New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 321 - SPECIALIZED BEHAVIORAL HEALTH SERVICES › Part 2 - SPECIALIZED BEHAVIORAL HEALTH PROVIDER ENROLLMENT AND REIMBURSEMENT › Section 8.321.2.37 - TREATMENT FOSTER CARE I and II

Current through Register Vol. 35, No. 13, July 16, 2024
MAD pays for medically necessary services furnished to an
				  eligible recipient under 21 years of age who has an identified need for
				  treatment foster care (TFC) and meets the TFC I or TFC II level of care (LOC)
				  as part of the EPSDT program. MAD covers those services included in the
				  eligible recipient's individualized treatment plan which is designed to help
				  him or her develop skills necessary for successful reintegration into his or
				  her family or transition back into the community. TFC I agency provides
				  therapeutic services to an eligible recipient who is experiencing emotional or
				  psychological trauma and who would optimally benefit from the services and
				  supervision provided in a TFC I setting. The TFC II agency provides therapeutic
				  family living experiences as the core treatment service to which other
				  individualized services can be added. The need for TFC I and II services must
				  be identified in the tot to teen health check or other diagnostic evaluation
				  furnished through the eligible recipient's health check referral.
A.
Eligible agencies:
In
				addition to the requirements of Subsections A and B of
				8.321.2.9 NMAC, in order to be
				eligible to be reimbursed for providing TFC services to an eligible recipient,
				the agency must be a CYFD certified TFC agency and be licensed as a child
				placement agency by CYFD protective services. In lieu of New Mexico CYFD
				licensure and certification, an out-of-state TFC agency must have equivalent
				accreditation and be licensed in its own state as a TFC agency.
B.
Coverage criteria:
(1) The treatment foster care agency provides
				intensive support, technical assistance, and supervision of all treatment
				foster parents.
(2) A TFC I and II
				parent is either employed or contracted by the TFC agency and receives
				appropriate training and supervision by the TFC agency.
(3) Placement does not occur until after a
				comprehensive assessment of how the prospective treatment foster family can
				meet the recipient's needs and preferences, and a documented determination by
				the agency that the prospective placement is a reasonable match for the
				recipient.
(4) An initial treatment
				plan must be developed within 72 hours of admission and a comprehensive
				treatment plan must be developed within 14 calendar days of the eligible
				recipient's admission to a TFC I or II program. See the BH policy and billing
				manual for the specific requirements of a TFC treatment plan.
(5) The treatment team must review the
				treatment plan every 30 calendar days.
(6) TFC families must have one parent readily
				accessible at all times, cannot schedule work when the eligible recipient is
				normally at home, and is able to be physically present to meet the eligible
				recipient's emotional and behavioral needs.
(7) In the event the treatment foster parents
				request a treatment foster recipient be removed from their home, a treatment
				team meeting must be held and an agreement made that a move is in the best
				interest of the involved recipient. Any treatment foster parent(s) who demands
				removal of a treatment foster recipient from his or her home without first
				discussing with and obtaining consensus of the treatment team, may have their
				license revoked.
(8) A recipient
				eligible for treatment foster care services, level I or II, may change
				treatment foster homes only under the following circumstances:
(a) an effort is being made to reunite
				siblings; or
(b) a change of
				treatment foster home is clinically indicated, as documented in the client's
				record by the treatment team.