New Mexico Administrative Code
Title 8 - SOCIAL SERVICES
Chapter 302 - MEDICAID GENERAL PROVIDER POLICIES
Part 1 - GENERAL PROVIDER POLICIES
Section 8.302.1.20 - TERMINATION OF PROVIDER STATUS
Universal Citation: 8 NM Admin Code 8.302.1.20
Current through Register Vol. 35, No. 18, September 24, 2024
A. Provider status may be terminated if the provider or MAD gives the other written notice of termination at least 60 calendar days before the effective termination date.
(1) Facility provider must also give at least
15 calendar days notice to the public by publishing a statement of the date
services are no longer available at the facility in one or more newspapers of
general circulation within the affected county or region.
(2) Normal termination and notice limits do
not apply if the state survey agency or health care financing administration
determines that the health and safety of residents in a nursing facility or
intermediate care facility for the intellectually disabled or the children,
youth and families department determines that the health and safety of children
or adolescents in a residential treatment center, group home, or treatment
foster care are in jeopardy.
B. Grounds for denial or revocation of enrollment: MAD may, with a 30-calendar days notice, deny or terminate a provider's enrollment in its medical assistance program including, but not limited to, medicaid (Title XIX of the Social Security Act) and other health insurance programs funded by the HCA, if any of the following are found to be applicable to the health care provider, their agent, a managing employee, or any person having an ownership interest equal to five percent or greater in the health care provider:
(1) misrepresentation by
commission or omission of any information on the MAD provider participation
agreement enrollment form;
(2)
previous or current exclusion, suspension, termination from, or the involuntary
withdrawal from participation in New Mexico medical assistance programs, any
other states medicaid program, medicare, or any other public or private health
or health insurance program;
(3)
conviction under federal or state law of a criminal offense relating to the
delivery of any goods, services, or supplies, including the performance of
management or administrative services relating to the delivery of the goods,
services, or supplies, under New Mexico medical assistance programs any other
states medicaid program, medicare, or any other public or private health or
health insurance program;
(4)
conviction under federal or state law of a criminal offense relating to the
neglect, or abuse of a patient in connection with the delivery of any goods,
services, or supplies;
(5)
conviction under federal or state law of a criminal offense relating to the
unlawful manufacture, distribution, prescription or dispensing of a controlled
substance;
(6) conviction under
federal or state law of a criminal offense relating to fraud, theft,
embezzlement, breach of fiduciary responsibility, or other financial
misconduct;
(7) conviction under
federal or state law of a criminal offense punishable by imprisonment of a year
or more which involved moral turpitude, or acts against the elderly, children,
or infirmed;
(8) conviction under
federal or state law of a criminal offense in connection with the interference
or obstruction of any investigation into any criminal offense listed in
Paragraphs (3) through (9) of this subsection;
(9) sanction pursuant to a violation of
federal or state laws or rules relative to New Mexico medical assistance
programs, any other state's medicaid program, medicare, or any other public
health care or health insurance program;
(10) violation of licensing or certification
conditions or professional standards relating to the licensure or certification
of health care providers or the required quality of goods, services, or
supplies provided;
(11) failure to
pay recovery properly assessed or pursuant to an approved repayment schedule
under New Mexico medical assistance programs; and
(12) see 8.351.2 NMAC, Sanctions and
Remedies, and 8.353.2 NMAC, Provider
Hearings.
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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