Section 59A-46-50.5 – Heart artery calcium scan coverage.
A. A group health maintenance organization contract, other than a small group health maintenance organization contract, that is delivered, issued for delivery or renewed in this state shall provide coverage for eligible enrollees to receive a heart artery calcium scan. B. Coverage provided pursuant to this section shall: (1) be limited to the provision of […]
Section 59A-46-51 – Repealed.
History: Laws 2010, ch. 94, § 3; 2013, ch. 74, § 32; 2018, ch. 57, § 24; 2019, ch. 235, § 11; 2019, ch. 235, § 12; repealed by Laws 2021, ch. 108, § 37. ANNOTATIONS Repeals. — Laws 2021, ch. 108, § 37 repealed 59A-46-51 NMSA 1978, as enacted by Laws 2010, ch. 94, […]
Section 59A-46-52 – Prescription drug prior authorization protocols.
A. After January 1, 2014, a health maintenance organization 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 […]
Section 59A-46-52.1 – Prescription drug coverage; step therapy protocols; clinical review criteria; exceptions.
A. Each individual or group health maintenance organization contract 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 on clinical practice guidelines that: (1) recommend […]
Section 59A-46-52.2 – Pharmacist prescriptive authority services; reimbursement parity.
A carrier 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 an individual or group contract at the standard contracted rate that the carrier reimburses, for the same service under that individual or group contract, any licensed physician […]
Section 59A-46-38.4 – Coverage of circumcision for newborn males.
An individual or group health maintenance organization policy, health care plan or certificate of health insurance that is delivered, issued for delivery or renewed in the state shall provide coverage for circumcision for newborn males. History: Laws 2004, ch. 122, § 8. ANNOTATIONS Effective dates. — Laws 2004, ch. 122, § 13 made Laws 2004, […]
Section 59A-46-49 – General anesthesia and hospitalization for dental surgery.
A. An individual or group health maintenance organization contract delivered, issued for delivery or renewed in this state 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 under local […]
Section 59A-46-38.5 – Hearing aid coverage for children required.
A. An individual or group health maintenance organization contract 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 dollars ($2,200) every thirty-six months for hearing aids for […]
Section 59A-46-39 – Maternity transport required.
All individual and group health maintenance organization contracts delivered or issued for delivery in this state which provide maternity coverage shall also provide, where necessary to protect the life of the infant or mother, coverage for transportation, including air transport, for the medically high-risk pregnant woman with an impending delivery of a potentially viable infant […]
Section 59A-46-40 – Home health care service option required.
A. Each health maintenance organization which delivers or issues for delivery in this state an individual or group contract shall make available to the contract holder the option of home health care coverage which includes benefits for the services described in this section. B. Home health care coverage offered shall include: (1) services provided by […]