New Mexico Register / Volume XXXI, Issue 8 / April
21, 2020
This is an
amendment to 8.285.600 NMAC, Sections 8, 10 and 11, effective 5/1/2020.
8.285.600.8 [RESERVED] MISSION STATEMENT:
To transform lives. Working with
our partners, we design and deliver innovative, high quality health and human
services that improve the security and promote independence for New Mexicans in
their communities.
[8.285.600.8 NMAC -
A, 5/1/2020]
8.285.600.10 BENEFIT DETERMINATION:
A. Subsequent to the receipt of emergency services, an
applicant must apply through the local county income support division (ISD)
office. The application must be filed at
the ISD office no later than the last day of the third month following the
month the presumed emergency services were received.
B. Documentation requirements: The applicant must bring a
completed emergency medical services for aliens referral for eligibility
determination form (MAD 308) to the ISD office for the financial eligibility
determination. The emergency services
provider must complete the referral form.
Financial documents: The
applicant must provide all necessary documentation to prove that he/she meets
all financial and non-financial eligibility standards. Medical providers cannot submit eligibility
applications on behalf of the applicant.
[The applicant must apprise medical providers of the status of the
application.] The applicant is
financially responsible for any services not covered by medicaid. A completed and signed application form must
be submitted for each request for emergency medical services for aliens.
[2/1/1995; 4/30/1998;
8.285.600.10 NMAC - Rn, 8 NMAC 4.ESA.620 & A, 12/1/2008; A, 5/1/2020]
8.285.600.11 INITIAL BENEFITS:
Applications for medicaid must be acted on
within 45 days of the date of application.
A. If an applicant is eligible for medicaid,
the [ISD worker notifies the individual of approval using notification of
approval of application for emergency medical services for aliens form (MAD
310).] individual is sent a notice of case action (NOCA) form. The approval of financial eligibility is not a
guarantee that medicaid will pay for the
services. The NOCA form also
serves as notice of case closure, since medicaid
covers only emergency services received during the specified term of the
emergency. [The applicant must give
the medical service provider a copy of the MAD 310 form.] The provider
is sent the decision for emergency medical services for aliens (EMSA) application
(MAD 778) form. The provider must
use [the MAD 310] the MAD 778 form to submit claims to the
medicaid utilization review contractor for emergency
review.
B. If an applicant is ineligible for medicaid
or a decision on the application is delayed beyond the 45 day time limit, the [ISD
worker sends a notification of denial or delay of action on] individual
is sent a NOCA form regarding the application for emergency medical
services for aliens [form (MAD 309) to the undocumented alien]. The [MAD 309] NOCA form
explains the reason for denial or delay and informs the applicant of his/her
right to an administrative hearing. If
the application is denied, the applicant must notify providers of the denial.
C. The applicant is
responsible for payment for the medical services if he/she fails to apply
promptly for coverage, verify eligibility for coverage, or notify the provider
of the approval or denial of the application.
[2/1/1995; 4/30/1998;
8.285.600.11 NMAC - Rn, 8 NMAC 4.ESA.623 & A, 12/1/2008; A, 5/1/2020]