N.M. Admin. Code § 8.326.4.10

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

Section 8.326.4.10 - ELIGIBLE PROVIDERS

A. Upon approval of New Mexico medical assistance program provider participation agreements by the New Mexico medical assistance division (MAD), the following agencies are reimbursed for furnishing case management services to recipients who are chronically mentally ill:

(1) community mental health centers funded by the mental health division of the department of health;

(2) Indian tribal governments; and

(3) other community-based agencies which have demonstrated direct experience in case management services and success in serving the target population, as certified by the department of health.

B.Agency qualifications: Agencies must be certified by the mental health division of the department of health. Agencies must meet the following criteria.

(1) agencies must have demonstrated direct experience in successfully serving the target population; and

(2) agencies must demonstrate knowledge of available community services and methods for accessing them.

C.Case manager qualification: Case managers employed by the agency must possess the education, skills, abilities, and experience to perform case management services for recipients who are chronically mentally ill. Case managers must meet at least one of the following requirements:

(1) bachelor's degree in social work, counseling, psychology or a related field, from an accredited institution and one year of experience in the mental health field; or

(2) licensed as a registered nurse with one year of experience in the mental health field;

(3) in the event that there are no suitable candidates with the above qualifications, individuals with the following qualifications and experience can be employed as case managers:

(a) associate's degree and a minimum of three (3) years of experience working with individuals with chronic mental illness;

(b) high school graduation or general educational development (GED) test and a minimum of four (4) years of experience working with individuals with chronic mental illness.

D. Once enrolled, providers receive a packet of information, including medicaid program policies, billing instructions, utilization review instructions, and other pertinent material from MAD. Providers are responsible for ensuring that they have received these materials and for updating them as new materials are received from MAD.

N.M. Admin. Code § 8.326.4.10

2/1/95; 8.326.4.10 NMAC - Rn, 8 NMAC 4.MAD.773.1, 3/1/12