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MAD Manual Revision Memoranda
MAD: Manual Revision Memoranda (MRs) – 2025
| Revision Number |
Policy Topic |
|---|---|
| 25-01 | MAD 029 and MAD 222 Forms Updates |
MAD Manual Revision Memoranda
MAD: Manual Revision Memoranda (MRs) – 2023
| Revision Number |
Policy Topic |
|---|---|
| 23-07 | Agency Based Community Benefit Program (ABCB) Provider Enrollment Forms |
| 23-06 | Centennial Care Nursing Facility Level of Care (NF LOC) Notification Form (MAD 842) |
| 23-05 | Standardized Health Risk Assessment (HRA) Form (MAD 754) |
| 23-04 | MAD 313, Notification of Birth Form |
| 23-03 | Centennial Care 2.0, Community Benefit Services Questionnaire (MAD 742) |
| 23-02 | July 2023 MAD 029 Aged, Blind and Disabled Medicaid Form |
| 23-01 | April 2023 FPL Update – MAD 222 and 029 |
MAD Manual Revision Memoranda
MAD: Manual Revision Memoranda (MRs) – 2022
| Revision Number |
Policy Topic |
|---|---|
| 22-01 | January 2022 MAD 029, Aged, Blind, and Disabled Medicaid Form |
|
|
Implementation of MAD 892, Technical Denial for Failure to Respond to Request for Action Letter |
| 22-03 |
Revised MAD 100 and MADSP 100 Medical Assistance Application
|
| 22-04 | April 2022 FPL Update – MAD 222 and 029 |
| 22-05 | July 2022 MAD 029 Aged, Blind, and Disabled Medicaid Form |
| 22-06 | January 2023 MAD 029 Aged, Blind and Disabled Medicaid Form |
MAD: Manual Revision Memoranda (MRs) – 2021
| Revision Number |
Policy Topic |
|---|---|
| 21-01 | January update MAD 029 Aged, Blind and Disabled Medicaid Program Chart |
| 21-02 | January update MAD 217 Presumptive Elegibility Determiner PED Updated Form |
| 21-03 | Revision to Third Party Assessor (TPA) Mi Via Letters |
| 21-04 | Centennial Care Nursing Facility Level of Care (NF LOC) Notification Form (MAD 842 |
| 21-05 | April 2021 FPL Update – MAD 222 and MAD 029 |
| 21-06 | July 2021 MAD 029 Aged, Blind and Disabled Medicaid Form |
| 21-07 | Revision to Out of State Professional or Ancillary Services Approval Letter (MAD 731) |
| 21-08 |
Revised 11/2/2021 MAD 299 (Disability Determination Unit Referral) |
| 21-09 | Alien Name Change to Non-Citizen; Update to MAD Emergency Medical Services for Aliens (EMSA) Forms |
MAD: Manual Revision Memoranda (MRs) – 2020
| Revision Number |
Policy Topic |
|---|---|
| 20-01 | January Update MAD 029 Aged, Blind and Disabled Medicaid Program Chart |
| 20-02 | April 2020 FPL Update – MAD 222 and MAD 029 |
| 20-03 | MAD 751 Brain Injury Services Fund (BISF) Referral Form |
| 20-04 | MAD 767 Brain Injury Service Fund (BISF) Document Cover Form |
| 20-05 | MAD 393 Brain Injury Services Fund (BISF) Program Independent Living Plan Revised February 2020 |
| 20-06 | Implementation of Support Waiver Recipient Notices |
| 20-07 | Updating CCSC Phone Number on MAD Forms |
| 20-08 | MAD 812 Issued October 2020 Brain Injury Services Fund (BISF) Master Quarterly Report |
| 20-09 | Revision of MAD 308 Forms |
| 20-10 | MAD 617 Brain Injury Services Fund (BISF) Program Service Coordination Intake Packet-Revised December 2020 |
| 20-11 | July Update MAD 029 Aged, Blind and Disabled |
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 |
| 19-05 | Revision of MAD 029 Form Effective July 1, 2019 |
| 19-06 | NM Brain Injury Services Fund (BISF) Program Application (MAD 386 Revised June 2019) |
| 19-06 | NM Brain Injury Services Fund (BISF) Program Application (MAD 386 Revised June 2019) Spanish fillable Application |
| 19-07 | MAD 790 Issued June 2019, Brain Injury Services Fund (BISF) Freedom of Choice |
| 19-08 | MAD 617 Brain Injury Services Fund (BISF) Program Service Coordination Intake Packet – Revised June 2019 |
| 19-09 | MAD 768 Brain Injury Services Fund (BISF) Program Travel Expense Reimbursement Form – Revised June 2019 |
| 19-10 | MAD 624 Brain Injury Services Fund (BISF) Appeals Form – Revised June 2019 |
| 19-11 | MAD 400 Brain Injury Services Fund (BISF) Exception Request – Revised September 2019 |
| 19-12 | MAD 401 Brain Injury Services Fund (BISF) Program Travel Expense Reimbursement Form – Revised June 2019 |
| 19-13 | MAD 404 Brain Injury Services Fund (BISF) Exception Request Approval/Denial – Revised September 2019 |
| 19-14 | MAD 770 Brain Injury Services Fund (BISF) Reactivation Form – Revised September 2019 |
| 19-15 | MAD 772 Brain Injury Services Fund (BISF) Treatment Verification Form – Revised September 2019 |
| 19-16 | MAD 788 Brain Injury Services Fund (BISF) Billing Form for Service Coordination – Issued June 2019 |
| 19-17 | MAD 789 Brain Injury Services Fund (BISF) Billing Form For Fiscal Intermediary Agent – Issued June 2019 |
| 19-18 | Implementation of MAD 748 and MAD 749 Recipient Notices for Disabilities Waiver and Medically Fragile Waiver |
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 |
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
|
Revision Number |
Policy Topic |
|---|---|
| 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) |