New Mexico Administrative Code
Title 8 - SOCIAL SERVICES
Chapter 302 - MEDICAID GENERAL PROVIDER POLICIES
Part 4 - RECIPIENT POLICIES -GENERAL RECIPIENT REQUIREMENTS
Section 8.302.4.17 - REIMBURSEMENT
Current through Register Vol. 35, No. 18, September 24, 2024
Reimbursement to an out-of-state or border area provider is made at the same rate as for an in-state provider except as otherwise stated in the relevant specific providers and services sections of the MAD program rules manual.
A. Unless payment for a service is made using a diagnosis related group or outpatient prospective payment system rate, reimbursement to a provider for covered services is made at the lesser of the following:
B. When a provider and an MCO are unable to agree to terms or fail to execute an agreement for any reason, the MCO shall be obligated to pay, and the provider shall accept, one hundred percent of the "applicable reimbursement rate" based on the provider type for services rendered under both emergency and non-emergency situations. The "applicable reimbursement rate" is defined as the rate paid by HCA to a provider participating in medicaid or other medical assistance programs administered by HCA and excludes disproportionate share hospital and medical education payments.
