N.M. Admin. Code § 8.321.2.39

Current through Register Vol. 36, No. 1, January 14, 2025

Section 8.321.2.39 - THERAPEUTIC INTERVENTIONS

MAD provides coverage for therapeutic intervention services rendered to individuals with mental health disorders. The mental health services rendered shall be necessary to reduce the disability resulting from mental illness and to restore the individual to their best possible functioning level in the community. Therapeutic interventions are the following evidence-based practices delivered by qualified licensed mental health practitioners: trauma-focused cognitive behavioral therapy (TF-CBT); eye movement desensitization and reprocessing (EMDR); and dialectical behavior therapy (DBT).

A.Eligible providers: In addition to the requirements of Subsections A and B of 8.321.2.9 NMAC, in order to be eligible to be reimbursed for providing TF-CBT, EMDR, or DBT services, an agency must be approved through the application process described in the BH policy and billing manual and hold an acceptable certification or licensure for the specific EBP identified above. The following mental health practitioners who are licensed in the state of NM to diagnose and treat behavioral health, acting within the scope of all applicable state laws and their professional license, may provide the above evidence-based practices if certification is obtained from the listed source:

(1) licensed psychologists;

(2) licensed clinical social workers (LCSWs);

(3) licensed professional clinical counselors (LPCCs);

(4) licensed marriage and family therapists (LMFTs);

(5) licensed alcohol and drug abuse counselors (LADAC); and

(6) advanced practice registered nurses (APRN) (must be a nurse practitioner specialist in adult psychiatric & mental health, and family psychiatric & mental health or a certified nurse specialist in psychosocial, gerontological psychiatric mental health, adult psychiatric and mental health, and child-adolescent mental health and may practice to the extent that services are within the APRN's scope of practice).

B.Additional provider requirements for DBT: DBT agencies must be able to provide 24-hours a day, seven days a week availability for skills coaching. Therapists must be independently licensed but may work with master's or bachelor's level staff with a degree in social work, counseling, psychology or a related human services field and must have at least three years of experience working with the target population that is, children or adolescents and their families. Unlicensed staff may not provide DBT therapy. Unlicensed staff may only provide service coordination and group therapy in conjunction with a trained licensed therapist. An active DBT team requires DBT certification of at least two certified treatment providers working collaboratively with one another using the DBT services as defined by the DBT services program selected by the state. DBT trainees and DBT care managers may be the second professional in a group setting where a DBT therapist is the group lead. In addition, while the DBT trainees and DBT care managers may bill for service coordination, they may not bill for DBT therapy. Only a licensed and trained DBT therapist may bill for DBT therapy.

C.Identified population: Individuals with mental health disorders. There is no age restriction for EMDR, or DBT. TF-CBT is limited to children under the age of 18 and their families. Services provided to family members or other supports are for the direct benefit of the medicaid recipient.

D.Covered services: Therapeutic interventions are services rendered to reduce disability resulting from mental illness and to restore the individual to their best possible functioning level in the community. Therapeutic interventions include:

(1)Trauma-focused cognitive behavioral therapy (TF-CBT): Is a combination of cognitive behavioral therapy, family therapy, and psychosocial education to address the effects of trauma using conjoint child and parent psychotherapy model for children who are experiencing significant emotional and behavioral difficulties related to traumatic life events. It is a components-based hybrid treatment model that incorporates trauma-sensitive interventions with cognitive behavioral, family, and humanistic principles. Trauma focus cognitive behavioral therapy certification program (tfcbt.org) is an acceptable certification. Any interventions involving parents and caregivers are for the direct benefit of the beneficiary.

(2)Eye movement desensitization and reprocessing (EMDR): An evidence-based psychotherapy that treats trauma-related symptoms. EMDR therapy is designed to resolve unprocessed traumatic memories in the brain. The therapist guides the client to process the trauma by attending to emotionally disturbing material in brief, sequential doses, while at the same time focusing on an external stimulus. The most commonly used external stimulus in EMDR therapy is alternating eye movements; however, sounds or taps may be used as well. EMDRIA (EMDR International Association) sets the standards and requirements for EMDR therapy training. EMDRIA certifies individual clinical practitioners in the practice of EMDR therapy by ensuring all basic requirements, initial training, and ongoing certification are met (see www.emdria.org). EMDRIA establishes two levels of training for practitioners in EMDR therapy. For the purposes of providing EMDR therapy under NM medicaid, either level (EMDRIA approved basic training, or EMDR certification) are acceptable qualifications. The standard level of training, which allows a practitioner to provide EMDR therapy, is referred to as "EMDRIA approved basic training".

(3)Dialectical behavior therapy (DBT): A cognitive behavioral approach to treatment to teach individuals better management of powerful emotions, urges, and thoughts that can disrupt daily living if not addressed in a structured treatment approach. DBT-linehan board of certification is an acceptable qualification. This evidence-based practice includes service coordination, individual, group, and family therapy. A DBT provider must include in their program individual DBT therapy, DBT skills groups, 24-hour coverage seven days per week availability for skills coaching, and a clinical consultation team.

E.Service exclusions and limitations: Therapeutic intervention services are subject to the limitations and coverage restrictions that exist for other MAD covered services. See subsection G of 8.321.2.9 NMAC for general non-covered specialized behavioral health services. All services provided while a person is a resident of an institution for mental disease (IMD) are considered content of the institutional service and are not otherwise reimbursable by medicaid. Services provided by licensed behavioral health practitioners via telehealth technologies are covered subject to the limitations as set forth in state regulations. The following activities services shall be excluded from medicaid coverage and reimbursement of these evidence-based practices:

(1) Components that are not provided to, or directed exclusively toward, the treatment of the medicaid eligible individual.

(2) Services provided at a work site, which are job-oriented and not directly related to the treatment of the member's needs.

(3) These rehabilitation services shall not duplicate any other medicaid state plan service or service otherwise available to the member at no cost.

(4) Any services or components in which the basic nature of which are to supplant housekeeping, homemaking, or basic services for the convenience of an individual receiving services.

F.Additional DBT service exclusions and limitations: DBT shall not be billed in conjunction with BH services by licensed and unlicensed individuals, other than medication management and psychological evaluation or assessment; and residential services, including therapeutic foster care and RTC services.

G.Reimbursement: Therapeutic intervention agencies must submit claims for reimbursement on the CMS-1500 claim form or its successor. See Subsection E of 8.321.2.9 NMAC for MAD general reimbursement requirements and 8.302.2 NMAC. Once enrolled, the agency receives instructions on how to access documentation, billing, and claims processing information.

N.M. Admin. Code § 8.321.2.39

Adopted by New Mexico Register, Volume XXXV, Issue 23, December 10, 2024, eff. 12/10/2024