reglab/housing_qa huggingface dataset:
NM Stat § 59A-22-53 (2021)
2021 New Mexico Statutes|Chapter 59A - Insurance Code|Article 22 - Health Insurance Contracts|Section 59A-22-53 - Pharmacy benefits; prescription synchronization.

A. An individual 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 a prescription drug benefit shall allow an insured 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 insured; (2) the insured 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 insured's prescription drug fills. B. An individual health insurance policy, health care plan or certificate of health insurance that offers 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 insured pursuant to Subsection A of this section established among the insurer, the prescribing practitioner and a pharmacist. The insurer 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 insurer 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 insured may pay for prescription synchronization services. History: Laws 2015, ch. 65, § 3. 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-22-53.2 (2021)
2021 New Mexico Statutes|Chapter 59A - Insurance Code|Article 22 - Health Insurance Contracts|Section 59A-22-53.2 - Pharmacist prescriptive authority services; reimbursement parity.

An insurer 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 health insurance plan, policy or certificate of health insurance at the standard contracted rate that the health insurance policy, health care plan or certificate of health insurance reimburses, for the same service pursuant to that policy, plan or certificate, 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, § 3; 2021, ch. 54, § 11. ANNOTATIONSThe 2021 amendment, effective June 18, 2021, after "Medical Practice Act", deleted "or the Osteopathic Medicine Act".
NM Stat § 59A-22-55 (2021)
2021 New Mexico Statutes|Chapter 59A - Insurance Code|Article 22 - Health Insurance Contracts|Section 59A-22-55 - Coverage exclusion. (Contingent repeal. See note.)

Coverage of vasectomy and male condoms pursuant to Section 3 [59A-22-42 NMSA 1978] of this 2019 act is excluded for high-deductible individual and group health insurance policies, health care plans or certificates of insurance with health savings accounts delivered or issued for delivery in this state until an insured's deductible has been met. History: Laws 2019, ch. 263, § 4. 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, Sections 4, 6, 8 and 10 of this 2019 act [59A-22-55, 59A-23-7.15, 59A-46-55 and 59A-47-45.6] are 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-22-56 (2021)
2021 New Mexico Statutes|Chapter 59A - Insurance Code|Article 22 - Health Insurance Contracts|Section 59A-22-56 - Physical rehabilitation services; limits on cost sharing.

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 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, § 2. ANNOTATIONSEffective dates. — Laws 2019, ch. 188, § 6 made Laws 2019, ch. 188 effective January 1, 2020.
NM Stat § 59A-22-57 (2021)
2021 New Mexico Statutes|Chapter 59A - Insurance Code|Article 22 - Health Insurance Contracts|Section 59A-22-57 - Behavioral health services; elimination of cost sharing. (Effective January 1, 2022.)

A. Until January 1, 2027, 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 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 the insured 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 insurance policy, health care plan or certificate of health insurance;(3) "copayment" means a cost-sharing method that requires the insured to pay a fixed dollar amount when health care services are received, with the insurer 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 insurance policy, health care plan or certificate of health insurance; and(4) "cost sharing" means a copayment, coinsurance, deductible or any other form of financial obligation of the insured 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 insurance policy, health care plan or certificate of health insurance.History: Laws 2021, ch. 136, § 6. ANNOTATIONSEffective dates. — Laws 2021, ch. 136, § 11 made Laws 2021, ch. 136, § 6 effective January 1, 2022.
NM Stat § 59A-22A-1 (2021)
2021 New Mexico Statutes|Chapter 59A - Insurance Code|Article 22A - Preferred Provider Arrangements|Section 59A-22A-1 - Short title.

Chapter 59A, Article 22A NMSA 1978 shall be known and may be cited as the "Preferred Provider Arrangements Law". History: 1978 Comp., § 59A-22A-1, enacted by Laws 1993, ch. 320, § 59.
NM Stat § 59A-22A-2 (2021)
2021 New Mexico Statutes|Chapter 59A - Insurance Code|Article 22A - Preferred Provider Arrangements|Section 59A-22A-2 - Purpose.

The purpose of the Preferred Provider Arrangements Law is to encourage health care cost containment while preserving quality of care by allowing health care insurers to enter into preferred provider arrangements in accordance with minimum standards for preferred provider arrangements and for the health benefit plans associated with those arrangements. History: 1978 Comp., § 59A-22A-2, enacted by Laws 1993, ch. 320, § 60.
NM Stat § 59A-22A-3 (2021)
2021 New Mexico Statutes|Chapter 59A - Insurance Code|Article 22A - Preferred Provider Arrangements|Section 59A-22A-3 - Definitions.

As used in the Preferred Provider Arrangements Law:A. "covered person" means any person on whose behalf the health care insurer is obligated to pay for or to provide health benefit services;B. "covered services" means health care services which the health care insurer is obligated to pay for or to provide under a health benefit plan;C. "emergency care" means health care procedures, treatments or services delivered to a covered person after the sudden onset of what reasonably appears to be a medical condition that manifests itself by symptoms of sufficient severity, including severe pain, that the absence of immediate medical attention could be reasonably expected by a reasonable layperson to result in jeopardy to a person's health, serious impairment of bodily functions, serious dysfunction of a bodily organ or part or disfigurement to a person; D. "health benefit plan" means the health insurance policy or subscriber agreement between the covered person or the policyholder and the health care insurer that defines the covered services and benefit levels available;E. "health care insurer" means any person who provides health insurance in this state. For the purposes of the Small Group Rate and Renewability Act [Chapter 59A, Article 23C NMSA 1978], "carrier" or "insurer" includes a licensed insurance company, a licensed fraternal benefit society, a prepaid hospital or medical service plan, a health maintenance organization, a nonprofit health care organization, a multiple employer welfare arrangement or any other person providing a plan of health insurance subject to state insurance regulation;F. "health care provider" means providers of health care services licensed as required in this state;G. "health care services" means services rendered or products sold by a health care provider within the scope of the provider's license. The term includes hospital, medical, surgical, dental, vision and pharmaceutical services or products;H. "preferred provider" means a health care provider or group of providers who have contracted with a health care insurer to provide specified covered services to a covered person; andI. "preferred provider arrangement" means a contract between or on behalf of the health care insurer and a preferred provider that complies with all the requirements of the Preferred Provider Arrangements Law. History: 1978 Comp., § 59A-22A-3, enacted by Laws 1993, ch. 320, § 61; 2021, ch. 108, § 22. ANNOTATIONSThe 2021 amendment, effective July 1, 2021, revised the definition of "emergency care"; and in Subsection C, after "'emergency care' means", complete rewrote the remainder of the subsection.
NM Stat § 59A-22A-4 (2021)
2021 New Mexico Statutes|Chapter 59A - Insurance Code|Article 22A - Preferred Provider Arrangements|Section 59A-22A-4 - Preferred provider arrangements.

Notwithstanding any provisions of law to contrary, any health care insurer may enter into preferred provider arrangements. A. Such arrangements shall: (1) establish the amount and manner of payment to the preferred provider. Such amount and manner of payment may include capitation payments for preferred providers; (2) include mechanisms which are designed to minimize the cost of the health benefit plan; for example: (a) the review or control of utilization of health care services; or (b) procedures for determining whether health care services rendered are medically necessary; and (3) assure reasonable access to covered services available under the preferred provider arrangement and an adequate number of preferred providers to render those services. B. Such arrangements shall not unfairly deny health benefits for medically necessary covered services. C. If an entity enters into a contract providing covered services with a health care provider, but is not engaged in activities which would require it to be licensed as a health care insurer, such entity shall file with the superintendent information describing its activities, a description of the contract or agreement it has entered into with the health care providers, and such other information as is required by the provisions of the Health Care Benefits Jurisdiction Act [59A-15-14 to 59A-15-19 NMSA 1978] and any regulations promulgated under its authority. Employers who enter into contracts with health care providers for the exclusive benefit of their employees and dependents are subject to the Health Care Benefits Jurisdiction Act and are exempt from this requirement only to the extent required by federal law. History: 1978 Comp., § 59A-22A-4, enacted by Laws 1993, ch. 320, § 62.
NM Stat § 59A-22A-5 (2021)
2021 New Mexico Statutes|Chapter 59A - Insurance Code|Article 22A - Preferred Provider Arrangements|Section 59A-22A-5 - Health benefit plans.

A. Health care insurers may issue health benefit plans which provide for incentives for covered persons to use the health care services of preferred providers. Such policies or subscriber agreement shall contain at least the following provisions: (1) a provision that if a covered person receives emergency care for services specified in the preferred provider arrangement and cannot reasonably reach a preferred provider that emergency care rendered during the course of the emergency will be reimbursed as though the covered person had been treated by a preferred provider; and (2) a provision which clearly identifies the differentials in benefit levels for health care services of preferred providers and benefit levels for health care services of non-preferred providers. B. If a health benefit plan provides differences in benefit levels payable to preferred providers compared to other providers, such differences shall not unfairly deny payment for covered services and shall be no greater than necessary to provide a reasonable incentive for covered persons to use the preferred provider. History: 1978 Comp., § 59A-22A-5, enacted by Laws 1993, ch. 320, § 63.
NM Stat § 59A-22A-6 (2021)
2021 New Mexico Statutes|Chapter 59A - Insurance Code|Article 22A - Preferred Provider Arrangements|Section 59A-22A-6 - Preferred provider participation requirements.

Health care insurers may place reasonable limits on the number or classes of preferred providers which satisfy the standards set forth by the health care insurer, provided that there is no discrimination against providers on the basis of religion, race, color, national origin, age, sex or marital status, and further provided that selection of preferred providers is primarily based on, but not limited to, cost and availability of covered services and the quality of services performed by the providers. History: 1978 Comp., § 59A-22A-6, enacted by Laws 1993, ch. 320, § 64.
NM Stat § 59A-22A-7 (2021)
2021 New Mexico Statutes|Chapter 59A - Insurance Code|Article 22A - Preferred Provider Arrangements|Section 59A-22A-7 - General requirements.

Health care insurers complying with the Preferred Provider Arrangements Law shall be subject to and are required to comply with all other applicable laws, rules and regulations of this state. History: 1978 Comp., § 59A-22A-7, enacted by Laws 1993, ch. 320, § 65.
NM Stat § 59A-22B-1 (2021)
2021 New Mexico Statutes|Chapter 59A - Insurance Code|Article 22B - Prior Authorization|Section 59A-22B-1 - Short title.

Sections 3 through 7 [59A-22B-1 to 59A-22B-5 NMSA 1978] of this act may be cited as the "Prior Authorization Act". History: Laws 2019, ch. 187, § 3. ANNOTATIONSCompiler's notes. — Laws 2019, ch. 187, § 3 was not enacted as part of the Insurance Code, but was compiled there for the convenience of the user.Effective dates. — Laws 2019, ch. 187 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.Applicability. — Laws 2019, ch. 187, § 8 provided that the provisions of the Prior Authorization Act apply to an individual or group policy contract, certificate or agreement to provide, deliver, arrange for, pay for or reimburse any of the costs of medical care, pharmaceutical benefits or related benefits that is entered into, offered or issued by a health insurer on or after July 1, 2019, pursuant to any of the following:A. Chapter 59A, Article 22 NMSA 1978;B. Chapter 59A, Article 23 NMSA 1978;C. the Health Maintenance Organization Law;D. the Nonprofit Health Care Plan Law; orE. the Health Care Purchasing Act.
NM Stat § 59A-22B-3 (2021)
2021 New Mexico Statutes|Chapter 59A - Insurance Code|Article 22B - Prior Authorization|Section 59A-22B-3 - Emergency care.

Emergency care provided to a covered person, regardless of where the emergency care is provided, shall not be subject to prior authorization requirements. History: Laws 2019, ch. 187, § 5. ANNOTATIONSCompiler's notes. — Laws 2019, ch. 187, § 5 was not enacted as part of the Insurance Code, but was compiled there for the convenience of the user.Effective dates. — Laws 2019, ch. 187 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.Applicability. — Laws 2019, ch. 187, § 8 provided that the provisions of the Prior Authorization Act apply to an individual or group policy contract, certificate or agreement to provide, deliver, arrange for, pay for or reimburse any of the costs of medical care, pharmaceutical benefits or related benefits that is entered into, offered or issued by a health insurer on or after July 1, 2019, pursuant to any of the following:A. Chapter 59A, Article 22 NMSA 1978;B. Chapter 59A, Article 23 NMSA 1978;C. the Health Maintenance Organization Law;D. the Nonprofit Health Care Plan Law; orE. the Health Care Purchasing Act.
NM Stat § 59A-22B-4 (2021)
2021 New Mexico Statutes|Chapter 59A - Insurance Code|Article 22B - Prior Authorization|Section 59A-22B-4 - Duties of office; prescribing penalties.

A. The office shall standardize and streamline the prior authorization process across all health insurers.B. On or before September 1, 2019, the office shall, in collaboration with health insurers and health care providers, promulgate a uniform prior authorization form for medical care, pharmaceutical benefits or related benefits to be used by every health insurer and health care provider after January 1, 2020; provided that the uniform prior authorization form shall conform to the requirements established for medicare and medicaid medical and pharmacy prior authorization requests.C. The office shall maintain a log of complaints against health insurers for failure to comply with the Prior Authorization Act. After two warnings issued by the superintendent of insurance, the office may levy a fine of not more than five thousand dollars ($5,000) on a health insurer that fails to comply with the provisions of the Prior Authorization Act.D. By September 1, 2019, and each September 1 thereafter, the office shall provide an annual written report to the governor and the legislature to include, at a minimum:(1) prior authorization data for each health insurer individually and for health insurers collectively;(2) the number and nature of complaints against individual health insurers for failure to follow the Prior Authorization Act; and(3) actions taken by the office, including the imposition of fines, against individual health insurers to enforce compliance with the Prior Authorization Act.E. The annual written report shall be posted on the office's website. History: Laws 2019, ch. 187, § 6. ANNOTATIONSCompiler's notes. — Laws 2019, ch. 187, § 6 was not enacted as part of the Insurance Code, but was compiled there for the convenience of the user.Effective dates. — Laws 2019, ch. 187 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.Applicability. — Laws 2019, ch. 187, § 8 provided that the provisions of the Prior Authorization Act apply to an individual or group policy contract, certificate or agreement to provide, deliver, arrange for, pay for or reimburse any of the costs of medical care, pharmaceutical benefits or related benefits that is entered into, offered or issued by a health insurer on or after July 1, 2019, pursuant to any of the following:A. Chapter 59A, Article 22 NMSA 1978;B. Chapter 59A, Article 23 NMSA 1978;C. the Health Maintenance Organization Law;D. the Nonprofit Health Care Plan Law; orE. the Health Care Purchasing Act.
NM Stat § 59A-23-1 (2021)
2021 New Mexico Statutes|Chapter 59A - Insurance Code|Article 23 - Group and Blanket Health Insurance Contracts|Section 59A-23-1 - Scope of article.

This article [Chapter 59A, Article 23 NMSA 1978] shall apply only as to group health insurance contracts and blanket health insurance contracts as hereinafter defined. History: Laws 1984, ch. 127, § 460. ANNOTATIONSAm. Jur. 2d, A.L.R. and C.J.S. references. — 44 Am. Jur. 2d Insurance §§ 1842 to 1870.