New Mexico § 27-2-12.31 - Heart artery calcium scan coverage

§ 27-2-12.31. Heart artery calcium scan coverage

A. In accordance with federal law, the secretary shall adopt and promulgate rules

that provide medical assistance coverage for eligible enrollees to receive a heart

artery calcium scan. B. Medical assistance 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 managed care organization providing

medical assistance 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 shall 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.