New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 290 - MEDICAID ELIGIBILITY - HOME AND COMMUNITY-BASED SERVICES WAIVER (CATEGORIES 090, 091, 092, 093, 094, 095 AND 096) › Part 400 - RECIPIENT POLICIES › Section 8.290.400.7 - DEFINITIONS

Current through Register Vol. 35, No. 13, July 16, 2024
A.
Adaptive
				behavior:
The effectiveness or degree with which individuals meet the
				standards of personal independence and social responsibility expected for their
				age and cultural group.
B.
Comprehensive care plan (CCP):
The comprehensive care plan of
				services that meets the member's physical, behavioral and long-term care needs
				in managed care.
C.
Developmental disability:
For the purposes of the developmental
				disabilities (DD) waiver, a developmental disability is limited to an
				intellectual disability or a specific related condition as defined by the
				department of health/developmental disabilities supports division (DOH/DDSD)
				that is likely to continue indefinitely and results in substantial functional
				limitations in three or more of the following areas of major life activity:
				self-care, receptive and expressive language, learning, mobility,
				self-direction, capacity for independent living and economic
				self-sufficiency.
D.
Developmental period:
The time between birth and the
				18th birthday.
E.
Disability determination unit
				(DDU):
The unit that determines disability as described in Section
				8.200.420.11
				NMAC.
F.
General intellectual
				functioning:
The results of one or more individually administered
				general intelligence tests developed for the purpose of assessing intellectual
				functioning.
G.
Individual
				service plan (ISP):
A treatment plan for an eligible recipient that
				includes the eligible recipient's needs, functional level, intermediate and
				long range goals, statement for achieving the goals and specifies
				responsibilities for the care needs. The plan determines the services allocated
				to the eligible recipient within program allowances.
H.
Intermediate care facility for
				individuals with intellectual disabilities (ICF/IID):
This term replaces
				all references to intermediate care facility for mental retardation
				(ICF/MR).
I.
Intellectual
				disability (ID):
Refers to significantly sub-average general
				intellectual functioning existing concurrently with deficits in adaptive
				behavior and manifested during the developmental period. Intellectual
				disability replaces all references to mental retardation.
J.
Letter of allocation:
Written
				notice to the applicant that they may proceed with the home and community-based
				services (HCBS) waiver application process.
K.
Level of care:
The level of
				institutional care needed by the eligible recipient.
L.
Medically Fragile:
For the
				purposes of the medically fragile waiver (MFW), medically fragile is a chronic
				physical condition, which results in a prolonged dependency on medical care for
				which daily skilled (nursing) intervention is medically necessary.
M.
Primary Freedom of Choice (PFOC):
The form included in the allocation packet that allows a registrant to
				confirm his or her interest in pursuing the opportunity to apply for community
				benefits.
N.
Prospective:
A period of time starting with the date of application
				going forward.
O.
Restricted
				coverage:
Medicaid eligibility without long term care services
				coverage.
P.
Significantly
				subaverage intellectual functioning:
IQ of 70 or below.
Q.
Unduplicated recipient positions
				(UDR):
Space available in a particular HCBS waiver program.
R.
Waiver:
Permission from the
				centers for medicare and medicaid services (CMS) to waive certain medicaid
				requirements in order for a state to furnish an array of home and
				community-based services to state-specified target group(s) of medicaid
				recipients who need a level of institutional care.