reglab/housing_qa huggingface dataset:
NM Stat § 59A-47-44 (2021)
2021 New Mexico Statutes|Chapter 59A - Insurance Code|Article 47 - Nonprofit Health Care Plans|Section 59A-47-44 - General anesthesia and hospitalization for dental surgery.

A. An individual or group health insurance policy, health care plan or certificate of health insurance delivered or issued for delivery in this state shall provide coverage for hospitalization and general anesthesia provided in a hospital or ambulatory surgical center for dental surgery for the following: (1) insureds exhibiting physical, intellectual or medically compromising conditions for which dental treatment under local anesthesia, with or without additional adjunctive techniques and modalities, cannot be expected to provide a successful result and for which dental treatment under general anesthesia can be expected to produce superior results; (2) insureds for whom local anesthesia is ineffective because of acute infection, anatomic variation or allergy; (3) insured children or adolescents who are extremely uncooperative, fearful, anxious or uncommunicative with dental needs of such magnitude that treatment should not be postponed or deferred and for whom lack of treatment can be expected to result in dental or oral pain or infection, loss of teeth or other increased oral or dental morbidity; (4) insureds with extensive oral-facial or dental trauma for which treatment under local anesthesia would be ineffective or compromised; or (5) other procedures for which hospitalization or general anesthesia in a hospital or ambulatory surgical center is medically necessary. B. The provisions of this section do not apply to short-term travel, accident-only or limited or specified disease policies. C. Coverage for dental surgery may be subject to copayments, deductibles and coinsurance subject to network and prior authorization requirements consistent with those imposed on other benefits under the same policy, plan or certificate. History: Laws 2007, ch. 218, § 5. ANNOTATIONSEffective dates. — Laws 2007, ch. 218, § 6 made Laws 2007, ch. 218, § 5 effective July 1, 2007.
NM Stat § 59A-47-45.1 (2021)
2021 New Mexico Statutes|Chapter 59A - Insurance Code|Article 47 - Nonprofit Health Care Plans|Section 59A-47-45.1 - Coverage for orally administered anticancer medications; limits on patient costs.

A. An individual or group health insurance policy, health care plan or certificate of health insurance 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 nonprofit health care plan 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, "nonprofit health care plan": (1) means: (a) a nonprofit health insurer; (b) a nonprofit health service provider; (c) a nonprofit health maintenance organization; (d) a nonprofit managed care organization; or (e) a nonprofit provider service 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, § 5. ANNOTATIONSEffective dates. — Laws 2011, ch. 55, § 7 made Laws 2011, ch. 55, § 5 effective June 17, 2011. Applicability. — Laws 2011, ch. 55, § 6 provided that the provisions of Laws 2011, ch. 55, § 5 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-47-45.2 (2021)
2021 New Mexico Statutes|Chapter 59A - Insurance Code|Article 47 - Nonprofit Health Care Plans|Section 59A-47-45.2 - Coverage of prescription eye drop refills.

A. An individual or group health insurance policy, health care plan or certificate of health insurance 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, § 5. ANNOTATIONSEffective dates. — Laws 2012, ch. 27, § 7 provided that Laws 2012, ch. 27, § 5 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-47-45.6 (2021)
2021 New Mexico Statutes|Chapter 59A - Insurance Code|Article 47 - Nonprofit Health Care Plans|Section 59A-47-45.6 - Coverage exclusion. (Contingent repeal. See note.)

Coverage of vasectomy and male condoms pursuant to Section 9 [59A-47-45.5 NMSA 1978] of this 2019 act is excluded for high-deductible health care plans with health savings accounts until a covered person's deductible has been met. History: Laws 2019, ch. 263, § 10. ANNOTATIONSContingent repeal. — Laws 2019, ch. 263, § 11 provided that 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-47-45.6 is repealed.Effective 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.
NM Stat § 59A-47-45.7 (2021)
2021 New Mexico Statutes|Chapter 59A - Insurance Code|Article 47 - Nonprofit Health Care Plans|Section 59A-47-45.7 - Heart artery calcium scan coverage.

A. A group health care plan, other than a small group health care plan, that is delivered, issued for delivery or renewed in this state shall provide coverage for eligible subscribers 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 subscriber to be used as a clinical management tool;(2) be provided every five years if an eligible subscriber has previously received a heart artery calcium score of zero; and(3) not be required for future heart artery calcium scans if an eligible subscriber receives a heart artery calcium score greater than zero.C. At its discretion or as required by law, a health care plan may offer or refuse coverage for further cardiac testing or procedures for eligible subscribers 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 subscriber" means a subscriber 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, § 5. 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-47-46 (2021)
2021 New Mexico Statutes|Chapter 59A - Insurance Code|Article 47 - Nonprofit Health Care Plans|Section 59A-47-46 - Repealed.

History: Laws 2010, ch. 94, § 4; 2013, ch. 74, § 33; 2018, ch. 57, § 26; 2019, ch. 235, § 15; 2019, ch. 235, § 16; repealed by Laws 2021, ch. 108, § 37. ANNOTATIONSRepeals. — Laws 2021, ch. 108, § 37 repealed 59A-47-46 NMSA 1978, as enacted by Laws 2010, ch. 94, § 4, relating to health insurers; direct services, effective July 1, 2021. For provisions of former section, see the 2020 NMSA 1978 on NMOneSource.com.
NM Stat § 59A-47-47 (2021)
2021 New Mexico Statutes|Chapter 59A - Insurance Code|Article 47 - Nonprofit Health Care Plans|Section 59A-47-47 - Prescription drug prior authorization protocols.

A. After January 1, 2014, a health care plan 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 care plan 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 care plan" means a nonprofit corporation authorized by the superintendent to enter into contracts with subscribers and to make health care expense payments but does not include: (1) a person that only issues a limited-benefit policy intended to supplement major medical coverage, including medicare supplement, vision, dental, disease-specific, accident-only or hospital indemnity-only insurance policies, or that only issues policies for long-term care or disability income; (2) a physician or a physician group to which a health care plan has delegated financial risk for prescription drugs and that does not use a prior authorization process for prescription drugs; or (3) a health care plan or its affiliated providers, if the health care plan owns and operates its pharmacies and does not use a prior authorization process. History: Laws 2013, ch. 170, § 8. 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-47-47.2 (2021)
2021 New Mexico Statutes|Chapter 59A - Insurance Code|Article 47 - Nonprofit Health Care Plans|Section 59A-47-47.2 - Pharmacist prescriptive authority services; reimbursement parity.

A health care plan 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 a subscriber at the same rate that the carrier reimburses, for the standard contracted service under that subscriber 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, § 6; 2021, ch. 54, § 14. ANNOTATIONSThe 2021 amendment, effective June 18, 2021, after "Medical Practice Act", deleted "or the Osteopathic Medicine Act".
NM Stat § 59A-47-48 (2021)
2021 New Mexico Statutes|Chapter 59A - Insurance Code|Article 47 - Nonprofit Health Care Plans|Section 59A-47-48 - Pharmacy benefit; prescription synchronization.

A. An individual or group health care plan that is delivered, issued for delivery or renewed in this state and that provides a prescription drug benefit shall allow a subscriber 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 in the best [sic] interest of the subscriber; (2) the subscriber 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 subscriber's prescription drug fills. B. An individual or group health care plan that is delivered, issued for delivery or renewed in this state and that provides a prescription drug benefit 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 subscriber pursuant to Subsection A of this section established among the health care plan, the prescribing practitioner and a pharmacist. The health care plan 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 care plan 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 subscriber may pay for prescription synchronization services. History: Laws 2015, ch. 65, § 6. ANNOTATIONSBracketed material. — The bracketed material was inserted by the compiler and is not part of the law. Effective 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-47-50 (2021)
2021 New Mexico Statutes|Chapter 59A - Insurance Code|Article 47 - Nonprofit Health Care Plans|Section 59A-47-50 - Physical rehabilitation services; limits on cost sharing.

A. An individual or group health care plan 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, § 5. ANNOTATIONSEffective dates. — Laws 2019, ch. 188, § 6 made Laws 2019, ch. 188 effective January 1, 2020.
NM Stat § 59A-47-51 (2021)
2021 New Mexico Statutes|Chapter 59A - Insurance Code|Article 47 - Nonprofit Health Care Plans|Section 59A-47-51 - Behavioral health services; elimination of cost sharing. (Effective January 1, 2022.)

A. Until January 1, 2027, an individual or group health care plan 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 a subscriber 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 care plan;(3) "copayment" means a cost-sharing method that requires a subscriber to pay a fixed dollar amount when health care services are received, with the health care plan 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 care plan; and(4) "cost sharing" means a copayment, coinsurance, deductible or any other form of financial obligation of a subscriber 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 care plan.History: Laws 2021, ch. 136, § 9. ANNOTATIONSEffective dates. — Laws 2021, ch. 136, § 11 made Laws 2021, ch. 136, § 9 effective January 1, 2022.
NM Stat § 59A-48-1 (2021)
2021 New Mexico Statutes|Chapter 59A - Insurance Code|Article 48 - Prepaid Dental Plans|Section 59A-48-1 - Short title.

This article [Chapter 59A, Article 48 NMSA 1978] may be cited as the "Prepaid Dental Plan Law". History: Laws 1984, ch. 127, § 880.
NM Stat § 59A-48-2 (2021)
2021 New Mexico Statutes|Chapter 59A - Insurance Code|Article 48 - Prepaid Dental Plans|Section 59A-48-2 - Definitions.

As used in this article: A. "member" means an individual who is enrolled in a group prepaid dental plan as a principal subscriber together with such person's dependents who are entitled to dental care services under the plan solely because of their status as dependents of the principal subscriber; B. "membership coverage" means any certificate or contract issued to a member setting out the dental coverage to which such member is entitled; C. "prepaid dental plan" means any contractual arrangement whereby any prepaid dental plan organization undertakes to provide directly or to arrange for prepaid dental services and to pay or make reimbursement for any remaining portion of such prepaid dental services on a prepaid basis through insurance or otherwise; D. "prepaid dental plan organization" means any person who undertakes to conduct one or more prepaid dental plans providing only dental services; provided, that this article shall not apply to nonprofit health care plans or accident and health insurance programs; E. "prepaid dental services" means services included in the practice of dentistry as defined in the Dental Act [61-5-1 to 61-5-9, 61-5-11 to 61-5-22 NMSA 1978][repealed]; and F. "provider" means any person licensed under the Dental Act [repealed] or otherwise authorized to furnish prepaid dental services in New Mexico. History: Laws 1984, ch. 127, § 881. ANNOTATIONSBracketed material. — The bracketed material was inserted by the compiler and is not part of the law. Laws 1994, ch. 55, § 41 repealed the Dental Act, effective July 1, 1994. For present comparable provisions, see 61-5A-1 NMSA 1978 et seq.
NM Stat § 59A-48-3 (2021)
2021 New Mexico Statutes|Chapter 59A - Insurance Code|Article 48 - Prepaid Dental Plans|Section 59A-48-3 - Certificate of authority required.

No person may establish or operate a prepaid dental plan organization in New Mexico, or sell or offer to sell or solicit offers to purchase, or receive advance or periodic consideration in conjunction with a prepaid dental plan without obtaining and maintaining a certificate of authority pursuant to the provisions of this article. History: Laws 1984, ch. 127, § 882.
NM Stat § 59A-48-5 (2021)
2021 New Mexico Statutes|Chapter 59A - Insurance Code|Article 48 - Prepaid Dental Plans|Section 59A-48-5 - Issuance of certificate of authority.

A. Issuance of a certificate of authority shall be granted by the superintendent if the superintendent is satisfied that the following conditions are met: (1) the persons responsible for conducting the affairs of the prepaid dental plan organization are competent and trustworthy and are professionally capable of providing or arranging for the provision of services offered; (2) the prepaid dental plan organization constitutes an appropriate mechanism to achieve an effective prepaid dental plan, in accordance with regulations issued by the director of the health services division of the health and environment department [department of health], which shall include at least the basic dental services appropriate to such plan as determined by the director of the health services division of the health and environment department; (3) the prepaid dental plan organization is financially responsible and may reasonably be expected to meet its obligations to members and prospective members. In making this determination, the superintendent shall consider at least: (a) the financial soundness of the prepaid dental plan's arrangement for services and the schedule of charges used; (b) any agreement with an insurer, a hospital or a medical service corporation, a government or any other organization for insuring the payment of the cost of prepaid dental services or the provisions for automatic applicability of an alternative coverage in the event of the discontinuance of the plan; and (c) the sufficiency of an agreement with providers for the provision of prepaid dental services; and (4) each officer responsible for conducting the affairs of the prepaid dental plan organization is covered under an individual or blanket fidelity bond in the amount of fifty thousand dollars ($50,000), and such bond has been filed with and approved by the superintendent. B. A certificate of authority shall be subject to continuance, expiration, termination, suspension or revocation on the same applicable bases as provided under Article 5 [Chapter 59A, Article 5 NMSA 1978] of the Insurance Code as to insurers in general. History: Laws 1984, ch. 127, § 884. ANNOTATIONSBracketed material. — The bracketed material was inserted by the compiler and is not part of the law. Laws 1991, ch. 25, § 16 repealed former 9-7-4 NMSA 1978, relating to the health and environment department, and enacted a new 9-7-4 NMSA 1978, creating the department of health.