New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 308 - MANAGED CARE PROGRAM › Part 12 - COMMUNITY BENEFIT › Section 8.308.12.19 - SDCB NON-COVERED SERVICES AND SERVICE LIMITATIONS

Current through Register Vol. 35, No. 13, July 16, 2024
MAD and the member's MCO do not cover certain procedures,
				  services, or miscellaneous items. Services and goods that are not covered by
				  the SDCB approach include, but are not limited to the following:
A. services covered by third-parties; MAD or
				the MCO is the payer of last resort;
B. any service or good, the provision of
				which would violate federal or state statutes, rules or guidance; this includes
				services that are considered primarily recreational or diversional in nature as
				defined in Paragraph (3) of Subsection K of Section 8.301.12.18 NMAC, including
				but not limited to, tickets for movies, theatrical and musical performances,
				sporting events, zoos, and museums;
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. room and board, meaning shelter expenses,
				including property-related costs, such as rental or purchase of real estate and
				furnishing(s), home and property maintenance, utilities and utility deposits,
				and related administrative expenses; utilities include gas, electricity,
				propane, fire wood, 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 a household
				that does not include a person with a disability would be expected to pay for
				as a routine household expense;
G.
				personal goods or items not related to the SDCB member's condition or
				disability;
H. purchase of animals
				and the costs of maintaining animals, including the purchase of food,
				veterinary visits, grooming and boarding but with the exception of training and
				certification for service dogs;
I.
				gas cards and gift cards; items that are purchased with SDCB program funds may
				not be returned for store credit, cash or gift cards;
J. purchase of insurance, such as car,
				health, life, burial, renters, home-owners, service warrantees or other such
				policies. This includes purchase of cell phone insurance;
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
				any other type of weapons;
N.
				gambling, games of chance (such as bingo or lottery), alcohol, tobacco, or
				similar items;
O. vacation
				expenses, including airline tickets, cruise ship or other means of transport,
				guided tours, meals, hotel, lodging or similar recreational expenses; this also
				includes mileage or driver time reimbursement for vacation travel by
				automobile;
P. purchase of usual
				and customary furniture and home furnishings, unless adapted to the SDCB
				member's disability or use, or of specialized benefit to the SDCB member's
				condition; requests for adapted or specialized furniture or furnishings must
				include a doctor's order from the member'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 SDCB member'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 SDCB member's qualifying condition or
				disability; requests must include documentation that the adapted vehicle is the
				SDCB member's primary means of transportation;
S. clothing and accessories, except adaptive
				clothing or accessories based on the SDCB member's disability or
				condition;
T. training expenses for
				paid employees;
U. conference or
				class fees may be covered for SDCB members or unpaid caregivers, but costs
				associated with such conferences or classes cannot be covered, including
				airfare, lodging or meals;
V. for
				member electronics such as cell phones, computers, printers and fax machines,
				or other electronic equipment, no more than one of each type of item may be
				purchased at one time, and member electronics may not be replaced more
				frequently than once every three years; laptops or any electronic tablets are
				considered computers;
W. home
				schooling materials or related supplemental materials and activities;
X. cell phone services that include more than
				one cell phone or cell phone line per SDCB member; cell phone service,
				including data, is limited to the cost of one hundred dollars per month;
				and
Y. moving expenses are limited
				to, the cost of moving truck rental, gas/mileage, labor, moving equipment,
				supplies, boxes, tape and moving blankets.