TITLE 7 HEALTH
CHAPTER 14 COMMUNITY
BASED SERVICES
PART 2 QUALITY MANAGEMENT SYSTEM AND REVIEW
REQUIREMENTS FOR
PROVIDERS OF COMMUNITY
BASED SERVICES
7.14.2.1 ISSUING
AGENCY: New Mexico Department of
Health, Division of Health Improvement
[7.14.2.1 NMAC – N,
2-3-03]
7.14.2.2 SCOPE:
This
rule is applicable to persons, organizations or legal entities that are under
contract to provide services to the New Mexico Department of Health and/or the
New Mexico Human Services Department under the following programs: Developmental Disability Waiver (DDW),
Disabled and Elderly Waiver (D&EW),
Medically Fragile Waiver (MFW), Traumatic Brain Injury (TBI) and Family,
Infants and Toddler (FIT) and any additional programs that may require
provider compliance with these requirements.
[7.14.2.2 NMAC – N,
2-3-03]
7.14.2.3 STATUTORY
AUTHORITY: Department of Health
Act, NMSA 1978 Section 9-7-6 (E) and Sections 24-1-3 (L) (O) (T) and (U) of the
Public Health Act, NMSA 1978 as amended.
[7.14.2.3 NMAC – N,
2-3-03]
7.14.2.4 DURATION:
Permanent.
[7.14.2.4 NMAC – N,
2-3-03]
7.14.2.5 EFFECTIVE
DATE: February 3, 2003, unless a
later date is cited at the end of a section.
[7.14.2.5 NMAC – N,
2-3-03]
7.14.2.6 OBJECTIVE: This rule
establishes standards for provider compliance with Department of Health (DOH)
requirements for quality assurance reviews of DDW, D&EW, MFW, TBI and FIT
programs and any additional programs that may require provider compliance with
these requirements and specifies that DOH authorized representatives shall have
timely access to records, personnel, service locations and clients.
[7.14.2.6 NMAC – N,
2-3-03]
7.14.2.7 DEFINITIONS:
For
purposes of these regulations, the following shall apply:
A. “Client” means any person who is requesting or receiving
services from one or more service providers subject to these requirements.
B. “DOH”
means the New Mexico Department
of Health.
C. “Developmental
Disability Waiver (DDW)” means a program offering community based services
under the administration of the DOH Long Term Services Division for persons
eligible based on the criteria described in 8.290.400.10 (B) NMAC.
D. “Disabled &
Elderly Waiver (D&EW)” means a program offering community based
services under the administration of the MAD for persons eligible based on the
criteria described in 8.290.400.10 (A) NMAC.
E. “Family Infant and
Toddler (FIT)” means a program
offering community based services under the administration of the DOH Long Term
Services Division for persons eligible based on the criteria described in
7.30.8 NMAC.
F. “HSD” means the New Mexico Human Services Department.
G. “MAD” means the Medical Assistance Division of the New Mexico Human Services Department or successor agency.
H. “Medically
Fragile Waiver (MFW)” means
a program offering community based services under the administration of the DOH
Long Term Services Division for persons eligible based on the criteria
described in 8.290.400.10 (C) NMAC.
I. “Provider” means
a person, organization or legal entity under contract with DOH or HSD to provide services
to clients eligible for services under one or more of the following programs:
Developmental Disability Waiver (DDW), Disabled and Elderly Waiver (D&EW),
Medically Fragile Waiver (MFW); or Traumatic Brain Injury (TBI) and any
additional programs that may require provider compliance with these
requirements.
J. “Timely Access” means physical or in-person, electronic or
other access needed by authorized representatives of the DOH to conduct a
quality review activity. Timely access
means immediate access upon request. If immediate access is not possible for a
legitimate reason, the access shall be as prompt as reasonably possible.
K. “Traumatic
Brain Injury Provider (TBI)” means a person, organization or other
legal entity as specified in 24-1-24 NMSA 1978, operating under the
administration of the DOH Long Term Services Division, which generally offers
community based services to eligible clients.
[7.14.2.7 NMAC – N,
2-3-03]
7.14.2.8 STANDARD OF COMPLIANCE: The degree of compliance required throughout
these regulations is designated by the use of the words “shall” or “must” or
“may”. “Shall” or “must” means
mandatory. “May” means permissive.
[7.14.2.8.NMAC – N,
2-3-03]
7.14.2.9 CONFIDENTIALITY: Client specific information reviewed or
obtained in the course of quality assurance reviews of providers is
confidential in accordance with all applicable federal and state law and
regulation and with all applicable contract provisions. Other confidential
information may include, but is not limited to: personnel records, the
provider’s internal incident investigations, financial documents and
proprietary business information.
[7.14.2.9 NMAC – N,
2-3-03]
7.14.2.10 ACCESS TO FACILITATE PROVIDER
REVIEW QA ACTIVITIES:
A. DOH shall review the quality of care delivered by
providers subject to these requirements.
These reviews may be either announced or unannounced.
B. Providers of services shall
facilitate timely physical or in-person
access to:
C. Provider records, regardless of media,
including but not limited to: financial records, all client records, ISPs,
personnel records, board and or committee minutes, incident reports, quality
assurance activities, client satisfaction surveys and agency policy/procedures
manuals;
D. All provider personnel;
E. Clients currently receiving services from the
provider;
F. Any information relevant to accessing
guardians, representatives and family members;
G. All records, regardless of media, relating to
former and deceased clients; and
H. All administrative and service
delivery sites.
I. Failure to grant and facilitate timely physical or in-person access as defined in Section 7.14.2.7 (J) of this rule may subject the provider to all available penalties and sanctions as provided in applicable federal, state and/or contract provisions.
[7.14.2.10
NMAC – N, 2-3-03]
History of 7.14.2 NMAC:
[RESERVED]