New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 308 - MANAGED CARE PROGRAM › Part 12 - COMMUNITY BENEFIT › Section 8.308.12.7 - DEFINITIONS

Current through Register Vol. 35, No. 13, July 16, 2024
A.
Agency
				based community benefit (ABCB):
The community benefit (CB) services
				offered to a member who does not wish to self-direct his or her CB
				services.
B.
ABCB care
				plan:
For a member who is participating in the ABCB approach, the care
				plan outlines the specific community benefit services that the member and the
				care coordinator have identified as needed services through the comprehensive
				needs assessment (CNA).
C.
Authorized representative:
The individual designated to represent
				and act on the member's behalf. The member or authorized representative must
				provide formal documentation authorizing the named individual or individuals to
				access the identified case information for a specified purpose and time frame.
				An authorized representative may be an attorney representing a person or
				household, a person acting under the authority of a valid power of attorney, a
				guardian, or any other individual or individuals designated in writing by the
				member.
D.
Budget:
The
				maximum budget allotment available to a self-directed community benefit (SDCB)
				member, determined by his or her CNA. Based on this maximum amount, the
				eligible member will develop a care plan in collaboration with their support
				broker to meet his or her assessed functional, medical and habilitative needs
				to enable that member to remain in the community.
E.
Care coordinator:
The care
				coordinator provides care coordination activities that comply with all state
				and federal requirements. This includes, but is not limited to: assigning an
				appropriate care coordination level; performing a CNA a minimum of annually to
				determine physical, behavioral and long-term care needs; developing a
				comprehensive care plan and budget based on those needs; and delivering
				on-going care coordination services based on the member's assessed need and in
				accordance with the care plan and contractual obligations.
F.
Community benefits (CB):
Services that allow a member to receive care in his or her home or in the
				community as an alternative to being placed in a long-term care facility.
				Services are intended to supplement natural supports and are not available
				24-hours per day.
G.
Comprehensive care plan:
A comprehensive plan that includes
				community benefit services that meet the member's long-term, physical and
				behavioral health care needs which must include, but is not limited to: the
				amount, frequency and duration of the community benefit services, the cost of
				goods and services; the type of provider who will furnish each service; other
				services the member will access; and the member's available supports that will
				complement community benefit services in meeting the member's needs. The member
				works with his or her care coordinator, support broker or both to develop a
				care plan which is submitted to the managed care organization (MCO) for review
				and approval.
H.
Comprehensive needs assessment (CNA):
The comprehensive needs
				assessment will be conducted in person, in the member's primary place of
				residence, by the MCO care coordinator for a member who is assigned a care
				coordination level of two or three. The CNA will assess the physical health,
				behavioral health, and long-term care needs; identify potential risks and
				provide social and cultural information. The results of the CNA will be used to
				create the care plan which is based on the member's assessed needs.
I.
Electronic Visit Verification
				(EVV):
A telephone and computer based system that electronically
				verifies the occurrence of HSD selected services visits and documents the
				precise time the service begins and ends.
J.
Eligible member:
A medical
				assistance programs (MAP) enrolled MCO member who meets a specific level of
				care (LOC) and who selects to receive his or her MCO community benefits either
				through the ABCB or the self-directed community benefit (SDCB) approach. The
				eligible member must continue to meet a specific LOC and financial eligibility
				to continue accessing his or her MCO community benefits.
K.
Employer of record (EOR):
The
				employer of record is the individual responsible for directing the work of the
				member's SDCB employees, including recruiting, hiring, managing and terminating
				all employees. The EOR tracks expenditures for employee payroll, goods, and
				services. The EOR authorizes the payment of timesheets by the financial
				management agency (FMA). A member through the use of the EOR self-assessment
				instrument is either deemed able to be his or her own EOR or the member must
				assign the EOR duties to another eligible individual meeting specific EOR
				qualifications. A member who is a minor or a member who has a plenary or
				limited guardianship or conservatorship over financial matters in place is not
				able to be his or her own EOR. If the recipient is his or her own EOR and
				delegates any EOR responsibilities through a power of attorney (POA) or other
				legal instrument, the delegate must be the designated EOR. A POA or other legal
				instrument shall not be used to assign the responsibilities of an EOR, in part
				or in full, to another individual and shall not be used to circumvent the
				requirements of the EOR as designated in this rule.
L.
Financial management agency
				(FMA):
An entity that contracts with a HSD MCO to provide the fiscal
				administration functions for members participating in the SDCB
				approach.
M.
Individual Plan
				of Care (IPoC):
The plan for the provision of an ABCB member's personal
				care services. The plan is developed by the personal care services (PCS) agency
				and approved by the member's MCO.
N.
Legally responsible individual
				(LRI):
A legally responsible individual is any person who has a duty
				under state law to care for another person. This category typically includes:
				the parent (biological, legal, or adoptive) of a minor child; the guardian of a
				minor child who must provide care to the child; or a spouse.
O.
Nursing Facility level of care (NF
				LOC):
The member's functional level is such that (2) two or more
				activities of daily living (ADLs) cannot be accomplished without consistent,
				ongoing, daily provision, of some or all of the following levels of service:
				skilled, intermediate or assistance. A member must meet the NF LOC to be
				eligible for community benefit services.
P.
Self-directed community benefit
				(SDCB):
The CB services offered to a member who is able to and who
				chooses to self-direct his or her CB services.
Q.
SDCB care plan:
For a member
				who selected the SDCB approach, the care plan includes the services that the
				member and the support broker have identified through the CNA that will be
				purchased with the member's budget.
R.
Support broker:
The function
				of the support broker is to directly assist the member in implementing the care
				plan and budget to ensure access to SDCB services and supports and to enhance
				success with self-direction. The support broker's primary function is to assist
				the member with employer or vendor related functions and other aspects of
				implementing his or her care plan and budget.