Current through Register Vol. 35, No. 18, September 24, 2024
A. Upon
approval of New Mexico medical assistance program provider participation
agreements by the New Mexico medical assistance division (MAD), the following
agencies are eligible to be reimbursed for providing case management services:
(1) state agencies in New Mexico providing
case management services to individuals with developmental
disabilities;
(2) Indian tribal
governments and Indian health service clinics; and
(3) community-based agencies in New Mexico
that do not furnish adult day habilitation, work related services, or adult
residential services to individuals with developmental disabilities.
B. Agency qualification: Agencies
must be certified by the developmental disabilities division of the HCA and
meet the MAD approved standards for agencies providing case management for
adults who are developmentally disabled.
(1)
Agencies must demonstrate knowledge of the community to be served, its
populations and its resources, including methods for accessing those
resources.
(2) Agencies must
demonstrate direct experience in case management services and success in
serving the target population.
(3)
Agencies must have personnel management skills, including written policies and
procedures that include recruitment, selection, retention and termination of
case managers, job descriptions for case managers, grievance procedures, hours
of work, holidays, vacations, leaves of absence, wage scales and benefits,
conduct and other general rules.
C. Case manager qualifications: Case managers
employed by case management agencies must possess the education, skills,
abilities and experience to perform case management service for adults with
developmental disabilities. At a minimum, case managers must meet one of the
following qualifications:
(1) bachelor's
degree from an accredited institution in a human services field or any related
academic discipline associated with the study of human behavior or human skills
development, such as psychology, sociology, speech, gerontology, education,
counseling, social work, human development or any other study of services
related field and one (1) year of experience working with individuals with
developmental disabilities;
(2)
licensed as a registered or licensed practical nurse with one year of
experience working with individuals with developmental disabilities;
or
(3) In the event that there are
no suitable candidates with the above qualifications, individuals with the
following qualifications and experience can be employed as case managers:
(a) associate's degree and a minimum of three
years of experience working with individuals with developmental disabilities;
or
(b) high school graduation or
general educational development (GED) test and a minimum of four (4) years of
experience working with individuals with developmental disabilities.
(4) Once enrolled, providers
receive a packet of information, including medicaid program policies, billing
instructions, utilization review instructions and other pertinent material from
MAD. Providers are responsible for ensuring that they have received these
materials and for updating them as new materials are received from
MAD.
