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Services are funded in part under contract with the State of New Mexico Rev 11/08 5196NM0209 PO Box 3887 Albuquerque, NM 87190-9859 Salud Member Handbook Molina Healthcare of New Mexico In the Bront oB this handbook is a Molina Healthcare Provider Directory on CD. IB you cannot use this CD and want a paper directory, please write your name and address below. Mail this postcard to Molina Healthcare.
We will mail a paper directory to you. IB you would like a copy oB this Member Handbook in Spanish, please check the box below and list your name and address. Name: Address: q Yes, please send me a Member Handbook in Spanish.
q Yes, please send me a paper Provider Directory in English. q Yes, please send me a paper Provider Directory in Spanish. Tank you, Molina Healthcare Molina Healthcare o1 New Mexico, Inc.
Attn: Member Services P.O. Box 3887 Albuquerque, New Mexico 87190-9859 Member Services: (505) 342-4681 in Albuquerque (800) 580-2811 toll Bree www.molinahealthcare.com Integrated &ransport Management (I&M) (transportation): (888) 593-2052 toll Bree Val?e Options o1 New Mexico (VONM) (behavioral health): (888) 251-7511 toll Bree VONM will provide behavioral health services through June 30, 2009 Opt?m Health New Mexico (behavioral health): (866) 660-7185 toll Bree Optum Health will begin providing behavioral health services July 1, 2009 March Vision Care: (888) 493-4070 toll Bree 55Y/5DD (877) 627-2456 N?rse Advice Line: (888) 275-8750 toll Bree English (866) 648-3537 toll Bree Spanish New Mexico Relay Services/&&Y: (800) 659-8331 toll Bree Health Improvement Hotline: (505) 342-4660 ext ... more.
182618 in Albuquerque (800) 377-9594 ext 182618 toll Bree Anti-Fra?d Hotline: (505) 341-7469 in Albuquerque (800) 827-2973 toll Bree Grievance and Appeals: (505) 342-4663 in Albuquerque (800) 723-7762 toll Bree Yo?r Primary Care Practitioner (PCP): Yo?r D?rable Medical Eq?ipment (DME) Provider: I1 yo? have a medical emergency dial 911 or go to the nearest emergency room.
More inBormation can be Bound on our website at www.molinahealthcare.com Para recibir esta información en español, llame por favor (505) 342-4681 o (800) 580-2811 Such services are funded in part under contract with the state of New Mexico. Important 5elephone Numbers and InBormation Important &elephone N?mbers ....................................................3 WELCOME .................................................................................................................8 Quality Care Services ............................................................................................9 IN&RODuC&ION Member Services What can Member Services do Bor you? ..........................................................10 5ranslation and 55Y Services ..........................................................................10 IB You Move .........................................................................................................10 New Medical Equipment and 5reatments .......................................................10 Handicapped Access ..........................................................................................11 Filing a Claim ......................................................................................................11 Coordination oB Bene ts ...................................................................................11 Member Rights and Responsibilities Member Rights (Patient Bill oB Rights) ............................................................11 Member Responsibilities ...................................................................................15 Your Rights about Your Medical Care (Advance Directive) .........................16 Primary Care Practitioner (PCP) How to Pick Your PCP .......................................................................................16 How to Change Your PCP .................................................................................17 How to Make Appointments .............................................................................17 Member Identi cation (ID) Card .....................................................................18 Choosing a Specialist as a PCP .........................................................................18 IB Your PCP leaves the Program .......................................................................19 How to Get InBormation about Providers .......................................................19 BENEFI&S AND SERVICES Some oB the services that Salud covers ............................................................20 Some oB the services that Salud doesn 9t cover, but are covered by Fee-Bor-Service (FFS) Medicaid ..................................................................20 Services you can get without a reBerral Brom your PCP ................................20 Family Planning Services...................................................................................21 Services Bor Native American Members ..........................................................21 Summary oB Most Common Services and Co-Payments ..............................21 Standard Covered Services ................................................................................23 How to Get a Second Opinion ..........................................................................25 How to Get Hospice Care ..................................................................................25 Behavioral Health Services ..................................................................................26 Table o 1 Contents Additional Bene\x2ts and Services How to Get Dental Care ....................................................................................26 How to Get Vision Care .....................................................................................27 Medicaid Birthing Options Program ...............................................................27 &ransportation Does Salud pay Bor 5ransportation?
.................................................................29 What are I5M 9s Hours oB Operation? ..............................................................29 What is I5M 9s Phone Number? ........................................................................29 How do I Get Routine 5ransportation?
...........................................................30 Will Molina Healthcare pay me to use my own car Bor transportation? .............30 What iB I have been using my car and the day oB my appointment the car breaks down? ...................................................................................30 Does Salud pay Bor housing and Bood?
............................................................31 What iB I need transportation outside oB the State? .......................................31 What iB I have a need Bor urgent or same-day transportation? .....................31 What iB the transportation is a true emergency?
............................................31 What iB my underage child needs to go to a medical appointment and I cannot go? ............................................................................................32 What iB I have a problem with transportation? ..............................................32 Services Req?iring Prior A?thorization (Approval) ..................................32 Service Limitations .............................................................................................33 Services Not Covered (Exclusions) ..................................................................35 Emergency/urgent Services Emergency Care ..................................................................................................37 What to do iB you have an emergency?
............................................................38 Getting Emergency Care While 5raveling ......................................................39 How to Get Services when you are outside oB New Mexico .........................39 Urgent Care .........................................................................................................39 How to Get Services A\x4er Hours .....................................................................40 Contact with you PCP .......................................................................................40 InBormation to take to the Emergency Room .................................................40 What to do iB you have an Emergency need Bor Durable Medical Equipment (DME)? ......................................................................................40 N?rse Advice Line Molina Healthcare 9s 24-Hour 5eleSalud Nurse Advice Line .........................41 Pharmacy Services Filling Prescriptions ...........................................................................................41 Medication Re lls ...............................................................................................42 Questions about Medications ...........................................................................42 Exceptions to Denied Medications ..................................................................42 Individ?als with Special Health Care Needs (ISHCN) How do I know iB My Child or I are Individuals with Special Health Care Needs? ............................................................................................43 ISHCN InBormation Packet ...............................................................................43 ISHCN Educational Programs ..........................................................................44 Choosing a Specialist as a PCP (ISHCN) ........................................................44 Behavioral Health Services Bor Individuals with Special Health Care Needs (ISHCN) ....................................................................................45 How to Arrange Bor 5ransportation Bor Individuals with Special Health Care Needs (ISHCN) .......................................................................45 What to do iB an Individual with Special Health Care Needs has an emergency?
...............................................................................................45 utilization Management In1ormation and Services What is Utilization Management (UM)? .........................................................45 What are Prior Authorizations (approvals) and Specialist ReBerrals? .........46 How to Get PCP, Specialist or Hospital Services ............................................46 Care Coordination/Complex Medical Case Management ............................47 What is Care Coordination?
.............................................................................47 Who needs Care Coordination? .......................................................................48 Goals oB Care Coordinators ..............................................................................48 How do I get Care Coordination? ....................................................................49 When do I call my Care Coordinator?.............................................................49 Te Woman 9s Health & Cancer Rights Act ......................................................49 Health Improvement Services Staying Healthy ...................................................................................................49 Preventive Health Guidelines/Well-Child Health Check ..............................50 Rewards Bor Healthy Choices ............................................................................50 Disease Management Services ..........................................................................51 breathe with ease sm Asthma Program .............................................................51 Healthy Living with Diabetes" ..........................................................................51 motherhood matters sm Program .......................................................................52 Quit For LiBe® 5obacco Cessation Program ....................................................52 Coverage and Eligibility Switching to another Managed Care Organization (MCO) .........................52 Disenrollment Brom SALUD .............................................................................54 Renewing Your Coverage ..................................................................................54 Losing Your Coverage ........................................................................................54 Other Insurance Coverage ................................................................................55 Out-oB-Pocket .....................................................................................................55 Table o 1 Contents Cons?mer Advisory Board ..................................................................................56 On-Line Services ePortal Services ...................................................................................................57 ePortal Registration ............................................................................................57 Privacy and Protected Health In1ormation (PHI) Your Privacy ........................................................................................................58 Why does Molina Healthcare use or share your PHI?
...................................58 When does Molina Healthcare need your written authorization (approval) to use or share your PHI? .........................................................58 What are your privacy rights? ...........................................................................58 How does Molina Healthcare protect your PHI?
...........................................59 What can you do iB you Beel your privacy rights have not