New Mexico § 59A-47-62 Level of care determinations for the provision of mental

New Mexico Statutes

§ 59A-47-62 — Level of care determinations for the provision of mental

New Mexico·Ch. 59A Insurance Code·Art. 47 Nonprofit Health Care Plans

health or substance use disorder services.

A.A health care plan shall provide coverage for all in-network mental health or substance use disorder services, consistent with generally recognized standards of care, including placing a subscriber into a medically necessary level of care.

B.Changes in level and duration of care shall be determined by the subscriber's provider in consultation with the insurer.

C.Level of care determinations shall include placement of a subscriber into a facility that provides detoxification services, a hospital, an inpatient rehabilitation treatment facility or an outpatient treatment program.

D.Level of care services for a subscriber with a mental health or substance use disorder shall be based on the mental health or substance use disorder needs of the sub

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health or substance use disorder services. A. A health care plan shall provide coverage for all in-network mental health or substance use disorder services, consistent with generally recognized standards of care, including placing a subscriber into a medically necessary level of care. B. Changes in level and duration of care shall be determined by the subscriber's provider in consultation with the insurer. C. Level of care determinations shall include placement of a subscriber into a facility that provides detoxification services, a hospital, an inpatient rehabilitation treatment facility or an outpatient treatment program. D. Level of care services for a subscriber with a mental health or substance use disorder shall be based on the mental health or substance use disorder needs of the subscriber rather than arbitrary time limits.

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