITS: Section 27-2-12.6 NMSA 1978 (being Laws 1994, Chapter 62, Section 22) is amended to read, “The department shall exclude from the provisions of this section any pharmaceutical benefit or service.”
SB 188 – New Mexico
Introduced: 2019 Status: Enacted
HEALTH INSURANCE PRIOR AUTHORIZATION ACT: A health insurer shall make its current prior authorization requirements and restrictions, including clinical criteria, readily accessible on its website to covered persons, health care providers and the public. Notice …
N.M. Stat § 59A-42A-2. Definitions: Provider Service Network Act – New Mexico
Introduced: Status: Enacted
Provides definitions for sections 59A-42A-1 through 59A-42A-9.
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N.M. Stat § 59A-2-8. General powers and duties of superintendent: Office of Superintendent of Insurance – New Mexico
Introduced: Status: Enacted
Provision governs the powers and duties of the superintendent of insurance including the power to conduct examinations.
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N.M. Stat § 59A-23-2. Blanket health insurance: Group and Blanket Health Insurance Contracts – New Mexico
Introduced: Status: Enacted
Blanket health insurance is declared to be that form of health insurance covering special groups of not fewer than ten persons as enumerated in one of the following paragraphs.
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N.M. Stat § 59A-54-4. Pool created; board: Medical Insurance Pool Act – New Mexico
Introduced: Status: Enacted
There is created a nonprofit entity to be known as the “New Mexico medical insurance pool”. All insurers shall organize and remain members of the pool as a condition of their authority to transact insurance …
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N.M. Stat §§ 53-14-1 through 53-14-7: Business Corporations; Mergers and Consolidations – New Mexico
Introduced: Status: Enacted
Provisions governing mergers and acquistions involving business corporations.
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Federal Trade Commission and State of Idaho v. St. Luke’s Health System, Ltd and Saltzer Medical Group, P.A. – California, Connecticut, Delaware, Idaho, Illinois, Iowa, Kentucky, Maine, Maryland, Mississippi, Montana, Nevada, New Mexico, Oregon, Pennsylvania, Tennessee, Washington
District Court: District of Idaho Status: Decided
In March 2013, the FTC and the Idaho Attorney General filed a joint complaint challenging the merger betweenSt. Luke’s Health System, Idaho’s largest health system, …
In re: Suboxone Antitrust Litigation (State of Wisconsin, et al. v. Indivior Inc, et al.) – Alabama, Alaska, Arkansas, California, Colorado, Connecticut, Delaware, District of Columbia, Florida, Georgia, Hawaii, Idaho, Illinois, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Nebraska, New Hampshire, New Mexico, New York, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, South Dakota, Tennessee, Utah, Virginia, Washington, West Virginia, Wisconsin
District Court: E.D. Pennsylvania Status: Pending
In September 2016, 35 state attorneys general and the District of Columbia brought a multi-district case against pharmaceutical manufacturer Indivior, MonoSol RX et al., alleging …
In Re: Generic Pharmaceuticals Pricing Antitrust Litigation – Alabama, Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, District of Columbia, Florida, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, South Carolina, Tennessee, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin
District Court: Eastern District of Pennsylvania Status: Pending
Plaintiffs are attorney generals from 48 states, Puerto Rico, and the District of Columbia, as well as classes of private plaintiffs that filed an antitrust …
Additional Resources
STATE BUDGET
New Mexico’s fiscal year begins on July 1 and ends on June 30. New Mexico enacts its annual budget during the regular legislative session. To view information about New Mexico’s state budget, click here.
STATE LEGISLATURE
The New Mexico Legislature convenes on the third Tuesday in January of each year. The Legislature holds 60- day sessions in odd-numbered years and 30-day sessions in even- numbered years. A Senate term is four years, for the House it is two. The state has 42 Senators and 70 Representatives. New Mexico does not pay its legislators a base salary, only a per diem. Bills do not carry over from year to year.