0001| HOUSE BUSINESS AND INDUSTRY COMMITTEE SUBSTITUTE FOR | 0002| | 0003| HOUSE BILL 361 | 0004| 43rd legislature - STATE OF NEW MEXICO - second session, 1998 | 0005| | 0006| | 0007| | 0008| | 0009| | 0010| | 0011| | 0012| AN ACT | 0013| RELATING TO INSURANCE; ENACTING THE PATIENT PROTECTION ACT; | 0014| PROVIDING PROTECTIONS FOR PERSONS IN MANAGED HEALTH CARE | 0015| PLANS; APPLYING PATIENT PROTECTIONS TO MEDICAID MANAGED CARE; | 0016| IMPOSING A CIVIL PENALTY; AMENDING AND ENACTING SECTIONS OF | 0017| THE NMSA 1978. | 0018| | 0019| BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF NEW MEXICO: | 0020| Section 1. A new section of the New Mexico Insurance | 0021| Code is enacted to read: | 0022| "[NEW MATERIAL] SHORT TITLE.--Sections 1 through 11 of | 0023| this act may be cited as the "Patient Protection Act"." | 0024| Section 2. A new section of the New Mexico Insurance | 0025| Code is enacted to read: | - 1 -0001| "[NEW MATERIAL] PURPOSE OF ACT.--The purpose of the | 0002| Patient Protection Act is to regulate aspects of health | 0003| insurance by specifying patient and provider rights and | 0004| confirming and clarifying the authority of the department to | 0005| adopt regulations to provide protections to persons enrolled | 0006| in managed health care plans. The insurance protections | 0007| should ensure that managed health care plans treat patients | 0008| fairly and arrange for the delivery of good quality services." | 0009| Section 3. A new section of the New Mexico Insurance | 0010| Code is enacted to read: | 0011| "[NEW MATERIAL] DEFINITIONS.--As used in the Patient | 0012| Protection Act: | 0013| A. "continuous quality improvement" means an | 0014| ongoing and systematic effort to measure, evaluate and improve | 0015| a managed health care plan's process in order to improve | 0016| continually the quality of health care services provided to | 0017| enrollees; | 0018| B. "covered person", "enrollee", "patient" or | 0019| "consumer" means an individual who is entitled to receive | 0020| health care benefits provided by a managed health care plan; | 0021| C. "department" means the insurance department; | 0022| D. "emergency care" means health care procedures, | 0023| treatments or services delivered to a covered person after the | 0024| sudden onset of what reasonably appears to be a medical | 0025| condition that manifests itself by symptoms of sufficient | - 2 -0001| severity, including severe pain, that the absence of immediate | 0002| medical attention could be reasonably expected by a reasonable | 0003| layperson to result in jeopardy to a person's health, serious | 0004| impairment of bodily functions, serious dysfunction of a bodily | 0005| organ or part or disfigurement to a person; | 0006| E. "health care facility" means an institution | 0007| providing health care services, including a hospital or other | 0008| licensed inpatient center; an ambulatory surgical or treatment | 0009| center; a skilled nursing center; a residential treatment center; | 0010| a home health agency; a diagnostic, laboratory or imaging center; | 0011| and a rehabilitation or other therapeutic health setting; | 0012| F. "health care insurer" means a person that has a | 0013| valid certificate of authority in good standing under the | 0014| Insurance Code to act as an insurer, health maintenance | 0015| organization, nonprofit health care plan or prepaid dental plan; | 0016| G. "health care professional" means a physician or | 0017| other health care practitioner, including a pharmacist, who is | 0018| licensed, certified or otherwise authorized by the state to | 0019| provide health care services consistent with state law; | 0020| H. "health care provider" or "provider" means a | 0021| person that is licensed or otherwise authorized by the state to | 0022| furnish health care services and includes health care | 0023| professionals and health care facilities; | 0024| I. "health care services" includes, to the extent | 0025| offered by the plan, physical health or community-based mental | - 3 -0001| health or developmental disability services, including services | 0002| for developmental delay; | 0003| J. "managed health care plan" or "plan" means a | 0004| health care insurer or a provider service network when offering a | 0005| benefit that either requires a covered person to use, or creates | 0006| incentives, including financial incentives, for a covered person | 0007| to use health care providers managed, owned, under contract with | 0008| or employed by the health care insurer or provider service | 0009| network. "Managed health care plan" or "plan" does not include a | 0010| health care insurer or provider service network offering a | 0011| traditional fee-for-service indemnity benefit or a benefit that | 0012| covers only short-term travel, accident-only, limited benefit, | 0013| student health plan or specified disease policies; | 0014| K. "person" means an individual or other legal | 0015| entity; | 0016| L. "point-of-service plan" or "open plan" means a | 0017| managed health care plan that allows enrollees to use health care | 0018| providers other than providers under direct contract with or | 0019| employed by the plan, even if the plan provides incentives, | 0020| including financial incentives, for covered persons to use the | 0021| plan's designated participating providers; | 0022| M. "provider service network" means two or more | 0023| health care providers affiliated for the purpose of providing | 0024| health care services to covered persons on a capitated or similar | 0025| prepaid flat-rate basis that hold a certificate of authority | - 4 -0001| pursuant to the Provider Service Network Act; | 0002| N. "superintendent" means the superintendent of | 0003| insurance; and | 0004| O. "utilization review" means a system for reviewing | 0005| the appropriate and efficient allocation of health care services | 0006| given or proposed to be given to a patient or group of patients." | 0007| Section 4. A new section of the New Mexico Insurance Code | 0008| is enacted to read: | 0009| "[NEW MATERIAL] PATIENT RIGHTS--DISCLOSURES--RIGHTS TO | 0010| BASIC AND COMPREHENSIVE HEALTH CARE SERVICES--GRIEVANCE | 0011| PROCEDURE--UTILIZATION REVIEW PROGRAM--CONTINUOUS QUALITY | 0012| PROGRAM.-- | 0013| A. Each covered person enrolled in a managed health | 0014| care plan has the right to be treated fairly. A managed health | 0015| care plan shall arrange for the delivery of good quality and | 0016| appropriate health care services to enrollees as defined in the | 0017| particular subscriber agreement. The department shall adopt | 0018| regulations to implement the provisions of the Patient Protection | 0019| Act and shall monitor and oversee a managed health care plan to | 0020| ensure that each covered person enrolled in a plan is treated | 0021| fairly and in accordance with the requirements of the Patient | 0022| Protection Act. In adopting regulations to implement the | 0023| provisions of Subparagraphs (a) and (b) of Paragraph (3) and | 0024| Paragraphs (5) and (6) of Subsection B of this section regarding | 0025| health care standards and specialists, utilization review | - 5 -0001| programs and continuous quality improvement programs, the | 0002| department shall cooperate with and seek advice from the | 0003| department of health. | 0004| B. The regulations adopted by the department to | 0005| protect patient rights shall provide at a minimum that: | 0006| (1) prior to or at the time of enrollment, a | 0007| managed health care plan shall provide a summary of benefits and | 0008| exclusions, premium information and a provider listing; within a | 0009| reasonable time after enrollment and at subsequent periodic times | 0010| as appropriate, a managed health care plan shall provide written | 0011| material that contains, in a clear, conspicuous and readily | 0012| understandable form, a full and fair disclosure of the plan's | 0013| benefits, limitations, exclusions, conditions of eligibility, | 0014| prior authorization requirements, enrollee financial | 0015| responsibility for payments, grievance procedures, appeal rights | 0016| and the patients' rights generally available to all covered | 0017| persons; | 0018| (2) a managed health care plan shall provide | 0019| health care services that are reasonably accessible and available | 0020| in a timely manner to each covered person; | 0021| (3) in providing reasonably accessible health | 0022| care services that are available in a timely manner, a managed | 0023| health care plan shall ensure that: | 0024| (a) the plan offers sufficient numbers and | 0025| types of qualified and adequately staffed health care providers | - 6 -0001| at reasonable hours of service to provide health care services to | 0002| the plan's enrollees; | 0003| (b) health care providers that are | 0004| specialists may act as primary care providers for patients with | 0005| chronic medical conditions, provided the specialists offer all | 0006| basic health care services that are required of them by a managed | 0007| health care plan; | 0008| (c) reasonable access is provided to | 0009| out-of-network health care providers if medically necessary | 0010| covered services are not reasonably available through | 0011| participating health care providers or if necessary to provide | 0012| continuity of care during brief transition periods; | 0013| (d) emergency care is immediately | 0014| available without prior authorization requirements, and | 0015| appropriate out-of-network emergency care is not subject to | 0016| additional costs; and | 0017| (e) the plan, through provider selection, | 0018| provider education, the provision of additional resources or | 0019| other means, reasonably addresses the cultural and linguistic | 0020| diversity of its enrollee population; | 0021| (4) a managed health care plan shall adopt and | 0022| implement a prompt and fair grievance procedure for resolving | 0023| patient complaints and addressing patient questions and concerns | 0024| regarding any aspect of the plan, including the quality of and | 0025| access to health care, the choice of health care provider or | - 7 -0001| treatment and the adequacy of the plan's provider network. The | 0002| grievance procedure shall notify patients of their right to | 0003| obtain review by the plan, their right to obtain review by the | 0004| superintendent, their right to expedited review of emergent | 0005| utilization decisions and their rights under the Patient | 0006| Protection Act; | 0007| (5) a managed health care plan shall adopt and | 0008| implement a comprehensive utilization review program. The basis | 0009| of a decision to deny care shall be disclosed to an affected | 0010| enrollee. The decision to approve or deny care to an enrollee | 0011| shall be made in a timely manner, and the final decision shall be | 0012| made by a qualified health care professional. A plan's | 0013| utilization review program shall ensure that enrollees have | 0014| proper access to health care services, including referrals to | 0015| necessary specialists. A decision made in a plan's utilization | 0016| review program shall be subject to the plan's grievance procedure | 0017| and appeal to the superintendent; and | 0018| (6) a managed health care plan shall adopt and | 0019| implement a continuous quality improvement program that monitors | 0020| the quality and appropriateness of the health care services | 0021| provided by the plan." | 0022| Section 5. A new section of the New Mexico Insurance Code | 0023| is enacted to read: | 0024| "[NEW MATERIAL] CONSUMER ASSISTANCE--CONSUMER ADVISORY | 0025| BOARDS--OMBUDSMAN OFFICE--REPORTS TO CONSUMERS--SUPERINTENDENT'S | - 8 -0001| ORDERS TO PROTECT CONSUMERS.-- | 0002| A. Each managed health care plan shall establish and | 0003| adequately staff a consumer assistance office. The purpose of | 0004| the consumer assistance office is to respond to consumer | 0005| questions and concerns and assist patients in exercising their | 0006| rights and protecting their interests as consumers of health | 0007| care. | 0008| B. Each managed health care plan shall establish a | 0009| consumer advisory board. The board shall meet at least quarterly | 0010| and shall advise the plan about the plan's general operations | 0011| from the perspective of the enrollee as a consumer of health | 0012| care. The board shall also review the operations of and be | 0013| advisory to the plan's consumer assistance office. | 0014| C. The department shall establish and adequately | 0015| staff a managed care ombudsman office, either within the | 0016| department or by contract. The purpose of the managed care | 0017| ombudsman office shall be to assist patients in exercising their | 0018| rights and help advocate for and protect patient interests. The | 0019| department's managed care ombudsman office shall work in | 0020| conjunction with each plan's consumer assistance office and shall | 0021| independently evaluate the effectiveness of the plan's consumer | 0022| assistance office. The department's managed care ombudsman | 0023| office may require a plan's consumer assistance office to adopt | 0024| measures to ensure that the plan operates effectively to protect | 0025| patient rights and inform consumers of the information to which | - 9 -0001| they are entitled. | 0002| D. The department shall prepare an annual report | 0003| assessing the operations of managed health care plans subject to | 0004| the department's oversight, including information about consumer | 0005| complaints. | 0006| E. A person adversely affected may file a complaint | 0007| with the superintendent regarding a violation of the Patient | 0008| Protection Act. Prior to issuing any remedial order regarding | 0009| violations of the Patient Protection Act or its regulations, the | 0010| superintendent shall hold a hearing in accordance with the | 0011| provisions of Chapter 59A, Article 4 NMSA 1978. The | 0012| superintendent may issue any order he deems necessary or | 0013| appropriate, including ordering the delivery of appropriate care, | 0014| to protect consumers and enforce the provisions of the Patient | 0015| Protection Act. The superintendent shall adopt special | 0016| procedures to govern the submission of emergency appeals to him | 0017| in health emergencies." | 0018| Section 6. A new section of the New Mexico Insurance Code | 0019| is enacted to read: | 0020| "[NEW MATERIAL] FAIRNESS TO HEALTH CARE PROVIDERS--GAG | 0021| RULES PROHIBITED--GRIEVANCE PROCEDURE FOR PROVIDERS.-- | 0022| A. No managed health care plan may: | 0023| (1) adopt a gag rule or practice that prohibits | 0024| a health care provider from discussing a treatment option with an | 0025| enrollee even if the plan does not approve of the option; | - 10 -0001| (2) include in any of its contracts with health | 0002| care providers any provisions that offer an inducement, financial | 0003| or otherwise, to provide less than medically necessary services | 0004| to an enrollee; or | 0005| (3) require a health care provider to violate | 0006| any recognized fiduciary duty of his profession or place his | 0007| license in jeopardy. | 0008| B. A plan that proposes to terminate a health care | 0009| provider from the managed health care plan shall explain in | 0010| writing the rationale for its proposed termination and deliver | 0011| reasonable advance written notice to the provider prior to the | 0012| proposed effective date of the termination. | 0013| C. A managed health care plan shall adopt and | 0014| implement a process pursuant to which providers may raise with | 0015| the plan concerns that they may have regarding operation of the | 0016| plan, including concerns regarding quality of and access to | 0017| health care services, the choice of health care providers and the | 0018| adequacy of the plan's provider network. The process shall | 0019| include, at a minimum, the right of the provider to present the | 0020| provider's concerns to a plan committee responsible for the | 0021| substantive area addressed by the concern, and the assurance that | 0022| the concern will be conveyed to the plan's governing body. In | 0023| addition, a managed health care plan shall adopt and implement a | 0024| fair hearing plan that permits a health care provider to dispute | 0025| the existence of adequate cause to terminate the provider's | - 11 -0001| participation with the plan to the extent that the relationship | 0002| is terminated for cause and shall include in each provider | 0003| contract a dispute resolution mechanism." | 0004| Section 7. A new section of the New Mexico Insurance Code | 0005| is enacted to read: | 0006| "[NEW MATERIAL] POINT-OF-SERVICE OPTION PLAN.-- | 0007| A. Except as otherwise provided in this section, the | 0008| department may require a plan that offers a point-of-service plan | 0009| or open plan to include in any managed health care plan it offers | 0010| an option for a point-of-service plan or open plan to the extent | 0011| that the department determines that the open plan option is | 0012| financially sound. | 0013| B. No health care insurer may be required to offer a | 0014| point-of-service plan or open plan as an option under a medicaid- | 0015| funded managed health care plan unless the human services | 0016| department has established such a requirement as part of a | 0017| procurement for managed health care under the medicaid program." | 0018| Section 8. A new section of the New Mexico Insurance Code | 0019| is enacted to read: | 0020| "[NEW MATERIAL] ADMINISTRATIVE COSTS AND BENEFIT COSTS | 0021| DISCLOSURES.--The department shall adopt regulations to ensure | 0022| that both the administrative costs and the direct costs of | 0023| providing health care services of each managed health care plan | 0024| are fully and fairly disclosed to consumers in a uniform manner | 0025| that allows meaningful cost comparisons among plans." | - 12 -0001| Section 9. A new section of the New Mexico Insurance Code | 0002| is enacted to read: | 0003| "[NEW MATERIAL] PRIVATE REMEDIES TO ENFORCE PATIENT AND | 0004| PROVIDER INSURANCE RIGHTS--ENROLLEE AS THIRD-PARTY BENEFICIARY TO | 0005| ENFORCE RIGHTS.-- | 0006| A. A person who suffers a loss as a result of a | 0007| violation of a right protected pursuant to the provisions of the | 0008| Patient Protection Act, its regulations or a managed health care | 0009| plan may bring an action to recover actual damages or the sum of | 0010| one hundred dollars ($100), whichever is greater. | 0011| B. A person likely to be damaged by a denial of a | 0012| right protected pursuant to the provisions of the Patient | 0013| Protection Act or its regulations may be granted an injunction | 0014| under the principles of equity and on terms that the court | 0015| considers reasonable. Proof of monetary damage or intent to | 0016| violate a right is not required. | 0017| C. To protect and enforce an enrollee's rights in a | 0018| managed health care plan, an individual enrollee participating in | 0019| or eligible to participate in a managed health care plan shall be | 0020| treated as a third-party beneficiary of the managed health care | 0021| plan contract between the plan and the party with which the plan | 0022| directly contracts. An individual enrollee may sue to enforce | 0023| the rights provided in the contract that governs the managed | 0024| health care plan; provided, however, that the plan and the party | 0025| to the contract may amend the terms of, or terminate the | - 13 -0001| provisions of, the contract without the enrollee's consent. | 0002| D. The relief provided pursuant to this section is in | 0003| addition to other remedies available against the same conduct | 0004| under the common law or other statutes of this state. | 0005| E. In any class action filed pursuant to this | 0006| section, the court may award damages to the named plaintiffs as | 0007| provided in this section and may award members of the class the | 0008| actual damages suffered by each member of the class as a result | 0009| of the unlawful practice. | 0010| F. Nothing in the Patient Protection Act is intended | 0011| to make a plan vicariously liable for the actions of independent | 0012| contractor health care providers." | 0013| Section 10. A new section of the New Mexico Insurance Code | 0014| is enacted to read: | 0015| "[NEW MATERIAL] APPLICATION OF ACT TO MEDICAID PROGRAM.-- | 0016| A. Except as otherwise provided in this section, the | 0017| provisions of the Patient Protection Act apply to the medicaid | 0018| program operation in the state. A managed health care plan | 0019| offered through the medicaid program shall grant enrollees and | 0020| providers the same rights and protections as are granted to | 0021| enrollees and providers in any other managed health care plan | 0022| subject to the provisions of the Patient Protection Act. | 0023| B. Nothing in the Patient Protection Act shall be | 0024| construed to limit the authority of the human services department | 0025| to administer the medicaid program, as required by law. | - 14 -0001| Consistent with applicable state and federal law, the human | 0002| services department shall have sole authority to determine, | 0003| establish and enforce medicaid eligibility criteria, the scope, | 0004| definitions and limitations of medicaid benefits and the minimum | 0005| qualifications or standards for medicaid service providers. | 0006| C. Medicaid recipients and applicants retain their | 0007| right to appeal decisions adversely affecting their medicaid | 0008| benefits to the human services department, pursuant to the Public | 0009| Assistance Appeals Act. Notwithstanding other provisions of the | 0010| Patient Protection Act, a medicaid recipient or applicant who | 0011| files an appeal to the human services department pursuant to the | 0012| Public Assistance Appeals Act may not file an appeal on the same | 0013| issue to the superintendent pursuant to the Patient Protection | 0014| Act, unless the human services department refuses to hear the | 0015| appeal. The superintendent may refer to the human services | 0016| department any appeal filed with the superintendent pursuant to | 0017| the Patient Protection Act if the complainant is a medicaid | 0018| beneficiary and the matter in dispute is subject to the | 0019| provisions of the Public Assistance Appeals Act. | 0020| D. Any managed health care plan participating in the | 0021| medicaid managed care program as of the effective date of the | 0022| Patient Protection Act and that is in compliance with contractual | 0023| and regulatory requirements applicable to that program shall be | 0024| deemed to comply with any requirements established in accordance | 0025| with that act until July 1, 1999; provided that, from the | - 15 -0001| effective date of that act, any rights established under that act | 0002| beyond those under requirements of the human services department | 0003| shall apply to enrollees in medicaid managed health care plans." | 0004| Section 11. A new section of the New Mexico Insurance Code | 0005| is enacted to read: | 0006| "[NEW MATERIAL] PENALTY.--In addition to any other | 0007| penalties provided by law, a civil administrative penalty of up | 0008| to ten thousand dollars ($10,000) may be imposed for each | 0009| violation of the Patient Protection Act. An administrative | 0010| penalty shall be imposed by written order of the superintendent | 0011| made after holding a hearing as provided for in Chapter 59A, | 0012| Article 4 NMSA 1978." | 0013| Section 12. Section 59A-1-16 NMSA 1978 (being Laws 1984, | 0014| Chapter 127, Section 16) is amended to read: | 0015| "59A-1-16. EXEMPTED FROM CODE.--In addition to | 0016| organizations and businesses otherwise exempt, the Insurance Code | 0017| shall not apply [as] to: | 0018| A. a labor organization [which] that, incidental only | 0019| to operations as a labor organization, issues benefit | 0020| certificates to members or maintains funds to assist members and | 0021| their families in times of illness, injury or need, and not for | 0022| profit; | 0023| B. the credit union share insurance corporation, as | 0024| identified in [Article 58-12] Chapter 58, Article 12 NMSA 1978, | 0025| and similar corporations and funds for protection of depositors, | - 16 -0001| shareholders or creditors of financial institutions and | 0002| businesses other than insurers; or | 0003| C. the risk management division of the general | 0004| services department [of finance and administration of New Mexico] | 0005| or [as] to insurance of public property or public risks by any | 0006| agency of government not otherwise engaged in the business of | 0007| insurance, except the provisions of the Patient Protection Act | 0008| shall apply to the risk management division and any managed | 0009| health care plan it offers." | 0010| Section 13. Section 59A-46-30 NMSA 1978 (being Laws 1993, | 0011| Chapter 266, Section 29, as amended) is amended to read: | 0012| "59A-46-30. STATUTORY CONSTRUCTION AND RELATIONSHIP TO | 0013| OTHER LAWS.-- | 0014| A. The provisions of the Insurance Code other than | 0015| Chapter 59A, Article 46 NMSA 1978 shall not apply to health | 0016| maintenance organizations except as expressly provided in the | 0017| Insurance Code and that article. To the extent reasonable and | 0018| not inconsistent with the provisions of that article, the | 0019| following articles and provisions of the Insurance Code shall | 0020| also apply to health maintenance organizations and their | 0021| promoters, sponsors, directors, officers, employees, agents, | 0022| solicitors and other representatives. For the purposes of such | 0023| applicability, a health maintenance organization may therein be | 0024| referred to as an "insurer": | 0025| (1) Chapter 59A, Article 1 NMSA 1978; | - 17 -0001| (2) Chapter 59A, Article 2 NMSA 1978; | 0002| (3) Chapter 59A, Article 3 NMSA 1978; | 0003| (4) Chapter 59A, Article 4 NMSA 1978; | 0004| (5) Subsection C of Section 59A-5-22 NMSA 1978; | 0005| (6) Sections 59A-6-2 through 59A-6-4 and | 0006| 59A-6-6 NMSA 1978; | 0007| (7) Chapter 59A, Article 8 NMSA 1978; | 0008| (8) Chapter 59A, Article 10 NMSA 1978; | 0009| (9) Section 59A-12-22 NMSA 1978; | 0010| (10) Chapter 59A, Article 16 NMSA 1978; | 0011| (11) Chapter 59A, Article 18 NMSA 1978; | 0012| (12) Chapter 59A, Article 19 NMSA 1978; | 0013| (13) Section 59A-22-14 NMSA 1978; | 0014| [(13)] (14) Chapter 59A, Article 23B NMSA 1978; | 0015| [(14)] (15) Sections 59A-34-9 through | 0016| 59A-34-13, 59A-34-17, 59A-34-23, 59A-34-36 and 59A-34-37 NMSA | 0017| 1978; [and | 0018| (15)] (16) Chapter 59A, Article 37 NMSA 1978; | 0019| and | 0020| (17) the Patient Protection Act. | 0021| B. Solicitation of enrollees by a health maintenance | 0022| organization granted a certificate of authority, or its | 0023| representatives, shall not be construed as violating any | 0024| provision of law relating to solicitation or advertising by | 0025| health professionals, but health professionals shall be | - 18 -0001| individually subject to the laws, rules, regulations and ethical | 0002| provisions governing their individual professions. | 0003| C. Any health maintenance organization authorized | 0004| under the provisions of the Health Maintenance Organization Law | 0005| shall not be deemed to be practicing medicine and shall be exempt | 0006| from the provisions of laws relating to the practice of | 0007| medicine." | 0008| Section 14. Section 59A-47-33 NMSA 1978 (being Laws 1984, | 0009| Chapter 127, Section 879.32, as amended by Laws 1997, Chapter 7, | 0010| Section 4 and by Laws 1997, Chapter 248, Section 3 and also by | 0011| Laws 1997, Chapter 255, Section 4) is amended to read: | 0012| "59A-47-33. OTHER PROVISIONS APPLICABLE.--The provisions | 0013| of the Insurance Code other than Chapter 59A, Article 47 NMSA | 0014| 1978 shall not apply to health care plans except as expressly | 0015| provided in the Insurance Code and that article. To the extent | 0016| reasonable and not inconsistent with the provisions of that | 0017| article, the following articles and provisions of the Insurance | 0018| Code shall also apply to health care plans, their promoters, | 0019| sponsors, directors, officers, employees, agents, solicitors and | 0020| other representatives; and, for the purposes of such | 0021| applicability, a health care plan may therein be referred to as | 0022| an "insurer": | 0023| A. Chapter 59A, Article 1 NMSA 1978; | 0024| B. Chapter 59A, Article 2 NMSA 1978; | 0025| C. Chapter 59A, Article 4 NMSA 1978; | - 19 -0001| D. Subsection C of Section 59A-5-22 NMSA 1978; | 0002| E. Sections 59A-6-2 through 59A-6-4 and | 0003| 59A-6-6 NMSA 1978; | 0004| F. Section 59A-7-11 NMSA 1978; | 0005| G. Chapter 59A, Article 8 NMSA 1978; | 0006| H. Chapter 59A, Article 10 NMSA 1978; | 0007| I. Section 59A-12-22 NMSA 1978; | 0008| J. Chapter 59A, Article 16 NMSA 1978; | 0009| K. Chapter 59A, Article 18 NMSA 1978; | 0010| L. Chapter 59A, Article 19 NMSA 1978; | 0011| M. Subsections B through E of Section | 0012| 59A-22-5 NMSA 1978; | 0013| N. Section 59A-22-14 NMSA 1978; | 0014| [N.] O. Section 59A-22-34.1 NMSA 1978; | 0015| [O.] P. Section 59A-22-39 NMSA 1978; | 0016| [P.] Q. Section 59A-22-40 NMSA 1978; | 0017| [Q.] R. Section 59A-22-41 NMSA 1978; | 0018| [R.] S. Sections 59A-34-9 through 59A-34-13 and | 0019| 59A-34-23 NMSA 1978; | 0020| [S.] T. Chapter 59A, Article 37 NMSA 1978, except | 0021| Section 59A-37-7 NMSA 1978; [and] | 0022| [T.] U. Section 59A-46-15 NMSA 1978; and | 0023| V. the Patient Protection Act." | 0024| Section 15. EFFECTIVE DATE.--The effective date of the | 0025| provisions of this act is July 1, 1998. | - 20 -0001| |