New Mexico Administrative Code
Title 8 - SOCIAL SERVICES
Chapter 314 - LONG TERM CARE SERVICES - WAIVERS
Part 7 - SUPPORTS WAIVER
Section 8.314.7.15 - NON-COVERED SERVICES
Current through Register Vol. 35, No. 18, September 24, 2024
The waiver does not pay for the purchase of goods or services that a household without a person with a disability would be expected to pay for as a routine household or personal expense. If the eligible recipient requests a specific good or service, the CSC and the state can work with the eligible recipient to find other, including less costly, alternatives. Non-covered services include, but are not limited to the following:
A. Services covered by the medicaid state plan (including EPSDT), MAD school-based services, medicare and other third parties.
B. Any service or good, the provision of which would violate federal or state statutes, regulations or guidance.
C. Formal academic degrees or certification-seeking education, educational services covered by IDEA or vocational training provided by the public education department (PED), division of vocational rehabilitation (DVR.
D. Food and shelter expenses, including property-related costs, such as rental or purchase of real estate and furnishing, maintenance, utilities and utility deposits, and related administrative expenses; utilities include gas, electricity, propane, firewood, wood pellets, water, sewer, and waste management.
E. Experimental or investigational services, procedures or goods, as defined in 8.325.6 NMAC.
F. Any goods or services that are to be used for recreational or diversional purposes.
G. Personal goods or items not related to the disability.
H. Animals and costs of maintaining animals including the purchase of food, veterinary visits, grooming and boarding except for training and certification for service dogs.
I. Gas cards and gift cards.
J. Purchase of insurance, such as car, health, life, burial, renters, homeowners, service warranties or other such policies.
K. Purchase of a vehicle, and long-term lease or rental of a vehicle.
L. Purchase of recreational vehicles, such as motorcycles, campers, boats or other similar items.
M. Firearms, ammunition or other weapons.
N. Vacation expenses, including airline tickets, cruise ship or other means of transport, guided.
O. Meals, hotel, lodging or similar recreational expenses.
P. Purchase of usual and customary furniture and home furnishings, unless adapted to the eligible recipient's disability or use, or of specialized benefit to the eligible recipient's condition; requests for adapted or specialized furniture or furnishings must include a recommendation from the eligible recipient's health care provider and, when appropriate, a denial of payment from any other source.
Q. Regularly scheduled upkeep, maintenance and repairs of a home and addition of fences, storage sheds or other outbuildings, except upkeep and maintenance of modifications or alterations to a home which are an accommodation directly related to the eligible recipient's qualifying condition or disability.
R. Regularly scheduled upkeep, maintenance and repairs of a vehicle, or tire purchase or replacement, except upkeep and maintenance of modifications or alterations to a vehicle or van, which is an accommodation directly related to the eligible recipient's qualifying condition or disability; requests must include documentation that the adapted vehicle is the eligible recipient's primary means of transportation.
S. Clothing and accessories, except specialized clothing based on the eligible recipient's disability or condition.
T. Training expenses for paid employees.
U. Costs associated with such conferences or class cannot be covered, including airfare, lodging or meals; consumer electronics such as computers, printers and fax machines, or other electronic equipment that does not meet the criteria specified in Subsection A of 8.314.6.14 NMAC; no more than one of each type of item may be purchased at one time; and consumer electronics may not be replaced more frequently than once every three years.
V. Cell phone services that include fees for data unless data is for an app specifically approved through supports waiver funds; or more than one cell phone line per eligible recipient.
