N.M. Code R. § 8.310.9.12 Covered Services and Service Limitations

• Library: New Mexico Administrative Code
• Edition: 2023
• Currency: Current through Register Vol. 34, No. 24, December 19, 2023
• Citation: N.M. Code R. § 8.310.9.12
• Year: 2023

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 42Outpatient hospital services and rural health clinic services440.20(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...