New Mexico Administrative Code

The New Mexico medicaid program and other health care programs are administered pursuant to regulations promulgated by the federal department of health and human services under Title XIX of the Social Security Act as amended or by state statute. See NMSA 1978, Section 27/1/2012 e…

Permanent

August 1, 2011, unless a later date is cited at the end of a section.

The objective of this rule is to provide instructions for the service portion of the New Mexico medical assistance division programs.

[RESERVED]

To reduce the impact of poverty on people living in New Mexico by providing support services that help families break the cycle of dependency on public assistance.

The New Mexico medical assistance division (MAD) administers the medicaid electronic health records incentive program (medicaid EHR incentive program) as authorized by the federal American Recovery and Reinvestment Act of 2009. Under this program, New Mexico MAD providers may qua…

New Mexico Health Care Authority.

A provider, its agents and employees are independent contractors who perform professional services for eligible recipients served through health care programs administered by HCA or its authorized agents and are not employees of HCA, or the state of New Mexico. A provider shall n…

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, or by state statute. See Section 27-212 et seq. NMSA 1978 (Repl. Pamp. 2007). Section …

Permanent.

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

The objective of these rules is to provide instruction for the service portion of the New Mexico medical assistance programs.

The mission of the New Mexico medical assistance division (MAD) is to maximize the health status of eligible recipients by furnishing payment for quality health services at levels comparable to private health plans.

MAD administers the state medicaid program and other health care programs. MAD pays for medically necessary services furnished to eligible recipients who qualify for public assistance programs, institutional care programs, and optional programs under federal Social Security Act a…

New Mexico Health Care Authority.

Recipients can receive emergency services and inpatient services without referrals from their designated providers. These services are exempt from medical management. Emergency room claims for services provided to any recipient may be reviewed before or after payment. Inappropria…

All medicaid recipients are potential candidates for inclusion in medical management, whether enrolled in Salud! or covered under medicaid fee-for-service. Recipients are identified as candidates for review by HCA, the MCO, a provider or other appropriate entities. The following …

HCA staff analyzes appropriate reports and documentation to decide whether a recipient will be referred to the MAD medical director for medical management determination. After reviewing HCA staff recommendations and supporting documentation, the MAD medical director or another ph…

Recipients who are in medical management are assigned to designated providers based on their specific health care situation. Recipients may be assigned to a designated provider who manages the recipient's overall receipt of health services by making referrals, a designated provid…

Initial medical management assignments are reevaluated by the HCA staff within a year of the effective date of the assignment or from the date of reevaluation. The reevaluation focuses on whether assignments met the objectives identified in the HCA staff recommendation or whether…

The medical assistance division gives a recipient and the MCO, if the recipient is enrolled in Salud!, 13 working days notice of the decision to place the recipient in medical management. Notice is given for the initial imposition of the assignment, modification of the assignment…

A recipient has a right to request a hearing regarding the MAD decision to assign the recipient into medical management. The request must be submitted to the quality assurance bureau of MAD, the HCA hearing bureau or the local ISD office within 90 days of the date the notice of a…

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 27-2-12 et. seq…

Permanent.

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

The objective of these regulations is to provide policies for the service portion of the New Mexico medicaid program. These policies describe eligible providers, covered services, noncovered services, utilization review, and provider reimbursement.

The mission of the New Mexico medical assistance division (MAD) is to maximize the health status of medicaid-eligible individuals by furnishing payment for quality health services at levels comparable to private health plans.

The New Mexico medicaid program (medicaid) pays for medically necessary medical services furnished to medicaid recipients. To make sure that recipients receive only necessary services, the New Mexico medical assistance division (MAD) has developed the medical management program. …

New Mexico Health Care Authority.

MAD reimburses eligible recipients or transportation providers for medically necessary transportation subject to the following: A. Free alternatives: Alternative transportation services which may be provided free of charge, include volunteers, relatives or transportation services…

Transportation services are subject to the same limitations and coverage restrictions which exist for other services. A payment for transportation to a MAD non-covered service is subject to retroactive recoupment. MAD does not cover the following services or related costs of trav…

All out-of-state transportation, meals and lodging must be prior approved by MAD. Out-of-state transportation is approved only if the out-ofstate medical service is approved. Documentation must be available to the reviewer to justify the out-of-state travel and verify that treatm…

In non-emergency situations, an eligible recipient can request reimbursement from the client medical transportation (CMT) fund through their local county ISD office for money they spend on transportation, meals and lodging. For reimbursement from the CMT fund, an eligible recipie…

Reimbursement for lodging and meal expenses is based on the MAD allowable fee schedule. The CMT fund reimbursement rate for transportation services and related expenses are: A. private automobile use is reimbursed by the mile, based on the established MAD reimbursement schedule; …

The rule applies to the general public.

The New Mexico medicaid and other health care programs are administered pursuant to regulations promulgated by the federal department of health and human services under the Social Security Act as amended, or by state statute. See Section 27-1-12 et seq. NMSA 1978. Section 9-8-1 e…

Permanent.

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

The objective of this rule is to provide instruction for the service portion of the New Mexico medical assistance programs.

To reduce the impact of poverty on the people living in New Mexico and to assure low income and individuals with disabilities in New Mexico equal participation in the life of their communities.

The medical assistance division (MAD) covers expenses for transportation, meals and lodging it determines are necessary to secure MAD covered medical examination and treatment for eligible recipients in or out of their home community 42 CFR 440.170. Travel expenses include the co…

New Mexico Health Care Authority.

A. Upon the approval of a New Mexico MAD provider participation agreement by MAD or its designee, a licensed practitioner or facility that meets applicable requirements is eligible to be reimbursed for furnishing covered services to an eligible program recipient. A provider must …

A provider who furnishes services to a medicaid eligible recipient agrees to comply with all federal and state laws, regulations, and executive orders relevant to the provision of services. A provider also must conform to MAD program rules, instructions, and program directions an…