New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 310 - HEALTH CARE PROFESSIONAL SERVICES › Part 10 - HEALTH HOME SERVICES › Section 8.310.10.10 - ELIGIBLE PROVIDERS AND PRACTITIONERS

Current through Register Vol. 35, No. 13, July 16, 2024
A. Health care to eligible recipients in a
				health home is furnished by a variety of providers and provider groups. The
				reimbursement and billing for these services is administered by medical
				assistance division (MAD). Upon approval of a New Mexico provider participation
				agreement (PPA) by MAD or its designee, licensed practitioners, facilities and
				other providers of services that meet applicable requirements are eligible to
				be reimbursed for furnishing covered services to eligible recipients. A
				provider agency must be enrolled before submitting a claim for payment to the
				MAD claims processing contractors or the HSD contracted managed care
				organizations (MCOs). MAD makes available on the HSD website, on other
				program-specific websites, or in hard copy format, information necessary to
				participate in health care programs administered by MAD or its designees
				including program rules, billing instructions, utilization review (UR)
				instructions, supplements, policy, and other pertinent materials. When
				enrolled, a provider agency and a practitioner receive instruction on how to
				access these documents. It is the provider agency's and practitioner's
				responsibility to access these instructions, to understand the information
				provided and to comply with the requirements. The provider agency must contact
				HSD or its authorized agents to obtain answers to questions related to the
				material. To be eligible for reimbursement, a provider agency and practitioner
				must adhere to the provisions of the MAD PPA and all applicable statutes,
				regulations, and executive orders. MAD, its selected claims processing
				contractor or the MCO, issues payments to a provider agency using electronic
				funds transfer (EFT) only. To be eligible to receive a CareLink NM health home
				designation, a provider agency must hold a comprehensive community support
				service (CCSS) certification or attest that the agency has received all
				required training.
B. A provider
				agency must follow CareLink NM staffing requirements found in this rule and
				further detailed in the CareLink NM policy manual. The provider agency must
				agree to fulfill other responsibilities as listed in Subsection B of
				8.310.10.10 NMAC. The following individuals and practitioners must be
				contracted or employed by the provider agency as part of its CareLink NM
				service delivery:
(1) A director specifically
				assigned to CareLink NM service oversight and administrative
				responsibilities.
(2) A health
				promotion coordinator with a bachelor's-level degree in a human or health
				services field and experience in developing curriculum and curriculum
				instruction. The health promotion coordinator manages health promotion services
				and resources appropriate for an eligible recipient such as interventions
				related to substance use prevention and cessation, nutritional counseling, or
				health weight management;
(3) A
				care coordinator who develops and oversees an eligible recipient's
				comprehensive care management, including the planning and coordination of all
				physical, behavioral, and support services. The number of care coordinators is
				based upon ratio in Paragraph (5) of Subsection D of
				8.310.10.11
				NMAC. The care coordinator:
(a) is a
				regulation and licensing department (RLD) licensed behavioral health
				practitioner; or
(b) holds a
				bachelor's or master's level degree and has two years of relevant healthcare
				experience; or
(c) is registered
				nurse in the State of New Mexico; or
(d) is approved through the CLNM NM health
				home steering committee.
(4) A community liaison who speaks a language
				that is utilized by a majority of non-fluent English-speaking eligible
				recipients, and who is experienced with the resources in the eligible
				recipient's local community. The community liaison identifies, connects, and
				engages with community services, resources, and providers. The community
				liaison works with an eligible recipient's care coordinator in appropriately
				connecting and integrating the eligible recipient to needed community services,
				resources, and practitioners.
(5) A
				supervisor who is an independently licensed behavioral health practitioner as
				described in 8.321.2 NMAC who supervises the care coordinator, the community
				liaison, the health promotion coordinator, peer and family support workers, and
				other optional staff that is the part of the CareLink NM multidisciplinary
				team. The supervisor must have direct service experience in working with both
				adult and child populations. Physical health and psychiatric consultants must
				comply with their respective licensing boards' requirements for
				supervision.
(6) Certified peer
				support worker(s) (CPSW) who hold a certification by the New Mexico
				credentialing board for behavioral health professionals as a certified peer
				support worker. The CPSW has successfully navigated his or her own behavioral
				health experiences, and is willing to assist his or her peers in their recovery
				processes.
(7) Certified family
				support specialist(s) who hold a certification by the New Mexico credentialing
				board for behavioral health professionals as a certified family support
				worker.
(8) A physical health
				consultant who is a physician licensed to practice medicine (MD) or osteopathy
				(DO), a licensed certified nurse practitioner (CNP), or a licensed certified
				nurse specialist (CNS) as described in 8.310.3 NMAC.
(9) A psychiatric consultant who is a
				physician (MD or DO) licensed by the board of medical examiners or board of
				osteopathy and is board-eligible or board-certified in psychiatry as described
				in 8.321.2 NMAC.