N.M. Admin. Code § 8.325.8.13 - NONCOVERED SERVICES

Rehabilitation services are subject to the limitations and coverage restrictions of other medicaid services. See 8.301.3 NMAC, General Noncovered Services. Medicaid does not cover the following rehabilitation services:

A. services furnished by providers who are not licensed and/or certified to furnish services;

B. educational programs or vocational training not part of an active treatment plan for residents in an intermediate care facility for the mentally retarded or for recipients under the age of twenty-one (21) receiving inpatient psychiatric services [42 CFR Section 441.13(b)] ;

C. services billed separately by home health agencies, independent physical therapists, independent occupational therapists, or outpatient rehabilitation centers to recipients in high nursing facilities or inpatient hospitals;

D. transportation, for recipients in low level nursing facilities or other medicaid recipients, to travel to outpatient hospital facilities unless there are no home health agencies, independent physical therapists or independent occupational therapists available in the area to provide the therapy at the recipient's residence; and

E. services solely for maintenance of the recipient's general condition; these services include repetitive services needed to maintain a recipient's functional level that do not involve complex and sophisticated therapy procedures requiring the judgement and skill of a therapist; services related to activities for the general good and welfare of recipients, such as general exercises to promote overall fitness and flexibility and activities to provide general motivation, are not considered physical or occupational therapy for medicaid reimbursement purposes.

Notes

N.M. Admin. Code § 8.325.8.13

2/1/95; 8.325.8.13 NMAC - Rn, 8 NMAC 4.MAD.767.4, 3/1/12