N.M. Admin. Code § 8.314.5.7 - DEFINITIONS
A.
Activities of daily living (ADLs): Basic personal everyday
activities that include bathing, dressing, transferring (e.g., from bed to
chair), toileting, oral care, mobility and eating, and skills necessary to
maintain the normal routines of the day such as housekeeping, shopping and
preparing meals. The term also includes exercising, personal, social and
community skills.
B.
Adult: An individual who is 18 years of age or older.
C.
Authorized representative:
HSD must permit applicants and beneficiaries to designate an individual or
organization to act responsibly on their behalf in assisting with the
individual's application and renewal of eligibility and other ongoing
communications. Such a designation must be in writing including the applicant's
signature and must be permitted at the time of application and at other times.
Legal documentation of authority to act on behalf of an applicant or
beneficiary under state law, such as a court order establishing legal
guardianship or a power of attorney, shall serve in the place of written
authorization by the applicant or beneficiary. Representatives may be
authorized to; sign an application on the applicant's behalf; complete and
submit a renewal form; receive copies of the applicant or beneficiary's notices
and other communications from the agency; and act on behalf of the applicant or
beneficiary in all other matters with the agency. The power to act as an
authorized representative is valid until the applicant or beneficiary modifies
the authorization or notifies the agency that the representative is no longer
authorized to act on their behalf, or the authorized representative informs the
agency that they are no longer acting in such capacity, or there is a change in
the legal authority upon which the individual's or organization's authority was
based. Such notice must be in writing and should include the applicant or
authorized representative's signature as appropriate. The authorized
representative is responsible for fulfilling all responsibilities encompassed
within the scope of the authorized representation to the same extent as the
individual they represent, and must agree to maintain, or be legally bound to
maintain, the confidentiality of any information regarding the applicant or
beneficiary provided by the agency. As a condition of serving as an authorized
representative, a provider, staff member or volunteer of an organization must
sign an agreement that they will adhere to the regulations relating to
confidentiality (relating to the prohibition against reassignment of provider
claims as appropriate for a health facility or an organization acting on the
facility's behalf), as well as other relevant state and federal laws concerning
conflicts of interest and confidentiality of information (42 CFR
435.923).
D.
Child: An individual under
the age of 18. For purpose of early periodic screening, diagnosis and treatment
(EPSDT) services eligibility, "child" is defined as an individual under the age
of 21.
E.
Developmental
disabilities supports division (DDSD): Operating agency that oversees
daily administration of New Mexico's 1915c home and community-based waiver
programs.
F.
Electronic visit
verification (EVV): A telephone and computer-based system that
electronically verifies the occurrence of selected services, as required by the
21st Century CURES Act. The EVV system verifies the occurrence of authorized
service visits electronically by documenting the precise time and location
where service delivery visit begins and ends. EVV is implemented according to
federal requirements and timelines. The 21st Century CURES Act requires EVV for
personal care services (PCS), defined as services that provide assistance with
activities of daily living (ADLs) or instrumental activities for daily living
(IADLs) effective January 1, 2020 and for home health services effective
January 1, 2023.
G.
Individual service plan (ISP): A person-centered plan for an
eligible recipient that includes their needs, functional levels, intermediate
and long-range outcomes for achieving their goals and specifies
responsibilities for the eligible recipient's support needs. The ISP enables
and assists the recipient to identify and access a personalized mix of paid
waiver and non-paid services and supports that assists them to achieve
personally defined outcomes in the community.
H.
Person centered planning
(PCP): Person centered planning is a process that places a person at the
center of planning their life and supports. It is an ongoing process that is
the foundation for all aspects of the DDW program and DDW service provider's
work with individuals with I/DD. The process is designed to identify the
strengths, capacities, preferences, needs, and desired outcomes of the
recipient. The process may include other persons, freely chosen by the
individual, who are able to serve as important contributors to the process. It
involves person centered thinking, person centered service planning and person-
centered practice.
I.
Supporting documentation: Sufficient information and documentation
that demonstrates the request for initial and ongoing developmental
disabilities waiver (DDW) services is necessary and appropriate based on the
service specific DDW clinical criteria established by the developmental
disabilities support division (DDSD) for adult recipients excluding former
class members of Walter Stephen Jackson, et al vs. Fort Stanton Hospital and
Training School et. al, (757 F. Supp. 1243 DNM 1990). Examples of supporting
documentation include but are not limited to: the DDW therapy documentation
form (TDF), intensive medical living supports (IMLS) and adult nursing services
parameter tools, electronic comprehensive health assessment tool (e-Chat), all
other assessments, clinical notes, progress notes, interdisciplinary team (IDT)
meeting minutes, letters or reports from physicians or ancillary service
providers that provide sufficient clinical information that demonstrates the
need for requested services, etc. Any relevant supporting information and
documentation is acceptable and will be considered by the outside
reviewer.
J.
Third party
assessor (TPA): The medical assistance division (MAD) contractor who
determines level of care and medical eligibility for the developmental
disabilities waiver and other 1915c waiver programs.
K.
Waiver: Permission from the
centers for medicaid and medicare services (CMS) to cover supports for a
particular population or service not ordinarily allowed.
L.
Young adult: An individual
between the ages of 18 through 20 years of age who is allocated to the DDW and
is receiving specific services as identified in the DOH/DDSD standards. An
individual under age 21 is eligible for medical services funded by their
medicaid providers under EPSDT. Upon the individual's
21st birthday, they are considered to be an adult
recipient of DDW services.
Notes
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