NM| Bulletin 2025-007, from the New Mexico Office of Superintendent of Insurance, outlines new and revised requirements for standardized language, administrative data submissions, and discontinuation notices for issuers offering major medical plans and Qualified Health Plans (QHPs) in New Mexico. The bulletin emphasizes integration of updated prior authorization requirements, maintenance of administrative data filings, and clear procedures for plan discontinuations and enrollee transitions.
Key Points
- Revised Prior Authorization Rules: Issuers must use standardized language clarifying which services require prior authorization, outlining timelines for standard and emergency determinations, and specifying exemptions for certain services, especially those for emergency, behavioral health, and specific FDA-approved medications based on medical necessity determinations.
- Administrative Data and Filing: QHP issuers are required to continue using the Administrative Data template and file it through SERFF as part of their QHP binder documentation on an annual basis.
- Discontinuation and Enrollee Protections: Issuers discontinuing a QHP must provide standardized discontinuation and auto-renewal notices, ensure accurate crosswalking of enrollees to new plans, and follow established protocols for enrollees’ rights during out-of-network care and behavioral health service transitions.