New Mexico Administrative Code
Title 8 - SOCIAL SERVICES
Chapter 326 - CASE MANAGEMENT SERVICES
Part 3 - CASE MANAGEMENT SERVICES FOR PREGNANT INDIVIDUALS AND THEIR INFANTS
Section 8.326.3.10 - Eligible Providers

Universal Citation: 8 NM Admin Code 8.326.3.10

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 certified agencies are eligible to be reimbursed for furnishing case management services to eligible pregnant individuals and their infants:

(1) public health offices of the New Mexico department of health;

(2) Indian tribal governments or Indian health services;

(3) federally qualified health centers (FQHC); and

(4) other community-based agencies which meet the requirements for participation.

B. Agency qualifications: Community-based agencies must be certified by the department of health and meet the following criteria:

(1) agencies must have demonstrated direct experience in successfully serving the target population; and

(2) agencies must have demonstrated knowledge of available community services and methods for accessing them.

C. Case manager qualifications: Case managers employed by the agency must possess the education, skills, abilities, and experience to perform case management services. It can be important that case managers have language skills, cultural sensitivity and acquired knowledge and expertise unique to the geographic area. At a minimum, case managers must have one of the following qualifications:

(1) case managers must be licensed as a registered nurse and have a bachelors degree in nursing or be licensed as a social worker; the nurse or social worker must have two years of experience in community health and at least one year of experience in maternal health or child health;

(2) or be a licensed registered nurse or have a bachelors degree in social work with a minimum of two years of experience in community health and at least two years experience in maternal health or child health nursing;

(3) in the event that there are no candidates with the above qualifications, an individual with an associates degree and four years of experience in social, community health or maternal health and child health may be employed as a case manager;

(4) if no individuals with a college degree and appropriate experience are available, an individual with a high school diploma and five years of experience in social services, community health or maternal health and child health may be considered; agencies that are considering hiring individuals listed in Paragraph (3) and (4) of 8.326.3.10 NMAC must complete a waiver process.

D. 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.

Disclaimer: These regulations may not be the most recent version. New Mexico may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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