New Mexico Administrative Code
Title 7 - HEALTH
Chapter 30 - FAMILY AND CHILDREN HEALTH CARE SERVICES
Part 3 - CHILDREN'S MEDICAL SERVICES AND ADULT CYSTIC FIBROSIS
Section 7.30.3.11 - CLIENT RESPONSIBILITIES

A. Clients are responsible for providing the division with accurate information concerning their financial and medical eligibility when requested by the children's medical services program.

B. Clients must apply for and inform the service coordinator of insurance, medicaid or other possible source of payment for medical expenses. Clients who meet eligibility criteria for medicaid must apply.

C. Clients must report the following changes to their care coordinator within 10 working days of the date the client becomes aware of the change: changes in income exceeding $100.00 per month; changes in household composition, insurance or medicaid coverage; or change of address or telephone number.

D. Private donations, if regular and predictable, will be considered income. If irregular or unpredictable, private donations for the care of the child must be reported to the service coordinator within ten working days of receipt of the donation if it exceeds $1,000.00.

E. Third party tort liability: The client must notify the care coordinator within 30 working days of knowledge of potential liability if a third party may be liable for medical expenses. The client must advise the care coordinator of the name of the potentially liable third party, and the names of all attorneys representing the client.

F. Failure to provide correct and complete information necessary to determine eligibility and failure to report changes, third party resources, including insurance recoveries, potential liability or private donations as required above may result in termination of benefits under these regulations and disqualification from receipt of benefits for a period not to exceed six months, or civil action to recover benefits wrongfully received.

G. Eligibility review: The client receiving benefits must have his/her eligibility reviewed annually. If the client does not respond to a request for review, services may be denied, and the case may be closed 30 days after the first letter of request is sent. Closure date may be extended in certain circumstances at the discretion of the CMS program manager or medical director.

H. If a client does not follow treatment recommendations or directions made by a CMS care coordinator, consultant or provider, services may be terminated and the children's medical services program manager or medical director may refuse to pay for services because of the failure to follow treatment recommendations or directions. Prior to termination of services or failure to pay for services due to failure to follow treatment recommendations or directions, a client may request a consult to review treatment recommendations or directions he does not wish to follow.