New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 310 - HEALTH CARE PROFESSIONAL SERVICES › Part 2 - GENERAL BENEFIT DESCRIPTION › Section 8.310.2.13 - GENERAL NONCOVERED SERVICES A. General noncovered services

Current through Register Vol. 35, No. 13, July 16, 2024
A.
General
				noncovered services:
MAD does not cover certain procedures, services, or
				miscellaneous items. See specific provider or service rules or sections of this
				rule for additional information on service coverage and limitations. A provider
				cannot turn an account over to collections or to any other factor intending to
				collect from the MAP eligible recipient or his or her authorized
				representative; see 8.302.2 NMAC
.
A provider cannot bill a MAP
				eligible recipient or his or her authorized representative for the copying of
				the MAP eligible recipient's records, and must provide copies of the MAP
				eligible recipient's records to other providers upon request of the MAP
				eligible recipient.
B.
Appointment, interest and carrying charges:
MAD does not cover
				penalties on payments for broken or missed appointments, costs of waiting time,
				or interest or carrying charges on accounts. A provider may not bill a MAP
				eligible recipient or his or her authorized representative for these charges or
				the penalties associated with missed or broken appointments or failure to
				produce eligibility cards, with the exception of MAP recipient eligibility
				categories of CHIP or WDI who may be charged up to $5 for a missed
				appointment.
C.
Contract
				services:
Services furnished by a contractor, an organization, or an
				individual who is not the billing provider must meet specific criteria for
				coverage as stated in MAD or its designee's NMAC rules, billing instructions,
				policy manuals; see 8.302.2 NMAC.
D.
Cosmetic services and
				surgeries:
MAD does not cover cosmetic items or services that are
				prescribed or used for aesthetic purposes. This includes items for aging skin,
				for hair loss, and personal care items such as non-prescription lotions,
				shampoos, soaps or sunscreens. MAD does not cover cosmetic surgeries performed
				for aesthetic purposes. "
Cosmetic surgery
" is defined as a
				procedure performed to improve the appearance of physical features that may or
				may not improve the functional ability of the area of concern. MAD covers only
				a surgery that meets specific criteria and is approved as medically necessary
				reconstructive surgery.
E.
Postmortem examinations:
MAD does not cover postmortem
				examinations.
F.
Education or
				vocational services:
MAD does not cover literature, booklets, and other
				educational materials. Dietary counseling is covered only for a MAP eligible
				recipient under 21 years of age, as part of the EPSDT program and for a
				pregnant MAP eligible recipient. MAD does not cover formal educational or
				vocational training services, unless those services are included as active
				treatment services for a MAP eligible recipient in intermediate care facility
				for individuals with intellectual disabilities (ICF-IID)or for a MAP eligible
				recipient under 21 years of age receiving inpatient psychiatric services.
				"
Formal educational services
" relate to training in
				traditional academic subjects. Vocational training services relate to organized
				programs directly related to the preparation of a MAP eligible recipient for
				paid or unpaid employment.
G.
Hair or nail analysis:
MAD does not cover hair or nail
				analysis.
H.
Preparations
				dispensed for home use:
MAD does not cover oral, topical, otic, or
				ophthalmic preparations dispensed to a MAP eligible recipient by a PCP, a CNP,
				a P.A., or an optometrist for home use or self administration unless authorized
				by MAD to assure the availability of medications.
I.
Routine physical
				examinations:
MAD only covers a routine physical examination for:
(1) a MAP eligible recipient residing in a NF
				or an ICF-IID facility.
(2) a MAP
				eligible recipient under 21 years of age through the tot to teen health check
				screen, New Mexico's EPSDT screening program. Included in the coverage is the
				physical examinations, screenings and treatment.