New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 314 - LONG TERM CARE SERVICES - WAIVERS › Part 7 - SUPPORTS WAIVER › Section 8.314.7.11 - ELIGIBLE RECIPIENT RESPONSIBILITIES

Current through Register Vol. 35, No. 13, July 16, 2024
Supports waiver eligible recipients have responsibilities to
				  participate in the program. Failure to comply with these responsibilities or
				  other program rules and service standards can result in termination from the
				  program. The eligible recipient has the following responsibilities:
A. To maintain eligibility the recipient must
				complete required documentation demonstrating medical and financial eligibility
				both upon application and annually at recertification, and seek assistance with
				the application and the recertification process as needed from a community
				supports coordinator (CSC).
B. To
				participate in the supports waiver program, the eligible recipient must:
(1) comply with applicable NMAC rules to
				include this rule and supports waiver service standards and requirements that
				govern the program;
(2) collaborate
				with the CSC to choose between the agency-based or participant directed service
				delivery models, and determine support needs related to planning and self
				direction as applicable;
(3)
				collaborate with the CSC to develop an ISP and budget using the IBA in
				accordance with applicable NMAC rules to include this rule and supports waiver
				service standards;
(4) use supports
				waiver program funds appropriately by only requesting and purchasing goods and
				services covered by the supports waiver program in accordance with program
				rules which are identified in the eligible recipient's approved ISP and
				budget;
(5) comply with the
				approved ISP and not exceed the AAB;
(a) if
				the eligible recipient, due to mismanangement or failure to properly track
				expenditures, prematurely depletes the AAB amount during an ISP year, the
				failure to properly manage the AAB does not substantiate a claim for a budget
				increase (e.g. if all of the AAB is expended within the first three months of
				the ISP year, it is not justification for an increase in the budget for the ISP
				year);
(b) revisions to the AAB may
				occur within the ISP year, and the eligible recipient is responsible for
				ensuring that all expenditures are in compliance with the most current AAB in
				effect;
(i) the ISP must be amended to reflect
				a change in the eligible recipient's needs or circumstances before any
				revisions to the AAB can be requested;
(ii) other than for critical health and
				safety reasons, budget revisions may not be submitted to the TPA for review
				within the last 60 calendar days of the budget year;
(c) no supports waiver program funds can be
				used to purchase goods or services prior to TPA approval of the ISP and annual
				budget request;
(d) any funds not
				utilized within the ISP and AAB year cannot be carried over into the following
				year;
(6) access CSC
				services based upon identified need(s) in order to carry out the approved
				ISP;
(7) collaborate with the CSC
				to appropriately document service delivery and maintain documents for evidence
				of services received;
(8) report
				concerns or problems with any part of the supports waiver program to the
				community supports coordinator or if the concern or problem is with the CSC, to
				DOH;
(9) work with the TPA by
				providing documentation and information as requested;
(10) respond to requests for additional
				documentation and information from the CSC provider, FMA, and the TPA within
				the required deadlines;
(11) report
				to the local HSD income support division (ISD) office within 10 calendar days
				any change in circumstances, including a change in address, which might affect
				eligibility for the program; changes in address or other contact information
				must also be reported to the CSC provider and the financial management agency
				(FMA) within 10 calendar days;
(12)
				report to the TPA and CSC provider if hospitalized for more than three
				consecutive nights so that an appropriate LOC can be obtained;
(13) have monthly contact and meet
				face-to-face quarterly with the CSC, as required by the DOH; and
(14) comply with all electronic visit
				verification (EVV) requirements.