New Mexico Register / Volume XXXIV,
Issue 5 / March 14, 2023
This
is an emergency amendment to 8.321.2 NMAC, Section 37, effective 3/1/2023.
8.321.2.37 TREATMENT FOSTER CARE I and II: MAD pays for medically
necessary services furnished to an eligible recipient under 21 years of age who
has an identified need for treatment foster care (TFC) and meets the TFC I or
TFC II level of care (LOC) as part of the EPSDT program. MAD covers those services included in the
eligible recipient’s individualized treatment plan which is designed to help
him or her develop skills necessary for successful reintegration into his or
her family or transition back into the community. TFC I agency provides therapeutic services to
an eligible recipient who is experiencing emotional or psychological trauma and
who would optimally benefit from the services and supervision provided in a TFC
I setting. The TFC II agency provides
therapeutic family living experiences as the core treatment service to which
other individualized services can be added.
The need for TFC I and II services must be identified in the tot to teen
health check or other diagnostic evaluation furnished through the eligible
recipient’s health check referral.
A. Eligible agencies: 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 TFC services to an eligible recipient, the agency must be a CYFD
certified TFC agency and be licensed as a child placement agency by CYFD
protective services. In lieu of New
Mexico CYFD licensure and certification, an out-of-state TFC agency must have
equivalent accreditation and be licensed in its own state as a TFC agency.
B. Coverage criteria:
(1) The
treatment foster care agency provides intensive support, technical assistance,
and supervision of all treatment foster parents.
(2) A
TFC I and II parent is either employed or contracted by the TFC agency and
receives appropriate training and supervision by the TFC agency.
(3) Placement
does not occur until after a comprehensive assessment of how the prospective
treatment foster family can meet the recipient’s needs and preferences, and a
documented determination by the agency that the prospective placement is a
reasonable match for the recipient.
(4) An
initial treatment plan must be developed within 72 hours of admission and a
comprehensive treatment plan must be developed within 14 calendar days of the
eligible recipient’s admission to a TFC I or II program. See the BH policy and billing manual for the
specific requirements of a TFC treatment plan.
(5) The
treatment team must review the treatment plan every 30 calendar days.
(6) TFC
families must have one parent readily accessible at all times, cannot schedule
work when the eligible recipient is normally at home, and is able to be
physically present to meet the eligible recipient’s emotional and behavioral
needs.
(7) In
the event the treatment foster parents request a treatment foster recipient be
removed from their home, a treatment team meeting must be held and an agreement
made that a move is in the best interest of the involved recipient. Any treatment foster parent(s) who demands
removal of a treatment foster recipient from his or her home without first
discussing with and obtaining consensus of the treatment team, may have their
license revoked.
(8) A
recipient eligible for treatment foster care services, level I or II, may
change treatment foster homes only under the following circumstances:
(a) an
effort is being made to reunite siblings; or
(b) a
change of treatment foster home is clinically indicated, as documented in the
client’s record by the treatment team.
C. Identified
population:
(1) TFC
I services are for an eligible recipient who meets the following criteria:
(a) is
at risk for placement in a higher level of care or is returning from a higher
level of care and is appropriate for a lower level of care; or
(b) has
complex and difficult psychiatric, psychological, neurobiological, behavioral,
psychosocial problems; and
(c) requires
and would optimally benefit from the behavioral health services and supervision
provided in a treatment foster home setting.
(2) TFC
II services are for an eligible recipient who meets the criteria listed in
Section 25 Subsection B of 8.321.2.9 NMAC and also meet one of the following
criteria:
(a) has
successfully completed treatment foster care services level I (TFC I), as
indicated by the treatment team; or
(b) requires
the initiation or continuity of treatment and support of the treatment foster
family to secure or maintain therapeutic gains; or
(c) requires
this treatment modality as an appropriate entry level service from which the
client will optimally benefit.
(3) An
eligible recipient has the right to receive services from any MAD TFC enrolled
agency of his or her choice.
D. Covered services: The family living experience is the core
treatment service to which other individualized services can be added, as
appropriate to meet the eligible recipient’s needs.
(1) The
TFC parental responsibilities include, but are not limited to:
(a) meeting
the recipient’s base needs, and providing daily care and supervision;
(b) participating
in the development of treatment plans for the eligible recipient by providing
input based on his or her observations;
(c) assuming
the primary responsibility for implementing the in-home treatment strategies
specified in the eligible recipient’s treatment plan;
(d) recording
the eligible recipient’s information and documentation of activities, as
required by the TFC agency and the standards under which it operates;
(e) assisting
the eligible recipient with maintaining contact with his or her family and
enhancing that relationship;
(f) supporting
efforts specified by the treatment plan to meet the eligible recipient’s
permanency planning goals;
(g) reunification
with the recipient’s family. The
treatment foster parents work in conjunction with the treatment team toward the
accomplishment of the reunification objectives outlined in the treatment plan;
(h) assisting
the eligible recipient obtain medical, educational, vocational and other services
to reach goals identified in treatment plan;
(i) ensuring proper and adequate supervision is provided at all times.
Treatment teams determine that all out-of-home activities are
appropriate for the recipient’s level of need, including the need for
supervision; and
(j) working
with all appropriate and available community-based resources to secure services
for and to advocate for the eligible recipient.
(2) The
treatment foster care agency provides intensive support, technical assistance,
and supervision of all treatment foster parents. The following services must be furnished by
both TFC I and II agencies unless specified for either I or II. Payment for performance of these services is
included in the TFC agency’s reimbursement rate:
(a) facilitation,
monitoring and documenting of treatment of TFC parents initial and ongoing
training;
(b) providing
support, assistance and training to the TFC parents;
(c) providing
assessments for pre placement and placement to
determine the eligible recipient’s placement is therapeutically appropriate;
(d) ongoing
review of the eligible recipient’s progress in TFC and assessment of family
interactions and stress;
(e) ongoing
treatment planning as defined in Subsection G of 8.321.2.9 NMAC and treatment
team meetings;
(f) provision
of individual, family or group psychotherapy to recipients as described in the
treatment plan. The TFC therapist is an
active treatment team member and participates fully in the treatment planning
process;
(g) family
therapy is required when client reunification with their family is the goal;
(h) ensuring
facilitation of age-appropriate skill development in the areas of household
management, nutrition, physical and emotional health, basic life skills, time
management, school attendance, money management, independent living, relaxation
techniques and self-care techniques for the eligible recipient;
(i) providing crisis intervention on
call to treatment foster parents, recipients and their families on a 24-hour,
seven days a week basis including 24-hour availability of appropriate staff to
respond to the home in crisis situations;
(j) assessing
the family’s strengths, needs and developing a family service plan when an
eligible recipient’s return to his or her family is planned;
(k) conducting
a private face-to-face visit with the eligible recipient within the first two
weeks of TFC I placement and at least twice monthly thereafter by the treatment
coordinator;
(l) conducting
a face-to-face interview with the eligible recipient’s TFC parents within the
first two weeks of TFC I placement and at least twice monthly thereafter by the
treatment coordinator;
(m) conducting
at a minimum one phone contact with the TFC I parents weekly; phone contact is
not necessary in the same week as the face-to-face contact by the treatment
coordinator;
(n) conducting
a private face-to face interview with the eligible recipient’s TFC II parent
within the first two weeks of TFC II placement and at least once monthly thereafter
by the treatment coordinator;
(o) conducting
a face-to-face interview with the eligible recipient’s TFC II parent within the
first two weeks of TFC II placement and at least once monthly thereafter by the
treatment coordinator; and
(p) conducting
at a minimum one phone contact with the TFC II parents weekly; phone contact is
not necessary in the same week as the face-to-face contact by the treatment
coordinator.
E. Non-covered service: TFC I and II 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 all
non-covered MAD behavioral health services or activities. Specific to TFC I and II services MAD does
not cover:
(1) room
and board;
(2) formal
educational or vocational services related to traditional academic subjects or
vocational training;
(3) respite
care; and
(4) CCSS
except as part of the discharge planning from either the eligible recipient’s
TFC I or II placement.
F. Prior authorization: Before any TFC service is furnished to an
eligible recipient, prior authorization is required from MAD or its UR
contractor. Services for which prior
authorization was obtained remain subject to utilization review at any point in
the payment process.
G. A TFC agency
must submit claims for reimbursement on the CMS-1500 form or its
successor. See Subsection H of 8.321.2.9
NMAC for MAD general reimbursement requirements and see 8.302.2 NMAC.
[8.321.2.37 NMAC - Rp, 8.321.2.37
NMAC, 8/10/2021; A/E, 3/1/2023]