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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 Application for 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18-10 Rescinded – Forms Manual Revision for FSP 013  “Important SNAP Information”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18-01 RESCINDED – Forms Manual Revision for HSD 100 Streamlined Application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 Form2
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 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)