reglab/housing_qa huggingface dataset:
NM Stat § 59A-57-7 (2021)
2021 New Mexico Statutes|Chapter 59A - Insurance Code|Article 57 - Patient Protection|Section 59A-57-7 - Point-of-service option plan.

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 that the open plan option is financially sound. B. No health care insurer may be required to offer a point-of-service plan or open plan as an option under a medicaid-funded managed health care plan unless the human services department has established such a requirement as part of a procurement for managed health care under the medicaid program. History: Laws 1998, ch. 107, § 7.
NM Stat § 59A-57-8 (2021)
2021 New Mexico Statutes|Chapter 59A - Insurance Code|Article 57 - Patient Protection|Section 59A-57-8 - Administrative costs and benefit costs disclosures.

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 among plans. History: Laws 1998, ch. 107, § 8.
NM Stat § 59A-57-9 (2021)
2021 New Mexico Statutes|Chapter 59A - Insurance Code|Article 57 - Patient Protection|Section 59A-57-9 - Private remedies to enforce patient and provider 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 recover actual damages or the sum of one hundred dollars ($100), whichever is greater. B. A person likely to be damaged by a denial of a right protected pursuant to the provisions of the Patient Protection Act or its regulations may be granted an injunction under the principles of equity and on terms that the court considers reasonable. Proof of monetary damage or intent to violate a right is not required. C. To protect and enforce an enrollee's rights in a managed health care plan, an individual enrollee participating in or eligible to participate in a managed health care plan shall be treated as a third-party beneficiary of the managed health care plan contract between the plan and the party with which the plan directly contracts. An individual enrollee may sue to enforce the rights provided in the contract that governs the managed health care plan; provided, however, that the plan and the party to the contract may amend the terms of, or terminate the provisions of, the contract without the enrollee's consent. D. The relief provided pursuant to this section is in addition to other remedies available against the same conduct under the common law or other statutes of this state. E. In any class action filed pursuant to this section, the court may award damages to the named plaintiffs as provided in this section and may award members of the class the actual damages suffered by each member of the class as a result of the unlawful practice. F. Nothing in the Patient Protection Act is intended to make a plan vicariously liable for the actions of independent contractor health care providers. History: Laws 1998, ch. 107, § 9. ANNOTATIONSLaw reviews. — For comment, "ERISA Right to Use: An RX for Health Care that Places Forum over Substantive Consumer Rights," see 31 N.M. L. Rev. 453 (2001).
NM Stat § 59A-57-10 (2021)
2021 New Mexico Statutes|Chapter 59A - Insurance Code|Article 57 - Patient Protection|Section 59A-57-10 - Application of act to medicaid program.

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 as are granted to enrollees and providers in any other managed health care plan subject to the provisions of the Patient Protection Act. B. Nothing in the Patient Protection Act shall be construed to limit the authority of the human services department to administer the medicaid program, as required by law. Consistent with applicable state and federal law, the human services department shall have sole authority to determine, establish and enforce medicaid eligibility criteria, the scope, definitions and limitations of medicaid benefits and the minimum qualifications or standards for medicaid service providers. C. Medicaid recipients and applicants retain their right to appeal decisions adversely affecting their medicaid benefits to the human services department, pursuant to the Public Assistance Appeals Act [27-3-1 to 27-3-5 NMSA 1978]. Notwithstanding other provisions of the Patient Protection Act, a medicaid recipient or applicant who files an appeal to the human services department pursuant to the Public Assistance Appeals Act may not file an appeal on the same issue to the superintendent pursuant to the Patient Protection Act, unless the human services department refuses to hear the appeal. The superintendent may refer to the human services department any appeal filed with the superintendent pursuant to the Patient Protection Act if the complainant is a medicaid beneficiary and the matter in dispute is subject to the provisions of the Public Assistance Appeals Act. D. Any managed health care plan participating in the medicaid managed care program as of the effective date of the Patient Protection Act and that is in compliance with contractual and regulatory requirements applicable to that program shall be deemed to comply with any requirements established in accordance with that act until July 1, 1999; provided that, from the effective date of that act, any rights established under that act beyond those under requirements of the human services department shall apply to enrollees in medicaid managed health care plans. History: Laws 1998, ch. 107, § 10.
NM Stat § 59A-57-11 (2021)
2021 New Mexico Statutes|Chapter 59A - Insurance Code|Article 57 - Patient Protection|Section 59A-57-11 - Penalty.

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 holding a hearing as provided for in Chapter 59A, Article 4 NMSA 1978. History: Laws 1998, ch. 107, § 11.
NM Stat § 59A-57A-1 (2021)
2021 New Mexico Statutes|Chapter 59A - Insurance Code|Article 57A - Surprise Billing Protection|Section 59A-57A-1 - Short title.

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. ANNOTATIONSEffective dates. — Laws 2019, ch. 227, § 16 made Laws 2019, ch. 227 effective January 1, 2020.
NM Stat § 59A-57A-3 (2021)
2021 New Mexico Statutes|Chapter 59A - Insurance Code|Article 57A - Surprise Billing Protection|Section 59A-57A-3 - Emergency care; reimbursement; limitation on charges.

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 insurance carrier shall not require that prior authorization for emergency care be obtained by, or on behalf of, a covered person prior to the point of stabilization of that covered person if a prudent layperson would reasonably believe that the covered person requires emergency care.C. A health insurance carrier may impose a cost-sharing or limitation of benefits requirement for emergency care performed by a nonparticipating provider only to the same extent that the copayment, co-insurance or limitation of benefits requirement applies for participating providers and is documented in the policy.D. A health insurance carrier may require an emergency care provider to notify a health insurance carrier of a covered person's admission to the hospital within a reasonable time period after the covered person has been stabilized. History: Laws 2019, ch. 227, § 3. ANNOTATIONSEffective dates. — Laws 2019, ch. 227, § 16 made Laws 2019, ch. 227 effective January 1, 2020.
NM Stat § 59A-57A-4 (2021)
2021 New Mexico Statutes|Chapter 59A - Insurance Code|Article 57A - Surprise Billing Protection|Section 59A-57A-4 - Non-emergency care; limitation on charges.

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 a nonparticipating provider that are delivered when:(1) the covered person at an in-network facility does not have the ability or opportunity to choose a participating provider who is available to provide the covered services; or(2) medically necessary care is unavailable within a health benefits plan's network; provided that "medical necessity" shall be determined by a covered person's provider in conjunction with the covered person's health benefits plan and health insurance carrier.B. Except as set forth in Subsection A of this section, nothing in this section shall preclude a nonparticipating provider from balance billing for non- emergency care provided by a nonparticipating provider to an individual who has knowingly chosen to receive services from that nonparticipating provider. History: Laws 2019, ch. 227, § 4. ANNOTATIONSEffective dates. — Laws 2019, ch. 227, § 16 made Laws 2019, ch. 227 effective January 1, 2020.
NM Stat § 59A-57A-5 (2021)
2021 New Mexico Statutes|Chapter 59A - Insurance Code|Article 57A - Surprise Billing Protection|Section 59A-57A-5 - Credit against maximum out-of-pocket cost-sharing 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 Act [Chapter 59A, Article 57 NMSA 1978], a covered person may appeal a health insurance carrier's determination made regarding a surprise bill.C. By July 1, 2020, the department of health shall require each health facility licensed pursuant to the Public Health Act [Chapter 24, Article 1 NMSA 1978] to post the following on the health facility's website in a publicly accessible manner:(1) the names and hyperlinks for direct access to the websites of all health insurance carriers with which the hospital has a contract for services;(2) a statement that sets forth the following:(a) services may be performed in the hospital by participating providers as well as nonparticipating providers who may separately bill the patient;(b) providers that perform health care services in the hospital may or may not participate in the same health benefits plans as the hospital; and(c) prospective patients should contact their health insurance carriers in advance of receiving services at that hospital to determine whether the scheduled health care services provided in that hospital will be covered at in-network rates;(3) the rights of covered persons under the Surprise Billing Protection Act; and(4) instructions for contacting the superintendent.D. Any written communication, other than a receipt of payment, from a provider or health insurance carrier pertaining to a surprise bill, shall clearly state that the covered person is responsible only for payment of applicable in-network cost-sharing amounts under the covered person's health benefits plan. A collection agency collecting medical debt from New Mexico residents shall post a notice of consumer rights pursuant to the Surprise Billing Protection Act on its website.E. When a nonparticipating provider under nonemergency circumstances has advance knowledge that the nonparticipating provider is not contracted with the covered person's health insurance carrier, the nonparticipating provider shall inform the covered person of the nonparticipating provider's nonparticipating status and advise the covered person to contact the covered person's health insurance carrier to discuss the covered person's options.History: Laws 2019, ch. 227, § 5. ANNOTATIONSEffective dates. — Laws 2019, ch. 227, § 16 made Laws 2019, ch. 227 effective January 1, 2020.
NM Stat § 59A-57A-6 (2021)
2021 New Mexico Statutes|Chapter 59A - Insurance Code|Article 57A - Surprise Billing Protection|Section 59A-57A-6 - Covered persons; providers; overpayment.

A. If a covered person pays a nonparticipating provider more than the in-network cost-sharing amount for services provided under circumstances giving rise to a surprise bill, the nonparticipating provider shall refund to the covered person within forty-five calendar days of receipt of payment from the health insurance carrier any amount paid in excess of the in-network cost-sharing amount.B. If a nonparticipating provider has not made a full refund to the covered person of any amount paid in excess of the in-network cost-sharing amount to the covered person within forty-five calendar days of receipt, interest shall accrue at the rate set for payment of interest on a health plan's liability for clean claims submitted by eligible providers to a health plan pursuant to Chapter 59A, Article 16 NMSA 1978.C. A covered person may seek recovery of the refund of the amount the covered person has paid in excess of the in-network cost-sharing amount that a nonparticipating provider owes, plus interest, pursuant to Subsection B of this section by filing an appeal with the office of superintendent of insurance. The superintendent of insurance shall develop an appeals process pursuant to this section. History: Laws 2019, ch. 227, § 6. ANNOTATIONSEffective dates. — Laws 2019, ch. 227, § 16 made Laws 2019, ch. 227 effective January 1, 2020.
NM Stat § 59A-57A-7 (2021)
2021 New Mexico Statutes|Chapter 59A - Insurance Code|Article 57A - Surprise Billing Protection|Section 59A-57A-7 - Nonparticipating providers; rebates and inducements; prohibition.

A nonparticipating provider shall not, either directly or indirectly, knowingly waive, rebate, give, pay or offer to waive, rebate, give or pay all or part of a cost-sharing amount owed by a covered person pursuant to the terms of the covered person's health benefits plan as an inducement for the covered person to seek a health care service from that nonparticipating provider. The superintendent may impose fines on providers for unlawful rebates and inducements; provided that a provider on which the superintendent intends to impose a fine shall be entitled to a hearing in accordance with the provisions of Section 59A-4-15 NMSA 1978.History: Laws 2019, ch. 227, § 7. ANNOTATIONSEffective dates. — Laws 2019, ch. 227, § 16 made Laws 2019, ch. 227 effective January 1, 2020.
NM Stat § 59A-57A-8 (2021)
2021 New Mexico Statutes|Chapter 59A - Insurance Code|Article 57A - Surprise Billing Protection|Section 59A-57A-8 - Health care provider reimbursement rates; surprise billing.

A. The superintendent shall convene appropriate stakeholders, including rural providers, insurers and consumer advocates, and review the reimbursement rate for surprise bills annually to ensure fairness to providers and to evaluate the impact on health insurance premiums and health benefits plan networks.B. Calculation of the date of health insurance carrier receipt of a claim shall align with requirements for prompt payment established pursuant to Section 59A-16-21.1 NMSA 1978.C. A health insurance carrier shall make available to providers access to claims status information. History: Laws 2019, ch. 227, § 8. ANNOTATIONSEffective dates. — Laws 2019, ch. 227, § 16 made Laws 2019, ch. 227 effective January 1, 2020.
NM Stat § 59A-57A-9 (2021)
2021 New Mexico Statutes|Chapter 59A - Insurance Code|Article 57A - Surprise Billing Protection|Section 59A-57A-9 - Reasonable health care cost management permitted.

Nothing in the Surprise Billing Protection Act shall be construed to prohibit a health insurance carrier from appropriately using reasonable health care cost management techniques. History: Laws 2019, ch. 227, § 9. ANNOTATIONSEffective dates. — Laws 2019, ch. 227, § 16 made Laws 2019, ch. 227 effective January 1, 2020.
NM Stat § 59A-57A-10 (2021)
2021 New Mexico Statutes|Chapter 59A - Insurance Code|Article 57A - Surprise Billing Protection|Section 59A-57A-10 - Private cause of action.

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. ANNOTATIONSEffective dates. — Laws 2019, ch. 227, § 16 made Laws 2019, ch. 227 effective January 1, 2020.
NM Stat § 59A-57A-11 (2021)
2021 New Mexico Statutes|Chapter 59A - Insurance Code|Article 57A - Surprise Billing Protection|Section 59A-57A-11 - Information from provider networks.

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; andB. may require by rule a report on changes to the percent of claims paid as an emergency claim. History: Laws 2019, ch. 227, § 11. ANNOTATIONSEffective dates. — Laws 2019, ch. 227, § 16 made Laws 2019, ch. 227 effective January 1, 2020.
NM Stat § 59A-57A-12 (2021)
2021 New Mexico Statutes|Chapter 59A - Insurance Code|Article 57A - Surprise Billing Protection|Section 59A-57A-12 - Applicability.

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. individual health insurance policies, health benefits plans and certificates of insurance governed by the provisions of Chapter 59A, Article 22 NMSA 1978;C. multiple-employer welfare arrangements governed by the provisions of Section 59A-15-20 NMSA 1978;D. group and blanket health insurance policies, health benefits plans and certificates of insurance governed by the provisions of Chapter 59A, Article 23 NMSA 1978;E. individual and group health maintenance organization contracts governed by the provisions of the Health Maintenance Organization Law; andF. individual and group nonprofit health benefits plans governed by the provisions of the Nonprofit Health Care Plan Law [Chapter 59A, Article 47 NMSA 1978]. History: Laws 2019, ch. 227, § 12. ANNOTATIONSEffective dates. — Laws 2019, ch. 227, § 16 made Laws 2019, ch. 227 effective January 1, 2020.
NM Stat § 59A-57A-13 (2021)
2021 New Mexico Statutes|Chapter 59A - Insurance Code|Article 57A - Surprise Billing Protection|Section 59A-57A-13 - Providers; reimbursement for a surprise bill. (Repealed effective July 1, 2023.)

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 surprise bill reimbursement rate for services.B. The surprise bill reimbursement rate shall be calculated using claims data reflecting the allowed amounts paid for claims paid in the 2017 plan year.C. As used in this section, "surprise bill reimbursement rate" means the sixtieth percentile of the allowed commercial reimbursement rate for the particular health care service performed by a provider in the same or similar specialty in the same geographic area, as reported in a benchmarking database maintained by a nonprofit organization specified by the superintendent after consultation with health care sector stakeholders; provided that no surprise bill reimbursement rate shall be paid at less than one hundred fifty percent of the 2017 medicare reimbursement rate for the applicable health care service provided.D. The nonprofit organization shall be conflict-free and unaffiliated with any stakeholder in the health care sector. History: Laws 2019, ch. 227, § 13. ANNOTATIONSDelayed repeals. — Laws 2019, ch. 227, § 15 repeals Laws 2019, ch. 227, § 13, effective July 1, 2023.Effective dates. — Laws 2019, ch. 227, § 16 made Laws 2019, ch. 227 effective January 1, 2020.
NM Stat § 59A-58-1 (2021)
2021 New Mexico Statutes|Chapter 59A - Insurance Code|Article 58 - Service Contract Regulation|Section 59A-58-1 - Short title.

Chapter 59A, Article 58 NMSA 1978 may be cited as the "Service Contract Regulation Act". History: Laws 2001, ch. 206, § 1; 2017, ch. 125, § 1. ANNOTATIONSThe 2017 amendment, effective June 16, 2017, changed "Sections 1 through 19 of this act" to "Chapter 59A, Article 58 NMSA 1978".
NM Stat § 59A-58-3 (2021)
2021 New Mexico Statutes|Chapter 59A - Insurance Code|Article 58 - Service Contract Regulation|Section 59A-58-3 - Exclusions from act.

The provisions of the Service Contract Regulation Act do not apply to: A. a warranty; B. a maintenance agreement; C. a service contract provided by a public utility on its transmission device if the service contract is regulated by the public regulation commission; D. a service contract sold or offered for sale to a person who is not a consumer; or E. a service contract for property if the purchase price of the property is less than two hundred fifty dollars ($250) and the consideration for the service contract is less than twenty-five dollars ($25.00). History: Laws 2001, ch. 206, § 3. ANNOTATIONSEffective dates. — Laws 2001, ch. 206, § 20 made Laws 2001, ch. 206, § 3 effective July 1, 2002.
NM Stat § 59A-58-4 (2021)
2021 New Mexico Statutes|Chapter 59A - Insurance Code|Article 58 - Service Contract Regulation|Section 59A-58-4 - Prohibition of sale of service contract unless registered.

A provider shall not issue, sell or offer for sale service contracts in this state unless the provider has been registered with the superintendent pursuant to the provisions of the Service Contract Regulation Act. However, an administrator or seller of a service contract is not required to be registered. The provisions of this section shall not apply to major manufacturing companies' service contracts. History: Laws 2001, ch. 206, § 4; 2017, ch. 125, § 3. ANNOTATIONSThe 2017 amendment, effective June 16, 2017, excluded administrators and sellers of service contracts from the registration requirement; and added "However, an administrator or seller of a service contract is not required to be registered."