Section 13. Covered Services And Service Limitations

Medicaid covers case management services for pregnant individuals and their infants which help recipients gain access to medical, social, educational or other needed services. Case management services provide necessary coordination with providers of non-medical services, such as nutrition or education programs, when these services are necessary to enable recipients to benefit from the health services paid for by medicaid. A. Medicaid covers the following case management service activities furnished to pregnant individuals: (1) identification of programs appropriate for the recipient’s needs, including those which teach basic maternal and child health skills; (2) help in accessing the identified programs; (3) assessment of the service needs of recipients to coordinate the delivery of services when multiple providers or programs are involved in the provision of care; (4) reassessment to ensure that the services which were obtained are necessary and appropriate in meeting the recipient’s needs; and 8.326.3 NMAC 3 (5) determination of whether any additional services are warranted. B. Medicaid covers five hours of case management services per client per pregnancy. The five hours include services to both the pregnant recipient and the infant. Additional units of service require prior approval by MAD or its designee.