A. The office shall standardize and streamline the prior authorization process across all health insurers.
B. On or before September 1, 2019, the office shall, in collaboration with health insurers and health care providers, promulgate a uniform prior authorization form for medical care, pharmaceutical benefits or related benefits to be used by every health insurer and health care provider after January 1, 2020; provided that the uniform prior authorization form shall conform to the requirements established for medicare and medicaid medical and pharmacy prior authorization requests.
C. The office shall maintain a log of complaints against health insurers for failure to comply with the Prior Authorization Act. After two warnings issued by the superintendent of insurance, the office may levy a fine of not more than five thousand dollars ($5,000) on a health insurer that fails to comply with the provisions of the Prior Authorization Act.
D. By September 1, 2019, and each September 1 thereafter, the office shall provide an annual written report to the governor and the legislature to include, at a minimum:
(1) prior authorization data for each health insurer individually and for health insurers collectively;
(2) the number and nature of complaints against individual health insurers for failure to follow the Prior Authorization Act; and
(3) actions taken by the office, including the imposition of fines, against individual health insurers to enforce compliance with the Prior Authorization Act.
E. The annual written report shall be posted on the office's website.
History: Laws 2019, ch. 187, § 6.
ANNOTATIONSCompiler's notes. — Laws 2019, ch. 187, § 6 was not enacted as part of the Insurance Code, but was compiled there for the convenience of the user.
Effective dates. — Laws 2019, ch. 187 contained no effective date provision, but, pursuant to N.M. Const., art. IV, § 23, was effective June 14, 2019, 90 days after the adjournment of the legislature.
Applicability. — Laws 2019, ch. 187, § 8 provided that the provisions of the Prior Authorization Act apply to an individual or group policy contract, certificate or agreement to provide, deliver, arrange for, pay for or reimburse any of the costs of medical care, pharmaceutical benefits or related benefits that is entered into, offered or issued by a health insurer on or after July 1, 2019, pursuant to any of the following:
A. Chapter 59A, Article 22 NMSA 1978;
B. Chapter 59A, Article 23 NMSA 1978;
C. the Health Maintenance Organization Law;
D. the Nonprofit Health Care Plan Law; or
E. the Health Care Purchasing Act.