44th legislature - STATE OF NEW MEXICO - first session, 1999

RELATING TO HEALTH; PROVIDING FOR RECOUPMENT OF MONEY PAID TO NURSING FACILITIES FOR INSUFFICIENT OR POOR QUALITY SERVICES.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF NEW MEXICO:

Section 1. NURSING FACILITIES--COMPLAINTS--INVESTIGATION--RECOUPMENT.--

A. As used in this section:

(1) "nursing facility" means a residential facility licensed by the department of health to provide care to patients, including a skilled nursing facility, an intermediate care facility or an intermediate care facility for the mentally retarded;

(2) "patient" means a person who is sick, disabled, elderly or mentally retarded and who is a resident of a nursing facility; and

(3) "responsible party" means a legal guardian or other person entitled to act on behalf of a patient.

B. Complaints alleging insufficient or poor quality services not meeting department of health standards required for nursing facilities may be made to the department of health, the long-term care ombudsman in the state agency on aging, the adult protective services division of the children, youth and families department or the human services department. The agency receiving the complaint shall promptly investigate the charges, pursuant to a joint protocol established under Subsection L of Section 24-1-5 NMSA 1978.

C. Beginning on July 1, 2001, medicaid reimbursements or payments for nursing home services shall be based on the nursing home's performance of quality care measures, including the number of complaints and the manner in which the nursing home resolves substantiated complaints by members of the joint protocol. The human services department shall adopt rules implementing this provision no later than October 1, 1999.

D. The human services department shall establish hearing procedures by rule assuring that minimal procedural due process safeguards are afforded. A person aggrieved by a final decision of a department may appeal pursuant to Section 39-3-1.1 NMSA 1978.