N.M. Admin. Code § 8.313.2.21 - Reimbursement

Intermediate care providers must submit claims for reimbursement on the long term care turn around documents (TAD) or its successor. See Section MAD-702, Billing for Medicaid Services. Once enrolled, providers receive instructions on documentation, billing, and claims processing.

A. MAD reimburses ICF-MR the lower of the following:

(1) the provider's billed charges; or

(2) the prospective rate as constrained by the ceilings established by MAD. See 8.313.3 NMAC, Cost Related Reimbursement of Intermediate Care Facilities for the Mentally Retarded.

B. Reimbursement limitations: Medicaid pays only those ICF-MRs which meet the conditions for participation, specified in this section. Payments to ICF-MRs for services are limited to those services which are included as allowable service costs under the approved state plan. All claims for payment submitted to MAD are subject to utilization review and control.

C. Reimbursement methodology: See 8.313.3 NMAC, Cost Related Reimbursement of Intermediate Care Facilities for the Mentally Retarded.

Notes

N.M. Admin. Code § 8.313.2.21

2-1-95; 8.313.2.21 NMAC - Rn, 8 NMAC 4.MAD.732.10, 11-1-00, Adopted by New Mexico Register, Volume XXXV, Issue 12, June 25, 2024, eff. 7/1/2024