N.M. Admin. Code § 8.320.6.15

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

Section 8.320.6.15 - NON-COVERED SERVICES

MAD school-based services billed in school settings are subject to the limitations and coverage restrictions that exist for other MAD services; see 8.301.3 NMAC. MAD does not cover the following services.

A. Services classified as educational.

B. Services to non-MAP eligible individuals.

C. Services billed by a practitioner outside his or her area of expertise.

D. Vocational training that is related solely to specific employment opportunities, work skills or work settings.

E. Services that duplicate services billed outside the school setting unless determined to be medically necessary and MAD or its designee gave prior authorization for the service.

F. Services not identified in the eligible recipient's IEP, IFSP, 504 plan, IHCP or other care plan.

G. Transportation services listed below:

(1) transportation that a MAP eligible recipient would otherwise receive in the course of attending school;

(2) transportation for the eligible recipient with special education needs under the Individuals with Disabilities Education Act (IDEA) who rides the regular school bus to and from school with non-disabled children; and

(3) transportation of a minor aged child, such as a sibling of the eligible recipient who is simply accompanying the eligible recipient to a MAD service.

N.M. Admin. Code § 8.320.6.15

8.320.6.15 NMAC - N, 1-1-14, Adopted by New Mexico Register, Volume XXVI, Issue 12, June 30, 2015, eff. 7/1/2015, Amended by New Mexico Register, Volume XXXIII, Issue 12, June 21, 2022, eff. 7/1/2022