A provider can request a hearing if he or she disagrees with
any of the aforementioned actions taken or sanctions or remedies imposed by
MAD, as applicable. Requests for a HSD provider administrative hearing must be
made within 30 calendar days or within the time limit specified on the notice
of MAD action. A NF or ICF-IID provider must submit the request to DOH within
60 calendar days of the notice of the proposed imposition of remedies related
to noncompliance with certification or licensing requirements. If a provider
fails to request a HSD provider administrative hearing during this time frame,
the provider waives its right to an appeal. See 8.352.3 NMAC for information on
the MAD provider administrative hearing process and a provider rights and
responsibilities.
A.
Imposition
of remedies: MAD can impose all remedies on a MAD enrolled provider
after notifying the provider in a timely manner of the deficiencies an
impending sanction, or remedy. Except for the imposition of civil monetary
penalties against a NF provider, imposition of sanctions for violation of the
Medicaid Provider Act and referrals based on credible allegations of fraud, any
applicable sanctions or remedy may be imposed prior to the HSD provider
administrative hearing.
B.
Stay granted: As applicable, the provider can request that the
imposition of sanctions or remedies be stayed while the HSD provider
administrative hearing process is pending by submitting such request in writing
to MAD. Granting of a stay is at the discretion of the MAD director upon
consideration of health service available and other related concerns. Interest
on civil money penalties or overpayments accrues from the date of the initial
determination.
C.
Collection
of civil monetary penalties for noncompliance: MAD may not collect a
civil money penalty against a NF provider until a final decision is made that
supports the imposition of the penalty. In instances where imposition of civil
money penalties are proposed due to noncompliance with certification
requirements, a NF provider may waive its right to a HSD provider
administrative hearing by submitting a written request to DOH. Waiver of the
right to such a hearing reduces the amount of the specified penalty by 35
percent. A NF provider may submit a plan of correction or request a resurvey
without prejudicing its position during the hearing.
