Section 59A-23-11 – Private health insurance cooperatives; incorporation.
A. A person may form a cooperative to purchase employer health benefit plans. A cooperative shall be organized as a nonprofit corporation and has the rights and duties provided by the Nonprofit Corporation Act [Chapter 53, Article 8 NMSA 1978]. B. Two or more large employers or small employers or any combination of large employers […]
Section 59A-23-12 – Prescription drug prior authorization protocols.
A. After January 1, 2014, an insurer shall accept the uniform prior authorization form developed pursuant to Sections 2 [59A-2-9.8 NMSA 1978] and 3 [61-11-6.2 NMSA 1978] of this 2013 act as sufficient to request prior authorization for prescription drug benefits. B. No later than twenty-four months after the adoption of national standards for electronic […]
Section 59A-23-12.1 – Prescription drug coverage; step therapy protocols; clinical review criteria; exceptions.
A. Each group or blanket health insurance policy, health care plan and certificate of health insurance delivered or issued for delivery in this state that provides a prescription drug benefit 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 […]
Section 59A-23-12.2 – Pharmacist prescriptive authority services; reimbursement parity.
An insurer shall reimburse a participating provider that is a certified pharmacist clinician or pharmacist certified to provide a prescriptive authority service who provides a service pursuant to a health insurance plan, policy or certificate of health insurance at the standard contracted rate that the health insurance policy, health care plan or certificate of health […]
Section 59A-23-7.8 – Hearing aid coverage for children required.
A. A blanket or group health insurance policy, health care plan or certificate of health insurance that is delivered, issued for delivery or renewed in this state 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 […]
Section 59A-23-13 – Pharmacy benefits; prescription synchronization.
A. A group or blanket health insurance policy, health care plan or certificate of health insurance that is delivered, issued for delivery or renewed in this state and that provides a prescription drug or device benefit shall allow an insured to fill or refill a prescription for less than a thirty-day supply of the prescription […]
Section 59A-23-7.9 – Coverage for autism spectrum disorder diagnosis and treatment.
A. A blanket or group health insurance policy or contract that is delivered, issued for delivery or renewed in this state shall provide coverage to an insured for: (1) well-baby and well-child screening for diagnosing the presence of autism spectrum disorder; and (2) treatment of autism spectrum disorder through speech therapy, occupational therapy, physical therapy […]
Section 59A-23-14 – Provider credentialing; requirements; deadline.
A. The superintendent shall adopt and promulgate rules to provide for a uniform and efficient provider credentialing process. The superintendent shall approve no more than two forms of application to be used for the credentialing of providers. B. An insurer shall not require a provider to submit information not required by a credentialing application established […]
Section 59A-23-7.10 – Coverage for orally administered anticancer medications; limits on patient costs.
A. A blanket or group health insurance policy or contract that is delivered, issued for delivery or renewed in this state and that provides coverage for cancer treatment shall provide coverage for a prescribed, orally administered anticancer medication that is used to kill or slow the growth of cancerous cells on a basis no less […]
Section 59A-23-15 – Physical rehabilitation services; limits on cost sharing.
A. A group or blanket health insurance policy, health care plan or certificate of health insurance that is delivered, issued for delivery or renewed in this state shall not impose a member cost share for physical rehabilitation services that is greater than that for primary care services on a coinsurance percentage basis when coinsurance is […]