New Mexico

There are multiple sections in New Mexico law that are relevant to parity and autism coverage.

Please be aware that it is not possible to provide direct links to any of the following sections of the law. To find these sections, go to this link and click on the plus sign next to the folder in the upper left side of the screen that says “statutes, rules, const.” Then click on the plus sign next to the folder that says NMSA (unannotated). Then, underneath chapter 24, click on the plus sign next to the “more” folder. Then, click on “Chapter 59A Insurance Code.”

To find all of the sections listed below, click on the appropriate article once you are on the “Chapter 59A” page and then the appropriate section on the article pages. For example, to find the mental health parity section, click on article “23E Health Insurance Portability”, and then click on section “59A-23E-18 Requirements for Mental Health Benefits…”

Chapter 59A Article 23E Section 18 (59A-23E-18)

Chapter 59A Article 23 Section 6 (59A-23-6); Chapter 59A Article 47 Section 35 (59A-47-35)

Chapter 59A Article 22 Section 49 (59A-22-49); Chapter 59A Article 23 Section 7.9 (59A-23-7.9); Chapter 59A Article 46 Section 50 (59A-46-50); Chapter 59A Article 47 Section 45 (59A-47-45)

The section about mental health requires large employer fully-insured plans and small employer fully-insured plans to cover mental health services. Plans cannot use treatment limitations or financial requirements for these services unless “identical” treatment limitations and financial requirements are used for other medical services.

Plans are allowed to require prior authorization for inpatient care and outpatient care . They are also allowed to restrict their coverage to only medically necessary services.

There is also two very detailed subsections about exemptions for plans if premium costs rise by 1.5% for small employer fully-insured plans and 2.5% for large employer fully-insured plans.

Insurers must offer optional coverage for alcohol treatment in large employer fully-insured plans and small employer fully-insured plans . This coverage must include:

• Deductibles and coinsurance similar to those used for other medical services
• Annual limits of no less than 30 days for inpatient care and 30 visits for outpatient care
• Lifetime limits of no less than 60 days for inpatient care and 60 visits for outpatient care

Large employer fully-insured plans , small employer fully-insured plans , individual plans and public employee plans are all required to cover autism services for all individuals through age 19 and any individual who is in high school through age 22.

Autism spectrum disorder is defined as anything in the DSM including autistic disorder, Asperger’s disorder, pervasive developmental disorder not otherwise specified, Rett’s disorder, and childhood disintegrative disorder.

Treatment of autism spectrum disorder is defined as speech therapy, occupational therapy, physical therapy and applied behavioral analysis .

These plans must have an annual maximum of at least $36,000 and a lifetime maximum of at least $200,000.

Plans do not have to cover any services in Part B of the Individuals with Disabilities Education Improvement Act (IDEA). Plans are not exempted from Part C, however. Part B is for individuals age 3 through age 21. Part C is for children at birth through age 2.

Deductibles and coinsurance must be the same as those used for other medical services.