HOUSE BILL 589
48th legislature - STATE OF NEW MEXICO - first session, 2007
INTRODUCED BY
Rhonda S. King
AN ACT
RELATING TO INSURANCE; AMENDING AND ENACTING SECTIONS OF THE NEW MEXICO INSURANCE CODE TO PROVIDE FOR APPROVAL BY THE PUBLIC REGULATION COMMISSION OF APPOINTMENTS BY THE SUPERINTENDENT OF INSURANCE; PROVIDING FOR APPEALS OF DECISIONS BY THE SUPERINTENDENT.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF NEW MEXICO:
Section 1. A new section of Chapter 59A, Article 2 NMSA 1978 is enacted to read:
"[NEW MATERIAL] SUPERINTENDENT--APPOINTMENTS APPROVED BY COMMISSION.--All appointments made by the superintendent of any person to a board, commission, committee or similar group pursuant to any statutory or regulatory authority shall be subject to the approval of the commission."
Section 2. Section 59A-4-20 NMSA 1978 (being Laws 1984, Chapter 127, Section 67, as amended) is amended to read:
"59A-4-20. APPEAL TO COURT.--
A. A party may appeal from an order of the superintendent made after an informal hearing or an administrative hearing only by filing a petition with the commission within thirty days after final disposition of the matter by the superintendent. The commission shall either grant or refuse the petition within twenty days after it is filed. If the commission fails to act on the petition within that time period, it shall be deemed a refusal. If the commission grants the petition, it shall render a final order of disposition within sixty days of the granting of the petition. A refusal of the petition or final order of disposition made by the commission pursuant to this section shall constitute the final order of agency action, and the entire matter may be subject to review by appeal to the district court. The appeal shall be taken to the district court pursuant to the provisions of Section 39-3-1.1 NMSA 1978.
B. This section shall not apply as to matters arising pursuant to Chapter 59A, Article 17 NMSA 1978."
Section 3. Section 59A-57-4.1 NMSA 1978 (being Laws 2003, Chapter 327, Section 2) is amended to read:
"59A-57-4.1. EXTERNAL GRIEVANCE APPEALS--APPOINTMENT--
COMPENSATION.--
A. Subject to the concurrence of the commission, the superintendent [may] shall appoint one or more qualified individuals to review external grievance appeals.
B. The superintendent shall fix the reasonable compensation of each appointee based upon, but not limited to, compensation amounts suggested by national or state legal or medical professional societies, organizations or associations.
C. Upon completion of the external grievance appeal review, the superintendent shall prepare a detailed statement of compensation due each appointee and shall present the statement to the enrollee's health insurer.
D. The enrollee's health insurer shall pay the compensation directly to each appointee who participated in the external grievance appeal review.
E. The superintendent shall promulgate rules to implement this section."
Section 4. Section 59A-57-5 NMSA 1978 (being Laws 1998, Chapter 107, Section 5) is amended to read:
"59A-57-5. CONSUMER ASSISTANCE--CONSUMER ADVISORY BOARDS [OMBUDSMAN OFFICE]--REPORTS TO CONSUMERS--SUPERINTENDENT'S ORDERS TO PROTECT CONSUMERS.--
A. Each managed health care plan shall establish and adequately staff a consumer assistance office. The purpose of the consumer assistance office is to respond to consumer questions and concerns and assist patients in exercising their rights and protecting their interests as consumers of health care.
B. Each managed health care plan shall establish a consumer advisory board. The board shall meet at least quarterly and shall advise the plan about the plan's general operations from the perspective of the enrollee as a consumer of health care. The board shall also review the operations of and be advisory to the plan's consumer assistance office.
[D.] C. The department shall prepare an annual report assessing the operations of managed health care plans subject to the department's oversight, including information about consumer complaints.
[E.] D. A person adversely affected may file a complaint with the superintendent regarding a violation of the Patient Protection Act. Prior to issuing any remedial order regarding violations of the Patient Protection Act or its regulations, the superintendent shall hold a hearing in accordance with the provisions of Chapter 59A, Article 4 NMSA 1978. The superintendent may issue any order [he] the superintendent deems necessary or appropriate, including ordering the delivery of appropriate care, to protect consumers and enforce the provisions of the Patient Protection Act. The superintendent shall adopt special procedures to govern the submission of emergency appeals to [him] the superintendent in health emergencies.
E. A person adversely affected by any order to grant or deny relief that is issued by the superintendent pursuant to Subsection D of this section shall have the right to hearing, review and appeal, pursuant to Sections 59A-17-34 and 59A-17-35 NMSA 1978, as they may apply."
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