N.M. Code R. § 8.321.2.34

Current through Register Vol. 35, No. 9, May 7, 2024

Section 8.321.2.34 - SCREENING, BRIEF INTERVENTION & REFERRAL TO TREATMENT (SBIRT) TO BE EFFECTIVE FOLLOWING CMS WAIVER APPROVAL

SBIRT is a community-based practice designed to identify, reduce and prevent problematic substance use or misuse and co-occurring mental health disorders as an early intervention. Through early identification in a medical setting, SBIRT services expand and enhance the continuum of care and reduce costly health care utilization. The primary objective is the integration of behavioral health with medical care. SBIRT is delivered through a process consisting of universal screening, scoring the screening tool and a warm hand-off to a SBIRT trained professional who conducts a face-to-face brief intervention for positive screening results. If the need is identified for additional treatment, the staff member will refer to behavioral health services. See Subsections A and B of 8.321.2.9 NMAC for MAD general provider requirements.

A.Eligible providers and practitioners:

(1) Providers may include:

(a) primary care offices including FQHCs, IHS 638 tribal facilities and any other "Indian Health Care Provider (IHCP)" defined in 42 Code of Federal Regulations §438.14(a);

(b) patient centered medical homes;

(c) urgent care centers;

(d) hospital outpatient facilities;

(e) emergency departments;

(f) rural health clinics;

(g) specialty physical health clinics;

(h) school based health centers; and

(i) nursing facilities.

(2) Practitioners may include:

(a) licensed nurse trained in SBIRT;

(b) licensed nurse practitioner or licensed nurse clinician trained in SBIRT;

(c) behavioral health practitioner trained in SBIRT;

(d) certified peer support worker trained in SBIRT;

(e) certified community health worker trained in SBIRT;

(f) licensed physician assistant trained in SBIRT;

(g) physician trained in SBIRT;

(h) home health agency trained in SBIRT

(i) nurse home visit EPSDT;

(j) medical assistant trained in SBIRT; and

(k) community health representative in tribal clinics trained in SBIRT.

B. Coverage Criteria:

(1) screening shall be universal for recipients being seen in a medical setting;

(2) referral relationships with mental health agencies and practices are in place;

(3) utilization of approved screening tool specific to age described in the BH policy and billing manual;

(4) all participating providers and practitioners are trained in SBIRT through state approved SBIRT training entities. See details in the BH policy and billing manual.

C. Identified population:

(1) MAD recipient adolescents 11-13 years of age with parental consent;

(2) MAD recipient adolescents 14-18 years of age;

(3) MAD recipient adults 19 years and older.

D. Covered services:

(1) SBIRT screening with negative results eligible for only screening component;

(2) SBIRT screening with positive results for alcohol, or other drugs, and co-occurring with depression, or anxiety, or trauma are eligible for:

(a) screening; and

(b) brief intervention and referral to behavioral health treatment, if needed.

E. Reimbursement:

(1) Screening services do not require a diagnosis; brief interventions can be billed with a provisional diagnosis.

(2) See BH policy and billing manual for coding and billing instruction.

N.M. Code R. § 8.321.2.34

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