Medical decisions must be made by qualified medical professionals. Adequate numbers of qualified staff are required. Emergency care must be available without prior approval. Fair and prompt grievance procedures must be available. Gag rules that deny or prohibit care are prohibited.
Protection is given all consumers of managed care.
Meaningful penalties are authorized. The Bill has been implemented by the NM Department of Insurance. The right to ongoing care from one s doctor when the patient joins a plan or the doctor leaves the plan. Ombudsmen will check compliance with the program. Medicaid Managed Care continues to have problems delivering care to special populations.