WHEELCHAIR INSURANCE COVERAGE
HB38 expands and standardizes insurance coverage for prosthetic devices, custom orthotic devices, and complex rehabilitation technology devices, including complex wheelchairs and related mobility equipment. The bill requires covered plans to provide medically necessary devices and associated services such as fitting, programming, instruction, repair, and replacement. It also specifies coverage for devices used for daily mobility, physical activity, and bathing/showering, and it limits the number of covered devices per limb or person while allowing additional coverage after three years when a device is no longer appropriate for the enrollee’s needs.
The bill applies these requirements across multiple categories of health coverage in New Mexico, including group health plans, individual plans, health maintenance organization contracts, and other health care plans regulated under the Insurance Code and Health Care Purchasing Act. It requires parity with Medicare-level reimbursement, prohibits separate financial requirements that are more restrictive than those applied to comparable medical and surgical benefits, and bars annual or lifetime dollar caps specific to these devices. It also requires access to at least two in-state network providers and an out-of-network referral process when medically necessary devices are unavailable in-network. The bill excludes short-term and other excepted-benefit plans and applies to policies renewed or issued on or after January 1, 2027.
HB38 amends multiple sections of New Mexico insurance law, including provisions in the Health Care Purchasing Act and the Insurance Code, to create uniform coverage and nondiscrimination standards for prosthetic, orthotic, and complex rehabilitation technology devices. It adds detailed utilization-review, provider-network, reimbursement, replacement, and anti-discrimination requirements for insurers, health plans, and HMOs, and it defines complex rehabilitation technology devices as specialized durable medical equipment, including manual and power wheelchairs. The bill also makes denial of certain covered device benefits on disability-related grounds an unfair and deceptive practice in specified circumstances.
The bill appears to have been broadly supported and noncontroversial. It passed the House 67-0 and the Senate 39-0, indicating unanimous support in both chambers. The limited committee commentary provided does not show significant opposition, and the voting history suggests strong bipartisan agreement on the need to improve coverage for mobility and rehabilitation devices.
The main policy issues reflected in the bill are not outright opposition but the scope and administration of coverage. The bill sets detailed limits and conditions, such as caps on the number of covered devices, a three-year exception for replacement needs, requirements for independent wheelchair evaluations, and staffing standards for suppliers. It also distinguishes between in-network and out-of-network reimbursement and excludes short-term and other excepted-benefit plans. These provisions suggest the likely areas of concern were cost control, medical necessity review, and ensuring access to appropriately specialized providers rather than whether coverage should exist at all.