N.M. Stat. § 27-2-12.31
This is the official text of N.M. Stat. § 27-2-12.31, part of New Mexico’s Stat — part of the compiled statutory law of New Mexico, published by the state as "Stat." Browse the sections below, each linked to its official government source.
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§ 27-2-12.31. Heart artery calcium scan coverage
Official statutory text
A. In accordance with federal law, the secretary shall adopt and promulgate rules that provide medical assistance coverage for eligible enrollees to receive a heart artery calcium scan.
B. Medical assistance coverage provided pursuant to this section shall:
(1) be limited to the provision of a heart artery calcium scan to an eligible enrollee to be used as a clinical management tool;
(2) be provided every five years if an eligible enrollee has previously received a heart artery calcium score of zero; and
(3) not be required for future heart artery calcium scans if an eligible enrollee receives a heart artery calcium score greater than zero.
C. At its discretion or as required by law, a managed care organization providing medical assistance may offer or refuse coverage for further cardiac testing or procedures for eligible enrollees based upon the results of a heart artery calcium scan.
D. The provisions of this section shall not apply to short-term travel, accident-only or limited or specified-disease policies, plans or certificates of health insurance.
E. As used in this section:
(1) “ eligible enrollee ” means an enrollee who:
(a) is a person between the ages of forty-five and sixty-five; and
(b) has an intermediate risk of developing coronary heart disease as determined by a health care provider based upon a score calculated from an evidence-based algorithm widely used in the medical community to assess a person's ten-year cardiovascular disease risk, including a score calculated using a pooled cohort equation;
(2) “ health care provider ” means a physician, physician assistant, nurse practitioner or other health care professional authorized to furnish health care services within the scope of the professional's license; and
(3) “ heart artery calcium scan ” means a computed tomography scan measuring coronary artery calcium for atherosclerosis and abnormal artery structure and function.
B. Medical assistance coverage provided pursuant to this section shall:
(1) be limited to the provision of a heart artery calcium scan to an eligible enrollee to be used as a clinical management tool;
(2) be provided every five years if an eligible enrollee has previously received a heart artery calcium score of zero; and
(3) not be required for future heart artery calcium scans if an eligible enrollee receives a heart artery calcium score greater than zero.
C. At its discretion or as required by law, a managed care organization providing medical assistance may offer or refuse coverage for further cardiac testing or procedures for eligible enrollees based upon the results of a heart artery calcium scan.
D. The provisions of this section shall not apply to short-term travel, accident-only or limited or specified-disease policies, plans or certificates of health insurance.
E. As used in this section:
(1) “ eligible enrollee ” means an enrollee who:
(a) is a person between the ages of forty-five and sixty-five; and
(b) has an intermediate risk of developing coronary heart disease as determined by a health care provider based upon a score calculated from an evidence-based algorithm widely used in the medical community to assess a person's ten-year cardiovascular disease risk, including a score calculated using a pooled cohort equation;
(2) “ health care provider ” means a physician, physician assistant, nurse practitioner or other health care professional authorized to furnish health care services within the scope of the professional's license; and
(3) “ heart artery calcium scan ” means a computed tomography scan measuring coronary artery calcium for atherosclerosis and abnormal artery structure and function.
Status: in_force
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