New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 321 - SPECIALIZED BEHAVIORAL HEALTH SERVICES › Part 2 - SPECIALIZED BEHAVIORAL HEALTH PROVIDER ENROLLMENT AND REIMBURSEMENT › Section 8.321.2.14 - BEHAVIORAL HEALTH PROFESSIONAL SERVICES FOR SCREENINGS, EVALUATIONS, ASSESSMENTS AND THERAPY

Current through Register Vol. 35, No. 13, July 16, 2024
MAD covers validated screenings for high risk conditions in
				  order to provide prevention or early intervention. Brief interventions or the
				  use of the treat first clinical model may be billed with a provisional
				  diagnosis for up to four encounters. After four encounters, if continuing
				  treatment is required, a diagnostic evaluation must be performed, and
				  subsequent reimbursement is based on the diagnosis and resulting service and
				  treatment plan. See the BH policy and billing manual for a description of the
				  treat first clinical model.
A.
				Psychological, counseling and social work: These services are diagnostic or
				active treatments with the intent to reasonably improve an eligible recipient's
				physical, social, emotional and behavioral health or substance abuse condition.
				Services are provided to an eligible recipient whose condition or functioning
				can be expected to improve with these interventions. Psychological, counseling
				and social work services are performed by licensed psychological, counseling
				and social work practitioners acting within their scope of practice and
				licensure (see Subsections B through E of
				8.321.2.9
				NMAC). These services include, but are not limited to assessments that appraise
				cognitive, emotional and social functioning and self-concept. Therapy includes
				planning, managing and providing a program of psychological services to the
				eligible recipient meeting a current DSM, ICD, or DC:0-5 behavioral health
				diagnosis and may include therapy with her or his family or parent/caretaker,
				and consultation with his or her family and other professional staff.
B. An assessment as described in the BH
				policy and billing manual, must be signed by the practitioner operating within
				his or her scope of licensure (see Subsection B of
				8.321.2.9
				NMAC). A non-independently licensed behavioral health practitioner must have an
				independently licensed behavioral health practitioner review and sign the
				assessment with a diagnosis. Based on the eligible recipient's current
				assessment, his or her treatment file must document the extent to which his or
				her treatment goals are being met and whether changes in direction or emphasis
				of the treatment are needed. See Subsection K of
				8.321.2.9
				NMAC for detailed description of the required eligible recipient file
				documentation.
C. Outpatient
				therapy services (individual, family and group) includes planning, managing,
				and providing a program of psychological services to the eligible recipient
				with a diagnosed behavioral health disorder, and may include consultation with
				his or her family and other professional staff with or without the eligible
				recipient present when the service is on behalf of the recipient. See the BH
				policy and billing manual for detailed requirements of service plans and
				treatment plans.