N.M. Admin. Code § 8.308.9.7

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

Section 8.308.9.7 - DEFINITIONS

A.Alternative benefits plan services with limitations (ABP): The medical assistance division (MAD) category of eligibility "other adults" has an alternative benefit plan (ABP). The HSD contracted managed care organization (MCO) covers ABP specific services for an ABP member. Services are made available through MAD under a benefit plan similar to services provided by commercial insurance plans. ABP benefits include preventive services and treatment services. An ABP member has limitations on specific benefits; and does not have all MCO medicaid benefits available. All early and periodic screening, diagnosis and treatment (EPSDT) program services are available to an ABP member under 21 years. ABP services for an ABP member under the age of 21 years are not subject to the duration, frequency, and annual or lifetime benefit limitations that are applied to an ABP eligible recipient 21 years of age and older. A MCO ABP contracted provider and an ABP member have rights and responsibilities as described in Title 8 Chapter 308 NMAC, Social Services.

B.Alternative benefits plan general benefits for ABP exempt member (ABP exempt): An ABP member who self-declares they have a qualifying condition is evaluated by the MCO's utilization management for determination if they meet the qualifying condition. An ABP exempt member utilizes their benefits described in 8.308.9 NMAC and in 8.308.12 NMAC.

C.Early childhood home visiting program: A program that uses home visiting as a primary service delivery strategy and offers services on a voluntary basis to eligible pregnant individuals and their children from birth up to kindergarten entry, according to the program standard.

D.Evidence-based, early childhood home visiting program: A home visiting program that is recognized by the U.S. department of health & human services maternal, infant, and early childhood home visiting (MIECHV) project and:

(1) is grounded in relevant, empirically-based best practice and knowledge that:

(a) is linked to and measures the following outcomes:

(i) babies that are born healthy;

(ii) children that are nurtured by their parents and caregivers;

(iii) children that are physically and mentally healthy;

(iv) children that are ready for school;

(v) children and families that are safe; and

(vi) families that are connected to formal and informal supports in their communities;

(b) has comprehensive home visiting standards that ensure high-quality service delivery and continuous quality improvement; and

(c) has demonstrated significant, sustained positive outcomes;

(2) follows program standards that specify the purpose, outcomes, duration and frequency of services that constitute the program;

(3) follows the curriculum of an evidence-based home visiting model;

(4) employs well-trained and competent staff and provides continual professional supervision and development relevant to the specific program and model being delivered;

(5) demonstrates strong links to other community-based services;

(6) operates within an organization that ensures compliance with home visiting standards;

(7) continually evaluates performance to ensure fidelity to the program standards;

(8) collects data on program activities and program outcomes; and

(9) is culturally and linguistically appropriate.

N.M. Admin. Code § 8.308.9.7

8.308.9.7 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 XXIX, Issue 23, December 11, 2018, eff. 1/1/2019, Amended by New Mexico Register, Volume XXXIII, Issue 07, April 5, 2022, eff. 4/5/2022