HB 302 creates a new process for health care professionals (like doctors and specialists) to qualify for exemptions from their health insurer’s prior authorization requirements for outpatient services. To qualify, a professional must have had at least 90% of their prior authorization requests approved in the previous six-month period for the same service type. Insurers must grant exemptions within 10 business days if criteria are met, provide clear written explanations for denials, and allow independent reviews of rescission decisions within 30 days. The exemption does not cover pharmaceutical services or prescription drugs.
HB 316 creates a state fund to cover malpractice insurance premiums for rural hospitals in New Mexico. It appropriates $100 million from the general fund to establish a trust fund that provides "premium grants" to eligible hospitals, defined as those operating in health care underserved areas and maintaining essential services. Hospitals must apply through the Department of Health, certify funds will only cover insurance premiums, and provide annual reports on financial stability and staffing. The program requires the Department to annually report on grant recipients, costs, and impacts on hospital operations. This direct policy change addresses rising insurance costs for rural facilities serving underserved communities.
HB 136 requires New Mexico's Health Care Authority to create a centralized credentialing system for Medicaid managed care providers, so providers submit one application to the Authority instead of multiple applications to different Medicaid plans. Medicaid managed care contractors must review applications within 30 days (extendable by 15 days for specific cases) and load approved provider information into their payment systems within that timeframe. The bill also limits re-credentialing to once every three years after initial approval. This directly affects Medicaid managed care providers and the contractors that manage Medicaid plans.
SB 189 requires all group health insurance plans in New Mexico (including employer self-insurance) to cover specific reproductive and gender-affirming care without deductibles, copays, or prior authorization. It mandates coverage for abortion care, gender-affirming care, contraception (including no cost-sharing for required services), and establishes a special enrollment period for pregnancy-related coverage. The bill applies to most plans but excludes high-deductible plans until the deductible is met and short-term/limited-benefit plans. This directly affects insurers and enrollees by removing financial barriers to these services under New Mexico's Health Care Purchasing Act.
SB 15 requires all health insurance plans in New Mexico (including group plans, HMOs, and nonprofit plans) to include every licensed healthcare provider - such as doctors, nurses, therapists, and other practitioners - within their legal scope of practice, provided the provider agrees to the plan's terms. The bill does not force insurers to contract with providers but mandates that if they do, all licensed providers must be included. It allows insurers to set different payment rates based on quality or performance but prohibits excluding providers solely due to their license type. The law takes effect July 1, 2026, directly affecting insurers, healthcare providers, and patients seeking coverage for physical or behavioral health services.
HB 129 requires New Mexico health insurance carriers to include all licensed health care providers (such as doctors, therapists, and specialists) within their legal scope of practice in coverage plans. It applies to group health plans, individual insurance policies, health maintenance organizations, and nonprofit health plans, effective July 1, 2026. The bill does not force insurers to contract with specific providers but mandates that if a provider is licensed to practice in New Mexico, they must be included in coverage plans. Insurers may still set different reimbursement rates based on quality or performance measures.
SB 33, the "Right to Try Individualized Treatments Act," allows New Mexico residents with life-threatening or severely debilitating illnesses (after exhausting all FDA-approved treatments) to access individualized investigational treatments based on their genetic profile. The law requires written informed consent from patients detailing treatment options and risks, and permits manufacturers to provide these treatments without charge or require patient payment. It does not mandate insurance coverage for these treatments, but protects patients' heirs from liability for treatment debts after death and shields healthcare providers from disciplinary action for recommending such treatments. The bill also prohibits state officials from blocking patient access to these treatments.
HB 4 adjusts how funds from New Mexico's health insurance premium surtax are distributed to the Health Care Affordability Fund. It changes the percentage of surtax revenue sent to the fund over time: 55% before July 2024, 30% from July 2024 to September 2025, 55% from September 2025 to September 2026, and 100% after September 2026. The bill directly affects the allocation of state revenue generated by the health insurance surtax, which supports healthcare affordability programs. This policy change modifies existing distribution rules without altering the surtax rate itself. The fund's purpose is to assist New Mexicans with healthcare costs, though the bill does not specify new eligibility criteria or program expansions.
HB 38 requires New Mexico health insurance plans to cover wheelchairs and activity chairs for individuals with permanent mobility-limiting conditions (such as paralysis, limb loss, or neuromuscular disorders) without more restrictive terms than other medical benefits. The bill mandates coverage equivalent to Medicare standards, including all necessary services like fittings, repairs, replacements, and instruction, while prohibiting separate cost-sharing or lifetime limits for these devices. It also ensures insurers must cover out-of-network providers when in-network options are unavailable and reimburse at in-network rates. This applies to all group health plans under the Health Care Purchasing Act.
This procedural memorial (HM 4) requests the Legislative Finance Committee to study health insurance access for public higher education educators and graduate student employees across New Mexico's public universities. The study will examine current coverage gaps - such as UNM being the only institution providing employer-funded medical insurance for graduate students - and evaluate options for expanding medical, dental, and vision coverage, including fiscal impacts and workforce effects, with a report due by October 2026.
