A. A health insurer shall not require prior authorization and referral requirements for the following mental health or substance use disorder services:(1) acute or immediately necessary care;(2) acute episodes of chronic mental health or substance use disorder conditions; or(3) initial in-network inpatient or outpatient substance use treatment services.B. Prior authorization shall be determined in consultation with the insured's mental health or substance use disorder services provider for:(1) continuation of services in chronic or stable conditions; or(2) additional services. C. Except in cases in which the insured terminates a plan, a health insurer shall not terminate coverage of services without consultation with the insured's mental health or substance use disorder services provider.D. A health insurer shall not limit coverage for mental health or substance use disorder services up to the point of relief of presenting signs and symptoms or to short-term care or acute treatment.E. The duration of coverage for an insured with a mental health or substance use disorder shall be based on the mental health or substance use disorder needs of the insured rather than on arbitrary time The duration of coverage for an insured with a mental health or substance use disorder shall be based on the mental health or substance use disorder needs of the insured rather than on arbitrary time limits. F. A health insurer may require a mental health or substance use disorder services provider to provide notification to the health insurer after the initiation of in-network mental health or substance use disorder treatment pursuant to Subsection A of this section.G. If a provider fails to notify a health insurer pursuant to Subsection F of this section, a health insurer may perform appropriate utilization review.H. A health insurer may require a mental health or substance use disorder services provider to develop and submit a treatment plan for an insured receiving in-network services in a manner that is compliant with federal law.History: Laws 2023, ch. 114, § 12. ANNOTATIONSEffective dates. — Laws 2023, ch. 114 contained no effective date provision, but, pursuant to N.M. Const., art. IV, § 23, was effective June 16, 2023, 90 days after adjournment of the legislature.Applicability. — Laws 2023, ch. 114, § 46 provided that the provisions of Laws 2023, ch. suant to N.M. Const., art. IV, § 23, was effective June 16, 2023, 90 days after adjournment of the legislature.Applicability. — Laws 2023, ch. 114, § 46 provided that the provisions of Laws 2023, ch. 114 are applicable to group health insurance policies, health care plans or certificates of health insurance, other than small group health plans, that are delivered, issued for delivery or renewed in this state on or after January 1, 2024.
New Mexico Legal Code