N.M. Admin. Code § 8.321.2.18 - COGNITIVE ENHANCEMENT THERAPY (CET)
CET services provide treatment service for an eligible recipient 18 years of age or older with cognitive impairment associated with the following serious mental illnesses: schizophrenia, bipolar disorder, major depression, recurrent schizoaffective disorder, or autism spectrum disorder. CET uses an evidence-based model to help eligible recipients with these conditions improve their processing speed, cognition, and social cognition. Any CET program must be approved by the BHSD and ensure that treatment is delivered with fidelity to the evidence-based model.
A.
Eligible providers: Services
may only be delivered through a MAD enrolled provider after demonstrating that
the agency meets all the requirements of CET program services and supervision.
See Subsections A and B of
8.321.2.9 NMAC for MAD general
provider requirements.
(1) CET services are
provided through an integrated interdisciplinary approach by staff with
expertise in the mental health condition being addressed and have received
training from a state approved trainer. Staff can include independently
licensed behavioral health practitioners, non-independently licensed behavioral
health practitioners, RNs, or CSWs. For every CET cohort of eligible
recipients, there must be two practitioners who have been certified in the
evidence-based practice by a state approved trainer or training center. The
agency shall retain documentation of the staff that has been trained. The size
of each cohort who receives CET must conform to the evidence-based practice
(EBP) model in use.
(2) The agency
must hold an approval letter issued by BHSD certifying that the staff have
participated in an approved training or have arranged to participate in
training and have supervision by an approved trainer prior to commencing
services.
(3) Weekly required
participation in hourly fidelity monitoring sessions with a certified CET
trainer for all providers delivering CET who have not yet received
certification.
B.
Covered services:
(1) CET
services include:
(a) weekly social cognition
groups with enrollment according to model fidelity;
(b) weekly computer skills groups with
enrollment according to model fidelity;
(c) weekly individual face-to-face coaching
sessions to clarify questions and to work on homework assignments;
(d) initial and final standardized
assessments to quantify social-cognitive impairment, processing speed,
cognitive style; and
(e) individual
treatment planning.
(2)
The duration of an eligible recipient's CET intervention is based on model
fidelity. Each individual participating in CET receives up to three hours of
group treatment and up to one hour of individual face-to-face
coaching.
C.
Identified population: CET services are provided to an eligible
adult recipient 18 years of age and older with cognitive impairment associated
with the following serious mental illnesses:
(1) schizophrenia;
(2) bipolar disorder;
(3) major depression, recurrent;
(4) schizoaffective disorder; or
(5) autism spectrum disorder.
D.
Non-covered
services:
(1) CET services are subject
to the limitation and coverage restrictions which exist for other MAD covered
services. See Subsection G of
8.321.2.9 NMAC for general
non-covered MAD behavioral health services and 8.310.2 NMAC for MAD general
non-covered services.
(2) MAD does
not cover the CET during an acute inpatient stay.
E.
Reimbursement: See Subsection
H of 8.321.2.9 NMAC for MAD behavioral
health general reimbursement.
(1) For CET
services, the agency must submit claims for reimbursement on the CMS-1500 claim
form or its successor.
(2) Core CET
services are reimbursed through a bundled rate. Medications and other mental
health therapies are billed and reimbursed separately from the bundled
rate.
(3) CET services furnished by
a CET team member are billed by and reimbursed to a MAD enrolled CET agency
whether the team member is under contract with or employed by the CET
agency.
(4) CET services not
provided in accordance with the conditions for coverage as specified in
8.321.2.9 NMAC are not a MAD
covered service and are subject to recoupments.
(5) Billing instructions for CET services are
detailed in the BH policy and billing manual.
Notes
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
No prior version found.