Current through Register Vol. 35, No. 18, September 24, 2024
MAD pays for time-limited IOP services utilizing a
multi-faceted approach to treatment for an eligible recipient who requires
structure and support to achieve and sustain recovery. IOP must utilize a
research and evidence-based model approved by the IOP interdepartmental
council, and target specific behaviors with individualized behavioral
interventions.
A.
Eligible
providers: Services may only be delivered through a MAD approved agency
after demonstrating that the agency meets all the requirements of IOP program
services and supervision. See Subsections A and B of
8.321.2.9
NMAC for MAD general provider requirements.
(1) IOP services are provided through an
integrated interdisciplinary approach including staff expertise in both
addiction and mental health treatment. This team may have services rendered by
non-independent practitioners under the direction of the IOP supervisor
including LMSW, LMHC, LADAC, CADC, LSAA, and a master's level psych
associates.
(2) Each IOP program
must have a clinical supervisor. Both clinical services and supervision by
licensed practitioners must be conducted in accordance with respective
licensing board regulations. An IOP clinical supervisor must meet all the
following requirements:
(a) be licensed as a
MAD approved independent practitioner; see Subsection C of
8.321.2.9
NMAC;
(b) have two years relevant
experience with an IOP program or approved exception by the interdepartmental
council;
(c) have one year
demonstrated supervisory experience; and
(d) have expertise in both mental health and
substance abuse treatment.
(3) The IOP agency is required to develop and
implement a program outcome evaluation system.
(4) The agency must maintain the appropriate
state facility licensure if offering medication treatment or medication
replacement services.
(5) The
agency must hold an IOP interdepartmental council approval letter and be
enrolled by MAD to render IOP services to an eligible recipient. In the
application process each IOP must identify if it is a youth program, an adult
program, a transitional age program, or multiple programs. Transitional age
programs must specify the age range of the target population. A MAD IOP agency
will be provisionally approved for a specified timeframe to render IOP services
to an eligible recipient. During this provisionally approved time, MAD or its
designee will determine if the IOP meets MAD IOP requirements and if so, the
agency will receive an approval letter for IOP full enrollment.
B.
Coverage criteria:
(1) An IOP is based on research and
evidence-based practice models (EBP) that target specific behaviors with
individualized behavioral interventions. All EBP services must be culturally
sensitive and incorporate recovery and resiliency values into all service
interventions. EBPs must be approved by the IOP interdepartmental council. A
list of pre-approved EBPs is available through the council, as are the criteria
for having another model approved. They are also listed in the BH policy and
billing manual.
(2) Treatment
services must address co-occurring mental health disorders, as well as
substance use disorders, when indicated.
C.
Covered services:
(1) IOP core services include:
(a) individual substance use disorder related
therapy;
(b) group therapy (group
membership may not exceed 15 in number); and
(c) psycho-education for the eligible
recipient and his or her family.
(2) Co-occurring mental health and substance
use disorders: The IOP agency must accommodate the needs of an eligible
recipient with co-occurring substance use and mental health disorders.
Treatment services are provided through an integrated interdisciplinary team
and through coordinated, concurrent services with MAD behavioral health
providers.
(3) Medication
management services are available either in the IOP agency or by referral to
oversee the use of psychotropic medications and medication assisted treatment
of substance use disorders.
(4) The
duration of an eligible recipient's IOP intervention is typically three to six
months. The amount of weekly services per eligible recipient is directly
related to the goals specified in his or her IOP treatment plan and the IOP EBP
in use.
(5) Other mental health
therapies: outpatient therapies may be rendered in addition to the IOP
therapies of individual and group when the eligible recipient's co-occurring
disorder requires treatment services which are outside the scope of the IOP
therapeutic services. The eligible recipient's file must document the medical
necessity of receiving outpatient therapy services in addition to IOP
therapies, and a statement from the IOP agency that to postpone such therapy
until the completion of the eligible recipient's IOP services is not in the
best interest of the eligible recipient. Such documentation includes, but is
not limited to: current assessment, a co-occurring diagnosis, and the inclusion
in service plan for outpatient therapy services. An IOP agency may:
(a) render these services when it is enrolled
as a provider covered under Subsection D of
8.321.2.9
NMAC with practitioners listed in Subsections C and E of
8.321.2.9
NMAC whose scope of practice specifically allows for mental health therapy
services; or
(b) refer the eligible
recipient to another provider if the IOP agency does not have such
practitioners available; the IOP agency may continue the eligible recipient's
IOP services coordinating with the new provider.
D.
Identified
population:
(1) IOP services are
provided to an eligible recipient 11 through 17 years of age diagnosed with
substance abuse disorder or with co-occurring disorders (mental illness and
substance abuse) or that meet the American society of addiction medicine (ASAM)
patient placement criteria for level 2.1 - intensive outpatient treatment; or
have been mandated by the local judicial system as an option of least
restrictive level of care. Services are not covered if the recipient is in
detention or incarceration. See eligibility rules
8.200.410.17
NMAC.
(2) IOP services are provided
to an eligible recipient of a transitional age in a transitional age program of
which the age range has been determined by the agency, and that have been
diagnosed with substance abuse disorder or with co-occurring disorders (mental
illness and substance abuse) or that meet the American society of addiction
medicine's (ASAM) patient placement criteria for level 2.1 - intensive
outpatient treatment, or have been mandated by the local judicial system as an
option of least restrictive level of care.
(3) IOP services are provided to an eligible
adult recipient 18 years of age and older diagnosed with substance abuse
disorders or co-occurring disorders (mental illness and substance abuse) that
meet the American society of addiction medicine's (ASAM) patient placement
criteria for level 2.1 - intensive outpatient treatment or have been mandated
by the local judicial system as an option of least restrictive level of
care.
(4) Prior to engaging in a
MAD IOP program, the eligible recipient must have a treatment file containing:
(a) one diagnostic evaluation with a
diagnosis of substance use disorder; and
(b) one individualized treatment service plan
that includes IOP as an intervention.
E.
Non-covered services: IOP
services are subject to the limitations and coverage restrictions which exist
for other MAD services see Subsection G of
8.321.2.9
NMAC for general non-covered MAD behavioral health services and 8.310.2 NMAC
for MAD general non-covered services. MAD does not cover the following specific
services billed in conjunction with IOP services:
(1) acute inpatient;
(2) residential treatment services (i.e.,
ARTC, RTC, group home, and transitional living services);
(3) ACT;
(4) partial hospitalization;
(5) outpatient therapies which do not meet
Subsection C of
8.321.2.9
NMAC;
(6) multi-systemic therapy
(MST);
(7) activity therapy;
or
(8) psychosocial rehabilitation
(PSR) group services.
F.
Reimbursement: See Subsection H of
8.321.2.9
NMAC for MAD behavioral health general reimbursement requirements.
(1) For IOP services, the agency must submit
claims for reimbursement on the CMS-1500 claim form or its successor.
(2) Core IOP services are reimbursed through
a bundled rate. Medication assisted treatment and other mental health therapies
are billed and reimbursed separately from the bundled rate.
(3) IOP services furnished by an IOP team
member are billed by and reimbursed to a MAD IOP agency whether the team member
is under contract with or employed by the IOP agency.
(4) IOP services not provided in accordance
with the conditions for coverage as specified in 8.321.2 NMAC are not MAD
covered services and are subject to recoupment.