TITLE 8 SOCIAL SERVICES

CHAPTER 300 MEDICAID GENERAL INFORMATION

PART 21 MEDICAL ASSISTANCE DIVISION POLICY MANUAL

8.300.21.1 ISSUING AGENCY: New Mexico Health Care Authority.

[8.300.21.1 NMAC - Rp 8.300.21.1 NMAC, 7/1/2024]

8.300.21.2 SCOPE: The rule applies to the general public.

[8.300.21.2 NMAC - Rp 8.300.21.2 NMAC, 7/1/2024]

8.300.21.3 STATUTORY AUTHORITY: The New Mexico medicaid program is administered pursuant to regulations promulgated by the federal department of health and human services under Title XIX of the Social Security Act as amended, or by state statute. See Section 27-2-12 et seq. NMSA 1978 (Repl. Pamp. 2007). Section 9-8-1 et seq. NMSA 1978 establishes the health care authority (HCA) as a single, unified department to administer laws and exercise functions relating to health care facility licensure and health care purchasing and regulation.

[8.300.21.3 NMAC - Rp 8.300.21.3 NMAC, 7/1/2024]

8.300.21.4 DURATION: Permanent.

[8.300.21.4 NMAC - Rp 8.300.21.4 NMAC, 7/1/2024]

8.300.21.5 EFFECTIVE DATE: July 1, 2024, unless a later date is cited at the end of a section.

[8.300.21.5 NMAC - Rp 8.300.21.5 NMAC, 7/1/2024]

8.300.21.6 OBJECTIVE: The objective of these rules is to provide instruction for the service portion of the New Mexico medical assistance programs.

[8.300.21.6 NMAC - Rp 8.300.21.6 NMAC, 7/1/2024]

8.300.21.7 DEFINITIONS: [RESERVED]

8.300.21.8 MISSION STATEMENT: The mission of the New Mexico medical assistance division (MAD) is to maximize the health status of eligible recipients by furnishing payment for quality health services at levels comparable to private health plans.

[8.300.21.8 NMAC - Rp 8.300.21.8 NMAC, 7/1/2024]

8.300.21.9 MEDICAL ASSISTANCE DIVISION POLICY MANUAL: The MAD rule manual (the manual) contains detailed information about the New Mexico medical assistance programs. It is intended for use by all participating providers who furnish health services, MAD applicants/recipients, HCA employees and designees, contractors, and all other interested parties.

A. Purpose of the manual: The purpose of the manual is to provide an overview of general rules on the administration and financing of medicaid and other health care programs administered by MAD, recipient eligibility, coverage of services, and reimbursement by provider group. Once enrolled, MAD providers receive instructions on how to access instructions, and other pertinent materials. The MAD eligibility manual sections are available at the HCA website or other program specific websites.

B. Updating manual: To ensure that MAD rules contained in this manual remains current, providers, local county ISD offices, and other interested parties on the mailing list are notified of updates at the conclusion of the publication process. The finalized rules are available on the HCA website or other program specific websites for viewing and copying.

(1) Rule updates are distributed in the form of New Mexico medical assistance manual revisions (MAD-MR). Each MAD-MR provides the rationale for the rule revision, specific changes, and instructions for updating the affected manual sections.

(2) Updates for claims processing, prior authorization, and utilization review instructions for providers are distributed in the form of MAD supplements.

[8.300.21.9 NMAC - Rp 8.300.21.9 NMAC, 7/1/2024]

HISTORY OF 8.300.21 NMAC:

Pre-NMAC History: The material in this part was derived from that previously filed with the State Records Center:

SP-004.0800, Section 4, General Program Administration Availability of Agency Program Manuals, filed 1/23/1981.

History of Repealed Material:

8 NMAC 4.MAD.080, Medical Assistance Division Policy Manual, filed 1/18/1995 - Repealed effective 4/15/2009.

8.300.21 NMAC - Medical Assistance Division Policy Manual (filed 3/25/2009) Repealed effective 7/1/2024.

Other: 8.300.21 NMAC - Medical Assistance Division Policy Manual (filed 3/25/2009) Replaced by 8.300.21 NMAC - Medical Assistance Division Policy Manual effective 7/1/2024.