HB 278

                                1  HOUSE BILL 278
                                2     57TH LEGISLATURE - STATE OF NEW MEXICO - SECOND SESSION, 2026
                                3  INTRODUCED BY
                                4  Tara L. Lujan and Kathleen Cates
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                                10  AN ACT
                                11   RELATING TO HEALTH CARE; ESTABLISHING REIMBURSEMENT
                                12   REQUIREMENTS FOR TOXICOLOGY SERVICES PROVIDED BY INDEPENDENT
                                13   REFERENCE LABORATORIES; MAKING AN APPROPRIATION.
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                                15   BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF NEW MEXICO:
                                16        SECTION 1.    A new section of the Public Assistance Act is
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                                17   enacted to read:
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                                18        "[NEW MATERIAL] MEDICAID REIMBURSEMENT FOR TOXICOLOGY
                                19   SERVICES.--
                                20  A.   The authority shall establish medicaid
                                21   reimbursement codes for toxicology services provided by an
                                22   independent reference laboratory that are consistent with the
                                23   provisions of this section.
                                24  B.   Medicaid reimbursement for toxicology services
                                25   provided by an independent reference laboratory shall be equal
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                                1    to the average medicaid fee-for-service rate schedule for the
                                2    healthcare common procedure coding system codes used for
                                3    billing of definitive drug testing.
                                4  C.   Toxicology services shall be reimbursed pursuant
                                5    to this section if the toxicology services are medically
                                6    necessary, as determined by a treating health care provider,
                                7    and performed in accordance with evidence-based clinical
                                8    protocols adopted by the authority that are consistent with
                                9    applicable behavioral health or substance use disorder
                                10   treatment standards.
                                11  D.   The authority shall promulgate rules to
                                12   establish protocols for medicaid reimbursement of toxicology
                                13   services.   While developing the rules, the authority shall
                                14   consider nationally accepted clinical guidance, such as
                                15   recommendations of the American society of addiction medicine
                                16   that provide for:
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                                17  (1)   weekly toxicology services for persons who
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                                18   are beginning treatment for a substance use disorder, unless
                                19   clinical documentation supports a different frequency;
                                20  (2)   monthly toxicology services for persons in
                                21   stable recovery from a substance use disorder, unless clinical
                                22   assessment and medical necessity indicate otherwise, as
                                23   specified by a treating health care provider; and
                                24  (3)   randomized toxicology services when
                                25   feasible and clinically appropriate.
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                                1  E.   The authority may request an independent
                                2    reference laboratory to provide tax filings and certificates of
                                3    good standing with the taxation and revenue department to
                                4    establish that the independent reference laboratory is eligible
                                5    for medicaid reimbursement pursuant to this section.
                                6  F.   Nothing in this section shall be construed to:
                                7  (1)   establish a mandatory minimum or maximum
                                8    frequency for reimbursement of toxicology services; or
                                9  (2)   restrict a provider's ability to order
                                10   toxicology services at a frequency supported by documented
                                11   clinical necessity.
                                12  G.   As used in this section:
                                13  (1)   "financially affiliated" means a business
                                14   arrangement in which one person, directly or indirectly, is
                                15   controlled by, is under common control with or controls another
                                16   person;
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                                17  (2)   "independent reference laboratory" means a
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                                18   laboratory that:
                                19  (a)   maintains a facility that is
                                20   physically located in the state and is staffed by laboratory
                                21   personnel who regularly and routinely report to the facility in
                                22   the ordinary course of business for the receipt, handling and
                                23   testing of human clinical specimens;
                                24  (b)   is certified pursuant to the federal
                                25   Clinical Laboratory Improvement Amendments of 1988, accredited
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                                1    by the college of American pathologists and licensed by the
                                2    authority;
                                3  (c)   is enrolled as a medicaid provider
                                4    under the medicaid program administered by the authority;
                                5  (d)   is not owned by, controlled by or
                                6    financially affiliated with a hospital, a physician practice or
                                7    physician group, a managed care organization or an insurer;
                                8  (e)   performs or contracts for the
                                9    performance of medicaid billing, coding, claim submission and
                                10   related revenue cycle management activities that occur
                                11   physically within the state; and
                                12  (f)   follows all applicable New Mexico
                                13   gross receipts tax laws and regulations;
                                14  (3)   "medicaid" means the joint federal-state
                                15   health coverage program pursuant to Title 19 or Title 21 of the
                                16   federal Social Security Act and rules promulgated pursuant to
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                                17   that act; and
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                                18  (4)   "toxicology services" means laboratory
                                19   testing of biological specimens, including urine, blood, saliva
                                20   and hair, for the presence of drugs or alcohol."
                                21        SECTION 2.    APPROPRIATION.--One hundred thousand dollars
                                22   ($100,000) is appropriated from the general fund to the health
                                23   care authority for expenditure in fiscal year 2027 to
                                24   administer medicaid reimbursement for toxicology services
                                25   provided by independent reference laboratories.     Any unexpended
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                                1    balance remaining at the end of fiscal year 2027 shall revert
                                2    to the general fund.
                                3  SECTION 3.   EFFECTIVE DATE.--The effective date of the
                                4    provisions of this act is July 1, 2026.
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