reglab/statecodes huggingface dataset:
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 321 - SPECIALIZED BEHAVIORAL HEALTH SERVICES › Part 2 - SPECIALIZED BEHAVIORAL HEALTH PROVIDER ENROLLMENT AND REIMBURSEMENT › Section 8.321.2.10 - ADULT ACCREDITED RESIDENTIAL TREATMENT CENTER (AARTC) FOR ADULTS WITH SUBSTANCE USE DISORDERS

Current through Register Vol. 35, No. 13, July 16, 2024
To help an eligible recipient 18 years of age and older, who
				  has been diagnosed as having a substance use disorder (SUD), and the need for
				  AARTC has been identified in the eligible recipient's diagnostic evaluation as
				  meeting criteria of the American society of addiction medicine (ASAM) level of
				  care three for whom a less restrictive setting is not appropriate, MAD pays for
				  services furnished to him or her by an AARTC accredited by the joint commission
				  (JC), the commission on accreditation of rehabilitation facilities (CARF) or
				  the council on accreditation (COA).
A.
Eligible facilities:
(1) To be
				eligible to be reimbursed for providing AARTC services to an eligible
				recipient, an AARTC facility:
(a) must be
				accredited by JC, COA, or CARF as an adult (18 and older) residential treatment
				facility;
(b) must be certified
				through an application process with the behavioral health services division
				which includes a supervisory certificate (see BH policy and billing manual for
				details on the supervisory certificate);
(c) must have written policies and procedures
				specifying ASAM level of care three criteria as the basis for accepting
				eligible recipients into the sub-level treatment program;
(d) must meet ASAM treatment service
				requirements for the ASAM level of care three recipients it admits into each
				sub-level of care;
(e) must provide
				medication assisted treatment (MAT) for SUD, as indicated; and
(f) all practitioners shall be trained in
				ASAM principles and levels of care.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 321 - SPECIALIZED BEHAVIORAL HEALTH SERVICES › Part 2 - SPECIALIZED BEHAVIORAL HEALTH PROVIDER ENROLLMENT AND REIMBURSEMENT › Section 8.321.2.11 - ACCREDITED RESIDENTIAL TREATMENT CENTER (ARTC) FOR YOUTH

Current through Register Vol. 35, No. 13, July 16, 2024
To help an eligible recipient under 21 years of age when the
				  need for ARTC has been identified in the eligible recipient's tot to teen
				  health check screen (EPSDT) program (42 CFR section
				  441.57) or other diagnostic evaluation, and
				  for whom a less restrictive setting is not appropriate, MAD pays for services
				  furnished to him or her by an ARTC accredited by the joint commission (JC), the
				  commission on accreditation of rehabilitation facilities (CARF) or the council
				  on accreditation (COA). A determination must be made that the eligible
				  recipient needs the level of care (LOC) for services furnished in an ARTC. This
				  determination must have considered all environments which are least
				  restrictive, meaning a supervised community placement, preferably a placement
				  with the juvenile's parent, guardian or relative. A facility or conditions of
				  treatment that is a residential or institutional placement should only be
				  utilized as a last resort based on the best interest of the juvenile or for
				  reasons of public safety.
A.
Eligible facilities:
(1) 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 ARTC services to
				an eligible recipient, an ARTC facility:
(a)
				must provide a copy of its JC, COA, or CARF accreditation as a children's
				residential treatment facility;
(b)
				must provide a copy of its CYFD ARTC facility license and certification;
				and
(c) must have written
				utilization review (UR) plans in effect which provide for review of the
				eligible recipient's need for the ARTC that meet federal requirements; see
				42 CFR
				Section 456.201 through
				456.245;
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 321 - SPECIALIZED BEHAVIORAL HEALTH SERVICES › Part 2 - SPECIALIZED BEHAVIORAL HEALTH PROVIDER ENROLLMENT AND REIMBURSEMENT › Section 8.321.2.12 - APPLIED BEHAVIOR ANALYSIS (ABA)

Current through Register Vol. 35, No. 13, July 16, 2024
MAD pays for medically necessary, empirically supported,
				  applied behavior analysis (ABA) services for eligible recipients who have a
				  well-documented medical diagnosis of autism spectrum disorder (ASD), and for
				  eligible recipients who have well-documented risk for the development of ASD.
				  As part of a three-stage comprehensive approach consisting of evaluation,
				  assessment, and treatment, ABA services may be provided in coordination with
				  other medically necessary services (e.g., family infant toddler program (FIT)
				  services, occupational therapy, speech language therapy, medication management,
				  developmentally disabled waiver services, etc.). ABA services are part of the
				  early periodic screening, diagnosis and treatment (EPSDT) program (CFR 42
				  section 441.57). There is no age requirement to receive ABA services and ABA is
				  a covered benefit for medicaid-enrolled adults.
A.
Coverage Criteria:
(1) Confirmation of the presence or risk of
				ASD must occur through an approved autism evaluation provider (AEP) through a
				comprehensive diagnostic evaluation (CDE) used to determine the presence of and
				a diagnosis of ASD. A targeted evaluation is used when the eligible recipient
				who has a full diagnosis of ASD presents with behaviors that are changed from
				the last CDE. An ASD risk evaluation is used when an eligible recipient meets
				the at-risk criteria found in Subsection C of 8.321.2.12 NMAC.
(2) An integrated service plan (ISP) must be
				developed by the AEP together with a referral to an approved ABA provider (AP)
				agency (stage one).
(3) The AP
				agency completes a behavior or functional analytic assessment. The assessment
				results determine if a focused or comprehensive model is selected and a
				treatment plan is completed (stage two).
(4) ABA stage two and three services are then
				rendered by a behavior analyst certification board (BACB) approved behavior
				analyst (BA), a board certified assistant behavior analyst (BCaBA) or a
				behavior technician (BT), in accordance with the treatment plan (stage three).
				A BCaBA is referred to 8.321.2 NMAC as a behavior analyst assistant
				(BAA).
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 321 - SPECIALIZED BEHAVIORAL HEALTH SERVICES › Part 2 - SPECIALIZED BEHAVIORAL HEALTH PROVIDER ENROLLMENT AND REIMBURSEMENT › Section 8.321.2.15 - BEHAVIORAL HEALTH RESPITE CARE (Managed Care Organization (MCO))

Current through Register Vol. 35, No. 13, July 16, 2024
As part of centennial care's comprehensive service system,
				  behavioral health (BH) respite service is for short-term direct care and
				  supervision of the eligible recipient in order to afford the parent(s) or
				  caregiver a respite for their care of the recipient and takes place in the
				  recipient's home or another setting. See Subsections A and B of
				  8.321.2.9
				  NMAC for MAD general provider requirements.
A.
Eligible practitioners:
(1) Supervisor:
(a) bachelor's degree and three years'
				experience working with the target population;
(b) supervision activities include a minimum
				of two hours per month individual supervision covering administrative and case
				specific issues, and two additional hours per month of continuing education in
				behavioral health respite care issues, or annualized respite provider
				training;
(c) access to on call
				crisis support available 24-hours a day; and
(d) supervision by licensed practitioners
				must be in accordance with their respective licensing board
				regulations.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 321 - SPECIALIZED BEHAVIORAL HEALTH SERVICES › Part 2 - SPECIALIZED BEHAVIORAL HEALTH PROVIDER ENROLLMENT AND REIMBURSEMENT › Section 8.321.2.17 - COGNITIVE ENHANCEMENT THERAPY (CET)

Current through Register Vol. 35, No. 13, July 16, 2024
CET services provide treatment service for an eligible
				  recipient 18 years of age or older with cognitive impairment associated with
				  the following serious mental illnesses: schizophrenia, bipolar disorder, major
				  depression, recurrent schizoaffective disorder, or autism spectrum disorder.
				  CET uses an evidence-based model to help eligible recipients with these
				  conditions improve their processing speed, cognition, and social cognition. Any
				  CET program must be approved by the behavioral health services division (BHSD)
				  and ensure that treatment is delivered with fidelity to the evidence-based
				  model.
A.
Eligible providers:
Services may only be delivered through a MAD approved agency after
				demonstrating that the agency meets all the requirements of CET program
				services and supervision. See Subsections A and B of
				8.321.2.9
				NMAC for MAD general provider requirements.
(1) CET services are provided through an
				integrated interdisciplinary approach by staff with expertise in the mental
				health condition being addressed and have received training from a state
				approved trainer. Staff can include independently licensed behavioral health
				practitioners, non-independently licensed behavioral health practitioners, RNs,
				or CSWs. For every CET cohort of eligible recipients, there must be two
				practitioners who have been certified in the evidence-based practice by a state
				approved trainer or training center. The agency shall retain documentation of
				the staff that has been trained. The size of each cohort who receives CET must
				conform to the evidence-based practice (EBP) model in use.
(2) The agency must hold an approval letter
				issued by BHSD certifying that the staff have participated in an approved
				training or have arranged to participate in training and have supervision by an
				approved trainer prior to commencing services.
(3) Weekly required participation in hourly
				fidelity monitoring sessions with a certified CET trainer for all providers
				delivering CET who have not yet received certification.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 321 - SPECIALIZED BEHAVIORAL HEALTH SERVICES › Part 2 - SPECIALIZED BEHAVIORAL HEALTH PROVIDER ENROLLMENT AND REIMBURSEMENT › Section 8.321.2.19 - CRISIS INTERVENTION SERVICES

Current through Register Vol. 35, No. 13, July 16, 2024
MAD pays for community-based crisis intervention services
				  which are immediate, crisis oriented services designed to ameliorate or
				  minimize an acute crisis episode or to prevent inpatient psychiatric
				  hospitalization or medical detoxification. Services are provided to eligible
				  recipients who have suffered a breakdown of their normal strategies or
				  resources and who exhibit acute problems or disturbed thoughts, behaviors, or
				  moods which could threaten the safety of self or others. MAD covers four types
				  of crisis services: telephone crisis services; face-to-face crisis intervention
				  in a clinic setting; mobile crisis services; and outpatient crisis
				  stabilization services.
A.
Coverage criteria:
(1)
Telephone crisis services:
(a) Must
				provide 24-hour, seven day-a-week telephone services to eligible recipients
				that are in crisis and to callers who represent or seek assistance for persons
				in a mental health crisis;
(b) The
				establishment of a toll-free number dedicated to crisis calls for the
				identified service area;
(c)
				Assurance that a backup crisis telephone system is available if the toll-free
				number is not accessible;
(d)
				Assurance that calls are answered by a person trained in crisis response as
				described in the BH policy and billing manual;
(e) Processes to screen calls, evaluate
				crisis situation, and provide counseling and consultation to crisis callers are
				documented and implemented;
(f)
				Assurance that face-to-face intervention services are available immediately if
				clinically indicated either by the telephone service or through memorandums of
				understanding with referral sources;
(g) Provision of a toll-free number to active
				clients and their support; and
(h)
				A crisis log documenting each phone call must be maintained and include:
(i) date, time and duration of
				call;
(ii) name of individual
				calling;
(iii) responder handling
				call;
(iv) description of crisis;
				and
(v) intervention provided,
				(e.g. counseling, consultation, referral, etc.).
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 321 - SPECIALIZED BEHAVIORAL HEALTH SERVICES › Part 2 - SPECIALIZED BEHAVIORAL HEALTH PROVIDER ENROLLMENT AND REIMBURSEMENT › Section 8.321.2.21 - DAY TREATMENT

Current through Register Vol. 35, No. 13, July 16, 2024
MAD pays for services provided by a day treatment provider
				  as part of the EPSDT program for eligible recipients under 21 years of age
				  (42 CFR section
				  441.57) . The need for day treatment services
				  (DTS) must be identified through an EPSDT tot to teen health check or other
				  diagnostic evaluation. Day treatment services include eligible recipient and
				  parent education, skill and socialization training that focus on the
				  amelioration of functional and behavioral deficits. Intensive coordination and
				  linkage with the eligible recipient's school or other child serving agencies is
				  included. The goals of the service must be clearly documented utilizing a
				  clinical model for service delivery and support.
A.
Eligible providers:
An
				agency must be certified by CYFD to provide day treatment services in addition
				to meeting the general provider enrollment requirements in Subsections A and B
				of
				8.321.2.9
				NMAC.
B.
Coverage
				criteria:
(1) Day treatment services
				must be provided in a school setting or other community setting; however, there
				must be a distinct separation between these services in staffing, program
				description and physical space from other behavioral health services
				offered.
(2) A family who is unable
				to attend the regularly scheduled sessions at the day treatment facility due to
				transportation difficulties or other reasons may receive individual family
				sessions scheduled in the family's home by the day treatment agency.
(3) Services must be based upon the eligible
				recipient's individualized treatment plan goals and should include
				interventions with a significant member of the family which are designed to
				enhance the eligible recipients' adaptive functioning in their home and
				community.
(4) The certified DTS
				provider delivers adequate care and continuous supervision of the client at all
				times during the course of the client's DTS program participation.
(5) 24-hour availability of appropriate staff
				or implementation of crisis plan (which may include referral) to respond to the
				eligible recipient's crisis situation.
(6) Only those activities of daily living and
				basic life skills that are assessed as a clinical problem should be addressed
				in the treatment plans and deemed appropriate to be included in the eligible
				recipient's individualized program.
(7) Day treatment services are provided at a
				minimum of four hours of structured programming per day, two to five days per
				week based on acuity and clinical needs of the eligible recipient and his or
				her family as identified in the treatment plan.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 321 - SPECIALIZED BEHAVIORAL HEALTH SERVICES › Part 2 - SPECIALIZED BEHAVIORAL HEALTH PROVIDER ENROLLMENT AND REIMBURSEMENT › Section 8.321.2.22 - FAMILY SUPPORT SERVICES (FSS) (MCO reimbursed only)

Current through Register Vol. 35, No. 13, July 16, 2024
Family support services are community-based, face-to-face
				  interactions with children, youth or adults and their family, available to
				  managed care members only. Family support services enhance the member family's
				  strengths, capacities, and resources to promote the member's ability to reach
				  the recovery and resiliency behavioral health goals they consider most
				  important. See Subsections A and B of
				  8.321.2.9
				  NMAC for MAD general provider requirements.
A.
Eligible providers:
(1) Family support service providers and
				staff shall meet standards established by the state of NM and documented in the
				New Mexico BH policy and billing manual.
(2) Family support service staff and
				supervision by licensed behavioral health practitioners must be in accordance
				with their respective licensing board regulations or credentialing standards
				for peer support workers or family peer support workers.
(3) Minimum staff qualifications for peer
				support workers or family peer support workers includes maintenance of
				credentials as a peer support worker or family peer support worker in New
				Mexico.
(4) Minimum staff
				qualifications for the clinical supervisor:
(a) Must be a licensed independent
				practitioner (i.e., psychiatrist, psychologist, LISW, LPCC, LMFT, or
				psychiatrically certified nurse practitioner) practicing under the scope of
				their NM licensure;
(b) Have four
				years' relevant experience in the delivery of case management or comprehensive
				community support services or family support services with the target
				population;
(c) Have one year
				demonstrated supervisory experience; and
(d) Have completed both basic and supervisory
				training regarding family support services.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 321 - SPECIALIZED BEHAVIORAL HEALTH SERVICES › Part 2 - SPECIALIZED BEHAVIORAL HEALTH PROVIDER ENROLLMENT AND REIMBURSEMENT › Section 8.321.2.23 - INPATIENT PSYCHIATRIC CARE IN FREESTANDING PSYCHIATRIC HOSPITALS AND PSYCHIATRIC UNITS OF ACUTE CARE HOSPITALS

Current through Register Vol. 35, No. 13, July 16, 2024
To assist the eligible recipient in receiving necessary
				  mental health services, MAD pays for inpatient psychiatric care furnished in
				  freestanding psychiatric hospitals as part of the EPSDT program (42 CFR
				  441.57) . A freestanding psychiatric hospital
				  (an inpatient facility that is not a unit in a general acute care hospital),
				  with more than 16 beds is an institution for mental disease (IMD) subject to
				  the federal medicaid IMD exclusion that prohibits medicaid payment for
				  inpatient stays for eligible recipients aged 22 through 64 years. Coverage of
				  stays in a freestanding psychiatric hospital that is considered an IMD are
				  covered only for eligible recipients up to age 21 and over age 64. A managed
				  care organization making payment to an IMD as an in lieu of service may pay for
				  stays that do not exceed 15 days. For stays in an IMD that include a substance
				  use disorder (SUD) refer to
				  8.321.2.24
				  NMAC,
Institution for Mental Diseases (IMD)
. However, for
				  freestanding psychiatric hospitals, if the eligible recipient who is receiving
				  inpatient services reaches the age of 21 years, services may continue until one
				  of the following conditions is reached: until the date the eligible recipient
				  no longer requires the services, or until the date the eligible recipient
				  reaches the age of 22 years, whichever occurs first. The need for inpatient
				  psychiatric care in a freestanding psychiatric hospital must be identified in
				  the eligible recipient's tot to teen health check screen or another diagnostic
				  evaluation furnished through a health check referral. Inpatient stays for
				  eligible recipients in an inpatient psychiatric unit of a general acute care
				  hospital are also covered. As these institutions are not considered to be IMDs,
				  there are no age exclusions for their services.
A.
Eligible providers:
A MAD
				eligible provider must be licensed and certified by the New Mexico DOH (or the
				comparable agency if in another state), comply with
				42 CFR
				456.201 through
				456.245;
				and be accredited by at least one of the following:
(1) the joint commission (JC);
(2) the council on accreditation of services
				for families and children (COA);
(3) the commission on accreditation of
				rehabilitation facilities (CARF); or
(4) another accrediting organization
				recognized by MAD as having comparable standards; and
(5) be an approved MAD provider before it
				furnishes services, see
				42 CFR
				Sections 456.201 through
				456.245.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 321 - SPECIALIZED BEHAVIORAL HEALTH SERVICES › Part 2 - SPECIALIZED BEHAVIORAL HEALTH PROVIDER ENROLLMENT AND REIMBURSEMENT › Section 8.321.2.24 - INSTITUTION FOR MENTAL DISEASES (IMD) FOR SUBSTANCE ABUSE

Current through Register Vol. 35, No. 13, July 16, 2024
IMD is defined as any facility with more than 16 beds that is
				  primarily engaged in the delivery of psychiatric care or treating substance use
				  disorders (SUD) that is not part of a certified general acute care hospital.
				  The federal medicaid IMD exclusion generally prohibits payment to these
				  providers for recipients aged 22 through 64. Based upon a New Mexico state plan
				  amendment and 1115 waiver MAD covers inpatient hospitalization in an IMD for
				  SUD diagnoses only with criteria for medical necessity and based on ASAM
				  admission criteria. The coverage may also include co-occurring behavioral
				  health disorders with the primary SUD. For other approved IMD stays for
				  eligible recipients under age 21 or over age 64, the number of days is
				  determined by medical necessity as the age restriction for IMDs does not apply
				  to ages under 21 or over 65. Also refer to
				  8.321.2.23
				  NMAC,
Inpatient Psychiatric Care in Freestanding Psychiatric Hospitals
				  and Psychiatric Units of Acute Care Hospitals
.
A.
Eligible recipients:
Adolescents and adults with a mental health or substance use disorder or
				co-occurring mental health and SUD.
B.
Covered services:
Withdrawal
				management (detoxification) and rehabilitation.
C.
Prior authorization
is
				required. Utilize the substance abuse and mental health services administration
				(SAMHSA) admission criteria for medical necessity.
D.
Reimbursement:
An IMD is
				reimbursed according to the provisions in Subsection E of
				8.321.2.23
				NMAC.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 321 - SPECIALIZED BEHAVIORAL HEALTH SERVICES › Part 2 - SPECIALIZED BEHAVIORAL HEALTH PROVIDER ENROLLMENT AND REIMBURSEMENT › Section 8.321.2.25 - INTENSIVE OUTPATIENT PROGRAM FOR SUBSTANCE USE DISORDERS (IOP)

Current through Register Vol. 35, No. 13, July 16, 2024
MAD pays for time-limited IOP services utilizing a
				  multi-faceted approach to treatment for an eligible recipient who requires
				  structure and support to achieve and sustain recovery. IOP must utilize a
				  research and evidence-based model approved by the IOP interdepartmental
				  council, and target specific behaviors with individualized behavioral
				  interventions.
A.
Eligible
				providers:
Services may only be delivered through a MAD approved agency
				after demonstrating that the agency meets all the requirements of IOP program
				services and supervision. See Subsections A and B of
				8.321.2.9
				NMAC for MAD general provider requirements.
(1) IOP services are provided through an
				integrated interdisciplinary approach including staff expertise in both
				addiction and mental health treatment. This team may have services rendered by
				non-independent practitioners under the direction of the IOP supervisor
				including LMSW, LMHC, LADAC, CADC, LSAA, and a master's level psych
				associates.
(2) Each IOP program
				must have a clinical supervisor. Both clinical services and supervision by
				licensed practitioners must be conducted in accordance with respective
				licensing board regulations. An IOP clinical supervisor must meet all the
				following requirements:
(a) be licensed as a
				MAD approved independent practitioner; see Subsection C of
				8.321.2.9
				NMAC;
(b) have two years relevant
				experience with an IOP program or approved exception by the interdepartmental
				council;
(c) have one year
				demonstrated supervisory experience; and
(d) have expertise in both mental health and
				substance abuse treatment.
(3) The IOP agency is required to develop and
				implement a program outcome evaluation system.
(4) The agency must maintain the appropriate
				state facility licensure if offering medication treatment or medication
				replacement services.
(5) The
				agency must hold an IOP interdepartmental council approval letter and be
				enrolled by MAD to render IOP services to an eligible recipient. In the
				application process each IOP must identify if it is a youth program, an adult
				program, a transitional age program, or multiple programs. Transitional age
				programs must specify the age range of the target population. A MAD IOP agency
				will be provisionally approved for a specified timeframe to render IOP services
				to an eligible recipient. During this provisionally approved time, MAD or its
				designee will determine if the IOP meets MAD IOP requirements and if so, the
				agency will receive an approval letter for IOP full enrollment.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 321 - SPECIALIZED BEHAVIORAL HEALTH SERVICES › Part 2 - SPECIALIZED BEHAVIORAL HEALTH PROVIDER ENROLLMENT AND REIMBURSEMENT › Section 8.321.2.26 - INTENSIVE OUTPATIENT PROGRAM FOR MENTAL HEALTH CONDITIONS (IOP)

Current through Register Vol. 35, No. 13, July 16, 2024
MAD pays for IOP services which provide a time-limited,
				  multi-faceted approach to treatment for an eligible recipient with a SMI or SED
				  including an eating disorder or borderline personality disorder who requires
				  structure and support to achieve and sustain recovery. IOP must utilize a
				  research and evidence-based model approved by the IOP interdepartmental
				  council, and target specific behaviors with individualized behavioral
				  interventions. The effective date will be January 1, 2019, or as otherwise
				  approved by the centers for medicare and medicaid services (CMS).
A.
Eligible providers:
Services
				may only be delivered through an agency approved by HSD and CYFD after
				demonstrating that the agency meets all the requirements of IOP program
				services and supervision. See Subsections A and B of
				8.321.2.9
				NMAC for MAD general provider requirements.
(1) IOP services are provided through an
				integrated interdisciplinary approach by staff with expertise in the mental
				health condition being addressed. This team may have services rendered by
				non-independent practitioners under the direction of the IOP supervisor
				including LMSW, LMHC, a master's level psych associates, RNs or registered
				dieticians.
(2) Each IOP program
				must have a clinical supervisor. Both clinical services and supervision by
				licensed practitioners must be conducted in accordance with respective
				licensing board regulations. An IOP clinical supervisor must meet all of the
				following requirements:
(a) be licensed as a
				MAD approved independent practitioner; see Subsection C of
				8.321.2.9
				NMAC;
(b) have two years relevant
				experience in providing the evidence-based model to be delivered; and
(c) have one year demonstrated supervisory
				experience.
(3) The IOP
				agency is required to develop and implement a program outcome evaluation
				system.
(4) The agency must
				maintain the appropriate state facility licensure if offering medication
				treatment.
(5) The agency must hold
				an IOP approval letter and be enrolled by MAD to render IOP services to an
				eligible recipient. In the application process each IOP must identify if it is
				a youth program, an adult program, a transitional age program, or multiple
				programs. Transitional age programs must specify the age range of the target
				population. A MAD IOP agency will be provisionally approved for a specified
				timeframe to render IOP services to an eligible recipient. During this
				provisionally approved time, MAD or its designee will determine if the IOP
				meets MAD IOP requirements and if so, the agency will receive an approval
				letter for IOP full enrollment.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 321 - SPECIALIZED BEHAVIORAL HEALTH SERVICES › Part 2 - SPECIALIZED BEHAVIORAL HEALTH PROVIDER ENROLLMENT AND REIMBURSEMENT › Section 8.321.2.27 - MEDICATION ASSISTED TREATMENT (MAT): BUPRENORPHINE TREATMENT FOR OPIOID USE DISORDER

Current through Register Vol. 35, No. 13, July 16, 2024
MAD pays for coverage for medication assisted treatment (MAT)
				  for opioid use disorder to an eligible recipient as defined in the Drug
				  Addiction Treatment Act of 2000 (DATA 2000), the Comprehensive Addiction and
				  Recovery Act of 2016 (CARA), and the Substance Use Disorder Prevention that
				  Promotes Opioid Recovery and Treatment for Patients and Communities Act of 2018
				  (SUPPORT Act). Services include, but are not limited to, the administration of
				  opioid replacement medication (excluding methadone) to an eligible recipient
				  for detoxification from opioids or maintenance treatment. See Subsections A and
				  B of
				  8.321.2.9
				  NMAC for MAD general provider requirements.
A.
Eligible providers and
				practitioners:
(1) Any clinic, office,
				or hospital staffed by required practitioners.
(2) Practitioners for diagnosing, assessment,
				and prescribing include:
(a) a physician or DO
				licensed in the state of New Mexico that has board certification in addiction
				medicine or addiction psychiatry or has completed special training and has the
				federal waiver to prescribe buprenorphine;
(b) a certified nurse practitioner that has
				completed 24 hours of required training and has a DATA 2000 waiver;
				or
(c) a physician assistant
				licensed in the state of New Mexico and has the federal DATA 2000 waiver to
				prescribe buprenorphine.
(3) Practitioners for administration and
				education:
(a) a registered nurse licensed in
				the state of New Mexico; or
(b) a
				physician assistant licensed in the state of New Mexico.
(4) Practitioners for counseling and
				education may include behavioral health practitioners licensed for counseling
				or therapy.
(5) Practitioners for
				skills and education include certified peer support workers or certified family
				peer support workers to provide skill-building, recovery and resiliency
				support.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 321 - SPECIALIZED BEHAVIORAL HEALTH SERVICES › Part 2 - SPECIALIZED BEHAVIORAL HEALTH PROVIDER ENROLLMENT AND REIMBURSEMENT › Section 8.321.2.28 - MULTI-SYSTEMIC THERAPY (MST)

Current through Register Vol. 35, No. 13, July 16, 2024
To help an eligible recipient 10 up to 18 years of age
				  receive behavioral health services to either remain in or re-enter his or her
				  home and community, MAD pays for MST services as part of EPSDT program
				  (42 CFR
				  441.57) . MAD covers medically necessary MST
				  services required by the condition of the eligible recipient. MST provides
				  intensive home, family and community-based treatment for an eligible recipient
				  10 to 18 years of age who is at risk of out-of-home placement or is returning
				  home from an out-of-home placement. The need for MST services must be
				  identified in the eligible recipient's tot to teen health check screen or
				  another diagnostic evaluation.
A.
Eligible providers:
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 MST services, an
				agency must hold a copy of MST Inc licensure, or any of its approved
				subsidiaries. MST Inc is a national organization located in Mt. Pleasant, South
				Carolina, and is deemed by MAD to be the primary authority on licensure of New
				Mexico MST programs.
(1) The MST program
				includes an assigned MST team for each eligible recipient. The MST team must
				include at minimum:
(a) master's level
				independently licensed behavioral health professional clinical supervision; see
				Subsection H of
				8.321.2.9
				NMAC;
(b) licensed master's and
				bachelor's level behavioral health staff able to provide 24-hour coverage,
				seven days a week; see Subsection E of
				8.321.2.9
				NMAC;
(c) a licensed master's level
				behavioral health practitioner that is required to perform all MST
				interventions; a bachelor's level behavioral health practitioner is limited to
				performing functions defined within the scope of his or her RLD practice board
				licensure or practice (see Subsection E of
				8.321.2.9
				NMAC;
(d) bachelor's level staff
				that has a degree in social work, counseling, psychology or a related human
				services field and must have at least three years' experience working with the
				identified population of children, adolescents and their families;
				and
(e) staffing for MST services
				is comprised of no more than one-third bachelor's level staff and, at minimum,
				two-thirds licensed master's level staff.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 321 - SPECIALIZED BEHAVIORAL HEALTH SERVICES › Part 2 - SPECIALIZED BEHAVIORAL HEALTH PROVIDER ENROLLMENT AND REIMBURSEMENT › Section 8.321.2.29 - NON-ACCREDITED RESIDENTIAL TREATMENT CENTERS (RTC) AND GROUP HOMES

Current through Register Vol. 35, No. 13, July 16, 2024
MAD pays for medically necessary services for an eligible
				  recipient under 21 years of age which are designed to develop skills necessary
				  for successful reintegration into his or her family or transition into his or
				  her community. A determination must be made that the eligible recipient needs
				  the level of care (LOC) for services furnished in a RTC or group home. This
				  determination must have considered all environments which are least
				  restrictive, meaning a supervised community placement, preferably a placement
				  with the juvenile's parent, guardian or relative. A facility or conditions of
				  treatment that is a residential or institutional placement should only be
				  utilized as a last resort based on the best interest of the juvenile or for
				  reasons of public safety. Residential services must be rehabilitative and
				  provide access to necessary treatment services in a therapeutic environment.
				  MAD pays for services furnished in a RTC or group home as part of EPSDT program
				  (42 CFR
				  441.57) . The need for RTC and group home
				  services must be identified in the eligible recipient's tot to teen health
				  check screen or other diagnostic evaluation furnished through a health check
				  referral.
A.
Eligible
				providers:
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 RTC or group home
				services to an eligible recipient, an agency must meet the following
				requirements:
(1) a RTC must be certified by
				the children, youth and families department (CYFD) see 7.20.12 NMAC;
(2) a group home must be certified and
				licensed by CYFD;
(3) if the RTC is
				operated by IHS or by a federally recognized tribal government, the facility
				must meet CYFD RTC licensing and certification requirements but is not required
				to be licensed or certified by CYFD. In lieu of receiving a license and
				certification, CYFD provides MAD copies of its facility findings and
				recommendations. MAD will work with the facility to address recommendations.
				The BH policy and billing manual provides guidance for addressing the facility
				findings and recommendations.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 321 - SPECIALIZED BEHAVIORAL HEALTH SERVICES › Part 2 - SPECIALIZED BEHAVIORAL HEALTH PROVIDER ENROLLMENT AND REIMBURSEMENT › Section 8.321.2.30 - OPIOID TREATMENT PROGRAM (OTP)

Current through Register Vol. 35, No. 13, July 16, 2024
MAD pays for coverage for medication assisted treatment for
				  opioid addiction to an eligible recipient through an opioid treatment center as
				  defined in (42 CFR Part 8), certification of opioid treatment programs (OTP).
				  Services include, but are not limited to, the administration of methadone
				  (opioid replacement medication) to an individual for detoxification from
				  opioids and maintenance treatment. The administration/supervision must be
				  delivered in conjunction with the overall treatment based upon a treatment
				  plan, which must include counseling/therapy, case review, drug testing, and
				  medication monitoring. See Subsections A and B of
				  8.321.2.9
				  NMAC for MAD general provider requirements.
A.
Eligible providers and
				practitioners:
(1) Provider
				requirements:
(a) Accreditation with a
				substance abuse and mental health services administration (SAMHSA)/CSAT
				approved nationally recognized accreditation body, (e.g., commission on
				accreditation of rehabilitation facilities (CARF), joint commission (JC) or
				council on accreditation of services for families and children (COA).
(b) Behavioral health services division
				(BHSD) approval. As a condition of approval to operate an OTP, the OTP must
				maintain above accreditation. In the event that such accreditation lapses, or
				approval of an application for accreditation becomes doubtful, or continued
				accreditation is subject to any formal or alleged finding of need for
				improvement, the OTP program will notify the BHSD within two business days of
				such event. The OTP program will furnish the BHSD with all information related
				to its accreditation status, or the status of its application for
				accreditation, upon request.
(c)
				The BHSD shall grant approval or provisional approval to operate pending
				accreditation, provided that all other requirements of these regulations are
				met.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 321 - SPECIALIZED BEHAVIORAL HEALTH SERVICES › Part 2 - SPECIALIZED BEHAVIORAL HEALTH PROVIDER ENROLLMENT AND REIMBURSEMENT › Section 8.321.2.31 - PARTIAL HOSPITALIZATION SERVICES

Current through Register Vol. 35, No. 13, July 16, 2024
To help an eligible recipient receive the level of services
				  needed, MAD pays for partial hospitalization services furnished by an acute
				  care or freestanding psychiatric hospital. Partial Hospitalization Programs
				  (PHP) are structured to provide intensive psychiatric care through active
				  treatment that utilizes a combination of clinical services. They are designed
				  to stabilize deteriorating conditions or avert inpatient admissions, or can be
				  a step-down strategy for individuals with SMI, SUD or SED who have required
				  inpatient admission. The environment is highly structured, is time-limited and
				  outcome oriented for recipients experiencing acute symptoms or exacerbating
				  clinical conditions that impede their ability to function on a day-to-day
				  basis. Program objectives focus on ensuring important community tdies and
				  closely resemble the real-life experiences of the recipients served.
A.
Eligible providers and
				practitioners:
In addition tothe requirements found in Subsections A and
				B of
				8.321.2.9
				NMAC, an eligible provider includes a facility joint commission accredited, and
				licensed and certified by DOH or the comparable agency in another state.
(1) The program team must include:
(a) registered nurse;
(b) a clinical supervisor that is an
				independently licensed behavioral health practitioner or psychiatric nurse
				practitioner or psychiatric nurse clinician; and
(c) licensed behavioral health
				practitioners.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 321 - SPECIALIZED BEHAVIORAL HEALTH SERVICES › Part 2 - SPECIALIZED BEHAVIORAL HEALTH PROVIDER ENROLLMENT AND REIMBURSEMENT › Section 8.321.2.32 - PSYCHOSOCIAL REHABILITATION SERVICES

Current through Register Vol. 35, No. 13, July 16, 2024
To help an adult eligible recipient (18 years and older) who
				  met the criteria of SMI, MAD pays for psychosocial rehabilitation services
				  (PSR). PSR is an array of services offered in a group setting through a
				  clubhouse or a classroom and is designed to help an individual to capitalize on
				  personal strengths, to develop coping strategies and skills to deal with
				  deficits, and to develop a supportive environment in which to function as
				  independently as possible. Psychosocial rehabilitation intervention is intended
				  to be a transitional level of care based on the individual's recovery and
				  resiliency goals. See Subsections A and B of
				  8.321.2.9
				  NMAC for MAD general provider requirements.
A.
Eligible providers and
				practitioners:
(1) Agency staff must
				possess the education, skills, abilities, and experience to perform the
				activities that comprise the full spectrum of PSR services. See Subsection A of
				8.321.2.9
				NMAC for MAD general provider requirements.
(2) Staffing requirements:
(a) Both clinical services and supervision by
				licensed practitioners must be in accord with their respective licensing board
				regulations.
(b) PSR services must
				meet a staff ratio sufficient to ensure that patients have reasonable and
				prompt access to services.
(c) In
				both clubhouse and classroom settings, the entire staff works as a
				team.
(d) The team must include a
				clinical supervisor/team lead and can include the following:
(i) certified peer support workers;
(ii) certified family support
				workers;
(iii) community support
				workers; and
(iv) other HIPAA
				trained individuals working under the direct supervision of the clinical
				supervisor.
(e) Minimum
				qualifications for the clinical supervisor/team lead:
(i) independently licensed behavioral health
				professional (i.e. psychiatrist, psychologist, LISW, LPCC, LMFT,
				psychiatrically certified (CNS) practicing under the scope of their NM
				license;
(ii) have one year of
				demonstrated supervisory experience;
(iii) demonstrated knowledge and competence
				in the field of psychosocial; rehabilitation; and
(iv) an attestation of training related to
				providing clinical supervision of non-clinical staff.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 321 - SPECIALIZED BEHAVIORAL HEALTH SERVICES › Part 2 - SPECIALIZED BEHAVIORAL HEALTH PROVIDER ENROLLMENT AND REIMBURSEMENT › Section 8.321.2.33 - RECOVERY SERVICES (MCOs only)

Current through Register Vol. 35, No. 13, July 16, 2024
Recovery services are peer-to-peer support for centennial
				  care members to develop and enhance wellness and health care practices.
				  Recovery services promote self-responsibility through recipients learning new
				  health care practices from a peer who has had similar life challenges and who
				  has developed self-efficacy in using needed skills. See Subsections A and B of
				  8.321.2.9
				  NMAC for MAD general provider requirements.
A.
Staffing requirements:
(1) all staff must possess a current and
				valid NM driver's license;
(2)
				clinical supervisor:
(a) licensed as an
				independent practitioner (i.e., psychiatrist, psychologist, LISW, LPCC, LMFT,
				CNP, CNS); and
(b) two years
				relevant experience with the target population; and
(c) one year demonstrated supervisory
				experience; and
(d) expertise in
				both mental health and addiction treatment services; and
(e) supervision must be conducted in accord
				with respective licensing board regulations.
(3) certified peer support workers;
				and
(4) certified family
				specialists.
(5) Group ratios
				should be sufficient to ensure that patients have reasonable and prompt access
				to services at the required levels of frequency and intensity within the
				practitioner's scope of practices.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 321 - SPECIALIZED BEHAVIORAL HEALTH SERVICES › Part 2 - SPECIALIZED BEHAVIORAL HEALTH PROVIDER ENROLLMENT AND REIMBURSEMENT › Section 8.321.2.34 - SCREENING, BRIEF INTERVENTION & REFERRAL TO TREATMENT (SBIRT) TO BE EFFECTIVE FOLLOWING CMS WAIVER APPROVAL

Current through Register Vol. 35, No. 13, July 16, 2024
SBIRT is a community-based practice designed to identify,
				  reduce and prevent problematic substance use or misuse and co-occurring mental
				  health disorders as an early intervention. Through early identification in a
				  medical setting, SBIRT services expand and enhance the continuum of care and
				  reduce costly health care utilization. The primary objective is the integration
				  of behavioral health with medical care. SBIRT is delivered through a process
				  consisting of universal screening, scoring the screening tool and a warm
				  hand-off to a SBIRT trained professional who conducts a face-to-face brief
				  intervention for positive screening results. If the need is identified for
				  additional treatment, the staff member will refer to behavioral health
				  services. See Subsections A and B of
				  8.321.2.9
				  NMAC for MAD general provider requirements.
A.
Eligible providers and
				practitioners:
(1) Providers may
				include:
(a) primary care offices including
				FQHCs, IHS 638 tribal facilities and any other "Indian Health Care Provider
				(IHCP)" defined in 42 Code of Federal Regulations §438.14(a);
(b) patient centered medical homes;
(c) urgent care centers;
(d) hospital outpatient facilities;
(e) emergency departments;
(f) rural health clinics;
(g) specialty physical health
				clinics;
(h) school based health
				centers; and
(i) nursing
				facilities.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 321 - SPECIALIZED BEHAVIORAL HEALTH SERVICES › Part 2 - SPECIALIZED BEHAVIORAL HEALTH PROVIDER ENROLLMENT AND REIMBURSEMENT › Section 8.321.2.35 - SMOKING CESSATION COUNSELING

Current through Register Vol. 35, No. 13, July 16, 2024
See 8.310.2 NMAC for a detailed description of tobacco
				  cessation services and approved behavioral health providers.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 321 - SPECIALIZED BEHAVIORAL HEALTH SERVICES › Part 2 - SPECIALIZED BEHAVIORAL HEALTH PROVIDER ENROLLMENT AND REIMBURSEMENT › Section 8.321.2.36 - SUPPORTIVE HOUSING PRE-TENANCY AND TENANCY SERVICES (PSH-TSS) (MCO only)

Current through Register Vol. 35, No. 13, July 16, 2024
MAD pays for coverage for permanent supportive housing
				  pre-tenancy and tenancy support services (PSH-TSS) to an eligible recipient
				  enrolled in a managed care organization to facilitate community integration and
				  contribute to a holistic focus on improved health outcomes, to reduce the
				  negative health impact of precarious housing and homelessness, and to reduce
				  costly inpatient health care utilization. Services include, but are not limited
				  to, pre-tenancy services including individual housing support and crisis
				  planning, tenancy orientation and landlord relationship services as well as
				  tenancy support services to identify issues that undermine housing stability
				  and coaching, education and assistance in resolving tenancy issues for an
				  eligible recipient who has a serious mental illness and is enrolled in a
				  medicaid managed care organization on, or after, July 1, 2019. The effective
				  date will be July 1, 2019, or as otherwise approved by the centers for medicare
				  and medicaid services (CMS).
A.
Eligible providers and practitioners:
(1) Any clinic, office or agency providing
				permanent supportive housing under the human services department's linkages
				program administered by the behavioral health services division.
(2) Behavioral health practitioners employed
				or contracted with such facilities including:
(a) behavioral health professional licensed
				in the state of New Mexico; and
(b)
				certified peer support workers or certified family peer support
				workers.