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Human Services Department / Medical Assistance Division – Supplements to Program Rules
1
Medical Assistance Division - Supplements
2013 2012 2011 2010 2009 2008 2007 2006 2005 2004
Number Date Title To Subjects / Keywords Link
04-01 February 16, 2004
BILLING FOR OXYGEN CONTENTS
ALL DURABLE MEDICAL EQUIPMENT PROVIDERS
Durables Medical Equipment (DME)
Medical Supplies
Oxygen
Nursing Facilities
http://www.hsd.state.nm.us/mad/pdf_files/Supplements/Oxygen.pdf
04-02 March 3, 2004
PERSONAL CARE OPTION (PCO) PROGRAM CLARIFICATION TO MAD-MR:03-34 ISSUED JANUARY 8, 2004
MEDICAID PERSONAL CARE OPTION PROVIDERS
Personal Care Services (PCO) http://www.hsd.state.nm.us/mad/pdf_files/Supplements/PCOclarificationmr0334.pdf
04-03 March 18, 2004
VISION SERVICES REIMBURSEMENT CHANGE
ALL VISION SERVICES PROVIDERS
Vision Services
Eyeglasses
Frames
Reimbursement
http://www.hsd.state.nm.us/mad/pdf_files/Supplements/VisionServices.pdf
04-04 March 16, 2004
Implementation of PCO Assessment Form (MAD057)
All Medicaid Personal Care Option Providers
Personal Care Services (PCO)
Assessment Form (MAD057)
http://www.hsd.state.nm.us/mad/pdf_files/Supplements/PCOassessment.pdf
04-06 April 26, 2004
1. MEDICAID FEE SCHEDULE REDUCTION 2. PAYMENT LIMITATION ON CO-INSURANCE AND COPAYMENTS
ALL PHYSICIANS, PHYSICIAN GROUPS, PHYSICIAN ASSISTANTS, NURSE PRACTITIONERS, OCCUPATIONAL THERAPISTS,
Reimbursement
Fee Schedules
Reimbursement reduction
Medicare
http://www.hsd.state.nm.us/mad/pdf_files/Supplements/MedicaidFeeSchedule.pdf
Human Services Department / Medical Assistance Division – Supplements to Program Rules
2
PHYSICAL THERAPISTS AND SPEECH THERAPISTS, DURABLE MEDICAL EQUIPMENT AND MEDICAL SUPPLY PROVIDERS AND OTHER PRACTITIONERS WHO BILL USING CURRENT PROCEDURAL TERMINOLOGY CODES (CPT) AND HEALTHCARE COMMON PROCEDURE CODING SYSTEM (HCPCS) CODES
Medicare co-insurance, deductibles and co-payments
04-07 April 30, 2004
BILLING RATE CHANGE FOR THE PERSONAL CARE OPTION PROGRAM
ALL MEDICAID PERSONAL CARE OPTION SERVICE PROVIDERS
Personal Care Services (PCO)
Billing
Reimbursement
Consumer-Delegated
Consumer-Directed
Personal Care Attendants
http://www.hsd.state.nm.us/mad/pdf_files/Supplements/PCObillratechange.pdf
04-08 June 7, 2004 DENTAL BENEFITS CHANGES DENTAL PROVIDERS Dental
endodontic services, periodontal services, restorative services and adjunctive general services
Benefits
Dental procedure codes
Fee reduction
http://www.hsd.state.nm.us/mad/pdf_files/Supplements/Dentalbenefitchanges.pdf
04-09 June 14, 2004
REDUCTION IN MEDICAID PAYMENTS EFFECTIVE JULY 1, 2004.
ALL PROVIDERS PARTICIPATING IN THE NEW MEXICO MEDICAID PROGRAM
Reimbursement
Fee reduction
http://www.hsd.state.nm.us/mad/pdf_files/Supplements/ReductioninMedicaid0704.pdf
04-10 June 25, 2004
REIMBURSEMENT FOR HEARING AIDS
ALL HEARING AID SERVICE PROVIDERS
Hearing aids
Reimbursement
04-11 July 1, 2004 DISABLED AND ELDERLY WAIVER SERVICE STANDARDS REVISIONS FOR CASE MANAGEMENT AND HOMEMAKER SERVICES
DISABLED AND ELDERLY WAIVER SERVICE PROVIDERS
Disabled and Elderly Waiver (D&E)
Case Management Services
Homemaker Services
Comprehensive Individual Assessment (CIA)
Service Standards
Individual Service Plan (ISP) and Waiver Review Form (MAD 046)
http://www.hsd.state.nm.us/mad/pdf_files/Supplements/DEServicesStandardsCMHomemaker.pdf
04-12 July 7, 2004 HOME AND COMMUNITY BASED SERVICES (HCBS)
HOME AND COMMUNITY BASED SERVICES WAIVER
Home & Community Based Services (HCBS) Waiver
http://www.hsd.state.nm.us/mad/pdf_files/Suppleme
Human Services Department / Medical Assistance Division – Supplements to Program Rules
3
WAIVERS RATE TABLES
PROVIDERS Billing Instructions
Procedure codes
Diasbled & Elderly (D&E) waiver
Medically Fragile (MF) waiver
HIV/AIDS waiver
Developmentally Disabled (DD) waiver
Home and Community Based Services
nts/HCBSWRateTables.pdf
04-13 August 9, 2004
CORRECTIONS TO DENTAL BENEFIT CHANGES (This supplement is to correct some information in Supplement 04-08 dated June 7, 2004 and Department Memorandum 04-22 dated June 28, 2004 concerning New Mexico Medicaid Dental Program benefit changes effective July 1, 2004.)
DENTAL PROVIDERS Dental Benefits
Fee reduction
http://www.hsd.state.nm.us/mad/pdf_files/Supplements/0413DentalCorrections.pdf
04-14 August 5, 2004
AMENDED MEDICAID/ CHILDREN, YOUTH & FAMILIES DEPARTMENT (CYFD) CHILDREN’S PANEL FEE-FOR-SERVICE (FFS) UTILIZATION REVIEW (UR) CHANGES
BEHAVIORAL MANAGEMENT SPECIALIST (BMS), DAY TREATMENT, RESIDENTIAL TREATMENT SERVICES (RTS), & TREATMENT FOSTER CARE (TFC) PROVIDERS
Early and Periodic Screening, Diagnosis and Treatment (EPSDT)
Residential Treatment, Group Home, Treatment Foster Care (TFC), Behavior Management Specialist (BMS), and Day Treatment
Utilization Review (UR)
Children,Youth and Families Department (CYFD)
http://www.hsd.state.nm.us/mad/pdf_files/Supplements/0414AmendedCYFDFFSURChanges.pdf
04-15 November 12, 2004
Preferred Drug List Implementation
ALL Pharmacy Providers Pharmacy
Preferred Drug List (PDL)
NMRX
http://www.hsd.state.nm.us/mad/pdf_files/Supplements/0415PDLImplementation.pdf
04-16 November 12, 2004
Preferred Drug List Implementation
All Prescribing Providers and Coordinators of Patient Care
Pharmacy
Preferred Drug List (PDL)
NMRX
Clients
http://www.hsd.state.nm.us/mad/pdf_files/Supplements/0416PDLImplementation.pdf
05-01 November 28, 2005
BILLING FOR BINAURAL HEARING AIDS AND DISPENSING
AUDIOLOGISTS, OTOLARYNGOLOGISTS, HEARING AID DEALERS
Hearing Aids
Procedure codes
http://www.hsd.state.nm.us/mad/pdf_files/Supplements/0501BinauralHearingAidFitting.pdf
05-02 July 28, 2005
PREFERRED DRUG LIST IMPLEMENTATION FOR
ALL PHARMACY PROVIDERS Native Americans
Pharmacy
http://www.hsd.state.nm.us/mad/pdf_files/Suppleme
Human Services Department / Medical Assistance Division – Supplements to Program Rules
4
NATIVE AMERICANS
Preferred Drug List (PDL)
NMRX
Indian Health Services (HIS) / Tribal 638 facilities.
Prescription benefits
nts/0502preferreddruglistfor%20NA.pdf
05-03 July 28, 2005
PREFERRED DRUG LIST IMPLEMENTATION FOR NATIVE AMERICANS
ALL PRESCRIBING PROVIDERS AND COORDINATORS OF PATIENT CARE
Native Americans
Pharmacy
Preferred Drug List (PDL)
NMRX
Clients
Prescription benefits
http://www.hsd.state.nm.us/mad/pdf_files/Supplements/0503PreferreddruglistforNA.pdf
05-04 August 31, 2005
MIRENA INTRAUTERINE DEVICE PROCEDURE CODE CHANGE FROM S4981 TO J7302
FAMILY PLANNING MEDICAID PROVIDERS, FAMILY PRACTICE PHYSICIANS, NURSE PRACTITIONERS, MIDWIVES, GYNECOLOGISTS, FEDERALLY QUALIFIED HEALTH CENTERS, RURAL HEALTH CENTERS
Family planning
Mirena Intrauterine Device (IUD)
Contraceptives
Procedure codes
http://www.hsd.state.nm.us/mad/pdf_files/Supplements/0504mirenaintrauterinedeviceprocedurecodechange.pdf
05-06 December 23, 2005
CHANGES RELATED TO MEDICARE PART D IMPLEMENTATION
ALL PHARMACY PROVIDERS Pharmacy
Part D
Prescription benefits
Medicare
Dual eligibles
NCPDP
http://www.hsd.state.nm.us/mad/pdf_files/Supplements/06MedicarePartDChanges.pdf
06-01 March 1, 2006
TREATMENT AT THE SCENE WITHOUT TRANSPORT
ALL GROUND AMBULANCE PROVIDERS
Ambulance
Transportation
Reimbursement
Billing
Procedure codes
http://www.hsd.state.nm.us/mad/pdf_files/Supplements/0601TreatmentatScenewoTransport.pdf
06-02 March 1, 2006
MEDICAID TRANSPORTATION HCPCS CODES
ALL TRANSPORTATION PROVIDERS
Ambulance (ground and air)
Transportation
Reimbursement
Billing
Procedure codes
non-emergency transportation
http://www.hsd.state.nm.us/mad/pdf_files/Supplements/0602TranspHCPCSCodes.pdf
06-03 June 2, 2006 PRIOR AUTHORIZATION AND BILLING FOR EPSDT PRIVATE DUTY NURSING SERVICES AND EPSDT PERSONAL CARE SERVICES
ALL PRIVATE DUTY NURSING AGENCIES, EPSDT MEDICALLY AT RISK CASE MANAGEMENT AGENCIES
Private duty nursing services
Procedure codes
EPSDT personal care
Billing
http://www.hsd.state.nm.us/mad/pdf_files/EPSDT_PD_PC_Services.pdf
Human Services Department / Medical Assistance Division – Supplements to Program Rules
5
06-04 June 1, 2006 PROVIDER NOTICE OF INCREASES IN MEDICAID REIMBURSEMENT
ALL PROVIDERS PARTICIPATING IN THE NEW MEXICO MEDICAID PROGRAM
Reimbursement
Fee increase
Managed Care Organizations (MCOs)
State Coverage Insurance (SCI)
Fee Schedule
http://www.hsd.state.nm.us/mad/pdf_files/Provider_Notice_of_Increase_04.pdf
06-05 June 30, 2006
(I) GUIDELINES FOR BILLING FEE-FOR-SERVICE MEDICAID FOR SERVICES BEING TRANSFERRED FROM THE HCBS WAIVER and (II) NEW WAIVER FEE SCHEDULE.
HCBS WAIVER PROVIDERS, HOME HEALTH AGENCIES, PRIVATE DUTY NURSING AGENCIES, AND REHABILITATION SERVICES PROVIDERS
Home and Community-Based Services (HCBS) waivers
Billing
EPSDT
Managed Care Organizations (MCOs)
Fee Schedule
http://www.hsd.state.nm.us/mad/pdf_files/Registers/REG-SU-06-05.pdf
06-06 October 12, 2006
BILLING PROCEDURE FOR DRUGS NOT INCLUDED IN THE DIALYSIS COMPOSITE RATE
ALL DIALYSIS FACILITY PROVIDERS PARTICIPATING IN THE NEW MEXICO MEDICAID PROGRAM
Dialysis Facilities
Billing
Drugs (pharmacy)
http://www.hsd.state.nm.us/mad/pdf_files/Registers/REG-SU-06-06.pdf
06-08 December 5, 2006
RATE TABLES FOR THE DEVELOPMENTAL DISABILITIES (DD) HOME AND COMMUNITY-BASED SERVICES WAIVER (HCBSW)
ALL HOME AND COMMUNITY-BASED SERVICES WAIVER PROVIDERS
Home and Community-Based Services (HCBS) waivers
Developmentally Disabled waiver (DD)
Fee schedule (rate table)
Billing
http://www.hsd.state.nm.us/mad/pdf_files/Supplements/08DDRateTable.pdf
06-09 December 28, 2006
MEDICAID TRANSPORTATION MODIFIERS
ALL GROUND AND AIR AMBULANCE PROVIDERS
Transportation
Billing
Modifiers
Ambulance (ground and air)
http://www.hsd.state.nm.us/mad/pdf_files/Supplements/REG-SU-06-09.pdf
07-01 February 16, 2007
PREPARING TO USE THE NATIONAL PROVIDER IDENTIFIER (NPI) AND NPI DEADLINES
ALL PROVIDERS PARTICIPATING IN THE NEW MEXICO MEDICAID PROGRAM
National Provider Identifier (NPI)
Billing
Taxonomy
http://www.hsd.state.nm.us/uploads/FileLinks/c78b68d063e04ce5adffe29376ff402e/MAD_SUPP_07_01_Preparing_to_Use_NPI_and_Deadlines.pdf
07-02 February 15, 2007
CORRECTIONS TO THE DEVELOPMENTAL DISABILITIES (DD) HOME AND COMMUNITY BASED SERVICES (HCBS) WAIVER
HOME AND COMMUNITY BASED SERVICES WAIVER PROVIDERS
Home and Community-Based Services (HCBS) waivers
Developmentally Disabled waiver (DD)
Fee schedule (rate table)
http://www.hsd.state.nm.us/uploads/FileLinks/c78b68d063e04ce5adffe29376ff402e/MAD
Human Services Department / Medical Assistance Division – Supplements to Program Rules
6
RATE TABLE Billing
Correction to previous supplement
_SUPP_07_02_Corrections_to_the_DD_HCBS_Waiver_Rate_Table.pdf
07-03 April 19, 2007
USING TAXONOMY WITH THE NATIONAL PROVIDER IDENTIFIER (NPI) AND DEADLINES
ALL PROVIDERS PARTICIPATING IN THE NEW MEXICO MEDICAID PROGRAM
National Provider Identifier (NPI)
Billing
Taxonomy
Claim Forms
Taxonomy table / crosswalk
http://www.hsd.state.nm.us/uploads/FileLinks/c78b68d063e04ce5adffe29376ff402e/MAD_SUPP_07_03_Using_Taxonomy_with_the_NPI_and_Deadlines.pdf
07-04 April 19, 2007
INCREASE IN THE AMOUNT ALLOWED FOR HEARING AIDS AND HEARING AID DISPENSING FEES
ALL PROVIDERS OF HEARING AIDS PARTICIPATING IN THE NEW MEXICO MEDICAID PROGRAM
Hearing Aids
Fee increase http://www.hsd.state.nm.us/uploads/FileLinks/c78b68d063e04ce5adffe29376ff402e/MAD_SUPP_07_04_Increase_in_the_Amount_Allowed_for_Hearing_Aids___Dispensing_Fees.pdf
07-05 October 25, 2007
HCBS WAIVER PROVIDER NOTICE OF INCREASES IN MEDICAID REIMBURSEMENT
ALL HOME AND COMMUNITY BASED SERVICES WAIVER PROVIDERS PARTICIPATING IN THE NEW MEXICO MEDICAID PROGRAM
Home and Community-Based Services (HCBS) waivers
Fee schedule / waiver rates
Billing / procedure codes
http://www.hsd.state.nm.us/uploads/FileLinks/c78b68d063e04ce5adffe29376ff402e/MAD_SUPP_07_05_HCBS_Waiver_Provider_Notice_of_Increases_in_Medicaid_Reimbursement.pdf
07-06 May 29, 2007
PROVIDER NOTICE OF INCREASES IN MEDICAID REIMBURSEMENT
SELECTED PROVIDERS PARTICPATING IN THE NEW MEXICO MEDICAID PROGRAM
Fee increase
Physicians and other providers, including clinics, midwives, anesthetists, nurse practitioners, audiologists, optometrists, podiatrists, radiology providers, and physical, occupational, and speech therapists.
Fee schedule
http://www.hsd.state.nm.us/uploads/FileLinks/c78b68d063e04ce5adffe29376ff402e/MAD_SUPP_07_06_Provider_Notice_of_Increase_in_Medicaid_Reimbursement.pdf
07-07 August 21, 2007
PERSONAL CARE PROVIDER NOTICE OF INCREASES IN
ALL PERSONAL CARE OPTION PROVIDERS PARTICIPATING IN
Fee increase
Personal Care Option services (PCO) http://www.hsd.state.nm.us/uploads/FileLink
Human Services Department / Medical Assistance Division – Supplements to Program Rules
7
MEDICAID REIMBURSEMENT THE NEW MEXICO MEDICAID PROGRAM
Reimbursement s/c78b68d063e04ce5adffe29376ff402e/MAD_SUPP_07_07_Personal_Care_Provider_Notice___Increase_in_Reimb..pdf
07-08 September 5, 2007
I. REMITTANCE ADVICES ON THE WEB AND PHASING OUT PAPER REMITTANCE ADVICES AND CHECKS II. FINAL DEADLINES FOR USING NATIONAL PROVIDER IDENTIFIER (NPI) ON NEW MEXICO MEDICAID CLAIMS III. PROVIDER FEE INCREASE NOTICE
ALL PROVIDERS PARTICIPATING IN THE NEW MEXICO MEDICAID PROGRAM
Remittance advice (RA) / HIPAA 835 electronic remittance advice.
National Provider Identifier (NPI)
Web portal
Fee increase
Electronic payments via electronic funds transfer (EFT)
Claim forms
Taxonomy
http://www.hsd.state.nm.us/uploads/FileLinks/c78b68d063e04ce5adffe29376ff402e/MAD_SUPP_07_08_Remittance_Advices_on_Web__NPI_Deadlines__Prov._Fee_incr..pdf
07-09 November 9, 2007
I. TAMPER-RESISTANT PRESCRIPTION PADS II. BILLING FOR DRUG ITEMS ADMINISTERED IN PROVIDER OFFICES, OUTPATIENT CLINICS AND HOSPITALS
ALL PHARMACY AND PRESCIBING PROVIDERS PARTICIPATING IN THE NEW MEXICO MEDICAID PROGRAM
Pharmacy
Prescription drugs / drug items
Prescribing
Tamper resistant
National Drug Code (NDC)
Claim forms
http://www.hsd.state.nm.us/uploads/FileLinks/c78b68d063e04ce5adffe29376ff402e/MAD_SUPP_07_09_Tamper_Resistant_Rx_Pads__Billing_for_Drug_Items.pdf
07-10 November 27, 2007
USING THE “NOTIFICATION OF BIRTH” FORM TO EXPEDITE PAYMENT FOR SERVICES TO NEWBORNS
ALL HOSPITALS AND PRACTITIONERS PROVIDING SERVICES TO MEDICAID NEWBORN RECIPIENTS
“Notification of Birth Form” (form MAD 313)
Infants
Pregnant women
Income Support Division (ISD)
http://www.hsd.state.nm.us/uploads/FileLinks/c78b68d063e04ce5adffe29376ff402e/MAD_SUPP_07_10_Using_the_Notification_of_Birth_Form_to_Expidite_Payment_for_Newborn_Svcs.pdf
08-02 January 28, 2008
MEDICAID REIMBURSEMENT FOR BIRTH CONTROL & FAMILY PLANNING SERVICES
SCHOOL BASED HEALTH SERVICES CLINICS, NON-PROFIT CLINICS, AND FAMILY PLANNING CLINICS
Birth control / contraceptives
Family planning
emergency contraception drugs and items
http://www.hsd.state.nm.us/uploads/FileLinks/c78b68d063e04ce5a
Human Services Department / Medical Assistance Division – Supplements to Program Rules
8
PARTICIPATING IN THE NEW MEXICO MEDICAID PROGRAM
Billing / procedure codes
School based health centers, licensed treatment & diagnostic clinics, and family planning clinics
dffe29376ff402e/MAD_SUPP_08_02_Medicaid_Reimbursement_for_Birth_Control___Family_Planning_Svcs.pdf
08-04 March 19, 2008
DENTAL PROCEDURE CODE D9920 – BEHAVIOR MANAGEMENT
ALL DENTAL SERVICES PROVIDERS
Dental
Dental procedure codes
Billing
Developmental disabilities (DD)
http://www.hsd.state.nm.us/uploads/FileLinks/c78b68d063e04ce5adffe29376ff402e/MAD_SUPP_08_04_Dental_Procedure_Code_D9920___Behavior_Management.pdf
08-05 March 7, 2008
ANNUAL HOSPICE RATE UPDATE
NEW MEXICO MEDICAID HOSPICE PROVIDERS
Hospice
Fee / rate schedule update
Billing / revenue codes
http://www.hsd.state.nm.us/uploads/FileLinks/c78b68d063e04ce5adffe29376ff402e/MAD_SUPP_08_05_Annual_Hospice_Rate_Update.pdf
08-06 May 7, 2008 I. NATIONAL PROVIDER IDENTIFIER II. TAMPER-RESISTANT PRESCRIPTION PADS
ALL PHARMACIES PARTICIPATING IN THE NEW MEXICO MEDICAID PROGRAM
Pharmacy
Prescription drugs / drug items
Prescribing
Tamper resistant
National Drug Code (NDC)
Claim forms
National Provider Identifier (NPI)
http://www.hsd.state.nm.us/uploads/FileLinks/c78b68d063e04ce5adffe29376ff402e/MAD_SUPP_08_06_NPI_and_Tamper_Resistant_Prescription_Pads.pdf
08-07 May 12, 2007
I. RECIPIENT CHANGE OF ADDRESS FORMS II. NATIONAL PROVIDER IDENTIFIER III. TAMPER-RESISTANT PRESCRIPTION PADS
ALL PHYSICIANS, HOSPITALS, AND PHARMACY PRESCRIBERS PARTICIPATING IN THE NEW MEXICO MEDICAID PROGRAM
Recipient change of address forms
Income Support Division (ISD)
Pharmacy
Prescription drugs / drug items
Prescribing
Tamper resistant
National Drug Code (NDC)
Claim forms
National Provider Identifier (NPI)
http://www.hsd.state.nm.us/uploads/FileLinks/c78b68d063e04ce5adffe29376ff402e/MAD_SUPP_08_07_Recipient_Change_of_Address_Forms__NPI_and_Tamper_Res._Rx_Pads.pdf
09-01 March 17, BILLING FOR COMMUNITY HOME AND COMMUNITY Community Living providers http://www.hsd.state.
Human Services Department / Medical Assistance Division – Supplements to Program Rules
9
2009 LIVING SERVICES BASED SERVICES WAIVER PROVIDERS
Individual Service Plan (ISP)
Reimbursement
Developmental Disabilities (DD) Waiver
nm.us/uploads/FileLinks/c78b68d063e04ce5adffe29376ff402e/MAD_SUPP_09_01_Billing_for_Community_Living_Services.pdf
09-02 March 16, 2009
Elimination of Mandated Minimum Wage Requirement for Personal Care Option (PCO) Services
All Personal Care Option (PCO) Service Providers
Personal Care Option (PCO) Service
Reimbursement / payment
Personal care attendants
http://www.hsd.state.nm.us/uploads/FileLinks/c78b68d063e04ce5adffe29376ff402e/MAD_SUPP_09_02_Elimination_of_Min_Wage_Req._for_PCO_Svcs.PDF
09-03 April 12, 2009
UPDATES TO THE DEVELOPMENTAL DISABILITIES (DD) HOME AND COMMUNITY BASED SERVICES (HCBS) WAIVER RATE TABLE
HOME AND COMMUNITY BASED SERVICES WAIVER PROVIDERS
Home and Community-Based Services (HCBS) waivers
Developmental Disabilities (DD) Waiver
Fee schedule / rate table
Procedure codes / billing
http://www.hsd.state.nm.us/uploads/FileLinks/c78b68d063e04ce5adffe29376ff402e/MAD_SUPP_09_03_Updates_to_DD_HCBS_Waiver_Rate_Table.pdf
09-04 May 13, 2009
I. REVISED MAD FORM 313-NOTIFICATION OF BIRTH II. MEDICAID FAMILY PLANNING WAIVER “QUICK FACTS”
ALL PROVIDERS OF MEDICAID NEWBORN AND WOMEN’S REPRODUCTIVE HEALTH SERVICES
MAD form 313-Notification of Birth
Infants
Family Planning
Contraceptives
STD screenings and treatment
Billing / procedure codes / revenue codes
http://www.hsd.state.nm.us/uploads/FileLinks/c78b68d063e04ce5adffe29376ff402e/MAD_SUPP_09_04_Revised_Form_303___Notification_of_Birth_and_FPW_Quick_Facts.pdf
09-05 July 1, 2009 I. PLAN B® (LEVONORGESTREL) FOR EMERGENCY CONTRACEPTION II. ORIGIN CODE REQUIREMENT FOR POINT OF SALE TRANSACTIONS
PHARMACY PROVIDERS Pharmacy
Prescription drugs and drug item
Over the counter drugs
Plan B
Emergency contraception
Point of Sale (POS) prescription Origin Code
NCPDP field 419-DJ
http://www.hsd.state.nm.us/uploads/FileLinks/c78b68d063e04ce5adffe29376ff402e/MAD_SUPP_09_05_OTC_Emergency_Contraception.pdf
09-06 May 28, 2009
EARLY PERIODIC SCREENING DIAGNOSTIC AND TREATMENT (EPSDT)
ALL PHYSICIANS AND PHYSICIAN GROUPS, CERTIFIED NURSE
Early Periodic Screening Diagnostic and Treatment (EPSDT)
Tot-to-Teen Healthchecks (well child
http://www.hsd.state.nm.us/uploads/FileLink
Human Services Department / Medical Assistance Division – Supplements to Program Rules
10
SCREENING SERVICES PRACTIONERS, CLINICS, FQHCS, RURAL HEALTH CLINICS AND INDIAN HEALTH SERVICE CLINICS
check-ups)
Billing / procedure codes s/c78b68d063e04ce5adffe29376ff402e/MAD_SUPP_09_06_EPSDT.pdf
09-07 July 1, 2009 PAYMENT TO PROVIDERS USING ELECTRONIC FUNDS TRANSFER
ALL PROVIDERS PARTICIPATING IN THE NEW MEXICO MEDICAID PROGRAM
Electronic Funds Transfer (EFT)
electronic payments http://www.hsd.state.nm.us/uploads/FileLinks/c78b68d063e04ce5adffe29376ff402e/MAD_SUPP_09_07_Payment_to_Providers_Using_EFT.pdf
09-08 June 26, 2009
IMPORTANT INFORMATION REGARDING BILLING FOR MEDICAID BEHAVIORAL HEALTH SERVICES
ALL PROVIDERS OF BEHAVIOR HEALTH SERVICES PARTICIPATING IN THE NEW MEXICO MEDICAID PROGRAM
Behavioral health
OptumHealth
Value Options
Statewide entity (SE)
Transition
Filing claims
http://www.hsd.state.nm.us/uploads/FileLinks/c78b68d063e04ce5adffe29376ff402e/MAD_SUPP_09_08_Billing_for_Medicaid_Behavioral_Health_Services.pdf
09-09 November 19, 2009
REDUCTION IN MEDICAID PAYMENTS FOR HOSPITAL SERVICES EFFECTIVE DECEMBER 1, 2009.
ALL HOSPITAL PROVIDERS PARTICIPATING IN THE NEW MEXICO MEDICAID PROGRAM AND MEDICAID MANAGED CARE ORGANIZATIONS
Fee reduction
Hospital
Payment reduction
DRG payments
Outpatient
Billing
http://www.hsd.state.nm.us/uploads/FileLinks/c78b68d063e04ce5adffe29376ff402e/MAD_SUPP_09_09_Reduction_in_Payments_for_Hospital_Svcs_Eff_12.1.2009.pdf
09-10 November 19, 2009
REDUCTION IN MEDICAID PAYMENTS FOR PRACTITIONER SERVICES EFFECTIVE DECEMBER 1, 2009.
ALL PHYSCIAN, CLINIC, AND OTHER PRACTITIONER PROVIDERS PARTICIPATING IN THE NEW MEXICO MEDICAID PROGRAM AND MEDICAID MANAGED CARE ORGANIZATIONS
Fee reduction
Practitioners
Payment reduction
Billing
http://www.hsd.state.nm.us/uploads/FileLinks/c78b68d063e04ce5adffe29376ff402e/MAD_SUPP_09_10_Reduction_in_Medicaid_Payments_for_Practitioner_Svcs__Eff_12.1.2009.pdf
09-12 November 19, 2009
REDUCTION IN MEDICAID PAYMENTS FOR SERVICES EFFECTIVE DECEMBER 1, 2009.
ALL ACCREDITED AND NON-ACCREDITED RESIDENTIAL TREATMENT CENTERS AND GROUP HOMES
Fee reduction
Practitioners
Payment reduction
http://www.hsd.state.nm.us/uploads/FileLinks/c78b68d063e04ce5a
Human Services Department / Medical Assistance Division – Supplements to Program Rules
11
PARTICIPATING IN THE NEW MEXICO MEDICAID PROGRAM AND MEDICAID MANAGED CARE ORGANIZATIONS
Billing
Accredited residential treatment centers (ARTCs), non-accredited residential treatment centers (RTC’s), and group homes
Daily accommodation rates
dffe29376ff402e/MAD_SUPP_09_12_Reduction_in_Medicaid_Payments_for_Servcies_Eff_12.1.2009.pdf
09-13 November 19, 2009
REDUCTION IN PHARMACY DISPENSING FEES EFFECTIVE FEBRUARY 1, 2010.
ALL PHARMACY PROVIDERS PARTICIPATING IN THE NEW MEXICO MEDICAID PROGRAM
Fee reduction
Practitioners
Payment reduction
Billing
Pharmacy
Dispensing fees
Product selection
http://www.hsd.state.nm.us/uploads/FileLinks/c78b68d063e04ce5adffe29376ff402e/MAD_SUPP_09_13_Reduction_in_Pharmacy_Dispensing_Fees_Eff_02.01.2010.pdf
09-14 November 19, 2009
REDUCTION IN MEDICAID PAYMENTS FOR PERSONAL CARE SERVICES EFFECTIVE DECEMBER 1, 2009.
ALL PERSONAL CARE OPTION PROVIDERS PARTICIPATING IN THE NEW MEXICO MEDICAID PROGRAM AND MEDICAID MANAGED CARE ORGANIZATIONS
Fee reduction
Practitioners
Payment reduction
Billing
Personal Care Option (PCO) services
http://www.hsd.state.nm.us/uploads/FileLinks/c78b68d063e04ce5adffe29376ff402e/MAD_SUPP_09_14_Reduction_in_Medicaid_Payments_for_PCO_Svcs_Eff_12.1.2009.pdf
10-01 March 1, 2010
BILLING FOR ANNUAL PHYSICAL HEALTH EXAMINATIONS FOR ADULTS APPLYING FOR OR RECEIVING HOME AND COMMUNITY-BASED SERVICES THROUGH ONE OF THE FOLLOWING WAIVER PROGRAMS: ACQUIRED IMMUNODEFICIENCY SYNDROME (AIDS); DEVELOPMENTAL DISABILITIES (DD); MEDICALLY FRAGILE (MF); MI VIA
PHYSICIANS, CERTIFIED NURSE PRACTITIONERS, PHYSICIANS ASSISTANTS, HOME AND COMMUNITY-BASED SERVICES WAIVER PROVIDERS
Home and Community-Based services (HCBS)
Acquired Immunodeficiency Syndrome; Developmental Disabilities; Medically Fragile; or Mi Via.
Billing / procedure codes
Medical Services Authorization ISD-309 form
New or annual physical health examinations
http://www.hsd.state.nm.us/uploads/FileLinks/c78b68d063e04ce5adffe29376ff402e/MAD_SUPP_10_01_Billing_for_Annual_Health_Exams_for_Adults_in_HCBS__AIDs__DDD__MF_or_Mi_Via_.pdf
10-02 April 26, 2010
I. Change in Pharmacy Dispensing Fees II. Pharmacies Contracted with 340B Entities
All Pharmacies Participating in the NM Medicaid Program
Pharmacy
Dispensing fees
Fee reduction
Product selection
National Drug Code (NDC)
http://www.hsd.state.nm.us/uploads/FileLinks/c78b68d063e04ce5adffe29376ff402e/MAD
Human Services Department / Medical Assistance Division – Supplements to Program Rules
12
III. Changes to the Payer Sheets
340B Drug Pricing Program
Outpatient drugs
Payer sheet
NDPDP
_SUPP_10_02_Change_in_Pharmacy_Dispensing_Fees__Contracted_Entities_340B_and_Payer_Sheets.PDF
10-03 May 15, 2010
I. EFFECTIVE SEPTEMBER 1, 2010, NEW REQUIREMENTS WHEN BILLING FOR DRUG ITEMS ADMINISTERED IN PRACTITIONERS’ OFFICES, OUTPATIENT CLINICS AND HOSPITALS II. EFFECTIVE SEPTEMBER 1, 2010, NEW REQUIREMENTS WHEN BILLING FOR DRUG ITEMS OBTAINED UNDER THE FEDERAL 340B DRUG PRICING PROGRAM
ALL PRACTITIONERS AND HOSPITALS PARTICIPATING IN THE NEW MEXICO MEDICAID PROGRAM
Pharmacy
Prescription drugs
Injectables
Office, clinic, outpatient hospital settings
National Drug Code (NDC)
Claim forms
Practitioner administered drugs
Billing / procedure codes
Providers paid at encounter rates (FQHC, IHS)
340B Drug Pricing Program
http://www.hsd.state.nm.us/uploads/FileLinks/c78b68d063e04ce5adffe29376ff402e/MAD_SUPP_10_03_New_Requirements_for_Billing_for_Drug_Items.pdf
10-04 July 7, 2010 APPLICATION REQUIREMENTS AND COVERAGE CHANGES FOR EMERGENCY SERVICES FOR ALIENS (EMSA)
PHYSICIANS AND HOSPITALS
Emergency Services for Aliens (EMSA)
Non-citizens
Emergency medical services
Covered and noncovered services
EMSA Referral for Eligibility Determination form MAD 308
Income Support Division (ISD)
Application requirements
http://www.hsd.state.nm.us/uploads/FileLinks/c78b68d063e04ce5adffe29376ff402e/MAD_SUPP_10_04_Application_Requirements_and_Coverage_for_Emergency_Svcs_for_Aliens__EMSA_.pdf
10-05 July 17, 2010
CHANGES TO ENVIRONMENTAL MODIFICATION SERVICES FUNDING FOR THE DEVELOPMENTAL DISABILITIES (DD) WAIVER PROGRAM
ENVIRONMENTAL MODIFICATIONS SERVICES PROVIDERS AND CASE MANAGEMENT AGENCIES FOR THE DEVELOPMENTAL DISABILITIES (DD) WAIVER PROGRAM
Developmental Disabilities (DD) waiver
Environmental modification services
Case management agencies
Fee reduction
Payment reduction
http://www.hsd.state.nm.us/uploads/FileLinks/c78b68d063e04ce5adffe29376ff402e/MAD_SUPP_10_05_Changes_to_Envir._Mod._Svcs_Funding_for_DD_Waiver_Program.pdf
10-06 July 20, 2010
NMRx PREFERRED DRUG LIST PROGRAM ENDS JULY 31, 2010
ALL PHARMACY PROVIDERS Pharmacy
Prescription drugs
Preferred Drug List (PDL)
NMRx
Billing
http://www.hsd.state.nm.us/uploads/FileLinks/c78b68d063e04ce5adffe29376ff402e/MAD
Human Services Department / Medical Assistance Division – Supplements to Program Rules
13
_SUPP_10_06_NMRx_Preferred_Drug_List_Program_Ends_7.31.2010.pdf
10-07 August 13, 2010
IMPLEMENTATION OF HOSPITAL OUTPATIENT PROSPECTIVE PAYMENT SYSTEM
ALL HOSPITAL PROVIDERS PARTICIPATING IN THE NEW MEXICO MEDICAID PROGRAM AND OTHER INTERESTED PARTIES
Hospital services
Outpatient Prospective Payment System (OPPS)
OPPS
Payment system / reimbursement methodology
APC Model
Billing
http://www.hsd.state.nm.us/uploads/FileLinks/c78b68d063e04ce5adffe29376ff402e/MAD_SUPP_10_07_Implementation_of_Hospital_Outpatient_Prospective_Payment_System__HOPPS_.pdf
10-08 October 6, 2010
IMPLEMENTATION OF OUTPATIENT HOSPITAL PROSPECTIVE PAYMENT SYSTEM EFFECTIVE NOVEMBER 1, 2010.
ALL ACUTE CARE AND REHABILITATION HOSPITAL PROVIDERS PARTICIPATING IN THE NEW MEXICO MEDICAID PROGRAM
Hospital services
Outpatient Prospective Payment System (OPPS)
OPPS
Payment system / reimbursement methodology
APC Model
Billing
Critical Access Hospitals (CAHs)
Medicare
http://www.hsd.state.nm.us/uploads/FileLinks/c78b68d063e04ce5adffe29376ff402e/MAD_SUPP_10_08_Implementation_of_OPHPP_System__Eff_11.1.2010.pdf
10-09 November 1, 2010
ANESTHESIA SERVICES REGULATION
ALL PROVIDERS OF ANESTHESIA SERVICES
Anesthesia
Billing / procedure codes / modifiers
Reimbursement
Calculating anesthesia time
http://www.hsd.state.nm.us/uploads/FileLinks/c78b68d063e04ce5adffe29376ff402e/MAD_SUPP_10_09_Anesthesia_Services_Regulation.pdf
10-11 December 3, 2010
SUBMITTING CLAIMS FOR CONSIDERATION OF A TIMELY FILING LIMIT WAIVER
ALL PROVIDERS PARTICIPATING IN THE NEW MEXICO MEDICAID PROGRAM
Filing claims
Timely filing
Billing
Transaction Control Number (TCN)
Claim forms
http://www.hsd.state.nm.us/uploads/FileLinks/c78b68d063e04ce5adffe29376ff402e/MAD_SUPP_10_11_Submitting_Claims_for_Consideration_of_Timely_Filing_Limit_Waiver.pdf
10-12 December ALL HOME AND COMMUNITY- REDUCTION IN THE HOME AND COMMUNITY- Home and Community-Based Waiver http://www.hsd.state.
Human Services Department / Medical Assistance Division – Supplements to Program Rules
14
10, 2010 BASED WAIVER SERVICE PROVIDERS PARTICIPATING AS A DEVELOPMENTAL DISABILITIES (DD) WAIVER PROVIDER IN THE NEW MEXICO MEDICAID PROGRAM
BASED WAIVER SERVICES FEE SCHEDULE AND RECIPIENT ANNUAL RESOURCE ALLOTMENT AMOUNTS FOR DD SERVICES EFFECTIVE JANUARY 1, 2011
(HCBS)
Developmentally Disabled (DD)
Fee reduction / payment reduction
Annual resource allotment (ARA)
nm.us/uploads/FileLinks/c78b68d063e04ce5adffe29376ff402e/MAD_SUPP_10_12_Reduction_in_the_HCBS_Fee_Schdl_and_Annl_Resource_Allotment_for_DD_Svcs.pdf
11-01 January 14, 2011
UPDATES TO THE MEDICALLY FRAGILE (MF) HOME AND COMMUNITY BASED SERVICES (HCBS) WAIVER RATE TABLE
HOME AND COMMUNITY BASED SERVICES WAIVER PROVIDERS
Home and Community-Based Waiver (HCBS)
Medically Fragile (MF)
Fee schedule / rate table
Billing / procedure codes
http://www.hsd.state.nm.us/uploads/FileLinks/c78b68d063e04ce5adffe29376ff402e/MAD_SUPP_11_01_Updates_to_Medically__Fragile_HCBS_Waiver_Rate_Table.pdf
11-02 March 22, 2011
BILLING FOR MI VIA CONSULTANT SERVICES
ALL MI VIA CONSULTANT SERVICE PROVIDERS
Mi Via
Consultant/support guide services
Billing / procedure codes
http://www.hsd.state.nm.us/uploads/FileLinks/c78b68d063e04ce5adffe29376ff402e/MAD_SUPP_11_02_Billing_for_Mi_Via_Consultant_Svcs.pdf
11-03 March 31, 2011
All Provider Notice on Multiple Topics: I. EFFECTIVE MAY 1, 2011, ALL PRACTITIONER ADMINISTERED DRUG ITEMS MUST BE BILLED WITH NDC CODES.
II. EFFECTIVE APRIL 1, 2011: VACCINES FOR CHILDRENS (VFC)
III. EFFECTIVE FEBRUARY 15, 2011: PLACING THE TCN NUMBER ON CLAIMS BEING RESUBMITTED TO DOCUMENT A CLAIM WAS ORIGINALLY FILED TIMELY
ALL PROVIDERS PARTICIPATING IN THE NEW MEXICO MEDICAID PROGRAM
National Drug Code (NDC)
Practitioner administered drugs
Pharmacy
Claim forms
Billing / procedure codes
Pharmacy revenue codes
Vaccines and immunizations for children (VFC program)
Injections
Filing claims
Timely filing
Transaction Control Number (TCN)
Recoupments
National Correct Coding Initiative (NCCI)
Affordable Care Act (ACA)
Noncovered Services
Sleep studies
http://www.hsd.state.nm.us/uploads/FileLinks/c78b68d063e04ce5adffe29376ff402e/MAD_SUPP_11_03_Provider_Changes_I_to_XI.pdf
Human Services Department / Medical Assistance Division – Supplements to Program Rules
15
IV. SUBMITTING CLAIMS TO ACS WHEN RECOUPMENTS ARE MADE BY A MANAGED CARE ORGANIZATION FOR SALUD, CoLTS, OR SCI OR BY MEDICARE
V. NATIONAL CORRECT CODING INITIATIVE
VI. SLEEP STUDIES AND ALLERGY TESTING
VII. PAP SMEARS, PSA TESTS, and CESAREAN SECTIONS
VIII. DOCUMENTATION AND CORRECT BILLING REQUIREMENTS
IX. HEALTH CARE ACQUIRED CONDITIONS (HCAC)
X. REVIEW OF HOSPITAL CLAIMS XI. NATIONAL PROVIDER IDENTIFIER FOR REFERRING PROVIDERS
Allergy testing
Pap smears
Prostate Antigen Testing (PSA)
Cesarean sections
Pregnant women
Routine screening, tests or services
Bariatric or other weight loss and weight reduction surgeries or procedures;
Surrogate mothers
Documentation , medical necessity and correct billing
Healthcare acquired conditions / hospital acquired conditions / provider preventable conditions (HAC) (PPC) (HCAC)
Wrong or improper procedures
Utilization review of hospital claims
Necessary admissions and premature discharges
National Provider Identifier (NPI)
Referring providers / referrals
11-04 April 29, 2011
EFFECTIVE JULY 1, 2011 DENTAL PROVIDERS MUST SUBMIT THE NATIONAL PROVIDER IDENTIFIER (NPI) NUMBER OF THE RENDERING PROVIDER
ALL DENTAL PROVIDERS PARTICIPATING IN THE NEW MEXICO MEDICAID PROGRAM
National Provider Identifier (NPI)
HIPAA standards
Rendering / servicing providers
Dental providers
http://www.hsd.state.nm.us/uploads/FileLinks/c78b68d063e04ce5adffe29376ff402e/MAD_SUPP_11_04_Dental_Providers_NPI_Eff_7.1.2011.pdf
11-05 June 20, 2011
NEW SUB-CODES FOR MI VIA BUDGETS, EFFECTIVE JULY 1, 2011
ALL MI VIA CONSULTANT SERVICES PROVIDERS
Mi Via
Annual Budgets
Billing / procedure codes
http://www.hsd.state.nm.us/uploads/FileLinks/c78b68d063e04ce5adffe29376ff402e/MAD_SUPP_11_05_New_Su
Human Services Department / Medical Assistance Division – Supplements to Program Rules
16
bcodes_for_Mi_Via_Budgets__Eff_7.1.2011.pdf
11-06 October 18, 2011
MI VIA PROGRAM EMPLOYEE RATES OF PAY CHANGES
ALL MI VIA EMPLOYERS OF RECORD (EORs)
Mi Via
Employee Agreement
Fee / rate increase
Timesheet
http://www.hsd.state.nm.us/mad/pdf_files/Registers/Registers2011/11%2006%20Mi%20Via%20pay%20changes%20REV.pdf
11-07 November 30, 2011
NEW REQUIREMENTS FOR THE FEE-FOR-SERVICE HOME HEALTH PROGRAM
ALL HOME HEALTH AGENCIES PARTICIPATING IN THE NEW MEXICO MEDICAID PROGRAM
Home health
Face-to-Face encounter (F2F)
Homebound
State plan
Affordable care act
Medical supplies and equipment
http://www.hsd.state.nm.us/uploads/FileLinks/c78b68d063e04ce5adffe29376ff402e/MAD_SUPP_11_07_New_Requirement_for_FFS_Home_Health_Program.pdf
11-08 November 22, 2011
EFFECTIVE JANUARY 1, 2012 NEW REQUIREMENTS WHEN BILLING FOR SPECIFIC PROCEDURE CODES
ALL NON-HOSPITAL PROFESSIONAL PROVIDERS PARTICIPATING IN THE NEW MEXICO MEDICAID PROGRAM
National Drug Code (NDC)
Claim forms
Professional practitioners
IV Infusion providers
Medical supply providers
Billing / procedure codes
Drug items administered in provider offices, outpatient clinics and hospitals
Filing claims
http://www.hsd.state.nm.us/uploads/FileLinks/c78b68d063e04ce5adffe29376ff402e/MAD_SUPP_11_08_New_Requirements_when_Billing_Specific_Procedure_Codes.pdf
12-01 January 30, 2012
GROUND AMBULANCE MILEAGE CODES
ALL GROUND AMBULANCE SERVICES PROVIDERS
Transportation
Ground ambulance
Billing / procedure codes
Advanced Life Support (ALS) and Basic Life Support (BLS) services
http://www.hsd.state.nm.us/uploads/FileLinks/c78b68d063e04ce5adffe29376ff402e/12_01_ground_ambulance.pdf
12-02 February 29, 2012
REPLACEMENT OF MEDICAL ASSESSMENT ABSTRACT FOR PROGRAMS REQUIRING NURSING FACILITY LEVEL OF CARE NEW REQUIREMENT FOR A HISTORY AND PHYSICAL FOR PERSONAL CARE OPTION CONSUMERS
PHYSICIANS, NURSE PRACTITIONERS AND PHYSICIAN ASSISTANTS, NURSING FACILITIES, PROGRAM OF ALL-INCLUSIVE CARE FOR THE ELDERLY, COORDINATION OF LONG-TERM SERVICES “C” WAIVER PROVIDERS, MI VIA
Nursing Facilities (NF)
Level of Care (LOC)
Income Support Division (ISD)
379 Long Term Care Assessment Abstract
MAD 379 Long Term Care Medical Assessment form.
Personal Care Option (PCO)
Third Party Assessor / Utilization
http://www.hsd.state.nm.us/uploads/FileLinks/c78b68d063e04ce5adffe29376ff402e/12_02_abstract_and_h___p.pdf
Human Services Department / Medical Assistance Division – Supplements to Program Rules
17
CONSULTANT PROVIDERS, PERSONAL CARE OPTION PROVIDERS, AND MANAGED CARE ORGANIZATIONS
Review (TPA/UR)
History and Physical (H&P)
12-03 March 2, 2012
TOBACCO CESSATION TREATMENT SERVICES: I. TOBACCO CESSATION SERVICES AND COVERAGE FOR MEDICAID RECIPIENTS
II. ELIGIBLE PROVIDERS AND PRACTITIONERS
III. PROCEDURE AND DIAGNOSIS CODES
IV. QUITLINE
ALL PROVIDERS PARTICIPATING IN THE NEW MEXICO MEDICAID PROGRAM
Tobacco cessation / smoking cessation services
Pregnant women
EPSDT / children
Behavioral health services
OptumHealth
Drug items
Pharmacy
Over-the-counter (OTC) nicotine replacement drug products
Counseling
Dental providers
Billing / procedure codes / diagnosis codes
Quitline
http://www.hsd.state.nm.us/uploads/FileLinks/c78b68d063e04ce5adffe29376ff402e/12_03_tobacco_cessation.pdf
12-04 April 27, 2012
I. REQUIREMENTS WHEN BILLING FOR SPECIFIC PROCEDURE CODES II. REQUIREMENTS WHEN BILLING FOR DENTAL CODES
ALL HOSPITAL PROVIDERS IN THE NEW MEXICO MEDICAID PROGRAM
Drug rebates
Practitioner administered drug items
Outpatient Prospective Payment System (OPPS)
Hospitals
Packaged items
National Drug Code (NDC)
Claim forms
Billing
Dental providers
Dental procedure codes ( “D” codes)
Dental: intravenous sedation or general anesthesia
http://www.hsd.state.nm.us/uploads/FileLinks/c78b68d063e04ce5adffe29376ff402e/12_04_Hospital_NDC_and_Dental_Supplement_April_2012.pdf
12-05 May 3, 2012 REPORTING REFERRING / PRESCRIBING / ORDERING PROVIDERS, REPORTING OF PROVIDER PREVENTABLE CONDITIONS, AND PROVIDER TERMINATIONS I. REPORTING REFERRING / PRESCRIBING / ORDERING PROVIDERS II. PROVIDER PREVENTABLE CONDITIONS: Hospital Acquired
ALL PROVIDERS PARTICIPATING IN THE NEW MEXICO MEDICAID PROGRAM
Patient Protection and Affordable Care Act (PPACA)
National Provider Identifier (NPI)
Ordering, prescribing or referring practitioners
Billing / claim forms
National Plan & Provider Enumeration System (NPPES)
Provider-Preventable Conditions (PPC)
Health Care-Acquired Conditions (HCAC)
http://www.hsd.state.nm.us/uploads/FileLinks/c78b68d063e04ce5adffe29376ff402e/12_05_Referring_Prov_Enrollment_notice_April_2012__3___3_.pdf
Human Services Department / Medical Assistance Division – Supplements to Program Rules
18
Conditions – Inpatient III. PROVIDER PREVENTABLE CONDITIONS: Other Provider Preventable Conditions – All Healthcare Providers IV. PROVIDER TERMINATIONS
Hospital Acquired Conditions (HAC)
Other provider-preventable conditions (OPPCs)
Present on Admission (POA) Indicator
Diagnosis Related Grouper (DRG)
Provider terminations
For cause terminations
Medicare
National Practitioner Data Bank (NPDB)
Fraud, abuse, misuse, and falsification
Exclusion
Provider enrollment
Provider enrollment forms
Provider participation agreement (PPA)
12-07 June 27, 2012
NEW DEVELOPMENTAL DISABILITIES WAIVER (DDW) SERVICES FEE SCHEDULE
ALL DEVELOPMENTAL DISABILITIES WAIVER (DDW) PROVIDERS PARTICIPATING IN THE NEW MEXICO MEDICAID PROGRAM
New Mexico Department of Health / Developmental Disabilities Supports Division (DOH / DDSD)
Developmental Disabilities (DD)
Waiver
Fee schedule / rates
Billing
Rate Study Steering Committee
Reimbursement study
http://www.hsd.state.nm.us/uploads/FileLinks/c78b68d063e04ce5adffe29376ff402e/12_07_Supplement_DDW_Rates_06_25_12wAppendix.pdf
12-08 July 12, 2012
CLARIFICATION ON REPORTING OF PRESENT ON ADMISSION INDICATOR (To clarify information that was given in a previous Supplement, 12-05 “Reporting Referring/Prescribing/Ordering Providers, Reporting of Provider Preventable Conditions, and Provider Terminations”)
ALL PROVIDERS PARTICIPATING IN THE NEW MEXICO MEDICAID PROGRAM
Provider-Preventable Conditions (PPC)
Health Care-Acquired Conditions (HCAC)
Hospital Acquired Conditions (HAC)
Other provider-preventable conditions (OPPCs)
Present on Admission (POA) Indicator
Electronic claims
Billing
HIPAA 5010
http://www.hsd.state.nm.us/uploads/FileLinks/c78b68d063e04ce5adffe29376ff402e/12_08_clarification_POA.pdf
12-10 September 24, 2012
MEDICATION ASSISTED TREATMENT SERVICES FOR OPIOID ADDICTION I. Enrollment
OPIATE TREATMENT PROGRAMS
Methadone clinics
Medication Assisted Treatment (MAT)
Opiate / opioid treatment centers and programs (OTC / OTP)
Public Health Act
http://www.hsd.state.nm.us/uploads/FileLinks/c78b68d063e04ce5adffe29376ff402e/12_1
Human Services Department / Medical Assistance Division – Supplements to Program Rules
19
A. Enrollment of Opiate Treatment Centers B. Enrollment of Practitioners II. Eligible Recipients III. Billing Instructions
Substance use and abuse disorder
Reimbursement
Behavioral health
OptumHealth
Provider enrollment
Eligible recipients
Billing instructions / procedure codes
Electronic billing
42 CFR Part 8, Certification of Opioid Treatment Programs
0_MAT_OTC_Clinics_Supp_09062012__2_.pdf
12-11 September 24, 2012
MEDICATION ASSISTED TREATMENT SERVICES FOR OPIOID ADDICTION
ALL PRESCRIBERS PARTICIPATING IN THE NEW MEXICO MEDICAID PROGRAM
Methadone clinics
Medication Assisted Treatment (MAT)
Opiate / opioid treatment centers and programs (OTC / OTP)
Substance use and abuse disorder
Referrals
Behavioral health
OptumHealth
Provider enrollment
Eligible recipients
Billing instructions / procedure codes
Electronic billing
42 CFR Part 8, Certification of Opioid Treatment Programs
New Mexico Department of Health (DOH)
http://www.hsd.state.nm.us/uploads/FileLinks/c78b68d063e04ce5adffe29376ff402e/12_11_MAT_Methadone_for_Practitioners_supp_09122012.pdf
12-12 October 10, 2012
NEW DEVELOPMENTAL DISABILITIES WAIVER SERVICES FEE SCHEDULE (This supplement replaces the State of New Mexico Medical Assistance Program Manual Supplement #12-07 dated June 27, 2012.)
ALL DEVELOPMENTAL DISABILITIES WAIVER (DDW) PROVIDERS PARTICIPATING IN THE NEW MEXICO MEDICAID PROGRAM
SIS (Supports Intensity Scale) assessment
Service packages
New Mexico Department of Health / Developmental Disabilities Supports Division (DOH / DDSD)
Developmental Disabilities (DD)
Waiver
Fee schedule / rates
Billing
Rate Study Steering Committee
Reimbursement study
http://www.hsd.state.nm.us/uploads/FileLinks/c78b68d063e04ce5adffe29376ff402e/12_12_DD_Waiver_Rates_October_2012.pdf
12-13 December 27, 2012
I. ALVEOLOPLASTY COVERAGE II. AUTHORIZATIONS III. DENTAL HYGIENISTS SCOPE OF PRACTICE
ALL DENTAL PROVIDERS Dental providers, services procedure codes and billing
Alveoloplasty
Extraction
Reimbursement
Prior authorization (PA)
DentaQuest
http://www.hsd.state.nm.us/uploads/FileLinks/c78b68d063e04ce5adffe29376ff402e/12_13_Dental_Supplement.pdf
Human Services Department / Medical Assistance Division – Supplements to Program Rules
20
IV. REPORTING OF RENDERING PROVIDERS
Documentation
ADA form
Billing
Orthodontia
Orthodontic authorization
Handicapping Labiolingual Deviation Index (HLD) score
Request for information (RFI)
Dental hygienists
Scope of practice
Collaborative Dental Hygienist
National Provider Identified (NPI)
Rendering provider
Claim form
13-01 January 15, 2013
I. INCREASE IN PAYMENT RATES FOR PRIMARY CARE PROVIDER SERVICES II. VACCINATION REIMBURSEMENT
PROVIDERS PARTICIPATING IN THE NEW MEXICO MEDICAID PROGRAM
Affordable Care Act (ACA)
Centers for Medicare & Medicaid Services (CMS)
Primary care providers and services
Procedure codes
Primary care services payment increase
Reimbursement increase
Attestation
Communication
Qualifying providers
Board certification
Physician Extenders
Payment process
Vaccine and immunization administration
Regional limit cap rate
Injection and oral administration
Vaccines for Children (VFC) program
Primary Care Increase Self -Attestation Form
http://www.hsd.state.nm.us/uploads/FileLinks/c78b68d063e04ce5adffe29376ff402e/13_01_Primary_Care_Increase_Revised_Feb_2013.pdf
13-02 January 18, 2013
REIMBURSEMENT RATES ASSOCIATED WITH NEW CPT CODES FOR 2013
BEHAVIORAL HEALTH PROVIDERS PARTICIPATING IN THE NEW MEXICO MEDICAID PROGRAM
Procedure codes
Billing
Behavioral health
CPT codes
Reimbursement
Psychiatric
Psychotherapy
OptumHealth
Evaluation and management (E&M) codes, therapy codes, and interactive
http://www.hsd.state.nm.us/uploads/FileLinks/c78b68d063e04ce5adffe29376ff402e/13_02_BH_Supplement__New_CPT_Codes.pdf
Human Services Department / Medical Assistance Division – Supplements to Program Rules
21
complexity codes
13-03 February 19, 2013
I. UPDATED INFORMATION: INCREASE IN PAYMENT RATES FOR PRIMARY CARE PROVIDER SERVICES II. NEW VACCINATION REIMBURSEMENT INFORMATION *Update to supplement 13-01
PROVIDERS PARTICIPATING IN THE NEW MEXICO MEDICAID PROGRAM
Affordable Care Act (ACA)
Centers for Medicare & Medicaid Services (CMS)
Primary care providers and services
Procedure codes
Primary care services payment increase
Reimbursement increase
Attestation
Communication
Qualifying providers
Board certification
Physician Extenders
Payment process
Vaccine and immunization administration
Regional limit cap rate
Injection and oral administration
Vaccines for Children (VFC) program
Primary Care Increase Self -Attestation Form
http://www.hsd.state.nm.us/uploads/FileLinks/c78b68d063e04ce5adffe29376ff402e/13_03_Primary_Care_Increase_Feb_2013.pdf
13-04 April 17, 2013
LONG TERM CARE MEDICAL ASSESSMENT REQUIREMENTS EFFECTIVE MAY 1,2013 I. CLARIFICATION REGARDING THE REQUIREMENT FOR A PROVIDER’S SIGNATURE II. ACCOMPANYING DOCUMENTATION III. PROVIDER PRIOR A UTHORIZATION TRAINING
NURSING FACILITY PROVIDERS PARTICIPATING IN THE NEW MEXICO MEDICAID PROGRAM
Nursing facilities (NF)
Long Term Care (LTC) Medical Assessment (MAD 379 form)
Provider’s signature
Documentation
Prior Authorization
Provider training
Utilization review (UR)
Level of Care (LOC)
Third Party Assessor (TPA)
http://www.hsd.state.nm.us/uploads/FileLinks/c78b68d063e04ce5adffe29376ff402e/13_04_C_Hodges_LTC_Assess_Form_Signed.pdf
13-05 I. LIMITING PAYMENT FOR INDUCTIONS AND CESAREAN SECTIONS THAT ARE NOT MEDICALLY NECESSARY
II. BILLING WHEN C-SECTIONS OR INDUCTIONS ARE
ALL PROVIDERS PARTICIPATING IN THE NEW MEXICO MEDICAID PROGRAM
Pregnant women
Cesarean sections / c-sections
Induction
Early Deliveries
Family Planning
Contraceptive devices / contraceptives
Birth control
http://www.hsd.state.nm.us/uploads/FileLinks/c78b68d063e04ce5adffe29376ff402e/13_05_Supplement__Hyst_Consent_Form_91213_
Human Services Department / Medical Assistance Division – Supplements to Program Rules
22
MEDICALLY NECESSARY III. HYSTERECTOMY CONSENT FORM IV. INSERTION OF LONG ACTING REVERSIBLE CONTRACEPTIVES AT TIME OF AN INPATIENT STAY
Hysterectomy
Consent forms
Billing and procedure codes
final__2_.pdf
13-06 October 25, 2013
NEW NURSING FACILITY LEVEL OF CARE (NF LOC) CRITERIA AND INSTRUCTIONS TO REPLACE LONG TERM CARE UTILIZATION REVIEW FOR NURSING FACILITIES (8.312.2UR) EFFECTIVE JANUARY 1, 2014
ALL MEDICAL PROVIDERS AND NURSING FACILITIES PARTICIPATING IN THE NEW MEXICO MEDICAID PROGRAM
Nursing facilities (NFs)
Level of care (LOC)
(NF LOC)
Utilization review
Forms
Activities of Daily Living (ADLs)
http://www.hsd.state.nm.us/uploads/FileLinks/c78b68d063e04ce5adffe29376ff402e/13_06_Supplement.pdf
13-07 December 23, 2013
BEHAVIORAL HEALTH CHANGES EFFECTIVE JANUARY 1, 2014 WITH THE IMPLEMENTATION OF CENTENNIAL CARE I. CHANGES IN RESPONSIBILITY FOR BEHAVIORAL HEALTH CLAIMS IN THE MEDICAID PROGRAM
II. PROVIDER ENROLLMENT ISSURES III. PRIOR AUTHORIZATION – FEE-FOR-SERVICE IV. BILLING FOR FEE-FOR-SERVICE RECIPIENTS
BEHAVIORAL HEALTH PROVIDERS
Behavioral health (BH)
Fee-for-service (FFS) billing
Prior authorization (PA)
OptumHealth
Centennial Care
Provider enrollment
Managed care organizations (MCOs)
http://www.hsd.state.nm.us/uploads/FileLinks/c78b68d063e04ce5adffe29376ff402e/13_07_Behavioral_Health_Changes_Effective_January_1__2013_with_the_implementation_of_Centennial_Care.pdf
14-01 January 13, 2014
I. UPDATED INFORMATION: PAYMENT RATES FOR PRIMARY CARE PROVIDER SERVICES II. ATTESTATION III. UPDATED REQUIREMENTS
ALL PROVIDERS PARTICIPATING IN THE NEW MEXICO MEDICAID PROGRAM
Affordable Care Act (ACA)
Primary care providers (PCPs)
Primary care payment increase
Vaccinations / immunizations
http://www.hsd.state.nm.us/uploads/files/Providers/Resources/Supplements/2014%20Supplements/14-01%20Payment%20Rates%20for%20Primary%
Human Services Department / Medical Assistance Division – Supplements to Program Rules
23
IV. EFFECTIVE DATES OF PAYMENTS
20Care%20Provider%20Services.pdf