New Mexico Register / Volume XXIX, Issue 4 / February 27, 2018

This is an amendment to 8.290.600 NMAC, Section 10, and Section 12 effective 3/1/2018.

8.290.600.10 BENEFIT DETERMINATION: Application for the waiver programs is made using the ["application/redetermination of eligibility for medical assistance of aged, blind, and disabled individuals" (form MAD 381).] HSD 100 application. Upon notification by the appropriate program manager that an unduplicated recipient (UDR) is available for waiver services, applicants are registered on the income support division eligibility system. Applications must be acted upon and notice of approval, denial, or delay sent out within 45 calendar days from the date of application, or within 90 calendar days if a disability determination is required from the DDSU. The eligible recipients must assist in completing the application, may complete the form themselves, or may receive help from a relative, friend, guardian, or other designated representative. [To avoid a conflict of interest, a case manager or any other MAD provider may not complete the application or be a designated representative.]

A. Representatives applying on behalf of individuals: If a representative makes application on behalf of the eligible recipient, that representative will continue to be relied upon for information regarding the eligible recipient's circumstances. The ISD caseworker will send all notices to the eligible recipient in care of the representative.

B. Additional forms: The following forms are also required as part of the application process:

(1) the eligible recipient or representative must complete and sign the primary freedom of choice of case management agency form at the time of allocation; and

(2) the eligible recipient or representative must sign the applicant's statement of understanding at the time waiver services are declined or terminated.

C. Additional information furnished during application: The ISD caseworker provides an explanation of the waiver programs, including, but not limited to, income and resource limits and possible alternatives, such as institutionalization. The ISD caseworker refers potentially eligible recipients to the social security administration to apply for supplemental security income (SSI) benefits. If a disability decision by the DDSU is required, but has not been made, the ISD caseworker must follow established procedures to refer the case for evaluation.

[2/1/1995; 1/1/1997; 8.290.600.10 NMAC - Rn, 8 NMAC 4.WAV.620 & A, 5/1/2002; A, 11/1/2007; A, 11/1/2012; A, 3/1/2018]

8.290.600.12 ONGOING BENEFITS:

A. Regular reviews: A complete redetermination of eligibility must be performed annually by the ISD caseworker for each open case. The redetermination includes contact with the eligible recipient or his representative to review financial and non-financial eligibility.

B. Additional reviews: Additional reviews are scheduled by the ISD caseworker depending upon the likelihood that the eligible recipient's income, resources or medical condition will change. The following are examples of frequently encountered changes which affect eligibility:

(1) social security cost-of-living increases;

(2) VA cost-of-living increases;

(3) rental income may be sporadic and require review every three months; and

(4) level of care review.

C. 90 day reconsideration period: HSD will reconsider in a timely manner the waiver eligibility of an individual who is terminated for failure to submit the renewal form or necessary information, if the individual subsequently submits the renewal form within 90 days after the date of termination without requiring a new application per 42 CFR 435.916(C)(iii).

[2/1/1995, 1/1/1997; 8.290.600.12 NMAC - Rn, 8 NMAC 4.WAV.624 & A, 5/1/2002; A, 11/1/2007; A, 11/1/2012; A, 3/1/2018]