New Mexico Register / Volume XXXVII,
Issue 13 / July 14, 2026
This is an amendment to 8.308.8 NMAC, Sections 1, 8,
10, 11, 12, 15, and 16, effective 8/1/2026.
8.308.8.1 ISSUING
AGENCY: New Mexico health care authority (HCA).
[8.308.8.1 NMAC -
Rp, 8.308.8.1 NMAC, 5/1/2018; A, 7/1/2024; A,
8/1/2026]
8.308.8.8 [RESERVED]
MISSION: We ensure that New Mexicans attain their highest level of health by
providing whole-person, cost-effective, accessible, and high-quality health
care and safety-net services.
[8.308.8.8 NMAC -
Rp, 8.308.8.8 NMAC, 5/1/2018; A, 8/1/2026]
8.308.8.10 WRITTEN
MEMBER MATERIALS:
A. All written
materials will be available in English and all languages spoken by approximately
five percent or more of the MCO’s membership, as determined by the [HSD]
HCA contracted managed care organization (MCO) or [HSD] HCA. Upon consent from the appropriate [native]
Native American tribal leadership, the MCO shall make every effort when
a written form is not in the member’s native language to translate the form in the
member’s native language.
B. The MCO is
responsible for providing a member or potential member with its member handbook
and provider directory, as requested by a member.
(1) The
MCO shall send such information to the member within 30 calendar days of receipt
of notification of enrollment in the MCO.
(2) Thereafter,
upon the request from a member, the MCO shall send such information within 10
calendar days. The MCO shall provide the
requestor the option to receive the material in a written or electronic form or
by citation to be found on the member’s MCO’s website.
(3) On
an annual basis, the MCO shall notify the member of the availability of updated
materials and how to obtain such materials.
C. All written
member materials must comply with provisions set forth in 42 CFR 438.10.
[8.308.8.10 NMAC -
Rp, 8.308.8.10 NMAC, 5/1/2018; A, 8/1/2026]
8.308.8.11 MEMBER
RIGHTS AND RESPONSIBILITIES: The MCO shall
provide each member or the member's authorized representative with written
information concerning [his or her] their rights and
responsibilities.
A. These include the
right:
(1) to
be treated with respect and with due consideration for [his or her] their
dignity and privacy;
(2) to
receive information on available treatment options and alternatives, presented
in a manner appropriate to [his or her] their condition and
ability to understand such information;
(3) to
make and have honored [his or her] their advance directive that
is consistent with state and federal laws;
(4) to
receive covered services in a nondiscriminatory manner;
(5) to
participate in decisions regarding [his or her] their health
care, including the right to refuse treatment;
(6) to
be free from any form of restraint or seclusion used as a means of coercion,
discipline, convenience or retaliation, as specified in federal regulations on
the use of restraints and seclusion;
(7) to
request and receive a copy of [his or her] their medical records
and to request that they be amended or corrected as specified in 45 CFR 164.524
and 526;
(8) to
choose an authorized representative to be involved, as appropriate, in making [his
or her] their health care decisions;
(9) to
provide informed consent;
(10) to
voice grievances concerning the care provided by the MCO;
(11) to
appeal any action regarding medicaid services that
the member or [his or her] their authorized representative or
authorized provider believes is erroneous;
(12) to
protect the member, [his or her] their authorized representative
or authorized provider who uses the grievance, appeal, and [HSD] HCA
administrative hearing processes from fear of retaliation;
(13) to
choose from among contracted providers in accordance with [his or her] their
MCO’s prior authorization requirements;
(14) to
receive information about covered services and how to access these covered
services, and providers;
(15) to
be free from harassment by the MCO or its contracted providers in regard to
contractual disputes between the MCO and the provider;
(16) to
participate in understanding physical and behavioral health problems and
developing mutually agreed-upon treatment goals; and
(17) to
be assured that the MCO complies with any other applicable federal and state
laws including: Title VI of the Civil
Rights Act of 1964 as implemented by regulations in 45 CFR part 80; the Age
Discrimination Act of 1975 as implemented by regulations 45 CFR part 91; the
Rehabilitation Act of 1973; Title IX of the Education Amendments of 1972
(regarding education programs and activities); Titles II and III of the Americans
with Disabilities Act; and section 1557 of the Patient Protection and
Affordable Care Act.
B. The MCO shall
ensure that each member or the member's authorized representative or authorized
provider is free to exercise [his or her] their
rights, and the exercise of those rights does not adversely affect the way that
the MCO or provider treats the member or member's authorized representative or
authorized provider.
C. The member or [his
or her] their authorized representative or authorized provider, to
the extent possible, has a responsibility:
(1) to
provide information that the MCO and providers need in order to care for the
member, such information includes, but is not limited to the member’s:
(a) most
current mailing address;
(b) most
current email address, if one is available;
(c) most
current phone number, including any land line and cell phone, if available; and
(d) most
current emergency contact information;
(2) to
follow the care plans and instructions from [his or her] their
provider that have been agreed upon;
(3) to
keep a scheduled appointment; and
(4) to
reschedule or cancel a scheduled appointment rather than simply fail to keep
it.
[8.308.8.11 NMAC -
Rp, 8.308.8.11 NMAC, 5/1/2018; A, 8/1/2026]
8.308.8.12 MEMBER
HEALTH RECORDS: The MCO shall provide a member with access to
electronic or hard copy versions of [his or her] their personal
health records.
[8.308.8.12 NMAC -
Rp, 8.308.8.12 NMAC, 5/1/2018; A, 8/1/2026]
8.308.8.15 MEMBER
TOLL-FREE LINE: The MCO shall operate a call center with a
toll-free phone line to respond to member questions, concerns, inquiries and
complaints from a member and [his or her] their provider. The line shall be equipped to handle calls
from an individual with limited English proficiency, as well as calls from a member
who is hearing impaired. It should be
staffed 24 hours a day, seven days a week, with qualified nurses to triage
urgent care and emergency calls from a member, and when necessary, to
facilitate the transfer of such calls to a care coordinator.
[8.308.8.15 NMAC -
Rp, 8.308.8.15 NMAC, 5/1/2018; A, 8/1/2026]
8.308.8.16 MEMBER
ADVISORY BOARD: The MCO shall convene advisory boards that
meet quarterly and are representative of its membership. The advisory board shall advise the MCO on
issues concerning service delivery, quality of its covered services, and other member
issues as needed or as directed by [HSD] HCA.
[8.308.8.16 NMAC -
Rp, 8.308.8.16 NMAC, 5/1/2018; A, 8/1/2026]