{"data":{"id":"us-nm/59a-46-65","jurisdiction":"us-nm","citation":"59A-46-65","heading":"Utilization review of mental health or substance use disorder services.","body":"A. A carrier shall, at least monthly, review and update the carrier's utilization review process to reflect the most recent evidence and generally recognized standards of care.\nB. When performing a utilization review of mental health or substance use disorder services, including level of care placement, continued stay, transfer and discharge, a carrier shall apply criteria in accordance with generally recognized standards of care.\nC. A carrier shall provide utilization review training to staff and contractors undertaking activities related to utilization review.\nD. A carrier shall:\n(1) develop utilization review policies regarding quantitative and non-quantitative limitations for mental health or substance use disorder services coverage that are no more restrictive than the utilization review policies regarding quantitative and non-quantitative limitations for medical and surgical care; and\n(2) make utilization review policies available to providers or enrollees.","path":["Chapter 59A - Insurance Code","ARTICLE 46 Health Maintenance Organizations"],"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":"d55e844e4fbaae2ee533c9b19cc7f6a33cbcb847046b255bf4dbc0ccbf669000","source_id":"us-nm","stale":false,"prev":"us-nm/59a-46-64","next":"us-nm/59a-46-66"},"notice":"GroundRules: Original legal text. Not legal advice."}