N.M. Admin. Code § 8.308.6.10 - SPECIAL SITUATIONS
A. HSD
newborn enrollment criteria.
(1) When a child
is born to a member enrolled in a MCO, the hospital or other providers will
complete a MAD form 313 (notification of birth) or its
successor, prior to or at the time of discharge. HSD shall ensure that upon
receipt of the MAD form 313 and upon completion of the eligibility process, the
newborn is enrolled into his or her mother's MCO. The newborn is eligible for a
period of 13 months, starting with the month of his or her birth.
(2) When the newborn's mother is covered by
health insurance through the New Mexico health insurance exchange and the
mother's qualified health plan is also a HSD-contracted MCO, HSD will enroll
the newborn into the mother's MCO as of the month of his or her
birth.
(3) When the newborn
member's mother is covered by health insurance through New Mexico health
insurance exchange and the mother's qualified health plan is not a
HSD-contracted MCO, HSD shall auto-assign and enroll the newborn in a medicaid
MCO as of the month of his or her birth.
(4) The newborn member's parent or legal
guardian will have three months from the first day of the month of birth to
change the newborn's MCO assignment. After the three-month period, the
newborn's MCO enrollment may only be changed for cause, as set forth in
Paragraph (2) of Subsection H of
8.308.7.9 NMAC.
B. Community benefit eligibility:
(1) A member who meets a nursing facility
(NF) level of care (LOC) and who does not reside in a NF will be eligible to
receive home and community-based services and may choose to receive such
services either through an agency-based or self-directed approach as outlined
in 8.308.12 NMAC.
(2) Members who
meet NFLOC and are eligible to receive community benefits must be enrolled in a
centennial care MCO.
C.
ICF/IID discharge: When an ICF/IID resident is discharged, enrollment into
managed care will begin 60 days following discharge.
Notes
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