New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 314 - LONG TERM CARE SERVICES - WAIVERS › Part 5 - DEVELOPMENTAL DISABILITIES HOME AND COMMUNITY-BASED SERVICES WAIVER › Section 8.314.5.7 - DEFINITIONS

Current through Register Vol. 35, No. 13, July 16, 2024
A.
Activities of daily living (ADLs):
Basic personal everyday
				activities that include bathing, dressing, transferring (e.g., from bed to
				chair), toileting, oral care, mobility and eating, and skills necessary to
				maintain the normal routines of the day such as housekeeping, shopping and
				preparing meals. The term also includes exercising, personal, social and
				community skills.
B.
Adult:
An individual who is 18 years of age or older.
C.
Authorized representative:
HSD must permit applicants and beneficiaries to designate an individual or
				organization to act responsibly on their behalf in assisting with the
				individual's application and renewal of eligibility and other ongoing
				communications. Such a designation must be in writing including the applicant's
				signature and must be permitted at the time of application and at other times.
				Legal documentation of authority to act on behalf of an applicant or
				beneficiary under state law, such as a court order establishing legal
				guardianship or a power of attorney, shall serve in the place of written
				authorization by the applicant or beneficiary. Representatives may be
				authorized to; sign an application on the applicant's behalf; complete and
				submit a renewal form; receive copies of the applicant or beneficiary's notices
				and other communications from the agency; and act on behalf of the applicant or
				beneficiary in all other matters with the agency. The power to act as an
				authorized representative is valid until the applicant or beneficiary modifies
				the authorization or notifies the agency that the representative is no longer
				authorized to act on their behalf, or the authorized representative informs the
				agency that they are no longer acting in such capacity, or there is a change in
				the legal authority upon which the individual's or organization's authority was
				based. Such notice must be in writing and should include the applicant or
				authorized representative's signature as appropriate. The authorized
				representative is responsible for fulfilling all responsibilities encompassed
				within the scope of the authorized representation to the same extent as the
				individual they represent, and must agree to maintain, or be legally bound to
				maintain, the confidentiality of any information regarding the applicant or
				beneficiary provided by the agency. As a condition of serving as an authorized
				representative, a provider, staff member or volunteer of an organization must
				sign an agreement that they will adhere to the regulations relating to
				confidentiality (relating to the prohibition against reassignment of provider
				claims as appropriate for a health facility or an organization acting on the
				facility's behalf), as well as other relevant state and federal laws concerning
				conflicts of interest and confidentiality of information (42 CFR
				435.923).
D.
Child:
An individual under
				the age of 18. For purpose of early periodic screening, diagnosis and treatment
				(EPSDT) services eligibility, "child" is defined as an individual under the age
				of 21.
E.
Developmental
				disabilities supports division (DDSD):
Operating agency that oversees
				daily administration of New Mexico's 1915c home and community-based waiver
				programs.
F.
Electronic visit
				verification (EVV):
A telephone and computer-based system that
				electronically verifies the occurrence of selected services, as required by the
				21st Century CURES Act. The EVV system verifies the occurrence of authorized
				service visits electronically by documenting the precise time and location
				where service delivery visit begins and ends. EVV is implemented according to
				federal requirements and timelines. The 21st Century CURES Act requires EVV for
				personal care services (PCS), defined as services that provide assistance with
				activities of daily living (ADLs) or instrumental activities for daily living
				(IADLs) effective January 1, 2020 and for home health services effective
				January 1, 2023.
G.
Individual service plan (ISP):
A person-centered plan for an
				eligible recipient that includes their needs, functional levels, intermediate
				and long-range outcomes for achieving their goals and specifies
				responsibilities for the eligible recipient's support needs. The ISP enables
				and assists the recipient to identify and access a personalized mix of paid
				waiver and non-paid services and supports that assists them to achieve
				personally defined outcomes in the community.
H.
Person centered planning
				(PCP):
Person centered planning is a process that places a person at the
				center of planning their life and supports. It is an ongoing process that is
				the foundation for all aspects of the DDW program and DDW service provider's
				work with individuals with I/DD. The process is designed to identify the
				strengths, capacities, preferences, needs, and desired outcomes of the
				recipient. The process may include other persons, freely chosen by the
				individual, who are able to serve as important contributors to the process. It
				involves person centered thinking, person centered service planning and person-
				centered practice.
I.
Supporting documentation:
Sufficient information and documentation
				that demonstrates the request for initial and ongoing developmental
				disabilities waiver (DDW) services is necessary and appropriate based on the
				service specific DDW clinical criteria established by the developmental
				disabilities support division (DDSD) for adult recipients excluding former
				class members of Walter Stephen Jackson, et al vs. Fort Stanton Hospital and
				Training School et. al, (757 F. Supp. 1243 DNM 1990). Examples of supporting
				documentation include but are not limited to: the DDW therapy documentation
				form (TDF), intensive medical living supports (IMLS) and adult nursing services
				parameter tools, electronic comprehensive health assessment tool (e-Chat), all
				other assessments, clinical notes, progress notes, interdisciplinary team (IDT)
				meeting minutes, letters or reports from physicians or ancillary service
				providers that provide sufficient clinical information that demonstrates the
				need for requested services, etc. Any relevant supporting information and
				documentation is acceptable and will be considered by the outside
				reviewer.
J.
Third party
				assessor (TPA):
The medical assistance division (MAD) contractor who
				determines level of care and medical eligibility for the developmental
				disabilities waiver and other 1915c waiver programs.
K.
Waiver:
Permission from the
				centers for medicaid and medicare services (CMS) to cover supports for a
				particular population or service not ordinarily allowed.
L.
Young adult:
An individual
				between the ages of 18 through 20 years of age who is allocated to the DDW and
				is receiving specific services as identified in the DOH/DDSD standards. An
				individual under age 21 is eligible for medical services funded by their
				medicaid providers under EPSDT. Upon the individual's
				21st birthday, they are considered to be an adult
				recipient of DDW services.