New Mexico Administrative Code
Title 8 - SOCIAL SERVICES
Chapter 315 - OTHER LONG TERM CARE SERVICES
Part 2 - PROGRAM OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE)
Section 8.315.2.14 - NONCOVERED SERVICES
Universal Citation: 8 NM Admin Code 8.315.2.14
Current through Register Vol. 35, No. 18, September 24, 2024
A. The following services are not the responsibility of the provider or medicaid:
(1) any medicaid capitated or fee-for-service
benefit which has not been authorized by the multidisciplinary team;
(2) in inpatient facilities, private room and
private duty nursing, unless medically necessary, and non-medical items for
personal convenience, such as telephone charges, radio, or television
rental;
(3) cosmetic surgery unless
required for improved functioning of a malformed part of the body resulting
from an accidental injury or for reconstruction following mastectomy;
(4) experimental medical, surgical or other
health procedures or procedures not generally available;
(5) care in a government hospital (veterans
administration, federal/state hospital) unless authorized;
(6) service in any hospital for the treatment
of chronic, medically uncomplicated drug dependency or alcoholism;
and
(7) any services rendered
outside of the United States.
B. The participant will be financially responsible for any of the above-mentioned services.
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