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A. A group health maintenance organization contract, other than a small group health maintenance organization contract, that is delivered, issued for delivery or renewed in this state shall provide coverage for eligible enrollees to receive a heart artery calcium scan.
B. 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 carrier 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 do 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.
Cite this article: FindLaw.com - New Mexico Statutes Chapter 59A. Insurance Code § 59A-46-50.5. Heart artery calcium scan coverage - last updated May 06, 2021 | https://codes.findlaw.com/nm/chapter-59a-insurance-code/nm-st-sect-59a-46-50-5/
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