A. Any data or information pertaining to the diagnosis, treatment or health of any enrollee or applicant obtained from such person or from any provider by any health maintenance organization shall be held in confidence and shall not be disclosed to any person except:
(1) to the extent that it may be necessary to carry out the purposes of the Health Maintenance Organization Law;
(2) upon the express consent of the enrollee or applicant;
(3) pursuant to statute or court order for the production of evidence or the discovery thereof; or
(4) in the event of claim or litigation between such person and the health maintenance organization in which such data or information is pertinent.
B. A health maintenance organization shall be entitled to claim any statutory privileges against disclosure of information described in Subsection A of this section that the provider who furnished the information to the health maintenance organization is entitled to claim.
C. A person who, in good faith and without malice, takes any action or makes any decision or recommendation as a member, agent or employee of a health care review committee or who furnishes any records, information or assistance to such a committee shall not be subject to liability for civil damages or any legal action in consequence of such action, nor shall the health maintenance organization that established such committee or the officers, directors, employees or agents of such health maintenance organization be liable for the activities of any such person. The provisions of this subsection do not relieve any person of liability arising from treatment of a patient.
D. The information considered by a health care review committee and the records of their actions and proceedings shall be confidential and not subject to subpoena or order to produce except in proceedings before the appropriate state licensing or certifying agency, or in an appeal, if permitted, from the committee's findings or recommendations. No member of a health care review committee, or officer, director or other member of a health maintenance organization or its staff engaged in assisting such committee, or any person assisting or furnishing information to such committee may be subpoenaed to testify in any judicial or quasi-judicial proceeding if such subpoena is based solely on such activities.
E. Information considered by a health care review committee and the records of its actions and proceedings that are used pursuant to Subsection D of this section by a state licensing or certifying agency or in an appeal shall be kept confidential and shall be subject to the same provision concerning discovery and use in legal actions as are the original information and records in the possession and control of a health care review committee.
F. To fulfill its obligations under Section 59A-46-7 NMSA 1978, the health maintenance organization shall have access to treatment records and other information pertaining to the diagnosis, treatment or health status of any enrollee.
History: 1978 Comp., § 59A-46-27, enacted by Laws 1993, ch. 266, § 27.
Recompilations. — Laws 1993, ch. 266, § 31, recompiled former 59A-46-27 NMSA 1978, as enacted by Laws 1984, ch. 127, § 874, relating to coverage for newly born children, as 59A-46-38 NMSA 1978, effective January 1, 1994.
Structure New Mexico Statutes
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-46-25 - 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-46-30 - 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-46-41.2 - 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-46-50.2 - 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-46-52 - Prescription drug prior authorization protocols.
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.