New
Mexico Register / Volume XXXI, Issue 23 / December 15, 2020
NOTICE
OF RULEMAKING
The Human Services Department (the
Department), through the Medical Assistance Division (MAD), is proposing to
amend the following New Mexico Administrative Code (NMAC) rules: 8.281.400
NMAC, Medicaid Eligibility-Institutional Care (categories 081, 083, 084),
Recipient Policies, 8.290.400 NMAC, Medicaid Eligibility-Home and
Community-Based Services Waiver (categories 090, 091, 092, 093, 094, 095 and
096), Recipient Policies.
Section 9-8-6 NMSA 1978 authorizes the Department
Secretary to promulgate rules and regulations that may be necessary
to carry out the duties of the Department and its divisions.
Notice
Date: December 15, 2020
Hearing
Date: January 21, 2021
Adoption
Date: Proposed as May 1, 2021
Technical
Citations: 42 CFR 435 subpart B and C
Background
HSD is revising Institutional Care and
Home and Community-Based Services Waiver (HCBSW) Medicaid rules to eliminate
the requirement for an interview at initial application, add language regarding
the requirement for a match letter for Intermediate Care Facility for
Individuals with Intellectual Disabilities (ICF/IID) applicants to confirm the
applicant or recipient meets the definition of an individual with a
developmental disability, and to add new language and delete outdated language
to HCBSW rules on what constitutes an intellectual disability and related
condition. HSD is revising the definitions to be a functional versus a
categorical definition of developmental disability which is a national best
practice.
The Department is proposing to amend the rules as
follows:
8.281.400
NMAC
Section 1 is
amended to add the acronym HSD for the Human Services Department.
Section 8 is
revised to include the Department’s current mission statement.
Section 10
is revised to change “applicant/recipient” to “applicant or recipient.” This change was implemented throughout this
rule for consistency.
Section 11
is revised to remove the requirement for an interview for Institutional Care
Medicaid. An interview may be requested
by an applicant or recipient.
Section 15
is amended to add language that to be eligible for ICF/IID applicants or
recipients must obtain a match letter from the Department of Health (DOH) to
confirm that he or she meets the definition of an individual with a
developmental disability as determined by the DOH/Developmental Disabilities
Supports Division.
8.290.400
NMAC
Section 7
was revised to delete the word “specific.”
Section 8 is
revised to include the Department’s current mission statement.
Section 10
pertaining to the Developmental Disabilities Waiver was revised to add language
regarding what constitutes an “intellectual disability.”
Specific
language was added to intellectual disability to define general intellectual
functioning as the results obtained by assessment with one or more of the
individually administered general intelligence tests developed for the purpose
of assessing intellectual functioning.
Significantly sub-average is defined as an intelligence quotient (IQ) of
70 or below. Adaptive behavior is defined as the effectiveness or degree with
which individuals meet the standards of personal independence and social
responsibility expected for age and cultural group. The developmental period is defined as the
period of time between birth and the 18th birthday.
Revisions
were made to add language as to what constitutes a “related condition” and
delete language that was no longer applicable.
Specific
language was added to exclude mental illness as a related condition. Language was added to define related
condition as attributable to a condition, other than mental illness, found to
be closely related to an intellectual disability (ID) because this condition
results in limitations in general intellectual functioning or adaptive behavior
similar to that of persons with an intellectual disability and requires similar
treatment or services.
A related
condition is manifested before the person reaches age twenty-two (22) years; is
likely to continue indefinitely and results in substantial functional
limitations (Adaptive Behavior scores less than or equal to 70) in three or
more of the following areas: self-care,
receptive and expressive language, learning, mobility, self-direction, capacity
for independent living, and economic self-sufficiency.
Section 11
was amended to remove the interview requirement for home and community-based
services waiver categories.
The
register for these proposed amendments to this rule will be available December
15, 2021 on the HSD web site at http://www.hsd.state.nm.us/LookingForInformation/registers.aspx
or at http://www.hsd.state.nm.us/2017-comment-period-open.aspx. If you do not have Internet access, a copy of
the proposed rules may be requested by contacting MAD in Santa Fe at 505-827-1337.
The Department proposes to implement
these rules effective May 1, 2021. A
public hearing to receive testimony on these proposed rule changes will be held
via conference call on Thursday, January 21, 2021 at 10:00 a.m., Mountain Time
(MT). Conference Number: 1-800-747-5150. Access Code:
2284263.
Interested
parties may submit written comments directly to: Human Services Department, Office of the
Secretary, ATT: Medical Assistance Division Public Comments, P.O. Box 2348,
Santa Fe, New Mexico 87504-2348.
If
you are a person with a disability and you require this information in an
alternative format or require a special accommodation to participate in the public
hearing, please contact MAD in Santa Fe at 505-827-1337. The Department requests at least ten (10)
days advance notice to provide requested alternative formats and special
accommodations.
Copies
of all comments will be made available by the MAD upon request by providing
copies directly to a requestor or by making them available on the MAD website
or at a location within the county of the requestor.