News from the Blues

Sept. 13, 2023

New Mexico House Bill 27: Breast Exam Health Coverage

Applies to the following plan types: Individual & Family Markets, student and grandfathered (excluding self-funded), fully insured small group, mid-market and large groups, Interagency Benefits Advisory Council (IBAC)* and Blue Balance Funded^SM

New Mexico House Bill 27 prohibits imposing cost sharing on covered diagnostic and supplemental breast exams that are medically necessary and clinically appropriate.

• Diagnostic breast exams: Medically necessary follow-up imaging used to take a closer look at an abnormality previously found or suspected in a routine screening, or other exam. This includes diagnostic mammography, and breast MRI / ultrasound.
   
• Supplemental breast exams: Medically necessary screening imaging used before an abnormality is seen or suspected, when the member has risk factors for breast cancer, such as a personal or family history of the disease. This includes breast MRI / ultrasound.

Cost sharing will be removed from services obtained from an in-network provider only. Services obtained from an out-of-network provider may still have cost-sharing.

• Note that preventive screenings provided by an in-network provider are still covered without cost sharing before the deductible for HDHP plans.

When does this go into effect?
The mandate is effective upon renewal on or after Jan. 1, 2024.

*IBAC entities include Albuquerque Public Schools (APS), New Mexico Public Schools Insurance Authority (NMPSIA), New Mexico Retiree Health Care Authority (NMRHCA, and State of New Mexico Risk Management Division (SONM).