N.M. Admin. Code § 8.309.4.9 - ALTERNATIVE BENEFITS PLAN SERVICES WITH LIMITATIONS (ABP)
The medical assistance division (MAD) category of eligibility "other adults" has an alternative benefit plan (ABP). MAD covers ABP specific services for an ABP eligible recipient. Services are made available through MAD under a benefit plan similar to services provided by commercial insurance plans. ABP benefits include preventive services and treatment services. An ABP eligible recipient:
(1) has
limitations on specific benefits;
(2) does not have all standard medicaid state
plan benefits available; and
(3)
has some benefits, primarily preventive services, that are available only to an
ABP eligible recipient. All early and periodic screening, diagnosis and
treatment (EPSDT) program services are available to an ABP eligible recipient
under 21 years. ABP services for an ABP eligible recipient under the age of 21
years not subject to the duration, frequency, and annual or lifetime benefit
limitations that are applied to an ABP eligible recipient 21 years of age and
older. A MAD ABP provider and ABP eligible recipient have rights and
responsibilities as described in chapters 349 through 352 of Title 8 NMAC,
Social Services. Long term care in a nursing facility (NF), mi via and
community benefits are not available to an ABP eligible recipient.
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