Current through Register Vol. 35, No. 18, September 24, 2024
Services are to be provided in the least restrictive manner.
HSD does not allow for the use of any restraints, restrictive interventions, or
seclusions to an eligible mi via recipient. The following resources and
services have been established to assist eligible recipients to self-direct
services. These include the following:
A.
Consultant services:
Consultant services are direct services intended to educate, guide and assist
the eligible recipient to make informed planning decisions about services and
supports, to develop a SSP that is based on the eligible recipient's assessed
disability-related needs and to assist the eligible recipient with quality
assurance related to the SSP and AAB.
B.
Third-party assessor: The TPA
or MAD's designee is responsible for determining medical eligibility through a
LOC assessment, assigning the applicable IBA, approving the SSP and authorizing
an eligible recipient's annual budget in accordance with 8.314.6 NMAC and the
mi via service standards. The TPA:
(1)
determines medical eligibility using the LOC criteria in
8.314.6.13
NMAC; determinations are done initially for an eligible recipient who is newly
enrolled in the mi via program and thereafter at least annually for currently
enrolled mi via eligible recipients; the LOC assessment is done in person with
the eligible recipient in his or her home, a location agreed upon by the
eligible recipient and TPA and approved by HSD, or in an inpatient setting; the
TPA may re-evaluate the LOC more often than annually if there is an indication
that the eligible recipient's medical condition or LOC has changed;
(2) applies the information from the LOC
documentation and the following assessments: long-term care assessment abstract
(ICF/IID), the comprehensive individual assessment (CIA), or other MAD approved
assessment tools, as appropriate for the COE, to assign the IBA for the
eligible recipient that is medically eligible; and
(3) reviews and approves the SSP and the
annual budget request resulting in an AAB, at least annually or more often if
there is a change in the eligible recipient's circumstances, in accordance with
8.314.6 NMAC and mi via service standards.
C.
Financial management agent
(FMA): The FMA acts as the intermediary between the eligible recipient
and the MAD payment system and assists the eligible recipient or the EOR with
employer-related responsibilities. The FMA pays employees and vendors based
upon an approved SSP and AAB. The FMA assures there is eligible recipient and
program compliance with state and federal employment requirements, monitors,
and makes available to the eligible recipient the reports related to
utilization of services and budget expenditures. Based on the eligible
recipient's approved individual SSP and AAB, the FMA must:
(1) verify that the recipient is eligible for
MAD services prior to making payment for services;
(2) receive and verify that all required
employee and vendor documentation and qualifications are in compliance with
8.314.6 NMAC and mi via service standards;
(3) establish an accounting for each eligible
recipient's AAB;
(4) process and
pay invoices for goods, services, and supports approved in the SSP and the AAB
and supported by required documentation;
(5) process all payroll functions on behalf
of the eligible recipient and EORs including:
(a) collect and process timesheets of
employees;
(b) process payroll,
withholding, filing, and payment of applicable federal, state and local
employment-related taxes and insurance; and
(c) track and report disbursements and
balances of the eligible recipient's AAB and provide a monthly report of
expenditures and budget status to the eligible recipient and his or her
consultant, and quarterly and annual documentation of expenditures to
MAD;
(6) receive and
verify employee and vendor agreements, including collecting required provider
qualifications;
(7) monitor hours
billed for services provided by the LRI and the total amounts billed for all
goods and services during the month;
(8) answer inquiries from the eligible
recipient and solve problems related to the FMA's responsibilities;
and
(9) report to the consultant
provider, MAD and DOH any concerns related to the health and safety of an
eligible recipient or if the eligible recipient is not following the approved
SSP and AAB.
