N.M. Code R. § 8.311.5.10

Current through Register Vol. 35, No. 11, June 11, 2024

Section 8.311.5.10 - ELIGIBLE PROVIDERS

A. Upon approval of New Mexico medical assistance program provider participation agreements by MAD, small rural hospitals that meet the following requirements are eligible to be reimbursed for providing services as swing bed providers:

(1) hospital is licensed and certified by the licensing and certification bureau of the New Mexico department of health (DOH) to participate in the medicare and/or the medicaid programs and has received additional certification from the DOH to act as a swing bed provider;

(2) hospital must have fewer than 100 inpatient hospital beds, counting all inpatient hospital beds maintained by the hospital, exclusive of beds for newborns and intensive care beds; and

(3) hospital must be located in a rural area; any geographic area not designated as "urban" in the most recent census is considered "rural" for the purpose of this regulation.

B. Since a swing bed hospital already has an approved provider agreement for the provision of acute care services, a separate agreement for swing bed services is not required. An addendum to the current provider agreement grants approval for swing bed participation.

C. Once enrolled, providers receive a packet of information, including medicaid program policies, billing instructions, utilization review instructions, and other pertinent material from MAD. Providers are responsible for ensuring that they have received these materials and for updating them as new materials are received from MAD.

N.M. Code R. § 8.311.5.10

2/1/95; 8.311.5.10 NMAC - Rn, 8 NMAC 4.MAD.723.1, 3/1/12