TITLE 8 SOCIAL SERVICES
CHAPTER 325 SPECIALTY SERVICES
PART 12 MEDICATION ASSISTED TREATMENT
SERVICES IN CORRECTIONAL SETTINGS
8.325.12.1 ISSUING AGENCY: New Mexico Health Care Authority (HCA).
[8.325.12.1 NMAC - N, 9/1/2024]
8.325.12.2 SCOPE: This rule governs delivery of
medication assisted treatment (MAT) for substance use disorder (SUD) (including
medication for opioid use disorder or MOUD) to individuals in correctional
facilities.
[8.325.12.2 NMAC -
N, 9/1/2024]
8.325.12.3 STATUTORY AUTHORITY: The
New Mexico medicaid program and other health care
programs are administered pursuant to regulations promulgated by the federal
department of health and human services under Title XIX of the Social Security
Act as amended or by state statute. See
Section 27-2-12 et seq., NMSA 1978.
[8.325.12.3 NMAC -
N, 9/1/2024]
8.325.12.4 DURATION:
Permanent.
[8.325.12.4 NMAC -
N, 9/1/2024]
8.325.12.5 EFFECTIVE
DATE: September 1, 2024, unless a later
date is cited at the end of a section.
A. By December 31, 2025, the New Mexico
corrections department (NMCD) operated correctional facilities shall provide
continuation of medication-assisted treatment (MAT) services or medication for
opioid use disorder (MOUD) in compliance with these regulations for individuals
receiving MAT or MOUD in the community or in a county detention facility prior
to booking.
B. By June 30, 2026, NMCD operated
correctional facilities shall initiate MAT or MOUD treatment services in
compliance with these regulations for qualified individuals diagnosed with
substance use disorder.
[8.325.12.5 NMAC - N, 9/1/2024]
8.325.12.6 OBJECTIVE: The
purpose of these regulations is to establish guidance and requirements for
delivery of substance use disorder treatment and reentry services for persons
diagnosed with substance use disorder in correctional facilities.
[8.325.12.6 NMAC -
N, 9/1/2024]
8.325.12.7 DEFINITIONS:
A. Certified peer support worker (CPSW): Peer
support workers who have successfully completed training with the behavioral
health service division’s office of peer recovery and engagement (OPRE) and
have obtained certification from the New Mexico credentialing board of
behavioral health professionals.
B. Clinical Assessment: A process of collecting clinical information
and drawing conclusions using evidence based tools and best practices to help
identify and choose pertinent interventions.
C. Community-based provider: An entity that provides substance use disorder
(SUD) treatment services in the community in addition to a correctional
facility.
D. Correctional facility: A state prison or county detention facility,
whether operated by a government or private contractor, that is used for
confinement of adult persons.
E. County detention facilities: Detention centers operated by local
governments used for the confinement of adult persons.
F. Discharge planning: The process of determining a participant’s
continued need for treatment services and may include development of a plan to
address ongoing post-treatment needs, referral into another level of care or
linkage of the individual to other support services.
G. Evidence-based: Best practices based on current scientific
evidence.
H. Healthcare practitioner: A person licensed by a professional licensing
board or authorized to provide health care in NM and may include physicians,
physician assistants, nurse practitioners or clinician pharmacists.
I. Medication for opioid use disorder (MOUD): An approach to clinical treatment that uses federal food and drug administration (FDA)
approved medications for persons diagnosed with opioid use disorder (OUD).
J. Medication-assisted treatment (MAT): The use of FDA-approved medications for the
treatment of SUD.
K. Naloxone: An opioid antagonist used for the
complete or partial reversal of an opioid overdose.
L. Narcotic treatment program (NTP): The drug enforcement agency’s term for opioid
treatment program (OTP).
M. New Mexico corrections department (NMCD): The state agency overseeing NM prison
facilities whether operated by state government or a private contractor.
N. Opioid use disorder (OUD): A pattern of opioid use leading to clinically
significant impairment or distress, as manifested by symptoms identified in the
most recent publication of the diagnostic and statistical manual of mental
disorders of the American psychiatric association or its successor.
O. Opioid treatment program (OTP): A clinic that has been certified and
DEA-approved, under both federal (42 CFR Section 8) and state (7.32.8.1 NMAC
and 8.321.2.30 NMAC) regulations to provide medication for OUD treatment
services with methadone.
P. Peer support workers (PSW): Individuals who have been successful in their
own recovery from SUD who help other individuals in their recovery process
though shared understanding, respect, and mutual empowerment, reducing the
likelihood of relapse.
Q. Program participant: A person who is incarcerated and diagnosed
with SUD for whom medication is clinically indicated and who elects to
participate in such treatment.
R. Reentry services: Resources offered that help individuals
prepare for return to their communities after incarceration. Reentry services
aim to reduce recidivism and improve public safety by supporting individuals
toward independent living skills. Services
may include psychological and financial counseling, education, skill
development, employment, housing, transportation and various types of
supportive services.
S. Screening: The use of an evidence-based tool and process
to identify an individual’s characteristics of substance use or dependency
through established criteria.
T. Substance use disorder (SUD): A pattern of use of substances leading to
clinical or functional impairment, in accordance with the definition in the
diagnostic and statistical manual of mental disorders (DSM-5) of the American
psychiatric association, or any subsequent editions.
U. Substance use disorder treatment: Treatment services provided by specifically
trained, certified or licensed professionals. SUD treatment programs can
include inpatient treatment, residential programs, partial hospitalization or
day treatment, outpatient and intensive outpatient programs, opioid treatment
programs, and primary care-based SUD treatment services.
V. Tapering guidelines: Guidance for the clinical process by which
medications are safely reduced or discontinued.
W. Telemedicine: The delivery of health care services through
interactive audio, video, or other electronic media used for diagnosis,
consultation, or treatment.
X. Transitional services: Resources offered to provide a continuum of
support to help ensure individuals engaged in SUD treatment services have
seamless access to medication, treatment and other services as needed. For this rule, transitional services also applies to program participants moving between treatment
programs within facilities.
Y. Withdrawal management: The medical and psychological care of patients
who are experiencing withdrawal symptoms as a result of
ceasing or reducing use of a substance.
[8.325.12.7 NMAC -
N, 9/1/2024]
8.325.12.8 MISSION STATEMENT: We ensure New Mexicans attain their highest
level of health by providing whole-person, cost-effective, accessible, and
high-quality health care and safety-net services.
[8.325.12.8 NMAC - N, 9/1/2024]
8.325.12.9 PROGRAM REQUIERED ELEMENTS:
A. Identification of the type of treatment
service delivery model(s) to be used by the correctional facility’s treatment
programs:
(1) Facility becomes an
accredited/certified and DEA-registered opioid treatment program/narcotic
treatment program (OTP/NTP).
(2) Facility contracts with medical
service provider (to include onsite or telemedicine resources).
(3) Facility transport to OTP/NTP.
(4) Facility arranges for MOUD provider
to come to the facility to provide services.
B. Screening and referral to
assessment:
(1) A preliminary SUD screening shall be
administered during the correctional facility’s in-take
process. The screening instrument shall:
(a) follow evidence-based practices
consistent with current scientifically-based and validated tools, protocols, or
guidance for SUD treatment and services to identify all individuals who may
have a SUD as well as individuals in need of withdrawal management services;
and
(b) assure identification of individuals
who are receiving continuation of SUD treatment (to include MAT and MOUD) in
the community or in a county detention facility prior to placement to inform
continuation of those services during the individual’s incarceration.
(2) Individuals screened and referred for
assessment, shall receive a comprehensive assessment and diagnostic evaluation
for SUD. The clinical assessment and
diagnostic evaluation shall:
(a) follow best practice and accepted
general SUD guidelines; and
(b) serve as basis for provision of
treatment services for those individuals diagnosed with a SUD for which there
are federal food and drug administration (FDA) approved medications. For persons specifically identified with OUD,
FDA-approved MAT/MOUD shall be offered.
(3) Beginning on July 1, 2026, current
inmates and detainees may request SUD screening at any time during their
incarceration, including prior to release, and this shall result in a referral
for screening and assessment, if indicated.
C. MAT/MOUD Medications:
(1) The program shall include provision
of all medications approved by the FDA for the treatment of SUD and withdrawal
management to ensure that each program participant receives the medication
identified to be the most effective at treating and meeting individual needs.
(2) The program shall provide existing or
prospective program participants education regarding the FDA-approved
medications for the treatment of SUD, including the benefits and risks.
(3) The decision as to which FDA-approved
medication is prescribed, dispensed and administered shall be made by the
healthcare practitioner in consultation with the program participant, taking
into consideration security, health and safety level, and community resource
availability. Transferring from one OUD medication to another to another may
commence, if:
(a) the new medication is deemed
medically necessary by a healthcare practitioner authorized to prescribe that
new medication and the program participant consents to the change; or
(b) the program participant elects to commence
the new medication, the new medication is FDA-approved to treat the program
participant’s SUD, and a qualified healthcare practitioner does not identify
any absolute contraindication to the change.
(4) Program participants who are
receiving MOUD during incarceration and who elect to discontinue MOUD shall
receive education on the risks of MOUD discontinuation and supervised clinical
taper from MOUD to avoid abrupt discontinuation of the medication.
(5) Program healthcare practitioners will
assess program participants on an annual basis at a minimum but can choose to
assess a program participant more frequently in order to
determine their response to a given medication. Following the assessment
(whether annual or interim), the healthcare practitioner may, in consultation
with the program participant, recommend that the medication be continued,
titrated or tapered. Education must be
provided to the program participant regarding the benefits and risks of the
clinical options and decision making.
D. Therapeutic services:
(1) An individualized treatment plan
shall be created for each program participant.
(2) Group or individual counseling
services with clinical support and supervision shall be provided where
available. Treatment services, to
include medication, shall not be withheld in the event of the lack of
availability of counseling services.
(3) Service delivery shall offer
engagement with qualified peer support workers or certified peer support
workers.
E. Reentry services:
(1) Reentry planning for the program participant
shall begin upon entry to the treatment program.
(2) Qualified peer support workers or
certified peer support workers shall be engaged with the reentry process from
the onset of the program participant’s enrollment in the treatment program.
(3) Facilities shall ensure referral to a
community-based provider if MAT/MOUD is indicated for a program participant
and, despite best efforts, treatment initiation is not possible prior to
release.
(4) Reentry planning shall occur to
assure continuity of care in the community for program participants who
received MAT/MOUD services for their SUD during incarceration and are exiting
facilities.
(5) Reentry services for program
participants receiving MAT/MOUD during incarceration, in
order to promote success and safeguard from poor outcomes, shall
include, but not be limited to:
(a) providing information and referral to
available SUD treatment facilities and primary care clinical facilities in the
program participant’s area of release;
(b) referring program participants who
are receiving treatment with methadone, to OTPs under medical order and in
compliance with current federal and state requirements and regulations
regarding services’ transfer;
(c) assisting program participants with
information and resources for housing and regional resources that include job
employment assistance, healthcare, transportation, and other safety-net
services in community of release, including tribal programs and services;
(d) assisting program participants with
information on and reactivation of medicaid/medicare enrollment and affiliation with a managed care
organization (MCO) or fee for service for eligible participants; and
(e) assuring program participant access
to naloxone rescue kits, or a prescription for a naloxone rescue kit as
indicated in 33-2-51 NMSA 1978.
F. Transitional services (to
include discharge):
(1) Transitional services shall include a
warm handoff with a transition of care plan from sending entity (correctional
facility medical provider) to receiving entity. This includes transition from county detention
facility to state correctional facility and vice versa.
(2) Discharge planning shall include:
(a) linking to MAT/MOUD and other SUD
services in the program participant’s geographic area of residence;
(b) providing behavioral and medical
health referrals;
(c) ensuring discharge prescription for
naltrexone or buprenorphine products; and
(d) referring program participants who
are receiving treatment with methadone, to OTPs under medical order and in
compliance with current federal and state requirements and regulations to
ensure continuity of care and access to MAT/MOUD.
(3) Program participants who are
receiving MOUD during incarceration and who elect to discontinue MOUD upon
their release shall receive education on the risks of MOUD discontinuation and
supervised clinical taper from MOUD to avoid abrupt discontinuation of the
medication.
(4) Program participants who are
transitioning to a community or region that does not have resources available
to continue treatment may receive supervised clinical taper from MOUD to avoid
abrupt discontinuation of the medication.
G. Program participant safeguards: Correctional facilities shall assure that:
(1) treatment services, once initiated,
are available for the duration of a program participant’s period of
incarceration;
(2) placement in the medication-assisted
treatment program shall be offered to all qualified individuals, but
participation shall not be mandatory;
(3) the program participant provides
written consent to receive treatment services or to discontinue treatment
services;
(4) no program participant shall be
charged fees for SUD treatment services;
(5) MAT/MOUD services shall not be denied
to any eligible program participant as a form of disciplinary action unless
that action is related to the diversion, abuse or misuse of the program’s
prescribed medication; and
(6) program participants are provided the
option to discontinue treatment services, should they choose to do so. (In such cases, discontinuation shall adhere
to medically appropriate tapering guidelines and educational practices.)
[8.325.12.9 NMAC - N, 9/1/2024]
8.325.12.10 POLICIES AND PROCEDURES:
A. Every program shall establish
written general policies, procedures and guidelines reflecting language in this
rule in its entirety.
B. These established policies,
procedures and guidelines shall further detail each of the following categories:
(1) Medication diversion:
(a) addressing prevention of diversion
and misuse of MOUD;
(b) assuring diversion policies are
visible in the facility;
(c) addressing consequential strategies for
diversion, to include non-punitive approaches for remediation instead of
immediately terminating from the program; and
(d) addressing critical incident
reporting.
(2) Screening and treatment of pregnant
individuals in compliance with 31.3.11 NMSA 1978.
(3) Withdrawal management:
(a) screening (clinical opiate withdrawal
scale (COWS) or its equivalent) and assessment to discern level of withdrawal
intensity, e.g. mild, moderate or severe;
(b) monitoring the individual;
(c) describing roles and responsibilities
for staff;
(d) identifying treatment and supportive
care to include assurances of the following:
(i) withdrawal
treatment is planned and supervised by the program medical director;
(ii) dose reduction occurs at a rate
deemed medically appropriate; and
(iii) program participant is informed of the
risks of withdrawal treatment.
(4) Transition of care, to include:
(a) engaging and educating the program
participant;
(b) assuring MCOs initiate transition of
care planning prior to release to facilitate continuity of care, and inclusion
of tribal 638 or Indian health service program staff for transition in tribal
communities for fee for service participants; and
(c) describing roles and responsibilities
for staff.
(5) Medication tapering guidelines: Each of the following shall have its own
guidelines:
(a) transferring patients to higher level
of care based on medical necessity;
(b) assuring pregnancy and postpartum
patient care; and
(c) providing reentry support.
[8.325.12.10 NMAC - N, 9/1/2024]
8.325.12.11 STAFFING, ADMINISTRATION AND EDUCATION: Correctional facilities shall:
A. Develop adequate staffing patterns
including healthcare practitioners authorized by law to prescribe, administer,
and monitor medication-assisted treatment (to include telehealth-supported
clinical review or services if necessary).
B. Facilitate timely access to
medication-assisted treatment, based upon the clinical need of the program
participant.
C. Provide trainings and technical
assistance on SUD (disease course and evidence-based treatment modalities),
including OUD and MOUD on an ongoing basis for new and existing healthcare and
custodial staff, ensuring that staff are educated on these topics from the
beginning of their career.
D. Provide education and training that
addresses and provides tools to combat the broader stigma associated with these
topics and emphasizes medication treatment as the standard of care for OUD. The trainings shall meet national standards
and be responsive to shifting needs in the facility.
[8.325.12.11 NMAC -
N, 9/1/2024]
8.325.12.12 PROGRAM REPORTING AND EVALUATION
A. Beginning October 1, 2023, and annually thereafter, the HCA shall report to the interim legislative health and human services committee and the legislative finance committee on the establishment, operation and effectiveness of the program(s) established pursuant to Section 24-1-5.11 NMSA 1978.
B. NMCD shall submit program reports to
HCA for review beginning August 31, 2024, and each year thereafter, as basis
for HCA’s compilation of report to interim legislative health and human
services committee and the legislative finance committee.
C. County detention facilities, upon
statutory mandate, shall submit annual program reports based on mutually agreed
upon data elements (e.g., numbers screened, numbers referred to assessment,
numbers qualified for program enrollment and enrollment in program).
D. The reports shall also include an
evaluation section that demonstrated the impact on institutional safety and
program performance and any recommendations for additional legislative
enactments that may be needed or required to improve or enhance the programs as
determined to be appropriate by the health care authority.
[8.325.12.12 NMAC - N, 9/1/2024]
8.325.12.13 RECORDKEEPING:
A. Records shall be maintained in
writing or electronically reflecting each program participant’s screening,
placement and participation, including, but not limited to, the offer of
placement, individualized treatment plan, medication regimen, establishment of
reentry plan, and discharge medications or orders for released individuals.
B. Contemporary medication
administration records shall be maintained in writing or electronically for
every program participant receiving MAT/MOUD pursuant to a facility’s SUD
treatment and transition services program.
C. Designated healthcare practitioners
and other facility healthcare staff shall retain all records required by this
section in the facility or shall otherwise have the ability
to immediately access such records when necessary.
[8.325.12.13 NMAC - N, 9/1/2024]
HISTORY OF 8.325.12 NMAC: [RESERVED]