N.M. Admin. Code § 8.312.2.7 - [Effective until 8/1/2025] DEFINITIONS
A. "Authorized representative" means the individual designated to represent and act on the claimant's behalf. The eligible recipient or managed care organization (MCO) member's authorized representative must provide formal documentation authorizing the named individual or individuals to access the identified case information for a specified purpose and time frame. An authorized representative may be an attorney representing a person or household, a person acting under the authority of a valid power of attorney, a guardian ad litem, or any other individual or individuals designated in writing by the eligible recipient or MCO member.
B. "Designee" means a state agency or an institution MAD has designated to be responsible for:
(1) conducting a preadmission screening and annual resident review (PASRR) level 1 screening to identify if a medical assistance program (MAP) eligible recipient or a MCO member has a mental illness or an intellectual disability; or
(2) conducting a PASRR level 2 evaluation.
C.
"HCA DDSD" means the developmental disabilities support division of the health care authority, which conducts the PASRR level II evaluation for a MAP eligible recipient or a MCO member that has been identified through a PASRR level 1 screen.
D.
"HCA administrative hearing" or "fair hearing" means an informal evidentiary hearing that is conducted by the HCA office of fair hearings so that evidence may be presented as it relates to an adverse action taken, or intended to be taken, by MAD, the MCO or their designees.
E. "MAD" means the medical assistance division, which administers medicaid and other medical assistance programs (MAP) under HCA.
F. "MAP" means the medical assistance programs administered by MAD.
G. "MCO" means a member's HCA contracted managed care organization.
H. "Member" means a MAP eligible recipient enrolled in a HCA contracted MCO. Once a member requests a HCA administrative hearing, the member is referred to as a claimant.
I. "Notice of action" means the notice issued by MAD, the MCO or their designees of their intent to take an adverse action against an eligible recipient or a member in the form an adverse determination is made with regard to the preadmission or annual resident review requirements.
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
A. " Authorized representative " means the individual designated to represent and act on the claimant's behalf. The eligible recipient or managed care organization (MCO ) member 's authorized representative must provide formal documentation authorizing the named individual or individuals to access the identified case information for a specified purpose and time frame. An authorized representative may be an attorney representing a person or household , a person acting under the authority of a valid power of attorney, a guardian ad litem, or any other individual or individuals designated in writing by the eligible recipient or MCO member .
B. " Designee " means a state agency or an institution MAD has designated to be responsible for:
(1) conducting a preadmission screening and annual resident review (PASRR) level 1 screening to identify if a medical assistance program (MAP ) eligible recipient or a MCO member has a mental illness or an intellectual disability; or
(2) conducting a PASRR level 2 evaluation.
C. "HCA DDSD " means the developmental disabilities support division of the health care authority, which conducts the PASRR level II evaluation for a MAP eligible recipient or a MCO member that has been identified through a PASRR level 1 screen.
D. "HCA administrative hearing " or "fair hearing" means an informal evidentiary hearing that is conducted by the HCA office of fair hearings so that evidence may be presented as it relates to an adverse action taken, or intended to be taken, by MAD , the MCO or their designees.
E. " MAD " means the medical assistance division, which administers medicaid and other medical assistance programs (MAP ) under HCA.
F. " MAP " means the medical assistance programs administered by MAD .
G. " MCO " means a member 's HCA contracted managed care organization.
H. " Member " means a MAP eligible recipient enrolled in a HCA contracted MCO . Once a member requests a HCA administrative hearing , the member is referred to as a claimant.
I. " Notice of action " means the notice issued by MAD , the MCO or their designees of their intent to take an adverse action against an eligible recipient or a member in the form an adverse determination is made with regard to the preadmission or annual resident review requirements .