SENATE BILL 15

57th legislature - STATE OF NEW MEXICO - second session, 2026

INTRODUCED BY

Linda M. Trujillo and Peter Wirth and Elizabeth "Liz" Stefanics and Cindy Nava

 

 

 

 

AN ACT

RELATING TO HEALTH COVERAGE; ENACTING SECTIONS OF THE HEALTH CARE PURCHASING ACT, THE NEW MEXICO INSURANCE CODE, THE HEALTH MAINTENANCE ORGANIZATION LAW AND THE NONPROFIT HEALTH CARE PLAN LAW TO PROVIDE THAT HEALTH COVERAGE CARRIERS SHALL COVER ALL TYPES OF HEALTH CARE PROVIDERS WORKING WITHIN THEIR LEGAL SCOPES OF PRACTICE; REPEALING AND ENACTING SECTIONS OF THE NMSA 1978.

 

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF NEW MEXICO:

     SECTION 1. A new section of the Health Care Purchasing Act is enacted to read:

     "[NEW MATERIAL] HEALTH CARE PROVIDER INCLUSION.--

          A. Group health coverage, including any form of self-insurance, offered, issued or renewed under the Health Care Purchasing Act shall include with respect to participation under the plan or coverage any type of health care provider who is acting within the scope of that provider's license, certification or other legal authority to practice in the state.

          B. This section shall not require that a group health plan contract with any health care provider willing to abide by the terms and conditions for participation established by the group health plan.

          C. Nothing in this section shall be construed as preventing a group health plan from establishing varying reimbursement rates based on quality or performance measures.

          D. As used in this section, "health care provider" means a person who is licensed, certified or otherwise authorized to provide services relating to physical or behavioral health care in the ordinary course of business in the state."

     SECTION 2. A new section of Chapter 59A, Article 22 NMSA 1978 is enacted to read:

     "[NEW MATERIAL] HEALTH CARE PROVIDER INCLUSION.--

          A. An individual or group health insurance policy, health care plan or certificate of health insurance that is delivered, issued for delivery or renewed in the state shall include with respect to participation under the policy, plan or certificate any type of health care provider who is acting within the scope of that provider's license, certification or other legal authority to practice in the state.

          B. This section shall not require that a health insurer contract with any health care provider willing to abide by the terms and conditions for participation established by the health insurance policy, health care plan or certificate of health insurance.

          C. Nothing in this section shall be construed as preventing a health insurer from establishing varying reimbursement rates based on quality or performance measures.

          D. As used in this section, "health care provider" means a person who is licensed, certified or otherwise authorized to provide services relating to physical or behavioral health care in the ordinary course of business in the state."

     SECTION 3. A new section of Chapter 59A, Article 23 NMSA 1978 is enacted to read:

     "[NEW MATERIAL] HEALTH CARE PROVIDER INCLUSION.--

          A. A group health insurance policy, health care plan or certificate of health insurance that is delivered, issued for delivery or renewed in the state shall include with respect to participation under the policy, plan or certificate any type of health care provider who is acting within the scope of that provider's license, certification or other legal authority to practice in the state.

          B. This section shall not require that a health insurer contract with any health care provider willing to abide by the terms and conditions for participation established by the health insurance policy, health care plan or certificate of health insurance.

          C. Nothing in this section shall be construed as preventing a health insurer from establishing varying reimbursement rates based on quality or performance measures.

          D. As used in this section, "health care provider" means a person who is licensed, certified or otherwise authorized to provide services relating to physical or behavioral health care in the ordinary course of business in the state."

     SECTION 4. A new section of the Health Maintenance Organization Law is enacted to read:

     "[NEW MATERIAL] HEALTH CARE PROVIDER INCLUSION.--

          A. An individual or group health maintenance organization contract that is delivered, issued for delivery or renewed in the state shall include with respect to participation pursuant to that contract any type of health care provider who is acting within the scope of that provider's license, certification or other legal authority to practice in the state.

          B. This section shall not require that a health maintenance organization contract with any health care provider willing to abide by the terms and conditions for participation established by the health maintenance organization contract.

          C. Nothing in this section shall be construed as preventing a health maintenance organization from establishing varying reimbursement rates based on quality or performance measures.

          D. As used in this section, "health care provider" means a person who is licensed, certified or otherwise

authorized to provide services relating to physical or behavioral health care in the ordinary course of business in

the state."

     SECTION 5. A new section of the Nonprofit Health Care Plan Law is enacted to read:

     "[NEW MATERIAL] HEALTH CARE PROVIDER INCLUSION.--

          A. An individual or group health care plan that is delivered, issued for delivery or renewed in the state shall include with respect to participation under the plan or coverage any type of health care provider who is acting within the scope of that provider's license, certification or other legal authority to practice in the state.

          B. This section shall not require that a health care plan contract with any health care provider willing to abide by the terms and conditions for participation established by the health care plan.

          C. Nothing in this section shall be construed as preventing a health care plan from establishing varying reimbursement rates based on quality or performance measures.

          D. As used in this section, "health care provider" means a person who is licensed, certified or otherwise

authorized to provide services relating to physical or behavioral health care in the ordinary course of business in

the state."

     SECTION 6. REPEAL.--Sections 59A-46-35, 59A-46-36, 59A-47-28.2 and 59A-47-28.3 NMSA 1978 (being Laws 1987, Chapter 335, Section 1, Laws 1989, Chapter 96, Section 2, Laws 1991, Chapter 145, Section 1 and Laws 1998, Chapter 39, Section 2, as amended) are repealed.

     SECTION 7. APPLICABILITY.--The provisions of this act apply to an individual or group policy, contract, certificate or agreement to provide, deliver, arrange for, pay for or reimburse any of the costs of medical care, pharmaceutical benefits or related benefits that is entered into, offered, renewed, extended, amended or issued by a health insurer on or after July 1, 2026.

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