2020 New Mexico Statutes
Chapter 59A - Insurance Code
Article 47 - Nonprofit Health Care Plans
Section 59A-47-41.1 - Prior authorization for gynecological or obstetrical ultrasounds prohibited.

A. An individual or group health insurance policy, health care plan or certificate of health insurance that is delivered, issued for delivery or renewed in this state and that provides coverage for gynecological or obstetrical ultrasounds shall not require prior authorization for gynecological or obstetrical ultrasounds.

B. Nothing in this section shall be construed to require payment for a gynecological or obstetrical ultrasound that is not:

(1) medically necessary; or

(2) a covered benefit.

C. As used in this section:

(1) "health care plan" means an organization that demonstrates to the office of superintendent of insurance that it has been granted exemption from the federal income tax by the United States commissioner of internal revenue as an organization described in Section 501(c)(3) of the United States Internal Revenue Code of 1986, as that section may be amended or renumbered, and is authorized by the office of superintendent of insurance to enter into contracts with subscribers and make health care expense payments; and

(2) "prior authorization" means advance approval that is required by a health care plan as a condition precedent to payment for medical care or related benefits rendered to a covered person, including prospective or utilization review conducted prior to the provision of covered medical care or related benefits.

History: Laws 2019, ch. 182, § 6.

Cross references. — For Section 501(c)(3) of the Internal Revenue Code of 1986, see 26 U.S.C. § 501(c)(3).

Emergency clauses. — Laws 2019, ch. 182, § 7 contained an emergency clause and was approved April 3, 2019.