N.M. Admin. Code § 8.326.6.14 - 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 residents of New Mexico;

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

C. formal educational or vocational services which are 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 by other practitioners, such as therapies, transportation and homemaker or personal care services; and

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

Notes

N.M. Admin. Code § 8.326.6.14

2/1/95; 5/15/96; 8.326.6.14 NMAC - Rn, 8 NMAC 4.MAD.775.5, 3/1/12