New Mexico Administrative Code

A. Upon approval of New Mexico medical assistance program provider participation agreements by the New Mexico medical assistance division (MAD), the following agencies are reimbursed for furnishing case management services to recipients who are chronically mentally ill: (1) commu…

Providers who furnish services to medicaid recipients must comply with all specified medicaid participation requirements. See 8.302.1 NMAC, General Provider Policies. Providers must verify that individuals are eligible for medicaid at the time services are furnished and determine…

Medicaid covers case management services furnished to medicaid recipients who are chronically mentally ill and who are not residents of an institution for mental disease. Chronic mental illness is defined by diagnosis, disability and duration. The major diagnoses include schizoph…

Medicaid covers the following case management service activities for recipients who are chronically mentally ill: A. assessment of the recipient's medical and social needs and functional limitations using standardized needs assessment instruments; B. development and implementatio…

Case management services are subject to the limitations and coverage restrictions which exist for other medicaid services. See 8.301.3 NMAC, General Noncovered Services. Medicaid does not cover the following specific activities: A. services furnished to individuals who are not me…

A. Case managers develop and implement plans of care in conjunction with the recipients, families or legal guardian(s), therapists, physicians, or others who assist with the recipient's care. B. The following must be contained in the plan of care or documents used in the developm…

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…

A. Case management providers must submit claims for reimbursement on the HCFA 1500 claim form or its successor. See 8.302.2 NMAC, Billing for Medicaid Services. Instructions on documentation, billing and claims processing are sent to approved medicaid providers. Reimbursement for…

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 pursuant to state statute. See Section 27-2-12 et seq. NMSA 1978 (Rep…

Permanent

February 1, 1995

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.

[RESERVED]

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 medical assistance program (medicaid) pays for medically necessary health services furnished to eligible recipients for case management services furnished to recipients who are chronically mentally ill [42 U.S.C. Section 1396 n(g)(1)(2) ]. This part describes eligi…

New Mexico Health Care Authority.

A. Upon approval of New Mexico medical assistance program provider participation agreements by the New Mexico medical assistance division (MAD), the following agencies are eligible for certification as case management agencies: (1) government or community agencies which meet cert…

Providers who furnish services to medicaid recipients must comply with all specified medicaid participation requirements. See 8.302.1 NMAC, General Provider Policies. A. Providers must verify that individuals are eligible for medicaid at the time services are furnished and determ…

A. Case management services are available for eligible medicaid recipients who meet all of the following criteria: (1) twenty-one (21) years of age or older; (2) resident of the state of New Mexico; (3) resident of Santa Fe, Chavez, Dona Ana, San Juan, McKinley or San Miguel coun…

Medicaid covers those case management services for traumatic brain-injured adults which are medically necessary to help these recipients gain access to needed medical, social, educational and other services. Medicaid covers the following specific case management services: A. iden…

Case management services are subject to the limitations and coverage restrictions which exist for other medicaid services. See 8.301.3 NMAC, General Noncovered Services. Medicaid does not cover the following specific activities: A. services furnished to individuals who are not me…

A. Case managers develop and implement individualized plans of care in consultation with recipients, families or legal guardians, physicians and others involved in the care. B. The following must be contained in the plan of care or documents used in the development of the plan of…

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…

A. Case management providers must submit claims for reimbursement on the HCFA-1500 claim form or its successor. See 8.302.2 NMAC, Billing for Medicaid Services. Instructions on documentation, billing and claims processing are sent to approved medicaid providers. Reimbursement for…

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

February 1, 1995

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.

[RESERVED]

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 health services furnished to eligible recipients, including covered case management services furnished to adult recipients who are traumatically brain injured [42 U.S.C. Section 1396 n(g)(1)(2) ]. This part d…

New Mexico Health Care Authority.

A. Upon approval of New Mexico medical assistance program provider participation agreements by the New Mexico medical assistance division (MAD), the following certified agencies are eligible to be reimbursed for furnishing case management services to children up to the age of thr…

Providers who furnish services to medicaid recipients must comply with all specified medicaid participation requirements. See 8.302.1 NMAC, General Provider Policies. Providers must verify that individuals are eligible for medicaid at the time services are furnished and determine…

Case management services are available to medicaid eligible children under the age of three (3) who are medically at risk due to family conditions but who are not developmentally delayed.

Medicaid covers case management services for children up to the age of three (3) which help recipients gain access to medical, social, educational or other needed services. Case management services provide necessary coordination with providers of non-medical services, such as nut…

Case management services are subject to the limitations and coverage restrictions which exist for other medicaid services. See 8.301.3 NMAC, General Noncovered Services. Medicaid does not cover the following specific activities: A. services furnished to individuals who are not me…

A. Case managers develop and implement plans of care for each medicaid recipient. Plans of care are developed in consultation with the recipients, families or legal guardian(s), physicians and others involved with care. B. The following must be contained in the plan of care or do…

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…

A. Case management providers must submit claims for reimbursement on the HCFA 1500 claim form or its successor. See 8.302.2 NMAC, Billing for Medicaid Services. Instructions on documentation, billing and claims processing are sent to approved medicaid providers. Reimbursement for…

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

February 1, 1995

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.

[RESERVED]

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 medical assistance program (medicaid) pays for medically necessary health services furnished to eligible recipients, including case management services furnished to medicaid eligible children up to the age of three (3) who are medically at risk due to family condit…