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Current Manual Revision Memoranda for MAD

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

 

22-02

 

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

 

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 For​m
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)