52-4-4. Temporary provision; rules and regulations.
286 words·~1 min read·
/nm/chapter-52-workers-compensation/article-4-health-care-providers/52-4-4·A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
A. The director shall adopt and promulgate regulations and contract with a peer review organization pursuant to Section 52-4-2 NMSA 1978 no later than October 1, 1990.
B. The director shall establish a baseline period of no less than six months, adjusted for seasonal variations, for the purpose of providing data for the calculations required pursuant to Subsection C of this section no later than January 1, 1991.
C. For the one-year period ending December 31, 1991, the director shall issue a report concerning the results of the utilization review program as provided in Section 52- 4-3 NMSA 1978 no later than December 1, 1992. If the director determines that based on such data the program has not resulted in a ten percent reduction in the utilization and cost of services subject to the utilization program, he shall have the authority to adopt and promulgate regulations, after notice and public hearings, to establish schedules of maximum charges for fees that are payable to health care providers as defined in Section 52-4-1 NMSA 1978. Such schedules shall be annually revised.
D. For the purposes of calculating the percentage as provided in Subsection C of this section, a comparison of both baseline and utilization program data shall be performed. Factors that shall be considered include, but are not limited to:
(1)severity and frequency of illness or injury;
(2)average length of stay of hospitalization;
(3)number of admissions per one hundred workers' compensation claims;
(4)number of services provided per one hundred workers' compensation claims; and
(5)factors that may affect the utilization and cost of medical services provided under the Workers' Compensation Act [Chapter 52, Article 1 NMSA 1978].
History: Laws 1990, ch. 65, § 4.