HMO Quality Assurance – N.M. Stat. Ann. §59A-46-7

A health maintenance organization (HMO) must have procedures in place the ensure that enrollees receive quality care, including availability, accessibility, and care continuity.  The HOM must have an ongoing quality assurance program to monitor and evaluate its health care services.  The program should include a written statement of the program’s goals to improve quality, a written quality assurance plan, a statement of ongoing quality improvement efforts, and a written plan to correct substandard quality issues. 

An HMO must use a patient medical record system that allows care quality and care coordination to be assessed and monitored.  The clinical patient records must be made available for inspection by the Superintendent of Insurance on request, unless there are other restrictions prohibiting this.