Chapter 59A, Article 46 NMSA 1978 may be cited as the “Health Maintenance Organization Law”. History: Laws 1984, ch. 127, § 848; 1993, ch. 266, § 1. ANNOTATIONS The 1993 amendment, effective January 1, 1994, substituted “Chapter 59A, Article 46 NMSA 1978” for “This article” and substituted “‘Law’” for “‘Act.’”. Am. Jur. 2d, A.L.R. and […]
A. A health maintenance organization shall provide to its subscribers or to its group contract holders for distribution to subscribers a list of providers upon enrollment and re-enrollment. B. Every health maintenance organization shall notify its subscribers within thirty days of any material change in the operation of the organization that will affect the service […]
A. Every health maintenance organization shall establish and maintain a grievance procedure that has been approved by the superintendent to provide procedures for the resolution of grievances initiated by enrollees. The health maintenance organization shall maintain records regarding grievances received since the date of its last examination of such grievances. B. The superintendent or his […]
With the exception of investments made in accordance with Paragraph (1) of Subsection A of Section 59A-46-5 NMSA 1978, the funds of a health maintenance organization shall be invested only in accordance with Chapter 59A, Article 9 NMSA 1978 and such regulations as the superintendent may promulgate consistent with that article and the provisions of […]
A. Health maintenance organizations shall be subject to the following net worth requirements: (1) before any certificate of authority is issued to a health maintenance organization, it shall have an initial net worth of one million five hundred thousand dollars ($1,500,000) and shall thereafter maintain the minimum net worth required under Paragraph (2) of this […]
A. If at any time uncovered expenditures exceed ten percent of total health care expenditures, a health maintenance organization shall place an uncovered expenditures insolvency deposit with the superintendent, with any organization or trustee acceptable to the superintendent through which a custodial or controlled account is maintained, cash or securities that are acceptable to the […]
A. In the event of an insolvency of a health maintenance organization, upon order of the superintendent, all other carriers that participated in the enrollment process with the insolvent health maintenance organization at a group’s last regular enrollment period shall offer such group’s enrollees of the insolvent health maintenance organization a thirty-day enrollment period commencing […]
A. No premium rate may be used until either a schedule of premium rates or methodology for determining premium rates has been filed with and approved by the superintendent. At the time the health maintenance organization files the rate with the superintendent it shall also file a schedule of benefits to which the rate applies. […]
A. Requirements and procedures for licensing of health maintenance organization insurance producers shall be governed by the provisions of Chapter 59A, Articles 11 and 12 NMSA 1978 and any regulations adopted by the superintendent pertaining to those articles. B. None of the following shall be required to hold a health maintenance organization insurance producer license: […]
A. An authorized insurer may either directly or through a subsidiary or affiliate organize and operate a health maintenance organization under the provisions of the Health Maintenance Organization Law. Notwithstanding any other law that may be inconsistent with the cited law, any two or more such insurance companies, or subsidiaries or affiliates thereof, may jointly […]
A. The superintendent may make an examination of the affairs of any health maintenance organization and providers with whom such organization has contracts, agreements or other arrangements as often as is reasonably necessary for the protection of the interests of the people of this state but not less frequently than once every three years. B. […]
As used in the Health Maintenance Organization Law: A. “basic health care services” means medically necessary services consisting of preventive care, emergency care, inpatient and outpatient hospital and physician care, diagnostic laboratory, diagnostic and therapeutic radiological services and services of pharmacists and pharmacist clinicians; B. “capitated basis” means fixed per member per month payment or […]
A. Any certificate of authority issued under the provisions of the Health Maintenance Organization Law may be suspended or revoked, and any application for a certificate of authority may be denied if the superintendent finds that: (1) the health maintenance organization is operating significantly in contravention of its basic organizational document or in a manner […]
A. Any rehabilitation, liquidation or conservation of a health maintenance organization shall be deemed to be the rehabilitation, liquidation or conservation of an insurer and shall be conducted under the supervision of the superintendent pursuant to the law governing the rehabilitation, liquidation or conservation of insurers. The superintendent may apply for an order directing him […]
A. Whenever the superintendent determines that the financial condition of any health maintenance organization is such that its continued operation might be hazardous to its enrollees, creditors or the general public, or that it has violated any provision of the Health Maintenance Organization Law, he may, after notice and hearing, order the health maintenance organization […]
ANNOTATIONS Repeals. — Laws 1991, ch. 9, § 45 repealed 59A-46-22.1 NMSA 1978, as enacted by Laws 1988, ch. 75, § 2, relating to supplemental premium tax, effective July 1, 1993. For provisions of former section, see the 1990 NMSA 1978 on NMOneSource.com.
The superintendent may, after notice and hearing, adopt and promulgate reasonable rules and regulations as are necessary or proper to carry out the provisions of the Health Maintenance Organization Law. History: 1978 Comp., § 59A-46-23, enacted by Laws 1993, ch. 266, § 23. ANNOTATIONS Repeals and reenactments. — Laws 1993, ch. 266, § 43 repealed […]
Every health maintenance organization subject to the provisions of the Health Maintenance Organization Law shall pay to the superintendent all applicable fees specified in Section 59A-6-1 NMSA 1978. History: 1978 Comp., § 59A-46-24, enacted by Laws 1993, ch. 266, § 24. ANNOTATIONS Repeals and reenactments. — Laws 1993, ch. 266, § 43 repealed former 59A-46-24 […]
A. The superintendent may, in lieu of suspension or revocation of a certificate of authority pursuant to the provisions of Section 59A-46-20 NMSA 1978, levy an administrative penalty in an amount up to five thousand dollars ($5,000), except that if the violation is willful or intentional, the administrative penalty may be up to ten thousand […]
All applications, filings and reports required under the Health Maintenance Organization Law shall be treated as public documents, except those that are trade secrets or privileged or confidential quality assurance, commercial or financial information, other than any annual financial statement that may be required under Section 59A-46-9 NMSA 1978. History: 1978 Comp., § 59A-46-26, enacted […]
