N.M. Admin. Code § 8.301.5.14

Current through Register Vol. 35, No. 23, December 10, 2024

Section 8.301.5.14 - REEVALUATION OF ASSIGNMENT

Initial medical management assignments are reevaluated by the HCA staff within a year of the effective date of the assignment or from the date of reevaluation. The reevaluation focuses on whether assignments met the objectives identified in the HCA staff recommendation or whether the initial assignments need modification. A reevaluation is conducted using information similar to that used in the initial medical management assignment analysis. If continuation or modification of an assignment is necessary, the reasons for the action are documented in the case file. The MAD medical director or another physician designated by MAD makes the final decision as to whether the assignment needs to be continued, modified or removed.

A. Medicaid eligibility changes: Changes in recipient eligibility status do not affect the status of a recipient in medical management or the reevaluation process. If a recipient on medical management becomes ineligible for medicaid benefits but later becomes medicaid eligible within the assignment period, the recipient remains in medical management.

B. Removal from the medical management program: Recipients are removed from medical management by HCA staff when the specific situation necessitating medical management has been resolved.

N.M. Admin. Code § 8.301.5.14

2-1-95; 8.301.5.14 NMAC - Rn, 8 NMAC 4.MAD.604.5 & A, 7-1-01, Adopted by New Mexico Register, Volume XXXV, Issue 12, June 25, 2024, eff. 7/1/2024