New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 308 - MANAGED CARE PROGRAM › Part 12 - COMMUNITY BENEFIT › Section 8.308.12.18 - COVERED SERVICES IN SELF-DIRECTED COMMUNITY BENEFIT SDCB

Current through Register Vol. 35, No. 13, July 16, 2024
MAD and the member's MCO cover certain procedures, services,
				  and miscellaneous items. For those services that are the same in ABCB and SDCB,
				  detailed descriptions are found in
				  8.308.12.13
				  NMAC. Other services may be available to a member in the SDCB approach and
				  detailed descriptions are included in each subsection of this section.
A. Behavior support consultation is the
				provision of assessment, treatment, evaluation and follow-up services to assist
				the member, his or her parents, family, and primary caregivers with coping
				skills which promote maintaining the member in a home environment. See
				Subsection C of Section
				8.308.12.13
				NMAC for a detailed description of this service.
B. Customized community supports include
				participation in community congregate day programs and centers that offer
				functional meaningful activities that assist with acquisition, retention or
				improvement in self-help, socialization and adaptive skills. Customized
				community supports may include day support models. Customized community
				supports are provided in community day program facilities and centers and can
				take place in non-institutional and non-residential settings. These services
				are provided at least four or more hours per day one or more days per week as
				specified in the member's care plan. Customized community supports settings
				must be integrated and support full access of individuals receiving medicaid
				HCBS to the greater community, engage in community life, control personal
				resources, and receive services in the community, to the same degree of access
				as individuals not receiving medicaid HCBS.
C. Emergency response services provide an
				electronic device that enables a member to secure help in an emergency at his
				or her home, avoiding institutionalization. The member may also wear a portable
				"help" button to allow for mobility. The system is connected to the member's
				phone and programmed to signal a response center when the "help" button is
				activated. The response center is staffed by trained professionals. See
				Subsection E of Section
				8.308.12.13
				NMAC for a detailed description of this service.
D. Employment supports include job
				development, job seeking and job coaching supports after available vocational
				rehabilitation supports have been exhausted. Employment supports settings must
				be integrated and support full access of individuals receiving medicaid HCBS to
				the greater community, engage in community life, control personal resources,
				and receive services in the community, to the same degree of access as
				individuals not receiving medicaid HCBS. See Subsection F of Section
				8.308.12.13
				NMAC for a detailed description of this service.
E. Environmental modification services
				include: the purchase of, the installation of equipment for the physical
				adaptations to a member's residence that are necessary to ensure the health,
				welfare, and safety of the member or enhance the member's level of
				independence. See Subsection G of Section
				8.308.12.13
				NMAC for a detailed description of this service.
F. Home health aide services provide total
				care or assist the member in all ADLs. See Subsection H of Section
				8.308.12.13
				NMAC for a detailed description of this service.
G. Self-directed personal care services (SD
				PCS) are provided on an episodic or continuing basis to assist the member with
				ADLs, performance of general household tasks, provide companionship to acquire,
				maintain, or improve social interaction skills in the community, and enable the
				member to accomplish tasks he or she would normally do for him or herself if he
				or she did not have a disability.
(1)
				Self-directed PCS are provided in the member's home and in the community,
				depending on the member's needs. The member identifies the caregiver's training
				needs, and, if the member is unable to do the training himself or herself, the
				member arranges for the needed training.
(2) Self-directed PCS are not intended to
				replace supports available from a primary caregiver. Self-directed PCS are not
				duplicative of home health aide services.
(3) Home health aides may provide basic
				non-invasive nursing assistant skills within the scope of their practice.
				Self-directed PCS caregivers do not have this ability to perform such
				tasks.
(4) Use of the Electronic
				Visit Verification (EVV) system is required for payment of Self-directed
				PCS.