N.M. Admin. Code § 8.354.2.9

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

Section 8.354.2.9 - CLAIMANT OR THE CLAIMANT'S AUTHORIZED REPRESENTATIVE AND HSD ADMINISTRATIVE HEARING PROCESS

HSD has established a hearing process for a MAP eligible recipient or a MCO member who is adversely affected by the preadmission screening and annual resident review (PASRR) or the transfer or discharge from a NF as required by Section 1919(e)(7) of the Social Security Act.

A. Claimant:

(1) When an adverse action (see Subsection B of 8.354.2.7 NMAC) is intended or taken against a MAP eligible recipient by MAD, its UR contractor or their designee, the MAP eligible recipient may file as a claimant to request a HSD administrative hearing.

(2) When an adverse action (see Subsection B of 8.354.2.7 NMAC) is intended or taken against a member by his or her MCO or its designee, the member may file as a claimant to request a HSD administrative hearing. A member is not required to first exhaust his or her MCO appeal process prior to filing for a HSD administrative hearing when affected by an adverse action listed in 8.354.2.7 NMAC. Upon requesting a HSD administrative hearing, the member is referred to as the claimant and is governed by the remaining sections of this rule.

(3) A claimant must request a HSD administrative hearing within 90 calendar days of the mailing of either the notice of action or the denial for new service.

B. A claimant or the claimant's authorized representative may have legal counsel assist him or her during the HSD administrative hearing process. If a claimant or the claimant's authorized representative, MAD, its UR contractor, the MCO or their designees retains legal counsel, that legal counsel must submit a notice of appearance to the assigned ALJ. The ALJ will forward this notice to the MAD administrative hearings unit (MAD AHU).

C. The claimant or claimant's authorized representative may also chose a relative, friend or other spokesperson (spokesperson) to represent or assist him or her in the HSD administrative hearing process.

N.M. Admin. Code § 8.354.2.9

8.354.2.9 NMAC - Rp, 8.354.2.9 NMAC, 8/1/14