NM| New Mexico’s Office of Superintendent of Insurance Bulletin 2026-012 directs health insurers offering major medical coverage in the state to provide nondiscriminatory coverage for medically necessary complex rehabilitation technology (CRT), including customized manual and power wheelchairs, seating and positioning components, accessories, repairs, replacements, and certain power-assisted mobility devices used for athletic participation. Coverage must be tailored to the insured’s medical, physical, functional, and environmental needs, and carriers must include prescribed standardized CRT disclosure language in all Explanations of Coverage.
- Network and cost sharing: Carriers must ensure access to two qualified New Mexico providers; if unavailable, they must refer the insured out of network and reimburse the provider at a mutually agreed rate while limiting the insured’s responsibility to in-network cost sharing, which cannot exceed inpatient medical/surgical cost sharing for CRT.
- Scope of coverage: Insurers must cover CRT-related fitting, customization, fabrication, components, programming, adjustment, alignment, training, repair, and replacement; plans generally must cover up to two CRT devices and may place clinical evaluations under either the CRT or rehabilitative-care benefit.
- Additional-device standard: After three years, an insured may qualify for another device when repairs would exceed 60% of replacement cost or documented physiological, medical-condition, or mobility changes make the current device unsuitable.