N.M. Admin. Code § 8.321.2.20

Current through Register Vol. 35, No. 23, December 10, 2024

Section 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.

D.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 crisis intervention services.

N.M. Admin. Code § 8.321.2.20

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