LOOKING FOR INFORMATION

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18-10 Rescinded – Forms Manual Revision for FSP 013  “Important SNAP Information”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18-01 RESCINDED – Forms Manual Revision for HSD 100 Streamlined Application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)

 

The next quarterly meeting of the Primary Care Council will be held in early 2023 (date TBA). The meeting is open to the public and will be held via zoom:

https://us02web.zoom.us/j/85812829319?pwd=bTljTFVHZmRhMDZzanRnZitldGoxZz09

Meeting ID: 858 1282 9319
Passcode: 521129
One tap mobile
+13462487799,,85812829319#,,,,*521129# US (Houston)
+16694449171,,85812829319#,,,,*521129# US

Please contact Elisa Wrede, Primary Care Project Manager, with any questions: Elisa.Wrede@state.nm.us.