Current through Register Vol. 35, No. 18, September 24, 2024
Recovery services are peer-to-peer support for centennial
care members to develop and enhance wellness and health care practices.
Recovery services promote self-responsibility through recipients learning new
health care practices from a peer who has had similar life challenges and who
has developed self-efficacy in using needed skills. See Subsections A and B of
8.321.2.9
NMAC for MAD general provider requirements.
A.
Staffing requirements:
(1) all staff must possess a current and
valid NM driver's license;
(2)
clinical supervisor:
(a) licensed as an
independent practitioner (i.e., psychiatrist, psychologist, LISW, LPCC, LMFT,
CNP, CNS); and
(b) two years
relevant experience with the target population; and
(c) one year demonstrated supervisory
experience; and
(d) expertise in
both mental health and addiction treatment services; and
(e) supervision must be conducted in accord
with respective licensing board regulations.
(3) certified peer support workers;
and
(4) certified family
specialists.
(5) Group ratios
should be sufficient to ensure that patients have reasonable and prompt access
to services at the required levels of frequency and intensity within the
practitioner's scope of practices.
B.
Coverage criteria: Services
occur individually or with consumers who support each other to optimize
learning new skills. This skill enhancement then augments the effectiveness of
other treatment and recovery support initiatives.
(1) Admissions criteria: Consumer has been
unable to achieve functional use of natural and community support systems to
effectively self-manage recovery and wellness.
(2) Continuation of services criteria:
Consumer has made progress in achieving use of natural and community support
systems to effectively self-manage recovery and wellness, but continues to need
support in developing those competencies.
(3) Discharge criteria: Consumer has achieved
maximum use of natural and community support systems to effectively self-manage
recovery and wellness.
C.
Identified population:
(1) Children experiencing serious
emotional/neurobiological/behavioral disorders;
(2) Adults with serious mental illness (SMI);
and
(3) Individuals with chronic
substance abuse; or individuals with a co-occurring disorder (mental
illness/substance abuse) or dually diagnosed with a primary diagnosis of mental
illness.
D.
Covered services:
(1) This service
will particularly focus on the individual's wellness, ongoing recovery and
resiliency, relapse prevention, and chronic disease management.
(2) Recovery services support specific
recovery goals through:
(a) use of strategies
for maintaining the eight dimensions of wellness;
(b) creation of relapse prevention
plans;
(c) learning chronic disease
management methods; and
(d)
identification of linkages to ongoing community supports.
(3) Activities must support the individual's
recovery goals. There must be documented evidence of the individual identifying
desired recovery goals and outcomes and incorporating them into a recovery
services treatment plan.
(4)
Recovery services activities include, but are not limited to:
(a) screening, engaging, coaching, and
educating.
(b) emotional support
that demonstrates empathy, caring, or concern to bolster the person's
self-esteem and confidence.
(c)
sharing knowledge and information or providing life skills training.
(d) provision of concrete assistance to help
others accomplish tasks.
(e)
facilitation of contacts with other people to promote learning of social and
recreational skills, create community and acquire a sense of
belonging.
(5) Recovery
services can be delivered in an individual or group setting.
E.
Non-covered services:
This service may not be billed in conjunction with:
(1) multi-systemic therapy (MST);
(2) assertive community treatment
(ACT);
(3) partial
hospitalization;
(4) transitional
living services (TLS); or
(5)
treatment foster care (TFC).
