Current through Register Vol. 35, No. 18, September 24, 2024
As part of centennial care's comprehensive service system,
behavioral health (BH) respite service is for short-term direct care and
supervision of the eligible recipient in order to afford the parent(s) or
caregiver a respite for their care of the recipient and takes place in the
recipient's home or another setting. See Subsections A and B of
8.321.2.9
NMAC for MAD general provider requirements.
A.
Eligible practitioners:
(1) Supervisor:
(a) bachelor's degree and three years'
experience working with the target population;
(b) supervision activities include a minimum
of two hours per month individual supervision covering administrative and case
specific issues, and two additional hours per month of continuing education in
behavioral health respite care issues, or annualized respite provider
training;
(c) access to on call
crisis support available 24-hours a day; and
(d) supervision by licensed practitioners
must be in accordance with their respective licensing board
regulations.
(2) Respite
care staff:
(a) minimum three years'
experience working with the target population;
(b) pass all criminal records and background
checks for all persons residing in the home over 18;
(c) possess a valid driver's license, vehicle
registration and insurance, if transporting member;
(d) CPR and first aid; and
(e) documentation of behavioral health
orientation, training and supervision as defined in the BH policy and billing
manual.
B.
Coverage criteria: The provider agency will assess the situation
and, with the caregiver, recommend the appropriate setting for respite. BH
respite services may include a range of activities to meet the social,
emotional and physical needs identified through the service or treatment plan,
and documented in the treatment record. These services may be provided for a
few hours during the day or for longer periods of time involving overnight
stays. BH respite, while usually planned, can also be provided in an emergency
or unplanned basis.
C.
Identified population:
(1) Members up
to 21 years of age diagnosed with a severe emotional disturbance (SED), as
defined by the state of New Mexico who reside with the same primary caregivers
on a daily basis; or
(2) Youth in
protective services custody whose placement may be at risk whether or not they
are diagnosed with SED.
D.
Non-covered services:
(1) 30 days or 720 hours per year at which
time prior authorization must be acquired for additional respite
care;
(2) May not be billed in
conjunction with the following medicaid services:
(a) treatment foster care;
(b) group home;
(c) residential services;
(d) inpatient treatment.
(3) Non-enrolled siblings of a child
receiving BH respite services are not eligible for BH respite benefits;
and
(4) Cost of room and board are
not included as part of respite care.
