N.M. Admin. Code § 8.301.5.15

Current through Register Vol. 35, No. 23, December 10, 2024

Section 8.301.5.15 - RECIPIENT NOTICE

The medical assistance division gives a recipient and the MCO, if the recipient is enrolled in Salud!, 13 working days notice of the decision to place the recipient in medical management. Notice is given for the initial imposition of the assignment, modification of the assignment, or continuation of the assignment.

A. Time constraints: A recipient can submit a request for a hearing of their assignment into medical management, assignment of the designated providers, modification, or continuation of the assignment. If the recipient requests a hearing within the time frame established below in Section 16, Recipient Hearing, the proposed assignment shall remain imposed until a hearing decision states otherwise.

B. Information contained in the notice: The recipient notice contains the following information 42 CFR 431.210:

(1) statement describing the action MAD intends to take;

(2) reasons for the intended action;

(3) specific state or federal regulations supporting the action or change(s) in the law which require the action;

(4) explanation of the recipient's right to request an administrative hearing and the method and timetable by which the hearing can be requested;

(5) statement explaining the recipient's right to be represented at the administrative hearing by legal counsel, a friend, or other representative;

(6) explanation of the circumstances under which the benefits are continued; and

(7) effective date of the assignment.

N.M. Admin. Code § 8.301.5.15

2-1-95; 8.301.5.15 NMAC - Rn, 8 NMAC 4.MAD.604.6 & A, 7-1-01, Adopted by New Mexico Register, Volume XXXV, Issue 12, June 25, 2024, eff. 7/1/2024