reglab/statecodes huggingface dataset:
New Mexico Administrative Code › Title 7 - HEALTH › Chapter 29 - PRIMARY AND RURAL HEALTH CARE SERVICES › Part 4 - PRIMARY CARE CAPITAL FUND PROGRAM › Section 7.29.4.8 - APPLICATION PROCEDURES FOR FINANCIAL ASSISTANCE

Current through Register Vol. 35, No. 13, July 16, 2024
A. Contingent upon a sufficient balance in
				the Fund, the Department and the Authority may establish one or more
				application cycles in any state fiscal year. At the beginning of any
				application cycle, the Department and the Authority will notify eligible
				entities that applications are being accepted for financing of Capital
				Projects.
B. The Department and the
				Authority will provide forms and/or guidelines for application to apply for
				Program funds. The application shall be signed by the Authorized Representative
				and submitted to the Department. The application shall include the following:
(1) type of Financial Assistance being sought
				and itemization of the proposed use or uses of the Financial
				Assistance;
(2) detailed
				description of the circumstances which justify the need for the Capital
				Project, including:
(a) eligibility of
				application entity
(b) programmatic
				appropriateness
(c) facility need
				as covered in Section 9.2.a.
(d)
				needs of community as covered in Section 9.2 b.
(3) detailed description of the Capital
				Project to be financed. Information on each Capital Project must include:
(a) description of the scope of work of the
				Capital Project;
(b) the estimated
				cost of the Capital Project;
(c)
				the target date for the initiation of the Capital Project and the estimated
				time to completion;
(d) the
				estimated useful life of the Capital Project and selected components
				(furnishings, equipment, etc.), as detailed on the application form;
(e) proof of applicable licenses and
				certifications; and
(f) other data
				as requested by the Department or the Authority.
(4) a copy of the Applicant's articles of
				incorporation and by-laws;
(5) a
				copy of the Applicant's Internal Revenue Service tax exempt determination
				letter;
(6) a letter certifying
				that the Capital Project was duly authorized and approved by the Applicant's
				governing body;
(7) identification
				of the source of funds for repayment of the Financial Assistance and the source
				of funds to operate and maintain the Capital Project over its useful
				life;
(8) the Applicant's audited
				financial reports for the most recent three years;
(9) the requested loan payback
				period;
(10) any existing title
				insurance policies, title abstracts or searches of the real property owned by
				the Applicant;
(11) information on
				the current and proposed services of the Applicant to the sick and medically
				indigent;
(12) additional
				information as requested by the Department, Board or Finance
				Committee.
New Mexico Administrative Code › Title 7 - HEALTH › Chapter 29 - PRIMARY AND RURAL HEALTH CARE SERVICES › Part 4 - PRIMARY CARE CAPITAL FUND PROGRAM › Section 7.29.4.10 - ELIGIBLE PUBLIC CAPITAL PROJECTS AND COSTS

Current through Register Vol. 35, No. 13, July 16, 2024
The Authority provides Financial Assistance to eligible
				  entities only for Capital Projects, as defined above. Costs which may be
				  financed under the Program include all or any portion of the cost of eligible
				  Capital Projects. An Applicant which has had Financial Assistance approved by
				  the Board may apply to the Board to redirect the Financial Assistance to modify
				  a Capital Project made necessary by unanticipated events.
New Mexico Administrative Code › Title 7 - HEALTH › Chapter 29 - PRIMARY AND RURAL HEALTH CARE SERVICES › Part 4 - PRIMARY CARE CAPITAL FUND PROGRAM › Section 7.29.4.11 - CAPITAL PROJECT FINANCING

Current through Register Vol. 35, No. 13, July 16, 2024
A.
				The Authority reserves the right to structure Financial Assistance packages
				that include loans, contracts for services, and any other type of assistance
				authorized by the Act. The structure, terms and conditions of the Financial
				Assistance will be determined by Board resolution. Financial Assistance for
				Capital Projects may be pooled, at the discretion of the Authority.
B. Priority will be given to applications for
				Capital Projects which show substantial community support, including, but not
				limited to, the identification of other financing.
C. Eligible Items/Ineligible Items. The
				following items shall be eligible or ineligible for purposes of funding through
				a loan or Contract for Services.
(1)
Eligible Item/Uses of Funds
a. Building, construction,
				renovation
b. Land (can only be
				funded by a loan)
c. Capital
				Project planning and design
d.
				Purchase of capital equipment
New Mexico Administrative Code › Title 7 - HEALTH › Chapter 29 - PRIMARY AND RURAL HEALTH CARE SERVICES › Part 4 - PRIMARY CARE CAPITAL FUND PROGRAM › Section 7.29.4.12 - FINANCING APPROVAL REQUIREMENTS

Current through Register Vol. 35, No. 13, July 16, 2024
Based on the evaluation factors set forth in 7.29.4.9, the
				  Board may award Financial Assistance to the Applicant provided the following
				  requirements are satisfied:
A. In
				determining the qualification for Financial Assistance, the Board may consider
				the ability of the Eligible Entity to secure financing from other sources and
				the costs of the Financial Assistance.
B. In approving a Contract for Services, the
				Board will consider the recommendations of the Finance Committee.
C. In approving a loan application, the Board
				will review the Applicant's ability to repay the loan extended. The Board will
				establish a base interest rate for loans. A portion or all of the loan
				repayment may be offset by a contract for service.
D. In approving an application for debt
				financing, the Board will find that the useful life of the Capital Project will
				meet or exceed the final maturity of loans made or bonds purchased or issued by
				the Board and must meet standards for reasonable costs set by the
				Board.
E. To be eligible for a
				loan, the Applicant shall agree to properly maintain separate Capital Project
				accounts in accordance with generally accepted accounting principles and to
				conduct an annual audit of the Capital Project's financial records during the
				term of the loan.
F. In order to
				receive Financial Assistance, the Applicant shall provide a written opinion,
				signed by an attorney, that the Eligible Entity has or will acquire proper
				title, easements and rights-of-way to the property upon or through which the
				Capital Project is to be constructed or extended.
G. Any contract or subcontract executed for
				the completion of any Capital Project shall contain a provision that there
				shall be no discrimination against any employee or Applicant for employment
				because of race, color, creed, sex, religion, sexual preference, ancestry or
				national origin.
H. In order to
				receive Financial Assistance, the Applicant shall require any contractor of a
				Capital Project to post a performance and payment bond in accordance with the
				requirements of Section
				13-4-18
				NMSA 1978 and its subsequent amendments and successor provisions.
I. In addition to the foregoing, the Eligible
				Entity shall satisfy any other requirements as may be determined by the
				Authority.
J. Reserved
New Mexico Administrative Code › Title 7 - HEALTH › Chapter 29 - PRIMARY AND RURAL HEALTH CARE SERVICES › Part 4 - PRIMARY CARE CAPITAL FUND PROGRAM › Section 7.29.4.13 - RECONSIDERATION

Current through Register Vol. 35, No. 13, July 16, 2024
A. An Applicant may
				request reconsideration of a contrary decision by the Department as to whether
				it is an Eligible Entity as defined by the Act. Notice must be given to the
				Department in writing within ten (10) working days of receipt of the
				Department's decision as to eligibility.
B. An Applicant may request reconsideration
				of a decision by the Board denying funding to an Eligible Entity by notifying
				the Authority in writing within forty-five days of the date on which notice of
				an adverse decision is given by the Authority to an Applicant. Notice is deemed
				to be given on the fifth business day following the date on which written
				notice is mailed to the Applicant by the Authority by certified U.S. mail. A
				request for reconsideration not timely or properly made will be barred. The
				Authority's Executive Director will promptly review each timely request for
				reconsideration and will recommend, at the next regular meeting of the Board,
				action to be taken by the Board. The Board will review and take action on the
				request for reconsideration and will notify the Applicant of the Board's
				decision, in writing, within five working days of the Board's decision. The
				decision of the Board is final.
New Mexico Administrative Code › Title 7 - HEALTH › Chapter 29 - PRIMARY AND RURAL HEALTH CARE SERVICES › Part 4 - PRIMARY CARE CAPITAL FUND PROGRAM › Section 7.29.4.14 - FINANCIAL ASSISTANCE AGREEMENT

Current through Register Vol. 35, No. 13, July 16, 2024
A. The Authority and the Eligible Entity will
				enter into an Agreement to establish the terms and conditions of Financial
				Assistance from the Authority including, as appropriate, a Contract for
				Services. The Agreement will include the terms of repayment and sanctions
				available to the Authority in the event of a default. The Authority will
				diligently monitor terms of the Agreement and enforce all terms and conditions
				thereof, including prompt notice and collection. The Department will monitor
				the performance of an Eligible Entity under any Contract for Services and
				report to the Authority quarterly on the contractor's efforts to provide free
				or reduced fee Primary Care services for Sick and Medically Indigent persons.
				The Authority will take actions as necessary to ensure loan repayment and the
				integrity of the Fund.
B. The
				interest on any Financial Assistance extended shall be determined by the Board
				based on the cost of funds and ability of the Eligible Entity to pay. The
				interest rate shall not change during the term of the Financial Assistance
				unless refinanced.
C. The Agreement
				will contain provisions which require Financial Assistance recipients to comply
				with all applicable federal, state and local laws and regulations.
D. In the event of default by the qualified
				entity, the Authority may enforce its rights by suit or mandamus and may
				utilize all other available remedies under state and applicable federal
				law.
E. If land is to be purchased
				with a loan from the Fund, the Authority shall ensure that the title is
				merchantable and free and clear from liens or encumbrances. The state shall
				also require that a title insurance policy insuring the state's interest as a
				first lien be obtained as a condition of making the loan. The Eligible Entity
				shall not encumber the land purchased by granting or creating any additional
				security interest in the land while any amount of the loan is unpaid. The
				Eligible Entity shall pay immediately any encumbrance or lien against the land
				that attaches while any amount of the loan is unpaid. No contracts for services
				shall be made to purchase land.
F.
				If an Eligible Entity that has received a loan or Contract for Services for a
				Capital Project ceases to maintain its nonprofit status or ceases to deliver
				Primary Care services at the site of the Capital Project for twelve consecutive
				months, the state shall have the following remedies at its option, subject to
				liens having preference:
(1) order
				liquidation of the premises and recover any loan balance or amount due on the
				contract and any interest previously forgiven on the loan, imputed at the
				prevailing interest rate at the time of the loan; or
(2) foreclose on the property and convert it
				to state use or transfer title to another Eligible Entity.
New Mexico Administrative Code › Title 7 - HEALTH › Chapter 29 - PRIMARY AND RURAL HEALTH CARE SERVICES › Part 4 - PRIMARY CARE CAPITAL FUND PROGRAM › Section 7.29.4.15 - ADMINISTRATION OF THE PRIMARY CARE CAPITAL FUND

Current through Register Vol. 35, No. 13, July 16, 2024
A. The Fund shall be administered by the
				Authority as a separate account in the State Treasury, but may consist of such
				sub accounts as the Authority deems necessary to carry out the purposes of the
				Fund.
B. Money from repayments of
				loans or payments on securities held by the Authority for Capital Projects
				authorized specifically by law shall be deposited in the Fund. The Fund shall
				also consist of any other money appropriated, distributed or otherwise
				allocated to the Fund for the purpose of financing Capital Projects authorized
				specifically by law.
C. The
				Authority shall adopt a uniform accounting system for the Fund and related
				accounts and sub-accounts established by the Authority, based on generally
				accepted accounting principles.
New Mexico Administrative Code › Title 7 - HEALTH › Chapter 29 - PRIMARY AND RURAL HEALTH CARE SERVICES › Part 5 - CERTIFICATION OF COMMUNITY HEALTH WORKERS › Section 7.29.5.2 - SCOPE

Current through Register Vol. 35, No. 13, July 16, 2024
This rule applies to any person seeking to practice as a
				  certified community health worker in the state of New Mexico.
New Mexico Administrative Code › Title 7 - HEALTH › Chapter 29 - PRIMARY AND RURAL HEALTH CARE SERVICES › Part 5 - CERTIFICATION OF COMMUNITY HEALTH WORKERS › Section 7.29.5.3 - STATUTORY AUTHORITY

Current through Register Vol. 35, No. 13, July 16, 2024
These rules are promulgated pursuant to the following
				  statutory authorities:
1) the
				Department of Health Act, Subsection E of Section
				9-7-6
				NMSA 1978, which authorizes the secretary of the department of health to
				"...make and adopt such reasonable and procedural rules and regulations as may
				be necessary to carry out the duties of the department and its divisions," and;
2) the Community Health Workers
				Act, Sections
				24-30-1
				through
				24-30-7
				NMSA 1978, which authorizes the department to adopt regulations to carry out
				the provisions of the act.
New Mexico Administrative Code › Title 7 - HEALTH › Chapter 29 - PRIMARY AND RURAL HEALTH CARE SERVICES › Part 5 - CERTIFICATION OF COMMUNITY HEALTH WORKERS › Section 7.29.5.5 - EFFECTIVE DATE

Current through Register Vol. 35, No. 13, July 16, 2024
January 30, 2015, unless a later date is cited at the end of
				  a section.
New Mexico Administrative Code › Title 7 - HEALTH › Chapter 29 - PRIMARY AND RURAL HEALTH CARE SERVICES › Part 5 - CERTIFICATION OF COMMUNITY HEALTH WORKERS › Section 7.29.5.6 - OBJECTIVE

Current through Register Vol. 35, No. 13, July 16, 2024
The objective of this rule is to implement the Community
				  Health Workers Act. This rule governs the voluntary certification of community
				  health workers (CHWs) in New Mexico.
New Mexico Administrative Code › Title 7 - HEALTH › Chapter 29 - PRIMARY AND RURAL HEALTH CARE SERVICES › Part 5 - CERTIFICATION OF COMMUNITY HEALTH WORKERS › Section 7.29.5.7 - DEFINITIONS

Current through Register Vol. 35, No. 13, July 16, 2024
A.
"Action
				against a certificate"
means any formal action taken by the department
				that adversely affects certification status, including but not limited to
				denial of initial certification or re-certification, suspension or revocation
				or a certificate, probation or reprimand.
B.
"Applicant"
means an
				individual applying for community health worker certification or
				recertification.
C.
"Board"
means the board of certification of community health workers
				established under these rules.
D.
"Certificate"
means the document issued by the department to
				qualified applicants who have successfully completed the application process
				for certification as community health workers.
E.
"Certification"
means the
				voluntary process by which the department grants recognition and use of a
				credential to individuals who are eligible to practice as certified community
				health workers.
F.
"Certified community health worker"
or
"CCHW"
means a
				community health worker to whom the department has issued a certificate to
				practice as a certified community health worker.
G.
"Community health worker"
or
"CHW"
means a public health worker, also known as a tribal
				community health representative or a promotora, who applies an understanding of
				the experience, language, and culture of the populations that the individual
				serves and who provides services aimed at optimizing individual, family and
				community health outcomes.
H.
"Continuing education"
means courses or training designed to
				develop and enhance knowledge, skills, and professional development to ensure
				that CCHWs are up to date with current practices in the field.
I.
"Conviction"
means a plea or
				adjudication of guilt, a plea of nolo contendre, or an Alford plea, and does
				not include a conditional discharge or deferred adjudication that results in
				dismissal of a charge.
J.
"Core competencies"
means a combination of qualities, practical skills
				and knowledge, defined by the department as essential to the provision of
				services by community health workers, demonstration of which is required for
				certification.
K.
"Department"
means the department of health.
L.
"Recertification"
means a
				renewal of certification.
M.
"Scope of practice"
means the roles and related tasks performed by CCHWs
				in the provision of services, including the knowledge, skills and attributes
				needed to perform work-related functions, as defined by the
				department.
N.
"Secretary"
means the secretary of the department of health.
New Mexico Administrative Code › Title 7 - HEALTH › Chapter 29 - PRIMARY AND RURAL HEALTH CARE SERVICES › Part 5 - CERTIFICATION OF COMMUNITY HEALTH WORKERS › Section 7.29.5.8 - BOARD OF CERTIFICATION OF COMMUNITY HEALTH WORKERS

Current through Register Vol. 35, No. 13, July 16, 2024
A.
Board membership:
(1) The board shall be comprised of nine
				members who are residents of New Mexico, appointed by the secretary, and shall
				include:
(a) three currently practicing CHWs,
				including at least one tribal community health representative;
(b) the secretary or the secretary's
				designee, who shall serve as chair of the board; and
(c) five additional members that the
				secretary shall endeavor to appoint from community health stakeholders
				including but not limited to health care providers, tribal representatives,
				individuals from institutions of higher learning, or members of the community
				from various geographic regions of the state.
New Mexico Administrative Code › Title 7 - HEALTH › Chapter 29 - PRIMARY AND RURAL HEALTH CARE SERVICES › Part 5 - CERTIFICATION OF COMMUNITY HEALTH WORKERS › Section 7.29.5.9 - NEW MEXICO REGISTRY OF COMMUNITY HEALTH WORKERS

Current through Register Vol. 35, No. 13, July 16, 2024
The New Mexico registry of community health workers shall be
				  maintained at the department. The registry is voluntary and open to all persons
				  who are CCHWs in the state of New Mexico. The registry shall contain the name,
				  certification number, certification status, and geographic location of the
				  CCHW. Registry information is subject to public inspection.
New Mexico Administrative Code › Title 7 - HEALTH › Chapter 29 - PRIMARY AND RURAL HEALTH CARE SERVICES › Part 5 - CERTIFICATION OF COMMUNITY HEALTH WORKERS › Section 7.29.5.10 - COMMUNITY HEALTH WORKER CERTIFICATION

Current through Register Vol. 35, No. 13, July 16, 2024
A.
Initial certification:
(1) All applicants for initial certification
				in New Mexico shall:
(a) submit to the
				department a completed application in a form specified by the department to
				include verification that applicant has met the eligibility
				requirements;
(b) submit to the
				department the designated application fee; and
(c) if an applicant otherwise meets the
				eligibility requirements, then in accordance with this rule, submit a request
				to the department of public safety (DPS) or a DPS vendor for a state and
				national criminal history screening. The results of the criminal history
				screening shall be received by the department before a certificate can be
				issued.
New Mexico Administrative Code › Title 7 - HEALTH › Chapter 29 - PRIMARY AND RURAL HEALTH CARE SERVICES › Part 5 - CERTIFICATION OF COMMUNITY HEALTH WORKERS › Section 7.29.5.11 - CRIMINAL HISTORY SCREENING

Current through Register Vol. 35, No. 13, July 16, 2024
A.
				The department is authorized to obtain the criminal history records of
				applicants and to exchange fingerprint data directly with the federal bureau of
				investigation (FBI), DPS and any other law enforcement agency or organization.
				The department shall require fingerprinting of applicants for the purposes of
				this section.
B. Procedure:
(1) If an applicant otherwise meets the
				eligibility requirements, then the department shall require the applicant to
				submit a request to DPS or a DPS vendor for a current state and national
				criminal history screening.
(2) The
				department shall provide applicants with the department's originating agency
				identification (ORI) number or other department identifier for the purposes of
				criminal history screening.
(3)
				Applicant shall provide to DPS or a DPS vendor a background check request,
				fingerprints, and supporting documentation including an authorization for
				release of information to the department in accordance with DPS or the
				designated vendor's procedures.
(4)
				DPS or the designated DPS vendor shall review state records and also transmit
				the fingerprints to the FBI for a national screening. The results of the
				screening shall be made available to the department for review.
(5) The department shall make a determination
				whether the applicant has been convicted of a felony that bears upon the
				applicant's fitness to provide services.
(6) Applicant shall bear any costs associated
				with ordering or conducting criminal history screening. Fees are determined by
				and payable to DPS or the designated DPS vendor. Fees cannot be waived by the
				department.
(7) The department
				shall comply with applicable confidentiality requirements of DPS and the FBI
				regarding the maintenance, dissemination, and destruction of criminal
				background check information.
(8)
				For applicants with no criminal history, or with no history of felony
				convictions, the department shall issue a certificate in accordance with this
				rule if all other requirements for certification have been satisfied.
New Mexico Administrative Code › Title 7 - HEALTH › Chapter 29 - PRIMARY AND RURAL HEALTH CARE SERVICES › Part 5 - CERTIFICATION OF COMMUNITY HEALTH WORKERS › Section 7.29.5.12 - CERTIFICATION REVIEW COMMITTEE

Current through Register Vol. 35, No. 13, July 16, 2024
A. A
				certification review committee is hereby established. The committee shall be
				appointed by the secretary and shall be comprised of five employees of the
				public health division, to include the division director, the deputy director
				of programs, and the CHW program manager. The committee shall conduct an
				individualized review of the grounds for action against a certificate and shall
				determine whether to pursue action against a certificate by a majority vote. A
				certificate may be denied, suspended or revoked, or may be subject to any
				lesser action, including but not limited to reprimand or probation.
B.
Grounds for action against a
				certificate:
(1) Conviction of a felony
				that bears upon the applicant's fitness to provide services.
(2) Fraud, deceit, or misrepresentation
				during the certification application process.
(3) Failure to possess and apply the
				knowledge, skill or care that is ordinarily possessed and exercised by CCHWs or
				as defined by the core competencies.
(4) Unprofessional conduct, which includes
				but is not limited to:
(a) verbally or
				physically abusing a client;
(b)
				unauthorized practice or practice which is beyond the defined scope of practice
				for CCHWs, including unauthorized use of the CCHW designation;
(c) unauthorized disclosure of medical or
				other confidential information;
(d)
				obtaining or attempting to obtain any fee for client services for one's self or
				for another through fraud, misrepresentation or deceit; or
(e) physical or mental incapacity which could
				result or has resulted in performance of CCHW duties in a manner which
				endangers the health and safety of others.
New Mexico Administrative Code › Title 7 - HEALTH › Chapter 29 - PRIMARY AND RURAL HEALTH CARE SERVICES › Part 5 - CERTIFICATION OF COMMUNITY HEALTH WORKERS › Section 7.29.5.13 - HEARINGS

Current through Register Vol. 35, No. 13, July 16, 2024
A.
Right to
				appeal:
An applicant may appeal a decision by the department to deny,
				suspend or revoke a certificate by requesting a hearing by mailing a certified
				return receipt letter to the address provided in the notice of action within 20
				days after service of notice.
B.
Notice:
The department shall serve upon an applicant written
				notice containing the action against a certificate and a statement of the
				grounds or subject upon which the action is based and instructions for
				requesting a hearing.
C.
Notice of hearing:
Upon receipt of a timely request for a hearing, the
				department shall appoint a hearing officer and schedule a hearing, to be held
				in Santa Fe, New Mexico within 60 working days of receipt of the request.
(1) Either party may request a continuance at
				least 10 days prior to the scheduled hearing, to be approved or denied by the
				hearing officer.
(2) If an
				applicant fails to appear after requesting a hearing, the hearing officer may
				proceed to consider the matter and render a report and
				recommendation.
(3) If no request
				for a hearing is made in the time and manner specified, the committee shall
				take the action against the certificate and such action shall be
				final.
New Mexico Administrative Code › Title 7 - HEALTH › Chapter 29 - PRIMARY AND RURAL HEALTH CARE SERVICES › Part 5 - CERTIFICATION OF COMMUNITY HEALTH WORKERS › Section 7.29.5.14 - INSPECTION OF RECORDS

Current through Register Vol. 35, No. 13, July 16, 2024
The following records are not subject to public inspection,
				  and shall be maintained in a confidential manner:
A. Health information protected by state and
				federal laws.
B. Materials
				associated with reviews conducted by the certification review committee,
				including but not limited to criminal history information.
C. Complaints or allegations regarding a CCHW
				that are not substantiated following investigation.
D. Personal identifiers in applications, such
				as date of birth, social security numbers, home address and phone
				numbers.
New Mexico Administrative Code › Title 7 - HEALTH › Chapter 30 - FAMILY AND CHILDREN HEALTH CARE SERVICES › Part 3 - CHILDREN'S MEDICAL SERVICES AND ADULT CYSTIC FIBROSIS › Section 7.30.3.1 - ISSUING AGENCY

Current through Register Vol. 35, No. 13, July 16, 2024
The Department of Health, Public Health
				  Division.
New Mexico Administrative Code › Title 7 - HEALTH › Chapter 30 - FAMILY AND CHILDREN HEALTH CARE SERVICES › Part 3 - CHILDREN'S MEDICAL SERVICES AND ADULT CYSTIC FIBROSIS › Section 7.30.3.3 - STATUTORY AUTHORITY

Current through Register Vol. 35, No. 13, July 16, 2024
The regulations set forth herein are promulgated by the
				  secretary of department of health by authority of Subsections E and F of
				  Section
				  9-7-6
				  NMSA 1978 and Section
				  24-2-1
				  NMSA 1978. Administration and enforcement of these regulations is the
				  responsibility of the public health division of the department of
				  health.
New Mexico Administrative Code › Title 7 - HEALTH › Chapter 30 - FAMILY AND CHILDREN HEALTH CARE SERVICES › Part 3 - CHILDREN'S MEDICAL SERVICES AND ADULT CYSTIC FIBROSIS › Section 7.30.3.5 - EFFECTIVE DATE

Current through Register Vol. 35, No. 13, July 16, 2024
October 30, 2012, unless a later date is cited at the end of
				  a section.
New Mexico Administrative Code › Title 7 - HEALTH › Chapter 30 - FAMILY AND CHILDREN HEALTH CARE SERVICES › Part 3 - CHILDREN'S MEDICAL SERVICES AND ADULT CYSTIC FIBROSIS › Section 7.30.3.6 - OBJECTIVE

Current through Register Vol. 35, No. 13, July 16, 2024
The objective is to establish criteria for eligibility and
				  application of services from the children's medical services program, to
				  delineate client and provider responsibilities as well as an appeals procedure,
				  and to set forth an index of eligible conditions.
New Mexico Administrative Code › Title 7 - HEALTH › Chapter 30 - FAMILY AND CHILDREN HEALTH CARE SERVICES › Part 3 - CHILDREN'S MEDICAL SERVICES AND ADULT CYSTIC FIBROSIS › Section 7.30.3.7 - DEFINITIONS

Current through Register Vol. 35, No. 13, July 16, 2024
A.
"Application"
means the written request, on forms prescribed by the
				division, for enrollment, and provision of supportive documentation of
				residence, income, age, and medical diagnosis for eligibility determination
				under children's medical services program.
B.
"Assets"
means savings
				accounts, stocks and bonds, checking accounts, accessible trust funds, and real
				property. Assets do not include loans which need to be repaid, or homestead
				acreage used for the production of income if this is the primary source of
				income, or personal property that is used in the production of income if
				related to the primary source of income.
C.
"Care coordination"
means
				coordination of resources across agency and professional lines to develop and
				attain the client's service plan with optimal client/family
				participation.
D.
"Care
				coordinator"
means the person employed by the children's medical
				services program to assist the family in planning, implementing, evaluating and
				coordinating with other health care professionals to establish and carry out a
				service plan for the client.
E.
"Child"
means a person below the age of 18.
F.
"Children's medical services
(
"CMS")
means a unit of the public health division in the New
				Mexico (NM) department of health that engages in:
(1) identification of children and youth
				with, or at risk for having, special health care needs (CYSHCN);
(2) provision of preventive, diagnostic, and
				treatment services and care coordination toward the attainment of maximum
				health for children with special health care needs, and adults with cystic
				fibrosis;
(3) promotion of the
				development of quality health care and outcome measures for this population
				(children and youth with special health care needs and adults with cystic
				fibrosis);
(4) monitoring these
				outcomes and the impact of changes in the health care system for this
				population;
(5) technical
				assistance and training for individuals serving this population; and
(6) administration of the universal newborn
				hearing screening program and the newborn genetic screening program, and other
				necessary administrative services to assess the needs of this population,
				facilitating access to care, and providing services.
New Mexico Administrative Code › Title 7 - HEALTH › Chapter 30 - FAMILY AND CHILDREN HEALTH CARE SERVICES › Part 3 - CHILDREN'S MEDICAL SERVICES AND ADULT CYSTIC FIBROSIS › Section 7.30.3.8 - ELIGIBILITY

Current through Register Vol. 35, No. 13, July 16, 2024
A.
Medical
				management eligibility:
To be eligible for medical management through
				CMS an applicant must meet all of the following requirements:
(1) the applicant must be a resident of
				NM;
(2) the applicant must be
				financially eligible; (income below 200% of the federal poverty level). CMS is
				always the payor of last resort; any and all third party payments must be fully
				utilized before CMS payments are made; clients who have two or more other payor
				sources such as insurance, medicare, etc., do not meet financial eligibility
				for payment by the children's medical services program; and
(3) the applicant must be medically eligible
				as defined in the medical index and the treatment protocols and guidelines
				adopted by the children's medical services program, and as determined by the
				medical director.
New Mexico Administrative Code › Title 7 - HEALTH › Chapter 30 - FAMILY AND CHILDREN HEALTH CARE SERVICES › Part 3 - CHILDREN'S MEDICAL SERVICES AND ADULT CYSTIC FIBROSIS › Section 7.30.3.9 - APPLICATION, ENROLLMENT AND REFERRAL

Current through Register Vol. 35, No. 13, July 16, 2024
Application for CMS services must be made in person, by
				  telephone, or by letter from the client or another referral source to any
				  children's medical services office, located in most counties in NM, generally
				  in the public health division's county health offices.
A. If an application is submitted within 30
				days of referral, eligibility begins on the date of referral. If the
				application is submitted after the 30-day time limit has expired, eligibility
				begins on the date the application was submitted.
B. The application shall include medical and
				financial information, as appropriate. Medical records and documentation of
				income and resources such as income tax returns, insurance policies, checks,
				check stubs, or deeds to real property may be required before the application
				will be deemed complete.
C. The
				care coordinator shall assist in obtaining medical and financial documentation
				insofar as she/he will define for the client what information is necessary to
				complete the application. The care coordinator may deny any application pending
				more than 30 days which has not been completed. Individuals whose application
				is denied may reapply at any time.
D. Upon receipt of a completed application,
				including medical records and documentation of income and assets, the division
				shall have 20 working days to determine eligibility for children with special
				health care needs or adults with cystic fibrosis. Written notification of
				application approval or denial will be sent to the client no later than 20
				working days after receipt of a completed application.
New Mexico Administrative Code › Title 7 - HEALTH › Chapter 30 - FAMILY AND CHILDREN HEALTH CARE SERVICES › Part 3 - CHILDREN'S MEDICAL SERVICES AND ADULT CYSTIC FIBROSIS › Section 7.30.3.10 - RESIDENCY

Current through Register Vol. 35, No. 13, July 16, 2024
To be eligible for any program under children's medical
				  services, applicant/recipients must be living in NM on the date of application
				  or determination of eligibility and have demonstrated intent to remain in
				  NM.
A.
Establishing
				residence:
Residence in NM is established by living in the state and
				carrying out the types of activities normally associated with everyday life,
				such as occupying a home, enrolling child(ren) in school, getting a driver's
				license, or renting a post office box. An applicant/recipient who is homeless
				is considered to have met residency requirements if he intends to remain in the
				state.
B.
Abandonment of
				residence:
Residence is not abandoned by temporary absences from the
				state. Temporary absences occur when recipients leave NM for specific purposes
				with time-limited goals. If a client will be absent from NM for more than 30
				days, he must notify the care coordinator of his intent to maintain residency
				and eligibility for CMS services. Residence is considered abandoned when any of
				the following occur:
(1) applicant/recipient
				leaves NM and indicates that he intends to establish residence in another
				state;
(2) applicant/recipient
				leaves NM for no specific purpose with no clear intention of
				returning;
(3) applicant/recipient
				leaves the state and applies for financial, food, or medical assistance in
				another state that makes residence a condition of eligibility; or
(4) applicant/recipient has been absent from
				NM for more than 30 days without notifying the care coordinator of departure
				and intention of returning.
New Mexico Administrative Code › Title 7 - HEALTH › Chapter 30 - FAMILY AND CHILDREN HEALTH CARE SERVICES › Part 3 - CHILDREN'S MEDICAL SERVICES AND ADULT CYSTIC FIBROSIS › Section 7.30.3.11 - CLIENT RESPONSIBILITIES

Current through Register Vol. 35, No. 13, July 16, 2024
A.
				Clients are responsible for providing the division with accurate information
				concerning their financial and medical eligibility when requested by the
				children's medical services program.
B. Clients must apply for and inform the
				service coordinator of insurance, medicaid or other possible source of payment
				for medical expenses. Clients who meet eligibility criteria for medicaid must
				apply.
C. Clients must report the
				following changes to their care coordinator within 10 working days of the date
				the client becomes aware of the change: changes in income exceeding $100.00 per
				month; changes in household composition, insurance or medicaid coverage; or
				change of address or telephone number.
D. Private donations, if regular and
				predictable, will be considered income. If irregular or unpredictable, private
				donations for the care of the child must be reported to the service coordinator
				within ten working days of receipt of the donation if it exceeds
				$1,000.00.
E. Third party tort
				liability: The client must notify the care coordinator within 30 working days
				of knowledge of potential liability if a third party may be liable for medical
				expenses. The client must advise the care coordinator of the name of the
				potentially liable third party, and the names of all attorneys representing the
				client.
(1) Any funds received from a third
				party because of liability for injuries to a client for whom the division is
				making medical payments must be used to repay the division for money expended
				on behalf of the client.
(2)
				Clients must assign to the division any right to recover or cause of action
				against a liable third party and all proceeds recovered from liable third
				parties to the extent that the division has made payment on behalf of the
				client.
(3) Failure to assign any
				right to recover or cause of action, or proceeds described above shall be
				grounds for denial of application or termination of payment for services by
				division for a period not to exceed six months.
(4) Failure to advise the division of
				anticipated court action as described above shall be grounds for termination of
				payment for services for a period not to exceed six months, and client shall be
				liable to the division for any sums expended by the division for which the
				client receives compensation from a third party.
New Mexico Administrative Code › Title 7 - HEALTH › Chapter 30 - FAMILY AND CHILDREN HEALTH CARE SERVICES › Part 3 - CHILDREN'S MEDICAL SERVICES AND ADULT CYSTIC FIBROSIS › Section 7.30.3.12 - PROVIDER RESPONSIBILITES

Current through Register Vol. 35, No. 13, July 16, 2024
A. Any
				person wishing to provide health care in the children's medical services
				program must be a medicaid provider and shall operate under a provider
				agreement with CMS.
B. Failure to
				comply with the terms of the provider agreement may result in termination of
				provider status and immediate cessation of payment for services rendered to the
				client.
C. Providers must submit
				legible and complete medical records for each service or set of related
				services authorized by the program to the care coordinator. Failure to submit
				medical reports may result in termination of the provider agreement. Medical
				reports submitted to the program are the property of the program. The program
				shall follow applicable federal and state laws regarding release of these
				reports.
D. Providers must meet
				standards of care established by appropriate licensing boards, certifying
				bodies and standards as may be established by the CMS services program
				manager.
E. Providers must seek and
				obtain prior approval for all services other than routine primary care. Prior
				approval is obtained through the client's CMS care coordinator and may require
				review of the CMS medical director.
F. Providers must submit legible and complete
				medical reports for each service or set of related services authorized by the
				program to the service coordinator. Failure to submit medical reports may
				result in termination of the provider agreement.
G. Violations: Sanctions may be imposed by
				CMS against a provider for any one or more of the following reasons.
(1) Knowingly and willfully making or causing
				to be made any false statement or misrepresentation of a material fact by:
(a) presenting or causing to be presented for
				payment under children's medical services any false or fraudulent claim for
				services or merchandise;
(b)
				submitting or causing to be submitted false information for the purpose of
				obtaining greater compensation than that to which the provider is legally
				entitled;
(c) submitting or causing
				to be submitted false information for the purpose of meeting prior approval
				status; and
(d) submission of a
				false or fraudulent application for provider status.
New Mexico Administrative Code › Title 7 - HEALTH › Chapter 30 - FAMILY AND CHILDREN HEALTH CARE SERVICES › Part 3 - CHILDREN'S MEDICAL SERVICES AND ADULT CYSTIC FIBROSIS › Section 7.30.3.13 - PROVIDER BILLING

Current through Register Vol. 35, No. 13, July 16, 2024
A.
				Providers must seek payment from insurance, medicaid, and other sources, if
				known, prior to billing the children's medical services program. This includes
				billing the medicaid program using the child's recipient medicaid
				identification number and not the CMS billing number.
B. Inpatient care shall be paid at the
				negotiated per diem rate and under the term established by the provider
				participation agreement. For other services covered under the program;
				including approved inpatient days, providers must agree to accept as payment in
				full the amounts established by the division.
C. If a provider receives a payment from a
				source other than the program which is equal to or exceeds the amount of the
				program fee schedule for the authorized services rendered, the provider is
				prohibited from seeking additional payment from either the client or the
				division.
D. Providers must submit
				all bills to the fiscal agent for payment on forms prescribed by the program
				and within the billing time limits established by the program. Unless the
				provider receives a waiver of the time limit from the program manager and
				medical director, failure to comply with the time limits may result in denial
				of claim. Providers may not hold clients responsible for bills denied because
				of failure to meet time limits. Providers must also follow all billing
				instructions in submitting claims for payment to the fiscal agent. If claims
				are denied due to not following instructions, providers may not hold clients
				responsible for payment of these bills.
New Mexico Administrative Code › Title 7 - HEALTH › Chapter 30 - FAMILY AND CHILDREN HEALTH CARE SERVICES › Part 3 - CHILDREN'S MEDICAL SERVICES AND ADULT CYSTIC FIBROSIS › Section 7.30.3.14 - EXPENDITURE OF FUNDS

Current through Register Vol. 35, No. 13, July 16, 2024
A.
				Expenditure of children's medical services program funds are based on the
				availability of funds, the eligibility of the client for services, and the
				receipt of prior approval by the provider for the services, if
				required.
B. Emergency services may
				be paid for if:
(1) the care coordinator is
				notified of the services rendered and the necessity of the services before the
				end of the fifth working day after the emergency expense is incurred;
				or
(2) the medical director
				determines that the services were consistent with the service plan, if
				applicable, are eligible for payment, and were rendered in an
				emergency.
New Mexico Administrative Code › Title 7 - HEALTH › Chapter 30 - FAMILY AND CHILDREN HEALTH CARE SERVICES › Part 3 - CHILDREN'S MEDICAL SERVICES AND ADULT CYSTIC FIBROSIS › Section 7.30.3.15 - OUT-OF-STATE PROVIDER POLICY

Current through Register Vol. 35, No. 13, July 16, 2024
Services must be purchased within the state of NM, unless the
				  need to purchase services elsewhere is documented and approved by the CMS
				  medical director.
A. Services may be
				purchased outside the state of NM when:
(1)
				the specific service is not available in NM; or
(2) an eligible client is temporarily out of
				state and does not qualify for medical assistance in the state of temporary
				residence, and the health of the client would be endangered if services were
				postponed until return to NM or by travel to NM; or
(3) excessive time, distance, and expense
				would be involved in order to obtain outpatient services in NM. Inpatient
				services are eligible out of state if urgent or emergency hospitalization is
				needed when distance is excessive or in-state tertiary centers are
				full.
New Mexico Administrative Code › Title 7 - HEALTH › Chapter 30 - FAMILY AND CHILDREN HEALTH CARE SERVICES › Part 3 - CHILDREN'S MEDICAL SERVICES AND ADULT CYSTIC FIBROSIS › Section 7.30.3.16 - CONFIDENTIALITY

Current through Register Vol. 35, No. 13, July 16, 2024
Information shall be released by the program only as
				  permissible per state and federal law.
New Mexico Administrative Code › Title 7 - HEALTH › Chapter 30 - FAMILY AND CHILDREN HEALTH CARE SERVICES › Part 3 - CHILDREN'S MEDICAL SERVICES AND ADULT CYSTIC FIBROSIS › Section 7.30.3.17 - NOTICE AND APPEALS PROCEDURE

Current through Register Vol. 35, No. 13, July 16, 2024
A.
Record review.
All applicants whose application for services from
				CMS has been denied and all clients who have been denied requested services by
				the program may request a record review from CMS.
B.
Procedure for requesting informal
				administrative review.
(1) The
				applicant or client may submit a written request for a record review. To be
				effective, the written request shall:
(a) be
				made within 30 calendar days, as determined by the postmark, from the date of
				the notice of action issued by CMS;
(b) be properly addressed to CMS;
(c) state the applicant's name, address, and
				telephone numbers; and
(d) provide
				a brief narrative rebutting the circumstances of the denial.
New Mexico Administrative Code › Title 7 - HEALTH › Chapter 30 - FAMILY AND CHILDREN HEALTH CARE SERVICES › Part 3 - CHILDREN'S MEDICAL SERVICES AND ADULT CYSTIC FIBROSIS › Section 7.30.3.18 - ELIGIBLE MEDICAL CONDITIONS

Current through Register Vol. 35, No. 13, July 16, 2024
The division shall periodically issue an index of conditions
				  which identifies eligible medical conditions. The index shall be reviewed at
				  least annually and revised as necessary. Coverage may change dependent upon
				  available funds. Coverage is provided subject to the further guidelines in the
				  index of children's medical services eligible conditions and treatment
				  protocols. Conditions that are similar in course and outcome to those in the
				  index may be eligible pending review by the medical director. The current index
				  of children's medical services eligible conditions is attached hereto as
				  attachment A.
New Mexico Administrative Code › Title 7 - HEALTH › Chapter 30 - FAMILY AND CHILDREN HEALTH CARE SERVICES › Part 3 - CHILDREN'S MEDICAL SERVICES AND ADULT CYSTIC FIBROSIS › Section 7.30.3.19 - PEDIATRIC SUBSPECIALISTS

Current through Register Vol. 35, No. 13, July 16, 2024
For children age 18 years and under with chronic, complex
				  cardiac, endocrine, neurology, and pulmonary conditions, the CMS program will
				  authorize payment for consultation and follow up services only to board
				  certified pediatric subspecialists when they are available within the
				  state.