Definition & Meaning
The New Mexico 379 form, officially known as the Long Term Care Medical Assessment (MAD 379), is utilized by the Medical Assistance Division of the New Mexico Human Services Department. It plays a crucial role in assessing eligibility for the Program of All-Inclusive Care for the Elderly (PACE), particularly determining the Nursing Facility Level of Care (NF LOC) needed by an individual. This assessment ensures that individuals receive the appropriate level of care and support based on their medical and daily living needs.
Key Elements of the New Mexico 379
- Patient Information: Includes detailed information such as name, address, date of birth, and contact details.
- Activities of Daily Living (ADL) Assessments: Evaluates the patient's ability to perform daily tasks such as eating, bathing, dressing, and mobility.
- Provider Attestation: Requires certification by a medical provider, confirming the patient's health status and care requirements.
- Confidentiality Requirements: Ensures sensitive information is protected, with access limited to authorized personnel.
Steps to Complete the New Mexico 379
- Gather Required Information: Collect patient details, medical records, and ADL assessments.
- Complete Patient Information Section: Ensure all personal details are accurate and up-to-date.
- Assess Activities of Daily Living: Conduct a thorough evaluation of the patient's ability to perform essential daily tasks.
- Medical Provider Attestation: The provider must review the form, provide a certification, and sign to attest to the information's accuracy.
- Submission for Review: Submit the completed form for evaluation by a Third Party Assessor (TPA).
Why Use the New Mexico 379
The New Mexico 379 form is essential for ensuring individuals receive necessary care tailored to their specific medical and living situations. By assessing NF LOC eligibility, the form facilitates appropriate allocation of resources and services. It ensures elders get comprehensive care through PACE, enhancing their quality of life and reducing unnecessary medical interventions.
Who Typically Uses the New Mexico 379
- Elderly Individuals: Those seeking care through PACE.
- Medical Providers: Responsible for evaluating and completing the form.
- Third Party Assessors (TPA): Conducting reviews for approval or denial of NF LOC.
- Family Members and Caregivers: Who may help gather information and support the assessment process.
Legal Use of the New Mexico 379
The completion and submission of the New Mexico 379 must adhere to state laws regarding confidentiality and data protection. The form is used to legally assess eligibility for PACE, ensuring compliance with medical and administrative protocols. Proper use of the form aligns with regulatory requirements to safeguard patient data.
State-Specific Rules for the New Mexico 379
- New Mexico Regulations: Govern the use and processing of the MAD 379 form.
- Confidentiality Standards: Set by state laws, ensuring personal and medical data security.
- Specific Eligibility Criteria: Detailed by the Medical Assistance Division and must be met for PACE enrollment.
Examples of Using the New Mexico 379
- Case Study 1: An elderly patient with limited mobility applies for PACE. The New Mexico 379 assesses their need for NF LOC and facilitates enrollment.
- Case Study 2: A medical provider assists with form completion for a patient requiring comprehensive at-home care services under PACE.
Who Issues the Form
The New Mexico Human Services Department’s Medical Assistance Division issues the form, providing guidance on its use in the assessment process for long-term care. They oversee the implementation of programs like PACE, ensuring eligible individuals receive adequate support and care.
Required Documents
- Medical Records: Pertinent to the patient's current health conditions.
- Identification Documents: Such as a driver's license or state ID.
- ADL Assessment Results: Documented evaluations completed by healthcare providers.
- Provider's Certification: Signed attestation of the patient's need for NF LOC.
Form Submission Methods
- Online Submission: Through the New Mexico Human Services Department portal.
- Mail Submission: Sending the completed form and supporting documents to the designated office.
- In-person Submission: Directly at an authorized Medical Assistance Division location.
