NM HB302

Health care professionals with 90% or higher prior authorization approval rates (on 10+ requests) for outpatient services during a six-month evaluation period may apply for exemption from the prior authorization process for those services

Health insurers must respond to exemption requests within 10 business days and provide written explanations with supporting data for any denials

Exemptions may only be rescinded if less than 90% of claims would have met medical necessity criteria based on a retrospective review of 5-20 random claims, with 25 days written notice required before rescission takes effect

Health care professionals may request independent review of rescission decisions by a physician licensed in New Mexico, with insurers paying review costs; the independent review organization's decision is binding on both parties

Exemptions do not apply to pharmaceutical services or prescription drugs, and insurers may immediately rescind exemptions in cases of fraud or abuse