N.M. Admin. Code § 8.326.4.14 - NONCOVERED SERVICES

Case management services are subject to the limitations and coverage restrictions which exist for other medicaid services. See 8.301.3 NMAC, General Noncovered Services. Medicaid does not cover the following specific activities:

A. services furnished to individuals who are not medicaid eligible or who are not eligible for these services;

B. services furnished by case managers which are not substantiated with appropriate documentation in the recipient's file;

C. formal educational or vocational services related to traditional academic subjects or job training;

D. outreach and identification activities in which providers attempt to contact potential recipients;

E. administrative activities, such as medicaid eligibility determinations and intake processing;

F. institutional discharge planning;

G. services which are furnished under other categories, such as therapies, transportation or counseling; or

H. services considered by MAD or its designee to be excessive based on the needs of recipient and documentation in the case management file.

Notes

N.M. Admin. Code § 8.326.4.14

2/1/95; 8.326.4.14 NMAC - Rn, 8 NMAC 4.MAD.773.5, 3/1/12