HEALTH CARE PROVIDER REIMBURSEMENTS

SB 512 (2025) amends New Mexico's Surprise Billing Protection Act to update how health insurance carriers calculate reimbursements for nonparticipating healthcare providers. It changes the benchmarking period from using 2017 claims data to using data from the calendar year two years prior to when the service was provided. The bill maintains that reimbursement rates must reflect the 60th percentile of commercial rates for similar services in the same specialty and geographic area, with a floor of 150% of the Medicare rate for that service. This directly affects nonparticipating providers who receive surprise billing claims and insurers responsible for payments under the law. The bill passed committee review but was postponed indefinitely on June 3, 2025.