New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 314 - LONG TERM CARE SERVICES - WAIVERS › Part 5 - DEVELOPMENTAL DISABILITIES HOME AND COMMUNITY-BASED SERVICES WAIVER › Section 8.314.5.20 - RIGHT TO A HSD ADMINISTRATIVE HEARING

Current through Register Vol. 35, No. 13, July 16, 2024
An eligible recipient may request a HSD administrative
				  hearing to appeal a decision of MAD or its third party assessor contractor,
				  that is an adverse action against the recipient. Prior to the fair hearing an
				  eligible recipient may be offered an agency review conference. An agency review
				  conference (AC) means an optional conference offered by HSD to provide an
				  opportunity to informally resolve a dispute over the denial, suspension,
				  reduction, termination or modification of DDW benefits or services. An AC will
				  be attended by the recipient and their authorized representative if applicable,
				  representatives of the TPA, HSD and any other necessary parties. The recipient
				  may also bring whomever they wish to assist during the AC. The AC is optional
				  and shall in no way delay or replace the fair hearing process or affect the
				  deadline for a fair hearing request.
A. An authorized representative means any
				individual designated by the eligible recipient or their guardian, if
				applicable, to represent the recipient and act on their behalf. The authorized
				representative must provide formal documentation authorizing them to access the
				identified case information for this specific purpose. An authorized
				representative may be, but need not be, the recipient's guardian or
				attorney.
B. The HSD will issue
				written notification describing the outcome of the AC and any agreements within
				seven business days of the AC to the recipient, recipient's guardian if
				applicable, and case manager.
C.
				Unless the fair hearing request is withdrawn by the recipient or recipient's
				guardian or lawyer, any requested fair hearing will proceed. At the fair
				hearing the claimant may raise any relevant issue and present any relevant
				information that they choose. See 8.352.2 NMAC for a description of a
				claimant's HSD administrative hearing rights and responsibilities.
D. In addition to the requirements set forth
				in 8.352.2 NMAC, HSD shall take such actions as are necessary to assure the
				presence at the hearing of all necessary witnesses within DOH's control,
				including, when relevant to a denial of services or when requested by the
				claimant, a representative of the TPA with knowledge of the claimant's case and
				the reason(s) for the denial, in whole or in part, of any requested
				services.
E. Denials of services
				through the exception authorization process or other actions during this
				process adverse to the participant can also be appealed through a fair
				hearing.
F. All HSD administrative
				hearings are conducted in accordance with state and federal law.
G. No ex parte communications with an HSD
				administrative law judge are permitted by any DDW participant or counsel
				regarding any pending case. The MAD director shall not have ex parte
				communications regarding any pending cases with any DDW participant or counsel
				involved in that case. The MAD director's decision shall be limited to an on
				the record review.