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 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 use 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 their family, parent or caretaker, and consultation with
their 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
their scope of licensure (see Subsection B of
8.321.2.9 NMAC). A
non-independently licensed behavioral health practitioner must have an
independently licensed RLD board approved supervisor review and sign the
assessment with a diagnosis. Based on the eligible recipient's current
assessment, their treatment file must document the extent to which their
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 their 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 treatment plans.
Notes
N.M. Admin.
Code §
8.321.2.15
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, Adopted
by
New
Mexico Register, Volume XXXV, Issue 23, December 10, 2024, eff.
12/10/2024
