0001| HOUSE BILL 1073 | 0002| 43rd legislature - STATE OF NEW MEXICO - first session, 1997 | 0003| INTRODUCED BY | 0004| TERRY T. MARQUARDT | 0005| | 0006| | 0007| | 0008| | 0009| | 0010| AN ACT | 0011| RELATING TO PUBLIC ASSISTANCE; PROVIDING FOR REVIEW AND | 0012| REGULATION OF MEDICAID PROVIDERS; PROVIDING ADMINISTRATIVE | 0013| PENALTIES. | 0014| | 0015| BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF NEW MEXICO: | 0016| Section 1. SHORT TITLE.--This act may be cited as the | 0017| "Medicaid Provider Act". | 0018| Section 2. DEFINITIONS.--As used in the Medicaid Provider | 0019| Act: | 0020| A. "department" means the human services | 0021| department; | 0022| B. "managed care organization" means a person | 0023| eligible to enter into risk-based prepaid capitation agreements | 0024| with the department to provide health care and related | 0025| services; | 0001| C. "medicaid" means the medical assistance program | 0002| established pursuant to Title 19 of the federal Social | 0003| Security, Act, as amended from time to time, and regulations | 0004| issued pursuant to that act; | 0005| D. "medicaid provider" means a person, including a | 0006| managed care organization, operating under contract with the | 0007| department to provide medicaid-related services to recipients; | 0008| E. "person" means an individual or other legal | 0009| entity; | 0010| F. "recipient" means a person whom the department | 0011| has determined to be eligible to receive medicaid-related | 0012| services; | 0013| G. "secretary" means the secretary of human | 0014| services; and | 0015| H. "subcontractor" means a person that contracts | 0016| with a medicaid provider to provide medicaid-related services | 0017| to recipients." | 0018| Section 3. REVIEW OF MEDICAID PROVIDERS--CONTRACT | 0019| REMEDIES--PENALTIES.-- | 0020| A. The secretary may review the operations of a | 0021| medicaid provider, and shall have the right of and be afforded | 0022| full access to the medicaid provider's records, personnel and | 0023| facilities for that purpose at all times. | 0024| B. The secretary may, consistent with the | 0025| provisions of the Medicaid Provider Act and regulations issued | 0001| pursuant to that act, carry out an administrative investigation | 0002| or conduct administrative proceedings to determine whether a | 0003| medicaid provider has: | 0004| (1) operated in a manner that materially | 0005| violates its organizational documents; | 0006| (2) materially breached its obligation to | 0007| furnish medicaid-related services to recipients, or any other | 0008| duty specified in its contract with the department; | 0009| (3) violated any provision of the Public | 0010| Assistance Act or the Medicaid Provider Act or any regulations | 0011| issued pursuant to those acts; | 0012| (4) made any false statement with respect to | 0013| any report or statement required by the Public Assistance Act, | 0014| or the Medicaid Provider Act, regulations issued pursuant to | 0015| either of those acts or a contract with the department; | 0016| (5) advertised or marketed, or attempted to | 0017| advertise or market, its services to recipients in such a | 0018| manner as to misrepresent its services or capacity for | 0019| services, or engaged in any deceptive, misleading or unfair | 0020| practice with respect to advertising or marketing; | 0021| (6) hindered or prevented the secretary from | 0022| performing any duty imposed by the Public Assistance Act, the | 0023| Human Services Department Act or the Medicaid Provider Act or | 0024| any regulations issued pursuant to those acts; or | 0025| (7) fraudulently procured or attempted to | 0001| procure any benefit from medicaid. | 0002| C. After affording a medicaid provider written | 0003| notice of hearing not less than ten days before the hearing | 0004| date and an opportunity to be heard, and upon making | 0005| appropriate administrative findings, the secretary may take any | 0006| or any combination of the following actions against the | 0007| provider: | 0008| (1) impose an administrative penalty of not | 0009| more than ten thousand dollars ($10,000) for engaging in any | 0010| practice described in Paragraphs (1) through (7) of Subsection | 0011| B of this section; provided, that each occurrence of each | 0012| practice shall constitute a separate offense; | 0013| (2) issue an administrative order requiring | 0014| the provider to: | 0015| (a) cease or modify any specified | 0016| conduct or practices engaged in by it, its employees, | 0017| subcontractors or agents; | 0018| (b) fulfill its contractual obligations | 0019| in the manner specified in the order; | 0020| (c) provide any service that has been | 0021| denied; | 0022| (d) take steps to provide or arrange for | 0023| any service that it has agreed or is otherwise obligated to | 0024| make available; or | 0025| (e) enter into and abide by the terms of | 0001| a binding or non-binding arbitration proceeding, if agreed to | 0002| by any opposing party, including the secretary; or | 0003| (3) suspend or revoke the contract between the | 0004| provider and the department, in which case the provider: | 0005| (a) during the period of any suspension, | 0006| shall not enroll or treat additional recipients, except newborn | 0007| children or other newly acquired dependents of existing | 0008| enrolled recipients, and shall not engage in any advertising, | 0009| marketing or solicitation for enrollment or treatment of | 0010| additional recipients; and | 0011| (b) immediately following the effective | 0012| date of any revocation, shall proceed expeditiously to wind up | 0013| its affairs under its contract with the department, and shall | 0014| not conduct further business except as may be essential to the | 0015| orderly conclusion of its medicaid-related affairs and transfer | 0016| to other medicaid providers of its recipients and their | 0017| records; provided, that the secretary may, by written order, | 0018| permit such further operation of the medicaid provider's | 0019| medicaid-related services as the secretary finds to be in the | 0020| best interest of recipients, to the end that they will be | 0021| afforded the greatest practical opportunity to obtain | 0022| continuous medicaid-related coverage." | 0023| Section 4. RETENTION AND PRODUCTION OF RECORDS.-- | 0024| A. Medicaid providers and their subcontractors | 0025| shall retain, for a period of at least five years from the date | 0001| of creation, all medical and business records relating to: | 0002| (1) treatment or care of any recipient; | 0003| (2) services or goods provided to any | 0004| recipient; | 0005| (3) amounts paid by medicaid or the medicaid | 0006| provider on behalf of any recipient; and | 0007| (4) records required by medicaid or used for | 0008| its administration. | 0009| B. Upon written request by medicaid or the | 0010| department to a medicaid provider or any subcontractor for | 0011| copies or inspection of records pursuant to the Public | 0012| Assistance Act, the medicaid provider or subcontractor shall | 0013| provide the copies or permit the inspection, as applicable, | 0014| within five business days after the date of the request. | 0015| C. Failure to provide copies or to permit | 0016| inspection of records requested pursuant to this section shall | 0017| constitute a violation of the Medicaid Provider Act within the | 0018| meaning of Paragraph (3) of Subsection B of Section 3 of that | 0019| act." | 0020| Section 5. REGULATIONS.--The secretary shall adopt and | 0021| promulgate regulations appropriate to administer, carry out and | 0022| enforce the provisions of the Medicaid Provider Act. | 0023|  State of New Mexico | 0024| House of Representatives | 0025| | 0001| FORTY-THIRD LEGISLATURE | 0002| FIRST SESSION, 1997 | 0003| | 0004| | 0005| March 1, 1997 | 0006| | 0007| | 0008| Mr. Speaker: | 0009| | 0010| Your CONSUMER AND PUBLIC AFFAIRS COMMITTEE, to | 0011| whom has been referred | 0012| | 0013| HOUSE BILL 1073 | 0014| | 0015| has had it under consideration and reports same with | 0016| recommendation that it DO PASS, and thence referred to the | 0017| JUDICIARY COMMITTEE. | 0018| | 0019| Respectfully submitted, | 0020| | 0021| | 0022| | 0023| | 0024| | 0025| Gary King, Chairman | 0001| | 0002| | 0003| Adopted Not Adopted | 0004| | 0005| (Chief Clerk) (Chief Clerk) | 0006| | 0007| Date | 0008| | 0009| The roll call vote was 6 For 0 Against | 0010| Yes: 6 | 0011| Excused: Heaton, Rios, Vaughn, Vigil | 0012| Absent: None | 0013| | 0014| | 0015| G:\BILLTEXT\BILLW_97\H1073 State of New Mexico | 0016| House of Representatives | 0017| | 0018| FORTY-THIRD LEGISLATURE | 0019| FIRST SESSION, 1997 | 0020| | 0021| | 0022| March 21, 1997 | 0023| | 0024| | 0025| Mr. Speaker: | 0001| | 0002| Your JUDICIARY COMMITTEE, to whom has been referred | 0003| | 0004| HOUSE BILL 1073 | 0005| | 0006| has had it under consideration and reports same with | 0007| recommendation that it DO PASS, amended as follows: | 0008| | 0009| 1. On page 2, line 20, strike "personnel and" and strike | 0010| line 21 and insert in lieu thereof "as are necessary to fully | 0011| disclose the extent of services provided to recipients under | 0012| Title 19 of the federal Social Security Act, including patient | 0013| and employee records and any information regarding payments | 0014| claimed by the medicaid provider for furnishing services under | 0015| the medicaid program."., | 0016| | 0017| and thence referred to the APPROPRIATIONS AND FINANCE | 0018| COMMITTEE. | 0019| | 0020| Respectfully submitted, | 0021| | 0022| | 0023| | 0024| | 0025| | 0001| Thomas P. Foy, Chairman | 0002| | 0003| | 0004| Adopted Not Adopted | 0005| | 0006| (Chief Clerk) (Chief Clerk) | 0007| | 0008| Date | 0009| | 0010| The roll call vote was 7 For 2 Against | 0011| Yes: 7 | 0012| No: M.P. Garcia, Pederson | 0013| Excused: Alwin, Rios, Sanchez, Foy | 0014| Absent: None | 0015| | 0016| | 0017| .118792.1 | 0018| G:\BILLTEXT\BILLW_97\H1073 |