N.M. Admin. Code § 7.30.3.14

Current through Register Vol. 35, No. 24, December 23, 2024

Section 7.30.3.14 - EXPENDITURE OF FUNDS

A. Expenditure of children's medical services program funds are based on the availability of funds, the eligibility of the client for services, and the receipt of prior approval by the provider for the services, if required.

B. Emergency services may be paid for if:

(1) the care coordinator is notified of the services rendered and the necessity of the services before the end of the fifth working day after the emergency expense is incurred; or

(2) the medical director determines that the services were consistent with the service plan, if applicable, are eligible for payment, and were rendered in an emergency.

C. Limit on yearly expenditure of funds:

(1) children's medical services program shall not expend more than $15,000.00 per client per year for medical management; or

(2) the CMS program manager in concurrence with the medical director may raise the $15,000.00 financial limit to provide additional coverage for good cause when monies are available.

D. Purchase of services related to educational activities is excluded under these regulations.

E. Purchase of services related to psychiatric disorders is excluded under these regulations except for psychological problems specifically related to an eligible condition, and with approval from the psychological consultant or medical director.

F. Children's medical services program shall be the last resource after other available sources of payment, such as insurance, medicaid, tortfeasors, the UNM care plan, and the NM department of education.

G. Children's medical services program shall not pay for any eligible services provided more than five working days before the date of referral.

H. Clients who have two or more other payor sources, such as insurance, medicare, or medicaid are not eligible for payment by CMS.

N.M. Admin. Code § 7.30.3.14

7.30.3.14 NMAC - Rp, 7 NMAC 30.3.12, 10/30/12