New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 308 - MANAGED CARE PROGRAM › Part 9 - BENEFIT PACKAGE › Section 8.308.9.19 - BEHAVIORAL HEALTH SERVICES

Current through Register Vol. 35, No. 13, July 16, 2024
A. The
				MCO shall cover the following behavioral health services listed below. When an
				additional behavioral health service is approved by MAD, the MCO shall cover
				that service as well. See 8.321.2 NMAC for detailed descriptions of each
				service. MAD makes available on its websiteits behavioral health service
				definitions and crosswalk, along with other information.
(1)
Applied behavior analysis:
The benefit package includes applied behavior analysis (ABA) services for
				eligible recipients who have a well-documented medical diagnosis of autism
				spectrum disorder (ASD), and for eligible recipients who have well-documented
				risk for the development of ASD. As part of a three-stage comprehensive
				approach consisting of evaluation, assessment, and treatment, ABA services may
				be provided in coordination with other medically necessary services (e.g.,
				family infant toddler program (FIT) services, occupational therapy, speech
				language therapy, medication management, developmentally disabled waiver
				services, etc.). ABA services are part of the early periodic screening,
				diagnosis and treatment (EPSDT) program (CFR 42 section 441.57). There is no
				age requirement to receive ABA services and ABA is a covered benefit for
				medicaid-enrolled adults.
(2)
Assertive community treatment services (ACT):
The benefit package
				includes assertive community treatment services for a member 18 years of age
				and older.
(3)
Behavioral
				health respite:
Behavioral health respite care is provided to a member
				under 21 years of age to support the member's family and strengthen their
				resiliency during the respite while the member is in a supportive environment.
				Respite care is provided to a member with a severe emotional disturbance who
				resides with his or her family and displays challenging behaviors that may
				periodically overwhelm the member's family's ability to provide ongoing
				supportive care. See the New Mexico interagency behavioral health purchasing
				collaborative service requirements and utilization guidelines-respite
				services-for a detailed description. Behavioral health respite is not a benefit
				for ABP eligible recipients.
(4)
Comprehensive community support services:
The benefit package
				includes comprehensive community support services for a member.
(5)
Crisis Services:
The benefit
				package includes three types of crisis services:
(a) 24-hour crisis telephone support;
				and
(b) mobile crisis team;
				and
(c) crisis triage
				centers.
(6)
Family support services:
The benefit package includes family
				support services to a member whose focus is on the member and his or her family
				and the interactive effect through a variety of informational and supportive
				activities that assists the member and his or her family develop patterns of
				interaction that promote wellness and recovery over time. The positive
				interactive effect between the member and his or her family strengthens the
				effectiveness of other treatment and recovery initiatives. See the New Mexico
				interagency behavioral health purchasing collaborative service requirements and
				utilization guidelines -family support services-for a detailed description.
				Family support services are not a benefit for ABP eligible
				recipients.
(7)
Hospital
				outpatient services:
The benefit package includes outpatient psychiatric
				and partial hospitalization services provided in PPS-exempt unit of a general
				hospital for a member.
(8)
Inpatient hospital services:
The benefit package includes
				inpatient hospital psychiatric services provided in general hospital units and
				prospective payment system (PPS)-exempt units in a general hospital as detailed
				in 8.311.2 NMAC.
(9)
Intensive outpatient (IOP) services:
The benefit package includes
				intensive outpatient services for a member 13 years of age.
(10)
Medication assisted treatment
				(MAT) and Opioid Treatment Programs:
The benefit package includes
				opioid treatment services for opioid addiction to a member through an opioid
				treatment center as defined in 42 CFR Part 8 , Certification of Opioid
				Treatment; and buprenorphine and related pharmaceuticals. Medication assisted
				treatments include use of buprenorphine and similarly acting
				products.
(11)
Outpatient
				therapy services:
The benefit package includes outpatient therapy
				services (individual, family, and group) for a member.
(12)
Psychological rehabilitation
				services:
The benefit package includes adult psychosocial rehabilitation
				services for a member 18 years and older.
(13)
Recovery services:
The MCO
				benefit package includes recovery services for a member. Recovery services are
				peer-to-peer support within a group setting to develop and enhance wellness and
				healthcare practices. The service enables a member to identify additional needs
				and goals and link him or herself to additional support as a result. See the
				New Mexico interagency behavioral health purchasing collaborative service
				requirements and utilization guidelines -recovery services-for a detailed
				description. Recovery services are not a benefit for ABP eligible
				recipients.