N.M. Admin. Code § 8.326.7.10 - 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 to be reimbursed for furnishing case management services
to an eligible recipient.
(1) Government
agencies or their delegates which by law receive reports or allegations of
abuse, exploitation or neglect and who by New Mexico state law are required to
provide adult protective services for the target population.
(2) 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.
B.
Agency
qualifications: Agencies must demonstrate direct experience in
successfully serving the target population; and past performance of such
agencies must demonstrate knowledge of available community services and methods
for gaining access to those services.
C.
Case manager qualifications:
Case managers employed by an agency must possess the education, skills,
abilities, and experience to perform case management services. Case managers
must have the necessary skills to meet the needs of specified recipients. In
some instances, it is important that individuals have language skills, cultural
sensitivity and acquired knowledge unique to a geographic area. Case managers
must also at a minimum, have a current license at the baccalaureate level
issued by the New Mexico board of social work. These individuals must work
under the direct supervision of an experienced case manager within the agency
who meets the educational requirements specified above.
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