Current through Register Vol. 35, No. 11, June 11, 2024
Section 8.10.5.7 - DEFINITIONSA. "Care coordination level (CCL)" identifies the level of support a member needs through care coordination services for the member to improve or maintain and manage their individual health needs effectively. Members are assigned to either care coordination level two (CCL2) or care coordination level three (CCL3) following the completion of a comprehensive needs assessment (CNA) for the member.B."Care coordinator (CC)" is the individual assigned to the newborn and the biological parents by the MCO, private insurer or children's medical services (CMS), to coordinate the care and services needed (to include such services as medical, behavioral health, infant mental health, early intervention, home visiting programs, family FIRST, long term care, prescriptions, medical equipment, and others).C."Caregiver" is a parent, guardian or custodian in the household who provides care and supervision for the child.D. "Centennial care" was implemented on January 1, 2019 as a replacement to the outdated New Mexico Medicaid system. Centennial care aims to educate recipients to become savvy health care consumers, promote more integrated care, properly manage the most at-risk members, involve members in their own wellness, and pay providers for outcomes rather than process.E."Children's medical services (CMS)" provides care coordination and services for the prevention, diagnosis, and treatment of disabling conditions in children. It is a statewide program within the department of health, public health division. CMS serves children from birth to 21 with chronic illnesses or medical conditions that require surgical or medical treatment.F."Comprehensive addiction and recovery act (CARA)" is federal legislation signed into law in 2016. This legislation establishes a comprehensive, coordinated, balanced strategy for substance exposed infants and their caregivers, through enhanced grant programs, that expands prevention and education efforts while also promoting treatment and recovery.G."Comprehensive addiction recovery act (CARA) Navigator" is an assigned position at children, youth and families department (CYFD) and another at the department of health (DOH). The positions assure compliance with the CARA state law and accept plans of care and notifications of substance exposed infants. They provide technical assistance and navigation to the entities and individuals involved in plans of care.H. "Comprehensive care plan" (CCP) is a comprehensive plan of services that meets the member's physical, behavioral, and long-term needs based on information received during the comprehensive needs assessment.I."Comprehensive needs assessment (CNA)" an assessment of the member's physical, behavioral health, and long-term care needs; it will identify potential risks and provide social and cultural information. The results of the CNA shall be used to create the comprehensive care plan (CCP), which is based on the member's assessed needs. The CNA shall be used to determine the member's care coordination level (CCL).J."Fictive kin" means a person not related by birth, adoption or marriage with whom the child has an emotionally significant relationship.K."Health care professional" may be a physician, physician's assistant, medical assistant, nurse, midwife, or doula that is providing health care treatment and advice to expectant or new parents.L. "Health risk assessment (HRA)" is an assessment the MCO shall conduct on all member's newly enrolled in centennial care and on members, not in CCL2 or CCL3, who have had a change in health condition that requires a higher level of care. The HRA shall introduce the member to the MCO, obtain basic health and demographic information and confirm the need for a CNA.M."Insurance-MCOs, private insurers, and CMS" are three entities that can assign a care coordinator for the substance exposed infant based on their parents' insurance coverage at the time of birth.N."Insurer" a company that underwrites an insurance risk; the party in an insurance contract undertaking to pay compensation.O."Key household members" is any individual who lives at the infant's discharge address who is 18 years or older and provides care for the infant listed on the plan of care.P."Managed care organization (MCO)" means an entity that participates in centennial care under contract with the New Mexico human services department (HSD) to assist the State in meeting the requirements established under Section 27-2-12 NMSA 1978.Q."Member" refers to a person enrolled in Medicaid or a managed care organization.R."Parent" as defined in Subsection Q of Section 32A-1-4 NMSA 1978, includes a biological or adoptive parent if the biological or adoptive parent has a constitutionally protected liberty interest in the care and custody of the child.S."Plan of care (POC)" as defined in Subsection T of Section 32A-1-4 NMSA 1978 means a plan created by a health care professional intended to ensure the safety and well-being of a substance-exposed newborn by addressing the treatment needs of the child and any of the child's parents, relatives, guardians, family members or caregivers to the extent those treatment needs are relevant to the safety of the child.T."Primary care physician (PCP)" is a specialist in family medicine, general internal medicine or general pediatrics who provides definitive care to the undifferentiated patient at the point of first contact and takes continuing responsibility for providing the patient's comprehensive care.U."Private insurer" is any health insurance policy purchased by an employer or by an individual from a private insurance company.V."Substance exposed newborn" is any newborn exposed in utero to an illicit substance such as methamphetamine or heroin, prescribed medication such as opioids, methadone, buprenorphine, and marijuana.W."Statewide central intake (SCI)" is the unit within PSD whose responsibilities may include but are not limited to receiving and screening reports of alleged child abuse or neglect and prioritizing and assigning accepted reports to the appropriate county office for investigation.Adopted by New Mexico Register, Volume XXXIII, Issue 04, February 22, 2022, eff. 2/22/2022