New Mexico Administrative Code

The New Mexico medical assistance division (MAD) covers expenses for transportation and other related expenses that MAD or its coordinated services contractor determines are necessary to secure covered medical and behavioral health examinations and treatment for a medical assista…

New Mexico Health Care Authority.

Health care to eligible recipients is furnished by a variety of providers and provider groups. The reimbursement and billing for these services is administered by MAD. Upon approval of a New Mexico MAD provider participation agreement by MAD or its designee, licensed practitioner…

A. A provider who furnishes services to a medicaid or other health care program eligible recipient must comply with all federal and state laws, regulations, and executive orders relevant to the provision of services as specified in the MAD provider participation agreement. A prov…

A. An applicant must be a noncitizen who is undocumented or who does not meet the qualifying immigration criteria specified in 8.200.410 NMAC, General Recipient Requirements, and in 8.285.400 NMAC, Medicaid Eligibility Emergency Medical Services for Non-Citizens-Category 085. B. …

A. "Emergency" as defined for EMSA includes labor and delivery including inductions and cesarean sections, as well as any other medical condition, manifesting itself with acute symptoms of sufficient severity such that the absence of immediate emergency medical attention could re…

To meet the categorical eligibility requirements, a recipient who is a non-citizen must be a resident of the state of New Mexico. Proof of residence must be furnished by the non-citizen to the local county ISD office. An individual traveling through New Mexico, entering the Unite…

MAD does not cover any medical service that is not necessary to treat or evaluate a condition for an individual who is a non-citizen that does not meet the definition of emergency. Additionally, MAD does not cover the following specific services: A. long term care; B. organ trans…

Claims for services to a recipient who is a non-citizen are reviewed by MAD or its designee before payment to determine if the circumstances warrant coverage. A. Eligibility determination: A non-citizen recipient who requests MAD coverage for services must meet specific categoric…

Reimbursement is made according to the rules applicable to the provider rendering the service.

The rule applies to the general public.

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 the Social Security Act as amended, or by state statute. See Section 27-2-12 et seq. NMSA 1978. 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 instructions for the service portion of the New Mexico medical assistance programs.

To reduce the impact of poverty on 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 New Mexico MAD is required to pay for necessary emergency medical services furnished to individuals who are non-citizens, reside in New Mexico and meet the requirements for MAD eligibility 42 CFR 440.255(c).

New Mexico Health Care Authority (HCA).

A. Every program shall establish written general policies, procedures and guidelines reflecting language in this rule in its entirety. B. These established policies, procedures and guidelines shall further detail each of the following categories: (1) Medication diversion: (a) add…

Correctional facilities shall: A. Develop adequate staffing patterns including healthcare practitioners authorized by law to prescribe, administer, and monitor medication-assisted treatment (to include telehealth-supported clinical review or services if necessary). B. Facilitate …

A. Beginning October 1, 2023, and annually thereafter, the HCA shall report to the interim legislative health and human services committee and the legislative finance committee on the establishment, operation and effectiveness of the program(s) established pursuant to Section 24-…

A. Records shall be maintained in writing or electronically reflecting each program participant's screening, placement and participation, including, but not limited to, the offer of placement, individualized treatment plan, medication regimen, establishment of reentry plan, and d…

This rule governs delivery of medication assisted treatment (MAT) for substance use disorder (SUD) (including medication for opioid use disorder or MOUD) to individuals in correctional facilities.

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 Section 27-2-12 et seq., NMSA …

Permanent.

September 1, 2024, unless a later date is cited at the end of a section. A. By December 31, 2025, the New Mexico corrections department (NMCD) operated correctional facilities shall provide continuation of medication-assisted treatment (MAT) services or medication for opioid use …

The purpose of these regulations is to establish guidance and requirements for delivery of substance use disorder treatment and reentry services for persons diagnosed with substance use disorder in correctional facilities.

A. Certified peer support worker (CPSW): Peer support workers who have successfully completed training with the behavioral health service division's office of peer recovery and engagement (OPRE) and have obtained certification from the New Mexico credentialing board of behavioral…

We ensure New Mexicans attain their highest level of health by providing whole-person, cost-effective, accessible, and high-quality health care and safety-net services.

A. Identification of the type of treatment service delivery model(s) to be used by the correctional facility's treatment programs: (1) Facility becomes an accredited/certified and DEA-registered opioid treatment program/narcotic treatment program (OTP/NTP). (2) Facility contracts…

New Mexico Health Care Authority.

A. Upon approval of New Mexico medical assistance program provider participation applications licensed practitioners or facilities that meet applicable requirements by the New Mexico medical assistance division (MAD), the following providers are eligible to be reimbursed for furn…

Providers who furnish services to medicaid recipients agree to 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 t…

Medicaid covers renal dialysis services for the first three months of dialysis pending the establishment of medicare eligibility. Medicare becomes the primary reimbursement source for individuals who meet the medicare eligibility criteria. Dialysis providers must assist medicaid …

Tests that are listed as separately billable (not included in the composite rate) and are performed at a frequency greater than specified in the composite rate require medical justification and are covered when furnished at specified frequencies. A. Tests for hemodialysis, perito…

Dialysis services are subject to the limitations and coverage restrictions of other medicaid services. See 8.301.3 NMAC, General Noncovered Services.

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…

Dialysis facilities must submit claims for reimbursement on the UB-92 claim form or its successor. Physicians must submit for reimbursement on the CMS-1500 claim form or its successor. See 8.302.2 NMAC, Billing for Medicaid Services. The facility's composite rate reimbursement is…

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.

Dialysis services are covered as an optional medical service for New Mexico medicaid program (medicaid) recipients 42 CFR Sections 440.10, 440.20; 440.50. This part describes eligible dialysis providers, covered services, service limitations, and general reimbursement methodology…

New Mexico Health Care Authority.

A. Upon approval of New Mexico medical assistance program provider participation by the New Mexico medical assistance division (MAD), hospice agencies meeting the following conditions are eligible to be reimbursed for providing hospice care services: (1) meet the conditions for p…

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 st…