Human Services Department / Medical Assistance Division ... Mexico... · Human Services Department / Medical Assistance Division – Supplements to Program Rules 1 ... 2004 Number

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

http://www.hsd.state.nm.us/mad/registers/2013.html













http://www.hsd.state.nm.us/mad/pdf_files/Supplements/PCOclarificationmr0334.pdf















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
















http://www.hsd.state.nm.us/mad/pdf_files/Supplements/HCBSWRateTables.pdf

http://www.hsd.state.nm.us/mad/pdf_files/Supplements/HCBSWRateTables.pdf


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


NMRX

Clients


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





















http://www.hsd.state.nm.us/mad/pdf_files/Supplements/0502preferreddruglistfor%20NA.pdf

http://www.hsd.state.nm.us/mad/pdf_files/Supplements/0502preferreddruglistfor%20NA.pdf


4

NATIVE AMERICANS


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


NMRX

Clients


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


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


























5

06-04 June 1, 2006 PROVIDER NOTICE OF INCREASES IN MEDICAID REIMBURSEMENT


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)


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


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


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


Developmentally Disabled waiver (DD)

Fee schedule (rate table)

http://www.hsd.state.nm.us/uploads/FileLinks/c78b68d063e04ce5adffe29376ff402e/MAD
























http://www.hsd.state.nm.us/uploads/FileLinks/c78b68d063e04ce5adffe29376ff402e/MAD_SUPP_07_02_Corrections_to_the_DD_HCBS_Waiver_Rate_Table.pdf





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



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


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








http://www.hsd.state.nm.us/uploads/FileLinks/c78b68d063e04ce5adffe29376ff402e/MAD_SUPP_07_04_Increase_in_the_Amount_Allowed_for_Hearing_Aids___Dispensing_Fees.pdf


























http://www.hsd.state.nm.us/uploads/FileLinks/c78b68d063e04ce5adffe29376ff402e/MAD_SUPP_07_07_Personal_Care_Provider_Notice___Increase_in_Reimb..pdf

http://www.hsd.state.nm.us/uploads/FileLinks/c78b68d063e04ce5adffe29376ff402e/MAD_SUPP_07_07_Personal_Care_Provider_Notice___Increase_in_Reimb..pdf


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


Remittance advice (RA) / HIPAA 835 electronic remittance advice.


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


























http://www.hsd.state.nm.us/uploads/FileLinks/c78b68d063e04ce5adffe29376ff402e/MAD_SUPP_08_02_Medicaid_Reimbursement_for_Birth_Control___Family_Planning_Svcs.pdf




8

PARTICIPATING IN THE NEW MEXICO MEDICAID PROGRAM


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


Prescribing

Tamper resistant


Claim forms


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


Pharmacy


Prescribing

Tamper resistant


Claim forms


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.































http://www.hsd.state.nm.us/uploads/FileLinks/c78b68d063e04ce5adffe29376ff402e/MAD_SUPP_09_01_Billing_for_Community_Living_Services.pdf


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



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





























http://www.hsd.state.nm.us/uploads/FileLinks/c78b68d063e04ce5adffe29376ff402e/MAD_SUPP_09_06_EPSDT.pdf

http://www.hsd.state.nm.us/uploads/FileLinks/c78b68d063e04ce5adffe29376ff402e/MAD_SUPP_09_06_EPSDT.pdf


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


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

http://www.hsd.state.nm.us/uploads/FileLinks/c78b68d063e04ce5adffe29376ff402e/MAD_SUPP_09_07_Payment_to_Providers_Using_EFT.pdf































http://www.hsd.state.nm.us/uploads/FileLinks/c78b68d063e04ce5adffe29376ff402e/MAD_SUPP_09_12_Reduction_in_Medicaid_Payments_for_Servcies_Eff_12.1.2009.pdf




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.


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




























http://www.hsd.state.nm.us/uploads/FileLinks/c78b68d063e04ce5adffe29376ff402e/MAD_SUPP_10_02_Change_in_Pharmacy_Dispensing_Fees__Contracted_Entities_340B_and_Payer_Sheets.PDF





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


Claim forms

Practitioner administered drugs


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


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


NMRx

Billing


























http://www.hsd.state.nm.us/uploads/FileLinks/c78b68d063e04ce5adffe29376ff402e/MAD_SUPP_10_06_NMRx_Preferred_Drug_List_Program_Ends_7.31.2010.pdf





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


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


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.

































http://www.hsd.state.nm.us/uploads/FileLinks/c78b68d063e04ce5adffe29376ff402e/MAD_SUPP_10_12_Reduction_in_the_HCBS_Fee_Schdl_and_Annl_Resource_Allotment_for_DD_Svcs.pdf


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 Waiver (HCBS)

Medically Fragile (MF)

Fee schedule / rate table


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


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



Practitioner administered drugs

Pharmacy

Claim forms


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























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


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


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


http://www.hsd.state.nm.us/uploads/FileLinks/c78b68d063e04ce5adffe29376ff402e/MAD_SUPP_11_05_New_Su








http://www.hsd.state.nm.us/uploads/FileLinks/c78b68d063e04ce5adffe29376ff402e/MAD_SUPP_11_05_New_Subcodes_for_Mi_Via_Budgets__Eff_7.1.2011.pdf






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


Claim forms

Professional practitioners

IV Infusion providers

Medical supply providers


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


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)


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



































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


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


Hospitals

Packaged items


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


Patient Protection and Affordable Care Act (PPACA)


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





















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”)


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













http://www.hsd.state.nm.us/uploads/FileLinks/c78b68d063e04ce5adffe29376ff402e/12_10_MAT_OTC_Clinics_Supp_09062012__2_.pdf





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





















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


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















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


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


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_













http://www.hsd.state.nm.us/uploads/FileLinks/c78b68d063e04ce5adffe29376ff402e/13_05_Supplement__Hyst_Consent_Form_91213_final__2_.pdf







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



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%















http://www.hsd.state.nm.us/uploads/files/Providers/Resources/Supplements/2014%20Supplements/14-01%20Payment%20Rates%20for%20Primary%20Care%20Provider%20Services.pdf








23

IV. EFFECTIVE DATES OF PAYMENTS

20Care%20Provider%20Services.pdf

Documents

Human Services Department / Medical Assistance Division ... Mexico... · Human Services Department / Medical Assistance Division – Supplements to Program Rules 1 ... 2004 Number