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    OpenPayerPolicy UpdatesPsychiatry/Behavioral HealthNew Mexico Medicaid behavioral health Coverage Upd…
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    ModifiedNew Mexico Health Care AuthorityPolicy N/A

    Specialized Behavioral Health Services rule (8.321.2 NMAC)

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    Replaces and updates New Mexico's Medicaid rule governing specialized behavioral health services including provider types, service definitions, coverage criteria, and new benefits for Centennial Care recipients.

    Policy Summary
    PayerNew Mexico Health Care Authority
    PolicySpecialized Behavioral Health Services rule (8.321.2 NMAC)
    Policy CodePolicy N/A
    Change TypeRule repeal and replacement with multiple added and revised behavioral health services and authorizations
    Effective DateJan 1, 2020
    Next Review DateN/A
    Key ActionComplete comprehensive assessments and treatment plans for SMI/SED recipients and follow new prior authorization rules (e.g., stage-two ABA no longer requires PA; stage-three still does).
    SourceLink
    POLICY UPDATE CHANGES

    The Department proposes to repeal and replace NMAC rule 8.321.2 Specialized Behavioral Health Services with additions and clarifications to provider types, service definitions, and coverage.

    New services are proposed including Accredited Residential Treatment Centers (ARTC) for adults and youth, crisis triage centers, crisis stabilization services, and expanded IMD coverage for SUD.

    Expanded list of allowable non-independent practitioners and agency types permitted to use supervised mid-level practitioners.

    Prior authorization rules changed for some ABA services: stage-two ABA no longer requires prior authorization; stage-three still requires it.

    IMD coverage for substance abuse disorders increased from 15 to 30 days for eligible recipients ages 22 through 64.

    Day Treatment (DT) coverage criteria clarified to allow in-home individual family sessions when families cannot attend due to transportation or other difficulties, require continuous supervision and 24-hour availability or crisis plan.

    IOP provider types expanded to include certain health homes, BHAs with BHSD supervisory certificates, and OTPs in methadone clinics; non-independent practitioners specified.

    Partial Hospitalization (PH) definition expanded with new admission, documentation, staffing, and treatment-plan requirements and elimination of routine prior authorization unless stay exceeds 45 days.

    Psychosocial Rehabilitation (PSR) staffing ratios and components defined, and PSR clarified as a transitional level of care without PA but with defined medical necessity factors.

    Treatment Foster Care (TFC) I and II combined with clarified eligibility, treatment plan timelines, supervision, contact frequency, and dual reimbursement updates with CCSS.

    OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.

    $34Mestimated annual fiscal impact
    30dIMD SUD days
    45dPH PA threshold
    8d/12bCTC limit
    Jan 1, 2019Proposed effective date

    Coverage and Medical Necessity Criteria

    Applied Behavior Analysis (ABA) initial coverage

    ABA coverage requires ALL of the following unless otherwise allowed:

    ABA coverage prerequisites: 1) confirmation of the presence or risk of Autism Spectrum Disorder (ASD) by an approved autism evaluation provider (AEP) via a comprehensive diagnostic evaluation, targeted evaluation, or targeted risk evaluation; 2) an integrated service plan (ISP) developed by the AEP together with a referral to an approved ABA provider agency; or 3) completion of a behavioral or functional analytic assessment to determine selection of a focused or comprehensive ABA model and completion of a treatment plan. All services must be rendered in accordance with the treatment plan.

    Refer to BH Policy and Billing Manual for stage definitions and provider qualifications; per HB 322 ASD is not subject to age restrictions or dollar limits.

    ABA provider and stage requirements: Stage-based provider requirements apply: eligible provider types are specified by stage; specialty behavior analysts enrolled as approved BAs must document skills, training, and clinical experience to oversee and render ABA services for highly complex recipients. Stage-two ABA does not require prior authorization; stage-three ABA requires prior authorization.

    Refer to BH Policy and Billing Manual for full stage definitions and operational details.

    Comprehensive assessment and service plan requirement for SMI/SED

    Comprehensive assessment and service plan requirement for SMI/SED:

    Comprehensive assessment billing rules: The lead provider designated in Subsection D must complete the comprehensive assessment and service plan for recipients with serious mental illness (SMI) or severe emotional disturbance (SED); only agencies designated in Subsection D may bill for a comprehensive assessment. Practitioners within such agencies may develop the assessment and plan if supervised by an independently licensed practitioner and HIPAA trained; a comprehensive assessment and service plan may not be billed when care coordination is billed through bundled packages (case rate, high-fidelity wraparound, or CLNM Health Homes).

    Lead provider and agency billing restrictions as specified in rule.

    Crisis intervention and stabilization coverage criteria

    Crisis stabilization and crisis services coverage:

    Crisis stabilization settings: Includes ambulatory withdrawal management, crisis stabilization services up to 24 hours in community-based centers, and a residential crisis stabilization option (crisis triage center) as an alternative to the emergency department or police involvement; eligible population for crisis stabilization services is age 14 years and older.duration <= 24 hours for outpatient stabilization; residential CTC up to 8 days

    Providers, staffing and accreditation requirements specified in rule; CTC residential capacity limited to 12 beds.

    Specialized residential and evidence-based program coverage (new/reclassified services)

    New or reclassified specialized services:

    ARTC and CET service requirements: Accredited Residential Treatment Centers (ARTC) for adults and youth added as benefits requiring national accreditation (Joint Commission, CARF, or COA) and alignment with ASAM level-three definitions; Cognitive Enhancement Therapy (CET) reclassified as a special service requiring BHSD application and letter of approval, documented provider training, and offering only at approved agency types.

    Effective dates and inclusion subject to CMS approval and 1115 waiver; see BH Policy and Billing Manual for operational details.

    Day Treatment (DT) coverage criteria

    Day Treatment (DT) covered when ALL of the following are met

    DT core criteria: 1) If a family is unable to attend regularly scheduled DT sessions due to transportation or other barriers, individual family sessions may be scheduled in the family's home by the DT agency; 2) a certified DT provider must deliver adequate care and continuous supervision of the client during DT participation; 3) 24-hour availability of appropriate staff or implementation of a crisis plan (which may include referral) to respond to the recipient's crisis situation.

    DT services must be identified in and guided by the treatment plan, including crisis planning, formulated on an ongoing basis by the treatment team; treatment plan requirements detailed in the BH Policy and Billing Manual.

    IOP for Substance Use Disorders coverage considerations

    Intensive Outpatient Program (IOP) coverage considerations

    IOP expanded services: IOP must address co-occurring mental health disorders when indicated; outpatient individual or group therapies outside the bundled IOP services may be provided when medically necessary with documentation (current assessment, co-occurring diagnosis, inclusion in the service plan) and a statement from the IOP agency that postponement until IOP completion is not in the recipient's best interest. Medication-assisted treatment (MAT) and other mental health therapies are billed separately from the bundled IOP rate.

    IOP provider types expanded and EBPs oversight delegated to the IOP Interdepartmental Council and BH Policy and Billing Manual.

    Partial Hospitalization (PH) coverage criteria

    Partial Hospitalization (PH) covered when ALL of the following are met

    PH admission and service criteria: 1) All services must be ordered by a psychiatrist or licensed Ph.D.; 2) PH is a voluntary, intensive, structured and medically staffed program with an interdisciplinary team intended for stabilization of acute psychiatric or substance use symptoms; 3) a history and physical must be conducted within 24 hours of admission; 4) an interdisciplinary biopsychosocial assessment including alcohol/drug screening within seven days of admission; 5) individualized written treatment plan within seven days and reviewed/updated every 15 days; 6) documentation must be sufficient to demonstrate coverage criteria; 7) treatment must be reasonably expected to improve condition or prevent relapse/hospitalization and improve or maintain function; 8) school-age recipients require coordination with their school system for educational services.

    Prior authorization is not required unless length of stay exceeds 45 days; documentation required for PA when >45 days.

    PH exclusion for medication-monitoring only programs: Programs that only monitor medication management for otherwise stable recipients are not the combination, structure, and intensity of active PH treatment and are non-covered for PH services.

    Such services risk denial if billed as PH without meeting active treatment elements.

    Psychosocial Rehabilitation (PSR) coverage stance and criteria

    Psychosocial Rehabilitation (PSR) coverage stance

    PSR service components and staffing: PSR is a transitional level of care composed of four components: basic living skills development; psychosocial skills training; therapeutic socialization; and individual empowerment. Staff ratio guideline is minimum 1:2 and maximum 1:10; clinical supervisor/team lead must be an independently licensed behavioral health professional with at least one year supervisory experience and demonstrated PSR competence. There is no prior authorization requirement for PSR, but medical necessity must be documented (assessment, diagnosis, service and treatment plans, and compliance with 8.321.2 NMAC).1:2 - 1:10

    Clinical supervisor must attest to training related to supervision of non-clinical staff; operational details in BH Policy and Billing Manual.

    Treatment Foster Care (TFC) I & II coverage and eligibility

    Treatment Foster Care (TFC) I and II combined — coverage and eligibility require ALL of the following:

    TFC agency and placement requirements: Agency must be CYFD certified and licensed as a child placement agency; placement occurs only after documented determination that the prospective placement reasonably matches the recipient's needs and preferences; treatment foster parents must be employed or contracted by the TFC agency, receive appropriate training and supervision, be readily accessible at all times, and be physically present to meet the recipient's needs.

    TFC I is for those at risk for higher level care or returning from higher level care; TFC II is for those who completed TFC I or require continued treatment/support per criteria.

    TFC treatment plan timelines and reviews: An initial treatment plan must be developed within 72 hours of admission and a comprehensive treatment plan within 14 calendar days; the treatment team must review the treatment plan every 30 calendar days; the TFC therapist participates fully in treatment planning and family therapy is required when reunification is the goal.initial plan within 72 hours; comprehensive plan within 14 days; reviews every 30 days

    Treatment team responsibilities and parental duties described in rule; CCSS may be reimbursed during transitional planning as specified.

    IMD coverage for substance use disorders — eligibility and day limits

    Institutions for Mental Disease (IMD) coverage for substance use disorders:

    IMD days for SUD: Coverage for residential psychiatric facilities (IMD) for substance use disorders is increased to 30 days for eligible recipients aged 22 through 64.30 days

    Effective date January 1, 2019 or as approved by CMS; see BH Policy and Billing Manual for operationalization.

    The rule removes prior age and dollar limits for Autism Spectrum Disorder (ASD) services and specifies coverage prerequisites for Applied Behavior Analysis (ABA). Coverage requires confirmation of ASD presence or risk by an approved autism evaluation provider via a comprehensive diagnostic evaluation, targeted evaluation, or targeted risk evaluation; an integrated service plan (ISP) developed by the AEP with referral to an approved ABA provider agency; or completion of a behavioral or functional analytic assessment with a treatment plan. The rule directs readers to the Behavioral Health (BH) Policy and Billing Manual for stage definitions, provider qualifications, and additional operational details. Per HB 322, ASD is not subject to age restrictions or dollar limits.

    Partial Hospitalization (PH) coverage requires active, interdisciplinary treatment and documentation that meets the PH admission and ongoing criteria. The Department explicitly states that a program that only monitors medication management for otherwise-stable recipients does not meet the combination, structure, and intensity required for PH active treatment and is therefore a non-covered service. Providers should ensure PH programs include the interdisciplinary services, history and physical within 24 hours, biopsychosocial assessment within seven days, and an individualized treatment plan as required for coverage.

    Within the coverage criteria section the rule does not include standalone declarations labeling specific services as "not medically necessary." Instead, the rule describes eligibility, documentation, and service requirements that define coverage (for example, ABA prerequisites and PH active-treatment elements). Where services fail to meet those defined active-treatment requirements (for example medication-monitoring-only PH programs), the rule treats them as non-covered by describing the deficiency rather than issuing an explicit "not medically necessary" statement.

    The rule clarifies that medication-monitoring-only programs lacking the required combination, structure, and intensity of an active Partial Hospitalization (PH) program do not constitute PH active treatment and therefore are not medically necessary for PH coverage. Subsection E explicitly identifies such medication-monitoring-only programs as non-covered services, and providers requesting PH coverage must document that the program delivers the interdisciplinary active-treatment components specified in the rule rather than only medication monitoring.

    Provider Responsibilities, Prior Authorization, and Documentation

    Prior Authorization

    ABA prior authorization change and parity compliance

    Stage-two ABA services no longer require prior authorization; stage-three ABA services continue to require prior authorization. All pre-authorizations must comply with federal parity laws.

    • Stage-two ABA: no PA required.
    • Stage-three ABA: PA required; specialty BAs must document skills/training/experience for highly complex recipients.
    • All behavioral health pre-authorizations must comply with federal parity laws.
    Prior Authorization

    PH prior authorization threshold (>45 days)

    Partial Hospitalization (PH) does not require prior authorization for typical stays, but prior authorization is required if the length of stay exceeds 45 days; PA requests must include the stipulated documentation per the rule.

    • PA eliminated for PH except when stay > 45 days.
    • PA request must document the conditions specified by the rule.

    Key Quantitative Limits and Coding-Related Thresholds

    IMD coverage days for SUD (proposed increase)
    IMD coverage days for SUD (proposed)30 days (increase from 15 days) for eligible recipients ages 22–64
    Effective dateJanuary 1, 2019 or as approved by CMS
    ScopeApplies to residential psychiatric (IMD) services for substance use disorders
    Partial Hospitalization (PH) prior authorization length threshold
    PH prior authorization threshold> 45 days — prior authorization required when PH length of stay exceeds 45 days
    Documentation when requesting PAPA must include the stipulated documentation as described in rule (see PH subsection F)

    New and Revised Service Definitions

    Accredited Residential Treatment Center (ARTC) definition and accreditation requirements
    DefinitionAccredited Residential Treatment Center (ARTC): a level-three ASAM service for adults (and a youth section aligned with CYFD) providing residential addiction treatment
    Accreditation requirementMust be accredited by Joint Commission (JC), CARF, or Council on Accreditation (COA)
    CMS approvalBenefit subject to CMS approval as part of 1115 waiver and Medicaid State Plan inclusion
    Crisis Triage Center (CTC) definition
    DefinitionCrisis Triage Center (CTC): provider of outpatient crisis stabilization and residential services
    Duration limitResidential CTC services up to 8 days per stay

    Level-of-Care Decision Trees

    Residential / Crisis / IMD level-of-care criteria

    Residential, Crisis Triage Center (CTC), and IMD level-of-care criteria:

    Residential / CTC / IMD admission criteria: Admission requires provider accreditation and staffing standards as specified (e.g., ARTC requires national accreditation; CTC residential stays limited to up to 8 days and 12 beds); IMD SUD stays proposed up to 30 days for ages 22–64.CTC residential <= 8 days with 12-bed cap; IMD SUD <= 30 days

    Continued stay contingent on documented clinical need and treatment plan; detailed operational requirements in the BH Policy and Billing Manual and applicable accreditation oversight.

    Partial Hospitalization (PH) level-of-care criteria

    Partial Hospitalization (PH) level-of-care continued stay criteria:

    PH continued stay: Treatment must be reasonably expected to improve condition or reduce/control psychiatric symptoms to prevent relapse or hospitalization and to improve or maintain level of function; the treatment plan must be reviewed every 15 days; documentation must demonstrate criteria are met; prior authorization required if stay exceeds 45 days.

    Applied Behavior Analysis (ABA) Staged Service Model and Criteria

    ABA staged service model, provider requirements, and criteria

    ABA staged service model, provider requirements, and criteria:

    ABA staged model and provider qualifications: Coverage follows a staged service model: services contingent on diagnostic confirmation or risk evaluation by an approved AEP, integrated service plan or behavioral/functional analytic assessment and treatment plan; stage-two ABA services do not require prior authorization while stage-three services require prior authorization; specialty behavior analysts providing stage-three services must document skills, training and clinical experience to serve highly complex recipients.

    Providers must consult the Behavioral Health Policy and Billing Manual for stage definitions, provider qualifications, and documentation expectations.

    Specific Treatment Modalities and Operational Notes

    ACT / BMS / CET modalities — 3 top-level nodes

    Assertive Community Treatment (ACT), Behavioral Management Skills (BMS), and Cognitive Enhancement Therapy (CET) modalities:

    ACT modalities: ACT team composition expanded to include certified psychiatric nurse practitioners, psychiatric clinical nurse specialists, and prescribing psychologists under MD supervision; service eligibility includes individuals 15–30 years for first episode psychosis or persons meeting SMI criteria; ACT remains voluntary, comprehensive case management and psychosocial intervention with specified levels of interaction (face-to-face, collateral, outreach, group encounters).

    Services must follow BH Policy and Billing Manual guidance for coordinated specialty care where applicable.

    BMS modalities: BMS delivered as part of an integrated plan; treatment plan must include crisis planning, 24-hour availability of appropriate staff or referral, and the treatment team (including family) must review the plan every 30 days with amendments if lack of progress is documented.

    Supervisory responsibilities and program specifics located in BH Policy and Billing Manual.

    Encounter and Duration Limits

    'Treat first' behavioral health encounter limit
    Treat-first encounter limitUp to 4 behavioral health encounters may be provided under a provisional diagnosis without a full diagnostic evaluation or treatment plan
    Billing requirement for provisional careA provisional diagnosis based on screening must be included for billing when using the treat-first model
    Trigger for diagnostic evaluationAfter four encounters a diagnostic evaluation with resultant diagnosis is required
    Residential Crisis Triage Center service limits
    Residential CTC service durationUp to 8 days per residential stay
    Bed capMaximum 12 beds per CTC

    Policy Background and Scope

    Background: The rule replaces and expands the Specialized Behavioral Health Services regulation to widen beneficiary access and add or reclassify services and provider types. Key updates include expansion of ABA provider types and removal of ASD age/dollar limits, alignment of outpatient screening and a "treat first" model allowing up to four initial behavioral health encounters before a full diagnostic evaluation, and strengthened Partial Hospitalization (PH) definitions including staffing and documentation standards. These changes are intended to increase access to behavioral health services across Medicaid recipients, clarify provider responsibilities, and align services with licensing, ASAM, and CYFD requirements; providers should refer to the BH Policy and Billing Manual and the rule text for operational details and effective dates tied to CMS approval where applicable.

    Policy Summary
    PayerNew Mexico Health Care Authority
    PolicySpecialized Behavioral Health Services rule (8.321.2 NMAC)
    Policy CodePolicy N/A
    Change TypeRule repeal and replacement with multiple added and revised behavioral health services and authorizations
    Effective DateJan 1, 2020
    Next Review DateN/A
    Key ActionComplete comprehensive assessments and treatment plans for SMI/SED recipients and follow new prior authorization rules (e.g., stage-two ABA no longer requires PA; stage-three still does).
    SourceLink
    On This Page
    Coverage and Medical Necessity CriteriaProvider Responsibilities, Prior Authorization, and DocumentationKey Quantitative Limits and Coding-Related ThresholdsNew and Revised Service DefinitionsLevel-of-Care Decision TreesApplied Behavior Analysis (ABA) Staged Service Model and CriteriaSpecific Treatment Modalities and Operational NotesEncounter and Duration LimitsPolicy Background and Scope
    TFC contact and crisis requirements: Treatment foster parents must provide daily care and supervision; program must provide 24/7 crisis intervention and appropriate staff availability; treatment coordinator must conduct specified face-to-face and phone contacts with recipients and TFC parents (detailed schedules differ for TFC I and II: TFC I—private face-to-face with recipient and with parents within first two weeks and at least twice monthly thereafter; weekly phone contact with parents; TFC II—similar schedule with at least once monthly thereafter).

    Failure to follow placement or removal procedures may result in license revocation for treatment foster parents as specified.

    Step Therapy

    'Treat first' — up to four encounters without full diagnostic evaluation

    The rule permits up to four behavioral health encounters under a 'treat first' model without a full diagnostic evaluation or treatment plan; a provisional diagnosis based on screening may be used for billing for these up to four encounters.

    • Up to 4 encounters allowed before a diagnostic evaluation is required.
    • Provisional diagnosis based on screening is acceptable for those encounters; no treatment plan required for up to four encounters.
    Billing Rule

    IOP and MAT billing separation — bill separately when documented

    When medically necessary and documented, outpatient mental health therapies and MAT may be billed separately from bundled IOP rates; the rule clarifies that MAT (buprenorphine) remains a covered Medicaid benefit and is reimbursed separately from IOP.

    • IOP: outpatient therapies outside the bundled IOP may be added if documented as medically necessary and supported by the IOP agency.
    • MAT (buprenorphine) is a covered Medicaid benefit and billed/reimbursed separately from IOP bundled rates.
    Documentation Required

    Lead provider must complete comprehensive assessment and service plan for SMI/SED

    The designated lead provider must complete a comprehensive assessment and service plan for recipients with SMI or SED; only designated agencies may bill for comprehensive assessments, and practitioners within those agencies may develop the assessment if supervised by an independently licensed practitioner and HIPAA trained.

    • Lead provider requirement for comprehensive assessment and service plan for SMI/SED.
    • Only agencies listed in Subsection D may bill for comprehensive assessments.
    • Practitioners within those agencies may develop the assessment if supervised by an independently licensed practitioner and HIPAA trained.
    Documentation Required

    Treatment plan and documentation timelines for DT and PH

    Day Treatment (DT) treatment plans must identify DT services including crisis planning and be formulated on an ongoing basis by the treatment team; for Partial Hospitalization (PH), documentation must include a history and physical within 24 hours, an interdisciplinary biopsychosocial assessment within seven days, and an individualized written treatment plan within seven days with reviews every 15 days to demonstrate coverage criteria are met.

    • DT: treatment plan identifies services, includes crisis planning, and is formulated ongoing by the treatment team.
    • PH: history and physical within 24 hours of admission; biopsychosocial assessment within 7 days; individualized written treatment plan within 7 days and reviewed/updated every 15 days.
    • All supporting documentation and the treatment plan must be available in the recipient's file.
    Denial Risk

    Prior authorization must comply with federal parity; ABA stage differences

    All behavioral health pre-authorizations must comply with federal parity laws; note that stage-three ABA continues to require prior authorization while stage-two does not.

    • Pre-authorizations must comply with federal parity requirements.
    • Stage-two ABA: no PA; stage-three ABA: PA required.
    Denial Risk

    PH active treatment requirement — medication-monitoring-only is non-covered

    Programs that only monitor medication management without providing the combination, structure, and intensity of active PH treatment are non-covered services and risk denial.

    • Medication-monitoring-only programs do not meet the active treatment required for PH and are non-covered.
    • Documentation should demonstrate the combination, structure, and intensity of active PH treatment to avoid denial.
    Routine PA policyPrior authorization eliminated for PH unless length exceeds 45 days
    IMD coverage days (reiteration)
    IMD coverage days30 days for eligible recipients ages 22–64
    Previous limitPreviously 15 days for SUD treatment
    Effective date noteEffective January 1, 2019 or as otherwise approved by CMS
    Bed cap and roleLimit of 12 beds; includes ambulatory withdrawal management and navigational services to support community transition
    Psychosocial Rehabilitation (PSR) definition
    DefinitionPsychosocial Rehabilitation (PSR): a transitional level of care focused on recovery and resiliency goals
    Four service components1) basic living skills development; 2) psychosocial skills training; 3) therapeutic socialization; 4) individual empowerment
    Staffing guidanceStaff ratio guideline minimum 1:2 and maximum 1:10 with a clinical supervisor who is an independently licensed behavioral health professional
    IMD definition and notes (SUD coverage extension)
    IMD definition / noteInstitutions for Mental Disease (IMD): residential psychiatric facility coverage extended to include substance use disorder treatment up to 30 days for recipients ages 22–64
    Change from prior ruleIncrease from prior 15-day limit to 30 days for SUD stays
    Effective dateEffective January 1, 2019 or as approved by CMS
    PA required if length of stay > 45 days

    Documentation requirements include history and physical within 24 hours and interdisciplinary biopsychosocial assessment within seven days.

    Treatment Foster Care (TFC) level-of-care criteria

    Treatment Foster Care (TFC) level-of-care criteria:

    TFC admission and continued stay: Admission: recipient meets TFC I or II clinical criteria; agency is CYFD certified and licensed as a child placement agency; placement determined by documented match to recipient needs. Continued stay: treatment team reviews every 30 calendar days; treatment foster parents provide ongoing supervision and participate in reunification; crisis intervention available 24/7; contact schedule prescribed by level (TFC I vs II).Initial treatment plan within 72 hours; comprehensive plan within 14 days

    Operational specifics and supervision responsibilities are detailed in rule and BH Policy and Billing Manual.

    CET modalities:
    CET reclassified as a special service requiring BHSD application, documented provider training, and a letter of approval to be delivered by approved agency types (CMHC, FQHC, IHS, tribal facilities, CSA, CLNM Health Home, or BHA with supervisory certificate).

    Effective date and implementation subject to CMS approval as indicated in rule.

    MAT / OTP modality — medication-assisted treatment and OTP guidance

    Medication-assisted treatment (MAT) and opioid treatment program (OTP) guidance:

    MAT billing and OTP guidance: Medication assisted treatment (buprenorphine) is a covered Medicaid benefit; MAT and other mental health therapies are billed and reimbursed separately from bundled IOP rates; OTP provisions expanded to include services within methadone clinics under supervisory certification.

    IOP agency and OTP enrollment and supervisory requirements are specified in rule and detailed in the BH Policy and Billing Manual.

    Intensive Outpatient Program (IOP) modality details

    Intensive Outpatient Program (IOP) modality details:

    IOP modality requirements: IOP must address co-occurring disorders and may include additional outpatient mental health therapies outside the bundled IOP services when medically necessary and documented; IOP provider types expanded to include CLNM Health Homes, BHAs with supervisory certificates, and OTPs in methadone clinics; evidence-based practice approvals managed by IOP Interdepartmental Council and BH Policy and Billing Manual.

    For adolescents the minimum age lowered from 13 to 11 in IOP provisions; documentation of medical necessity required when adding outpatient therapies to IOP.

    Service types includedIncludes outpatient crisis stabilization, ambulatory withdrawal management, and navigational services to support transition
    Treatment coordinator contact schedule (TFC)
    Treatment coordinator face-to-face contacts (TFC I)Private face-to-face visit with recipient within first two weeks of TFC I placement and at least twice monthly thereafter; face-to-face interview with TFC parents within first two weeks and at least twice monthly thereafter
    Phone contact cadence (TFC I)At minimum one phone contact with TFC I parents weekly; phone contact not required the same week as a face-to-face contact
    TFC II contact schedulePrivate face-to-face with recipient and TFC II parent within first two weeks and at least once monthly thereafter; minimum one phone contact with TFC II parents weekly