N.M. Admin. Code § 8.321.2.41

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

Section 8.321.2.41 - HIGH FIDELITY WRAPAROUND (HFW)

An intensive care coordination service designed as a comprehensive, holistic, youth and family-driven way of responding when children or youth experience serious mental health or behavioral challenges. HFW aligns with the children's system of care (SOC) approach in NM. HFW supports teams to effectively coordinate within the state's children's behavioral health service array including access to community supports and resources. When services are provided to family or other supports the service must be for the direct benefit of the medicaid recipient.

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 HFW an agency must complete the application process as described in the behavioral health billing and policy manual. HFW agencies must maintain a clinical director and program director or administrator.

(1) The HFW program includes an assigned HFW team for each eligible recipient. The HFW team includes:

(a) wraparound facilitator who has completed the requirements of the facilitator in training (FIT) track, obtained wraparound certification from the NM credentialing board for behavioral health professionals (NMCBBHP), and meets the educational requirements identified in the BH policy and billing manual;

(b) wraparound supervisor-coach who has completed the requirements of the facilitator in training (FIT) track, obtained wraparound certification from the NM credentialing board for behavioral health professionals (NMCBBHP), completed the requirements of the coach in training (CIT) track, and meets the educational requirements identified in the BH policy and billing manual; and

(c) a family peer support worker.

B.Identified population: individuals are eligible to receive HFW intensive care coordination if they meet the following criteria:

(1) children or youth with an SED diagnosis;

(2) functional impairment in two or more domains identified by the child and adolescent needs and strengths (CANS) tool;

(3) involved in two or more systems such as special education, behavioral health, protective services or juvenile justice, or (for children aged 0-5) are at risk of such involvement; and

(4) are at risk or in an out of home placement.

C.Covered services include:

(1) Intensive care coordination through dedicated full-time care coordinators working with small numbers of children and families. The care coordinator is required to follow state guidelines described in the BH policy and billing manual for care of children with SED who are eligible for HFW. Care coordinators work in partnership with representatives of key stakeholder groups, including families, agencies, providers, and community representatives to plan, implement and oversee HFW coordination plans. Intensive care coordination includes, but is not limited to:

(a) functional, needs and strengths assessment and service planning;

(b) accessing and arranging for services, resources and supports;

(c) coordinating multiple services, levels of care, resources, supports and teams;

(d) conducting safety and stability planning and response;

(e) assisting children and families in meeting basic needs;

(f) advocating for children and families;

(g) monitoring progress; and

(h) conducting a team and strengths-based approach.

(2) Treatment planning: the individualized care coordination plans are developed by engaging with the beneficiary's family or caretakers and other members of the beneficiary's community. Such plans must be family and youth-driven, team-based, collaborative, individualized, and outcomes-based. The plan of care must address youth and family needs across domains of physical and behavioral health and social services.

D.Non-covered services: HFW 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: HFW 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 HFW agency receives instructions on how to access documentation, billing, and claims processing information.

N.M. Admin. Code § 8.321.2.41

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