reglab/statecodes huggingface dataset:
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 321 - SPECIALIZED BEHAVIORAL HEALTH SERVICES › Part 11 - CRISIS TRIAGE CENTERS › Section 8.321.11.64 - WATER

Current through Register Vol. 35, No. 13, July 16, 2024
A. A CTC licensed
				pursuant to these regulations must be provided with an adequate supply of water
				that is of a safe and sanitary quality suitable for domestic use.
B. If the water supply is not obtained from
				an approved public system, the private water system must be inspected, tested,
				and approved by the New Mexico environment department prior to licensure. It is
				the CTC's responsibility to ensure that subsequent periodic testing or
				inspection of such private water systems be made at intervals prescribed by the
				New Mexico environment department or recognized authority.
C. Hot and cold running water under pressure
				must be distributed at sufficient pressure to operate all fixtures and
				equipment during maximum demand periods.
D. Back flow preventers (vacuum breakers)
				must be installed on hose bibs, laboratory sinks, service sinks, and on all
				other water fixtures to which hoses or tubing can be attached.
E. Water distribution systems are arranged to
				provide hot water at each hot water outlet at all times.
F. Hot water to hand washing facilities must
				not exceed 120 degrees fahrenheit.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 321 - SPECIALIZED BEHAVIORAL HEALTH SERVICES › Part 11 - CRISIS TRIAGE CENTERS › Section 8.321.11.65 - SEWAGE AND WASTE DISPOSAL

Current through Register Vol. 35, No. 13, July 16, 2024
A. All
				sewage and liquid wastes must be disposed of into a municipal sewage system
				where such facilities are available.
B. Where a municipal sewage system is not
				available, the system used must be inspected and approved by the New Mexico
				environment department or recognized local authority.
C. Where municipal or community garbage
				collection and disposal service are not available, the method of collection and
				disposal of solid wastes generated by the CTC must be inspected and approved by
				the New Mexico environment department or recognized local authority.
D. All garbage and refuse receptacles must be
				durable, have tight fitting lids, must be insect and rodent proof, washable,
				leak proof and constructed of materials which will not absorb liquids.
				Receptacles must be kept closed and clean.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 321 - SPECIALIZED BEHAVIORAL HEALTH SERVICES › Part 11 - CRISIS TRIAGE CENTERS › Section 8.321.11.66 - ELECTRICAL STANDARDS

Current through Register Vol. 35, No. 13, July 16, 2024
A. All
				electrical installation and equipment must comply with all current state and
				local codes.
B. Circuit breakers or
				fused switches that provide electrical disconnection and over current
				protection shall be:
(1) enclosed or guarded
				to provide a dead front assembly;
(2) readily accessible for use and
				maintenance;
(3) set apart from
				traffic lanes;
(4) located in a
				dry, ventilated space, free of corrosive fumes or gases;
(5) able to operate properly in all
				temperature conditions;
(6) panel
				boards servicing lighting and appliance circuits shall be on the same floor and
				in the same facility area as the circuits they serve; and
(7) each panel board will be marked showing
				the services.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 321 - SPECIALIZED BEHAVIORAL HEALTH SERVICES › Part 11 - CRISIS TRIAGE CENTERS › Section 8.321.11.67 - LIGHTING

Current through Register Vol. 35, No. 13, July 16, 2024
A. All spaces
				occupied by people, machinery, or equipment within buildings, approaches to
				buildings, and parking lots shall have lighting.
B. Lighting will be sufficient to make all
				parts of the area clearly visible.
C. All lighting fixtures must be
				shielded.
D. Lighting fixtures must
				be selected and located with the comfort and convenience of the staff and
				clients in mind.
E. Lighting
				fixtures in the residential unit shall be recessed, tamperproof or protective
				translucent cover.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 321 - SPECIALIZED BEHAVIORAL HEALTH SERVICES › Part 11 - CRISIS TRIAGE CENTERS › Section 8.321.11.68 - ELECTRICAL CORDS AND RECEPTACLES

Current through Register Vol. 35, No. 13, July 16, 2024
A.
Electrical cords and extension cords
				shall:
(1) be U/L approved;
(2) be replaced as soon as they show
				wear;
(3) be plugged into an
				electrical receptacle within the room where used;
(4) not be used as a general wiring method;
				and
(5) not be used in
				series.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 321 - SPECIALIZED BEHAVIORAL HEALTH SERVICES › Part 11 - CRISIS TRIAGE CENTERS › Section 8.321.11.69 - EMERGENCY POWER & LIGHTING

Current through Register Vol. 35, No. 13, July 16, 2024
Emergency electrical service with an independent power source
				  which covers lighting at attendant stations, exit and corridor lights, boiler
				  room, and fire alarm systems shall be provided.
A. The service may be battery operated if
				effective for at least four hours.
B. Facilities shall have emergency lighting
				with a minimum of two bulbs to light exit passageways.
C. Independent power source shall be in an
				exterior area near the exits and activate automatically upon disruption of
				electrical service.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 321 - SPECIALIZED BEHAVIORAL HEALTH SERVICES › Part 11 - CRISIS TRIAGE CENTERS › Section 8.321.11.70 - FIRE SAFETY COMPLIANCE

Current through Register Vol. 35, No. 13, July 16, 2024
All current applicable requirements of state and local codes
				  for fire prevention and safety must be met by the CTC.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 321 - SPECIALIZED BEHAVIORAL HEALTH SERVICES › Part 11 - CRISIS TRIAGE CENTERS › Section 8.321.11.71 - FIRE CLEARANCE AND INSPECTIONS

Current through Register Vol. 35, No. 13, July 16, 2024
Each CTC must request from the fire authority having
				  jurisdiction an annual fire inspection. If the policy of the fire authority
				  having jurisdiction does not provide for annual inspection of the CTC, the CTC
				  must document the date the request was made and to whom. If the fire
				  authorities do make annual inspections; a copy of the latest inspection must be
				  kept on file in the CTC.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 321 - SPECIALIZED BEHAVIORAL HEALTH SERVICES › Part 11 - CRISIS TRIAGE CENTERS › Section 8.321.11.72 - AUTOMATIC FIRE PROTECTION (SPRINKLER) SYSTEM

Current through Register Vol. 35, No. 13, July 16, 2024
Facilities with residential services shall have an automatic
				  fire protection (sprinkler) system. The system shall be in accordance with NFPA
				  13 or NFPA 13D or its subsequent replacement as applicable. Sprinkler heads in
				  the residential unit shall be of the protective type, either vandal proof or
				  tamper resistant. Sprinkler systems for facilities without residential services
				  must be incompliance with current state building code requirements regarding a
				  sprinkler system.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 321 - SPECIALIZED BEHAVIORAL HEALTH SERVICES › Part 11 - CRISIS TRIAGE CENTERS › Section 8.321.11.73 - FIRE ALARMS, SMOKE DETECTORS AND OTHER EQUIPMENT

Current through Register Vol. 35, No. 13, July 16, 2024
The system shall be in accordance with NFPA 13 or NFPA 13D or
				  its subsequent replacement as applicable.
A. Facilities shall have a manual fire alarm
				system. The manual fire alarm shall be inspected and approved in writing by the
				fire authority with jurisdiction.
B. Approved smoke detectors shall be
				installed on each floor that when activated provides an alarm which is audible
				in all sleeping areas. Areas of assembly, such as the dining, living or
				activity room(s) must also be provided with smoke detectors.
(1) Detectors shall be powered by the house
				electrical service and have battery backup.
(2) Construction of new facilities or
				facilities remodeling or replacing existing smoke detectors shall provide
				detectors in common living areas and in each sleeping room.
(3) Smoke detectors shall be installed in
				corridors at no more than 30 feet spacing.
(4) Heat detectors shall be installed in all
				kitchens and also powered by the house electrical service.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 321 - SPECIALIZED BEHAVIORAL HEALTH SERVICES › Part 11 - CRISIS TRIAGE CENTERS › Section 8.321.11.74 - FIRE EXTINGUISHERS

Current through Register Vol. 35, No. 13, July 16, 2024
Fire extinguisher(s) must be located in the CTC, as approved
				  by the state fire marshal or the fire prevention authority with
				  jurisdiction.
A. Facilities must as a
				minimum have two 2A10BC fire extinguishers:
(1) one extinguisher located in the kitchen
				or food preparation area;
(2) one
				extinguisher centrally located in the CTC;
(3) all fire extinguishers shall be inspected
				yearly, recharged as needed and tagged noting the date of the
				inspection;
(4) The maximum
				distance between fire extinguishers shall be 50 feet.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 321 - SPECIALIZED BEHAVIORAL HEALTH SERVICES › Part 11 - CRISIS TRIAGE CENTERS › Section 8.321.11.75 - STAFF FIRE AND SAFETY TRAINING

Current through Register Vol. 35, No. 13, July 16, 2024
A.
				All staff of the CTC must know the location of and instructed in proper use of
				fire extinguishers and other procedures to be observed in case of fire or other
				emergencies. The CTC should request the fire authority having jurisdiction to
				give periodic instruction in fire prevention and techniques of
				evacuation.
B. CTC staff must be
				instructed as part of their duties to constantly strive to detect and eliminate
				potential safety hazards, such as loose handrails, frayed electrical cords,
				faulty equipment, blocked exits or exit ways, and any other condition which
				could cause burns, falls, or other personal injury to the patients or
				staff.
C. Fire and evacuation
				drills: The CTC must conduct at least one fire and evacuation drill for each
				work shift for each quarter. When drills are conducted between 9:00 pm and 6:00
				am, a coded announcement shall be permitted for use instead of audible alarms.
				A log must be maintained by the CTC showing the date, time, number of staff
				participating and outlining any problems noted in the conduct of the
				drill.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 321 - SPECIALIZED BEHAVIORAL HEALTH SERVICES › Part 11 - CRISIS TRIAGE CENTERS › Section 8.321.11.76 - EVACUATION PLAN

Current through Register Vol. 35, No. 13, July 16, 2024
Each CTC must have a fire evacuation plan conspicuously
				  posted in each separate area of the building showing routes of evacuation in
				  case of fire or other emergencies.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 321 - SPECIALIZED BEHAVIORAL HEALTH SERVICES › Part 11 - CRISIS TRIAGE CENTERS › Section 8.321.11.77 - HEATING, VENTILATION, AND AIRCONDITIONING

Current through Register Vol. 35, No. 13, July 16, 2024
A. Heating, airconditioning, piping, boilers,
				and ventilation equipment must be furnished, installed and maintained to meet
				all requirements of current state and local mechanical, electrical, and
				construction codes.
B. The heating,
				ventilation and air-conditioning system must be able to maintain interior
				temperatures in all rooms used by clients, staff or visitors with interior
				temperatures between 65 degrees fahrenheit and 78 degrees fahrenheit
				year-round.
C. The use of
				non-vented heaters, open flame heaters or portable heaters is
				prohibited.
D. An ample supply of
				outside air must be provided in all spaces where fuel fired boilers, furnaces,
				or heaters are located to assure proper combustion.
E. All fuel fired boilers, furnaces, or
				heaters must be connected to an approved venting system to take the products of
				combustion directly to the outside air.
F. A CTC must be adequately ventilated at all
				times to provide fresh air and the control of unpleasant odors.
G. All gas-fired heating equipment must be
				provided with a one hundred percent automatic cutoff control valve in event of
				pilot failure.
H. The CTC must be
				provided with a system for maintaining clients and staff's comfort during
				periods of hot weather, evaporative cooling is not allowed.
I. All boiler, furnace or heater rooms shall
				be protected from other parts of the building by construction having a fire
				resistance rating of not less than one hour. The door must be self-closing with
				three -quarter hour fire resistance.
J. Fireplace or wood burning stoves are
				prohibited.
K. The ceiling and air
				distribution devices (supply & return, etc.) in the residential component
				shall be a tamper resistant type.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 321 - SPECIALIZED BEHAVIORAL HEALTH SERVICES › Part 11 - CRISIS TRIAGE CENTERS › Section 8.321.11.78 - WATER HEATERS

Current through Register Vol. 35, No. 13, July 16, 2024
A. Must be able
				to supply hot water to all hot water taps within the CTC at full pressure
				during peak demand periods and maintain a maximum temperature of 120 degrees
				fahrenheit.
B. Fuel fired hot water
				heaters must be enclosed and separated from other parts of the building by
				construction as required by current state and local building codes.
C. All water heaters must be equipped with a
				pressure relief valve (pop-off valve).
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 321 - SPECIALIZED BEHAVIORAL HEALTH SERVICES › Part 11 - CRISIS TRIAGE CENTERS › Section 8.321.11.81 - CLIENT RIGHTS

Current through Register Vol. 35, No. 13, July 16, 2024
All licensed facilities shall understand, protect and respect
				  the rights of all youth demonstrating substantial compliance with all
				  applicable New Mexico Children's Code, Section 32A-1-1 NMSA 1978, including the
				  NM Children's Mental Health and Developmental Disabilities Act, Section
				  32A-6A-1 NMSA 1978.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 321 - SPECIALIZED BEHAVIORAL HEALTH SERVICES › Part 11 - CRISIS TRIAGE CENTERS › Section 8.321.11.82 - CLIENT CLINICAL RECORD

Current through Register Vol. 35, No. 13, July 16, 2024
The client clinical records maintained by a crisis triage
				  center in a paper based or electronic system shall document the degree and
				  intensity of the treatment provided to clients who are furnished services by
				  the CTC. A client's clinical record shall contain at a minimum all required NM
				  Children's Code documentation defined in Subsection A through Subsection O of
				  Section 32A-6A-10 NMSA 1978 associated with the use of any emergency
				  interventions such as physical restraint.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 321 - SPECIALIZED BEHAVIORAL HEALTH SERVICES › Part 11 - CRISIS TRIAGE CENTERS › Section 8.321.11.83 - STAFFING REQUIREMENTS

Current through Register Vol. 35, No. 13, July 16, 2024
Other staff requirements:
A. All CYFD background check requirements
				governing criminal records clearances must remain in effect while a program is
				accredited.
B. When a prospective
				employee that will work with or have access to youth has not lived in the
				United States continuously for the five years prior to hire, the CTC must
				obtain the equivalent of a criminal records and background clearance from any
				country in which the prospective employee has lived within the last five years,
				for a period longer than one year.
C. If the CTC receives reliable evidence that
				indicates that an employee or prospective employee poses an unreasonable risk,
				as defined or pursuant to Subsection W of Section
				8.8.3.7 NMAC, the CTC may not hire
				the prospective employee or retain the employee.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 321 - SPECIALIZED BEHAVIORAL HEALTH SERVICES › Part 11 - CRISIS TRIAGE CENTERS › Section 8.321.11.84 - PERSONNEL RECORDS

Current through Register Vol. 35, No. 13, July 16, 2024
Each CTC licensed pursuant to these regulations intending to
				  work with youth must maintain a complete record on file for each staff member
				  or volunteer including:
A. Completed
				CYFD criminal records and background check, including the FBI-approved
				electronic fingerprint for each employee that serves as direct service staff
				working with youth including licensed and certified staff. (supervisors,
				physicians, nurses, therapists, client care workers, coordinators, or other
				agency personnel who work in immediate direct unsupervised contact with youth.)
				The agency must have received the background clearance from the CYFD background
				check unit prior to the employee's direct, unsupervised contact with
				youth.
B. The date the employee was
				first employed and dates of transfers or changes in position.
C. Documentation that of a minimum of three
				references were checked.
D. A
				clearance letter from CYFD stating the applicant's background check has been
				conducted with negative results or a signed statement by the administrator,
				director, or operator attesting to direct supervision of an uncleared employee
				by a cleared employee until official clearance is received.
E. Documentation that each uncleared employee
				is identified on the staff schedule.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 321 - SPECIALIZED BEHAVIORAL HEALTH SERVICES › Part 11 - CRISIS TRIAGE CENTERS › Section 8.321.11.85 - STAFF TRAINING

Current through Register Vol. 35, No. 13, July 16, 2024
At least 12 hours of on-going training shall be provided to
				  staff that provides direct care at least annually; the training and proof of
				  competency shall include at a minimum: NM Children's Mental Health and
				  Developmental Disabilities Act Section 32A-6A-1 et. seq., NMSA
				  1978.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 324 - ADJUNCT SERVICES › Part 4 - PHARMACY SERVICES, PRESCRIBING, AND PRACTITIONER ADMINISTERED DRUG ITEMS › Section 8.324.4.3 - 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 NMSA 1978, Section 27-2-12 et seq.
				  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 324 - ADJUNCT SERVICES › Part 4 - PHARMACY SERVICES, PRESCRIBING, AND PRACTITIONER ADMINISTERED DRUG ITEMS › Section 8.324.4.5 - EFFECTIVE DATE

Current through Register Vol. 35, No. 13, July 16, 2024
January 1, 2014, unless a later date is cited at the end of a
				  section.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 324 - ADJUNCT SERVICES › Part 4 - PHARMACY SERVICES, PRESCRIBING, AND PRACTITIONER ADMINISTERED DRUG ITEMS › Section 8.324.4.6 - OBJECTIVE

Current through Register Vol. 35, No. 13, July 16, 2024
The objective of this rule is to provide instruction for the
				  service portion of the New Mexico medical assistance
				  programs.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 324 - ADJUNCT SERVICES › Part 4 - PHARMACY SERVICES, PRESCRIBING, AND PRACTITIONER ADMINISTERED DRUG ITEMS › Section 8.324.4.8 - MISSION STATEMENT

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 324 - ADJUNCT SERVICES › Part 4 - PHARMACY SERVICES, PRESCRIBING, AND PRACTITIONER ADMINISTERED DRUG ITEMS › Section 8.324.4.9 - PHARMACY SERVICES

Current through Register Vol. 35, No. 13, July 16, 2024
The New Mexico medical assistance division (MAD) pays for
				  medically necessary health services furnished to MAP eligible recipients,
				  including covered pharmacy services and practitioner administered drugs [
				  42
				  CFR Section 440.120(a) ].
				  Pharmacy claims must be submitted to the appropriate pharmacy claims processor
				  as designated by MAD.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 324 - ADJUNCT SERVICES › Part 4 - PHARMACY SERVICES, PRESCRIBING, AND PRACTITIONER ADMINISTERED DRUG ITEMS › Section 8.324.4.10 - ELIGIBLE PROVIDERS

Current through Register Vol. 35, No. 13, July 16, 2024
A. Health
				care to New Mexico MAP eligible recipients is furnished by a variety of
				providers and provider groups. The reimbursement and billing for these services
				is administered by MAD. Upon approval of a New Mexico MAD provider
				participation agreement by MAD or its designee, licensed practitioners,
				facilities and other providers of services that meet applicable requirements
				are eligible to be reimbursed for furnishing covered services to MAP eligible
				recipients. A provider must be enrolled before submitting a claim for payment
				to the MAD claims processing contractors. MAD makes available on the HSD/MAD
				website, on other program-specific websites, or in hard copy format,
				information necessary to participate in health care programs administered by
				HSD or its authorized agents, including program rules, billing instructions,
				utilization review instructions, and other pertinent materials. When enrolled,
				a provider receives instruction on how to access these documents. It is the
				provider's responsibility to access these instructions, to understand the
				information provided and to comply with the requirements. The provider must
				contact HSD or its authorized agents to obtain answers to questions related to
				the material or not covered by the material. To be eligible for reimbursement,
				a provider must adhere to the provisions of the MAD provider participation
				agreement (PPA), an agreement with a HSD contracted managed care organization
				(MCO) and all applicable statutes, regulations, rules, and executive orders.
				MAD or its selected claims processing contractor issues payments to a provider
				using electronic funds transfer (EFT) only. Providers must supply necessary
				information in order for payment to be made. Eligible providers include:
(1) pharmacies licensed by the New Mexico
				pharmacy board;
(2) clinics
				licensed for outpatient dispensing by the New Mexico pharmacy board;
(3) institutional pharmacies licensed for
				outpatient dispensing by the New Mexico pharmacy board;
(4) family planning clinics and rural health
				clinics licensed for outpatient dispensing by the New Mexico pharmacy
				board;
(5) prescribing
				practitioners practicing in communities more than 15 miles from a licensed
				pharmacy;
(6) Indian health service
				(IHS), Indian Self-Determination and Education Assistance Act ("tribal 638")
				and IHS contract pharmacies and drug rooms operated consistent with IHS
				standards of practice for pharmaceutical care; and
(7) mail order pharmacies licensed to
				dispense in New Mexico.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 324 - ADJUNCT SERVICES › Part 4 - PHARMACY SERVICES, PRESCRIBING, AND PRACTITIONER ADMINISTERED DRUG ITEMS › Section 8.324.4.12 - COVERED SERVICES

Current through Register Vol. 35, No. 13, July 16, 2024
MAD covers medically necessary prescription drugs and some
				  over-the-counter drugs, subject to the limitations and restrictions delineated
				  in this section of this rule. Claims for injectable drugs, intravenous (IV)
				  admixtures, IV nutritional products and other expensive medications may be
				  reviewed for medical necessity before or after reimbursement. Providers must
				  consult MAD, or its designated contractor, before supplying items not
				  specifically listed in this policy or billing instructions. Drug restrictions
				  include dosage, day supply, and refill frequency limits necessary to ensure
				  appropriate utilization or to prevent fraud and abuse. In establishing such
				  limits, professional standards are considered.
A. For a MAP eligible recipient 21 years of
				age and older not in an institution, coverage of over-the-counter items is
				limited to insulin
,
diabetic test strips, prenatal vitamins,
				electrolyte replacement system, ophthalmic lubricants, pediculosides and
				scabicides, sodium chloride for inhalations, topical and vaginal antifungals
				and topical anti-inflammatories. MAD, or its designee, may expand the list of
				covered over-the-counter items after making a specific determination that it is
				overall more economical to cover an over-the-counter item as an alternative to
				prescription items or when an over the counter item is a preferred therapeutic
				alternative to prescription drug items. Such coverage is incorporated as part
				of the generic-first coverage provisions. Otherwise, the MAP eligible recipient
				21 years and older, or his or her authorized representative is responsible for
				purchasing or otherwise obtaining an over-the-counter item. Prior authorization
				for coverage of other over the counter products may be requested when a
				specific regimen of over the counter drugs is required to treat chronic disease
				conditions.
B. When drugs are
				provided through a preferred drug list, drugs are subject to generic-first
				coverage provisions. The MAP eligible recipient must first use one or more
				generic items available on the preferred drug list to treat a condition before
				MAD covers a brand name drug for the condition. MAD publishes a list of the
				therapeutic categories of drug items that are exempt from the generic-first
				coverage provisions. Brand name drug items may be covered upon approval by MAD,
				or its designee, including HSD contracted managed care organization (MCO),
				based upon medical justification by the prescriber. Generic-first provisions do
				not apply to injectable drug items.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 324 - ADJUNCT SERVICES › Part 4 - PHARMACY SERVICES, PRESCRIBING, AND PRACTITIONER ADMINISTERED DRUG ITEMS › Section 8.324.4.13 - COVERAGE REQUIREMENTS

Current through Register Vol. 35, No. 13, July 16, 2024
A.
Legal requirements:
All drug items must be assigned a national
				drug code by the respective manufacturer, repackager or labeler. A prescription
				must meet all federal and state laws, regulations and rules. A pharmacy
				provider and a prescriber must fulfill all the requirements of federal and
				state laws relating to his or her practice and ethics.
B.
Rebate requirements:
MAD pays
				only for the drugs of pharmaceutical manufacturers that have entered into and
				have in effect a rebate agreement with the federal department of health and
				human services. This limitation does not apply to dispensing a single-source or
				innovator multiple-source drug if MAD has determined that the availability of
				the drug is essential to the health of a MAP eligible recipient.
C.
Prescribing:
A prescriber
				must be enrolled as a MAD provider in order to prescribe drug items for a MAP
				eligible recipient. A provider who has been terminated or suspended by MAD or
				is not enrolled as a provider must notify his or her MAP eligible recipients
				that he or she cannot prescribe drug items for them.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 324 - ADJUNCT SERVICES › Part 4 - PHARMACY SERVICES, PRESCRIBING, AND PRACTITIONER ADMINISTERED DRUG ITEMS › Section 8.324.4.14 - NONCOVERED SERVICES OR SERVICE RESTRICTIONS

Current through Register Vol. 35, No. 13, July 16, 2024
Pharmacy services are subject to the limitations and coverage
				  restrictions that exist for other MAD services.
A. MAD does not cover the following specific
				pharmacy items:
(1) medication supplied by
				state mental hospitals to a MAP eligible recipient on convalescent leave from
				the center;
(2) methadone for use
				in drug treatment programs except as part of a MAD approved medication assisted
				treatment program (MAT);
(3)
				personal care items such as non-prescription shampoos, soaps;
(4) cosmetic items, such as retin-A for aging
				skin, rogaine for hair loss;
(5)
				drug items that are not eligible for federal financial participation (FFP),
				including drugs not approved as effective by the federal food and drug
				administration (FDA), known as DESI (drug efficacy study implementation)
				drugs;
(6) fertility
				drugs;
(7) antitubercular drug
				items available from the New Mexico department of health (DOH) or the United
				States public health service;
(8)
				weight loss/weight control drugs;
(9) barbiturate hypnotic drugs whose primary
				action is to induce sleep unless the MAP eligible recipient resides in a
				nursing home;
(10) drug items used
				to treat sexual dysfunction;
(11)
				compounded drug items which lack an ingredient approved by the federal food and
				drug administration (FDA) for the indication for which the drug is
				intended;
(12) compounded drug
				items for which the therapeutic ingredient does not have an assigned national
				drug code and is not approved by the FDA for human use; and
(13) cough and cold preparations for a MAP
				eligible recipient under the age of four.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 324 - ADJUNCT SERVICES › Part 4 - PHARMACY SERVICES, PRESCRIBING, AND PRACTITIONER ADMINISTERED DRUG ITEMS › Section 8.324.4.16 - REIMBURSEMENT

Current through Register Vol. 35, No. 13, July 16, 2024
Pharmacy providers must submit claims for reimbursement on
				  the separate pharmacy claim form or its successor, see 8.302.2 NMAC and Section
				  17 of this rule.
A.
General
				reimbursement methodology:
The estimated ingredient cost will not exceed
				the lowest of the estimated acquisition cost (EAC), the maximum allowable cost
				(MAC), the actual acquisition cost of a 340B drug, or the federal upper limit
				(FUL).
(1)
Estimated acquisition cost
				(EAC).
MAD determines EAC as follows:
(a) MAD establishes EAC, defined as MAD's
				approximation of the net or actual acquisition costs of such drugs;
(b) the factors MAD considers in setting
				rates for drugs under this subparagraph include:
(i) product cost, which may vary among
				purchasing contracts;
(ii) clinical
				concerns;
(iii) MAD's budget
				limits;
(iv) the actual package
				size dispensed; and
(v) payments by
				other payers in New Mexico and other state MAD and medicare pricing
				policies;
(c) MAD uses
				the EAC as its reimbursement for a drug when the EAC, plus a dispensing fee
				established by MAD, is the lowest of the rates calculated under the methods
				listed in general reimbursement methodology;
(d) EAC is calculated using the current
				published average wholesale price (AWP) of a drug less a percentage established
				by MAD, the average manufacturer price (AMP) plus a percentage established by
				MAD, or the wholesale acquisition cost (WAC) plus a percentage established by
				HSD, and other pricing limits determined by other pricing information sources
				selected by MAD; and
(e) MAD uses
				the ingredient cost indicated in the ingredient cost field on the billing
				transaction as the EAC when that indicated ingredient cost is lower than the
				MAD EAC.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 324 - ADJUNCT SERVICES › Part 4 - PHARMACY SERVICES, PRESCRIBING, AND PRACTITIONER ADMINISTERED DRUG ITEMS › Section 8.324.4.17 - POINT OF SALE

Current through Register Vol. 35, No. 13, July 16, 2024
The point-of-sale system provides relevant drug utilization
				  information that the pharmacist must consider before dispensing a drug. If
				  utilization information indicates that a MAP eligible recipient has an adequate
				  supply of the drug item or that the quantity being dispensed is excessive, the
				  claim will initially be denied. The pharmacist is responsible for resolving the
				  issue and obtaining an authorization to dispense the drug, if necessary.
A.
General requirements:
All MAD
				in-state and border area pharmacy providers are required to submit claims
				through the point-of-sale system.
B.
Exceptions to general
				requirements:
The following are exceptions to this general requirement:
(1) the provider is out-of-state and is not a
				border area provider;
(2) the
				provider is a family planning clinic dispensing prescriptions;
(3) the provider submitted on average less
				than 50 claims per month to MAD for the preceding six-month period;
(4) the claim requires an attachment or
				explanation; or
(5) a required data
				element on the claim cannot be entered in the current standard point-of-sale
				format.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 324 - ADJUNCT SERVICES › Part 4 - PHARMACY SERVICES, PRESCRIBING, AND PRACTITIONER ADMINISTERED DRUG ITEMS › Section 8.324.4.18 - PRESCRIPTIONS AND REFILLS

Current through Register Vol. 35, No. 13, July 16, 2024
A.
Dispensing frequencies:
MAD limits the frequency for which it
				reimburses the same pharmacy for dispensing the same drug to the same MAP
				eligible recipient.
(1) The limitation is
				established individually for each drug.
(2) Maintenance drugs are subject to a
				maximum of three times in 90 days with a 14-calendar day grace period to allow
				for necessary early refills.
(3)
				Certain drugs are given more flexibility due to their specific dosage forms,
				packaging or clinical concerns.
(4)
				The excessive dispensing limitation applies regardless of whether the claim is
				for a new prescription or refill.
(5) Schedule II controlled substances are
				limited to a maximum 34-day supply. Initial use of controlled substances may
				also be further limited by state law.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 324 - ADJUNCT SERVICES › Part 5 - VISION APPLIANCES, HEARING APPLIANCES, DURABLE MEDICAL EQUIPMENT, OXYGEN, MEDICAL SUPPLIES, PROSTHETICS AND ORTHOTICS › Section 8.324.5.1 - 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 324 - ADJUNCT SERVICES › Part 5 - VISION APPLIANCES, HEARING APPLIANCES, DURABLE MEDICAL EQUIPMENT, OXYGEN, MEDICAL SUPPLIES, PROSTHETICS AND ORTHOTICS › Section 8.324.5.2 - 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 324 - ADJUNCT SERVICES › Part 5 - VISION APPLIANCES, HEARING APPLIANCES, DURABLE MEDICAL EQUIPMENT, OXYGEN, MEDICAL SUPPLIES, PROSTHETICS AND ORTHOTICS › Section 8.324.5.3 - 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 NMSA 1978, Section 27-1-12 et seq.
				  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 324 - ADJUNCT SERVICES › Part 5 - VISION APPLIANCES, HEARING APPLIANCES, DURABLE MEDICAL EQUIPMENT, OXYGEN, MEDICAL SUPPLIES, PROSTHETICS AND ORTHOTICS › Section 8.324.5.4 - DURATION

Current through Register Vol. 35, No. 13, July 16, 2024
Permanent.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 324 - ADJUNCT SERVICES › Part 5 - VISION APPLIANCES, HEARING APPLIANCES, DURABLE MEDICAL EQUIPMENT, OXYGEN, MEDICAL SUPPLIES, PROSTHETICS AND ORTHOTICS › Section 8.324.5.5 - EFFECTIVE DATE

Current through Register Vol. 35, No. 13, July 16, 2024
January 1, 2014, unless a later date is cited at the end of a
				  section.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 324 - ADJUNCT SERVICES › Part 5 - VISION APPLIANCES, HEARING APPLIANCES, DURABLE MEDICAL EQUIPMENT, OXYGEN, MEDICAL SUPPLIES, PROSTHETICS AND ORTHOTICS › Section 8.324.5.6 - OBJECTIVE

Current through Register Vol. 35, No. 13, July 16, 2024
The objective of this rule is to provide instructions for the
				  service portion of the New Mexico medical assistance programs
				  (MAP).
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 324 - ADJUNCT SERVICES › Part 5 - VISION APPLIANCES, HEARING APPLIANCES, DURABLE MEDICAL EQUIPMENT, OXYGEN, MEDICAL SUPPLIES, PROSTHETICS AND ORTHOTICS › Section 8.324.5.7 - DEFINITIONS

Current through Register Vol. 35, No. 13, July 16, 2024
[RESERVED]
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 324 - ADJUNCT SERVICES › Part 5 - VISION APPLIANCES, HEARING APPLIANCES, DURABLE MEDICAL EQUIPMENT, OXYGEN, MEDICAL SUPPLIES, PROSTHETICS AND ORTHOTICS › Section 8.324.5.8 - MISSION STATEMENT

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 324 - ADJUNCT SERVICES › Part 5 - VISION APPLIANCES, HEARING APPLIANCES, DURABLE MEDICAL EQUIPMENT, OXYGEN, MEDICAL SUPPLIES, PROSTHETICS AND ORTHOTICS › Section 8.324.5.9 - VISION APPLIANCES, HEARING APPLIANCES, DURABLE MEDICAL EQUIPMENT, OXYGEN, MEDICAL SUPPLIES, PROSTHETICS AND ORTHOTICS

Current through Register Vol. 35, No. 13, July 16, 2024
The New Mexico medical assistance division (MAD) pays for
				  medically necessary health services furnished to a medical assistance program
				  (MAP) eligible recipient, including covered vision appliances, hearing aids and
				  related services [
				  42
				  CFR Section 440.60(a) and
				  Section
				  440.110(c)
				  ], durable medical equipment and medical supplies, [
				  42 CFR Section
				  440.70(c) ] and covered
				  prosthetic and orthotic services [
				  42
				  CFR Section 440.120(c)
				  ].
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 324 - ADJUNCT SERVICES › Part 5 - VISION APPLIANCES, HEARING APPLIANCES, DURABLE MEDICAL EQUIPMENT, OXYGEN, MEDICAL SUPPLIES, PROSTHETICS AND ORTHOTICS › Section 8.324.5.10 - ELIGIBLE PROVIDERS

Current through Register Vol. 35, No. 13, July 16, 2024
Health care to a MAP eligible recipient is furnished by a
				  variety of providers and provider groups. The reimbursement and billing for
				  these services is administered by MAD. Upon approval of a New Mexico MAD
				  provider participation agreement (PPA), a licensed practitioner of a facility
				  that meets applicable requirements is eligible to be reimbursed for furnishing
				  covered services to a MAP eligible recipient. A provider must be enrolled
				  before submitting a claim for payment to the MAD claims processing contractors.
				  MAD makes available on the HSD/MAD website, on other program-specific websites,
				  or in hard copy format, information necessary to participate in health care
				  programs administered by HSD or its authorized agents, including program rules,
				  billing instruction, utilization review (UR) instructions, and other pertinent
				  materials. When enrolled, a provider receives instruction on how to access
				  these documents. It is the provider's responsibility to access these
				  instructions, to understand the information provided, to comply with the
				  requirements and to update his or her knowledge as new material is provided by
				  MAD. The provider must contact HSD or its authorized agents to request hard
				  copies of any MAD New Mexico administrative code (NMAC) program rules, MAD
				  billing and UR instructions and other pertinent material, and to obtain answers
				  to questions related to the material or not covered by the material. To be
				  eligible for reimbursement, a provider must adhere to the provisions of his or
				  her MAD PPA and all applicable statutes, regulations, rules and executive
				  orders. MAD or its selected claims processing contractor issues payments to a
				  provider using electronic funds transfer (EFT) only. A provider must supply
				  necessary information in order for payment to be made. Upon approval of his or
				  her MAD PPA, the following practitioners and facilities may be enrolled as MAD
				  providers:
A.
Vision appliance
				provider:
(1) an ophthalmologist
				licensed to practice medicine in New Mexico, who limits his or her practice to
				ophthalmology (ophthalmologist) and the groups, corporations, and professional
				associations they form;
(2) an
				optometrist licensed to practice optometry in New Mexico and the groups,
				corporations, and professional associations they form;
(3) an optician qualified to provide
				eyeglasses, contact lenses, supplies, and other vision-related materials;
				or
(4) Indian health service (IHS)
				or a tribal facility operating under Public Law 93-638.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 324 - ADJUNCT SERVICES › Part 5 - VISION APPLIANCES, HEARING APPLIANCES, DURABLE MEDICAL EQUIPMENT, OXYGEN, MEDICAL SUPPLIES, PROSTHETICS AND ORTHOTICS › Section 8.324.5.11 - PROVIDER RESPONSIBILITIES AND REQUIREMENTS

Current through Register Vol. 35, No. 13, July 16, 2024
A. A provider who furnishes services to a MAP
				eligible recipient must comply with all federal, state, local laws, rules,
				regulations, executive orders and the provisions of his or her PPA. A provider
				must adhere to the NMAC program rules and program policies that include but are
				not limited to supplements, billing instructions, and UR directions, as
				updated. The provider is responsible for following coding manual guidelines and
				centers for medicare and medicaid services (CMS) correct coding initiatives,
				including not improperly unbundling or upcoding services.
B. A provider must verify an individual is
				eligible for a specific MAD service and verify the recipient's enrollment
				status at time of service, as well as determining if a copayment is applicable
				or if services require prior authorization. A provider must determine if a MAP
				eligible recipient has other health insurance. A provider must maintain records
				that are sufficient to fully disclose the extent and nature of the services
				provided to the MAP eligible recipient.
C. Services furnished must be within the
				scope of practice defined by the provider's licensing board, scope of practice
				act, or regulatory authority; see 8.302.2 NMAC.
D.
Vision appliances providers:
A provider must ensure that a prescription for eyeglasses or contact lenses is
				accurate to the extent that the prescription corrects the MAP eligible
				recipient's vision to the degree of acuity indicated on his or her vision
				examination record. An eyeglass and contact lens supplier is responsible for
				verifying that the correct prescription is provided.
(1) If a prescription is inaccurate and the
				MAP eligible recipient is unable to use his or her eyeglasses or contact
				lenses, payment for both the eye examination and the eyeglasses or contact
				lenses is subject to recoupment.
(2) If the eyeglasses or contact lenses are
				not ground to the correct prescription, payment for the eyeglasses or contact
				lenses is subject to recoupment.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 324 - ADJUNCT SERVICES › Part 5 - VISION APPLIANCES, HEARING APPLIANCES, DURABLE MEDICAL EQUIPMENT, OXYGEN, MEDICAL SUPPLIES, PROSTHETICS AND ORTHOTICS › Section 8.324.5.14 - SERVICE LIMITATIONS AND COVERAGE RESTRICTIONS

Current through Register Vol. 35, No. 13, July 16, 2024
A.
Special requirements for the
				purchase of wheelchairs:
Before billing for a customized wheelchair, the
				provider who delivers the wheelchair and seating system to a MAP eligible
				recipient must make a final evaluation to ensure that the wheelchair and
				seating system meets the medical, social and environmental needs of the MAP
				eligible recipient for whom it was authorized.
(1) The provider assumes responsibility for
				correcting defects or deficiencies in the wheelchair and seating systems that
				make them unsatisfactory for use by the MAP eligible recipient.
(2) The provider is responsible for
				consulting physical therapists, occupational therapists, special education
				instructors, teachers, parents or guardians as necessary to ensure that the
				wheelchair meets the MAP eligible recipient's needs.
(3) Evaluations by a physical therapist or
				occupational therapist are required when ordering customized wheelchair and
				seating system. The therapist should be familiar with the brands and categories
				of wheelchairs and appropriate seating systems and work with the MAP eligible
				recipient and those consultants listed in Paragraph (2) above to assure that
				the selected system matches physical seating needs. The physical or
				occupational therapist may not be a wheelchair vendor or under the employment
				of a wheelchair vendor or wheelchair manufacturer.
(4) MAD does not pay for special
				modifications or replacement of a customized wheelchair after the wheelchair is
				furnished to the MAP eligible recipient.
(5) When the equipment is delivered to the
				MAP eligible recipient and the MAP eligible recipient accepts the order, the
				provider will submit the claim for reimbursement.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 324 - ADJUNCT SERVICES › Part 5 - VISION APPLIANCES, HEARING APPLIANCES, DURABLE MEDICAL EQUIPMENT, OXYGEN, MEDICAL SUPPLIES, PROSTHETICS AND ORTHOTICS › Section 8.324.5.15 - NONCOVERED SERVICES

Current through Register Vol. 35, No. 13, July 16, 2024
The following services are subject to the limitations and
				  coverage restrictions that exist for other MAD services; see 8.302.1 NMAC and
				  8.310.2 NMAC. The provider must notify the MAP eligible recipient of the
				  coverage limitations prior to providing services.
A.
Vision appliances:
MAD does
				not cover the following specific vision services:
(1) orthoptic assessment and
				treatment;
(2) photographic
				procedures, such as fundus or retinal photography and external ocular
				photography;
(3) polycarbonate
				lenses other than those listed in Subsection A of Section 13 of this
				part;
(4) ultraviolet (UV)
				lenses;
(5) trifocals;
(6) progressive lenses;
(7) tinted or photochromic lenses, except in
				cases of documented medical necessity; see Subsection D of Section 12 of this
				part;
(8) oversize frames and
				oversize lenses;
(9) low vision
				aids;
(10) eyeglass
				cases;
(11) eyeglass or contact
				lens insurance; and
(12)
				anti-scratch, anti-reflective, or mirror coating.