Senate Bill 278 (SB 278):  The bill makes several key changes to coronary artery calcium screening requirements across various statutes in New Mexico law, including eliminating cost sharing and broadening eligibility criteria and ensures coverage for subsequent cardiac care is guided by medical necessity and standard coverage rules. 

 Senate Bill 278 (SB 278):  Overview of Major Changes- 
•	Terminology - Replaces references to a “heart scan” with “coronary artery calcium screening.”
Broader Eligibility:
•	Removes the previous age-range (45–65) and intermediate-risk requirements, effectively broadening who may receive the screening at a health care provider’s discretion.
New Coverage Interval:
•	Changes the screening interval from once every five years to once every four years if an individual’s prior score was zero.
•	Individuals receiving a score greater than zero are not automatically entitled to future covered screenings under these provisions.
No Cost Sharing:
•	Prohibits deductibles, copayments, and coinsurance from being charged for coronary artery calcium screenings.
Further Testing:

•	In Section 1 (relating to the Health Care Purchasing Act), insurers must offer coverage for further cardiac testing or procedures based on the screening results; in most other sections, prior references to “may offer or refuse” are deleted, deferring to standard coverage determinations under other laws or standard medical-necessity rules.
Applicability Date:
•	These changes apply to group health insurance policies and plans delivered, issued, or renewed on or after January 1, 2026.
This bill recommends the following amendments:
Section 1 (Amends §13-7-24 NMSA 1978) — Health Care Purchasing Act
Coverage Requirement:
•	Requires group health coverage under the Health Care Purchasing Act to include coronary artery calcium screening at the discretion of a health care provider.
Screening Interval:
•	If a previous screening score was zero, coverage is provided once every four years (changed from five years).
Further Testing:
•	Requires insurers to offer coverage for additional cardiac testing or procedures when medically indicated by the screening results (changed from the insurer’s discretion to a mandate).
Section 2 (Amends §27-2-12.31 NMSA 1978) — Public Assistance Act (Medicaid)
Medical Assistance Coverage:
•	Directs the Human Services Department to cover coronary artery calcium screenings for Medicaid enrollees.
•	Screening Interval: Same four-year interval if a prior score was zero; no mandated coverage for subsequent screenings if the score is above zero.
No Cost Sharing:
•	Prohibits any form of cost sharing for these screenings under Medicaid.
Further Testing:
•	Removes prior language about a managed care organization’s discretion; coverage for follow-up testing is typically governed by other Medicaid rules or medical-necessity determinations.
Section 3 (Amends §59A-23-7.16 NMSA 1978) — Group Health Plans (Large Groups)
Required Coverage:
•	Group health plans (other than small group or blanket policies) must provide coronary artery calcium screenings.
Interval:
•	Four-year interval if the score is zero; no requirement for future screenings if the score is above zero.
No Cost Sharing:
•	Screenings must be covered without deductibles, copayments, or coinsurance.
Further Testing:
•	Previous language about insurer discretion for additional cardiac testing is removed.
Section 4 (Amends §59A-46-50.5 NMSA 1978) — Group Health Maintenance Organizations
Required Coverage:
•	Large-group HMO contracts must provide coverage for coronary artery calcium screenings at a provider’s discretion.
Interval:
•	Four-year interval for a score of zero; no mandated coverage if the score is above zero.
No Cost Sharing:
•	HMOs cannot impose any form of cost sharing for the screening.
Further Testing:
•	Removes old discretionary coverage language; follow-up coverage is handled under other standard rules.
Section 5 (Amends §59A-47-45.7 NMSA 1978) — Group Health Care Plans
Coverage Requirement:
•	Requires group health care plans, other than small group plans, to include coronary artery calcium screenings.
Interval:
Screening every four years if a prior score was zero; no requirement if the score is above zero.
•	No Cost Sharing:
•	No deductibles, copays, or coinsurance for screening.
Further Testing:
•	Deletes prior language allowing an insurer to refuse further testing; standard coverage rules apply to subsequent cardiac procedures.
Section 6 (Applicability)
Effective Date:
•	These requirements apply to affected group health insurance policies, plans, or certificates of health insurance issued or renewed on or after January 1, 2026.
 

 The current law provides provisions requiring insurance coverage for heart artery calcium scans under the Health Care Purchasing Act:
•	Requires Coverage
•	Every group health plan (including self-insured plans) governed by the Health Care Purchasing Act must cover heart artery calcium scans for certain individuals.
An “eligible insured” is someone:
•	Age 45 to 65; and
•	Considered at intermediate risk for developing coronary heart disease, based on a commonly used medical risk algorithm (such as a pooled cohort equation).
What Is Covered
•	A heart artery calcium scan is a specialized CT scan that checks for calcium in the coronary arteries, helping detect atherosclerosis or other artery abnormalities.
•	Coverage is limited to the scan itself, which is used as a clinical management tool to guide future care decisions.
Frequency of Coverage
•	If your previous scan score was zero, you can get another covered scan every five years.
•	If your scan score is greater than zero, the plan does not have to cover additional scans under this provision.
Further Testing
•	After you receive the scan results, the insurer may or may not cover further cardiac tests or procedures at its discretion or as required by other laws or policies.
Exclusions
•	The requirement does not apply to short-term travel, accident-only, or limited-disease insurance policies.
In short, this law ensures that individuals aged 45–65 who are at intermediate risk for coronary heart disease can receive a regular, insurance-covered heart artery calcium scan to help diagnose and manage potential heart disease. The scan is covered every five years if prior results are zero, but the insurer is not obliged to pay for follow-up scans or procedures unless it chooses or other laws require it.
 

 Committee Substitute March 16, 2025, in STBTC.

STBTCcs/SB 278:  This proposed legislation proposes the following:  
•	Renames “Heart Scan” to “Coronary Artery Calcium Screening.”
•	Throughout the bill, the term “heart scan” is replaced with “coronary artery calcium screening,” which is more precise and describes the type of computed tomography scan used to measure calcification in the coronary arteries.
Broadens Eligibility for Screening.
•	Old law: Coverage was limited to individuals aged 45–65 who had an “intermediate risk” of coronary heart disease (based on a 10-year cardiovascular risk score).
•	New bill: Removes the strict age- and risk-based definitions of “eligible insured.” Now, if a health care provider deems it clinically appropriate, a patient is eligible for coverage of a coronary artery calcium screening.
•	Prohibits Cost Sharing for Individuals Aged 50 and Over.
The bill adds a new provision stating that insurers may not impose “cost sharing” (i.e., deductibles, copayments, or coinsurance) on individuals over age 49.
•	In practical terms, if you are 50 or older, you can receive a coronary artery calcium screening without having to pay anything out of pocket, provided the screening is ordered at the discretion of a health care provider.
•	Establishes When Screenings Are Covered (Zero Score vs. Non-Zero).
•	If a patient’s coronary artery calcium score is “zero,” they may receive additional covered screenings every five years (unless the provider directs otherwise).
•	If the score is above zero, the insurer is not required to provide future coverage of coronary artery calcium screening. (The assumption is that patients with a positive score will transition to further diagnosis or treatment, outside of this specific screening requirement.)
•	Excludes Certain Types of Insurance Plans.
As with the previous law, certain limited plans do not have to follow these requirements, including:
•	Short-term travel policies
•	Accident-only or limited/specified-disease policies
•	Catastrophic plans (as defined under federal law)
•	High-deductible health plans with health savings accounts (until the deductible is met)
•	Other types of coverage not considered comprehensive major medical coverage
Effective Date.

•	The changes in this bill apply to health insurance policies (or similar coverage) that are delivered, issued, or renewed on or after January 1, 2026.
•	Why These Changes Matter
•	Expanded Access. By removing the specific age range (45–65) and the requirement that an individual have an “intermediate risk,” this bill makes it easier for patients—at the discretion of a health care provider—to receive a covered calcium screening.
•	No Cost Sharing for Those 50+. Once you turn 50, insurers must cover the full cost of the screening, making it more accessible to older adults who may be at risk.
•	Aligns with Clinical Judgment. The bill emphasizes that the decision to order a coronary artery calcium screening is made by a licensed health care professional, rather than being narrowly tied to one particular risk calculator or score.