N.M. Admin. Code § 8.309.4.9

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

Section 8.309.4.9 - ALTERNATIVE BENEFITS PLAN SERVICES WITH LIMITATIONS (ABP)

The medical assistance division (MAD) category of eligibility "other adults" has an alternative benefit plan (ABP). MAD covers ABP specific services for an ABP eligible recipient. 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 eligible recipient:

(1) has limitations on specific benefits;

(2) does not have all standard medicaid state plan benefits available; and

(3) has some benefits, primarily preventive services, that are available only to an ABP eligible recipient. All early and periodic screening, diagnosis and treatment (EPSDT) program services are available to an ABP eligible recipient under 21 years. ABP services for an ABP eligible recipient under the age of 21 years 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 MAD ABP provider and ABP eligible recipient have rights and responsibilities as described in chapters 349 through 352 of Title 8 NMAC, Social Services. Long term care in a nursing facility (NF), mi via and community benefits are not available to an ABP eligible recipient.

N.M. Admin. Code § 8.309.4.9

8.309.4.9 NMAC - N, 1-1-14