New Mexico Statutes
Article 46 - Health Maintenance Organizations
Section 59A-46-30 - Statutory construction and relationship to other laws.

A. The provisions of the Insurance Code [Chapter 59A NMSA 1978] other than Chapter 59A, Article 46 NMSA 1978 shall not apply to health maintenance organizations except as expressly provided in the Insurance Code and that article. To the extent reasonable and not inconsistent with the provisions of that article, the following articles and provisions of the Insurance Code shall also apply to health maintenance organizations and their promoters, sponsors, directors, officers, employees, agents, solicitors and other representatives. For the purposes of such applicability, a health maintenance organization may therein be referred to as an "insurer":
(1) Chapter 59A, Article 1 NMSA 1978;
(2) Chapter 59A, Article 2 NMSA 1978;
(3) Chapter 59A, Article 4 NMSA 1978;
(4) Subsection C of Section 59A-5-22 NMSA 1978;
(5) Sections 59A-6-2 through 59A-6-4 and 59A-6-6 NMSA 1978;
(6) Chapter 59A, Article 8 NMSA 1978;
(7) Chapter 59A, Article 10 NMSA 1978;
(8) Chapter 59A, Article 16 NMSA 1978;
(9) the Domestic Abuse Insurance Protection Act [59A-16B-1 to 59A-16B-10 NMSA 1978];
(10) the Insurance Fraud Act [Chapter 59A, Article 16C NMSA 1978];
(11) Chapter 59A, Article 18 NMSA 1978;
(12) the Policy Language Simplification Law [59A-19-1 to 59A-19-7 NMSA 1978];
(13) Section 59A-22-14 NMSA 1978;
(14) the Health Insurance Portability Act [Chapter 59A, Article 23E NMSA 1978];
(15) Sections 59A-34-2, 59A-34-7 through 59A-34-13, 59A-34-17, 59A-34-23, 59A-34-33, 59A-34-36, 59A-34-37, 59A-34-40 through 59A-34-42 and 59A-34-44 through 59A-34-46 NMSA 1978;
(16) the Insurance Holding Company Law [Chapter 59A, Article 37 NMSA 1978];
(17) the Patient Protection Act [Chapter 59A, Article 57 NMSA 1978]; and
(18) the Surprise Billing Protection Act [59A-57A-1 to 59A-57A-13 NMSA 1978].
B. Solicitation of enrollees by a health maintenance organization granted a certificate of authority, or its representatives, shall not be construed as violating any provision of law relating to solicitation or advertising by health professionals, but health professionals shall be individually subject to the laws, rules and ethical provisions governing their individual professions.
C. Any health maintenance organization authorized under the provisions of the Health Maintenance Organization Law shall not be deemed to be practicing medicine and shall be exempt from the provisions of laws relating to the practice of medicine.
History: 1978 Comp., § 59A-46-30, enacted by Laws 1993, ch. 266, § 29; 1997, ch. 248, § 2; 1998, ch. 107, § 13; 1999, ch. 289, § 34; 2001, ch. 297, § 5; 2009, ch. 212, § 4; 2021, ch. 108, § 26.
Recompilations. — Laws 1993, ch. 266, § 31, recompiled former 59A-46-30 NMSA 1978, as enacted by Laws 1984, ch. 127, § 876.1, relating to continuation of coverage and conversion rights, as 59A-46-32 NMSA 1978, effective January 1, 1994.
The 2021 amendment, effective July 1, 2021, revised the list of articles and provisions of the Insurance Code that also apply to health maintenance organizations; and in Subsection A, deleted Paragraph A(8) and redesignated former Paragraph A(9) as Paragraph A(8), added new Paragraphs A(9) and A(10) and redesignated former Paragraphs A(10) through A(12) as Paragraphs A(11) through A(13), respectively, deleted former Paragraphs A(13) through A(15), added new Paragraph A(14) and redesignated former Paragraphs A(16) through A(18) as Paragraphs A(15) through A(17), respectively, and added a new Paragraph A(18).
The 2009 amendment, effective June 19, 2009, added Paragraph (14) of Subsection A.
The 2001 amendment, effective June 15, 2001, in Subsection A, substituted "Policy Language Supplication Act" for "Chapter 59A, Article 19 NMSA 1978" in Pargraph (11), deleted former Paragraph and (12), which listed Section 59A-22-2.1, redesignated former Paragraph (13) as (12), inserted current Paragraph (13), substituted "the Minimum Healthcare Protection Act" for "Chapter 59A, Article 23B NMSA 1978" in Paragraph (14), and substituted "The Insurance Holding Company Law" for "Chapter 59A, Article 37 NMSA 1978" in Paragraph (16).
The 1999 amendment, effective June 18, 1999, in Subsection A deleted Paragraph (3) which read "Chapter 59A, Article 3 NMSA 1978", added Paragraph (12), and redesignated the remaining paragraphs accordingly, and in Paragraph (15) deleted "59A-34-9" and inserted "59A-34-2, 59A-34-7", "59A-34-33", and "59A-34-40 through 59A-34-42 and 59A-34-44 through 59A-34-46".
The 1998 amendment, effective July 1, 1998, added Paragraph A(13), redesignated the following paragraphs accordingly, and added Paragraph A(17).
The 1997 amendment, effective June 20, 1997, made a stylistic change in the second sentence in Subsection A and inserted "59A-34-17" in Paragraph A(14).

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.)