N.M. Admin. Code § 8.321.2.20 - CRISIS INTERVENTION SERVICES
MAD pays for a continuum of community-based crisis intervention services which are immediate, and designed to ameliorate, prevent, or minimize a crisis episode or to prevent inpatient psychiatric hospitalization, medical detoxification, emergency department use, multiple system involvement or incarceration. Services are provided to eligible recipients who are unable to use their current coping strategies and need immediate support. Crisis intervention services include telephone crisis services; face-to-face crisis triage and intervention; mobile crisis services; and crisis stabilization services.
A.
Coverage criteria:
(1)
Telephone crisis services:
(a)
agencies providing telephone crisis services must develop policy and procedures
regarding telephone crisis services which must be made available to MAD or is
designee upon request;
(b)
assurance that a backup crisis telephone system is available if the toll-free
number is not accessible;
(c)
assurance that calls are answered by a person trained in crisis response as
described in the BH policy and billing manual;
(d) processes to screen calls, evaluate
crisis situation, provide referral to mobile crisis team (MCT) or mobile
response and stabilization services (MRSS) when appropriate, and provide
counseling and consultation to crisis callers are documented and
implemented;
(e) assurance that
face-to-face intervention services are available immediately if clinically
indicated either by the telephone service or through memorandums of
understanding with referral sources;
(f) provision of a toll-free number, such as
988, and the agency's number to active clients and their support; and
(g) documentation of each phone call must be
maintained and include:
(i) date, time and
duration of call;
(ii) name of
individual calling;
(iii) responder
handling call;
(iv) description of
crisis; and
(v) intervention
provided, (e.g. counseling, consultation, referral, etc.).
(2)
Face-to-face clinic
crisis services:
(a) the provider shall
make an immediate assessment for purposes of developing a system of triage to
determine urgent or emergent needs of the person in crisis. This may include a
referral to MCT or MRSS when appropriate. (Note: The immediate assessment may
have already been completed as part of a telephone crisis response.)
(b) within the first two hours of the crisis
event, the provider will initiate the following activities:
(i) immediately conduct the crisis
assessment;
(ii) protect the
individual (possibly others) and de-escalate the situation;
(iii) determine if a higher level of service
or other supports are required and arrange, if applicable; and
(iv) develop or update the crisis and safety
plans.
(c) follow-up:
initiate telephone call or face-to-face follow up contact with individual
within 24 hours of initial crisis.
(3)
Mobile crisis intervention
services:
(a) mobile crisis services
provide rapid response, individual assessment, and evaluation and treatment of
mental health crisis to individuals experiencing a mental health crisis or SUD
crisis. A crisis is defined as a turning point in the course of anything
decisive or critical in an individual's life, in which the outcome may decide
whether possible negative consequences will follow mobile crisis services:
(i) are provided in two models: MCT and MRSS.
MRSS is a child, youth and family specific crisis intervention and prevention
service. In order to be eligible to provide services MCT and MRSS teams must be
approved though the application process outlined in the BH policy and billing
manual;
(ii) must be provided by a
multidisciplinary team of at least two behavioral health professionals or
paraprofessionals, as defined in
8.321.2.9 NMAC, that includes at
minimum a RLD board approved clinical supervisor who must be available to
provide real-time clinical assessment and clinical support in-person or via
telehealth at any time during the initial response;
(iii) must be available where the individual
is experiencing a mental health, or SUD, crisis and may not be restricted to a
specific location and in the least restrictive environment available;
(iv) must be available 24 hours a day, seven
days a week and 365 days per year and may not be restricted to select days or
times;
(v) must be person and
family centered as well as culturally, linguistically, and developmentally
appropriate;
(vi) may be provided
prior to an intake evaluation for mental health services; and
(vii) may not be provided in a hospital or
other facility setting.
(b) at a minimum, mobile crisis services
including initial response of conducting immediate crisis screening an
assessment, mobile crisis stabilization and de-escalation, and coordination
with and referral to health social and other services as needed to effect
symptom reduction, harm reduction or to safely transition an individual in
acute crisis to the appropriate environment for continued stabilization. MCT
and MRSS teams must:
(i) be trained in
trauma-informed care, de-escalation strategies, and harm reduction;
(ii) be able to respond in a timely
manner;
(iii) have the ability to
provide screening and assessment, stabilization and de-escalation, and
coordination and referral to services as appropriate;
(iv) ensure language access for individuals
with limited-English proficiency, those who are deaf or hard of hearing, and
comply with all applicable requirements under the Americans with Disabilities
Act, Rehabilitation Act, and Civil Rights Act;
(v) maintain relationships with relevant
community partners, including medical and behavioral health providers, primary
care providers, community health centers, crisis respite centers, and managed
care organizations for the purpose of coordination and referral to services;
and
(vi) be able to administer
naloxone.
(c) MCTs and
MRSS may connect individuals to facility-based care as needed, through warm
hand-offs and coordinating transportation only in situations that warrant
transition to other locations or higher levels of care. Services may also
include telephone follow-up or intervention services for up to 72 hours after
the initial mobile response. Follow-up may include additional intervention and
de-escalation services as well as referral to care as appropriate.
(4)
Mobile response and
stabilization services (MRSS):
(a) MRSS
must comply with requirements outlined in Paragraph (3) of Subsection A of
8.321.2.19 NMAC as well as the meet
the following criteria:
(i) provider response
and stabilization services to individuals 0-21 years of age;
(ii) provide immediate, in-person, response
to de-escalate crisis or safety and stability event that is defined by the
family. A safety and stability event is defined as the perception of an event
or situation as an intolerable difficulty that exceeds the resources and coping
mechanisms of the caregiver; an unexpected or out of control event that causes
pain, suffering, or instability for the family; an event occurs that could
result in movement to a higher level of care or a restrictive setting; or the
caregiver does not know what to do about a child's behavior; and
(iii) provide up to 56 days of stabilization
service support, follow-up and navigation to reduce the likelihood of future
crisis or out of home placement.
(b) MRSS aligns with the children's system of
care (SOC) approach in NM. MRSS supports teams to effectively coordinate within
the state's children's behavioral health service array including access to
community support and resources.
(5)
Crisis stabilization
services: Outpatient, clinic-based, stabilization services for substance
use and co-occurring disorder crises which includes ASAM level two withdrawal
management. Crisis stabilization services include assessment, safety planning
and coordination with appropriate resources for up to 24 hours. This service is
available across the lifespan.
B.
Eligible practitioners:
(1)
Telephone crisis services:
(a) individual crisis workers who are
covering the crisis telephone must meet the following criteria:
(i) CPSW with one year work experience with
individuals with behavioral health condition;
(ii) bachelor level community support worker
employed by the agency with one year work experience with individuals with a
behavioral health condition;
(iii)
RN with one year work experience with individuals with behavioral health
condition;
(iv) LMHC with one year
work experience with individuals with behavioral health condition;
(v) LMSW with one year work experience with
individuals with behavioral health condition; or
(vi) psychiatric physician
assistant;
(vii) LADAC;
or
(viii) LSAA with one year of
work experience with individuals with behavioral health conditions.
(b) Supervision by a:
(i) psychiatrist; or
(ii) RLD board approved clinical
supervisor.
(c)
training:
(i) 20 hours of crisis intervention
training that addresses the developmental needs of the full age span of the
target population by a licensed independent mental health professional with two
years crisis work experience; and
(ii) 10 hours of crisis related continuing
education annually.
(2)
Mobile crisis intervention services
for MCT and MRSS:
(a) services must be
delivered by an agency designated as an MCT or MRSS through the approval
process defined in the BH policy and billing manual and must be an enrolled
medicaid provider. Allowable agency types are identified in Subsection D of
8.321.2.9 NMAC.
(b) services must be delivered by a minimum
of a two-person team that includes at minimum a RLD board approved clinical
supervisor who must be available to provide real-time clinical assessment and
clinical support in-person or via telehealth;
(c) additional team members may include:
(i) a licensed mental health
therapist;
(ii) certified peer
support worker;
(iii) certified
family peer support worker;
(iv)
certified youth peer support specialist;
(v) community support worker;
(vi) community health worker;
(vii) community health
representative;
(viii) certified
prevention specialist;
(ix)
registered nurse;
(x) emergency
medical service provider;
(xi)
licensed alcohol and drug abuse counselor (LADAC);
(xii) non-independently licensed behavioral
health professionals as defined in
8.321.2.9 NMAC.
(xiii) emergency medical
technicians;
(xiv) licensed
practical nurses;
(xv) other
certified or credentialed individuals;
(xvi) tribal 638 or IHS facilities may
request a waiver to the staffing requirements outlined above for MRSS by
submitting a staffing plan to the department as defined in the BH billing and
policy manual.
(3)
Crisis stabilization
services: staffing must include RLD board approved clinical supervisor
and:
(a) one registered nurse (RN) licensed by
the NM board of nursing with experience or training in crisis triage and
managing intoxication and withdrawal management when providing ASAM level two
detoxification services;
(b) one
regulation and licensing department (RLD) master's level licensed mental health
professional on-site during all hours of operation;
(c) certified peer support worker, certified
family per support worker, or certified youth peer support worker, on-site or
available for on-call response during all hours of operation; and
(d) board certified physician or certified
nurse practitioner licensed by the NM board of nursing either on-site or on
call.
C.
Covered services:
(1)
Telephone crisis services:
(a)
the screening of calls, evaluation of the crisis situation and provision of
counseling and consultation to the crisis callers.
(b) referrals to appropriate mental health
professions, where applicable.
(c)
maintenance of telephone crisis communication until a face-to-face response
occurs, as applicable.
(2)
Face-to-face clinic crisis
services:
(a) crisis
assessment;
(b) other screening, as
indicated by assessment;
(c) brief
intervention or counseling; and
(d)
referral to needed resource.
(3)
Mobile crisis intervention
services:
(a) immediatecrisis screening
and assessment;
(b) other
screening, as indicated by assessment;
(c) mobile crisis stabilization and
de-escalation and crisis prevention activities specific to the needs of the
individual;
(d) coordination with
and referral to health, social, and other service as needed to effect symptom
reduction harm reduction or to safely transition person in acute crisis to the
appropriate environment for continued stabilization;
(e) warm hand off and coordination of
transportation in situations that warrant transition to other locations;
and
(f) telephonic follow-up
interventions for up to 72 hours after the initial mobile response. Follow-up
may include additional intervention and de-escalation services as well as
referral to care as appropriate.
(4)
Mobile crisis intervention services
for MRSS: includes all mobile crisis intervention defined in Paragraph
(3) of Subsection C of 8.321.2.19 and up to 56 days of stabilization
services.
(5)
Crisis
stabilization services:
(a) ambulatory
withdrawal management includes:
(i)
evaluation, withdrawal management and referral services under a defined set of
physician approved policies and clinical protocols. The physician does not have
to be on-site, but available during all hours of operation;
(ii) clinical consultation and supervision
for bio-medical, emotional, behavioral, and cognitive problems;
(iii) comprehensive medical history and
physical examination of recipient at admission;
(iv) psychological and psychiatric
consultation;
(v) conducting or
arranging for appropriate laboratory and toxicology test;
(vi) assistance in accessing transportation
services for recipients who lack safe transportation.
(b) crisis stabilization includes but is not
limited to:
(i) crisis triage that involves
making crucial determinations within several minutes about an individual's
course of treatment;
(ii) screening
and assessment;
(iii) de-escalation
and stabilization;
(iv) brief
intervention or psychological counseling;
(v) peer support; and
(vi) prescribing and administering
medication, if applicable.
(c) navigational services to support
individuals in the community include assistance with:
(i) prescription and medication
assistance;
(ii) arranging for
temporary or permanent housing;
(iii) family or caregiver and natural support
group planning;
(iv) outpatient
behavioral health referrals and appointments; and
(v) other services determined through the
assessment process.
Notes
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