N.M. Admin. Code § 8.326.5.12

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

Section 8.326.5.12 - ELIGIBLE INDIVIDUALS

A. Case management services are available for eligible medicaid recipients who meet all of the following criteria:

(1) twenty-one (21) years of age or older;

(2) resident of the state of New Mexico;

(3) resident of Santa Fe, Chavez, Dona Ana, San Juan, McKinley or San Miguel counties;

(4) suffer from traumatic brain injury; and

(5) reside outside an institution.

B.Definition of traumatic brain injury: "Traumatic brain injury" is defined as an insult to the brain which is not caused by a degenerative or congenital process, but by an external physical force. The physical force produces a diminished or altered state of consciousness resulting in impairment of cognitive abilities or physical functioning. It can also result in the disturbance of behavioral or emotional functioning. These impairments can be either temporary or permanent and cause partial or total functional disability or psychological maladjustment.

C.Recipient freedom of choice: Adults with traumatic brain injuries are not required to receive case management services even if they are eligible for the service. Case management services can only be furnished at the request of recipients. Recipients have the freedom to choose among medicaid-eligible case management agencies and specific case managers within an agency.

N.M. Admin. Code § 8.326.5.12

2/1/95; 10/15/96; 8.326.5.12 NMAC - Rn, 8 NMAC 4.MAD.774.3, 3/1/12