NEW MEXICO HUMAN SERVICES
DEPARTMENT
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TO: |
ALL MEDICAID DME PROVIDERS and MAD STAFF |
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FROM: |
CHUCK MILLIGAN, DIRECTOR |
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BY: |
MARY MARTINEZ, RN, BENEFITS BUREAU |
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SUBJECT: |
1) MEDICAID COVERAGE FOR AUGMENTATIVE AND ALTERNATIVE COMMUNICATION (AAC) DEVICES 2) SCHIP (STATE CHILDREN'S HEALTH INSURANCE PROGRAM |
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1. GENERAL INFORMATION - (AAC Devices)
Effective March 1, 1999 the Human Services Department approved final regulation regarding coverage of Augmentative and Alternative Communication (AAC) Devices. Special requirements for approval and repairs of AAC Devices were added to MAD 754. Restrictions to coverage of AAC Devices were removed from Sections 602, 754, and 757. The proposed regulations were issued October 22, 1998 in the New Mexico Human Services Department Register Vol. 21, No 50. The new regulations replace Sections 602, 754, 757 of the Medical Assistance Program Policy Manual.
Procedures for AAC Devices
Effective March 1,1999 the following codes will be used to bill for Augmentative Communication Devices.
1220Y purchase or rental for Augmentative Communication Device/Manual
1221Y purchase or rental Augmentative Communication Device/Electronic
1222Y parts for repair or modification of Augmentative Communication Devices (Manual or Electronic)
1223Y repair of Augmentative Communication Devices (Manual or Electronic)
If billing for purchase, use billing type of service J.If billing for rental, use billing type of service H.
For repair, use code 1222Y for every 15 minutes of labor. One unit of service is 15 minutes.
If billing for purchase, use code 1222Y for each part replaced.
Invoices must be attached for all services billed.
2. GENERAL INFORMATION - (SCHIP)
Effective March 1, 1999, SCHIP, the State Children's Health Insurance Program will be implemented. SCHIP is an expansion of Category 032 Medicaid and will provide Medicaid coverage for children up to the age of 19 in families whose income is between 185% and 235% of federal poverty guidelines. The some medical services will be covered as are currently covered under Category 032. Also, children eligible for Category 032 under SCHIP are entitled to 12 month continuous eligibility for benefits regardless of changes in the household's income. SCHIP eligible children will also be requested to enroll in SALUD! in accordance with established procedures.
However, unlike Category 032, SCEP does not cover children who already have health insurance. Also, any child whose health insurance has been voluntarily dropped is not eligible for SCHIP for 12 months berg with the first month the child was not covered by mother health insurance. Due to New Mexico's income demographics, the Department anticipates the number of eligible children statewide to be approximately 3500 to 6000 persons.
Also, unlike Category 032, families qualifying under SCHIP will be required to make co-payments to providers at the time a medical service is rendered. It is the responsibility of the provider to collect the co-pay. The amount of the co-pay depends on the service provided lithe co-pays are: $5 per doctor, dentist, outpatient and urgent care visit, or missed appointment; $2 per prescription; $15 per emergency room visit; and $25 per inpatient hospital admissions There is no co-pay required for preventative and prenatal care, services provided at Indian Health Services (IHS) facilities, urban Indian providers and tribal 638s, and services being covered retroactively.