N.M. Admin. Code § 8.326.5.14

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

Section 8.326.5.14 - NONCOVERED SERVICES

Case management services are subject to the limitations and coverage restrictions which exist for other medicaid services. See 8.301.3 NMAC, General Noncovered Services. Medicaid does not cover the following specific activities:

A. services furnished to individuals who are not medicaid-eligible, who do not meet the definition of traumatically brain injured, or who are not residents of Santa Fe county or the state of New Mexico;

B. services furnished by case managers which are not substantiated with appropriate documentation in the recipient's file;

C. daily independent living skills training;

D. outreach and identification activities in which providers attempt to contact potential recipients;

E. administrative activities, such as medicaid eligibility determinations and intake processing;

F. institutional discharge planning: if recipients are in medical institutions, medicaid covers case management only for the thirty (30) days prior to discharge; this service cannot duplicate required discharge planning activities conducted by medical institutions;

G. actual provision of services or treatment identified in the case management assessment; or

H. services furnished by other practitioners, such as therapies, transportation, homemaker or personal care services or psycho-social rehabilitation services.

N.M. Admin. Code § 8.326.5.14

2/1/95; 10/15/96; 8.326.5.14 NMAC - Rn, 8 NMAC 4.MAD.774.5, 3/1/12