New Mexico Administrative Code
Title 8 - SOCIAL SERVICES
Chapter 352 - ADMINISTRATIVE HEARINGS
Part 2 - CLAIMANT HEARINGS
Section 8.352.2.14 - SUMMARY OF EVIDENCE (SOE)
Universal Citation: 8 NM Admin Code 8.352.2.14
Current through Register Vol. 35, No. 18, September 24, 2024
A. Summary of evidence.
(1) At a
HSD administrative hearing, MAD has the burden to prove through the
preponderance of the evidence that an adverse action against a claimant is
correct. A summary of evidence (SOE) provides information concerning the basis
of MAD, its UR contractor or the MCO's adverse action. MAD may have its
designee complete an SOE for final review by MAD; however, MAD is ultimately
responsible for the submission of its SOE. An SOE is submitted by MAD to the
ALJ and claimant or the claimant's authorized representative within specified
timeframes.
(2) A claimant or the
claimant's authorized representative may submit an SOE to provide the ALJ with
information to refute MAD's SOE. A claimant or the claimant's authorized
representative is not required to provide a SOE, as the burden of proof falls
on MAD.
(3) The MAD SOE shall, at a
minimum, contain:
(a) the claimant's name,
and as applicable, his or her authorized representative's or legal counsel's
telephone number and address, and the status of any previous or concurrent
appeal through his or her MCO or MAD UR contractor;
(b) the adverse action against the
claimant;
(c) the documentation
supporting MAD, its UR contractor, or the MCO basis for the intended or taken
adverse action; and
(d) any
applicable federal or state statutes, regulations, rules or any combination of
these; however, that a failure by MAD, the UR contractor or a MCO to submit an
applicable statute, regulation or rule shall not constitute per se grounds for
the ALJ to find that MAD, the UR contractor or the MCO failed to meet its
burden of proof.
B. Timeframes.
(1) The HSD administrative hearing.
(a) MAD's SOE shall be delivered to the ALJ
and the parties to the HSD administrative hearing at least 10 working days
prior to the HSD administrative hearing.
(b) MAD's SOE may be amended by MAD at any
point prior to the HSD administrative hearing if the ALJ and the claimant or
the claimant's authorized representative is delivered copies of the amended SOE
at least two working days prior to the HSD administrative hearing. MAD is
responsible for providing its UR contractor or MCO the amended SOE.
(c) If the claimant or his or her authorized
representative has an SOE that he or she wants entered into evidence for the
HSD administrative hearing, he or she must provide the ALJ the SOE not less
than three working days prior to the HSD administrative hearing. The ALJ will
provide MAD AHU with a copy of the claimant's SOE within one working day of its
receipt. The MAD AHU will provide a copy of the SOE to either its UR contractor
or the MCO within one working day of its receipt.
(d) If the claimant or the claimant's
authorized representative has an amendment to his or her SOE, he or she shall
follow the process in Subparagraph (c) of Paragraph (1) of Subsection B of this
section.
(2) The failure
of MAD to provide its SOE in a timely manner may, at the ALJ's discretion
result in its exclusion or a postponement of the HSD administrative hearing
charged against MAD.
(3) If the
claimant or the claimant's authorized representative fails to provide the
assigned ALJ a SOE or any amendments to the SOE within the specified
timeframes, and the claimant or the claimant's authorized representative wishes
to submit such documents for consideration at the HSD administrative hearing,
the claimant or the claimant's authorized representative will utilize his or
her one allowed postponement opportunity in which to submit the SOE or any
amendments to the ALJ. The ALJ will follow the process in Subparagraph (b) of
Paragraph (1) of Subsection B of this section for the disbursement of the
amended SOE.
C. Availability of information to the claimant or the claimant's representative: MAD, its UR contractor or the MCO shall:
(1) provide upon request to the claimant or
his or her authorized representative, any document in its possession concerning
its adverse action against the claimant that is not already in its
SOE;
(2) provide the claimant or
the claimant's authorized representative the requested documents; such
documents will be provided by MAD, its UR contractor or MCO to the claimant or
the claimant's authorized representative in a timely manner and without
charge.
D. No party to a HSD administrative hearing may present into evidence, as part of an amended SOE, any document or record that any other party of the hearing has not received at least two working days prior to the HSD administrative hearing. The ALJ will not take such information into consideration when reaching his or her recommendation.
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