reglab/statecodes huggingface dataset:
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 298 - MEDICAID ELIGIBILITY - LOSS OF PARENT CARETAKER MEDICAID DUE TO EARNINGS FROM EMPLOYMENT › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.298.500.8 - MISSION

Current through Register Vol. 35, No. 13, July 16, 2024
To reduce the impact of poverty on people living in New
				  Mexico by providing support services that help families break the cycle of
				  dependency on public assistance.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 298 - MEDICAID ELIGIBILITY - LOSS OF PARENT CARETAKER MEDICAID DUE TO EARNINGS FROM EMPLOYMENT › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.298.500.9 - RESOURCE STANDARDS

Current through Register Vol. 35, No. 13, July 16, 2024
There are no resource standards for this category of
				  eligibility.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 298 - MEDICAID ELIGIBILITY - LOSS OF PARENT CARETAKER MEDICAID DUE TO EARNINGS FROM EMPLOYMENT › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.298.500.10 - INCOME STANDARDS

Current through Register Vol. 35, No. 13, July 16, 2024
There are no income standards for this category of
				  eligibility.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 298 - MEDICAID ELIGIBILITY - LOSS OF PARENT CARETAKER MEDICAID DUE TO EARNINGS FROM EMPLOYMENT › Part 600 - BENEFIT DESCRIPTION › Section 8.298.600.1 - ISSUING AGENCY

Current through Register Vol. 35, No. 13, July 16, 2024
New Mexico Health Care Authority.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 298 - MEDICAID ELIGIBILITY - LOSS OF PARENT CARETAKER MEDICAID DUE TO EARNINGS FROM EMPLOYMENT › Part 600 - BENEFIT DESCRIPTION › Section 8.298.600.2 - SCOPE

Current through Register Vol. 35, No. 13, July 16, 2024
The rule applies to the general public.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 298 - MEDICAID ELIGIBILITY - LOSS OF PARENT CARETAKER MEDICAID DUE TO EARNINGS FROM EMPLOYMENT › Part 600 - BENEFIT DESCRIPTION › Section 8.298.600.3 - STATUTORY AUTHORITY

Current through Register Vol. 35, No. 13, July 16, 2024
The New Mexico medicaid program is administered pursuant to
				  regulations promulgated by the federal department of health and human services
				  under Title XIX of the Social Security Act as amended or by state statute. See
				  Section 27-1-12
et seq
., NMSA 1978. Section 9-8-1 et seq. NMSA
				  1978 establishes the health care authority (HCA) as a single, unified
				  department to administer laws and exercise functions relating to health care
				  facility licensure and health care purchasing and regulation.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 298 - MEDICAID ELIGIBILITY - LOSS OF PARENT CARETAKER MEDICAID DUE TO EARNINGS FROM EMPLOYMENT › Part 600 - BENEFIT DESCRIPTION › Section 8.298.600.5 - EFFECTIVE DATE

Current through Register Vol. 35, No. 13, July 16, 2024
January 1, 2019, or upon a later approval date by the federal
				  centers for medicare and medicaid services (CMS), unless a later date is cited
				  at the end of the section.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 298 - MEDICAID ELIGIBILITY - LOSS OF PARENT CARETAKER MEDICAID DUE TO EARNINGS FROM EMPLOYMENT › Part 600 - BENEFIT DESCRIPTION › Section 8.298.600.6 - OBJECTIVE

Current through Register Vol. 35, No. 13, July 16, 2024
The objective of this rule is to provide eligibility
				  guidelines when determining eligibility for the medical assistance division
				  (MAD) medicaid program and other health care programs it administers. Processes
				  for establishing and maintaining this category of eligibility are found in the
				  affordable care general provision chapter located at 8.291.400 NMAC through
				  8.291.430 NMAC.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 298 - MEDICAID ELIGIBILITY - LOSS OF PARENT CARETAKER MEDICAID DUE TO EARNINGS FROM EMPLOYMENT › Part 600 - BENEFIT DESCRIPTION › Section 8.298.600.7 - DEFINITIONS

Current through Register Vol. 35, No. 13, July 16, 2024
Refer to
				  8.291.400.7
				  NMAC.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 298 - MEDICAID ELIGIBILITY - LOSS OF PARENT CARETAKER MEDICAID DUE TO EARNINGS FROM EMPLOYMENT › Part 600 - BENEFIT DESCRIPTION › Section 8.298.600.9 - BENEFIT DESCRIPTION

Current through Register Vol. 35, No. 13, July 16, 2024
A medicaid eligible recipient under this category is eligible
				  to receive the full range of medicaid covered services.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 298 - MEDICAID ELIGIBILITY - LOSS OF PARENT CARETAKER MEDICAID DUE TO EARNINGS FROM EMPLOYMENT › Part 600 - BENEFIT DESCRIPTION › Section 8.298.600.10 - BENEFIT DETERMINATION

Current through Register Vol. 35, No. 13, July 16, 2024
The HSD income support division (ISD) determines initial and
				  ongoing eligibility.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 298 - MEDICAID ELIGIBILITY - LOSS OF PARENT CARETAKER MEDICAID DUE TO EARNINGS FROM EMPLOYMENT › Part 600 - BENEFIT DESCRIPTION › Section 8.298.600.11 - PERIODIC REDETERMINATIONS OF ELIGIBILITY

Current through Register Vol. 35, No. 13, July 16, 2024
A. A 12 month period of eligibility following
				parent caretaker medicaid is established without a new application. At the end
				of the 12 month period of eligibility a beneficiary is evaluated for other
				medicaid coverage in accordance with
				8.291.410.19
				NMAC. Retroactive medicaid coverage is not provided in accordance with
				8.200.400.14
				NMAC.
B. All changes that may
				affect eligibility must be reported within 10 calendar days from the date of
				the change as detailed in 8.291.400 NMAC.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 299 - MEDICAID ELIGIBILITY - FAMILY PLANNING SERVICES › Part 400 - RECIPIENT REQUIREMENTS › Section 8.299.400.3 - STATUTORY AUTHORITY

Current through Register Vol. 35, No. 13, July 16, 2024
The New Mexico medicaid program and other health care
				  programs are administered pursuant to regulations promulgated by the federal
				  department of health and human services under Title XIX of the Social Security
				  Act as amended or by state statute. See Section 27-1-12
et
				  seq
., NMSA 1978. Section 9-8-1 et seq. NMSA 1978 establishes the
				  health care authority (HCA) as a single, unified department to administer laws
				  and exercise functions relating to health care facility licensure and health
				  care purchasing and regulation.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 299 - MEDICAID ELIGIBILITY - FAMILY PLANNING SERVICES › Part 400 - RECIPIENT REQUIREMENTS › Section 8.299.400.5 - EFFECTIVE DATE

Current through Register Vol. 35, No. 13, July 16, 2024
January 1, 2019, or upon a later approval date by the federal
				  centers for medicare and medicaid services (CMS), unless a later date is cited
				  at the end of the section.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 299 - MEDICAID ELIGIBILITY - FAMILY PLANNING SERVICES › Part 400 - RECIPIENT REQUIREMENTS › Section 8.299.400.6 - OBJECTIVE

Current through Register Vol. 35, No. 13, July 16, 2024
The objective of this rule is to provide specific
				  instructions when determining eligibility for the medicaid program and other
				  health care programs. Processes for establishing and maintaining this category
				  of eligibility are found in the affordable care general provision chapter
				  located at 8.291.400 NMAC through 8.291.430 NMAC.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 299 - MEDICAID ELIGIBILITY - FAMILY PLANNING SERVICES › Part 400 - RECIPIENT REQUIREMENTS › Section 8.299.400.9 - WHO CAN BE A RECIPIENT (42 CFR 435.214)

Current through Register Vol. 35, No. 13, July 16, 2024
HSD provides medicaid limited to family planning and family
				  planning related services to individuals (of any gender) who:
A. are under the age of 51 and do not have
				other health insurance; or
B. who
				are under the age of 65 who have only medicare coverage and no other health
				insurance; and
C. who are not
				pregnant; and
D. meet the general
				recipient requirements found at 8.291.410 NMAC; and
E. meet the income eligibility requirements
				found at Subsection B of
				8.299.500.10
				NMAC.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 299 - MEDICAID ELIGIBILITY - FAMILY PLANNING SERVICES › Part 400 - RECIPIENT REQUIREMENTS › Section 8.299.400.10 - BASIS FOR DEFINING THE GROUP

Current through Register Vol. 35, No. 13, July 16, 2024
At time of application, an applicant or recipient and the
				  department shall identify everyone who is to be considered for inclusion in the
				  assistance unit and budget group as defined in 8.291.430
				  NMAC.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 299 - MEDICAID ELIGIBILITY - FAMILY PLANNING SERVICES › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.299.500.3 - STATUTORY AUTHORITY

Current through Register Vol. 35, No. 13, July 16, 2024
The New Mexico medicaid program is administered pursuant to
				  regulations promulgated by the federal department of health and human services
				  under Title XIX of the Social Security Act as amended or by state statute. See
				  Section 27-1-12 et seq, NMSA 1978. Section 9-8-1 et seq. NMSA 1978 establishes
				  the health care authority (HCA) as a single, unified department to administer
				  laws and exercise functions relating to health care facility licensure and
				  health care purchasing and regulation.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 299 - MEDICAID ELIGIBILITY - FAMILY PLANNING SERVICES › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.299.500.5 - EFFECTIVE DATE

Current through Register Vol. 35, No. 13, July 16, 2024
October 1, 2017, unless a later date is cited at the end of a
				  section.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 299 - MEDICAID ELIGIBILITY - FAMILY PLANNING SERVICES › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.299.500.6 - OBJECTIVE

Current through Register Vol. 35, No. 13, July 16, 2024
The objective of this rule is to provide specific
				  instructions when determining eligibility for the medicaid program and other
				  health care programs. Processes for establishing and maintaining this category
				  of eligibility are found in the affordable care general provision chapter
				  located at 8.291.400 NMAC through 8.291.430 NMAC.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 299 - MEDICAID ELIGIBILITY - FAMILY PLANNING SERVICES › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.299.500.8 - MISSION

Current through Register Vol. 35, No. 13, July 16, 2024
To transform lives. Working with our partners, we design and
				  deliver innovative, high quality health and human services that improve the
				  security and promote independence for New Mexicans in their
				  communities.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 299 - MEDICAID ELIGIBILITY - FAMILY PLANNING SERVICES › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.299.500.9 - RESOURCE STANDARDS

Current through Register Vol. 35, No. 13, July 16, 2024
Resources are not an eligibility factor for this category of
				  eligibility.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 299 - MEDICAID ELIGIBILITY - FAMILY PLANNING SERVICES › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.299.500.10 - INCOME STANDARD

Current through Register Vol. 35, No. 13, July 16, 2024
In order to become eligible for family planning medicaid, the
				  total countable income of the budget group must be less than two hundred fifty
				  percent of the federal poverty guidelines found at 8.291.430
				  NMAC.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 299 - MEDICAID ELIGIBILITY - FAMILY PLANNING SERVICES › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.299.500.11 - INCOME ELIGIBILITY

Current through Register Vol. 35, No. 13, July 16, 2024
Income methodology is based on modified adjusted gross income
				  (MAGI) in accordance with 42 Code of Federal Regulations (CFR) 435.603. Per
				  42 CFR
				  435.603(h)(2) HSD bases
				  financial eligibility on current monthly household income and family size.
				  Current monthly household income is defined as a 30-day period. If an amount of
				  income is received less frequently than monthly, that amount is converted by
				  dividing the total income by the number of months the income is intended to
				  cover.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 299 - MEDICAID ELIGIBILITY - FAMILY PLANNING SERVICES › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.299.500.12 - DISREGARD

Current through Register Vol. 35, No. 13, July 16, 2024
An income disregard according to 8.291.430 NMAC will be given
				  only to individuals whose countable modified adjusted gross income (MAGI) is at
				  or above two hundred fifty percent of the federal poverty level for the size of
				  the budget group.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 299 - MEDICAID ELIGIBILITY - FAMILY PLANNING SERVICES › Part 600 - BENEFIT DESCRIPTION › Section 8.299.600.3 - STATUTORY AUTHORITY

Current through Register Vol. 35, No. 13, July 16, 2024
The New Mexico medicaid program and other health care
				  programs are administered pursuant to regulations promulgated by the federal
				  department of health and human services under Title XIX of the Social Security
				  Act as amended or by state statute. See Section 27-1-12
et
				  seq
., NMSA 1978. Section 9-8-1 et seq. NMSA 1978 establishes the
				  health care authority (HCA) as a single, unified department to administer laws
				  and exercise functions relating to health care facility licensure and health
				  care purchasing and regulation.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 299 - MEDICAID ELIGIBILITY - FAMILY PLANNING SERVICES › Part 600 - BENEFIT DESCRIPTION › Section 8.299.600.5 - EFFECTIVE DATE

Current through Register Vol. 35, No. 13, July 16, 2024
January 1, 2019, or upon a later approval date by the federal
				  centers for medicare and medicaid services (CMS), unless a later date is cited
				  at the end of the section.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 299 - MEDICAID ELIGIBILITY - FAMILY PLANNING SERVICES › Part 600 - BENEFIT DESCRIPTION › Section 8.299.600.6 - OBJECTIVE

Current through Register Vol. 35, No. 13, July 16, 2024
The objective of this rule is to provide specific
				  instructions when determining eligibility for the medicaid program and other
				  health care programs. Processes for establishing and maintaining this category
				  of eligibility are found in the affordable care general provision chapter
				  located at 8.291.400 NMAC through 8.291.430 NMAC.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 299 - MEDICAID ELIGIBILITY - FAMILY PLANNING SERVICES › Part 600 - BENEFIT DESCRIPTION › Section 8.299.600.9 - BENEFIT DESCRIPTION

Current through Register Vol. 35, No. 13, July 16, 2024
This category provides a limited range of medicaid-covered
				  services for family planning and family planning-related services for both men
				  and women.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 299 - MEDICAID ELIGIBILITY - FAMILY PLANNING SERVICES › Part 600 - BENEFIT DESCRIPTION › Section 8.299.600.10 - BENEFIT DETERMINATION

Current through Register Vol. 35, No. 13, July 16, 2024
The HSD income support division (ISD) determines initial and
				  ongoing eligibility. Refer to affordable care general provision chapters
				  located at 8.291.400 through 8.291.430 NMAC for eligibility requirements.
				  Retroactive medicaid coverage is provided in accordance with
				  8.200.400.14
				  NMAC.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 299 - MEDICAID ELIGIBILITY - FAMILY PLANNING SERVICES › Part 600 - BENEFIT DESCRIPTION › Section 8.299.600.11 - PERIODIC REDETERMINATIONS OF ELIGIBILITY

Current through Register Vol. 35, No. 13, July 16, 2024
A. A redetermination of eligibility is
				conducted in accordance with 8.291.410 NMAC.
B. All changes that may affect eligibility
				must be reported within 10 calendar days of the date of the change as detailed
				in 8.291.400 NMAC.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 300 - MEDICAID GENERAL INFORMATION › Part 1 - GENERAL PROGRAM DESCRIPTION › Section 8.300.1.3 - STATUTORY AUTHORITY

Current through Register Vol. 35, No. 13, July 16, 2024
The New Mexico medicaid program is administered pursuant to
				  regulations promulgated by the federal department of health and human services
				  under Title XIX of the Social Security Act as amended, and by state statute.
				  See Section 27-2-12 et seq. NMSA 1978 (Repl. Pamp. 1991). Section 9-81 et seq.
				  NMSA 1978 establishes the health care authority (HCA) as a single, unified
				  department to administer laws and exercise functions relating to health care
				  facility licensure and health care purchasing and regulation.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 300 - MEDICAID GENERAL INFORMATION › Part 1 - GENERAL PROGRAM DESCRIPTION › Section 8.300.1.6 - OBJECTIVE

Current through Register Vol. 35, No. 13, July 16, 2024
The objective of these rules is to provide policies for the
				  service portion of the New Mexico medical assistance
				  programs.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 300 - MEDICAID GENERAL INFORMATION › Part 1 - GENERAL PROGRAM DESCRIPTION › Section 8.300.1.8 - MISSION STATEMENT

Current through Register Vol. 35, No. 13, July 16, 2024
The mission of the New Mexico medical assistance division
				  (MAD) is to maximize the health status of eligible recipients by furnishing
				  payment for quality health services at levels comparable to private health
				  plans.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 300 - MEDICAID GENERAL INFORMATION › Part 1 - GENERAL PROGRAM DESCRIPTION › Section 8.300.1.9 - GENERAL PROGRAM DESCRIPTION

Current through Register Vol. 35, No. 13, July 16, 2024
The HCA, through MAD, is responsible for the administration
				  of the medicaid program and other health care programs. This joint federal and
				  state program provides payment for medically necessary health services
				  furnished to eligible recipients.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 300 - MEDICAID GENERAL INFORMATION › Part 1 - GENERAL PROGRAM DESCRIPTION › Section 8.300.1.10 - RELATIONSHIP TO MEDICARE

Current through Register Vol. 35, No. 13, July 16, 2024
MAD covers medically necessary health services furnished to
				  eligible recipients who meet specific income, resource and eligibility
				  standards. Medicare is a federal program which offers health insurance coverage
				  to eligible recipients 65 years of age or older, to those who have received
				  disability benefits for 24 consecutive months, to those who have end stage
				  renal disease, and to other eligible recipients, as specified by other
				  provisions of the Social Security Act.
A. The state of New Mexico has entered into
				an agreement with the social security administration to pay medicaid eligible
				recipient premiums for medicare part B, and under some circumstances, medicare
				part A premiums.
B. After medicare
				has made payment for services, the medicaid program pays for the medicare
				co-insurance and deductible amounts for all eligible medicaid recipients
				subject to the following medicaid reimbursement limitations.
(1) Medicaid payment for the co-insurance and
				deductible is limited such that the payment from medicare, plus the amount
				allowed by medicaid for the co-insurance and deductible, shall not exceed the
				medicaid allowed amount for the service. When the medicare payment exceeds the
				amount that medicaid would have allowed for the service, no payment is made for
				the co-insurance or deductible. The claim is considered paid in full. The
				provider may not collect any remaining portion of the medicare co-insurance or
				deductible from the eligible recipient or their personal representative. For
				services for which medicare part B applies a fifty percent co-insurance rate,
				medicare co-insurance and deductible amounts may be paid at an amount that
				allows the provider to receive more than medicaid allowed amount, not to exceed
				a percentage determined by HCA.
(2)
				The medicaid program will pay toward the medicare co-insurance and deductible
				to the extent that the amount paid by medicare and the allowed medicare
				co-insurance and deductible together do not exceed the medicaid allowed amount.
				The medicaid program will pay the medicare co-insurance and deductible when the
				medicaid program does not have a specific amount allowed for the
				service.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 300 - MEDICAID GENERAL INFORMATION › Part 2 - HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT OF 1996 (HIPAA) POLICIES › Section 8.300.2.1 - ISSUING AGENCY

Current through Register Vol. 35, No. 13, July 16, 2024
New Mexico Health Care Authority.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 300 - MEDICAID GENERAL INFORMATION › Part 2 - HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT OF 1996 (HIPAA) POLICIES › Section 8.300.2.2 - SCOPE

Current through Register Vol. 35, No. 13, July 16, 2024
The rule applies to the general public.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 300 - MEDICAID GENERAL INFORMATION › Part 2 - HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT OF 1996 (HIPAA) POLICIES › Section 8.300.2.3 - STATUTORY AUTHORITY

Current through Register Vol. 35, No. 13, July 16, 2024
The New Mexico medicaid program is administered pursuant to
				  regulations promulgated by the federal department of health and human services
				  under Title XIX of the Social Security Act as amended, and by state statute.
				  See Section 27-2-12 et seq. NMSA 1978 (Repl. Pamp. 1991). Section 9-81 et seq.
				  NMSA 1978 establishes the health care authority (HCA) as a single, unified
				  department to administer laws and exercise functions relating to health care
				  facility licensure and health care purchasing and regulation.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 300 - MEDICAID GENERAL INFORMATION › Part 2 - HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT OF 1996 (HIPAA) POLICIES › Section 8.300.2.5 - EFFECTIVE DATE

Current through Register Vol. 35, No. 13, July 16, 2024
July 1, 2024, unless a later date is cited at the end of a
				  section.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 300 - MEDICAID GENERAL INFORMATION › Part 2 - HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT OF 1996 (HIPAA) POLICIES › Section 8.300.2.6 - OBJECTIVE

Current through Register Vol. 35, No. 13, July 16, 2024
The objective of this rule is to provide Health Insurance
				  Portability and Accountability Act (HIPAA) instructions and policies for the
				  New Mexico medical assistance programs.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 300 - MEDICAID GENERAL INFORMATION › Part 2 - HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT OF 1996 (HIPAA) POLICIES › Section 8.300.2.8 - MISSION STATEMENT

Current through Register Vol. 35, No. 13, July 16, 2024
The mission of the New Mexico medical assistance division
				  (MAD) is to maximize the health status of eligible recipients by furnishing
				  payment for quality health services at levels comparable to private health
				  plans.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 300 - MEDICAID GENERAL INFORMATION › Part 2 - HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT OF 1996 (HIPAA) POLICIES › Section 8.300.2.9 - GENERAL HIPAA APPLICATION AND INTERPRETATION

Current through Register Vol. 35, No. 13, July 16, 2024
This part describes HIPAA policies including health plan
				  responsibilities, disclosure requirements, minimum necessary, business
				  associates, sanctions, reporting, and documentation requirements. The HCC shall
				  meet all requirements in this chapter.
A. Medicaid is a health plan and a covered
				entity under HIPAA: The New Mexico medicaid program under title XIX of the
				Social Security Act qualifies as a health plan under HIPAA regulations at
				45 CFR
				160.103 and is considered a covered
				entity.
B. Inconsistency between
				state and federal law: In the event of any inconsistency between the federal
				HIPAA privacy rule and New Mexico statutes or regulations, the HIPAA privacy
				rule shall preempt state law, except where
				45CFR
				160.203] :
(1) a determination is made by the secretary
				of the United States department of health and human services pursuant to
				45 CFR
				160.204;
(2) the provision of state law relates to the
				privacy of individually identifiable health information and is more stringent
				than a standard, requirement, or implementation specification under the HIPAA
				privacy rule;
(3) the provision of
				state law and procedures established thereunder provides for the reporting of
				disease or injury, child abuse, birth, or death, or for the conduct of public
				health surveillance, investigation or intervention; or
(4) the provision of state law requires the
				HCC to report, or to provide access to, information for the purpose of
				management audits, financial audits, program monitoring and evaluation, or the
				licensure or certification of facilities or individuals.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 300 - MEDICAID GENERAL INFORMATION › Part 2 - HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT OF 1996 (HIPAA) POLICIES › Section 8.300.2.10 - NOTICE OF PRIVACY PRACTICES

Current through Register Vol. 35, No. 13, July 16, 2024
The HCA shall establish policies protecting a recipient's
				  rights regarding HIPAA privacy practices
				  45CFR
				  164.520.
A. Notice of privacy practices requirements:
(1) HCA shall provide notice of privacy
				practices, update the notice as necessary, and distribute the notice and any
				revised notices to all recipients or their personal representatives.
(2) All notice of privacy practices required
				elements listed in the HIPAA privacy rule shall be contained in the HCA notice
				of privacy practices 45 CFR
				164.520.
(3) The name of every recipient and, as
				applicable, their personal representative to whom the HCA notice of privacy
				practices is sent shall be recorded.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 300 - MEDICAID GENERAL INFORMATION › Part 2 - HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT OF 1996 (HIPAA) POLICIES › Section 8.300.2.11 - RECIPIENT'S RIGHTS

Current through Register Vol. 35, No. 13, July 16, 2024
HCA shall establish policies protecting a recipient's rights
				  regarding HIPAA privacy practices.
A.
				Alternate means of communication: A recipient or their personal representative
				shall have the right to request an alternate means of communication and an
				alternative address to receive communications of protected health information
				(PHI) from the HCC. The HCC shall accommodate such requests when reasonable
				45CFR
				164.522(b).
(1) If the recipient or their personal
				representative is unable to write the request, the recipient or their personal
				representative may request assistance from the HCC. If assistance is provided,
				the HCC shall document that the assistance was given, have the recipient or
				their personal representative sign and date the document, co-sign and retain
				the document in the medical record.
(2) The HCC staff may determine the
				reasonableness of a request. If an HCC staff member is unable to determine if
				the request is reasonable, the staff member may request a supervisor's
				assistance.
(3) If the recipient or
				the recipient's personal representative is present when the request is approved
				or denied, HCC staff shall notify the recipient or the recipient's personal
				representative verbally of the decision, and shall document the notification in
				the recipient's file.
(4) If the
				recipient or their personal representative is not present when the request is
				approved or denied, HCC shall notify the recipient or their personal
				representative of the decision in writing and retain the copy of the decision
				in the recipient's file.
(5) If the
				request is approved, an HCC staff member shall record the alternative method or
				address in the medical record and in the PSO's database.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 300 - MEDICAID GENERAL INFORMATION › Part 2 - HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT OF 1996 (HIPAA) POLICIES › Section 8.300.2.12 - USE AND GENERAL DISCLOSURES OF PROTECTED HEALTH INFORMATION

Current through Register Vol. 35, No. 13, July 16, 2024
PHI shall be used or disclosed only by authorized HCC staff
				  or contractors and only in accordance with HCC policies and procedures
				  45 CFR
				  164.502(a) and
				  45 CFR
				  164.530(i).
A. Making a disclosure when an authorization
				is required: When PHI is requested, an authorized HCC employee shall:
(1) determine if a valid authorization is
				presented. See
				8.300.2.13 NMAC;
(2) determine the identity and authority of
				the requestor as per
				8.300.2.21 NMAC;
(3) if a valid authorization is presented and
				the identity and authority of the requestor is verified, the HCC is authorized
				to disclose the PHI in accordance with the valid authorization's
				instructions;
(4) HCC shall retain
				the valid authorization in the recipient's file;
(5) the valid authorization and the
				disclosure shall be documented in the PSO's database;
(6) if the request is not accompanied by a
				valid authorization, the HCC shall determine if an exception to the
				authorization requirement applies; and
(7) if no exception applies, the HCC shall
				deny the request for disclosure of PHI, document the denial and instruct the
				requestor that a valid authorization shall be obtained from the recipient or
				their personal representative before MAD will disclose PHI.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 300 - MEDICAID GENERAL INFORMATION › Part 2 - HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT OF 1996 (HIPAA) POLICIES › Section 8.300.2.13 - AUTHORIZATIONS

Current through Register Vol. 35, No. 13, July 16, 2024
When a disclosure is made as a result of an exception to an
				  authorization being required, the authorized HCC employee shall follow the
				  specific procedure established for that exception
				  45CFR
				  164.502(b),
				  45 CFR
				  164.508,
				  45 CFR
				  164.512,
				  45 CFR
				  164.532.
A. Treatment, payment, or health care
				operations (TPO):
(1) When conducting daily
				business that involves the use or disclosure of PHI, the HCC shall determine
				whether the use or disclosure is for TPO.
(2) If the person who requested the PHI is
				unknown, the HCC shall verify the identity and authority in accordance with
				8.300.2.21 NMAC.
(3) The HCC shall apply the minimum necessary
				criteria to disclosures of PHI for payment or health care operations.
(4) The HCC shall ensure that there are no
				restrictions to the requested disclosure for PHI.
(5) The HCC shall use or disclose the minimum
				necessary PHI. The minimum necessary criteria do not apply to disclosures or
				requests by a health care provider for treatment purposes.
(6) Disclosures made for the purpose of
				providing TPO are not required to be documented.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 300 - MEDICAID GENERAL INFORMATION › Part 2 - HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT OF 1996 (HIPAA) POLICIES › Section 8.300.2.14 - DISCLOSURES FOR RESEARCH PURPOSES

Current through Register Vol. 35, No. 13, July 16, 2024
A. Before a disclosure is made for research
				purposes, a valid authorization must be signed by the recipient or a waiver of
				authorization must have been obtained from a properly constituted institutional
				review board (IRB), a privacy board or representation that the PHI is necessary
				for research purposes 45CFR
				164.512(i)(l);
				45 CFR
				164.514(b) and
				(e).
B. Disclosure requirements: The HCC shall:
(1) accept requests for PHI for research
				purposes with an authorization; or without a recipient authorization where the
				research entity provides documentation reflecting alteration or waiver of the
				authorization requirement 45CFR 164.512(i)(1) and
				(2):
(2) forward all requests to the
				PSO;
(3) if the requestor is
				unknown, verify the identity and authority of the requestor in accordance with
				8.300.2.21 NMAC;
(4) grant or deny requests in accordance with
				the HIPAA privacy rule 45CFR
				164.512(i): and
(5) enter the disclosure information into the
				PSO's database.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 300 - MEDICAID GENERAL INFORMATION › Part 2 - HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT OF 1996 (HIPAA) POLICIES › Section 8.300.2.15 - RECORDING AUTHORIZATIONS AND DISCLOSURES

Current through Register Vol. 35, No. 13, July 16, 2024
The HCC shall record all valid authorizations and record all
				  disclosures of PHI.
A. Recording of
				authorizations: All valid authorizations shall be recorded when received in the
				PSO's database 45CFR
				164.508(b)(6). Any
				disclosures of PHI shall be made and recorded only by authorized members of the
				HCC workforce in the PSO's database.
B. Exceptions: The only exceptions that shall
				be allowed to the recording of disclosures of PHI are those:
(1) made to carry out TPO;
(2) for notification purposes that include
				disaster relief, emergencies, or in the case of recipient death;
(3) for national security purposes;
(4) to correctional institutions or law
				enforcement officials having custody of an inmate;
(5) made prior to July 1, 2003 45CFR 164.528a
				:
(6) made six years prior to the
				date the accounting is requested;
(7) made to the recipient of the recipient's
				own PHI; or
(8) made to individuals
				involved in the recipient's care.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 300 - MEDICAID GENERAL INFORMATION › Part 2 - HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT OF 1996 (HIPAA) POLICIES › Section 8.300.2.16 - MINIMUM NECESSARY

Current through Register Vol. 35, No. 13, July 16, 2024
The HCC shall apply minimum necessary criteria to limit PHI
				  for the use, disclosure, or request for PHI to the amount necessary to
				  accomplish the task, except for disclosures to or requests by a health care
				  provider for treatment purposes. The minimum necessary criteria do not apply
				  with respect to disclosures to or requests by a health care provider for
				  treatment. 45CFR
				  164.514(d)(2)-(5),
				  45 CFR
				  164.502(b) (2).
A. HCC's use of protected health information:
(1) An HCC supervisor shall determine the
				minimum necessary PHI needed by each HCC employee to perform their job duties
				and shall:
(a) grant appropriate medical
				record access;
(b) grant
				appropriate access to billing and payment information;
(c) grant appropriate access to other files
				containing PHI; or
(d) grant
				appropriate electronic access to PHI and set security levels.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 300 - MEDICAID GENERAL INFORMATION › Part 2 - HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT OF 1996 (HIPAA) POLICIES › Section 8.300.2.17 - DEIDENTIFICATION OF PROTECTED HEALTH INFORMATION

Current through Register Vol. 35, No. 13, July 16, 2024
The HCC may de-identify PHI on recipients by removing all
				  recipient identifiable information
				  45CFR
				  164.514(a)(b). Authorized
				  HCC employees shall forward the PHI to be deidentified to a person with
				  appropriate knowledge of and experience with generally accepted statistical and
				  scientific principles and methods for rendering information not individually
				  identifiable; or they shall remove all the following recipient identifiable
				  information.
A. Names.
B. Location: All geographic subdivisions
				smaller than a state, including street address, city, county, precinct, zip
				code, and their equivalent geocodes, except for the initial three digits of a
				zip code if, according to the current publicly available data from the bureau
				of the census:
(1) the geographic unit formed
				by combining all zip codes with the same three initial digits contains more
				than 20,000 people; and
(2) the
				initial three digits of a zip code for all such geographic units containing
				20,000 or fewer people is changed to 000.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 300 - MEDICAID GENERAL INFORMATION › Part 2 - HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT OF 1996 (HIPAA) POLICIES › Section 8.300.2.18 - TERMINATION OF RESTRICTIONS

Current through Register Vol. 35, No. 13, July 16, 2024
A.
Termination requirements:
Restrictions on the uses and disclosures
				of PHI shall be terminated if:
(1) the
				recipient or the recipient's personal representative requests the termination
				in writing;
(2) the PSO informs the
				recipient or the recipient's personal representative in writing that the HCC
				agreement to a restriction has ended and that the termination of the
				restriction is effective with any PHI created or received after the recipient
				or the recipient's personal representative is notified of the termination
				45CFR
				164.522(a)(2): or
(3) if the recipient is unable to write the
				request, the recipient may request assistance from HCC; if assistance is
				provided, HCC shall document that the assistance was given, have the recipient
				sign and date the document, co-sign and retain the document in the medical
				record.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 300 - MEDICAID GENERAL INFORMATION › Part 2 - HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT OF 1996 (HIPAA) POLICIES › Section 8.300.2.19 - BUSINESS ASSOCIATES

Current through Register Vol. 35, No. 13, July 16, 2024
The HCC shall have privacy protections in all contracts if
				  the contract anticipates that HCC will make disclosures of PHI to the
				  contractor so that the contractor may use the PHI to perform a business
				  associate function on behalf of MAD relating to TPO. The written protections
				  shall satisfy HIPAA privacy rule
				  45 CFR
				  164.504(e).
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 300 - MEDICAID GENERAL INFORMATION › Part 2 - HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT OF 1996 (HIPAA) POLICIES › Section 8.300.2.20 - MITIGATION

Current through Register Vol. 35, No. 13, July 16, 2024
A. HCC workforce:
				To the extent practicable, the HCC shall mitigate any harmful effect that is
				known to the HCC from an improper use or disclosure of a recipient's PHI by an
				HCC employee by applying the requirements set forth in the HCA HIPAA privacy
				policies and procedures applicable to an HCC workforce disciplinary action and
				training 45CFR
				164.530(f). See 8.300.2 23
				and 8.300.2.24 NMAC.
B. Business associates: To the extent
				practicable, the HCC will mitigate any harmful effect that is known to it from
				an improper use or disclosure of a recipient's PHI by any of its business
				associates by including language in its contracts with business associates that
				may impose fines and penalties to the business associate, up to and including
				immediate termination of a business associate's relationship with the HCC
				45CFR
				164.530(f).
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 300 - MEDICAID GENERAL INFORMATION › Part 2 - HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT OF 1996 (HIPAA) POLICIES › Section 8.300.2.21 - VERIFYING IDENTITY AND AUTHORITY

Current through Register Vol. 35, No. 13, July 16, 2024
If the identity or authority of a requestor of PHI is
				  unknown, the identity and authority of that requestor shall be verified prior
				  to any disclosure 45CFR
				  164.514(h).
A. Identification: Upon receipt of a request
				for PHI, an authorized HCC employee must determine whether the requestor is a
				recipient or personal representative of a recipient.
(1) If the requestor is unknown to the
				authorized HCC employee, the employee shall request proof of identity, such as
				a photograph ID, credit card issued to the requestor, or medicaid card issued
				to the requestor.
(2) If the
				request is made over the phone, the HCC employee shall require proof of
				identity by asking for a social security number or omnicaid system
				ID.
(3) If the requestor is the
				recipient, a valid signed authorization satisfies the authority
				requirement.
(4) If the requestor
				is the recipient's personal representative, the HCC employee shall require
				proof of authority to act on the recipient's behalf.
(5) If the request for PHI disclosure is by a
				government official, and the government official's identity is unknown, the HCC
				employee shall verify the identity of the government official by viewing an
				agency identification badge or other official credentials.
(6) The HCC employee shall forward all
				requests for PHI for research purposes to the PSO. See
				8.300.2.14 NMAC.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 300 - MEDICAID GENERAL INFORMATION › Part 2 - HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT OF 1996 (HIPAA) POLICIES › Section 8.300.2.22 - SAFEGUARDING PROTECTED HEALTH INFORMATION

Current through Register Vol. 35, No. 13, July 16, 2024
PHI shall be confidential and shall be subject to
				  safeguarding procedures. PHI shall be restricted from the public
				  45CFR
				  164.530(c).
A. Restricting access to PHI: When meeting
				with recipients or their personal representative, HCC employees shall ensure
				that any PHI that does not belong to that recipient is not visible. If meeting
				with the general public, HCC employees shall ensure that no PHI is accessible
				or visible.
B. Computer monitors:
				The HCC workforce shall:
(1) ensure that all
				computer monitors that provide access to PHI that are located in an area
				accessible to or visible by the general public are not facing the public;
				and
(2) ensure that each computer
				monitor that provides access to PHI is locked with a password-protected screen
				saver or otherwise secure the computer monitor by a method approved by the PSO
				before leaving the computer monitor for any reason.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 300 - MEDICAID GENERAL INFORMATION › Part 2 - HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT OF 1996 (HIPAA) POLICIES › Section 8.300.2.23 - STAFF TRAINING

Current through Register Vol. 35, No. 13, July 16, 2024
All members of the HCC workforce shall be trained within
				  appropriate timeframes on HIPAA privacy policies and procedures regarding the
				  proper use and disclosure of PHI
				  45CFR
				  164.530(b).
A. Initial training: The HCC shall:
(1) develop a training plan with HCC
				supervisory staff involvement to determine the timing of and level of training
				appropriate to members of the HCC workforce;
(2) develop bureau-specific training
				curricula and materials; the training material shall be maintained for six
				years;
(3) provide bureau-specific
				training for the current HCC workforce no later than July 1, 2003;
				and
(4) ensure documentation of
				initial training completion and forward documentation to the HCA office of
				human resources.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 300 - MEDICAID GENERAL INFORMATION › Part 6 - RESPONSIBILITY AND DELEGATION OF AUTHORITY › Section 8.300.6.3 - STATUTORY AUTHORITY

Current through Register Vol. 35, No. 13, July 16, 2024
The New Mexico medicaid program is administered pursuant to
				  regulations promulgated by the federal department of health and human services
				  under Title XIX of the Social Security Act as amended, or by state statute. See
				  Section 27-212 et seq. NMSA 1978 (Repl. Pamp. 2007). Section 9-8-1 et seq. NMSA
				  1978 establishes the health care authority (HCA) as a single, unified
				  department to administer laws and exercise functions relating to health care
				  facility licensure and health care purchasing and regulation.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 300 - MEDICAID GENERAL INFORMATION › Part 6 - RESPONSIBILITY AND DELEGATION OF AUTHORITY › Section 8.300.6.5 - EFFECTIVE DATE

Current through Register Vol. 35, No. 13, July 16, 2024
July 1, 2024, unless a later date is cited at the end of a
				  section.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 300 - MEDICAID GENERAL INFORMATION › Part 6 - RESPONSIBILITY AND DELEGATION OF AUTHORITY › Section 8.300.6.6 - OBJECTIVE

Current through Register Vol. 35, No. 13, July 16, 2024
The objective of these rules is to provide instruction for
				  the service portion of the New Mexico medical assistance
				  programs.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 300 - MEDICAID GENERAL INFORMATION › Part 6 - RESPONSIBILITY AND DELEGATION OF AUTHORITY › Section 8.300.6.8 - MISSION STATEMENT

Current through Register Vol. 35, No. 13, July 16, 2024
The mission of the New Mexico medical assistance division
				  (MAD) is to maximize the health status of eligible recipients by furnishing
				  payment for quality health services at levels comparable to private health
				  plans.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 300 - MEDICAID GENERAL INFORMATION › Part 6 - RESPONSIBILITY AND DELEGATION OF AUTHORITY › Section 8.300.6.9 - RESPONSIBILITY AND DELEGATION OF AUTHORITY TO DIVISION

Current through Register Vol. 35, No. 13, July 16, 2024
MAD administers the state medicaid program and other health
				  care programs. MAD pays for medically necessary services furnished to eligible
				  recipients who qualify for public assistance programs, institutional care
				  programs, and optional programs under federal Social Security Act and other
				  designated programs. See 27-2-12 et seq. NMSA 1978 (Repl. Pamp. 2007). Coverage
				  of services by medicaid is based on the federal Social Security Act, as
				  amended, and subject to the appropriations and availability of federal and
				  state funds. Administration may be provided through designated contractors and
				  other state agencies.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 300 - MEDICAID GENERAL INFORMATION › Part 6 - RESPONSIBILITY AND DELEGATION OF AUTHORITY › Section 8.300.6.10 - STATUS OF PROVIDER TO HEALTH CARE AUTHORITY

Current through Register Vol. 35, No. 13, July 16, 2024
A provider, its agents and employees are independent
				  contractors who perform professional services for eligible recipients served
				  through health care programs administered by HCA or its authorized agents and
				  are not employees of HCA, or the state of New Mexico. A provider shall not
				  purport to bind either HCA or the state of New Mexico to any obligation not
				  expressly authorized, unless HCA has given the provider express written
				  permission to do so.