N.M. Admin. Code § 8.308.2.18

Current through Register Vol. 35, No. 21, November 5, 2024

Section 8.308.2.18 - DELEGATION

Delegation is a process whereby a MCO gives another entity the authority and responsibilities to perform certain functions on its behalf. The MCO is fully accountable for all pre-delegation and delegation activities and decisions made. The MCO shall document its oversight of the entity that performs the delegated activity. The MCO may assign, transfer, or delegate to a subcontractor key management functions with the explicit written approval of HSD.

A. Each contract or written agreement between the MCO and delegated entity shall describe:

(1) the responsibilities of the MCO and the entity to which the activity is delegated;

(2) the delegated activities or obligations;

(3) the reporting responsibilities to include the frequency and method of reporting to the MCO;

(4) the process by which the MCO evaluates the delegated entity's performance;

(5) the remedies up to, and including, revocation of the delegation, available to the MCO if the delegated entity does not fulfill its obligations; and

(6) the requirements specified in 42 CFR § 438.214, if the delegated entity will be providing or securing covered services to members.

B. The MCO shall provide evidence to HSD that it:

(1) evaluated the delegated entity's capacity to perform the delegated activities prior to delegation;

(2) monitors the delegated entity's performance on an ongoing basis and identifies deficiencies or areas for improvement that require the delegated entity to take corrective action as necessary; and

(3) conducts an annual evaluation of its delegated entity in accordance with the MCO's expectations and HSD's standards.

N.M. Admin. Code § 8.308.2.18

Adopted by New Mexico Register, Volume XXIX, Issue 08, April 24, 2018, eff. 5/1/2018