N.M. Stat. § 13-7-34
Utilization review of mental health or substance use
disorder services.
A. An insurer shall, at least monthly, review and update the insurer's utilization
review process to reflect the most recent evidence and generally recognized standards
of care.
B. When performing a utilization review of mental health or substance use disorder
services, including level of care placement, continued stay, transfer and discharge, an
insurer shall apply criteria in accordance with generally recognized standards of care.
C. An insurer shall provide utilization review training to staff and contractors
undertaking activities related to utilization review.
D. An insurer shall:
(1)
develop utilization review policies regarding quantitative and non-
quantitative limitations for mental health and substance use disorder services coverage
that are no more restrictive than the utilization review policies regarding quantitative and
non-quantitative limitations for medical and surgical care; and
(2)
make utilization review policies available to providers or plan members.