HB 259

                                1  HOUSE BILL 259
                                2     57TH LEGISLATURE - STATE OF NEW MEXICO - SECOND SESSION, 2026
                                3  INTRODUCED BY
                                4  Nicole Chavez and Elaine Sena Cortez
                                5
                                6
                                7
                                8
                                9
                                10  AN ACT
                                11   RELATING TO HEALTH CARE; CREATING AN OPTIONAL PROCESS FOR
                                12   ACTUARIAL REVIEWS OF PROPOSED LEGISLATION THAT MAY CHANGE THE
                                13   COVERAGE REQUIREMENTS FOR HEALTH INSURERS; REQUIRING THE
                                14   LEGISLATIVE FINANCE COMMITTEE TO RETAIN CONTRACTORS THAT
                                15   PERFORM ACTUARIAL REVIEWS OF LEGISLATIVE PROPOSALS; MAKING AN
                                16   APPROPRIATION.
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                                18   BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF NEW MEXICO:
                                19        SECTION 1.     A new section of Chapter 2, Article 5 NMSA
                                20   1978 is enacted to read:
                                21        "[NEW MATERIAL] ACTUARIAL REVIEWS OF PROPOSED HEALTH CARE
                                22   LEGISLATION.--
                                23  A.    On or before September 1, 2026, subject to
                                24   appropriation, the legislative finance committee shall retain
                                25   at least one contractor that is capable of performing actuarial
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                                1    reviews of legislative proposals that may change the health
                                2    insurance or health plan coverage or compliance requirements.
                                3    A contractor retained by the legislative finance committee
                                4    shall have experience in conducting actuarial reviews on health
                                5    care policy and health insurance premiums.
                                6  B.   Every year, each member of the legislature may
                                7    request the legislative finance committee to perform an
                                8    actuarial review of one piece of legislation that may change
                                9    the coverage requirements for health insurers.    For each
                                10   regular legislative session, the legislative finance committee
                                11   shall provide actuarial reviews of proposed legislation for:
                                12  (1)   up to two members of the majority party of
                                13   the house of representatives.    If more than two members of the
                                14   majority party of the house of representatives submit an
                                15   actuarial review request to the legislative finance committee,
                                16   the director of the legislative finance committee shall notify
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                                17   the speaker of the house of representatives, who shall select
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                                18   two legislative proposals to be actuarially reviewed;
                                19  (2)   up to two members of the minority party of
                                20   the house of representatives.    If more than two members of the
                                21   minority party of the house of representatives submit an
                                22   actuarial review request to the legislative finance committee,
                                23   the director of the legislative finance committee shall notify
                                24   the minority floor leader of the house of representatives, who
                                25   shall select two legislative proposals to be actuarially
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                                1    reviewed;
                                2  (3)   up to two members of the majority party of
                                3    the senate.      If more than two members of the majority party of
                                4    the senate submit an actuarial review request to the
                                5    legislative finance committee, the director of the legislative
                                6    finance committee shall notify the president pro tempore of the
                                7    senate, who shall select two legislative proposals to be
                                8    actuarially reviewed; and
                                9  (4)   up to two members of the minority party of
                                10   the senate.      If more than two members of the minority party of
                                11   the senate submit an actuarial review request to the
                                12   legislative finance committee, the director of the legislative
                                13   finance committee shall notify the minority floor leader of the
                                14   senate, who shall select two legislative proposals to be
                                15   actuarially reviewed.
                                16  C.    A legislative proposal shall only be eligible
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                                17   for actuarial review if a request for actuarial review is
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                                18   submitted to the legislative finance committee by October 1 of
                                19   a given year.
                                20  D.    An actuarial review performed by a contractor
                                21   shall provide, at a minimum:
                                22  (1)   an estimate of the number of New Mexico
                                23   residents who will be directly affected by the legislative
                                24   proposal;
                                25  (2)   estimates of changes in the rates of
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                                1    utilization of specific health care services that may result
                                2    from the legislative proposal;
                                3  (3)    estimates concerning any changes in
                                4    consumer cost sharing that would result from the legislative
                                5    proposal;
                                6  (4)    estimates of any increases or decreases in
                                7    health insurance premiums;
                                8  (5)    an estimate of the out-of-pocket health
                                9    care cost changes associated with the legislative proposal;
                                10  (6)    an estimate of the potential long-term
                                11   health care cost changes associated with the legislative
                                12   proposal;
                                13  (7)    identification of potential health
                                14   benefits for individuals or communities that would result from
                                15   the legislative proposal;
                                16  (8)    to the extent practicable, the social and
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                                17   economic impacts of the legislative proposal, including
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                                18   potential impacts to health care providers, provider networks
                                19   and other health insurance markets;
                                20  (9)    an estimate of the impact on state
                                21   spending related to programs administrated pursuant to the
                                22   Health Care Purchasing Act and the Public Assistance Act;
                                23  (10)   an evaluation of whether coverage for any
                                24   health care services included in the legislative proposal is or
                                25   could be available without passage of the legislative proposal;
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                                1    and
                                2  (11)   an analysis of whether the legislative
                                3    proposal is supported by:
                                4  (a)   determinations made by the United
                                5    States food and drug administration;
                                6  (b)   coverage determinations made by the
                                7    federal centers for medicare and medicaid services;
                                8  (c)   determinations made by the United
                                9    States preventive services task force; and
                                10  (d)   nationally recognized clinical
                                11   practice guidelines.
                                12  E.   If an actuarial review performed by a contractor
                                13   requires the analysis of health data, the actuarial review
                                14   shall rely on health data collected pursuant to the Health
                                15   Information System Act whenever practicable.
                                16  F.   No later than January 1 of each year, the
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                                17   legislative finance committee shall prepare a written report
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                                18   containing the results of the actuarial reviews conducted
                                19   pursuant to this section and shall make the report available on
                                20   the legislature's website.
                                21  G.   For the purposes of this section:
                                22  (1)    "contractor" means an entity retained by
                                23   the legislative finance committee for the purpose of providing
                                24   actuarial reviews of legislative proposals that may change the
                                25   coverage requirements for health insurers;
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                                1  (2)   "health insurer" means a health
                                2    maintenance organization, nonprofit health care plan, provider
                                3    service network, medicaid managed care organization or third-
                                4    party payer or its agent;
                                5  (3)   "legislative proposal" means a proposal
                                6    that would statutorily require a health insurer to:
                                7  (a)   provide coverage or increase the
                                8    amount of coverage for the treatment of a particular disease,
                                9    condition or health care need;
                                10  (b)   provide coverage or increase the
                                11   amount of coverage for a particular type of health care
                                12   treatment or service or equipment, supply or prescription drug
                                13   used in connection with a health care treatment or service;
                                14  (c)   provide coverage for care delivered
                                15   by a specific health care provider;
                                16  (d)   follow a particular benefit design
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                                17   or cost-sharing requirement for:    1) the treatment of a
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                                18   particular disease, condition or health care need; 2) a
                                19   particular type of health care treatment or service; or 3) the
                                20   provision of medical equipment, supplies or prescription drugs
                                21   used in connection with treating a particular disease,
                                22   condition or health care need; or
                                23  (e)   impose limits or conditions on a
                                24   contract between a health insurer and health care provider; and
                                25  (4)   "legislative proposal" does not mean a
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                                1    proposal that would:
                                2  (a)   amend the scope of practice of a
                                3    licensed health care professional; or
                                4  (b)   make state law consistent with
                                5    federal law."
                                6  SECTION 2.   APPROPRIATION.--One hundred thousand dollars
                                7    ($100,000) is appropriated from the general fund to the
                                8    legislative finance committee for expenditure in fiscal year
                                9    2027 to procure contractors to perform actuarial reviews of
                                10   legislative proposals that may change the coverage requirements
                                11   for health insurance plans.      Any unexpended balance remaining
                                12   at the end of fiscal year 2027 shall revert to the general
                                13   fund.
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