New Mexico Administrative Code
Title 8 - SOCIAL SERVICES
Chapter 200 - MEDICAID ELIGIBILITY - GENERAL RECIPIENT POLICIES
Part 430 - RECIPIENT RIGHTS AND RESPONSIBILITIES
Section 8.200.430.14 - ELIGIBLE RECIPIENT RESPONSIBILITY TO COOPERATE WITH ASSIGNMENT OF SUPPORT RIGHTS
Universal Citation: 8 NM Admin Code 8.200.430.14
Current through Register Vol. 35, No. 18, September 24, 2024
A. Cooperation: As a condition of MAP eligibility, an applicant or an eligible recipient must cooperate with HSD to:
(1) obtain physical and behavioral health
support and payments for his or herself and other individuals for whom he or
she can legally assign rights;
(2)
pursue liable third parties by identifying individuals and providing
information to HSD;
(3) cooperate
with CSED to establish paternity and medical support as appropriate, see
8.50.105.12 NMAC;
(4) appear at a
state or local office designated by HSD to give information or evidence
relevant to the case, appear as a witness at a court or other proceeding or
give information or attest to lack of information, under penalty of
perjury;
(5) refund HSD any money
received for physical or behavioral health care that has already been paid;
this includes payments received from insurance companies, personal injury
settlements, and any other liable third party; and
(6) respond to the trauma inquiry letter that
is mailed to an eligible recipient (
42 CFR
433.138(4)); the letter
asks an eligible recipient to provide more information about possible
accidents, causes of accidents, and whether legal counsel has been obtained (
42
CFR 433.147; 45 CFR 232.42, 232.43; NMSA 1978
27-2-28(G)(3)).
B. Good cause waiver of cooperation: The requirements for cooperation may be waived by HSD if it decides that the applicant or the eligible recipient has good cause for refusing to cooperate. Waivers can be obtained for cooperating with CSED. The applicant or the eligible recipient should request a good cause waiver from CSED per 8.50.105.14 NMAC.
C. Penalties for failure to cooperate:
(1) When the parent, the
specified relative or legal guardian fails or refuses to cooperate, the parent
or specified relative will not be eligible for MAD services. The eligible
recipient child maintains MAP eligibility provided all other eligibility
criteria are met.
(2) When the
parent or the specified relative fails or refuses to refund payments received
from insurance or other settlement sources, such as personal injury case
awards, he or she is not eligible for MAD services for one year and until full
restitution has been made to HSD. The eligible recipient child maintains MAP
eligibility provided all other eligibility criteria are
met.
Disclaimer: These regulations may not be the most recent version. New Mexico may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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