reglab/statecodes huggingface dataset:
2023 New Mexico Statutes › Chapter 27 - Public Assistance › Article 8 - Community Action › Section 27-8-2 - Policy; purpose.

Although in recent years New Mexico has shown improvement in indices such as personal income and the number of families below the poverty level, the state continues to compare poorly with other states. New Mexico has risen from 48th in 1974 to 41st in per capita personal income; however, poverty continues to be the lot of a substantial number of New Mexicans. New Mexico can achieve its full economic and social potential only if every individual has the opportunity to contribute to the full extent of his capabilities and to participate in the working of our society. It is, therefore, the policy of this state to eliminate the paradox of poverty in the midst of plenty in this state by opening to everyone the opportunity to live in decency and dignity. It is the purpose of the Community Action Act to strengthen, supplement and coordinate efforts in furtherance of that policy.
History:
Laws 1983, ch. 139, § 2.
2023 New Mexico Statutes › Chapter 27 - Public Assistance › Article 8 - Community Action › Section 27-8-3 - Definitions.

As used in the Community Action Act:
A. "poverty level" means the official poverty level established by the federal director of the office of management and budget and revised periodically by the federal secretary of health and human services; and
B. "secretary" means the secretary of human services.
History:
Laws 1983, ch. 139, § 3.
2023 New Mexico Statutes › Chapter 27 - Public Assistance › Article 8 - Community Action › Section 27-8-4 - Financial assistance for community action agencies.

A. The secretary may provide financial assistance to community action agencies for the planning, conduct, administration and evaluation of community action programs as described in the Community Action Act in accordance with state and federal law and regulations.
B. No funds provided pursuant to Subsection A of this section shall be distributed to a community action agency unless the agency has submitted to the secretary a plan on the proposed use of the funds and the secretary has approved that plan.
C. Subject to applicable federal law or regulation, community action agencies shall be eligible to receive federal funds, including but not limited to community services block grant funds, which have been previously designated as antipoverty funds.
D. Each community action agency receiving funds pursuant to this section shall report annually to the secretary concerning the use of the funds.
E. The secretary shall provide annually for an audit of funds distributed pursuant to this section to community action agencies and shall make any requirements necessary to insure fiscal responsibility and accountability and effective, efficient handling of funds.
History:
Laws 1983, ch. 139, § 4.
2023 New Mexico Statutes › Chapter 27 - Public Assistance › Article 8 - Community Action › Section 27-8-5 - Community action agencies; designation; powers.

A. A community action agency is a political subdivision of the state, a combination of political subdivisions or a public or private nonprofit agency that:
(1) has the power and authority to enter into contracts with public and private nonprofit agencies and organizations in fulfilling the purposes of the Community Action Act;
(2) is capable of planning, conducting, administering and evaluating a community action program;
(3) has a service area at least equivalent to the geographic boundaries of a county; and
(4) is designated a community action agency by the governor or by federal law or was officially designated a community action agency, community action program or limited purpose agency under the provisions of the federal Economic Opportunity Act of 1964 on September 30, 1981.
B. The governor is empowered to declare that an entity designated as a community action agency under Subsection A of this section is no longer a community action agency upon a determination that such entity is unable or unwilling to carry out its responsibilities under the Community Action Act.
C. A community action agency is empowered to:
(1) receive, administer and transfer funds in support of a community action program under the Community Action Act; and
(2) delegate powers to other agencies and programs subject to the powers of its governing board and its overall program responsibilities.
History:
Laws 1983, ch. 139, § 5.
ANNOTATIONS
Cross references.
— For the federal Economic Opportunity Act of 1964,
see
42 U.S.C.S. § 2704 et seq.
2023 New Mexico Statutes › Chapter 27 - Public Assistance › Article 8 - Community Action › Section 27-8-6 - Community action agencies; board; local participation.

A. Each community action agency shall administer its community action program through a community action board. Board members shall be selected as follows:
(1) one-third of the members of the board shall be elected public officials currently holding office in the geographical area to be served by the community action agency or their representatives, except that if the number of elected officials reasonably available and willing to serve is less than one-third of the membership of the board, membership on the board of appointive officials may be counted in meeting this one-third requirement;
(2) at least one-third of the members shall be persons chosen in accordance with democratic selection procedures adequate to ensure that they are representative of the poor in the area served; and
(3) the other members shall be officials or members of business, industry, labor, religious, welfare, education or other major groups and interests in the community.
B. Each member of the board selected to represent a specific geographic area within a community shall reside in the area represented.
C. No person selected under Paragraph (2) or (3) of Subsection A of this section shall serve for more than five consecutive years.
History:
Laws 1983, ch. 139, § 6; 2021, ch. 105, § 1
ANNOTATIONS
The 2021 amendment,
effective June 18, 2021, changed the structure of community action boards, and revised the term limit provision; in Subsection A, after "community action board", deleted "consisting of fifteen members"; and in Subsection C, after "more than five consecutive years", deleted "or more than a total of ten years".
2023 New Mexico Statutes › Chapter 27 - Public Assistance › Article 8 - Community Action › Section 27-8-7 - Community action programs.

Each community action agency shall use available funds for a community action program which:
A. provides a range of services and activities which have a measurable and potentially major impact on causes of poverty in the community;
B. provides activities designed to assist low-income participants, including the elderly poor, to:
(1) secure and retain meaningful employment;
(2) attain an adequate education;
(3) make better use of available income;
(4) provide and maintain adequate housing and a suitable living environment;
(5) obtain emergency assistance through loans or grants to meet immediate and urgent individual and family needs, including the need for health services, nutritious food, housing and employment-related assistance;
(6) remove obstacles and solve problems which block the achievement of self-sufficiency;
(7) achieve greater participation in the affairs of the community; and
(8) make more effective use of other programs related to the purposes of the Community Action Act;
C. provides on an emergency basis for the provision of such supplies and services, nutritious food and related services as may be necessary to counteract conditions of starvation and malnutrition among the poor;
D. coordinates and establishes linkages between governmental and other social services programs to assure the effective delivery of such services to low-income individuals;
E. encourages the use of entities in the private sector of the community in efforts to alleviate poverty in the community; and
F. furthers any other purpose consistent with federal or state law or regulations.
History:
Laws 1983, ch. 139, § 7.
2023 New Mexico Statutes › Chapter 27 - Public Assistance › Article 8 - Community Action › Section 27-8-9 - Financial assistance; limitations.

The secretary, consistent with federal law, shall make grants of not less than ninety percent of the annual allocation of funds available under the community services block grant to community action agencies defined in Subsection A of Section 5 [27-8-5 NMSA 1978] of the Community Action Act. The human services department [health care authority department] is authorized to implement, by regulation or contract, a limitation on the amount of community services block grant funds allocated to administrative costs.
History:
Laws 1983, ch. 139, § 9.
ANNOTATIONS
Bracketed material.
— The bracketed material was inserted by the compiler and is not part of the law. Laws 2023, ch. 205, § 16 provided that references to the human services department shall be deemed to be references to the health care authority department.
2023 New Mexico Statutes › Chapter 27 - Public Assistance › Article 9 - Community Care › Section 27-9-1 - Program; demonstrations.

The human services department [health care authority department], in cooperation with the department of health, is authorized to administer demonstration programs that provide in-home and coordinated community care services to the frail elderly and to persons with a disability who would otherwise require institutionalization. The programs authorized by this section shall serve both those eligible and not eligible for federal medical assistance programs.
History:
Laws 1983, ch. 323, § 1; 2007, ch. 46, § 22.
ANNOTATIONS
Bracketed material.
— The bracketed material was inserted by the compiler and is not part of the law. Laws 2023, ch. 205, § 16 provided that references to the human services department shall be deemed to be references to the health care authority department.
The 2007 amendment,
effective June 15, 2007, made non-substantive language changes.
2023 New Mexico Statutes › Chapter 27 - Public Assistance › Article 9 - Community Care › Section 27-9-2 - Implementation.

The secretary of human services shall, by regulation, specify the areas in which the programs shall operate, specify the services to be provided, establish eligibility criteria of persons to be served and provide for cost sharing, where possible, with individuals and participating communities.
History:
Laws 1983, ch. 323, § 2.
2023 New Mexico Statutes › Chapter 27 - Public Assistance › Article 10 - Statewide Health Care › Section 27-10-1 - Short title.

Sections 1 through 4 [27-10-1 to 27-10-4 NMSA 1978] of this act may be cited as the "Statewide Health Care Act".
History:
Laws 1991, ch. 212, § 1.
ANNOTATIONS
Cross references.
— For County Local Option Gross Receipts Tax Act,
see
Chapter 7, Article 20E NMSA 1978.
For imposition of intermediate sanctions and civil penalty for health facility's noncompliance with any departmental licensing requirement,
see
24-1-5.2 NMSA 1978.
2023 New Mexico Statutes › Chapter 27 - Public Assistance › Article 10 - Statewide Health Care › Section 27-10-2 - Findings and purpose.

A. Access to health care reduces long-term medical and social costs. The effectiveness of statewide health care has been decreased by excessive fragmentation and failure to maximize the use of existing in-state revenues and to develop effective ways of drawing upon potential federal revenue sources. An effective statewide health care system must retain local health care efforts, stimulate local innovations for meeting particular health care needs and use existing resources to expand health care options, especially for those citizens unable to pay for their own care.
B. The purpose of the county-supported medicaid fund is to leverage existing resources to better address the state's health care needs. The county-supported medicaid fund will be used to accomplish this purpose by using local revenues to support the state medicaid program and to institute or support primary care health care services pursuant to Section 24-1A-3.1 NMSA 1978. Money appropriated from the county-supported medicaid fund to institute or support primary care health care services pursuant to Section 24-1A-3.1 NMSA 1978 shall be supplemental to general fund appropriations.
History:
Laws 1991, ch. 212, § 2; 1993, ch. 321, § 19; 1996, ch. 29, § 5.
ANNOTATIONS
The 1996 amendment,
effective May 15, 1996, in Subsection B, inserted "or support" in the second sentence and added the last sentence.
The 1993 amendment,
effective July 1, 1993, substituted "to support the state medicaid program" for "solely to expand eligibility for federal medicaid optional coverages in supplementation to mandated federal medicaid services" in the second sentence of Subsection B.
2023 New Mexico Statutes › Chapter 27 - Public Assistance › Article 10 - Statewide Health Care › Section 27-10-4 - Alternative revenue source to imposition of county health care gross receipts tax; transfer to county-supported medicaid fund.

A. In the event a county does not enact an ordinance imposing a county health care gross receipts tax pursuant to Section 7-20D-3 [7-20E-18] NMSA 1978, the county shall, by ordinance to be effective July 1, 1993, dedicate to the county-supported medicaid fund an amount equal to a gross receipts tax rate of one-sixteenth of one percent applied to the taxable gross receipts reported during the prior fiscal year by persons engaging in business in the county. For purposes of this subsection, a county may use funds from any existing authorized revenue source of the county.
B. For each county that has in effect an ordinance enacted pursuant to Subsection A of this section on July 1 of each year, the taxation and revenue department shall certify to the county by September 15, 1993 and by September 15 of each subsequent fiscal year the amount of gross receipts reported for the county for purposes of the gross receipts tax during the prior fiscal year. Upon certification by the department, any county enacting an ordinance pursuant to Subsection A of this section shall transfer to the county-supported medicaid fund by the last day of March, June, September and December of each year an amount equal to a rate of one-sixty-fourth of one percent applied to the certified amount.
C. The requirements of an ordinance enacted pursuant to this section may be terminated for a county only on the effective date of an ordinance enacted by the county imposing the county health care gross receipts tax; provided that if the effective date of the ordinance imposing the tax is January 1, the termination does not apply to the payments required for September and December of that year.
History:
Laws 1991, ch. 212, § 4; 1992, ch. 31, § 3; 1993, ch. 321, § 21.
ANNOTATIONS
Bracketed material.
— The bracketed material was inserted by the compiler and is not part of the law. Section 7-20D-3 NMSA 1978 was recompiled as 7-20E-18 NMSA 1978 by Laws 1993, ch. 354, § 18.
The 1993 amendment,
effective July 1, 1993, deleted "except as may be otherwise provided in Section 27-5-7 NMSA 1978" from the end of Subsection A.
The 1992 amendment,
effective May 20, 1992, substituted references to fiscal year for calendar year in three places; in Subsection A, substituted "pursuant to Section 7-20D-3 NMSA 1978" for "pursuant to Section 3 of the County Health Care Gross Receipts Tax Act and if no balance remains in the county indigent hospital claims fund for the current fiscal year" and "July 1, 1993" for "January 1, 1992"; in Subsection B, substituted "July 1 of each year" for "January 1 of each year", "by September 15, 1993 and by September 15" for "by March 15, 1992 and by March"; and, in Subsection C, substituted "January 1" for "July 1" and "payments required for September and December" for "payments required for March and June".
2023 New Mexico Statutes › Chapter 27 - Public Assistance › Article 11 - Medicaid Providers › Section 27-11-1 - Short title.

Chapter 27, Article 11 NMSA 1978 may be cited as the "Medicaid Provider and Managed Care Act".
History:
Laws 1998, ch. 30, § 1; 2019, ch. 215, § 1.
ANNOTATIONS
The 2019 amendment,
effective January 1, 2020, changed "This act" to "Chapter 27, Article 11 NMSA 1978", and after "Medicaid Provider", added "and Managed Care".
Severability.
— Laws 2019, ch. 215, § 19, provided that if any part or application of this act is held invalid, the remainder or its application to other situations or persons shall not be affected.
Temporary provisions.
— Laws 2019, ch. 215, § 18 provided that as of the effective date of this act, all references in law to the Medicaid Provider Act shall be deemed to be references to the Medicaid Provider and Managed Care Act.
2023 New Mexico Statutes › Chapter 27 - Public Assistance › Article 11 - Medicaid Providers › Section 27-11-4 - Retention and production of records.

A. Medicaid providers, managed care organizations and their subcontractors shall retain, for a period of at least six years from the date of creation, all medical and business records that are necessary to verify the:
(1) treatment or care of any recipient for which the medicaid provider, managed care organization or subcontractor received payment from the department to provide that benefit or service;
(2) services or goods provided to any recipient for which the medicaid provider, managed care organization or subcontractor received payment from the department to provide that benefit or service;
(3) amounts paid by medicaid or the medicaid provider or managed care organization on behalf of any recipient; and
(4) records required by medicaid under any contract between the department and the medicaid provider or managed care organization.
B. Upon written request by the department to a medicaid provider, managed care organization or any subcontractor for copies or inspection of records pursuant to the Public Assistance Act [27-2-1 to 27-2-34 NMSA 1978], the medicaid provider, managed care organization or subcontractor shall provide the copies or permit the inspection, as applicable within two business days after the date of the request unless the records are held by a subcontractor, agent or satellite office, in which case the records shall be made available within ten business days after the date of the request.
C. Failure to provide copies or to permit inspection of records requested pursuant to this section shall constitute a violation of the Medicaid Provider and Managed Care Act within the meaning of Paragraph (3) of Subsection B of Section 27-11-3 NMSA 1978.
History:
Laws 1998, ch. 30, § 4; 1999, ch. 229, § 2; 2019, ch. 215, § 4.
ANNOTATIONS
The 2019 amendment,
effective January 1, 2020, added a "managed care organization" as a medicaid provider; after each occurrence of "medicaid provider", added "or managed care organization" throughout the section; after each occurrence of "Medicaid Provider", added "and Managed Care" throughout the section; and in Subsection A, Paragraph A(1), after "medicaid provider", added "managed care organization or subcontractor", and in Paragraph A(2), after "medicaid provider", added "managed care organization or subcontractor".
Severability.
— Laws 2019, ch. 215, § 19, provided that if any part or application of this act is held invalid, the remainder or its application to other situations or persons shall not be affected.
The 1999 amendment,
effective June 18, 1999, in Subsection B, substituted "Upon request" for "Upon written request" and deleted "within five business days after the date of the request unless the records are held by a subcontractor, agent or satellite office, in which case the records shall be made available within ten business days after the date of the request"; in Subsection C, substituted "Section 27-11-3 NMSA 1978" for "Section 3 of that act".
2023 New Mexico Statutes › Chapter 27 - Public Assistance › Article 11 - Medicaid Providers › Section 27-11-6 - Repealed.

History:
Laws 2004, ch. 4, § 1; repealed by Laws 2006, ch. 25, § 2.
ANNOTATIONS
Repeals.
— Laws 2006, ch. 25, § 2 repealed 27-11-6 NMSA 1978, as enacted by Laws 2004, ch. 4, § 1, relating to the imposition of a daily bed surcharge, effective March 2, 2006. For provisions of former section,
see
the 2005 NMSA 1978 on
NMOneSource.com
.
2023 New Mexico Statutes › Chapter 27 - Public Assistance › Article 11 - Medicaid Providers › Section 27-11-7 - Determination of overpayments or credible allegation of fraud; audit findings; sampling; extrapolation limited; notice of right to informal conference and expedited adjudicatory proceeding.

A. The department may audit a medicaid provider or subcontractor for overpayment, using sampling for the time period audited. If the department contracts for the audit, the department shall contract only with an independent auditor approved by the state auditor. Each audited claim shall be reviewed by a person who is licensed, certified, registered or otherwise credentialed in New Mexico as to the matters such person reviews, including coding or specific clinical practice.
B. The department shall not extrapolate audit findings unless a medicaid provider's or subcontractor's error rate exceeds ten percent based upon an appropriate sampling and a representative sample of claims computed by valid statistical methods in accordance with the most recently published medicare program integrity manual and using statistical software approved by the United States department of health and human services.
C. Prior to reaching either a final determination of overpayment or a credible allegation of fraud, the department shall serve the medicaid provider or subcontractor with a written preliminary finding of overpayment.
D. The preliminary finding of overpayment shall:
(1) state with specificity the factual and legal basis for each claim forming the basis of an alleged overpayment;
(2) include a copy of the final audit report if the alleged overpayment is based on an audit; and
(3) notify the medicaid provider or subcontractor that is the subject of a preliminary finding of overpayment of its right to request, within thirty calendar days of service of the preliminary finding of overpayment, an informal conference with a representative of the department who is knowledgeable about the department's preliminary finding of overpayment and with a member of the audit team, if an audit formed the basis of any alleged overpayment, to informally address, resolve or dispute the department's preliminary finding of overpayment.
E. Prior to making either a final determination of overpayment or a determination of credible allegation of fraud, the department may impose corrective action upon the medicaid provider or subcontractor to address systemic conditions contributing to errors in the submission of claims for payment to which a medicaid provider or subcontractor is not entitled.
History:
Laws 2019, ch. 215, § 5.
ANNOTATIONS
Effective dates.
— Laws 2019, ch. 215, § 20 made Laws 2019, ch. 215 effective January 1, 2020.
Severability.
— Laws 2019, ch. 215, § 19, provided that if any part or application of this act is held invalid, the remainder or its application to other situations or persons shall not be affected.
2023 New Mexico Statutes › Chapter 27 - Public Assistance › Article 11 - Medicaid Providers › Section 27-11-8 - Informal conference; corrective action; requirements.

A. A medicaid provider or subcontractor seeking an informal conference pursuant to this section shall serve the department with a written request for such conference no later than thirty calendar days following the service of a preliminary determination of overpayment by the department on the medicaid provider or subcontractor. Upon receipt of a request for an informal conference, the department shall set a date for the conference to occur no later than fourteen business days following receipt of the request.
B. Within seven days following the informal conference, a medicaid provider or subcontractor may submit a proposed corrective action plan to the department to correct clerical, typographical, scrivener's and computer errors or to provide requested credentialing, licensure or training records identified in audit findings. The department shall not unreasonably withhold approval of the proposed corrective action plan. A medicaid provider or subcontractor shall have no less than thirty days from the date of approval of its corrective action plan to provide additional information or documentation to the department to attempt to address or resolve a disputed preliminary finding of overpayment.
History:
Laws 2019, ch. 215, § 6.
ANNOTATIONS
Effective dates.
— Laws 2019, ch. 215, § 20 made Laws 2019, ch. 215 effective January 1, 2020.
Severability.
— Laws 2019, ch. 215, § 19, provided that if any part or application of this act is held invalid, the remainder or its application to other situations or persons shall not be affected.
2023 New Mexico Statutes › Chapter 27 - Public Assistance › Article 11 - Medicaid Providers › Section 27-11-9 - Expedited adjudicatory proceedings; requirements.

A. A medicaid provider or subcontractor seeking an expedited adjudicatory proceeding pursuant to the Medicaid Provider and Managed Care Act shall serve the department and the administrative hearings office with a written request for such proceeding no later than thirty calendar days following the service of a final determination of overpayment by the department on the medicaid provider or subcontractor.
B. The chief hearing officer of the administrative hearings office shall appoint or contract with a hearing officer qualified pursuant to Section 8 [27-11-10 NMSA 1978] of this 2019 act no later than thirty calendar days after service upon the administrative hearings office of a request for an expedited adjudicatory proceeding pursuant to the Medicaid Provider and Managed Care Act by a medicaid provider or subcontractor.
C. The expedited adjudicatory proceeding requested by a medicaid provider or subcontractor in accordance with the Medicaid Provider and Managed Care Act shall commence no later than thirty calendar days following the appointment of the hearing officer or as stipulated by the parties or as otherwise ordered by the hearing officer upon a showing of good cause. The evidentiary hearing of an expedited adjudicatory proceeding pursuant to this section shall not exceed ten business days in length and shall be conducted in accordance with Section 12-8-11 NMSA 1978.
D. After affording the parties the opportunity to submit proposed findings and conclusions of law, and based solely upon the record in accordance with the Medicaid Provider and Managed Care Act and the Administrative Procedures Act [12-8-1 to 12-8-25 NMSA 1978], the hearing officer shall make findings of fact and conclusions of law on all material issues of fact, law or discretion, stating the basis for each. In addition, the hearing officer shall determine the amount of overpayment with respect to each disputed claim submitted for payment, if any. The findings of fact and conclusions of law of the hearing officer shall be made and served upon all parties of record within thirty calendar days following the hearing officer's receipt of the record.
E. The hearing officer's findings of fact and conclusions of law shall be binding on the department and constitute a final agency decision, which may be appealed pursuant to Section 39-3-1.1 NMSA 1978.
History:
Laws 2019, ch. 215, § 7.
ANNOTATIONS
Effective dates.
— Laws 2019, ch. 215, § 20 made Laws 2019, ch. 215 effective January 1, 2020.
Severability.
— Laws 2019, ch. 215, § 19, provided that if any part or application of this act is held invalid, the remainder or its application to other situations or persons shall not be affected.
2023 New Mexico Statutes › Chapter 27 - Public Assistance › Article 11 - Medicaid Providers › Section 27-11-10 - Qualifications and selection of hearing officer for expedited adjudicatory proceedings.

A. The hearing officer presiding over the expedited adjudicatory proceeding held pursuant to the Medicaid Provider and Managed Care Act shall:
(1) be licensed and in good standing to practice law in New Mexico or another state;
(2) have at least three years' cumulative experience in one or more of the following areas: the health insurance industry, the medicaid program, health care regulatory compliance, medical claims administration or health law;
(3) not currently be employed by or represent, or belong to a law firm that currently represents, the department or a medicaid provider or managed care organization or third-party administrator currently doing business with the department; and
(4) not be related within the third degree of consanguinity to a person currently employed by the department, currently doing business with the department or currently employed by an organization doing business with the department.
B. The hearing officer shall not be:
(1) a lobbyist registered under the Lobbyist Regulation Act [Chapter 2, Article 11 NMSA 1978] who currently represents, or has in the prior calendar year represented, a client in matters before the department; or
(2) affiliated with, or the spouse of, a lobbyist registered under the Lobbyist Regulation Act who currently represents, or has in the prior calendar year represented, a client in matters before the department.
C. The chief hearing officer of the administrative hearings office shall select the hearing officer to preside over an expedited adjudicatory proceeding held pursuant to the Medicaid Provider and Managed Care Act and the Administrative Procedures Act [12-8-1 to 12-8-25 NMSA 1978].
History:
Laws 2019, ch. 215, § 8.
ANNOTATIONS
Effective dates.
— Laws 2019, ch. 215, § 20 made Laws 2019, ch. 215 effective January 1, 2020.
Severability.
— Laws 2019, ch. 215, § 19, provided that if any part or application of this act is held invalid, the remainder or its application to other situations or persons shall not be affected.
2023 New Mexico Statutes › Chapter 27 - Public Assistance › Article 11 - Medicaid Providers › Section 27-11-11 - Costs of expedited adjudicatory proceeding.

A. Each party shall be responsible for its own costs related to the expedited adjudicatory proceeding, including costs associated with preparation for the hearing, discovery, depositions, subpoenas, service of process and witness expenses, travel expenses and investigation expenses and attorney fees.
B. The hearing officer shall allow telephonic testimony of a witness if requested by a party.
C. The department shall reimburse the administrative hearings office for the costs of a contract hearing officer.
History:
Laws 2019, ch. 215, § 9.
ANNOTATIONS
Effective dates.
— Laws 2019, ch. 215, § 20 made Laws 2019, ch. 215 effective January 1, 2020.
Severability.
— Laws 2019, ch. 215, § 19, provided that if any part or application of this act is held invalid, the remainder or its application to other situations or persons shall not be affected.
2023 New Mexico Statutes › Chapter 27 - Public Assistance › Article 11 - Medicaid Providers › Section 27-11-12 - Rights of medicaid provider or subcontractor; preliminary or final determination of overpayment.

A. A medicaid provider or subcontractor may challenge:
(1) the department's preliminary or final determination of overpayment as:
(a) exceeding statutory authority;
(b) arbitrary or capricious;
(c) a failure to follow department procedure; or
(d) not supported by substantial evidence;
(2) the credentials of persons who participated in the audit or claims review; or
(3) the methodology or accuracy of the department's audit.
B. A medicaid provider or subcontractor may, but shall not be required to, conduct its own audit or sampling to challenge a preliminary or final determination of overpayment.
History:
Laws 2019, ch. 215, § 10.
ANNOTATIONS
Effective dates.
— Laws 2019, ch. 215, § 20 made Laws 2019, ch. 215 effective January 1, 2020.
Severability.
— Laws 2019, ch. 215, § 19, provided that if any part or application of this act is held invalid, the remainder or its application to other situations or persons shall not be affected.
2023 New Mexico Statutes › Chapter 27 - Public Assistance › Article 11 - Medicaid Providers › Section 27-11-13 - Release of suspended payment for services previously rendered; prepayment review; remedial training and education; temporary assistance.

A. The department shall direct the release of a suspended payment to a medicaid provider or subcontractor that is the subject of a referral based upon a determination of a credible allegation of fraud for services previously rendered if the medicaid provider or subcontractor posts a surety bond in the amount of the suspended payment, which posting shall be deemed good cause not to suspend payment.
B. The provisions of this section shall not prevent the department from:
(1) conducting a prepayment review of claims for ongoing services rendered by the medicaid provider or subcontractor;
(2) requiring the medicaid provider or subcontractor or its employees to complete remedial training or education to prevent the submission of claims for payment to which the medicaid provider or subcontractor is not entitled; or
(3) requiring the medicaid provider or subcontractor to engage an independent third party approved by the department to temporarily manage or provide technical assistance to the medicaid provider or subcontractor.
C. The department shall direct that the release of a suspended payment occur no later than ten business days following the earlier of:
(1) the posting of a surety bond by the medicaid provider or subcontractor in the amount of the suspended payment;
(2) notice from the attorney general that the attorney general will not pursue legal action against the medicaid provider or subcontractor arising out of the referral of the medicaid provider or subcontractor based on a determination of a credible allegation of fraud;
(3) the date on which an administrative decision as to the basis for suspending such payments, or portion of such payments, in favor of the medicaid provider or subcontractor becomes final; or
(4) the date on which a judicial decision as to the basis for suspending such payments, or portion of such payments, in favor of the medicaid provider or subcontractor becomes final and not subject to further appeal.
History:
Laws 2019, ch. 215, § 11.
ANNOTATIONS
Effective dates.
— Laws 2019, ch. 215, § 20 made Laws 2019, ch. 215 effective January 1, 2020.
Severability.
— Laws 2019, ch. 215, § 19, provided that if any part or application of this act is held invalid, the remainder or its application to other situations or persons shall not be affected.
2023 New Mexico Statutes › Chapter 27 - Public Assistance › Article 11 - Medicaid Providers › Section 27-11-14 - Maintenance of services; payment for ongoing services.

A. Following the referral of a medicaid provider or subcontractor based on a determination of a credible allegation of fraud, and during the pendency of a dispute between the department and a medicaid provider or subcontractor regarding an alleged overpayment, including an overpayment based in whole or in part on a credible allegation of fraud, the department shall not terminate or deny the medicaid provider's or subcontractor's continued participation in the state's medicaid program if the medicaid provider or subcontractor:
(1) submits to a prepayment review of claims for ongoing services;
(2) demonstrates that its employees have completed remedial training or education required by the department to prevent the submission of claims for payment to which the medicaid provider or subcontractor is not entitled; and
(3) engages an independent third party approved by the department to temporarily manage or provide technical assistance to the medicaid provider or subcontractor following the referral or during the pendency of the dispute.
B. The department shall not unreasonably withhold approval of a third party proposed by the medicaid provider or subcontractor pursuant to Paragraph (3) of Subsection A of this section.
C. A medicaid provider or subcontractor that complies with the requirements of Subsection A of this section shall be reimbursed for each clean claim for ongoing services within ten calendar days of receipt if submitted electronically or thirty calendar days if submitted manually.
History:
Laws 2019, ch. 215, § 12.
ANNOTATIONS
Effective dates.
— Laws 2019, ch. 215, § 20 made Laws 2019, ch. 215 effective January 1, 2020.
Severability.
— Laws 2019, ch. 215, § 19, provided that if any part or application of this act is held invalid, the remainder or its application to other situations or persons shall not be affected.
2023 New Mexico Statutes › Chapter 27 - Public Assistance › Article 11 - Medicaid Providers › Section 27-11-15 - Disposition of recovered medicaid funds.

A. Overpayments collected pursuant to the Medicaid Provider and Managed Care Act on behalf of the state shall be remitted to the department for deposit in the general fund to be used for the state's medicaid program.
B. The department shall not enter into a contract to pay any portion of funds recovered by the state from a medicaid provider, a managed care organization or a subcontractor to any other person unless expressly authorized or required to do so by state or federal law.
History:
Laws 2019, ch. 215, § 13.
ANNOTATIONS
Effective dates.
— Laws 2019, ch. 215, § 20 made Laws 2019, ch. 215 effective January 1, 2020.
Severability.
— Laws 2019, ch. 215, § 19, provided that if any part or application of this act is held invalid, the remainder or its application to other situations or persons shall not be affected.
2023 New Mexico Statutes › Chapter 27 - Public Assistance › Article 11 - Medicaid Providers › Section 27-11-16 - Credible allegation of fraud; judicial review; substantial evidence required.

A. A credible allegation of fraud determination by the department shall be deemed a final agency decision and may be appealed pursuant to Section 39-3-1.1 NMSA 1978.
B. A medicaid provider or subcontractor that is the subject of a referral to the attorney general for further investigation based on a credible allegation of fraud may seek judicial review, pursuant to Section 39-3-1.1 NMSA 1978, of the department's determination that the allegation of fraud is credible. The department shall show by substantial evidence that:
(1) it has followed its own procedures; and
(2) the evidence relied upon to make its credible allegation of fraud determination was relevant, credible and material to the issue of fraud.
C. In a proceeding for judicial review under this section, the reviewing court shall not consider evidence acquired by the department after making its credible allegation of fraud determination.
History:
Laws 2019, ch. 215, § 14.
ANNOTATIONS
Effective dates.
— Laws 2019, ch. 215, § 20 made Laws 2019, ch. 215 effective January 1, 2020.
Severability.
— Laws 2019, ch. 215, § 19, provided that if any part or application of this act is held invalid, the remainder or its application to other situations or persons shall not be affected.
2023 New Mexico Statutes › Chapter 27 - Public Assistance › Article 11 - Medicaid Providers › Section 27-11-18 - Applicability of Administrative Procedures Act.

A. The department shall be subject to Sections 12-8-2, 12-8-10 through 12-8-13, 12-8-15 and 12-8-16 NMSA 1978 for expedited adjudicatory proceedings as provided by the Medicaid Provider and Managed Care Act.
B. Sections 12-8-2, 12-8-10 through 12-8-13, 12-8-15 and 12-8-16 NMSA 1978 apply to Sections 5 [22-11-7 NMSA 1978], 7 [27-11-9 NMSA 1978] through 11 [27-11-13 NMSA 1978] and 14 [27-11-16 NMSA 1978] of this 2019 act.
History:
Laws 2019, ch. 215, § 16.
ANNOTATIONS
Effective dates.
— Laws 2019, ch. 215, § 20 made Laws 2019, ch. 215 effective January 1, 2020.
Severability.
— Laws 2019, ch. 215, § 19, provided that if any part or application of this act is held invalid, the remainder or its application to other situations or persons shall not be affected.
2023 New Mexico Statutes › Chapter 27 - Public Assistance › Article 12 - Child Health (Repealed.) › Section 27-12-1 to 27-12-7 - Repealed.

ANNOTATIONS
Repeals.
— Laws 1998, ch. 52, § 9 repealed 27-12-1 to 27-12-7 NMSA 1978, the Child Health Act, as enacted by Laws 1998, ch. 52, §§ 1 to 7, effective July 1, 2002. For provisions of former sections,
see
the 1999 NMSA 1978 on
NMOneSource.com
.
2023 New Mexico Statutes › Chapter 27 - Public Assistance › Article 13 - Consumer Direction › Section 27-13-1 - Short title.

This act [27-13-1 to 27-13-6 NMSA 1978] may be cited as the "Consumer Direction Act".
History:
Laws 2003, ch. 210, § 1.
ANNOTATIONS
Effective dates.
— Laws 2003, ch. 210, § 7 made the act effective July 1, 2003.
2023 New Mexico Statutes › Chapter 27 - Public Assistance › Article 13 - Consumer Direction › Section 27-13-2 - Purpose.

The purpose of the Consumer Direction Act is to ensure a consumer the right to direct his personal assistance services if he so chooses by selecting an attendant appropriate to his needs and to maximize personal assistance service availability and satisfaction.
History:
Laws 2003, ch. 210, § 2.
ANNOTATIONS
Effective dates.
— Laws 2003, ch. 210, § 7 made the act effective July 1, 2003.
2023 New Mexico Statutes › Chapter 27 - Public Assistance › Article 13 - Consumer Direction › Section 27-13-3 - Definitions.

As used in the Consumer Direction Act:
A. "attendant" means a person, including an allowable family member, who provides personal assistance services;
B. "consumer" means a person receiving personal assistance services through any personal assistance programs offered by the state of New Mexico;
C. "department" means any department or agency of the state offering personal assistance service to individuals;
D. "fiscal intermediary" means a person or entity selected by agreement between the consumer and the department under contract to the department to assist the consumer to perform certain employment functions, including payroll responsibilities for the attendant and filing necessary eligibility information with the department;
E. "personal assistance services" means a prescribed course of regular personal care, including hygiene, mobility and daily living assistance that permits a person to live in his home rather than an institution, including bathing, dressing, grooming, eating, toileting, shopping, transporting, cueing medication administration and communicating;
F. "plan" means a written and signed agreement between a consumer or surrogate and the department for the provision of personal assistance services; and
G. "surrogate" means a family member, legal guardian or other person approved by the consumer and identified in the personal assistance services plan to assist in direction of personal assistance services and choice of attendant.
History:
Laws 2003, ch. 210, § 3.
ANNOTATIONS
Effective dates.
— Laws 2003, ch. 210, § 7 made the act effective July 1, 2003.
2023 New Mexico Statutes › Chapter 27 - Public Assistance › Article 13 - Consumer Direction › Section 27-13-4 - Consumer direction programs authorized.

Consistent with the federal Social Security Act and subject to the appropriation and availability of federal and state funds, each administering department or agency shall by rule provide a program permitting a consumer or surrogate to direct personal assistance services through the hiring, supervision and training of an attendant or attendants paid through a fiscal intermediary under contract with the department.
History:
Laws 2003, ch. 210, § 4.
ANNOTATIONS
Cross references.
— For the federal Social Security Act,
see
42 U.S.C. § 301 et seq.
Effective dates.
— Laws 2003, ch. 210, § 7 made the act effective July 1, 2003.
2023 New Mexico Statutes › Chapter 27 - Public Assistance › Article 13 - Consumer Direction › Section 27-13-5 - Department duties.

A department shall:
A. establish by rule the criteria and procedures for developing and amending a personal assistance services plan with a consumer;
B. develop criteria and procedures for selection of a fiscal intermediary to contract with the department to provide fiscal intermediary services to a consumer; and
C. establish rates for reimbursement of an attendant providing personal assistance services to a consumer and for the compensation of a fiscal intermediary.
History:
Laws 2003, ch. 210, § 5.
ANNOTATIONS
Effective dates.
— Laws 2003, ch. 210, § 7 made the act effective July 1, 2003.
2023 New Mexico Statutes › Chapter 27 - Public Assistance › Article 13 - Consumer Direction › Section 27-13-6 - Report.

Annually by October 1, each department shall deliver a report to the legislative finance committee and the legislative health and human services committee on services provided pursuant to the Consumer Direction Act and a comparison of those services and services provided by the department through other means and an evaluation of the effectiveness and consumer satisfaction with the respective means of service delivery.
History:
Laws 2003, ch. 210, § 6.
ANNOTATIONS
Effective dates.
— Laws 2003, ch. 210, § 7 made the act effective July 1, 2003.
2023 New Mexico Statutes › Chapter 27 - Public Assistance › Article 13 - Consumer Direction › Section 27-13-7 - Fiscal intermediary; exemptions; workers' compensation.

A. A fiscal intermediary shall not be subject to vicarious liability as an employer or principal for a wrongful act committed by a personal care attendant if the attendant:
(1) is not a current or former employee of the fiscal intermediary;
(2) has not received training or instruction from the fiscal intermediary with respect to providing personal care services to a person with a disability, not including administrative paper work;
(3) has been hired by and received training or instruction from the consumer or the consumer's authorized representative to provide personal care to the consumer; and
(4) provides basic assistance with daily living activities that do not require the education, certification or training of a licensed health care practitioner.
B. A fiscal intermediary may identify a personal care attendant as a covered employee with the fiscal intermediary's workers' compensation carrier solely to provide workers' compensation coverage in the event of a work-related injury. Nothing in this subsection shall be construed to create an employer-employee relationship between the fiscal intermediary and the personal care attendant.
C. Nothing in this section shall be construed to provide the fiscal intermediary with immunity from a claim for a wrongful act committed by the fiscal intermediary or its employees.
D. As used in this section:
(1) "consumer" means a person who is eligible for and receives state-funded or -operated services based on the person's disabilities;
(2) "fiscal intermediary" means a provider that furnishes administrative assistance for a consumer who selects a consumer-directed, rather than consumer-delegated, personal care program;
(3) "personal care attendant" means a person who provides assistance to a consumer with activities of daily living, including bathing, dressing, eating, transportation, shopping and similar activities; and
(4) "personal care program" means a state-funded or -operated support program, including medicaid, that provides the services of a personal care attendant for certain persons with a disability.
History:
Laws 2003, ch. 207, § 1; 2007, ch. 46, § 23.
ANNOTATIONS
The 2007 amendment,
effective June 15, 2007, made non-substantive language changes.
2023 New Mexico Statutes › Chapter 27 - Public Assistance › Article 14 - Medicaid False Claims Act › Section 27-14-1 - Short title.

This [act] may be cited as the "Medicaid False Claims Act" .
History:
Laws 2004, ch. 49, § 1.
ANNOTATIONS
ANNOTATIONS
Bracketed material.
— The bracketed material was added by the compiler and is not a part of the law.
Cross references.
— For the Medicaid Fraud Act,
see
Chapter 30, Article 44 NMSA 1978.
Effective dates.
— Laws 2004, ch. 49 contained no effective date provision, but, pursuant to N.M. Const., art. IV, § 23, was effective May 19, 2004, 90 days after adjournment of the legislature.
2023 New Mexico Statutes › Chapter 27 - Public Assistance › Article 14 - Medicaid False Claims Act › Section 27-14-2 - Purpose.

The purpose of the Medicaid False Claims Act is to deter persons from causing or assisting to cause the state to pay medicaid claims that are false and to provide remedies for obtaining treble damages and civil recoveries for the state when money is obtained from the state by reason of a false claim.
History:
Laws 2004, ch. 49, § 2.
ANNOTATIONS
Effective dates.
— Laws 2004, ch. 49 contained no effective date provision, but, pursuant to N.M. Const., art. IV, § 23, was effective May 19, 2004, 90 days after adjournment of the legislature.