New Mexico Statutes
Article 46 - Health Maintenance Organizations
Section 59A-46-17 - Regulation of health maintenance organization insurance producers.

A. Requirements and procedures for licensing of health maintenance organization insurance producers shall be governed by the provisions of Chapter 59A, Articles 11 and 12 NMSA 1978 and any regulations adopted by the superintendent pertaining to those articles.
B. None of the following shall be required to hold a health maintenance organization insurance producer license:
(1) any regular salaried officer or employee of a health maintenance organization who devotes substantially all of that person's time to activities other than the taking or transmitting of applications or membership fees or premiums for health maintenance organization membership or who receives no commission or other compensation directly dependent upon the business obtained and who does not solicit or accept from the public applications for health maintenance organization membership;
(2) employers or their officers or employees or the trustees of any employee benefit plan to the extent that such employers, officers, employees or trustees are engaged in the administration or operation of any program of employee benefits involving the use of health maintenance organization memberships, if those employers, officers, employees or trustees are not compensated directly or indirectly by the health maintenance organization issuing the health maintenance organization memberships;
(3) banks or their officers and employees to the extent that such banks, officers and employees collect and remit charges by charging same against accounts of depositors on the orders of such depositors; or
(4) any person or the employee of any person who has contracted to provide administrative, management or health care services to a health maintenance organization and who is compensated for those services by the payment of an amount calculated as a percentage of the revenues, net income or profit of the health maintenance organization, if that method of compensation is the sole basis for subjecting that person or the employee of the person to the provisions of the Health Maintenance Organization Law.
C. The superintendent may by rule exempt certain classes of persons from the requirement of obtaining a license if:
(1) the functions they perform do not require special competence, trustworthiness or the regulatory surveillance made possible by licensing; or
(2) other existing safeguards make regulation unnecessary.
History: 1978 Comp., § 59A-46-17, enacted by Laws 1993, ch. 266, § 17; 2016, ch. 89, § 66.
Repeals and reenactments. — Laws 1993, ch. 266, § 43 repealed former 59A-46-17 NMSA 1978, as enacted by Laws 1984, ch. 127, § 864, related to suspension or revocation of certificate of authority, and Laws 1993, ch. 266, § 17 enacted a new section, effective January 1, 1994.
The 2016 amendment, effective July 1, 2017, replaced "agent" with "insurance producer" throughout the section; in Subsection A, after "pertaining", deleted "thereto" and added "to those articles"; and in Subsection B, Paragraph (1), after "substantially all of", deleted "his" and added "that person's", and in Paragraph (2), after "organization issuing", deleted "such" and added "the".
Severability. — Laws 2016, ch. 89, § 71 provided that if any part or application of Laws 2016, ch. 89 is held invalid, the remainder or its application to other situations or persons shall not be affected.

Structure New Mexico Statutes

New Mexico Statutes

Chapter 59A - Insurance Code

Article 46 - Health Maintenance Organizations

Section 59A-46-1 - Short title.

Section 59A-46-2 - Definitions.

Section 59A-46-3 - Establishment of health maintenance organizations.

Section 59A-46-4 - Issuance of certificate of authority.

Section 59A-46-5 - Powers of health maintenance organizations.

Section 59A-46-6 - Fiduciary responsibilities; fidelity bond.

Section 59A-46-7 - Quality assurance program.

Section 59A-46-8 - Requirements for group contract, individual contract and evidence of coverage.

Section 59A-46-9 - Annual report.

Section 59A-46-10 - Information to enrollees or subscribers.

Section 59A-46-11 - Grievance procedures.

Section 59A-46-12 - Investments.

Section 59A-46-13 - Protection against insolvency.

Section 59A-46-14 - Uncovered expenditures insolvency deposit.

Section 59A-46-15 - Enrollment period; replacement coverage in the event of insolvency.

Section 59A-46-16 - Filing requirements for rating information.

Section 59A-46-17 - Regulation of health maintenance organization insurance producers.

Section 59A-46-18 - Powers of insurers.

Section 59A-46-19 - Examinations.

Section 59A-46-20 - Suspension or revocation of certificate of authority.

Section 59A-46-21 - Rehabilitation, liquidation or conservation of health maintenance organizations.

Section 59A-46-22 - Summary orders and supervision.

Section 59A-46-22.1 - Repealed.

Section 59A-46-23 - Regulations.

Section 59A-46-24 - Fees.

Section 59A-46-25 - Penalties and enforcement.

Section 59A-46-26 - Filings and reports as public documents.

Section 59A-46-26.1 - Employer utilization and loss experience availability.

Section 59A-46-27 - Confidentiality of medical information and limitation of liability.

Section 59A-46-28 - Authority to contract.

Section 59A-46-29 - Health maintenance organizations; contract or certificate provisions relating to individuals who are eligible for medical benefits under the medicaid program.

Section 59A-46-30 - Statutory construction and relationship to other laws.

Section 59A-46-31 - Coordination of benefits.

Section 59A-46-32 - Continuation of coverage and conversion rights; health care plans.

Section 59A-46-32.1 - Recompiled.

Section 59A-46-33 - Governing body.

Section 59A-46-34 - Prohibited practices.

Section 59A-46-35 - Provider discrimination prohibited.

Section 59A-46-36 - Doctor of oriental medicine; discrimination prohibited.

Section 59A-46-37 - Coverage for adopted children.

Section 59A-46-38 - Newly born children coverage.

Section 59A-46-38.1 - Coverage of children.

Section 59A-46-38.2 - Childhood immunization coverage required.

Section 59A-46-38.3 - Maximum age of dependent.

Section 59A-46-38.4 - Coverage of circumcision for newborn males.

Section 59A-46-38.5 - Hearing aid coverage for children required.

Section 59A-46-39 - Maternity transport required.

Section 59A-46-40 - Home health care service option required.

Section 59A-46-41 - Coverage for mammograms.

Section 59A-46-41.1 - Mastectomies and lymph node dissection; minimum hospital stay coverage required.

Section 59A-46-41.2 - Prior authorization for gynecological or obstetrical ultrasounds prohibited.

Section 59A-46-42 - Coverage for cytologic and human papillomavirus screening.

Section 59A-46-42.1 - Coverage for the human papillomavirus vaccine.

Section 59A-46-43 - Coverage for individuals with diabetes.

Section 59A-46-43.2 - Coverage for medical diets for genetic inborn errors of metabolism.

Section 59A-46-44 - Coverage for contraception.

Section 59A-46-45 - Coverage for smoking cessation treatment.

Section 59A-46-46 - Coverage of alpha-fetoprotein IV screening test.

Section 59A-46-47 - Coverage of part-time employees.

Section 59A-46-48 - Coverage of colorectal cancer screening.

Section 59A-46-49 - General anesthesia and hospitalization for dental surgery.

Section 59A-46-50 - Coverage for autism spectrum disorder diagnosis and treatment.

Section 59A-46-50.1 - Coverage for orally administered anticancer medications; limits on patient costs.

Section 59A-46-50.2 - Coverage of prescription eye drop refills.

Section 59A-46-50.3 - Coverage for telemedicine services.

Section 59A-46-50.4 - Prescription drugs; prohibited formulary changes; notice requirements.

Section 59A-46-51 - Repealed.

Section 59A-46-52 - Prescription drug prior authorization protocols.

Section 59A-46-52.1 - Prescription drug coverage; step therapy protocols; clinical review criteria; exceptions.

Section 59A-46-52.2 - Pharmacist prescriptive authority services; reimbursement parity.

Section 59A-46-53 - Pharmacy benefits; prescription synchronization.

Section 59A-46-54 - Provider credentialing; requirements; deadline.

Section 59A-46-55 - Coverage exclusion. (Contingent repeal. See note below.)

Section 59A-46-56 - Physical rehabilitation services; limits on cost sharing.

Section 59A-46-57 - Behavioral health services; elimination of cost sharing. (Effective January 1, 2022.)