TITLE 8 SOCIAL SERVICES
CHAPTER 308 MANAGED CARE PROGRAM
PART 13 MEMBER REWARDS
8.308.13.1 ISSUING AGENCY: New Mexico Human Services Department (HSD).
[8.308.13.1
NMAC - N, 1/1/2014]
8.308.13.2 SCOPE: This rule applies to the general public.
[8.308.13.2
NMAC - N, 1/1/2014]
8.308.13.3 STATUTORY AUTHORITY: The New Mexico medicaid program and other
health care programs are administered pursuant to regulations promulgated by
the federal department of health and human services under Title XIX of the
Social Security Act as amended or by state statute. See NMSA 1978, Section 27-1-12 et seq.
[8.308.13.3
NMAC - N, 1/1/2014]
8.308.13.4 DURATION: Permanent.
[8.308.13.4
NMAC - N, 1/1/2014]
8.308.13.5 EFFECTIVE DATE: May 1, 2018, unless a later date is cited at
the end of a section.
[8.308.13.5
NMAC - N, 1/1/2014; A, 5/1/2018]
8.308.13.6 OBJECTIVE: The objective of this rule is to provide
instructions for the service portion of the New Mexico medical assistance
programs.
[8.308.13.6
NMAC - N, 1/1/2014]
8.308.13.7 DEFINITIONS: [RESERVED]
8.308.13.8 [RESERVED]
[8.308.13.8
NMAC - N, 1/1/2014; Repealed, 5/1/2018]
8.308.13.9 ELIGIBLE MEMBERS: A member of a HSD contracted managed care
organization (MCO) is eligible to participate in the managed care member
rewards program.
A. For a native
American member who elects to opt out of receiving medical assistance division
(MAD) services through a HSD contracted MCO, and retains MAP category of
eligibility, he or she no longer will earn reward credits as of the last day of
enrollment in his or her MCO.
B. Upon losing
eligibility for continued enrollment in a HSD contracted MCO, the individual no
longer will earn member reward credits.
[8.308.13.9
NMAC - N, 1/1/2014; A, 5/1/2018]
8.308.13.10 REWARD CREDITS: A member may earn reward credits when
engaging in healthy behaviors included in the member rewards program. Reward credits are determined for specific
member healthy behaviors. Details on the
requirements to earn a healthy behavior reward credit are made available to a
member on MAD’s website and provided in writing to a member through his or her
MCO.
A. Maximum amount of a member’s reward credit
balance: A member must use credits
earned during the calendar year by the end of the following calendar year. Any credits that are not used by the end of
the following calendar year in which they are earned are lost.
B. Portability of reward credits: A member may carry his or her reward credits
when transitioning from one HSD contracted MCO to another HSD contracted
MCO. When a member earns reward credits
for a specific healthy behavior, he or she may not earn reward credits for the
same healthy behavior within the same calendar year with his or her new MCO.
C. Retention of reward credits: A member’s reward credit balance will be
accessible for the member’s use up to 365 days after he or she loses MAP
eligibility. For a native American who
was a member of a HSD contracted MCO, and later opts in to fee-for-service
(FFS) administration of benefits, the previously earned MCO reward credits are
accessible up to 365 days after the close of his or her HSD contracted MCO
membership.
D. Reward credit
disputes: If a member believes there is
a discrepancy in the way his or her HSD contracted MCO has determined a reward
credit or balance, the member shall contact his or her MCO for resolution.
[8.308.13.10
NMAC - N, 1/1/2014]
HISTORY OF
8.308.13 NMAC: [RESERVED]