New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 314 - LONG TERM CARE SERVICES - WAIVERS › Part 3 - MEDICALLY FRAGILE HOME AND COMMUNITY-BASED SERVICES WAIVER SERVICES › Section 8.314.3.7 - DEFINITIONS

Current through Register Vol. 35, No. 13, July 16, 2024
A.
Activities
				of daily living (ADLs):
Those activities associated with an individual's
				daily functioning. The basic skills of everyday living such as toileting,
				bathing, dressing, grooming, and eating and the skills necessary to maintain
				the normal routines of the day, such as housekeeping, shopping and preparing
				meals. The term also includes exercising, personal, social and community
				skills.
B.
Adult:
An
				individual who is 18 years of age or older.
C.
Authorized representative:
An
				individual designated by the eligible recipient or his or her guardian, if
				applicable, to represent the eligible recipient and act on his or her behalf.
				The authorized representative must provide formal documentation authorizing him
				or her to access the identified case information for this specific purpose. An
				authorized representative may be, but need not be, the eligible recipient's
				guardian or attorney.
D.
Category of eligibility (COE):
To qualify for medical assistance
				program (MAP) services, an applicant must meet financial criteria and belong to
				one of the groups that the New Mexico medical assistance division (MAD) has
				defined as eligible.
E.
Centers for medicare and medicaid services (CMS):
Federal agency
				within the United States department of health and human services that works in
				partnership with New Mexico to administer medicaid and MAP services under
				HSD.
F.
Child:
An
				individual under the age of 18. For purpose of early periodic screening,
				diagnosis and treatment (EPSDT) services eligibility, "child" is defined as an
				individual under the age of 21.
G.
Eligible recipient:
An applicant meeting the financial and medical
				level of care (LOC) criteria to receive MAD services through the medically
				fragile program.
H.
Home and
				community-based services (HCBS) waiver:
A set of MAD services that
				provides alternatives to long-term care services in institutional settings,
				such as the medically fragile waiver program. CMS waives certain statutory
				requirements of the Social Security Act to allow HSD to provide an array of
				home and community-based options through these waiver programs.
I.
Intermediate care facilities for
				individuals with intellectual disabilities (ICF/IID):
Facilities that
				are licensed and certified by the New Mexico department of health (DOH) to
				provide room and board, continuous active treatment and other services for
				eligible recipients with a primary diagnosis of intellectual
				disabilities.
J.
Level of
				care (LOC):
The level of care an eligible recipient must meet to be
				eligible for the medically fragile program.
K.
Medically Fragile:
a chronic
				physical condition, which results in a prolonged dependency on medical care for
				which daily skilled (nursing) intervention is medically necessary and is
				characterized by one or more of the following: a life threatening condition
				characterized by reasonable frequent periods of acute exacerbation which
				require frequent medical supervision, or physician consultation and which in
				the absence of such supervision or consultation would require hospitalization;
				a condition requiring frequent, time consuming administration of specialized
				treatments which are medically necessary; or dependence on medical technology
				such that without the technology a reasonable level of health could not be
				maintained; examples include but are not limited to ventilators, dialysis
				machines, enteral or parenteral nutrition support and supplemental
				oxygen.
L.
Medically Fragile
				Waiver (MFW):
New Mexico's 1915 (c) HCBS program serving individuals
				diagnosed with a medically fragile condition prior to the age of 22 and a
				developmental disability or who are developmentally delayed or at risk for
				developmental delay and meet an ICF/IID level of care.
M.
Person centered planning:
A
				service planning process that is directed and led by the recipient, with
				assistance as needed or desired from a representative or other persons of the
				recipient's choosing. Person-centered planning is designed to identify the
				strengths, capacities, preferences, needs, and desired outcomes of the
				recipient. The person-centered process is an ongoing process that enables and
				assists the recipient to identify and access a personalized mix of paid and
				non-paid services and supports that assists him or her to achieve personally
				defined outcomes in the community.
N.
Recipient:
Individual
				receiving waiver services.
O.
Waiver:
A program in which the CMS has waived certain statutory
				requirements of the Social Security Act to allow states to provide an array of
				HCBS options as an alternative to providing long-term care services in an
				institutional setting.