Managing Healthcare Compliance in New Mexico

Sarah Jones
Outline of New Mexico over healthcare photo

Healthcare compliance in New Mexico mirrors the state’s diverse culture, with unique regulations that differ from other states, such as credentialing documentation requirements for managed care organizations. Healthcare organizations, providers, and compliance professionals must skillfully handle these state-specific rules, while ensuring ethical healthcare and avoiding troubles that come from non-compliance.

All healthcare sites in New Mexico should develop robust compliance systems to monitor regulatory changes and keep staff informed. This article is your guide to the important aspects of healthcare compliance in New Mexico with strategic insights for effective management.

New Mexico Healthcare Compliance Resources

Let’s start with the important state government agencies you’ll need to work with:

  • The New Mexico Department of Health (NMDOH) is a state government agency dedicated to promoting, protecting, and ensuring the health and wellness of all the residents of New Mexico through various public health services and initiatives.
  • The New Mexico Hospital Association (NMHA) is a non-profit organization that advocates for and supports hospitals and healthcare providers across New Mexico, focusing on improving healthcare delivery and patient care throughout the state.
  • The Medical Assistance Division (MAD) within the New Mexico Human Services Department (HSD) administers the state’s Medicaid program, providing essential healthcare services and financial assistance to eligible low-income residents and families in New Mexico.
  • The New Mexico Medical Board is responsible for licensing and regulating medical practitioners in the state, ensuring that they meet professional standards for safe and ethical medical practice.
  • The New Mexico Counseling and Therapy Practice Board oversees the licensing and regulation of professional counselors and therapists in the state, ensuring adherence to ethical and professional standards in mental health services.

These agencies help maintain the integrity and quality of healthcare services in New Mexico, protecting the public and promoting patient safety. The resources provided by these New Mexico state agencies are essential for promoting public health, ensuring access to healthcare, supporting healthcare professionals, and enhancing overall health outcomes for the residents of New Mexico.

Regulations Unique to New Mexico

To meet the standards of healthcare compliance in New Mexico, there are a few additional regulations.

Telehealth Policy

For providers in New Mexico, telehealth services are governed by regulations that emphasize equitable access and reimbursement rates. New Mexico’s parity law requires insurers to cover telemedicine services to the same extent as in-person services. Medicaid providers may offer remote clinical care via live video, audio-only, and store-and-forward; however, remote patient monitoring is not reimbursable. Of note, private payer laws require that telemedicine services be encrypted in order to meet regulatory requirements. Understanding these requirements is crucial for delivering compliant and effective remote healthcare services across New Mexico’s diverse patient population.

Medical Marijuana and Cannabis Regulations

In New Mexico, medical cannabis regulations for providers center around a structured program that requires providers to be licensed medical personnel authorized to prescribe and administer drugs under the Controlled Substance Act. To participate in the Medical Cannabis Program, providers must complete a Medical Provider application. Once approved, providers can use the Online Patient Portal to submit patient applications for medical cannabis. The program recognizes 30 qualifying conditions for medical cannabis use. Providers whose patients do not have a qualifying condition but may benefit from medical cannabis can petition the Medical Advisory Board to include new conditions. However, ‘write-in’ diagnoses are not accepted; patients must be diagnosed with one of the approved qualifying conditions to enroll in the program​.

Tips To Manage Healthcare Compliance in New Mexico

Effectively managing healthcare compliance in New Mexico is a critical responsibility for healthcare organizations, as it ensures the delivery of high-quality care while adhering to legal and regulatory requirements. Here are some key strategies to help healthcare organizations manage compliance effectively:

  • Conduct State-Specific Training: Provide ongoing training and education to staff that is customized to your state’s regulations as well as your facility. If using a learning management system, ensure the vendor offers New Mexico-approved training.
  • Organize Policies By Requirement: Including “NM” in every document that is required by the state will make it much easier for you to find these documents in an online system when a surveyor is onsite. It is also best practice to include the standard you are meeting for additional clarity.
  • Establish a System for Monitoring Risk: Being able to identify compliance risks before they become incidents or violations can save the entire organization time and money. Identifying trends and consistently reviewing reports can signal issues, such as training not being completed or a large number of incidents in one location.
  • Use Compliance Management Software: Accreditation surveyors say organizations that use compliance software are more prepared for onsite visits and surveys. The software helps to keep documents and policies organized, ensures training content is up to date, and makes reporting easy.

By implementing these strategies and fostering a culture of compliance within your healthcare organization, you can effectively manage healthcare compliance, reduce risks, and provide the best possible care to your patients while staying within legal boundaries.

Credentialing Compliance in New Mexico

For credentialing teams in New Mexico, Section 8.308.2.16 of the Administrative Code is a crucial guideline for managed care organizations (MCOs). The rule requires that the entire credentialing process be thoroughly documented, from primary source verification to enrollment with New Mexico’s Medical Assistance Division (MAD). While much of the required documentation is standard, as part of the process for MCOs, New Mexico also requires a statement from the provider. The written statement needs to outline their ability to perform essential functions of their role, their lack of present illegal drug use, any history of loss of license or felony convictions, any history of privilege limitations or disciplinary actions, and any sanctions, suspensions or terminations imposed by Medicare or Medicaid. While it’s important for providers to write a complete statement, credentialers need to double check that the statement — and all credentialing requirements — are complete in order to avoid delay or denial.

Meet New Mexico Compliance Requirements With MedTrainer 

While the path may be complex, healthcare providers who prioritize compliance will not only avoid legal troubles but also enhance the quality of care they provide to their patients in New Mexico

MedTrainer’s all-in-one compliance platform can streamline management of New Mexico healthcare compliance. MedTrainer seamlessly consolidates your organization’s policies, incident reports, safety plans, HR documents, contracts, and more. This centralized repository ensures all employees have easy access to essential information. The course library is curated to align with regulatory and accreditation requirements, and courses are regularly added and updated to ensure the most current information. Learn more about MedTrainer today!