N.M. Admin. Code § 8.370.2.7

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

Section 8.370.2.7 - DEFINITIONS

For purposes of this rule, the following shall apply.

A."Adjudicate" means to decide, settle or determine a disputed action. The term applies to a determination of facts and the application of law and reason to the facts by an impartial decision maker.

B."Administrator" means the person or manager in charge of the day-to-day operation of the facility or medicaid provider. The administrator may be the licensee or an authorized representative of the licensee.

C."Annual license" is the legally required authority-issued license authorizing a facility to operate for the one year period of time noted on the face of the document and issued on an initial and renewal basis.

D."Appellant" means the party seeking review in a court of competent jurisdiction of a final decision of the licensing authority.

E."Applicant" means the individual responsible for the day-to-day operations of the facility, and who signs the license application. The applicant must be the individual. The applicant may be the same individual as the prospective licensee or may be an authorized representative of the prospective licensee.

F."Application" means the forms, attachments and other writings and drawings required by the licensing authority, to be completed and submitted by the applicant for the licensing authority's review for granting or denying a license.

G."Burden of proof" refers to the requirement of a party to produce an amount of evidence tending to prove a proposition.

H."Cease and desist order" means a formal, enforceable order of the licensing authority issued to a facility, usually in instances where the facility is operating without a license.

I."Certification" means the determination made by the licensing authority as to whether a health facility or agency complies with applicable federal regulations and the conditions of participation in the medicare or medicaid program. Certification of noncompliance may be the basis for denial or termination of provider participation in the medicare or medicaid programs, or the basis for the imposition of other sanctions including license revocation.

J."Denial of an application" and "denial of an annual license" mean action by the licensing authority declining to grant an annual license on the basis of noncompliance with applicable laws and regulations.

K."Director" means the director of the division of health improvement of the New Mexico health care authority.

L."Emergency suspension of license" means the licensing authority's prohibition of operation of a facility for a stated period of time by temporary withdrawal of the license, prior to a hearing on the matter, when immediate action is required to protect human health and safety. The emergency suspension is carried out by personal service of an emergency suspension order and notice of a hearing. A hearing must be held within five working days of the effective date of suspension ("five-day hearing"), as noticed in the emergency suspension order and notice of hearing, unless the right to a hearing is waived by the licensee or the right to a five-day hearing is waived and a hearing is requested at a later date by the licensee.

M."Facility" means any health facility or health agency required to be licensed by the licensing authority pursuant to the authority of the Public Health Act, Sections 24-1-1 to 24-1-21 NMSA 1978, as amended, or required to be certified by the licensing authority in order to be eligible to receive and medicaid reimbursement for services provided to eligible recipients. This does not refer to community providers.

N."Final decision" means the dispositive written document entered following a request for hearing under this rule, stating the final determination of the secretary made after review of the hearing officer's report and recommendation.

O."Five-day hearing" means the hearing noticed in the emergency suspension order and notice of hearing. See the definition of "emergency suspension of license" in Subsection E of this section.

P."Hearing" means a proceeding in which legal rights, duties or privileges of a party are at issue and which shall include an opportunity for the parties to present such testimony and evidence as the hearing officer deems relevant and material to the issues to be adjudicated.

Q."Hearing officer" means an individual designated to conduct prehearing conferences and hearings and to make reports and recommendations, based on the evidence taken, to the secretary.

R."Initial applicant" means the individual who signs the initial license application.

S."License" means the document issued by the licensing authority which authorizes the lawful operation of a facility. The term "license" includes an annual license and a temporary license.

T."Licensee" means the person in whose name a license for a facility has been issued and who is legally responsible for the facility's compliance with applicable laws and regulations.

U."Licensing authority" means the division of health improvement of the New Mexico health care authority. The licensing authority is also the state survey agency authorized to perform survey and certification functions for the medicaid and medicare programs.

V."Official notice" means administrative notice, the act by which the hearing officer, in conducting the hearing or framing their decision, recognizes the existence and truth of certain facts without the production of evidence by the parties.

W."Party" and "parties" means the original persons, entities, or agencies to a hearing under this rule and such intervenors permitted to intervene by written order of the hearing officer.

X."Person" means an individual, partnership, proprietorship, agency, corporation, company, association, tribal government or tribal organization, state or local government entity, or similar legal entity and the legal successor thereof.

Y."Prospective licensee" means the person in whose name a license for operation of a facility is to be issued.

Z."Recipient" means the individual who receives service of notice and, specifically includes the person who receives a cease and desist order issued by the licensing authority.

AA."Renewal applicant" means the individual who signs the renewal license application.

BB."Revocation of license" means the licensing authority's cancellation and withdrawal of a license on a permanent basis.

CC. "Secretary" means the secretary of the New Mexico health care authority and includes their authorized representative.

DD."Subpoena" means a written command issued by the hearing officer, at the request of a party, directing the appearance by a person, at a designated time and place, to give testimony upon a certain matter. The subpoena may include a command to produce books, papers, documents and other things, in which case it is issued as a subpoena duces tecum.

EE."Suspension of license" means the licensing authority's temporary cancellation and withdrawal of a license for a stated period of time.

FF."Taking of appearances" means recording for the record the names of persons appearing at the hearing and their representatives, if any.

GG."Temporary license" means, with respect to a health facility, an operating license issued for a stated period of time not to exceed 120 days. Not more than two consecutive temporary licenses may be granted by the licensing authority.

HH."Working days" means, when determining compliance with various deadlines in this rule, Monday through Friday of each calendar week, excluding state observed holidays.

N.M. Admin. Code § 8.370.2.7

Adopted by New Mexico Register, Volume XXXV, Issue 12, June 25, 2024, eff. 7/1/2024