NM| New Mexico OSI 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/positioning equipment, accessories, and power-assisted mobility devices used for athletic participation. Coverage must be tailored to each insured’s medical, functional, physical, and environmental needs and includes evaluation, fitting, fabrication, configuration, training, repair, and replacement. Carriers generally must cover up to two CRT devices, allow an additional device after three years when medically necessary because replacement repairs exceed 60% of replacement cost or documented physiological/mobility changes make the current device unsuitable, meet provider-network standards, limit member cost sharing to no more than inpatient medical/surgical levels, and include OSI-mandated standardized CRT language in all Explanations of Coverage.
Key Points:
Provider access: Plans must ensure access to two qualified New Mexico providers; if that is not possible, they must arrange an out-of-network provider, reimburse that provider in full at a mutually agreed rate, and limit the insured’s responsibility to in-network cost sharing.
Clinical and supplier standards: Plans must provide access to an independent licensed PT or OT for medical-necessity evaluation and a CRT supplier employing a RESNA-certified assistive technology professional directly involved in device selection and configuration.
Carrier implementation: Bulletin requirements apply to all New Mexico major-medical plans, and carriers must incorporate the prescribed consumer-facing coverage notice into every Explanation of Coverage.