New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 321 - SPECIALIZED BEHAVIORAL HEALTH SERVICES › Part 2 - SPECIALIZED BEHAVIORAL HEALTH PROVIDER ENROLLMENT AND REIMBURSEMENT › Section 8.321.2.13 - ASSERTIVE COMMUNITY TREATMENT SERVICES

Current through Register Vol. 35, No. 13, July 16, 2024
To help an eligible recipient with medically necessary
				  services MAD pays for covered assertive community treatment services (ACT). See
				  Subsections A and B of
				  8.321.2.9
				  NMAC for MAD general provider requirements.
A.
Eligible providers:
(1) An ACT agency must demonstrate compliance
				with administrative, financial, clinical, quality improvement and information
				services infrastructure standards established by MAD or its designee, including
				compliance and outcomes consistent with the ACT fidelity model. See Subsections
				A and B of
				8.321.2.9
				NMAC for MAD general provider requirements.
(2) An ACT agency providing coordinated
				specialty care for an individual with first episode psychosis must provide
				services consistent with the coordinated specialty care (CSC) model.
(3) ACT services must be provided by an
				agency designated team of 10 to 12 members; see Paragraph (5) of Subsection A
				of 8.321.2.13 NMAC for the required composition. Lower number of team member
				compositions may be considered by BHSD for a waiver request dependent on the
				nature of the clinical severity and rural vs. urban environment pending BHSD
				approval. Each team must have a designated team leader. Practitioners on this
				team shall have sufficient individual competence, professional qualifications
				and experience to provide service coordination; crisis assessment and
				intervention; symptom assessment and management; individual counseling and
				psychotherapy; prescription, administration, monitoring and documentation of
				medications; substance abuse treatment; work-related services; activities of
				daily living services; support services or direct assistance to ensure that the
				eligible recipient obtains the basic necessities of daily life; and
				coordination, support and consultation to the eligible recipient's family and
				other major supports. The agency must coordinate its ACT services with local
				hospitals, local crisis units, local law enforcement agencies, local behavioral
				health agencies, and consider referrals from social service agencies.
(4) Each ACT team staff member must be
				successfully and currently certified or trained according to ACT fidelity model
				standards. The training standards focus on developing staff competencies for
				delivering ACT services according to the most recent ACT evidenced-based
				practices and ACT fidelity model. Each ACT team shall have sufficient numbers
				of qualified staff to provide treatment, rehabilitation, crisis and support
				services 24-hours a day, seven days a week.
(5) Each ACT team shall have a staff-to
				eligible recipient ratio dependent on the nature of the team based on clinical
				severity and rural vs. urban environment pending BHSD approval to ensure
				fidelity with current model.
(6)
				Each ACT team must comply with
				8.321.2.9
				NMAC for specific licensing requirements for ACT staff team members as
				appropriate, and must include:
(a) one team
				leader who is an independently licensed behavioral health practitioner (LPCC,
				LMFT, LISW, LCSW, LPAT, psychologist);
(b) medical director/prescriber:
(i) board certified or board eligible
				psychiatrist; or
(ii) NM licensed
				psychiatric certified nurse practitioner; or
(iii) NM licensed psychiatric clinical nurse
				specialist; or
(iv) prescribing
				psychologist under the supervision or consultation of an MD; or
(c) two licensed nurses, one of
				whom shall be a RN, or other allied medical professionals may be used in place
				of one nurse;
(d) at least one
				other MAD recognized licensed behavioral health professional;
(e) at least one MAD recognized licensed
				behavioral health practitioner with expertise in substance use
				disorders;
(f) at least one
				employment specialist;
(g) at least
				one New Mexico certified peer support worker (CPSW) through the approved state
				of New Mexico certification program; or certified family peer support worker
				(CFPSW);
(h) one administrative
				staff person; and
(i) the eligible
				recipient shall be considered a part of the team for decisions impacting his or
				her ACT services.
(7)
				The agency must have a HSD ACT approval letter to render ACT services to an
				eligible recipient. The approval letter will authorize an agency also
				delivering CSC services.
(8) Any
				adaptations to the model require an approved variance from BHSD.