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Compliance Corner

State Updates

Superintendent of Insurance Issues Notice of SEP for State Exchange

March 02, 2021

On February 16, 2021, Superintendent Toal issued a notice announcing a special enrollment period (SEP) for the state’s health insurance exchange, beWellnm. The SEP follows that of the federal exchange: from February 15, 2021, through May 15, 2021.

While the creation of the SEP will affect individuals that will enroll on the marketplace, employers should be mindful of this extension in case there are employees who seek to drop coverage under their plans to take advantage of the SEP. Specifically, the permissible qualifying event for a revocation due to enrollment in a qualified plan will allow an employee to drop their employer’s plan mid-year if they intend to enroll in the marketplace.

Notice of Special Enrollment Period for Health Insurance »

State Reminds Insurers of their Telemedicine Obligations

February 17, 2021

On February 10, 2021, Superintendent Toal issued Bulletin No. 2021-003. The bulletin reiterates the requirements outlined in previous bulletins concerning telemedicine during the public health emergency. Previously, the state reminded insurers subject to its regulation that telemedicine services should be reimbursed at the same rates as those paid for the same service provided in-person. Plans can include a supplemental telemedicine program, but they cannot require participants to use those services. The bulletin states that the Biden administration expects the public health emergency to last through 2021.

In addition, the bulletin reminds insurers that HHS waived potential penalties for HIPAA violations by providers who use certain communication technologies during the public health emergency. The bulletin states that if this waiver expires, the requirement to cover services obtained through telemedicine (if those services would normally be in-person) may remain.

Finally, the bulletin makes clear that no law authorizes a carrier to exclude certain telemedicine services if the carrier determines that it is less effective than an in-person service.

Employers with plans regulated by the state should be aware of this information.

Bulletin No. 2021-003 »

State Insurance Update for COVID-19 Issues

December 22, 2020

In response to the executive order issues by Gov. Lujan Grisham on December 4, 2020, Superintendent Toal issued a release highlighting various notices that the agency published during the year to address insurance issues that arose during the COVID-19 pandemic. The relevant notices highlighted in this release included those covered in the April 14 and May 12, 2020, editions of Compliance Corner.

Press Release »

COVID-19 Insurance Update

August 18, 2020

On August 4, 2020, the Office of the Superintendent of Insurance issued Bulletin 2020-016. The bulletin expresses the state’s expectation that health insurers licensed in the state will notify contracted providers that they are not allowed to charge patients for COVID-19 testing or treatment. The bulletin states that provider charges for office visits are considered part of the COVID-19 testing process, so they should not require patients to share that cost. In addition, the bulletin states that network adequacy requirements include in-network COVID-19 testing services, although insurers are not required to cover testing as part of a “back to work” requirement. It also reminds insurers of the agency’s request that they avoid coverage cancellations.

Although this bulletin is focused upon health insurers, employers with plans regulated by the state should be aware of its contents.

Bulletin 2020-016 »

COVID-19 Insurance Updates

May 12, 2020

On April 30, 2020, the Office of the Superintendent of Insurance issued Bulletin No. 2020-009, which applies to all major medical insurers subject to regulation by the state. The bulletin reminds those carriers that they must hold insureds harmless for expenses related to the testing, diagnosis and treatment of COVID-19. The bulletin also reminds carriers that they can only charge insureds for emergency medical services provided by out-of-network providers at in-network rates, and must pay these providers at rates consistent with New Mexico’s surprise billing laws.

The regulation is primarily directed at carriers. However, employers should also be aware of these developments.

Bulletin No. 2020-009 »

COVID-19 Insurance Updates

April 14, 2020

On March 26, 2020, the Superintendent of Insurance issued Bulletin 2020-007, requiring insurers with an office in New Mexico to comply with orders issued by the state’s Department of Health regarding social distancing and other methods of mitigating or preventing the spread of COVID-19. The bulletin also reminds insurers that call centers in New Mexico must reduce their workforces by 100%, asks for help in fighting fraud, and reminds insurers that excepted benefit policies must include notices that state that they may not cover costs relating to the diagnosis or treatment of COVID-19.

On April 1, 2020, the Superintendent issued Bulletin 2020-008, urging all insurers licensed in New Mexico to speed up payments to hospitals and streamline administration in the following ways:

  • Accelerating claim payments from 30 days to 10 or 15 days
  • Reducing or eliminating prior authorization requirements, and suspending or eliminating concurrent and retrospective reviews
  • Taking steps to facilitate discharging processes
  • Advancing payments to hospitals
  • Implementing emergency credentialing and enrollment to make sure there are providers able to care for patients
  • Clarify that coverage and cost sharing decisions will be made on presenting symptoms, not a final diagnosis
  • Allow members to use out of network providers as if they were in network under certain circumstances

The bulletins are primarily directed at insurers. However, employers should also be aware of these developments.

Bulletin 2020-007 »
Bulletin 2020-008 »

Medical Insurance Pool Available for Uninsured Residents Diagnosed with COVID-19

March 31, 2020

New Mexico residents who do not have health insurance and have been diagnosed with COVID-19 can enroll in the New Mexico Medical Insurance Pool (NMMIP), which is a non-profit program that enables private health insurance companies to pool resources and cover New Mexicans who have been denied health insurance.

Employers whose employees may lose their jobs and their health insurance as a result of COVID-19 should be aware of this option.

NMMIP Information »

COVID-19 Insurance Updates

March 31, 2020

In March, the Superintendent of Insurance issued an emergency rule, two orders, and two bulletins in response to the COVID-19 outbreak. These actions apply to insurance plans regulated by the state.

On March 12, 2020, the superintendent ordered that insurers providing major medical coverage and insurers providing limited benefits coverage to notify their members whether and to what extent their policies cover testing and health care services related to COVID-19. Additionally, if an insurer only offers limited coverage, they must notify their members of available full coverage options. The Superintendent also ordered limited benefit plans (such as workers’ compensation and automobile medical payment insurance) to provide notice to their members that their plans do not provide comprehensive medical coverage and to give members information on where they should go to check on their eligibility to apply for and obtain such coverage.

On March 12, 2020, the superintendent ordered an emergency amendment to an existing cost sharing rule that creates a presumption that it is unreasonable and prohibit any cost sharing requirement for the provision of health care services for COVID-19, pneumonia, influenza or any disease or condition that is the cause of, or the subject of, a public health emergency. This amendment was ordered under the authority of Gov. Grisham, who issued Executive Order 2020-004 that directed the superintendent to promulgate emergency rules maximizing the available insurance coverage for New Mexicans suffering from COVID-19, pneumonia or influenza, while simultaneously ensuring that medical costs do not create a barrier to testing and treatment. The amendment would apply to insurance policies regulated by the state.

On March 17, 2020, the superintendent issued Bulletin 2020-005. The bulletin reminds insurers that New Mexico law requires them to treat telemedicine visits and in-person visits equally. In addition, the bulletin reminds insurers that they cannot impose prior authorization requirements or cost sharing requirements upon services to person with COVID-19 and that limits or barriers to telemedicine visits may cause their plans to fail network adequacy requirements.

On March 20, 2020, the Superintendent of Insurance issued Bulletin 2020-006. The bulletin requests that all insurance companies refrain from cancelling or nonrenewing policies of businesses and individuals negatively impacted by the disruption due to the nonpayment of premiums during this public health emergency, or at a minimum, provide extended grace periods for payment of premiums. It also requests that all insurance companies work with their insureds after the public health emergency is over to allow the insureds to catch up on past due premiums in installments without loss of coverage.

Employers with policies regulated by New Mexico should be aware of these developments.

Press Release »
Emergency Rule »
Excepted Benefit Plan Order »
Bulletin 2020-005 »
Bulletin 2020-006 »

Insurance Updates Regarding COVID-19

March 17, 2020

On March 6, 2020, the Office of Superintendent of Insurance issued Bulletin 2020-004 that applies to all insurers licensed to sell health insurance in the state. The Bulletin encourages applicable insurers to educate their members regarding guidance issued by the New Mexico Department of Health and the CDC on COVID-19, as well as to let network providers know about the recommendations and protocols issued by those agencies. The Bulletin advises insurers that they and their network providers are expected to bill and process claims using codes promulgated by CMS relating to COVID-19.

The Bulletin also asks insurers to make sure that members who may be self-quarantined can obtain one-time refills of their prescriptions prior to the expiration of the normal refill waiting period.

Employers with policies regulated in New Mexico should be aware of these developments.

Bulletin 2020-004 »

Excepted Benefit Form Filings Not Approved Until Rules in Place

March 03, 2020

On February 25, 2020, the Office of Superintendent of Insurance issued a statement that the office will not approve excepted form filings until rules and standards are in place to protect the public from purchasing insurance products that may not provide benefits or protections required under the ACA. Excepted benefits, such as limited health benefits and accident and sickness coverage, are not intended to replace major medical plans. However, the office has become aware that some excepted benefit plans are being packaged and sold as replacements.

The Short-Term Health Plan and Excepted Benefit Act, effective June 14, 2019, requires the office to promulgate rules to establish permissible content and terms of those plans. In the meantime, the office will not approve excepted plan filings.

Employers should be aware of these developments and alert to attempts to sell excepted benefit plans as medical plans.

Press Release »

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