PROVIDERS
The Health Care Authority’s mission is: We ensure that New Mexicans attain their highest level of health by providing whole-person, cost-effective, accessible, and high-quality health care and safety-net services.
Managed Care Policy Manual
The purpose for the Managed Care Policy Manual is to provide a reference for the policies established by HCA for the administration of the Medicaid managed care program and to provide direction to the Managed Care Organizations (MCOs) and other entities providing service under managed care.
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Section 01 - General Provisions-Final
Section 02 - Provider Networks -Final
Section 03 - Member Education-Final
Section 04 - Care Coordination-Final
Section 05 - Transitions of Care-Final
Section 06 - Nursing Facilities-Final
Section 07 - Community Benefits-Final
Section 08 - Agency Based Community Benefits-Final
Section 09 - Self Directed Community Benefits-Final
Section 10 - Dental Services - New, Final
Section 11 - Marketing-Final
Section 12 - Section Reserved, Final
Section 13 - Alternative Benefit Packages-Final
Section 14 - School Based Health Centers-Final
Section 15 - ITU-Final
Section 16 - Fair Hearings-Final
Section 17 - Managed Care Reporting-Final
Section 18 - Quality-Final
Section 19 - Program Integrity-Final
Section 20 - Pharmacy-Final
Section 21 - Section Reserved, Final
Section 22 - Medicaid Home Visiting- Revised, Final
Section 23 - Section Reserved, Final
Section 24 - Children In State Custody - New, Final
Turquoise Care Managed Care Policy Manual Effective July 1, 2024
Centennial Care Managed Care Policy Manual Effective October 1, 2020
Centennial Care Managed Care Policy Manual Effective January 1, 2019
For Agency Based Community Benefits Program (ABCB) documents and forms, click here.