N.M. Stat. § 13-7-33
Provider network adequacy.
A. An insurer shall maintain an adequate provider network to provide mental health
and substance use disorder services.
B. The superintendent of insurance shall ensure access to mental health and
substance use disorder services providers, including parity with medical and surgical
services provider access, through regulation and review of claims processing, provider
reimbursement procedures, network adequacy and provider reimbursement rate
adequacy.
C. An insurer shall ensure that the process by which reimbursement rates for mental
health and substance use disorder services are determined is comparable to and no
more stringent than the process for reimbursement of medical or surgical benefits. In
developing provider reimbursement rates, an insurer shall demonstrate that it has
performed a comparability analysis of provider:
(1)
reimbursement rates in surrounding states;
(2)
reimbursement rates between mental health and substance use disorder
providers and medical or surgical providers; and
(3)
credentialing processes for mental health and substance use disorder
providers and medical or surgical providers.
D. An insurer shall undertake all efforts, including increasing provider
reimbursement rates through the processes and strategies described in Subsection C of
this section, to ensure state-mandated network adequacy for the provision of mental
health or substance use disorder services.
E. When in-network access to mental health or substance use disorder services is
not reasonably available, an insurer shall provide access to out-of-network services with
the same cost-sharing obligations to the insured as those required for in-network
services.