Current through Register Vol. 35, No. 18, September 24, 2024
To help an eligible recipient 10 up to 18 years of age
receive behavioral health services to either remain in or re-enter his or her
home and community, MAD pays for MST services as part of EPSDT program
(42 CFR
441.57) . MAD covers medically necessary MST
services required by the condition of the eligible recipient. MST provides
intensive home, family and community-based treatment for an eligible recipient
10 to 18 years of age who is at risk of out-of-home placement or is returning
home from an out-of-home placement. The need for MST services must be
identified in the eligible recipient's tot to teen health check screen or
another diagnostic evaluation.
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 MST services, an
agency must hold a copy of MST Inc licensure, or any of its approved
subsidiaries. MST Inc is a national organization located in Mt. Pleasant, South
Carolina, and is deemed by MAD to be the primary authority on licensure of New
Mexico MST programs.
(1) The MST program
includes an assigned MST team for each eligible recipient. The MST team must
include at minimum:
(a) master's level
independently licensed behavioral health professional clinical supervision; see
Subsection H of
8.321.2.9
NMAC;
(b) licensed master's and
bachelor's level behavioral health staff able to provide 24-hour coverage,
seven days a week; see Subsection E of
8.321.2.9
NMAC;
(c) a licensed master's level
behavioral health practitioner that is required to perform all MST
interventions; a bachelor's level behavioral health practitioner is limited to
performing functions defined within the scope of his or her RLD practice board
licensure or practice (see Subsection E of
8.321.2.9
NMAC;
(d) bachelor's level staff
that has a degree in social work, counseling, psychology or a related human
services field and must have at least three years' experience working with the
identified population of children, adolescents and their families;
and
(e) staffing for MST services
is comprised of no more than one-third bachelor's level staff and, at minimum,
two-thirds licensed master's level staff.
(2) Clinical supervision must include at a
minimum:
(a) weekly supervision provided by an
independently licensed master's level behavioral health practitioner (see
Subsection C of
8.321.2.9
NMAC) who is MST trained; this supervision, following the MST supervisory
protocol, is provided to team members on topics directly related to the needs
of the eligible recipient and his or her family on an ongoing basis;
and
(b) one hour of local group
supervision per week and one hour of telephone consultation per week with the
MST systems supervisor, provided to team members on topics directly related to
the needs of the eligible recipient and his or her family on an ongoing
basis.
(3) All clinical
staff is required to participate in and complete a prescribed five-day MST
introductory training and subsequent quarterly trainings.
B.
Identified population:
(1) MST is provided to an eligible recipient
10 to 18 years of age who meets the criteria of SED, involved in or at serious
risk of involvement with the juvenile justice system; has antisocial,
aggressive, violent, and substance-abusing behaviors; is at risk for an
out-of-home placement; or is returning from an out-of-home placement where the
above behaviors were the focus of his or her treatment and his or her family's
involvement.
(2) A co-occurring
diagnosis of substance abuse shall not exclude an eligible recipient from the
program.
C.
Covered services and service limitations: MST is a culturally
sensitive service, rendered by a MST team, to provide intensive home, family
and community-based treatment for the family of an eligible recipient who is at
risk of an out-of-home placement or is returning home from an out-of-home
placement. MST services are primarily provided in the eligible recipient's
home, but a MST worker may also intervene at the eligible recipient's school
and other community settings. Specialized therapeutic and rehabilitative
interventions are used to address specific areas of need, such as substance
abuse, delinquency and violent behavior.
(1)
The following services must be furnished as part of the MST service to be
eligible for reimbursement:
(a) an initial
assessment to identify the focus of the MST intervention;
(b) therapeutic interventions with the
eligible recipient and his or her family;
(c) case management; and
(d) crisis stabilization.
(2) MST services are conducted by
practitioners using the MST team approach. The MST team must have the ability
to deliver services in various environments, such as homes, schools, homeless
shelters, or street locations. MST services:
(a) promote the recipient's family's capacity
to monitor and manage his or her behavior;
(b) involve the eligible recipient's family
and other systems, such as the school, probation officers, extended families
and community connections;
(c)
provide access to a variety of interventions 24-hours a day, seven days a week,
by staff that maintain contact and intervene as one organizational unit;
and
(d) include structured
face-to-face therapeutic interventions to provide support and guidance in all
areas of the recipient's functional domains, such as adaptive, communication,
psychosocial, problem solving, and behavior management.
(3) The duration of MST intervention is
typically three to six months. Weekly interventions may range from three to 20
hours a week; less as an eligible recipient nears discharge.
D.
Non-covered
services: MST services are subject to the limitations and coverage
restrictions that exist for other MAD services. See Subsection G of
8.321.2.9
NMAC for general non-covered specialized behavioral health services.
E.
Reimbursement: MST 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 MST agency receives instructions on how to access documentation,
billing, and claims processing information.
