bcbsnm.com/medicaid
A Guide to Your Managed Health Care Program
2024 Member Handbook
NTENNIAL
CARE
Such services are funded in part with the State of New Mexico.
Blue Cross and Blue Shield of New Mexico, a Division of Health Care Service Corporation,
a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association 475480.1123
Dear Blue Cross Community Centennial
SM
Care Member,
Welcome to the Centennial Care Managed Health Care Program, administered by
BlueCross and Blue Shield of New Mexico. We look forward to working with you and your
health providers to help you get the health care you need.
BCBSNM has contracts with providers across New Mexico and along its borders in Texas,
Arizona and Colorado. When a provider has a contract to provide services to Centennial Care
members, those providers are in the BCBSNM Centennial Care network. Centennial Care
members can choose to see any provider in the BCBSNM Centennial Care network. To see a
provider that is not in the BCBSNM network, you may need to get prior authorization from
us. There are exceptions to this rule. The exceptions are explained in Section 4: Covered and
Non-Covered Benets of this handbook.
For more information about our company (such as its structure or operations), or to nd out
more about our provider network, please call Member Services at 1-866-689-1523.
Please take some time to review this handbook and any other materials you received in your
welcome packet. Learning how your program works can help you make the best use of your
health care benets.
Note: The State of New Mexico Human Services Department may change the benets
described in this handbook. If that happens, BCBSNM will notify you within 30calendar days.
This handbook is updated on a yearly basis and the most updated version will be mailed
to you. If you would like to view this handbook electronically, you can view and download
the most current version by visiting the Blue Cross Community Centennial website at
bcbsnm.com/medicaid
. If you need a copy in an alternate format, please call Member Services
at 1-866-689-1523.
Sincerely,
Nancy Smith-Leslie
Centennial Care CEO, Blue Cross and Blue Shield of New Mexico
P. O. Box 27838 • Albuquerque, New Mexico 87125-7838
1-866-689-1523 • bcbsnm.com/medicaid
Table of Contents
1 | Blue Cross Community Centennial Member Services 1-866-689-1523 (TTY:711)
Member Assistance ......................4
24/7 Nurseline .............................. 4
Non-Emergency Transportation ............... 4
BCBSNM Website, Internet Help and Email ..... 5
Blue for Your Health
SM
....................... 5
What to Do in an Emergency .................. 5
Interpreter Services ......................... 6
Contacting Member Services ................. 6
Writing to Member Services .................. 6
How We Can Help ........................... 6
After-Hours Help ............................ 6
Ombudsman Specialist ....................... 7
Community Social Services ................... 7
Health Education and HealthLiteracy .......... 7
Member Feedback ........................... 8
Member Advisory Board ..................... 8
Member Rights and Responsibilities .......9
Member Rights .............................. 9
Member and Member Representative
Responsibilities ............................. 11
Managed Care Program Participation ......... 12
Selecting a Managed Care Organization ...... 12
Auto Assignment ........................... 12
Lock-In Period .............................. 12
Recertication .............................. 12
Coverage Due to Being Pregnant ............. 12
Newborns ................................. 12
Section 1: Enrollment ....................12
ID Cards ................................... 13
Change in Eligibility and/or Address ........... 13
When to Contact Your Local ISD Oce ........ 13
Section 2: Native Americans .............14
Prior Authorizations ........................ 14
Care Coordinator ........................... 14
Native American Advisory Board ............. 14
Section 3: Providers .....................15
Provider Directory and Provider Finder
®
...... 16
Primary Care Provider ...................... 16
Choosing a PCP ............................ 17
Changing Your PCP ......................... 17
Medicare PCP Selection ..................... 17
PCP Lock-In ................................ 17
Specialists ................................. 18
Specialist PCP .............................. 18
PCP Terminations ........................... 18
Referrals .................................. 18
Out-of-Network Providers ................... 19
Filing Claims for In-NetworkProviders ......... 19
Making an Appointment ..................... 19
Transportation to Appointments .............20
Second Opinions ...........................20
Cancelling an Appointment ..................21
Always Talk to Your Doctor ...................21
Section 4: Covered and Non-Covered
Benets ................................22
Prior Authorization .........................22
Times You May Have to Pay for Services .......23
Other Insurance ............................23
Outside New Mexico ........................25
Duplicate (Double) Coverage .................25
Experimental, Investigational or Unproven
Services ...................................25
No Eect on Treatment Decisions ............26
Utilization Management .....................26
Medically Unnecessary Services .............. 27
Cosmetic Services ..........................27
No Legal Payment Obligation ................27
Section 4A: Physical Health Benets ......28
Preventive Services .........................28
Well-Child Visits ............................28
Table of Contents
2024 Member Handbook bcbsnm.com/medicaid | 2
Early and Periodic Screening, Diagnostic and
Treatment ................................. 28
Adults .....................................29
Medical/Surgical Services .................... 29
Non-Covered Medical Services ...............32
Family Planning Services .....................33
Pregnancy-Related and MaternityServices ....34
Prenatal Care ..............................35
Special Beginnings
®
........................35
Safe Sleep for Baby .........................35
Birthing Options Program ...................36
Centennial Home Visiting Program ...........36
Hospital Services ...........................37
Urgent Care Services ........................37
Emergency Medical Conditions ............... 38
Emergency Services ........................38
What to Do in an Emergency ................. 38
What is Not an Emergency ...................39
Emergency Room and AmbulanceServices ....39
Observation Stays in the Hospital ............39
Follow-Up Care .............................39
What is Not Covered for EmergencyCare ......39
Section 4B: Behavioral Health Benets ....40
Behavioral Health Benets ..................40
What is Not Covered for
Behavioral Health Benets ...................43
Certied Peer Support Workers ..............43
Learn to Live ...............................43
Section 4C: Long-Term Care and
Community Benets ....................44
Long-Term Care and Community Benets .....44
Community Benet Services .................45
Community Benets Services Descriptions ....47
Agency-Based Community Benet ............47
What is Not Covered for Agency-Based
Community Benet Services .................47
Self-Directed Community Benet .............47
Your Participation ..........................48
Support Broker. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
Recruiting, Hiring, Supervising and Firing
Providers ..................................48
What is Not Covered for Self-Directed
Community Benet Services .................49
Section 4D: Prescription Drug Benets ....50
Drug List ..................................50
Exceptions ................................. 50
Pain Medication Requirement ................50
Covered Medications and OtherItems ........ 51
Retail Pharmacy Program .................... 51
Drug Plan Supply Limits .....................52
93-Day Supply .............................52
Mail-Order Program ........................52
What is Not Covered for Prescription Drugs
and Other Items ............................ 52
Brand-Name Exclusion ......................53
Pharmacy Lock-In ..........................53
Section 4E: Vision Benets ...............54
Vision Coverage ............................ 54
What is Not Covered for Vision Care ..........55
ABP Members ..............................55
Section 4F: Dental Benets ...............56
Covered Dental Services. . . . . . . . . . . . . . . . . . . . . 56
What is Not Covered for DentalServices ......56
Finding a Dentist ...........................56
Urgent Dental Care .........................56
Non-Urgent Dental Care. . . . . . . . . . . . . . . . . . . . . 56
Routine Dental Checkup .....................56
Section 4G: Transportation Benets ......58
What is Not Covered for Transportation Services 58
Scheduling Transportation for Routine Care ...59
Transportation Services Needing Prior
Authorization for Long Distance Travel ........59
Meals and Lodging ..........................60
Payment for Mileage ........................60
Table of Contents
3 | Blue Cross Community Centennial Member Services 1-866-689-1523 (TTY:711)
Address for Expense Reports ................ 61
Address for Mileage Reimbursement .......... 61
Transportation Services for Rides to PCP
Oces Requiring Authorization .............. 61
Rides to Out-of-Network Providers ........... 61
Accompanying Persons or FamilyMembers ....62
Picking Up Medical Supplies andPrescriptions . 62
Section 4H: Value Added Services ........63
Section 4I: Member Rewards .............65
Section 5: Alternative Benet Plan ........66
ABP Benet Package ........................66
ABP Exempt Benet Package ................66
Value Added Services .......................67
ID Cards ...................................67
Provider Network ...........................67
Section 6: Care Coordination .............68
Considering Your Needs .....................68
Care Coordination Levels ...................68
Care Coordination ..........................69
Getting Help with Special Health Care Needs ..70
Community Social Services ..................70
Supportive Housing ........................71
Tobacco Cessation .......................... 71
Section 7: Grievances (Complaints)
&Appeals ..............................72
Grievance (Complaint) ....................... 72
Filing a Grievance ........................... 72
Grievance Address and PhoneNumber .......72
Time Limits for Filing a Grievance ............72
Time Frame for an Answer to aGrievance .....72
People Who Can File a Grievance .............73
A Grievance is Not an Appeal ................73
Appeal ....................................73
Time Limits for Filing an Appeal ..............73
Filing an Appeal ............................ 74
Appeals Address and Phone Number ........75
How Your Appeal is Handled .................76
Keeping Your Services During anAppeal and
HSD Administrative Hearing .................76
Expedited Appeal ...........................78
Expedited Appeal Request Denials ...........78
HSD Administrative Hearing .................79
Section 8: Disenrollment .................80
Annual Choice Period .......................80
Moving Out-of-State ........................80
Member Disenrollment Requests .............80
HSD Reasons for DisenrollingMembers .......80
BCBSNM Reasons for DisenrollingMembers ...80
Long-Term Care Residential or Employment
Support Provider Leaving Network ...........80
Disenrolling During a Hospital Stay or While
in a Nursing Facility .........................81
How to Disenroll ...........................81
Section 9: General Information ...........82
Changes to Handbook or Benets ............82
Disclosure and Release ofInformation ........82
Accessing your Medical Records ..............82
Advance Directives .........................82
Mental Health Advance Directives ............83
Major Disasters ............................83
Women’s Health and
Cancer Rights Act of 1998 ...................83
Health Care Fraud and Abuse ................83
How You Can Help .........................84
Reporting Fraud and Abuse .................84
Medical Policy ..............................84
Privacy of Your Information ..................85
How We Use or Share Your PHI ..............85
How We Protect Your PHI ....................85
Information ................................85
Independent Companies ....................85
2024 Member Handbook bcbsnm.com/medicaid | 4
Member Assistance
The Blue Cross and Blue Shield of New Mexico
Medicaid (also known as Centennial Care) plan is
called Blue Cross Community Centennial. When you
have a question about Centennial Care, you may call
us at 1-866-689-1523, or you may visit our oce in
Albuquerque. You do not need an appointment to
visit our oce.
Telephone Hours: Monday through Friday from 8
a.m. to 5 p.m. Closed Saturdays
and Sundays.
Oce Hours: Monday through Friday
from 8 a.m. to 5 p.m. Closed Saturdays and
Sundays. Closed on New Year’s Day, Memorial Day,
Independence Day, Labor Day, Thanksgiving Day and
Christmas Day.
Location: 4373 Alexander Blvd. NE,
Albuquerque, NM 87107
If you need help after hours, you may call Member
Services at 1-866-689-1523 and leave a message. We
will return your call by 5p.m. the next business day.
24/7 Nurseline
If you can’t reach your primary care provider, the
24/7 Nurseline will connect you with a nurse who can
help you decide if you need to go to the emergency
room or urgent care center, or if you should make an
appointment with your PCP. If you think you have an
urgent problem and your provider cannot see you
right away, call the Nurseline for advice. Call toll-free:
1-877-213-2567.
We also have a phone library of more than 300 health
topics available through the 24/7 Nurseline.
Non-Emergency Transportation
To request a ride to a scheduled appointment, call
the ModivCare™ reservation line at 1-866-913-4342.
Call at least three working days before your visit
Monday through Friday from 8 a.m. to 5 p.m. To
return home or to arrange a ride after hours (such
as for urgent care), call the Ride Assist phone line.
You can call 1-866-418-9829 toll-free 24 hours a day,
seven days a week. You can read about ModivCare in
Section 4G: Transportation Benets
.
Member Assistance
5 | Blue Cross Community Centennial Member Services 1-866-689-1523 (TTY:711)
Member Assistance
BCBSNM Website, Internet Help and Email
Do you need to nd a provider, download
the member handbook, view the drug list
or nd forms and other plan information?
Visit the BCBSNM website at
bcbsnm.com/medicaid
.
You can also email Member Services from the website
(go to ‘Contact Us’).
If you have Internet access, BCBSNM has
online programs and tools you can use.
Blue Access for Members
SM
is our secure member
portal that allows you to:
•
Read your member handbook
•
Search for health care providers that
participate with BCBSNM for Centennial
Care - doctors, hospitals, others
•
Submit a request to change your PCP
•
Read frequently asked questions
about your health plan
•
Find health and wellness information
•
Search a list for drugs that are covered by your
health plan and learn about genericdrugs
•
Print a temporary ID card, request a new
ID card or view a digital ID card
•
Download forms
•
Find Internet links to other services, important
phone numbers and email addresses
•
Email BCBSNM a question or
comment via securemessaging
To check out our online features and programs, log
in to BAM
SM
. If you have never logged in to BAM, click
‘Create an Account’ in the login box. Then follow the
steps to register.
If you need help getting into BAM, call the Blue Access
for Members Help Desk toll-free at 1-888-706-0583
(TTY: 711). The Help Desk is available 24 hours a day,
seven days a week.
We encourage you to enroll in BAM and use the online
features. Programs and rules may change or end
without notice as new programs are designed and/or
as your needs change.
If you have questions about your Blue Cross
Community Centennial health plan, call Member
Services at 1-866-689-1523.
Blue for Your Health
SM
The Blue Cross Community Centennial newsletter,
called
Blue for Your Health
, is available online
through the BAM portal and on our public website.
The newsletter is posted once a quarter (every three
months). If you do not have access to the Internet, you
can request a hard copy by calling Member Services
at 1-866-689-1523 (TTY: 711).
What to Do in an Emergency
If there is a need for cardiopulmonary resuscitation,
or there is an immediate threat to your life or limb,
call 911. If there is no need to call 911, go to the
nearest hospital or emergency room. For members
who are experiencing a mental health crisis or
emergency, call 988. Prior authorization is not needed
for emergency services. You should call your PCP
as soon as possible after receiving care to arrange
follow-up services. See Section 4A: Physical Health
Benets for details on getting emergency care. Do
not use the emergency room in a non-emergency
situation. If you are a member receiving services at a
Core Service Agency, you may also use your crisis plan
for further instructions and contact your CSA crisis
line. Before an emergency arises, please contact your
assigned care coordinator and ask about a personal
crisis plan.
2024 Member Handbook bcbsnm.com/medicaid | 6
Member Assistance
Interpreter Services
Tell your provider’s oce when making an
appointment if you need an interpreter for any
language other than English or for sign language. The
provider should have an interpreter there during
your appointment. During your visit, if your provider
cannot oer you translation services, please call
MemberServices.
If you need oral interpretations in any language,
please call Member Services. Written materials
will also be translated into Spanish or another
format if needed.
Deaf, hard-of-hearing and speech-disabled
callers may use the New Mexico Relay Network.
Dialing 711 connects the caller to the Human Services
Department/Medical Assistance Division transfer
relay service for TTY and voice calls.
Contacting Member Services
When you have questions about Centennial Care,
you may call, write or email us. You may also visit our
oce in Albuquerque. We are here to help you. Call
us at 1-866-689-1523. For help at any time, you can
access our telephone number, which is listed on the
back of your ID card.
Writing to Member Services
Send your question to:
Blue Cross Community Centennial
P.O. Box 27838
Albuquerque, NM 87125-7838
How We Can Help
Whether you call, write, email or visit BCBSNM,
Member Services Advocates can help with:
•
Picking a PCP or nding other Centennial
Care network providers
•
Arranging transportation to provider appointments
•
Prior authorization requests
•
Checking on a claim status
•
Ordering a replacement ID card, a printed listing of
in-network providers, a handbook or member forms
•
Any questions about what is covered and what is
not covered under the Centennial Care program
After-Hours Help
If you need help or want to le a complaint outside
normal business hours, you may call Member
Services. Your call will be answered by our automatic
phone system. You can use this system to:
•
Leave a message for us to call you
back on the next business day
•
Leave a message saying you have
a complaint or appeal
•
Talk to a nurse at the 24/7 Nurseline right
away if you have a health problem
7 | Blue Cross Community Centennial Member Services 1-866-689-1523 (TTY:711)
Member Assistance
Ombudsman Specialist
The Ombudsman Specialist is available to all
Centennial Care members at no cost. The
Ombudsman explores problems and deals with them
fairly. This is done by using Medicaid guidelines and
BCBSNM resources to help you. The Ombudsman
wants to help you receive the benets of your Blue
Cross Community Centennial health plan.
The Ombudsman can help you:
•
Address your concerns about services or benets
you feel should be covered but were denied
•
Understand or clarify your rights
and responsibilities and the covered
services that are available to you
•
Reach appropriate BCBSNMpersonnel
•
Understand the pros and cons of your
possible options and BCBSNM policies
and procedures to help you you get the
most out of your health care benets
You can reach the Ombudsman Specialist by
phone or email:
Toll Free: 1-888-243-1134 TTY: 711
Email:
NMCentennialCareOmbudsman@bcbsnm.com
Community Social Services
The Community Social Services program is available
to all Centennial Care members. This service is to
help you nd community resources to help keep you
healthy and safe. We are the connectors between
you and the many nonprot organizations helping
people in the community. Call us at 1-877-232-5518,
option 3, then option 5, between 8a.m. to 5p.m.,
Monday through Friday. We can help you nd
resources such as:
•
Food pantries
•
Benet coordinators
•
Early Head Start Program for your child
•
Food stamps, Temporary Assistance
for Families with Young Children, or
Women, Infants and Children oce
•
Help with your electric bill
•
Information about local support groups/services
•
Home Visiting Program, including Nurse Family
Partnership and Parents as Teachers
•
Other community resources
Health Education and HealthLiteracy
We oer many ways to access information about
health promotions, maintenance and prevention
for you and your children. This information can
teach you about healthy lifestyles and behaviors
that may aect your health. Listed below are the
ways to get this information. Visit our website
at
bcbsnm.com/medicaid
where you can
learn more about:
•
Health education classes near you
•
How to talk to your provider or
nurse during your visits
•
Programs to manage diabetes,
asthma or tobacco cessation
•
How the case management program
can help when you need care
2024 Member Handbook bcbsnm.com/medicaid | 8
Member Assistance
•
How to set up a Virtual Visit with doctors and
therapists for certain non-emergency conditions
like allergies, asthma, cold/u, ear infections,
online counseling and stress management
Log into BAM to:
•
Read the health newsletter
•
Access the Special Beginnings program
•
Learn how to set up a Virtual Visit with doctors
and therapists for non-emergency conditions
•
View wellness guidelines and health topics
•
Sign up for text messages to be sent to your
cell phone and email. These messages will
give you information about diabetes, asthma,
heart health and tness. You can also choose
to get prescription drug reminders.
Call Member Services at 1-866-689-1523 for more
information.
To help you connect with community resources, we
participate at community health fairs and outreach
events. When an event is scheduled in your area, you
will receive a mailing to let you know which health
topics will be discussed and what screenings will
take place.
Centennial Care gives information about health
literacy at events in your community and through
brochures at your provider’s oce. The goal is to
help you to be an informed member and get the
full benet of all the services Centennial Care oers.
If you need any other materials, just call Member
Services at 1-866-689-1523 and ask a Member
Advocate to help you.
Member Feedback
BCBSNM needs your help to improve our service
to you. Please email, call or write to Member
Services with ideas on how BCBSNM can improve
service to you.
Member Advisory Board
The Member Advisory Board (MAB) is a team of Blue
Cross Community Centennial members and BCBSNM
sta who meet six times a year to discuss your
benets and ways to improve services. You can learn
about your rights and responsibilities as a member
and provide feedback on member information.
You may receive a phone call inviting you to join
us for a meeting. You can call or write us at
bcbs_ab@bcbsnm.com and let us know you want
to join. To learn more about MAB or to make a
reservation, please call 1-866-825-6034 (TTY: 711).
You can visit our website at
bcbsnm.com/medicaid
for more information.
For a schedule of upcoming meetings, visit
https://www.bcbsnm.com/community-centennial/
member-resources/resources
9 | Blue Cross Community Centennial Member Services 1-866-689-1523 (TTY:711)
Member Rights and Responsibilities
Member Rights
It is the policy of BCBSNM to make sure that you know
you have the below rights.
As a member of Centennial Care, you have
the right to:
•
Health care when medically necessary as
determined by a medical professional or BCBSNM;
24 hours per day, seven days per week for urgent
or emergency care services and for other health
care services as dened in the member handbook
•
Receive health care that is free from discrimination
•
Be treated with respect and recognition
of your dignity and right to privacy
•
Choose a PCP or provider from the BCBSNM
network and be able to refuse care from
certain providers (a prior authorization may
be necessary to see some providers)
•
Receive a copy of, as well as make
recommendations about BCBSNM’s member
rights and responsibilities policy
•
Be provided with information about BCBSNM’s
member rights and responsibilities, policies
and procedures regarding products, services,
providers, appeals procedures and other
information about the company and get
information about how to access covered
services and the providers in our network
•
Receive a paper copy of the ocial Privacy
Notice from the HSD upon request
•
Be assured that your MCO is in compliance
with applicable federal state laws including
Civil Rights Act of 1964, Age Discrimination
Act of 1975, Rehab Act of 1973, Education
Amendments of 1972, Americans with
Disabilities Act (ADA) and Section 1557 of the
Patient Protection and Aordable Care Act
•
Be given the name and professional background of
anyone involved in your treatment and the name
of the person primarily responsible for your care
•
Choose a surrogate decision-maker to be involved
and assist with care decisions as appropriate;
this can be done by you or your legal guardian
•
Have an interpreter present when you do not speak
or understand the language that is being spoken
•
Participate with your provider in all decisions
about your health care, including gaining an
understanding of your physical and/or behavioral
condition, being involved in your treatment plan,
deciding on acceptable treatments and knowing
your right to refuse health care treatment or
medication after possible consequences have been
explained in a language you understand. Family
members, legal guardians, representatives or
decision-makers also have this right, as appropriate
Member Rights and Responsibilities
2024 Member Handbook bcbsnm.com/medicaid | 10
Member Rights and Responsibilities
•
Talk with your provider about treatment
options, risks, alternatives and possible results
for your health conditions, regardless of cost
or benet coverage and have this information
documented in your medical record. If you cannot
understand the information, the explanation
will be provided to your family, guardian,
representative or surrogate decision-maker
•
Give informed consent for physical and/or
behavioral health medical services
•
Decide on advance directives for your
physical and/or behavioral health care.
These decisions can be made by you or
your legal guardian as allowed by law
•
Access your medical records in accordance with the
applicable federal and state laws. This means that
you have the right to receive communications about
your private records, request a change or addition
if you feel they are incomplete or wrong, request
restricted disclosure of your medical records and
be notied if accidental disclosure occurs. If the
member has a legal guardian, the legal guardian has
the right to access the member’s medical records
•
Request a second opinion from another
BCBSNM provider. This can be done
by you or your legal guardian
•
File a grievance about BCBSNM or the care that
you received or le an appeal about coverage
for a service that has been denied or reduced
by BCBSNM. After nishing your appeal, you
can request an HSD administrative hearing. The
grievance, appeal, and HSD administrative hearing
processes can be used without fear of retaliation
•
Receive prompt notication of termination or
changes in benets, services or providernetwork
•
Be free from harassment from BCBSNM or
its network providers in regard to contractual
disputes between BCBSNM and providers
•
Select a health plan and exercise switch enrollment
rights without threats or harassment
•
Be free from any form of restraint or seclusion used
as a means of coercion, discipline, convenience or
retaliation, as specied in federal or New Mexico
regulations on the use of restraints and seclusion
•
Exercise rights without concern that
care will be negatively aected
•
Receive information on available treatment options
and alternatives in an understandable manner
11 | Blue Cross Community Centennial Member Services 1-866-689-1523 (TTY:711)
Member Rights and Responsibilities
Member and Member
Representative Responsibilities
It is the policy of BCBSNM to make sure that you know
about the below responsibilities.
As a member of Centennial Care, you have these
responsibilities:
•
Give complete health information to help
your provider give you the care you need
•
Follow your treatment plan and instructions
for medications, diet and exercise as
agreed upon by you and your provider
•
Do your best to understand your physical, long-
term care and/or behavioral health conditions
and take part in developing treatment goals
agreed upon by you and your provider
•
Make appointments ahead of time for provider visits
•
Keep your appointment or call your
provider to reschedule or cancel at least
24 hours before your appointment
•
Tell your providers if you don’t understand
explanations about your health care
•
Treat your provider and other health care
employees with respect and courtesy
•
Show your ID card to each provider
before receiving medical services (or
you may be billed for the service)
•
Know the name of your PCP and have your
PCP provide or arrange your care
•
Call your PCP or the 24/7 Nurseline before going
to an emergency room, except in situations that
you believe are life threatening, or that could
permanently damage your health, or if you are
having thoughts of harm to yourself or others
•
Provide information to New Mexico
HSD and BCBSNM of your current:
−
Mailing address
−
Phone number, including any land
line and cell phone, if available
−
Emergency contact information
−
Email address, if available
•
Tell New Mexico HSD and BCBSNM about
changes to your phone number or address
•
Tell BCBSNM if you have other health
insurance, including Medicare
•
Give a copy of your living will and advance
directives regarding your physical, long-
term care and/or behavioral health to your
PCP to include in your medical records
•
Read and follow the member handbook
2024 Member Handbook bcbsnm.com/medicaid | 12
Section 1: Enrollment
Section 1: Enrollment
Managed Care Program Participation
When you apply for Medicaid coverage at your
Income Support Division oce, you will need to
pick a managed care plan. All members have to pick
a managed care plan except for Native American
members who are not receiving a nursing facility
level of care. If you are Native American and
receiving a nursing facility level of care or have both
Medicare and Medicaid, you will have to enroll in a
managed care plan.
Selecting a Managed Care Organization
You can choose an MCO when you apply for Medicaid
coverage at your local ISD oce or at YESNM
(
www.yes.state.nm.us
).
Auto Assignment
You are given a chance to choose an MCO when lling
out your Medicaid application. If you do not choose
one, one will be automatically assigned for you. You
will be randomly assigned to an MCO unless you were
covered by an MCO for less than six months since
your coverage ended. If you re-enroll in Medicaid
during this period, you will be automatically assigned
to the same MCO. Family members will be assigned to
the same household MCO. Newborns will be covered
by the same MCO as their mother‘sMCO.
Lock-In Period
During the rst three months of your eective
date with Centennial Care, you can choose a new
MCO. After three months, you cannot choose a
new MCO until your next 12-month re-enrollment
period with HSD.
Recertication
Most members have to renew Medicaid coverage
every 12 months. This can be done through the
ISD oce, or in some cases, by calling HSD at
1-888-997-2583.
Coverage Due to Being Pregnant
Some members are eligible for Medicaid because they
are pregnant. Coverage for these members lasts for
one year after the pregnancy has ended.
Newborns
If the mother is enrolled in Medicaid, her newborn
has Medicaid coverage for 13 months starting with
the month of birth. If the mother is enrolled in an
MCO, the child is enrolled in the same MCO. Up to
three months after the newborn’s birth, the baby’s
MCO can be changed if the mother (or legal guardian)
requests it.
A child may be born to a mother who is not enrolled in
Medicaid. If the mother has applied and is eligible for
Medicaid, the child will have 12 months of coverage. If
the mother applies within three months of birth, the
child will have coverage from birth through the month
of the child’s rst birthday.
During your prenatal visits, be sure to let your
provider know the name of the PCP you want for
your baby. After your baby is born, the hospital will
complete the Notice of Birth form, which is sent to
your MCO and local ISD oce. It is very important to
tell your local ISD oce right away that your baby has
been born. They will work with your MCO to get your
newborn enrolled and mail ID cards to you.
13 | Blue Cross Community Centennial Member Services 1-866-689-1523 (TTY:711)
Section 1: Enrollment
Remember, the sooner your local ISD oce knows
your baby is born, the sooner you can arrange
medical services for your baby. This includes shots
and well-baby checkups. If you have any questions
about enrolling your baby, call your care coordinator
at 1-877-232-5518, option 3, then option 2. If you do
not have a care coordinator, call Member Services at
1-866-689-1523.
ID Cards
Your Blue Cross Community Centennial ID card gives
you the information needed for covered health care.
Show your ID card to your provider when you receive
services. This ID card can be used to get prescription
drugs, physical health, behavioral health, long-term
care, dental and vision services. If you have Medicare
or another insurance, also remember to show that
card. You can also ask your provider to verify Medicaid
eligibility. This can be done by the provider contacting
BCBSNM or checking in the Medicaid Web Portal. Do
not let anyone (other than you) use your Centennial
Care ID card. If you do this, you could lose your
Medicaid eligibility.
If you need to order a replacement Centennial Care
ID card, you can go to
bcbsnm.com/medicaid
, log
in to BAM, and request a new ID card. Or you can
call Member Services at 1-866-689-1523. Your
replacement ID card will be sent to you within 10
calendar days of ordering it. If you need services
before your ID card arrives, log in to BAM and print a
temporary ID. You can also access your digital ID card
in BAM. If you have never logged in to BAM before,
follow the steps to register for BAM. If you need
help getting into BAM, call the Help Desk toll-free at
1-888-706-0583.
Change in Eligibility and/or Address
A lot of important information is mailed to the
address you gave the ISD oce. If you change your
address or phone number, it is very important
to call your ISD oce right away and give them
your new information. Or you can go to YESNM
(
www.yes.state.nm.us
) to update your information.
Medicaid eligibility is based on how many people are
in your family. If you have a change in family size, it is
important to report this to the ISD oce right away.
When to Contact Your Local ISD Oce
You need to call your local ISD oce or go to
YESNM (www.yes.state.nm.us) and update your
information if you:
•
Change your name
•
Move to another address
•
Change your phone number
•
Have a new child, adopt a child or
place your child up for adoption
•
Get other health insurance, including Medicare
•
Move out of New Mexico
•
Have any questions about your Medicaideligibility
bcbsnm.com/medicaid
|
14
Section 2: Native Americans
Section 2: Native Americans
Prior Authorizations
Native American members do not need prior
authorizations to visit an Indian Health Service, tribal
health provider or urban Indian provider (all together
referred to as “I/T/U”). This also applies to Tribal 638
facilities. Even if these facilities and providers are out
of network for Centennial Care, you can still see them.
We understand the importance of your relationship
with your I/T/U provider. Our care coordinators can
help you coordinate your care with these providers.
You can receive services directly from any I/T/U
provider, including facilities that are operated by
Native American/Alaskan Indian tribes. You can also
get prescriptions at I/T/U facilities that are not on
the Drug List without obtaining prior authorization
from BCBSNM.
Care Coordinator
You can ask to be assigned to a Native American care
coordinator.
Native American Advisory Board
The Native American Advisory Board (NAAB) is a
team of Blue Cross Community Centennial members
and BCBSNM sta who meet four times a year to
discuss your benets and ways to improve services.
You can learn about your rights and responsibilities
as a member and provide feedback on member
information.
You may receive a phone call inviting you to
join us for a meeting. You can call or write us
at bcbs_ab@bcbsnm.com and let us know you
want to join. To learn more about NAAB or to
make a reservation, please call 1-866-825-6034
(TTY:711). Visit our website at bcbsnm.com/medicaid.
https://www.bcbsnm.com/community-centennial/
native-americans for the NAAB meeting schedule and
resource information.
15 | Blue Cross Community Centennial Member Services 1-866-689-1523 (TTY:711)
Section 3: Providers
Section 3: Providers
All of the places and people you can receive covered
services from are called providers. Examples of
providers are PCPs, specialists, nurses, counselors,
hospitals, urgent care centers and pharmacies.
If you want to know more about your provider,
such as where he or she went to medical school or
performed their residency, their qualications, their
special expertise, or board certication status, call
Member Services at1-866-689-1523.
Centennial Care helps manage health care costs by
asking you to have your care coordinated by a PCP
and to stay within a ‘network’ of Centennial Care
providers. These are independent providers that have
agreed by contract to see Centennial Care members
and follow the rules of the BCBSNM Centennial Care
program. In this handbook, we call these independent
providers ‘in-network’ or ‘Centennial Care providers’
or ‘Centennial Care networkproviders.’
Under your Centennial Care plan, you must get
services from network providers. Providers who are
not in the Centennial Care network are called out-of-
network providers, and services from them will not be
covered, except in the following cases:
•
Urgent care or emergency care described
in Section 4A: Physical Health Benets
•
Family planning services
•
Native Americans visiting any I/T/U
providers or Tribal 638 facilities
•
When prior authorization is received from BCBSNM
(such as when there are no Centennial Care
providers that can give you the care you need)
If you are a new member of the Centennial Care
program, we may need to plan for you to switch to
a Centennial Care network provider. For example,
you may already be using a home health service or
seeing a provider that is not in our Centennial Care
network. We will approve you to continue seeing this
provider while we help you change to a Centennial
Care provider. Just call or email Member Services. We
are here to help you.
2024 Member Handbook bcbsnm.com/medicaid | 16
Section 3: Providers
Provider Directory and Provider Finder
®
To nd a Centennial Care provider in your area,
please visit Provider Finder on our website at
bcbsnm.com/medicaid
. The Provider Finder has a
list of PCPs and other network providers. You can
also nd a copy of the provider directory on our
website. To request a printed list of providers from
the provider directory, call Member Services at
1-866-689-1523. We will send one to you within 10
calendar days of your request at no cost to you. The
directory lists all providers in the local Centennial
Care network. The directory will not include any
transportation providers. You must call ModivCare
to set up all non-emergency transportation.
You can read about ModivCare in Section 4G:
Transportation Benets.
The directory will tell you the provider’s specialty,
what languages are spoken in the oce, what
the oce hours are, telephone numbers and
other information. To nd this information on the
website directory, click on the provider’s name. The
website directory will also give you a map to the
provider’s oce.
Some providers are listed as taking established
patients only. This means that if you are not already a
patient of that provider, you cannot choose him or her
as your PCP. Some of these providers may open or
close their practices to new patients after a directory
has already been printed. You may want to ask the
PCP if he or she is accepting new patients before
seeing the provider.
Primary Care Provider
The role of a PCP is to take care of you and help you
stay healthy. Your PCP is the most important person
to help you with your health care needs. They will
provide most of your health care. This is who you
will go to rst when you are sick or need a check-up.
Your PCP will keep a record of your health and your
health care. Your PCP will deliver your health care
services or send you to other providers when you
need specialty care. You and your PCP should work as
a team to take care of your health. You should be able
to talk to your PCP about all of your health care needs,
including your medical and behavioral health, and
long-term care needs.
PCPs have signed a special Primary Care Provider
agreement with BCBSNM. PCPs are located in
New Mexico and along the New Mexico border of
neighboring states. PCPs include:
•
Family and general practice
•
Internal medicine
•
Gerontology
•
Obstetrics /gynecology
•
Pediatric health care providers
•
Certied nurse practitioners and midwives
•
Physician assistants
Centennial Care providers know when to request
authorizations for certain services and how to work
with us when you need special care. They will also
help you when they believe you need hospital care.
17 | Blue Cross Community Centennial Member Services 1-866-689-1523 (TTY:711)
Section 3: Providers
Choosing a PCP
You must select a PCP from the Centennial Care
provider network. When you enroll in Centennial Care,
we will give you information on how to choose a PCP
or we can help assign you a PCP.
If you have a new PCP, you should make an
appointment for a physical exam as soon as possible
so that you can get to know each other. You can tell
your new PCP about your health conditions and talk
about any concerns you have.
If you are a new member of Centennial Care and your
provider is not in our network, you can continue your
care with your current provider for 30 days while you
nd a new PCP in our network. If you are more than
six months pregnant when you enroll with us, you can
keep seeing your current OB provider for the rest of
your pregnancy. You can call Member Services to help
you with your PCPneeds.
When you enroll, please let us know if you need to
continue services, such as:
•
Medical equipment
•
Home health services
•
Case management
•
Surgery that has already been scheduled
•
Pregnancy care
•
Other ongoing care, such as radiation,
chemotherapy, dialysis, diabetic
care or pain management
Please also let us know if you see I/T/U providers or if
you are pregnant.
Changing Your PCP
You may select a new PCP at any time by calling or
writing Member Services. Tell us the name of the PCP
you want. If the PCP is taking new patients, we will
make the change.
•
If you call on or before the 20th of the
month, the PCP change will be eective
the rst day of the next month.
•
If you call on or after the 21st of the month,
the PCP change will be eective the rst
day of the second following month.
•
We will mail you a new ID card with the name
of your new PCP. Your legal guardian or
representative can request this change as well.
You can begin seeing your new PCP right away.
You do not have to wait for your new ID card.
Medicare PCP Selection
If you are eligible for both Medicare and Medicaid,
you do not have to pick a new PCP for Centennial
Care. You can continue to see your Medicare PCP. You
must take your Medicare ID card and your Centennial
Care ID card with you any time you see a provider,
including yourPCP.
PCP Lock-In
If you get services that are not needed or are getting
the same services from multiple providers, Centennial
Care can lock you into one PCP. We will need to get
approval from your PCP or the provider you are
getting care from to do this. If needed, a PCP lock-in
can be done for more than one provider.
2024 Member Handbook bcbsnm.com/medicaid | 18
Section 3: Providers
Specialists
There may be times when you need to see a provider
who can treat a special medical problem. A provider
who takes care of specic health problems (such
as heart problems, asthma, cancer, etc.), is called a
specialist. These providers don’t usually see patients
for routine care or minor health problems.
If your PCP thinks you should see a specialist or
go to another provider for medical tests, he or she
may make the appointment for you. A referral is
not required. Sometimes you will have to make the
appointment yourself. This is called ‘direct access,’
or the ability to self-refer. You may also call Member
Services if you need help seeing a specialist or getting
an appointment.
Specialist PCP
A specialist may be able to act as your PCP. A PCP
may help you get the treatment for all of your medical
problems. BCBSNM and the specialist have to agree
with the treatment. If you think you need a specialist
as your PCP, please call Member Services. We will work
with you and your provider to help make thischange.
PCP Terminations
If your PCP tells us they are going to leave the
Centennial Care network, we will make a good faith
eort to send you a letter telling you within 15 days
after your PCP gives their termination notice.
If your PCP is terminated or suspended from the
network for potential quality or fraud and abuse
reasons, you must select another PCP within 15
days of the termination. If you do not select another
PCP, we will choose one for you and notify you
in writing of the PCP’s name, location and oce
telephone number. If you need help, we will help you
nd a newPCP.
Referrals
BCBSNM does not require a referral when you see
any in-network medical, behavioral or long-term
care provider. A referral is not needed for emergency
services, Early and Periodic Screening, Diagnostic and
Treatment services, women’s services or any service
such as vision and dental.
When you need to go to a specialist, remember that
your PCP knows you and your medical history. They
may be able to suggest a treatment or a provider that
is better for you. Please talk to your PCP if you can
before making an appointment with a specialist. Some
providers may not accept you as a patient if you have
not received a written referral by another provider.
This is sometimes referred to as a physician-to-
physician referral. BCBSNM does not need to be told
when thishappens.
19 | Blue Cross Community Centennial Member Services 1-866-689-1523 (TTY:711)
Section 3: Providers
Out-of-Network Providers
Providers and facilities not listed in our provider
directory or in our online Provider Finder are
considered out-of-network providers. If you have
Medicare, your Medicare PCP is not considered
out-of-network. Services from an out-of-network
provider are not covered without rst getting prior
authorization from BCBSNM, except in the situations
listed below:
•
Emergency care (life-threatening) from a
hospital and emergency ambulance
•
Urgent care received at an urgent carecenter
•
Family planning such as education and counseling
about birth control and pregnancy, lab tests, follow-
up care, birth control pills and devices such as IUDs
and condoms, tubal ligation and vasectomies
•
Native Americans visiting I/T/U
providers or Tribal 638 facilities
All out-of-network providers must also enroll
in the Medicaid program by registering in
the Conduent system. If your out-of-network
service is preauthorized and that provider
recommends another out-of-network service, it
is your responsibility to make sure you have prior
authorization for the new service. If you do not get
prior authorization before you receive out-of-network
services, you may have to pay the provider.
Call BCBSNM for help or prior authorization at
1-866-689-1523.
Filing Claims for In-NetworkProviders
All Centennial Care providers le claims to BCBSNM.
BCBSNM makes payments directly to your providers.
Be sure these providers know you have Centennial
Care coverage. Do not le claims for in-network
services yourself. Please contact Member Services
at 1-866-689-1523 for assistance with any billing you
may have received from a provider.
Making an Appointment
To make an appointment, please follow thesesteps:
•
For routine visits or sudden illnesses, call your
provider’s oce and tell them you are a Centennial
Care member. Your provider’s oce will help you.
•
When you get to the provider’s oce, show
your Centennial Care ID card. If you have
a Medicare or other insurance ID card,
please be sure to show that as well.
•
You may contact your Core Service Agency
(CSA) or other behavioral health provider for
an appointment for routine or urgent needs.
•
You may also contact your assigned care
coordinator if you need assistance.
•
If you need a ride to your provider’s
oce or behavioral health appointment
please callModivCare.
If you go to a provider’s oce without an
appointment, the provider may not be able to see
you. Please call your provider before you go to his
or her oce.
We do not guarantee that a certain type of room or
service will be available at any hospital or other facility
within the Centennial Care provider network or that
the services of a particular hospital, provider or other
provider will be available.
2024 Member Handbook bcbsnm.com/medicaid | 20
Section 3: Providers
Transportation to Appointments
If you do not have a car or anyone to give you a ride,
you may be eligible for transportation to help you
get to your non-emergency medical, behavioral and
long-term care appointments. ModivCare coordinates
all non-emergency transportation for Centennial Care
members. This includes food and lodging expenses
when you have to travel a long distance to get covered
medical care.
Call ModivCare at least three working days before
your routine appointment to schedule a ride. More
information about ModivCare is provided in the
section regarding non-emergency transportation
services. See Section 4: Covered and Non-
Covered Benets for more information on
transportation services.
Second Opinions
Getting a second opinion means seeing another
provider about your illness or your treatment after
your own PCP or specialist has seen you. You have a
right to see another provider if:
•
You disagree with your PCP or specialist
•
You have more concerns about your illness
•
You want another provider to
approve your treatment plan
•
You need more information about treatment
than your provider has suggested
•
Your PCP or specialist does not want to
give you a referral to another provider
who requires that you have a referral
You must get your second opinion from providers
who are in the Centennial Care network or get a prior
authorization from BCBSNM to see a provider outside
the network. We will cover a second opinion from a
qualied provider outside the network at no cost to
you only if one is not available in our network. You
must have prior authorization from BCBSNM before
getting a third or fourth opinion.
21 | Blue Cross Community Centennial Member Services 1-866-689-1523 (TTY:711)
Section 3: Providers
Cancelling an Appointment
If you need to cancel an appointment tell your
provider’s oce as soon as possible. Try to tell them
at least 24 hours before the appointment time.
If you are going to be late, please call your provider’s
oce. You may be asked to schedule a new time for
your visit.
If you have arranged for a ride to your provider’s
oce, call ModivCare and cancel or reschedule your
ride. You need to cancel your ride at least two hours
before you were supposed to be picked up.
Always Talk to Your Doctor
None of BCBSNM’s programs or services replace
in any way the care you can get from your doctor
or other health care providers. Always talk to your
doctor or other health care providers about your
health. None of the doctors and other health care
providers mentioned in this handbook are employed
by BCBSNM. They are all independent from BCBSNM.
2024 Member Handbook bcbsnm.com/medicaid | 22
Section 4: Covered and Non-Covered Benefits
Section 4: Covered and Non-Covered Benets
Your Centennial Care plan covers medical, behavioral,
long-term care, dental, vision, transportation and
prescription services for eligible members. All
members are covered for these services. The amount,
duration and scope of all covered and non-covered
benets are described in this section.
You must use Centennial Care network providers
except for the below situations:
•
Emergency care (see Section 4A: Physical
Health Benets) from a hospital or
emergency ambulance service
•
Urgent care received at an urgent care center
•
Family planning, such as education
and counseling about birth control and
pregnancy, lab tests, follow-up care, birth
control pills, devices such as IUDs and
condoms, tubal ligations and vasectomies
•
Native Americans visiting I/T/U
providers or Tribal 638 facilities
If you have to see an out-of-network provider for any
other reason, you must rst get prior authorization
from BCBSNM.
Prior Authorization
What is a prior authorization? Not all services are
automatically covered. Prior authorization means that
BCBSNM has the chance to approve or deny coverage
before you receive the service. If you go to a provider
in the Blue Cross Community Centennial network, the
provider will ask BCBSNM for you. If BCBSNM does
not fully approve coverage, you can le an appeal. See
Section 7: Grievances (Complaints) &Appeals.
To go outside of the Centennial Care network of
providers,* to be admitted to the hospital or to
receive certain services, such as home health care,
you will need a prior authorization from BCBSNM.
The Centennial Care network of providers will get
approvals for you. BCBSNM may not approve the
request. If the request for these types of services is
denied by BCBSNM, you and your provider will be
notied and the reason for the denial will be explained.
Standard requests are reviewed as quickly as your
health condition requires but no later than seven
business days after BCBSNM receives the request from
your provider. A 14-day extension may be granted if
requested by your provider or if there is a reason that
the delay would be in your best interest.
BCBSNM can deny your claim if your primary
insurance company provider does not follow required
procedures, including receiving prior authorization or
timely ling.
* Contracted providers within 100 miles of the
New Mexico border (Mexico excluded) are not
considered out-of-state providers.
23 | Blue Cross Community Centennial Member Services 1-866-689-1523 (TTY:711)
Section 4: Covered and Non-Covered Benefits
Times You May Have to Pay for Services
There may be times when Centennial Care will not
pay for services you received. You may have to pay for
services in the following times:
•
If you do not tell the provider that you
are covered by Centennial Care
•
If you agree to pay for non-covered
services in writing with your provider
Providers cannot bill you for charges they make when
they don’t follow Centennial Care procedures. If you
cannot pay for services that were not covered, you will
not lose your Medicaid benets.
Other Insurance
If you or your family have other medical or dental plan
coverage, including Medicare, it is very important that
you tell your local ISD oce. Also, tell your provider
before your appointment. If you do not know how
to contact your local ISD oce, call HSD/MAD at
1-888-997-2583 to get information. You will need to
tell BCBSNM about your other health insurance. This
will help us coordinate your health care coverage so
that your medical services get paid correctly. Please
call Member Services at 1-866-689-1523.
Always show your Centennial Care ID card and other
health insurance ID cards when you see a provider
and go to the hospital. The other insurance plan
needs to be billed for your health care services before
Centennial Care can be billed. BCBSNM’s sta will
work with the other insurance plan on payment for
these services. The only time this rule is dierent is if
you also have Indian Health Services (IHS) coverage.
Medicaid will pay before IHS does.
Please contact BCBSNM if you have been hurt in a
car accident or if you receive services for an injury at
work. This may involve insurance coverage through
other companies and will help get your medical
services paid. This is also called subrogation.
2024 Member Handbook bcbsnm.com/medicaid | 24
Section 4: Covered and Non-Covered Benefits
If this happens, Human Services Division has the
following rights:
•
Right to reimbursement for all benets provided
from any and all damages collected from the third
party for those same expenses whether by action
at law, settlement, or compromise, by the Member
or the Member’s legal representative as a result of
that sickness or injury, in the amount of the total
Covered Charges for Covered Services for which
BCBSNM has provided benets to the Member.
•
HSD is assigned the right to recover from
the third party, or his or her insurer,
to the extent of the benets BCBSNM
provided for that sickness or injury.
•
HSD shall have the right to rst reimbursement
out of all funds the Member, the Member’s
covered family Members, or the Member’s legal
representative, are or were able to obtain for
the same expenses for which HSD has provided
benets as a result of that sickness or injury.
•
The Member is required to furnish any information
or assistance or provide any documents that HSD
may reasonably require in order to obtain our
rights under this provision. This provision applies
whether or not the third party admits liability.
If you have both Medicare and Medicaid, you have
more than one insurance coverage. Medicare is
considered your primary insurance and Centennial
Care is your secondary insurance. Your Centennial
Care benets will not change your primary
insurance benets.
If you have a care coordinator, they will work with
your primary insurance to help set up your health
care. If you do not have a care coordinator, call
Member Services at 1-866-689-1523 and they will be
able to help.
If you have both Medicare and Centennial Care,
Medicare Part D will cover most of your drugs. You
will still have to pay Medicare Part D copays unless
you live in a nursing facility. If you have Medicare, you
can use your current provider. You can get Medicare
specialty services without approval from BCBSNM. We
will work with your provider for the services you get.
We can help you pick a provider if you do not have
one. This provider can set up your Centennial Care
and Medicare services. Centennial Care may cover
some services that are not covered by Medicare.
25 | Blue Cross Community Centennial Member Services 1-866-689-1523 (TTY:711)
Section 4: Covered and Non-Covered Benefits
Outside New Mexico
If you are outside of New Mexico but within the
United States and need emergency services, go to
the nearest emergency room. Claims for covered
emergency medical/surgical services received outside
New Mexico from providers that do not contract as
Centennial Care providers should also be mailed to
BCBSNM. If you would like to see an out-of-state
provider for non-emergency services, you must rst
receive prior authorization from BCBSNM. If you do
not get a prior authorization, the services will not
be covered.
Duplicate (Double) Coverage
Centennial Care does not cover amounts already paid
when members have other sources of coverage that
are legally liable. These may include private insurance,
Medicare or other public programs. If you have any
other health care coverage, you must let us know.
Experimental, Investigational
or Unproven Services
Centennial Care does not cover any treatment,
procedure, facility, equipment, drug, device or supply
not accepted as standard medical practice. Standard
medical practice means the services or supplies that
are in general use in the medical community in the
United States, and:
•
Have been demonstrated in standard medical
textbooks published in the United States and/or
peer-reviewed literature to have scientically
established medical value for curing or
alleviating the condition being treated
•
Are appropriate for the hospital or other facility
provider in which they are performed
•
The physician or other professional provider has
had the appropriate training and experience
to provide the treatment or procedure
The service must be medically necessary and not
excluded by any other contract exclusion.
With one exception, Centennial Care also does not
cover any treatment, procedure, facility, equipment,
drug, device or supply not accepted as standard
medical practice that is considered experimental,
investigational or unproven. The one exception is for
certain services in qualifying cancer trials per HSD
rules. In addition, if federal or other government
agency approval is required for use of any items
and such approval was not granted when services
were administered, the service is experimental and
will not be covered. To be considered experimental,
investigational or unproven, one or more of the
following conditions must be met:
•
The device, drug or medicine cannot be
marketed lawfully without approval of the U.S.
Food and Drug Administration, and approval
for marketing has not been given at the time
the device, drug or medicine is furnished.
2024 Member Handbook bcbsnm.com/medicaid | 26
Section 4: Covered and Non-Covered Benefits
•
Reliable evidence shows that the treatment,
device, drug or medicine is the subject of
ongoing phase I, II, III or IV clinical trials or
under study to determine its maximum
tolerated dose, its toxicity, its safety, its
capability, or its capability as compared with the
standard means of treatment or diagnosis.
•
Reliable evidence shows that the consensus of
opinion among experts regarding the treatment,
procedure, device, drug or medicine is that
further studies or clinical trials are necessary
to determine its maximum tolerated dose, its
toxicity, or its ecacy as compared with the
standard means of treatment or diagnosis.
•
The guidelines and practices of Medicare, the
FDA or other government programs or agencies
may be considered in a determination; however,
approval by other bodies will neither constitute
nor necessitate approval by BCBSNM.
•
Reliable evidence means only published reports and
articles in authoritative peer-reviewed medical and
scientic journals; the written protocol or protocols
used by the treating facility, or the protocol(s) of
another facility studying mainly the same medical
treatment, procedure, device or drug; or the written
informed consent used by the treating facility
or by another facility studying mainly the same
medical treatment, procedure, device or drug.
If you disagree with BCBSNM’s decision regarding any
item or service, you may le an appeal. See Section 7:
Grievances (Complaints) &Appeals.
No Eect on Treatment Decisions
Benet decisions by BCBSNM (like prior
authorizations) are dierent from treatment decisions
by you and your health care providers. At times,
providers may use clinical practice guidelines to
inform their treatment recommendations. You can
request these guidelines by calling Member Services
at 1-866-689-1523 (TTY: 711). Regardless of any
benet decision, the nal decision about your care
and treatment is between you and your health
careprovider.
Utilization Management
Utilization management means we look at medical
records, claims and prior authorization requests
to make sure services are medically necessary,
provided in the right setting and consistent with the
condition reported.
If this management is done before a service is
received, it is part of the ‘prior authorization’
process. If it is done while a service is still being
received, it is part of the ‘concurrent review’ process.
If it is done after a service is received, it is called
‘retrospective review.’
Utilization management decisions are based only on
appropriateness of care and service. BCBSNM does
not reward providers or persons conducting our
programs for denying services and does not oer
incentives to program decision-makers that would
encourage them to approve fewer services than you
need. We want to help you get the care you need in
the best way possible.
The amount, duration or scope of service will not
be denied solely because of your specic condition,
diagnosis or illness.
A service must be medically necessary, even if a prior
authorization is not required. All services are subject
to review. If the service is found not needed, you may
have to pay for the service in agreement with state
and federalguidelines.
27 | Blue Cross Community Centennial Member Services 1-866-689-1523 (TTY:711)
Section 4: Covered and Non-Covered Benefits
Medically Unnecessary Services
Centennial Care does not cover services that are not
medically necessary. Medically necessary services are
clinical and rehabilitative physical or behavioral health
services that are:
•
Necessary to prevent, diagnose or treat medical
conditions or are needed to enable the patient to
attain, maintain or regain functional capacity
•
Delivered in the amount, duration, scope and
setting that is clinically appropriate to the
specic health care needs of the patient
•
Provided within professionally accepted
standards of practice and national guidelines
•
Required to meet the physical, behavioral
and long-term needs of the patient and
are not primarily for the convenience of
the patient, the provider or BCBSNM
BCBSNM determines whether a service or supply
is medically necessary and whether it is covered.
Because a provider prescribes, orders, recommends
or approves a service or supply, does not make it
medically necessary or make it a covered service,
even if it is not specically listed as an exclusion.
Cosmetic Services
Centennial Care does not cover cosmetic services,
which are dened as services that are provided
primarily to alter and/or enhance appearance
in the absence of documented impairment of
physical function.
This coverage exclusion does not apply to primary
gender reassignment chest and/or genital surgeries or
to pharmaceutical gender reassignment services, all
of which require prior authorization from BCBSNM.
No Legal Payment Obligation
Centennial Care does not cover services for which
you have no legal obligation to pay or that are at no
cost, including:
•
Charges made only because benets
are available under this program
•
Services for which you have received a
discount that you have arranged
•
Volunteer services
•
Services provided by you or a family
member for yourself, or by a person
ordinarily residing in your household
2024 Member Handbook bcbsnm.com/medicaid | 28
Section 4A: Physical Health Benefits
Preventive Services
Preventive health care is for everyone. Preventive
health care can keep you healthy and prevent illness.
Below are some of the screenings and services
available to you and your children.
Well-Child Visits
Well-child visits are for children from birth to age 21.
Your child’s PCP can check your child’s health, growth,
development and provide immunizations. This can
occur many times throughout childhood. Well-child
visits can sometimes be done when your child sees
the PCP for a sick visit.
Your PCP will guide you if more services are needed.
Early and Periodic Screening,
Diagnostic and Treatment
EPSDT services are provided to every Medicaid-
eligible child from birth to age 21. Centennial Care
wants your child to be healthy. Centennial Care will
provide checkups and preventive services through
your child’s regular provider. A well-child checkup will
be provided for your child. Your child should have
exams at the ages shown on the chart below.
Well-Child Health Check Schedule
Under age 1 3 – 5 days, 1 month,
2 months, 4 months,
6 months and 9 months
Ages 1 to 30 months 12 months, 15 months,
18 months, 24 months and
30 months
Ages 3 to 21 years Each year
Exams may include vaccinations or shots. If your
child has not had his or her checkup this year, call the
provider and schedule one.
•
Lead Testing: The provider will need to do a
blood test to make sure your child does not
have too much lead. Your child should be
checked at ages 12 months and 24 months
or if they have never been checked.
•
Dental Exam: Your child should have
their teeth cleaned and receive uoride
treatments every six months.
•
Private Duty Nursing: When your child’s provider
wants a nurse to provide care at home or at school.
•
Personal Care Services: When your child’s
provider wants a caregiver to help your child
with eating, bathing, dressing and toileting.
EPSDT also provides hearing and vision services,
school-based services and more. If you have
questions, please contact your care coordinator. If
you need a care coordinator, call 1-877-232-5518,
select option 3.
Health problems should be identied and treated as
early as possible. When your child needs assistance
with daily activities due to a qualifying medical
condition, special services like Private Duty Nursing or
Personal Care Services will be provided under EPSDT
through Centennial Care.
Immunizations help keep you well. You can receive
shots at a PCP visit. Many immunizations are needed
before the age of two years. Yearly u shots are
important, too. Ask your PCP which shots you need.
Teenage children will also need to receive some shots.
Section 4A: Physical Health Benets
29 | Blue Cross Community Centennial Member Services 1-866-689-1523 (TTY:711)
Section 4A: Physical Health Benefits
Adults
There are recommended health screenings for both men and women. Women age 40 through 74 should have
a mammogram every one to two years to screen for breast cancer. If you need help nding a screening center,
talk with your health care provider or call BCBSNM Member Services at 1-866-689-1523 (TTY: 711). Both men
and women ages 45 to 50 and older should be screened for colon cancer. These are just a few of the necessary
screenings.
During PCP visits, talk with the provider about exercise, eating right and safety issues for children and adults.
Your PCP can measure height and weight to ensure you and/or your child is at a healthy weight.
Medical/Surgical Services
A list of covered services available for the Standard Medicaid Plan and Alternative Benet Plan is included in
the table below. The “ü” in the column will tell you if the service(s) are covered for the Standard Medicaid Plan
and the ABP.
The ABP is a part of the New Mexico Medicaid Centennial Care program. The ABP oers coverage for Medicaid-
eligible adults ages 19-64 who have income up to 138% of the Federal Poverty Level, which includes the
Medicaid Expansion Population and Transitional Medical Assistance categories. If you are eligible for ABP
covered services, please refer to the services listed under the column titled, “ABP Covered Service.”
If you are an ABP member and have a physical or behavioral health condition that meets certain criteria, you
may be eligible for covered services under the column titled, “Standard Medicaid Plan Covered Service.”
In the chart below, it sometimes says that prior authorization is “dependent on exact service.” That
means you will need to call Member Services to nd out if the exact service you are checking on requires
priorauthorization. To learn more about prior authorizations, please see page 22 of this handbook.
The following services are covered when medically necessary:
Service
Standard
Medicaid
Plan
Covered
Service
ABP
Covered
Services
Prior Authorization Required
Allergy care, including tests and serum
ü ü
Dependent on exact service
Anesthesia Services
ü ü
No
Bariatric surgery
ü
Lifetime limit Yes
Breast pumps and replacement supplies
ü ü
No
Cancer clinical trials
ü ü
Yes
Chemotherapy and radiation therapy
ü ü
Yes
Community Interveners for Deaf
and Blind
ü ü
Yes
Note: These services are covered when medically necessary. Other terms, conditions and/or limitations may apply.
2024 Member Handbook bcbsnm.com/medicaid | 30
Section 4A: Physical Health Benefits
Service
Standard
Medicaid
Plan
Covered
Service
ABP
Covered
Services
Prior Authorization Required
Covered services provided in school-based
health clinics
ü ü
No
Hemodialysis
ü ü
Yes, if more than three times a week
DME and supplies
ü
ü
Limits apply
Please call Member Services
Early and Periodic Screening, Diagnosis and
Treatment (EPSDT)
ü
ü
Age limited
No
Emergency dental care
ü ü
No
Emergency services
ü ü
No
EPSDT personal care services
ü
ü
Age limited
Yes - if your child is disabled, he or she
may qualify for more services; please call
Member Services and ask to speak with a
care coordinator/case manager for more
information
EPSDT private duty nursing
ü
ü
Age limited
Yes - if your child is disabled, he or she
may qualify for more services; please call
Member Services and ask to speak with a
care coordinator/case manager for more
information
EPSDT rehabilitation services
ü
ü
Age limited
Yes - if your child is disabled, he or she
may qualify for more services; please call
Member Services and ask to speak with a
care coordinator/case manager for more
information
Family planning
ü ü
No
Ground and air ambulance
ü ü
Ground - No
Air - No
Hearing services and devices
ü
ü
Age limited
Yes
Home birthing
ü ü
Dependent on exact service
Home health care and
intravenous services
ü
ü
Limits apply
Yes
Hospice services
ü ü
Yes
Hospital services (inpatient, outpatient and
skilled nursing)
ü ü
Dependent on exact service
Inhalation therapy services
ü ü
No
Note: These services are covered when medically necessary. Other terms, conditions and/or limitations may apply.
31 | Blue Cross Community Centennial Member Services 1-866-689-1523 (TTY:711)
Section 4A: Physical Health Benefits
Service
Standard
Medicaid
Plan
Covered
Service
ABP
Covered
Services
Prior Authorization Required
Injections
ü ü
Dependent on exact service
Inpatient rehabilitative facilities
ü
ü
Skilled
nursing or
acute rehab
facility only
Yes
IV outpatient services
ü ü
Yes
Laboratory, X-ray, EKGs, medical imaging
services and other diagnostic tests
ü ü
Dependent on exact service
Long-term services and supports
ü ü
Yes - please call Member Services and
ask to speak with a care coordinator for
more information
Molecular genetics
ü ü
Yes
Nursing facility services
ü ü
Yes
Nutritional counseling services
ü ü
Dependent on exact service
Nutritional services
ü
Yes
Oce visits to PCPs or specialists, including
dieticians, nurse practitioners and physician
assistants
ü ü
No
Organ and tissue transplant services
ü
ü
Lifetime limit
All transplant and pre-transplant
evaluations require prior authorization
Orthotics and prosthesis
ü
ü
Limits apply
Dependent on exact service
Outpatient professional services
ü ü
No
Outpatient surgery
ü ü
Dependent on exact service
PET, MRA, MRI and CT scans
ü ü
Dependent on exact service
Pharmaceutical gender reassignment
services
ü ü
Yes
Physical therapy
ü
ü
Limits apply
Dependent on exact service
Podiatry (foot and ankle) services
ü
ü
Limits apply
Dependent on exact service
Note: These services are covered when medically necessary. Other terms, conditions and/or limitations may apply.
2024 Member Handbook bcbsnm.com/medicaid | 32
Section 4A: Physical Health Benefits
Service
Standard
Medicaid
Plan
Covered
Service
ABP
Covered
Services
Prior Authorization Required
Pregnancy-related and maternity
services, including pregnancy termination
procedures
ü ü
No
Primary gender reassignment (male-to-
female or female-to-male) chest and/or
genital surgeries
ü ü
Yes
Routine physicals, children's preventive
health programs and Tot-to-Teen checkups
ü ü
No
Smoking cessation services
ü ü
No
Special rehabilitation services, such as
physical therapy, occupational therapy,
speech therapy, cardiac rehabilitation,
pulmonary rehabilitation
ü
ü
Limits apply
Dependent on exact service
Telemedicine services
ü ü
No
Treatment of diabetes
ü ü
Dependent on exact service
Urgent care services
ü ü
No
Note: These services are covered when medically necessary. Other terms, conditions and/or limitations may apply.
All services received from an out-of-network provider
must have a prior authorization except for the
examples listed in Section 3: Providers.
Non-Covered Medical Services
Centennial Care does not cover the following
medical services:
•
Abdominoplasty
•
Acupuncture, massage therapists, hypnotherapy,
rolng, biofeedback or chiropractic services
•
Blepharoplasty (unless necessary to
restore unobstructed vision)
•
Brow lift
•
Calf implants
•
Cheek implants
•
Chin or nose implants
•
Cosmetic services, including plastic surgery,
wigs, hairpieces or medications for hair loss
•
Duplicate equipment, except for backup ventilator
•
External penile prosthesis (vacuum erection devices)
•
Face lift (rhytidectomy)
•
Facial bone reconstruction sculpturing/reduction,
includes jaw shortening, forehead lift or contouring
•
Hair removal (may include donor skin sites) or
hair transplantation (electrolysis or hairplasty)
•
Infertility services and treatments
•
Laryngoplasty
•
Lip reduction or lip enhancement
•
Liposuction/lipolling or body contouring
or modeling of waist, buttocks,
hips and thighs reduction
33 | Blue Cross Community Centennial Member Services 1-866-689-1523 (TTY:711)
Section 4A: Physical Health Benefits
•
Medical services provided to a person who is an
inmate of a public institution for more than 30 days
•
Neck tightening
•
Panniculectomy (unless necessary to restore
appropriate hygiene following signicant weight loss)
•
Pectoral implants
•
Personal care items, like toothbrushes
or television sets in hospital rooms
•
Private room expenses, unless your
medical condition requires isolation and
charges are preauthorized by BCBSNM
•
Reduction thyroid chondroplasty or trachea
shaving (reduction of Adam’s apple)
•
Redundant/excessive skin removal
•
Reproductive services including but not limited
to procurement cryopreservation/freezing,
storage/banking and thawing of reproductive
tissues, such as oocytes, ovaries, embryos,
spermatozoa and testicular tissue
•
Reversal of a voluntary sterilization
•
Rhinoplasty (nose correction)
•
Services received outside the United
States, including emergency services
•
Skin resurfacing
•
Some durable medical equipment and
supplies (Centennial Care suppliers of these
services know what is covered by Medicaid
and what needs prior authorization)
•
Temporomandibular joint or
craniomandibular joint treatment
•
Testicular expanders
•
Voice modication surgery and/or voice
(speech) therapy or voice lessons
Family Planning Services
Family planning or birth control helps you decide
when you are ready to have a baby. To get help with
your decision, you can see your PCP, any qualied
family planning center or other provider. This
includes an OB/GYN provider or going to Planned
Parenthood. You can get family planning services in or
out-of-network. You can do this without asking your
PCP. This includes adolescents. Members have the
right to refer themselves to an in-network women’s
health specialist for routine and preventive women’s
healthservices.
Centennial Care oers the following family planning
and related services to all members. You have the
right to receive these services when you need them:
•
Family planning counseling and health
education, so you will know which birth
control method, if any, is best for you
•
Lab tests if you need them to help you decide
which birth control you should use
•
Follow-up care for trouble you may have
from using a birth control method that a
family planning provider gave you
•
Birth control pills
•
Pregnancy testing and counseling
2024 Member Handbook bcbsnm.com/medicaid | 34
Section 4A: Physical Health Benefits
Centennial Care also oers the following FDA-
approved devices and other procedures:
•
Injection of Depo-Provera for birth control purposes
•
Diaphragm, including tting
•
IUDs or cervical caps, including
tting, insertion and removal
•
Contraceptive arm implants, including
insertion and removal
•
Surgical sterilization procedures, such
as vasectomies and tubal ligations
You do not need to get prior authorization from
BCBSNM if you wish to visit Planned Parenthood or
other out-of-network providers for family planning
services. If you need a ride to the provider’s oce,
please contact ModivCare for prior authorization.
Pregnancy-Related and
MaternityServices
Once you are sure you are pregnant, you may choose
either your PCP or another Centennial Care network
provider to provide maternity care. The provider
is then responsible for notifying BCBSNM of any
admissions or home birth plans.
If you are pregnant or think you may be pregnant,
you or your provider should call BCBSNM right away.
The care of a pregnant mother is important and the
mother’s health can aect the health of her newborn.
When you call, we will:
•
Help you choose a primary OB/GYN provider or
certied nurse midwife for your pregnancy
•
Have you enroll in our special program for
pregnant members, Special Beginnings
•
Help you choose a PCP for your baby (if your
baby is eligible for Centennial Care coverage)
You may self-refer to any Centennial Care provider
for your maternity care. If there is no Centennial
Care maternity services provider in your area, you or
your provider may request prior authorization from
BCBSNM to go to an out-of-network women’s health
care provider.
Centennial Care covers all medically necessary
hospitalizations, including up to 48 hours of inpatient
care following a vaginal delivery and 96 hours
following a C-section delivery. If you need emergency
services and must go to a hospital outside the
network (such as while you are traveling), call Member
Services within 48 hours or as soon as possible so
we can help coordinate your care and arrange for
follow-up services.
If you are pregnant on the date you become a
Centennial Care member and you are already
seeing a provider, please call Member Services so
that we can approve your visits to the provider if
she or he is outside our network. If you are in your
rst or second trimester, in most cases you will be
allowed to continue your care with that provider for
at least 30days. If you are six months or more than
six months pregnant, you can continue seeing your
provider for the rest of your pregnancy.
35 | Blue Cross Community Centennial Member Services 1-866-689-1523 (TTY:711)
Section 4A: Physical Health Benefits
Prenatal Care
Early and regular prenatal care is very important
for you and your baby’s health. Your provider or
midwife will:
•
Give you information about childbirth classes
•
Tell you how often you need to visit your provider
or midwife after your rst visit. Usually you will visit
your provider or midwife every four weeks until you
are about six months pregnant. Then you will visit
your provider or midwife every two weeks until your
last month. You will continue visiting your provider
or midwife every week during the last month
•
Schedule you for routine lab work and other tests
that will check the health of you and your baby
•
Let you know about good nutrition and
exercise, about the dangers of smoking,
alcohol/drug use, and other behavior and
give you information about vitamins, breast
feeding, infant safety car seats and cribs
•
Ask you to return to see your provider for
a postpartum visit between seven and
84 days after you have your baby
•
Help you in the future with family
planning (such as birth control)
•
Talk to you about preventing sexually transmitted
diseases (STDs), u shots during pregnancy and
whether or not to get a rubella shot after delivery
Special Beginnings
®
This program is for Centennial Care members
whenever you need it both during and after
pregnancy. It can help you better understand and
manage you and your family’s needs during this very
important time. You should enroll in the program as
soon as you learn you are pregnant, if possible. When
you enroll, you will receive a questionnaire to nd out
if there may be any problems or risks to watch for,
information on nutrition, access to care, newborn care
and other topics helpful to parents.
You also receive personal and private phone calls
from an experienced Care Coordinator throughout
your pregnancy and postpartum period, depending
on your needs.
To learn more or to enroll, call toll-free
at 1-888-421-7781 (TTY: 711) or email
NMCNTLSpecialBeginnings@bcbsnm.com
.
If you enroll in our Special Beginnings Care
Coordination Program, you may be eligible to receive
value added services. There is no cost to you for these
services. Please see Section 4H: Value Added Services
for more information.
Safe Sleep for Baby
Learn about safe sleep for your baby by contacting
BCBSNM’s Special Beginnings program at
1-888-421-7781 (TTY: 711).
2024 Member Handbook bcbsnm.com/medicaid | 36
Section 4A: Physical Health Benefits
Birthing Options Program
You can choose to have your pregnancy-related
services provided at home or in a birthing center by
a licensed certied nurse-midwife or by a licensed
direct-entry midwife. These services will be covered
only if they are provided by health care providers
who have an approved Provider Agreement with
HSD/MAD. If you are planning to have your baby at
home or in a birthing center, you must have prior
authorization from BCBSNM. This will help us make
sure you are seeing a provider or midwife that
can provide such services under the Centennial
Care program.
If you are interested in having a midwife, call us and
ask for a midwife packet and follow the instructions. If
you choose a midwife for at-home or birthing center
delivery, it is your right and responsibility to:
•
Ask the midwife if he or she has
malpractice insurance
•
Receive the conrmation or release
statement from the midwife
•
Sign the conrmation release or statement
sent to you by the midwife
•
Receive an ‘informed consent’ or ‘informed
choice’ agreement from the midwife about
complications that may or may not occur
If the midwife does not have malpractice insurance,
you are assuming all risks of damage and injury.
Centennial Home Visiting Program
Expectant mothers and families with children through
age ve may qualify to participate in Centennial Home
Visiting. This program provides services that promote
maternal, infant and early childhood health and
development.
Home Visiting helps families raise happy, healthy
children by providing education, support,
screenings and resources. Families will learn about
pregnancy, child development, parent-child bonding,
support services in the community, safety, ways
to promote learning through play and everyday
interactions and more.
Learn more about Centennial Home Visiting by
contacting BCBSNM’s Special Beginnings program
at 1-888-421-7781 (TTY: 711) or via email at
CHV@bcbsnm.com
.
Nurse Family Partnership
If you are a rst-time mother, less than 28 weeks
pregnant and live in a service area, you may be
eligible to receive help from a personal nurse who
will come to your home and provide advice, support,
information and screenings during your pregnancy
and after your baby arrives, up to age two.
Parents as Teachers
If you are pregnant or have a child that is ve years
old or younger and live in a service area, you may
be eligible to receive help from a certied parent
educator. The parent educator will provide support,
guidance, screenings, resources and activities for
you and your child that promote early learning and
development.
Learn more about the Centennial Home Visiting
Program by contacting BCBSNM’s Special Beginnings
program at 1-888-421-7781 (TTY: 711).
37 | Blue Cross Community Centennial Member Services 1-866-689-1523 (TTY:711)
Section 4A: Physical Health Benefits
Hospital Services
Services you get in a hospital are covered. You may
stay in the hospital overnight or visit the emergency
room. Some examples of services you might get in a
hospital are:
•
Emergency room care
•
Medical care for when your provider
admits you to the hospital
•
Physical therapy
•
Lab tests
•
X-rays
Many hospital services must be approved before
you go to the hospital. For more information
about hospital services, call Member Services at
1-866-689-1523.
Urgent Care Services
Urgent care is needed for sudden illnesses or injuries
that are not life-threatening. If you can wait a day or
more to receive care without putting your life or a
body part in danger, you may not need urgent care. If
you do not know if your condition is urgent, you can
call the 24/7 Nurseline for advice.
If you think you need urgent care, you can choose any
of the following steps:
•
Call your PCP or behavioral health provider’s oce
and say you need to see a provider as soon as
possible, but there is no emergency. If your provider
tells you to go to the emergency room because he
or she cannot see you right away and you do not
believe you have an emergency, please call our toll-
free 24/7 Nurseline at 1-877-213-2567 for advice.
•
Ask your provider to recommend another provider if
your provider is not able to see you within 24 hours.
•
Contact your Core Service Agency or other
behavioral health provider if you feel you
need urgent behavioral health care.
•
Visit the nearest urgent care center in
the Centennial Care network.
•
If there is not an in-network urgent care center
nearby, go to the closest urgent care center.
•
If you are outside New Mexico and need
urgent care, call Member Services for help
or go to a local urgent care center.
BCBSNM does not cover follow-up care from out-of-
network providers without prior authorization.
2024 Member Handbook bcbsnm.com/medicaid | 38
Section 4A: Physical Health Benefits
Emergency Medical Conditions
An emergency medical condition is a behavioral or
physical health condition that is bad enough for an
average person to think that without immediate help,
there is serious danger to the health, bodily functions,
body parts, organs or appearance of that person or
that person’s unborn child.
Emergency Services
An emergency is a medical or behavioral condition
that has symptoms so severe (including severe
pain), that if you do not receive care right away,
your health might seriously suer (in the case of a
pregnant woman, the health of the unborn child.) An
emergency might also be when you believe you might
ruin a bodily function, lose an organ or lose a body
part if you do not get medical attention right away.
To nd out if you have an emergency, you should
ask yourself:
•
Do you have a severe medical or behavioral
condition, including severe pain?
•
Do you believe your health could be seriously
harmed if you don’t get health care right away?
•
Do you believe your life or the lives of
others could be seriously harmed if you
don’t get health care right away?
•
Do you believe a bodily function, body
part or organ can be damaged if you
don’t get health care right away?
If you answered “yes” to one or more of these
questions, you may have an emergency. Here are
some examples of emergencies:
•
Heart attack
•
Stroke
•
Bad chest pain or other pain that does not go away
•
Hard time breathing
•
Bleeding that does not stop
•
Loss of consciousness (passing out)
•
Seizures
•
Poisoning or drug overdose
•
Severe burns
•
Serious injury from an accident or fall
•
Broken bones
•
Injured eye or sudden loss of eyesight
•
Feelings of wanting to hurt yourself or others
If you have an emergency, you do not need to call
BCBSNM before going to the emergency room or
calling 911 for emergency ambulance services. In an
emergency, you do not have to worry about whether
or not the emergency room or ambulance is in the
Centennial Care network.
What to Do in an Emergency
If CPR is necessary, or if there is an immediate threat
to your life or a limb, call 911. If you do not call 911, go
to the nearest medical facility or trauma center.
39 | Blue Cross Community Centennial Member Services 1-866-689-1523 (TTY:711)
Section 4A: Physical Health Benefits
What is Not an Emergency
Do not go to an emergency room if you are not
having a true emergency. The emergency room is
for patients who are very sick or injured and should
never be used because it seems easier for you or
your family. You may have to wait to be seen for a
very long time and the charges for emergency room
services are very expensive even if you have only a
small problem.
If you have an illness or problem, call your PCP rst. If
you cannot get in touch with your PCP, call the toll-
free 24/7 Nurseline at 1-877-213-2567. Call 711 for
TTY service. A nurse from the Nurseline may suggest
that you go to your PCP, an urgent care center or
the nearest emergency room. If your PCP’s oce is
closed, the Nurseline can also help you decide what
you should do.
If you know that your illness is not serious or life-
threatening and you go to the emergency room
or call an ambulance anyway, you may be billed. If
you are billed and do not pay your bill, the provider
and/or Centennial Care may use legal action to collect
payment from you.
Emergency Room and
AmbulanceServices
If you have an emergency, you do not need to call
BCBSNM before going to the emergency room or
calling 911 for emergency ambulance services. In an
emergency, you do not have to worry about whether
or not the emergency room or ambulance is in the
CentennialCarenetwork.
Observation Stays in the Hospital
If you are admitted to the hospital after an emergency
room visit and you only need to stay a few days, your
care could be covered as an observation stay instead
of an inpatient stay. Your provider will be notied
when your illness qualies as an observation stay.
Follow-Up Care
After a visit to the emergency room, you may need
follow-up care. The health care you receive will either
keep your health stable or improve or resolve your
health problem. This is called post-stabilization care.
This type of care may require prior authorization from
BCBSNM. You may receive post-stabilization care in a
hospital or other facility. Centennial Care covers this
care. For other follow-up care, such as medicine rells
or having a cast removed, go to your PCP’s oce.
For help on how to nd post-stabilization providers
and get to their locations, call Member Services at
1-866-689-1523.
What is Not Covered for EmergencyCare
•
Follow-up care outside New Mexico if you
could return to New Mexico to receive care
without medically harmful results
•
Follow-up care received from an out-of-network
provider if it is not preauthorized by BCBSNM
•
Services received outside the UnitedStates
2024 Member Handbook bcbsnm.com/medicaid | 40
Section 4B: Behavioral Health Benefits
Behavioral Health Benets
Behavioral health services help to support people
facing emotional problems, mental health conditions
and/or substance abuse. Sometimes, behavioral
health conditions may occur in combination with each
other or in addition to a physical condition. Covered
services are services paid for by Centennial Care.
The type of service you may need depends on your
situation. A care coordinator can help you nd out
what services are covered for you and whether the
service will need prior authorization. To learn more
about prior authorizations, please see page 22 of
this handbook. If you need a care coordinator, call
1-877-232-5518. A list of covered services available
for the behavioral health benet on the Standard
Medicaid Plan and Alternative Benet Plan (ABP) is
included in the table on the following pages. The “ü” in
the column will tell you if the service(s) are covered for
the Standard Medicaid Plan and the ABP.
The ABP is a part of the New Mexico Medicaid
Centennial Care program. The ABP oers coverage
for Medicaid-eligible adults ages 19-64 who have
income up to 138% of the Federal Poverty Level,
which includes the Medicaid Expansion Population
and Transitional Medical Assistance categories. If you
are eligible for ABP covered services, please refer
to the services listed under the column titled, ‘ABP
Covered Service.’
If you are an ABP member and have a physical
or behavioral health condition that meets certain
criteria, you may be eligible for covered services
under the column titled, ‘Standard Medicaid Plan
Covered Service.’
Section 4B: Behavioral Health Benets
41 | Blue Cross Community Centennial Member Services 1-866-689-1523 (TTY:711)
Section 4B: Behavioral Health Benefits
Behavioral Health Service
Standard
Medicaid
Plan
Covered
Service
ABP
Covered
Services
Behavioral
Health Age
Prior
Authorization
Required
Accredited Residential Treatment Center Services
for Adults with Substance Use Disorders
ü
ü
18 years and
older
Yes
Accredited Residential Treatment Center Services
for Youth
ü
ü
Under age 21 Yes
Applied Behavior Analysis (ABA)
ü
ü
12 months and
older
Yes*
Assertive Community Treatment
ü
ü
18 years and
older
No
Behavior Management Services
ü
ü
Under age 21 No
Cognitive Enhancement Therapy
ü
ü
18 years and
older
No
Comprehensive Assessments
ü ü
All ages No
Comprehensive Community Support Services
(CCSS)
ü ü
All ages No
Crisis Intervention
ü
ü
All ages No
Crisis Triage Centers
ü
ü
All ages No
Day Treatment
ü
ü
Under age 21 No
Electroconvulsive Therapy
ü
All ages Yes
Emergency Services
ü ü
All ages No
Family Peer Support Services
ü ü
All ages No
Family Support (Behavioral Health)
ü ü
All ages No
Group Home
ü
ü
Under age 21 Yes
Inpatient Psychiatric Service
ü ü
All ages Yes
Inpatient Substance Abuse Services
ü
ü
All ages Yes
Integrated Care and Interdisciplinary Teaming
ü ü
All ages No
Intensive Outpatient Programs for Mental Health
and Substance Use Disorders
ü
ü
11 years and
older
No
Medication Assisted Treatment: Buprenorphine
for Opioid Use Disorder
ü ü
All ages No
Multi-Systemic Therapy
ü ü
Ages 10 to 18 No
Note: This is not a comprehensive list of services. These services are covered when medically necessary. Other
terms, conditions, and/or limitations may apply. Please contact Member Services at 1-866-689-1523 for any
benet questions.
* For Adaptive Behavior Treatment by Protocol (97153) and Adaptive Behavior Treatment with Protocol
Modication (0373T)
2024 Member Handbook bcbsnm.com/medicaid | 42
Section 4B: Behavioral Health Benefits
Behavioral Health Service
Standard
Medicaid
Plan
Covered
Service
ABP
Covered
Services
Behavioral
Health Age
Prior
Authorization
Required
Non-Accredited Residential Treatment Center
Services for Youth
ü ü
Under age 21 Yes
Opioid Treatment Program
ü ü
All ages No
Outpatient Crisis Stabilization Center
ü ü
14 years and
older
No
Outpatient Professional Services
ü ü
All ages No
Partial Hospitalization
ü
ü
5 years
and older
Yes, requires prior
authorization
beyond 45 days
Peer Support Services
ü ü
All ages No
Psychological/Neuropsychological Testing
ü ü
All ages No
Psychosocial Rehabilitation (PSR) Program
ü ü
18 years and
older
No
Recovery Services
ü ü
All ages No
Respite Care
ü ü
Under age 21
Yes, for services
beyond 30 days
or 720 hours in a
calendar year
Screening, Brief Intervention, Referral to
Treatment (SBIRT) Services
ü ü
Age 11
and older
No
Smoking Cessation
ü ü
Under age
21 OR for
pregnant
members
No
Standard Oce Visits to Mental Health Specialists
(which could include counselors, social workers,
psychiatrists or psychologists)
ü ü
All ages No
Sub Acute Residential Treatment Center for Youth
ü
ü
Under age 21 Yes
Supportive Housing
ü
ü
All ages No
Telemedicine Services
ü ü
All ages No
Treat First
ü ü
All ages No
Treatment Foster Care
ü
ü
Under age 21 Yes
Note: This is not a comprehensive list of services. These services are covered when medically necessary. Other
terms, conditions, and/or limitations may apply. Please contact Member Services at 1-866-689-1523 for any
benet questions.
* For Adaptive Behavior Treatment by Protocol (97153) and Adaptive Behavior Treatment with Protocol
Modication (0373T)
43 | Blue Cross Community Centennial Member Services 1-866-689-1523 (TTY:711)
Section 4B: Behavioral Health Benefits
You do not need a referral from your PCP to get
behavioral health services. You can call Member
Services at 1-866-689-1523 to get more information.
If you are not sure what kind of help you need,
call Member Services and they will help you nd a
provider or help you speak to a care coordinator.
You may need to complete an assessment with
the help of your care coordinator and meet certain
conditions to get behavioral health services. A licensed
clinician may need to determine that the services are
medically necessary.
If you do not have a personal crisis plan, please talk
to your behavioral health provider or call the 24/7
Nurseline at 1-877-213-2567. It is important that you
make a plan in advance that may help you prevent
crisis or relapse.
In an emergency, (such as if you feel like hurting
yourself or others or if you are not able to take care
of yourself), call 911 or go to the nearest hospital
emergency room.
What is Not Covered for
Behavioral Health Benets
Non-covered services are the services not paid for
by Centennial Care. These services would be paid
for by you. Call Member Services at 1-866-689-1523
for more information about if a service is covered or
notcovered.
Centennial Care does not cover the following
behavioral health services:
•
Activity therapy, group activities and other
services that are primarily recreational in nature
•
Biofeedback
•
Conditions that do not meet the standard of medical
necessity as dened in Centennial Care rules
•
Educational or vocational services related to
traditional academic subjects or vocational training
•
Experimental or investigational
procedures, technologies or non-drug
therapies and related services
•
Hypnotherapy
•
Services for which prior authorization
is required but was not obtained
•
Services provided by a behavioral health
practitioner who is not in compliance with
Centennial Care rules or renders services
outside their scope of practice
•
Services not considered medically necessary
for the condition of the eligible recipient
•
Treatment greater than 15 days a month
in Institutions for Mental Disease (IMD) for
members between the ages of 22 and 64
•
Treatment of intellectual disabilities alone
Certied Peer Support Workers
Certied Peer Support Workers (CPSWs) provide a
bridge between you and your care coordinator. They
work with dierent agencies to develop a bond to help
you and your family use resources that benet you.
You can call Care Coordination at 1-877-232-5518
and select option 3 to receive helpful information
on how to contact a behavioral health CPSW or
wellness center.
Learn to Live
The Learn to Live platform is a no cost, online
health program. It is oered to members 13 and
older and caregivers. Learn to Live gives self-
paced mental health solutions plus access to
24/7 member coaches. It can help with common
challenges including stress, anxiety, depression,
and substance abuse. To start, register at
www.learntolive.com/welcome/bcbsnmmedicaid
.
(Access Code: NMMED).
2024 Member Handbook bcbsnm.com/medicaid | 44
Section 4C: Long-Term Care and Community Benefits
Long-Term Care and Community Benets
Your Centennial Care plan covers long-term care
services. Long-term care includes medical and non-
medical care for people who have disabilities or long-
lasting illnesses. Long-term care helps meet health
or personal needs. Most long-term care is to help
people with support services such as activities of daily
living like dressing, bathing and using the bathroom.
Long-term care can be provided in the home, in the
community, in assisted living or in the nursing home.
It is important to remember that you may need long-
term care at any age.
If your care requires it, coverage is available for
nursing facilities and swing bed hospital services.
Prior authorization is required. If you live in a nursing
home and want to move out, we want to help you nd
a place that is right for you.
Call your care coordinator to learn more about the
Community Benet. This benet oers the same
needed care services at home for members who are
eligible for nursing facility services.
You may be eligible for the Community Benet based
on Medicaid eligibility requirements or through
eligibility based on medical need as determined on
program availability through HSD/MAD.
To determine if you meet the Medicaid eligibility
requirements, your care coordinator will do an
assessment of your level of care. If the assessment
shows you need a nursing facility level of care, you will
be eligible for the Community Benet.
If you are eligible for the Community Benet, you
will participate in the Agency-Based Community
Benet (ABCB) and after a minimum of 120 days
have the option to switch to the Self-Directed
Community Benet.
Section 4C: Long-Term Care and Community Benets
45 | Blue Cross Community Centennial Member Services 1-866-689-1523 (TTY:711)
Section 4C: Long-Term Care and Community Benefits
Community Benet Services
A list of the services available for the Community Benet is included in the table below. Please remember that
some of these services are only covered for agency-based community benets and some for self-directed
community benets. The “ü” in the column will tell you if the service(s) are covered for ABCB, SDCB or both.
To learn more about prior authorizations, please see page 22 of this handbook. For a description of services,
see page 46.
Service ABCB SDCB
Prior
Authorization
Required
Details
Adult Day Health
ü
Yes
Assisted Living
ü
Yes
These services will not be covered for
individuals in Assisted Living Facilities,
Personal Care, Respite Environmental
Modications, Emergency Response or Adult
Day Health. The Assisted Living Program is
responsible for all of these services at the
Assisted Living Facility.
Behavioral Support
Consultation
ü ü
Yes
Community Transition
(community reintegration
members only)
ü
Yes
Limit: Coverage for these services is limited
to $4,000 per person every ve years.
Deposits for Assisted Living Facilities are
limited to a maximum of $500. To be eligible
for this service, the person must have a
nursing facility stay at least 90 days prior to
transition into the community.
Customized Community
Supports
ü
Yes
Emergency Response
ü ü
Yes
Employment Supports
ü ü
Yes
Environmental Modication
ü ü
Yes
Limit: Coverage for these services is limited
to $6,000 every ve years.
Home Health Aide
ü ü
Yes
Nutritional Counseling
ü ü
Yes
Personal Care Services
(consumer-directed and
consumer-delegated)
ü
Yes
Private Duty Nursing Services
for Adults (RN or LPN)
ü ü
Yes
NOTE: There is an annual cost limit for Community Benets. It is set by HSD. Your Comprehensive Needs
Assessment will decide your cost of care for Community Benets. If the cost from your Comprehensive Needs
Assessment is greater than the annual cost limit from HSD, BCBSNM is not required to pay more than the limit
from HSD.
2024 Member Handbook bcbsnm.com/medicaid | 46
Section 4C: Long-Term Care and Community Benefits
Service ABCB SDCB
Prior
Authorization
Required
Details
Related Goods
(phone, internet, printer, etc.)
ü
Yes
Limit: Coverage is limited to $2,000 every
year (this is separate from the one-time
funding for start-up goods). Experimental
or prohibited treatments and goods are not
covered.
Respite
(short term or temporary care)
ü ü
Yes
Limit: Coverage is limited annually to 300
maximum hours per care plan year.
Respite RN
ü ü
Yes
Limit: Coverage is limited annually to
300 maximum hours per care plan year.
Additional hours may be requested if an
eligible member’s health and safety needs
exceed the specied amount. Nursing
respite services must not be provided by
a member of the member’s household or
by any relative approved as the employed
caregiver.
Self-Directed Personal Care
(Homemaker)
ü
Yes
Skilled Maintenance Therapy
Services (occupational, physical
and speech therapy)
ü ü
Yes
A signed therapy referral for treatment
notice must be provided from the member’s
Primary Care Provider.
Specialized Therapies
(acupuncture, biofeedback,
chiropractic, cognitive
rehabilitation therapy,
hippotherapy, massage
therapy, naprapathy, Native
American healers)
ü
Yes
Limit: Coverage is limited to $2,000 every
year (annually) for all combined therapy
services (Value Added Services have
separate limits).
Start-up Goods
ü
Yes Limit: One-time coverage up to $2,000
Transportation - Non-Medical
ü
Yes
Limit: Only vehicle mileage and bus/taxi
passes are covered. Coverage is limited to a
total of $1,000 every year for vehicle mileage
and bus/taxi passes. Not a covered service
for minors. Limited to a 75-mile radius of the
member’s home.
NOTE: There is an annual cost limit for Community Benets. It is set by HSD. Your Comprehensive Needs
Assessment will decide your cost of care for Community Benets. If the cost from your Comprehensive Needs
Assessment is greater than the annual cost limit from HSD, BCBSNM is not required to pay more than the limit
from HSD.
47 | Blue Cross Community Centennial Member Services 1-866-689-1523 (TTY:711)
Section 4C: Long-Term Care and Community Benefits
Community Benets
Services Descriptions
Adult Day Health: Day programs in the community
where the member can enjoy activities such as
making art, exercising or visiting others.
Behavioral Support Consultation: Training and
supports for individuals who are caring for members
with special needs.
Customized Community Support: Day programs
in the community where the member can enjoy
activities such as making art, exercising or visiting
with others.
Emergency Response: An electronic device that will
help members get help in an emergency.
Employment Support: Helps member with job training
or nding a job.
Home Health Aide: A trained provider helps the
member with activities of daily living, including
bathing, dressing and eating.
Nutritional Counseling: Eating plans and support for
health conditions such as diabetes, under-nutrition,
cardiovascular health, etc.
Personal Care Services (consumer-directed and
consumer-delegated): Helps the member with
activities of daily living, including bathing, dressing,
cooking and shopping. The member may choose the
consumer delegated or consumer directed model. A
family member may be able to provide this service.
•
Private Duty Nursing Services for
Adults (RN or LPN): Health-related
services provided by an RN or LPN.
•
Self-Directed Personal Care (Homemaker): Helps
the member with activities of daily living, including
bathing, dressing, cooking and shopping. A family
member may be able to provide this service.
•
Start-Up Goods: Start-up goods are available to
a member who is transitioning from the ABCB to
the SDCB for the rst time. Start-up goods help
the member in self-directing his or her services.
Examples of start-up goods include, but are not
limited to, a computer, fax machine and printer.
Agency-Based Community Benet
You will need to work with your care coordinator,
based on your comprehensive needs assessment, to
coordinate your care.
What is Not Covered for Agency-Based
Community Benet Services
Certain procedures, services or miscellaneous items
are not covered under the ABCB plan. To get more
information on what is not covered, please contact
your care coordinator for more information.
Self-Directed Community Benet
The SDCB is certain Home and Community-Based
Services that are available to eligible members
meeting nursing facility level of care. Self-direction
gives you the opportunity to have choice and
control over how your Community Benets services
are provided. You can also choose who provides
the services and how much providers are paid in
accordance with SDCB-approved rates.
2024 Member Handbook bcbsnm.com/medicaid | 48
Section 4C: Long-Term Care and Community Benefits
Your Participation
If you choose SDCB, you must participate in the
ABCB for a minimum of 120 calendar days before
you can switch to SDCB. When you switch over to
SDCB, you will need an employer of record (EOR),
care coordinator and support broker. You can be
the EOR or designate someone on your behalf.
The EOR, with assistance from the support broker
and care coordinator, will be responsible for the
following activities:
•
Managing a self-directed budget
•
Recruiting, hiring and supervising providers
•
Developing job descriptions for direct supports
•
Completing employee forms
•
Approving timesheets and purchase orders
•
Getting quotes for services
•
Completing all required documentation
•
Developing a back-up plan
•
Attending training
•
Reporting incidents, such as fraud andabuse
Support Broker
A support broker provides support to you or your
family in arranging, directing and managing your
SDCB services. The support broker supports, as well
as develops, monitors and implements your SDCB
care plan and budget.
A support broker will be available to help you make
sure you meet all of the requirements. If you are
interested in SDCB service, please call member
services at 1-877-232-5518 to get connected with a
care coordinator.
Recruiting, Hiring, Supervising
and Firing Providers
The EOR is the person responsible for directing the
work under the SDCB. The EOR will recruit, hire
and re all employees. The EOR will make all work
schedules and assign tasks. The EOR will supervise
and give training to all employees.
When the EOR works with employees, they will set
how much employees will be paid. The payment rates
must stay within the set range of rates. The EOR must:
•
Track money spent on paying employees
•
Track money spent on goods and services
•
Approve employee time sheets
The EOR cannot be paid for doing the EORtasks.
49 | Blue Cross Community Centennial Member Services 1-866-689-1523 (TTY:711)
Section 4C: Long-Term Care and Community Benefits
What is Not Covered for Self-Directed
Community Benet Services
Centennial Care does not cover the following
SDCB services:
•
Services covered by the Medicaid state
plan (including EPSDT), MAD school-based
services, Medicare and other third parties
•
Any service or good that would violate federal
or state statutes, regulations orguidance
•
Formal academic degrees or
certication-seeking education
•
Food and shelter expenses, including
property-related costs
•
Experimental or investigational
services, procedures or goods
•
Any goods or services a household, not
including a person with a disability, would be
expected to pay for as a regular expense
•
Any goods or services to be used
primarily for recreational purposes
•
Personal goods or items not related to the disability
•
Animals and costs of maintaining
animals, with the exception of training
and certication for service dogs
•
Gas cards and gift cards; items that are
purchased with SDCB program funds may not
be returned for store credit, cash or gift cards
•
Purchase of insurance
•
Purchase of a vehicle and long-term
lease or rental of a vehicle
•
Purchase of recreational vehicles
•
Firearms, ammunition or other weapons
•
Gambling, games of chance, alcohol,
tobacco or similar items
•
Vacation expenses, including airline tickets,
cruise ship or other means of transport,
guided tours, meals, hotel, lodging or
similar recreational expenses
•
Purchase of usual and customary furniture and
home furnishings, unless adapted to the eligible
recipient’s disability or use, or of specialized
benet to the eligible recipient’s condition;
requests for adapted or specialized furniture
must include a doctor’s order from a member’s
health care provider and when appropriate a
denial of payment from any other sources
•
Regularly scheduled upkeep, maintenance,
and repairs of a home and addition of fences,
storage sheds or other outbuildings
•
Regularly scheduled upkeep, maintenance
and repairs of a vehicle, or tire purchase or
replacement, except upkeep and maintenance
of modications or alterations to a vehicle
or van, which is an accommodation directly
related to the SDCB member’s qualifying
condition or disability; request must include
documentation that the adapted vehicle is the
SDCB member’s primary means of transportation
•
Clothing and accessories
•
Training expenses for paid employees
•
Conference or class fees may be covered for
eligible recipients or unpaid caregivers, but costs
associated with such conferences or classes cannot
be covered, including airfare, lodging or meals
•
Consumer electronics such as computers,
printers and fax machines or other electronic
equipment that does not meet criteria
•
Cell phone services that include fees for data
in excess of $100 per month or more than
one cell phone line per eligible recipient
2024 Member Handbook bcbsnm.com/medicaid | 50
Section 4D: Prescription Drug Benefits
Centennial Care covers drugs and other items listed
in this section only when bought at an in-network
pharmacy (unless required in an emergency) or
ordered through the Mail-Order Service.
Drug List
The Blue Cross Community Centennial Drug List is a
list of drugs that are covered under Centennial Care.
HSD approves the Drug List for all Medicaid managed
care plans and it is updated quarterly. BCBSNM will
send a copy of the Drug List if you request one. You
can also see the Drug List on our website,
bcbsnm.com/medicaid
.
Centennial Care will usually cover only the drugs
on the Drug List. When there is a brand-name drug
and a generic version of the same drug, only the
generic drug is covered. Requests to pay for a brand-
name drug instead of the generic drug may be
denied because:
•
Brand-name drugs and generic drugs
are made exactly the same.
•
Generic drugs usually cost less.
•
Generally, a trial of at least two covered generic
drugs is required before a brand-name drug will
be covered. In some cases, all available generic
therapeutic alternatives must be tried rst.
Exceptions
To make sure you do not have any problems lling
your prescriptions, always ask your provider to check
the Drug List. If your provider prescribes a drug that
is not on the list or that is not already approved to
treat your condition, the provider must have prior
authorization from BCBSNM before you can get that
medicine. A prior authorization is sometimes called an
‘exception.’ Without prior authorization, the pharmacy
will not be able to ll your prescription. We will look at
your provider’s request and give approval only if we
nd the drug is medically necessary. Most of the time,
we give approval for
two reasons:
•
A similar drug on the list does not improve your
health as much as the drug you are asking for
•
A similar drug on the list is harmful to yourhealth
In an emergency, BCBSNM will respond to your
provider’s request within 72 hours. You may use
the appeals process (see Section 7: Grievances
(Complaints) &Appeals) if your request isdenied.
Native Americans receiving prescriptions from I/T/U
providers may receive drugs that are not on the Drug
List without getting prior authorization from BCBSNM.
Pain Medication Requirement
BCBSNM recommends that a doctor provide a
diagnosis code for your medication. This allows
the pharmacy to pay for your medication. This
also helps BCBSNM to understand the reason
why your doctor has written the pain medication
prescription for you. Additional requirements for pain
medications may apply.
Section 4D: Prescription Drug Benets
51 | Blue Cross Community Centennial Member Services 1-866-689-1523 (TTY:711)
Section 4D: Prescription Drug Benefits
Covered Medications and OtherItems
Centennial Care covers the following drugs, supplies
and other products when purchased from an in-
network pharmacy and prescribed by a Centennial
Care network provider:
•
Prescription drugs and medicines on the
Drug List, unless listed as an exclusion
•
Certain vaccines that can be given at
a pharmacy (such as u shots)
•
Specialty pharmacy drugs such as self-administered
injectable drugs. Most injectable and high-cost
drugs require prior authorization from BCBSNM.
Some self-administered drugs, whether injectable
or not, are specialty pharmacy drugs and you
must order them through an in-network specialty
pharmacy provider in order to be covered
•
Insulin, insulin needles, syringes and other
diabetic supplies (e.g., glucagon emergency kits,
autolet, injection aids, lancets, blood glucose and
visual reading urine and ketone test strips)
•
Non-prescription medications and birth control
items on the Drug List and prescribed by your
provider. These will not be covered if a prescription
is lled anywhere other than at an in-network
pharmacy. Non-prescription medications are
subject to quantity limits (usually one package
size per 30 days). Some over-the-counter
products will not be covered for members
under the age of four or over the age of 18
•
Prescription or over-the counter drugs to help
you quit tobacco use or smoking. You may
also seek support/assistance from a Tobacco
Cessation Nurse by calling Member Services at
877-232-5518, option 3, option 2 (TTY: 711).
Retail Pharmacy Program
All items must be purchased from an in-network
retail pharmacy. Some drugs must be purchased
from an in-network specialty pharmacy provider
to be covered. See your provider directory for a list
of in-network pharmacies and specialty pharmacy
providers. If you do not have a directory, call Member
Services for a list or visit the BCBSNM website at
bcbsnm.com/medicaid
.
You must present your ID card to the pharmacist at
the time of purchase to receive this benet. If you
have both Medicare and Centennial Care, Medicare
Part D will cover your drugs. You will still have to pay
Medicare Part D copays, unless you live in a nursing
facility. If you have other insurance, make sure to
show that card too.
You do not receive a separate prescription drug ID
card. Use your Centennial Care ID card to receive all
services covered under thisprogram.
If you do not have your Blue Cross Community
Centennial card with you, or if you purchase
your prescription or other covered item from
an out-of-network pharmacy in an emergency,
you may have to pay for the purchase in full and
then submit the pharmacy receipts. If possible,
you should ask the pharmacy to call BCBSNM
before lling the prescription so that we can
make payment directly to the pharmacy.
If you are leaving the country and need a larger supply
of medication, call Member Services at least two
weeks before you plan to leave. In some cases, you
may be asked to provide proof of continued eligibility
under CentennialCare.
2024 Member Handbook bcbsnm.com/medicaid | 52
Section 4D: Prescription Drug Benefits
Drug Plan Supply Limits
For most medications, you can get up to a 31-day
supply of a single covered prescription drug or
other item or up to 120 pills, whichever is less. For
commercially packaged items (such as an inhaler,
a tube of ointment or a blister pack of tablets or
capsules), you will receive one package as a 30-day
supply. Covered birth control products are exempt
from this limit.
93-Day Supply
You can ll a 93-day supply of medications used
to treat chronic conditions through our mail-order
program. Narcotic pain medications (opioids) are not
allowed for mail-order.
Mail-Order Program
You can use the mail-order program to order a 93-day
supply of a medication that you use regularly for a
long-term or chronic condition. To use the mail-order
program, call Member Services. We will help you ll
out a mail-order form so you will get your medication
in themail.
What is Not Covered for Prescription
Drugs and Other Items
Centennial Care does not cover the following
prescription drugs and other items:
•
Prescription, nonprescription and over-the-counter
drugs that are not listed as covered on the Drug
List, including herbal or homeopathic preparations
•
Drugs or other items purchased from an out-of-
network pharmacy or any other provider that does
not contract with BCBSNM, unless in an emergency
•
Rells needed earlier than expected if you had
taken the number of pills each day the provider
indicated. Call Member Services for instructions
on obtaining a greater supply if you are leaving
home for more than a 30-day period of time
•
Replacement of drugs or other items that have
been lost, stolen, destroyed or misplaced
•
Infertility medications
•
Drugs or other items for treatment
of any sexual dysfunction
•
Medications or preparations for cosmetic
purposes, such as for hair growth or medicated
cosmetics, including tretinoin (sold under such
brand names as Retin-A) for cosmetic purposes
•
Non-prescription enteral nutritional products
taken by mouth or delivered by a temporary
naso-enteric tube (e.g., nasogastric, nasoduodenal
or nasojejunal tube), unless you have a
genetic inborn error of metabolism and the
product is preauthorized by BCBSNM
•
Shipping, handling or delivery charges,
unless preauthorized by BCBSNM
•
Drugs required for international travel or work
•
Food, diet supplements or special medical foods.
Coverage does not include commercially available
food alternatives, such as low- or sodium-free
foods, low- or fat-free foods, low- or cholesterol-free
foods, low- or sugar-free foods, low- or high-calorie
foods for weight loss or weight gain or alternative
foods due to food allergies or intolerance
53 | Blue Cross Community Centennial Member Services 1-866-689-1523 (TTY:711)
Section 4D: Prescription Drug Benefits
•
Drugs, medicines, drug combinations, or devices
not approved by the FDA and any products
experimental, investigational orunproven
•
Methadone used in drug treatment programs
•
Personal care items, such as
nonprescription shampoo or soap
•
Probiotics
•
Weight loss or weight control drugs
•
Cough and cold products for
members under the age of four
•
Drug Ecacy Study Implementation (DESI) drugs;
compounded drugs that use a product that has
not been approved by the FDA for the intended
use; compound drugs that do not have a national
drug code and have not been approved by the FDA
for use in humans; repackaged drug products
•
The following over-the-counter products
for members over the age of 21:
−
Pain relievers/fever reducers
−
Ear, nose and throat products (except
sodium chloride inhalation solution)
−
Stomach products (to treat heartburn,
constipation, diarrhea)
−
Eye products (except eye lubricants)
−
Cough/cold products
−
Benzoyl peroxide
−
Antibiotics for use on the skin
−
Supplements (except oral electrolyte
replacement and prenatal vitamins)
−
MCT Oil
−
Neutra-Phos, Neutro-Phos K
Brand-Name Exclusion
Some drugs are sold under more than one brand
name. Centennial Care may cover only one of the
brand names being sold for a single drug. If you
do not accept the brand that is covered under
Centennial Care, the brand name drug you want will
not be covered.
Pharmacy Lock-In
In some special cases, we may tell a member that
he or she must purchase drugs only from a certain
pharmacy. This is known as “pharmacy lock-in.” We
will tell you and/or your representative before you are
placed on pharmacy lock-in. You will have the chance
to le a grievance against BCBSNM’s decision to place
you on a pharmacy lock-in. See Section 7: Grievances
(Complaints) &Appeals. Only one pharmacy can be a
lock-in pharmacy.
You will be removed from pharmacy lock-in when the
problems have been xed.
2024 Member Handbook bcbsnm.com/medicaid | 54
Section 4E: Vision Benefits
Vision Coverage
Centennial Care covers routine vision care, eyeglasses and eye checkups through a program administered by
DavisVision.
The following routine services are covered under your Centennial Care plan:
*
Covered Service Time Limit Age
Minor repairs to eyeglasses Any time All ages
Lens tinting if certain conditions are present Any time All ages
Lenses to prevent double vision Any time All ages
Eye exam for medical conditions (diabetes, cataracts,
hypertension and glaucoma)
Every 12 months All ages
One routine eye exam Every 12 months Under age 21
Frames Every 12 months Under age 21
Replacement lenses, if lost, broken or have deteriorated Any time Under age 21
Corrective lenses One set every 12 months Under age 21
One routine eye exam Every 36 months Age 21 and older
Frames Every 36 months Age 21 and older
Replacement lenses for members with a developmental
disability, if lost, broken or have deteriorated
Any time Age 21 and older
Corrective lenses One set every 36 months Age 21 and over
* Please note: Alternative Benet Plan (ABP) members do NOT have routine vision coverage.
Please see section “ABP Members.”
Please call Member Services at 1-866-689-1523 for more information on priorauthorizations.
You may receive more than the standard number of eye exams each year if you have diabetes or other
diseases that could aect your eyesight.
Section 4E: Vision Benets
55 | Blue Cross Community Centennial Member Services 1-866-689-1523 (TTY:711)
Section 4E: Vision Benefits
What is Not Covered for Vision Care
Centennial Care does not cover the following vision
care services:
•
Eyeglass or contact lens insurance
•
Orthoptic assessment and treatment
•
Low vision aids
•
Anti-scratch, anti-reective or mirror coating
•
Photochromic lenses or tint, unless
medically necessary
•
Trifocals
•
Laser vision correction
•
Eyeglass cases
•
Progressive lenses
•
Ultraviolet (UV) lenses
•
Services performed for aesthetic
or cosmetic purposes
ABP Members
ABP members do not have routine vision benets.
The ABP plan only covers vision services that
are medically necessary for the diagnosis of and
treatment of eye diseases. One eye exam will be
covered every 36 months only for the detection of an
eye disease or injury. Refractions or eyeglasses are
not covered under the ABP plan, except for aphakia
following the removal of the lens.
2024 Member Handbook bcbsnm.com/medicaid | 56
Section 4F: Dental Benefits
Centennial Care covers services for eligible members
through a program administered by DentaQuest
®
.
Dental visits are necessary for good health. Regular
dental checkups and cleanings are important for
children as well as adults. Schedule a well-baby
checkup with your dental provider by the time your
baby is two years old.
If you need oral surgery or have an accident
that injures your teeth, the services may be
covered through Centennial Care as part of the
medical/surgical program. Please call Member
Services at 1-866-689-1523 before receiving such
services so you know which providers will be
approved for payment.
Covered Dental Services
The services listed in the chart on page 57 are covered
under your Centennial Care plan.
What is Not Covered for DentalServices
Centennial Care does not cover the following dental
services if for cosmetic reasons:
•
Permanent xed bridges
•
Cosmetic services
•
Desensitization, re-mineralization
or tooth bleaching
•
TMJ disorders, bite openers
and orthotic appliances
•
Implants and implant-related services
•
Removable unilateral cast metal partial dentures
Finding a Dentist
If you need to nd a dentist in your area, call Member
Services or check the provider directory. A paper copy
of the directory is available to you at no charge or on
our website at
bcbsnm.com/medicaid
.
Member Services has information about handicap-
accessible oces, other languages the dentist
speaks and if the dentist is an expert with children
or individuals who have special health care needs.
Once you choose a dentist, call the dentist to make
an appointment and nd out if the service will be
covered by Centennial Care.
Urgent Dental Care
If you have an urgent dental problem, you should
be seen within 24 hours. An urgent problem means
you need to be seen that day, but it is not serious
enough to go to an emergency room. Most dental
problems are not considered emergencies under the
medical/surgical plan. If you have an urgent dental
problem and cannot nd a dentist to see you within
24 hours, please call Member Services.
Non-Urgent Dental Care
If you have a non-urgent dental problem, you should
be seen within 14 calendar days. A non-urgent
problem means you have symptoms, but you do not
need to see a dentist that same day.
Routine Dental Checkup
If you need a regular dental checkup or have a dental
condition that is not causing you problems or pain,
you should be seen within 60 calendar days of your
request. If your dentist cannot see you within 60
calendar days, please call Member Services. We
may be able to send you to another dentist who can
see you sooner.
Section 4F: Dental Benets
57 | Blue Cross Community Centennial Member Services 1-866-689-1523 (TTY:711)
Section 4F: Dental Benefits
With any questions about your dental coverage, please call Member Services at 1-866-689-1523. To learn more
about prior authorizations (PA), please see page 22 of this handbook.
Covered Service Time Limit Age PA
Dental services in a hospital N/A Under age 21; unless
over the age of 21 with a
developmental disability
No – Dentist
Yes – Facility
Emergency services No limit All ages No
Fillings; prefrabricated stainless steel
crown per permanent or deciduous
tooth; one prefrabricated resin crown
per permanent or deciduous tooth; one
recementation of a crown or inlay; one
recementation xed bridge
N/A All ages No
Fixed space maintainers
(passive appliances)
N/A Under age 21 Yes
General anesthesia and IV sedation,
including nitrous oxide
N/A Under age 21 Yes
General anesthesia and IV sedation,
not including nitrous oxide
N/A Age 21 and older Yes
Incision and drainage of an abscess N/A All ages No
One cleaning Every six months Under age 21 No
One cleaning Every 12 months; every six
months for members with
developmental disabilities
Age 21 and older No
One complete oral exam Every six months Under age 21 No
One complete oral exam Every 12 months Age 21 and older No
One complete series of intraoral X-rays
(with one added set of bitewing X-rays)
Every ve years; added set
of bitewing X-rays once
every 12 months
All ages No
One uoride treatment Every six months Under age 21 No
One uoride treatment Every 12 months Age 21 and older No
One sealant for each permanent molar
(replacement of a sealant within the ve-
year period requires prior authorization)
Every ve years Under age 21 No
Orthodontic services (braces) N/A Under age 21 Yes
Periodontic scaling and root planning N/A All ages Yes
Reimplantation of permanent tooth N/A Under age 21 No
Therapeutic pulpotomy N/A Under age 21 No
Tooth extractions (pulling of teeth) N/A All ages No
Two denture adjustments Every 12 months All ages No
Note: Federally Qualied Health Center members will not need prior authorization on any dental service.
2024 Member Handbook bcbsnm.com/medicaid | 58
Section 4G: Transportation Benefits
If you do not have a car or anyone to give you a
ride, you may be eligible for transportation to help
you get to your non-emergency medical, long-term
care, or behavioral health appointments. If you
have an emergency and you need help getting to
an emergency room, call 911. Please don’t call an
ambulance for non-emergency transportation.
ModivCare (formerly Logisticare) coordinates all non-
emergency transportation for members, including
food and lodging expenses, when you have to travel
a long distance to get covered medical, long-term
care or behavioral services. You can use these benets
only for medical, long-term care, and/or behavioral
needs. Transportation for any non-medical reason is
not covered.
The services in the table below are covered under your Centennial Care plan. To learn more about prior
authorizations, please see page 22 of this handbook.
Covered Service
Prior
Authorization
Required
Prior Notice to ModivCare
Ride to routine appointment No Three working days up to two weeks
Ride to behavioral health appointment No Three working days up to two weeks
Mass transit No Four working days
Mileage reimbursement Yes Call at least 14 calendar days prior,
up to the day of the appointment
Meals Yes Three working days
Lodging Yes Three working days
For Justice-Involved Members with a valid, current
and unlled prescription, one trip within seven days
of release from jail or prison to pharmacy and then
home within the same city limits as pick up.
No Within seven days after release
What is Not Covered for Transportation Services
Centennial Care does not cover the following transportation services:
•
Transportation to a pharmacy to get prescriptions,
or to a medical supply store to get medical
supplies or durable medicalequipment
•
Transportation for non-medical needs
•
Transportation to a provider who is 120 miles or
farther away from where you live, needs special
authorization from the referring or servicing doctor.
−
The doctor will need to state care is not
available in your home community.
−
If continued out-of-community care is
authorized and non-emergency transportation
is received, the information will need
to be submitted every six months.
•
Transportation to an out-of-network provider
without special authorization from ModivCare.
Section 4G: Transportation Benets
59 | Blue Cross Community Centennial Member Services 1-866-689-1523 (TTY:711)
Section 4G: Transportation Benefits
Scheduling Transportation
for Routine Care
Call the Reservation Line phone number to schedule
a ride to your appointment from 8 a.m. to 5 p.m.,
Monday through Friday at 1-866-913-4342. When
you call ModivCare’s Reservation Line, tell them you
are a Centennial Care member and give them your
ID number. Give them the date and time of your
appointment and tell them where you are going. Call
ModivCare at least three working days before your
routine appointment to schedule a ride. Saturdays,
Sundays and holidays are not working days. If you
do not call at least three working days before your
appointment, your request may be denied. This three-
day notice does not apply to urgent care. When you
call for a ride on the same day as your appointment,
ModivCare must call your provider to verify you have
an appointment, and your ride may take up to four
hours to arrive. If you need to see a provider on a
regular basis, you may schedule your ride two weeks
(10 working days) ahead of time.
Call the Ride Assist phone line at
1-866-418-9829 to be picked up after seeing your
provider, or after being discharged from a hospital or
if your ride is late. Drivers are required to wait only
ve minutes, so be sure you are ready to leave when
the driver arrives. If you are not ready within ve
minutes, the driver will not wait longer because he or
she has other people to transport.
ModivCare can help transport you if you have a special
health care need. ModivCare will keep notes on any
special transportation needs, and provide a driver
trained in CPR, if needed. When you call ModivCare, be
sure to mention if you have special needs.
If your medical appointment is canceled and you have
already made arrangements with ModivCare, please
call at least two hours before you were supposed to
be picked up to cancel your ride.
If you live in an area with public transportation,
ModivCare may give you a mass transit pass to get
to your medical, long-term care, or behavioral health
appointments. You must request a mass transit pass
four working days before your appointment. To nd
out about getting a mass transit pass, please call
ModivCare at 1-866-913-4342.
Transportation Services Needing Prior
Authorization for Long Distance Travel
Sometimes you must travel a distance for medical or
behavioral health care. If you must travel more than
120 miles (one way) from your home for this care, you
must get a written note of approval from the referring
provider or the service provider. This note needs to be
from the provider who referred you for care. You must
also get a written note from the service provider you
traveled to see. This note should explain that medical
or behavioral health care you need is not available in
your home community.
Sometimes you must travel outside New Mexico
to receive health care. This is called out-of-state
transportation. Out-of-state transportation and
related expenses require prior authorization.
Sometimes you must travel to another city or state
for an approved appointment. You need to plan your
transportation for these trips. You should make your
plans at least two weeks (10 working days) ahead of
time. If that is not possible, make your plans no later
than three working days before the appointment.
2024 Member Handbook bcbsnm.com/medicaid | 60
Section 4G: Transportation Benefits
Meals and Lodging
Through ModivCare, Centennial Care may pay
for your meals when you travel to another city or
state for an approved appointment. If you go to an
appointment and are away from home for eight hours
or more, you can be repaid for your meals if you get
authorization from ModivCare no fewer than three
business days before you travel. You will be repaid up
to $18 per day when you are away from home.
When a trip takes more than four hours one way and
an overnight stay is medically necessary to receive
covered services, you may call ModivCare to arrange
for lodging. All lodging expenses must be coordinated
by ModivCare. Do not arrange your own lodging for
any expenses not coordinated and authorized in
advance by ModivCare.
If you need to get paid for lodging that was authorized
by ModivCare , you are required to ll out a
Transportation Meals and Lodging Expense Report for
lodging and meals, which is available on the BCBSNM
website at
bcbsnm.com/medicaid
(under ‘Member
Resources/Forms’) or by calling MemberServices.
When you call ModivCare to approve meals
and/or lodging, you will be given an authorization/job
number if the travel is approved. You must include
original receipts for each meal and lodging expense
(not photocopies) and write your authorization/job
number on the ModivCare Expense Report you send
in to ModivCare. You will not be paid for meals or
lodging if the form and receipts are received more
than 60 days after you travel. Mail the form to the
address shown on the form.
Payment for Mileage
You might be able to be repaid for mileage if you have
to drive your own vehicle to a covered appointment.
This must be authorized by ModivCare. Do not
expect to be paid for mileage if you do not call the
ModivCare Reservation Line rst at 1-866-913-4342.
ModivCare will verify you have an appointment and
will tell you the number of miles covered. You must
call at least 14 calendar days prior, up to the day of the
appointment. If ModivCare authorizes your trip, you
will be given a trip/job number. Please do not lose this
trip/job number. You will need it to be paid for your
mileage. If you cannot drive yourself, a friend or family
member may drive you. He or she can get mileage
reimbursement as well. The same procedures and
authorization requirements apply.
After you receive approval, complete a Mileage
Reimbursement Form and take it with you to your
appointment. The provider’s oce must sign the form
and you must write the trip/job number given to you
by ModivCare in the area titled ‘trip/job #.’ If the trip is
approved and the provider has signed the form, you
will be repaid for mileage costs based on the BCBSNM
mileage reimbursement rate. This rate is for a round
trip from your home to the provider’s oce or to
the hospital.
You will not be paid if the form is received more than
60 days after the appointment, or if the trip was
not approved in advance by ModivCare. Send the
completed and signed form to ModivCare within 60
days of theappointment.
61 | Blue Cross Community Centennial Member Services 1-866-689-1523 (TTY:711)
Section 4G: Transportation Benefits
Type of County County Name
Distance Between
PCP’s Oce and
Your Home
Urban Bernalillo, Doña Ana, Los Alamos, Santa Fe 30 miles
Rural Chaves, Curry, Eddy, Grant, Lea, Luna, McKinley, Otero, Rio Arriba,
Roosevelt, Sandoval, San Juan, Taos, Valencia
45 miles
Frontier Catron, Cibola, Colfax, DeBaca, Guadalupe, Harding, Hidalgo, Lincoln,
Mora, San Miguel, Sierra, Socorro, Torrance, Quay, Union
60 miles
Address for Expense Reports
ModivCare - Travel Department
2602 S. 47th Street, Suite 100
Phoenix, AZ 85034
Address for Mileage Reimbursement
ModivCare
798 Park Avenue NW
Norton, VA 24273
Transportation Services for Rides to
PCP Oces Requiring Authorization
If you choose a PCP who is farther from your home
than the distances shown above (based on the county
you live in), you will not be able to receive rides to
and from the PCP’s oce, unless you receive special
authorization from BCBSNM. If there is a PCP closer
to you, you may be asked to change PCPs or you will
have to arrange your own rides to and from your
PCP’s oce.
Rides to Out-of-Network Providers
You will have to call BCBSNM Care Coordination rst,
if you need a ride to any out-of-network provider
(even for family planning and even if you already have
prior authorization for the visit). The approval for a
ride to an out-of-network provider is dierent from
any prior authorization you might have received for
the provider visit itself.
When you call BCBSNM, you will be issued a
conrmation number that you must give to
ModivCare when you call them about arranging
a ride. ModivCare must call BCBSNM and make
sure any ride to an out-of-network provider will be
covered. ModivCare will verify with BCBSNM that
the conrmation number you gave over the phone
is correct.
Only BCBSNM can authorize ModivCare to give you a
ride to an out-of-network provider.
2024 Member Handbook bcbsnm.com/medicaid | 62
Section 4G: Transportation Benefits
Accompanying Persons or
FamilyMembers
Centennial Care covers one other person to ride
with you to your appointments (including that one
other person’s meals and lodging, if applicable) in the
following situations:
•
You are under the age of 18 and the other person
to ride with you is your parent or legal guardian; or
•
It is medically necessary for the other person to ride
with you. Your medical provider must provide proof
of medical necessity in writing. The other person
to ride with you must be at least 18 years of age.
Except in the previous situations, Centennial Care
does not cover other persons to ride with you to your
appointments. For example, Centennial Care does
not cover your minor children to ride with you to your
appointments.
Picking Up Medical Supplies
andPrescriptions
You must make your own arrangements to pick up
prescriptions, medical supplies and durable medical
equipment. These items may also be delivered to
your home, but you will have to make your own
arrangements fordelivery.
63 | Blue Cross Community Centennial Member Services 1-866-689-1523 (TTY:711)
Section 4H: Value Added Services
In addition to covering the services required by state
law, your Blue Cross Community Centennial health plan
oers extra services to help keep you and your family
healthy. These are called Value Added Services .
Some VAS are not always available all year and may
have additional limits and steps. Call Member Services
at 1-866-689-1523 for more details. Also, some services
may change from year to year. See the table below for a
list of VAS.
Value Added Service Applies To
Members
on
Standard
Medicaid
Plan
Members on
Alternative
Benet
Plan (ABP)
Members
on ABP-
Exempt Plan
Prior
Authorization
Required for
Value Added
Service?
Physical Health Services
Home Meal Delivery
Members who are
transitioning from an inpatient
facility into the community
and expectant mothers
ü ü ü
No
Native American Traditional
Healing and Wellness
(grant for traditional healing
practices used to treat
medical conditions)
Native American members
ü ü ü
No
Remote Monitoring Program
Members with chronic
conditions like diabetes
or high blood pressure
ü ü ü
Member must
participate in the
Paramedicine
Program;
requires an
assessment
Respite Bed (temporary
bed based on medical
necessity and availability)
Certain members discharging
from an emergency
room or hospital
ü ü ü
Yes
Assistance with Social
Determinants of Health*
(payments for tangible goods
such as interview clothing, bus
passes for work and more)
Medicaid and Medicaid
Expansion Population
members
ü ü ü
Yes
Heading Home and
Health Partnership*
Bernalillo County homeless
members with behavioral
health and substance
abuse disorders
ü ü ü
Yes
Section 4H: Value Added Services
2024 Member Handbook bcbsnm.com/medicaid | 64
Section 4H: Value Added Services
Value Added Service Applies To
Members
on
Standard
Medicaid
Plan
Members on
Alternative
Benet
Plan (ABP)
Members
on ABP-
Exempt Plan
Prior
Authorization
Required for
Value Added
Service?
Maternity Services
Prenatal Education*
(Classes include childbirth,
labor and prep, baby education
and breastfeeding)
Pregnant members
ü ü ü
No
Infant Car Seat*
#
Pregnant members
ü ü ü
Yes
Portable Infant Crib*
#
Pregnant members
ü ü ü
Yes
Behavioral Health Services
Electroconvulsive Therapy
(ECT) treatment for
psychiatric conditions
Members who meet standard
ECT medical necessity criteria
ü
Not a
Value Added
Service;
standard ABP
benets apply
Not a
Value Added
Service;
standard
benets apply
Yes
Transitional Living for
Chemically Dependent/
Psychiatrically Impaired
Adults 18 years or older
Members enrolled in
outpatient substance abuse
center or in active treatment
for psychiatric issues
ü ü ü
Yes
Wellness/Drop-in Centers
and Family Support Centers
Medicaid members
ü ü ü
No
Assistance with Social
Determinants of Health*
(payments for tangible goods
such as interview clothing, bus
passes for work and more)
Medicaid and Medicaid
Expansion population
members
ü ü ü
Yes
Heading Home and
Health Partnership*
Bernalillo County homeless
members with behavioral
health and substance
abuse disorders
ü ü ü
Yes
Learn to Live
Medicaid and Medicaid
Expansion members
13 years or older
ü ü ü
No
*Must participate in BCBSNM’s Care Coordination program to redeem
#
Must complete prenatal visit requirements to redeem
Please note funding is limited.
65 | Blue Cross Community Centennial Member Services 1-866-689-1523 (TTY:711)
Section 4I: Member Rewards
Every member of Centennial Care is able to enroll in the Centennial Rewards Program. The Rewards Program
allows you to earn credits* by just taking part in certain healthy actions.
To use your credits, enrollment is required. You can enroll at
centennialrewards.com
or call Centennial
Rewards at 1-877-806-8964. Credits can be used by making choices from a catalog. You can order catalog
items through BCBSNM’s website or by calling Centennial Rewards at 1-877-806-8964.
You will get your Centennial Rewards Program catalog when you earn your rst credits.
Healthy Actions and the Reward Benets are called ‘credits.’ The full list of Healthy Actions and the current
Reward Benets are available on the
centennialrewards.com
website.
If you would like to know more about this program, please call toll-free 1-877-806-8964.
* Credits are for qualifying catalogue use only. Credits have no cash or monetary value and can never
be exchanged or redeemed for cash. They are not transferable to other persons. They may not
be combined with other member’s credits or with other rewards or incentive programs oered by
Centennial Care. Centennial Rewards are subject to change without notice.
Section 4I: Member Rewards
2024 Member Handbook bcbsnm.com/medicaid | 66
Section 5: Alternative Benefit Plan
The Alternative Benet Plan is a part of the New
Mexico Medicaid Centennial Care program.
The ABP oers coverage for Medicaid-eligible
adults ages 19-64 who have income up to 138%
of the Federal Poverty Level, which includes
the Medicaid Expansion Population and
Transitional Medical Assistance categories.
There are two kinds of ABP benet packages.
ABP Benet Package
If you are eligible for the ABP benet package, all of
the detail outlined in this member handbook applies
to you except for some of the covered and non-
covered services. VAS are also dierent. To nd out
if a service is covered, you can check the covered
services in Sections 4A – 4G or call Member Services
at 1-866-689-1523.
ABP Exempt Benet Package
If you are an ABP member and have a physical or
behavioral health condition that meets certain criteria,
you may be eligible to move to the Expansion State
Plan. This is also called ABP Exempt. Examples of the
criteria are listed below:
•
Individuals who qualify for medical assistance
on the basis of being blind ordisabled
•
Individuals who are terminally ill and are
receiving benets for hospice care
•
Pregnant members
•
Individuals who meet Medically Frail Criteria;
to learn more about Medically Frail Criteria,
call Member Services at 1-866-689-1523
or ask your care coordinator
You may meet the Medically Frail Criteria if you have
one of the following conditions:
•
Disabling mental disorder, including individuals
up to age 21 with serious emotional disturbances
and adults with serious mental health conditions
•
A continuing substance use disorder
•
A serious medical condition
•
A disability that weakens your ability to
perform one or more activities of daily living
•
A disability determination based
on Social Security criteria
Your condition will be reviewed by a care coordinator
to see if you meet these criteria. You can also call and
ask us to complete this review at any time if you think
you meet the criteria for ABP Exempt. BCBSNM will let
you know of your exempt status within 10 business
days. If you do not have a care coordinator, please call
Member Services at 1-866-689-1523 (TTY: 711).
If you meet the criteria and choose to move to the
ABP Exempt benet package, you will then have the
same benets and provider network as the standard
Medicaid plan. This means that everything in this
handbook about standard Medicaid, except VAS, also
applies to you. If you meet ABP Exempt criteria during
the middle of the month, you will be moved to that
plan the rst day of that same month.
Under the ABP Exempt benet package, you can
also access community benets and nursing facility
care when the requirements for those services are
met. To determine if you meet the Medicaid eligibility
requirements, your care coordinator can do an
assessment of your level of care. If the assessment
shows you need a nursing facility level of care, you will
also be eligible for the CommunityBenet.
Section 5: Alternative Benet Plan
67 | Blue Cross Community Centennial Member Services 1-866-689-1523 (TTY:711)
Section 5: Alternative Benefit Plan
ABP Exempt Covered and Non-CoveredServices
ABP Exempt members have the same benets as
the standard Medicaid plan. Please see Section 4:
Covered and Non-Covered Benets of this handbook
formoreinformation.
Value Added Services
ABP VAS
See the table in Section 4H: Value Added Services for
a list of ABP VAS.
ID Cards
ABP ID Cards
When you apply for Medicaid coverage, you will know
that you are eligible for the ABP. Another way to know
is by looking at the front of your Centennial Care ID
card. Your ID card will say it. Please see the
example below:
ABP Exempt ID Cards
When you move to ABP Exempt, you will also receive
a new ID card. The front of your ID card will say “State
Plan.” Please see the example below:
Provider Network
The providers you are eligible to see are the same
as the standard Medicaid plan for both of the
ABP benet packages. More information about
providers can be found in Section 3: Providers of
this handbook.
Subscriber Name:
<FNAME M LNAME>
Identification No: YIF<SBSB_ID>
Group Number: N72100
Date of Birth: <MEME_BIRTH_DT>
Enrollment Effective Date: <MEIA_REQ_DT>
Medicaid ID: <12345678910>
Expansion State Plan
RxBin: 011552
RxPCN: SALUD
OFFICE VISIT
EMERGENCY ROOM*
URGENT CARE
HOSPITAL
<$XXX>
<$XXX>
<$XXX>
<$XXX>
PCP:
<PRPR_NAME>
<PRAD_PHONE>
*You may be billed <$XXX> for non
emergency use of the ER.
P.O. Box 11968
Albuqerque, NM 87192-0968
2024 Member Handbook bcbsnm.com/medicaid | 68
Section 6: Care Coordination
Considering Your Needs
To give you extra help getting appropriate care when
and where you may need it, we have a number of
programs to help you. The rst step is to work with
you to perform a Health Risk Assessment sometimes
called an HRA. We will call you on the phone to ask
health questions. These questions help us assist you
with any needs related to your health condition. Our
goal is to work with you to develop a care plan based
on your needs andpreferences.
BCBSNM will look at your completed Health Risk
Assessment, to identify your medical, long-term care
and behavioral health needs and will determine if you
require a Comprehensive Needs Assessment (CNA).
Care Coordination Levels
Level 2: You will have a care coordinator who will
work directly with you. Your care coordinator will be
in contact with you to conduct a CNA. We use this
assessment to help connect you with providers who
can help with your identied needs. It will happen in
person in your home. Your care coordinator will be
in contact with you often to monitor your care plan
and provide you education on concerns you may be
dealing with.
Level 3: You will have a care coordinator who will work
directly with you. This care coordinator knows a lot
about special health needs. Your care coordinator will
contact you to conduct a CNA in person with you. This
assessment helps us make sure you are getting all the
care you need from the right providers. It will happen
in person in your home. Your care coordinator will
be in contact with you often to monitor your care
plan. You can talk to your care coordinator about any
education you may need to help you with yourillness.
If your medical health, behavioral health or long-term
needs change, or if you are in the hospital, please
contact your care coordinator. This is also referred
to as reporting a change in health status. Keep in
touch with your care coordinator and let them know
if your phone number or address changes. This helps
your care coordinator give you the assistance you
need. If you do not have a care coordinator and need
help with your care, please call care coordination at
1-877-232-5518 and select option 3.
Section 6: Care Coordination
69 | Blue Cross Community Centennial Member Services 1-866-689-1523 (TTY:711)
Section 6: Care Coordination
Care Coordination
Care coordination is a service that provides extra help
to members with special health care needs, whether
at home, in a skilled facility or in the hospital. Care
coordination focuses on you, the member, and when
appropriate, your family. It is sensitive to your cultural
background. Care coordination can help you better
identify your health care needs. It also helps you
get appropriate services. This includes coordination
of services between doctors in our Blue Cross
Community Centennial network as well as out-of-
network doctors, as appropriate. This includes your
medical, behavioral and long-term needs.
Care coordination includes complex case
management and disease management. You may
have a chronic condition, such as childhood asthma
or adult diabetes, a complex condition or several
health conditions, which might include mental health
or substance use. BCBSNM’s Care Coordinators can
work with you and your provider to manage your
condition(s). At a time that can be very stressful, our
care coordinators can assist you with understanding
your medical condition/diagnosis and treatment
plans, communicating with your providers to
coordinate your care, getting the health benets
to which you are entitled and nding health care
services based on your condition(s). Your caregiver or
your provider can refer you to the program or you can
self-refer. You can end the program at any time.
If you have special needs, BCBSNM will assign you a
care coordinator who speaks your preferred language
and is responsible for coordinating your health care
services by:
•
Giving you information about providers in
BCBSNM’s network who may address those needs
•
Coordinating medical, behavioral
and long-term care services
•
Assisting in coordinating care when you
also have Medicare or other coverage
•
Getting help with dierent appointments, non-
emergency transportation or other needs; or getting
community services not covered by Centennial Care
•
Making sure care coordination is
provided when needed
You can call your care coordinator at 1-877-232-5518
to discuss your medical, behavioral and long-term
care needs. Call 711 for TTY service.
2024 Member Handbook bcbsnm.com/medicaid | 70
Section 6: Care Coordination
Getting Help with Special
Health Care Needs
Some members need extra help with their health
care. They may have long-term health problems and
need more health care services than most members.
They also may have medical, behavioral or long-term
care problems that limit their ability to function. We
have special programs to help members with special
health care needs.
If you believe you or your child has special health
care needs, please call a care coordinator at
1-877-232-5518 and select option 3. The care
coordinator can provide you with a list of resources
to help you with your special needs. We also provide
education for members with special health care
needs and their caregivers. Information is provided
about how to deal with stress and/or a chronicillness.
Community Social Services
The Community Social Service program is designed to
connect you to local resources necessary to improve
your health. These social needs impact your overall
health and wellness. This program can help you with
your needs related to non-emergency transportation
issues, hunger, place of residence and understanding
yourhealth.
Local community resources are available to help you.
All sta members in the program make your cultural
needs a priority. We contract with Core Service
Agencies and other providers throughout the state.
These community-based agencies, via Community
Health Workers (CHW) may conduct home visits
and/or well checks, coordinate transportation
to medical appointments and provide some
health education, among other tasks assigned to
meet your needs.
If you have a community social need, CSS
helps you by:
•
Connecting with you through a local CHW either by
phone or in person, if one is available in your area.
•
Providing you with the local contacts you may
need to locate a food pantry, a public service
agency for help with Women Infants and
Children, food stamps, temporary assistance
for families with young children (TANF) or a
program that covers the costs of electricity.
•
Setting up a PCP for you so you have a medical
or behavioral health home where you can get to
know the sta as they learn more about you. These
oces are called “homes” because they coordinate
care among doctors, pharmacists and therapists.
You can call BCBSNM Community Social Services at
1-877-232-5518.
71 | Blue Cross Community Centennial Member Services 1-866-689-1523 (TTY:711)
Section 6: Care Coordination
Supportive Housing
Supportive Housing is a service to help members with
housing needs.
The goal of this service is to rst determine
housing needs and then nd the right community
resources to help.
Some of these services include:
•
Finding and applying for housing
•
Checking the home for safety features
such as smoke detectors
•
Getting necessary household supplies
•
Creating a housing plan
•
Coaching on how to keep good relationships
with neighbors and landlords
•
Coaching on how to follow rules from the landlord
•
Education on renter rights and responsibilities
•
Assistance in xing renter issues
•
Regular review and updates to housing plan
•
Helping nd community resources to help
with keeping the house in working order
To receive this service, members must meet certain
requirements. To nd out if you qualify for these
services, please call the BCBSNM Supportive Housing
Specialist at 1-877-232-5518 (TTY: 711).
Tobacco Cessation
The Tobacco Cessation Program can help you reach
your goal to quit using tobacco products with the
support of a Tobacco Cessation Nurse. The program
is designed to provide support, connect you to
resources and providers for tobacco cessation aides
and/or counseling, as well as assist you in your
journey to a healthy, tobacco-free lifestyle.
The program can help you:
•
Receive one-on-one help with quitting—
at no cost to you and without judgment!
•
Create a plan that will work for you.
•
Understand how to receive tobacco cessation
aides/medications that could help you quit.
•
Get resources in your community,
online or on the phone.
•
Increase the likelihood that you will
quit using tobacco products.
To enroll in the Tobacco Cessation Program, or to
nd out more about tobacco cessation, please call
1-877-232-5518, option 3, option 2 (TTY: 711).
You may also call our Quit Line at 1-877-262-2674.
2024 Member Handbook bcbsnm.com/medicaid | 72
Section 7: Grievances (Complaints) & Appeals
There is a dierence between grievance and appeals.
Grievance (Complaint)
A grievance is also known as a complaint. It is an
expression of dissatisfaction about any matter
or part of BCBSNM or its services, other than an
Adverse Benet Determination. You can also le
a grievance if you are not happy with a provider.
For example, a grievance is a complaint about the
quality of the provider network or any other service
BCBSNM provides.
Filing a Grievance
If you have a grievance about BCBSNM or a provider,
call our Member Services line at 1-866-689-1523 or
call 711 for TTY service for help. Member Services can
help you le a grievance and will get it to a Centennial
Care Appeals/Grievance Coordinator.
Grievance Address and PhoneNumber
To le a grievance, contact the Centennial Care
Appeals/Grievance Coordinator by writing a letter to
the address below. You can also call member services,
write to us, email or fax to the the number below.
Centennial Care Appeals/Grievance Coordinator
P.O. Box 660717
Dallas, TX 75266
Telephone (toll-free): 1-866-689-1523
Fax: 1-888-240-3004
Email:
GPDAG@bcbsnm.com
Telephone hours are Monday through Friday from
8 a.m. to 5 p.m. Closed Saturdays and Sundays.
If you want to leave us a message about your
grievance after normal business hours, you may
call 1-877-232-5520 (TTY: 711). We will return your
message by 5 p.m. the next business day.
Time Limits for Filing a Grievance
You may le a grievance either verbally or in writing at
any time from the date the dissatisfaction occurred.
We will send you a letter within ve business days
of the receipt of your grievance to let you know we
received it and are working to resolve it within 30
calendar days. If you have information that supports
your grievance, please send that to us as well. We
will add it to your le for consideration. Please send
this information to the address, fax or email address
listed under the Grievance Address and Phone
Number section.
Time Frame for an Answer to aGrievance
BCBSNM has 30 calendar days to review and respond
to your concerns or as fast as your health condition
requires. Your grievance will be reviewed by someone
who was not involved and can research the problem.
We will send you a letter within 30 calendar days to
let you know how your concerns were answered. In
some cases, we may need an extra 14 calendar days
and will ask the State of New Mexico for more time,
if this is in your best interest. You will be sent a letter
within two calendar days of the decision to extend
the timeframe. You may also ask for more time if you
need it to explain your grievance. This extra time is
called an extension.
Section 7: Grievances (Complaints) &Appeals
73 | Blue Cross Community Centennial Member Services 1-866-689-1523 (TTY:711)
Section 7: Grievances (Complaints) & Appeals
People Who Can File a Grievance
A member may le a grievance verbally or in writing.
The legal guardian for children or incapacitated adults,
a representative as stated in writing, an attorney or
a provider acting on the member’s behalf with the
member’s written permission, can le a grievance
on behalf of a member. All grievances are kept
condential. You may ask for a copy of your grievance.
You can call the Centennial Care Appeals/Grievance
Coordinator or Member Services for help in getting a
copy. No negative action will be taken against you or
your provider for ling.
A Grievance is Not an Appeal
You can le a grievance even if you do not request
an appeal. However, a grievance alone will not work
to dispute a benet decision. You must le an appeal
to dispute a benet decision. You can le both a
grievance and an appeal at the same time.
Appeal
An appeal is dened by the State as a request for
review of an Adverse Benet Determination taken
by BCBSNM about a service. For example, you can
request an appeal when a service is denied, delayed,
limited or stopped. An appeal is a request for review
of a BCBSNM Adverse Benet Determination. An
adverse benet determination is the denial, reduction,
limited authorization, suspension or termination of
a newly requested benet or benet currently being
provided to a member including determinations
based on the type or level of service, medical
necessity criteria or requirements, appropriateness of
setting or eectiveness of a service.
We will tell you when we make a decision or action in
writing. We will send you a letter to let you know when
a service is denied, delayed, limited or stopped. It will
also give you the instructions for ling an appeal.
Appeals and HSD administrative hearings are not
available if BCBSNM limits, reduces, denies or
stops any VAS.
Time Limits for Filing an Appeal
You have to appeal within 60 calendar days from
the date of the Adverse Benet Determination
letter. You can le an appeal verbally or in writing.
You can call Member Services and get help with
submitting your appeal request. BCBSNM then has
30 calendar days from the day of your initial request
to resolve the appeal. If you do not le an appeal
within 60 calendar days from the date of the Adverse
Benet Determination letter, you may lose your
right to appeal.
2024 Member Handbook bcbsnm.com/medicaid | 74
Section 7: Grievances (Complaints) & Appeals
Filing an Appeal
You can le an appeal by calling member services or you can send your written appeal to the Centennial Care
Appeals/Grievance Coordinator to the following address or fax a copy of your appeal to the fax number.
Appeals forms are available at
https://www.bcbsnm.com/community-centennial/member-resources/forms.html
.
Types of Appeal Helpers
There are dierent types of helpers who can help you with your appeal and go by dierent names. You can get
help with your appeal from an ‘Authorized Provider,’ ‘Authorized Representative’ and/or a ‘Spokesperson.’ Each
type of helper can do some things for you but may not be able to do other things. To use each type of helper,
you need to give BCBSNM the form for that helper and make sure the helper agrees to help you.
The types of helpers, the forms and what the helpers can and cannot do for you is in the following table:
Type of
Appeal
Helper
Who Can be
the Appeal
Helper
Form Needed
Support
You and
Advocate
for You
Access Case
Information
File
Appeal
for
You
Ask to
Continue
Your
Benets
Make
Medical
Decisions
for You*
Authorized
Provider
Your health
care provider
Authorized
Provider Form
Yes Yes Yes Yes Yes
Authorized
Representative
Friend, relative,
attorney health
care provider
or anyone else
Authorized
Representative
Form
Yes Yes Yes Yes Yes**
Spokesperson
Friend, relative
or anyone else
Standard
Authorization
Form - HIPAA
Yes Yes No No No
*Only in the context of a Medicaid appeal, not applicable in a clinical setting (e.g., at a hospital).
** An Authorized Representative for a Medicaid appeal is not the same as an agent who you make your power of
attorney for health care. A power of attorney for health care lets you name another person as agent to make
health care decisions for you in a clinical setting (e.g., at a hospital) if you become incapable of making your own
decisions or if you want someone else to make those decisions for you now even though you are still capable. If
you want to make someone your power of attorney for health care, please use the health care power of attorney
form available at https://www.bcbsnm.com/community-centennial/member-resources/forms.html
.
75 | Blue Cross Community Centennial Member Services 1-866-689-1523 (TTY:711)
Section 7: Grievances (Complaints) & Appeals
After your appeal is led, you can give more
information to BCBSNM before your appeal is
decided. The information can be written comments,
documents or verbal testimony. The information
can also be written or verbal arguments of law or
facts. You or your Authorized Provider, Authorized
Representative or Spokesperson can give this
information to us. To give us more information before
your appeal is decided, you must ask us right away
because BCBSNM has limited time to nish your
appeal. After you ask to give us more information,
BCBSNM will schedule a time for you to give us the
information before we decide your appeal. If you
need more time to gather your information, you can
request an extension of the appeal up to 14 more
calendar days. When you ask for an extension, please
tell us why.
Appeals Address and Phone Number
Centennial Care Appeal/Grievance Coordinator
P.O. Box 660717
Dallas, TX 75266
Telephone (toll-free): 1-866-689-1523
Fax: 1-888-240-3004
Email: Go to
GPDAG@bcbsnm.com
Please include your ID number and all information
related to your appeal including provider name, date
of service and your reason for ling the appeal.
Telephone hours are Monday through Friday from
8 a.m. to 5 p.m. Closed Saturdays and Sundays.
If you want to leave us a message about your
appeal after normal business hours, you may call
1-877-232-5520 (TTY: 711). We will return your
message by 5:00 p.m. the next business day.
2024 Member Handbook bcbsnm.com/medicaid | 76
Section 7: Grievances (Complaints) & Appeals
How Your Appeal is Handled
Within ve business days of receiving your appeal
request, BCBSNM will send you a notice conrming
we have received it. The notice will also tell you when
BCBSNM expects to have an answer for you. If you
or your provider believes an answer is needed more
quickly from BCBSNM, you can request an “expedited”
review and response.
A provider who was not involved in the initial denial
decision will review your case when you request an
appeal. This provider can give another opinion about
whether the request will be approved or denied again.
An answer to your appeal will be provided within 30
calendar days. The resolution letter will explain the
appeal decision. If we need more time to answer your
appeal and believe it is in your best interest to take
more time, we will ask the State if they will approve
an extension of up to 14 calendar days. You may also
ask for an extension. If we ask for an extension, we
will call to let you know and also follow up in writing
within two calendar days.
Keeping Your Services During anAppeal
and HSD Administrative Hearing
You, your Authorized Provider or your Authorized
Representative may have the right to request that
BCBSNM continue to cover (pay for) the services
in question while your appeal is in process. You,
your Authorized Provider or your Authorized
Representative may have the right to request that
BCBSNM continue to pay for the services in question
while your HSD administrative hearing is in process.
Your Spokesperson does not have this right. The
request to continue your benets must be made prior
to the date the initial denial goes into eect or within
10 calendar days after BCBSNM mails an appeal
decision to you, whichever is later. You may request
continued benets by calling Member Services at
1-866-689-1523 (TTY: 711). You can also send written
requests to the mailing address, email address or fax
number listed below.
Blue Cross and Blue Shield of New Mexico
Attention: Blue Cross Community Centennial,
Appeals Coordinator
P.O. Box 660717
Dallas, TX 75266
Toll-Free: 1-866-689-1523
Fax Number: 1-888-240-3004 TTY: 711
77 | Blue Cross Community Centennial Member Services 1-866-689-1523 (TTY:711)
Section 7: Grievances (Complaints) & Appeals
You have the right to receive continued benets only
under certain conditions:
•
Benets for the services at issue will be continued
during the process of your appeal to BCBSNM if: (1)
you, your Authorized Provider or your Authorized
Representative request an appeal within 60
calendar days from the date of the denial letter;
(2) the appeal is of the termination, suspension
or reduction of a previously authorized course of
treatment; (3) the services were ordered by an
authorized provider; (4) the original period covered
by the original authorization has not expired;
and (5) you, your Authorized Provider or your
Authorized Representative ask for your benets
to continue any time prior to the date the denial
goes into eect or within 10 calendar days from
the date of the denial letter, whichever is later.
•
If your request to continue benets for the
appealed service has been approved by BCBSNM,
you will continue to receive the disputed benet
during the appeal process unless: (1) you,
your Authorized Provider or your Authorized
Representative withdraw the appeal; (2) you or
your Authorized Representative fail to request an
HSD administrative hearing and continuation of
benets within 10 calendar days after BCBSNM
mails an appeal decision to you; (3) the Human
Services Department Medical Assistance Division
Director issues a hearing decision against you; (4)
the time period or service limits of a previously
authorized service has been met; or (5) you,
your Authorized Provider or your Authorized
Representative choose to end continued benets.
•
If you or your Authorized Representative have
asked for benets to continue within 10 calendar
days from the date of the denial letter, BCBSNM
may still deny your appeal. You can le for an
HSD administrative hearing at that time. However,
it will be too late to ask for your benets to
continue if you wait until the HSD administrative
hearing process to make such a request.
•
The result of the appeal or the HSD administrative
hearing could be the same as BCBSNM’s rst
decision to terminate, modify, suspend, reduce or
deny a service. In this event, you are responsible for
paying for the services used. BCBSNM may recover
the cost of the services furnished to you (request
payment back from the provider or member).
•
If BCBSNM started an expedited appeal on
your behalf, you are not responsible to pay
for the continued benets during the appeal
even if BCBSNM’s initial decision is upheld.
•
If the result of the appeal to BCBSNM or of
the HSD administrative hearing is in your
favor, BCBSNM will continue to pay for the
services through the authorized time frame.
2024 Member Handbook bcbsnm.com/medicaid | 78
Section 7: Grievances (Complaints) & Appeals
Expedited Appeal
If you think the normal 30 calendar day appeal time
will put your health at risk, you can ask us to ‘expedite’
your appeal (review it faster). Your Centennial Care
plan automatically provides an expedited review
for all requests related to a continued hospital stay
or other health care services for a member who
has received emergency services and is still in the
hospital. You or your provider can le an expedited
appeal by calling Member Services. We will tell you
within one working day if we agree to expedite your
appeal. If we agree, we will tell you and/or your
provider the outcome over the phone within 72 hours
after we receive your appeal. We will send a follow-up
letter within two (2) calendar days telling you and your
provider the outcome.
You or your authorized representative may ask for up
to a 14 calendar day extension to submit additional
information to BCBSNM that supports your request
for an expedited appeal.
If we need more time to collect and review additional
documentation to answer your expedited appeal, we
can extend the 72-hour time frame up to 14 calendar
days. We will write you a letter to explain why we
extended the 72-hour time frame.
If BCBSNM decides that taking the time for a standard
appeal puts your health at serious risk, BCBSNM will
start an expedited appeal on your behalf. BCBSNM
will contact you if we have started the expedited
appeal. We will continue your benets without cost to
you during an expedited appeal started by BCBSNM.
We will give you an expedited appeal decision
in 72 hours.
BCBSNM or the New Mexico HSD are not responsible
for any fees or cost you incur during the regular or
expedited appeals process.
Expedited Appeal Request Denials
If an expedited appeal request is denied, it goes
through the normal appeal process. It will be resolved
within 30 calendar days. BCBSNM will call you within
one working day to tell you the appeal is not going to
be expedited. We will also follow up in writing within
two calendar days. If we deny your expedited request,
you can request a standard or expedited HSD
administrative hearing.
79 | Blue Cross Community Centennial Member Services 1-866-689-1523 (TTY:711)
Section 7: Grievances (Complaints) & Appeals
HSD Administrative Hearing
You have the right to ask for a hearing with the HSD
Fair Hearings Bureau if after exhausting BCBSNM’s
internal appeal process, you do not agree with the
nal decision. You also have the right to ask for an
HSD administrative hearing if we denied your request
for an expedited appeal. You or your representative
must ask for an HSD administrative hearing from
the HSD Fair Hearings Bureau within 90 calendar
days of BCBSNM’s nal appeal decision. You have the
right to have someone represent you at the hearing.
The parties who may attend the HSD administrative
hearing include representatives from BCBSNM, as
well as you and/or your representative, or attorney,
or the representative of a deceased member’s estate.
You will receive a summary of evidence (SOE) packet
for the HSD administrative hearing. The SOE provides
information regarding your appeal. Your case may be
dismissed if you do not go to your scheduled hearing
without a good reason. If you requested continuation
of benets, and the result of the HSD administrative
hearing is not in your favor, you will have to pay for
the services received.
You can ask for an HSD administrative hearing by
calling or writing:
New Mexico Human Services Department
HSD Fair Hearings Bureau
P.O. Box 2348
Santa Fe, NM 87504-2348
Telephone: 1-800-432-6217, then press 6;
or (505) 476-6213 TTY: 711
Fax: (505) 476-6215
Email:
HSD-FairHearings@hsd.nm.gov
2024 Member Handbook bcbsnm.com/medicaid | 80
Section 8: Disenrollment
Annual Choice Period
During the rst three months after your eective
date of Centennial Care, you are given one chance
to change to another managed care plan. If you do
not change during this time, you will have to wait
12moremonths.
Moving Out-of-State
If you move out-of-state, you are no longer eligible
for Centennial Care coverage. It is very important to
let your local ISD oce know if you move out-of-state
right away.
Member Disenrollment Requests
You can switch to another managed care plan
at any time if there is ‘good cause.’ You or your
representative must make the request in writing and
send it to HSD. If you do not receive approval from
HSD, you may ask for an HSD administrative hearing.
See Section 7: Grievances (Complaints) &Appeals
for details about requesting an HSD administrative
hearing. Below are examples of when you may make
a special request:
•
Centennial Care does not cover the service
because of moral or religious reasons
•
Centennial Care has been given penalties by HSD
•
In-network providers are not available to
perform multiple services at the same time
•
You do not have access to in-network
providers for your health care needs
•
Moved out-of-state
•
Poor quality of care
HSD Reasons for DisenrollingMembers
HSD can also ask a member to disenroll from the
Managed Care program. These reasons include:
•
Loss of Medicaid eligibility
•
At any time during the HSD administrative hearing
process, HSD nds it would be best for the
member or HSD for the member to disenroll
BCBSNM Reasons for
DisenrollingMembers
BCBSNM can also request a member disenrollment
request from HSD. This can be done when the
member’s continued enrollment could harm the
Centennial Care plan’s ability to oer services to
its members.
Long-Term Care Residential
or Employment Support
Provider Leaving Network
If your long-term care residential or employment
support provider leaves our network, you may switch
to another MCO at any time within 90 calendar days
from the date you were notied that the provider was
leaving the network.
Section 8: Disenrollment
81 | Blue Cross Community Centennial Member Services 1-866-689-1523 (TTY:711)
Section 8: Disenrollment
Disenrolling During a Hospital Stay
or While in a Nursing Facility
If you change to another managed care plan while
you are hospitalized, BCBSNM will be responsible for
payment of all covered inpatient facility and related
professional services until your discharge date. Once
you are discharged, all services will be handled by
your new managed care plan under Centennial Care.
If you change managed care plans while in a nursing
facility, BCBSNM is responsible for payment of
covered services until the discharge date or the
date you change managed care plans, whichever
comes rst.
If your coverage ends as a result of being not eligible
for Centennial Care while you are hospitalized or in
a nursing facility, BCBSNM will be responsible for
payment of all covered inpatient facility and related
professional services until the end of the month in
which you were determined not eligible.
After the end of that month, you are responsible for
all charges even if you continue to be hospitalized or
in a nursing facility.
How to Disenroll
To send a request to disenroll, call the NM Medicaid
Call Center at 1-888-997-2583 or go to YESNM at
www.yes.nm.state.us
.
You need to contact ISD if you:
•
Change your name
•
Move to another address
•
Change your phone number
•
Get married or get divorced
•
Know of a Centennial Care member who has died
•
Have a new child, adopt a child or
place your child for adoption
•
Get other health insurance, including Medicare
•
Think you lost eligibility or must change
your eligibility with HSD/MAD
•
Move out of New Mexico
•
Need a referral for community resources
through Centennial Care
•
Have any questions about your
eligibility with Centennial Care
2024 Member Handbook bcbsnm.com/medicaid | 82
Section 9: General Information
Changes to Handbook or Benets
HSD/MAD reserves the right to add or delete benets
to the Centennial Care program.
Disclosure and Release ofInformation
BCBSNM will only disclose information, including
medical records, as permitted or required under state
and federal law.
Accessing your Medical Records
Your health information may be available online
through your patient portal. This is a secure website
through your doctor’s oce or health care system.
Using a secure user name and password, you can log
in and view some of your health information such as:
•
Recent doctor visit notes
•
Discharge summaries
•
Lab and test results
•
Medications
•
Immunizations
•
Allergies
•
Online prescription rells
•
Online appointment scheduling
•
Secure messaging with your provider
Your patient portal may allow you to download this
information or share it with others. If this information
is not available, you can request it from your doctor’s
oce. You may have more than one patient portal for
all the places you receive care. Like your primary care
physician, a hospital, your specialists, your pharmacy,
laboratories or your insurance provider.
Advance Directives
Advance directives are written documents (such as
a Living Will, Health Care Treatment Directives and
Durable Power of Attorney) that give a person you
select the responsibility for making your health care
decisions if you cannot express your own wishes.
These documents also describe the kind of treatment
you do and do not want. Talk with your provider about
advance directives. Keep a copy of your advance
directives in your medical record at your PCP’s oce.
Members over age 18 or emancipated minors have
the right to refuse or accept medical or surgical care
and to make advance directives.
BCBSNM, in-network providers, and sta do not
discriminate care based on whether you have signed
any type of advance directive. If you have questions or
concerns about advance directives, contact your PCP
to discuss these issues.
Complaints about noncompliance with advance
directive requirements may be led with HSD/MAD
Division of Health Improvement in the New Mexico
Department of Health.
Federal law says hospitals, nursing homes and other
providers have to tell you about advance directives.
They need to explain your legal choices about medical
decisions. The law was made to give you more control
during times when you may not be able to make
health care decisions.
If you need help to get an advance directive, contact
Member Services or your care coordinator. If you are
speech or hearing impaired, call 711 for TTY service.
You can also call the State of New Mexico Aging and
Disability Resource Center at1-800-432-2080.
Section 9: General Information
83 | Blue Cross Community Centennial Member Services 1-866-689-1523 (TTY:711)
Section 9: General Information
Mental Health Advance Directives
New Mexico’s Mental Health Care Treatment
Decisions Act allows you to put in writing your wishes
for psychiatric treatment. This is called a Psychiatric
Advance Directive (PAD). If you are unable to make
a decision, mental health advance directives will
describe your wishes. You can list a person you trust
to make decisions for you. If you need help to get an
advance directive, contact Member Services or your
care coordinator.
Major Disasters
In the event of any major disaster, epidemic or other
circumstance beyond your control, BCBSNM will
render or try to arrange covered services with in-
network providers as much as possible. BCBSNM will
do this according to its best judgment and within the
limitations of facilities, supplies, pharmaceuticals and
personnel available. Such events include, complete
or partial disruption of facilities, war, riot, civil
uprising, disability of BCBSNM personnel, disability of
Centennial Care providers or an act of terrorism.
Women’s Health and
Cancer Rights Act of 1998
As required by the Women’s Health and Cancer
Rights Act of 1998, BCBSNM provides benets for
mastectomy-related services, including reconstruction
and surgery to achieve symmetry between the
breasts, prostheses and treatment of complications
resulting from a mastectomy (including lymphedema).
If you have any questions, please call, write or email
Member Services.
Health Care Fraud and Abuse
Health care fraud, waste and abuse hurts everyone
by causing higher costs, receiving inappropriate
medical services and/or supplies and creating
distrust within the medical community.
Denitions:
•
Fraud means an intentional deception or
misrepresentation by a person or an entity, with
the knowledge that the deception could result in
some unauthorized benet to himself or some
other person. It includes any act that constitutes
fraud under applicable federal or state law.
•
Waste means the over-utilization of services or
other practices that result in unnecessary costs.
•
Abuse means any intentional, knowing or reckless
act or failure to act that produces or is likely to
produce physical or great mental or emotional
harm, unreasonable connement, sexual abuse
or sexual assault. Provider practices that are
inconsistent with sound scal, business, medical
or service-related practices and result in an
unnecessary cost to the Medicaid program or in
reimbursement for services that are not medically
necessary services or that fail to meet professionally
recognized standards for health care. Abuse
also includes member practices that result in
unnecessary costs to the Medicaid program.
What you can do to prevent yourself from being a
victim to health care fraud:
•
Understand your treatment program;
ask your physician to explain why a
test or procedure is necessary
•
Never use someone else’s health
insurance identication card
•
Don’t share your health insurance
information with anyone over the phone
2024 Member Handbook bcbsnm.com/medicaid | 84
Section 9: General Information
How You Can Help
Always review the bills from your providers. Make
sure that you received all the services that were
claimed. If you think there is a problem or that the
Centennial Care program is being charged for services
that you did not receive, call Member Services at
1-866-689-1523.
•
Be very careful about giving information about
your health care insurance over the telephone
•
Keep your Centennial Care ID card
safe; do not let anyone else use it
•
Report any suspicion of fraud
and/or abuse to BCBSNM
Reporting Fraud and Abuse
If you feel health care fraud and abuse has happened,
or will happen, report it right away. BCBSNM will
look into the report and will work with any needed
government, regulatory or law enforcement agency
for both member and provider cases.
You can report fraud and abuse by doing
the following:
•
File a fraud and abuse report with BCBSNM’s Special
Investigations Department (SID). SID’s toll-free Fraud
and Abuse Hotline at 1-800-543-0867 that is staed
24 hours a day, seven days a week. Call 711 for TTY
service. The Fraud and Abuse Hotline has Spanish-
speaking sta and is also capable of receiving
complaints from the hearing impaired. All calls are
condential and you do not have to give your name.
•
Go to BCBSNM’s SID website at
https://www.bcbsnm.com/company-info/
about/fraud-prevention
.
•
Contact the New Mexico Attorney General’s Oce,
which has a dedicated unit called the Medicaid
Fraud & Elder Abuse Division. The MFEAD unit
investigates and prosecutes providers who
commit health care fraud and abuse, neglect,
and exploitation of Medicaid recipients. It also
reviews complaints about abuse and neglect
for persons receiving services in long-term care
Medicaid-funded facilities. You can report fraud
to the MFEAD by lling out a Complaint Form at
www.nmag.gov/about-the-oce/criminal-aairs/
medicaid-fraud-control-unit. When the form is
complete, please submit via fax, email or mail.
Phone: 1-505-717-3585
Fax: 1-505-318-1006
Email:
report.mfcu@nmag.gov
Mail: New Mexico Oce of the Attorney General
Attn: Medicaid Fraud Control Division
201 Third St. NW, Suite 300
Albuquerque, NM 87102
Medical Policy
A medical policy is a medical coverage position
developed by BCBSNM. It summarizes the scientic
knowledge about new or existing technology,
products, devices, procedures, treatments, services,
supplies or drugs and used by BCBSNM to process
claims and provide benets for covered services.
BCBSNM’s medical policies are based on scientic and
medical research. They are often used as a guide to
determine what is covered by a health plan. Policies
can be about a medical procedure, treatment, drug or
device. You can check to see if these are:
•
Cosmetic
•
Under investigation or experimental
•
Medically necessary
Medical policies are posted on the BCBSNM website
at
bcbsnm.com/medicaid
under Member Resources.
Specic medical policies may be requested in writing
from Member Services. Please note that these policies
do not replace professional health care.
85 | Blue Cross Community Centennial Member Services 1-866-689-1523 (TTY:711)
Section 9: General Information
Privacy of Your Information
As a Centennial Care member, HSD is responsible
for providing you with a notice. This notice explains
how your Protected Health Information (PHI) can be
used and shared. PHI includes medical information. It
also includes information about your Centennial Care
benets. PHI can be communicated by spoken word,
in writing or electronically.
BCBSNM manages a contract with HSD to provide
the Blue Cross Community Centennial health plan
to BCBSNM’s Centennial Care members. So that
you may use the benets of this plan, BCBSNM has
access to your PHI in all its forms. Due to this fact,
we wanted you to know how BCBSNM protects and
secures your PHI.
How We Use or Share Your PHI
To operate the health plan and for you to receive
services from your health care providers, BCBSNM
uses your PHI. BCBSNM shares it with your providers
and other organizations. We also share your PHI to
help with the following:
•
Public health
•
Safety issues
•
Other legal or law enforcement activities
Please know that BCBSNM only shares your PHI when
allowed by law.
Your Rights:
•
Authorizations: There may be times when BCBSNM
requires your authorization to release your PHI.
Sometimes we need to share your PHI. This may
be with your legal guardian, legal representative or
others involved in making decisions about your care.
•
Access to your PHI: You have the right to
ask BCBSNM for a copy of your health
information, claims records or other PHI.
How We Protect Your PHI
BCBSNM has policies, procedures and strong security
controls in place. These are in place to protect your
PHI. BCBSNM protects your PHI whether it is spoken,
written or maintained electronically. Employees at
BCBSNM have to take privacy and security training
at least once a year. Employees are also required
to comply with all privacy and security policies
and procedures.
Information
For more information about this notice or your rights,
please call Member Services at 1-866-689-1523
(TTY: 711) or contact HSD.
Independent Companies
Prime Therapeutics is a separate company that is
the pharmacy benet manager for the Blue Cross
Community Centennial health plan. Davis Vision,
DentaQuest and ModivCare are independent
companies that provide certain administrative
services for the Blue Cross Community Centennial
health plan in the areas of vision, dental and
transportation, respectively. All of these companies
are independent contractors that do not oer
BlueCross and BlueShield products and services and
are solely responsible for the products and services
they provide.
To ask for auxiliary aids and services or materials in other
formats and languages at no cost, please call 1-866-689-1523
(TTY/TDD: 711).
Blue Cross and Blue Shield of New Mexico complies with applicable federal civil rights laws and does
not discriminate on the basis of health status or need for services or race, color, national origin, age,
disability, sex, ancestry, spousal aliation, sexual orientation and/or gender identity. Blue Cross and
Blue Shield of New Mexico does not exclude people or treat them dierently because of health status
or need for services or race, color, national origin, age, disability, sex, ancestry, spousal aliation, sexual
orientation and/or gender identity.
Blue Cross and Blue Shield of New Mexico provides:
•
Free aids and services to people with disabilities to communicate eectively with us, such as:
–
Qualied sign language interpreters
–
Written information in other formats (large print, audio, accessible electronic formats and more)
•
Free language services to people whose primary language is not English, such as:
–
Qualied interpreters
–
Information written in other languages
If you need these services, contact the Civil Rights Coordinator.
If you believe that Blue Cross and Blue Shield of New Mexico has failed to provide these services or
discriminated in another way on the basis of health status or need for services or race, color, national
origin, age, disability, sex, ancestry, spousal aliation, sexual orientation and/or gender identity, you
can le a grievance with: Civil Rights Coordinator, Oce of Civil Rights Coordinator, 300 E. Randolph St.,
35th oor, Chicago, Illinois 60601, 1-855-664-7270, T TY/TDD: 1-855-661-6965 or Fax: 1-855-661-6960
You can le a grievance in person, by mail or fax. If you need help ling a grievance, a Civil Rights
Coordinator is available to help you.
You can also le a civil rights complaint with the U.S. Department of Health and Human Services,
Oce for Civil Rights, electronically through the Oce for Civil Rights Complaint Portal, available at
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
, or by mail or phone at:
U.S. Department of Health and Human Services
200 Independence Avenue, SW
Room 509F, HHH Building
Washington, D.C. 20201
1-800-368-1019, 1-800-537-7697 (TDD)
Complaint forms are available at
http://www.hhs.gov/ocr/oce/le/index.html
.
To ask for auxiliary aids and services or materials in other
formats and languages at no cost, please call 1-866-689-1523
(TTY/TDD: 711).
Blue Cross and Blue Shield of New Mexico complies with applicable federal civil rights laws and does
not discriminate on the basis of health status or need for services or race, color, national origin, age,
disability, sex, ancestry, spousal aliation, sexual orientation and/or gender identity. Blue Cross and
Blue Shield of New Mexico does not exclude people or treat them dierently because of health status
or need for services or race, color, national origin, age, disability, sex, ancestry, spousal aliation, sexual
orientation and/or gender identity.
Blue Cross and Blue Shield of New Mexico provides:
•
Free aids and services to people with disabilities to communicate eectively with us, such as:
–
Qualied sign language interpreters
–
Written information in other formats (large print, audio, accessible electronic formats and more)
•
Free language services to people whose primary language is not English, such as:
–
Qualied interpreters
–
Information written in other languages
If you need these services, contact the Civil Rights Coordinator.
If you believe that Blue Cross and Blue Shield of New Mexico has failed to provide these services or
discriminated in another way on the basis of health status or need for services or race, color, national
origin, age, disability, sex, ancestry, spousal aliation, sexual orientation and/or gender identity, you
can le a grievance with: Civil Rights Coordinator, Oce of Civil Rights Coordinator, 300 E. Randolph St.,
35th oor, Chicago, Illinois 60601, 1-855-664-7270, T TY/TDD: 1-855-661-6965 or Fax: 1-855-661-6960
You can le a grievance in person, by mail or fax. If you need help ling a grievance, a Civil Rights
Coordinator is available to help you.
You can also le a civil rights complaint with the U.S. Department of Health and Human Services,
Oce for Civil Rights, electronically through the Oce for Civil Rights Complaint Portal, available at
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
, or by mail or phone at:
U.S. Department of Health and Human Services
200 Independence Avenue, SW
Room 509F, HHH Building
Washington, D.C. 20201
1-800-368-1019, 1-800-537-7697 (TDD)
Complaint forms are available at
http://www.hhs.gov/ocr/oce/le/index.html
.
ATTENTION: If you speak English, language assistance services, free of charge, are available to you.
Call 1-855-710-6984 (TTY: 711).
ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística.
Llame al 1-855-710-6984 (TTY: 711).
Díí baa akó nínízin: Díí saad bee yáníti’go Diné Bizaad, saad bee áká’ánída’áwo’d
’, t’áá jiik’eh, éí ná
hól
, koj’ hódíílnih 1-855-710-6984 (TTY: 711).
CHÚ Ý: Nu bn nói Ting Vit, có các dch v h tr ngôn ng min phí dành cho bn.
Gi s 1-855-710-6984 (TTY: 711).
ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur
Verfügung. Rufnummer: 1-855-710-6984 (TTY: 711).
注意：如果您使用繁體中文，您可以免費獲得語言援助服務。請致電 1-855-710-6984
(TTY: 711)。
  .            :1-855-710-6984
:   )711.(
주의: 한국어를 사용하시는 경우, 언어 지원 서비스를 무료로 이용하실 수 있습니다.
1-855-710-6984 (TTY: 711) 번으로 전화해 주십시오.
PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika
nang walang bayad. Tumawag sa 1-855-710-6984 (TTY: 711).
注意事項：日本語を話される場合、無料の言語支援をご利用いただけます。1-855-710-6984
（TTY: 711）まで、お電話にてご連絡ください。
ATTENTION : Si vous parlez français, des services d'aide linguistique vous sont proposés gratuitement.
Appelez le 1-855-710-6984 (ATS: 711).
ATTENZIONE: In caso la lingua parlata sia l'italiano, sono disponibili servizi di assistenza linguistica
gratuiti. Chiamare il numero 1-855-710-6984 (TTY: 711).
:      ,      .
 1-855-710-6984 (: 711).
󰉠󰍷󰏱󰏳󰍺󰉣󰍷󰉤󰍺
1-855-710-6984 (TTY: 711)󰍷
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.  (TTY: 711) 1-855-710-6984
 1-855-710-6984
(TTY: 711).