New Mexico Register / Volume XXXII, Issue 24
/ December 28, 2021
This is an
amendment to 8.285.600 NMAC, Sections 10 and 11, effective 1/1/2022.
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] non-citizens (EMSNC)
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 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.]
C. Financial documents: The applicant must provide all necessary
documentation to prove that they meet all financial and non-financial
eligibility standards. Medical providers
cannot submit eligibility applications on behalf of the applicant. 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 EMSNC.
[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; A, 1/1/2022]
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 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
provider is sent the decision for emergency medical services for [aliens
(EMSA)] non-citizens (EMSNC) application (MAD 778) form. The provider must use 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 individual is
sent a NOCA form regarding the application for [emergency medical services
for aliens] EMSNC. The
NOCA form explains the reason for denial
or delay and informs the applicant of [his/her] their 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] they
fail 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; A, 1/1/2022]