Section 27-11-13 – Release of suspended payment for services previously rendered; prepayment review; remedial training and education; temporary assistance.
A. The department shall direct the release of a suspended payment to a medicaid provider or subcontractor that is the subject of a referral based upon a determination of a credible allegation of fraud for services previously rendered if the medicaid provider or subcontractor posts a surety bond in the amount of the suspended payment, […]
Section 27-11-14 – Maintenance of services; payment for ongoing services.
A. Following the referral of a medicaid provider or subcontractor based on a determination of a credible allegation of fraud, and during the pendency of a dispute between the department and a medicaid provider or subcontractor regarding an alleged overpayment, including an overpayment based in whole or in part on a credible allegation of fraud, […]
Section 27-10-3 – County-supported medicaid fund created; use; appropriation by the legislature.
A. There is created in the state treasury the “county-supported medicaid fund”. The fund shall be invested by the state treasurer as other state funds are invested. Income earned from investment of the fund shall be credited to the county-supported medicaid fund. The fund shall not revert in any fiscal year. B. Money in the […]
Section 27-10-4 – Alternative revenue source to imposition of county health care gross receipts tax; transfer to county-supported medicaid fund.
A. In the event a county does not enact an ordinance imposing a county health care gross receipts tax pursuant to Section 7-20D-3 [7-20E-18] NMSA 1978, the county shall, by ordinance to be effective July 1, 1993, dedicate to the county-supported medicaid fund an amount equal to a gross receipts tax rate of one-sixteenth of […]
Section 27-11-1 – Short title.
Chapter 27, Article 11 NMSA 1978 may be cited as the “Medicaid Provider and Managed Care Act”. History: Laws 1998, ch. 30, § 1; 2019, ch. 215, § 1. ANNOTATIONS The 2019 amendment, effective January 1, 2020, changed “This act” to “Chapter 27, Article 11 NMSA 1978”, and after “Medicaid Provider”, added “and Managed Care”. […]
Section 27-11-2 – Definitions.
As used in the Medicaid Provider and Managed Care Act: A. “claim” means a request for payment for services; B. “clean claim” means a claim for reimbursement that: (1) contains substantially all the required data elements necessary for accurate adjudication of the claim without the need for additional information from the medicaid provider or subcontractor; […]
Section 27-11-3 – Review of medicaid provider or managed care organization; contract remedies; penalties.
A. Consistent with the terms of any contract between the department and a medicaid provider or managed care organization, the secretary shall have the right to be afforded access to such of the medicaid provider’s or managed care organization’s records and personnel, as well as its subcontracts and that subcontractor’s records and personnel, as may […]
Section 27-11-4 – Retention and production of records.
A. Medicaid providers, managed care organizations and their subcontractors shall retain, for a period of at least six years from the date of creation, all medical and business records that are necessary to verify the: (1) treatment or care of any recipient for which the medicaid provider, managed care organization or subcontractor received payment from […]
Section 27-9-1 – Program; demonstrations.
The human services department, in cooperation with the department of health, is authorized to administer demonstration programs that provide in-home and coordinated community care services to the frail elderly and to persons with a disability who would otherwise require institutionalization. The programs authorized by this section shall serve both those eligible and not eligible for […]
Section 27-9-2 – Implementation.
The secretary of human services shall, by regulation, specify the areas in which the programs shall operate, specify the services to be provided, establish eligibility criteria of persons to be served and provide for cost sharing, where possible, with individuals and participating communities. History: Laws 1983, ch. 323, § 2.