Medicaid State Plan Amendments

This removes the five percent (5%) assessment of outpatient hospital services, clarify the Outpatient Prospective Payment System (OPPS) payment methodology, and add the reimbursement methodology for Long Acting Reversible Contraceptives (LARCs).

This restores OLP denturist services for adults.

Coverage & Limitations: Physical Therapy and Related Services.

Revised the Developmentally Disabled Targeted Case Management (TCM) provider qualifications and added conflict free requirements.

Reimbursement update for Dental Services.

Proposes to add a Substance Use Disorder (SUD) Continuum of Services to the New Mexico State plan.

Revises the Ambulatory Patient Group methodology for hospital-based clinic and ambulatory surgery services, including emergency room services.

Updates the State's APG system for Freestanding Clinic services.

Amends Attachment 4.19-B of the Medicaid State Plan to align with the changes made in SPA 16-0016-A. SPA 16-0016-B removes the person-centered medical home (PCMH) language from the outpatient hospital section of Attachment 4.19-B. This change is because SPA 16-0016-A implements an ambulatory payment classification (APC) reimbursement system for outpatient hospital services, includes facility services only and excludes professional services.Professional services must be billed under the physician or other licensed practitioner benefit categories in sections 1905(a)(5) and (6). Accordingly, any PCMH services provided in the outpatient hospital setting will be provided under those benefit categories (without any change to the existing language in those categories), so the PCMH language in the outpatient hospital section is no longer necessary. Also removes a payment limitation that no longer applies under the APC payment methodology and removes obsolete hospital reimbursement.

Revised payment rates for Personal Care Attendant (PCA) services.