New Mexico Register / Volume
XXXI, Issue 6 / March 24, 2020
This is an emergency
amendment to 13.10.13 NMAC, Section 12, effective 3/12/2020.
13.10.13.12 [COPAYMENTS] COST SHARING:
A. All
[copayments] cost sharing (including copayments, deductibles,
co-insurance, or similar charges) required of covered persons by the health
care insurer or managed health care plan for the provision of health care
services shall be reasonable and shall include any applicable state and federal
taxes.
B. Any cost sharing requirement for the provision of testing and delivery of health care services for COVID-19, pneumonia, influenza, or any disease or condition which is the cause of, or subject of, a declared public health emergency is presumptively unreasonable and is prohibited. For purpose of this rule, a public health emergency exists when declared by the state or federal government, or by order of the superintendent.
[B] C. [Copayment] Cost sharing
requirements, including any variations in contribution requirements based on
the type of health care service rendered or provider used, shall be disclosed
to covered persons in MHCP contracts, enrollment materials, and in the evidence
of coverage.
[C] D. No female covered person shall be assessed
a higher [copayment] cost sharing requirement, over and above the
[copayment] cost sharing required of all covered persons to be
seen by a primary care physician, for choosing a women’s health care provider
as her primary care physician
E. Health
care services for any disease or condition for which cost sharing is
prohibited, under Paragraph B of this section shall be subject to the Surprise
Billing Protection Act, Section 59A-57A-1 through 13, NMSA 1978.
[13.10.13.12 NMAC - Rp, 13.10.13.27 NMAC, 09/01/2009; A/E, 3/12/2020]