Current through Register Vol. 35, No. 18, September 24, 2024
Brain injury services fund (BISF) services are provided
through two contractor components, service coordination and fiscal intermediary
agent for BISF HCBS.
A.
Service
coordination services: Service coordination services serve a
problem-solving function. They are intended to resolve a participant's stated
crisis need, ensure service continuity, prevent fragmentation of services and
endeavor to tap into any and all resources that are appropriate and accessible,
including community-based supports, while resolving the crisis that brought the
participant into the program. The intent of service coordination is to augment,
not replace, the participant's natural supports in a manner that facilitates
independent living and self-determination. All participants must have a BISF
program service coordinator before they can receive any other BISF program
services.
(1)
Qualifications for
service coordination: Service coordination agencies serving the BISF
program must ensure the following pertaining to staff qualifications:
(a) have a current social worker license in
good standing with the New Mexico board of social work examiners; or
(b) have a current registered nurse license,
in good standing from the New Mexico board of nursing; or
(c) have a bachelor's degree in social work,
counseling, nursing, special education or closely related field plus one-year
clinical experience related to the brain injury population working in any of
the following settings:
(i) home health or
community health program;
(ii)
hospital;
(iii) private
practice;
(iv) publicly funded
institution or long-term care program;
(v) mental health program;
(vi) school or school health
setting;
(vii) community-based
social service program; or
(viii)
other programs addressing the needs of individuals with brain injury.
(d) With prior approval from the
HSD BISF program manager or designee, exceptions to service coordinator
qualifications can be made; contractors requesting qualification exceptions
must demonstrate that applicant candidates have relevant education, internships
or volunteer experience. Other qualifications may be:
(i) associates degree and a minimum of three
years of experience in the mental health or brain injury field; or
(ii) high school graduation or general
educational development (GED) test and a minimum of five years of experience in
the mental health or brain injury field.
(e) All BISF service coordinators whether
subcontracting or employed by a BISF program contracted agency must meet these
requirements and attend continuing education as determined by HSD.
(2)
Scope of
services: Service coordination includes but is not limited to
facilitating eligibility determination for individuals applying to the BISF;
conducting an in-person assessment; developing an independent living plan
(ILP); coordination and documentation of the delivery of services; maintaining
a complete permanent case record for each participant which includes
documentation as prescribed by HSD; and creating a transition plan for
discharge from the BISF program, coordinating with other case managers, as
needed.
(a) Service coordinators must
identify, and resolve known or suspected issues that may have an impact on the
safety and well-being of the participant.
(b) Service coordinators must evaluate and
monitor direct service and implementation of the ILP through face-to-face
contact with the participant at a frequency prescribed by HSD.
(c) Service coordination agencies are
required to maintain a 24-hour emergency response system that allows
participants to contact the agency and respond to individual emergency
situations within a reasonable amount of time after notification on a 24-hour
basis. An emergency response written policy is to be provided to all program
participants.
B.
Fiscal intermediary agent
(FIA): The fiscal intermediary agent (FIA) serves as the intermediary
for the arrangement and payment of brain injury specific home and
community-based services (HCBS). BISF services are only accessible through the
coordination of a BISF program service coordination agency and are limited to
filling a participant's needs as outlined in the participant's independent
living plan (ILP), when there is an imminent risk to the participant's health
and safety.
(1)
Qualifications for
FIA: FIA service staff must demonstrate the following qualifications:
(a) have a bachelor's degree in business,
social work, counseling, nursing, special education or closely related field;
and
(b) have experience related to
the brain injury population, working in any of the following settings:
(i) home health or community health
program;
(ii) hospital;
(iii) private practice;
(iv) publicly funded institution or long-term
care program;
(v) mental health
program; or
(vi) community-based
social service program; or other program addressing the needs of individuals
with brain injuries.
(c)
With prior approval from the BISF program manager or designee, exceptions to
FIA personnel qualifications can be made. Contractors requesting qualification
exceptions must demonstrate relevant education internships or volunteer
experience. Other qualifications may be:
(i)
associate degree and experience in the mental health or brain injury field;
or
(ii) high school graduation or
general educational development (GED) test and extensive experience in the
mental health or traumatic brain injury field.
(d) All BISF FIA staff employed by the agent,
must meet these requirements and attend continuing education as determined by
HSD. Contracted FIA service providers must have the required education and be
duly licensed by the state of New Mexico within their respective
disciplines.
(2)
Scope of services: Fiscal intermediary agent services include but
are not limited to the following activities: maintain a network of providers of
brain injury related services and goods and ensure that subcontracted providers
are duly licensed by the state of New Mexico or otherwise certified within
their respective disciplines; procure goods and arrange contracts and letters
of agreement with vendors and contractors who provide the goods, services and
supports; receive service and goods referral requests submitted by BISF service
coordinators for prior authorization; and arrange for delivery of BISF goods
and services.
(a) Prior to arranging for and
funding requested services or goods, the FIA must verify that other responsible
payer source coverage is not available to pay for services or goods and that
the participant has exhausted any other financial resources.
(b) The FIA must monitor and document service
expenditures for participants receiving BISF HCBS and ensure that coverage does
not exceed the allowable limits set by HSD;
(c) The FIA must assure that subcontracted
providers and vendors are providing the services and goods as contracted and
ensure timely reimbursement to such providers and vendors.
C.
General administrative
requirements: Agencies contracted to provide BISF service coordination
or fiscal intermediary services are required to:
(1) have and follow confidentiality
standards;
(2) maintain a current
business license issued by the state, county or city government if
required;
(3) comply with all
applicable federal or state regulations, policies and procedures that apply to
their business and to their contract with HSD;
(4) demonstrate financial solvency;
(5) maintain full professional liability
insurance coverage;
(6) establish
and maintain written policies and procedures related to:
(a) service provision and appropriate
supervision;
(b) professional
documentation standards;
(c)
training and education on brain injury; and
(d) grievances and appeals as outlined in
8.326.10.15
NMAC in a manner that is accommodating to those living with brain injury and
agreeable to the HSD BISF program; and
(7) have a governing board with at least one
external member with a brain injury, a family member with a brain injury or
professional working with brain injury;
(8) maintain an in-house directory of brain
injury resources for each region served.