N.M. Admin. Code § 8.308.9.22

Current through Register Vol. 35, No. 23, December 10, 2024

Section 8.308.9.22 - MAD ALTERNATIVE BENEFITS PLAN GENERAL BENEFITS FOR ABP EXEMPT MEMBERS (ABP exempt)

An ABP member who self-declares they have a qualifying condition is evaluated by their MCO for determination if they meet an ABP qualifying condition. An ABP exempt member may select to no longer utilize their ABP benefits package. Instead, the ABP exempt member will utilize their MCO's medicaid benefits package. See 8.308.9.11-20 NMAC for detailed description of the MCO medicaid benefit services. All services, services limitations and co-payments that apply to full benefit medicaid recipients apply to APB-exempt recipients. An ABP-exempt recipient does not have access to the benefits that only apply to ABP recipients. The ABP co-payments do not apply to an ABP-exempt recipient. The limitations on services that apply only to ABP-recipients do not apply to ABP-exempt recipients. The MCO shall comply with all HSD contractual provisions and with all NMAC rules that pertain to the MCO's responsibilities to its members as listed below:

A. provider networks found in 8.308.2 NMAC;

B. managed care eligibility found in 8.308.6 NMAC;

C. enrollment and disenrollment from managed care found in 8.308.7 NMAC;

D. managed care member education - rights and responsibilities found in 8.308.8 NMAC;

E. care coordination found in 8.308.10 NMAC;

F. transition of care found in 8.308.11 NMAC;

G. community benefits found in 8.308.12 NMAC;

H. managed care member rewards found in 8.308.13 NMAC

I. managed care cost sharing found in 8.308.14 NMAC;

J. managed care grievance and appeals found in 8.308.15 NMAC;

K. managed care reimbursement found in 8.308.20 NMAC;

L. quality management found in 8.308.21 NMAC; and

M. managed care fraud, waste and abuse found in 8.308.22 NMAC.

N.M. Admin. Code § 8.308.9.22

8.308.9.22 NMAC - N, 1-1-14, Adopted by New Mexico Register, Volume XXIX, Issue 08, April 24, 2018, eff. 5/1/2018, Amended by New Mexico Register, Volume XXXIII, Issue 07, April 5, 2022, eff. 4/5/2022