New Mexico Statutes
Article 46 - Health Maintenance Organizations
Section 59A-46-25 - Penalties and enforcement.

A. The superintendent may, in lieu of suspension or revocation of a certificate of authority pursuant to the provisions of Section 59A-46-20 NMSA 1978, levy an administrative penalty in an amount up to five thousand dollars ($5,000), except that if the violation is willful or intentional, the administrative penalty may be up to ten thousand dollars ($10,000). The superintendent may augment this penalty by an amount equal to the sum that he calculates to be the damages suffered by enrollees or other members of the public.
B. If the superintendent shall for any reason have cause to believe that any violation of the provisions of the Health Maintenance Organization Law has occurred or is threatened, the superintendent may give notice to the health maintenance organization and to the representatives, or other persons who appear to be involved in such suspected violation, to arrange a conference with the alleged violators or their authorized representatives for the purpose of attempting to ascertain the facts relating to such suspected violation and, in the event it appears that any violation has occurred or is threatened, to arrive at an adequate and effective means of correcting or preventing such violation.
C. A conference arranged under the provisions of Subsection B of this section shall not be governed by any formal procedural requirements, and may be conducted in such manner as the superintendent may deem appropriate under the circumstances.
D. The superintendent may issue an order directing a health maintenance organization or a representative of a health maintenance organization to cease and desist from engaging in any act or practice in violation of the provisions of the Health Maintenance Organization Law. Within thirty days after service of the cease and desist order, the respondent may request a hearing on the question of whether acts or practices in violation of that law have occurred. Such hearings shall be governed by the provisions of Chapter 59A, Article 4 NMSA 1978.
E. In the case of any violation of the provisions of the Health Maintenance Organization Law, if the superintendent elects not to issue a cease and desist order, or in the event of noncompliance with a cease and desist order issued pursuant to Subsection D of this section, the superintendent may institute a proceeding to obtain injunctive or other appropriate relief in the Santa Fe county district court.
F. Notwithstanding any other provisions of the Health Maintenance Organization Law, if a health maintenance organization fails to comply with the net worth requirement of that law, the superintendent is authorized to take appropriate action to assure that the continued operation of the health maintenance organization will not be hazardous to its enrollees.
History: 1978 Comp., § 59A-46-25, enacted by Laws 1993, ch. 266, § 25.
Repeals and reenactments. — Laws 1993, ch. 266, § 43 repealed former 59A-46-25 NMSA 1978, as enacted by Laws 1984, ch. 127, § 872, related to filings and reports as public documents, and Laws 1993, ch. 266, § 25 enacted a new section, effective January 1, 1994.

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.)