H 53 DELIVERY OF NECESSARY DIABETIC RESOURCES

Rep Elizabeth "Liz" Thomson

Actions: HPREF [2] HHHC/HAFC-HHHC [4] DNP-CS/DP-HAFC [11] DP/a [13] PASSED/H (65-1) [12] SHPAC-SHPAC- DP [20] PASSED/S (37-0)

Scheduled: Not Scheduled

 House Bill 53 (HB 53) updates health insurance for diabetics; makes an appropriation; and sets requirements for delivery of diabetic resources. 

 The Act modifies Section 13-1-25 NMSA 1978 to clarify the types of health care insurers are required to provide coverage for diabetics; defines “health care insurance”, “basic health care”, “basic health care benefit”,  "covered person”, and “device”, and specifies/defines eligible services, equipment/devices/supplies, insulin, or other drugs/treatments of diabetes. It also incorporates new definitions for “health care practitioner”, “managed health care plan”, “medically accepted standard of care for diabetes”, “official compendium” (U.S. formulary/pharmaceutical standards) and defines and limits requirements for “prior authorization”.

The Act further states that “Nothing…in this Section shall be construed to limit coverage for new or improved equipment, appliances, devices, diabetic technology, supplies, insulin or other prescription drugs…”

The Act modifies the law to specify that coverage must be provided for Type 1, Type 2, and gestational diabetes, and makes some stylistic/clarification changes throughout regarding medical standard of care, deductibles (and other patient expenses), prior authorization, and reviews/processes.

The Act adds requirements that every health insurer maintain adequate suppliers, have active contracts in place with those suppliers; ensure timely delivery; guarantee reimbursement within 30 days of the insured’s written demand (or pay interest if this requirement is not met); and submit regular written reports to assist in compliance reviews.

Under the Act, health insurers will be subject to corrective action.

An appropriation of $350,000 is made from the General Fund to the office of superintendent of insurance for the purposes of hiring compliance personnel. Any unexpended or unencumbered balance remaining at the end of Fiscal Year 2024 will revert to the General Fund.
 

 If the bill does not pass, the proposed appropriation and changes, updates and clarifications regarding the law will not be made. 

 Amended February 22, 2023 by HAFC

HAFCa/HB 53:  The House Appropriations and Finance Committee’s amendment to the House Health and Human Services Committee Substitute for HB 53 changes the bill as follows:

•	On page 1, lines 13 and 14, strike “;MAKING AN APPROPRIATION”. 2. On page 36, strike Section 7 in its entirety. 3. Renumber the succeeding section accordingly.
 

 Committee Substitute February 8, 2023 in HHHC
HHHCcs / HB 53: The House Health and Human Services Committee Substitute for HB 53 is generally the same as the original bill, except it is reorganized and has various stylistic and clarification changes, including:
•	Reversion to the original term of ‘individuals’ rather than ‘persons’
•	Clarification that care from health care practitioners must be insured, as well as care from physicians (throughout)
•	New phraseology of “covered benefits” replaces “basic health care benefit”
 

 HB 51, related to prescription drug affordability
SB 51, related to cost-sharing contributions for prescriptions