New Mexico Administrative Code

Staff will report the following to the council by September 1st and at other times as requested, ensuring that reports contain no confidential information: A. Number of cases reviewed; B. Number of cases where the board concurred and did not concur with the department's progress …

This rule sets out the duties of the substitute care advisory council relating to substitute care review boards pursuant to the citizen substitute care review act Section 32A-8-1 et seq., NMSA 1978.

Authority for Part 7 of Chapter 26 is found in Section 32A-8-1 et seq., NMSA 1978.

Permanent.

March 12, 2019 unless a later date is cited at the end of a section.

This rule establishes council responsibilities, membership criteria, and operating procedures for case reviews by board members.

A. "Advisory committee" means the six-member advisory committee appointed by the council. B. "Board" means a substitute care review board established by the council for the purpose of reviewing cases. C. "Council" means the substitute care advisory council. D. "Department" means …

A. The council shall elect a chair, vice-chair, and any other officers deemed necessary. B. The council shall hold a meeting quarterly and at other times as determined by the chair. (1) The agenda for the first quarter meeting shall include, but is not limited to:(a) a review of …

A. Recruitment: (1) Staff will pursue ongoing recruitment of members. (2) Recruitment will focus on including individuals who:(a) are representative of the communities of New Mexico; (b) have expertise in the prevention and treatment of child abuse and neglect; (c) are adult form…

New Mexico Health Care Authority.

Recipients and eligible applicants must live in certain designated zip codes within New Mexico. A PACE recipient cannot concurrently receive other medicaid home and community-based services. A PACE recipient may be placed in a qualifying nursing facility upon a medical doctor's o…

Applicants must live within the designated PACE service area and meet all of the criteria listed below at the time of application and enrollment. A. Applicants must be 55 years of age or older. Applicants/recipients must be determined blind or disabled if under the age of 65 year…

Applicants and recipients are responsible for establishing eligibility for medicaid. As part of this responsibility, the applicant or recipient must provide required information and documents or take the actions necessary to establish eligibility. Failure to do so must result in …

All changes that may affect eligibility must be reported within 10 calendar days of the date of the change in accordance with 8.200.430.18 NMAC.

The rule applies to the general public.

The New Mexico medicaid program is administered pursuant to regulations promulgated by the federal department of health and human services under Title XIX of the Social Security Act, as amended and by the state health care authority pursuant to state statute. See Section 27-2-12 …

Permanent.

January 1, 2019, or upon a later approval date by the federal centers for medicare and medicaid services (CMS), unless a later date is cited at the end of the section.

The objective of these regulations is to provide eligibility policy and procedures for the medicaid program.

To transform lives. Working with our partners, we design and deliver innovative, high quality health and human services that improve the security and promote independence for New Mexicans in their communities.

Certain populations meeting financial, non-financial, and medical criteria can receive acute and long-term care services in the community. These services are funded by medicaid on a capitated basis.

New Mexico Health Care Authority.

See 8.281.500.10 NMAC and all following subsections.

An applicant/recipient is eligible for medicaid on the factor of resources if countable resources do not exceed $2,000. See 8.281.500.11 NMAC.

See 8.281.500.12 NMAC.

See 8.281.500.13 NMAC.

See 8.281.500.14 NMAC for regulations governing transfers of assets. All provisions pertaining to transfers under institutional care medicaid apply to transfers under PACE with the exception of the penalty for transfers without fair return. The penalty for transfers of assets wit…

See 8.281.500.15 NMAC.

See 8.281.500.16 NMAC for spousal impoverishment methodology used in the determination of eligibility for married applicants/recipients with a spouse in the home who began receiving PACE services on or after September 30, 1989. A resource assessment is completed as of the first m…

Not applicable to PACE.

An applicant/recipient's gross countable monthly income must be less than the maximum allowable monthly income standard. See 8.281.500.18 NMAC.

See 8.281.500.19 NMAC.

The rule applies to the general public.

See 8.281.500.20 NMAC.

See 8.281.500.21 NMAC.

See 8.281.500.22 NMAC.

There are medical care credits in PACE only when a PACE recipient enters a nursing facility. See 8.281.500.22 NMAC.

The New Mexico medicaid program is administered pursuant to regulations promulgated by the federal department of health and human services under Title XIX of the Social Security Act, as amended, and by the state health care authority pursuant to state statute. See Section 27-2-12…

Permanent.

July 1, 2024, unless a later date is cited at the end of a section.

The objective of these regulations is to provide eligibility policy and procedures for the medicaid program.

To transform lives. Working with our partners, we design and deliver innovative, high quality health and human services that improve the security and promote independence for New Mexicans in their communities.

Eligibility for PACE is determined prospectively. Applicants/recipients must meet, or expect to meet, all financial eligibility criteria in the month for which a determination of eligibility is made. Applicants for and recipients of medicaid through PACE must apply for, and take …

New Mexico Health Care Authority.

Application for PACE is made using the HSD 100 application. Applications must be acted upon and notice of approval, denial, or delay sent out within 45 days of the date of application. The applicant/recipient may complete the form himself, or receive help from a relative, friend,…

An application for PACE can be approved when all factors of eligibility have been met and the individual is enrolled in the program. The effective date for PACE enrollment is the first day of the calendar month following the signing of the enrollment agreement (if all financial, …

A. A complete redetermination of eligibility must be performed annually by the income support division worker for each open case. B. Level of care reviews are required to be completed at least annually. Level of care determinations for PACE are made by the utilization review cont…

Retroactive coverage is not available in the PACE program.