Medicaid Providers are responsible for complying with all instructions, directives, billing, reimbursement, audit, recoupment, and withholding provisions made available by the Health Care Authority (HCA) and its authorized agents.
Providers are also responsible for obtaining, maintaining, and keeping updated program rules and instructions on billing and utilization review and other pertinent material made available by HCA and its authorized agents through mailings and as found on this website.
- The New Mexico Administrative Code (NMAC) is collection of formal rules that New Mexico State agencies and departments publish about the programs that they run. Simply put, rules are a special category of law written by state agencies to support, clarify, or implement specific laws enacted by the legislature called statutes. State rules can include building codes, air quality standards, tax codes, public assistance regulations, and public health regulations, to name but a few. They are subordinate to statutes and must work within the framework established by statute. A defining aspect of rules is that they affect people or other agencies outside the agency that writes them.
The state rules that govern the NM Medicaid program are found in Title 8, Social Services, of the NMAC. This section is commonly called the ‘policy manual’ but is more formally referred to as the rules.
To go to an on-line version of the relevant chapters of the NMAC, click here.
For rule changes that are in process, please refer to the ‘Notices of Rulemaking’ section of the NM Medical Assistance Division (MAD) website, which can be found here.
Public notices of rule changes and their associated public hearings are published in the New Mexico Register, published by The Administrative Law Division of The Commission of Public Records, and the following newspapers: the Las Cruces Sun, and the Albuquerque Journal.
