Our Blog

NM SB 317 insurance must cover rehab

New State Law: Insurance Must Cover Full Cost of Addiction Treatment

For decades, Americans have struggled to overcome significant barriers to treatment. The most common obstacles are stigma, proximity, and cost. In most cases, rehab programs are simply too expensive – insurers would not pay enough to cover the cost of care. Today, New Mexico has finally addressed this problem. Thanks to Senate Bill 317 (SB 317), most private/ commercial insurance carriers based in New Mexico will now cover the entire cost of addiction treatment through an in-network provider such as Vista Taos.

SB 317 Explained: What’s in the Bill?

SB 317, summarized as “no behavioral health cost-sharing” passed in March of 2021. Sponsored by Senator Martin Hickey [D] and Senator Jeff Steinborn [D], the bill aims to alleviate the financial burden associated with recovery. It does so through the establishment of the Health Care Affordability Fund, a resource available to working families across the state of New Mexico. It also places sanctions against copays and cost-sharing for covered individuals seeking treatment for behavioral health concerns (there can be occasional exceptions).

Senate Bill 317 makes additions to the existing Health Care Purchasing Act, as well as to the state’s Insurance Code. Costs for the Health Care Affordability Fund are covered through an updated taxing structure applied to insurance companies. This increase will take the surtax from 1% to 3.75%, representing about $165 million in revenue each year. Thanks to these newly available funds, New Mexicans will gain access to affordable care (and more affordable insurance coverage for the uninsured).

“Mental health issues and substance use disorders plague our state,” said co-sponsor Senator Martin Hickey. “With this law in place, financial barriers will no longer get in the way of treatment, giving more people access to the care they need.”

How SB 317 Helps the Insured and Uninsured

Since SB 317 modified the Health Care Affordability Fund, countless New Mexicans stand to benefit from its provisions. For example, the newly available $165 million will also allow the state to invest in initiatives promoting affordable healthcare.

Legislators hope to lower premiums and reduce out-of-pocket costs for those who purchase coverage through New Mexico’s health insurance exchange. Small businesses will also receive assistance in paying for employee health care. Finally, uninsured citizens will receive aid in the form of lower costs. Research shows that more than 20,000 New Mexico residents could be eligible to afford the coverage they need.

“With this bill’s signage into law, more than 23,000 uninsured New Mexicans will now gain access to the affordable health care that we all deserve, and thousands of those already insured will see their premiums and deductibles go down,” stated Representative Debbie Armstrong. “Not only is providing quality health care to all New Mexicans the right thing to do, but it decreases costs for everyone [and] improves public health.”

A Promising Change for New Mexico Insurance

Governor Michelle Lujan Grisham signed SB 317 in April of 2021, with a designation that it should take effect in January of 2022. “The pandemic has highlighted the devastating economic impact of out-of-pocket medical bills. This legislation is an important first step,” she said.

“We can make a real, meaningful difference by reducing the costs for those with insurance who seek help by eliminating the copays for behavioral health services – and I’m so proud and grateful to sign this priority measure.”

Overcoming Barriers to Treatment

An estimated 23 million Americans struggle with alcohol or drug addiction. Although this problem is widespread, only around 10% of people will receive treatment for their substance use disorder. This statistic is especially troubling when compared to the numbers for other conditions; for example, 85% of Americans with diabetes receive treatment. We are glad to see that New Mexico is making strides that will close this gap for those in our state.

Vista Taos is an in-network, accredited behavioral health provider with almost all New Mexico health insurance carriers. Located in beautiful Taos, NM; our caring staff provides round-the-clock care and evidence-based therapies. We offer detoxification, residential treatment, and long-term care. To verify your coverage, contact the Vista Taos admissions team.

*Per The Office of Superintendent of Insurance for New Mexico: Insured patients who believe they are being incorrectly required to pay for a covered BH service are advised to first contact their health insurance company to correct the situation. If the insurance company does not resolve the issue, patients and providers can submit a complaint to the Managed Health Care Bureau at https://www.osi.state.nm.us/index.php/managed-healthcare-complaint/ or call 855-427-5674.

Share this post