BUPRENORPHINE TREATMENT FOR OPIOID USE DISORDER:
MAD pays for coverage for medication assisted treatment (MAT) for
opioid use disorder to an eligible recipient as defined in the Drug Addiction
Treatment Act of 2000 (DATA 2000), the Comprehensive Addiction and Recovery Act
of 2016 (CARA), and the Substance Use Disorder Prevention that Promotes Opioid
Recovery and Treatment for Patients and Communities Act of 2018 (SUPPORT Act).
Services include, but are not limited to, medication for opioid use disorder
(excluding methadone) to an eligible recipient for medically managed withdrawal
form opioids or medication for opioid use disorder. See Subsections A and B of
8.321.2.9 NMAC for MAD general
provider requirements.
A.
Eligible providers and practitioners:
(1) Any clinic, office, or hospital staffed
by required practitioners.
(2)
Practitioners for diagnosing, assessing, and prescribing include:
(a) a physician or DO licensed in the state
of NM and has completed drug enforcement agency (DEA) approved training and has
the federal waiver to prescribe buprenorphine;
(b) an advanced practice registered nurse
that has completed DEA approved training; or
(c) a physician assistant licensed in the
state of NM and has the federal DATA 2000 waiver to prescribe
buprenorphine.
(3)
Practitioners for administration and education:
(a) a registered nurse licensed in the state
of NM; or
(b) a physician assistant
licensed in the state of NM.
(4) Practitioners for counseling and
education may include behavioral health practitioners licensed for counseling
or therapy.
(5) Practitioners for
skills and education include certified peer support workers or certified family
peer support workers to provide skill-building, recovery, and resiliency
support.
B.
Coverage criteria:
(1) an
assessment and diagnosis, which may be conducted either in person or via
telehealth, by the prescribing practitioner to determine whether the recipient
has an opioid use diagnosis and their readiness for change must be conducted
prior to starting treatment;
(2) an
assessment for concurrent medical or behavioral health illnesses;
(3) an assessment for co-occurring substance
use disorders;
(4) providing
psychoeducation related to all available treatment options, prior to starting
treatment; and
(5) a treatment plan
that prescribes either in house counseling or therapy, or referral to outside
services, as indicated.
C.
Eligible recipients:
Individuals with an opioid use disorder diagnosis defined by DSM 5 or ICD
10.
D.
Covered
services:
(1) history and
physical;
(2) comprehensive
assessment and treatment plan;
(3)
induction phase of opioid treatment;
(4) administration of medication and
concurrent education;
(5)
subsequent evaluation and management visits;
(6) development and maintenance of medical
record log of opioid replacement medication prescriptions;
(7) development and maintenance of required
records regarding inventory, storage and destruction of controlled medications
if dispensing from office;
(8)
initiation and tracking of controlled substance agreements with eligible
recipients;
(9) regular monitoring
and documentation of NM prescription monitoring program results;
(10) urine drug screens;
(11) recovery services (MCO members
only);
(12) family support services
(MCO members only).
E.
Reimbursement: See Subsection H of
8.321.9 NMAC for MAD behavioral
health general reimbursement requirements. See the BH policy and billing manual
for reimbursement specific to MAT.
Notes
N.M. Admin.
Code §
8.321.2.28
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
