New Mexico Rate Review Grants Award List
Cycle I Grant Application Summary
New Mexico Grantee: New Mexico Public Relation Commission Insurance Division
Award Date: August 16, 2010
Award Amount: $1,000,000
- Pursue Additional Legislative Authority: New Mexico will introduce legislation to allow improved transparency and require the division to post health insurance premium filings on its website as well as to set forth the authority to release information to the public, which insurers will be required to provide.
- Improve the Review Process: Currently all rate requests are subject to a review and approval process that includes a tiered approach with a more in-depth review (including trends analysis of historical medical loss ratio, evaluation of medical cost index and comparison of claims and financial Statement data) for proposed increases greater than 5 percent. The Department of Insurance will implement actuarial review of unreasonable rates and strengthen the rate review process by developing procedures that incorporate and implement federal regulations and State laws. Within the Insurance Division, the Department also intends to develop a Consumer and Business Services Bureau responsible for approving rates for the individual, small group and portability health insurance markets.
- Increase Transparency and Accessibility: The State provides access to health insurance premium filings upon request. The Department of Insurance will seek legislation to make rate filings public information and require the Division to post health insurance premium filings on its website once they are deemed complete.
- Develop and Upgrade Technology: New Mexico will improve efficiency and streamline data sharing.
Cycle II Grant Application Summary
New Mexico Grantee: New Mexico Public Regulation Commission Insurance Division
Award Date: September 20, 2011
Total Award: $3,000,000
Baseline Award: $3,000,000
- Expand scope of rate review: New Mexico will give its Consumer and Business Services Task Force the responsibility of reviewing rates and identifying potentially unreasonable increases, triggering further review by a contracted actuary firm.
- Improve rate filing requirements: New Mexico will use SB 208 to require insurers to provide additional information with submitted rate filings. New Mexico will also require insurers to make reimbursement for direct services at a level not less than 85% of premiums.
- Improve transparency and consumer interfaces: New Mexico will implement the requirements of SB 208, requiring the Superintendent to provide public web access to all health insurance rate filings and a 30 day public comment period for filings. New Mexico will also hold quarterly town hall meetings throughout the State.
- Hire new staff: New Mexico will create 2 new positions with the Cycle II grant funding; these positions are in addition to the 4 positions created with Cycle I resources.
- Improve IT: New Mexico will use IT Professional Contract Developers to enhance the web application and database data transfer interfaces.
Last updated: September 21, 2012