New Mexico Administrative Code
Title 8 - SOCIAL SERVICES
Chapter 312 - LONG TERM CARE SERVICES - NURSING SERVICES
Part 2 - NURSING FACILITIES
Section 8.312.2.7 - DEFINITIONS
Current through Register Vol. 35, No. 18, September 24, 2024
A. "Authorized representative" means the individual designated to represent and act on the claimant's behalf. The eligible recipient or managed care organization (MCO) member's authorized representative must provide formal documentation authorizing the named individual or individuals to access the indentified case information for a specified purpose and time frame. An authorized representative may be an attorney representing a person or household, a person acting under the authority of a valid power of attorney, a guardian ad litem, or any other individual or individuals designated in writing by the eligible recipient or MCO member.
B. "Designee" means a state agency or an institution MAD has designated to be responsible for:
C. "DOH-DDSD" means the developmental disabilities support division of the department of health, which conducts the PASRR level II evaluation for a MAP eligible recipient or a MCO member that has been identified through a PASRR level 1 screen.
D. "HSD administrative hearing" or "fair hearing" means an informal evidentiary hearing that is conducted by the HSD fair hearings bureau (FHB) so that evidence may be presented as it relates to an adverse action taken, or intended to be taken, by MAD, the MCO or their designees.
E. "MAD" means the medical assistance division, which administers medicaid and other medical assistance programs (MAP) under HSD.
F. "MAP" means the medical assistance programs administered by MAD.
G. "MCO" means a member's HSD contracted managed care organization.
H. "Member" means a MAP eligible recipient enrolled in a HSD contracted MCO. Once a member requests a HSD administrative hearing, the member is referred to as a claimant.
I. "Notice of action" means the notice issued by MAD, the MCO or their designees of their intent to take an adverse action against an eligible recipient or a member in the form an adverse determination is made with regard to the preadmission or annual resident review requirements.
J. "Nursing facility (NF)" means a MAD enrolled, and as appropriate, a MCO contracted, nursing facility which meets the requirements as described in 8.312.2 NMAC. The NF completes a PASRR level one screen for a MAP eligible recipient or a MCO member.
