N.M. Admin. Code § 8.310.9.12

Current through Register Vol. 35, No. 21, November 5, 2024

Section 8.310.9.12 - COVERED SERVICES AND SERVICE LIMITATIONS

All services provided by the clinic must be furnished in accordance with applicable federal, state, and local laws and regulations and must be furnished within the limitations applicable to medicaid covered benefits.

A. The following are covered services:

(1) medically necessary diagnostic and therapeutic services, supplies, and treatment of medical conditions, including medically necessary family planning services; see Section MAD-762, Reproductive Health Services;

(2) laboratory and diagnostic imaging services for diagnosis and treatment; and

(3) surgical procedures, emergency room physician services, and inpatient hospital visits furnished at a different facility when performed by a physician under contract to a rural health clinic.

B.Visiting nurse services: Medicaid covers visiting nurse services through a rural health clinic if the following criteria are met [ 42 CFR Section 440.20(b)(4)] :

(1) the rural health clinic is located in an area in which there is a shortage of home health agencies, as determined by the secretary of the federal department of health and human services; the rural health clinic does not need separate or additional home health agency certification to furnish visiting nurse services;

(2) the services are furnished to homebound recipients;

(3) the services are furnished by a registered nurse, licensed practical nurse, or licensed vocational nurse who is employed by, or receives compensation for the services from the clinic;

(4) the services are furnished under a written plan of treatment that is:

(a) established and reviewed at least every sixty (60) days by supervising physicians at the rural health clinics;

(b) established by certified nurse practitioners, certified physician assistants, certified nurse midwives, licensed nurse midwives, or specialized nurse practitioners and reviewed at least every sixty (60) days by supervising physicians; and

(c) signed by nurse practitioners, physician assistants, nurse midwives, specialized nurse practitioners, or supervisory physicians of the clinic;

(5) prior approval for nursing services must be obtained from the MAD utilization review contractor.

C.Primary care network restrictions: All rural health clinics are subject to the primary care network restrictions. See Section MAD-603, Primary Care Network.

N.M. Admin. Code § 8.310.9.12

8.310.9.12 NMAC - Rp, 8.310.3.12 NMAC, 1-1-14