New Mexico Administrative Code

A. The acceptance of a client for treatment shall be based on an intake procedure and assessment of the client. B. The agency shall have written policies and procedures governing the intake process including the following: (1) the types of information to be obtained on all applic…

A. Assessment shall be done by members of the treatment staff and shall be clearly explained to the client, family, spouse, guardian or other interested person as appropriate. B. During the assessment process, the designated staff member shall collect the following information fo…

A. Each client to be admitted shall receive an orientation in accordance with a written orientation policy and procedure. B. Unless an emergency situation is documented during the intake/assessment process, each client to be admitted shall sign acknowledgment that they understand…

Based on the screening/ intake/assessment made of the client's needs, a written treatment plan shall be developed and recorded in the client's case record. A. A preliminary treatment plan shall be developed as soon as possible. B. The treatment may begin before completion of the …

There shall be written referral policies and procedures that facilitate client referral between the agency and other community service providers which include: A. a description of the methods by which continuity of care is assured for the client; B. a listing of resources that pr…

A. If the individual meets the agencys admission criteria and the screening/intake/assessment shows that: (1) the person would benefit from services provided in a treatment facility (outpatient services, residential social detoxification, medical detoxification, residential long-…

Agencies which receive state or federal funding from the division for the purpose of providing one or more of those substance abuse services authorized by the Alcoholism and Alcohol Abuse Prevention, Screening and Treatment Act (Sections 43-3-8, et seq. NMSA 1978) or the Drug Abu…

If a screening/intake/assessment shows that a person is found not able to consent to, admission to an agency, and the screening/intake/assessment shows that treatment services would be in the persons best interest and will be consistent with the least drastic means principle, the…

A. If the screening/ intake/assessment determines that a person who is also a minor needs services in an agency, and parents or guardian of the minor agree, then the minor may be admitted to an agency which agrees to serve the minor. B. If a minor voluntarily seeks admission to a…

A. Services in an agency may be provided on an emergency basis to any individual believed to be diagnosed as having a substance related disorder when the agency determines that:(1) there is imminent danger that the physical health or safety of the individual will be seriously imp…

Subsection E of Section 9-7-6 NMSA 1978 and Section 43-2-5 NMSA 1978. Section 9-8-1 et seq. NMSA 1978 establishes the health care authority as a single, unified department to administer laws and exercise functions relating to health care facility licensure and health care purchas…

Permanent.

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

To establish minimum standards for admission criteria, policies and procedures for agencies providing substance abuse services. These standards are designed to ensure that each agency that receives funding from the division to provide substance abuse services has in place policie…

A. "Admission" means the agency's acceptance of a client for the purpose of providing services on a scheduled basis in accordance with a client treatment plan. B. "Adult" means an individual who has attained the age of eighteen years. C. "Advocate" means any individual, group or …

Each agency shall have and utilize a written policy on nondiscriminatory practices as described below: A. No agency shall discriminate or permit discrimination against any person or group of persons in any treatment service on the basis of race, color, religious creed, age, marit…

Each agency shall have and utilize a written policy and procedure for ensuring the confidentiality and security of all clients' case records and identifying information which conform to the requirements of state and federal confidentiality laws and regulations. The procedure must…

New Mexico Health Care Authority.

A. At the request of a contractor/offeror and with the director's authorization, the division may issue a written waiver of any of the requirements of these regulations which are not otherwise required by law. B. The request for waiver must be in writing and must be signed by the…

A. A contractor's performance shall be evaluated by review of: (1) its compliance with all applicable federal and state rules and regulations, including such regulations as may be amended or adopted by the authority, and the terms and conditions of its individual contract; (2) th…

A. A public notice of the request for proposals (RFP) shall be given by publishing a notice not less than ten (10) calendar days prior to the date set for receipt of the proposal. The notice shall be published at least once in a newspaper of a general circulation in New Mexico or…

A. All offerors submitting proposals for division funding shall utilize the format and forms designated by the division and shall submit all information and copies consistent with instructions stipulated in the RFP packet. B. The proposal by a non-profit corporation shall be sign…

A. Completed proposals shall be submitted to the division or the organizational unit designated within the division as specified in the notice of the RFP. B. The organizational unit of the division receiving the completed proposal(s) shall establish a log of all proposals receive…

A. Division staff shall, immediately upon receipt of proposals or soon after the deadline for submission, evaluate every responsive proposal submitted. B. All responsive proposals will be evaluated and ranked in order, taking into consideration the evaluation factors and relative…

A. The secretary of the authority will award a contract(s) to the offeror(s) which is (are) most advantageous to the authority. B. The division's award is contingent upon the offerors acceptance of any additional or special terms and conditions listed in the contract and any chan…

All protests filed with the authority will be governed by 7.1.6 NMAC, "Protest Procedure Under the Procurement Code", or such regulations as may be amended or adopted by the authority.

Each entity (offeror/contractor) which submits a proposal(s) for or receives division funding for the purpose of establishing, expanding or continuing one or more of those substance abuse services authorized by the Alcoholism and Alcohol Abuse Prevention, Screening and Treatment …

Subsection E of Section 9-8-6 NMSA 1978, Subsection A of Section 43-3-11 NMSA 1978 of the Alcoholism and Alcohol Abuse Prevention, Screening and Treatment Act (Sections 43-3-8 et seq. NMSA 1978), or Subsection D of Section 26-2-4 of the Drug Abuse Act (Sections 26-2-1 et seq. NMS…

Permanent.

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

To establish procedures for procurement of professional services by competitive sealed proposals for substance abuse treatment and/or prevention services; and to establish minimum standards of eligibility for division funding.

A. "Client" means an individual or family requesting or receiving services. B. "Contractor" means an entity under contract with the authority to provide substance abuse prevention, treatment, screening or assessment services. C. "Director" means the director of the behavioral hea…

A. These regulations comprise the minimum standards of eligibility for division funding. Meeting the minimum standards of eligibility does not guarantee that a contractor/offeror will receive division funding, nor that funding will be awarded in subsequent fiscal years. B. The di…

A contractor/offeror who is required to be licensed by the licensing and certification bureau of the public health division of the department of health must obtain and retain such license.

New Mexico Health Care Authority.

A. Upon approval of New Mexico medical assistance program provider participation application by the New Mexico medical assistance division (MAD), ambulatory surgical centers certified to participate in medicare under Title XVIII of the Social Security Act as free-standing ambulat…

Providers who furnish services to medicaid recipients must comply with all federal and state laws and regulations relevant to the provision of medical services, including but not limited to, Title XIX of the Social Security Act, the Medicare and Medicaid Anti-Fraud Act, and the s…

A. Medicaid covers ambulatory surgical center facility services, as required by the condition of the recipient and if the following conditions are met: (1) the surgical procedure and use of the facility are medically necessary and are covered by medicaid; and (2) all medicaid req…

Ambulatory surgical center services are subject to the limitations and coverage restrictions which exist for other medicaid services. If the surgery is non-covered, the anesthesia is non-covered. See 8.301.3 NMAC, General Noncovered Services. A. Direct payment to physician. Ambul…

All medicaid services are subject to utilization review for medical necessity and program compliance. Reviews can be performed before services are furnished, after services are furnished and before payment is made, or after payment is made. See 8.302.5 NMAC, Prior Authorization a…

Ambulatory surgical centers must submit claims for reimbursement on the CMS-1500 claim form or its successor. See 8.302.2 NMAC, Billing for Medicaid Services. Once enrolled, providers receive instructions on documentation, billing and claims processing. A. Inclusion of all servic…

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.

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.

New Mexico medicaid program (medicaid) pays for medically necessary health services furnished to eligible recipients, including covered services furnished in ambulatory surgical centers 42 CFR Section 440.20(a). This part describes eligible providers, covered services, service li…

New Mexico Health Care Authority.