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1,724 sections in this chapter.
NMSA 1978, § 59A-46-18 Powers of insurers
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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…
NMSA 1978, § 59A-46-19 Examinations
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A. The superintendent may make an examination of the affairs of any health maintenance organization and providers with whom the health maintenance organization has contracts, agreements or other arrangements as often as is reasonably necessary for the protection of the interests …
NMSA 1978, § 59A-46-2 Definitions
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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 radiologic…
NMSA 1978, § 59A-46-20 Suspension or revocation of certificate of authority
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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 operat…
NMSA 1978, § 59A-46-21 Rehabilitation, liquidation or conservation of health
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maintenance organizations. 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 th…
NMSA 1978, § 59A-46-22 Summary orders and supervision
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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…
NMSA 1978, § 59A-46-23 Regulations
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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.
NMSA 1978, § 59A-46-24 Fees
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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.
NMSA 1978, § 59A-46-25 Penalties and enforcement
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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 int…
NMSA 1978, § 59A-46-26 Filings and reports as public documents
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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 finan…
NMSA 1978, § 59A-46-26.1 Employer utilization and loss experience availability
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Employer claims information, including utilization and loss experience under health insurance provided under Chapter 59A, Article 46 NMSA 1978 shall be made available by the carrier only upon the written request of and to employers of enrollees with such coverage within thirty da…
NMSA 1978, § 59A-46-27 Confidentiality of medical information and limitation of
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liability. A. Any data or information pertaining to the diagnosis, treatment or health of any enrollee or applicant obtained from such person or from any provider by any health maintenance organization shall be held in confidence and shall not be disclosed to any person except: (…
NMSA 1978, § 59A-46-28 Authority to contract
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The secretary of health, in carrying out his obligations as requested by the superintendent under the provisions of the Health Maintenance Organization Law, may contract with qualified persons to make recommendations concerning the determinations required to be made by him, which…
NMSA 1978, § 59A-46-29 Health maintenance organizations; contract or
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certificate provisions relating to individuals who are eligible for medical benefits under the medicaid program. A. Each individual or group contract or certificate that is delivered, issued for delivery or renewed in this state shall include provisions that require any indemnity…
NMSA 1978, § 59A-46-3 Establishment of health maintenance organizations
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A. Notwithstanding any law of this state to the contrary, any person may apply to the superintendent for a certificate of authority to establish and operate a health maintenance organization in compliance with Chapter 59A, Article 46 NMSA 1978. No person shall establish or operat…
NMSA 1978, § 59A-46-30 Statutory construction and relationship to other laws
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A. The provisions of the Insurance Code [Chapter 59A NMSA 1978] other than Chapter 59A, Article 46 NMSA 1978 shall not apply to health maintenance organizations except as expressly provided in the Insurance Code and that article. To the extent reasonable and not inconsistent with…
NMSA 1978, § 59A-46-31 Coordination of benefits
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A. Health maintenance organizations are permitted, but not required, to adopt coordination of benefits provisions to avoid overinsurance and to provide for the orderly payment of claims when a person is covered by two or more group health insurance or health care plans. B. If hea…
NMSA 1978, § 59A-46-32 Continuation of coverage and conversion rights; health
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care plans. A. Every individual or group contract entered into by a health maintenance organization and that is delivered, issued for delivery or renewed in this state on or after January 1, 1985 shall provide covered family members of subscribers the right to continue such cover…
NMSA 1978, § 59A-46-33 Governing body
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The governing body of any health maintenance organization may include providers or other individuals, or both. Such governing body shall establish a mechanism to afford the enrollees an opportunity to participate in matters of policy and operation through the establishment of adv…
NMSA 1978, § 59A-46-34 Prohibited practices
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A. No health maintenance organization, or representative thereof, may cause or knowingly permit the use of advertising which is untrue or misleading, solicitation which is untrue or misleading, or any form of evidence of coverage which is deceptive. For purposes of this article: …
NMSA 1978, § 59A-46-35 Provider discrimination prohibited
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No class of licensed individual providers willing to meet the terms and conditions offered by a health maintenance organization shall be excluded from a health maintenance organization. For purposes of this section, "providers" means those persons licensed pursuant to: A. the Opt…
NMSA 1978, § 59A-46-36 Doctor of oriental medicine; discrimination prohibited
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Doctors of oriental medicine as a class of licensed providers willing to meet the terms and conditions offered by a health maintenance organization shall not be excluded from a health maintenance organization and shall not be discriminated against relative to other classes of lic…
NMSA 1978, § 59A-46-37 Coverage for adopted children
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A. No individual or group health maintenance organization contract shall be offered, issued or renewed in New Mexico on or after July 1, 1988, unless the contract covers adopted children of the subscriber or enrollee on the same basis as other dependents. B. The coverage required…
NMSA 1978, § 59A-46-38 Newly born children coverage
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A. All individual and group health maintenance organization contracts delivered or issued for delivery in this state shall also provide that the health benefits applicable for children shall be payable with respect to a newly born child of the subscriber or the subscriber's spous…
NMSA 1978, § 59A-46-38.1 Coverage of children
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A. An insurer shall not deny enrollment of a child under the health plan of the child's parent on the grounds that the child: (1) was born out of wedlock; (2) is not claimed as a dependent on the parent's federal tax return; or (3) does not reside with the parent or in the insure…
NMSA 1978, § 59A-46-38.2 Childhood immunization coverage required
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A. Each individual and group health maintenance contract delivered or issued for delivery in this state shall provide coverage for childhood immunizations, in accordance with the current schedule of immunizations recommended by the American academy of pediatrics, including covera…
NMSA 1978, § 59A-46-38.3 Maximum age of dependent
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Each individual or group health maintenance organization contract delivered or issued for delivery or renewed in New Mexico that provides coverage for an enrollee's dependents shall not terminate coverage of an unmarried dependent by reason of the dependent's age before the depen…
NMSA 1978, § 59A-46-38.4 Coverage of circumcision for newborn males
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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.
NMSA 1978, § 59A-46-38.5 Hearing aid coverage for children required
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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…
NMSA 1978, § 59A-46-39 Maternity transport required
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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…
NMSA 1978, § 59A-46-4 Issuance of certificate of authority
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A. Upon receipt of an application for issuance of a certificate of authority, the superintendent may transmit copies of such application and accompanying documents to the secretary of health. B. If requested by the superintendent, the secretary of health shall determine whether t…
NMSA 1978, § 59A-46-40 Home health care service option required
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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. H…
NMSA 1978, § 59A-46-41 Coverage for mammograms
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Each individual and group health maintenance organization contract delivered or issued for delivery in this state shall provide coverage for low-dose screening mammograms for determining the presence of breast cancer. Such coverage shall make available one baseline mammogram to p…
NMSA 1978, § 59A-46-41.1 Mastectomies and lymph node dissection; minimum
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hospital stay coverage required. A. Each individual and group health maintenance contract delivered or issued for delivery in this state shall provide coverage for not less than forty-eight hours of inpatient care following a mastectomy and not less than twenty-four hours of inpa…
NMSA 1978, § 59A-46-41.2 Prior authorization for gynecological or obstetrical
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ultrasounds prohibited. A. An individual or group health maintenance organization contract that is delivered, issued for delivery or renewed in this state and that provides coverage for gynecological or obstetrical ultrasounds shall not require prior authorization for gynecologic…
NMSA 1978, § 59A-46-41.3 Diagnostic and supplemental breast examinations
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A. An individual or group health maintenance organization contract that is delivered, issued for delivery or renewed in this state that provides coverage for diagnostic and supplemental breast examinations shall not impose cost sharing for diagnostic and supplemental breast exami…
NMSA 1978, § 59A-46-42 Coverage for cytologic and human papillomavirus
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screening. A. Each individual and group health maintenance organization contract delivered or issued for delivery in this state shall provide coverage for cytologic and human papillomavirus screening to determine the presence of precancerous or cancerous conditions and other heal…
NMSA 1978, § 59A-46-42.1 Coverage for the human papillomavirus vaccine
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A. An individual or group health maintenance organization contract delivered, issued for delivery or renewed in this state shall provide coverage for the human papillomavirus vaccine in accordance with the current standards of the federal centers for disease control and preventio…
NMSA 1978, § 59A-46-43 Coverage for individuals with diabetes
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A. Each individual and group health maintenance organization contract delivered or issued for delivery in this state shall provide coverage for individuals with insulin-using diabetes, with non-insulin-using diabetes and with elevated blood glucose levels induced by pregnancy. Th…
NMSA 1978, § 59A-46-43.2 Coverage for medical diets for genetic inborn errors of
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metabolism. As of July 1, 2003, each health maintenance organization that delivers or issues for delivery in the state an individual or group contract shall provide coverage for the treatment of genetic inborn errors of metabolism as set forth in Chapter 59A, Article 22 NMSA 1978…
NMSA 1978, § 59A-46-44 Coverage for contraception
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A. Each individual and group health maintenance organization contract delivered or issued for delivery in this state that provides a prescription drug benefit shall provide, at a minimum, the following coverage: (1) at least one product or form of contraception in each of the con…
NMSA 1978, § 59A-46-45 Coverage for smoking cessation treatment
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A. An individual or group health maintenance organization contract that is delivered or issued for delivery in this state and that offers maternity benefits shall offer coverage for smoking cessation treatment. B. Coverage for smoking cessation treatment may be subject to deducti…
NMSA 1978, § 59A-46-46 Coverage of alpha-fetoprotein IV screening test
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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 an alpha-fetoprotein IV screening test for pregnant women, generally betwee…
NMSA 1978, § 59A-46-47 Coverage of part-time employees
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A health maintenance organization that provides coverage for health care services pursuant to the Health Maintenance Organization Law shall make available, upon an employer's request prior to issuance, delivery or renewal, coverage for regular part-time employees who work or are …
NMSA 1978, § 59A-46-48 Coverage of colorectal cancer screening
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A. An individual or group health maintenance organization contract that is delivered, issued for delivery or renewed in this state shall provide coverage for colorectal screening for determining the presence of precancerous or cancerous conditions and other health problems. The c…
NMSA 1978, § 59A-46-49 General anesthesia and hospitalization for dental
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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 fo…
NMSA 1978, § 59A-46-5 Powers of health maintenance organizations
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A. The powers of a health maintenance organization include, but are not limited to, the following: (1) the purchase, lease, construction, renovation, operation or maintenance of hospitals, medical facilities, or both, and their ancillary equipment, and such property as may reason…
NMSA 1978, § 59A-46-50 Coverage for autism spectrum disorder diagnosis and
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treatment. A. An individual or group health maintenance contract that is delivered, issued for delivery or renewed in this state shall provide coverage to an enrollee for: (1) well-baby and well-child screening for diagnosing the presence of autism spectrum disorder; and (2) trea…
NMSA 1978, § 59A-46-50.1 Coverage for orally administered anticancer
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medications; limits on patient costs. A. An individual or group health maintenance organization 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 an…
NMSA 1978, § 59A-46-50.2 Coverage of prescription eye drop refills
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A. An individual or group health maintenance organization contract that is delivered, issued for delivery or renewed in this state and that provides coverage for prescription eye drops shall not deny coverage for a renewal of prescription eye drops when: (1) the renewal is reques…
