PROVIDERS
The Health Care Authority’s mission is: We ensure that New Mexicans attain their highest level of health by providing whole-person, cost-effective, accessible, and high-quality health care and safety-net services.
Supplements to MAD NMAC Program Rules – 2024
|
Supplement Numbers
|
Policy Topic |
Date |
| 24-23 | Billing and Guidance for Lactation Care Providers in the Outpatient Setting | December 20, 2024 |
| 24-22 | Implementation of Certified Community Behavioral Health Clinics | December 9, 2024 |
| 24-21 | Dental Procedure Code (D1354) – Application of Silver Diamine Fluoride Provided by Dental Providers | November 4, 2024 |
| 24-20 | Silver Diamine Fluoride (0792T) by a Physician or Other Qualified Health Care Professional | November 4, 2024 |
| 24-19 | Billing and Reimbursement Guidance for Comprehensive Addiction Recovery Act (CARA) Program-Plan of Safe Care in the Hospital Setting | October 23, 2024 |
| 24-18 | Billing and Reimbursement Guidelines for Chiropractic Services | October 23, 2024 |
| 24-17 | Billing and Coding Discarded or No Discarded Drugs and Biologicals with a JW or JZ Modifier | October 16, 2024 |
| 24-16 | Revised Medical Necessity Criteria for Orthodontic Treatment | October 16, 2024 |
| 24-15 | Coverage of Gender Affirming Healthcare Medications and Procedures | October 11, 2024 |
| 24-14 |
Implementation of Mobile Crisis Intervention Services and Mobile Response and Stabilization
Replaces Supplement 24-03 |
October 7, 2024 |
| 24-13 |
Applied Behavior Analysis (ABA) Guidance Replaces 23-02 |
September 17, 2024 |
| 24-12 |
Provider Payment Rate Changes for Intensive Outpatient Program (IOP) Services
Replaces 24-05 |
July 25, 2024 |
| 24-11 |
Provider Full Transition to Electronic Enrollment Requirements |
July 31, 2024 |
| 24-10 |
Human Donor Milk Billing and Guidance in Outpatient Setting |
July 9, 2024 |
| 24-09 |
Reimbursement for Tribal 638 Nursing Facilities |
June 25, 2024 |
| 24-08 |
Implementation of Community Health Workers (CHW) and Community Health Representatives (CHR) |
May 31, 2024 |
| 24-07 |
State Fiscal Year 2024 Behavioral Health Fee Schedule |
May 14, 2024 |
| 24-06 |
Repeal of Hepatitis C Virus (HCV) Checklist – and Elimination of Prior Authorization for Glecaprevir/Pibrentasivir (Mavyret®) and Sofosbuvir/Velpatasvir (Epclusa ®) Replaces Supplement 20-13 |
May 14, 2024 |
| 24-05 |
Provider Payment Rate Changes for Intensive Outpatient Program (IOP) Services See Updated Supplement 24-12 |
April 8, 2024 |
| 24-04 | Clarification on Billing for Nursing Facility Short-Term Stays | April 1, 2024 |
| 24-03 |
Implementation of Mobile Crisis Intervention Services and Mobile Response and Stabilization See Updated Supplement 24-14 |
March 18, 2024 |
| 24-02 |
Implementation of High-Fidelity Wraparound Program Revised Replaces Supplement 23-05 |
March 8, 2024 |
| 24-01 | Implementation of Behavioral Health Evidence-Based Practices | February 26, 2024 |
Supplements to MAD NMAC Program Rules – 2023
|
Supplement Numbers |
Policy Topic |
Date |
| 23-11 | Medical Aid in Dying (MAID) | November 6, 2023 |
| 23-10 | Annual Indigent Care Reporting Requirements | November 6, 2023 |
| 23-09 | Non-Emergency Transportation (NEMT) Referrals for Outside of the Home Community | September 5, 2023 |
| 23-08 | FFS Applied Behavioral Analysis Submission Process | September 5, 2023 |
| 23-07 | Changes to Claim Submittal Process and Rates for Abortion Procedures
Replaces Supplement 22-15 |
August 21, 2023 |
| 23-06 | Medicaid Billing for Human Donor Milk for Medicaid Eligible Recipients in Inpatient Hospital | August 9, 2023 |
| 23-05 | Implementation of High-Fidelity Wraparound Program
See Updated Supplement 24-02 |
August 9, 2023 |
| 23-04 | Suspension of Prior Authorization Requirements for Skilled Nursing, Long-Term Care, and Home Health Facilities/Agencies | April 17, 2023 |
| 23-03 | Suspension of Prior Authorization Requirements for Skilled Nursing, Long-Term Care, and Home Health Facilities/Agencies
Replaces Supplement 22-12 |
April 17, 2023 |
| 23-02 | Applied Behavior Analysis (ABA) Guidance
Replaces Supplement 22-02 – Revised |
April 13, 2023 |
| 23-01 | Upgrade to Comagine Health Provider Portal (CHPP) | March 29, 2023 |
Supplements to MAD NMAC Program Rules – 2022
| Supplement Numbers | Policy Topic | Date |
| 22-15 |
Changes to Claim Submittal Process and Rates for Abortion Procedures See Updated Supplement 23-07 |
December 21, 2022 |
| 22-14 | Billing and Reimbursement Guidance for Project Extension for Community Healthcare Outcomes (ECHO) Model Case Presentation | December 13, 2022 |
| 22-13 |
Annual Indigent Care Reporting Requirements |
December 13, 2022 |
| 22-12 |
Suspension of Prior Authorization Requirements for Skilled Nursing, Long-Term Care, and Home Health Facilities/Agencies See Updated Supplement 23-03 |
December 9, 2022 |
| 22-11 | Billing for Long-Acting Reversible Contraception Products in Federally Qualified Health Centers (FQHCs), Rural Health Clinics (RHCs), and Hospital-Based Rural Health Clinics (HB-RHCs) | December 9, 2022 |
| 22-10 | Prenatal Maternal Genetic Screening for Cystic Fibrosis, Spinal Muscular Atrophy (SMA) and Fetal Chromosomal Aneuploidy Billing and Guidance | December 7, 2022 |
| 22-09 |
Changes to NMAC 8.321.2.37 Eligible Agencies for Treatment Foster Care (TFC) I and II`Nove Replaces Supplement 22-08 Revised |
November 3, 2022 |
| 22-08 | Changes to NMAC 8.321.2.37 Eligible Agencies for Treatment Foster Care (TFC) I and II | November 2, 2022 |
| 22-07 |
Changes to Claim Submittal Process and Rates for Abortion Procedures See Updated Supplement 22-15 |
October 20, 2022 |
| 22-06 | Name Change to Emergency Medical Services for Aliens (EMSA) Program Title | April 29, 2022 |
| Developmental Disabilities Waiver Fee Schedule | April 29, 2022 | |
| 22-04 | Temporary Economic Recovery Payment Increase for Home and Community Based Services (HCBS) | March 28, 2022 |
| 22-03 | Pharmaceutical Service Reimbursement to Parity | March 24, 2022 |
| 22-01 | Revisions to Third Party Liability (TPL) Requirements | January 3, 2022 |
| 22-02 |
Applied Behavioral Analysis Guidance See Updated Supplement 23-02 |
January 27, 2022 |
Supplements to MAD NMAC Program Rules – 2021
| Supplement Numbers | Policy Topic | Date |
| 21-01 | Newborn Medicaid Program | March 17, 2021 |
| 21-02 | National Drug Code (NDC) and 340B Drug Rebates | April 9, 2021 |
| 21-03 | Home & Community Based Services – Supports Waiver Fee Schedule | May 10, 2021 |
| 21-04 | Tribal FQHC Designation and Billing Guidance | May 10, 2021 |
| 21-05 | ICF/IID Level of Care Procedures & Discharges | October 18, 2021 |
| 21-06 | I.H.S. Tribal 638 Outpatient Pharmacy Reimbursement | November 23, 2021 |
| 21-07 | Funding Sources and Presumptive Eligibility | November 23, 2021 |
Supplements to MAD NMAC Program Rules – 2020
| Supplement Numbers | Policy Topic | Date |
| Special COVID-19 Supplement #1 | Fingerprinting Guidance | April 2, 2020 |
| Special COVID -19 Supplement #2 | Medicaid Coverage of COVID-19 Testing for All Uninsured | April 2, 2020 |
| Special COVID -19 Supplement #3 | Guidance for New Mexico Medicaid Providers | April 6, 2020 |
| Special COVID -19 Supplement #4 | Families First Coronavirus Response Act (FFCRA) Coverage of COVID-19 Testing for Uninsured Patients | May 6, 2020 |
| Special COVID-19 Supplement #5 | COVID-19 Emergency Process for Eligibility and Claims Related to the Emergency Medical Services for Aliens (EMSA) Program | November 12, 2020 |
| Special COVID-19 Supplement #6 | Supplement for COVID-19 Positive Recipients in Nursing Facilities | September 2, 2020 |
| Special COVID-19 Supplement #8 | Administrative Order for Intermediate Care Facilities for Individuals with Intellectual Disabilities | June 24, 2020 |
| Special COVID-19 Supplement #9 | 2020 Hospital Inpatient Payment Rates Effective April 1, 2020 | August 28, 2020 |
| Special COVID-19 Supplement #10 | 2020 Non-DRG Reimbursed Hospital Inpatient Payment Rates | April 1, 2020 |
| Special COVID-19 Supplement #11 | COVID-19 Testing: Billing and Reimbursement for Testing and Services Rendered Offsite | September 10, 2020 |
| Special COVID-19 Supplement #13 | COVID-19 Proposed Rate increases Effective April 1, 2020-June 30, 2020 | March 16, 2021 |
| Special COVID-19 Supplement #14 |
See Updated Special COVID-19 Supplement #18 COVID Testing and Treatment Services and Codes for New Mexico Medicaid Services |
December 30, 2020 |
| Special COVID -19 Supplement #16 | COVID-19 Vaccine Coverage, Billing and Reimbursement | August 16, 2021 |
| Special COVID-19 Supplement #17 | COVID-19 Claims – Waive Timely Filing for COVID-19 Testing and Vaccine Administration Claims for all In-State Medicaid Enrolled Providers | June 29, 2021 |
| Special COVID-19 Supplement #18 | COVID-19 Testing and Treatment Services and Codes for New Mexico Medicaid Providers | June 2, 2022 |
| 20-01 | New Mexico Health Insurance Prior Authorization | January 15, 2020 |
| 20-02 | Senate Bill 246 Health Care Quality Surcharge (HCQS) Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID) | May 21, 2020 |
| 20-03 | Supports Waiver Supplement – Effective July 1, 2020 | July 10, 2020 |
| 20-04 | Billing 340B Modifiers Under the Hospital Outpatient Prospective Payment System (OPPS) | August 24, 2020 |
| 20-05 | Updated: Applied Behavior Analysis (ABA) Fee Schedule Effective October 1, 2019 | August 24, 2020 |
| 20-06 | Supports Waiver Fee Schedule | August 25, 2020 |
| 20-07 | Changes to Billing Procedure and Reimbursement for Hospice Services | August 28, 2020 |
| 20-08 | Medically Fragile Waiver Fee Schedule | September 22, 2020 |
| 20-09 | Increased Reimbursement Rates for Air Ambulance Services | October 23, 2020 |
| 20-10 | Developmental Disabilities Waiver Fee Schedule | October 23, 2020 |
| 20-11 | Naturopathic Doctors: Participation in the New Mexico Medicaid Program | October 23, 2020 |
| 20-12 | AARTC Medicaid Behavioral Health Services Updates | December 22, 2020 |
| 20-13 |
Revised 8/30/2021 Uniform New Mexico Hepatitis C Virus Checklist – Repeal and Replace MAD 634 Form See Updated Supplement 24-06
|
August 30, 2021 |
Supplements to MAD NMAC Program Rules – 2019
| Supplement Numbers | Policy Topic | Date |
| 19-01 | Reimbursement for Neurological and Neurosurgical Consultations Provided through ACCESS Program | January 3, 2019 |
| 19-02 | Birthing Options Program-Billing Procedures and Reimbursement | June 21, 2019 |
| 19-03 | BH Supplement & BH Manual – Comments and Responses | January 22, 2019 |
| 19-04 |
BH Supplement Behavioral Health Policy and Billing Manual |
January 22, 2019 |
| 19-05 | Revised MAD 303 Fee for Service Prior Approvals Request Form | March 19, 2019 |
| 19-06 | Billing for Annual Physical Health Examinations for Adults Applying for or Receiving Home and Community-Based Services through one of the following Waiver Programs: Developmental Disabilities (DD); Medically Fragile (MF); or Mi Via | March 30, 2019 |
| 19-07 | Autism Spectrum Disorder Services – Prohibition on Age and Dollar Limits Effective June 15, 2019 | June 15, 2019 |
| 19-08 | Medically Fragile Waiver Fee Schedule | July 19, 2019 |
| 19-09 | Medicaid Billing for Long-Acting Reversible Contraception (LARC) Products Provided in an Inpatient Setting | August 13, 2019 |
| 19-10 | Chronic Care Management Services and Transitional Care | August 16, 2019 |
| 19-11 | Medicaid Drug Utilization Review (DUR) Provisions of the Support ACT | October 02, 2019 |
Supplements to MAD NMAC Program Rules – 2018
| Supplement Numbers | Policy Topic | Date |
| 18-02 | Co-payment Change Resulting from the Behavioral Health Parity Analysis for Recipients in the Children’s Health Insurance Program (CHIP) and Working Disabled Individuals (WDI) | March 6, 2018 |
| 18-03 | Developmental Disabilities Waiver Fee Schedule | June 11, 2018 |
| 18-04 |
See Updated Supplement 20-13 Notice of New Hepatitis C Virus (HCV) Treatment Requirements for Fee-for-Service (FFS) Medicaid Recipients |
April 17, 2018 |
| 18-05 |
Critical Incident Reporting
|
May 1, 2018 |
| 18-08 | Developmental Disabilities Waiver Fee Schedule | December 19, 2018 |
| 18-10 | Billing for Annual Physical Health Examinations for Adults Applying for or Receiving Home and Community-Based Services through one of the following Waiver Programs: Developmental Disabilities (DD); Medically Fragile (MF); or Mi Via | December 6, 2018 |
| 18-12 | Revised Nursing Facility Level of Care (NF LOC) Criteria and Instructions Effective January 1, 2019 | January 1, 2019 |
| 18-13 | Applied Behavior Analysis Prior Authorization (Stage 3) Submission for FFS Population |
December 5, 2018 |
Supplements to MAD NMAC Program Rules – 2017
| Supplement Numbers | Policy Topic | Date |
| 17-01 | Behavioral Health Respite Services – Effective 1/1/2017 | January 20,2017 |
| 17-02 | Notice of Proposed Medicaid Co-Payment Requirements for Medicaid Recipients | February 8, 2017 |
| 17-03 | MAD 616 Fee for Service Out-of-State Prior Authorization | March 16, 2017 |
| 17-04 | Changes to HCPCS and CPT Codes for Drug Testing for March | March 28, 2017 |
| 17-05 | Qualis Health Provider Portal (QHPP) Requirement for Level of Care Requests and Prior Authorization Requests | June 29, 2017 |
| 17-06 |
Comprehensive Community Support Services (CCSS) I. Revised Service Definition II. Provider Requirements |
June 23, 2017 |
| 17-07 | Requirements for Reporting Attending, Ordering, Referring, and Rendering Providers on Claims | September 11,2017 |
| 17-08 | Requirements for Reporting Ordering, Referring, and Rendering Providers on Claims | September 11, 2017 |
| 17-09 | Requirements for Reporting Rendering, Ordering, and Referring Providers on Claims | September 11, 2017 |
| 17-10 | Licensed Birth Centers | October 26, 2017 |
| 17-11 | Early Periodic Screening, Diagnostic, and Treatment (EPSDT)Screening Services | November 15, 2017 |
Supplements to MAD NMAC Program Rules – 2016
| Supplement Numbers | Policy Topic | Date |
| 16-01 | Notice of Proposed Reductions to the Medicaid Fee Schedule and Other Medicaid Payment Reductions | April 29, 2016 |
| 16-03 | Notice of Final Reductions to the Medicaid Fee Schedule and Other Medicaid Payment Reductions – Effective July 1, 2016 | June 29,2016 |
| 16-04 | Revised MAD 303 Fee for Service Prior Approval Request Form | December 1, 2016 |
| 16-05 | Changes to MAD 307 Denial of Claims Emergency Medical Services for Aliens (EMSA) Form | July 18, 2016 |
| 16-06 | Changes to MAD 378 ICF/IID and Disabilities Home and Community Based Services Waiver Long Term Care Medical Assessment Abstract Form | July 18, 2016 |
| 16-07 | Notice of Final Reductions to the Medicaid Fee Schedule -Effective August 1, 2016 | July 22, 2016 |
| 16-08 |
Change to ABA Stage 1 Comprehensive Diagnostic Evaluation/Targeted Evaluation Requirements: ABA Stage 2 and 3 Behavior Analyst Requirements Specialty Care Practitioners Certification of Behavior Technicians |
September 23, 2016 |
| 16-09 |
See Updated Supplement 22-11 Billing for Long Acting Reversible Contraception Products |
September 16, 2016 |
| 16-10 |
|
September 23, 2016 |
| 16-11 |
|
December1, 2016 |
| 16-12 | Reminder of Final Reductions to the Medicaid Fee Schedule – Effective January 1, 2017 | December 13, 2016 |
| 16-13 | Billing and Payments to Federally Qualified Health Centers (FQHC), Rural Health Clinics (RHC), Hospital Based Rural Health Clinics (HB-RHC) and Indian Health Service (IHS) FQHCs | January 6, 2017 |
| 16-14 | Rescinding Behavioral Health Fee Schedule Reductions that were to be effective on January 1, 2017 | December 22, 2016 |
Supplements to MAD NMAC Program Rules – 2015
| Supplement Numbers | Policy Topic | Date |
| 15-01 | Specialized Behavior Health Services Billing Instructions | January 23, 2015 |
| 15-02 | Medicaid Utilization Review & Third-Party Assessor Eff. 03/01/2015 | February 9, 2015 |
| 15-03 | Supplement on Multiple Topics, including ICD-10, Billing Using Paper Claims, etc. | May 13, 2015 |
|
|
Extension of Enhanced Payments for Primary Care Provider Services in 2015 and Beyond Primary Care Increase Self-Attestation Form – January 1, 2015 |
June 4, 2015 |
| 15-07 | Short Term Medicaid for Incarcerated Individuals (STMII) | August 3, 2015 |
| 15-08 | Changes to HCPCS & CPT Codes for Drug Testing 2016 | December 29, 2015 |
2014 MAD Supplements
14-01 Payment Rates for Primary Care Provider Services
14-02 NM Alternate Benefits Plan Recipients
14-03 Billing Info for RTCs and TFC
14-04 OPPS Hospital & Lab Supplement
14-07 Nursing Facility Long-Term Care Guidelines
2013 MAD Supplements
13 01 Increase in Payment Rates for Primary Care Provider Services & Vaccination Reimbursement
13 02 Reimbursement Rates Associated with New CPT Codes for 2013
13 04 Long Term Care Medical Assessment Requirements Effective May 1, 2013
13 07 Behavioral Health Changes Effective January 1, 2014 with the Implementation of Centennial Care
13 05 Supplement, Hysterectomy Consent Form
2012 MAD Supplements
12 01 Ground Ambulance Mileage Codes
12 07 New Developmental Disabilities Waiver (DDW) Services Fee Schedule
12 08 Clarification on Reporting of Present on Admission Indicator
12 11 Medication Assisted Treatment Services for Opioid Addiction
12 12 New Developmental Disabilities Waiver Services Fee Schedule
2011 MAD Supplements
11 01 Updates to the Medically Fragile HCBS Waiver Rate Table
11 02 Billing for Mi Via Consultant Services
11 03 All Provider Notice on Multiple Topics
11 04 Dental Providers Must Submit the NPI Number of the Rendering Provider, Eff 7.1.2011
11 05 New Sub-codes for Mi Via Budgets, Effective 7/1/2011
11 06 Mi Via Program Employee Rates of Pay Changes
11 07 New Requirement for FFS Home Health Program
11 08 New Requirements when Billing Specific Procedure Codes
2010 MAD Supplements
10 04 Application Requirements and Coverage for Emergency Services for Aliens (EMSA)
10 07 Implementation of Hospital Outpatient Prospective Payment System
10 08 Implementation of Outpatient Hospital Prospective Payment System, Effective 11/1/2010
10 09 Anesthesia Services Regulation
10 11 Submitting Claims for Consideration of Timely Filing Limit Waiver
2009 Supplements
09 01 Billing for Community Living Services
09 02 Elimination of Mandated Minimum Wage Requirement for Personal Care Option (PCO) Services
09 03 Updates to the Developmental Disabilities (DD) HCBS Waiver Rate Table
09 06 Early Periodic Screening Diagnostic and Treatment (EPSDT) Screening Services
9 07 Payment to Providers Using Electronic Funds Transfer
09 08 Important Information regarding Billing for Medicaid Behavioral Health Services
09 09 Reduction in Payments for Hospital Services, Effective 12/1/2009
09 10 Reduction in Medicaid Payments for Practitioner Services, Effective 12/1/2009
09 12 Reduction in Medicaid Payments for Services, Effective 12/1/2009
09 13 Reduction in Pharmacy Dispensing Fees, Effective 02/01/2010
09 14 Reduction in Medicaid Payments for Personal Care Services, Effective 12.1.2009
2008 MAD Supplements
08 02 Medicaid Reimbursement for Birth Control & Family Planning Services
08 04 Dental Procedure Code D9920 – Behavior Management
08 05 Annual Hospice Rate Update
08 06 National Provider Identifier and Tamper Resistant Prescription Pads
2007 MAD Supplements
07 01 Preparing to Use National Provider Identifier (NPI) and NPI Deadlines
07 02 Corrections to the DD HCBS Waiver Rate Table
07 03 Using Taxonomy with the National Provider Identifier (NPI) and Deadlines
07 04 Increase in the Amount Allowed for Hearing Aids & Dispensing Fees
07 05 HCBS Waiver Provider Notice of Increases in Medicaid Reimbursement
07 06 Provider Notice of Increases in Medicaid Reimbursement
07 07 Personal Care Provider Notice – Increases in Medicaid Reimbursement
07 10 Using the “Notification of Birth” Form to Expedite Payment for Services to Newborns
2006 MAD Supplements
06 01Treatment at the Scene without Transport
06 02 Transportation HCPCS Codes
06 04 Provider Notice of Increase in Medicaid Reimbursement
06 05 Guidelines for Billing FFS Medicaid for services being transferred from the HCBS Waiver
06 06 Billing Procedure for Drugs not Included in the Dialysis Composite Rate
06 08 Rate Tables for the DD HCBSW
06 09 Medicaid Transportation Modifiers
2005 MAD Supplements
05 01 Binaural Hearing Aid Fitting
05 02 Preferred Drug List Implementation for Native Americans
05 03 Preferred Drug List Implementation for Native Americans
05 04 Mirena Intrauterine Device Procedure Code Change From S4981 to J7302
05 06 Changes Related to Medicare Part D Implementation
2004 MAD Supplements
04 01 Billing for Oxygen Contents
04 02 PCO – Clarification to MAD MR 03-34
04 03 Vision Services Reimbursement Change
04 04 Implementation of PCO Assessment Form (MAD 057)
04 06 Medicaid Fee Schedule Reduction & Payment Limitation on Co-Insurance & Co-Payments
04 07 Billing Rate change for the Personal Care Option Program
04 09 Reduction in Medicaid Payments, Effective 7/1/2004
04 10 Reimbursement for Hearing Aids
04 11 Disabled & Elderly Waiter Service Standards Revisions for Case Management & Homemaker Services
04 12 Home & Community-Based Services (HCBS) Waivers Rate Tables
04 13 Corrections to Dental Benefit Changes
04 14 Amended Medicaid & CYFD Children’s Panel FFS Utilization Review Changes
04 15 Preferred Drug List Implementation
04 16 Preferred Drug List Implementation