HEALTH CARE PROVIDER COVERAGE

SB0015

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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