N.M. Stat. § 59A-23-7
Blanket or group health policy or certificate; provisions
relating to individuals who are eligible for medical benefits under
the medicaid program.
A. Each blanket or group health policy or certificate of insurance that is delivered,
issued for delivery or renewed in this state shall include provisions that require benefits
paid on behalf of a child or other insured person under the policy or certificate to be paid
to the human services department [health care authority department] when:
(1)
the human services department [health care authority department] has
paid or is paying benefits on behalf of the child or other insured person under the state's
medicaid program pursuant to Title XIX of the federal Social Security Act, 42 U.S.C.
1396, et seq.;
(2)
payment for the services in question has been made by the human
services department [health care authority department] to the medicaid provider; and
(3)
the insurer is notified that the insured individual receives benefits under
the medicaid program and that benefits must be paid directly to the human services
department [health care authority department].
B. The notice required under Paragraph (3) of Subsection A of this section may be
accomplished through an attachment to the claim by the human services department
[health care authority department] for insurance benefits when the claim is first
submitted by the human services department [health care authority department] to the
insurer.
C. Notwithstanding any other provisions of law, checks in payment for claims
pursuant to any blanket or group health insurance policy or certificate for health care
services provided to persons who are also eligible for benefits under the medicaid
program and provided by medical providers qualified to participate under the policy or
certificate shall be made payable to the provider. The insurer may be notified that the
insured individual is eligible for medicaid benefits through an attachment to the claim by
the provider for insurance benefits when the claim is first submitted by the provider to
the insurer.
D. No blanket or group health insurance policy or certificate delivered, issued for
delivery or renewed in this state on or after the effective date of this section shall
contain any provision denying or limiting insurance benefits because services are
rendered to an insured who is eligible for or who has received medical assistance under
the medicaid program of this state.
E. To the extent that payment for covered expenses has been made pursuant to the
state medicaid program for health care items or services furnished to an individual, in
any case where the insurer has a legal liability to make payments, the state is
considered to have acquired the rights of the individual to payment by an insurer for
those health care items or services.