N.M. Code R. § 8.321.2.20 - CRISIS TRIAGE CENTER
MAD pays for a set of services, either outpatient only or including residential, to eligible adults and youth 14 years of age and older, to provide voluntary stabilization of behavioral health crises including emergency mental health evaluation and care. Crisis triage centers (CTC) shall provide emergency screening and evaluation services 24 hours a day, seven days a week.
A.
Coverage criteria
for CTCs which include residential care:
(1) The CTC shall provide emergency
screening, and evaluation services 24-hours a day, seven days a week and shall
admit 24-hours a day seven days a week and discharge seven days a
week;
(2) Readiness for discharge
shall be reviewed in collaboration with the recipient every day;
(3) An independently licensed mental health
practitioner or non-independent mental health practitioner under supervision
must assess each individual with the assessment focusing on the stabilization
needs of the client;
(4) The
assessment must include medical and mental health history and status, the onset
of the illness, the presenting circumstances, risk assessment, cognitive
abilities, communication abilities, social history and history of
trauma;
(5) A licensed mental
health professional must document a crisis stabilization plan to address needs
identified in the assessment which must also include criteria describing
evidence of stabilization and either transfer or discharge criteria;
(6) The CTC identifies recipients at high
risk of suicide or intentional self-harm, and subsequently engages these
recipients through solution-focused and harm-reducing methods;
(7) Education and program offerings are
designed to meet the stabilization and transfer of recipients to a different
level of care;
(8) The charge
nurse, in collaboration with a behavioral health practitioner, shall make the
determination as to the time and manner of transfer to ensure no further
deterioration of the recipient during the transfer between facilities, and
shall specify the benefits expected from the transfer in the recipient's
record;
(9) The facility shall
develop policies and procedures addressing risk assessment and mitigation
including, but not limited to: assessments, crisis intervention plans,
treatment, approaches to supporting, engaging and problem solving, staffing,
levels of observation and documentation. The policies and procedures must
prohibit seclusion and address physical restraint, if used, and the facility's
response to clients that present with imminent risk to self or others,
assaultive and other high-risk behaviors;
(10) Use of seclusion is
prohibited;
(11) The use of
physical restraint must be consistent with federal and state laws and
regulation;
(12) Physical
restraint, as defined in the BH policy and billing manual, shall be used only
as an emergency safety intervention of last resort to ensure the physical
safety of the client and others, and shall be used only after less intrusive or
restrictive interventions have been determined to be ineffective;
(13) If serving both youth and adult
populations, the service areas must be separate; and
(14) If an on-site laboratory is part of
services, the appropriate clinical laboratory improvement amendments (CLIA)
license must be obtained.
B.
Coverage criteria for CTCs which
are outpatient only: Paragraph (3) through (14) of Subsection A of
8.321.2.20 NMAC are conditions of coverage for outpatient only
services.
C.
Eligible
providers and practitioners:
(1) A
provider agency licensed through the department of health as a crisis triage
center offering one of the following types of service:
(a) a CTC structured for less than 24-hour
stays providing only outpatient withdrawal management or other stabilization
services;
(b) a CTC providing
outpatient and residential crisis stabilization services; or
(c) a CTC providing residential crisis
stabilization services.
(2) Practitioners must be contracted or
employed by the provider agency as part of its crisis triage center service
delivery.
(3) All providers must be
licensed in New Mexico for services performed in New Mexico. For services
performed by providers licensed outside of New Mexico, a provider's
out-of-state license may be accepted in lieu of licensure in New Mexico if the
out-of-state licensure requirements are similar to those of the state of New
Mexico.
(4) For services provided
under the public health service including IHS, providers must meet the
requirements of the public health service corps.
(5) The facility shall maintain sufficient
staff including supervision and direct care and mental health professionals to
provide for the care of residential and non-residential clients served by the
facility, based on the acuity of client needs.
(6) The following individuals and
practitioners must be contracted or employed by the provider agency as part of
its crisis triage center service delivery:
(a)
An on-site administrator which can be the same person as the clinical director.
The administrator is specifically assigned to crisis triage center service
oversight and administrative responsibilities and:
(i) is experienced in acute mental health;
and
(ii) is at least 21 years of
age; and
(iii) holds a minimum of a
bachelor's degree in the human services field; or
(iv) is a registered nurse (RN) licensed by
the NM board of nursing with experience or training in acute mental health
treatment.
(b) A full
time clinical director that is:
(i) at least
21 years of age; and
(ii) is a
licensed independent mental health practitioner or certified nurse practitioner
or clinical nurse specialist with experience and training in acute mental
health treatment and withdrawal management services, if withdrawal management
services are provided.
(c) A charge nurse on duty during all hours
of operation under whom all services are directed, with the exception of
services provided by the physician and the licensed independent mental health
practitioner, and who is:
(i) at least 18
years of age; and
(ii) a RN
licensed by the NM board of nursing with experience in acute mental health
treatment and withdrawal management services, if withdrawal management services
are provided.
(d) A
regulation and licensing department (RLD) master's level licensed mental health
practitioner.
(e) Certified peer
support workers (CPSW) holding a certification by the New Mexico credentialing
board for behavioral health professionals as a certified peer support worker
staffed appropriate to meet the client needs 24 hours a day 7 days a
week.
(f) An on call physician
during all hours of operation who is a physician licensed to practice medicine
(MD) or osteopathy (DO), or a licensed certified nurse practitioner (CNP), or a
licensed clinical nurse specialist (CNS) with behavioral health experience as
described in 8.310.3 NMAC.
(g) A
part time psychiatric consultant or prescribing psychologist, hours determined
by size of center, who is a physician (MD or DO) licensed by the board of
medical examiners or board of osteopathy and is board eligible or board
certified in psychiatry as described in 8.321.2 NMAC, or a prescribing
psychologist licensed by the board of psychologist examiners or psychiatric
certified nurse practitioner as licensed by the board of nursing. These
services may be provided through telehealth.
(h) At least one staff trained in basic
cardiac life support (BCLS), the use of the automated external defibrillator
(AED) equipment, and first aid shall be on duty at all times.
(7) Additional staff may include
an emergency medical technician (EMT) with documentation of three hours of
annual training in suicide risk assessment.
D.
Identified population:
(1) An eligible recipient is 18 years of age
and older who meets the crisis triage center admission criteria if the CTC is
an adults only agency.
(2) If
serving youth, an eligible recipient is 14 years through 17 years.
(3) Recipients may also have other
co-occurring diagnoses.
(4) The CTC
shall not refuse service to any recipient who meets the agency's criteria for
services, or solely based on the recipient being on a law enforcement hold or
living in the community on a court ordered conditional release.
E.
Covered services:
(1) Comprehensive medical history and
physical examination of recipient at admission;
(2) Development and update of the assessment
and plan as described in the BH policy and billing manual;
(3) Crisis stabilization including, but not
limited to:
(a) crisis triage that involves
making crucial determinations within several minutes about an individual's
course of treatment;
(b) screening
and assessment as described in the BH policy and billing manual;
(c) de-escalation and
stabilization;
(d) brief
intervention and psychological counseling;
(e) peer support.
(4) Ambulatory withdrawal management
(non-residential) based on American society of addiction medicine (ASAM) 2.1
level of care includes:
(a) evaluation,
withdrawal management and referral services under a defined set of physician
approved policies and clinical protocols;
(b) clinical consultation and supervision for
bio-medical, emotional, behavioral, and cognitive problems;
(c) psychological and psychiatric
consultation; and
(d) other
services determined through the assessment process.
(5) Clinically or medically monitored
withdrawal management in residential setting, if included, not to exceed
services described in level 3.7 of the current ASAM patient placement
criteria.
(6) Prescribing and
administering medication, if applicable.
(7) Conducting or arranging for appropriate
laboratory and toxicology testing.
(8) Navigational services for individuals
transitioning to the community when available include:
(a) prescription and medication
assistance;
(b) arranging for
temporary or permanent housing;
(c)
family and natural support group planning;
(d) outpatient behavioral health referrals
and appointments; and
(e) other
services determined through the assessment process.
(9) Assistance in accessing transportation
services for recipients who lack safe transportation.
F.
Non-covered services: are
subject to the limitations and coverage restrictions that exist for other MAD
services. See 8.310.2 and 8.321.2 NMAC for general non-covered services.
Specific to crisis triage services, the following apply:
(1) Acute medical alcohol detoxification that
requires hospitalization as diagnosed by the agency physician or certified
nurse practitioner.
(2) Medical
care not related to crisis triage intervention services beyond basic medical
care of first aid and CPR.
G.
Prior authorization and utilization
review: All MAD services are subject to utilization review (UR) for
medical necessity and program compliance. The provider agency must contact HSD
or its authorized agents to request UR instructions. It is the provider
agency's responsibility to access these instructions or ask for hard copies to
be provided, to understand the information provided, to comply with the
requirements, and to obtain answers to questions not covered by these
materials.
(1)
Prior
authorization: Crisis triage services do not require prior
authorization, but are provided as approved by the crisis triage center
provider agency. However, other procedures or services may require prior
authorization from MAD or its designee when such services require prior
authorization for other MAD eligible recipients, such as inpatient admission.
Services for which prior authorization was obtained remain subject to
utilization review at any point in the payment process, including after payment
has been made. It is the provider agency's responsibility to contact MAD or its
designee and review documents and instructions available from MAD or its
designee to determine when prior authorization is necessary.
(2)
Timing of UR: A UR may be
performed at any time during the service, payment, or post payment processes.
In signing the MAD PPA, a provider agency agrees to cooperate fully with MAD or
its designee in their performance of any review and agree to comply with all
review requirements.
H.
Reimbursement: Crisis triage center services are reimbursed
through an agency specific cost based bundled rate relative to type of services
rendered. Billing details are provided in the BH policy and billing
manual.
Notes
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