New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 314 - LONG TERM CARE SERVICES - WAIVERS › Part 7 - SUPPORTS WAIVER › Section 8.314.7.15 - NON-COVERED SERVICES

Current through Register Vol. 35, No. 13, July 16, 2024
The waiver does not pay for the purchase of goods or
				  services that a household without a person with a disability would be expected
				  to pay for as a routine household or personal expense. If the eligible
				  recipient requests a specific good or service, the CSC and the state can work
				  with the eligible recipient to find other, including less costly, alternatives.
				  Non-covered services include, but are not limited to the following:
A. Services covered by the medicaid state
				plan (including EPSDT), MAD school-based services, medicare and other third
				parties.
B. Any service or good,
				the provision of which would violate federal or state statutes, regulations or
				guidance.
C. Formal academic
				degrees or certification-seeking education, educational services covered by
				IDEA or vocational training provided by the public education department (PED),
				division of vocational rehabilitation (DVR.
D. Food and shelter expenses, including
				property-related costs, such as rental or purchase of real estate and
				furnishing, maintenance, utilities and utility deposits, and related
				administrative expenses; utilities include gas, electricity, propane, firewood,
				wood pellets, water, sewer, and waste management.
E. Experimental or investigational services,
				procedures or goods, as defined in 8.325.6 NMAC.
F. Any goods or services that are to be used
				for recreational or diversional purposes.
G. Personal goods or items not related to the
				disability.
H. Animals and costs of
				maintaining animals including the purchase of food, veterinary visits, grooming
				and boarding except for training and certification for service dogs.
I. Gas cards and gift cards.
J. Purchase of insurance, such as car,
				health, life, burial, renters, homeowners, service warranties or other such
				policies.
K. Purchase of a vehicle,
				and long-term lease or rental of a vehicle.
L. Purchase of recreational vehicles, such as
				motorcycles, campers, boats or other similar items.
M. Firearms, ammunition or other
				weapons.
N. Vacation expenses,
				including airline tickets, cruise ship or other means of transport,
				guided.
O. Meals, hotel, lodging or
				similar recreational expenses.
P.
				Purchase of usual and customary furniture and home furnishings,
unless
adapted to the eligible recipient's disability or use,
				or of specialized benefit to the eligible recipient's condition; requests for
				adapted or specialized furniture or furnishings must include a recommendation
				from the eligible recipient's health care provider and, when appropriate, a
				denial of payment from any other source.
Q. Regularly scheduled upkeep, maintenance
				and repairs of a home and addition of fences, storage sheds or other
				outbuildings,
except
upkeep and maintenance of modifications
				or alterations to a home which are an accommodation directly related to the
				eligible recipient's qualifying condition or disability.
R. Regularly scheduled upkeep, maintenance
				and repairs of a vehicle, or tire purchase or replacement,
except
upkeep and maintenance of modifications or alterations to a vehicle or
				van, which is an accommodation directly related to the eligible recipient's
				qualifying condition or disability; requests must include documentation that
				the adapted vehicle is the eligible recipient's primary means of
				transportation.
S. Clothing and
				accessories, except specialized clothing based on the eligible recipient's
				disability or condition.
T.
				Training expenses for paid employees.
U. Costs associated with such conferences or
				class cannot be covered, including airfare, lodging or meals; consumer
				electronics such as computers, printers and fax machines, or other electronic
				equipment that does not meet the criteria specified in Subsection A of
				8.314.6.14
				NMAC; no more than one of each type of item may be purchased at one time; and
				consumer electronics may not be replaced more frequently than once every three
				years.
V. Cell phone services that
				include fees for data unless data is for an app specifically approved through
				supports waiver funds; or more than one cell phone line per eligible
				recipient.