Section 27-12-1 to 27-12-7 – Repealed.
ANNOTATIONS Repeals. — Laws 1998, ch. 52, § 9 repealed 27-12-1 to 27-12-7 NMSA 1978, the Child Health Act, as enacted by Laws 1998, ch. 52, §§ 1 to 7, effective July 1, 2002. For provisions of former sections, see the 1999 NMSA 1978 on NMOneSource.com.
Section 27-13-1 – Short title.
This act [27-13-1 to 27-13-6 NMSA 1978] may be cited as the “Consumer Direction Act”. History: Laws 2003, ch. 210, § 1. ANNOTATIONS Effective dates. — Laws 2003, ch. 210, § 7 made the act effective July 1, 2003.
Section 27-11-5 – Rules.
The secretary shall adopt and promulgate rules appropriate to administer, carry out and enforce the provisions of the Medicaid Provider Act. History: Laws 1998, ch. 30, § 5.
Section 27-11-6 – Repealed.
History: Laws 2004, ch. 4, § 1; repealed by Laws 2006, ch. 25, § 2. ANNOTATIONS Repeals. — Laws 2006, ch. 25, § 2 repealed 27-11-6 NMSA 1978, as enacted by Laws 2004, ch. 4, § 1, relating to the imposition of a daily bed surcharge, effective March 2, 2006. For provisions of former section, […]
Section 27-11-7 – Determination of overpayments or credible allegation of fraud; audit findings; sampling; extrapolation limited; notice of right to informal conference and expedited adjudicatory proceeding.
A. The department may audit a medicaid provider or subcontractor for overpayment, using sampling for the time period audited. If the department contracts for the audit, the department shall contract only with an independent auditor approved by the state auditor. Each audited claim shall be reviewed by a person who is licensed, certified, registered or […]
Section 27-11-8 – Informal conference; corrective action; requirements.
A. A medicaid provider or subcontractor seeking an informal conference pursuant to this section shall serve the department with a written request for such conference no later than thirty calendar days following the service of a preliminary determination of overpayment by the department on the medicaid provider or subcontractor. Upon receipt of a request for […]
Section 27-11-9 – Expedited adjudicatory proceedings; requirements.
A. A medicaid provider or subcontractor seeking an expedited adjudicatory proceeding pursuant to the Medicaid Provider and Managed Care Act shall serve the department and the administrative hearings office with a written request for such proceeding no later than thirty calendar days following the service of a final determination of overpayment by the department on […]
Section 27-11-10 – Qualifications and selection of hearing officer for expedited adjudicatory proceedings.
A. The hearing officer presiding over the expedited adjudicatory proceeding held pursuant to the Medicaid Provider and Managed Care Act shall: (1) be licensed and in good standing to practice law in New Mexico or another state; (2) have at least three years’ cumulative experience in one or more of the following areas: the health […]
Section 27-11-11 – Costs of expedited adjudicatory proceeding.
A. Each party shall be responsible for its own costs related to the expedited adjudicatory proceeding, including costs associated with preparation for the hearing, discovery, depositions, subpoenas, service of process and witness expenses, travel expenses and investigation expenses and attorney fees. B. The hearing officer shall allow telephonic testimony of a witness if requested by […]
Section 27-11-12 – Rights of medicaid provider or subcontractor; preliminary or final determination of overpayment.
A. A medicaid provider or subcontractor may challenge: (1) the department’s preliminary or final determination of overpayment as: (a) exceeding statutory authority; (b) arbitrary or capricious; (c) a failure to follow department procedure; or (d) not supported by substantial evidence; (2) the credentials of persons who participated in the audit or claims review; or (3) […]