New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 321 - SPECIALIZED BEHAVIORAL HEALTH SERVICES › Part 2 - SPECIALIZED BEHAVIORAL HEALTH PROVIDER ENROLLMENT AND REIMBURSEMENT › Section 8.321.2.9 - GENERAL PROVIDER INSTRUCTION

Current through Register Vol. 35, No. 13, July 16, 2024
A. Health care to New Mexico eligible
				recipients is furnished by a variety of providers and provider groups. The
				reimbursement for these services is administered by the HSD medical assistance
				division (MAD). Upon approval of a New Mexico MAD provider participation
				agreement (PPA) a licensed practitioner, a facility or other providers of
				services that meet applicable requirements are eligible to be reimbursed for
				furnishing MAD covered services to an eligible recipient. A provider must be
				approved before submitting a claim for payment to the MAD claims processing
				contractors. Information necessary to participate in health care programs
				administered by HSD or its authorized agents, including New Mexico
				administrative code (NMAC) program rules, program policy manuals, billing
				instructions, supplements, utilization review (UR) instructions, and other
				pertinent materials is available on the HSD website, on other program specific
				websites or in hard copy format. When approved, a provider receives
				instructions on how to access these documents. It is the provider's
				responsibility to access these instructions, to understand the information
				provided and to comply with the requirements. The provider must contact HSD or
				its authorized agents to obtain answers to questions related to the material or
				not covered by the material. To be eligible for reimbursement, providers and
				practitioners must adhere to the provisions of his or her MAD PPA and all
				applicable statutes, regulations, rules, and executive orders. MAD or its
				selected claims processing contractor issues payment to a provider using the
				electronic funds transfer (EFT) only. Providers must supply necessary
				information as outlined in the PPA for payment to be made.
B. Services must be provided within the
				licensure for each facility and scope of practice for each provider and
				supervising or rendering practitioner. Services must be in compliance with the
				statutes, rules and regulations of the applicable practice act. Providers must
				be eligible for reimbursement as described in 8.310.2 NMAC and 8.310.3
				NMAC.
C. The following independent
				providers with active licenses (not provisional or temporary) are eligible to
				be reimbursed directly for providing MAD behavioral health professional
				services unless otherwise restricted or limited by NMAC rules:
(1) a physician licensed by the board of
				medical examiners or board of osteopathy who is board eligible or board
				certified in psychiatry, to include the groups they form;
(2) a psychologist (Ph.D., Psy.D. or Ed.D.)
				licensed as a clinical psychologist by the New Mexico regulation and licensing
				department's (RLD) board of psychologist examiners, to include the groups they
				form;
(3) a licensed independent
				social worker (LISW) or a licensed clinical social worker (LCSW) licensed by
				RLD's board of social work examiners, to include the groups they
				form;
(4) a licensed professional
				clinical counselor (LPCC) licensed by RLD's counseling and therapy practice
				board, to include the groups they form;
(5) a licensed marriage and family therapist
				(LMFT) licensed by RLD's counseling and therapy practice board, to include the
				groups they form;
(6) a licensed
				alcohol and drug abuse counselor (LADAC) licensed by RLD's counseling and
				therapy practice board or a certified alcohol and drug abuse counselor (CADC)
				certified by the New Mexico credentialing board for behavioral health
				professionals (CBBHP). Independent practice is for alcohol and drug abuse
				diagnoses only. The LADAC or CADC may provide therapeutic services that may
				include treatment of clients with co-occurring disorders or dual diagnoses in
				an integrated behavioral health setting in which an interdisciplinary team has
				developed an interdisciplinary treatment plan that is co-authorized by an
				independently licensed counselor or therapist. The treatment of a mental health
				disorder must be supervised by an independently licensed counselor or
				therapist; or
(7) a clinical nurse
				specialist (CNS) or a certified nurse practitioner (CNP) licensed by the New
				Mexico board of nursing and certified in psychiatric nursing by a national
				nursing organization, to include the groups they form, who can furnish services
				to adults or children as his or her certification permits; or
(8) a licensed professional art therapist
				(LPAT) licensed by RLD's counseling and therapy practice board, and certified
				for independent practice by the art therapy credentials board (ATCB);
				or
(9) an out-of-state provider
				rendering a service from out-of-state must meet his or her state's licensing
				and certification requirements which are acceptable when deemed by MAD to be
				substantially equivalent to the license.