ACTUARIAL REVIEW OF HEALTH LEGISLATION

HB0259

HOUSE BILL 259

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

INTRODUCED BY

Nicole Chavez
and
Elaine Sena Cortez

AN ACT

RELATING TO HEALTH CARE; CREATING AN OPTIONAL PROCESS FOR
ACTUARIAL REVIEWS OF PROPOSED LEGISLATION THAT MAY CHANGE THE
COVERAGE REQUIREMENTS FOR HEALTH INSURERS; REQUIRING THE
LEGISLATIVE FINANCE COMMITTEE TO RETAIN CONTRACTORS THAT
PERFORM ACTUARIAL REVIEWS OF LEGISLATIVE PROPOSALS; MAKING AN
APPROPRIATION.

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

SECTION 1.
A new section of Chapter 2, Article 5 NMSA
1978 is enacted to read:

"[
NEW MATERIAL
] ACTUARIAL REVIEWS OF PROPOSED HEALTH CARE
LEGISLATION.--

A. On or before September 1, 2026, subject to
appropriation, the legislative finance committee shall retain
at least one contractor that is capable of performing actuarial
reviews of legislative proposals that may change the health
insurance or health plan coverage or compliance requirements.
A contractor retained by the legislative finance committee
shall have experience in conducting actuarial reviews on health
care policy and health insurance premiums.

B. Every year, each member of the legislature may
request the legislative finance committee to perform an
actuarial review of one piece of legislation that may change
the coverage requirements for health insurers. For each
regular legislative session, the legislative finance committee
shall provide actuarial reviews of proposed legislation for:

(1) up to two members of the majority party of
the house of representatives. If more than two members of the
majority party of the house of representatives submit an
actuarial review request to the legislative finance committee,
the director of the legislative finance committee shall notify
the speaker of the house of representatives, who shall select
two legislative proposals to be actuarially reviewed;

(2) up to two members of the minority party of
the house of representatives. If more than two members of the
minority party of the house of representatives submit an
actuarial review request to the legislative finance committee,
the director of the legislative finance committee shall notify
the minority floor leader of the house of representatives, who
shall select two legislative proposals to be actuarially
reviewed;

(3) up to two members of the majority party of
the senate. If more than two members of the majority party of
the senate submit an actuarial review request to the
legislative finance committee, the director of the legislative
finance committee shall notify the president pro tempore of the
senate, who shall select two legislative proposals to be
actuarially reviewed; and

(4) up to two members of the minority party of
the senate. If more than two members of the minority party of
the senate submit an actuarial review request to the
legislative finance committee, the director of the legislative
finance committee shall notify the minority floor leader of the
senate, who shall select two legislative proposals to be
actuarially reviewed.

C. A legislative proposal shall only be eligible
for actuarial review if a request for actuarial review is
submitted to the legislative finance committee by October 1 of
a given year.

D. An actuarial review performed by a contractor
shall provide, at a minimum:

(1) an estimate of the number of New Mexico
residents who will be directly affected by the legislative
proposal;

(2) estimates of changes in the rates of
utilization of specific health care services that may result
from the legislative proposal;

(3) estimates concerning any changes in
consumer cost sharing that would result from the legislative
proposal;

(4) estimates of any increases or decreases in
health insurance premiums;

(5) an estimate of the out-of-pocket health
care cost changes associated with the legislative proposal;

(6) an estimate of the potential long-term
health care cost changes associated with the legislative
proposal;

(7) identification of potential health
benefits for individuals or communities that would result from
the legislative proposal;

(8) to the extent practicable, the social and
economic impacts of the legislative proposal, including
potential impacts to health care providers, provider networks
and other health insurance markets;

(9) an estimate of the impact on state
spending related to programs administrated pursuant to the
Health Care Purchasing Act and the Public Assistance Act;

(10) an evaluation of whether coverage for any
health care services included in the legislative proposal is or
could be available without passage of the legislative proposal;
and

(11) an analysis of whether the legislative
proposal is supported by:

(a) determinations made by the United
States food and drug administration;

(b) coverage determinations made by the
federal centers for medicare and medicaid services;

(c) determinations made by the United
States preventive services task force; and

(d) nationally recognized clinical
practice guidelines.

E. If an actuarial review performed by a contractor
requires the analysis of health data, the actuarial review
shall rely on health data collected pursuant to the Health
Information System Act whenever practicable.

F. No later than January 1 of each year, the
legislative finance committee shall prepare a written report
containing the results of the actuarial reviews conducted
pursuant to this section and shall make the report available on
the legislature's website.

G. For the purposes of this section:

(1) "contractor" means an entity retained by
the legislative finance committee for the purpose of providing
actuarial reviews of legislative proposals that may change the
coverage requirements for health insurers;

(2) "health insurer" means a health
maintenance organization, nonprofit health care plan, provider
service network, medicaid managed care organization or third-party payer or its agent;

(3) "legislative proposal" means a proposal
that would statutorily require a health insurer to:

(a) provide coverage or increase the
amount of coverage for the treatment of a particular disease,
condition or health care need;

(b) provide coverage or increase the
amount of coverage for a particular type of health care
treatment or service or equipment, supply or prescription drug
used in connection with a health care treatment or service;

(c) provide coverage for care delivered
by a specific health care provider;

(d) follow a particular benefit design
or cost-sharing requirement for: 1) the treatment of a
particular disease, condition or health care need; 2) a
particular type of health care treatment or service; or 3) the
provision of medical equipment, supplies or prescription drugs
used in connection with treating a particular disease,
condition or health care need; or

(e) impose limits or conditions on a
contract between a health insurer and health care provider; and

(4) "legislative proposal" does not mean a
proposal that would:

(a) amend the scope of practice of a
licensed health care professional; or

(b) make state law consistent with
federal law."

SECTION 2.
APPROPRIATION.--One hundred thousand dollars
($100,000) is appropriated from the general fund to the
legislative finance committee for expenditure in fiscal year
2027 to procure contractors to perform actuarial reviews of
legislative proposals that may change the coverage requirements
for health insurance plans. Any unexpended balance remaining
at the end of fiscal year 2027 shall revert to the general
fund.

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