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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.
Written Tribal Notification Letters
Disclaimer: Using the New Mexico Written Tribal Notification Guides
This portion of the website is reserved for tribal consultation, and Indian Health Service facility and 638 Tribal facility notifications.
Reminder – You have acknowledged that you are accessing this site because of your tribal responsibilities or responsibilities with an Indian Health Service or 638 Tribal Facility
Written Tribal Notification Letters – Comment Period Open 2025
Written Tribal Notification Letter 25-12
- 8.200.400 NMAC, Medicaid Eligibility – General Recipient Rules, General Medicaid Eligibility
- 8.249.400 NMAC, Medical Assistance Program Eligibility – Refugee Medical Assistance (RMA) Program, Recipient Requirements
- 8.249.600 NMAC, Medical Assistance Program Eligibility – Refugee Medical Assistance (RMA) Program, Benefit Description
Written Tribal Notification Letter 25-11
- 8.281.600 NMAC, Medicaid Eligibility – Institutional Care (Categories 081, 083 and 084), Benefit Description
- 8.290.600 NMAC, Medicaid Eligibility – Home and Community-Based Services Waiver (Categories 091, 092, 093, 094, 095 and 096), Benefit Description
Written Tribal Notification Letter 25-10
Written Tribal Notification Letter 25-09
Written Tribal Notification Letter 25-08
- 8.200.510 NMAC, General Recipient Policies, Resource Standards
- 8.200.520 NMAC, General Recipient Rules, Income Standards
- 8.291.430 NMAC, Medicaid Eligibility – Affordable Care, Financial Responsibility Requirements
Written Tribal Notification Letters – Comment Period Closed 2025
Written Tribal Notification Letter 25-07
Written Tribal Notification Letter 25-06
Written Tribal Notification Letter 25-05
Written Tribal Notification Letter 25-04
Written Tribal Notification Letter 25-03
Written Tribal Notification Letter 25-02
Zoom will no longer be utilized. Please use the information below to join online or by phone:
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+1 505-312-4308,,634831785# United States, Albuquerque
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Written Tribal Notification Letters – Comment Period Closed 2024
Written Tribal Notification Letter 24-30
Written Tribal Notification Letter 24-29
Written Tribal Notification Letter 24-28
Written Tribal Notification Letter 24-27
- Proposed House Bill 2 Medicaid Provider Payment Rates
- Proposed Special Rates Table – REVISED
- Youth RTCs and Group Home Rates
Written Tribal Notification Letter 24-26
Written Tribal Notification Letter 24-25
The Comment Period has been extended through January 16, 2025
Written Tribal Notification Letter 24-24
Written Tribal Notification Letter 24-23
Written Tribal Notification Letter 24-22
Written Tribal Notification Letter 24-21
Written Tribal Notification Letter 24-20
Written Tribal Notification Letter 24-19
Written Tribal Notification Letter 24-18
The Comment Period has been extended through September 30, 2024
Written Tribal Notification Letter 24-17
Written Tribal Notification Letter 24-16
- Proposed Developmental Disabilities Waiver (DDW)
- Proposed Medically Fragile Waiver (MFW)
- Proposed Mi Via Waiver (MVW)
Written Tribal Notification Letter 24-15
Written Tribal Notification Letter 24-14
Written Tribal Notification Letter 24-13
Written Tribal Notification Letter 24-12
Written Tribal Notification Letter 24-11
Written Tribal Notification Letter 24-10
- Proposed Developmental Disabilities Waiver (DDW)
- Proposed Medically Fragile Waiver (MFW)
- Proposed Mi Via Waiver
Written Tribal Notification Letter 24-09
- Section 01 General Provisions
- Section 02 Provider Network
- Section 03 Member Education
- Section 04 Care Coordination
- Section 05 Transitions of Care
- Section 06 Nursing Facilities (NFs)
- Section 07 Community Benefits
- Section 08 Agency-Based Community Benefits (ABCB)
- Section 09 Self-Directed Community Benefits (SDCB)
- Section 10 Reserved
- Section 11 Marketing
- Section 12 Patient-Centered Initiatives
- Section 13 ABP Medically Frain and ABP Exempt
- Section 14 School-Based Health Centers
- Section 15 Indian Health Services, Tribal Health Providers, and Urban Indian Providers (I/T/U)
- Section 16 Fair Hearings
- Section 17 Managed Care Reporting
- Section 18 Quality
- Section 19 Program Integrity
- Section 20 Pharmacy
- Section 21 Manual Acronyms
Written Tribal Notification Letter 24-08
Written Tribal Notification Letter 24-07
Written Tribal Notification Letter 24-06
Written Tribal Notification Letter 24-05
Written Tribal Notification Letter 24-04
Written Tribal Notification Letter 24-03
Written Tribal Notification Letter 24-02
- 8.200.510 NMAC, General Recipient Policies, Resource Standards
- 8.200.520 NMAC, General Recipient Rules, Income Standards
- 8.291.430 NMAC, Affordable Care, Financial Responsibility Requirements
Written Tribal Notification Letter 24-01
Written Tribal Notification Letters – Comment Period Closed 2023
Written Tribal Notification Letter 23-24
Written Tribal Notification Letter 23-23
Written Tribal Notification Letter 23-22
Written Tribal Notification Letter 23-21
- 8.291.400 NMAC, Affordable Care, Eligibility Requirements
- 8.200.400 NMAC, General Recipient Rules, General Medicaid Eligibility
- 8.200.410 NMAC, General Recipient Rules, General Recipient Requirements
Written Tribal Notification 23-20
Written Tribal Notification Letter 23-19
Written Tribal Notification Letter 23-18
Written Tribal Notification Letter 23-17
- Proposed Developmental Disabilities Waiver (DDW)
- Proposed Medically Fragile Waiver (MFW)
- Proposed Mi Via Waiver
Written Tribal Notification Letter 23-16
The Comment Period has been extended through November 17, 2023
Written Tribal Notification Letter 23-15
Written Tribal Notification Letter 23-14
ITO Consultation Letter for E&T FY24 State Plan Proposal
Written Tribal Notification Letter 23-13
Written Tribal Notification Letter 23-12
Written Tribal Notification Letter 23-11
Written Tribal Notification Letter 23-10
Written Tribal Notification Letter 23-09
Written Tribal Notification Letter 23-08
Written Tribal Notification Letter 23-07
Written Tribal Notification Letter 23-06
Written Tribal Notification Letter 23-05
Written Tribal Notification Letter 22-04
- 8.200.510 NMAC, Medicaid Eligibility – General Recipient Policies, Resource Standards
- 8.200.520 NMAC, Medicaid Eligibility – General Recipient Policies, Income Standards
- 8.291.430 NMAC, Medicaid Eligibility – Affordable Care, Financial Responsibilities
Written Tribal Notification Letter 23-03
Written Tribal Notification Letter 23-02
Written Tribal Notification Letters – Comment Period Closed 2022
Written Tribal Notification Letter 22-35
Written Tribal Notification Letter 22-34
Written Tribal Notification Letter 22-33
Written Tribal Notification Letter 22-32
Written Tribal Notification Letter 22-31
Written Tribal Notification Letter 22-30
Written Tribal Notification Letter 22-29
Written Tribal Notification Letter 22-28
Written Tribal Notification Letter 22-27
Written Tribal Notification Letter 22-26
Written Tribal Notification Letter 22-25
Written Tribal Notification Letter 22-24
Written Tribal Notification Letter 22-22
- 8.200.400 NMAC, Medicaid Eligibility – General Recipient Rules. General Medicaid Eligibility
- 8.249.400 NMAC, Medical Assistance Program Eligibility – Refugee Medical Assistance (RMA) Program, Recipient Requirements
- 8.249.600 NMAC, Medical Assistance Program Eligibility – Refugee Medical Assistance (RMA) Program, Benefit Description
Written Tribal Notification Letter 22-21
Written Tribal Notification Letter 22-20
- 8.280.500 NMAC, Medicaid Eligibility – Program of All Inclusive for the Elderly (PACE), Income Resource Standards
- 8.281.400 NMAC, Institutional Care, Recipient Policies
- 8.281.500 NMAC, Institutional Care, Income and Resource Standards
Written Tribal Notification Letter 22-18
Written Tribal Notification Letter 22-17
- 8.313.2 NMAC, Long Term Care Services – Intermediate Care Facilities for the Mentally Retarded
- 8.313.3 NMAC, Long Term Care Services – Intermediate Care Facilities Cost Related Reimbursement of ICF-IID
Written Tribal Notification Letter 22-16
Written Tribal Notification Letter 22-15
Written Tribal Notification Letter 22-14
Written Tribal Notification Letter 22-13
- 8.200.510 NMAC, Medicaid Eligibility – General Recipient Rules, Resource Standards
- 8.200.520 NMAC, Medicaid Eligibility – General Recipient Policies, Income Standards
- 8.291.430 NMAC, Medicaid Eligibility – Affordable Care, Financial Responsibility Requirements
Written Tribal Notification Letter 22-12
PUBLIC HEARING RESCHEDULED FOR JUNE 3, 2022, 10:00 a.m. MOUNTAIN TIME (MT). Conference call toll-free number is: 1-800-747-5150, Access Code: 0440241
- Draft Developmental Disabilities Waiver (DDW)
- Draft Medically Fragile Waiver (MFW)
- Draft Mi Via Waiver
- Draft Supports Waiver
Written Tribal Notification Letter 22-11
Written Tribal Notification Letter 22-10
- SPA 22-0013 Extended Postpartum Coverage SPA pages 1
- SPA 22-0013 Extended Postpartum Coverage SPA pages 2
Written Tribal Notification Letter 22-09
Written Tribal Notification Letter 22-08
Written Tribal Notification Letter 22-07
- SPA 22-0010 Qualifying Clinical Trials Alternative Benefit Plan (ABP) SPA pages-1
- SPA 22-0010 Qualifying Clinical Trials Alternative Benefit Plan (ABP) SPA pages-2
- SPA 22-0010 Qualifying Clinical Trials Alternative Benefit Plan (ABP) SPA pages-3
Written Tribal Notification Letter 22-06
Written Tribal Notification Letter 22-05
Written Tribal Notification Letter 22-04
Written Tribal Notification 22-03
- SPA 22-0001 NM Disaster Relief #13 Non-Emergency Medical Transportation (NEMT) Increase
- SPA 22-0002 NM Disaster Relief #14 Nursing Facility (NF) Increase
- SPA 22-0003 NM Disaster Relief #15 Hospital Rate Increase
Written Tribal Notification 22-02
Written Tribal Notification Letters – Comment Period Closed 2021
Written Tribal Notification 21-25
- 8.291.400 NMAC, Affordable Care Act – Medicaid Eligibility Manual, Eligibility Requirements
- 8.293.600 NMAC, Affordable Care Act –Pregnant Women, Benefit Description
- 8.294.600 NMAC, Affordable Care Act –Pregnancy-Related Services, Benefit Description
- 8.308.9 NMAC, Managed Care Program, Benefit Package
- 8.308.11 NMAC, Managed Care Program, Transition of Care
- 8.308.20 NMAC, Managed Care Program, Reimbursement
- 8.310.2 NMAC, Health Care Professional Services, General Benefit Description
- 8.326.3 NMAC, Case Management Services, Case Management for Pregnant Women and their Infants
Written Tribal Notification 21-24
Written Tribal Notification Letter 21-23
Written Tribal Notification Letter 21-22
Written Tribal Notification Letter 21-21
Written Tribal Notification Letter 21-20
Written Tribal Notification Letter 21-19
Written Tribal Notification Letter 21-18
- 8.200.400 NMAC, Medicaid Eligibility – General Recipient Rules, General Medicaid Eligibility
- 8.200.410 NMAC, Medicaid Eligibility – General Recipient Rules, General Recipient Requirements
- 8.231.400 NMAC, Medicaid Eligibility – Infants of Mothers Who Are Medicaid Eligible (Category 031), Recipient Policies
- 8.231.600 NMAC, Medicaid Eligibility – Infants of Mothers Who Are Medicaid or Medical Assistance Program Eligible, Benefit Description
- 8.234.400 NMAC, Medicaid Eligibility – SSI Ineligibility – Due to Income or Resources from a Non-Citizen Sponsor, Recipient Requirements
- 8.234.500 NMAC, Medicaid Eligibility – SSI Ineligibility – Due to Income or Resources from a Non-Citizen Sponsor, Income and Resource Standards
- 8.243.400 NMAC, Medicaid Eligibility – Working Disabled Individuals (WDI) (Category 043), Recipient Policies
- 8.249.400 NMAC, Medical Assistance Program Eligibility – Refugee Medical Assistance (RMA) Program, Recipient Requirements
- 8.249.500 NMAC, Medical Assistance Program Eligibility – Refugee Medical Assistance (RMA) Program, Income and Resource Standards
- 8.250.400 NMAC, Medical Assistance Program Eligibility – Qualified Individuals Whose Income Exceeds QMB and SLIMB, Recipient Requirements
- 8.252.400 NMAC, Medicaid Eligibility – Breast and Cervical Cancer Program (Category 052), Recipient Policies
- 8.280.400 NMAC, Medicaid Eligibility – Program of All Inclusive Care for the Elderly (PACE), Recipient Policies
- 8.285.400 NMAC, Medical Assistance Program Eligibility – Emergency Medical Services for Non-Citizens, Recipient Requirements
- 8.285.500 NMAC, Medicaid Eligibility – Emergency Medical Services for Non-Citizens, Income and Resource Standards
- 8.285.600 NMAC, Medicaid Eligibility – Emergency Medical Services for Non-Citizens, Benefit Description
- 8.291.410 NMAC, Medicaid Eligibility – Affordable Care, General Recipient Requirements
- 8.292.500 NMAC, Medicaid Eligibility – Parent Caretaker, Income and Resource Standards
- 8.293.500 NMAC, Medicaid Eligibility – Pregnant Women, Income and Resource Standards
- 8.294.500 NMAC, Medicaid Eligibility – Pregnancy-Related Services, Income and Resource Standards
- 8.295.500 NMAC, Medicaid Eligibility – Children Under 19, Income and Resource Standards
- 8.296.500 NMAC, Medicaid Eligibility – Other Adults, Income and Resource Standards
- 8.299.500 NMAC, Medicaid Eligibility – Family Planning Services, Income and Resource Standards
- 8.325.10 NMAC, Specialty Services, Emergency Medical Services for Non-Citizens
Written Tribal Notification Letter 21-17
Written Tribal Notification Letter 21-16
Written Tribal Notification Letter 21-15
Written Tribal Notification Letter 21-14
Written Tribal Notification Letter 21-13
Written Tribal Notification Letter 21-12
- Draft Behavioral Health Policy and Billing Manual
- Draft Behavioral Health Policy and Billing Manual Appendices
Written Tribal Notification Letter 21-11
Written Tribal Notification Letter 21-10
- Proposed 8.200.510 NMAC, Medicaid Eligibility – General Recipient Policies, Resource Standards
- Proposed 8.200.520 NMAC Medicaid Eligibility – General Recipient Rules, Income Standards
- Proposed 8.291.430 NMAC, Medicaid Eligibility – Affordable Care, Financial Responsibility Requirements
Written Tribal Notification Letter 21-09
- Proposed 8.311.3 NMAC, Hospital Services, Methods and Standards for Establishing Payment-Inpatient Hospital Services
- Proposed 8.312.3 NMAC, Long Term Care Services – Nursing Services, Cost Related Reimbursement of Nursing Facilities
Written Tribal Notification Letter 21-08
Written Tribal Notification Letter 21-07
Written Tribal Notification Letter 21-06
Written Tribal Notification Letter 21-05
Written Tribal Notification Letter 21-04
Written Tribal Notification Letter 21-03
Written Tribal Notification Letters – Comment Period Closed 2020
Written Tribal Notification Letter 20-33
- 8.281.400 NMAC, Medicaid Eligibility – Institutional Care (Categories 081, 083 and 084), Recipient Policies
- 8.290.400 NMAC, Medicaid Eligibility – Home and Community-Based Services Waiver (Categories 090, 091, 092, 093, 094, 095 AND 096), Recipient Policies
Revised February 17, 2021
Written Tribal Notification Letter 20-32
The Comment period has been extended through February 26, 2021
Written Tribal Notification Letter 20-31
Revised February 17, 2021
Written Tribal Notification Letter 20-28
The Comment period has been extended through February 26, 2021
Written Tribal Notification Letter 20-27
Written Tribal Notification Letter 20-26
Written Tribal Notification Letter 20-25
Written Tribal Notification Letter 20-24
Written Tribal Notification Letter 20-23
Written Tribal Notification Letter 20-22
Written Tribal Notification Letter 20-21
Written Tribal Notification Letter 20-20
Written Tribal Notification Letter 20-19
Written Tribal Notification Letter 20-18
Written Tribal Notification Letter 20-17
Written Tribal Notification Letter 20-16
Written Tribal Notification Letter 20-15
Written Tribal Notification Letter 20-14
Written Tribal Notification Letter 20-12
Written Tribal Notification Letter 20-13
- 8.215.500 NMAC, Medicaid Eligibility SSI Methodology, Income and Resource Standards
- 8.240.500 NMAC, Medicaid Eligibility – Qualified Medicare Beneficiaries (QMB) (Category 040), Income and Resource Standards
- 8.242.500 NMAC, Medical Assistance Program Eligibility – Qualified Disabled Individuals, Income and Resource Standards
- 8.245.500 NMAC, Medicaid Eligibility – Specified Low Income Medicare Beneficiaries (SLIMB) (Category 045), Income and Resource Standards
- 8.250.500 NMAC, Medical Assistance Program Eligibility – Qualified Disabled Individuals Whose Income Exceeds QMB and SLIMB, Income and Resource Standards
- Regulatory Impact Form
Written Tribal Notification Letter 20-09
- 8.200.510 NMAC, Medicaid Eligibility – General Recipient Policies, Resource Standards
- 8.200.520 NMAC, Medicaid Eligibility – General Recipient Rules, Income Standards
- Section 2 Provider Network
- Section 4 Care Coordination
- Section 5 Transitions of Care
- Section 6 Nursing Facilities
- Section 7 Community Benefits
- Section 8 Agency-Based Community Benefit
- Section 9 Self-Directed Community Benefit
- Section 11 Marketing
- Section 13 Alternative Benefit Package
- Section 14 School-Based Health Centers
- Section 18 Quality
- Section 20 Pharmacy
Written Tribal Notification Letter 20-11
Written Tribal Notification Letter 20-10
Written Tribal Notification Letter 20-08
Written Tribal Notification Letter 20-07
Written Tribal Notification Letter 20-06 Reissue
Written Tribal Notification Letter 20-06
Written Tribal Notification Letter 20-05
Written Tribal Notification Letter 20-04
- 8.291.430 NMAC, Medicaid Eligibility – Affordable Care, Fianancial Responsibility Requirements
- Regulatory Impact Form
Written Tribal Notification Letter 20-03
- 8.285.400 NMAC-Medical Assistance Program Eligibility-Emergency Medical Services for Aliens, Recipient Requirements
- 8.285.600 NMAC-Medicaid Eligibility-Emergency Medical Services for Aliens (Category 085) Benefit Description
- 8.325.10 NMAC- Specialty Services, Emergency Medical Services for Aliens
- Regulatory Impact Form
Written Tribal Notification Letter 20-02
- 8.200.510 NMAC- Medicaid Eligibility- General Recipient Policies, Resource Standards
- Regulatory Impact Form
Written Tribal Notification Letter 20-01
Draft 1915(c) Home and Community Based Services (HCBS) Supports Waiver Application
On March 11, 2020, Governor Michell Lujan Grisham declared an Executive Order that a Public Health Emergency exists due to the presence of COVID-19 in the State of New Mexico. Therefore, the Public Hearing for the Supports Waiver Application scheduled for Friday, March 13, 2020 in Santa Fe, New Mexico will be held VIA CONFERENCE CALL ONLY.
Date: Friday, March 13, 2020
Time: 10:00 a.m., Mountain Time (MT)
Toll-free number: 1-800-747-5150, Access Code: 0440241
The Comment Period has been extended to Friday, March 20, 2020 at 5:00 p.m.
- Draft 1915(c) Home and Community Based Services (HCBS) Supports Waiver Application
- Important Public Hearing Notice
Written Tribal Notification Letters – Comment Period Closed 2019
Written Tribal Notification Letter 19-26
Written Tribal Notification Letter 19-24
Written Tibal Notification Letter 19-19
Written Tribal Notification Letter 19-18
- List of Not for Profit Community Hospitals effective 10/01/19
- Proposed Outpatient Behavioral Health Fee Schedule Changes effective 10/01/19
- Proposed Fee Schedule for Project ECHO Case Consultations effective 10/01/19
Written Tribal Notification Letter 19-17
Written Tribal Notification Letter 19-16
Written Tribal Notification Letter 19-15
- 8.320.6 NMAC – Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Services
- Regulatory Impact Form
Written Tribal Notification Letter 19-14
- 8.320.2 NMAC – Early and Periodic Screening, Diagnostic and Treatment (EPSDT) Services
- Regulatory Impact Form
Written Tribal Notification Letter 19-13
Written Tribal Notification Letter 19-12
Written Tribal Notification Letter 19-11
Written Tribal Notification Letter 19-10
- Proposed Fee Schedule for Evaluation & Management (E&M) Codes
- Proposed Fee Schedule for Dental Codes
- Proposed Fee Schedule for New Chronic Care Management & Transitional Care Management
- Proposed Rates and Codes for Centennial Care Supoortive Housing
Written Tribal Notification Letter 19-08
- 8.200.410 NMAC – Medicaid Eligibility-General Recipient Rules, General Recipient Requirements
- Regulatory Impact Form
Written Tribal Notification Letter 19-06
- 8.200.510 NMAC – Medicaid Eligibility-General Recipient Rules, Resource Standards
- 8.200.520 NMAC – Medicaid Eligibility-General Recipient Rules, Income Standards
- 8.291.430 NMAC – Medicaid Eligibility-Affordable Care, Financial Responsibility Requirements
- Regulatory Impact Form
Written Tribal Notification Letter 19-05
Written Tribal Notification Letter 19-04
- 8.200.400 NMAC – Medicaid Eligibility – General Recipient Rules, General Medicaid Eligibility
- 8.200.430 NMAC – Medicaid Eligibility – General Recipient Rules, Recipients Rights and Responsibilities
- 8.296.400 NMAC – Medicaid Eligibility – Other Adults, Recipient Requirements
- Regulatory Impact Form
Written Tribal Notification Letter 19-03
Amended Written Tribal Notification Letter 19-02
- Written Tribal Notification Letter- January 11, 2019
- Draft Medically Fragile Waiver Amendment
- Proposed Medically Fragile Waiver Fee Schedule
Written Tribal Notification Letter 19-01
***The Comment period has been extended until April 4, 2019***
Written Tribal Notification Letters – Comment Closed 2018
Written Tribal Notification Letter 18-01
Written Tribal Notification Letter 18-02
Written Tribal Notification Letter 18-03
Written Tribal Notification Letter 18-05
Written Tribal Notification Letter 18-06
Written Tribal Notification Letter 18-07
Written Tribal Notification Letter 18-14
Written Tribal Notification Letter 18-16
Written Tribal Notification Letter 18-17
Written Tribal Notification Letter 18-18
- Proposed Behavioral Health Supplement
- Proposed Behavioral Health Policy and Billing Manual
- Appendix A: Severe emotional disturbance (SED)
- Appendix B: Serious mental illness (SMI)
- Appendix C: Monitoring Tool for Trauma Informed Care (TIC)
- Appendix D: Creating Cultures of Trauma Informed Care
- Appendix E: Promoting Cultural Competence Self-Assessment Checklist for Providers
- Appendix EE: Clinical Supervision Implementation Guide: A practical implementation guide for community-based behavioral health organizations
- Appendix F: Review Tool for Supervisory Certification
- Appendix G: Supervisory Certification Roster of Approved Agencies
- Appendix H: Supervisory Certification Process Flow
- Appendix I: Supervisory Certification Attestation Form
- Appendix J: Critical Incident Report Form
- Appendix K: Behavioral Health Providers Critical Incident Reporting Protocol
- Appendix M: Tip Sheet for Practitioners in Integrated Care Settings: Practice Principles and Functions for use in behavioral health center
- Appendix N: “Interdisciplinary Teaming in Behavioral HealthCare”
- Appendix O: Practice Standards for Family Teaming
- Appendix P: Highlights of the 1st Four Encounters for Treat First
- Appendix Q: Treat First Approach Protocol
- Appendix R: Adult and Child Self Check-In and Session Check-Out instruments
- Appendix T: Behavioral Health Level of Care Guidelines
- Appendix U: Comprehensive Assessment & Service Plan Adult Form
- Appendix V: Comprehensive Assessment & Service Plan Child Form
- Appendix Y: Healthy Lifestyle Questionnaire
- Appendix YY: Health Lifestyle Questionnaire (Spanish) Cuestionario Respecto a la Salud y la Vida
- Appendix Z: DAST 10: Drug Abuse Screening Test
- Appendix ZA: Audit 10: Alcohol Screen
- Appendix ZB: PHQ9: Patient Health Questionnaire
- Appendix ZC: PCL-C: Post Traumatic Stress Disorder Checklist
- Appendix ZD: GAD-7: Generalized Anxiety Disorder Screen
- Appendix ZE: IOP Attestation Form
- Appendix ZF: IOP Certification Tool
- Appendix ZG: IOP Provider Certification Information
- Appendix ZH: IOP Provider Application
- Appendix ZI: IOP Site Visit Preparation Form
- Appendix ZJ: IOP Process Flow
- Appendix ZK: IOP Site Visit Tool
- Appendix ZL: ACT Readiness Tool
- Appendix ZM: ACT Review Tool
- Appendix ZN: DACTS/G01Scale: Dartmouth Assertive Community Treatment Scale
- Appendix ZO: ACT Chart Audit Tool
- Appendix ZP: ACT Service Audit Tool
- Appendix ZQ: ACT Process Flow
- Appendix ZR: OTP Regulations Crosswalk
- Appendix ZS: OTP Clinic and Personnel Check List
- Appendix ZT: OTP Counselor Questionnaire
- Appendix ZU: OTP Personnel site review form
- Appendix ZV: OTP Patient Record Audit Form
- Appendix ZW: Prudent Parenting and Prevention of Sex Trafficking
Written Tribal Notification Letter 18-19
- Proposed SPA 18-006 Substance Use Disorder
- Proposed SPA 18-007 Substance Use Disorder – Alternative Benefit Plan
Written Tribal Notification Letter 18-20
- Proposed Applied Behavior Analysis (ABA) Fee Schedule
- Proposed Behavioral Health (BH) Fee Schedule
- Proposed Physical Health (PH) Fee Schedule
Written Tribal Notification Letter 18-08
- 8.201.400 NMAC, Medicaid Eligibility – Medicaid Extension
- 8.215.400 NMAC, Medicaid Eligibility – Supplemental Security Income (SSI) Methodology
- 8.281.400 NMAC, Medicaid Eligibility – Institutional Care (Categories 081, 083 and 084)
- Comments Received:
Written Tribal Notification Letter 18-09
- 8.308.6 NMAC, Managed Care Organization (MCO) Enrollment
- 8.308.7 NMAC, Enrollment and Disenrollment
- 8.308.9 NMAC, Benefit Package
- 8.308.10 NMAC, Care Coordination
- 8.308.12 NMAC, Community Benefit
Written Tribal Notification Letter 18-11
- 8.200.400 NMAC, General Recipient Rules – General Medicaid Eligibility
- 8.201.600 NMAC, Medicaid Extension (Category 01, 03 and 04) – Benefit Description
- 8.215.600 NMAC, Supplemental Security Income (SSI) Methodology – Benefit Description
- 8.231.600 NMAC, Infants of Mothers who are Medicaid or Medical Assistance Program Eligible – Benefit Description
- 8.242.600 NMAC, Medical Assistance Program Eligibility – Qualified Disabled Individuals Whose Income Exceeds QMB and SLIMB – Benefit Description
- 8.243.400 NMAC, Medicaid Eligibility – Working Disabled Individuals (WDI)(Category 043) – Recipient Policies
- 8.243.600 NMAC, Medicaid Eligibility – Working Disabled Individuals (WDI)(Category 043) – Benefit Description
- 8.245.600 NMAC, Medicaid Eligibility – Specified Low Income Medicare Beneficiaries (SLIMB)(Category 045) – Benefit Description
- 8.249.600 NMAC, Medical Assistance Program Eligibility – Refugee Medical Assistance (RMA) Program – Benefit Description
- 8.250.600 NMAC, Medicaid Eligibility – Qualified Individuals Whose Income Exceeds QMB and SLIMB (Category 045) – Benefit Description
- 8.252.600 NMAC, Medical Assistance Program Eligibility – Breast and Cervical Cancer Program – Benefit Description
- 8.280.400 NMAC, Medicaid Eligibility – Program of All Inclusive Care for the Elderly (PACE) – Recipient Policies
- 8.280.600 NMAC, Medicaid Eligibility – Program of All Inclusive Care for the Elderly (PACE) – Benefit Description
- 8.281.600 NMAC, Medicaid Eligibility – Institutional Care (Categories 081, 083 and 084) – Benefit Description
- 8.290.400 NMAC, Medicaid Eligibility – Home and Community-Based Services Waiver (Categories 090, 091, 092, 093, 094, 095 and 096) – Recipient Policies
- 8.290.600 NMAC, Medicaid Eligibility – Home and Community-Based Services Waiver (Categories 090, 091, 092, 093, 094, 095 and 096) – Benefit Description
- 8.292.600 NMAC, Medicaid Eligibility – Parent Caretaker – Benefit Description
- 8.293.600 NMAC, Medicaid Eligibility – Pregnant Women – Benefit Description
- 8.294.600 NMAC, Medicaid Eligibility – Pregnancy-Related Services – Benefit Description
- 8.295.600 NMAC, Medicaid Eligibility – Children Under 19 – Benefit Description
- 8.296.400 NMAC, Medicaid Eligibility – Other Adults – Recipient Requirements
- 8.296.600 NMAC, Medicaid Eligibility – Other Adults – Benefit Description
- 8.297.400 NMAC, Medicaid Eligibility – Loss of Parent Caretaker Medicaid Due to Spousal Support – Recipient Requirements
- 8.297.600 NMAC, Medicaid Eligibility – Loss of Parent Caretaker Medicaid Due to Spousal Support – Benefit Description
- 8.298.400 NMAC, Medicaid Eligibility – Loss of Parent Caretaker Medicaid Due to Earnings from Employment – Recipient Requirements
- 8.298.600 NMAC, Medicaid Eligibility – Loss of Parent Caretaker Medicaid Due to Earnings from Employment – Benefit Description
- 8.299.400 NMAC, Medicaid Eligibility – Family Planning Services – Recipient Requirements
- 8.299.600 NMAC, Medicaid Eligibility – Family Planning Services – Benefit Description
- 8.302.2 NMAC, Medicaid General Provider Policies – Billing for Medicaid Services
Written Tribal Notification Letter 18-15
- Section 02 Provider Network
- Section 03 Member Education
- Section 04 Care Coordination
- Section 05 Transitions of Care
- Section 06 Nursing Facility Level of Care
- Section 07 Community Benefit
- Section 08 Agency-Based Community Benefit
- Section 09 Self-Directed Community Benefit
- Section 11 Marketing
- Section 12 Patient Centered Initiatives
- Section 14 School Based Health Centers
- Section 16 Fair Hearings
- Section 17 Managed Care Reporting
- Section 18 Quality
- Section 19 Program Integrity
- Section 20 Pharmacy
Written Tribal Notification Letters – Comment Period Closed – 2017
Written Tribal Notification Letter 17-13
Written Tribal Notification Letter 17-12
- 8.281.510 NMAC, Institutional Care-Trust Standards
- 8.290.600 NMAC, Home and Community-Based Services Waiver-Benefit Description
Written Tribal Notification Letter 17-11
- 8.200.510 NMAC, General Recipient Rules-Resource Standards
- 8.215.500 NMAC, SSI Methodology-Income and Resource Standards
- 8.240.500 NMAC, QMB-Income and Resource Standards
- 8.281.400 NMAC, Institutional Care-Recipient Policies
- 8.281.500 NMAC, Institutional Care-Income and Resource Standards
- 8.290.400 NMAC, Home and Community-Based Services Waiver-Recipient Policies
Written Tribal Notification Letter 17-10
Written Tribal Notification Letter 17-09
- 8.308.2 NMAC, Managed Care Program, Provider Network
- 8.308.6 NMAC, Managed Care Program, Eligibility
- 8.308.7 NMAC, Managed Care Program, Enrollment and Disenrollment
- 8.308.8 NMAC, Managed Care Program, Member Education
- 8.308.9 NMAC, Managed Care Program, Benefit Package
- 8.308.10 NMAC, Managed Care Program, Care Coordination
- 8.308.11 NMAC, Managed Care Program, Transition of Care
- 8.308.13 NMAC, Managed Care Program, Member Rewards
- 8.308.15 NMAC, Managed Care Program, Grievances and Appeals
- 8.308.21 NMAC, Managed Care Program, Quality Management
- 8.302.3 NMAC, Medicaid General Provider Policies, Third Party Liability Provider Responsibilities
Written Tribal Notification Letter 17-07
Written Tribal Notification Letter 17-06
Tribal Notification Letter 17-03
Written Tribal Notification Letter 17-02
Written Tribal Notification Letter 17-01
- G1 – Cost-Sharing Requirements
- G2a – Cost-Sharing Amounts – Categorically Needy Individuals
- G2c – Cost-Sharing Amounts – Targeting
- G3 – Cost-Sharing Limitation
Written Tribal Notification Letters – Comment Period Closed – 2016
Written Tribal Notification Letter 16-01
- Section 03 Member Education
- Section 04 Care Coordination
- Section 06 Nursing Facility Level of Care Determination
- Section 07 Community Benefit
- Section 08 Agency Based Community Benefit
- Section 09 Self-Directed Community Benefit
- Section 21 Quality
Written Tribal Consultation Letter 16-02
Written Tribal Consultation Letter 16-03
Written Tribal Consultation Letter 16-04
Written Tribal Consultation Letter 16-05
Written Tribal Consultation Letter 16-07
Written Tribal Consultation Letter 16-08
Written Tribal Consultation Letter 16-09
- Proposed SPA 16-004 – Terminate Primary Care Provider (PCP) Enhanced Payments
- Proposed SPA 16-005 – Outpatient Hospital Reimbursement
- Proposed SPA 16-006 – Inpatient Hospital Reimbursement
- Proposed SPA 16-007 – Practitioner and Dental Reimbursement
***Comment period extended to June 15, 2016***
Written Tribal Notification Letter 16-10
- Section 03 Member Education
- Section 04 Care Coordination
- Section 11 Marketing
- Section 12 Patient Centered Initiatives
- Section 14 School Based Health Centers
- Section 17 Managed Care Reports
Written Tribal Notification Letter 16-11
Written Tribal Notification Letter 16-12
Written Tribal Notification Letter 16-13
Written Tribal Notification Letter 16-14
***Comment period has been extended to January 2, 2017***
Written Tribal Notification Letter 16-17
Written Tribal Notification Letter 16-18
***The comment period for Section 04 Care Coordination has been extended to February 20, 2017***
- Section 02 Provider Network
- Section 04 Care Coordination
- Section 05 Transitions of Care
- Section 07 Community Benefit
- Section 08 Agency Based Community Benefit
- Section 09 Self-Directed Community Benefit
- Section 13 Alternative Benefit Package
- Section 14 School-Based Health Centers
- Section 17 Managed Care Reporting
- Section 17 Managed Care Reporting – Appendix Q
Archive
2013 Written Tribal Consultation Letters
Consultation Letter #1 dated 09.20.13.pdf
Consultation Letter #2 dated 10.08.2013
Consultation Letter #3 Dated 10.23.13 re SPAs.pdf
Consultation Letter #4 dated 10.23.13 re Managed Care Program Benefit Rules.pdf
Consultation Letter #5 dated 10.23.13 re Medical Assistance Provider Rules.pdf
Consultation Letter #6 dated 10.23.13 re Alternative Benefit Program Rules.pdf
2013 Written Tribal Consultation Rules 13-01
8.200.400 General Medicaid Eligibility.pdf
8.200.410 General Recipient Requirements.pdf
8.200.420 Special Recipient Requirements.pdf
8.200.430 Recipient Rights and Responsibilities.pdf
8.200.520 Income Standards.pdf
8.202.400 Recipient Requirements.pdf
8.202.500 Income and Resource Standards.pdf
8.202.600 Benefit Description.pdf
8.206.400 Recipient Requirements.pdf
8.227.400 Recipient Requirements.pdf
8.227.500 Income and Resource Standards.pdf
8.227.500 Income and Resource Standards.pdf
8.227.600 Benefit Description.pdf
8.227.600 Benefit Description.pdf
8.228.400 Recipient Requirements.pdf
8.228.400 Recipient Requirements.pdf
8.228.500 Income and Resource Standards.pdf
8.228.500 Income and Resource Standards.pdf
8.228.600 Benefit Description.pdf
8.228.600 Benefit Description.pdf
8.230.400 Recipient Requirements.pdf
8.230.500 Income and Resource Standards.pdf
8.230.600 Benefit Description.pdf
8.231.600 Benefit Description.pdf
8.232.400 Recipient Requirements.pdf
8.232.500 Income and Resource Standards.pdf
8.232.600 Benefit Description.pdf
8.234.400 Recipient Responsibilities.pdf
8.234.600 Benefit Description.pdf
8.235.400 Recipient Requirements.pdf
8.235.500 Income and Resource Standards.pdf
8.235.600 Benefit Description.pdf
8.242.400 Recipient Requirements.pdf
8.242.500 Income and Resource Standards.pdf
8.242.600 Benefit Description.pdf
8.249.400 Recipient Requirements.pdf
8.249.500 Income and Resource Standards.pdf
8.249.600 Benefit Description.pdf
8.250.400 Recipient Requirements.pdf
8.252.500 Income and Resource Standards.pdf
8.252.600 Benefit Description.pdf
8.259.400 Recipient Requirements.pdf
8.259.500 Income and Resource Standards.pdf
8.259.600 Benefit Description.pdf
8.285.400 Recipient Requirements.pdf
8.291.400 Eligibility Requirements.pdf
8.291.410 General Recipient Requirements.pdf
8.291.420 Recipient Rights and Responsibilities.pdf
8.291.430 Financial Responsiblity Requirements.pdf
8.292.400 Recipient Requirements.pdf
8.292.500 Income and Resource Standards.pdf
8.292.600 Benefit Description.pdf
8.293.400 Recipient Requirements.pdf
8.293.500 Income and Resource Standards.pdf
8.293.600 Benefit Description.pdf
8.294.400 Recipient Requirements.pdf
8.294.500 Income and Resource Standards.pdf
8.294.600 Benefit Description.pdf
8.295.400 Recipient Requirements.pdf
8.295.500 Income and Resource Standards.pdf
8.295.600 Benefit Description.pdf
8.308.22 Fraud, Waste and Abuse.pdf
2013 Written Tribal Consultation Rules 13-02
8.250.500 Income and Resource Standards.pdf
8.305.1 General Provisions.pdf
8.305.11 Reimbursement for Managed Care.pdf
8.305.12 MCO Member Grievance System.pdf
8.305.12 MCO Member Grievance System.pdf
8.305.14 Reporting Requirements.pdf
8.305.15 Services for Individuals with Special Health Care Needs.pdf
8.305.16 Client Transistion of Care.pdf
8.305.17 Value Added Services.pdf
8.305.3 Contract Management.pdf
8.305.4 Managed Care Eligibility.pdf
8.305.4 Managed Care Eligibility.pdf
8.305.4 Managed Care Eligibility.pdf
8.305.4 Managed Care Eligibility.pdf
8.305.5 Enrollment in Managed Care.pdf
8.306.1 General Provisions.pdf
8.306.12 Member Grievance Resolution.pdf
8.306.14 Reporting Requirements.pdf
8.306.15 Services for SCI Members with Special Health Care Needs.pdf
8.306.16 Member Transistion of Care.pdf
8.306.3 Contract Management.pdf
8.306.8 Quality Management.pdf
8.306.9 Coordination of Benefits.pdf
8.307.1 General Provisions.pdf
8.307.12 Member Grievance Resolution.pdf
8.307.14 Reporting Requirements.pdf
8.307.15 Services for Members with Special Health Care Needs.pdf
8.307.16 Client Transistion of Care.pdf
8.307.17 Value Added Services.pdf
8.307.18 CoLTS 1915 (c) Home and Community-Based Services Waiver.pdf
8.307.3 Contract Management.pdf
8.307.8 Quality Management.pdf
8.307.9 Coordination of Services.pdf
8.310.12 IHS and Tribal 638 Facilities.pdf
8.310.2 General Benefit Description.pdf
8.310.3 Professional Providers and Reimbursement.pdf
8.320.2 Early, Periodic Screening, Diagnosis and Treatment Services (EPSDT).pdf
8.320.6 School Based Services for MAP Eligible Recipients under Twenty-One Years of Age.pdf
8.324.4 Pharmacy Services, Perscribing and Practitioner Administered Drug Items.pdf
8.324.7 Transportation Services and Lodging.pdf
2013 Written Tribal Consultation Rules 13-03
CS14 Children who lose Medicaid due to loss of disregards – Tribal Consultation draft.pdf
CS3 Eligibility for Medicaid Expansion Program – Tribal Consultation draft.pdf
S10 MAGI Income Methodology – Tribal Consultation draft.pdf
S14 AFDC Income Standard – Tribal Consutlation draft.pdf
S21 Hospital Presumptive Eligibility – Tribal Consultation draft.pdf
S25 Parents and Other Caretakers – Tribal Consultation draft.pdf
S28 Pregnant Women – Tribal Consultation draft.pdf
S30 Infants and Children Under Age 19 – Tribal Consultation draft.pdf
S33 Former Foster Care Children up to age 26 – Tribal Consultation draft.pdf
S51 Optional Parents and Caretakers – Tribal Consultation draft.pdf
S52 Reasonable Classification of Individuals – Tribal Consultation draft.pdf
S53 Non IV-E Adoption Assistance – Tribal Consultation draft.pdf
S54 Optional Targeted Low Income Children – Tribal Consultation draft.pdf
S55 Tuberculosis – Tribal Consultation draft.pdf
S57 Foster Care Adolescents – Chafee – Tribal Consultation draft.pdf
S59 Family Planning – Tribal Consutltation draft.pdf
S88 Residency – Tribal Consultation draft.pdf
S89 Citizenship and Immigration Status – Tribal Consultation draft.pdf
Training Materials MOSAA and PE.pdf
2013 Written Tribal Consultation Rules 13-04
8.302.2 NMAC Billing for Medicaid Services.pdf
8.321.2 Specialized Behavioral Health Provider Enrollment and Reimbursement.pdf
8.351.2 Sanctions and Remedies.pdf
2013 Written Tribal Consultation Rules 13-05
8.308.12 Community Benefit.pdf
2013 Written Tribal Consultation Rules 13-06
8.309.4 MAD Administered Benefits and Limitation of Services.pdf