N.M. Admin. Code § 8.326.5.10 - ELIGIBLE PROVIDERS

A. Upon approval of New Mexico medical assistance program provider participation agreements by the New Mexico medical assistance division (MAD), the following agencies are eligible for certification as case management agencies:

(1) government or community agencies which meet certification standards developed by MAD or its designee;

(2) Indian tribal governments;

(3) Indian health services; and

(4) federally qualified health centers (FQHC).

B. Once enrolled, providers receive a packet of information, including medicaid program policies, billing instructions, utilization review instructions and other pertinent material from MAD. Providers are responsible for ensuring that they have received these materials and for updating them as new materials are received from MAD.

C. Qualification of case management agencies: Case management agencies must have direct experience in serving traumatically brain-injured adults and must demonstrate knowledge of available community services and methods for gaining access to those services.

D. Qualifications of case managers: Case managers employed by case management agencies must have the education, skills, abilities and experience to perform case management services for adults with traumatic brain injuries. Case managers may also need language skills, cultural sensitivity and acquired knowledge and expertise unique to a geographic area. Case managers must have at least one of the following qualification:

(1) bachelor's degree from an accredited institution in social work, counseling, psychology or a related field and one year of experience working with traumatically brain injured adults;

(2) licensed as a registered nurse with one year of experience working with traumatically brain injured adults; or

(3) if there are no suitable candidates with the above qualifications, individuals with the following qualifications and experience can be employed as case managers:

(a) associate's degree and a minimum of three (3) years experience in the mental health or traumatic brain injury field; or

(b) high school graduation or general educational development (GED) test and a minimum of five (5) years experience in the mental health or traumatic brain injury field.

(4) This individual must work under the direct supervision of an experienced case manager within the agency who meets the educational and experience requirements, described above.

Notes

N.M. Admin. Code § 8.326.5.10

2/1/95; 10/15/96; 8.326.5.10 NMAC - Rn, 8 NMAC 4.MAD.774.1, 3/1/12