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New Mexico Statutes Chapter 59A. Insurance Code § 59A-23-26. Utilization review of mental health or substance use disorder services

Current as of May 06, 2021 | Updated by FindLaw Staff

A. An insurer shall, at least monthly, review and update the insurer's utilization review process to reflect the most recent evidence and generally recognized standards of care.

B. When performing a utilization review of mental health or substance use disorder services, including level of care placement, continued stay, transfer and discharge, an insurer shall apply criteria in accordance with generally recognized standards of care.

C. An insurer shall provide utilization review training to staff and contractors undertaking activities related to utilization review.

D. An insurer shall:

(1) develop utilization review policies regarding quantitative and non-quantitative limitations for mental health or substance use disorder services coverage that are no more restrictive than the utilization review policies regarding quantitative and non-quantitative limitations for medical and surgical care; and

(2) make utilization review policies available to providers or plan members.

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Cite this article: FindLaw.com - New Mexico Statutes Chapter 59A. Insurance Code § 59A-23-26. Utilization review of mental health or substance use disorder services - last updated May 06, 2021 | https://codes.findlaw.com/nm/chapter-59a-insurance-code/nm-st-sect-59a-23-26/

Read this complete New Mexico Statutes Chapter 59A. Insurance Code § 59A-23-26. Utilization review of mental health or substance use disorder services on Westlaw

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