Current through Register Vol. 35, No. 18, September 24, 2024
A.
Consumer assistance office: Each MHCP shall establish and adequately staff a
consumer assistance office. Those MHCPs currently doing business in New Mexico
shall submit to the superintendent for approval a plan of how the MHCP's
consumer assistance office will be organized and established. At a minimum, the
plan shall address:
(1) the staffing of the
consumer assistance office, including whether the planned hours and level of
staffing are sufficient for the numbers and types of covered persons served by
the MHCP;
(2) the MHCP's
arrangements to meet the needs of covered persons with special needs;
(3) how the consumer assistance staff will be
trained;
(4) how the independence
of staff assigned to assist consumers is assured; and
(5) whether staff will have the authority to
assist consumers in filing and pursuing a grievance or appeal.
B. A MHCP new to this state shall
submit a plan for establishing a consumer assistance office to the
superintendent as part of its application for licensure.
C. The superintendent shall approve or reject
a plan submitted by a MHCP within 45 days after the plan is submitted to the
superintendent. If the superintendent rejects a plan submitted by a MHCP, the
superintendent shall state in writing in a letter addressed to the MHCP the
specific grounds for rejection.
D.
Consumer advisory board: Each MHCP shall establish and maintain a consumer
advisory board.
(1) The consumer advisory
board shall meet at least quarterly and shall advise the MHCP about the MHCP's
general operations from the perspective of the enrollee as a consumer of health
care.
(2) The consumer advisory
board shall review the operations of and be advisory to the MHCP's consumer
assistance office.
(3) All members
of the consumer advisory board shall be current enrollees of the MHCP,
employees of groups which subscribe to the MHCP, or be representatives of
consumer organizations which represent the interests of health care consumers.
No member of the consumer advisory board shall be an employee of the MHCP, nor
shall the board members' immediate family be employees of the MHCP.
(4) The MHCP shall implement procedures
whereby, when specific recommendations are made by the advisory board,
representatives of the MHCP with responsibility for the substantive areas
addressed in the recommendation will consider the matters raised in the
recommendation and timely respond to the advisory board.
(5) The MHCP shall inform enrollees of the
advisory board's existence and role in the operation of the MHCP in the
evidence of coverage.
