LEGISLATIVE ACTIONS:

• Senate Bill 367 The enacted legislation facilitates OSI’s administrative duties by:
  • Removing the requirement that the Attorney General file a civil suit against insurers that file their annual statements late in order for the Office of the Superintendent of Insurance to be able to fine them.
  • Providing a due date and a penalty for the late payment of fraud assessments. 3. Giving OSI 60 days rather than 30 days to review credit life and credit health product filings and to review marketing materials for products that are subject to the Minimum Healthcare Protection Act.

Section 4 of the bill is similar to HB 336.  Section 12 of the bill is identical to HB 127, which adds electronic funds transfer as a means of settling reimbursable claims under the New Mexico Insurance Code.  The first three sections of the bill bring New Mexico’s procedures for examining insurance companies into compliance with the National Association of Insurance Commissioners’ Model Law on Examinations.  The bill also attaches a severability clause to the Risk-Based Capital Act as required by the National Association of Insurance Commissioners.  The bill’s removal of stop loss insurance from the list of health insurance products resolves the Insurance Code’s current failure to exclude stop loss insurance from the requirements of major medical insurance. The bill also ensures that property/casualty insurers can continue to write accident & health products. Several sections of the bill regulate student health plans as individual or managed health plans rather than as blanket sickness or accident policies.  Effective Date June 18, 2017.

REGULATORY ACTIVITY:

• New Mexico Workers’ Compensation Administration Director Darin A. Childers has appointed Rachel A. Bayless to serve as a workers’ compensation judge. She assumed her new position on April 8, 2017, replacing retiring Judge Terry Kramer. Bayless joined the WCA in February 2014 and has served as the agency’s General Counsel since that time. As the agency’s chief legal advisor, she advised the director on a vast array of legal issues affecting the WCA and the workers’ compensation system, in addition to often serving as an expert advisor on workers’ compensation law during legislative sessions.  Effective April 10, all pending and administratively closed cases before the New Mexico Workers’ Compensation Administration previously assigned to Judge Terry Kramer will be reassigned to Bayless. Parties who have not yet exercised their right to challenge or excuse will have 10 days from April 10, to challenge or excuse Judge Bayless pursuant to N.M.A.C. Rule 11.4.4.13. Questions about case assignments should be directed to WCA Clerk of the Court Heather Jordan at 505-841-6028.
• The IME Provider Selection Committee is revising its list of qualified IME Providers. Applications from providers will be accepted from March 1, 2017 through April 30, 2017. Written public comments on any health care provider being considered for inclusion or continuation in the list of certified IME providers will be accepted from May 1, through the close of business May 31, 2017. A list of all applications received from new and continuing IME providers is available from the Medical Cost Containment Unit, PO Box 27198, Albuquerque, NM 87125-7198, (505) 841-6811.
• New Mexico Governor Susana Martinez has signed Senate Bill 155, sponsored by Sen. Jacob Candelaria (D-Albuquerque). The new law attempts to clarify a worker’s entitlement to disability benefits when an injured worker unreasonably refuses a post-injury return to work offer, or is terminated for misconduct after returning to work post-injury. The new law would also allow for fines of up to $10,000 against employers who terminate workers for pretextual reasons in order to avoid payment of benefits to the worker, or as retaliation against the worker for simply seeking benefits.

LEGISLATIVE ACTIONS:

• Senate Bill 155
  The enacted legislation amends sections of the workers’ compensation act to reestablish return to work and clarify benefit entitlement.  Effective Date: June 18, 2017.

• Senate Bill 367
  The enacted legislation amends sections of the New Mexico Insurance code; amending requirements related to examination Reports and investigatory hearings.  The enacted legislation changes annual financial Statement filing penalties. It removes stop-loss insurance from the list of accident and health insurance products; allowing Accident and health insurers to write stop-loss insurance.  The legislation allows casualty insurers to continue to write accident and Health insurance. The legislation revises various requirements related to Surplus lines insurance. It allows insurers to pay claims by Electronic fund transfer. The legislation amends the insurance fraud act to establish a fee payment deadline and late payment penalty; including student health policies within provisions relating to individual health insurance. It removes student health plans from the list of blanket health insurance products and from the list of products that are not managed health care plans. The legislation extends the superintendent of insurance's review period for marketing materials and for credit life and credit health product filings; It repeals the surplus lines insurance Multistate compliance compact.  Effective Date June 18, 2017.

REGULATORY ACTIVITY:

• The IME Provider Selection Committee organized pursuant to §52-1-1.2. D is revising its list of qualified IME Providers. A list of all applications received from new and continuing IME providers is available from the Medical Cost Containment Unit, P.O. Box 27198, Albuquerque, NM 87125-7198, (505) 841-6811. Written public comments on any health care provider being considered for inclusion or continuation in the list of certified IME providers will be accepted from May 1, through the close of business May 31, 2017.  In making its decisions, the Committee shall, "to the greatest extent possible, designate only health care providers whose judgments are respected, or not objected to, by recognized representatives of both employer and worker interests and whose judgments are not perceived to favor any particular interest group."

LEGISLATIVE ACTIONS:

• House Bill 122
  The enacted legislation specifies that pharmacy benefit managers (PBMs) could not charge a fee to pharmacies for the following parts of the adjudication of claims made by a pharmacy to a PBM: Adjudication of the claim; Receipt and processing of the claim; Development or management of a claim processing network, and Participation in a claim processing network. Effective Date: June 18, 2017.

FEE SCHEDULE NEWS:

• The state has adopted a new Hospital and Healthcare Provider Fee Schedules effective January 1, 2017.   The next expected update is January of 2018.
• A new Gross Tax Receipts has also been adopted for the period of January 1 through June 30 2017.

REGULATORY ACTIVITY:

• New Mexico has released their fee schedule for 2017.  Also, released the Director's Fee Schedule Order and the agency's response to public comment.
• The Director of the NM WCA announces the vacancy of an Administrative Law Judge, effective April 1, 2017. The primary location of the position is in Albuquerque, NM, with travel throughout the state. The agency is currently accepting applications and will begin the review process beginning Jan. 3, 2017. The application process will be ongoing until filled.

LEGISLATIVE ACTIONS:

• House Bill 43
  The legislation relates to public employees. The legislation amends the public employees’ retirement act and the public employer group insurance provisions. The amended statute requires that an affiliated public employer pay certain employee’s member contributions and group insurance contributions if the employee sustains a non-administrative work-related injury rendering the employee absent from work on approved workers’ compensation leave.  Effective Date July 1, 2016.
• House Bill 168
  The enacted legislation relates to transportation. The legislation enacts the Transportation Company Services Act.  It provides for the administration of the act by the public regulation commission.  The legislation creates a dedicated fund to support the required activities.  The legislation provides for penalties for violations of requirements set forth in the legislation.   Effective Date June 14, 2016.
• Senate Bill 108
  The enacted legislation relates to the insurance industry in general. It increases the minimum capital, surplus and deposit requirements for insurance carriers acquiring a certificate of authorization. It changes the terms “insurance agent”, “insurance broker” and “insurance solicitor” to “insurance producer. It makes changes to the licensing and renewal requirements for insurance producers.  It enacts insurance producer license renewal and fee requirements.  It introduces licensing and fee requirements for independent review organizations.  The legislation introduces filing fee for continuing education providers.  The legislation introduces penalties for late notification of change of name or address. It requires adjusters to fulfill continuing education requirements and requires applicants for adjuster licenses to pass an examination. Effective Date July 1, 2016.
• Senate Bill 214
  The enacted legislation repeals and amends Section 52-1-12.1 Reduction in Compensation When Alcohol or Drugs Contribute to the Injury or Death section of the state’s workers’ compensation statute. The current section is repealed and replaced with a new section which includes a definition of intoxication or influence.  It further provides that drug or controlled substance does not include medications prescribed to a worker by the worker’s licensed health care provide and taken in accordance with the directions of the health care provider unless the medication is combined with alcohol or a non-prescribed drug or controlled substance. The statute is amended by allowing for a benefit that is otherwise due and payable be reduced by the degree to which the intoxication or influence contributed to the worker’s injury or death provided that the reduction shall be a minimum of 10 percent but no more than 90 percent. Further, the amended statute provides that test results relied on as evidence of a worker’s intoxication or influence shall not be considered in making a reduction unless the test and testing procedures conform with standard testing procedures generally accepted in the medical community.  Further, that the test is performed by a laboratory certified to do the testing by an organization nationally recognized.  The workers’ compensation agency is directed to adopt rules regarding test, testing and cutoff level for intoxication or influence. The enacted legislation further provides that if the injured employee refuses to submit to the test or release the results to the employer no compensation is due. The act requires that the test samples shall be taken as a split sample with one part of the sample to be held by the testing facility for twelve months from the date of the original test.  The worker is provided the right to request a second test be conducted within that 12-month period at the worker’s expense.   The amended act bares the employer from claiming the reduction if, before the accident, the employer had actual or constructive knowledge of the worker’s intoxication or influence and had a reasonable opportunity to take appropriate measures in response to the condition of the employee.  Further, the employer is barred from claiming the reduction if the employer fails to implement a written policy that declares a drug- and alcohol-free workplace and provides the employee such notice.  Reduction in benefits shall not affect payment of medical benefits nor shall affect payments of benefits to the dependents of the deceased worker.  Effective Date June 18, 2016.
• Senate Bill 263
  The enacted legislation establishes a new section in New Mexico Drug, Device and Cosmetic Act. The new section requires a practitioner who prescribes or dispenses an opioid to a patient to obtain and review reports from the state’s prescription monitoring program. The practitioner is also required to obtain reports for adjacent states if that information is accessible from the adjacent states. The act clarifies that practitioner does not include a pharmacist, veterinarian or euthanasia technician.   The practitioner must obtain and review such reports every three months for each established patient for whom the practitioner continuously prescribes or dispenses opioids.  The practitioner shall document the receipt and review of reports in the patient’s medical record. Effective Date: January 1, 2016