New Mexico Administrative Code
Title 8 - SOCIAL SERVICES
Chapter 350 - RECONSIDERATION OF UTILIZATION REVIEW
Part 2 - RECONSIDERATION OF UTILIZATION REVIEW DECISIONS
Section 8.350.2.11 - CLAIMANT HEARINGS
Current through Register Vol. 35, No. 18, September 24, 2024
MAD has established a process to determine if an individual is eligible to request a HSD administrative hearing. MAD has also established a process for an individual or the individual's authorized representative to request an HSD administrative hearing when an UR reconsideration decision results in an adverse action that is intended or has been taken by MAD, its UR contractor or a MAD designee. See 8.352.2 NMAC for the definition of an authorized representative. 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 Section 27-3-3 NMSA 1978. A request for a HSD administrative hearing must be received within 30 days of the date of its UR reconsideration decision. A HSD administrative hearing occurs telephonically between the parties to the hearing and the assigned ALJ. See 8.352.2 NMAC for detailed description of a HSD administrative claimant hearing process. At the time the eligible recipient or his or her authorized representative requests a HSD administrative hearing, the eligible recipient is referred to as the claimant.
A. Record preservation: To preserve a record for review, MAD, its UR contractor or a MAD designee documents and retains a record of the reconsideration determination.
B. Documentation requirements: The record preserved by MAD, its UR contractor or a MAD designee includes all documentation of the initial UR decision, copies of any documents relevant to the initial decision, any additional evidence presented during the reconsideration, and a copy of the reconsideration determination.
