Chapter 59A — Chapter 59A

1,829 sections in this chapter.

1,829 sectionsFiltered byCh 59A

NMSA 1978, § 59A-55-6 Risk retention groups; reports
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A. Each risk retention group shall report to the superintendent the net premium written for risks resident or located within New Mexico. B. To the extent a licensed insurance producer is utilized pursuant to Section 59A- 55-24 NMSA 1978, the licensed insurance producer shall repo…
NMSA 1978, § 59A-55-7 Compliance with unfair claims settlement practices
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All risk retention groups doing business in New Mexico and their agents and representatives shall comply with the provisions of Section 59A-16-20 NMSA 1978. History: Laws 1988, ch. 125, § 7.
NMSA 1978, § 59A-55-8 Deceptive, false or fraudulent practices
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All risk retention groups doing business in New Mexico shall comply with the laws contained in the New Mexico Insurance Code regarding deceptive, false or fraudulent acts or practices. History: Laws 1988, ch. 125, § 8.
NMSA 1978, § 59A-55-9 Examination regarding financial condition
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Each risk retention group shall submit to an examination by the superintendent to determine its financial condition if the superintendent of the jurisdiction in which the group is chartered and licensed has not initiated an examination or does not initiate an examination within s…
NMSA 1978, § 59A-56-1 Repealed
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History: Laws 1994, ch. 75, § 1; 1997, ch. 243, § 34; repealed by Laws 2013, ch. 54, § 15.
NMSA 1978, § 59A-56-10 Repealed
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History: Laws 1994, ch. 75, § 10; 1997, ch. 243, § 42; repealed by Laws 2013, ch. 54, § 15.
NMSA 1978, § 59A-56-11 Repealed
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History: Laws 1994, ch. 75, § 11; 1997, ch. 243, § 43; 1999, ch. 289, § 42; 2001, ch. 310, § 2; repealed by Laws 2013, ch. 54, § 15.
NMSA 1978, § 59A-56-12 Repealed
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History: Laws 1994, ch. 75, § 12; repealed by Laws 2013, ch. 54, § 15.
NMSA 1978, § 59A-56-13 Repealed
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History: Laws 1994, ch. 75, § 13; 1997, ch. 243, § 44; 2001, ch. 310, § 3; repealed by Laws 2013, ch. 54, § 15.
NMSA 1978, § 59A-56-14 Repealed
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History: Laws 1994, ch. 75, § 14; 1997, ch. 243, § 45; 2006, ch. 3, § 1; repealed by Laws 2013, ch. 54, § 15.
NMSA 1978, § 59A-56-15 Repealed
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History: Laws 1994, ch. 75, § 15; repealed by Laws 2013, ch. 54, § 15.
NMSA 1978, § 59A-56-16 Repealed
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History: Laws 1994, ch. 75, § 16; repealed by Laws 2013, ch. 54, § 15.
NMSA 1978, § 59A-56-17 Repealed
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History: Laws 1994, ch. 75, § 17; 1997, ch. 243, § 46; repealed by Laws 2013, ch. 54, § 15.
NMSA 1978, § 59A-56-18 Repealed
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History: Laws 1994, ch. 75, § 18; 1997, ch. 243, § 47; repealed by Laws 2013, ch. 54, § 15.
NMSA 1978, § 59A-56-19 Repealed
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History: Laws 1994, ch. 75, § 19; 1997, ch. 243, § 48; repealed by Laws 2013, ch. 54, § 15.
NMSA 1978, § 59A-56-2 Repealed
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History: Laws 1994, ch. 75, § 2; 1997, ch. 243, § 35; repealed by Laws 2013, ch. 54, § 15.
NMSA 1978, § 59A-56-20 Repealed
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History: Laws 1994, ch. 75, § 20; 1997, ch. 243, § 49; 1998, ch. 41, § 28; repealed by Laws 2013, ch. 54, § 15.
NMSA 1978, § 59A-56-21 Repealed
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History: Laws 1994, ch. 75, § 21; 1997, ch. 243, § 50; repealed by Laws 2013, ch. 54, § 15.
NMSA 1978, § 59A-56-22 Repealed
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History: Laws 1994, ch. 75, § 22; repealed by Laws 2013, ch. 54, § 15.
NMSA 1978, § 59A-56-23 Repealed
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History: Laws 1994, ch. 75, § 23; 1997, ch. 243, § 51; 2005, ch. 21, § 3; repealed by Laws 2013, ch. 54, § 15.
NMSA 1978, § 59A-56-24 Repealed
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History: Laws 1994, ch. 75, § 24; 1997, ch. 243, § 52; repealed by Laws 2013, ch. 54, § 15.
NMSA 1978, § 59A-56-25 Repealed
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History: Laws 1994, ch. 75, § 25; 2005, ch. 21, § 4; 2013, ch. 74, § 36; repealed by Laws 2013, ch. 54, § 15.
NMSA 1978, § 59A-56-3 Repealed
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History: Laws 1994, ch. 75, § 3; 1997, ch. 243, § 36; 1998, ch. 41, § 27; 2003, ch. 391, § 8; 2013, ch. 74, § 35; repealed by Laws 2013, ch. 54, § 15.
NMSA 1978, § 59A-56-4 Repealed
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History: Laws 1994, ch. 75, § 4; 1997, ch. 243, § 37; 2005, ch. 21, § 1; 2013, ch. 54, § 12; repealed by Laws 2013, ch. 54, § 15.
NMSA 1978, § 59A-56-5 Repealed
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History: Laws 1994, ch. 75, § 5; 1997, ch. 243, § 38; repealed by Laws 2013, ch. 54, § 15.
NMSA 1978, § 59A-56-6 Repealed
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History: Laws 1994, ch. 75, § 6; 1997, ch. 243, § 39; 2010, ch. 95, § 5; repealed by Laws 2013, ch. 54, § 15.
NMSA 1978, § 59A-56-7 Repealed
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History: Laws 1994, ch. 75, § 7; repealed by Laws 2013, ch. 54, § 15.
NMSA 1978, § 59A-56-8 Repealed
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History: Laws 1994, ch. 75, § 8; 1997, ch. 243, § 40; 2005, ch. 21, § 2; repealed by Laws 2013, ch. 54, § 15.
NMSA 1978, § 59A-56-9 Repealed
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History: Laws 1994, ch. 75, § 9; 1997, ch. 243, § 41; 2001, ch. 310, § 1; repealed by Laws 2013, ch. 54, § 15.
NMSA 1978, § 59A-57-1 Short title
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Chapter 59A, Article 57 NMSA 1978 may be cited as the "Patient Protection Act". History: Laws 1998, ch. 107, § 1; 2003, ch. 327, § 1.
NMSA 1978, § 59A-57-10 Application of act to medicaid program
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A. Except as otherwise provided in this section, the provisions of the Patient Protection Act apply to the medicaid program operation in the state. A managed health care plan offered through the medicaid program shall grant enrollees and providers the same rights and protections …
NMSA 1978, § 59A-57-11 Penalty
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In addition to any other penalties provided by law, a civil administrative penalty of up to ten thousand dollars ($10,000) may be imposed for each violation of the Patient Protection Act. An administrative penalty shall be imposed by written order of the superintendent made after…
NMSA 1978, § 59A-57-2 Purpose of act
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The purpose of the Patient Protection Act is to regulate aspects of health insurance by specifying patient and provider rights and confirming and clarifying the authority of the department to adopt regulations to provide protections to persons enrolled in managed health care plan…
NMSA 1978, § 59A-57-3 Definitions
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As used in the Patient Protection Act: A. "continuous quality improvement" means an ongoing and systematic effort to measure, evaluate and improve a managed health care plan's process in order to improve continually the quality of health care services provided to enrollees; B. "c…
NMSA 1978, § 59A-57-4 Patient rights; disclosures; rights to basic and
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comprehensive health care services; grievance procedure; utilization review program; continuous quality program. A. Each covered person enrolled in a managed health care plan has the right to be treated fairly. A managed health care plan shall arrange for the delivery of good qua…
NMSA 1978, § 59A-57-4.1 External grievance appeals; appointment;
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compensation. A. The superintendent may appoint one or more qualified individuals to review external grievance appeals. B. The superintendent shall fix the reasonable compensation of each appointee based upon, but not limited to, compensation amounts suggested by national or stat…
NMSA 1978, § 59A-57-5 Consumer assistance; consumer advisory boards;
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ombudsman office; reports to consumers; superintendent's orders to protect consumers. A. Each managed health care plan shall establish and adequately staff a consumer assistance office. The purpose of the consumer assistance office is to respond to consumer questions and concerns…
NMSA 1978, § 59A-57-6 Fairness to health care providers; gag rules prohibited;
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grievance procedure for providers. A. No managed health care plan may: (1) adopt a gag rule or practice that prohibits a health care provider from discussing a treatment option with an enrollee even if the plan does not approve of the option; (2) include in any of its contracts w…
NMSA 1978, § 59A-57-7 Point-of-service option plan
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A. Except as otherwise provided in this section, the department may require a plan that offers a point-of-service plan or open plan to include in any managed health care plan it offers an option for a point-of-service plan or open plan to the extent that the department determines…
NMSA 1978, § 59A-57-8 Administrative costs and benefit costs disclosures
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The department shall adopt regulations to ensure that both the administrative costs and the direct costs of providing health care services of each managed health care plan are fully and fairly disclosed to consumers in a uniform manner that allows meaningful cost comparisons amon…
NMSA 1978, § 59A-57-9 Private remedies to enforce patient and provider
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insurance rights; enrollee as third-party beneficiary to enforce rights. A. A person who suffers a loss as a result of a violation of a right protected pursuant to the provisions of the Patient Protection Act, its regulations or a managed health care plan may bring an action to r…
NMSA 1978, § 59A-57A-1 Short title
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Sections 1 through 13 [59A-57A-1 to 59A-57A-13 NMSA 1978] of this act may be cited as the "Surprise Billing Protection Act". History: Laws 2019, ch. 227, § 1.
NMSA 1978, § 59A-57A-10 Private cause of action
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Except as provided in Subsection C of Section 6 [59A-57A-6 NMSA 1978] of the Surprise Billing Protection Act, nothing in that act shall be construed to create or imply a private cause of action for a violation of that act. History: Laws 2019, ch. 227, § 10.
NMSA 1978, § 59A-57A-11 Information from provider networks
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The superintendent: A. may require that health insurance carriers report the annual percentage of claims and expenditures paid to nonparticipating providers for health care services; and B. may require by rule a report on changes to the percent of claims paid as an emergency clai…
NMSA 1978, § 59A-57A-12 Applicability
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The provisions of the Surprise Billing Protection Act apply to the following types of health coverage delivered or issued for delivery in this state: A. group health coverage governed by the provisions of the Health Care Purchasing Act [Chapter 13, Article 7 NMSA 1978]; B. indivi…
NMSA 1978, § 59A-57A-13 Providers; reimbursement for a surprise bill
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(Repealed effective July 1, 2028.) A. For services provided pursuant to Section 3 [59A-57A-3 NMSA 1978] or 4 [59A- 57A-4 NMSA 1978] of the Surprise Billing Protection Act, a health insurance carrier shall directly reimburse a nonparticipating provider for care rendered the surpri…
NMSA 1978, § 59A-57A-2 Definitions
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As used in the Surprise Billing Protection Act: A. "allowed amount" means the maximum portion of a billed charge that a health insurance carrier will pay, including any applicable covered person cost-sharing responsibility, for a covered health care service or item rendered by a …
NMSA 1978, § 59A-57A-3 Emergency care; reimbursement; limitation on charges
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A. A health insurance carrier shall reimburse a nonparticipating provider for emergency care necessary to evaluate and stabilize a covered person if a prudent layperson would reasonably believe that emergency care is necessary, regardless of eventual diagnosis. B. A health insura…
NMSA 1978, § 59A-57A-4 Non-emergency care; limitation on charges
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A. Other than applicable cost sharing that would apply if a participating provider had rendered the same services, a health insurance carrier shall provide reimbursement for and a covered person shall not be liable for charges and fees for covered non- emergency care rendered by …
NMSA 1978, § 59A-57A-5 Credit against maximum out-of-pocket cost-sharing
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amount; communication by hospitals; advance notification of charges for health care services. A. A nonparticipating provider shall not knowingly submit a surprise bill to a covered person. B. In accordance with the hearing procedures established pursuant to the Patient Protection…