Current through Register Vol. 35, No. 18, September 24, 2024
A.
Administrative law judge.
(1) A HSD administrative hearing is conducted
by an impartial official who:
(a) does not
have any personal stake or involvement in the case; and
(b) was not involved in the determination or
the action which is being contested; if the ALJ had any involvement with the
action in question, including giving advice or consultation on the points at
issue, or is personally related in any relevant degree to the parties, the ALJ
must disqualify his or herself as the assigned ALJ for that case.
(2) In conducting a HSD
administrative hearing, the ALJ must:
(a)
explain how the HSD administrative hearing will be conducted to participants at
the start of the hearing, before administering oaths;
(b) administer oaths and
affirmations;
(c) request, receive,
and make part of the record all evidence that has been provided to each party
within the required time-frames that the ALJ considers necessary to decide the
issues raised;
(d) regulate the
conduct and the course of the HSD administrative hearing to ensure an orderly
HSD administrative hearing;
(e)
request, if appropriate, an independent physical or behavioral health
assessment or a professional evaluation from a source mutually satisfactory to
the parties at no cost to the claimant; and
(f) produce the ALJ HSD administrative
hearing report that includes findings of fact and recommendations for the MAD
director's consideration.
(3) Appointment of the ALJ: the ALJ is
appointed by FHB upon receipt of the request for a HSD administrative hearing.
The ALJ will be copied on all written communications between the parties to HSD
administrative hearing to ensure all parties are free of undue influence and
receive written notices and documents within the required
time-frames.
B.
Record of the hearing: A HSD administrative hearing is digitally
recorded. The digital recording, findings of fact, SOEs and any amendments,
pleadings, documents, NMAC rules, other relevant statutes or other exhibits
admitted into evidence, as well as the ALJ's recommendations will be available
to the parties for one calendar year following the HSD administrative hearing
final decision. These items are referred to as the record of the HSD
administrative hearing. Parties to the HSD administrative hearing may request
one copy of the record without charge. Subsequent copies will be charged at a
pre-determined rate set by HSD.
C.
Rights at an administrative hearing: A claimant or the claimant's
authorized representative will provide the assigned ALJ a signed
release-of-information in order for a designated spokesperson to assist or
represent the claimant or the claimant's authorized representative in
presenting the claimant's case at a HSD administrative hearing. If the claimant
or the claimant's authorized representative, MAD, its UR contractor or MCO have
retained legal counsel, that legal counsel will submit a notice appearance to
the assigned ALJ and the ALJ will forward this information to the MAD
administrative hearings unit (MAD AHU). The parties are given an opportunity
to:
(1) call witnesses to present information
relevant to the case;
(2) submit
evidence to establish all pertinent facts and circumstances in the
case;
(3) advance arguments without
undue interference; and
(4)
question or contradict any testimony or evidence, including an opportunity to
confront and cross-examine opposing witnesses.
D.
Evidence and procedure:
Formal rules of evidence and civil procedure do not apply to a HSD
administrative hearing. A free, orderly exchange of relevant information is
necessary for the decision-making process.
(1)
Admissibility: all relevant evidence is admissible subject to the ALJ's
authority to limit repetitive, scandalous or unduly cumulative evidence and his
or her ability to conduct an orderly HSD administrative hearing. The ALJ must
admit evidence that is relevant to the intended or taken adverse action by MAD,
its UR contractor, or the MCO.
(2)
Confidentiality: the confidentiality of records is to be maintained;
(3) Information not entered in the hearing
record: information which is not presented during the HSD administrative
hearing in the presence of the claimant or the claimant's authorized
representative, MAD, its UR contractor, or the MCO may not be used by the ALJ
in making his or her record of fact finding and recommendation.
(4) Administrative notice: the ALJ may take
administrative notice of any matter in which courts of this state may take
judicial notice.
(5) Privilege: the
rules of privilege apply to the extent that they are required to be recognized
in civil actions in the district courts of New Mexico.
(6) Medical issues: in a case involving
physical or behavioral health issues, the parties may submit expert testimony,
reports, affidavits or health care records into evidence as necessary.
Admission of this evidence is at the discretion of the ALJ and must meet the
SOE time-frames for submission. All parties of the HSD administrative hearing
have the right to examine any documents which may influence the HSD
administrative hearing final decision.
