- A. For services provided pursuant to Section 3 [59A-57A-3 NMSA 1978] or 4 [59A-57A-4 NMSA 1978] of the Surprise Billing Protection Act, a health insurance carrier shall directly reimburse a nonparticipating provider for care rendered the surprise bill reimbursement rate for services.
- B. The surprise bill reimbursement rate shall be calculated using claims data reflecting the allowed amounts paid for claims paid in the 2017 plan year.
- C. As used in this section, "surprise bill reimbursement rate" means the sixtieth percentile of the allowed commercial reimbursement rate for the particular health care service performed by a provider in the same or similar specialty in the same geographic area, as reported in a benchmarking database maintained by a nonprofit organization specified by the superintendent after consultation with health care sector stakeholders; provided that no surprise bill reimbursement rate shall be paid at less than one hundred fifty percent of the 2017 medicare reimbursement rate for the applicable health care service provided.
- D. The nonprofit organization shall be conflict-free and unaffiliated with any stakeholder in the health care sector.
History: Laws 2019, ch. 227, § 13.
ANNOTATIONS
Delayed repeals. — Laws 2023, ch. 7, § 1, amended the delayed repeal date of Laws 2019, ch. 227, § 13, as enacted by Laws 2019, ch. 227, § 15, from July 1, 2023 to July 1, 2028.
Effective dates. — Laws 2019, ch. 227, § 16 made Laws 2019, ch. 227 effective January 1, 2020.