Committee backs no-cost calcium scans for commercial health-plan enrollees in bill sponsor—s pitch to reduce cardiac deaths

Senate Health and Public Affairs recommended passage of Senate Bill 278, which would require fully insured commercial group health plans in New Mexico to cover coronary artery calcium screening without cost-sharing and to promote follow-up care for people found to have atherosclerotic plaque.

Sponsor testimony emphasized that coronary artery calcium screening — a brief CT scan that detects calcified plaque in coronary arteries — can identify patients at risk of heart attack who otherwise appear asymptomatic. The sponsor said treating elevated low-density lipoprotein (LDL) cholesterol identified through screening is inexpensive compared with the costs of cardiac events and hospitalizations. “With this one screening, we can save lives and tens of millions in health care spending,” the sponsor told the committee.

Dr. David Shade (introduced as an expert online) and other witnesses described how LDL contributes to plaque formation, how calcified plaque appears on scans, and how lipid-lowering therapy can be effective and affordable. A state employee who paid for a private scan testified she received useful guidance about lifestyle and medical care after a $250 test.

Several senators asked whether the bill would apply to federal programs such as TRICARE and Medicare (it would not), how the measure applies to out-of-state providers and networks, and how cost impacts on premiums should be scored. The sponsor said the bill applies to fully insured commercial plans regulated by the Office of the Superintendent of Insurance; self-funded plans and federal programs are not governed by the state statute.

Senators also asked the sponsor to work with the Office of Superintendent of Insurance to refine technical definitions in the fiscal-impact review (FIR). The committee recorded a due-pass recommendation by an 8-1 vote. Senators explained votes on the record; one senator said he would wait to see the final technical amendments before supporting the bill on the Senate floor.

The bill also included a related proposal to eliminate cost-sharing for two generic cholesterol-lowering medicines (rosuvastatin and ezetimibe) in a companion measure presented later in the hearing.

The committee discussion noted implementation questions — such as how to define which plans must comply, negotiate pricing with imaging providers and whether pharmacists could play a role in ordering and follow-up — that the sponsor said would be addressed in amendments and guidance from agencies.