N.M. Code R. § 8.308.9.7 - DEFINITIONS
A.
Alternative benefits plan services with limitations (ABP): The
medical assistance division (MAD) category of eligibility "other adults" has an
alternative benefit plan (ABP). The HSD contracted managed care organization
(MCO) covers ABP specific services for an ABP member. 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 member has limitations on specific benefits; and
does not have all MCO medicaid benefits available. All early and periodic
screening, diagnosis and treatment (EPSDT) program services are available to an
ABP member under 21 years. ABP services for an ABP member under the age of 21
years are 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 MCO ABP contracted provider and an ABP member have rights and
responsibilities as described in Title 8 Chapter 308 NMAC, Social
Services.
B.
Alternative
benefits plan general benefits for ABP exempt member (ABP exempt): An
ABP member who self-declares they have a qualifying condition is evaluated by
the MCO's utilization management for determination if they meet the qualifying
condition. An ABP exempt member utilizes their benefits described in 8.308.9
NMAC and in 8.308.12 NMAC.
C.
Early childhood home visiting program: A program that uses home
visiting as a primary service delivery strategy and offers services on a
voluntary basis to eligible pregnant individuals and their children from birth
up to kindergarten entry, according to the program standard.
D.
Evidence-based, early childhood home
visiting program: A home visiting program that is recognized by the U.S.
department of health & human services maternal, infant, and early childhood
home visiting (MIECHV) project and:
(1) is
grounded in relevant, empirically-based best practice and knowledge that:
(a) is linked to and measures the following
outcomes:
(i) babies that are born
healthy;
(ii) children that are
nurtured by their parents and caregivers;
(iii) children that are physically and
mentally healthy;
(iv) children
that are ready for school;
(v)
children and families that are safe; and
(vi) families that are connected to formal
and informal supports in their communities;
(b) has comprehensive home visiting standards
that ensure high-quality service delivery and continuous quality improvement;
and
(c) has demonstrated
significant, sustained positive outcomes;
(2) follows program standards that specify
the purpose, outcomes, duration and frequency of services that constitute the
program;
(3) follows the curriculum
of an evidence-based home visiting model;
(4) employs well-trained and competent staff
and provides continual professional supervision and development relevant to the
specific program and model being delivered;
(5) demonstrates strong links to other
community-based services;
(6)
operates within an organization that ensures compliance with home visiting
standards;
(7) continually
evaluates performance to ensure fidelity to the program standards;
(8) collects data on program activities and
program outcomes; and
(9) is
culturally and linguistically appropriate.
Notes
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
No prior version found.