N.M. Admin. Code § 8.325.10.13

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

Section 8.325.10.13 - COVERAGE CRITERIA

A. "Emergency" as defined for EMSA includes labor and delivery including inductions and cesarean sections, as well as any other medical condition, manifesting itself with acute symptoms of sufficient severity such that the absence of immediate emergency medical attention could reasonably be expected to result in one of the following:

(1) the non citizen recipient's death;

(2) placement of the non-citizen recipient's health in serious jeopardy;

(3) serious impairment of bodily functions; or

(4) serious dysfunction of any bodily organ or part.

B. Services are covered only when necessary to treat or evaluate a condition meeting the definition of emergency and are covered only for the duration of that emergency.

C. After delivery, a child can have legally documented or citizenship status because of its birth in the United States and, therefore, is not eligible for emergency services for non-citizens. The child may be eligible for another MAD category of eligibility on their own.

D. Determination of coverage is made by MAD or its designee.

N.M. Admin. Code § 8.325.10.13

2/1/95; 8.325.10.13 NMAC - Rn, 8 NMAC 4.MAD.769.4 & A, 12/1/03; A, 10/15/08; A, 11/15/10, Amended by New Mexico Register, Volume XXXI, Issue 08, April 21, 2020, eff. 5/1/2020, Amended by New Mexico Register, Volume XXXII, Issue 24, December 28, 2021, eff. 1/1/2022, Adopted by New Mexico Register, Volume XXXV, Issue 12, June 25, 2024, eff. 7/1/2024