N.M. Admin. Code § 8.326.8.14 - 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. In addition, medicaid does not cover the following specific activities:

A. services furnished to individuals who are not medicaid eligible or who are not eligible for these services;

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

C. formal educational or vocational services related to traditional academic subjects or job training;

D. outreach and identification activities in which providers attempt to contact potential clients;

E. administrative activities, such as medicaid eligibility determinations and intake processing;

F. discharge planning from inpatient hospital, residential facility or community-based placement;

G. services which are furnished under other categories, such as therapies, transportation or counseling;

H. services provided to clients that are not part of the target population or services which are not documented in the client file; or

I. services provided to clients that relate to the legal and/or corrections functions performed by JPPOs.

Notes

N.M. Admin. Code § 8.326.8.14

3/1/00; 8.326.8.14 NMAC - Rn, 8 NMAC 4.MAD.778.5, 3/1/12