New Mexico § 13-7-33 - Provider network adequacy

§ 13-7-33. Provider network adequacy

A. An insurer shall maintain an adequate provider network to provide mental health

and substance use disorder services. B. The superintendent of insurance shall ensure access to mental health and substance

use disorder services providers, including parity with medical and surgical services

provider access, through regulation and review of claims processing, provider reimbursement

procedures, network adequacy and provider reimbursement rate adequacy. C. An insurer shall ensure that the process by which reimbursement rates for mental

health and substance use disorder services are determined is comparable to and no

more stringent than the process for reimbursement of medical or surgical benefits. In developing provider reimbursement rates, an insurer shall demonstrate that it

has performed a comparability analysis of provider: (1) reimbursement rates in surrounding states; (2) reimbursement rates between mental health and substance use disorder providers

and medical or surgical providers; and (3) credentialing processes for mental health and substance use disorder providers

and medical or surgical providers. D. An insurer shall undertake all efforts, including increasing provider reimbursement

rates through the processes and strategies described in Subsection C of this section,

to ensure state-mandated network adequacy for the provision of mental health or substance

use disorder services. E. When in-network access to mental health or substance use disorder services is not

reasonably available, an insurer shall provide access to out-of-network services with

the same cost-sharing obligations to the insured as those required for in-network

services.