1. A. Record review. All applicants whose application for services from CMS has been denied and all clients who have been denied requested services by the program may request a record review from CMS.

2. B. Procedure for requesting informal administrative review.

   (1) The applicant or client may submit a written request for a record review. To be effective, the written request shall:

   (a) be made within 30 calendar days, as determined by the postmark, from the date of the notice of action issued by CMS;

   (b) be properly addressed to CMS;

   (c) state the applicant’s name, address, and telephone numbers; and

   (d) provide a brief narrative rebutting the circumstances of the denial.

   (2) If the applicant or client wishes to submit additional documentation for consideration, such additional documentation must be included with the request for a record review.

3. C. Record review proceeding. The review proceeding is intended to be an informal, non-adversarial administrative review of written documentation. It shall be conducted by an administrative review committee designated for that purpose by CMS. In cases where the administrative review committee finds the need for additional or clarifying information, the review committee shall request that the applicant or client supply such additional information within the time set forth in the committee’s request.

4. D. Final determination.

   (1) Content: the administrative review committee shall render, sign, and enter a written decision within 60 days setting forth the reasons for the decision and the evidence upon which the decision is based.

   (2) Effect: the decision of the administrative review committee is the final decision of the informal administrative review proceeding.

   (3) Notice: a copy of the decision shall be mailed by registered or certified mail to the applicant.

5. E. Judicial review. Judicial review of the administrative review committee’s final decision is permitted to the extent provided by law. The party requesting the appeal shall bear the cost of such appeal.

[7.30.3.17 NMAC - Rp, 7 NMAC 30.3.15, 10/30/12]