New Mexico Administrative Code
Title 8 - SOCIAL SERVICES
Chapter 354 - PREADMISSION SCREENING AND ANNUAL RESIDENT REVIEW (PASRR) AND PATIENT STATUS POLICIES
Part 2 - PASRR AND PATIENT STATUS HEARINGS
Section 8.354.2.18 - IMPLEMENTATION OF THE HSD ADMINISTRATIVE FINAL DECISION
Current through Register Vol. 35, No. 6, March 26, 2024
The HSD administrative hearing final decision is binding on all issues that have been the subject of the HSD administrative hearing as to the claimant unless stayed by either a court order or by the MAD director or designee. MAD is responsible for ensuring that the HSD administrative hearing final decision is fulfilled.
A. If the claimant is a member and he or she received a benefit under his or her approved continuation of the benefit and the decision is favorable to the MCO, the claimant's MCO will not take action to file a repayment claim to the claimant or the claimant's authorized representative for the services received during the MCO appeal and the HSD administrative hearing process up to the date of the HSD administrative hearing final decision.
B. If the claimant is not enrolled in an MCO and the HSD administrative hearing final decision is favorable to MAD, its UR contractor or designee, MAD will not take action to file a repayment claim to the claimant or the claimant's authorized representative for the services received during the HSD administrative hearing process up to the date of the HSD administrative hearing final decision.
C. When the HSD administrative hearing final decision is favorable to the claimant, MAD, its UR contractor, the MCO or their designee will authorize the benefit and coverage set forth in the HSD administrative hearing final decision.
