N.M. Code R. § 9.2.12.11 - MINIMUM CONTRACT REQUIREMENTS
A. An area agency cannot execute an agreement
or contract that demands exclusivity. An area agency must be free to negotiate
other similar agreements or contracts.
B. An area agency cannot enter into an
agreement or contract that obligates it to be identified with or to promote the
company or its products, or places it in a conflict of interest with its public
mission.
C. The contract must state
that the area agency has the right to refuse services to a company or its
employees or clients in the event that there is a potential conflict of
interest for the area agency, as identified by the area agency or state
agency.
D. The contract must
provide that an area agency has the right to reveal its findings, plans and
recommendations to the client, regardless of the company's final decision
regarding client eligibility and/or services provided.
E. The contract must provide that all
information, as to personal facts and circumstances, obtained by the area
agency shall be treated as privileged communications, shall be held
confidential, and shall not be divulged without the written consent of the
individual receiving the services, his/her attorney, or his/her legal guardian,
except as is required by the corporation, insurance company, or brokering
agent, or as may be required by the state agency for the purposes of monitoring
for compliance with the provisions of this policy, directed by the state or
federal court. However, nothing prohibits the disclosure of information in
summary, statistical or other form which does not identify particular
individuals.
F. The contract must
provide that the information obtained through the performance of the contract
be treated as confidential information. The area agency shall not use any
information obtained in the performance of the contract in any manner except as
necessary to the proper discharge of its obligations. All area agency personnel
having access to information pertaining to individuals receiving services shall
complete and sign a nondisclosure agreement.
G. The contract must hold the area agency and
the state agency, where it is a party to the contract, harmless and defend them
in any actions brought against them on the basis of companies' policies or
decisions regarding benefits and services.
H. Provisions of the contract may not require
the withholding of information or otherwise limit the ability of the area
agency to judge or act in the public interest; nor may they restrict the
ability of state agency to exercise appropriate oversight of the area agency in
its fulfillment of its public mission and responsibilities.
I. In contracts covering long-term care
insurance case management services, companies must assure:
(1) they are financially stable, are in good
standing and are in compliance with all statutes and rules governing insurance
companies in the state of New Mexico; and
(2) their long-term care insurance policies
comply with the New Mexico insurance laws.
Notes
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