New Mexico Administrative Code
Title 8 - SOCIAL SERVICES
Chapter 314 - LONG TERM CARE SERVICES - WAIVERS
Part 6 - MI VIA HOME AND COMMUNITY-BASED SERVICES WAIVER
Section 8.314.6.19 - REIMBURSEMENT
Universal Citation: 8 NM Admin Code 8.314.6.19
Current through Register Vol. 35, No. 18, September 24, 2024
A. Mi via eligible recipients must follow all billing instructions provided by the FMA to ensure payment of service providers, employees, and vendors.
B. Claims must be billed to the FMA per the billing instructions. Reimbursement to a service provider and a vendor in the mi via program is made, as follows:
(1) mi via
service provider and vendor must enroll with the FMA;
(2) the eligible recipient receives
instructions and documentation forms necessary for a service provider's and a
vendor's claims processing;
(3) an
eligible recipient must submit claims for payment of his or her mi via service
provider and vendor to the FMA for processing; claims must be filed per the
billing instructions provided by the FMA;
(4) the eligible recipient and his or her mi
via service provider and vendor must follow all FMA billing instructions;
and
(5) reimbursement of a mi via
service provider and vendor is made at a predetermined reimbursement rate
negotiated by the eligible recipient with the mi via service provider or
vendor, approved by the TPA contractor, and documented in the SSP and in the mi
via provider or vendor agreement; at no time can the total expenditure for
services exceed the eligible recipient's AAB.
C. The FMA must submit claims that have been paid by the FMA on behalf of eligible recipient to the MAD fiscal contractor for processing.
D. Reimbursement may not be made directly to the eligible recipient, either to reimburse him or her for expenses incurred or to enable the eligible recipient to pay a service provider directly.
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