New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 321 - SPECIALIZED BEHAVIORAL HEALTH SERVICES › Part 2 - SPECIALIZED BEHAVIORAL HEALTH PROVIDER ENROLLMENT AND REIMBURSEMENT › Section 8.321.2.16 - BEHAVIOR MANAGEMENT SKILLS DEVELOPMENT SERVICES

Current through Register Vol. 35, No. 13, July 16, 2024
To help an eligible recipient under 21 years of age who is
				  in need of behavior management intervention receive services, MAD pays for
				  behavior management services (BMS) as part of the EPSDT program and when the
				  need for BMS is identified in a tot to teen health check screen or other
				  diagnostic evaluation (see
				  42 CFR Section
				  441.57) . BMS services are designed to
				  provide highly supportive and structured therapeutic behavioral interventions
				  to maintain the eligible recipient in his or her home or community. BMS assists
				  in reducing or preventing inpatient hospitalizations or out-of-home residential
				  placement of the eligible recipient through use of teaching, training and
				  coaching activities designed to assist him or her in acquiring, enhancing and
				  maintaining the life, social and behavioral skills needed to function
				  successfully within his or her home and community settings. BMS is provided as
				  part of a comprehensive approach to treatment and in conjunction with other
				  services as indicated in the eligible recipient's comprehensive behavioral
				  health treatment or service plan. BMS is not provided as a stand-alone service,
				  but delivered as part of an integrated plan of services to maintain eligible
				  recipients in their communities as an alternative to out-of-home
				  services.
A.
Eligible providers:
An agency must be certified by CYFD to provide BMS services. See
				Subsections A and B of
				8.321.2.9
				NMAC for MAD general provider requirements.
B.
Coverage criteria:
MAD
				reimburses for behavior management services specified in the eligible
				recipient's individualized treatment plan which are designed to improve his or
				her performance in targeted behaviors, reduce emotional and behavioral episodic
				events, increase social skills and enhance behavioral skills through a regimen
				of positive intervention and reinforcement.
(1) Implementation of the eligible
				recipient's BMS treatment plan, which includes crisis planning, must be based
				on a clinical assessment that includes identification of skills deficits that
				will benefit from an integrated program of therapeutic services. A detailed
				description of required elements of the assessment and treatment plan are found
				in the BH policy and billing manual.
(2) 24-hour availability of appropriate staff
				or implementation of crisis plan, which may include referral, to respond to the
				eligible recipient's crisis situations.
(3) Supervision of behavioral management
				staff by an independent level practitioner is required for this service
				(8.321.2.9
				NMAC). Policies governing supervisory responsibilities are detailed in the BH
				policy and billing manual. The supervisor must ensure that:
(a) a clinical assessment of the eligible
				recipient is completed upon admission into BMS. The clinical assessment
				identifies the need for BMS as medically necessary to prevent inpatient
				hospitalizations or out-of-home residential placement of the eligible
				recipient;
(b) the assessment is
				signed by the recipient or his or her parent or legal guardian; and
(c) the BMS worker receives documented
				supervision for a minimum of two hours per month dependent on the complexity of
				the needs presented by recipients and the supervisory needs of the BMS
				worker.
(4) An eligible
				recipient's treatment plan must be reviewed at least every 30 calendar days
				after implementation of the comprehensive service plan. The BMS, in partnership
				with the client and family as well as all other relevant treatment team members
				such as school personnel, juvenile probation officer (JPO), and guardian ad
				litem (GAL), shall discuss progress made over time relating to the BMS service
				goals. If the BMS treatment team assesses the recipient's lack of progress over
				the last 30 days, the treatment plan will be amended as agreed upon during the
				treatment team meeting. Revised BMS treatment plans will be reviewed and
				approved by the BMS supervisor, which must be documented in the recipient's
				file.