Current through Register Vol. 35, No. 11, June 11, 2024
Section 11.4.7.10 - QUALIFICATION OF OUT OF STATE HEALTH CARE PROVIDERSA. An HCP that is not licensed in the state of New Mexico must be approved by the director to qualify as an HCP under the act.B. No party shall have recourse to the billing and payment dispute resolution provisions of these rules with respect to the services of an HCP who is not licensed in New Mexico or approved by the director.C. The director's approval may be obtained by submitting an application to the director and proposed order, supported by an original affidavit of the HCP seeking approval. Nothing in this rule shall prevent the director from entering into agreements with any party or HCP to provide for simplified and expeditious qualification of HCPs in individual cases, provided, however, that all such agreements shall be considered public records.D. The director's approval of a health care provider in a particular case, pursuant to the provisions of Section 52-4-1 NMSA 1978 will be deemed given when an out of state health care provider provides services to that injured worker and the employer/insurer pays for those services. Unless otherwise provided, the approval obtained by this method will not apply to the provision of health care by that provider to any other worker, except by obtaining separate approval as provided in these rules.E. The out of state health care provider shall comply with the New Mexico HCP fee schedule, however, nothing in these rules shall preclude the separate negotiation of fees between an out of state provider and a payer within the HCP fee schedule for any health care service as set forth in these rules.F. In lieu of a formal director's approval, the payer may accept an original Out of State Health Care Provider Affidavit, as provided on the WCA website, from an HCP who is licensed by their state and in good standing.11.4.7.10 NMAC - Rp, 11.4.7.9 NMAC, 12-31-13, Amended by New Mexico Register, Volume XXVI, Issue 18, September 29, 2015, eff. 10/1/2015, Amended by New Mexico Register, Volume XXVII, Issue 18, September 30, 2016, eff. 9/30/2016, Adopted by New Mexico Register, Volume XXXIII, Issue 24, December 27, 2022, eff. 1/1/2023