N.M. Admin. Code § 8.200.400.11

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

Section 8.200.400.11 - PRESUMPTIVE ELIGIBILITY FOR BREAST AND CERVICAL CANCER

PE provides immediate access to health services when an individual appears to be eligible for Category 052.

A.Breast and cervical cancer (BCC) (Category 052): PE provides temporary medicaid coverage for an uninsured woman, under the age of 65 who has been screened and diagnosed by the DOH as having breast or cervical cancer to include pre-cancerous conditions. Only one PE period is allowed per calendar year.

B. PE is determined by a qualified entity certified by HCA. Qualified entities may include community and rural health centers, hospitals, physician offices, local health departments, family planning agencies and schools.

C. The PE period begins on the date the provider determines presumptive eligibility and terminates at the end of the following month.

D. Providers shall notify the MAD claims processing contractor of the determination within 24-hours of the PE determination.

E. For continued medicaid eligibility beyond the PE period, a completed and signed application for medicaid must be submitted to HCA/ISD. An eligible PE provider must submit the application to ISD within 10 calendar days from the receipt of the application.

N.M. Admin. Code § 8.200.400.11

8.200.400.11 NMAC - Rp, 8.200.400.11 NMAC, 1-1-14, Adopted by New Mexico Register, Volume XXVIII, Issue 18, September 26, 2017, eff. 10/1/2017, Adopted by New Mexico Register, Volume XXIX, Issue 24, December 27, 2018, eff. 1/1/2019, Amended by New Mexico Register, Volume XXXV, Issue 20, October 22, 2024, eff. 10/1/2024