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Medical Assistance Division State Plan

The following is New Mexico’s State Plan:

A State Plan is a contract between a state and the Federal Government describing how that state administers its Medicaid program. It gives an assurance that a state abides by Federal rules and may claim Federal matching funds for its Medicaid program activities. The state plan sets out groups of individuals to be covered, services to be provided, methodologies for providers to be reimbursed and the administrative requirements that States must meet to participate.

States frequently send a state plan amendment, otherwise referred to as a SPA, to the Centers for Medicare and Medicaid Services (CMS) for review and approval. There are many reasons why a state might want to amend their state plan. For example, the state may wish to implement changes required by Federal or state law, Federal or state regulations, or court orders. States also have the flexibility to request permissible program changes, make corrections, or update their plan with new information.

CMS maintains the Medicaid.gov website, where more information regarding SPAs can be found.

The following is New Mexico’s State Plan:

State Plan

     

Pending State Plan Amendments (SPAs)

   SPA Number Date Submitted to CMS                   Topic and Attachments 
21-0004 3/30/2021 Medication Assisted Treatment (MAT)
21-0002 3/22/2021 Rescission of SPA 20-0014 Pharmacy Curbside Payment
20-0019 9/30/2020 Graduate Medical Education (GME) Program

 

Completed/Approved State Plan Amendments (SPAs)


SPA   Number 
Date Approved By CMS       Topic and Attachments 
21-0001 5/10/2021 IHS & Tribal 638 Pharmacy Payment
20-0022 5/5/2021 Federally Qualified Health Center (FQHC) Designation
21-0005 4/15/2021 Health Homes Substance Use Disorder (SUD)
20-0025 3/19/2021 NM Disaster Relief #11 (COVID Vaccine)
20-0020 3/10/2021 Air Ambulance Rates
20-0016 3/4/2021 Elimination of Medicare Savings Plan (MSP) Resource Standard
20-0018 1/19/2021 Nursing Facility (NF) Payment
20-0017 1/14/2021 Diagnosis Related Group (DRG) Payment
20-0024 12/17/2020 NM Disaster Relief #10 (Targeted Access Payments)
20-0021 10/30/2020 NM Disaster Relief #7 (FIT Rate Increases)
20-0014 11/5/2020 NM Disaster Relief #9 (Pharmacy Curbside)
20-0013 11/5/2020 NM Disaster Relief #8 (Non-hospital Providers)
20-0011 10/15/2020 Family Infant Toddler (FIT) Rate Increases
20-0010 8/4/2020 NM Disaster Relief #6 (Inpatient Hospital Rate Increase)
20-0009 5/22/2020 NM Disaster Relief #4 (Nursing Facility Rate Increase)
20-0008 6/16/2020 NM Disaster Relief #5 (UPL Payments)
20-0007 5/13/2020 NM Disaster Relief #3 (COVID Testing Group)
20-0005 5/7/2020 NM Disaster Relief #2 (DRG & DSH)
20-0004 4/24/2020 NM Disaster Relief #1 (PE Qualified Entities)
20-0003 4/24/2020 Vision Screening Reimbursement
20-0002 4/23/2020 LARC Reimbursement
19-0019 3/5/2020 Medicaid Drug Utilization Review (DUR)
19-0017 2/19/2020 Telehealth & Teleconsultation Services Reimbursement
19-0016 4/30/2020 Federally Qualified Health Center (FQHC) Rates
19-0015 2/18/2020 Behavioral Health Fee Schedule Pricing
19-0014 2/26/2020 Inpatient Hospital Reimbursement
19-0013 4/8/2020 Outpatient Hospital Reimbursement
19-0012 4/3/2020 Fee Schedule Pricing
19-0011 2/24/2020 Dental Reimbursement
19-0010 12/17/2019 Single State Agency
19-0009 10/18/2019 Census Wages Exclusion
19-0008 8/16/2019 Family Infant Toddler (FIT) Increases
19-0007 12/12/2019 Durable Medical Equipment
19-0006 6/27/2019 Autism Intervention Services (AIS) Fee Schedule Changes
19-0005 6/27/2019 BH Fee Schedule Changes
19-0004 6/27/2019 Fee Schedule Changes
19-0003 11/4/2019 Substance Use Disorder Alternative Benefit Program (SUD ABP)
19-0002 10/22/2019 Substance Use Disorder (SUD)
19-0001 6/27/2019 Former Foster Care
18-0005 12/4/2018 Behavioral Health (BH) Fee Schedule
18-0004 12/4/2018 Fee Schedule Pricing
18-0002 7/3/2018 Health Homes
18-0001 5/11/2018 Home Equity
17-0005 7/6/2017 Foster Care
17-0004 11/3/2017 Alternative Benefit Plan (ABP)
17-0003 4/10/2018 Coverage Outpatient Drugs
17-0002 6/19/2017 Licensed Birth Centers
16-0009 2/16/2017 Medical Practitioner Reimbursement
16-0008 12/15/2016 Payment Methodology for IMG and GME
16-0007 2/15/2017 Dental Reimbursement
16-0006 2/15/2017 Inpatient Hospital Reimbursement
16-0005 2/15/2017 Outpatient Hospital Reimbursement
16-0004 2/15/2017 Terminate Primary Care Provider (PCP) Enhanced Payments
16-0003 6/16/2016 Tribal Consultation Requirements
16-0002 3/3/2017 Alternate Methodology for FQHC Payments
16-0001 3/21/2016 Pharmacy Dispensing Fees
15-0016 11/30/2015 Outpatient Hospital Prospective Payment System Dental Rate Increase
15-0015 5/26/2016 Cost Settlement for Medicaid School-Based Services Program
15-0014 3/22/2016 Health Homes
15-0013 6/30/2015 Nursing Facility Rate Increase
15-0011 11/3/2015 Hospital Based Rural Health Clinic Reimbursement
15-0010 6/24/2015 Former Foster Care Children
15-0009 7/7/2015 State Long-Term Insurance Partnership
15-0001 2/1/2015 Applied Behavior Analysis (ABA) Services & Reimbursement
14-0014 4/16/2015 Continuation of Primary Care Increase
14-0012 9/9/2014 Removal of Personal Care Option Services
14-0011 6/17/2014 Title XXI Children’s Health Insurance Program (CHIP) – Coverage provided by a separate CHIP of the Affordable Care Act
14-0010 7/23/2014 Title XXI Children’s Health Insurance Program (CHIP) – conversion of income eligibility standards to MAGI-equivalent standards
14-0005 11/25/2014 Safety Care Net Pool Approval
14-0004 11/14/2014 Removal of Sole Community Provider Payment Adjustment and State Operated Teaching Hospital Adjustment
14-0003 5/8/2014 State Financial Participation
13-0030 3/18/2014 Alternative Benefit Plan (New Adult Group)
13-0027 6/13/2014 New Mexico Medicaid Administration: Single State Agency
13-0026 6/13/2014 Hospital Presumptive Eligibility
13-0025  3/19/2014 Citizenship and Non-Citizen Eligibility
13-0024  4/11/2014 Non-Financial Eligibility State Residency
13-0023 3/3/2014 MAGI-Based Income Methodologies
13-0022 4/11/2014 MAGI-Based Eligibility Groups
13-0021 2/12/2014 General Eligibility Requirements
13-0015 5/22/2014 Final Federal Medical Assistance Percentage (FMAP) Claiming for the New Adult Group