Current Manual Revision Memoranda for ISD and MAD

ISD Manual Revision Memoranda

ISD: Manual Revision Memoranda (MRs) - 2019

Revision Number	Policy Topic

19-02	Updates to HSD 100 Streamlined Applicationfor Benefits Revised 5/17/19
19-01	Repeal and Replace of 8.102.500.8 NMAC and 8.106.500.8 NMAC

ISD: Manual Revision Memoranda (MRs) - 2018

Revision Number	Policy Topic

18-44	Forms Manual Revision - Funeral Expenses Payment Request (FAP 217e) & Funeral Expenses Payment Eligibility Worksheet (FAP 218)
18-20	Forms Manual Revision - Providers Statement and Medical Release Form GAP 003
18-18	Notice for Clothing Allowance
18-16	Forms Manual Revision for HSD 100 & HSDSP 100 Streamlined Application for Assistamce
18-15	Forms Manual Revision for ISD 017 & ISDSP 017
18-14	Rescinding MR 16-11 and Deleting EBT Recipient Sworn Statement of Identity (EBT 005 & EBTSP 005)
18-12	Forms Manual Revision for FAP 013 "Important Cash Assistance Information"
18-10	Forms Manual Revision for FSP 013 "Important SNAP Information"
18-08	Forms Manual Revision for ISD 616 Fair Hearing Poster
18-06	Update to FSP 020 - SNAP Employment (E&T) Reimbursement Request form revised 12-11-17
18-04	Forms Manual Revision for ISD 436 SNAP Schedule for Getting Benefits
18-03	Forms Manual Revision for ISD 615 Fair Hearing Brochure
18-02	Forms Manual Revision for MAD 100 Application
18-01	RESCINDED - Forms Manual Revision for HSD 100 Streamlined Application

ISD: Manual Revision Memoranda (MRs) - 2017

Revision Number	Policy Topic

17-28	Forms Manual Revision for ISD150e Request to Delete Claim Amount
17-27	Forms Manual Revision for ISD 801 IRS Penalties Poster
17-26	Forms Manual Revision for ASD 013 Notice of Collection
17-25	Forms Manual Revision for ISDB 003 Request for Benefit Verification
17-24	Forms Manual Revision for ISD 120 Interim Report
17-23	Forms Manual Revision for ISD 127 Notice of Appointment
17-22	Forms Manual Revision for ISD 201 Notice to Client
17-21	Forms Manual Revision for ISD 211 HUMAD
17-20	Forms Manual Revision for ASD 500 Overpayment Statement
17-19	Forms Manual Revision for MAD 308 Emergency Medical Services for Aliens Referral for Eligibility Determination
17-18	Forms Manual Revision for ASD 031 Notice of Intent to Collect
17-17	Forms Manual Revision for ISD 204 Notice of Address Verification
17-16	Forms Manual Revision for FSP 003 E&T and ABAWD Requirements
17-15	Forms Manual Revision for ISD 109 Change Report
17-14	Forms Manual Revision for LHP 605 & LHPSP 605 2017 Moratorium Letter
17-13	Forms Manual Revision for LHP 007
17-12	Forms Manual Revision for ISD 017 & ISDSP 017
17-11	Manual Revision for HSR Vol. 40 No. 14
17-10	Manual Revision for HSR Vol. 40 No. 16
17-09	Forms Manual Revision for LHP 017
17-07	Forms Manual Revision for FAP282 Notice of Noncompliance
17-06	Forms Manual Revision for ASD-045L LIHEAP Affidavit for Duplicate State Warrant
17-05	Grievance Procedure under the ADA-Revised ISD 672
17-04	Manual Revision for HSR Vol. 40 No 5. NMCAP

ISD: Manual Revision Memoranda (MRs) - 2016

Revision Number	Policy Topic

16-16	RESCINDED - Forms Manual Revision for ISD 017 & ISDSP 017
16-15	ISD 446 Affidavit of Loss of Food Purchased with SNAP Benefits
16-14	Forms Manual Revision for LHP 602 & LHPSP 602
16-13	Forms Manual Revision for LHP 001 & LHPSP 001
16-12	LIHEAP Moratorium Letter LHP 605 & LHPSP 605
16-11	EBT Recipient Sworn Statement of Identitiy
16-10	No Weapons Poster
16-09	Manual Revision for FSP 013 SNAP Worker Checklist
16-08	Notice under the Americans with Disabilities Act ISD 670 / Grievance Procedures under the Americans with Disabilities Act ISD 672
16-06	Required Postings-Revised IPRA 001 Notices
16-05	Manual Revision for HSD 100 New Mexico Streamlined Application for Assistance
16-04	Manual Revision EBT Card Quarterly Report Form and Instructions
16-02	Manual Revision for NM Human Services Register Vol. 38 No. 37
16-01	HSDSP 100 New Mexico Steamlined Application for Assistance

ISD: Manual Revision Memoranda (MRs) - 2015

Revision Number	Policy Topic

15-73	RESCINDED - Forms Manual Revision for FSP 400 & FSPSP 400 Verification of Able Bodied Adults Time Limit Requirement
15-26	Forms Manual Revision HSD 100 New Mexico Streamlined Application for Assistance
15-24	Forms Manual Revision FSP 013 Worker Checklists for SNAP
15-23	RESCINDED - Forms Manual Revision for FSP 200 & FSPSP 200 Able Bodied Adult Time Limit Exemption Request
15-22	RESCINDED - Forms Manual Revision for FSP 300 SNAP Medical & Caretaker Exemption Form(2)
15-21	Forms Manual Revision for ISD 615, ISDSP 615, ISD 616 & ISDSP 616
15-19	Forms Manual Revision for LHP 602 & LHPSP 602 LIHEAP Application
15-18	RESCINDED - Forms Manual Revision for HSD 600 & HSDSP 600 Maybe WE Can Help Brochure
15-17	RESCINDED - Forms Manual Revision for ISD 122 & ISDSP 122 Recertification Application
15-16	Delete and Remove Forms AS 310, ISD 458 and EBT 005
15-15	Forms Manual Revision for FSP 020 & FSPSP 020 E&T Reimbursement Claim Form
15-14	RESCINDED - Forms Manual Revision for FSP 005 & FSPSP 005 SNAP Work Participation Agreement (WPA)
15-13	RESCINDED - Forms Manual Revision for FSP 013 and FAP 013 Worker Checklist for SNAP and TANF
15-12	Forms Manual Revision for EBT001 & EBTSP 002 Informational Brochure
15-11	Forms Manual Revision for LHP 602 & LHPSP 602
15-10	Forms Manual Revision for LHP 602 & LHPSP 602
15-09	RESCINDED - FFY16 LIHEAP Moratorium Letters LHP 605 and LHPSP 605
15-08	RESCINDED - Forms Manual Revision for LHP 017
15-07	RESCINDED - Forms Manual Revision for ISD 017 and ISDSP 017
15-06	Forms Manual Revision for HSD 600, FSP 440, and ISD 436
15-05	Forms Manual Revision for ISD 271 Wage Subsidy Agreement
15-02	Manual Revisions for NM HSR Vol. 38 No. 7 SNAP Resources
15-01	Forms Manual Revision for ISD 121

ISD: Manual Revision Memoranda (MRs) - 2014
Revision Number	Policy Topic
14-19	RESCINDED - Manual Revision ISD 615 Fair Hearings Brochure and ISD 616 Fair Hearings Poster
14-18	Manual Revision ISD 670 Notice under the Americans with Disabilities Act and ISD 672 Grievance Procedures under the Americans with Disabilities Act English & Spanish
14-17	RESCINDED - Manual Revision Update LIHEAP Moratorium Letter, English and Spanish LHP 605 & LHPSP 605
14-15	RESCINDED - Manual Revision Income Eligibility Guidelines ISD 017 and ISDSP 017
14-14	Manual Revision Request for Access to Case Record Information ISD 121 & ISDSP 121
14-13	Manual Revision Complaint Form ISD 416 and ISDSP 416
14-12	Manual Revision Refugee Cash Assistance Forms
14-09	Manual Revision for ISD 271 Wage Subsidy Agreement
14-08	Manual Revision Electronic Benefit Transfer (EBT) Transactions
14-07	RESCINDED - Manual Revision Cash Benefits EBT Transactions Poster (English and Spanish)
14-05	Manual Revisions for HSR Vol. 36 No. 26 and HSR Vol. 36 No. 34
14-03	Forms Manual Revisions ISD203 Refugees Receiving Cash Assistance Information Referral
14-02	RESCINDED - Forms Manual Revision for ISD 122 and ISDSP 122

ISD: Manual Revision Memoranda (MRs) - 2013
Revision Number	Policy Topic
13-28	RESCINDED - LIHEAP Moratorium Letter
13-22	RESCINDED - Forms Manual Revision-Notice of Rights
13-21	RESCINDED - Forms Manual Revision-Application for Assistance
13-20	RESCINDED - Forms Manual Revision for ISD 017 & ISDSP 017 for October 2013
13-19	RESCINDED - Forms Manual Revision for ISD 017 & ISDSP 017 for November 2013
13-18	RESCINDED - Forms Manual Revision-Revised Employment and Training (E&T) Forms English and Spanish Versions (ASPEN Modification)
13-17	HSR Vol. 36 No. 18 Cash Assistance Regulatory Updates
13-16	RESCINDED - Forms Manual Revision-DWP 300 Appointment Notice for NM Works SNAP E&T and DWPSP 300 Trabajo de Nuevo Mexico Aviso de Cita
13-15	HSR Vol. 36 No 13 Employment and Training Final Rule
13-14	RESCINDED - MR 13_14 Forms Manual Revision-Revised Employment and Training (E&T) Forms English and Spanish Versions
13-13	RESCINDED - Lobby Hours During ASPEN Implementation-Posters
13-12	RESCINDED - Forms Manual Revision-ISD 143 Overpayment Documentation Summary and ISD 150e Request to Delete Amount Established in Error
13-11	RESCINDED - Forms Manual Revision-ISD 100 Income Support Division Program Application and ISDSP 101 Solicitud del Programa
13-10	RESCINDED - New Mexico Combined Application Project (NMCAP) Benefit Changes
13-09	RESCINDED - MR 13-09 ISD 202 Eligibility Review Interview Notice and presentation of new ISD 202SP Aviso de Entrevista de Reviso de Elegibilidad
13-08	RESCINDED - Forms Manual Revision-DWP 130 NMW Participation Status Information Notice
13-07	RESCINDED - Diversion Payment Posters (English and Spanish)
13-06	Forms update-LITAP_LHP 004 Help with telephone Bills Updated flier, English and Spanish Version
13-05	RESCINDED - Forms Manual Revision-ISD 211 Help Us Make A Decision
13-04	RESCINDED - Forms Manual Revision-LHPSP 001 LIHEAP Factura De Utildad en Otro Nombre
13-03	RESCINDED - Forms Manual Revision ISDB 003 Client Request for Benefit Verification
13-02	RESCINDED - Forms Manual Revision HB 562 Tax Return Tax Year 2012 flyer
13-01	RESCINDED - Forms Manual Revision ISD 615 Fair Hearings Brochure

MAD Manual Revision Memoranda

MAD: Manual Revision Memoranda (MRs) - 2019

Revision Number	Policy Topic
19-01	Deletion and Removal of Forms MAD 309 and MAD 310; Introduction of MAD 778 Decision for EMSA Application, 3/28/2019
19-02	Revised MAD 303 Form, Effective 04/01/2019
19-03	2019 FPL UPDATE - MAD 222 AND MAD 029
19-04	MAD 313 - Notification of Birth Form Revisions

MAD: Manual Revision Memoranda (MRs) - 2018

Revision

Number

Policy Topic

18-01

ABCB Provider Enrollment Form

18-02

Delete and Remove Form MAD 399, Add Form MAD 029

18-03

Standardized HRA MAD 747

18-04

Weighted Standardized HRA MAD 748

18-05

MAD 379 Program of All-Inclusive Care of the Elderly (PACE) Long Term Care Medical Assessment

18-06

April 2018 FPL Update - MAD 222 and MAD 029

18-07

Weighted Standardized HRA MAD 754

18-08

Revision of MAD 307 Form

18-09

Centennial Care Community Benefit Services Questionnaire (MAD 742) and Community Benefit Member Agreement (MAD 743)

18-10

Brain Injury Services Fund Crisis Interim Services Referral Form, MAD 751, Issued June 2018

18-11

Brain Injury Services Fund Crisis Interim Services Document Cover Page, MAD 767, Issued June 2018

18-12

Transition from UHC to Presbyterian and Revised Application for Assistance Form

18-13

BISF Service Coordination Assessment, MAD 387 Revised August 2018

18-14

Brain Injury Services Fund (BISF) Treatment Verification Form, MAD 772 Issued August 2018

18-15

Brain Injury Services Fund (BISF) Physician’s Order, MAD 404 Revised August 2018

18-16

Centennial Care Involuntary Termination Request for Self-Directed Community Benefits (SDCB) to Agency Based Community Benefits (ABCB) Form

18-17

Brain Injury Services Fund (BISF) Exception Request Approval/Denial Form, MAD 401 Revised August 2018

18-18

Brain Injury Services Fund (BISF) Exception Request for Continued BISF Services, MAD 400 Revised August 2018

18-19

Brain Injury Services Fund (BISF) Reactivation Form, MAD 770 Issued August 2018

18-20

MAD 379 Program of All-Inclusive Care for the Elderly (PACE) Long Term Care Medical Assessment

18-21

Revised Application for Assistance Forms Effective November 1, 2018

18-22

Revised Process for the Submission of Manual PE Enrollment Forms and Revision of the MAD070 Form Effective November 5, 2018

18-23

January Update MAD 029 Aged, Blind and Disabled Medicaid Program Chart | 12/12/2018

18-24

Revision of MAD 029 Form

18-25

Revised Breast and Cervical Cancer Application Form Effective January 1, 2019 | 12/14/2018

18-26

Centennial Care 2.0 Eligibility Rule Changes | 01/01/2019

18-27

Centennial Care 2.0 Community Benefit Services Questionnaire (MAD 742) and Community Benefit Member Agreement (MAD 743) | 12/12/2018

Revision

Number

Policy Topic

MAD: Manual Revision Memoranda (MRs) - 2017

Revision Number	Policy Topic
17-14	Centennial Care Self Directed Community Benefit & Mi Via Provider Attestation Form - Revised MAD 627
17-13	BISF Service Coordination Assessment, MAD 387 Revised 9-08-17
17-12	Centennial Care Self-Directed Community Benefit Employer of Record (EOR) Self-Assessment Form
17-10	BISF Appeals Form, MAD 624, Issued 4-18-2017
17-09	2017 MAD 222, MAD 399
17-08	MAD 616 Fee for Services Out of State Prior Authorization Request Form
17-07	Centennial Care Self-Directed Community Benefit Budget Reduction Form
17-06	BISF Service Coordination Intake Packet, MAD 617 Issued 2-24-2017
17-05	Revision of MAD 307 Form
17-04	NM Brain Injury Services Fund (BISF) Program Application (Spanish)
17-03	NM Brain Injury Services Fund (BISF) Program Application
17-02	8.200.510 NMAC General Recipient Policies - Resource Standards and 8.200.520 NMAC Medicaid Eligibility - General Recipient Rules Income Standards

MAD: Manual Revision Memoranda (MRs) - 2016

Revision Number	Policy Topic
16-10	Revisions to MAD 378 ICF/IID and Developmental Disabilities Home and Community Based Services Waiver Long Term Care Assessment Abstract Form
16-09	Revisions to MAD 307 EMSA Denial of Claims Form
16-07	Revisions to MAD 303 Prior Approval Request Form
16-06	REVISED 2016 MAD 222 and MAD 399; DELETE and REMOVE OBSOLETE MAD 214
16-04	ISD and Presumptive Eligibility Determiners Inquiry
16-03	Health Home Opt-In/Opt-Out MAD 602 Form
16-02	Notice of Privacy Practices
16-01	Revised Spanish Application for Medical Assistance MADSP 100

MAD: Manual Revision Memoranda (MRs) - 2015

15-26

Delete and Remove Form MAD 009 & MAD 606

15-24

Revised Application for Medical Assistance MAD 100

15-23

Medicare Savings Program Comparison Chart - MAD 399

15-22

NM Brain Injury Services Fund (BISF) Program application

15-20

CNA Exception Request Form

15-19

8.291.430 Category of Affordable Care Eligibility

15-18

Health Homes Applications

15-17

8.200.410 NMAC General Recipient Policies

15-16

8.206.400 Medicaid Eligibility - Recipients For Whom CYFD Full or Partial Responsibility

15-14

8.281.500 Medicaid Eligibility - Institutional Care Income and Resource Standards

15-13

8.320.6 School-Based Services for MAP Eligible Recipients under Twenty-One Years of Age

15-12

8.200.520 Medicaid Eligibility – Income Standards & 8.291.430 Medicaid Eligibility – Affordable Care

15-08

8.200.510 General Recipient Policies – Resource Standards

15-07

8.291.410 Affordable Care General Recipient Requirements
8.293.500 Pregnant Women Income and Resource Standards
8.295.400 Children under 19 Recipient Requirements

15-06

8.321.2 Specialized Behavioral Health Service

15-05

8.200.520 Medicaid Eligibility – Income Standards & 8.291.430 Medicaid Eligibility – Affordable Care

15-03

8.314.5 Long Term Care Services - Waivers, Developmental Disabilities Home & Community

15-02

REVISED MAD 299 (Disability Determination Unit Referral)