New Mexico Register / Volume XXIX, Issue 8 / April 24, 2018

NEW MEXICO HUMAN SERVICES DEPARTMENT

MEDICAL ASSISTANCE DIVISION

NOTICE OF MINOR, NON-SUBSTANTIVE CORRECTION

Pursuant to the authority granted under State Rules Act, Subsection D of Section 14-4-5 NMSA, please note the following minor, non-substantive corrections to the formatting of 8.302.3 NMAC - “Third Party Liability Provider Responsibilities”, 8.308.7 NMAC - “Enrollment and Disenrollment”, 8.308.8 NMAC - “Members Rights, Responsibilities and Education” and 8.308.13 NMAC - “Member Rewards” filed on April 12, 2018, published and effective on May 1, 2018:

8.302.3 NMAC - “Third Party Liability Provider Responsibilities”- Subparagraph (e) of Paragraph (1) of Subsection C of 8.302.3.12 NMAC, corrected spelling “eligible”.

8.308.7 NMAC - “Enrollment and Disenrollment” - Added Paragraph (2) to Subsection C of 8.308.7.9 NMAC (see below):

C. Auto assignment:

(1) HSD will auto-assign an eligible recipient to a MCO in specific circumstances, including but not limited to:

(a) the eligible recipient is not exempt from managed care and does not select a MCO at the time of his or her application for MAD eligibility;

(b) the eligible recipient cannot be enrolled in the requested MCO pursuant to the terms of this rule (e.g., the MCO is subject to and has reached its enrollment limit). HSD may modify the auto-assignment algorithm, at its discretion, when it determines it is in the best interest of the program, including but not limited to, sanctions imposed on the MCO, consideration of quality measures, cost or utilization management performance criteria.

(2) The HSD auto-assignment process will consider the following:

(a) if the eligible recipient was previously enrolled with a MCO and lost his or her eligibility for a period of six months or less, he or she will be re-enrolled with that MCO;

(b) if the eligible recipient has a family member enrolled in a specific MCO, he or she will be enrolled with that MCO;

(c) if the eligible recipient is a newborn, he or she will be assigned to the mother’s MCO; see Subsection A of 8.308.6.10 NMAC; or

(d) if none of the above applies, the eligible recipient will be assigned using the default logic that assigns an eligible recipient to a MCO.

8.308.8 NMAC - “Members Rights, Responsibilities and Education” - Deleted Open Bracket before Section 8.308.8.9 NMAC.

8.308.13 NMAC - “Member Rewards” - Added Repealed to history notes.

8.310.10 NMAC - “ Health Home Services” - Added Repealed to history notes.

A copy of this Notification will be filed with the official version of the above rule.