Mi Via: Choosing Self-Direction
NM Aging & Long-term Services Department
NM Dept. of Health
New Mexico Human Services

Publications & Forms

 

Publications

Mi Via Consultant Standards (4/29/11, added 5/3/11)

Mi Via’s New Service Descriptions and Cover Page for New Service Descriptions (4/29/11, added 5/3/11)

Mi Via Critical Incident Reporting Requirements for D&E/CoLTS or Brain Injury (Added 4/8/11)

For Consultant Agency

For Mi Via Contractor/subcontractor

For Mi Via Participant and/or Legal Representative

Mi Via REGULATIONS 8.314.6 Mi Via Home and Community-Based Services Waiver (Added 3/28/11) Effective 4/1/11

FINAL REGISTER – Vol. 34, No.10 Mi Via Home and Community-Based Services Waiver  (Added 3/28/11)

HSD Memorandum MANUAL REVISIONS (3/9/11; Added 3/28/11):
MAD-MR: 11-07 Mi Via Home and Community-Based Services Waiver (8.314.6)
MAD-MR:  11-08 Developmental Disabilities (DD) Waiver Changes to Respite Services (8.314.5)

FINAL REGISTERS: Vol. 33 No. 6 Respite, Environmental Modifications and Emergency Response Services, the corresponding rule 8.314.2 NMAC, & Vol. 33 No. 7, Emergency Response Services/Mi Via and CoLTS Waivers, 8.314.6 NMAC and  8.307.7 NMAC. Effective 5-1-10. www.hsd.state.nm.us/mad/RPolicyManual (Added 4/6/10)

Mi Via Service Standards (Updated 3/27/08; Removed 3/31/11 for revision)

Is It Right for You?
Individuals who are considering Mi Via will want to review the "Is It Right for You" booklet to find out if Mi Via is the right choice.

"Is It Right for You?" in English

"Is It Right for You?" in Spanish

 

Forms

Mi Via Emergency Back-Up Plan Acknowledgement Form (4/25/11, added
4/26/11)

Mi Via Service & Support Plan (4/25/11, added 4/26/11)

Transition to a Different Consultant Agency (11/19/10; Revised 12/21/10; Final 1-11-11; Added 1/25/11)

This defines the process if you want to choose another Consultant Agency.

Letter of Records Transfer to new consultant agency (12/21/10; Final 1-11-11; Added 1/25/11)

New 2-week Timesheet (11/18/10; posted 12/14/10)

ACS Toolkit for completing timesheets (11/22/10; posted 12/14/10)

Range of Rates and Codes (Revised 7/1/10, updated 11/10/10 added 11/29/10)

effective 10/25/10

Payment Request Form (Revised 8/16/10, added 10/27/10)

Mi Via Explanation Letter to Vendors for Mi Via Goods and Services (3/27/08; Updated and Added 8/26/10)

New ACS Letter to participants, new paycheck/payment style (Added 6/21/10)

Request for Services by Legally Responsible Individuals - Revised Form (Revised 12/2/10; Added 1/24/11)

Under some circumstances, a Legally Responsible Individual (biological or adoptive parent of a child under age 18 or spouse of an adult participant) may request to provide and be paid for services for their child or spouse. Participants may use the Request for Services by Legally Responsible Individuals form to make that request. The form must be submitted with the Service & Support Plan.

Brain Injury Checklist, Financial Eligibility (Updated 8/25/2008)
Individuals with a brain injury may be eligible to apply for the Mi Via Self-Directed Waiver. The Brain Injury Checklist guides individuals through the process of determining financial eligibility.

Brain Injury Checklist, Medical Eligibility (Updated 7/09)
Individuals with a brain injury may be eligible to apply for the Mi Via Self-Directed Waiver. This checklist guides individuals through the process of determining medical eligibility.

Mi Via Coverage Review Criteria (Added 1/4/10)

Mi Via Service and Support Plan and Budget Coverage Review Criteria - Effective 12/11/09