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.
Cycle III Grant Application Summary
New Mexico Grantee: State of New Mexico Office of Superintendent of Insurance
Award Date: September 23, 2013
Total Award Amount: $3,204,929
Baseline Award Amount: $2,000,000
Workload Award Amount: $804,929
Performance Award Amount: $400,000
- Expand the Scope of Rate Review: To enhance the rigor of the state’s review of rate filings, New Mexico plans to pursue more in-depth analysis of coinsurance, co-pays, and deductibles. In addition, New Mexico plans to convene an advisory group that will help the state to identify and implement methodologies to incorporate quality improvement into rate review. After a review of best practices from other states, New Mexico will also implement new rate review methodologies that encourage delivery system reform.
- Expand Rate Review Transparency: The New Mexico Office of the Superintendent of Insurance plans to use Cycle III funds to expand consumer outreach and engagement throughout the state. In addition, New Mexico plans to make its website more user-friendly by developing enhanced online search tools, new interactive features, and an improved user interface.
- Health Pricing Transparency and Rate Review: With Cycle III funds, New Mexico plans to use pricing data to better evaluate rate submissions. New Mexico will also analyze and publish pricing data in coordination with premium and rate filing information. In order to solicit feedback regarding these pricing transparency initiatives, New Mexico plans to convene a “Pricing Transparency Initiative Task Force.”
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