N.M. Code R. § 8.10.5.10

Current through Register Vol. 35, No. 11, June 11, 2024

Section 8.10.5.10 - ROLES AND RESPONSIBILITIES OF DIFFERENT ENTITIES INVOLVED WITH THE PLAN OF CARE

A. Children youth and families department (CYFD):

(1) Protective services division (PSD) statewide central intake (SCI): SCI shall complete the following with every hospital provider or call that involves a substance exposed newborn:

(a) Ask the reporter if a POC has been created and if there are any concerns for abuse or neglect of the child;

(b) Ask the reporter if the child is an Indian child or if the family is a member of any Tribe. If the child is an Indian child, then SCI cross reports with the identified Tribal social services/Indian Child Welfare Act (ICWA) coordinator and notifies the CARA navigator. If the child is an Indian child, then the POC is jointly created with the Tribal social services/ICWA coordinator;

(c) Explain to the provider that if there are concerns any time during the POC or if families disengage from services, the provider may make a report with SCI or consult the CARA navigators to determine next steps. If a family disengages, SCI will utilize their screening tool to further assess if an investigation is needed;

(d) Inform reporters that investigators receive a copy of the POC for families that have open CYFD investigations. If a POC does not exist on an open investigation, SCI shall notify the CARA navigators; and

(e) Inform providers that a SCI report shall be screened in by CYFD only if there is an immediate concern for abuse and neglect. The report shall not be screened in solely on the basis that a parent used substances during pregnancy.

(f) When a SCI supervisor reviews a report involving a CARA POC, they may decide between three different screening options depending on the reported information:

(i) Screen-out: The SCI supervisor may screen out the report when there is not enough information that warrants an investigation.

(ii) Screen-in: The SCI supervisor may screen in the report when there are concerning behaviors or information that warrant an investigation for abuse or neglect.

(iii) Family resource connection (FRC) referral: The SCI supervisor may refer the report to the family resource connections program if the report does not warrant an investigation, however the caregivers may benefit from referrals to services within their community.

(2) Licensed resource families:

(a) Licensed resource families shall ensure the newborn has a primary care provider (PCP) and attends all scheduled appointments for the newborn.

(b) Licensed resource families shall accept care coordination for the newborn and referrals for supportive services as recommended by the CC or PCP.

B. The CARA navigators:

(1) are children, youth, and families department (CYFD) or department of health (DOH) employees designated to oversee the CARA program and ensure plans of care are implemented. DOH and CYFD CARA navigators shall collaborate to ensure continuity of care and implementation of the CARA program.

(2) shall receive a copy of either the notification of newborn status form or the POC document for each newborn with substance exposure. If a family has agreed to services on a POC, but declined care coordination by their MCO, private insurer or CMS, the CARA navigator will assist in identifying an individual or agency to support implementation of the plan. When requested by the family, the CARA navigator shall fulfill the role of coordination of the POC.

(3) shall ensure that, if CYFD is involved, the POC is provided to the assigned investigator or other CYFD service provider working with the family.

(4) If, during the implementation of the POC, a CC or service provider has concerns regarding the safety or well-being of an infant that warrant a report to SCI, that individual shall inform the CARA navigator when a SCI report has been made. If modifications or revisions to the POC need to be made following a CYFD investigation, the CARA navigator shall assist the CYFD investigator or CYFD service provider to make the necessary changes.

(5) If the CARA navigator is notified by the CC that the family is difficult to engage or unable to be reached, and there is no evidence of involvement of the family with other service providers, the CARA navigator shall follow-up with families to support re-engagement. Other instances for check in with families would include modifying plans of care, perform a warm handoff with a service provider, and other situations deemed appropriate that requires family contact.

(6) The CARA navigator shall receive notification of new POC's. The CARA navigator reviews all plans of care for completeness, to assure that PCP is identified, assure that correct insurance is on the plan, and that services referred to are complete. The CARA navigator serves as a consultant to assist with complex medical cases to assure that babies with plans of care are referred to appropriate providers for follow up. The DOH CARA navigator works with the CYFD CARA navigator on follow up for referrals and services on the POC. The CARA navigator will send POC's to MCO's, private insurances and CMS for care coordination, for those providers without access to the portal.

(7) The CARA navigator shall assist in identifying the CC's with the MCOs, CMS and private insurers if the newborn is discharged without notice; and

(8) DOH family health bureau shall collect data relevant to POC's as needed for evaluation and tracking purposes.

(9) CYFD shall collect data relevant to plans of care as needed for evaluation and tracking purposes.

(10) Out of state births: The CARA navigators shall notify the family that the insurance CC will create a POC on newborns that were born out of state and when families have moved to another city or town in New Mexico.

(11) Tribal members: If the newborn or family reside on Tribal land, then the CARA navigator notifies the identified Tribal social services/ICWA coordinator. If the newborn or family are identified tribal members and a report has been made to SCI, the CARA navigator or Tribal liaison shall notify the Tribal social services/ICWA coordinator.

C. Hospitals and birthing centers: Birthing hospitals and birth centers are responsible for ensuring staff are trained in the POC law and processes outlined in Subsection G of Section 32A-3A-13 of NMSA 2020. Hospital staff are responsible for offering a POC for every newborn who qualifies for one. The POC process shall be completed prior to the newborn's discharge from the hospital, which includes sending referrals to service providers for services for which consent has been provided on the POC.

(1) Prior to the offering and creation of the POC, the healthcare professional, social worker or discharge planner shall review with the infant's caregivers the CARA handouts that inform the caregivers what a POC is and what the involvement of CYFD, DOH and the insurance care coordinator (CC) will be.

(2) Hospital staff are responsible for making a referral to the MCO or private insurers for a CC prior to discharge (or a referral to CMS, if the infant is fee for service exempt or uninsured). Hospital staff shall refer to the instructions for each MCO in how to refer for a CC.

(a) If a CC has been assigned prior to the newborn's discharge from the hospital or birthing facility, the POC process shall be completed by collaboration of the caregiver, hospital staff and the assigned CC.

(b) Upon the newborn's discharge, if a CC has not yet been identified, the CARA navigators shall ensure the CC is provided a copy of the POC once assigned.

(c) Over the weekend and holidays: Upon admission and screening of the pregnant individual for substance use disorders, education on the POC shall be done with the family, along with a referral for a CC. Using the secured email links, referral for a CC shall be done and the insurance shall pick up the referral and make an assignment on Monday morning or the next business day, following a weekend or holiday discharge.

(3) If the hospital staff creating the POC does not identify any safety concerns, only a POC is needed. If there is an abuse or neglect concern, hospital staff shall make a report to CYFD SCI while continuing to support the parent(s) or designated caregiver(s) to develop a POC. The POC shall be submitted to the CARA navigators regardless of protective services involvement.

(4) A POC shall be offered with services to every family of a newborn exposed to substances, which includes medication assisted therapy and legal substances such as alcohol, regardless of families declining services or care coordination. The POC shall be integrated into the discharge plan for the mother and newborn. Referrals for services that are accepted are to be sent from the hospital prior to discharge as part of the POC process.

(5) A warm hand off from hospital staff to the CC during hospital stay is considered best practice. A warm hand off shall occur prior to the newborn's discharge either in person or by phone with the CC or identified supportive service provider.

(6) Hospital staff creating the POC shall document services declined or unavailable and current services caregivers are involved in. Further discussion regarding the reason for declining a service shall take place with the family and shall be documented in the POC.

(7) When a hospital screens a newborn by sending the umbilical cord or meconium for drug testing, the hospital staff is responsible for informing the patient if the results are positive and that the CARA navigator will be notified using notification of CARA newborn status form.

(8) If the hospital notifies the caregiver of the positive result on the newborn, the hospital shall explain that the CARA navigators shall be notified, and that a CARA navigator shall contact the caregiver to offer a POC for their newborn using the notification of CARA newborn status form. When a positive result is received, and the family has been discharged, the notification of CARA newborn status form is to be completed and sent to the CARA navigators.

D. Emergency room and out of the hospital deliveries: The hospital staff shall fill out and send a notification of CARA newborn status form to the CARA navigators.

E. Medical professionals shall:

(1) participate in CARA training on definitions and evidence-based validated screening tools that shall be used to identify children exposed to substances in utero.

(2) complete the CARA on-line modules on the best practices regarding substance exposed infants and substance use disorder that providers may receive CME/CEU credits for completing.

(3) notify staff who complete a POC when an exposure has been identified by them.

(4) obtain the substance use history and provide education on treatment options.

F. Infant's primary care physician (PCP):

(1) PCP's shall receive a copy of the POC from the infant's CC.

(2) If PCP's have concerns regarding the infant related to their exposure, or regarding the disengagement of the caregivers in the services identified within the POC, they shall notify the CC or CARA navigators. If the PCP has immediate safety concerns, the PCP shall make a report to CYFD SCI.

G. MCOs, private insurers, and children's medical services:

(1) Children's medical services (CMS) shall serve as a CC for the newborn if the newborn is uninsured, fee for service exempt or military.

(2) For MCOs and private insurers, the same CC shall be assigned for the mother and newborn. A CC shall be assigned prior to discharge except weekend discharges (which shall be assigned on the Monday morning immediately following the weekend discharge) and have a warm hand off in person or by phone with the family.

(3) If the newborn enters CYFD custody, the assigned PSD worker shall sign a release of information for the CC to work with the resource family.

(4) Care coordination continues after the child reaches one year if services are still needed or if the POC is still being utilized.

(5) The MCOs, private insurers and CMS shall develop an internal quality assurance process to ensure the CCs meet the requirements regarding contact, timeframes, follow up with services and reporting to CARA navigators.

H. Care coordinators (CC):

(1) The CC shall send the POC to the newborn's PCP within five business days of receiving notification for a new POC.

(2) If a POC was not completed by the time of the newborn's hospital discharge, the CC shall complete one upon their initial contact.

(3) The CC shall follow their agencies' requirements regarding first face to face contact.

(4) The MCO's CC shall follow a "treat first model" to complete their comprehensive needs assessment (CNA) over the course of four appointments, with a maximum of 90 days to complete the CNA. CMS and private insurers shall follow their regulations and guidelines for assessments.

(5) Once the CC receives the POC, a letter to the caregivers shall be sent to the discharge address provided. The letter outlines the roles and contact information of the CC, DOH, CYFD and service providers to which referrals were made. The CC will contact agencies that referrals were made to on the POC to assure the referral was received. If referral was not received than the CC has permission with the POC/ROI to make the referral if this is on the POC.

(6) CC's shall ensure the newborn's primary care physician receives a copy of the POC.

(7) For families who are difficult to reach, unable to be reached, refuse care coordination, do not engage, disengage with CCs or providers, three attempts shall be made to engage as well as contact the referred supportive service providers and the infant's PCP to discuss their engagement with them prior to contacting the CARA navigators.

(8) CC's shall contact the CARA navigators when a family has moved to another city or town for a new POC to be created.

(9) If the CC has immediate concerns for abuse or neglect, the CC shall make a report to CYFD SCI.

(10) Prior to the MCO/private insurer/CMS CC closing a referral for non-engagement or non-compliance, they shall contact the PCP of the newborn by phone and by mail to notify them on closure.

(11) If a family has refused care coordination from their MCO/private insurer/CMS, the CC shall offer the family a check-in phone call every three months during the first year of the POC.

(12) If the CC has made final attempts to re-engage a family and notified the PCP, they shall then notify the CARA navigators.

N.M. Code R. § 8.10.5.10

Adopted by New Mexico Register, Volume XXXIII, Issue 04, February 22, 2022, eff. 2/22/2022