2023 New Mexico Statutes › Chapter 9 - Executive Department › Article 8 - Health Care Authority Department › Section 9-8-7.1 - Behavioral health services division; powers and duties of the department.

Subject to appropriation, the department shall:
A. contract for behavioral health treatment and support services, including mental health, alcoholism and other substance abuse services;
B. establish standards for the delivery of behavioral health services, including quality management and improvement, performance measures, accessibility and availability of services, utilization management, credentialing and recredentialing, rights and responsibilities of providers, preventive behavioral health services, clinical treatment and evaluation and the documentation and confidentiality of client records;
C. ensure that all behavioral health services, including mental health and substance abuse services, that are provided, contracted for or approved are in compliance with the requirements of Section 9-7-6.4 NMSA 1978;
D. assume responsibility for and implement adult mental health and substance abuse services in the state in coordination with the children, youth and families department;
E. create, implement and continually evaluate the effectiveness of a framework for targeted, individualized interventions for persons who are incarcerated in a county or municipal correctional facility and adult and juvenile offenders who have behavioral health diagnoses, which framework shall address those persons' behavioral health needs while they are incarcerated and connect them to resources and services immediately upon release;
F. establish criteria for determining individual eligibility for behavioral health services; and
G. maintain a management information system in accordance with standards for reporting clinical and fiscal information.
History:
Laws 2007, ch. 325, § 4; 2019, ch. 211, § 1; 2019, ch. 222, § 1; 2023, ch. 205, § 8.
ANNOTATIONS
Repeals.
— Laws 2023, ch. 205, § 17 repealed Laws 2019, ch. 211, § 1, effective June 16, 2023.
The 2023 amendment,
effective June 16, 2023, in the section heading, deleted "human services".
Temporary provisions.
— Laws 2023, ch. 205, § 16 provided:
A. The governor may issue an executive order that further delineates the organizational structure, power and duties of the health care authority department and moves divisions and programs to or from other departments to accomplish the reorganizational goals of this act. The governor shall report the reorganizational changes and recommend statutory changes to the legislative health and human services committee and the legislative finance committee by November 1, 2023 and provide a final reorganization report to the legislature by January 1, 2024.
B. On July 1, 2023, statutory references to the human services department shall be deemed to be references to the health care authority department, and contractual obligations of the human services department shall be binding on the health care authority department. Rules of the human services department shall be the rules of the health care authority department until amended or repealed. As functions of government are transferred to the health care authority department as specified in Section 9-8-4 NMSA 1978, statutory references shall be deemed to be references to the health care authority department, contractual obligations shall be binding on the department and existing pertinent rules shall be the rules of the department until amended or repealed.
C. The department of finance and administration, the secretary of health care authority, the secretary of health, the secretary of general services, members of the governor's staff and other persons assigned by the governor shall develop a transition plan that includes:
(1) what units of the executive department shall be transferred to or from the health care authority department and working and final organizational charts for all affected units of the executive departments;
(2) how and when functions, personnel, money, appropriations, equipment, supplies and other property of the human services department, the department of health, the general services department and other units of the executive department shall be transferred to or from the health care authority department; and
(3) proposed statutory changes, including changes in Chapters 9, 10 and 24 NMSA 1978 and the creation of a new chapter of the NMSA 1978 to include sections of Chapters 9 and 24 NMSA 1978 and other provisions of law pertaining to health care purchasing and regulation.
The 2019 amendment,
effective June 14, 2019, required the behavioral health services division of the human services department to create, implement, and evaluate a framework of interventions for adult and juvenile offenders incarcerated in a county or municipal correctional facility to address offenders' needs while they are incarcerated and connect them to resources and services upon their release; added new Subsection E and redesignated former Subsections E and F as Subsections F and G, respectively..
Department's burden in an action to recover improper payments from providers.
— In an action to recover improper payments to providers, the New Mexico human services department [health care authority department] not only must provide by a preponderance of the evidence at the fair hearing that the identified claims failed, but also that its mathematical calculations of the overpayment were properly calculated and the methodology it used to choose the sample was valid.
Counseling Center, Inc. v. N.M. Human Servs. Dep't
, 2018-NMCA-063, cert. denied.
Provider's burden in a department action to recover improper payments.
— If a health care provider wishes to challenge the methodology used to choose the sample size of an audit or to randomly select the claims for audit, the relevant regulation requires that, rather than merely choose a different sample size, or select a different set of claims for audit, the provider must audit the entire universe of claims at issue.
Counseling Center, Inc. v. N.M. Human Servs. Dep't
, 2018-NMCA-063, cert. denied.
The administrative law judge improperly shifted the burden of proof.
— Where the New Mexico human services department (HSD) [health care authority department] appealed the district court's reversal of an administrative decision requiring respondent, a behavioral health care provider, to reimburse HSD for claimed overpayments, and where the administrative law judge (ALJ) failed to reach any conclusion regarding the validity of the alleged failed claims because respondent had not performed a one-hundred percent audit of the universe of provider records, the ALJ improperly shifted the burden of proof to respondent, as respondent was not required to provide a one-hundred percent audit of the universe of providers before the ALJ could properly consider whether the claims used to extrapolate respondent's alleged overpayment actually failed.
Counseling Center, Inc. v. N.M. Human Servs. Dep't
, 2018-NMCA-063, cert. denied.
Substantial evidence of over payment of medicaid funds.
— Where the New Mexico human services department (HSD) [health care authority department] appealed the district court's reversal of an administrative decision requiring respondent, a behavioral health care provider, to reimburse HSD for claimed overpayments, and where the administrative law judge (ALJ) concluded that respondent was credited with medicaid funds, notwithstanding that respondent did not bill these claims to medicaid, the district court erred when it concluded that the ALJ's decision requiring respondent to return fees was not supported by substantial evidence, because the uncontroverted evidence established that respondent was paid with medicaid funds that were not eligible for payment by medicaid, and federal law requires that overpayments of medicaid funds must be returned.
Counseling Center, Inc. v. N.M. Human Servs. Dep't
, 2018-NMCA-063, cert. denied.