PRIOR AUTHORIZATION PROCESS EXEMPTIONS

SB 263 requires New Mexico health insurers to establish procedures for granting exemptions from prior authorization requests to healthcare providers who historically achieved at least 90% approval rates for those services. Insurers must approve or deny exemption requests within 10 business days, provide clear denial reasons with supporting data, and allow independent medical reviews if exemptions are rescinded. Providers can challenge rescissions through a 30-day independent review process led by licensed physicians, with insurers covering review costs. This bill directly affects healthcare providers seeking streamlined authorization and insurers managing prior authorization workflows, effective January 1, 2026.