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 children up to the age of three (3) who are medically at risk due
to family conditions:
(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.
(1) At a minimum, case
managers must have one of the following qualifications:
(a) 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 (2) years of experience
in community health and at least one (1) year of experience in maternal health
or child health;
(b) or be a
licensed registered nurse or have a bachelors degree in social work with a
minimum of two (2) years of experience in community health and at least two (2)
years experience in maternal health or child health nursing;
(c) in the event that there are no candidates
with the above qualifications, an individual with an associates degree and four
(4) years of experience in social, community health and/or maternal health and
child health may be employed as a case manager;
(d) if no individuals with a college degree
and appropriate experience are available, an individual with a high school
diploma and five (5) years of experience in social services, community health
or maternal health and child health may be considered; agencies that are
considering hiring individuals in option 3 or 4 must complete a waiver
process.
(2) 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.
