REQUIREMENTS FOR REIMBURSEMENT PARITY BETWEEN CERTIFIED PHARMACIST CLINICIANS, CERTAIN PHARMACISTS,

ST ATE OF NEW MEXICO OFFICE OF SUPERINTENDENT OF INSURANCE SUPERINTENDENT OF INSURANCE Russell Toal ":*SI 0l:.Ct (T NEV/ MEXIC(:). irii )llfvi:flll DEPUTY SUPERINTENDENT Robert E. Doucette. Jr. r- BULLETIN 2020-015 June 29, 2020 ,r- r I'- :: i-l .'.:i', I - I 'I " . 1 TO: ALL HEALTH INSURANCE CARRIERS, GROUP HEALTH PLANS, HEALTH MAINTENANCE ORGANIZATIONS, NON-PROFIT HEALTH CAJIE PLANS RE: REQUIREMENTS FOR REIMBURSEMENT PARITY BETWEEN CERTIFIED PHARMACIST CLINICIANS, CERTAIN PCISTS AND OTHER LICENSED HEALTH CARE PROFESSIONALS FOR THE SAME CLINICAL SERVICES House Bill 42, "Pharmaceutical Service Reimbursement Parity" was enacted by the New Mexico Legislahire and went into effect June 4, 2020. It has been chaptered at Sections 59A-22- 53.2, 59A-23-12.2, 59A-46-52.2, 59A-47-47.2 NMSA 1978, but will hereinafter be referi-ed to as House Bill 42. The bill applies to all health insurance cariiers, medical assistance providers (Medicaid) and its contractors, group health plans, blanket health plans, health maintenance organizations and nonprofit health care plans, wich shall be refened to hereinafter as "cairiers." Under House Bill 42, carriers are required to reimburse in-network certified pharn'iacist clinicians or certified pharmacists with prescriptive authoiity at the same contracted rate as a licensed physician or physician's assistant licensed pursuant to the Medical Practice Act or the Osteopathic Medicine Act or any advanced practice certified nurse practitioner licensed pursuant to the Nursing Practice Act for the provision Main Office: 1120 Paseo de Peralta, Room 428, Santa Fe, NM 87501 Satellite Office: 6200 Uptown Blvd NE, Suite 100, Albuquerque, NM 87110 Main Phone: (505) 827-4601 i Satellite Phone: (505) 322-2186i Toll Free: (855) 4 - ASK - OSI www.osi.state.nm.us BULLEI-)N 2020-015 Page2 of the same service. Cairiers should infoim their contracted pharn'iacists of their tights to reimbursement for applicable services under this act as well as any procedures for reimbursement. Caniers must perfoim the reimbursement provisions established above in an equitable and organized manner. It is the determination of the Supeiintendent, therefore, that carriers shall reimburse in-network ceitified pharmacist clinicians or ceitified phaimacists with prescriptive authority at the same contracted rate as a licensed physician or physician's assistant licensed pursuant to the Medical Practice Act or the Osteopathic Medicine Act or any advancedpractice certified nurse practitioner licensed pursuant to the Nursing Practice Act for the provision of the same service in the same geozip code area. Geozip code, for purposes of this bulletffi, is the first three digits of a postal code zip code. The requirements for timely payment of claims pursuant to Section 59A-16-21.1 NMSA 1978 shall apply to the reimbursement of in-network phaimacists and pharmacist clinicians for clinical services. Any questions or complaints related to House Bill 42 can be submitted to Renee Blechner at Renee.Blechner@state.nm.us. ISSUED this 29th day of June, 2020. Superintendent of Insurance Main Office: 1120 Paseo de Peralta, Room 428, Santa Fe, NM 87501 Satellite Office: 6200 Uptown Blvd NE, Suite 100, Albuquerque, NM 87110 Main Plione: (505) 827-4601 i Satellite Plione: (505) 322-2186i Toll Free: (855) 4 - ASK - OSI www.osi.state.nm.us