New Mexico Administrative Code
Title 8 - SOCIAL SERVICES
Chapter 326 - CASE MANAGEMENT SERVICES
Part 2 - CASE MANAGEMENT SERVICES FOR ADULTS WITH DEVELOPMENTAL DISABILITIES
Section 8.326.2.13 - COVERED SERVICES
Current through Register Vol. 35, No. 18, September 24, 2024
Medicaid coverage for case management services varies by the priority assigned recipients by the CST.
A. Case management services for recipients assigned a priority three: Case management services for recipients assigned a priority three are limited. Medicaid covers assessments of recipients' needs and the coordination and performance of evaluations and assessments. A follow-up is performed during the third month with appropriate recommendations. Medicaid covers case management services for recipients classified as priority three only for an initial 90 day period, unless the recipient's urgency of need priority changes to priority one or priority two.
B. Case management services for recipients assigned priority one or priority two: Medicaid covers case management services for those recipients assigned a priority one or priority two for up to 60 days after suitable placement or services are received. Medicaid covers the following case management service activities for these recipients:
C. Administrative activities: Medicaid eligibility determinations or intake processing are covered services for individuals with developmentally disabilities who have not applied for medicaid but who have been referred to the CST for evaluation. These administrative services are billed as administrative activities, not as case management services.