New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 314 - LONG TERM CARE SERVICES - WAIVERS › Part 6 - MI VIA HOME AND COMMUNITY-BASED SERVICES WAIVER › Section 8.314.6.14 - ELIGIBLE RECIPIENT AND EOR RESPONSIBILITIES

Current through Register Vol. 35, No. 13, July 16, 2024
Mi via eligible recipients have certain 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 and EOR, or authorized signer if the recipient
				  has vendors only, have 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, meet in person with the
				TPA for a comprehensive LOC assessment in the eligible recipient's home, or in
				a location approved by the state and seek assistance with the application and
				the recertification process as needed from a mi via consultant.
B. To participate in the mi via program, the
				eligible recipient must:
(1) comply with
				applicable NMAC rules to include this rule, mi via service standards and
				requirements that govern the program;
(2) collaborate with the consultant to
				determine support needs related to the activities of self-direction;
(3) collaborate with the consultant to
				develop an SSP using the IBA in accordance with applicable NMAC rules to
				include this rule and service standards;
(4) use mi via program funds appropriately by
				only requesting and purchasing goods and services covered by the mi via program
				in accordance with program rules which are identified in the eligible
				recipient's approved SSP;
(5)
				comply with the approved SSP and not exceed the AAB;
(a) if the eligible recipient does not
				adequately allocate the resources contained in the AAB resulting in a premature
				depletion of the AAB amount during an SSP year due to mismanagement or failure
				to properly track expenditures, the failure to properly allocate does not
				substantiate a claim for a budget increase (i.e., if all of the AAB is expended
				within the first three months of the SSP year, it is not justification for an
				increase in the budget for the SSP year);
(b) revisions to the AAB may occur within the
				SSP year, and the eligible recipient is responsible for assuring that all
				expenditures are in compliance with the most current AAB in effect;
(i) the SSP must be amended first 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 mi via program funds can be used to
				purchase goods or services prior to TPA approval of the SSP and annual budget
				request;
(d) any funds not utilized
				within the SSP and AAB year cannot be carried over into the following
				year;
(6) access
				consultant services based upon identified need(s) in order to carry out the
				approved SSP;
(7) collaborate with
				the consultant to appropriately document service delivery and maintain those
				documents for evidence of services received;
(8) report concerns or problems with any part
				of the mi via program to the consultant or if the concern or problem is with
				the consultant, to DOH;
(9) work
				with the TPA agent by attending scheduled meetings, in the eligible recipient's
				home if necessary and providing documentation as requested;
(10) respond to requests for additional
				documentation and information from the consultant 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 consultant provider and the FMA within
				10 calendar days;
(12) report to
				the TPA and consultant provider if hospitalized for more than three consecutive
				nights so that an appropriate LOC can be obtained;
(13) keep track of all budget expenditures
				and assure that all expenditures are within the AAB;
(14) have monthly contact and meet
				face-to-face quarterly with the consultant; and
(15) have an EOR if utilizing employees for
				services; the eligible recipient may be his or her own EOR unless the eligible
				recipient is a minor, or he or she has a plenary or limited guardianship or
				conservatorship over financial matters; an eligible recipient may also
				designate an individual of his or her choice to serve as the EOR, subject to
				the EOR meeting the qualifications specified in this rule. If the recipient is
				using vendors only and selects not to have an EOR then the recipient will
				identify an authorized signer for payment request forms; the eligible recipient
				may be his or her own authorized signer unless the eligible recipient is a
				minor, or he or she has a plenary or limited guardianship or conservatorship
				over financial matters. A POA or other legal instrument may not be used to
				assign the EOR, or authorized signer, responsibilities, in part or in full, to
				another individual and may not be used to circumvent the requirements of the
				EOR, or authorized signer, as designated in this rule.