New Mexico Administrative Code
Title 8 - SOCIAL SERVICES
Chapter 301 - MEDICAID GENERAL BENEFIT DESCRIPTION
Part 5 - MEDICAL MANAGEMENT
Section 8.301.5.9 - MEDICAL MANAGEMENT

The New Mexico medicaid program (medicaid) pays for medically necessary medical services furnished to medicaid recipients. To make sure that recipients receive only necessary services, the New Mexico medical assistance division (MAD) has developed the medical management program. The medical management program is designed to enhance the receipt of health care to a recipient by assigning a designated provider. This may also reduce the use of unnecessary services by medicaid recipients in certain instances. See 42 CFR 431.54(e). Medical management involves the identification of appropriate cases, selection of actual cases, documentation of the health care issue(s) necessitating management, development of assignment recommendations, and evaluation of the effectiveness of the assignments. The medical assistance division (MAD) medical director or another physician specifically appointed by MAD determines whether recipients are assigned to the medical management program.