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.
Notes
N.M. Code R. §
8.321.2.14
Adopted by
New
Mexico Register, Volume XXX, Issue 23, December 17, 2019, eff.
1/1/2020, Adopted by
New
Mexico Register, Volume XXXII, Issue 15, August 10, 2021, eff.
8/10/2021
