N.M. Admin. Code § 8.352.3.14 - HEARING DECISION
The final HSD provider administrative hearing decision concerning the hearing is made by the MAD director or designee after review of the record and the ALJ's report and recommendation.
A.
Decision based on the record:
The ALJ's recommendation may be adopted or rejected in a final written decision
by the MAD director or designee on issues that were the subject of the hearing.
The MAD director or designee specifies the reasons for the decision and
identifies the regulatory authority and the evidence supporting the decision,
including the record created by the provider administrative hearing, applicable
federal and state law, regulations and NMAC rules, policies and instructions or
any combination of these. No person who participated in the original action
under appeal or in the provider administrative hearing may participate in
arriving at a final decision.
B.
ALJ recommendation: The ALJ reviews the record of the provider
administrative hearing and all applicable federal and state law, regulations
and NMAC rules, policy and instructions or any combination of these, and
evaluates the evidence submitted. The ALJ submits the complete record of the
hearing, along with his or her written recommendation to the MAD director.
(1) Content of recommendation. The ALJ
specifies the reasons for his or her conclusions, identifies the supporting
evidence, references the applicable federal and state law, regulations and NMAC
rules, policies and instructions or any combination of these, and responds to
the arguments of the parties in a written report and recommendation.
(2) The ALJ recommends:
(a) in favor of the provider if MAD's action
or proposed action is not supported by a preponderance of the evidence
available as a result of the provider administrative hearing;
(b) in favor of MAD, if the preponderance of
the evidence available supports the action or proposed action; or
(c) any other result supported by the
record.
C.
Review of recommendation: The provider administrative hearing file
and recommendation are reviewed by the MAD director or designee to ensure
conformity with applicable federal and state law, regulations and NMAC rules,
policies and instructions or any combination of these.
D.
Final decision: The ALJ's
recommendation may be adopted or rejected in a final written decision by the
MAD director or designee on issues that were the subject of the hearing. The
MAD director specifies the reasons for the decision and identifies the
regulatory authority and the evidence supporting the decision, including the
record created by the provider administrative hearing, applicable federal and
state law, rules and policies or any combination of these. No person who
participated in the original action under appeal or in the hearing may
participate in arriving at a final decision.
E.
Notice to parties: The
parties receive the written decision, including the effective date of
sanctions, terms of sanctions, and amounts of overpayment to be recovered by
MAD. When the provider is represented by legal counsel, counsel must receive
the decision. The notice of the decision includes an explanation that the
parties have exhausted all administrative remedies and may pursue judicial
review of the decision. This explanation includes information on time limits,
and where and how to pursue judicial review.
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