Amendment To Compensation Provided Pursuant TO NMSA 1978, Section 59A-57-4.1

# STATE OF NEW MEXICO # OFFICE OF SUPERINTENDENT OF INSURANCE P.O. Box 1689, Santa Fe, NM 87504-1689 1120 Paseo de Peralta, Room 428, Santa Fe, NM 87501 Phone: (505) 827-4601; Fax (505) 827-4734 SUPERINTENDENT OF INSURANCE John G. Franchini 505. 827.4299  ACTING DEPUTY SUPERINTENDENT Alan Seeley 505. 827.4307 BULLETIN NO. 2015-008 FEBRUARY 26, 2015 FILED 2015 FEB 26 PM 3 33 OF INSURANCE SUPERINTENDENT NM OFFICE OF TO: ALL HEALTH MAINTENANCE ORGANIZATIONS AND MANAGED HEALTH CARE PLANS IN NEW MEXICO RE: AMENDMENT TO COMPENSATION PROVIDED PURSUANT TO NMSA 1978, SECTION 59A-57-4.1 Issued pursuant to NMSA 1978, Section 59A-2-8 of the New Mexico Insurance Code, 13.1.2 et seq. NMAC13. THE PURPOSE OF THIS BULLETIN is to amend compensation amounts for hearing officers who conduct external grievance appeals. The Patient Protection Act, NMSA 1978, Section 59A-57-1 et seq states that: - A. The superintendent may appoint one or more qualified individuals to review external grievance appeals. - B. The superintendent shall fix the reasonable compensation of each appointee based upon, but not limited to, compensation amounts suggested by national or state legal or medical professional societies, organizations or associations. - C. Upon completion of the external grievance appeal review, the superintendent shall prepare a detailed statement of compensation due each appointee and shall present the statement to the enrollee's health insurer. - D. The enrollee's health insurer shall pay the compensation directly to each appointee who participated in the external grievance appeal review. The New Mexico Office of Superintendent of Insurance, has determined that all appointed hearing officers shall be compensated at the rate of three hundred fifty dollars ($350.00) per hour, for a maximum of three (3) hours per hearing. Pursuant to Subsection C (2), 13.10.17.31 NMAC, each hearing officer involved in an external review appeal shall provide an itemized statement regarding compensation to the Superintendent of Insurance upon completion of the external review hearing. Forms approved by the Superintendent of Insurance shall be used to document claims for compensation. Subsection C (3) of 13.10.17.31 NMAC provides that within thirty (30) days of receipt of the statement from the hearing officer(s), the grievant's health care insurer shall remit the approved compensation directly to the hearing officer (s). Questions may be directed to Kathi Padilla, Bureau Chief, Managed Health Care Bureau, New Mexico Office of Superintendent of Insurance at 505.827.3811. ISSUED at Santa Fe, New Mexico on February 26, 2015. # OFFICE OF NEW MEXICO SUPERINTENDENT OF INSURANCE John G. Franchini Superintendent of Insurance