reglab/statecodes huggingface dataset:
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 371 - DEVELOPMENTAL DISABILITIES › Part 7 - (APPENDIX A) INDIVIDUAL TRANSITION PLANNING PROCESS › Section 8.371.7.28 - ACTIVITY 14: PROPOSAL REVIEW

Current through Register Vol. 35, No. 13, July 16, 2024
The health care authority shall review the community service
				  provider's proposal and may discuss or clarify any aspect of the proposal with
				  the community service provider. The cost proposals shall be negotiated and
				  approved, according to agreed upon costs, by the division's community programs
				  bureau. The authority shall submit to the community service provider a written
				  notice of the state's intent to fund services for an individual within 30 days
				  of receipt of the community service provider's written proposal. The written
				  notice of intent is not a contract. Unusual costs or specialized services may
				  require an additional two weeks to negotiate and approve. It is incumbent upon
				  the community service providers to submit cost proposals no later than 30 days
				  after the distribution of the ITP.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 371 - DEVELOPMENTAL DISABILITIES › Part 7 - (APPENDIX A) INDIVIDUAL TRANSITION PLANNING PROCESS › Section 8.371.7.29 - ACTIVITY 15: COMMUNITY SERVICE PROVIDER / STATE AGREEMENT

Current through Register Vol. 35, No. 13, July 16, 2024
Unless delayed because of extraordinary circumstances or an
				  administrative (DRP) or judicial stay order, within 30 days of the community
				  service provider's submittal described in Activity 13 above, providers of
				  service and the health care authority shall negotiate and execute agreements
				  for the delivery of services as specified in the ITP. The medicaid waiver plan
				  of care (POC) shall be approved and submitted to the case manager for
				  signatures. The case manager shall obtain signatures on the completed plan of
				  care, based upon the approved authority cost proposals, at the ITP quality
				  assurance review meeting (Activity 17, below).
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 371 - DEVELOPMENTAL DISABILITIES › Part 7 - (APPENDIX A) INDIVIDUAL TRANSITION PLANNING PROCESS › Section 8.371.7.30 - ACTIVITY 16: ALTERNATE COMMUNITY SERVICE PROVIDE R SELECTION

Current through Register Vol. 35, No. 13, July 16, 2024
A. An ITP quality
				assurance review meeting shall be held within 30 - 45 days prior to the
				placement date specified in the ITP. The purpose of this meeting is to assure
				that the ITP is being successfully implemented, assigned responsibilities have
				been or are being met and that activities are appropriately accomplished in
				preparation for the community placement. Participants at the ITPQA review
				meeting are the same TIDT members, including designated representatives, who
				were responsible for the development of the ITP. The
Jackson
transition representative (JTR) is responsible for documenting activities at
				this meeting. Activities occurring at this meeting include:
(1) review of ITP objectives that occur prior
				to placement and their implementation status;
(2) confirm accomplishment or initiation of
				tasks by TIDT members;
(3)
				amendments to the ITP, if required, due to failure to implement objectives or a
				change in the individual's circumstances;
(4) confirm identity of housemates, staff and
				others;
(5) confirm cross-over
				training agenda, participants and schedule with the facility;
(6) describe and plan activities of the
				actual transition day, including responsible parties and times;
(7) recommend a change in placement date, if
				required, to assure a successful transition;
(8) finalization of the waiver plan of care:
				The case manager shall obtain signatures on the completed approved plan of
				care, based upon the approved cost proposals.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 371 - DEVELOPMENTAL DISABILITIES › Part 7 - (APPENDIX A) INDIVIDUAL TRANSITION PLANNING PROCESS › Section 8.371.7.31 - ACTIVITY 18 DISPUTES

Current through Register Vol. 35, No. 13, July 16, 2024
See: Appendix B, Dispute Resolution Process (DRP) for
				  Individual Transition Plans.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 371 - DEVELOPMENTAL DISABILITIES › Part 7 - (APPENDIX A) INDIVIDUAL TRANSITION PLANNING PROCESS › Section 8.371.7.32 - ACTIVITY 19: IMPLEMENTATION DECISION BY HEALTH CARE AUTHORITY

Current through Register Vol. 35, No. 13, July 16, 2024
A. Within seven
				days of the completion of the DRP, if any, the health care authority shall
				inform the parties to the DRP in writing whether, on the basis of the cost of
				the individual's ITP or the aggregate costs of individual ITPs, or because the
				health care authority believes the ITP fails to satisfy constitutional or
				statutory requirement, it is unable to implement the ITP. If the decision was
				based on cost, the authority shall not implement the ITP until and unless they
				have sufficient funds to do so. The authority has the sole discretion to
				determine whether there are sufficient funds available to implement an ITP. The
				decision of the authority as to the allocation of funds to ITPs is final and
				not reviewable. The authority shall engage in good faith efforts to seek the
				necessary funds through the supplemental and regular budgetary process for the
				developmental disabilities division of the health care authority and the
				medicaid DD waiver program and through federal funding which might be available
				to these programs. Upon appropriation of funding determined by the authority to
				be sufficient, the TIDT or the community IDT, as appropriate, shall convene to
				review the final ITP in light of the individual's current circumstances and
				determine whether any changes should be made.
B. In the event the ITP is not implemented
				because of cost or because the authority believes the ITP fails to satisfy
				constitutional or statutory requirements, within 14 days of the completion of
				the DRP, the authority (with the assistance of its qualified professionals)
				shall prepare and mail to everyone specified in Activity 12, an interim plan
				which can be implemented immediately within available resources and which meets
				constitutional and statutory requirements; or the authority shall immediately
				request the reconvening of the TIDT and direct the team to develop an interim
				plan which can be implemented immediately. The interim plan shall be
				distributed within 14 days of its completion by the reconvened TIDT. Any party
				eligible to initiate a DRP of the original ITP may initiate a DRP of the
				interim plan pursuant to Section IV(E) of the DRP. However, the authority's
				decision regarding the allocation of resources to any ITP or interim plan is
				within the authority's sole discretion and is not reviewable in the DRP
				process.
C. If within 20 days of
				mailing the interim plan no party challenges the plan in a DRP, and the
				authority approves, the interim plan shall be implemented forthwith.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 371 - DEVELOPMENTAL DISABILITIES › Part 7 - (APPENDIX A) INDIVIDUAL TRANSITION PLANNING PROCESS › Section 8.371.7.33 - ACTIVITIES 20 - 23

Current through Register Vol. 35, No. 13, July 16, 2024
Activities 20 - 23 shall take place in the time frame
				  specified unless delayed because of the DRP, or extraordinary
				  circumstances.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 371 - DEVELOPMENTAL DISABILITIES › Part 7 - (APPENDIX A) INDIVIDUAL TRANSITION PLANNING PROCESS › Section 8.371.7.34 - ACTIVITY 20: IMPLEMENTING THE ITP

Current through Register Vol. 35, No. 13, July 16, 2024
TIDT members shall carry out their assigned pre-placement
				  responsibilities. The TIDT is responsible for assuring the completion of
				  placement activities and the readiness of the placement unless delayed pursuant
				  to the policies of Appendix B, Section IV.F., dispute resolution
				  process.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 371 - DEVELOPMENTAL DISABILITIES › Part 7 - (APPENDIX A) INDIVIDUAL TRANSITION PLANNING PROCESS › Section 8.371.7.35 - ACTIVITY 21: MONITORING IMPLEMENTATION OF THE ITP

Current through Register Vol. 35, No. 13, July 16, 2024
The assigned
Jackson
office representative
				  shall check and document progress twice per month beginning 60 days prior to
				  the placement date on fulfillment of responsibilities assigned in the ITP. If
				  the representative learns of serious implementation problems the
Jackson
office shall direct the case manager to reconvene the
				  TIDT, either in person or through teleconference, to correct the
				  problem.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 371 - DEVELOPMENTAL DISABILITIES › Part 7 - (APPENDIX A) INDIVIDUAL TRANSITION PLANNING PROCESS › Section 8.371.7.36 - ACTIVITY 22: REPORTING ON IMPLEMENTATION OF THE ITP

Current through Register Vol. 35, No. 13, July 16, 2024
Every other week the division's
Jackson
office representative shall send to TIDT members a report on the status of
				  pre-placement activity. The
Jackson
coordinator shall report
				  specifically on the status of all agreements and community service provider
				  plans of care. Any delay in execution of agreements that may affect other time
				  lines or preplacement activities shall be identified and strategies for
				  specific action developed and implemented.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 371 - DEVELOPMENTAL DISABILITIES › Part 7 - (APPENDIX A) INDIVIDUAL TRANSITION PLANNING PROCESS › Section 8.371.7.37 - ACTIVITY 23: COMMUNITY PLACEMENT

Current through Register Vol. 35, No. 13, July 16, 2024
Pre-placement visits with staff and to the new home and work
				  site shall take place as provided in the ITP. Placement shall be accomplished
				  on the date established by the TIDT consistent with the timelines established
				  in Section 13 above.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 371 - DEVELOPMENTAL DISABILITIES › Part 8 - (APPENDIX B) DISPUTE RESOLUTION PROCESS › Section 8.371.8.2 - SCOPE

Current through Register Vol. 35, No. 13, July 16, 2024
A. This dispute
				resolution process (DRP) provides for the resolution of disputes concerning the
				content of or the substantial failure to implement individual program,
				transition or community plans for class members in
Jackson et al. v.
				Fort Stanton, et al.,
Civ. No. 87839 JP.
B. This DRP provides a two-step
				administrative mechanism for resolving disputes:
(1) a conciliation or mediation stage;
				and
(2) a review by an independent
				hearing officer.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 371 - DEVELOPMENTAL DISABILITIES › Part 8 - (APPENDIX B) DISPUTE RESOLUTION PROCESS › Section 8.371.8.3 - STATUTORY AUTHORITY

Current through Register Vol. 35, No. 13, July 16, 2024
Subsection E of Section 9-8-6 NMSA 1978. Section 9-8-1 et
				  seq. NMSA 1978 establishes the health care authority (authority) as a single,
				  unified department to administer laws and exercise functions relating to health
				  care purchasing and regulation.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 371 - DEVELOPMENTAL DISABILITIES › Part 8 - (APPENDIX B) DISPUTE RESOLUTION PROCESS › Section 8.371.8.5 - EFFECTIVE DATE

Current through Register Vol. 35, No. 13, July 16, 2024
July 1, 2024, unless a later date is cited at the end of a
				  section.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 371 - DEVELOPMENTAL DISABILITIES › Part 8 - (APPENDIX B) DISPUTE RESOLUTION PROCESS › Section 8.371.8.6 - OBJECTIVE

Current through Register Vol. 35, No. 13, July 16, 2024
A. These
				regulations amend the authority's previously adopted provisions for resolution
				of disputes arising from the community transition plans of individuals residing
				at Fort Stanton hospital and training school and Los Lunas hospital and
				training school. They provide a process for informal resolutions and
				administrative hearings as well as for suspending the implementation of
				challenged provisions of an individual's transition or program plan during the
				time period necessary to allow the dispute to be heard and decided. These
				amendments reflect the authority's cumulative experience in resolving disputes
				arising from the transition process.
B. These regulations are promulgated, in
				part, to satisfy requirements arising from the implementation of the decision
				in
Jackson, et al. v. Fort Stanton, et al.,
N.M. Dist. Ct. No.
				Civ. No. 87-839. The transition process appearing in these regulations has
				evolved over time, initially appearing as Appendix B to the
Jackson
management manual and later as authority regulations
				under the title
Jackson
Dispute Resolution (DRP) process for
				individual transition plans, Appendix B, HCA 93-1 (DDD). These regulations
				incorporate certain agreements reached by the parties, including the authority,
				to the
Jackson
lawsuit.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 371 - DEVELOPMENTAL DISABILITIES › Part 8 - (APPENDIX B) DISPUTE RESOLUTION PROCESS › Section 8.371.8.8 - APPLICABILITY

Current through Register Vol. 35, No. 13, July 16, 2024
A. Facility IPP:
				This DRP may be used for the resolution of disputes concerning the content of
				or the substantial failure to implement individual program plans for residents
				of Fort Stanton and Los Lunas hospitals and training schools.
B. Transition planning:
(1) If the dispute involves an individual
				transition plan (ITP) the DRP may not be invoked until Activity 18 of the
				"individual transition planning process" (8.371.7 NMAC, hereinafter "ITP
				Process").
(2) Interim plans: This
				DRP may be used for the resolution of disputes concerning interim plans
				developed per Activity 19 of the "individual transition planning process"
				(8.371.7 NMAC) by the same parties eligible to initiate a dispute concerning
				the original ITP.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 371 - DEVELOPMENTAL DISABILITIES › Part 8 - (APPENDIX B) DISPUTE RESOLUTION PROCESS › Section 8.371.8.9 - PARTICIPANTS

Current through Register Vol. 35, No. 13, July 16, 2024
This DRP may be utilized by: the individual; the individual's
				  parent/ guardian; or the authority. The participants may be represented by
				  legal counsel or other representatives.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 371 - DEVELOPMENTAL DISABILITIES › Part 8 - (APPENDIX B) DISPUTE RESOLUTION PROCESS › Section 8.371.8.10 - LIMITATIONS

Current through Register Vol. 35, No. 13, July 16, 2024
The state retains the discretion to provide, within current
				  and future resources, individualized plans which may exceed what is required by
				  law. To this end, the DRP provides guidelines for hearing officer decisions in
				  Paragraphs (7) and (8) of Subsection D of 8.371.8.12 NMAC that go beyond the
				  requirements of the law. Neither the fact that such guidelines are part of the
				  DRP nor the fact that the state agrees in some cases to provide ITPs or other
				  plans that may exceed the state's legal obligations shall be construed as a
				  waiver of any of the state's legal defenses in any legal proceeding concerning
				  such plans or as an agreement to provide in other cases, plans that exceed what
				  is required by law.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 371 - DEVELOPMENTAL DISABILITIES › Part 8 - (APPENDIX B) DISPUTE RESOLUTION PROCESS › Section 8.371.8.11 - PRELIMINARY MATTERS

Current through Register Vol. 35, No. 13, July 16, 2024
A. Prior to or
				at the facility IPP or community ISP meeting, the social worker or case manager
				shall explain the DRP to the individual, the parent/guardian and helper, if
				any. Prior to or at the initial meeting of the transition interdisciplinary
				team (TIDT), the case manager shall explain the DRP to the individual, the
				parent/guardian and helper, if any.
B. Team meetings are intended to be the
				primary and most effective means of addressing and resolving planning issues.
				Therefore, all team members are encouraged to participate actively in meetings
				and in the development of proposed plans.
C. Completed plans shall be distributed as
				follows:
(1) The completed proposed IPP shall
				be mailed or delivered, within 30 days of completion, to all team members and
				to the individual's or the parent's/ guardian's chosen representative, if
				any.
(2) The completed proposed ITP
				shall be mailed or delivered, within 14 days of completion of the proposed ITP,
				to all TIDT members, to plaintiffs and to intervenors if the parent/guardian of
				the individual is an intervenor.
(3) The completed ISP shall be mailed or
				delivered to all team members and to the individual's or the parent's/
				guardian's chosen representative within 30 days of the meeting.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 371 - DEVELOPMENTAL DISABILITIES › Part 8 - (APPENDIX B) DISPUTE RESOLUTION PROCESS › Section 8.371.8.12 - THE PROCESS

Current through Register Vol. 35, No. 13, July 16, 2024
A. Request for
				facilitated conference: The DRP is initiated by a request for a facilitated
				conference by any of the parties identified in Section 7 in the capacities
				specified in that section. The request must be directed to the
Jackson
coordinator or dispute resolution process coordinator
				and must be received by the coordinator no later than 30 days after the mailing
				of the completed plan. The request may be made by telephone, in person, or in
				writing and shall identify any disputed portions of the plan. The coordinator
				shall record the date of receipt of the request and shall notify the members of
				the team and the parties of the substance of the dispute. If the request
				involves an allegation of substantial failure to implement the plan, the
				request shall be received by the coordinator no later than 30 days after the
				special team meeting held to address that implementation issue, as provided in
				Subsection K of 8.371.8.11 NMAC, above. In the event the case manager does not
				convene the team meeting as requested, or within the time allotted, the DRP
				must be initiated within 30 days of the request to reconvene the
				team.
B. Informal resolution: The
				coordinator shall promptly communicate with the parties and with appropriate
				team members to determine whether there is a genuine dispute and whether the
				dispute can be resolved informally without a facilitated conference. If it
				appears that the dispute can be resolved informally, the coordinator shall
				attempt to do so. If the dispute is resolved, the coordinator shall notify the
				members of the team and the parties in writing.
C. Facilitated conference: If the dispute is
				not resolved informally, the coordinator shall schedule a facilitated
				conference. The conference shall occur and the resolution or determination
				shall be distributed within 45 days of receipt of the request for the
				facilitated conference. The parties shall be notified of the time and location
				of the conference at least 10 days prior to the conference. The coordinator may
				request the attendance of team members, professionals, authority personnel or
				other persons whose presence the coordinator believes could assist in resolving
				the disputed portions of the plan.
(1) The
				purpose of the facilitated conference is to resolve the dispute to the extent
				possible and to agree on any material facts. If the conference participants are
				unable to resolve the dispute issues to the satisfaction of the party who
				requested the facilitated conference, the coordinator shall make determinations
				regarding the disputed issues as follows:
(a)
				determine that the objection(s) to portion(s) of the plan has merit and either:
(i) amend the plan, accordingly; or
(ii) remand the plan to the team for revision
				consistent with the coordinator's determination; or
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 371 - DEVELOPMENTAL DISABILITIES › Part 9 - ADMISSION, DISCHARGE AND TRANSFER OF ELIGIBLE RECIPIENTS FOR SERVICES IN ICF/MR FACILITIES › Section 8.371.9.2 - SCOPE

Current through Register Vol. 35, No. 13, July 16, 2024
A. These
				regulations provide a systematic process for admission of persons requesting
				services from an intermediate care facility for the mentally retarded (ICF/MR);
				the transfer between ICF/ MR facilities of persons previously determined
				eligible; and the discharge of persons residing in an ICF/MR.
B. These regulations apply to persons who
				request admission to an ICF/MR and who reside in the community; in a nursing
				facility; in a hospital; or, in an ICF/ MR. In addition, these regulations
				apply to any ICF/MR in the state of New Mexico that is licensed under health
				care authority regulations governing long term care facilities.
C. These regulations are limited to the
				admission, transfer and discharge of persons receiving support and services
				funded in whole or in part by state funds or for whom services can reasonably
				be expected to be funded in whole or in part with state funds within six months
				of admission into an ICF/MR.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 371 - DEVELOPMENTAL DISABILITIES › Part 9 - ADMISSION, DISCHARGE AND TRANSFER OF ELIGIBLE RECIPIENTS FOR SERVICES IN ICF/MR FACILITIES › Section 8.371.9.3 - STATUTORY AUTHORITY

Current through Register Vol. 35, No. 13, July 16, 2024
Subsection E of Section 9-8-6 NMSA 1978 and Section 28-16A-15
				  NMSA 1978. Section 9-8-1 et seq. NMSA 1978 establishes the health care
				  authority (HCA) as a single, unified department to administer laws and exercise
				  functions relating to health care purchasing and regulation.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 371 - DEVELOPMENTAL DISABILITIES › Part 9 - ADMISSION, DISCHARGE AND TRANSFER OF ELIGIBLE RECIPIENTS FOR SERVICES IN ICF/MR FACILITIES › Section 8.371.9.5 - EFFECTIVE DATE

Current through Register Vol. 35, No. 13, July 16, 2024
July 1, 2024, unless a later date is cited at the end of a
				  section.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 371 - DEVELOPMENTAL DISABILITIES › Part 9 - ADMISSION, DISCHARGE AND TRANSFER OF ELIGIBLE RECIPIENTS FOR SERVICES IN ICF/MR FACILITIES › Section 8.371.9.6 - OBJECTIVE

Current through Register Vol. 35, No. 13, July 16, 2024
The purpose of these regulations is to:
A. establish the process for the admission of
				any and all persons requesting admission to an ICF/MR, to be transferred
				between ICF/MR facilities, or to be discharged from an ICF/MR;
B. establish admission, transfer and
				discharge procedures for ICF/MR facilities licensed and located in the state of
				New Mexico consistent with the Developmental Disabilities Act, Section
				28-16A-15 NMSA 1978;
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 371 - DEVELOPMENTAL DISABILITIES › Part 9 - ADMISSION, DISCHARGE AND TRANSFER OF ELIGIBLE RECIPIENTS FOR SERVICES IN ICF/MR FACILITIES › Section 8.371.9.7 - DEFINITIONS

Current through Register Vol. 35, No. 13, July 16, 2024
A.
"Discharge"
means the termination of services for a person
				previously admitted into an ICF/MR and the discharging facility ceases to be
				legally responsible for the care of the person.
B.
"Eligible central registry
				person"
means a person who has requested admission to an ICF/ MR, or
				discharge from an ICF/MR and transfer to a community-based HCA funded program,
				and who is determined by the HCA to meet preadmission screening criteria for
				ICF/ MR and home/community-based developmental disabilities services.
C.
"ICF/MR"
means an
				intermediate care facility that provides food, shelter, health or
				rehabilitative and active treatment for persons with mental retardation or
				related conditions, and that has a current license issued by the HCA.
D.
"New admission"
means a
				person requesting an ICF/ MR admission for the first time and does not
				otherwise qualify as a re-admission. New admissions are subject to
				pre-admission screening.
E.
"NMSA"
means the New Mexico Statutes Annotated 1978 compilation
				and all the revisions and compilations thereof.
F.
"Pre-admission screening"
means the evaluation process of the health care authority to determine a
				person's choice between ICF/MR and community based services, and whether the
				person has a developmental disability as described in the
American
				association on mental retardation's manual on classification in mental
				retardation (1996)
, or a related condition as defined by
				42 CFR
				435.1009.
G.
"Readmission"
means a person
				re-admitted to an ICF/ MR from another type of institution to which they were
				transferred for the purpose of receiving acute, psychiatric care or
				rehabilitation following a temporary, acute care episode. A readmission is not
				subject to pre-admission screening.
H.
"Transfer"
means movement of
				an individual from one ICF/MR to another ICF/MR, with or without an intervening
				hospital stay. A transfer is not subject to preadmission screening.
I.
"State medicaid agency"
means
				the health care authority.
J.
"Central registry"
means a registry of persons who are requesting
				or receiving services established by the HCA in accordance with Section
				28-16A-15 NMSA 1978.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 371 - DEVELOPMENTAL DISABILITIES › Part 9 - ADMISSION, DISCHARGE AND TRANSFER OF ELIGIBLE RECIPIENTS FOR SERVICES IN ICF/MR FACILITIES › Section 8.371.9.8 - ADMISSION

Current through Register Vol. 35, No. 13, July 16, 2024
A. No person shall
				be admitted into an ICF/MR unless the person has been pre-screened and referred
				to an ICF/MR by the health care authority central registry.
B. Consistent with the provisions of
				42 CFR
				431.51 any person who requests to be placed
				on the HCA's central registry will be provided the opportunity to indicate a
				choice between ICF/MR and home/ community-based waiver services at the time of
				application to the central registry. The purpose of this information request is
				for system service planning to identify persons who may be potentially eligible
				for ICF/MR services.
C. All
				applicants to the central registry may choose to be placed on the central
				registry for both ICF/MR and home/community-based waiver services.
D. All persons referred for admission into an
				ICF/MR from the central registry may choose to remain on the central registry
				for home/community-based waiver services. All persons referred for admission
				into home/community-based waiver services may choose to remain on the central
				registry for ICF/ MR services.
E.
				All persons applying to the central registry will be pre-screened by the HCA
				before placement on the central registry to determine each person's choice
				between ICF/MR and home/ community-based waiver services, and whether the
				person has a developmental disability or related condition. Pre-screening does
				not include determination of financial eligibility and level of care, which are
				functions performed by the state medicaid agency.
F. The HCA will implement application
				procedures for the central registry that identifies applicant's freedom to
				choose between ICF/MR and home and community based services.
G. Upon notification from a ICF/MR to the HCA
				that a vacancy exist in their facility, the HCA will identify three persons
				from the central registry, in the order of date of application to the central
				registry, who have indicated a choice for ICF/MR services, and who:
(1) have never been admitted into an ICF/MR;
				or
(2) were discharged from an
				ICF/MR for at least 30 days; or
(3)
				did not qualify as a readmission;
(4) the group of three individuals will be
				classified as "new admission" for the purposes of these regulations.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 371 - DEVELOPMENTAL DISABILITIES › Part 9 - ADMISSION, DISCHARGE AND TRANSFER OF ELIGIBLE RECIPIENTS FOR SERVICES IN ICF/MR FACILITIES › Section 8.371.9.9 - TRANSFER

Current through Register Vol. 35, No. 13, July 16, 2024
A. A person may be
				transferred to another ICF/MR operated by the same entity, or an ICF/MR that
				operates independent of the ICF/MR where the person currently resides without
				referral through the central registry, provided:
(1) the person's interdisciplinary team
				recommends the transfer;
(2) the
				person's transfer is based on the person's freedom of choice of providers;
				and
(3) the receiving ICF/MR has
				identified a vacancy.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 371 - DEVELOPMENTAL DISABILITIES › Part 9 - ADMISSION, DISCHARGE AND TRANSFER OF ELIGIBLE RECIPIENTS FOR SERVICES IN ICF/MR FACILITIES › Section 8.371.9.10 - DISCHARGE

Current through Register Vol. 35, No. 13, July 16, 2024
A. A person may be
				discharged from an ICF/MR when the individual/guardian requests to be
				discharged; when the person's interdisciplinary team recommends the facility
				cannot meet the individual's needs; the individual no longer requires an active
				treatment program in an ICF/MR setting; the discharge would be more beneficial
				to the person; or for any other good cause. Any decision to discharge a person
				from an ICF/MR based on good cause must be adequately justified in writing by
				the ICF/MR and reviewed by the HCA prior to discharge.
B. The ICF/MR will ensure the person's
				family/guardian and the person's advocate is involved in the interdisciplinary
				team process, involving a discussion and proposed decision regarding
				discharge.
C. The ICF/MR will
				ensure a transition plan is developed 30 working days prior to discharge in
				accordance with HCA policies on discharge and transition of persons in
				services.
D. The ICF/MR will ensure
				the person and their guardian are fully informed of their right to a fair
				hearing in accordance with 42 CFR 431.200-431.250.
E. The ICF/MR will ensure any discharge
				decision is carried out in accordance with provisions of
				42 CFR
				456.380.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 371 - DEVELOPMENTAL DISABILITIES › Part 9 - ADMISSION, DISCHARGE AND TRANSFER OF ELIGIBLE RECIPIENTS FOR SERVICES IN ICF/MR FACILITIES › Section 8.371.9.11 - NOTIFICATION OF THE HCA

Current through Register Vol. 35, No. 13, July 16, 2024
A. The
				ICF/MR will notify the HCA of any vacancy or anticipated vacancy in their
				facility.
B. The ICF/MR will notify
				the HCA of any person requesting ICF/MR services and for whom state funding may
				be necessary.
C. The HCA will
				notify an ICF/MR of any person on the central registry indicating a choice of
				ICF/MR services in the long term services division region in which the ICF/MR
				is located.
D. Notice by either
				party shall be based on timelines adopted by the HCA.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 372 - INTERAGENCY BEHAVIORAL HEALTH PURCHASING COLLABORATIVE › Part 1 - GENERAL PROVISIONS › Section 8.372.1.3 - STATUTORY AUTHORITY

Current through Register Vol. 35, No. 13, July 16, 2024
Subsection F of Section 9-7-6.4 NMSA 1978 requires the
				  interagency behavioral health purchasing collaborative (the collaborative) to
				  adopt rules through the health care authority (HCA). The collaborative is
				  created by statute and comprised of the secretaries of aging and long-term
				  services; Indian affairs; health care authority; health; corrections; children,
				  youth and families; finance and administration; workforce solutions; public
				  education; and transportation; the directors of the administrative office of
				  the courts; the New Mexico mortgage finance authority; the governor's
				  commission on disability; the developmental disabilities planning council; the
				  vocational rehabilitation division of the public education department; the New
				  Mexico health policy commission; and the governor's health policy coordinator,
				  or their designees. Section 9-8-1 et seq. NMSA 1978 establishes the health care
				  authority as a single, unified department to administer laws and exercise
				  functions relating to health care facility licensure and health care purchasing
				  and regulation.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 372 - INTERAGENCY BEHAVIORAL HEALTH PURCHASING COLLABORATIVE › Part 1 - GENERAL PROVISIONS › Section 8.372.1.5 - EFFECTIVE DATE

Current through Register Vol. 35, No. 13, July 16, 2024
July 1, 2024, unless a later date is cited at the end of a
				  section.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 372 - INTERAGENCY BEHAVIORAL HEALTH PURCHASING COLLABORATIVE › Part 1 - GENERAL PROVISIONS › Section 8.372.1.6 - OBJECTIVE

Current through Register Vol. 35, No. 13, July 16, 2024
The objective of this rule is to provide policies for the
				  standard of delivery for behavioral health services through contracted
				  behavioral health entities and for approval of contracts by the
				  collaborative.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 372 - INTERAGENCY BEHAVIORAL HEALTH PURCHASING COLLABORATIVE › Part 1 - GENERAL PROVISIONS › Section 8.372.1.7 - DEFINITIONS

Current through Register Vol. 35, No. 13, July 16, 2024
This section contains the glossary for the New Mexico
				  behavioral health system. The following definitions apply to terms used in this
				  chapter and shall guide any rules promulgated by collaborative members
				  regarding behavioral health.
A.
Definitions beginning with letter "A":
(1)
Abuse, individual:
Any
				intentional, knowing or reckless act or failure to act that produces or is
				likely to produce physical or great mental or emotional harm, unreasonable
				confinement, sexual abuse or sexual assault consistent with 30-47-1 NMSA
				1978.
(2)
Abuse,
				provider:
Provider practices that are inconsistent with sound fiscal,
				business, medical or service related practices and result in an unnecessary
				cost to the program, or in reimbursement for services that are not medically,
				clinically, or psychosocially necessary or in services that fail to meet
				professionally recognized standards for behavioral health care.
(3)
Adult behavioral health procedures
				manual:
The procedures manual that includes the psychiatric
				rehabilitation program requirements and comprehensive community support
				services requirements.
(4)
Advance directive:
Written instructions such as a mental
				healthcare advance directive, psychiatric advance directive, living will,
				durable health care power of attorney, durable mental health care power of
				attorney, or advance health directive, relating to the provision of health care
				when an adult is incapacitated. (See generally, Sections 27-7A-1 - 27-7A-18
				NMSA, 1978, and Section 24-7B-1 - 24-7B-16 NMSA 1978.)
(5)
Adverse determination:
A
				determination by the BHE that the behavioral health services furnished, or
				proposed to be furnished to a consumer, are not medically, clinically or
				psychosocially necessary or not appropriate.
(6)
American society of addiction
				medicine (ASAM):
An organization of professionals in addiction services
				that developed, in the early 1990s, a set of criteria and tools to identify the
				level of care best suited to an individual in need of addiction
				services.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 372 - INTERAGENCY BEHAVIORAL HEALTH PURCHASING COLLABORATIVE › Part 1 - GENERAL PROVISIONS › Section 8.372.1.8 - MISSION STATEMENT

Current through Register Vol. 35, No. 13, July 16, 2024
The mission of the collaborative is to ensure that quality
				  behavioral health services are provided to both medicaid and nonmedicaid
				  consumers; that providers are reimbursed timely and accurately; that services
				  promote prevention, recovery, resilience in consumers, and that available
				  resources are used in the most efficient and effective manner. This mission
				  serves the collaborative's vision of establishing a single service delivery
				  system in which consumers and family members are assisted in participating
				  fully in the life of their communities; support of recovery and development of
				  resiliency are expected; behavioral health is promoted; and the adverse effects
				  of substance abuse and mental illness are prevented or
				  reduced.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 372 - INTERAGENCY BEHAVIORAL HEALTH PURCHASING COLLABORATIVE › Part 2 - STANDARDS OF DELIVERY FOR BEHAVIORAL HEALTH SERVICES › Section 8.372.2.3 - STATUTORY AUTHORITY

Current through Register Vol. 35, No. 13, July 16, 2024
Subsection F of Section 9-7-6.4 NMSA 1978 requires the
				  interagency behavioral health purchasing collaborative (the collaborative) to
				  adopt rules through the health care authority (HCA). The collaborative is
				  created by statute and comprised of the secretaries of aging and long-term
				  services; Indian affairs; health care authority; health; corrections; children,
				  youth and families; finance and administration; workforce solutions; public
				  education; and transportation; the directors of the administrative office of
				  the courts; the New Mexico mortgage finance authority; the governor's
				  commission on disability; the developmental disabilities planning council; the
				  vocational rehabilitation division of the public education department; the New
				  Mexico health policy commission; and the governor's health policy coordinator,
				  or their designees. Section 9-8-1 et seq. NMSA 1978 establishes the health care
				  authority as a single, unified department to administer laws and exercise
				  functions relating to health care facility licensure and health care purchasing
				  and regulation.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 372 - INTERAGENCY BEHAVIORAL HEALTH PURCHASING COLLABORATIVE › Part 2 - STANDARDS OF DELIVERY FOR BEHAVIORAL HEALTH SERVICES › Section 8.372.2.5 - EFFECTIVE DATE

Current through Register Vol. 35, No. 13, July 16, 2024
July 1, 2024, unless a later date is cited at the end of a
				  section.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 372 - INTERAGENCY BEHAVIORAL HEALTH PURCHASING COLLABORATIVE › Part 2 - STANDARDS OF DELIVERY FOR BEHAVIORAL HEALTH SERVICES › Section 8.372.2.6 - OBJECTIVE

Current through Register Vol. 35, No. 13, July 16, 2024
The objective of this rule is to provide policies for the
				  standard of delivery for behavioral health services through contracted
				  behavioral health entities.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 372 - INTERAGENCY BEHAVIORAL HEALTH PURCHASING COLLABORATIVE › Part 2 - STANDARDS OF DELIVERY FOR BEHAVIORAL HEALTH SERVICES › Section 8.372.2.8 - MISSION STATEMENT

Current through Register Vol. 35, No. 13, July 16, 2024
The mission of the interagency behavioral health
				  collaborative (the collaborative) is to ensure quality behavioral health
				  services are provided to medicaid and non-medicaid consumers; providers are
				  reimbursed timely and accurately; data is collected, and services promote
				  prevention, recovery, resilience, and efficient use of available resources.
				  This mission serves the collaborative vision to establish a behavioral health
				  service delivery system in which consumers and family members are assisted in
				  participating fully in the life of their communities; support of recovery and
				  development of resiliency are expected; behavioral health is promoted; and the
				  adverse effects of substance abuse and mental illness are prevented or
				  reduced.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 372 - INTERAGENCY BEHAVIORAL HEALTH PURCHASING COLLABORATIVE › Part 2 - STANDARDS OF DELIVERY FOR BEHAVIORAL HEALTH SERVICES › Section 8.372.2.9 - QUALITY MANAGEMENT

Current through Register Vol. 35, No. 13, July 16, 2024
The collaborative recognizes that strong programs of quality
				  improvement and assurance help ensure that better care is delivered in a
				  cost-effective manner with better outcomes for consumers and families. Under
				  the terms of the interagency behavioral health collaborative contracts, quality
				  assurance and management programs are incorporated into behavioral health care
				  delivery and administrative systems.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 372 - INTERAGENCY BEHAVIORAL HEALTH PURCHASING COLLABORATIVE › Part 2 - STANDARDS OF DELIVERY FOR BEHAVIORAL HEALTH SERVICES › Section 8.372.2.10 - BROAD STANDARDS

Current through Register Vol. 35, No. 13, July 16, 2024
A.
Commitment to persons served:
The behavioral health entity (BHE)
				and provider shall provide or ensure that:
(1)
				service delivery is individually centered and family-centered, and furthers an
				individual's capacity for recovery and resiliency;
(2) all services are designed to enhance,
				promote and expand the recovery, resiliency, independence, self-sufficiency,
				self-esteem and quality of life of the persons served;
(3) individuals served are involved in the
				individual planning, decision-making, implementation and evaluation of services
				provided;
(4) agents under an
				advance directive, family members, guardians or treatment guardians,
				caregivers, or other persons critical to the consumer's life and well-being are
				involved in the individual planning, decision-making, implementation and
				evaluation of services provided, subject to requirements or principles of
				confidentiality and individual choice;
(5) the system offers a full range of
				appropriate behavioral health services for multi-diagnosed clients, including
				facilitating access to and coordinating care with appropriate medical care
				providers;
(6) services are based
				on evidence of effectiveness;
(7)
				services consider the individual consumer's and family's preferences;
(8) services and providers comply with Title
				VI of the Civil Rights Act of 1964; Title IX of the Education Amendments of
				1972 (regarding education programs and activities); the Age Discrimination Act
				of 1975; the Rehabilitation Act of 1973; and the Americans with Disabilities
				Act.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 372 - INTERAGENCY BEHAVIORAL HEALTH PURCHASING COLLABORATIVE › Part 2 - STANDARDS OF DELIVERY FOR BEHAVIORAL HEALTH SERVICES › Section 8.372.2.11 - STANDARDS FOR QUALITY MANAGEMENT AND IMPROVEMENT

Current through Register Vol. 35, No. 13, July 16, 2024
A.
Program structure and
				operations:
Quality management is an integrated approach that links
				knowledge, structure and processes together throughout a BHE's system to assess
				and improve quality. The BHE's quality management (QM) and improvement (QI)
				structures and processes shall be planned, systematic, clearly defined, and in
				full compliance with the BHE contract. The BHE shall comply with the provisions
				of 8.305.8.12 NMAC, regardless of the funding source of services. The BHE shall
				ensure that the QM/QI program is applied to the entire range of covered
				services and all major demographic population groups in accordance with the BHE
				contract. The BHE shall have an annual QM/QI work plan, prior approved by the
				collaborative, and as specified in its BHE contact with the
				collaborative.
B.
Continuous
				quality improvement/total quality management:
The BHE shall base its
				administrative operations and service delivery on principles of continuous
				quality improvement/total quality management (QM/QI). Such an approach shall
				include at least the following:
(1) recognize
				that opportunities for improvement are unlimited;
(2) ensure that the QM/QI process shall be
				data driven;
(3) require the
				continual measurement of clinical and non-clinical effectiveness and
				programmatic improvements of clinical and non-clinical processes driven by such
				measurements;
(4) require the
				re-measurement of effectiveness and continuing development and implementation
				of improvements as appropriate; and
(5) rely on consumer and stakeholder
				input.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 372 - INTERAGENCY BEHAVIORAL HEALTH PURCHASING COLLABORATIVE › Part 2 - STANDARDS OF DELIVERY FOR BEHAVIORAL HEALTH SERVICES › Section 8.372.2.12 - PERFORMANCE MEASURES

Current through Register Vol. 35, No. 13, July 16, 2024
A. BHE
				shall be accountable as specified in its contract for the achievement of any
				performance measure targets identified by the collaborative. The BHE shall
				measure and track performance measures, report on such measures at intervals
				defined by the collaborative, and incorporate performance measures as part of
				its QM/QI program. Performance measures include those required by the federal
				government or specified by the collaborative.
B.
Effectiveness of the QI
				program:
The BHE shall evaluate the overall effectiveness of its QI
				program and demonstrate improvements in the quality of clinical care and
				non-clinical service to consumers. The BHE shall conduct data-driven
				evaluations of clinical practices to improve quality of care. The BHE shall
				demonstrate how it has influenced or changed provider practice
				patterns.