New Mexico Register / Volume
XXXI, Issue 2 / January 28, 2020
This is an amendment to 8.320.6 NMAC,
Sections 8, 11 and 13 effective 2/1/2020.
8.320.6.8 [MISSION
STATEMENT: To reduce the impact of poverty on people
living in New Mexico by providing support services that help families break the
cycle of dependency on public assistance.] [RESERVED]
[8.320.6.8 NMAC - Rp, 8.320.6.8 NMAC, 7/1/2015; Repealed, 2/1/2020]
8.320.6.11 ELIGIBLE
PROVIDERS:
A. Upon approval of
a New Mexico MAD PPA by MAD or its designee, local education agencies (LEAs),
regional educational cooperatives (RECs), and other state-funded educational
agencies (SFEAs) that meet specified requirements are eligible to be reimbursed
for furnishing services to an eligible recipient. The LEA, REC, or other SFEA must enter into a
governmental services agreement (GSA) with HSD and abide by the terms and
conditions of it.
B. The following
individual service providers must be employed by, or under contract to, the
LEA, REC, or other SFEA when furnishing treatment and meet other specified
qualification criteria:
(1) physical therapists (PT);
(2) physical therapy assistants working under the supervision of
a MAD enrolled PT;
(3) occupational therapists (OT);
(4) occupational therapy assistants working under the
supervision of a MAD enrolled licensed occupational therapist;
(5) speech and language pathologists (SLP) and clinical fellows;
(6) apprentices
in speech-language (ASL) working under the supervision of a MAD enrolled
licensed speech therapist; supervision for those providers listed in Paragraphs
(1) - (6) above must adhere to the requirements of the practitioner’s
applicable licensing board;
(7) audiologists;
(8) licensed
nutritionists or registered dieticians;
(9) case managers meeting one of the following requirements:
(a) bachelor’s degree in social work, counseling, psychology,
nursing or a related health or social services field from an accredited
institution;
(b) one
year experience serving medically-at-risk children or adolescents; or
(c) a licensed registered (RN).
(10) psychologists meeting one of the following requirements:
(a) psychologists (Ph.D., Psy.D., or Ed.D.); or
(b) master's
level practitioners licensed by the New Mexico psychologist examiners board as
psychologist associates or licensed by PED as school psychologists and working
under the supervision of a MAD enrolled licensed psychiatrist or a licensed
psychologist (Ph.D., Psy.D., or Ed.D.)
or a PED level 3 independent school psychologist, as applicable;
(c) supervision of psychologist associates and school
psychologists must adhere to the requirements of the practitioner’s applicable
licensing board.
(11) social work practitioners meeting one of the following
requirements:
(a) licensed independent social worker (LISW); or
(b) licensed
master social worker (LMSW) or licensed baccalaureate social worker (LBSW) and
working under the supervision of a MAD enrolled licensed independent social
worker (LISW) or licensed psychologist (Ph.D., Psy.D.,
Ed.D.) or other supervisor approved by the New
Mexico board of social work examiners;
(i) services
provided by licensed master social workers (LMSW) and licensed baccalaureate
social workers (LBSW) must be within the scope of their practice respectively
and supervised and periodically evaluated;
(ii) an eligible recipient receiving services from an LMSW or
LBSW must be diagnosed by the practitioner’s supervisor; the diagnosis must be
documented in the MAP eligible recipient’s record with the signature of the
supervisor.
(12) licensed counselors or therapists meeting one of the
following requirements:
(a) licensed professional clinical mental health counselor
(LPCC); or
(b) licensed marriage and family therapist (LMFT); or
(c) licensed
mental health counselor (LMHC) or licensed professional mental health counselor
(LPC) and working under the supervision of a MAD enrolled licensed psychiatrist,
a licensed psychologist (Ph.D., Psy.D., or Ed.D.), licensed professional clinical mental health
counselor (LPCC), licensed marriage and family therapist (LMFT), or licensed
independent social worker (LISW);
(i) supervision
of licensed mental health counselors (LMHC) and licensed professional mental
health counselors (LPC) must adhere to the requirements of the practitioner’s
applicable licensing board;
(ii) an eligible recipient receiving services from a LMHC or LPC
must be diagnosed by the practitioner’s supervisor; the diagnosis must be
documented in the eligible recipient’s record with the signature of the
supervisor.
(d) licensed associate marriage and
family therapist (LAMFT); supervision of LAMFTs must adhere to the requirements
of the practitioner’s applicable licensing board;
(13) licensed
psychiatric clinical nurse specialist (CNS);
(14) physicians and psychiatrists licensed by the board of
medical examiners.
C. For a LEA, REC, or
other SFEA that employs a RN or a licensed practical nurse (LPN) not as a case
worker, each is under the oversight of the department of health’s (DOH)
district health officer, as provided by state statue (Section 24-1-4 NMSA 1978). A LPN must work under the supervision of a RN
who is a PED licensed school nurse.
D. As applicable, each
provider must be licensed by the public education department (PED) when such
licensure exists.
E. As applicable,
each provider must be licensed by its specific regulation and licensing
division (RLD)’s board of practice or by PED.
[8.320.6.11 NMAC - Rp, 8.320.6.11 NMAC, 7/1/2015; A, 2/1/2020]
8.320.6.13 COVERED
SERVICES: MAD covers the following services when
medically necessary and rendered as part of an eligible recipient’s IEP or IFSP
by specified providers in school settings.
A. For services in
Subsections A - E of 8.320.6.13 NMAC, a provider must first develop and then
update the eligible recipient’s present level of performance for each of his or
her IEP or IFSP cycles. MAD requires the
following elements be included in the provider’s treatment notes:
(1) the specific activity provided to the MAP eligible recipient
for each date of service billed;
(2) a description of the level of engagement and the ability of
the eligible recipient for each date of service billed; and
(3) the outcomes of session on the impact on the eligible
recipient’s exceptionality for each date of service billed.
B. To be reimbursed
for a MAD school-based service, all of the requirements in this subsection must
be met.
(1) Services
must be medically necessary and must meet the needs specified in his or her IEP
or IFSP. The services must be necessary
for the treatment of the eligible recipient’s specific identified condition.
(2) The
ITP portion of the IEP or IFSP must be developed in conjunction with the
appropriate qualified PT, OT, SLP, audiologist, RN, or behavioral health
provider listed in 8.320.6.11 NMAC.
(3) The
LEA, REC or other SFEA must complete a MAD specified good faith effort to
notify the eligible recipient’s PCP of the services to be provided.
(4) Frequency
and duration of services billed may not exceed those specified in the eligible
recipient’s IEP or IFSP.
(5) Reimbursement
is made directly to the LEA, REC, or other SFEA when therapy, licensed
nutritionists or registered dieticians, transportation, case manager, or nurse providers
furnish services under contract to the LEA, REC, or other SFEA.
C. Therapy services: MAD covers physical, occupational,
audiological and speech evaluations, and therapy required for treatment of an
identified medical condition that is part of an eligible recipient’s ITP.
D. Nutritional assessment and counseling: MAD covers nutritional assessment and
counseling when rendered by a licensed nutritionist or dietician for an eligible
recipient who has been referred for a nutritional need when part of his or her
ITP. A nutritional assessment consists
of an evaluation of the nutritional needs of the eligible recipient based upon
appropriate biochemical, anthropometric, physical, and dietary data, including
a recommendation for appropriate nutritional intake.
E. Transportation services: MAD covers transportation services for an eligible
recipient who must travel from his or her school to receive a covered service
from a MAD provider when the service is unavailable in the school setting and
when the service is medically necessary and are part of the eligible recipient’s
IEP or IFSP; see 8.324.7 NMAC. MAD
covers transportation to and from the school on the date a medically necessary MAD
school-based service is rendered in the school setting for an eligible
recipient who has a disability.
(1) MAD
school-based services are billed on the specific day on which transportation is
rendered and are part of the ITP portion of his or her IEP or IFSP.
(2) The
eligible recipient requires transportation in a vehicle adapted to serve his or
her needs that are part of the ITP portion of his or her IEP or IFSP.
(3) Transportation
occurs in a modified school bus for disabled students.
F. Case management: MAD covers school-based case management
services rendered in school settings to an eligible recipient who is medically
at risk when these services are part of the eligible recipient’s ITP of his or
her IEP or IFSP. Medically at risk
refers to an eligible recipient who has a diagnosed physical condition which
has high probability of impairing cognitive, emotional, neurological, social,
or physical development.
(1) The service is developed in
conjunction with a qualified case manager.
(2) MAD
covers the following school-based case management services.
(a) The
assessment of the eligible recipient’s medical, social and functional abilities
at least every six months, unless more frequent reassessment is indicated by the
eligible recipient’s condition.
(b) The
development and implementation of a comprehensive case management plan of care
that helps the eligible recipient retain or achieve the maximum degree of
independence.
(c) The
mobilization of the use of natural helping networks, such as family members,
church members, community organizations, support groups, friends, and the
school, if the eligible recipient is able to attend.
(d) Coordination
and monitoring of the delivery of services, evaluation of the effectiveness and
quality of the services, and revision of the case management plan of care as
necessary.
(e) All
services must be delivered to be eligible for MAD reimbursement.
(3) An
eligible recipient has the freedom to choose a case management service
provider. MAD will pay for only one case management provider to furnish
services to an eligible recipient at any given time period. If an eligible recipient has a case manager
or chooses to use a case manager who is not employed or under contract to the
LEA, REC or other SFEA, the LEA, REC or other SFEA must coordinate with the
case manager in the development of the eligible recipient’s ITP.
G. Nursing: MAD covers certain nursing services required
for treatment of a diagnosed medical condition that qualifies an eligible
recipient for an IEP or IFSP when provided by a licensed RN or LPN. Nursing services require professional nursing
expertise and are provided by a licensed RN or a LPN and must be provided in
accordance with the New Mexico Nursing Practice Act and must be a covered MAD
service.
H. Behavioral health services: MAD covers counseling, evaluation and therapy
required for treatment of an identified behavioral health condition that is
part of an eligible recipient’s ITP.
[H.] I. Telemedicine
services: MAD covers school-based services provided via telemedicine; see
8.310.2 NMAC.
[I.] J. Administrative activities: MAD
covers the cost of certain administrative activities that directly support
efforts to provide health-related services to a MAP eligible recipient with
special education and health care needs.
These administrative activities include, but are not limited to,
providing information about MAD services and how to access them; facilitating
the eligibility determination process; assisting in obtaining transportation
and translation services when necessary to receive health care services; making
referrals for MAD reimbursable services; and coordinating and monitoring MAD
covered medical services.
(1) Payment
for an allowable administrative activity is contingent upon the following:
(a) the LEA, REC or other SFEA must complete a MAD PPA to become
an approved school-based health services provider;
(b) the LEA, REC or other SFEA must enter into a GSA with HSD
and agree to abide by the terms and conditions of the GSA;
(c) the LEA, REC or other SFEA must submit claims for allowable
administrative activities in accordance with federal and state regulations, rules
and guidelines.
(2) A
provider or contractor coordination with the school or contractor or in consultation
with principals, school counselors, or teachers are not billable as a service by
the provider. The provider must consult
with the school to determine if the school will include such activities in its
contract with the provider or contractor.
The school may not bill MAD separately for these services but can
include the costs as administrative costs.
(3) Administrative
claiming is subject to compliance reviews and audits conducted by HSD, the state
medicaid fraud control unit and the Centers for
Medicare and Medicaid Services (CMS). By
signing the MAD PPA, the LEA, REC or other SFEA agrees to cooperate fully with
HSD, the state medicaid fraud control unit and CMS in
the performance of all reviews and audits and further agrees to comply with all
review and audit requirements.
[8.320.6.13 NMAC - Rp, 8.320.6.13 NMAC, 7/1/2015; A, 2/1/2020]