{"data":{"id":"us-nm/59a-22b-7","jurisdiction":"us-nm","citation":"59A-22B-7","heading":"Prior authorization or referral requirement for in-network mental health or substance use disorder services coverage prohibited.","body":"A. A health insurer shall not require prior authorization and referral requirements for the following mental health or substance use disorder services:\n(1) acute or immediately necessary care;\n(2) acute episodes of chronic mental health or substance use disorder conditions; or\n(3) initial in-network inpatient or outpatient substance use treatment services.\nB. Prior authorization shall be determined in consultation with the insured's mental health or substance use disorder services provider for:\n(1) continuation of services in chronic or stable conditions; or\n(2) additional services.\nC. Except in cases in which the insured terminates a plan, a health insurer shall not terminate coverage of services without consultation with the insured's mental health or substance use disorder services provider.\nD. A health insurer shall not limit coverage for mental health or substance use disorder services up to the point of relief of presenting signs and symptoms or to short-term care or acute treatment.\nE. The duration of coverage for an insured with a mental health or substance use disorder shall be based on the mental health or substance use disorder needs of the insured rather than on arbitrary time limits.\nF. A health insurer may require a mental health or substance use disorder services provider to provide notification to the health insurer after the initiation of in-network mental health or substance use disorder treatment pursuant to Subsection A of this section.\nG. If a provider fails to notify a health insurer pursuant to Subsection F of this section, a health insurer may perform appropriate utilization review.\nH. A health insurer may require a mental health or substance use disorder services provider to develop and submit a treatment plan for an insured receiving in-network services in a manner that is compliant with federal law.","path":["Chapter 59A - Insurance Code","ARTICLE 22B Prior Authorization"],"source_url":"https://nmonesource.com/nmos/nmsa-unanno/en/item/18562/index.do","current_through":"2026-07-01","vintage":"","retrieved_at":"2026-09-03T15:02:20Z","sha256":"84316ab626c0e9343eb6088124a2a5aa11a48ea8a8011971183bb118773c826f","source_id":"us-nm","stale":false,"prev":"us-nm/59a-22b-6","next":"us-nm/59a-22b-8"},"notice":"GroundRules: Original legal text. Not legal advice."}