New Mexico Administrative Code
Title 8 - SOCIAL SERVICES
Chapter 350 - RECONSIDERATION OF UTILIZATION REVIEW
Part 3 - ABSTRACT SUBMISSION FOR LEVEL OF CARE DETERMINATIONS
Section 8.350.3.9 - ABSTRACT SUBMISSION FOR LEVEL OF CARE DETERMINATIONS

Universal Citation: 8 NM Admin Code 8.350.3.9
Current through Register Vol. 35, No. 18, September 24, 2024

The medical assistance division (MAD) utilization review (UR) contractor performs prior approval and abstract review on admissions, readmissions, and continued stay requests for all long-term care nursing facilities (NF) and intermediate care facilities for the mentally retarded (ICF-MR). Within ten (10) working days after a recipient's admission to a nursing facility or intermediate care facility for the mentally retarded (ICF-MR), the facility must submit a long-term care abstract to the UR contractor for review. The initial admission abstract describes the recipient's functional level and level of care needs and includes the physician's history and physical examination and preadmission screening and annual resident review (PASARR). Readmissions and continued-stay request abstracts must be submitted to the UR contractor ten (10) working days before the expiration of the currently certified length of stay.

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