New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 10 - CHILD PROTECTIVE SERVICES › Part 5 - COMPREHENSIVE ADDICTIONS AND RECOVERY ACT (CARA) GUIDELINES › Section 8.10.5.7 - DEFINITIONS

Current through Register Vol. 35, No. 13, July 16, 2024
A. "
Care
				coordination level (CCL)"
identifies the level of support a member needs
				through care coordination services for the member to improve or maintain and
				manage their individual health needs effectively. Members are assigned to
				either care coordination level two (CCL2) or care coordination level three
				(CCL3) following the completion of a comprehensive needs assessment (CNA) for
				the member.
B.
"Care
				coordinator (CC)"
is the individual assigned to the newborn and the
				biological parents by the MCO, private insurer or children's medical services
				(CMS), to coordinate the care and services needed (to include such services as
				medical, behavioral health, infant mental health, early intervention, home
				visiting programs, family FIRST, long term care, prescriptions, medical
				equipment, and others).
C.
"Caregiver"
is a parent, guardian or custodian in the household
				who provides care and supervision for the child.
D. "
Centennial care"
was
				implemented on January 1, 2019 as a replacement to the outdated New Mexico
				Medicaid system. Centennial care aims to educate recipients to become savvy
				health care consumers, promote more integrated care, properly manage the most
				at-risk members, involve members in their own wellness, and pay providers for
				outcomes rather than process.
E.
"Children's medical services (CMS)"
provides care coordination and
				services for the prevention, diagnosis, and treatment of disabling conditions
				in children. It is a statewide program within the department of health, public
				health division. CMS serves children from birth to 21 with chronic illnesses or
				medical conditions that require surgical or medical treatment.
F.
"Comprehensive addiction and
				recovery act (CARA)"
is federal legislation signed into law in 2016.
				This legislation establishes a comprehensive, coordinated, balanced strategy
				for substance exposed infants and their caregivers, through enhanced grant
				programs, that expands prevention and education efforts while also promoting
				treatment and recovery.
G.
"Comprehensive addiction recovery act (CARA) Navigator"
is an
				assigned position at children, youth and families department (CYFD) and another
				at the department of health (DOH). The positions assure compliance with the
				CARA state law and accept plans of care and notifications of substance exposed
				infants. They provide technical assistance and navigation to the entities and
				individuals involved in plans of care.
H. "
Comprehensive care plan"
				(CCP)
is a comprehensive plan of services that meets the member's
				physical, behavioral, and long-term needs based on information received during
				the comprehensive needs assessment.
I.
"Comprehensive needs assessment
				(CNA)"
an assessment of the member's physical, behavioral health, and
				long-term care needs; it will identify potential risks and provide social and
				cultural information. The results of the CNA shall be used to create the
				comprehensive care plan (CCP), which is based on the member's assessed needs.
				The CNA shall be used to determine the member's care coordination level
				(CCL).
J.
"Fictive
				kin"
means a person not related by birth, adoption or marriage with whom
				the child has an emotionally significant relationship.
K.
"Health care professional"
may be a physician, physician's assistant, medical assistant, nurse, midwife,
				or doula that is providing health care treatment and advice to expectant or new
				parents.
L. "
Health risk
				assessment (HRA)
" is an assessment the MCO shall conduct on all member's
				newly enrolled in centennial care and on members, not in CCL2 or CCL3, who have
				had a change in health condition that requires a higher level of care. The HRA
				shall introduce the member to the MCO, obtain basic health and demographic
				information and confirm the need for a CNA.
M.
"Insurance-MCOs, private insurers,
				and CMS"
are three entities that can assign a care coordinator for the
				substance exposed infant based on their parents' insurance coverage at the time
				of birth.
N.
"Insurer"
a company that underwrites an insurance risk; the party in an insurance
				contract undertaking to pay compensation.
O.
"Key household members"
is
				any individual who lives at the infant's discharge address who is 18 years or
				older and provides care for the infant listed on the plan of care.
P.
"Managed care organization
				(MCO)"
means an entity that participates in centennial care under
				contract with the New Mexico human services department (HSD) to assist the
				State in meeting the requirements established under Section
				27-2-12
				NMSA 1978.
Q.
"Member"
refers to a person enrolled in Medicaid or a managed care
				organization.
R.
"Parent"
as defined in Subsection Q of Section
				32A-1-4 NMSA 1978,
				includes a biological or adoptive parent if the biological or adoptive parent
				has a constitutionally protected liberty interest in the care and custody of
				the child.
S.
"Plan of care
				(POC)"
as defined in Subsection T of Section
				32A-1-4 NMSA 1978
				means a plan created by a health care professional intended to ensure the
				safety and well-being of a substance-exposed newborn by addressing the
				treatment needs of the child and any of the child's parents, relatives,
				guardians, family members or caregivers to the extent those treatment needs are
				relevant to the safety of the child.
T.
"Primary care physician
				(PCP)"
is a specialist in family medicine, general internal medicine or
				general pediatrics who provides definitive care to the undifferentiated patient
				at the point of first contact and takes continuing responsibility for providing
				the patient's comprehensive care.
U.
"Private insurer"
is any
				health insurance policy purchased by an employer or by an individual from a
				private insurance company.
V.
"Substance exposed newborn"
is any newborn exposed in utero to an
				illicit substance such as methamphetamine or heroin, prescribed medication such
				as opioids, methadone, buprenorphine, and marijuana.
W.
"Statewide central intake
				(SCI)"
is the unit within PSD whose responsibilities may include but are
				not limited to receiving and screening reports of alleged child abuse or
				neglect and prioritizing and assigning accepted reports to the appropriate
				county office for investigation.