New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 308 - MANAGED CARE PROGRAM › Part 12 - COMMUNITY BENEFIT › Section 8.308.12.20 - TRANSITION TO THE SELF-DIRECTED COMMUNITY BENEFIT

Current through Register Vol. 35, No. 13, July 16, 2024
A member who meets a NF LOC and who qualifies for MCO CB
				  must first access services through his or her MCO's ABCB approach. After 120
				  calendar days, the member may continue his or her CB services provided through
				  the MCO's ABCB or may select the MCO's SDCB approach. The member's MCO shall
				  obtain a signed statement from the member regarding his or her decision to
				  participate in the SDCB approach. The signed statement will include member
				  attestation that he or she understands the responsibilities of self-directing
				  his or her CB services, including the management of his or her care plan. For a
				  member transitioning from a NF: and the member continues to meet NF LOC; the
				  member selects his or her MCO's SDCB approach; the member must access CB
				  services through the MCO's ABCB approach for the first 120 calendar days of
				  eligibility; and after 120 calendar days, the member may transition to the
				  MCO's SDCB.
A. Self-assessment: The
				member's care coordinator shall provide him or her with the MAD self-assessment
				instrument. The self-assessment instrument shall be completed by the member
				with assistance from the member's care coordinator upon request. The care
				coordinator shall file the completed self-assessment in the member's
				file.
B. Employer of record (EOR):
				A member who is an unemancipated minor or has an authorized representative over
				financial matters in place cannot serve as his or her own EOR. When the
				member's care coordinator, based on the results of the member's
				self-assessment, determines the member requires assistance to direct his or her
				SDCB services, the member must designate in writing an EOR to assume the
				functions on behalf of the member. A member that serves as his or her EOR has
				the option to do so or may, on his or her own, designate a person to serve as
				his or her EOR in writing. A designated EOR may not also be an employee of the
				member. The member's file must have documentation of either the member acting
				as his or her EOR or of the designated EOR. The member's MCO will make the
				final determination on whether the member may be his or her own EOR.
C. Supports for self-direction: A member or
				his or her authorized representative may designate a person to provide support
				to the member's self-directed functions. The member or his or her authorized
				representative may act as his or her EOR. A member's authorized representative
				may function as the member's spokesperson. The member's care coordinator shall
				include a copy of any EOR or spokesperson forms in the member's file and
				provide copies to the member, the member's authorized representative,
				spokesperson and the FMA.
(1) Care
				coordination for self-direction: The MCO shall ensure that the member or the
				member's authorized representative fully participates in developing and
				administering SDCB services and that sufficient supports, such as care
				coordinators and support brokers, are made available to assist the member or
				the member's authorized representative who requests or requires assistance. In
				this capacity, the care coordinator shall fulfill, in addition to contractual
				requirement, the following tasks:
(a)
				understand member and EOR roles and responsibilities;
(b) identify resources outside the member's
				MCO SDCB, including natural and informal supports, that may assist in meeting
				the member's long term care needs;
(c) understand the array of SDCB
				services;
(d) assign the annual
				SDCB budget based on the member's CNA to address the needs of the
				member;
(e) monitor utilization of
				SDCB services on a regular basis;
(f) conduct employer-related activities such
				as assisting a member in identifying a designated EOR as appropriate;
(g) identify and resolve issues related to
				the implementation of the member's SDCB care plan;
(h) assist the member with quality assurance
				activities to ensure implementation of the member's SDCB care plan and
				utilization of his or her authorized budget;
(i) recognize and report critical incidents,
				including abuse, neglect, exploitation, emergency services, law enforcement
				involvement, and environmental hazards;
(j) monitor quality of services provided by
				the member's support broker; and
(k) work with the member to provide the
				necessary assistance for successful SDCB implementation.