Current through Register Vol. 35, No. 18, September 24, 2024
MAD pays for coverage for medication assisted treatment (MAT)
for opioid use disorder to an eligible recipient as defined in the Drug
Addiction Treatment Act of 2000 (DATA 2000), the Comprehensive Addiction and
Recovery Act of 2016 (CARA), and the Substance Use Disorder Prevention that
Promotes Opioid Recovery and Treatment for Patients and Communities Act of 2018
(SUPPORT Act). Services include, but are not limited to, the administration of
opioid replacement medication (excluding methadone) to an eligible recipient
for detoxification from opioids or maintenance treatment. See Subsections A and
B of
8.321.2.9
NMAC for MAD general provider requirements.
A.
Eligible providers and
practitioners:
(1) Any clinic, office,
or hospital staffed by required practitioners.
(2) Practitioners for diagnosing, assessment,
and prescribing include:
(a) a physician or DO
licensed in the state of New Mexico that has board certification in addiction
medicine or addiction psychiatry or has completed special training and has the
federal waiver to prescribe buprenorphine;
(b) a certified nurse practitioner that has
completed 24 hours of required training and has a DATA 2000 waiver;
or
(c) a physician assistant
licensed in the state of New Mexico and has the federal DATA 2000 waiver to
prescribe buprenorphine.
(3) Practitioners for administration and
education:
(a) a registered nurse licensed in
the state of New Mexico; or
(b) a
physician assistant licensed in the state of New Mexico.
(4) Practitioners for counseling and
education may include behavioral health practitioners licensed for counseling
or therapy.
(5) Practitioners for
skills and education include certified peer support workers or certified family
peer support workers to provide skill-building, recovery and resiliency
support.
B.
Coverage criteria:
(1) an assessment
and diagnosis by the prescribing practitioner as to whether the recipient has
an opioid abuse diagnosis and their readiness for change must be conducted
prior to starting treatment;
(2) an
assessment for concurrent medical or behavioral health illnesses;
(3) an assessment for co-occurring substance
abuse disorders;
(4) educating the
recipient as to differing treatment options prior to starting treatment;
and
(5) a service plan that
prescribes either in house counseling or therapy, or referral to outside
services, as indicated.
C.
Eligible recipients:
Individuals with an opioid use disorder diagnosis defined by DSM 5 or ICD
10.
D.
Covered services:
(1) history and physical;
(2) comprehensive assessment and treatment
plan;
(3) induction phase of opioid
treatment;
(4) administration of
medication and concurrent education;
(5) subsequent evaluation and management
visits;
(6) development and
maintenance of medical record log of opioid replacement medication
prescriptions;
(7) development and
maintenance of required records regarding inventory, storage and destruction of
controlled medications if dispensing from office;
(8) initiation and tracking of controlled
substance agreements with eligible recipients;
(9) regular monitoring and documentation of
NM prescription monitoring program results;
(10) urine drug screens;
(11) recovery services (MCO members
only);
(12) family support services
(MCO members only).
E.
Reimbursement: See Subsection H of 8.321.9 NMAC for MAD
behavioral health general reimbursement requirements. See the BH policy and
billing manual for reimbursement specific to MAT.
