reglab/housing_qa huggingface dataset:
NM Stat § 59A-46-50.1 (2021)
2021 New Mexico Statutes|Chapter 59A - Insurance Code|Article 46 - Health Maintenance Organizations|Section 59A-46-50.1 - Coverage for orally administered anticancer 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 anticancer medication that is used to kill or slow the growth of cancerous cells on a basis no less favorable than intravenously administered or injected cancer medications that are covered as medical benefits by the plan. B. A health maintenance organization shall not increase patient cost-sharing for anticancer medications in order to achieve compliance with the provisions of this section. C. Coverage of orally administered anticancer medication shall not be subject to any prior authorization, dollar limit, copayment, deductible or coinsurance provision that does not apply to intravenously administered or injected anticancer medication used to kill or slow the growth of cancerous cells. D. As used in this section, "health maintenance organization contract": (1) means: (a) a health maintenance organization; or (b) a managed care organization; and (2) does not include individual policies intended to supplement major medical group-type coverages such as medicare supplement, long-term care, disability income, specified disease, accident-only, hospital indemnity or other limited-benefit health insurance policies. History: Laws 2011, ch. 55, § 4. ANNOTATIONSEffective dates. — Laws 2011, ch. 55, § 7 made Laws 2011, ch. 55, § 4 effective June 17, 2011. Applicability. — Laws 2011, ch. 55, § 6 provided that the provisions of Laws 2011, ch. 55, § 4 apply to insurance policies that provide coverage for cancer treatment and that are delivered, issued for delivery, amended, renewed or continued in this state on or after January 1, 2012.
NM Stat § 59A-46-50.2 (2021)
2021 New Mexico Statutes|Chapter 59A - Insurance Code|Article 46 - Health Maintenance Organizations|Section 59A-46-50.2 - Coverage of prescription eye drop refills.

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 requested by the insured at least twenty-three days for a thirty-day supply of eye drops, forty-five days for a sixty-day supply of eye drops or sixty-eight days for a ninety-day supply of eye drops from the later of the date that the original prescription was dispensed to the insured or the date that the last renewal of the prescription was dispensed to the insured; and (2) the prescriber indicates on the original prescription that additional quantities are needed and that the renewal requested by the insured does not exceed the number of additional quantities needed. B. As used in this section, "prescriber" means a person who is authorized pursuant to the New Mexico Drug, Device and Cosmetic Act [Chapter 26, Article 1 NMSA 1978] to prescribe prescription eye drops. History: Laws 2012, ch. 27, § 4. ANNOTATIONSEffective dates. — Laws 2012, ch. 27, § 7 provided that Laws 2012, ch. 27, § 4 was effective January 1, 2013. Applicability. — Laws 2012, ch. 27, § 6 provided that the provisions of Laws 2012, ch. 27, §§ 1 to 5 apply to insurance policies that provide coverage for prescription eye drops and that are delivered, issued for delivery, amended, renewed or continued in this state on or after January 1, 2013.
NM Stat § 59A-46-50.5 (2021)
2021 New Mexico Statutes|Chapter 59A - Insurance Code|Article 46 - Health Maintenance Organizations|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 a heart artery calcium scan to an eligible enrollee to be used as a clinical management tool;(2) be provided every five years if an eligible enrollee has previously received a heart artery calcium score of zero; and(3) not be required for future heart artery calcium scans if an eligible enrollee receives a heart artery calcium score greater than zero.C. At its discretion or as required by law, a carrier may offer or refuse coverage for further cardiac testing or procedures for eligible enrollees based upon the results of a heart artery calcium scan.D. The provisions of this section do not apply to short-term travel, accident-only or limited or specified-disease policies, plans or certificates of health insurance.E. As used in this section:(1) "eligible enrollee" means an enrollee who:(a) is a person between the ages of forty-five and sixty-five; and(b) has an intermediate risk of developing coronary heart disease as determined by a health care provider based upon a score calculated from an evidence-based algorithm widely used in the medical community to assess a person's ten-year cardiovascular disease risk, including a score calculated using a pooled cohort equation;(2) "health care provider" means a physician, physician assistant, nurse practitioner or other health care professional authorized to furnish health care services within the scope of the professional's license; and(3) "heart artery calcium scan" means a computed tomography scan measuring coronary artery calcium for atherosclerosis and abnormal artery structure and function. History: Laws 2020, ch. 79, § 4. ANNOTATIONSEffective dates. — Laws 2020, ch. 79 contained no effective date provision, but, pursuant to N.M. Const., art. IV, § 23, was effective May 20, 2020, 90 days after adjournment of the legislature.Applicability. — Laws 2020, ch. 79, § 6 provided that the provisions of Laws 2020, ch. 79, are applicable to group health insurance policies, health care plans or certificates of health insurance, other than small group health plans, that are delivered, issued for delivery or renewed in this state on or after January 1, 2021.
NM Stat § 59A-46-51 (2021)
2021 New Mexico Statutes|Chapter 59A - Insurance Code|Article 46 - Health Maintenance Organizations|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. ANNOTATIONSRepeals. — Laws 2021, ch. 108, § 37 repealed 59A-46-51 NMSA 1978, as enacted by Laws 2010, ch. 94, § 3, relating to health maintenance organizations, direct services, effective July 1, 2021. For provisions of former section, see the 2020 NMSA 1978 on NMOneSource.com.
NM Stat § 59A-46-52 (2021)
2021 New Mexico Statutes|Chapter 59A - Insurance Code|Article 46 - Health Maintenance Organizations|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 for electronic prior authorization, a health insurer shall exchange prior authorization requests with providers who have e-prescribing capability. C. If a health maintenance organization fails to use or accept the uniform prior authorization form or fails to respond within three business days upon receipt of a uniform prior authorization form, the prior authorization request shall be deemed to have been granted. D. As used in this section, "health maintenance organization": (1) means: (a) a health maintenance organization; or (b) a managed care organization; and (2) does not include: (a) a person that delivers, issues for delivery or renews an individual policy intended to supplement major medical group-type coverages such as medicare supplement, long-term care, disability income, specified disease, accident-only, hospital indemnity or other limited-benefit health insurance policy; (b) a physician or a physician group to which a health maintenance organization has delegated financial risk for prescription drugs and that does not use a prior authorization process for prescription drugs; or (c) a health maintenance organization or its affiliated providers if the health maintenance organization owns and operates its pharmacies and does not use a prior authorization process. History: Laws 2013, ch. 170, § 7. ANNOTATIONSEffective dates. — Laws 2013, ch. 170 contained no effective date provision, but, pursuant to N.M. Const., art. IV, § 23, was effective June 14, 2013, 90 days after the adjournment of the legislature.
NM Stat § 59A-46-52.2 (2021)
2021 New Mexico Statutes|Chapter 59A - Insurance Code|Article 46 - Health Maintenance Organizations|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 or physician assistant licensed pursuant to the Medical Practice Act [Chapter 41, Article 5 NMSA 1978] or any advanced practice certified nurse practitioner licensed pursuant to the Nursing Practice Act [Chapter 61, Article 3 NMSA 1978].History: Laws 2020, ch. 58, § 5; 2021, ch. 54, § 13. ANNOTATIONSThe 2021 amendment, effective June 18, 2021, after "Medical Practice Act", deleted "or the Osteopathic Medicine Act".
NM Stat § 59A-46-53 (2021)
2021 New Mexico Statutes|Chapter 59A - Insurance Code|Article 46 - Health Maintenance Organizations|Section 59A-46-53 - Pharmacy benefits; prescription synchronization.

A. An individual or group health maintenance organization contract that is delivered, issued for delivery or renewed in this state and that provides prescription drug benefits shall allow an enrollee to fill or refill a prescription for less than a thirty-day supply of the prescription drug, and apply a prorated daily copayment or coinsurance for the fill or refill, if: (1) the prescribing practitioner or the pharmacist determines the fill or refill to be in the best interest of the enrollee; (2) the enrollee requests or agrees to receive less than a thirty-day supply of the prescription drug; and (3) the reduced fill or refill is made for the purpose of synchronizing the enrollee's prescription drug fills. B. An individual or group health maintenance organization contract that is delivered, issued for delivery or renewed in this state and that provides prescription drug benefits shall not: (1) deny coverage for the filling of a chronic medication when the fill is made in accordance with a plan to synchronize multiple prescriptions for the enrollee pursuant to Subsection A of this section established among the health maintenance organization, the prescribing practitioner and a pharmacist. The health maintenance organization shall allow a pharmacy to override any denial indicating that a prescription is being refilled too soon for the purposes of medication synchronization; and (2) prorate a dispensing fee to a pharmacy that fills a prescription with less than a thirty-day supply of prescription drug pursuant to Subsection A of this section. The health maintenance organization shall pay in full a dispensing fee for a partially filled or refilled prescription for each prescription dispensed, regardless of any prorated copayment or coinsurance that the enrollee may pay for prescription synchronization services. History: Laws 2015, ch. 65, § 5. ANNOTATIONSEffective dates. — Laws 2015, ch. 65 contained no effective date provision, but, pursuant to N.M. Const., art. IV, § 23, was effective June 19, 2015, 90 days after the adjournment of the legislature.
NM Stat § 59A-46-55 (2021)
2021 New Mexico Statutes|Chapter 59A - Insurance Code|Article 46 - Health Maintenance Organizations|Section 59A-46-55 - Coverage exclusion. (Contingent repeal. See note below.)

Coverage of vasectomy and male condoms pursuant to Section 7 [59A-46-44 NMSA 1978] of this 2019 act is excluded for high-deductible individual or group health maintenance organization contracts with health savings accounts delivered or issued for delivery in this state until an enrollee's deductible has been met. History: Laws 2019, ch. 263, § 8. ANNOTATIONSEffective dates. — Laws 2019, ch. 263 contained no effective date provision, but, pursuant to N.M. Const., art. IV, § 23, was effective June 14, 2019, 90 days after the adjournment of the legislature. Contingent repeal. — Laws 2019, ch. 263, § 11 provided upon certification by the superintendent of insurance to the director of the legislative council service and the New Mexico compilation commission that federal law permits coverage of vasectomies and male condoms under high-deductible health benefits plans with health savings accounts, 59A-46-56 NMSA 1978 is repealed.
NM Stat § 59A-46-56 (2021)
2021 New Mexico Statutes|Chapter 59A - Insurance Code|Article 46 - Health Maintenance Organizations|Section 59A-46-56 - Physical rehabilitation services; limits on cost sharing.

A. An individual or group health maintenance contract that is delivered, issued for delivery or renewed in this state shall not impose a member cost share for physical rehabilitation services that is greater than that for primary care services on a coinsurance percentage basis when coinsurance is applied or on an absolute dollar amount when a copay is applied.B. As used in this section:(1) "physical rehabilitation services" means services aimed at maximizing an individual's level of function, returning to a prior level of function or maintaining or slowing the decline of function, which services are provided by or under the direction of a licensed physical therapist, occupational therapist or speech therapist; and(2) "primary care services" means the first level of basic or general health care for a person's health needs, including diagnostic and treatment services, initiation of referrals for other health care services and maintenance of the continuity of care when appropriate. History: Laws 2019, ch. 188, § 4. ANNOTATIONSEffective dates. — Laws 2019, ch. 188, § 6 made Laws 2019, ch. 188 effective January 1, 2020.
NM Stat § 59A-46-57 (2021)
2021 New Mexico Statutes|Chapter 59A - Insurance Code|Article 46 - Health Maintenance Organizations|Section 59A-46-57 - Behavioral health services; elimination of cost sharing. (Effective January 1, 2022.)

A. Until January 1, 2027, an individual or group health maintenance organization contract that is delivered, issued for delivery or renewed in this state that offers coverage of behavioral health services shall not impose cost sharing on those behavioral health services.B. For the purposes of this section:(1) "behavioral health services" means professional and ancillary services for the treatment, habilitation, prevention and identification of mental illnesses, substance abuse disorders and trauma spectrum disorders, including inpatient, detoxification, residential treatment and partial hospitalization, intensive outpatient therapy, outpatient and all medications, including brand-name pharmacy drugs when generics are unavailable;(2) "coinsurance" means a cost-sharing method that requires an enrollee to pay a stated percentage of medical expenses after any deductible amount is paid; provided that coinsurance rates may differ for different types of services under the same individual or group health maintenance organization contract;(3) "copayment" means a cost-sharing method that requires an enrollee to pay a fixed dollar amount when health care services are received, with the carrier paying the balance of the allowable amount; provided that there may be different copayment requirements for different types of services under the same individual or group health maintenance organization contract; and(4) "cost sharing" means a copayment, coinsurance, deductible or any other form of financial obligation of an enrollee other than a premium or a share of a premium, or any combination of any of these financial obligations, as defined by the terms of an individual or group health maintenance organization contract.History: Laws 2021, ch. 136, § 8. ANNOTATIONSEffective dates. — Laws 2021, ch. 136, § 11 made Laws 2021, ch. 136, § 8 effective January 1, 2022.
NM Stat § 59A-47-1 (2021)
2021 New Mexico Statutes|Chapter 59A - Insurance Code|Article 47 - Nonprofit Health Care Plans|Section 59A-47-1 - Short title.

Chapter 59A, Article 47 NMSA 1978 may be cited as the "Nonprofit Health Care Plan Law". History: Laws 1984, ch. 127, § 878; 2003, ch. 391, § 6. ANNOTATIONSThe 2003 amendment, effective June 20, 2003, substituted "Chapter 59A, Article 47 NMSA 1978" for "This article" at the beginning. Law reviews. — For note, "Nonprofit Health Care Corporations Are Not Insurance Providers," see 10 N.M.L. Rev. 481 (1980). Am. Jur. 2d, A.L.R. and C.J.S. references. — Nonprofit purposes and character which warrant creation of nonprofit organization, 16 A.L.R.2d 1345.
NM Stat § 59A-47-2 (2021)
2021 New Mexico Statutes|Chapter 59A - Insurance Code|Article 47 - Nonprofit Health Care Plans|Section 59A-47-2 - Purpose; exemptions.

A. The purpose of this article is to provide for the reasonable regulation of membership corporations organized for the purpose of making health care expense payments on a service benefit basis or on an indemnity benefit basis, or both, for persons who become subscribers under contracts with such corporation. B. Nothing in this article shall apply to any professional or hospital association which accepts health care expense payments for health care on a service basis or on an indemnity basis, or both, which are underwritten by any authorized insurer. History: Laws 1984, ch. 127, § 879.
NM Stat § 59A-47-4 (2021)
2021 New Mexico Statutes|Chapter 59A - Insurance Code|Article 47 - Nonprofit Health Care Plans|Section 59A-47-4 - Organization; profit corporations prohibited; merger and consolidation of health care plans.

A. A corporation may be organized under the laws of this state which provide for the organization of nonprofit corporations, as a nonprofit corporation organized for making health care expense payments on a service benefit basis or an indemnity basis, or both, for subscribers under contract with such corporation. B. The articles of incorporation of each domestic health care plan shall have endorsed thereon or annexed thereto the consent of the superintendent prior to filing. The amendment of the articles of incorporation of any domestic health care plan shall have endorsed thereon or annexed thereto the consent of the superintendent prior to filing. C. The directors of a domestic health care plan shall be chosen in accordance with the bylaws of the corporation, subject to the following: (1) at least twenty-five percent of the directors shall be members of the general public; and (2) the balance of the directors shall be either representatives of purveyors or members of the general public. D. No domestic health care plan shall be converted into a corporation organized for pecuniary profit; and any such plan shall be maintained and operated primarily for the benefit of its subscribers. E. A domestic health care plan may merge only with another domestic health care plan in accordance with applicable provisions of the Insurance Holding Company Law [Chapter 59A, Article 37 NMSA 1978] and the Nonprofit Corporation Act [Chapter 53, Article 8 NMSA 1978]. History: Laws 1984, ch. 127, § 879.2; 1999, ch. 133, § 2. ANNOTATIONSThe 1999 amendment, effective June 18, 1999, added "Merger and Consolidation of Health Care Plans" in the section heading; inserted "domestic" throughout the section; rewrote former Subsection E which read: "No health care plan shall furnish or contract to furnish health care expense payments in this state unless organized under the laws of this state as above provided and so authorized to operate under the provisions of this article. No foreign health care plan may be authorized to conduct business in this state". Law reviews. — For note, "Nonprofit Health Care Corporations Are Not Insurance Providers," see 10 N.M.L. Rev. 481 (1980).
NM Stat § 59A-47-5 (2021)
2021 New Mexico Statutes|Chapter 59A - Insurance Code|Article 47 - Nonprofit Health Care Plans|Section 59A-47-5 - Qualifications for health care plan authority.

The superintendent shall not authorize any proposed health care plan to solicit preliminary applications from subscribers or to transact business as a health care plan unless he finds after such investigation and hearings as he deems advisable that the proposed health care plan is qualified therefor as follows: A. it shall be duly incorporated as a health care plan under the laws of a state governing incorporation of nonprofit corporations; B. its sponsors shall have financial stability and its directors and officers shall be individuals of good personal and business reputation and integrity; C. its proposed management shall possess experience and competence as to the business in which to engage; D. it shall have ready access to health care facilities in this state reasonably sufficient to provide the health care services to be covered by its subscriber contracts, whether on service or indemnity bases; E. it shall actually or prospectively have sufficient funds to finance preliminary solicitation of subscribers and to conduct its operations with reasonable margin of financial safety; F. its proposed contracts to be offered subscribers shall be well drafted and provide substantial health care coverage and benefits at reasonable premium rates; G. operation of the health care plan in the area of this state proposed to be served would be in the public interest and of convenience to its residents; and H. if it [is] a newly formed health care plan, prior to being granted an initial certificate of authority to engage in business, it shall have applied for and received from the superintendent a preliminary permit to solicit subscribers' applications for health care contracts as proposed to be offered, and thereunder have solicited and received, within one year from date of the preliminary permit, applications for coverage of not less than one thousand individuals under such contracts together with payment in advance of one month's premium therefor or if it is a foreign health care plan with a certificate of authority from its state of domicile, it must already cover not less than one thousand individuals. History: Laws 1984, ch. 127, § 879.3; 1987, ch. 259, § 30; 1999, ch. 133, § 3. ANNOTATIONSBracketed material. — The bracketed material was inserted by the compiler and it is not part of the law. The 1999 amendment, effective June 18, 1999, substituted "shall" for "must" throughout the section; substituted "a" for "this" in Subsection A; inserted "if it a newly formed health care plan" at the beginning of Subsection H and added the language following "premium therefor" at the end of Subsection H.