N.M. Stat. § 59A-46-51. Health maintenance organizations; direct services: Health Maintenance Organization Law – New Mexico

Status: Enacted
Year Enacted: 2010
Year Amended: 2013
File: Download

A health maintenance organization shall make reimbursement for direct services at a level not less than eighty-five percent of premiums across all health product lines, except individually underwritten health insurance policies, contracts or plans, that are governed by the provisions of Chapter 59A, Article 22 NMSA 1978, the Health Maintenance Organization Law and the Nonprofit Health Care Plan Law [Chapter 59A, Article 47 NMSA 1978]. Reimbursement shall be made for direct services provided over the preceding three calendar years, but not earlier than calendar year 2010, as determined by reports filed with the office of superintendent of insurance. Nothing in this subsection shall be construed to preclude a purchaser from negotiating an agreement with a health maintenance organization that requires a higher amount of premiums paid to be used for reimbursement for direct services for one or more products or for one or more years. Note: A new version of this statute goes into effect on January 1, 2020.


Return to Database Search

© 2018- The SLIHCQ DatabaseInitial funding for this project was provided by the Robert Wood Johnson Foundation. The views expressed here do not necessarily reflect the views of the Foundation.

Associated Litigation:

No items found