New Mexico Register / Volume XXXVII, Issue 16
/ August 25, 2026
This is an amendment to 8.371.9 NMAC, Sections 1, 2 and
6-11, effective 9/1/2026.
8.371.9.1 ISSUING AGENCY: New Mexico health care authority (HCA).
[8.371.9.1 NMAC - N, 7/1/2024; A, 9/1/2026]
8.371.9.2 SCOPE:
A. These regulations provide a
systematic process for admission of persons requesting services from an
intermediate care facility for [the mentally retarded (ICF/MR)] individuals
with intellectual disabilities (ICF/IID); the transfer between [ICF/MR]
ICF/IID facilities of persons previously determined eligible; and the
discharge of persons residing in an [ICF/MR] ICF/IID.
B. These regulations apply to
persons who request admission to an [ICF/MR] ICF/IID and who
reside in the community; in a nursing facility; in a hospital; or, in an [ICF/MR]
ICF/IID. In addition, these
regulations apply to any [ICF/MR] ICF/IID in the state of New
Mexico that is licensed under health care authority regulations governing long
term care facilities.
C. These regulations are limited to
the admission, transfer and discharge of persons receiving support and services
funded in whole or in part by state funds or for whom services can reasonably
be expected to be funded in whole or in part with state funds within six months
of admission into an [ICF/MR] ICF/IID.
[8.371.9.2 NMAC - N, 7/1/2024; A, 9/1/2026]
8.371.9.6 OBJECTIVE: The purpose of these regulations is to:
A. establish the process for the
admission of any and all persons requesting admission to an [ICF/MR] ICF/IID,
to be transferred between [ICF/MR] ICF/IID facilities, or to be
discharged from an [ICF/MR] ICF/IID;
B. establish admission, transfer and
discharge procedures for [ICF/MR] ICF/IID facilities licensed and
located in the state of New Mexico consistent with the Developmental
Disabilities Act, Section 28-16A-15 NMSA 1978;
[8.371.9.6 NMAC - N, 7/1/2024; A, 9/1/2026]
8.371.9.7 DEFINITIONS:
[ A. “Discharge” means the termination of
services for a person previously admitted into an ICF/MR and the discharging
facility ceases to be legally responsible for the care of the person.
B. “Eligible central registry person”
means a person who has requested admission to an ICF/MR, or discharge from an ICF/MR
and transfer to a community-based HCA funded program, and who is determined by
the HCA to meet pre-admission screening criteria for ICF/MR and
home/community-based developmental disabilities services.
C. “ICF/MR” means an intermediate care
facility that provides food, shelter, health or rehabilitative and active
treatment for persons with mental retardation or related conditions, and that
has a current license issued by the HCA.
D. “New admission” means a person
requesting an ICF/MR admission for the first time and does not otherwise
qualify as a re-admission. New
admissions are subject to pre-admission screening.
E. “NMSA” means the New Mexico Statutes
Annotated 1978 compilation and all the revisions and compilations thereof.
F. “Pre-admission screening” means the
evaluation process of the health care authority to determine a person’s choice
between ICF/MR and community based services, and whether the person has a
developmental disability as described in the American association on mental retardation’s manual on classification
in mental retardation (1996) or a related condition as defined by 42 CFR
435.1009.
G. “Readmission” means a person
re-admitted to an ICF/MR from another type of institution to which they were
transferred for the purpose of receiving acute, psychiatric care or
rehabilitation following a temporary, acute care episode. A readmission is not subject to pre-admission
screening.
H. “Transfer” means movement of an
individual from one ICF/MR to another ICF/MR, with or without an intervening
hospital stay. A transfer is not subject
to pre-admission screening.
I. “State
medicaid agency” means the health care authority.
J. “Central registry” means a registry of
persons who are requesting or receiving services established by the HCA in
accordance with Section 28-16A-15 NMSA 1978.]
A. Definitions
beginning with “A”: [RESERVED]
B. Definitions
beginning with “B”: [RESERVED]
C. Definitions
beginning with “C”: “Central registry” means a registry of
persons who are requesting or receiving services established by the HCA in
accordance with Section 28-16A-15 NMSA 1978.
D. Definitions beginning with “D”:
“Discharge” means the termination of services for a person
previously admitted into an ICF/IID and the discharging facility ceases to be
legally responsible for the care of the person.
E. Definitions
beginning with “E”: “Eligible central registry person”
means a person who has requested admission to an ICF/IID, or discharge from an
ICF/IID and transfer to a community-based HCA funded program, and who is
determined by the HCA to meet pre-admission screening criteria for ICF/IID and
home/community-based developmental disabilities services.
F. Definitions
beginning with “F”: [RESERVED]
G. Definitions
beginning with “G”: [RESERVED]
H. Definitions
beginning with “H”: [RESERVED]
I. Definitions
beginning with “I”: “ICF/IID” means an intermediate care
facility that provides food, shelter, health or rehabilitative and active
treatment for persons with intellectual disabilities or related conditions, and
that has a current license issued by the HCA.
J. Definitions
beginning with “J”: [RESERVED]
K. Definitions
beginning with “K”: [RESERVED]
L. Definitions
beginning with “L”: [RESERVED]
M. Definitions
beginning with “M”: [RESERVED]
N. Definitions
beginning with “N”:
(1) “New admission” means a
person requesting an ICF/IID admission for the first time and does not
otherwise qualify as a re-admission. New
admissions are subject to pre-admission screening.
(2) “NMSA” means the New Mexico Statutes Annotated 1978 compilation and
all the revisions and compilations thereof.
O. Definitions
beginning with “O”: [RESERVED]
P. Definitions
beginning with “P”: “Pre-admission screening” means the
evaluation process of the health care authority to determine a person’s choice
between ICF/IID and community based services, and whether the person has a
developmental disability as described in the American Association on
Intellectual Disability: Definition, Diagnosis, Classification, and Systems of
Supports (12th edition, published in 2021), or a related condition
as defined by 42 CFR 435.1009.
Q. Definitions
beginning with “Q”: [RESERVED]
R. Definitions
beginning with “R”: “Readmission” means a person
re-admitted to an ICF/IID from another type of institution to which they were
transferred for the purpose of receiving acute, psychiatric care or
rehabilitation following a temporary, acute care episode. A readmission is not subject to pre-admission
screening.
S. Definitions beginning with “S”: “State
medicaid agency” means the health care authority.
T. Definitions
beginning with “T”: “Transfer” means movement of an
individual from one ICF/IID to another ICF/IID, with or without an intervening
hospital stay. A transfer is not subject
to pre-admission screening.
U. Definitions beginning with “U”: [RESERVED]
V. Definitions beginning with “V”: [RESERVED]
W. Definitions beginning with “W”: [RESERVED]
X. Definitions beginning with “X”: [RESERVED]
Y. Definitions beginning with “Y”: [RESERVED]
Z. Definitions beginning with “Z”: [RESERVED]
[8.371.9.7 NMAC - N, 7/1/2024; A, 9/1/2026]
8.371.9.8 ADMISSION:
A. No person shall be admitted into an [ICF/MR]
ICF/IID unless the person has been pre-screened and referred to an [ICF/MR]
ICF/IID by the health care authority central registry.
B. Consistent with the provisions of 42
CFR 431.51 any person who requests to be placed on the HCA’s central registry
will be provided the opportunity to indicate a choice between [ICF/MR] ICF/IID
and home/community-based waiver services at the time of application to the
central registry. The purpose of this information
request is for system service planning to identify persons who may be
potentially eligible for [ICF/MR] ICF/IID services.
C. All applicants to the central
registry may choose to be placed on the central registry for both [ICF/MR]
ICF/IID and home/community-based waiver services.
D. All persons referred for admission
into an [ICF/MR] ICF/IID from the central registry may choose to
remain on the central registry for home/community-based waiver services. All persons referred for admission into
home/community-based waiver services may choose to remain on the central
registry for [ICF/MR] ICF/IID services.
E. All persons applying to the central
registry will be pre-screened by the HCA before placement on the central
registry to determine each person’s choice between [ICF/MR] ICF/IID
and home/community-based waiver services, and whether the person has a
developmental disability or related condition.
Pre-screening does not include determination of financial eligibility
and level of care, which are functions performed by the state medicaid agency.
F. The HCA will implement application
procedures for the central registry that identifies applicant’s freedom to
choose between [ICF/MR] ICF/IID and home and community based
services.
G. Upon notification from a [ICF/MR]
ICF/IID to the HCA that a vacancy exist in their facility, the HCA will
identify three persons from the central registry, in the order of date of
application to the central registry, who have indicated a choice for [ICF/MR]
ICF/IID services, and who:
(1) have never been admitted into an [ICF/MR]
ICF/IID; or
(2) were discharged from an [ICF/MR]
ICF/IID for at least 30 days; or
(3) did not qualify as a readmission;
(4) the group of three individuals will be classified as “new admission” for the purposes of these regulations.
H. The HCA will notify the three persons
about the availability of a vacancy and request each person to reaffirm in
writing their choice between [ICF/MR] ICF/IID, developmental
disabilities home and community waiver services, or other services.
I. The HCA will furnish to an [ICF/MR]
ICF/IID the names and contact information of any persons on the central
registry who indicate a choice for [ICF/MR] ICF/IID services in
the long term services division region in which the [ICF/MR] ICF/IID
is located.
J. The [ICF/MR] ICF/IID will
contact and review each person’s request for admission in accordance with
federal licensing and certification requirements.
K. The [ICF/MR] ICF/IID will
refer any person referred by the central registry, and whom the [ICF/MR]
ICF/IID determined appropriate for admission based on its admission
decision, to the state medicaid agency for level of
care and financial eligibility determination.
L. The [ICF/MR] ICF/IID will
notify the HCA and the eligible central registry person of the results of its
admission decision for all three persons referred by the HCA with an
explanation for its decision on each person referred. The [ICF/MR] ICF/IID will
notify any person not admitted of their right to a review of the admission
decision.
M. The [ICF/MR] ICF/IID may
admit any person who meets the definition of “readmission” without referral
through the HCA’s central registry. A
readmission will not be subject to pre-screening by the HCA.
N. The health care authority central
registry may refer an individual to an [ICF/MR] ICF/IID vacancy
based on the HCA’s determination that the referral is an emergency. The HCA may exempt an emergency referral from
the central registry to be made based on the person’s date of application to
the central registry.
[8.371.9.8 NMAC - N, 7/1/2024; A, 9/1/2026]
8.371.9.9 TRANSFER:
A. A person may be transferred to
another [ICF/MR] ICF/IID operated by the same entity, or an [ICF/MR]
ICF/IID that operates independent of the [ICF/MR] ICF/IID where
the person currently resides without referral through the central registry,
provided:
(1) the person’s interdisciplinary team recommends the transfer;
(2) the person’s transfer is based on the person’s freedom of choice of providers; and
(3) the receiving [ICF/MR] ICF/IID
has identified a vacancy.
B. An [ICF/MR] ICF/IID may
transfer a person temporarily to a psychiatric acute care hospital, or
temporarily to a nursing facility for care following a hospital stay. Persons returning to the [ICF/MR] ICF/IID
under these conditions will be classified a “readmission” and will not be
subject to pre-screening by the HCA.
C. Persons receiving services from an [ICF/MR]
ICF/IID may be transferred to a home and community-based waiver program
provided the person has been allocated to the program by the HCA in accordance
with central registry policies and procedures.
D. The [ICF/MR] ICF/IID shall
provide a complete copy of the person’s medical and service records, including
assessments required for individual program planning to the [ICF/MR] ICF/IID
or community to which the person is transferred.
[8.371.9.9 NMAC - N, 7/1/2024; A, 9/1/2026]
8.371.9.10 DISCHARGE:
A. A person may be discharged from an [ICF/MR]
ICF/IID when the individual/guardian requests to be discharged; when the
person’s interdisciplinary team recommends the facility cannot meet the
individual’s needs; the individual no longer requires an active treatment
program in an [ICF/MR] ICF/IID setting; the discharge would be
more beneficial to the person; or for any other good cause. Any decision to discharge a person from an [ICF/MR]
ICF/IID based on good cause must be adequately justified in writing by
the [ICF/MR] ICF/IID and reviewed by the HCA prior to discharge.
B. The [ICF/MR] ICF/IID will
ensure the person’s family/guardian and the person’s advocate is involved in
the interdisciplinary team process, involving a discussion and proposed
decision regarding discharge.
C. The [ICF/MR] ICF/IID will
ensure a transition plan is developed 30 working days prior to discharge in
accordance with HCA policies on discharge and transition of persons in
services.
D. The [ICF/MR] ICF/IID will
ensure the person and their guardian are fully informed of their right to a
fair hearing in accordance with 42 CFR 431.200-431.250.
E. The [ICF/MR] ICF/IID will
ensure any discharge decision is carried out in accordance with provisions of
42 CFR 456.380.
[8.371.9.10 NMAC - N, 7/1/2024; A, 9/1/2026]
8.371.9.11 NOTIFICATION OF THE HCA:
A. The [ICF/MR] ICF/IID will
notify the HCA of any vacancy or anticipated vacancy in their facility.
B. The [ICF/MR] ICF/IID will
notify the HCA of any person requesting [ICF/MR] ICF/IID services
and for whom state funding may be necessary.
C. The HCA will notify an [ICF/MR]
ICF/IID of any person on the central registry indicating a choice of [ICF/MR]
ICF/IID services in the long term services division region in which the [ICF/MR]
ICF/IID located.
D. Notice by either party shall be based on timelines adopted by the HCA.
[8.371.9.11 NMAC - N, 7/1/2024; A, 9/1/2026]