New Mexico Administrative Code
Title 8 - SOCIAL SERVICES
Chapter 351 - SANCTIONS OR REMEDIES
Part 2 - SANCTIONS AND REMEDIES
Section 8.351.2.14 - NOTICE REQUIREMENTS
Current through Register Vol. 35, No. 18, September 24, 2024
A. Content of provider notice: With the exception of a referral based on a credible allegation of fraud, as that term is defined in federal statute or regulation or both, when MAD seeks overpayment recovery, or to impose sanctions or remedies, written notice is sent to the provider or other entity. The notice sent to a non-nursing facility provider or other entity contains the following information:
B. Notice requirements for credible allegations of fraud:
C. Notice to other organizations: When a MAD provider or other entity is sanctioned, MAD notifies the applicable professional society, board of certification, licensing or registration, and state or federal agencies of the sanctions imposed and rationale for imposition of sanctions. If MAD learns that a provider or other entity is convicted of a MAD-related offense, MAD also notifies the federal secretary of DHHS of the conviction.
D. Notice to a MAP eligible recipient: When MAD terminates or suspends a provider from participation, it notifies each MAP eligible recipient for whom the provider has submitted claims for services after the date of the alleged fraud or misconduct.
E. Notice deadlines for a NF or ICF-IID provider: The notice period begins on the date of the MAD notice. In no event will the effective date of the action be later than 20 calendar days after MAD sends the notice.
F. Exceptions to the notice requirements: Notice is not sent and a HSD provider administrative hearing is not available if the basis for the provider sanction is the non-nursing facility provider's failure to meet standards for licensing, certification, or registration required by federal or state laws and rules for MAD participation Additional notice is not required if MAD has notified the provider in writing of the failure to meet standards and has given the provider 30 calendar days notice to correct or produce necessary documentation curing the failure and the provider fails to respond.