New Mexico § 59A-22B-7 Prior authorization or referral requirement for in-

New Mexico Statutes

§ 59A-22B-7 — Prior authorization or referral requirement for in-

New Mexico § 59A-22B-7

Ch. 59AInsurance Code

Art. 22BPrior Authorization

This text of New Mexico § 59A-22B-7 (Prior authorization or referral requirement for in-) is published on Counsel Stack Legal Research, covering New Mexico primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook

N.M. Stat. Ann. § 59A-22B-7 (2026).

Text

network mental health or substance use disorder services coverage prohibited. 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 consult

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network mental health or substance use disorder services coverage prohibited. 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 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.