Program Policy Manual
Index
| Each rule of the program policy manual appears below along with two citations. One citation serves as the link to the most current material for that rule. The other citation, which sometimes refers to repealed or revised material, appears for reference purposes | ||
| NMAC Citation | MAD Citation | RULE NAME |
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Chapter 300 MEDICAID GENERAL ADMINISTRATION POLICIES |
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| 8.300.1 | MAD 010 | General Program Description |
| 8.300.2 | -- | Health Insurance Portability and Accountability Act 1996 |
| 8.300.6 | MAD 020 | Responsibility and Delegation of Authority |
| 8.300.11 | MAD 030 | Confidentiality |
| 8.300.17 | MAD 042 | Conflict of Interest |
| 8.300.21 | MAD 085 | Medical Assistance Division Policy |
| 8.300.22 | -- | Electronic Health Records Incentive Program (Medicaid EHR) |
| APPLICABLE TO ALL SERVICES & PROVIDERS | ||
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Chapter 301 MEDICAID GENERAL BENEFIT DESCRIPTION |
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| 8.300.1 | MAD 010 | General Program Description |
| 8.301.2 | MAD 601 | Medicaid General Benefit Description |
| 8.301.3 | MAD 602 | Medicaid General Non Covered Services |
| 8.301.5 | MAD 604 | Medical Management Services |
| 8.301.6 | MAD 605 | Client Medical Transportation Services |
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Chapter 302
MEDICAID GENERAL PROVIDER POLICIES |
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| 8.302.1 | MAD 701 | General Provider Policies |
| 8.302.2 | MAD 702 | Billing for Medicaid Services |
| 8.302.3 | MAD 703 | Third Party Liability Provider Responsibilities |
| 8.302.4 | MAD 704 | Out-of-State and Border Area Providers |
| 8.302.5 | MAD 705 | Prior Authorization & Utilization Review |
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Chapter 305 MEDICAID MANAGED CARE |
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| 8.305 | MAD 606 | Managed Care Policies |
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Chapter 306
STATE COVERAGE INSURANCE (SCI) |
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| 8.306 | -- | State Coverage Insurance |
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Chapter 307 COORDINATED LONG-TERM SERVICES |
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| 8.307 | -- | Coordinated Long-Term Services |
| MEDICAL AND INSTITUTIONAL SERVICES & PROVIDERS | ||
| CHAPTER 310 HEALTH CARE PROFESSIONAL SERVICES | ||
| 8.310.2 | MAD 711 | Medical Services Providers |
| 8.310.3 | MAD 712 | Rural Health Clinic Services |
| 8.310.4 | MAD 713 | Federally-Qualified Health Center Services |
| 8.310.5 | MAD 714 | Anesthesia Services |
| 8.310.6 | MAD 715 | Vision Care Services |
| 8.310.7 | MAD 716 | Dental Services |
| 8.310.8 | MAD 717 | Behavioral Health Professional Services |
| 8.310.10 | MAD 718.1 | Midwife Services |
| 8.310.11 | MAD 718.2 | Podiatry Services |
| 8.310.13 | -- | Telehealth Services |
| 8.310.15 | -- | Intensive Out Patient Services |
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Chapter 311 HOSPITAL SERVICES |
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| 8.311.2 | MAD 721 | Hospital Services |
| 8.311.3 | MAD 721.d | Methods and Standards for Establishing Payment - Inpatient Hospital Services |
| 8.311.4 | MAD 722 | Outpatient Psychiatric Services and Partial Hospitalization |
| 8.311.5 | MAD 723 | Swing Bed Hospital Services |
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Chapter 312 LONG TERM CARE SERVICES - NURSING SERVICES |
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| 8.312.2 | MAD 731 | Nursing Facilities |
| 8.312.3 | MAD 731.d | Cost-related Reimbursement of Nursing Facilities |
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Chapter 313 LONG-TERM CARE SERVICES - INTERMEDIATE CARE FACILITIES |
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| 8.313.2 | MAD 732 | Intermediate Care Facilities for the Mentally Retarded |
| 8.313.3 | MAD 732.d | Cost Related Reimbursement of ICF-MR Facilities |
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Chapter 314 HOME AND COMMUNITY-BASED SERVICES WAIVERS & PROVIDERS (Previously “Long Term Care Services – Waivers”) |
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| 8.314.2 | MAD 733 | Disabled and Elderly Home and Community-Based Services Waiver |
| 8.314.3 | MAD 734 | Medically-Fragile Home and Community-Based Services Waiver |
| 8.314.4 | MAD 735 | Acquired Immunodeficiency Syndrome (AIDS) or AIDS-Related Condition Home and Community-Based Services Waiver |
| 8.314.5 | MAD 736 | Developmental Disabilities Home and Community-Based Services Waiver |
| 8.314.6 | -- | Mi Via Home and Community-Based Services Waiver |
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Chapter 315 OTHER SPECIALIZED SERVICES & PROVIDERS (Previously “Other Long Term Care Services”) |
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| 8.315.2 | MAD 777 | Program of All-Inclusive Care for the Elderly (PACE) |
| 8.315.3 | MAD 737 | Psychosocial Rehabilitation Services |
| 8.315.4 | MAD 738 | Personal Care Option (PCO) Services |
| 8.315.5 | -- | Assertive Community Treatment (ACT) Services |
| 8.315.6 | -- | Comprehensive Community Support Services (CCSS) |
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Chapter 320 EARLY AND PERIODIC SCREENING, DIAGNOSIS AND TREATMENT (EPSDT) SERVICES |
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| 8.320.2 | MAD 740 | Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Services |
| 8.320.3 | MAD 741 | Tot-to-Teen Health Check |
| 8.320.4 | MAD 743 | Special Rehabilitation Services |
| 8.320.5 | MAD 744 | EPSDT Case Management |
| 8.320.6 | 747 | School Based Services for Recipients under 21 years of age |
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Chapter 321 ENHANCED EPSDT - RESIDENTIAL SERVICES |
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| 8.321.2 | MAD 742.1 | Inpatient Psychiatric Care in Freestanding Psychiatric Hospital |
| 8.321.3 | MAD 742.2 | Accredited Residential Treatment Center Services |
| 8.321.4 | MAD 742.3 | Non-Accredited Residential Treatment Centers and Group Homes |
| 8.321.5 | MAD 742.4 | Outpatient and Partial Hospitalization Services in Freestanding Psychiatric Hospitals |
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Chapter 322 ENHANCED EPSDT - COMMUNITY MENTAL HEALTH SERVICES |
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| 8.322.2 | MAD745.1 | Treatment Foster Care |
| 8.322.3 | MAD745.2 | Behavior Management Skills Development Services |
| 8.322.4 | MAD745.3 | Day Treatment |
| 8.322.5 | MAD745.4 | Treatment Foster Care II |
| 8.322.6 | -- | Multi-Systemic Therapy Services |
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Chapter 323 ENHANCED EPSDT - OUTPATIENT PROVIDERS |
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| 8.323.2 | MAD746.5 | EPSDT Personal Care Services |
| 8.323.3 | MAD 746.6 | Licensed Alcohol and Drug Abuse Counselors |
| 8.323.4 | MAD 746.3 | EPSDT Private Duty Nursing Services |
| 8.323.5 | MAD 746.4 | EPSDT Rehabilitation Services |
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Chapter 324 ADJUNCT SERVICES |
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| 8.324.2 | MAD 751 | Laboratory Services |
| 8.324.3 | MAD 752 | Diagnostic Imaging and Therapeutic Radiology Services |
| 8.324.4 | MAD 753 | Pharmacy Services |
| 8.324.5 | MAD 754 | Durable Medical Equipment and Medical Supplies |
| 8.324.6 | MAD 755 | Hearing Aids and Related Evaluations |
| 8.324.7 | MAD 756 | Transportation Services |
| 8.324.8 | MAD 757 | Prosthetics and Orthotic |
| 8.324.9 | MAD 758 | Nutrition Services |
| 8.324.10 | MAD 759 | Ambulatory Surgical Center Services |
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Chapter 325 SPECIALTY SERVICES |
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| 8.325.2 | MAD 761 | Dialysis Services |
| 8.325.3 | MAD762 | Reproductive Health Services |
| 8.325.4 | MAD 763 | Hospice Care Services |
| 8.325.5 | MAD 764 | Transplant Services |
| 8.325.6 | MAD 765 | Experimental or Investigational Procedures, Technologies or Non-Drug Therapies |
| 8.325.7 | MAD 766 | Pregnancy Termination Procedures |
| 8.325.8 | MAD 767 | Rehabilitation Services Providers |
| 8.325.9 | MAD 768 | Home Health Services |
| 8.325.10 | MAD 769 | Emergency Medical Services for Aliens |
| CASE MANAGEMENT SERVICES & PROVIDERS | ||
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Chapter 326 CASE MANAGEMENT SERVICES |
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| 8.326.2 | MAD 771 | Case Management Services for Adults with Developmental Disabilities |
| 8.326.3 | MAD 772 | Case Management Services for Pregnant Women and their Infants |
| 8.326.4 | MAD 773 | Case Management Services for the Chronically-Mentally ill |
| 8.326.5 | MAD 774 | Case Management Services for Traumatically Brain-Injured Adults |
| 8.326.6 | MAD 775 | Case Management Services for Children up to Age Three |
| 8.326.7 | MAD 776 | Adult Protective Services Case Management Services |
| 8.326.8 | MAD 778 | Case Management Services for Children Provided by Juvenile Probation & Parole Officers |
| APPEALS, DECISIONS, UTILIZATION, DETERMINATIONS, SANCTIONS, & HEARINGS | ||
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Chapter 349 COORDINATED SERVICE CONTRACTORS |
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| 8.349.2 | -- | Appeals and Grievance Process |
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Chapter 350 RECONSIDERATION OF UTILIZATION REVIEW |
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| 8.350.2 | MAD 953 | Reconsideration of Utilization Review Decisions |
| 8.350.3 | MAD 954 | Abstract Submission for Level of Care Determinations |
| 8.350.4 | MAD 955 | Reconsideration of Audit Settlements |
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Chapter 351 SANCTIONS OR REMEDIES |
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| 8.351.2 | MAD 960 | Sanctions and Remedies |
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Chapter 352 RECIPIENT HEARING POLICIES |
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| 8.352.2 | MAD 970 | Recipient Hearings |
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Chapter 353 PROVIDER HEARING POLICIES |
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| 8.353.2 | MAD 980 | Provider Hearings |
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Chapter 354 PREADMISSION SCREENING AND ANNUAL RESIDENT REVIEW (PASRR) AND PATIENT STATUS POLICIES |
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| 8.354.2 | MAD 990 | PASRR and Patient Status Hearing Policies |
Utilization Review Section
| 8.312.2UR | Long Term Care Utilization Review for Nursing Facilities |
| 8.310.7UR | Dental Services Utilization Review Instructions |