N.M. Code R. § 8.321.2.18 - COMPREHENSIVE COMMUNITY SUPPORT SERVICES (CCSS)
To help a New Mexico eligible recipient receive medically necessary services, MAD pays for covered CCSS. This culturally sensitive service coordinates and provides services and resources to an eligible recipient and his or her family necessary to promote recovery, rehabilitation and resiliency. CCSS identifies and addresses the barriers that impede the development of skills necessary for independent functioning in the eligible recipient's community, as well as strengths that may aid the eligible recipient and family in the recovery or resiliency process.
A.
Eligible providers and
practitioners:
(1) See Subsections A
and B of
8.321.2.9
NMAC for MAD general provider requirements. To provide CCSS services, a
provider must receive CCSS training through the state or state approved trainer
and attest that they have received this training when contacting the state's
fiscal agent to add the specialty service 107, CCSS to their existing
enrollment in medicaid. The children, youth and families department (CYFD) will
provide background checks for CCSS direct service and clinical staff for
child/youth CCSS programs.
(2)
Clinical services and supervision by licensed behavioral health practitioners
must be in accord with their respective licensing board regulations:
(a) Minimum staff qualifications for the
community support worker (CSW):
(i) must be
at least 18 years of age; and
(ii)
hold a bachelor's degree in a human services field from an accredited
university and have one year of relevant experience with the target population;
or
(iii) hold an associate's degree
and a minimum of two years of experience working with the target population;
or
(iv) hold an associate's degree
in approved curriculum in behavioral health coaching; no experience necessary;
or
(v) have a high school diploma
or equivalent and a minimum of three years of experience working with the
target population; or
(vi) hold a
certification from the New Mexico credentialing board for behavioral health
professionals as a certified peer support worker (CPSW) or as a certified peer
family specialist (CPFS).
(b) Minimum staff qualifications for
certified peer support workers (CPSW):
(i)
must be 18 years of age or older; and
(ii) have a high school diploma or
equivalent; and
(iii) be
self-identified as a current or former consumer of mental health or substance
abuse services, and have at least two years of mental health or substance abuse
recovery; and
(iv) have received
certification as a CPSW.
(c) Minimum staff qualifications for
certified family peer support workers (CFPSW):
(i) must be 18 years of age or older;
and
(ii) have a high school diploma
or equivalent; and
(iii) must have
lived-experience of being actively involved in raising a child who experienced
emotional, behavioral, mental health, or mental health with co-occurring
substance use or developmental disability challenges prior to the age of 18
years.
(iv) must have personal
experience navigating child serving systems on behalf of their own child. Must
also have an understanding of how these systems operate in New Mexico;
and
(v) have received certification
as a CFPSW.
(d) Minimum
staff qualifications for certified youth peer support workers (CYPSW):
(i) must be 18 years of age or older;
and
(ii) have a high school diploma
or equivalent; and
(iii) have
personal experience navigating any of the child/family-serving systems prior to
the age of 18 years. Must also have an understanding of how these systems
operate in New Mexico; and
(iv)
have received certification as a CYPSW.
(e) Minimum staff qualifications for the CCSS
program supervisor:
(i) must hold a bachelor's
degree in a human services field from an accredited university; and
(ii) have four years relevant experience in
the delivery of case management or CCSS with the target population;
and
(iii) have one year
demonstrated supervisory experience.
(f) Minimum staff qualifications for the
clinical supervisor:
(i) must be a licensed
independent practitioner (i.e. psychiatrist, psychologist, LISW, LPCC, LMFT),
psychiatrically certified clinical nurse specialist or clinical nurse
practitioner practicing under the scope of their NM licensure; and
(ii) have one year demonstrated supervisory
experience; and
(iii) provide
documented clinical supervision on a regular basis to the CSW, CPS and
CFS.
(3)
Staff training requirements:
(a) Minimum staff
training requirements for a community support worker includes:
(i) an initial training comprised of 20 hours
of documented education within the first 90 days of employment drawn from an
array of areas documented in the BH policy and billing manual;
(ii) documentation of ongoing training
comprised of 20 hours is required of a CSW every year, after the first year of
hire, with content of the education based upon agency assessment of staff
need.
(b) Minimum staff
training requirements for supervisors:
(i) the
same 20 hours of documented training or continuing education as required for
the CCSS community support worker;
(ii) an attestation of training related to
providing clinical supervision of non-clinical staff.
(4) The clinical supervisor and
the CCSS program supervisor may be the same individual.
(5) Documentation requirements: In addition
to the standard client record documentation requirements for all services, the
following is required for CCSS:
(a) case notes
identifying all activities and location of services;
(b) duration of service span (e.g., 1:00
p.m.-2:00 p.m.); and
(c)
description of the service provided with reference to the CCSS treatment plan
and related goals.
B.
Coverage criteria:
(1) CCSS must be identified in the service
plan for an individual. When identifying a need for this service, if the
provider agency is utilizing the "Treat First" clinical model, they may be
placed in this service for up to four encounters without having had a
psychiatric diagnostic evaluation with the utilization of a provisional
diagnosis for billing purposes. After four encounters, an individual must have
a comprehensive needs assessment, a diagnostic evaluation, and a CCSS treatment
plan. Further details related to the CCSS treatment plan can be accessed in the
BH policy and billing manual.
(2) A
maximum of 16 units per each admission or discharge may be billed concurrently
with:
(a) accredited residential treatment
center (ARTC);
(b) adult accredited
residential treatment center (AARTC);
(c) residential treatment center
(RTC);
(d) group home
service;
(e) inpatient
hospitalization; or
(f) treatment
foster care (TFC).
C.
Covered services: The purpose
of CCSS is to provide an eligible recipient and his or her family with the
services and resources necessary to promote recovery, rehabilitation and
resiliency. Community support services address goals specifically in the
following areas of the eligible recipient's activities: independent living;
learning; working; socializing and recreation. CCSS consists of a variety of
interventions, based on coaching and addressing barriers that impeded the
development of skills necessary for independent functioning in the community.
Community support services also include assistance with identifying and
coordinating services and supports identified in an individual's service plan;
supporting an individual and family in crisis situations; and providing
individual interventions to develop or enhance an individual's ability to make
informed and independent choices.
D.
Identified population:
(1) CCSS is provided to an eligible recipient
under 21 years who meets the NM state criteria for severe emotional disturbance
(SED)/neurobiological/behavioral disorders; and
(2) CCSS is provided to an eligible recipient
21 years and older whose diagnosis or diagnoses meet the NM state criteria of
serious mental illness (SMI) and for an eligible recipient with a diagnosis
that does not meet the criteria for SMI, but for whom time-limited CCSS would
support his or her recovery and resiliency process; and
(3) Recipients with a moderate to severe
substance use disorder (SUD) according to the current DSM V or its successor;
and
(4) Recipients with a
co-occurring disorder (mental illness/substance use) or dually diagnosed with a
primary diagnosis of mental illness.
E.
Non-covered services: CCSS is
subject to the limitations and coverage restrictions which exist for other MAD
services. See 8.310.2 NMAC for a detailed description of MAD general
non-covered services and Subsection G of
8.321.2.9
NMAC for all non-covered MAD behavioral health services or activities.
Specifically, CCSS may not be billed in conjunction with multi-systemic therapy
(MST) or ACT services, or resource development by New Mexico corrections
department (NMCD).
F.
Reimbursement: CCSS agencies must submit claims for reimbursement
on the CMS-1500 claim form or its successor; see 8.302.2 NMAC. Once enrolled, a
provider receives instructions on how to access documentation, billing, and
claims processing information. General reimbursement instructions are found in
this rule under Subsection H of
8.321.2.9
NMAC. Billing instructions for CCSS are found in the BH policy and billing
manual.
Notes
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