N.M. Admin. Code § 8.326.7.14

Current through Register Vol. 35, No. 21, November 5, 2024

Section 8.326.7.14 - NONCOVERED SERVICES

Case management services are subject to the limitations and coverage restrictions which exist for other medicaid services. See 8.301.3 NMAC, General Noncovered Services. Medicaid does not cover the following specific services as adult protective services case management:

A. services furnished to individuals who are not medicaid eligible or who do not meet the definition of an adult who is abused, neglected or exploited;

B. services furnished by case managers which are not substantiated with appropriate documentation in the recipient's file;

C. formal educational or vocation services related to traditional academic subjects or vocational training;

D. client outreach activities in which a provider attempts to contact potential recipients;

E. administrative activities, such as medicaid eligibility determinations and intake processing;

F. case management for a recipient who is institutionalized, except for the last thirty (30) days of the institutionalization to ensure follow-up services;

G. institutional discharge planning which is a required condition for payment of hospital, nursing home or residential treatment center services;

H. services which are furnished under other categories, such as therapies, transportation or counseling; or

I. services considered by MAD or its designee to be excessive based on the needs of the recipient and documentation in the case management file.

N.M. Admin. Code § 8.326.7.14

1/31/96; 8.326.7.14 NMAC - Rn, 8 NMAC 4.MAD.776.5, 3/1/12