Revised effective date for grievance procedures

SUPERINTENDENT OF INSURANCE John G. Franchini 505-827-4299 NEW MEXICO OFFICE OF SUPERINTENDENT OF INSURANCE FILED 1998 MAR 9 PM 3 OFFICE OF SUPERINTENDENT DEPUTY SUPERINTENDENT Robert Doucette 505-827-5832 Bulletin 2016-005 March 9, 2016 TO: ALL HEALTH INSURANCE CARRIERS THAT OFFER OR ADMINISTER HEALTH BENEFIT PLANS RE: REVISED EFFECTIVE DATE FOR GRIEVANCE PROCEDURES THE FOLLOWING Bulletin is issued pursuant to NMSA 1978 Sections 59A-2-8, 59A-2-10 and 59A-4-3, and Sections 13.1.2.1 to 13.1.2.10 NMAC. The purpose of this Bulletin is to announce the change in the effective date of the Grievance Procedures as described in 13.10.17.1 to 13.10.17.41 NMAC, from January 1, 2016 until January 1, 2017. Please refer to the OSI website http://www.osi.state.nm.us/rule-making/index.html for the rules that are currently in effect through December 31, 2016 and the rules with the effective date of January 1, 2017. Insurance carriers shall commence the Notice requirements, so that all subscribers/policy holders are notified of their rights in a timely manner during their annual 2016 review process. The New Mexico Superintendent of Insurance (OSI) has determined that it is in the public interest to delay implementation of the Grievance Procedures described at 13.10.17 NMAC from January 1, 2016 until January 1, 2017. These regulations were promulgated following public rulemaking, including publication of proposed rules, hearing, and public comment. The prior rules provide protections which will remain in place during the interim period. The newly implemented Grievance Procedures will be effective for any grievances initiated on or after January 1, 2017. This delay in implementation is permissible under the Federal Regulations found at 45 C.F.R. § 147.136(c)(2) and (c)(3). Any person aggrieved by a bulletin may request a hearing before the Superintendent in accordance with NMSA 1978 59A-4-15. Main Phone: 505-827-4601 Main Fax: 505-827-4734 Toll Free: 1-855-4-ASK-OSI Mailing Address: P.O. Box 1689 vances initiated on or after January 1, 2017. This delay in implementation is permissible under the Federal Regulations found at 45 C.F.R. § 147.136(c)(2) and (c)(3). Any person aggrieved by a bulletin may request a hearing before the Superintendent in accordance with NMSA 1978 59A-4-15. Main Phone: 505-827-4601 Main Fax: 505-827-4734 Toll Free: 1-855-4-ASK-OSI Mailing Address: P.O. Box 1689 Santa Fe, NM 87504-1689 Physical Address: 1120 Paseo de Peralta Santa Fe, NM 87501 If you have additional questions regarding this Bulletin, please contact the Managed Health Care Bureau at 1-505-827- 3928. DONE and ORDERED this 9th day of March 2016. JOHN G. FRANCHINI Superintendent of Insurance