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Current Manual Revision Memoranda for ISD and MAD
ISD Manual Revision Memoranda
ISD: Manual Revision Memoranda (MRs) – 2020
| Revision Number | Policy Topic |
| 20-02 | Required Postings – And Justice for All with attachment |
| 20-01 2nd Amendment | 2nd Amended Updates to HSD 100 Streamlined Application for Benefits Revised 2/24/2020, Updates to MAD 100 Streamlined Application for Benefits Revised 2/24/2020 |
| 20-01 Amended RECINDED | RECINDED Amended Updates to HSD 100 Streamlined Application for Benefits Revised 2/24/2020, Updates to MAD 100 Streamlined Application for Benefits Revised 2/24/2020 |
| 20-01 RECINDED | RECINDED Updates to HSD 100 Streamlined Application for Benefits Revised 2/24/2020, Updates to MAD 100 Streamlined Application for Benefits Revised 2/24/2020 |
Memoranda (MRs) – 2019
|
Revision Number |
Policy Topic |
| 19-06 | SNAP-Ed New Mexico – Required Posters |
| 19-05 | Required Postings – SNAP Quality Control (QC) Reviews |
| 19-04 | Required Postings – Revised IPRA 001 Notices |
| 19-03 | YES-NM Client Information – Required Posters |
| 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| 18-10 | Rescinded – Forms Manual Revision for FSP 013 “Important SNAP Information” |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| 18-01 | RESCINDED – Forms Manual Revision for HSD 100 Streamlined Application |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 | Rescinded – 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) – 2021
|
Revision Number |
Policy Topic |
| 21-01 | January update MAD 029 Aged, Blind and Disabled Medicaid Program Chart |
| 21-02 | Revisions of MAD 217 form |
| 21-03 | Revision to Third Party Assessor (TPA) Mi Via Letters |
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 Cordination Intake Packet-Revised December 2020 |
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) |