New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 300 - MEDICAID GENERAL INFORMATION › Part 22 - ELECTRONIC HEALTH RECORDS INCENTIVE PROGRAM › Section 8.300.22.10 - ELIGIBLE PROVIDERS

Current through Register Vol. 35, No. 13, July 16, 2024
A. Health
				care to New Mexico MAD eligible recipients is furnished by a variety of
				providers and provider groups. The reimbursement for these services is
				administered by MAD. Upon approval of a New Mexico MAD provider participation
				agreement or a MAD EHR incentive payment agreement by MAD or its designee,
				licensed practitioners, facilities and other providers of services that meet
				applicable requirements are eligible to be reimbursed for furnishing covered
				services to eligible recipients. A provider must be approved before submitting
				a claim for payment to the MAD claims processing contractors. MAD makes
				available on the HSD/MAD website, on other program-specific websites, or in
				hard copy format, information necessary to participate in health care programs
				administered by HSD or its authorized agents, including program rules, billing
				instructions, utilization review instructions, and other pertinent materials.
				When approved, a provider receives instruction on how to access these
				documents. It is the provider's responsibility to access these instructions, to
				understand the information provided and to comply with the requirements. The
				provider must contact HSD or its authorized agents to obtain answers to
				questions related to the material or not covered by the material. To be
				eligible for reimbursement, a provider must adhere to the provisions of the MAD
				provider participation agreement or a MAD EHR incentive payment agreement, and
				all applicable statutes, regulations, and executive orders. MAD or its selected
				claims processing contractor issues payments to a provider using electronic
				funds transfer (EFT) only.
B. To
				qualify for incentive payments, a provider must be an eligible professional or
				an eligible hospital. A provider who receives incentive payments must have an
				existing fee-for-service (FFS) MAD provider participation agreement or a MAD
				EHR incentive payment agreement, and at least one of their facilities must be
				located within the state of New Mexico.
(1) An
				eligible professional provider may not be hospital-based, unless they practice
				predominantly at a federally qualified health center (FQHC) or a rural health
				center (RHC) as defined by the CMS final rule. A professional provider is
				considered "hospital-based" if he/she furnishes 90 percent or more of his/her
				medicaid professional services during the relevant EHR reporting period in a
				hospital inpatient or emergency room, using the facilities and equipment of the
				hospital. An eligible professional provider may not participate in both the
				medicaid EHR incentive payment program and medicare EHR incentive payment
				program during the same payment year. Eligible professional providers include:
(a) a physician;
(b) a physician assistant practicing in a
				FQHC or RHC led by a physician assistant;
(c) a board certified pediatrician;
(d) a nurse practitioner;
(e) a certified nurse midwife;
(f) a dentist; or
(g) other type of provider when specifically
				allowed by CMS.