N.M. Admin. Code § 8.321.2.29

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

Section 8.321.2.29 - MULTI-SYSTEMIC THERAPY (MST) and MST PROBLEM SEXUAL BEHAVIOR (MST-PSB)

To help an eligible recipient 10 up to 18 years of age receive behavioral health services to either remain in or re-enter their home and community, MAD pays for MST and MST-PSB services as part of EPSDT program (42 CFR 441.57). MAD covers medically necessary MST services required by the condition of the eligible recipient. MST provides intensive home, family and community-based treatment for an eligible recipient 10 to 18 years of age who is at risk of out-of-home placement or is returning home from an out-of-home placement. The need for MST services must be identified in the eligible recipient's tot to teen health check screen or another diagnostic evaluation. MST is an intensive family and community, evidence-based treatment for youth who are at risk of out-of-home placement or are returning home from out-of-home placement. MST addresses the multiple causes of serious antisocial behavior across key systems within which youth are embedded. MST-PSB focuses on aspects of a youth's ecology that are functionally related to the problem sexual behavior. Unless otherwise described below the acronym MST may be interpreted to include both MST and MST-PSB. When services are provided to family or other supports the service must be for the direct benefit of the medicaid recipient. The acronym MST used throughout this section includes both MST and MST-PSB unless otherwise specified.

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 MST services, an agency must hold a copy of MST Inc licensure, or any of its approved subsidiaries and meet the state licensure and provider enrollment requirements for each MST team. Additionally, the agency must complete the application process as described in the behavioral health billing and policy manual. All clinical staff are required to complete a prescribed five-day MST introductory training and subsequent quarterly trainings. Any staff person providing MST-PSB must have completed the MST-PSB specific training and be on a specially trained team with national certification from MST Services, LLC for MST-PSB.

(1) The MST program includes an assigned MST team for each eligible recipient. The MST team must include at minimum:

(a) master's level independently licensed behavioral health professional clinical supervision; see Subsection H of 8.321.2.9 NMAC;

(b) licensed master's and bachelor's level behavioral health staff able to provide 24-hour coverage, seven days a week; see Subsection E of 8.321.2.9 NMAC;

(c) a licensed master's level behavioral health practitioner that is required to perform all MST interventions; a bachelor's level behavioral health practitioner is limited to performing functions defined within the scope of their RLD practice board licensure or practice (see Subsection E of 8.321.2.9 NMAC);

(d) bachelor's level staff that has a degree in social work, counseling, psychology, or a related human services field and must have at least three years' experience working with the identified population of children, adolescents, and their families. Bachelor's level staff may provide the non-clinical components of treatment including treatment planning, skill-building, and family psychoeducation but not family therapy; and

(e) staffing for MST services is comprised of no more than one-third bachelor's level staff and, at minimum, two-thirds licensed master's level staff unless an exception is granted by MST Services, LLC.

(2) Clinical supervision must include at a minimum:

(a) weekly supervision provided by an independently licensed master's level behavioral health practitioner (see Subsection C of 8.321.2.9 NMAC) who is MST trained; this supervision, following the MST supervisory protocol, is provided to team members on topics directly related to the needs of the eligible recipient and their family on an ongoing basis; and

(b) one hour of local group supervision per week and one hour of telephone consultation per week with the MST systems supervisor, provided to team members on topics directly related to the needs of the eligible recipient and their family on an ongoing basis.

(3) All clinical staff is required to participate in and complete a prescribed five-day MST introductory training and subsequent quarterly trainings.

B.Identified population:

(1) MST is provided to an eligible recipient 10 to 18 years of age who meets the criteria of SED, involved in or at serious risk of involvement with the juvenile justice system; has antisocial, aggressive, violent, and substance-using behaviors; is at risk for an out-of-home placement; or is returning from an out-of-home placement where the above behaviors were the focus of their treatment and their family's involvement. MST for youth with problem sexual behaviors (MST-PSB) is a clinician adaptation of MST that has been specifically designed and developed to treat youth for problematic sexual behavior.

(2) A co-occurring diagnosis of SUD shall not exclude an eligible recipient from the program.

C.Covered services and service limitations: MST is a culturally sensitive service, rendered by a MST team, to provide intensive home, family, and community-based treatment for the family of an eligible recipient who is at risk of an out-of-home placement or is returning home from an out-of-home placement. MST services are provided in the community. Specialized therapeutic and rehabilitative interventions are used to address specific areas of need, such as substance use, delinquency, and violent behavior. MST service components include treatment planning; restoration of social skills which is available 24-hours a day, seven days a week; and family therapy and psychoeducation.

(1) The following services must be furnished as part of the MST service to be eligible for reimbursement:

(a) an initial assessment to identify the focus of the MST intervention;

(b) therapeutic interventions with the eligible recipient and their family;

(c) case management; and

(d) crisis stabilization.

(2) MST services are conducted by practitioners using the MST team approach. The MST team must have the ability to deliver services in various environments, such as homes, schools, homeless shelters, or street locations. MST services:

(a) promote the recipient's family's capacity to monitor and manage their behavior;

(b) involve the eligible recipient's family and other systems, such as the school, probation officers, extended families and community connections;

(c) provide access to a variety of interventions 24-hours a day, seven days a week, by staff that maintain contact and intervene as one organizational unit;

(d) include structured face-to-face therapeutic interventions to provide support and guidance in all areas of the recipient's functional domains, such as adaptive, communication, psychosocial, problem solving, and behavior management; and

(e) services provided to family members or other supports must be for the direct benefit of the medicaid recipient.

(3) The duration of MST intervention is typically three to six months. Weekly interventions may range from three to 20 hours a week; less as an eligible recipient nears discharge.

D.Non-covered services: MST 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.

E.Reimbursement: MST 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 MST agency receives instructions on how to access documentation, billing, and claims processing information.

N.M. Admin. Code § 8.321.2.29

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