New Mexico § 27-2-12.4 - Long-term care facilities; noncompliance with standards and conditions; sanctions

§ 27-2-12.4. Long-term care facilities; noncompliance with standards and conditions; sanctions

A. In addition to any other actions required or permitted by federal law or regulation,

the human services [health care authority] department shall impose a hold on state

medicaid payments to a long-term care facility thirty days after the health and environment

department [department of health] notifies the human services department in writing

pursuant to an on-site visit that the long-term care facility is not in substantial

compliance with the standards or conditions of participation promulgated by the federal

department of health and human services pursuant to which the facility is a party

to a medicaid provider agreement, unless the substantial noncompliance has been corrected

within that thirty-day period or the facility's medicaid provider agreement is terminated

or not renewed based in whole or in part on the noncompliance. The written notice shall cite the specific deficiencies that constitute noncompliance. B. The human services [health care authority] department shall remove the payment

hold imposed under Subsection A of this section when the health and environment department

[department of health] pursuant to an on-site visit certifies in writing to the human

services [health care authority] department that the long-term care facility is in

substantial compliance with the standards or conditions of participation pursuant

to which the facility is a party to a medicaid provider agreement. C. The human services [health care authority] department shall not reimburse any long-term

care facility during the payment hold period imposed pursuant to Subsection A of this

section for any medicaid recipient-patients who are new admissions and who are admitted

on or after the day the hold is imposed and prior to the day the hold is removed. D. If a long-term care facility is certified in writing to be in noncompliance pursuant

to Subsection A of this section for the second time in any twelve-month period, the

human services [health care authority] department shall cancel or refuse to execute

the long-term care facility's medicaid provider agreement for a two-month period,

unless it can be demonstrated that harm to the patients would result from this action

or that good cause exists to allow the facility to continue to participate in the

medicaid program. The provisions of this subsection are subject to appeal procedures set forth in

federal regulations for nonrenewal or termination of a medicaid provider agreement. E. A long-term care facility shall not charge medicaid recipient-patients, their families

or their responsible parties to recoup any payments not received because of a hold

on medicaid payments imposed pursuant to this section. F. This section shall not be construed to affect any other provisions for medicaid

provider agreement termination, nonrenewal, due process and appeal pursuant to federal

law or regulation. G. As used in this section: (1) “day” means a twenty-four hour period beginning at midnight and ending one second

before midnight; (2) “long-term care facility” means any intermediate care facility or skilled nursing

facility which is licensed by the health and environment department [department of

health] and which is medicaid certified; (3) “new admissions” means medicaid recipients who have never been in the long-term

care facility or, if previously admitted, had been discharged or had voluntarily left

the facility. The term does not include: (a) individuals who were in the long-term care facility before the effective date

of the hold on medicaid payments and became eligible for medicaid after that date;

and (b) individuals who, after a temporary absence from the facility, are readmitted to

beds reserved for them in accordance with federal regulations; and (4) “substantial compliance” means the condition of having no cited deficiencies or

having only those cited deficiencies which: (a) are not inconsistent with any federal statutory requirement; (b) do not interfere with adequate patient care; (c) do not represent a hazard to the patients' health or safety; (d) are capable of correction within a reasonable period of time; and (e) are ones which the long-term care facility is making reasonable plans to correct.