Chapter 27, Chapter 27

Although in recent years New Mexico has shown improvement in indices such as personal income and the number of families below the poverty level, the state continues to compare poorly with other states. New Mexico has risen from 48th in 1974 to 41st in per capita personal income; …

As used in the Community Action Act: A. "poverty level" means the official poverty level established by the federal director of the office of management and budget and revised periodically by the United States secretary of health and human services; and B. "secretary" means the s…

A. The secretary may provide financial assistance to community action agencies for the planning, conduct, administration and evaluation of community action programs as described in the Community Action Act in accordance with state and federal law and regulations. B. No funds prov…

A. A community action agency is a political subdivision of the state, a combination of political subdivisions or a public or private nonprofit agency that: (1) has the power and authority to enter into contracts with public and private nonprofit agencies and organizations in fulf…

A. Each community action agency shall administer its community action program through a community action board. Board members shall be selected as follows: (1) one-third of the members of the board shall be elected public officials currently holding office in the geographical are…

Each community action agency shall use available funds for a community action program which: A. provides a range of services and activities which have a measurable and potentially major impact on causes of poverty in the community; B. provides activities designed to assist low-in…

The secretary shall adopt such rules and regulations as may be necessary to carry out the provisions of the Community Action Act. History: Laws 1983, ch. 139, § 8.

The secretary, consistent with federal law, shall make grants of not less than ninety percent of the annual allocation of funds available under the community services block grant to community action agencies defined in Subsection A of Section 5 [27-8-5 NMSA 1978] of the Community…

The health care authority, in cooperation with the aging and long-term services department, is authorized to administer demonstration programs that provide in-home and coordinated community care services to the frail elderly and to persons with disabilities who would otherwise re…

The secretary of health care authority shall, by rule, 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 persons and participating c…

Chapter 27, Article 10 NMSA 1978 may be cited as the "Statewide Health Care Act". History: Laws 1991, ch. 212, § 1; 2024, ch. 39, § 115.

A. Access to health care reduces long-term medical and social costs. The effectiveness of statewide health care has been decreased by excessive fragmentation and failure to maximize the use of existing in-state revenues and to develop effective ways of drawing upon potential fede…

appropriation by the legislature. A. The "county-supported medicaid fund" is created as a nonreverting fund in the state treasury. 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 t…

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…

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.

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 leas…

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 expens…

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; o…

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 f…

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 overpa…

A. Overpayments collected pursuant to the Medicaid Provider and Managed Care Act on behalf of the state shall be remitted to the department for deposit in the general fund to be used for the state's medicaid program. B. The department shall not enter into a contract to pay any po…

evidence required. A. A credible allegation of fraud determination by the department shall be deemed a final agency decision and may be appealed pursuant to Section 39-3-1.1 NMSA 1978. B. A medicaid provider or subcontractor that is the subject of a referral to the attorney gener…

A. If a medicaid provider or subcontractor is the prevailing party in any expedited adjudicatory or court proceeding brought by the medicaid provider or subcontractor pursuant to the Medicaid Provider and Managed Care Act on or after January 1, 2020 in connection with a prelimina…

A. The department shall be subject to Sections 12-8-2, 12-8-10 through 12-8-13, 12-8-15 and 12-8-16 NMSA 1978 for expedited adjudicatory proceedings as provided by the Medicaid Provider and Managed Care Act. B. Sections 12-8-2, 12-8-10 through 12-8-13, 12-8-15 and 12-8-16 NMSA 19…

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 th…

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 organi…

negotiated rates. The department shall not reduce hospital payment rates made pursuant to medicaid below those in effect on the date this 2024 act takes effect. A managed care organization shall not reduce negotiated rates paid to a hospital pursuant to medicaid below the hospita…

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 …

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.

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 co…

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 depa…

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 d…

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.

The purpose of the Consumer Direction Act is to ensure a consumer the right to direct his personal assistance services if he so chooses by selecting an attendant appropriate to his needs and to maximize personal assistance service availability and satisfaction. History: Laws 2003…

As used in the Consumer Direction Act: A. "attendant" means a person, including an allowable family member, who provides personal assistance services; B. "consumer" means a person receiving personal assistance services through any personal assistance programs offered by the state…

Consistent with the federal Social Security Act and subject to the appropriation and availability of federal and state funds, each administering department or agency shall by rule provide a program permitting a consumer or surrogate to direct personal assistance services through …

A department shall: A. establish by rule the criteria and procedures for developing and amending a personal assistance services plan with a consumer; B. develop criteria and procedures for selection of a fiscal intermediary to contract with the department to provide fiscal interm…

Annually by October 1, each department shall deliver a report to the legislative finance committee and the legislative health and human services committee on services provided pursuant to the Consumer Direction Act and a comparison of those services and services provided by the d…

A. A fiscal intermediary shall not be subject to vicarious liability as an employer or principal for a wrongful act committed by a personal care attendant if the attendant: (1) is not a current or former employee of the fiscal intermediary; (2) has not received training or instru…

Chapter 27, Article 14 NMSA 1978 may be cited as the "Medicaid False Claims Act". History: Laws 2004, ch. 49, § 1; 2024, ch. 39, § 118.

A. A court shall not have jurisdiction of an action brought pursuant to the Medicaid False Claims Act against a department official if the action is substantially based on evidence or information known to the department when the action was brought. B. A person shall not bring an …

The department shall not be liable for expenses that a person incurs in bringing an action pursuant to the Medicaid False Claims Act. History: Laws 2004, ch. 49, § 11.

Any employee who is discharged, demoted, suspended, threatened, harassed or otherwise discriminated against in the terms and conditions of employment by the employer because of lawful acts done by the employee on behalf of the employee or others in disclosing information to the d…

A. A civil action shall be brought within the limitations set forth in Section 37-1-4 NMSA 1978. B. In any action brought pursuant to the Medicaid False Claims Act, the department or the person bringing the action shall be required to prove all essential elements of the cause of …

The application of a civil remedy pursuant to this law does not preclude the application of other laws, statutes or regulatory remedy, except that a person may not be liable for a civil remedy pursuant to the Medicaid False Claims Act and civil damages or recovery pursuant to the…

A. Damages collected pursuant to the Medicaid False Claims Act on behalf of the state shall be remitted to the state treasurer for deposit in the general fund to be used for the state's medicaid program. B. Penalties, legal fees or costs of investigation recovered pursuant to the…

The purpose of the Medicaid False Claims Act is to deter persons from causing or assisting to cause the state to pay medicaid claims that are false and to provide remedies for obtaining treble damages and civil recoveries for the state when money is obtained from the state by rea…

As used in the Medicaid False Claims Act: A. "claim" means a written or electronically submitted request for payment of health care services pursuant to the medicaid program; B. "department" or "authority" means the health care authority; C. "medicaid" means the federal-state pro…

A person commits an unlawful act and shall be liable to the state for three times the amount of damages that the state sustains as a result of the act if the person: A. presents, or causes to be presented, to the state a claim for payment under the medicaid program knowing that s…

A. The department shall have access to all documentary materials of persons and medicaid recipients to which a state agency has access. Documentary material provided pursuant to this subsection is provided to allow investigation of an alleged unlawful act or for use or potential …