Turquoise Care Letters of Direction

LOD #1 Transition of Payment from Medicaid to Medicare for OTP Services

LOD #2 Rate Corrections for IOP Services

LOD #3 State Fiscal Year 2024 Behavioral Health Fee Schedule

LOD #4 NM High-Fidelity Wraparound Program

LOD #5 Supervisory Certification & Rostering

LOD #6 Billing for Specialized Behavioral Health Services by FQHCs

LOD #7 MCO Systems Configurations for BH Claims from FQHC Satellite Locations

LOD #8 Rate Increase for Residential Treatment Centers (RTC’s) for Youth

LOD #9 Medication Assisted Treatment (MAT) Medications; Narcan and Naloxone

LOD #10 Behavioral Health Evidence-based Practices

LOD #11 State Fiscal Year 2024 Applied Behavioral Analysis (ABA) Fee Schedule

LOD #12 Delivery of Necessary Diabetic Resources

LOD #13 MCOR Guidance Amendment

LOD #14 Human Donor Milk Billing and Guidance in Outpatient Setting

LOD #15 Medicaid Home Visiting Billing Codes

LOD #16 Silver Diamine Fluoride Provided by Dental Providers

LOD #17 Silver Diamine Fluoride Provided by Physician or Other Qualified Healthcare Professional

LOD #18 Chiropractic Services

LOD #19 Revised Medical Necessity Criteria for Orthodontic Treatment

LOD #20 Mobile Crisis Intervention and Mobile Response and Stabilization Services

LOD #21 Comprehensive Well Child Checkups for Children in State Custody (CISC) Within 30 Days

LOD #22 Coverage of Gender Affirming Healthcare Medications and Procedures

LOD #23 Comprehensive Addiction Recovery Act (CARA) Program Plan of Safe Care

LOD #24 MCO Required Coverage of Over-The-Counter Reproductive Health Services

LOD #25 HHS OIG PCS Audit Remediation

LOD #26 EOB Exception for BH Services and BH Provider

LOD #27 Transcranial Magnetic Stimulation (TMS) Services

LOD #28 MCO Requirements for Coordinating Treatment Foster Care (TFC) Placement for Children in State Custody (CISC)

Inactive-LOD #29 HCQS Per Diem and MBI Increase for SFY 2025-Repealed and Replaced by LOD #29-1

LOD #29-1 HCQS Per Diem MBI Increase for SFY2025 RR LOD 29

LOD #30 CCBHC Demonstration Implementation

LOD #31 Rate Corrections for IOP Services

LOD #32 Prenatal Genetic Screening

LOD #33 Updated Coverage for Prosthetic and Custom Orthotic Devices

LOD #34 UNM Medical Group & UNM Hospital Professional Group Directed Payment

LOD #35 Opioid Treatment Program Changes to align 42 CFR part 8 Final Rule

LOD #36 State Fiscal Year 2025 Payment Rate Increases with 2 Attachments

LOD #37 Lactation Care Provider Services

LOD #38 CHW and CHR Benefit

LOD #39 Payment Rate Increase Effective July 1, 2024

LOD #40 NEMT Guidance

 

 

 

Centennial Care Letters of Direction

Inactive – LOD #1 – Guidance for CHV Program Implementation – Repealed and Replaced by LOD #1-1

LOD #1-1 Repeal and Replace CHV Program Implementation, Statewide

LOD #2 – Community Intervener I and II

Inactive – LOD #3 – Tracking Measure Reporting Requirements- Repealed and replaced by LOD #16

Inactive – LOD #4 – Nursing Facility Level of Care extensions- Sunset 6/30/2019

Inactive-LOD #5 – Implementation of the Annual Consumer, Family-Caregiver and Youth Satisfaction Project Survey – Repealed and Replaced by LOD #5-1

LOD #5-1 – Implementation of the Annual Consumer, Family-Caregiver and Youth Satisfaction Project (C/F/YSP) Survey

Inactive – LOD #6 – Compilation of NF LOC Criteria and Instructions eff. 1/1/2019 – Sunset on inclusion in the Managed Care Policy Manual eff. 10/1/2020

Inactive – LOD #7 – Directed Payment to UNM Medical Group- Repealed and replaced by LOD #9

Inactive – LOD #8 – Valle Del Sol Payment of Adult Psycho-Social Rehab Services-Sunset 6/30/2019

Inactive – LOD #9 – Directed Payment to UNM Medial Group- Repealed and Replaced by LOD #9-1

Inactive – LOD #9-1- UNM Medical Group and UNM Hospital Professional Group Directed Payment Repeal & Replace LOD #9| PHE ended: LOD sunset on May 11, 2023

Inactive – LOD #9-2 – UNM Medical Group and UNM Hospital Professional Group Directed Payment – Repealed and replaced by LOD #9-3

Inactive – LOD #9-3 – UNM Medical Group and UNM Hospital Professional Group Directed Payment-Repealed and Replaced by LOD #9-4

Inactive LOD #9-4 UNM Medical Group and UNM Hospital Professional Group Directed Payment-Repealed and Replaced by LOD #9-5

LOD #9-5 UNM Medical Group and UNM Hospital Professional Group Directed Payment

Inactive – LOD #10 – CY19 Telemedicine DSIPT- Repealed and replaced by LOD #11

Inactive – LOD #11 – CY19 Telemedicine DSIPT- Sunset upon completion of the CY19 DSIPT Reporting Period

Inactive-LOD #11-1 – Reporting Requirements for Prior Authorization and Cost-Sharing|PHE ended: LOD sunset on May 11, 2023

LOD #12 – Medicaid Provider Payment Rates

Inactive – LOD #13 – Hospital Payment Rate Increase- Repealed and replaced by LOD #14

Inactive – LOD #14 – Hospital Payment Rate Increase- Repealed and replaced by LOD #20

Inactive – LOD #15 – Payment to Raton Nursing & Rehabilitation center- Sunset 11/30/2019

Inactive – LOD #16 – Tracking Measure Reporting Requirements- Repealed and replaced by LOD #22

Inactive – LOD #17 – SUPPORT Act Requirements- Sunset on inclusion in Contract Amendment #2

Inactive-LOD #18 – Use of Electronic Visit Verification for EPSDT Personal Care Services- Sunset upon inclusion in Contract Amendment 4

LOD #19 – Medicaid Provider Payment Rates

LOD #20 – Hospital Payment Rates Effective July 1, 2019 Repeal LOD #14

Inactive – LOD #21 – CBSQ and CBMA-Sunset on inclusion in the Managed Care Policy Manual eff. 10/1/2020

Inactive – LOD #22 – Tracking Measure Reporting Requirements- Repealed and replaced by LOD #33

Inactive- LOD #23 – Delivery System Improvement Performance Targets (DSIPTs)- Sunset on inclusion in Contract Amendment #2

Inactive- LOD #24 – 2020 Performance Measures and Targets- Sunset on inclusion in Contract Amendment #2

Inactive- LOD #25 – Payment Rate Increases Effective January 1, 2020- Repealed and Replaced by LOD #28

Inactive- LOD #26 – Quarterly Care Coordination Performance Standards- Sunset on inclusion in Contract Amendment #2

Inactive-LOD #27 – CY 19 Performance Measures-Sunset with the next iteration of the Medicaid Managed Care Services Agreement

Inactive-LOD #28 – Payment Rate Increases Effective January 1, 2020 Repealed and Replaced by LOD 28-1

Inactive-LOD #28-1 – Payment Rate Increases Effective January 1, 2020-Repealed and Replaced by LOD #28-2

Inactive-LOD #28-2 – Payment Rate Increases Effective January 1, 2020

Inactive-LOD #28-3 – Payment Rate Increases Effective January 1, 2024 Repealed and Replaced by LOD #28-4

LOD #28-4 – Payment Rate Increases Effective January 1, 2024

Inactive-LOD #29 – ABP Corrections- Sunset on inclusion in Contract Amendment #2

Inactive-LOD #30 – COVID-19 Guidance for CC 2.0 MCOs- Repealed and Replaced by LOD #31

Inactive-LOD #31 – COVID-19 Guidance for CC 2.0 MCOs- Repealed and Replaced by the “Special COVID-19 LODs” below

LOD #32 – Health Care Quality Surcharge (HCQS) created by Senate Bill 246 (SB246)

Inactive-LOD #33 – Tracking Measure Reporting Requirements Repeal and Replaced LOD #22

Inactive – LOD #33-1- Tracking Measure Reporting Requirements – Sunset upon inclusion in Contract Amendment 6

Inactive-LOD #34 – Tobacco Cessation Coverage for all MAP Recipients-Sunset upon inclusion in the Medicaid Managed Care Services Agreement

Inactive-LOD #35 – UNM Hospital Directed Payment -Repealed and Replaced by LOD #35-1

Inactive-LOD #35-1 -UNM Hospital Directed Payment-Repealed and Replaced by LOD #35-2

Inactive-LOD #35-2 -UNM Hospital Directed Payment-Repealed and Replaced by LOD #35-3

Inactive-LOD #35-3 – UNM Hospital Directed Payment

Inactive-LOD #35-4 – UNM Hospital Directed Payment-Repealed an Replaced by LOD #35-5

LOD #35-5 – UNM Hospital Directed Payment

Inactive-LOD #36 – Hospital Access Program (HAP) Directed Payment-Repealed and Replaced by LOD #36-1

Inactive-LOD #36-1-Hospital Access Program (HAP) Directed Payment-Repealed and Replaced by LOD #36-2

Inactive-LOD #36-2 – Hospital Access Program (HAP) Directed Payment -Repealed and Replaced by LOD #36-3

Inactive LOD #36-3 Hospital Value Based Program (HVBP) Directed Payment – Repealed and Replaced by LOD #36-4

LOD #36-4 Hospital Value Based Program (HVBP) Directed Payment

LOD #37 – Nursing Facility Value Based Purchasing (NF VBP)

Inactive-LOD #38 – Change Contact Requirements for DTE Members requiring a CNA-Sunset upon inclusion in the Medicaid Managed Care Services Agreement 

Inactive-LOD #39 – Care Link New Mexico Health Homes-Sunset on 12/31/2020

Inactive-LOD #40 – Medication Assisted Treatment (MAT) Medications: Narcan and Naloxone- Repealed and Replaced by LOD #40-1

LOD #40-1 – Medication Assisted Treatment (MAT) Medications; Narcan and Naloxone

LOD #41 – MCO Program Integrity Requirements

LOD #42 – Transition of Payment from Medicaid to Medicare for OTP Services

Inactive-LOD #43 – Community Benefit Reconciliation-Sunset upon inclusion in Medicaid Managed Care Services Agreement

LOD #44 – ABA Payment Rates Increases Effective October 1, 2019

Inactive-LOD #45 – Adult Accredited Residential Treatment Centers-Repealed and Replaced by LOD #45-1

Inactive-LOD #45-1 – Implementation of Adult Accredited Residential Treatment Center Services-Sunset with the next iteration of the Behavioral Health Policy and Billing Manual

Inactive-LOD #46 – Medical Residency Pilot Program- Sunset

LOD #47 – HCQS Per Diem and MBI increase for SFY 2021

Inactive-LOD #48 – Reconciliation of claims for the ABA Payment Rates Increases Effective October 1, 2019-Sunset upon completion of claim reimbursement

Inactive-LOD #49 – MCO Payment Recoupment from Providers-Sunset upon inclusion in the Systems Manual

LOD #50 – Naturopathic Doctors: Participation in the NM Medicaid Program

LOD #51 – New 1915 (c) Home and Community-Based Services Program – Supports Waiver

LOD #52 – MCO Systems Configurations for BH Claims from FQHC Satellite Locations

Inactive – LOD #53 – Managed Care Subrogation Recoveries – Sunset upon inclusion in Contract Amendment 6

Inactive – LOD #54 – BH DSIPT – Sunset upon inclusion in Contract Amendment 6

Inactive-LOD #55 – Provider Changes for Minimum Wage Adjustment-Repealed and Replaced by LOD #55-1

Inactive-LOD #55-1 – Provider Changes for Minimum Wage Adjustment-Sunset on 1/20/2022 upon approval of LOD #75

Inactive-LOD #56 – CareLink NM Health Homes -Sunset December 31,2021

Inactive – LOD #57 – Gross Receipts Tax (GRT) – Sunset upon inclusion in Contract Amendment 6

Inactive – LOD #58 – CY 20 Performance Measures – Sunset upon inclusion in Contract Amendment

Inactive – LOD #59 – Non-Clinical PIPs Revision – Sunset upon inclusion in Contract Amendment 8

LOD #60 – NDC Requirement for Drug Rebate Collection and 340B Claim Billing

Inactive – LOD #61 – Change Contract Requirements for Full Delegation Model Members – Sunset upon inclusion in Contract Amendment 6

Inactive-LOD #62 – Crisis Triage Centers- Sunset upon inclusion in the Behavioral Health Policy and Billing Manual

Inactive – LOD #63 – Grievances Appeals Systems – Sunset upon inclusion in Contract Amendment 6

Inactive-LOD #64 – Expedited Provider Set Up and Allowances of Treat First Service Delivery-Sunset on 12/31/2021

LOD #65 – HCQS Per Diem and MBI increase for SFY 2022

Inactive – LOD #66 – Health Risk Assessment for Transitioning Members – Sunset upon inclusion in Contract Amendment 6

LOD #67 – EOB Exception for Behavioral Health Services and Providers

Inactive-LOD #68 – Trauma Hospitals Directed Payment-Repealed and Replaced by LOD #68-1

Inactive – LOD #68-1 – Trauma Hospital Directed Payment-Repeal and Replaced by #68-2

Inactive – LOD #68-2 – Trauma Hospital Directed Payment – Repealed and Replaced by LOD # 68-3

LOD #68-3 – Trauma Hospitals Directed Payment-Repealed and Replaced by LOD # 68-4

LOD #68-4 – Trauma Hospitals Directed Payment

Inactive – LOD #69 – MCO Requirements for Children in State Custody (CISCs)-Repealed and Replaced by LOD #69-1

LOD #69-1 – MCO Requirements for Children in State Custody (CISCs)-Repealed and Replaced by LOD #69-1

Inactive – LOD #70 – I.H.S. & Tribal 638 Outpatient Pharmacy Reimbursement Change

Inactive – LOD #70-1 – I.H.S. & Tribal 638 Outpatient Pharmacy Annual Reimbursement Rates Changes – Repealed and Replaced by LOD #70-2

LOD #70-2 – I.H.S. & Tribal 638 Outpatient Pharmacy Annual Reimbursement Rate Changes

Inactive-LOD #71 – Bernalillo Academy Reimbursement for Multiple Assessments-Sunset on 12/31/2021

Inactive – LOD #72 – MY 2020 CAHPS 5.0H Revised State Supplemental Questions – Sunset upon inclusion in Contract Amendment 6

Inactive – LOD #73 – Performance Measures Reporting Requirements – Sunset upon inclusion in Contract Amendment 6

Inactive – LOD #74 – Revision to Comprehensive Care Plan Requirements – Sunset upon inclusion in Contract Amendment 6

Inactive-LOD #75 – Minimum Wage Adjustment

LOD #75-1 Minimum Wage Adjustments Repeal and Replace #75

Inactive – LOD #76 – CAHPS 5.0H AHRQ Reporting and Revised Supplemental Questions – Sunset upon inclusion in Contract Amendment 6

Inactive – LOD #77 – Revision to PCP and Pharmacy Lock-In Requirements – Sunset upon inclusion in Contract Amendment 6

Inactive-LOD #78 – Pharmaceutical Service Reimbursement Parity-Sunset upon inclusion in the Managed Care Policy Manual

LOD #78-1 – Pharmaceutical Service Reimbursement Parity

Inactive-LOD #79 – 15 % Temporary Economic Recovery Payments for HCBS Services-Repealed and Replaced by LOD #79-1

LOD #79-1 10% and 5% Temporary Economic Recovery Payments for HCBS Services

LOD #80 – SBHC LARC Inventory Pilot Project

Inactive – LOD #81 – Critical Incident Performance Measures – Sunset upon inclusion in Contract Amendment 6

Inactive – LOD #82 – MCO Requirements for NMHIX aka beWellnm Coverage – Sunset upon inclusion in Contract Amendment 6

Inactive-LOD# 83 – HCQS Per Diem and MBI increase for SFY 2023-Repealed and Replaced by LOD #83-1

LOD #83-1 Health Care Quality Surcharge (HCQS) SFY2024

LOD #84 – Paid Sick Leave

Inactive – LOD #85 – Community Benefit Audits

Inactive-LOD #86 – Out of-state Treatment Foster Care-Repealed and Replaced by #86-1

LOD #86-1 – Out of-state Treatment Foster Care Repeal and Replace #86

Inactive – LOD #87- MCO Quarterly Pharmacy and Therapeutics Committee Meeting Updates – Sunset upon inclusion in Contract Amendment 6

LOD #88 – Billing for Specialized BH Services by FQHCs

LOD #89 – Suspension of Prior Authorization Requirements for Skilled Nursing, Long-Term Care, and Home Health Facilities

Inactive – LOD #90 – New BH DSIPT – Sunset upon inclusion in Contract Amendment 8

LOD #91 – Supervisory Certification and Rostering

LOD #92 – Ventilator Services

LOD #93 – Community Benefit Environmental Modifications and Community Transition Services

Inactive – LOD #94 MCO PHE Unwinding Outreach Report – Repealed and Replaced by LOD #94-1

Inactive – LOD #94-1 MCO Outreach Efforts

Inactive – LOD #95 MY2023 CAHPS Supplemental Questions – Sunset upon inclusion in Contract Amendment 8

Inactive – LOD # 96 – Comprehensive Well Child Check Ups for Children in State Custody Within 30 Days Repealed and Replaced by LOD # 96-1

LOD # 96-1- Comprehensive Well Child Checkups for Children in State Custody (CISC) Within 30 Days

LOD #97 – Human Donor Milk Billing and Guidance in an Inpatient Hospital

LOD #98 – Expiration of the PHE

Inactive – LOD #99 – NM High-Fidelity Wraparound Program

LOD #99-1 – NM High-Fidelity Wraparound Program

LOD #100 – Coordination of Treatment of Foster Care (TFC) Placement for Children in State Custody CISC

LOD #101 Prenatal Genetic Screening

LOD #102 NEMT Referrals for Outside of the Home Community Guidance

Inactive – LOD #103 State Fiscal Year 2024 Payment Rate Increases

LOD #103-1 State Fiscal Year Payment Rate Increases

LOD #104 Public Health Order Issued 09/15/2023

LOD #105 Care Coordination for Comprehensive Addiction and Recovery Act (CARA) Infants

Inactive – LOD #106 Operational Letter of Direction – Sunset upon inclusion in Contract Amendment 8

Inactive – LOD #107 BH standards for Crisis Now and 988, Certified Community Behavioral Health Centers (CBHCs), and Appointments – Sunset upon inclusion in Contract Amendment 8

LOD #108 Legally Responsible Individuals as Caregivers

LOD #109 Program Integrity Requirements

LOD #110 Non-Emergency Transportation Network Companies

LOD #111 Nursing Facility Short Term Stays

LOD #112 Transcranial Magnetic Stimulation (TMS) Services

Inactive – LOD #113 Behavioral Health Evidence-based Practices Repealed and Replaced by LOD # 113-1

LOD # 113-1 Behavioral Health Evidence-based Practices

LOD #114 EVV Stipend for EPSDT PCS and HH

LOD #115 Updated Coverage for Prosthetic and Custom Orthotic Devices

LOD #116 Mobile Crisis Intervention and Mobile Response and Stabilization Services

LOD #117 Rate Corrections for IOP Services

LOD #118 Tribal 638 Nursing Facilities (NFs)

LOD #119 Repeal of HCV Checklist and Elimination of Prior Authorization

LOD #120 State Fiscal Year 2024 Behavior Health Fee Schedule

LOD #121  Community Health Workers (CHW) and Community Health Representatives (CHR) Benefit

LOD #122 MCO Required Coverage of OTC Reproductive Health Services

LOD #123 Rate Increase for Residential Treatment Centers (RTC’s) for Youth

LOD #124 State Fiscal Year 2024 Applied Behavioral Analysis (ABA) Fee Schedule

LOD #125 Delivery of Necessary Diabetic Resources

LOD #126 Miners Colfax Medical Center Payment

LOD # 127 Rural Hospital Obstetrics (OB) Inpatient and Outpatient Services Rate Increase