N.M. Admin. Code § 8.326.8.13 - COVERED SERVICES

Case management is defined as services which assist clients in the target population in gaining access to needed medical, social, educational and other services.

A. Medicaid covers the following case management service activities for clients in the target population:

(1) assessment of the client's medical, social, educational and other service needs and functional limitations using standardized needs assessment instruments;

(2) development and implementation of individualized plan of care;

(3) mobilizing the use of "natural helping" networks, such as family members, church members and friends;

(4) development of increased opportunities for community access and involvement including assistance in the location of housing, community living skills, vocational, social, educational or other service programs;

(5) coordination and monitoring of the delivery of services; and

(6) evaluation of the effectiveness of services furnished under the plan of care and revision of the plan as conditions warrant.

B. For clients in the target population that participate in the medicaid managed care program, HSD covers only those activities that relate to accessing social, educational, and other services. The medicaid managed care organizations are responsible for ensuring that clients have access to medical services and coordination occurs with other case managers.

C. For clients in the target population that are not enrolled in the medicaid managed care program, HSD covers all delineated case management activities.

Notes

N.M. Admin. Code § 8.326.8.13

3/1/00; 8.326.8.13 NMAC - Rn, 8 NMAC 4.MAD.778.4, 3/1/12