PROVIDERS

The Human Services Department mission is: To transform lives. Working with our partners, we design and deliver innovative, high quality health and human services that improve the security and promote independence for New Mexicans in their communities.

Supplements to MAD NMAC Program Rules – 2021

Supplement Numbers Policy Topic Date
21-01 Newborn Medicaid Program March 17, 2021
21-02 National Drug Code (NDC) and 340B Drug Rebates April 9, 2021
21-03 Home & Community Based Services – Supports Waiver Fee Schedule May 10, 2021
21-04 Tribal FQHC Designation and Billing Guidance May 10, 2021
21-05 ICF/IID Level of Care Procedures & Discharges October 18, 2021

Supplements to MAD NMAC Program Rules – 2020

Supplement Numbers Policy Topic Date
Special COVID-19 Supplement #1 Fingerprinting Guidance April 2, 2020
Special COVID -19 Supplement #2 Medicaid Coverage of COVID-19 Testing for All Uninsured April 2, 2020
Special COVID -19 Supplement #3 Guidance for New Mexico Medicaid Providers April 6, 2020
Special COVID -19 Supplement #4 Families First Coronavirus Response Act (FFCRA) Coverage of COVID-19 Testing for Uninsured Patients May 6, 2020
Special COVID-19 Supplement #5 COVID-19 Emergency Process for Eligibility and Claims Related to the Emergency Medical Services for Aliens (EMSA) Program November 12, 2020
Special COVID-19 Supplement #6 Supplement for COVID-19 Positive Recipients in Nursing Facilities September 2, 2020
Special COVID-19 Supplement #8 Administrative Order for Intermediate Care Facilities for Individuals with Intellectual Disabilities June 24, 2020
Special COVID-19 Supplement #9 2020 Hospital Inpatient Payment Rates Effective April 1, 2020 August 28, 2020
Special COVID-19 Supplement #10 2020 Non-DRG Reimbursed Hospital Inpatient Payment Rates April 1, 2020
Special COVID-19 Supplement #11 COVID-19 Testing: Billing and Reimbursement for Testing and Services Rendered Offsite September 10, 2020
Special COVID-19 Supplement #13 COVID-19 Proposed Rate increases Effective April 1, 2020-June 30, 2020 March 16, 2021
Special COVID-19 Supplement #14 
COVID Testing and Treatment Services and Codes for New Mexico Medicaid Services December 30, 2020
Special COVID -19 Supplement #16 COVID-19 Vaccine Coverage, Billing and Reimbursement August 16, 2021
Special COVID-19 Supplement #17 COVID-19 Claims – Waive Timely Filing for COVID-19 Testing and Vaccine Administration Claims for all In-State Medicaid Enrolled Providers June 29, 2021
20-01 New Mexico Health Insurance Prior Authorization January 15, 2020
 20-02 Senate Bill 246 Health Care Quality Surcharge (HCQS) Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID) May 21, 2020
20-03 Supports Waiver Supplement – Effective July 1, 2020 July 10, 2020
20-04 Billing 340B Modifiers Under the Hospital Outpatient Prospective Payment System (OPPS) August 24, 2020
20-05 Updated: Applied Behavior Analysis (ABA) Fee Schedule Effective October 1, 2019 August 24, 2020
20-06 Supports Waiver Fee Schedule August 25, 2020
20-07 Changes to Billing Procedure and Reimbursement for Hospice Services August 28, 2020
20-08 Medically Fragile Waiver Fee Schedule September 22, 2020
20-09 Increased Reimbursement Rates for Air Ambulance Services October 23, 2020
20-10 Developmental Disabilities Waiver Fee Schedule October 23, 2020
20-11 Naturopathic Doctors: Participation in the New Mexico Medicaid Program October 23, 2020
20-12 AARTC Medicaid Behavioral Health Services Updates December 22, 2020
20-13

Revised 8/30/2021

Uniform New Mexico Hepatitis C Virus Checklist – Repeal and Replace MAD 634 Form

August 30, 2021

Supplements to MAD NMAC Program Rules – 2019

Supplement Numbers Policy Topic Date
19-01 Reimbursement for Neurological and Neurosurgical Consultations Provided through ACCESS Program January 3, 2019
19-02 Birthing Options Program-Billing Procedures and Reimbursement June 21, 2019
19-03 BH Supplement & BH Manual – Comments and Responses January 22, 2019
19-04

BH Supplement

Behavioral Health Policy and Billing Manual

Behaviorial Health Policy and Billing Manual – Appendices

Supplement 19-04 Addendum 1

January 22, 2019
19-05 Revised MAD 303 Fee for Service Prior Approvals Request Form March 19, 2019
19-06 Billing for Annual Physical Health Examinations for Adults Applying for or Receiving Home and Community-Based Services through one of the following Waiver Programs: Developmental Disabilities (DD); Medically Fragile (MF); or Mi Via March 30, 2019
19-07 Autism Spectrum Disorder Services – Prohibition on Age and Dollar Limits Effective June 15, 2019 June 15, 2019
19-08 Medically Fragile Waiver Fee Schedule July 19, 2019
19-09 Medicaid Billing for Long-Acting Reversible Contraception (LARC) Products Provided in an Inpatient Setting August 13, 2019
19-10 Chronic Care Management Services and Transitional Care August 16, 2019
19-11 Medicaid Drug Utilization Review (DUR) Provisions of the Support ACT October 02, 2019

 

Supplements to MAD NMAC Program Rules – 2018

Supplement Numbers Policy Topic Date
18-02 Co-payment Change Resulting from the Behavioral Health Parity Analysis for Recipients in the Children’s Health Insurance Program (CHIP) and Working Disabled Individuals (WDI) March 6, 2018
18-03 Developmental Disabilities Waiver Fee Schedule June 11, 2018
18-04

“See Updated Supplement 20-13”

Notice of New Hepatitis C Virus (HCV) Treatment Requirements for Fee-for-Service (FFS) Medicaid Recipients

April 17, 2018
18-05

Critical Incident Reporting

  • I. Critical Incident Reporting Form
  • II. Critical Incident Reporting Protocol
May 1, 2018
18-08 Developmental Disabilities Waiver Fee Schedule December 19, 2018
18-10 Billing for Annual Physical Health Examinations for Adults Applying for or Receiving Home and Community-Based Services through one of the following Waiver Programs: Developmental Disabilities (DD); Medically Fragile (MF); or Mi Via December 6, 2018
18-12 Revised Nursing Facility Level of Care (NF LOC) Criteria and Instructions Effective January 1, 2019 January 1, 2019
18-13 Applied Behavior Analysis Prior Authorization (Stage 3) Submission for FFS Population

 

December 5, 2018

Supplements to MAD NMAC Program Rules – 2017

Supplement Numbers Policy Topic Date
17-01 Behavioral Health Respite Services – Effective 1/1/2017 January 20,2017
17-02 Notice of Proposed Medicaid Co-Payment Requirements for Medicaid Recipients February 8, 2017
17-03 MAD 616 Fee for Service Out-of-State Prior Authorization March 16, 2017
17-04 Changes to HCPCS and CPT Codes for Drug Testing for March March 28, 2017
17-05 Qualis Health Provider Portal (QHPP) Requirement for Level of Care Requests and Prior Authorization Requests June 29, 2017
17-06

Comprehensive Community Support Services (CCSS)

I. Revised Service Definition

II. Provider Requirements

June 23, 2017
17-07 Requirements for Reporting Attending, Ordering, Referring, and Rendering Providers on Claims September 11,2017
17-08 Requirements for Reporting Ordering, Referring, and Rendering Providers on Claims September 11, 2017
17-09 Requirements for Reporting Rendering, Ordering, and Referring Providers on Claims September 11, 2017
17-10 Licensed Birth Centers October 26, 2017
17-11 Early Periodic Screening, Diagnostic, and Treatment (EPSDT)Screening Services November 15, 2017

 

Supplements to MAD NMAC Program Rules – 2016

Supplement Numbers Policy Topic Date
16-01 Notice of Proposed Reductions to the Medicaid Fee Schedule and Other Medicaid Payment Reductions April 29, 2016
16-03 Notice of Final Reductions to the Medicaid Fee Schedule and Other Medicaid Payment Reductions – Effective July 1, 2016 June 29,2016
16-04 Revised MAD 303 Fee for Service Prior Approval Request Form December 1, 2016
16-05 Changes to MAD 307 Denial of Claims Emergency Medical Services for Aliens (EMSA) Form July 18, 2016
16-06 Changes to MAD 378 ICF/IID and Disabilities Home and Community Based Services Waiver Long Term Care Medical Assessment Abstract Form July 18, 2016
16-07 Notice of Final Reductions to the Medicaid Fee Schedule -Effective August 1, 2016 July 22, 2016
16-08

Change to ABA Stage 1 Comprehensive Diagnostic Evaluation/Targeted Evaluation Requirements:

ABA Stage 2 and 3 Behavior Analyst Requirements

Specialty Care Practitioners

Certification of Behavior Technicians

 

September 23, 2016

16-09 Billing for Long Acting Reversible Contraception Products September 16, 2016
16-10
  1. Naloxone Kit Reimbursement for FFS Pharmacy Providers
  2. Medicaid Coverage of Insect Repellents
  3. Correct Way to Bill for Drugs Purchased at 340B Prices
  4. Identifying Prescribing Providers
  5. Pharmacy Dispensing Fees
  6. Discontinued Funding of Non-Prescribed Emergency Contraception
September 23, 2016
16-11
  1. Billing for Medication Monitoring by RNs
  2. Group Therapy – Same Day Billing
  3. Clarification on Prolonged Service
  4. Assertive Community Treatment (ACT) Updates
  5. The Use of Provisional Diagnoses for the “Treat First” Clinical Model
December1, 2016
16-12 Reminder of Final Reductions to the Medicaid Fee Schedule – Effective January 1, 2017 December 13, 2016
16-13 Billing and Payments to Federally Qualified Health Centers (FQHC), Rural Health Clinics (RHC), Hospital Based Rural Health Clinics (HB-RHC) and Indian Health Service (IHS) FQHCs January 6, 2017
16-14 Rescinding Behavioral Health Fee Schedule Reductions that were to be effective on January 1, 2017 December 22, 2016

 

Supplements to MAD NMAC Program Rules – 2015

Supplement Numbers Policy Topic Date
15-01 Specialized Behavior Health Services Billing Instructions  January 23, 2015
15-02 Medicaid Utilization Review & Third-Party Assessor Eff. 03/01/2015 February 9, 2015
15-03 Supplement on Multiple Topics, including ICD-10, Billing Using Paper Claims, etc. May 13, 2015

 

 

15-04

Extension of Enhanced Payments for Primary Care Provider Services in 2015 and Beyond

Primary Care Increase Self-Attestation Form – January 1, 2015

 

 

June 4, 2015

15-07 Short Term Medicaid for Incarcerated Individuals (STMII) August 3, 2015
15-08 Changes to HCPCS & CPT Codes for Drug Testing 2016 December 29, 2015

                                                             2014 MAD Supplements

14-01 Payment Rates for Primary Care Provider Services

14-02 NM Alternate Benefits Plan Recipients

14-03 Billing Info for RTCs and TFC

14-04 OPPS Hospital & Lab Supplement

14-07 Nursing Facility Long-Term Care Guidelines

2013 MAD Supplements

13 01 Increase in Payment Rates for Primary Care Provider Services & Vaccination Reimbursement

13 02 Reimbursement Rates Associated with New CPT Codes for 2013

13 03 Updated Info. – Increase in Payment Rates for PCP and New Vaccination reimbursement information

13 04 Long Term Care Medical Assessment Requirements Effective May 1, 2013

13 06 New Nursing Facility Level of Care Criteria and Instructions to Replace LTC UR for Nursing Facilities (8.312.2UR) Effective January 1, 2014

13 07 Behavioral Health Changes Effective January 1, 2014 with the Implementation of Centennial Care

13 05 Supplement, Hysterectomy Consent Form

2012 MAD Supplements

12 01 Ground Ambulance Mileage Codes

12 02 Replacement of Medical Assessment Abstract for Programs Requiring Nursing Facility Level of Care; New Requirement for a History & Physical for Personal Care Option Consumers

12 03 Tobacco Cessation Treatment Services: (I) Tobacco Cessation Services and Coverage for Medicaid Recipients; (II) Eligible Providers and Practitioners; (III) Procedure and Diagnosis Codes; (IV) Quit line

12 04 (I) Requirements when Billing for Specific Procedure Codes; (II) Requirements when Billing for Dental Codes

12 05 Reporting Referring, Prescribing & Ordering Providers; Reporting of Provider Preventable Conditions and Provider Terminations

12 07 New Developmental Disabilities Waiver (DDW) Services Fee Schedule

12 08 Clarification on Reporting of Present on Admission Indicator

12 10 Medication Assisted Treatment Services for Opioid Addiction: (I) Enrollment, (II) Eligible Recipients, (III) Billing Instructions

12 11 Medication Assisted Treatment Services for Opioid Addiction

12 12 New Developmental Disabilities Waiver Services Fee Schedule

12 13 Dental Supplement: (I) Algeoloplasty Coverage, (II) Authorizations, (III) Dental Hygienists Scope of Practice, (IV) Reporting of Rendering Providers

2011 MAD Supplements

11 01 Updates to the Medically Fragile HCBS Waiver Rate Table

11 02 Billing for Mi Via Consultant Services

11 03 All Provider Notice on Multiple Topics

11 04 Dental Providers Must Submit the NPI Number of the Rendering Provider, Eff 7.1.2011

11 05 New Sub-codes for Mi Via Budgets, Effective 7/1/2011

11 06 Mi Via Program Employee Rates of Pay Changes

11 07 New Requirement for FFS Home Health Program

11 08 New Requirements when Billing Specific Procedure Codes

2010 MAD Supplements

10 01 Billing for Annual Health Exams for Adults Applying for or Receiving HCBS through one of the following Waiver Programs: AIDs, DD, MF and Mi Via

10 02 Change in Pharmacy Dispensing Fees, Pharmacies Contracted with 340B Entities and Changes in Payer Sheets

10 03 New Requirements when Billing for Drug Items Administered in Practitioners’ Offices, Outpatient Clinics and Hospitals, and New Requirements when Billing for New Drug Items Obtained Under the Federal 340B Drug Pricing Program, Effective 9/1/2010

10 04 Application Requirements and Coverage for Emergency Services for Aliens (EMSA)

10 05 Changes to Environmental Modification Services Funding for the Developmental Disabilities (DD) Waiver Program

10 07 Implementation of Hospital Outpatient Prospective Payment System

10 08 Implementation of Outpatient Hospital Prospective Payment System, Effective 11/1/2010

10 09 Anesthesia Services Regulation

10 11 Submitting Claims for Consideration of Timely Filing Limit Waiver

2009 Supplements

09 01 Billing for Community Living Services

09 02 Elimination of Mandated Minimum Wage Requirement for Personal Care Option (PCO) Services

09 03 Updates to the Developmental Disabilities (DD) HCBS Waiver Rate Table

09 04 (1) Revised MAD Form 313 – Notification of Birth and (2) Medicaid Family Planning Waiver “Quick Facts”

09 05 (I) Plan B (Levonorgestrel) for Emergency Contraception and (II) Origin Code Requirement for Point of Sale Transactions

09 06 Early Periodic Screening Diagnostic and Treatment (EPSDT) Screening Services

9 07 Payment to Providers Using Electronic Funds Transfer

09 08 Important Information regarding Billing for Medicaid Behavioral Health Services

09 09 Reduction in Payments for Hospital Services, Effective 12/1/2009

09 10 Reduction in Medicaid Payments for Practitioner Services, Effective 12/1/2009

09 12 Reduction in Medicaid Payments for Services, Effective 12/1/2009

09 13 Reduction in Pharmacy Dispensing Fees, Effective 02/01/2010

09 14 Reduction in Medicaid Payments for Personal Care Services, Effective 12.1.2009

2008 MAD Supplements

08 02 Medicaid Reimbursement for Birth Control & Family Planning Services

08 04 Dental Procedure Code D9920 – Behavior Management

08 05 Annual Hospice Rate Update

08 06 National Provider Identifier and Tamper Resistant Prescription Pads

08 07 (I) Recipient Change of Address Forms, (II) National Provider Identifier and (III) Tamper Resistant Prescription Pads

2007 MAD Supplements

07 01 Preparing to Use National Provider Identifier (NPI) and NPI Deadlines

07 02 Corrections to the DD HCBS Waiver Rate Table

07 03 Using Taxonomy with the National Provider Identifier (NPI) and Deadlines

07 04 Increase in the Amount Allowed for Hearing Aids & Dispensing Fees

07 05 HCBS Waiver Provider Notice of Increases in Medicaid Reimbursement

07 06 Provider Notice of Increases in Medicaid Reimbursement

07 07 Personal Care Provider Notice – Increases in Medicaid Reimbursement

07 08 (I) Remittance Advices on Web & Phasing Out Paper Remittance Advices & Checks, (II) Final Deadlines for Using NPI on NM Medicaid Claims, and (III) Provider Fee Increase Notice

07 09 (I) Tamper Resistant Prescription Pads, (II) Billing for Drug Items Administered in Provider Offices, Outpatient Clinics and Hospitals

07 10 Using the “Notification of Birth” Form to Expedite Payment for Services to Newborns

2006 MAD Supplements

06 01Treatment at the Scene without Transport

06 02 Transportation HCPCS Codes

06 03 EPSDT_PD PC_Services

06 04 Provider Notice of Increase in Medicaid Reimbursement

06 05 Guidelines for Billing FFS Medicaid for services being transferred from the HCBS Waiver

06 06 Billing Procedure for Drugs not Included in the Dialysis Composite Rate

06 08 Rate Tables for the DD HCBSW

06 09 Medicaid Transportation Modifiers

2005 MAD Supplements

05 01 Binaural Hearing Aid Fitting

05 02 Preferred Drug List Implementation for Native Americans

05 03 Preferred Drug List Implementation for Native Americans

05 04 Mirena Intrauterine Device Procedure Code Change From S4981 to J7302

05 06 Changes Related to Medicare Part D Implementation

2004 MAD Supplements

04 01 Billing for Oxygen Contents

04 02 PCO – Clarification to MAD MR 03-34

04 03 Vision Services Reimbursement Change

04 04 Implementation of PCO Assessment Form (MAD 057)

04 06 Medicaid Fee Schedule Reduction & Payment Limitation on Co-Insurance & Co-Payments

04 07 Billing Rate change for the Personal Care Option Program

04 08 Dental Benefit Changes

04 09 Reduction in Medicaid Payments, Effective 7/1/2004

04 10 Reimbursement for Hearing Aids

04 11 Disabled & Elderly Waiter Service Standards Revisions for Case Management & Homemaker Services

04 12 Home & Community-Based Services (HCBS) Waivers Rate Tables

04 13 Corrections to Dental Benefit Changes

04 14 Amended Medicaid & CYFD Children’s Panel FFS Utilization Review Changes

04 15 Preferred Drug List Implementation

04 16 Preferred Drug List Implementation