Current through Register Vol. 35, No. 6, March 26, 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 a claimant
or the claimant's authorized representative, MAD, its UR contractor, the MCO or
their designee retains legal counsel, that legal counsel must 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, the MCO or their designees.
(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, the MCO or
their designees 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.
