Chapter 27 — Chapter 27

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.

History: Laws 2004, ch. 4, § 1; repealed by Laws 2006, ch. 25, § 2.

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 …

Notwithstanding any other law, a person is not civilly or criminally liable for providing access to documentary material pursuant to the Medicaid False Claims Act [27-14-1 NMSA 1978] to a person identified in Subsection B of Section 5 of that act. History: Laws 2004, ch. 49, § 6.

A. The department shall diligently investigate suspected violations. If the department finds that a person has violated or is violating the provisions of the Medicaid False Claims Act, the department may bring a civil action pursuant to Subsection F of this section. B. A private …

A. If the department proceeds with the action, it shall have the exclusive responsibility for prosecuting the action and shall not be bound by an act of the person bringing the action. The person bringing the action shall have the right to continue as a nominal party to the actio…

A. If the department proceeds with an action brought by a person pursuant to the Medicaid False Claims Act, the person shall, subject to the limitations in this subsection, receive at least fifteen percent but not more than twenty-five percent of the proceeds of the action or set…

This act [27-15-1 to 27-15-5 NMSA 1978] may be cited as the "Money Follows the Person in New Mexico Act". History: Laws 2006, ch. 112, § 1.

As used in the Money Follows the Person in New Mexico Act, "department" means the aging and long-term services department [9-23-4 NMSA 1978]. History: Laws 2006, ch. 112, § 2.

An elderly or disabled individual who is identified and assessed as eligible for community-based living shall be allowed to choose, from among all service options available, the type of service that best meets that individual's needs. The individual's medical assistance funds sha…

The department shall identify and provide adequate information to a medicaid- eligible individual residing in a nursing home and, if appropriate, the individual's representative, of the opportunity for the individual to receive community-based services and support pursuant to the…

The department shall develop and implement a quality improvement system of performance indicators and outcome measures to evaluate the level and effectiveness of participation of individuals who are eligible for community-based services and to ensure that the services and support…