New Mexico Administrative Code

MAD school-based services billed in school settings are subject to the limitations and coverage restrictions that exist for other MAD services; see 8.301.3 NMAC. MAD does not cover the following services. A. Services classified as educational. B. Services to non-MAP eligible indi…

Certain procedures or services identified in the UR instructions may require prior authorization from MAD or its designee. Services for which prior authorization was obtained remain subject to UR at any point in the payment process. All services are subject to UR for medical nece…

Reimbursement to the LEA, REC, or SFEA is not contingent upon billing a third party payer first when the eligible recipient has other insurance. MAD is generally the payer of last resort. However, if medical services are included in the eligible recipient's IEP, IFSP, 504 plan, I…

Reimbursement to the LEA, REC, or SFEA is not contingent upon billing a third party payer first when the MAP eligible recipient has other insurance. MAD is generally the payer of last resort. However, if medical services are included in the MAP eligible recipient's IEP or IFSP, a…

The rule applies to the general public.

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 27-1-12 et seq NMSA 19…

Permanent.

July 1, 2015, unless a later date is cited at the end of a section.

The objective of these rules is to provide instruction for the service portion of the New Mexico medical assistance division's (MAD) medical assistance programs (MAP).

To transform lives. Working with our partners, we design and deliver innovative, high quality health and human services that improve the security and promote independence for New Mexicans in their communities.

MAD pays for medically necessary services for a MAP eligible recipient under twenty-one years of age when the services are part of the MAP eligible recipient's (eligible recipient's) individualized education program (IEP) or an individualized family service plan (IFSP), a section…

New Mexico Health Care Authority.

A. Each OTP sponsor applicant shall submit to the HCA an application for approval to operate an opioid treatment program application using the form provided by the HCA. This application shall be in addition to the application to drug enforcement agency, SAMHSA/CSAT, the NM board …

A. The HCA shall not deny approval to operate until the applicant has been notified in writing of the deficiency in the application resulting in the contemplated denial, and given opportunity to remedy the application deficiency within a specified time period. B. The HCA shall pr…

A. OTP providers who wish to renew their approval shall submit an application form and requested documentation no less than 90 calendar days, and no more than 180 calendar days, before its expiration date. B. The HCA shall consider the operating history of the OTP provider in mak…

Opioid treatment programs operating in New Mexico prior to the effective date of these regulations shall be granted approval on the effective date of these regulations ("grandfathered in"). A. The term of these initial grandfathered approvals shall be not less than 24 months nor …

Renewal of grandfathered approvals shall follow the ordinary renewal process. Such approvals shall have a term of 36 months.

The HCA shall have the authority to conduct inspections of the records, policies, procedures, physical plant or any other aspect of an OTP for the purpose of determining its compliance with these regulations or the presence of any factor posing a danger to the health or welfare o…

A. If an inspection conducted by the HCA shows that an OTP is not in compliance with these regulations, the HCA shall deliver to the program a written notice of the deficiencies identified. B. The program shall respond to the notification of deficiencies within 30 days of the not…

A. The HCA, at its discretion, may immediately suspend the approval of any OTP found to be in a substantial violation of this regulation that results in danger to the health and welfare of any patient or of the public, until such time as the violation(s) are corrected to the sati…

The program sponsor shall ensure that: A. a physician licensed to practice in New Mexico is designated to serve as medical director and to have authority over all medical aspects of opioid treatment; B. the medical director is responsible for ensuring that the OTP is in complianc…

A. The program sponsor shall ensure through policy and procedure that an individual is only admitted for opioid dependency treatment after the program medical director determines and documents that: (1) the individual meets the definition of opioid dependence using generally acce…

This rule is applicable to opioid treatment programs. These regulations are not intended to preempt county or municipal ordinances that supplement and do not conflict with these regulations. County and municipal ordinances are preempted when they conflict with these regulations.

The program sponsor shall ensure that: A. each patient receives a comprehensive intake assessment upon admission, conducted by a qualified professional, to determine the most appropriate combination of services and treatment, which results in an intake treatment plan based on the…

The program sponsor shall ensure that: A. a dose of opioid dependency treatment medication is administered only after an order from the program medical director; B. a patient's dosage of opioid dependency treatment medication is individually determined; C. a dose of opioid depend…

The program sponsor shall ensure that: A. staff members have knowledge of the benefits and limitations of laboratory drug detection tests and other toxicological testing procedures; B. a patient in comprehensive maintenance treatment receives at least eight random laboratory drug…

A. The program sponsor shall ensure that policies and procedures are developed, implemented, and complied with for the use of take-home medication and include: (1) criteria for determining when a patient is ready to receive take-home medication; (2) criteria for when a patient's …

The program sponsor shall ensure that: A. policies and procedures are developed, implemented, and complied with for withdrawal treatment and: (1) are designed to promote successful withdrawal treatment; (2) require that dose reduction occur at a rate deemed medically appropriate …

The program sponsor shall ensure that: A. substance abuse counseling and behavioral health treatment planning is provided by a practitioner licensed in the state of New Mexico to provide behavioral health treatment services to each patient based upon the patient's individual need…

A. The program sponsor shall ensure that:(1) opioid treatment is provided regardless of race, ethnicity, gender, age, or sexual orientation; (2) the program facility is compliant with the Americans with Disabilities Act (ADA); (3) opioid treatment is provided with consideration f…

A. The program sponsor shall ensure that the program has: (1) a written plan to ensure uninterrupted dispensing of medication in the event of dispensing staff turnover; and (2) a written agreement with at least one other provider for the provision of opioid treatment medication t…

A. The OTP program shall establish and maintain a recordkeeping system that is adequate to document and monitor patient care. The system shall comply with all federal and state requirements relevant to OTPs and to confidentiality of patient records. B. Each patient record shall i…

A. A program sponsor shall ensure that policies and procedures are developed, implemented, and complied with to educate and promote understanding in the community about opioid treatment and include: (1) a mechanism for eliciting input from the community about the provider's impac…

Section 9-8-1 et seq. NMSA 1978 establishes the health care authority (authority) as a single, unified department to administer laws and exercise functions relating to health care facility licensure and health care purchasing and regulation.

The program sponsor shall ensure that a written plan is developed, implemented, and complied with to prevent diversion of opioid treatment medication from its intended purpose to illicit purposes. This plan shall assign specific responsibility to licensed and administrative staff…

Permanent.

July 1, 2024, unless a later date is cited at the end of a section.

This rule establishes standards for opioid treatment programs to be consistent with the SAMHSA/CSAT regulations and the OTP accreditation requirements of nationally recognized accreditation bodies approved by SAMSA/CSAT, such as CARF and JCAHO. The intent is to: A. be consistent …

A. "Accrediting bodies" means nationally recognized organizations, such as the joint commission on accreditation of healthcare organizations (JCAHO) and the commission on accreditation of rehabilitation facilities (CARF), which promulgate standards for OTPs that are approved by t…

Providers who receive written approval by the health care authority, shall be permitted to provide opioid dependency treatment services.

Only applicants who possess all of the following shall be eligible to receive approval to operate from the New Mexico health care authority (HCA): A. drug enforcement agency (DEA) approval to operate an OTP; B. SAMHSA/CSAT approval to operate an OTP; C. accreditation by a SAMHSA/…

New Mexico Health Care Authority.

These regulations should be thoroughly understood and used by the applicant, when applying for the initial CTC license. The applicant for an initial CTC license under these regulations must follow these procedures when applying for a license. A. Notification and letter of intent:…

A. Temporary license: (1) The licensing authority may, at its sole discretion, issue a temporary license prior to the initial survey, or when the licensing authority finds partial compliance with these regulations. (2) The licensing authority may, at its sole discretion, issue a …

A. Licensee must submit a renewal application, electronically, if available, or on forms authorized by the licensing authority, along with the required license fee at least 30 days prior to expiration of the current license. The applicant shall certify that the CTC complies with …

The CTC's official license must be posted in a conspicuous place on the licensed premises in an area visible to the public.

A license granted under these regulations is not transferable to any other owner, whether an individual or legal entity, or to another location. The authority shall not guarantee or be liable for or responsible for guaranteeing the transfer of the license to any other owner or ot…

When a change of ownership occurs, an initial license application must be submitted by the new owner per the requirements in this section. The new owner must demonstrate compliance with these regulations the instant it takes responsibility of the CTC. The licensing authority may,…

An existing license shall automatically expire at midnight on the day indicated on the license, unless it is renewed sooner, or it has been suspended or revoked. A. If a CTC discontinues operation, is sold, leased or otherwise changes any ownership interest or changes location, t…