N.M. Admin. Code § 7.20.11.12

Current through Register Vol. 35, No. 23, December 10, 2024

Section 7.20.11.12 - SANCTIONS

A. Sanctions, as follows, may be imposed for the reasons listed in Section 11. The severity of the action taken by the department depends upon the specific facts in each case, the seriousness and history of the events prompting the department to take action, and the ability and willingness of the agency to promptly take adequate corrective action.

(1) REVOCATION: The LCA cancels certification, making it void. The medicaid provider agreement terminates on the date of revocation.

(2) SUSPENSION: The LCA temporarily revokes certification until the identified deficiencies are corrected and the LCA approves the corrections. The medicaid provider agreement terminates on the date of suspension.

(3) NON-RENEWAL: The LCA refuses to renew certification and issues a notice stating that the certification is void as of a specific date, on or about the date of expiration. The medicaid provider agreement terminates on the effective date of non-renewal.

(4) DENIAL: The LCA refuses to issue certification.

(5) ADMISSIONS HOLD: The LCA restricts the program from accepting any new clients until the identified deficiencies are corrected and the LCA approves the corrections.

(6) EXPANSION HOLD: The LCA restricts the program from expanding into additional services until the identified deficiencies are corrected and the LCA approves the corrections.

(7) MAINTENANCE OR REDUCTION IN PROGRAM CAPACITY: The LCA directs the program to maintain or reduce the capacity of the program to a designated client census until the LCA determines that all of the deficiencies resulting in the sanction have been corrected.

(8) COMPLIANCE MONITOR: The LCA may select and assign a compliance monitor and assign it to an agency for a specified period of time to oversee an agency's compliance efforts. The compliance monitor has the authority to review all applicable facility records, including financial records and policies, and the authority to interview facility staff and clients. The compliance monitor may also advise the program regarding steps to correct violations and improve overall clinical programming. The compliance monitor reports to the LCA on a weekly basis or more often when indicated. The agency pays all costs of the compliance monitor.

(9) TEMPORARY MANAGEMENT: The LCA appoints temporary professional management with expertise in the field of the child and adolescent mental health and/or substance abuse services provided by the program. The temporary management assumes primary responsibility to oversee the operation of the program; to protect the health and safety of its clients; to assess and direct the correction of deficiencies; and/or to facilitate an orderly closure. The temporary management reports to the LCA. The agency pays all costs of temporary management.

B. EXTENUATING CIRCUMSTANCES: In assessing the appropriateness or severity of sanctions, the LCA may consider any relevant factor(s) that may mitigate or exacerbate the situation precipitating the sanction.

C. CORRECTION OF DEFICIENCIES: When the LCA determines that deficiencies exist, the program must correct the deficiencies according to the following time frames or further sanctions may be imposed:

(1) Health and/or safety deficiencies are corrected immediately.

(2) Deficiencies that do not compromise health and/or safety are corrected within a period of time specified by the LCA.

D. SERVICE OF NOTICE: The department provides notification, by fax and certified mail or personal service/delivery, of its imposition of any emergency sanction against a program. A notice of contemplated action under these certification requirements may be sent by fax and mail, personal service or delivery, or by certified mail. Each notice of emergency sanction or contemplated action will be forwarded by fax to the medical assistance division immediately. (The medical assistance division of the human services department is responsible for any notices related to medicaid payments sent to the provider.)

E. NEW OWNERSHIP: In the event a provider sells or otherwise transfers its interest in its certified program to another entity, and a sanction or other corrective measure is pending, the sale of the certified program does not stay or otherwise impact the pending sanction. The new owner/entity must comply with all areas of correction noted in the sanction or action plan. If a sanction(s) is pending, the LCA will proceed with the appeals process and may issue a notice of final action pursuant to these certification requirements.

N.M. Admin. Code § 7.20.11.12

7.20.11.12 NMAC - Rp 7 NMAC 20.11.12, 03/29/02