(DD) Waiver Service Standards - New Mexico Department of Health

eaks. Services from the Children’s Category shall be coordinated with and not
duplicate other services such as the Medicaid School Based Services Program or
the Medicaid Early Periodic Screening Diagnosis and Treatment (EPSDT)
Program and/or the New Mexico State Department of Education public schools
or the New Mexico Department of Health Family Infant Toddler Program.
Services may be provided in any location appropriate to the service, including a
community setting. The Case Manager is required to assist the family in
accessing services from other payment sources.
The child’s Level of Care (LOC) is used to determine the Annual Resource
Allotment (ARA) within the Children’s Category. The family, the Case Manager
and the other IDT members are responsible for using the ARA to support
achievement of the individual’s ISP desired outcomes and to support the family
to care for the child at home.
The amount of reimbursement for each service is a fixed amount, indicated as a
flat fee, fifteen (15) minute, hourly, daily, monthly or per item/event units based
on each specific service definition and as specified in the HSD/MAD billing
instructions and DD Waiver rate table. The number of units across all services
shall be budgeted so as not to exceed the ARA. The child’s family may shift the
amount or number of units, as well as drop and add units throughout the year, to
accommodate changing needs. Revisions to the ISP are approved by the Case
Management Provider Agency. If the individual uses all the funding in the ARA
prior to the end of the ISP year, funding for services will terminate until the
beginning of the next ISP year.
B. Case Management Services in the Children’s Category. Case Management
Services are funded through the ARA and shall be provided a minimum of four
(4) times per ISP year. However, the family of an eligible child may choose to
have Case Management services up to the 12 unit annual cap. Case Management
will be provided in accordance with the corresponding DD Waiver Standards and
applicable policies for Case Management. When a family chooses less than 12
units (months) of case management service, the family assumes responsibility for
the quality assurance and service utilization tracking functions typically
performed by the Case Manager during those months when case management has
not been included in the ISP budget. Medically necessary services are covered
through the state plan under EPSDT, therefore, Case Management may be the
only service listed in the ISP for children if that is the only waiver service
desired.
C. Service Options funded with the ARA. The individual, in conjunction with the
IDT, may choose any or all of the following service options, however the total
budget for the selected services may not exceed the Annual Resource Allotment.
Each service must be provided in accordance with the corresponding DD Waiver
regulations, standards, and applicable DDSD policies:
(1) Behavior Support Consultation;
(2) Community Access;
(3) Occupational Therapy (limited and when not covered by EPSDT or IDEA);
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