N.M. Admin. Code § 8.326.6.13

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

Section 8.326.6.13 - COVERED SERVICES AND SERVICE LIMITATIONS

Medicaid covers case management services for children up to the age of three (3) which help recipients gain access to medical, social, educational or other needed services. Case management services provide necessary coordination with providers of non-medical services, such as nutrition or education programs, when these services are necessary to enable recipients to benefit from the health services paid for by medicaid.

A. Medicaid covers the following case management service activities furnished children up to the age of three (3):

(1) identification of programs appropriate for the recipient's needs, including those which teach basic maternal and child health skills;

(2) help in accessing the identified programs;

(3) assessment of the service needs of recipients to coordinate the delivery of services when multiple providers or programs are involved in the provision of care;

(4) reassessment to ensure that the services which were obtained are necessary and appropriate in meeting the recipient's needs; and

(5) determination of whether any additional services are warranted.

B. Medicaid covers four (4) hours of case management services per child per year. Additional units of service require prior approval by MAD or its designee.

N.M. Admin. Code § 8.326.6.13

2/1/95; 5/15/96; 8.326.6.13 NMAC - Rn, 8 NMAC 4.MAD.775.4, 3/1/12