SENATE BILL 64

51st legislature - STATE OF NEW MEXICO - first session, 2013

INTRODUCED BY

Gerald Ortiz y Pino

FOR THE LEGISLATIVE HEALTH AND HUMAN SERVICES COMMITTEE

AN ACT

RELATING TO HEALTH CARE; ENACTING A NEW SECTION OF THE HEALTH MAINTENANCE ORGANIZATION LAW TO PROVIDE FOR A SINGLE, STATEWIDE ENTITY FOR CREDENTIALING HEALTH CARE PROFESSIONAL PERSONNEL AND TO REQUIRE THAT ALL HEALTH MAINTENANCE ORGANIZATIONS IN THE STATE USE THE ENTITY FOR CREDENTIALING PURPOSES.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF NEW MEXICO:

     SECTION 1. A new section of the Health Maintenance Organization Law is enacted to read:

     "[NEW MATERIAL] PROVIDER CREDENTIALING.--

          A. To credential providers, a health maintenance organization operating in the state shall use exclusively the services of a single entity that provides credentialing services statewide as established by rule of the superintendent. The credentialing entity created pursuant to this section shall not have any affiliation with or any income derived from any other employment or contract with a health maintenance organization.

          B. As used in this section, "credentialing" means the process that a health maintenance organization uses for assessing and validating the qualifications of a provider. "Credentialing" does not mean the peer review or qualifications review process that a health care facility undertakes when granting or reviewing a provider's practice privileges with respect to that health care facility."

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