Section 13-7-18 – Prescription drug coverage; step therapy protocols; clinical review criteria; exceptions.
A. Group health coverage, including any form of self-insurance, offered, issued or renewed under the Health Care Purchasing Act that provides coverage for prescription drugs for which any step therapy protocols are required shall establish clinical review criteria for those step therapy protocols. The clinical review criteria shall be based on clinical practice guidelines that: […]
Section 13-7-19 – Prior authorization for gynecological or obstetrical ultrasounds prohibited.
A. Group health coverage, including any form of self-insurance, offered, issued or renewed under the Health Care Purchasing Act that provides coverage for gynecological or obstetrical ultrasounds shall not require prior authorization for gynecological or obstetrical ultrasounds. B. Nothing in this section shall be construed to require payment for a gynecological or obstetrical ultrasound that […]
Section 13-7-20 – Prior Authorization Act.
Benefits administrators of group health coverage, including any form of self-insurance, offered, issued or renewed under the Health Care Purchasing Act are subject to and shall comply with the Prior Authorization Act [59A-22B-1 to 59A-22B-5 NMSA 1978]. History: Laws 2019, ch. 187, § 1 ANNOTATIONS Effective dates. — Laws 2019, ch. 187 contained no effective […]
Section 13-7-5 – Consolidated purchasing for other persons.
A. Counties, municipalities, state educational institutions and other political subdivisions that wish to use the consolidated purchasing single process for the procurement of health care benefits shall create or enter into an existing association, cooperative or other mutual alliance to create larger pools of eligible participants. B. Counties, municipalities, state educational institutions and other political […]
Section 13-7-6 – Use of social security numbers.
The publicly funded health care agencies, political subdivisions and other persons providing health care benefits through the consolidated purchasing single process, in compliance with state and federal law, shall not require the use of participants’ social security numbers as health care benefit plan identification numbers. History: Laws 2001, ch. 351, § 2. ANNOTATIONS Effective dates. […]
Section 13-7-7 – Consolidated administrative functions; benefit.
A. The publicly funded health care agencies, political subdivisions and other persons participating in the consolidated purchasing single process pursuant to the Health Care Purchasing Act may enter into a joint powers agreement pursuant to the Joint Powers Agreements Act [11-1-1 to 11-1-7 NMSA 1978] with the publicly funded health care agencies and political subdivisions […]
Section 13-7-8 – Maximum age of dependent.
Any group health care coverage, including any form of self-insurance, offered, issued or renewed under the Health Care Purchasing Act on or after July 1, 2003 that offers coverage of an insured’s dependent shall not terminate coverage of an unmarried dependent by reason of the dependent’s age before the dependent’s twenty-fifth birthday, regardless of whether […]
Section 13-7-9 – General anesthesia and hospitalization for dental surgery.
A. Group health care coverage, including any form of self-insurance, offered, issued or renewed under the Health Care Purchasing Act shall provide coverage for hospitalization and general anesthesia provided in a hospital or ambulatory surgical center for dental surgery for the following: (1) insureds exhibiting physical, intellectual or medically compromising conditions for which dental treatment […]
Section 13-7-10 – Hearing aid coverage for children required.
A. Group health care coverage, including any form of self-insurance, offered, issued or renewed under the Health Care Purchasing Act shall provide coverage for a hearing aid and any related service for the full cost of one hearing aid per hearing-impaired ear up to two thousand two hundred dollars ($2,200) every thirty-six months for hearing […]
Section 13-7-11 – Required coverage of patient costs incurred in cancer clinical trials.
Group health coverage, including any form of self-insurance, offered, issued or renewed under the Health Care Purchasing Act shall provide coverage pursuant to Section 59A-22-43 NMSA 1978 for routine patient care costs incurred as a result of the patient’s participation in cancer clinical trials. History: Laws 2009, ch. 212, § 1. ANNOTATIONS Effective dates. — […]