N.M. Admin. Code § 8.313.2.10

Current through Register Vol. 36, No. 1, January 14, 2025

Section 8.313.2.10 - ELIGIBLE PROVIDERS

A. Upon approval of New Mexico medical assistance program provider participation agreements by New Mexico medical assistance division (MAD), intermediate care facilities for the mentally retarded (ICF-MR) which meet the following conditions for participation are eligible to be reimbursed for providing services to eligible medicaid recipients:

(1) the ICF-MR must be licensed and certified by the division of health improvement, health facility licensing and certification bureau of the HCA to meet the intermediate care facility requirements. See 42 CFR 483 Subpart I;

(2) the ICF-MR must comply with 8.313.2.17 NMAC, Recipient Personal Fund Accounts; and

(3) the ICF-MR must participate in the MAD utilization review process and must agree to operate in accordance with all policies and procedures of that system, including the performance of discharge planning.

B. Once enrolled, providers receive instruction on how to access medicaid and other medical assistance provider program policies, billing instructions, utilization review instructions, and other pertinent material. It is the provider's responsibility to access these instructions or ask for paper copies to be provided, to understand the information provided and to comply with the requirements. To be eligible for medical assistance program reimbursement, providers are bound by the provisions of the provider participation agreement.

N.M. Admin. Code § 8.313.2.10

2-1-95; 8.313.2.10 NMAC - Rn, 8 NMAC 4.MAD.732.1, 11-1-00; A, 5-1-07, Adopted by New Mexico Register, Volume XXXV, Issue 12, June 25, 2024, eff. 7/1/2024