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This page lists some of the action toward parity compliance undertaken by New Mexico regulatory agencies since 2008.

Are we missing any actions taken by state regulatory agencies? Let us know at info@paritytrack.org.

Action in the Regulatory Arena

5/2018

Primary Focus:  Mandated Benefit; Provider; Parity
Title/Description:  General Program Description for Managed Care Organizations
Agency: New Mexico Human Services Department
Citation: N.M. Code R. § 8.308.9.11(E)  
Summary:  Managed Care Organizations shall meet all behavioral health parity requirements as set forth in CFR 42, Chapter IV, subchapter C, 438.905 – Parity requirements.
Effective Date: May 1, 2018
Notes:  8.308.9.11 NMAC – Rp, 8.308.9.11 NMAC, 5/1/2018

Primary Focus Mandated Benefit; Provider
Title/Description: Behavioral Health Services for Managed Care Organizations
Agency: New Mexico Human Services Department
Citation: N.M. Code R. § 8.308.9.19
Summary:  MCOs must cover the enumerated behavioral health services. Some services include applied behavior analysis, crises services, and comprehensive community support services.
Effective Date: May 1, 2018
Notes:  8.308.9.19 NMAC – Rp, 8.308.9.19 NMAC, 5/1/2018

3/2015

New Mexico’s Office of the Superintendent of Insurance (OSI) issued a bulletin (pdf | Get Adobe® Reader®) to insurance plans about autism coverage. The bulletin explained that because of the Affordable Care Act (ACA), individual plans and small employer fully-insured plans are not allowed to impose the annual maximums ($36,000) and lifetime maximums ($200,000) for autism care that are specified in the section about autism coverage in the state insurance law (summarized at the bottom of this page).

The bulletin goes on to explain that although this part of the ACA does not apply to large employer fully-insured plans, the Federal Parity Law does, which means the annual maximums and lifetime maximums in the state law cannot be used for autism services if they are not used for other medical services.

The bulletin also asks the Legislature to change the section about autism coverage in the state insurance law so that it references the DSM V, not the DSM IV.

9/2014

New Mexico’s OSI issued a bulletin, (pdf | Get Adobe® Reader®) but withdrew it three days later. There were two sentences in the bulletin about the Federal Parity Law. It stated that plans have to cover behavioral health services “at parity with other medical conditions” if those services are offered.

New Mexico Parity Law

There are multiple sections in New Mexico law that are relevant to parity and autism coverage.

Please be aware that it is not possible to provide direct links to any of the following sections of the law. To find these sections, go to this link and click on the plus sign next to the folder in the upper left side of the screen that says “statutes, rules, const.” Then click on the plus sign next to the folder that says NMSA (unannotated). Then, underneath chapter 24, click on the plus sign next to the “more” folder. Then, click on “Chapter 59A Insurance Code.”

To find all of the sections listed below, click on the appropriate article once you are on the “Chapter 59A” page and then the appropriate section on the article pages. For example, to find the mental health parity section, click on article “23E Health Insurance Portability,” and then click on section “59A-23E-18 Requirements for Mental Health Benefits…”

Mental Health

Chapter 59A Article 23E Section 18 (59A-23E-18)

Substance Use Disorders

Chapter 59A Article 23 Section 6 (59A-23-6); Chapter 59A Article 47 Section 35 (59A-47-35)

Autism

Chapter 59A Article 22 Section 49 (59A-22-49); Chapter 59A Article 23 Section 7.9 (59A-23-7.9); Chapter 59A Article 46 Section 50 (59A-46-50); Chapter 59A Article 47 Section 45 (59A-47-45)

Mental Health

The section about mental health requires large employer fully-insured plans and small employer fully-insured plans to cover mental health services. Plans cannot use treatment limitations or financial requirements for these services unless “identical” treatment limitations and financial requirements are used for other medical services.

Plans are allowed to require prior authorization for inpatient care and outpatient care . They are also allowed to restrict their coverage to only medically necessary services.

There is also two very detailed subsections about exemptions for plans if premium costs rise by 1.5% for small employer fully-insured plans and 2.5% for large employer fully-insured plans.

Substance Use Disorders

Insurers must offer optional coverage for alcohol treatment in large employer fully-insured plans and small employer fully-insured plans . This coverage must include:

  • Deductibles and coinsurance similar to those used for other medical services
  • Annual limits of no less than 30 days for inpatient care and 30 visits for outpatient care
  • Lifetime limits of no less than 60 days for inpatient care and 60 visits for outpatient care

Autism

Large employer fully-insured plans , small employer fully-insured plans , individual plans and public employee plans are all required to cover autism services for all individuals through age 19 and any individual who is in high school through age 22.

Autism spectrum disorder is defined as anything in the DSM including autistic disorder, Asperger’s disorder, pervasive developmental disorder not otherwise specified, Rett’s disorder, and childhood disintegrative disorder.

Treatment of autism spectrum disorder is defined as speech therapy, occupational therapy, physical therapy and applied behavioral analysis .

These plans must have an annual maximum of at least $36,000 and a lifetime maximum of at least $200,000.

Plans do not have to cover any services in Part B of the Individuals with Disabilities Education Improvement Act (IDEA). Plans are not exempted from Part C, however. Part B is for individuals age 3 through age 21. Part C is for children at birth through age 2.

Deductibles and coinsurance must be the same as those used for other medical services.

Get Support

New Mexico Insurance Division

Common Violations

In seeking care or services, be aware of the common ways parity rights can be violated.

Common Violations

Definition

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