N.M. Admin. Code § 8.352.2.11

Current through Register Vol. 35, No. 21, November 5, 2024

Section 8.352.2.11 - RIGHT TO A HSD ADMINISTRATIVE HEARING

MAD must grant an individual or his or her authorized representative the opportunity for a HSD administrative hearing under specific circumstances pursuant to 42 CFR Section 431.220(a) and 27 - 3 - 3 NMSA 1978. A HSD administrative hearing occurs telephonically between the parties to the hearing and the assigned ALJ.

A. An individual or the individual's authorized representative may request a HSD administrative hearing based on his or her belief that MAD or its UR contractor intends to take, or has taken, an adverse action.

B. A member shall have the right to request a HSD administrative hearing after he or she has exhausted the MCO's appeal process and:

(1) the member does not agree with the MCO's final decision;

(2) the member requests an HSD administrative hearing within 30 calendar days of the date of the MCO's final decision; and

(3) the basis for the member's request for an HSD administrative hearing meets one of the definitions of an adverse action in Section 10 of this rule.

C. MAD, its UR contractor or the MCO will not be responsible for any fees or costs, incurred by the individual or his or her authorized representative as a result of a MCO appeal or a HSD administrative hearing, or if he or she files an appeal of the HSD administrative hearing final decision to a New Mexico district court.

N.M. Admin. Code § 8.352.2.11

8.352.2.11 NMAC - Rp, 8.352.2.11 NMAC, 6-15-14