MedicaidReimbursementMedium impact
Supplement 24-09: Reimbursement for Tribal 638 Nursing Facilities
New Mexico Medicaid·NM · Geriatrics·Claims & Billing
Effective date
Aug 18, 2023
We identified it
Jun 21, 2026
Summary
New Mexico Medicaid will reimburse Tribal 638 Nursing Facilities at the federal OMB outpatient rate instead of standard nursing facility rates, with a single daily rate for both high and low acuity levels. MCOs must reprocess claims back to August 18, 2023 within 60 days of the directive and can waive timely filing limits.
Action Required
Within 60 days of LOD #118 issuance: Billing teams at Tribal 638 Nursing Facilities in New Mexico must update billing systems to use the annual CMS OMB outpatient rate for all nursing facility claims instead of separate HNF/LNF rates. Resubmit all claims back to August 18, 2023 using the new rate structure. Coordinate with MCOs to ensure proper reprocessing and utilize waived timely filing provisions as needed.