8.308.12 NMAC - Community Benefit (Managed Care Program), including Agency-Based and Self-Directed Personal Care Services and Electronic Visit Verification

What this rule requires your agency to do

• 1For self-directed providers, the FMA, member, or EOR shall verify that a potential provider meets all applicable qualifications prior to rendering a service; a provider or employee who cannot pass a nationwide criminal history screening pursuant to NMSA 1978 Section 29-12-2 et seq., or who is listed in the abuse registry per NMSA 1978 Section 27-7a-1 et seq., may not be employed to render any service to the member (8.308.12.16.A).(8.308.12 NMAC - Community Benefit (Managed Care Program), including Agency-Based and Self-Directed Personal Care Services and Electronic Visit Verification)
• 2The MCO, together with the other MCOs, shall contract with a vendor to implement an EVV system in accordance with the federal Twenty First Century Cures Act and shall maintain an EVV system capable of leveraging up-to-date technology to improve functionality in all areas of the state, including rural areas (8.308.12.22.A-B).(8.308.12 NMAC - Community Benefit (Managed Care Program), including Agency-Based and Self-Directed Personal Care Services and Electronic Visit Verification)
• 3An EOR shall have a signed employee or vendor agreement (on the MAD-prescribed template) with each of the member's providers before any payment is made; the FMA shall ensure the provider meets all qualifications and that an agreement is signed, agreements must be updated on any change in terms and re-signed on any change in EOR, and a copy provided to the member and EOR (8.308.12.16.B).(8.308.12 NMAC - Community Benefit (Managed Care Program), including Agency-Based and Self-Directed Personal Care Services and Electronic Visit Verification)
• 4The PCS agency must develop an Individual Plan of Care (IPoC) for the ABCB member's personal care services, which must be approved by the member's MCO; services not approved in the member's IPoC are not covered (8.308.12.7.M; 8.308.12.13.J(10)(e)).(8.308.12 NMAC - Community Benefit (Managed Care Program), including Agency-Based and Self-Directed Personal Care Services and Electronic Visit Verification)
• 5A personal care attendant must meet training and criminal background check requirements; services provided by a person not meeting the requirements and qualifications of a personal care attendant (including training and criminal background checks) are not covered as PCS (8.308.12.13.J(10)(d)).(8.308.12 NMAC - Community Benefit (Managed Care Program), including Agency-Based and Self-Directed Personal Care Services and Electronic Visit Verification)
• 6PCS agencies electing to provide PCS (consumer-delegated or consumer-directed) must obtain agency certification by MAD or its designee, must be an enrolled MAD provider, and must comply with the requirements listed in the MAD MCO policy manual (8.308.12.13.J(2)-(3)).(8.308.12 NMAC - Community Benefit (Managed Care Program), including Agency-Based and Self-Directed Personal Care Services and Electronic Visit Verification)
• 7All ABCB agencies must apply and be approved to be a MAD provider and must then contract with any or all approved MCOs, and ABCB providers must meet all Federal requirements for home and community based providers (8.308.12.11).(8.308.12 NMAC - Community Benefit (Managed Care Program), including Agency-Based and Self-Directed Personal Care Services and Electronic Visit Verification)
• 8Use of the Electronic Visit Verification (EVV) system is required for payment of personal care services (PCS) and self-directed PCS; the managed care organizations shall collaborate to offer a single EVV vendor for PCS and monitor compliance with the federal 21st Century Cures Act (8.308.12.13.J; 8.308.12.18.G(4); 8.308.12.22).(8.308.12 NMAC - Community Benefit (Managed Care Program), including Agency-Based and Self-Directed Personal Care Services and Electronic Visit Verification)