N.M. Admin. Code § 8.326.6.13 - COVERED SERVICES AND SERVICE LIMITATIONS
Medicaid covers case management services for children up to the age of three (3) which help recipients gain access to medical, social, educational or other needed services. Case management services provide necessary coordination with providers of non-medical services, such as nutrition or education programs, when these services are necessary to enable recipients to benefit from the health services paid for by medicaid.
A. Medicaid covers the following case
management service activities furnished children up to the age of three (3):
(1) identification of programs appropriate
for the recipient's needs, including those which teach basic maternal and child
health skills;
(2) help in
accessing the identified programs;
(3) assessment of the service needs of
recipients to coordinate the delivery of services when multiple providers or
programs are involved in the provision of care;
(4) reassessment to ensure that the services
which were obtained are necessary and appropriate in meeting the recipient's
needs; and
(5) determination of
whether any additional services are warranted.
B. Medicaid covers four (4) hours of case
management services per child per year. Additional units of service require
prior approval by MAD or its designee.
Notes
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