N.M. Stat. § 59A-23-7.12
Coverage for telemedicine services.
A. A blanket or group health insurance policy or contract that is delivered, issued for
delivery or renewed in this state shall provide coverage for services provided via
telemedicine to the same extent that the health insurance plan, policy or contract covers
the same services when those services are provided via in-person consultation or
contact. An insurer shall not impose any unique condition for coverage of services
provided via telemedicine.
B. An insurer shall not impose an originating-site restriction with respect to
telemedicine services or distinguish between telemedicine services provided to patients
in rural locations and those provided to patients in urban locations; provided that the
provisions of this section shall not be construed to require coverage of an otherwise
noncovered benefit.
C. A determination by an insurer that health care services delivered through the use
of telemedicine are not covered under the plan shall be subject to review and appeal
pursuant to the Patient Protection Act [Chapter 59A, Article 57 NMSA 1978].
D. The provisions of this section shall not apply in the event that federal law requires
the state to make payments on behalf of enrollees to cover the costs of implementing
this section.
E. Nothing in this section shall require a health care provider to be physically
present with a patient at the originating site unless the consulting telemedicine provider
deems it necessary.
F. An insurer shall not limit coverage of services delivered via telemedicine only to
those health care providers who are members of the health insurance plan, policy or
contract provider network where no in-network provider is available and accessible, as
availability and accessibility are defined in network adequacy standards issued by the
superintendent.
G. An insurer may charge a deductible, copayment or coinsurance for a health care
service delivered via telemedicine if it does not exceed the deductible, copayment or
coinsurance applicable to a service delivered via in-person consultation or contact.
H. An insurer shall not impose any annual or lifetime dollar maximum on coverage
for services delivered via telemedicine, other than an annual or lifetime dollar maximum
that applies in the aggregate to all items and services covered under the health
insurance plan, policy or contract, or impose upon any person receiving benefits
pursuant to this section any copayment, coinsurance or deductible amounts, or any
plan, policy or contract year, calendar year, lifetime or other durational benefit limitation
or maximum for benefits or services, that is not equally imposed upon all terms and
services covered under the health insurance plan, policy or contract.
I. An insurer shall reimburse for health care services delivered via telemedicine on
the same basis and at least the same rate that the insurer reimburses for comparable
services delivered via in-person consultation or contact.
J. Telemedicine used to provide clinical services shall be encrypted and shall
conform to state and federal privacy laws.
K. The provisions of this section shall not apply to a group or blanket policy, plan or
contract intended to supplement major medical group-type coverage, such as medicare
supplement, long-term care, disability income, specified disease, accident-only, hospital
indemnity or any other limited-benefit health insurance policy.
L. As used in this section:
(1)
"consulting telemedicine provider" means a health care provider that
delivers telemedicine services from a location remote from an originating site;
(2)
"health care provider" means a duly licensed hospital or other licensed
facility, physician or other health care professional authorized to furnish health care
services within the scope of the professional's license;
(3)
"in real time" means occurring simultaneously, instantaneously or within
seconds of an event so that there is little or no noticeable delay between two or more
events;
(4)
"originating site" means a place at which a patient is physically located
and receiving health care services via telemedicine;
(5)
"store-and-forward technology" means electronic information, imaging and
communication, including interactive audio, video and data communication, that is
transferred or recorded or otherwise stored for asynchronous use; and
(6)
"telemedicine" means the use of telecommunications and information
technology to provide clinical health care from a distance. "Telemedicine" allows health
care professionals to evaluate, diagnose and treat patients in remote locations using
telecommunications and information technology in real time or asynchronously,
including the use of interactive simultaneous audio and video or store-and-forward
technology, or remote patient monitoring and telecommunications in order to deliver
health care services to a site where the patient is located, along with the use of
electronic media and health information. "Telemedicine" allows patients in remote
locations to access medical expertise without travel.