A. Every health maintenance organization shall annually, on or before the first day of March, file a report, verified by at least two principal officers, with the superintendent covering the preceding calendar year.
B. The report shall be on forms prescribed by the superintendent and shall include:
(1) a financial statement of the organization prepared pursuant to forms prescribed by the superintendent, including its balance sheet and receipts and disbursements for the preceding year;
(2) any material changes in the information submitted pursuant to Subsection C of Section 59A-46-3 NMSA 1978;
(3) the number of persons enrolled during the year and the number of enrollees as of the end of the year; and
(4) such other reasonable information materially relating to the performance of the health maintenance organization as is necessary to enable the superintendent to carry out the superintendent's duties under the Insurance Code.
C. In addition, the health maintenance organization shall file by the dates indicated:
(1) on or before March 1, an annual statement in accordance with the requirements of Section 59A-5-29 NMSA 1978 and a risk-based capital report in accordance with the requirements of Section 59A-5A-3 NMSA 1978;
(2) a list of the providers who have executed a contract that complies with Subsection E of Section 59A-46-13 NMSA 1978 on or before March 1; and
(3) a description of the grievance procedures and the total number of grievances handled through such procedures, a compilation of the causes underlying those grievances and a summary of the final disposition of those grievances, on or before March 1.
D. The superintendent may require such additional reports as are deemed necessary and appropriate to enable the superintendent to carry out the superintendent's duties under the Health Maintenance Organization Law.
History: 1978 Comp., § 59A-46-9, enacted by Laws 1993, ch. 266, § 9; 2014, ch. 59, § 51.
Repeals and reenactments. — Laws 1993, ch. 266, § 43 repealed former 59A-46-9 NMSA 1978, as amended by Laws 1986, ch. 51 § 3, and Laws 1993, ch. 266, § 9 enacted a new section, effective January 1, 1994.
The 2014 amendment, effective July 1, 2014, required insurers to annually file a statement of financial condition and transactions and a risk-based capital report; in Subsection C, Paragraph (1), deleted "audited financial statements as of the end of the preceding calendar year on or before June 1 or within one hundred twenty days following the end of its fiscal year, whichever is later" and added the current language of the paragraph.
Severability. — Laws 2014, ch. 59, § 54 provided that if any part or application of the provisions of Laws 2014, ch. 59 is held invalid, the remainder or its application to other situations or persons shall not be affected.
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.