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STATE | New Mexico Moves to Define Insurance Network Adequacy Standards

The New Mexico Superintendent of Insurance released a draft rule to develop and maintain adequate insurance networks. The rule also institutes a system where insurers can obtain waivers or exceptions to network requirements for remote and less populated areas of the state. The proposed rule includes many good starting points, including: geographic accessibility requirements (i.e., time and distance standards), standards for timely access to urgent and emergent care, definitions of certain provider-to-enrollee ratios, and an outline of the requirements of provider directories. While the proposal incorporates many of the Society's recommendations on network adequacy, there are several provisions in the rule that need further refining.

To ensure that patients have in-network access to necessary specialty care providers, ASPS submitted comments asking for the development of specific provider-to-enrollee ratios for all specialty providers. Unfortunately, the proposal also lacks a mechanism to truly ensure the accuracy of provider directories. Therefore, ASPS requested more robust language that would give insurers the incentive to keep updated directories.

ASPS anticipates that this network adequacy proposal marks the beginning of more extensive changes to out-of-network reimbursement and other related areas in New Mexico.

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