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7.20.11NMAC


Published: 2015

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TITLE 7                 HEALTH

CHAPTER 20       MENTAL HEALTH

PART 11               CERTIFICATION

REQUIREMENTS FOR CHILD AND ADOLESCENT MENTAL

                                HEALTH

SERVICES

 

7.20.11.1               ISSUING

AGENCY:  Children, Youth and Families

Department

[7.20.11.1 NMAC - Rp 7

NMAC 20.11.1, 03/29/02]

 

7.20.11.2               SCOPE:  This policy applies to all child and

adolescent behavioral health programs described herein.

[7.20.11.2 NMAC - Rp 7

NMAC 20.11.2, 03/29/02]

 

7.20.11.3               STATUTORY AUTHORITY:  1978 NMSA Sections 32A-12.1.et seq.

[7.20.11.3 NMAC - Rp 7

NMAC 20.11.3, 03/29/02]

 

7.20.11.4               DURATION: 

Permanent

[7.20.11.4 

NMAC - Rp 7 NMAC 20.11.4, 03/29/02]

 

7.20.11.5               EFFECTIVE

DATE:  March 29, 2002 unless a later

date is cited at the end of section.

[7.20.11.5 NMAC - Rp 7

NMAC 20.11.5, 03/29/02]

 

7.20.11.6               OBJECTIVES:

                A.            to establish certification

requirements for behavioral health services provided to children and

adolescents of New Mexico through the medicaid program (Title XIX of the Social

Security Act);

                B.            to provide for monitoring of agency compliance with these certification

requirements to identify any factors that could affect the health, safety, and

welfare of the clients or the staff;

                C.            to

assure that the agency establishes and follows written policies and procedures

that specify how these certification requirements are met; and

                D.            to

assure that adequate supervision is provided at all times.

[7.20.11.6 NMAC - Rp 7

NMAC 20.11.6, 03/29/02]

 

7.20.11.7               DEFINITIONS:

                A.            ABUSE means an intentional or

negligent infliction of physical or psychological harm; intentional or

negligent sexual contact or sexual exploitation; intentional or negligent

behavior that jeopardizes life or health; torture, cruel confinement or

corporal punishment.

                B.            ACCREDITED means written

acknowledgement from a national organization that an agency or program meets

the published standards of the organization issuing the accreditation.

                C.            ACCREDITED RESIDENTIAL TREATMENT

CENTER (ARTC) means a facility with 16 beds or less that may be attached to, or

housed within, a hospital or other institution; that provides residential

treatment services pursuant to these requirements; and that is accredited by

JCAHO.

                D.            ACTION PLAN means a written document

that may be required by the licensing and certification authority (LCA)

detailing an agency’s proposed actions for resolving deficiencies identified by

the LCA.

                E.             ACTIVE STATUS means a type of

certification granted to a program currently serving clients.

                F.             ADMINISTRATOR means the person in

charge of the day-to-day operation of an agency.  The administrator may also be referred to as

the director or operator.

                G.            ADMISSIONS HOLD means a type of

sanction under which a program is prohibited from admitting new clients until

the LCA determines that identified deficiencies are corrected, and lifts the

sanction.

                H.            ADVANCE DIRECTIVES means an optional

component of the comprehensive service plan. An individual has the right to

make decisions in advance, including behavioral health treatment decisions,

through a process called advance directive. An advance directive can be used to

state the individual’s treatment choices, preferences or instructions regarding

pre-cursor crisis strategies, or can be used to name a health care agent that

is someone that will make health care decisions for the individual. This section

of the comprehensive service plan provides the individual the opportunity to

take part in behavioral health care decisions if at some point in the future

the individual is unable. This document allows the individual to express

consent or refusal to medications and other health care decisions, including

use of the seclusion and restraints.

                I.              AGENCY means the legally

responsible organizational entity administering the facility or program(s) of

specific services identified and certified pursuant to these certification

requirements.

                J.             ASSISTANCE WITH SELF-ADMINISTRATION

OF MEDICATION means the supervision and assistance given to a client in the

self-administration of a drug.

                K.            BEHAVIORAL HEALTH ASSESSMENT means

an assessment by an integrated series of procedures conducted with an

individual to provide the basis for the development of an effective,

comprehensive and individualized treatment plan.

                L.             BEHAVIORAL HEALTH SERVICES means

services designed to meet behavioral and mental health and substance abuse

needs of medicaid recipients in certified services.

                M.           BEHAVIOR MANAGEMENT means the use of

basic techniques, such as reinforcement, redirection and voluntary time-outs to

teach clients skills for managing and improving their own behavior; and the use

of verbal de-escalation, therapeutic holds, personal restraint and seclusion in

order to maintain a safe and therapeutic environment and to enhance the

abilities of clients and care givers to manage client behavior.

                N.            BEHAVIOR MANAGEMENT SKILLS

DEVELOPMENT SERVICES (BMS) means services provided on a staff-to-child ratio of

at least 1:1.  Behavior management skills

development services are for children and adolescents with psychological,

emotional, behavioral, neurobiological or substance abuse problems in the home,

community or school when such problems are of such severity that highly

supportive and structured therapeutic behavioral interventions are required.

These services are designed to maintain the client in his/her home, community

or school setting.

                O.            BEHAVIOR MANAGEMENT SERVICES PLAN

means a service plan used in behavior management skills development services.

                P.             CANCELLATION means an LCA action

nullifying a program’s certification.

                Q.            CAPACITY means the maximum number of

clients allowed to receive services in a licensed facility at any specified

time in accordance with these certifications requirements.

                R.            CASE MANAGEMENT SERVICES means

services provided in order to assist children and adolescents with identifying

and meeting multiple and complex, special physical, cognitive and behavioral

health care needs through planning, securing, monitoring, advocating and

coordinating services.

                S.             CARF means council on accreditation

of rehabilitation facilities.

                T.            CERTIFICATION means an authorized

status conferred by the department on a program that meets these certification

requirements for providing service(s) to children and adolescents.

                U.            CERTIFIED FAMILY SPECIALISTS (CFS)

means an individual 18 years of age or older who has personal experience navigating

any of the child or family-serving systems or advocating for family members who

have a knowledge of and are involved with the behavioral health systems and are

certified by an approved state of New Mexico certification program.

                V.            CERTIFIED PEER SPECIALISTS (CPS)

means a self-identified current or former consumer, 18 years of age or older,

of mental health or substance abuse services and has at least one year of

mental health or substance abuse recovery and is certified as a CPS by an

approved state of New Mexico certification program.

                W.           CHEMICAL RESTRAINT means the

administration of a medication(s) which is neither a standard treatment for the

client’s medical or psychiatric condition nor a part of the client’s daily

medication regimen, and is used for the primary purpose of controlling a

client’s behavior or restricting a client’s freedom of movement.

                X.            CHILD/ADOLESCENT means a person

under the chronological age of 21 years.

                Y.            CLEARED STAFF MEMBER means an

individual who has been approved by the department for employment in the

immediate presence of children and adolescents by means of a state and federal

criminal background clearance.

                Z.            CLIENT means any child or adolescent

who receives treatment from a service certified by the department.

                AA.        COA means council on accreditation for

children and family services.

                AB.         CLINICAL STAFF means licensed mental

health practitioners and treatment coordinators.

                AC.         CLINICAL SUPERVISOR means a staff

member who is a licensed independent practitioner and who has responsibility

and authority for supervising other clinical staff.

                AD.         COMMUNITY SUPPORTS means the

coordination of resources to individuals/families necessary for them to

implement strategies to promote recovery, rehabilitation and resilience.

                AE.         COMMUNITY SUPPORT WORKER (CSW) means

the primary staff responsible for assisting the client and family with

implementation of the comprehensive service plan and coordinating or

facilitating family and treatment team meetings and is certified by an approved

state of New Mexico certification program.

                AF.         COMPREHENSIVE COMMUNITY SUPPORT SERVICES

(CCSS) means a variety of interventions, primarily face-to-face and in

community locations that address barriers that impede the development of skills

necessary to independent functioning in the community. It provides assistance

with identifying and coordinating services and supports identified in an

individual’s comprehensive service plan; supporting an individual and family in

crisis situations; and providing individual interventions to develop or enhance

an individual’s ability to make informed and independent choices. The target

population for CCSS includes children, youth and adults with significant

behavioral health disorders and who meet other criteria as identified by the

collaborative.

                AG.         CONTRACTOR means an individual who

provides direct services to clients through contracts with the agency.

                AH.         CORPORAL PUNISHMENT means a form of

discipline or behavior control that involves forced exercise or touching a child’s

body with the intent to induce pain and includes, but is not limited to,

shaking, spanking, hitting, hair pulling, and ear pulling.

                AI.          CRIMINAL RECORDS CHECK (CRC) means the

process of submitting state and FBI approved fingerprint cards and any additional

required background information to the department for the purpose of

determining whether or not an individual has state or federal convictions on

record that may disqualify the individual from direct unsupervised contact with

children/adolescents and, when applicable, for the purpose of obtaining and

reviewing a record of convictions.

                AJ.          CRIMINAL RECORDS CLEARANCE means a

determination made by the department, based on the results of the criminal

records check, that an individual may work directly and unsupervised with

children and adolescents.

                AK.         CRISIS MANAGEMENT SERVICES means those

services identified in the individual’s crisis plan. Such services are located

in the community, include natural supports and are available to the client and

family after the agency’s normal operating hours.

                AL.         CRISIS PLAN means a component of the

comprehensive service plan that clearly identifies the level of intensity and

severity of potential crisis events and how they will be managed after normal

business hours with specific resources identified for the client, family and

natural supports.  The crisis plan shall

include defined client, family and treatment team roles and activities.

                AM.        CULTURAL COMPETENCE means the

involvement, integration and transformation of knowledge, information and data

about individuals and groups of people into specific clinical standards,

service approaches, techniques and marketing programs. Cultural competence is

illustrated by congruent behaviors, attitudes and policies that match a

client’s culture to increase the quality and appropriateness of behavioral

health care and outcomes.

                AN.         CULTURALLY COMPETENT ASSESSMENT means

the relevant cultural considerations in the assessment of the behavioral health

needs of a client.

                AO.         DAY TREATMENT SERVICES (DTS) means a

coordinated and intensive set of structured individualized therapeutic

services, in a school, or a facility licensed by the LCA, provided for

children, adolescents and their families who are living in the community.

                AP.         DEFICIENCY means a violation of, or

failure to comply with, a provision(s) of these certification requirements.

                AQ.         DENIAL means a sanction imposed by the

LCA to refuse to issue a certification, based on a determination made by the

LCA.

                AR.         DEPARTMENT means the New Mexico

children, youth and families department.

                AS.         DESIGNATED AGENCY means the agency that

has the primary responsibility of partnering with the client and family for

implementation of the comprehensive service plan.

                AT.         DIRECT PHYSICAL SUPERVISION means, with

reference to criminal records clearances, either continuous visual observation

or live video observation of a non-cleared agency staff member by a cleared

agency staff member or by the client’s legal guardian, while the non-cleared

staff is in immediate presence of the client.

                AU.         DIRECT SERVICE STAFF means supervisors,

physicians, nurses, therapists, client care workers, coordinators or other

agency personnel who work in immediate direct unsupervised contact with

children.

                AV.         DIRECT UNSUPERVISED CONTACT means

physical proximity to clients, such that physical contact or abuse could occur,

without being observed or noticed by another staff member who has been cleared

by the department.

                AW.       DIRECTED ACTION means a formal action(s)

specified by the LCA that the agency is required to undertake or complete in

order to correct a deficiency(ies) within a specified time frame.

                AX.         DISCHARGE CRITERIA means specific

clinically-based indicator(s) used to measure the client’s degree of readiness

for release from a given level of care stated in terms of achievement of

treatment goals or reduction of symptoms; discharge criteria may also include

indicators that a given level of care is inappropriate for a client due to such

factors as dangerousness or non-responsiveness to treatment.

                AY.         DISCHARGE PLAN means a written section

of a treatment plan/service plan and treatment plan/service plan reviews

containing the following elements: behavioral and other clinical criteria that

describe the conditions under which discharge will occur, identification of

barriers to discharge; the level of care, specific services to be delivered,

and the living situation into which discharge is projected to occur; the

projected date of discharge, individuals responsible for implementing each

action specified in the discharge plan, and, when indicated, revisions.

                AZ.         DISCIPLINE means non-abusive training

that enables a client to develop self-control and orderly conduct in

relationship to others.

                BA.         DOCUMENTATION means the written or

printed record of information supporting the facts related to the certified

services being provided to clients found in client files, personnel files, and

other pertinent printed sources.

                BB.          EARLY AND PERIODIC, SCREENING,

DIAGNOSIS AND TREATMENT (EPSDT) means periodic, comprehensive services to

persons under 21 years of age; these services are defined in the medicaid

program policies.

                BC.          EMERGENCY SAFETY INTERVENTION means

personal restraint or seclusion.

                BD.         EMERGENCY SANCTION means an immediate

requirement that is imposed on a program by the LCA in response to a finding of

health or safety deficiency(ies).

                BE.          EMERGENCY SERVICE means an

unanticipated admission to an acute medical or psychiatric facility or the

provision of other medical services by paramedics or other emergency or urgent

care personnel.

                BF.          EMERGENCY SUSPENSION means an

immediate and temporary cancellation of a certification due to an existing

health or safety deficiency(ies), pending an appeal hearing and correction of

health or safety deficiencies. During a period of emergency suspension, the

medicaid provider agreement is not in effect.

                BG.          EMPLOYMENT HISTORY means a verifiable

written summary of employment including names, addresses and telephone numbers

of employers, immediate supervisors as well as dates of and explanations for

any period(s) of unemployment for a minimum of three years immediately prior to

hire for employment by a certified program.

                BH.         ENHANCED SERVICE means, in the medicaid

managed care system, any and all services beyond the scope of the medicaid

(fee-for-service) benefit package available to recipients in the medicaid

managed care program.

                BI.           EXCLUSIONARY CRITERIA means

agency-written criteria that define the diagnoses, behaviors, or conditions that

preclude admission to the certified program.

                BJ.           EXEMPLARY means a certified status

conferred by the LCA on a program that has no history of temporary

certification, sanctions or loss of certification in the previous two years and

meets all of the certification requirements with minor or no deficiencies.

                BK.         EXPANSION HOLD means a type of sanction

under which an agency is prohibited from obtaining certification for additional

services until the LCA determines that identified deficiencies are corrected

and lifts the sanction.

                BL.          EXPLOITATION means the act or process

of using a client or client’s property for another person’s profit, advantage

or benefit.

                BM.        FACILITY means the physical plant and

building(s) licensed by the LCA in which residential or day treatment mental

health services are provided.

                BN.         FUNCTIONAL LEVEL means a determination

of the client and as applicable, his family’s, functional skills in multiple

domains.

                BO.         GENERAL PROVISIONS means the series of

certification requirements found in Sections 9 through 25 of these

certification requirements.

                BP.          GOVERNING BODY means the

organizational entity of an agency that has the ultimate responsibility for all

planning, direction, control, and management of the activities and functions of

a program certified pursuant to these certification requirements.

                BQ.         GROUP HOME SERVICES (GHS) means mental

and behavioral health services offered in a supervised, licensed facility that

provides structured therapeutic group living for children/adolescents with

moderate behavioral, psychological, neurobiological, or emotional problems,

when clinical history and opinion establish that the needs of the client cannot

be met in a less restrictive environment.

                BR.          HEALTH OR SAFETY DEFICIENCY means a

deficiency that poses an immediate threat to the welfare of clients up to and

including loss of life; physical harm; physical, sexual, psychological abuse or

exploitation.

                BS.          HUMAN SERVICES DEGREE means an

approved bachelors or masters degree from an accredited school in one of the

following degrees: counseling and therapy, rehabilitation, psychology, criminal

justice, social work/social services, or human development. If workforce issues

are identified in a region of the state, the some other defined degrees may be

considered as human services degrees. However, any experience required in the

service definition must be met. In order for an agency to utilize staff with

these degrees, they must submit a written waiver request to LCA with

documentation supporting the workforce issues. Those alternative degrees may

include nursing, sociology, public health, education, occupational therapy,

speech and hearing sciences, speech-language pathology, communication sciences

and disorders, gerontology, or social sciences.

                BT.          INACTIVE STATUS means a type of

certification granted to a program that is not currently serving clients.

                BU.         INCIDENT REPORT means the document(s)

describing a serious incident or alleged serious incident.

                BV.          INFORMAL RESOLUTION CONFERENCE means

an informal meeting and problem-solving process between the department and an

agency to resolve any filed or potential appeal arising from the imposition or

potential imposition of a sanction(s).

                BW.        INFORMED CONSENT means a document that

reflects that a client and the legal guardian(s) are advised of the benefits,

risks, and alternatives of a given medication or treatment and agree to the use

of the medication or treatment.  Clients

age 14 and above may consent to the use of a medication or treatment without

the approval of their legal guardian(s).

                BX.         INITIAL CERTIFICATION means a type of

certification granted to a program that has met the minimum requirements to

implement a program to provide services pursuant to these requirements.

                BY.          INVESTIGATION means a formal process

of inquiry used by the LCA to: determine the validity of complaints or

allegations made against certified agencies; or to determine whether trends in

incidents reported to the LCA that affect the health and safety of clients are

the result of negligent practices, insufficient supervision of personnel or

clients, or any other factor that requires correction; or to determine whether

or not an agency has made corrective responses to resolve matters of threat to

client health and safety substantiated by the LCA.

                BZ.          JCAHO means the joint commission on

accreditation of healthcare organizations.

                CA          LICENSE means the written

authorization issued by the LCA pursuant to 7.20.12 NMAC granting right to

operate the designated facility for a specified period of time; or, in context,

any necessary authorization by the appropriate credentialing authority to

undertake the professional activity in question.

                CB.          LICENSED INDEPENDENT PRACTITIONER

means New Mexico-licensed clinical staff who are authorized to practice at the

independent level.

                CC.          LICENSED INDEPENDENT MEDICAL

PRACTITIONER means a New Mexico licensed medical doctor (MD), doctor of

osteopathy (DO), certified nurse practitioner (CNP), clinical nurse specialist

(LCNS), or physician assistant (PA).

                CD.         LICENSING AND CERTIFICATION AUTHORITY

(LCA) means the licensing and certification unit of the children’s behavioral

health and community services bureau of the prevention and intervention

division of the department.

                CE.          MAINTENANCE OR REDUCTION IN PROGRAM

CAPACITY means a sanction that directs the agency to maintain or reduce the

capacity of the program to a designated census until the LCA determines that

deficiencies resulting in the sanction have been corrected.

                CF.          MECHANICAL RESTRAINT means use of a

mechanical device(s) to physically restrict a client’s freedom of movement,

performance of physical activity, or normal access to his or her body, and is

distinct from personal restraint as defined below.

                CG.          MEDICAID means Title XIX of the Social

Security Act; the joint federal-state program that pays for medical care for

low-income persons.

                CH.         MONITORING means the ongoing review of

a program’s progress in correcting deficiencies. During a period of

certification, monitoring is done at the discretion of the LCA.  Monitoring may be implemented by means of a

monitoring plan, and may require that specified documentation be submitted to

the LCA by the agency or may include the use of on-site surveys by the LCA to ascertain

compliance in specified areas.

                CI.           MONITORING PLAN means a written set

of guidelines and instructions specified by the LCA for a program to follow for

the purpose of correcting deficiencies.

                CJ.           MORAL TURPITUDE means conduct

contrary to justice, honesty, modesty or good morals, as further specified in

8.8.3 NMAC.

                CK.         MULTISYSTEMIC THERAPY (MST) is an

intensive family and community-based treatment program that addresses the known

determinants of serious antisocial behavior in adolescents and their families.

MST treats the factors in the youth's environment that are contributing to his

or her behavior problems. Such factors might pertain to individual

characteristics of the youth (poor problem solving skills), family relations

(inept discipline), peer relations (association with deviant peers) and school

performance. Treatment goals for therapeutic change are developed on an

individualized basis in collaboration with the family.

                CL.          NEGLECT by individuals or an agency

means:

                   

(1)     failure to provide any

treatment, service, care, medication or item that is reasonably necessary to

maintain the health or safety of a client; or

                   

(2)     failure to take any

reasonable precaution that is necessary to prevent damage to the health or

safety of a client; or

                   

(3)     failure to carry out a

duty to supervise properly or control the provision of any treatment, care,

good service or medication reasonably necessary to maintain the health or

safety of a client; or

                   

(4)      failure to take any

reasonable precaution that would prevent the physical abuse, sexual abuse, or

sexual exploitation of a client, as defined in the Children’s Code at 1978 NMSA

32A-4-2, or the lack of which causes the client to become an abused child or neglected

child as defined in the Children’s Code at NMSA 1978  32A-4-2.

                CM.        NON-ACCREDITED RTC means a program that

provides residential treatment services pursuant to these requirements that is

not accredited by JCAHO.

                CN.         NON-RENEWAL means a sanction whereby

certification is cancelled on or about the date of expiration.

                CO.         NON-RESIDENTIAL SERVICES means a

program that provides certified services other than twenty-four-hour continuous

care within the confines of a facility or treatment foster home.

                CP.          NOTICE OF CONTEMPLATED ACTION means a

letter issued by the LCA identifying grounds for sanction of a program.

                CQ.         NOTICE OF EMERGENCY SANCTION means a

letter issued by the LCA when an emergency sanction is imposed.

                CR.          NOTICE OF FINAL ACTION means a letter

issued by the LCA stating that the sanctions proposed in a previous notice of

contemplated action are in effect.  This

letter is issued upon the conclusion of any appeal/informal resolution

proceeding or the expiration of the appeal period to the notice of contemplated

action.

                CS.          PARTIAL COMPLIANCE means a

determination by the LCA that a program is found to have moderate and few

deficiencies, none of which immediately compromises the health or safety of the

clients.

                CT.          PARTIALLY SUBSTANTIATED COMPLAINT

means a complaint that the LCA has determined is factually accurate in part,

but not factually accurate in its entirety.

                CU.         PERMANENCY PLAN means the long-term

plan for the child/adolescent developed by the protective services division of

the department with one of the following outcomes: reunification, permanent

guardianship, adoption, permanent placement with a fit and willing relative, or

planned permanent living arrangements.

                CV.          PERSONAL RESTRAINT means the

application of physical force without the use of any device, for the purposes

of restraining the free movement of a client’s body.  The term personal restraint is distinct from

therapeutic hold and mechanical restraint as defined herein and does not include

briefly holding a client, without undue force, in order to calm or comfort him

or her, or holding a client’s hand to safely escort a client from one area to

another.

                CW.        PHYSICAL ESCORT means the temporary

touching or holding of the hand, wrist, arm, shoulder or back for the purposes

of inducing a client who is exhibiting unsafe or potentially unsafe behavior to

walk to a safe location.

                CX.         PHYSICAL HARM means physical injury

that requires treatment beyond basic first aid; or that results in loss of

functional use of a bodily member or organ or of a major life activity for a

prolonged period of time; or results in loss of consciousness for any amount of

time.

                CY.          PHYSICIAN means an individual who has

received a degree of doctor of medicine or doctor of osteopathic medicine and

is licensed to practice medicine in the state of New Mexico.

                CZ.          POLICY means a statement of principle

that guides and determines present and future decisions and actions.

                DA.         PREMISES means all parts of buildings,

grounds, vehicles and equipment of a facility.

                DB.         PRE-SERVICE TRAINING means training

that is provided to a newly hired employee prior to the employee’s provision of

direct services.

                DC.         PROCEDURE means the action(s) that will

be taken to implement a policy; and the written description of such action(s) that

serves as instruction to agency staff.

                DD.         PROGRAM means an agency, or subdivision

of an agency, operated with the intent to provide certified services.

                DE.          PROVIDER means an agency or its

personnel who have a medicaid provider number and deliver direct services to

clients.

                DF.          PSYCHIATRIST means a physician who

specializes in the treatment of psychiatric disorders, has completed an

accredited psychiatric residency program, and holds a current license to

practice medicine in the state of New Mexico.

                DG.         PSYCHOLOGICAL HARM means harm that

causes symptoms of mental or emotional trauma, or that causes distress of

sufficient magnitude to cause behavioral change, or physical symptoms that may

require psychological or psychiatric evaluation or treatment.

                DH.         PSYCHOLOGIST means a doctoral level

psychologist who specializes in assessing and treating psychological disorders

and holds a current license to practice in the state of New Mexico.

                DI.           PUNISHMENT means a penalty imposed on

a child/adolescent by one in authority for wrongdoing.

                DJ.          RECOVERY means the process, outlook,

vision and guiding principle that stresses that hope and restoration of a

meaningful life are possible, despite serious mental illness. Instead of

focusing primarily on symptom relief, as the medical model dictates, recovery

casts a much wider spotlight on restoration of self-esteem and identity and on

attaining meaningful roles in society (adapted from Mental Health: A Report to the Surgeon General, Chapter 2, 1999).

                DK.         RECOVERY/RESILIENCY MANAGEMENT PLAN

means the foundational component for building the comprehensive service plan.

The recovery/resiliency management plan component focuses on strengths and

preferences based on identified competencies, the process of autonomy (independence),

and developing a system of natural supports (satisfying and supportive social

relationships). The recovery/resiliency management plan component shall

include:

                   

(1)     the client and family’s

personal choice of service options and priorities in service delivery with a

client centered focus;

                   

(2)     client driven

interventions including attainable objective to address the client’s defined

needs;

                   

(3)     a clear identification of

the environment in which the client lives including: family, school peers,

community and home, and how each will play a part in the comprehensive service

plan; and

                   

(4)     a clear approach to the

development of resiliency based on life skills identified by the client and

service team.

                DL.          REFERENCE CHECK means a documented

contact with previous employers, supervisors, co-workers, or other sources,

initiated by the agency to evaluate a prospective employee prior to hire by

establishing the accuracy of his/her employment history and to obtain other

information relevant to potential hire.

                DM.        REHABILITATION means a process that

enhances the efficacy of clients with functional limitations due to behavioral

health disorders to obtain information, develop skills and access resources

needed to make decisions and implement strategies to be successful and

satisfied in the living, working, learning, and social environments of their

choice. Rehabilitation services are driven by the client’s desire for recovery

and resiliency based outcomes and are individualized, collaborative and person

directed.

                DN.         RESIDENTIAL FACILITY means a facility

licensed by the LCA, in which 24-hour continuous therapeutic care is provided

to a group of children/adolescents in accordance with these certification

requirements.

                DO.         RESIDENTIAL TREATMENT SERVICES means a

program that provides 24-hour therapeutic care to children/adolescents with

severe behavioral, psychological, neurobiological, or emotional problems, who

are in need of psychosocial rehabilitation in a residential facility.

                DP.          RESTRAINT/SECLUSION CLINICIAN means a

New Mexico licensed medical doctor (MD), doctor of osteopathy (DO), certified

nurse practitioner (CNP), clinical nurse specialist (LCNS), physician assistant

(PA) or doctoral level psychologist (Psy.D., Ph.D., or Ed.D.), who is trained

in the use of emergency safety interventions.

                DQ.         REVOCATION means a type of sanction

making a certification null and void through its cancellation.

                DR.         SANCTION means a measure imposed by the

LCA on a certified program, pursuant to these certification requirements, in

response to findings(s) of a deficiency(ies), with the intent of obtaining

increased compliance with these certification requirements.

                DS.          SECLUSION means a behavior management

technique that involves locked isolation. 

Seclusion is distinct from therapeutic time-out.

                DT.         SERIOUS INCIDENT means an incident

involving the death of a client, suicide attempt by a client; psychological or

physical harm to a client; serious homicidal threat to or by a client; physical

or sexual abuse/perpetration to, or by, a client or a staff member; the use,

possession, or distribution of illegal substances by clients or staff; neglect

or exploitation of a client by staff; AMA or emergency discharge; arrest or

detention of a client; natural disasters, or contagious disease outbreaks; or

agency knowledge that a staff member has been charged with, or convicted of, a

felony or of a misdemeanor involving moral turpitude, including but not limited

to convictions referenced in 8.8.3 NMAC.

                DU.         SEXUAL ABUSE means any intentional and

uninvited contact, demand or enticement of a sexual nature, including contact

with another person’s clothed or unclothed genital area, anus, buttocks, or

breast(s) if the recipient is female; or, intentional causing of another person

to touch any of these areas on one’s own or a third party’s body; or,

consensual contact with any of these areas if the initiator is in a position of

significant influence over the recipient by reason of differences in age,

physical size, development, intellectual sophistication, sexual sophistication,

or position of authority; or, a verbal request, offer, or demand such as would

initiate such contact when the initiator of the verbal behavior is in a

position of significant influence as described above.  Physical contact, as described above,

includes contact between clothed or unclothed body parts of individuals, or may

be between clothed or unclothed body parts of one person and an object.

                DV.         STAFF means a person who has contact

with children in a certified program and includes the owner, operator or

director of a program, volunteers, full-time, part-time, contract employees,

and treatment foster parents.

                DW.        STAY means the department is temporarily

refraining from taking an action on a sanction, revocation, or suspension of

certification.

                DX.         SUBSTANTIAL COMPLIANCE means a

determination by the LCA that a program is found to be without deficiencies, or

with minor and few deficiencies, none of which compromise the health and safety

of clients.

                DY.         SUBSTANTIATED COMPLAINT means a

complaint or allegation that the LCA has determined is factual.

                DZ.         SUPERVISION means one of the following,

as indicated by context: the monitoring of clients’ whereabouts and activities

by the program staff in order to ensure their health, safety, and welfare; or

the clinical or managerial oversight of staff.

                EA.         SURVEY means examination, or other

review, of a program’s premises, records or other documents; or interview of

client(s) or staff, at the discretion of the LCA, pursuant to these

certification requirements.

                EB.          SUSPENSION means a type of sanction

whereby certification is temporarily revoked, during which time the medicaid

provider agreement is not in effect.

                EC.          THERAPEUTIC HOLD means the brief

physical holding of a client, without undue force, used as part of a behavioral

plan by an individual trained and certified by a state recognized body in the

use of therapeutic holds and personal 

restraints, in a manner consistent with written agency policy, for the

purpose of providing emotional comfort or calming to the client, or physical

safety to the client, other clients, staff member(s) or others. Therapeutic

hold is distinct from personal restraint and mechanical restraint as defined

above.

                ED.          THERAPEUTIC LEAVE means a period of

time during which a treatment foster care services client is temporarily placed

in a different treatment foster home. 

This affords the primary treatment foster parents a period of authorized

leave.

                EE.          THERAPEUTIC TIME-OUT means a technique

involving individual isolation used as part of a written behavioral plan to

prevent or decrease the potential for unsafe behavior and to give the client

the opportunity to regain control.

                EF.          THERAPIST means a person who has a

license from an appropriate licensing authority to provide direct clinical care

services such as individual, family, or group therapy.

                EG.          TREATMENT FOSTER CARE SERVICES (TFC)

LEVEL I means a program that provides therapeutic services to children or

adolescents who are psychologically or emotionally disturbed, or behaviorally

disordered, in a foster family setting, pursuant to these certification

requirements.

                EH.          TREATMENT FOSTER CARE SERVICES LEVEL

II means a program that provides therapeutic services to children or

adolescents who are psychologically or emotionally disturbed, or behaviorally

disordered, in a foster family setting, pursuant to these certification

requirements.  It is distinct from

treatment foster care services level I in that it is provided to children and

adolescents who have successfully completed treatment foster care services

level I as determined by the treatment team, and are in the process of

returning to biological family and community, or who meet other established

criteria.

                EI.           TREATMENT FOSTER HOME means a

licensed residence overseen by a certified program and licensed child placement

agency in which treatment foster care services are being provided to agency

clients by licensed treatment foster parents.

                EJ.           TREATMENT PLAN means a written

document formulated on an ongoing basis by a treatment team that guides and

records for each client: individualized therapeutic goals and objectives;

individualized therapeutic services provided; individualized discharge plans

and aftercare plans.

                EK.          TREATMENT PLANNING means an ongoing

process, based on assessment and regular reassessment of a client’s needs, of

documenting those needs, the interventions intended to address those needs, and

the client’s behavioral responses to interventions.  Treatment planning includes initial treatment

plans, comprehensive treatment plans, treatment plan reviews and discharge

plans.

                EL.          TREATMENT TEAM means the group of

individuals that assesses, plans, coordinates, implements, evaluates, reviews,

and adjusts all aspects of a client’s care over the course of treatment in a

certified program.  The treatment team

includes the client, and as applicable, the client’s family or legal guardian(s),

therapist, direct service staff, treatment coordinators, treatment foster

parents, the department’s social worker or juvenile probation/parole officer,

case manager, a representative from an educational agency, or other significant

individuals in the client’s life.

                EM.         UNSUBSTANTIATED COMPLAINT means a

complaint or allegation that could not be verified by the LCA based on its

investigation.

                EN.          VARIANCE means a deviation from a

portion(s) of these certification requirements approved in writing at the sole

discretion of the LCA. It is based upon stipulated conditions to be met by the

agency, for an unlimited time period, provided that the health, safety, and

welfare of the clients and staff are not in danger.

                EO.          VOLUNTEER means an individual who

works without compensation at an agency in the physical presence or proximity

of clients.

                EP.          WRAPAROUND means a team-based activity

that helps groups of people involved in a family’s life work together toward a

common goal.

                EQ.          WAIVE/WAIVER means a deviation(s) from

any part of these certification requirements approved in writing by the LCA, at

the sole discretion of the LCA.  It is

based on stipulated conditions to be met by the agency, for a limited period of

time, provided the health, safety, and welfare of clients and staff is not in

danger.

[7.20.11.7 NMAC - Rp 7 NMAC 20.11.7, 03/29/02; A, 04/14/05;

A, 01/01/08; A, 12/31/08]

 

7.20.11.8               RELATED REGULATIONS, LAWS AND

CODES:  These certification

requirements supplement and apply in conjunction with the following regulations

laws and codes and any future amendments to such regulations or superseding

regulations.

                A.            Licensing Requirements for Child and

Adolescent Mental Health Facilities, 7.20.12 NMAC.

                B.            Health Facility Sanctions and Civil

Monetary Penalties, 7 NMAC 1.8 (1996).

                C.            New Mexico Children’s Code NMSA 1978

32A-1-1 et Seq. (1997).

[7.20.11.8 NMAC - Rp 7 NMAC 20.11.8, 03/29/02]

 

7.20.11.9               ISSUANCE OF CERTIFICATION:

                A.            Application for initial

certification:

                   

(1)     Applications for the

initial certification of a new program offering case management services,

behavior management skills development services, day treatment services, group

home services, all residential treatment services, or treatment foster care

services are submitted to the LCA for review and approval.  The application for initial certification of

a program includes, but is not limited to, the following:

                             

(a)     a letter of intent naming

the service for which the agency is requesting initial certification and describing how and where the proposed

service will be delivered.

                             

(b)     policies and procedures

showing that the agency complies with both the general provisions and the

service-specific requirements of the program for which the agency is requesting

initial certification; and an index that references each policy and procedure

by the applicable certification requirement that the policy is designed to

meet.

                             

(c)     job descriptions, required

qualifications,  resumes, current

licenses, proof of credentials, and criminal records clearances for

professional staff;

                             

(d)     job descriptions, required

qualifications and criminal records clearances for direct service staff; and

                              (e)     a complete set of the forms that will be

used to document the services being provided.

                   

(2)     At the discretion of the

LCA, the application process may include interviews with staff, administrators,

or program directors.

                   

(3)     When applicant agencies

have an established in-state or out-of-state history of providing mental health

or substance abuse services for children and adolescents, whether or not the agency is currently providing such

services, the agency’s record with regulatory compliance will be considered

during review of the new application;

                   

(4)     Applications will be

reviewed by the LCA within 15 business days and

a written response will be sent to the agency. 

The findings of the review will determine which of the following

responses will be issued by the LCA:

                             

(a)     Complete applications that

comply with all the requirements of these certification requirements will be

issued an initial certification for a period of up to 120 days.

                             

(b)     Incomplete applications

will be returned with a letter detailing what elements of the application are

missing.  initial certification will not

be issued.

                              (c)     When an application is complete, but fails

to show that the agency has fully or substantially complied with all of these

certification requirements, the LCA will issue a letter detailing the findings

of the review, with a list of the changes required to show the new program to

be in compliance with these certification requirements.  An initial certification will not be issued.

                   

(5)     If, three months subsequent to the issuance of

an LCA letter detailing missing or insufficient elements of an application, the

agency has not responded with a completed application or has not achieved

compliance with these certification requirements sufficient to warrant initial

certification, the application will be considered void.  The agency may reapply for certification of

the service, but will be required to begin a new application process.

                   

(6)     COA/CARF/JCAHO

Accreditation does not confer state certification status on a program.

                B.            Types of certification:

                   

(1)     FULL CERTIFICATION: Full

certification is granted to a program currently serving clients and found by

the LCA to be in substantial compliance with these certification requirements.

At the discretion of the LCA, the duration of full certification status is 12

to 24 months.

                   

(2)     EXEMPLARY STATUS is a type

of full certification that may be granted to a program that has no history of

temporary certification, sanctions

or loss of certification in the previous two years and that, based on a

determination made by the LCA, adheres to these certification requirements with

only minor deficiencies, which pose no health and safety risks to clients.  Exemplary status may be granted for up to 24

months.

                    (3)     FULL CERTIFICATION: This certification is

granted to a program currently serving clients and found to be in substantial

compliance with these certification requirements, when only minor and few

deficiencies, none of which compromise client health and safety, are identified

in the LCA certification report. The program submits an action plan for the

LCA’s approval within the time frame specified by the LCA, detailing the

measures that will be used to correct the deficiencies.  At the discretion of the LCA, the program may

also be required to implement a directed action(s) within specified time

frames; or may be required to comply with monitoring as specified by the LCA

during the period of certification. Based on a determination made by the LCA,

the program produces proof of correction of deficiencies and/or compliance with

directed action(s) and/or monitoring through submission of relevant

documentation and/or by subsequent on-site review.  The terms and the timeframes for monitoring

are established in writing in the certification report.

                             

(a)     The LCA provides written

notification indicating whether the program’s action plan is approved.  Action plans may be approved with amendments

recommended and/or required within a time frame specified by the LCA.  If an action plan is not approved, the LCA

will specify items that require revision or supplementation in order to receive

LCA approval.

                             

(b)     If another survey reveals

additional deficiencies, the LCA may require amendment of the action plan,

and/or issue new written directed actions, and/or implement a revised

monitoring plan, and/or sanction the program based on new deficiencies

identified.

                   

(4)     TEMPORARY CERTIFICATION:

Temporary certification is granted to a program currently serving clients that

is found by the LCA to be in partial compliance with the certification

requirements, or to a program that has been on inactive status and is returning

to active status.

                             

(a)     The LCA determines the

duration of a temporary certification. Temporary certification may be granted

for a period of up to 180 days.  The LCA

determines the duration of temporary certification based on factors that may

include severity of deficiencies and the program’s history of compliance with

certification requirements.

                             

(b)     The program submits an

action plan for the LCA’s approval within 14 days of receipt of the LCA

certification report detailing its findings of deficiencies, unless otherwise

specified by the LCA.  At the discretion

of the LCA, the program may also be required to implement directed action(s)

within specified time frames.  The

program may be required to comply with terms of monitoring specified by the LCA

during the period of temporary certification, based on a determination made by

the LCA.

                             

(c)     Items 9.B(3)(a) and (b)

above are applicable for action plans that accompany temporary certification.

                             

(d)     For programs returning to

active status, an action plan, directed action, and/or monitoring are not

required unless specified by the LCA.

                             

(e)     If the program does not

achieve substantial compliance with these certification requirements at the end

of a temporary certification period, a sanction(s) may be imposed including

non-renewal of certification.

                             

(f)     At the discretion of the

LCA, a second consecutive temporary

certificate may be issued for a

period of up to 180 days, or

certification may be allowed to expire without renewal.

                   

(5)     INITIAL CERTIFICATION:

This certification is granted for a period of 120 days to a program that has

met the minimum requirements to provide child and adolescent mental health or

substance abuse services as determined by the application process described in

certification requirement 9.A above.  If

the program has no clients at the end of 120 days, a second 120-day initial

certification may be granted.  If the

program remains without clients beyond 240 days, the program’s initial

certificate expires and re-application for certification is required; or, at

the discretion of the LCA, inactive status may be granted.

                   

(6)     INACTIVE STATUS: This

certification is granted to a program not presently serving clients, but which has served clients within the current

period of certification.   A certificate

of inactive status covers a period of time not to exceed 180 days from the date

of issue.  If the program continues

without clients beyond 180 days, a second 180-Day certificate of inactive

status may be granted upon request.  If

the program remains without clients beyond 365 days, the program’s inactive

status expires and re-application for initial certification is required.

                             

(a)     To return to active status

from inactive status for a certified service, the program must notify the LCA

in writing at least two weeks prior to its intended admission of

clients.  In addition to the written

notice, the agency must submit the following to the LCA: information on any

changes in personnel or agency policies and procedures during inactive status;

proof of criminal records clearances, qualifications, and, as applicable,

licensure for new supervisory and direct service staff of the certified

program.

                             

(b)     Upon review of the

submitted information, the LCA may grant temporary certification.  The agency will not admit any client(s) until

the LCA issues and the program receives temporary certification.

                   

(7)     AMENDED CERTIFICATE: This

certification is granted to a program currently serving clients that has had a change

of ownership or licensee, or that chooses to change its name.  The agency submits a written request for an

amended certificate to the LCA ten business

days prior to the change.

                    (8)     DEEMED CERTIFICATION: The LCA has

discretion to grant deemed certification when a program is

accredited by the council on accreditation (COA), the council on accreditation

of rehabilitation facilities (CARF), or for residential treatment services, by

the joint commission on accreditation of health care organizations (JCAHO), and

the LCA determines that the standards of the accrediting body apply

substantially to the program for which deemed certification is being

considered.  A certified program that is

accredited by one of these organizations and wishes to request deemed

certification must provide a copy of the accreditation report to the LCA within

30 days of receipt of the report, and must provide any other

accreditation-related documentation to the LCA upon request.  Upon receipt and review of the COA, CARF or

JCAHO survey reports, the LCA, at its discretion, may issue deemed

certification status effective for up to 24 months. For those

intervening years that the above-mentioned accrediting bodies do not conduct

on-site visits, the LCA may conduct annual or biennial

certification on-site surveys.

                              (a)     EXCEPTION: The deemed certification may

not apply when COA, CARF or JCAHO identify any condition that the LCA, at its

sole discretion, determines to be a significant violation of certification or accreditation

standards, or that requires follow-up by the accrediting body; or when any

condition reported to the LCA appears to pose a threat to health and/or safety;

or when there is any other information indicating the existence of such a

threat.

                              (b)    All agencies and programs that receive

deemed certification must comply with all applicable provisions of the

Children’s Health Act of 2000 and these certification requirements.

                C.            AUTOMATIC EXPIRATIONS OF A

CERTIFICATION:

                   

(1)     A certificate

automatically expires at midnight on the day a certified program discontinues

or suspends operation or changes location.

                   

(2)     A certificate

automatically expires at midnight on the tenth day after a certified program is

sold, leased, or otherwise changes ownership and/or licensee, unless the agency

has made a timely written request for amended certification.  In such a case, the automatic expiration is

stayed, and previous certification remains in effect if the agency has until

the LCA acts on the application or takes other certification action.

                D.            WAIVERS AND/OR VARIANCES: Upon

written request of the agency and at

the discretion of the LCA, the LCA may issue a waiver and/or variance

                E.             CERTIFICATION REVIEWS: When

possible, the LCA schedules on-site program reviews prior to expiration of

certification.  If the LCA does not

perform a certification on-site review

of a program prior to the expiration of its certification, and the program has

not received a written report from the LCA recommending that the program’s

certification be allowed to expire, the certification continues in effect until

the LCA performs a certification review.

                F.             The LCA, at its sole discretion,

may extend any certification for a period of up to 12 months.

                G.            In the event that a program’s

certification is revoked, suspended, denied, or not renewed, the medicaid

provider agreement terminates on the date of the revocation, suspension or

denial.

[7.20.11.9 NMAC - Rp 7 NMAC 20.11.9, 03/29/02; A, 04/14/05]

 

7.20.11.10             EMERGENCY REVOCATION, SUSPENSION,

NON-RENEWAL OF CERTIFICATION OR IMPOSITION OF EMERGENCY SANCTIONS, WITHOUT

PRIOR HEARING:  If immediate action

is required to protect human health and/or safety, the LCA may immediately

revoke, suspend, not renew, or impose an emergency sanction(s) against the

certification status of a program

pending a hearing, provided that such hearing is held within five business days of the above-mentioned action and/or

sanction(s), unless the program waives its right to a hearing.  The medicaid provider agreement terminates on

the date of the revocation, suspension, or non-renewal of certification.

[7.20.11.10 NMAC - Rp 7 NMAC 20.11.10, 03/29/02]

 

7.20.11.11             GROUNDS FOR IMPOSITION OF

SANCTIONS:  Sanctions may be imposed by the LCA

based on its specific findings, including but not limited to any of the

following:

                A.            failure to comply with any

provision(s) of these certification requirements;

                B.            failure to allow surveys by

authorized representatives of the LCA;

employment of any person convicted of a felony or

misdemeanor without clearance by the department, including a misdemeanor

involving moral turpitude;

                C.            allowing any agency personnel to work under the influence of alcohol

or mood-altering drugs (if after employment, a staff member is charged and/or

convicted of a felony or misdemeanor involving moral turpitude and this fact is known to the agency, it must be

immediately reported to the LCA);

                D.            purposeful, deliberate or

intentional misrepresentation(s) or falsification(s) of any information on

application forms or other documents provided to the LCA;

                E.             repeated violations of

these certification requirements, or failure to correct deficiencies of survey

findings in current or past contiguous or noncontiguous certification periods;

                F.             presence of, and/or a history of,

certification/licensure revocation, suspension, non-renewal, or denial of

certification, sanction(s) or penalties or other similar disciplinary actions

taken by regulatory bodies in other states or countries and/or within New

Mexico regardless of whether any of these actions resulted in a settlement in

lieu of a sanction;

                G.            failure to provide a client in the

program with care, supervision and services or to protect client rights as

outlined in these certification requirements;

                H.            any neglect as defined in these

certification requirements;

                I.              presence of, and/or a history of

health and/or safety deficiencies found in current or previous surveys or

on-site visits;

                J.             death or serious injury to a

client;

                K.            psychological harm or cruelty and

indifference to the welfare of a client;

                L.             incidents that include acts of

physical harm to a client(s) by staff;

                M.           regulatory deficiencies that

jeopardize the health and/or safety of a client;

                N.            numerous deficiencies, that in

combination, jeopardize the health and/or safety of a client; or

                O.            non-disclosure and/or deceit

regarding condition of a facility/program or the services it provides.

[7.20.11.11 NMAC - Rp 7 NMAC 20.11.11, 03/29/02]

 

7.20.11.12             SANCTIONS:

                A.            Sanctions, as follows, may be

imposed for the reasons listed in Section 11. The severity of the action taken

by the department depends upon the specific facts in each case, the seriousness

and history of the events prompting the department to take action, and the

ability and willingness of the agency to promptly take adequate corrective

action.

                   

(1)     REVOCATION: The LCA

cancels certification, making it void. The medicaid provider agreement

terminates on the date of revocation.

                   

(2)     SUSPENSION: The LCA

temporarily revokes certification until the identified deficiencies are

corrected and the LCA approves the corrections. The medicaid provider agreement

terminates on the date of suspension.

                   

(3)     NON-RENEWAL:  The LCA refuses to renew certification and

issues a notice stating that the certification is void as of a specific date,

on or about the date of expiration. The medicaid provider agreement terminates

on the effective date of non-renewal.

                   

(4)     DENIAL:  The LCA refuses to issue certification.

                   

(5)     ADMISSIONS HOLD: The LCA

restricts the program from accepting any new clients until the identified

deficiencies are corrected and the LCA approves the corrections.

                   

(6)     EXPANSION HOLD:  The LCA restricts the program from expanding

into additional services until the identified deficiencies are corrected and

the LCA approves the corrections.

                   

(7)     MAINTENANCE OR REDUCTION

IN PROGRAM CAPACITY: The LCA directs the program to maintain or reduce the

capacity of the program to a designated client census until the LCA determines

that all of the deficiencies resulting

in the sanction have been corrected.

                   

(8)     COMPLIANCE MONITOR: The

LCA may select and assign a compliance monitor and assign it to an agency for a

specified period of time to oversee an agency’s compliance efforts.  The compliance monitor has the authority to

review all applicable facility records, including financial records and policies,

and the authority to interview facility staff and clients.  The compliance monitor may also advise the

program regarding steps to correct violations and improve overall clinical

programming. The compliance monitor reports to the LCA on a weekly basis or

more often when indicated.  The agency

pays all costs of the compliance monitor.

                   

(9)     TEMPORARY MANAGEMENT: The

LCA appoints temporary professional management with expertise in the field of

the child and adolescent mental health and/or substance abuse services provided

by the program.  The temporary management

assumes primary responsibility to oversee the operation of the program; to

protect the health and safety of its clients; to assess and direct the

correction of deficiencies; and/or to facilitate an orderly closure. The

temporary management reports to the LCA. 

The agency pays all costs of temporary management.

                B.            EXTENUATING CIRCUMSTANCES:  In assessing the appropriateness or severity

of sanctions, the LCA may consider any relevant factor(s) that may mitigate or

exacerbate the situation precipitating the sanction.

                C.            CORRECTION OF DEFICIENCIES:  When the LCA determines that deficiencies

exist, the program must correct the deficiencies according to the following

time frames or further sanctions may be imposed:

                   

(1)     Health and/or safety

deficiencies are corrected immediately.

                    (2)     Deficiencies that do not compromise health and/or safety are corrected within a period of time specified by the LCA.

                D.            SERVICE OF NOTICE: The department

provides notification, by fax and certified mail or personal service/delivery,

of its imposition of any emergency sanction against a program.  A notice of contemplated action under these

certification requirements may be sent by fax and mail, personal service or

delivery, or by certified mail.  Each

notice of emergency sanction or contemplated action will be forwarded by

fax to the medical assistance division immediately. (The medical assistance

division of the human services department is responsible for any notices

related to medicaid payments sent to the provider.)

                E.             NEW OWNERSHIP: In the event a

provider sells or otherwise transfers its interest in its certified program to

another entity, and a sanction or other corrective measure is pending, the sale

of the certified program does not stay or otherwise impact the pending

sanction.  The new owner/entity must

comply with all areas of correction noted in the sanction or action plan. If a

sanction(s) is pending, the LCA will proceed with the appeals process and may

issue a notice of final action pursuant to these certification requirements.

[7.20.11.12 NMAC - Rp 7 NMAC 20.11.12, 03/29/02]

 

7.20.11.13             APPEALS AND HEARINGS:

                A.            HEARING OFFICER: The department

appoints an impartial hearing officer to conduct any administrative appeal.

                B.            PROCEDURES: Adjudicatory Hearing

procedures, 7.1.2 NMAC, apply in all administrative appeals.

                C.            ADDRESS FOR REQUESTING AN

ADMINISTRATIVE APPEAL:  All requests for

appeal must be addressed to: Licensing and Certification Unit; Children’s

Behavioral Health and Community Services Bureau; Children, Youth and Families

Department; Post Office Drawer 5160; Santa Fe, New Mexico 87502-5160 (facsimile

505-827-4595).

                D             APPEALS OF EMERGENCY SANCTIONS:

                   

(1)     If an emergency sanction

is imposed, the LCA conducts a hearing within five business days of the Notice.  The LCA notifies the agency of the name of

the hearing officer and the date and time of the hearing.

                   

(2)     The emergency sanction

takes effect immediately, and is not stayed by any request for administrative

hearing or for an informal resolution conference.

                   

(3)     Any informal resolution

conference, if requested, will be held within five business days of the date of

the notice of emergency sanction.

                E.             APPEALS OF ADVERSE ACTIONS OTHER

THAN EMERGENCY SANCTIONS:

                   

(1)     A program may appeal any

adverse action set forth in a notice of contemplated action.  The notice of contemplated action will

include instructions and time frames for the program to request an appeal

and/or an informal resolution conference. 

The program must request the appeal in writing within ten business days

of receipt of the notice of contemplated action.

                   

(2)     When an appeal has been

requested, the adverse action(s) is stayed until either of the following events

occurs:

                             

(a)     the administrative hearing

officer has conducted the hearing and issued an opinion; or

                             

(b)     the LCA and the program

reach agreement through an informal resolution process.

                   

(3)     The administrative hearing

will be held within 30 calendar days, unless both the LCA and the program agree

to an extension.  The LCA will inform the

program of the date and location of the administrative hearing, and will

identify the hearing officer.

                   

(4)     After the appeal process

is concluded, or upon expiration of the time for appeal if no appeal is

requested, the LCA will issue a notice of final action which will state the

final decision of the LCA and the effective date of sanction(s) or any other

adverse action. The notice of final action is not appealable.

                F.             INFORMAL RESOLUTION CONFERENCE: The

department and the program may resolve any filed or potential administrative

appeal through an informal resolution conference.  The informal resolution conference provides

an opportunity for the program to present new evidence or arguments regarding

the deficiencies cited by, or corrective action proposed by, the department,

and to present information regarding plans to remedy deficiencies and discuss

possible pre-hearing disposition.  The

LCA has discretion to accept or reject any proposal made by the program.  The informal resolution conference does not

postpone any deadlines for appeal unless the LCA and the program both

explicitly agree in writing to the extension.

[7.20.11.13 NMAC - Rp 7 NMAC 20.11.13, 03/29/02]

 

7.20.11.14             PROGRAM

SURVEYS, INVESTIGATIONS, AND REPORTS:

                A.            Application

for certification, whether initial or renewal, constitutes permission for entry

into, and surveys of a program by the authorized LCA representatives at

reasonable times while the application is pending.

                B.            LCA

surveyors may enter the premises of an agency at any time and review any and

all records of medicaid recipients, CYFD custody clients and agency staff; the

LCA may conduct interviews with staff and/or clients in programs that are

certified or required to be certified, whether or not an application for

certification has been made, for the purpose of determining compliance with

these certification requirements.

                C.            The LCA may conduct a survey(s) to

assess/monitor progress with correction of violations found on previous

surveys; or to investigate complaints or allegations of abuse, neglect or

exploitation.  The LCA may also conduct

inquiry into matters of potential health and/or safety risk to clients as

identified in serious incident reports or other information received by the

LCA.

                D.            Findings made by the LCA during

on-site surveys or investigations described in these certification requirements

may result in changes of certification status, sanction(s), suspension,

revocation, non-renewal, or denial of certification in accordance with all of

the guidelines governing such actions as defined in these certification requirements.

                E.             When

certification on-site surveys are conducted concurrently with licensing on-site

surveys and there are violations found of both licensing and certification

requirements that do not directly overlap, the LCA may issue a single report

citing deficiencies with reference to both licensing and certification

requirements.

                F.             When,

during a certification survey, the LCA finds a violation(s) of these

certification requirements that also constitute(s) a violation(s) of the

licensing regulations of the department, the LCA may issue a single report

addressing the violation(s) with reference to certification requirements only.

                G.            REPORTS:

                    (1)     The LCA issues a written report of the

findings for all required certification surveys within 30 business days of

completion of the survey.

                    (2)     When a survey is conducted for purposes of

investigation, the LCA issues a report in instances of partial or fully

substantiated complaint(s)/allegation(s) within 30 business days of the completion of the investigation.

                    (3)     When a survey is conducted for purposes of

investigation and the complaint(s)/allegation(s) are unsubstantiated, the LCA

issues a letter indicating that the complaint was not substantiated, but does

not issue a report.

                    (4)     When a survey is conducted for the

purposes of inquiry into questions of compliance arising from incident reports

or other reports, the LCA may issue a report of any findings of noncompliance.  If such a report is issued, it will be issued

within 30 calendar days after completion of the survey.

                    (5)     When a survey is conducted for purposes of

following-up a monitoring plan, the LCA issues a follow up letter, but does not issue a report unless

information obtained during such a visit indicates the need for a full program

review and/or additional investigation(s).

                    (6)     When a survey is conducted for purposes of

technical assistance, the LCA does not issue a report.

                    (7)     A report of a survey or investigation may

be combined with a notice of contemplated action or notice of emergency

sanction.

[7.20.11.14 NMAC - Rp 7 NMAC

20.11.14, 03/29/02]

 

7.20.11.15             CRIMINAL RECORDS CHECKS AND CLEARANCES:

                A.            Every program that provides child/adolescent mental health and/or substance abuse services pursuant to these

certification requirements, operating in the state of New Mexico, must initiate

and provide to the department two completed state-and FBI-approved fingerprint

cards for each employee who will serve as direct services staff.  The

agency must have received the

criminal records clearance from the prevention and intervention division of the

department prior to the employee’s direct, unsupervised contact with clients of

the program.  Non-compliance with this

requirement may result in sanction up to loss of certification as referenced in

NMSA 1978 32A-15-3.

                B.            All agencies must comply with 8.8.3 NMAC Regulations governing criminal records

checks.

                C.            Student trainees in psychiatry,

psychology, social work and/or nursing, or other related health, social or

human-services disciplines who are

enrolled in a clinical training program of a New Mexico state accredited

institution of higher learning, and who are under the supervision of a cleared

licensed independent practitioner, may be allowed to work with children without

direct physical supervision during their enrolled student

tenure if the trainee signs a sworn affidavit attesting that he or she has

never been convicted of a crime that would disqualify him or her from providing

direct services to children.

                D.            The certification requirements

governing criminal records clearances remain in effect while a program is

accredited by COA, CARF or JCAHO.

                E.             If a prospective employee has not

lived in the United States continuously for the five years previous to hire,

the equivalent of a criminal records clearance is required from any country in

which he/she has lived within the last five years, for a period longer than one

year.

                F.             If the agency receives reliable

evidence that indicates that an employee or prospective employee poses a

potential risk of child abuse, sexual abuse, exploitation, moral turpitude,

cruelty, or indifference to children, the agency is in violation of these

certification requirements and subject to sanction up to loss of certification

if that individual is hired or retained.

                G.            Upon request by the LCA, the agency

will provide a list of employees who are not required to have a criminal

records clearance, and the reason why not.

                H.            Non-compliance with any

certification requirement relating to criminal

records checks and clearances may result in sanction or

loss of certification.  In addition to

the foregoing, the following certification requirements relate to criminal

records checks and clearances:

                   

(1)     16.G.1(f) concerning

prospective employee history verification and reference checks;

                   

(2)     16.G.1(h) concerning

letters of attestation for employees pending clearances;

                   

(3)     16.G. 2 concerning

disclosure of arrests/convictions;

                    (4)     16.H.1-5 concerning staff schedules.

[7.20.11.15 NMAC - Rp 7 NMAC 20.11.15, 03/29/02]

 

7.20.11.16             PERSONNEL:

                A.            The agency provides personnel who

are trained, supervised and in all respects qualified to perform the functions

for which they are responsible.

                B.            Each position, or group of like

positions, is detailed in a written job description that clearly states qualifications,

responsibilities and requirements.

                C.            Each agency employee meets all state

registration, licensing and/or certification requirements applicable to his or

her position and/or use of professional title(s) and the agency has copies of

such licenses, etc. on file.

                D.            Orientation of personnel:

                   

(1)     The agency orients its

personnel to the agency’s goals, services, policies and procedures, and to the

responsibilities of the staff member’s position.  Initial and ongoing orientation is documented

in the personnel record.

                   

(2)     Orientation includes

training on the establishment and maintenance of appropriate and responsive

relationships and boundaries with clients.

                E.             Personnel training, development,

responsibilities and supervision:

                   

(1)     The agency provides a

training and development program to allow personnel to improve their knowledge,

skills and abilities and to promote awareness and appreciation of the cultural

background and need of persons served by the agency.   This training will be documented in the

personnel file.

                   

(2)     The agency provides staff

development opportunities for personnel, including in-service training.

                   

(3)     Staff who require training

to qualify for a position in which they are responsible for the care of

children do not have sole responsibility for the care of children until after

the successful completion of the training.

                   

(4)     Staff designated as direct

service staff under service-specific certification requirements receive ongoing

training related to the age and/or emotional development of the children for

whom they are responsible.

                   

(5)     All certified services are

provided under supervision of a clinical director who provides clinical

oversight of the program, by way of documented supervision and consultation to

all agency staff.  Supervision may be

direct, or may occur through a clinical supervisor who is directly supervised

by the clinical director.

                   

(6)     All clinical

supervision/consultation is documented and documentation includes the theme,

date, length of time of supervision and signatures of those participating.

                   

(7)    In the event that the

therapist and clinical supervisor are the same person, another properly

credentialed clinician, either from within the agency or from outside the

agency, provides supervision at least one time per month to the clinical

supervisor.

                    (8)   

The responsibilities of the therapist include providing therapy and

participating in the development of a treatment plan. These activities are

documented.

                   

(9)     When the agency utilizes

the services of professionals on a per interview, hourly, part-time, or

independent contractor basis, the agency documents regular assessment of the

quality of services provided.

                F.             Accountability:

                   

(1)     The agency ensures that

the performance of all employees, consultants, contractors, and volunteers is

consistent with agency policy and these certification requirements.

                   

(2)     At least once a year,

written performance reviews are conducted jointly between each staff member,

including volunteers, and the person’s supervisor.

                G.            Personnel records:

                   

(1)     A personnel record is

maintained for each employee and volunteer. 

Each personnel record is readily accessible to the LCA at each site

visit, and contains, at a minimum:

                              (a)     documentation of all orientation and

training, including dates, hours or credits, names of trainer and trainee,  and written confirmation by trainer or

training organization that the training has occurred;

                              (b)     employee’s name, current address,

telephone number and emergency contact(s);

                             

(c)     job title and description;

                             

(d)     evidence of licensure for

those employees required to be licensed;

                             

(e)     date first employed and

dates of transfers or changes in position;

                             

(f)    documentation of a minimum

of three employment reference checks within three weeks prior to employment (if

this process yields fewer than three employment reference checks, additional

professional and/or personal references are obtained to achieve the required

minimum of three references);

                             

(g)     a copy of the employee’s current CPR and first aid certificates;

                             

(h)     for cleared staff, the

criminal records clearance letter, or for uncleared staff, a signed statement

by the administrator, director, or operator attesting  to direct supervision of the uncleared

employee by a cleared employee until the clearance is received;

                             

(i)     application for employment

or resume consistent with agency policy;

                             

(j)     performance reviews, as

applicable.

                   

(2)     The agency’s written

policies and practices require that an applicant for employment disclose any

prior criminal convictions, and employees report any arrests and/or convictions

that occur while employed.

                    (3)     The agency’s written policies provide

personnel with access to their records and a process to review the record and

to make additions and corrections to the record.

                H.            Schedules of direct service staff in

day treatment and residential facilities:

                    (1)    Each facility or licensed unit maintains a

written, legible schedule clearly identifying direct service staff responsible

for care of clients.

                   

(2)     Each uncleared employee is

identified on the staff schedule.

                   

(3)   The staff schedule is

updated daily to reflect actual hours staff are present and changes in

attendance as they occur.

                   

(4)     Original updated staff

schedules are kept on file for at least 12 months.

                    (5)     The updated schedule documents the client

census for each unit of a residential treatment services center or group home

service on a daily basis.

[7.20.11.16 NMAC - Rp 7 NMAC 20.11.16, 03/29/02; A,

10/29/04]

 

7.20.11.17             ALLEGATIONS OF ABUSE/NEGLECT,

COMPLAINTS, AND SERIOUS INCIDENT REPORTING:

                A.            The agency maintains and follows

policies and procedures consistent with these certification requirements for

timely reporting of any serious incidents and allegations of abuse or neglect.

The agency immediately reports allegations of abuse or neglect to all

appropriate entities, including but not limited to the protective services

division of the department via statewide ventral intake/tribal social services

agency, the client’s legal guardian, the jurisdictional law enforcement agency,

and the LCA.

                B.            The agency reports all serious

incidents to the LCA by fax within 24 hours of any staff member becoming aware

of the incident or allegation of incident. Incidents involving minor illnesses

or injuries not requiring emergency services do not need to be reported to the

LCA. Day treatment services, case management services, and behavioral

management skills development services are not required to report serious

incidents that do not occur during program hours, with the exception that all

deaths must be reported.

                C.            Additional reporting requirements

for deaths:  Deaths are reported to the

LCA immediately by telephone and followed by fax within 24 hours, whether or

not the death occurs during program hours. 

Agencies are required to report any client death to the regional office

of the federal centers for medicare and medicaid services by no later than by

the close of business the next business day after the client’s death, and must

document in the client’s record that the death was reported to the centers for

medicare and medicaid services.

                D.            Each serious incident report is

written by the staff who have personal or firsthand knowledge of the

incident/allegation, and is signed and dated by that person(s). Once written,

the report is not altered, but may be amended. 

Any amendment is signed and dated by its author and filed with the

original report. The report clearly distinguishes between events witnessed by

the reporter and statements made to the reporter. The report contains, but is not limited to the following information regarding the

incident: date, time, and location of the incident, behavioral description(s)

of relevant event(s), descriptions of health/safety risk(s) relevant to the

incident, identification of person(s) present, birth date(s) of client(s)

involved, level of care of the client(s) involved, initial actions in response

to the incident, names of persons providing information to the reporter, and

identification of other entities receiving the report.

                E.             Each serious incident for which a

report to the LCA is required herein and that involves possible criminal

activity is reported immediately to the appropriate law enforcement

agency.

                F.             The agency responds in a timely

manner to protect its clients from physical or psychological risks of which it

is or reasonably should be aware, in order to reduce and prevent future risks.

                G.            Outcomes, dispositions, and

descriptions of any voluntary corrective action(s) taken by the agency in

response to serious incidents are faxed or

mailed to the LCA in a timely

manner.

                H.            The program will not rely on the

fact that it has made a serious incident report to the LCA, or the fact that it

may not have received a response from the LCA, to delay appropriate corrective

or protective action in response to an incident.

                I.              The agency maintains and follows

policies and procedures for investigating and responding to allegations of

abuse or neglect in a confidential and timely

manner.

                J.             The agency maintains and follows

policies and procedures for investigating and responding to complaints in a

timely manner.

                K.            The agency provides a written

response, in a timely manner, to the complaining party and, as

applicable, the parent, legal or treatment guardian, regarding the resolution

of each complaint or allegation.

[7.20.11.17 NMAC - N, 03/29/02; A, 04/14/05]

 

7.20.11.18             AGENCY IN THE COMMUNITY:

                A.            The agency identifies a defined

purpose, uses a multi-disciplinary approach in which services are coordinated

within the agency and within the provider community, and collaborates with

other agencies in provision of services for its clients.

                B.            Agency purpose: The agency’s

statement of purpose includes a description of its primary function as

providing services that:

                    (1)     serve those clients in need of treatment who are most

vulnerable or at risk;

                   

(2)     are habilitative in focus;

and

                   

(3)     are consistent with the

least restrictive means principle.

                C.            Community access to services:

                   

(1)     The agency provides

culturally competent services and serves the needs of those clients who are

bicultural and/or who are non-English speaking through the use of:

                             

(a)     bilingual/bicultural

professional and qualified paraprofessional personnel;

                             

(b)     translators to meet the

clients’ communication needs.

                   

(2)     The agency provides public

information concerning its services to persons in the community who are

non-English-speaking. This information is designed to encourage full

participation of non-English speaking clients.

[7.20.11.18 NMAC - Rp 7 NMAC 20.11.18, 03/29/02]

 

7.20.11.19             AGENCY GOVERNANCE AND

ADMINISTRATION:

                A.            The agency is legally authorized to

operate, identifies the members of its governing body, and administers its

program in accordance with its own policies, which support compliance with

these certification requirements.

                B.            The agency’s governing body is responsible

for adopting bylaws and policies and defining the scope of its services.   The agency is legally authorized to operate

as one of the following:

                   

(1)     Not-profit agency,

incorporated in the state in which it operates, with a charter, constitution,

and by laws;

                   

(2)     Not-profit agency operated

by its own independent governing body, under the aegis of a religious body or

other organization recognized under the laws of the state;

                   

(3)     Public agency authorized

and established by statute, or a sub-unit of a public agency with which clear

administrative relationship exists;

                   

(4)    Proprietary agency

organized as a legal entity as a corporation, partnership, or association, but

excluding therefrom sole proprietors; or

                   

(5)     Agency of a tribal

government, or subdivision thereof.

                C.            Policies and procedures:  The agency maintains a manual containing

current policies and procedures for agency administration, service delivery,

and protection of consumer rights.

                   

(1)     The agency makes a copy of

its policies and procedures manual available to new personnel upon employment.

                   

(2)     The agency documents that

it keeps all personnel advised regularly of revisions to its policies and

procedures manual as revisions occur.

                   

(3)     The agency conducts annual

reviews of its policies and procedures and makes revisions as necessary to

maintain compliance with applicable laws, regulations, and these certification

requirements.

[7.20.11.19 NMAC - Rp 7 NMAC 20.11.19, 03/29/02]

 

7.20.11.20             QUALITY IMPROVEMENT AND UTILIZATION

REVIEW:

                A.            The agency has a continuous quality

improvement process, reviewed annually, through which the agency systematically

evaluates the effectiveness of services provided by determining whether its

services meet pre-determined quality improvement expectations and outcomes, and

corrects any observed deficiencies identified through the quality improvement

process.

                B.            The agency explicitly details the

desired expectations and service outcomes for each of its programs and has a

written plan to achieve them.

                C.            The agency establishes a committee

or other mechanism for the timely and regular evaluation of serious incidents,

complaints, grievances, and related investigations.  Committee evaluations include identification

of events, trends and patterns that may affect client health, safety,

and/or treatment efficacy.  Committee

evaluation findings and recommendations are documented and submitted to agency

management for corrective action. 

Actions implemented and outcomes are documented, and trends are analyzed

over time.  The agency has a well-defined

plan for correcting problems.  When

problems (or potential problems) are identified, the facility acts as soon as

possible to avoid any risks to clients by taking corrective steps that may

include, but are not limited to:

                   

(1)     changes in policies and/or

procedures;

                    (2)    

staffing and assignment changes;

                   

(3)     additional education or

training for staff;

                   

(4)     addition or deletion of

services.

                D.            The agency develops a system to

utilize its collected data regarding the outcome of its activities for

delivering continuously improving services.

                E.             Formal and informal feedback from

consumers of services and other collateral sources is aggregated and used to

improve management strategies and service delivery practices.

                F.             The agency collects and maintains

information necessary to plan, manage, and evaluate its programs

effectively.  The outcomes are evaluated

on a quarterly basis, the results of which are used continuously to improve performance.

                G.            The agency implements and maintains

ongoing utilization review processes.

[7.20.11.20 NMAC - Rp 7 NMAC 20.11.20, 03/29/02]

 

7.20.11.21             LEGAL,

REGULATORY, AND ACCREDITATION COMPLIANCE FOR PROGRAM OPERATION, INCLUDING

HEALTH, SAFETY AND PHYSICAL PLANT REQUIREMENTS:

                A.            The agency promotes and protects the

health and safety of its clients, demonstrates compliance with all applicable

laws and regulations, adheres to the requirements of its accrediting bodies, if

any, and possesses all applicable licenses required by law and departmental

policy.

                   

(1)     License(s) required:  The agency possesses a license(s) and

complies with applicable licensing requirements for each service required by

state and local law and departmental regulation including, but not limited to the following:

                             

(a)     Each treatment foster care

child placement agency is licensed by the protective services division of the

department as a child placement agency.

                             

(b)     All residential facilities

are licensed by the department. Each maintains a separate license.

                             

(c)     Day treatment services are

licensed as day treatment centers by the department.  Each day treatment services facility

maintains a separate license.  Exception:

day treatment services provided in a

public school facility do not require licensure by the department.

                   

(2)     Residential treatment

services and group home services are certified only when provided in a facility

licensed by the LCA for 16 beds or fewer per unit.

                B.            An agency accredited by an

accrediting organization recognized by the LCA complies with the current

requirements of the accrediting organization. 

The accrediting organizations recognized by the LCA are:

                   

(1)     Council on accreditation

for children and family services (COA);

                   

(2)     Joint commission on

accreditation of healthcare organizations (JCAHO); and

                   

(3)     Council on accreditation

of rehabilitation facilities (CARF).

[7.20.11.21 NMAC - Rp 7 NMAC 20.11.21, 03/29/02]

 

7.20.11.22             CLIENT PARTICIPATION, PROTECTION,

AND CASE REVIEW:

                A.            The agency takes all reasonable

action(s) to protect the health, safety, confidentiality, and rights of its clients.  The agency informs the client of his or her

rights and responsibilities and develops and implements policies and procedures

that support and facilitate the client’s full participation in treatment and

related agency activities. The agency protects the confidentiality of client

records through adherence to its own set of policies and procedures governing

access to, and release of, confidential information.

                B.            Materials describing services

offered, eligibility requirements and client rights and responsibilities are

provided in a form understandable to the client and client’s legal guardian(s)

with consideration of the client’s/guardian’s primary language, and the mode of

communication best understood by persons with visual or hearing impairments.

                    (1)     If the client is unable to understand the

materials for any reason, every effort is made to explain his or her rights and

responsibilities in a manner understandable to the client. These efforts will

be documented in the client’s record.

                   

(2)     Materials are available or

posted in the agency’s reception area and/or handed to potential clients during

their initial contact with the agency.

                C.            The agency explains to each client

what his or her legal rights are in a manner consistent with the client’s

ability to understand and makes this information available to the client in

writing, or in any other medium appropriate to the client’s level of

development.  A written explanation of

these rights is given to the parent/legal guardian upon admission.

                   

(1)    A client who receives

residential treatment services has the rights enumerated in the New Mexico

children’s mental health and developmental disabilities Code, NMSA 1978,

Sections 32A-6-1 et seq. (1995). 

Explanation of rights to the client and parents/legal guardian is

documented in the client’s record.

                   

(2)     The agency maintains and

follows written policy affirming that clients may refuse any treatment or

medication, unless the right to refuse treatment(s) has been limited by law or

court order. The agency informs the individual of the risks of such refusal. Client

refusal of treatment and advisement of risks of the refusal is documented in

the client’s record.

                    (3)    

The agency specifies in written policies and procedures the conditions

under which it serves minors without parental/legal guardian consent, and when

parental/legal guardian consent is not possible, designates who is authorized to

give consent to treat the minor.

                             

(a)     The client record contains

all applicable consents for treatment, including consent for emergency medical

treatment and informed consent for prescription medication.

                             

(b)      Exception: Day treatment

services, behavioral management skills development services and case management

services programs are not required to file consents for prescription

medications that are not taken during program hours unless the medications are

prescribed by a program physician.

                             

(c)     Consent forms must contain the information identifying the

specific treatment, prescription medication, information release, or event for

which consent is being given prior to being signed by a client or guardian.

                   

(4)     Upon admission, each

client receives an orientation to the agency’s services that includes the basic

expectations of the clients, the hours during which services are available, and

any rules established by the agency regarding client conduct, with specific

reference to behavior that could result in discontinuation of a service.  Orientation of the client and parents/legal

guardians is documented in the client’s record.

                   

(5)     The agency maintains a written

grievance/complaint procedure that is reviewed with the client and parent/legal

guardian upon admission. The client’s record contains documentation of the

agency’s explanation of the grievance procedure to the client and the

parent/legal guardian.

                   

(6)     Financial arrangements are

fully explained to the client and/or his or her parent/legal guardian upon

admission, and at the time of any change in the financial arrangements.

                   

(7)     Procedures for protecting

client assets:  The agency establishes

and follows written policies and procedures to identify how it manages,

protects, and maintains accountability for client assets, including the segregation

of client funds when an agency assumes fiduciary responsibility for a client’s assets and/or disburses

funds such as maintenance or allowance funds to clients.

                   

(8)     The agency establishes

written procedures for providing client access to emergency medical services.

                    (9)     Written agency policy specifies clinically

appropriate and legally permissible methods of behavior management and

discipline and provides training in their use to all direct service staff. 

The agency prohibits in policy and practice the following:

                             

(a)     degrading punishment;

                             

(b)     corporal or other physical

punishment;

                             

(c)     group punishment for one

individual’s behavior;

                              (d)     deprivation of an individual’s rights and

needs (e.g., food, phone contacts, etc.) when not  based on documented clinical rationale;

                             

(e)     aversive stimuli used in

behavior modification;

                              (f)      punitive work assignments;

                             

(g)     isolation or seclusion,

except as delineated in Section 24;

                             

(h)     harassment; and

                             

(i)     chemical or mechanical

restraints, except as delineated in Section 24.I.

                   

(10)     The agency establishes

and follows written policies and procedures for the use of therapeutic time-out

in accordance with these

certification requirements, including the following directives:

                             

(a)     therapeutic time-out can

only be used for the length of time necessary for the client to resume

self-control and/or to prevent harm to the client or others;

                             

(b)     therapeutic time-out is not used as a means

of punishment;

                             

(c)     therapeutic time-out is

not used for the convenience of staff; and

                             

(d)     therapeutic time-out is

monitored closely and frequently to ensure the client’s safety.

                D.            The agency prohibits the use or

depiction of individuals (residents, clients, etc.), either personally or by

name or likeness (e.g., photograph), in material (photographs, videotape or

audiotape), presented in a context that is either commercial or public-service

oriented in nature.  An exception to this

prohibition applies to children presented on the “Wednesday’s child” television

program, Los Ninos or other

adoption exchange publications, in which case any participation and

presentation is in accordance with the department’s rules and regulations and

with the knowledge, consent and active participation of the department.

                E.             Client information and case review:

The agency maintains records and follows policies and procedures governing the

access to, and release of, confidential information. The agency provides

adequate facilities for the storage, processing and handling of clinical

records, including suitably locked and secured rooms.

                   

(1)     The agency’s written

policies govern the retention, maintenance, and destruction of board

administrative records, and records of former clients and personnel.  These policies address:

                             

(a)     protection of the privacy

of former clients and personnel; and

                             

(b)     legitimate future requests

by former personnel or clients for information, particularly information that may not be available elsewhere.

                   

(2)     The agency has policies

governing the disposition of records, security of  records and timely access and retrieval of

records in case of the agency’s dissolution. The retention of records is

required for the later of:

                             

(a)     four years after the

client is released from treatment; or

                             

(b)     two years after the client

reaches age 18; or

                             

(c)     two years after a client

has been released from most recent legal guardianship, and is no

longer under legal guardianship.

                   

(3)     The agency specifies in

written policies and procedures how it releases information.  Any release is in accordance with applicable

state and federal laws.   The agency does

not request or use any information release form that has been signed by a

client, parent, guardian or other party prior to pertinent information being

completed on the form.

                   

(4)     In the event of a medical

emergency that warrants immediate intervention in order to protect the life or

safety of the client, access to information regarding the client’s diagnoses

and treatment plan/service plan may be provided to medical personnel.

                F.             Contents of the client record:

                   

(1)     Agency policy defines

information to be contained in the client record.  At the time of admission, the client’s date

of admission to each and any certified service is documented in a consistent

location in the client record.

                   

(2)     Agency policy and practice

provide that entries in the client record are made in an accurate, objective,

factual, legible, timely, and clinically-based manner.

                             

(a)    Entries made in the client

record pursuant to these certification requirements clearly identify the person

completing the entry and his or her credentials.

                             

(b)     Late entries are

identified as such; late entries include the actual date of the entry and the

signature of the person completing the entry.

                G.            When prescribing medication or other

treatments, the prescribing professional documents the indication for any

medical procedures and/or prescription medications.

                   

(1)     When a client is seen by

the prescribing professional, subsequent to a medical prescription or

treatment, the professional documents the response to the prescription or

treatment and any observed side

effects.

                   

(2)     Medication, including

non-prescription medication that is administered by a nurse or is self-administered,

is documented by the agency staff with the date and time of administration, the

name and dosage and any side effects observed.

                H.            A written discharge summary is

placed in the client’s record within 15 days of termination of services and

includes:

                   

(1)     clinical and safety

status;

                   

(2)     medications being taken at

discharge;

                   

(3)     documentation of

notification to primary care physician;

                   

(4)     specification of

referrals/appointments made with specific names;

                   

(5)     target behaviors

addressed;

                   

(6)     services provided;

                   

(7)     progress attained, or lack

thereof;

                   

(8)     description of

interventions to which the client did and did not respond, including

medications;

                   

(9)     recommendations for

continued treatment and services.

                I.              Client review of case record:

                   

(1)     An individual may review

his or her case record in the presence of a therapist or licensed independent

practitioner of the agency on the agency’s premises unless to do so would not

be clinically indicated. The reasons

why review is not clinically indicated are documented in the client’s record. 

The confidentiality of other individuals is protected.

                   

(2)     The agency’s policies and

procedures allow the client to insert a statement into the record about his or

her needs or about services he or she is receiving or may wish to receive.  Any agency statements or responses are

documented with evidence that the client was informed of insertion of such

responses.

[7.20.11.22 NMAC - Rp 7 NMAC 20.11.22, 03/29/02; A,

04/14/05]

 

7.20.11.23             INTAKE, ASSESSMENT, TREATMENT PLANNING, DISCHARGE PLANNING, AND DISCHARGE:

                A.            The agency establishes criteria for

admission, conducts ongoing clinical assessments, and develops, reviews,

revises treatment plans and provides ongoing discharge planning with the full

participation of the treatment team.

                B.            Clinical decisions are made only by

qualified clinical personnel.

                C.            Intake and screening:

                   

(1)     The agency establishes and

follows written criteria for admission to its program(s) and service(s),

including exclusionary criteria.

                   

(2)     The agency establishes and

follows written intake procedures to address clinical appropriateness for

admission.

                   

(3)     The agency’s eligibility

criteria are consistent with EPSDT requirements and Licensing Requirements for

Child and Adolescent Mental Health Facilities, 7.20.12 NMAC.

                D.            Assessments: The following applies

to all certified services, except case management services. Each client is

assessed at admission and reassessed at regularly specified times to evaluate

his or her response to treatment, and specifically when significant changes

occur in his or her condition or diagnosis. The assessment process is

multidisciplinary, involves active participation of the family or guardian, whenever

possible, and includes documented consideration of the client's and family's

perceptions of treatment needs and priorities. Assessment processes

include consideration of the client’s physical, emotional, cognitive,

educational, nutritional, and social development, as applicable.  At a minimum, the

following assessments are conducted and documented:

                   

(1)     An

initial screening, conducted at admission, of physical, psychological, and

social functioning, to determine the client's need for treatment, care, or

services, and the need for further assessment; and assessment of risk of

behavior that is life-threatening or otherwise dangerous to the client or

others, including the need for special supervision or intervention.

                    (2)    

A full EPSDT screen (tot-to-teen health check) within 30 days of the

initiation of services, unless such an examination has taken place and is

documented within the 12 months prior to admission. The documented content of

the history and physical examination must meet EPSDT requirements.

                   

(3)     The agency conducts a

comprehensive assessment of each client’s clinical needs.  The comprehensive assessment is completed

prior to writing the comprehensive treatment plan, and includes the following:

                             

(a)     Assessment of the client’s

personal, family, medical and social history, including:

                                       

(i)     relevant previous records

and collateral information;

                                        (ii)    relevant family and custodial history,

including non-familial custody and guardianship;

                                       

(iii)     client and family abuse

of substances;

                                        (iv)     medical history, including medications;

                                       

(v)     history, if available, as a victim of physical abuse, sexual abuse, neglect, or other

trauma;

                                       

(vi)     history as a perpetrator

of physical or sexual abuse;

                                       

(vii)     the individual’s and

family’s perception of  his or her

current need for services;

                                       

(viii)     identification of the

individual’s and family’s strengths and resources; and

                                       

(ix)     evaluation of current

mental status.

                             

(b)     A psychosocial evaluation

of the client’s status and needs relevant to the following areas, as

applicable:

                                       

(i)     psychological functioning;

                                       

(ii)    intellectual functioning;

                                       

(iii)     educational/vocational

functioning;

                                        (iv)     social functioning;

                                       

(v)     developmental functioning;

                                        (vi)    

substance abuse;

                                       

(vii)     culture; and

                                       

(viii)     leisure and recreation.

                             

(c)     Evaluation of high risk

behaviors or potential for such;

                             

(d)     A summary of information

gathered in the clinical assessment process, in a clinical formulation

that includes identification of underlying dynamics that contribute to

identified problems and service needs.

                   

(4)     If the comprehensive

assessment is completed prior to admission, it is updated at the time of

admission to each certified service.

                   

(5)     Assessment processes

include the following:

                             

(a)     within 30 days of

admission, an educational evaluation or current, age-appropriate individualized

educational plan (IEP), or documented evidence that the client is performing

satisfactorily at school;

                             

(b)     when indicated by clinical

severity, a psychiatric evaluation;

                            

 (c)     a psychological evaluation, when

specialized psychological testing is indicated;

                             

(d)     monthly updates on mental status and current level of

functioning, performed by a New

Mexico licensed master’s or doctoral level

behavioral health practitioner.

                   

(6)     Assessment information is

reviewed and updated as clinically indicated, and is documented in the client’s

record. For clients who have been in the service for one year or longer, an

annual mental status exam and psychosocial assessment are conducted and

documented in the client’s record as an addendum to previous

assessment(s).  The agency makes every

effort to obtain all significant collateral information and documents its

efforts to do so.  As collateral

information becomes available, the comprehensive assessment is amended.

                E.             Treatment planning and discharge

planning: The treatment planning process is

individualized and ongoing, and

includes initial treatment planning, comprehensive treatment planning,

discharge planning, and regular re-evaluation of treatment plans and discharge

criteria.

                   

(1)     For certified services

other than case management services and

behavior management skills development services, an initial treatment plan is

developed and documented within 72 hours of admission to each service. Based on

information available at the time, the initial treatment plan contains the

treatment planning elements identified above in 23.E (3) (a) through (j) below,

with the exception that individualized treatment goals and objectives are

targeted the first 14 days of treatment.

                   

(2)     For certified services

other than case management and

behavior management skills development services, a comprehensive treatment plan

based on the comprehensive assessment is developed within 14 days of admission.

The comprehensive treatment plan contains the treatment planning elements

identified above in 23.E (3) (a) through (j) below.

                   

(3)     Each initial and

comprehensive treatment plans fulfill the following functions:

                             

(a)     involves the full

participation of treatment team members, including  the client and his or her parents/legal

guardian, who are involved to the maximum extent possible; reasons for

nonparticipation of client and/or family/legal guardian are documented in the

client’s record;

                             

(b)     is conducted in a language

the client and/or family members can understand, or is explained to the client

in language that invites full participation;

                             

(c)     is designed to improve the

client’s motivation and progress, and strengthen appropriate family

relationships;

                             

(d)     is designed to improve the

client’s self-determination and personal responsibility;

                             

(e)     utilizes the client’s strengths;

                             

(f)     is conducted under the

direction of a person who has the authority to effect change and who possesses

the experience and qualifications to enable him/her to conduct treatment

planning; treatment plans meet the provisions of the Children’s Code, NMSA

1978, Sections 32A-6-10, as amended, and are otherwise implemented in accordance

with the provisions of Article 6 of the Children’s Code;

                             

(g)     documents in measurable

terms the specific behavioral changes targeted, including potential high-risk

behaviors; corresponding time-limited intermediate and long-range treatment

goals and objectives; frequency and duration of program-specific

intervention(s) to be used, including medications,

behavior management practices, and specific safety measures; the staff

responsible for each intervention; projected timetables for the attainment of

each treatment goal; a statement of the nature of the specific problem(s) and

needs of the client; and a statement and rationale for the plan for achieving

treatment goals;

                             

(h)     specifies and incorporates

the client’s permanency plan, for clients in the custody of the department;

                             

(i)     provides that clients with

known or alleged history of sexually inappropriate behavior, sexual aggression

or sexual perpetration are adequately supervised so as to ensure their safety

and that of others; and

                             

(j)     documents a discharge plan

that:

                                       

(i)     requires that the client

has achieved the objectives of the treatment plan;

                                       

(ii)     requires that the

discharge is safe and clinically appropriate for the client;

                                       

(iii)     evaluates high risk

behaviors or the potential for such;

                                        (iv)     explores options for alternative or

additional services that may better meet the client’s needs;

                                       

(v)     establishes specific

criteria for discharge to a less restrictive setting; and

                                       

(vi)     establishes a projected

discharge date, which is updated as clinically indicated.

                   

(4)     For residential treatment

services and group home services, the comprehensive treatment plan also

includes the following elements: a statement of the least restrictive

conditions necessary to achieve the purposes of treatment, and an evaluation of

the client’s cultural needs and provision for access to cultural practices,

including culturally traditional treatment.

                   

(5)     For case management

services, a service plan is developed and written within 30 days of the

initiation of services (see 26.F.1).

                   

(6)     For behavior management

skills development services, a service plan is developed within 14 days of

initiation of services (see 28.C (1) (c).

                F.             The

treatment plan is reviewed by the treatment team at intervals not to exceed 30

days and is revised as indicated by changes in the child’s behavior or situation,

the child’s progress, or lack thereof.

                   

(1)     Each treatment plan review

documents assessment of the following, in measurable terms:

                             

(a)     progress, or lack thereof,

toward each treatment goal and objective;

                             

(b)     progress toward and/or

identification of barriers to discharge;

                             

(c)     the client’s response to

all interventions, including specific

behavioral interventions;

                              (d)     the client’s response to  medications;

                             

(e)     consideration of

significant events, incidents, and/or safety issues occurring in the period

under review;

                             

(f)     revisions of  goals, objectives, and interventions, if

applicable;

                             

(g)     any change(s) or updates

in diagnosis, mental status or level

of functioning;

                             

(h)     the results of any

referrals and/or the need for

additional consultation;

                             

(i)     the effectiveness of

behavior-management techniques used in the period under review.

                   

(2)     Some or all of the

required elements of a treatment planning document may be recorded in a

document other than the treatment plan/review, such as a clinical review form

or format provided by, or to a payor, when the following conditions are met:

                             

(a)     all required elements are

performed and documented in a timely manner by qualified clinical personnel;

                             

(b)     the client’s record

contains evidence of participation of treatment team members in each phase of

the treatment planning process.

                G.            When aftercare is indicated at the

time of non-emergency discharge, the agency involves the client, case manager

(if applicable), the parent, legal guardian, or guardian ad litem, if

applicable; and assists the client, family, or guardian in arranging

appointments, obtaining medication (if applicable), transportation and meeting

other identified needs as documented in the treatment/discharge plan.

                H.            Prevention, planning, and processing

of emergency discharge:

                   

(1)     The agency establishes

policies and procedures for management of a child who is a danger to

him/herself or others or presents a likelihood of serious harm to him/herself

or others.  The agency acts immediately

to prevent such harm. At a minimum, the policies and procedures provide that

the following be documented in the client’s file:

                             

(a)     that the agency makes all

appropriate efforts  to manage the

child’s behavior prior to proposing emergency discharge;

                             

(b)     that the agency takes all appropriate

action to protect the health and safety of other children and staff who are

endangered.

                   

(2)     In the event of a proposed

emergency discharge, the agency provides, at a minimum, procedural due process

including written notice to the family/legal guardian, guardian ad litem and

department, if applicable, and provision to stop the discharge action until the

parent/legal guardian, guardian ad litem and/or the department exhausts any

other legal remedy they wish to pursue. 

The agency documents the following in the client record:

                             

(a)     provision for

participation of the parent/legal guardian, and guardian ad litem in the

discharge process, whenever possible; and

                             

(b)     arrangement for a conference to be held

including all interested persons or parties to discuss the proposed discharge,

whenever possible.

                   

(3)     If the child’s

parent/legal guardian is unavailable to take custody of the child and immediate

discharge of the child endangers the child, the agency does not discharge the

child until a safe and orderly discharge is effected.  If the child’s family refuses to take

physical custody of the child, the agency refers the case to the department.

                I.              Discharge: Non-emergency discharge

occurs in accordance with the client's discharge plan, unless precipitated by a

client's or guardian's refusal to consent to further treatment, or other

unforeseen circumstances.  Prior to

discharge, the agency:

                    (1)     evaluates the appropriateness of release

of the client to the parent/legal guardian;

                    (2)     provides that any discharge of the client

occurs in a manner that provides for a safe and orderly transition; and

                    (3)     provides for adequate pre-discharge

notice, including specific reason for discharge.

[7.20.11.23 NMAC - Rp 7 NMAC 20.11.23, 03/29/02]

 

7.20.11.24             BEHAVIOR MANAGEMENT, PERSONAL

RESTRAINT, AND SECLUSION PRACTICES: 

Certain provisions of this section are included to implement regulations

of the federal centers for medicare and medicaid services (CMS) and may be

amended when appropriate to reflect subsequent changes in the federal CMS

regulations.  These provisions are

intended to implement, and to be consistent with the Child Health Act of 2000

and the CMS Interim Final Rule issued May 22, 2001, and are subject to further

modifications as dictated by CMS.

                A.            The agency protects and promotes the

rights of each client in the program, including the right to be free from

physical or mental abuse, corporal punishment, and any personal restraint or

seclusion imposed for purposes of discipline or convenience.  The agency establishes and follows policies

and procedures governing the use of behavior management practices including

therapeutic hold, personal restraint and seclusion (when allowed as delineated

below). This will include documentation of each therapeutic hold, personal

restraint and seclusion in the client’s record.

                B.            For those behavior management

practices that are allowed for each type of program and are described above,

the program supports their limited

and justified use through:

                   

(1)     staff orientation and

education that create a culture emphasizing prevention of the need for

therapeutic hold, personal restraint and seclusion and their appropriate use;

                   

(2)     assessment processes that

identify and prevent potential behavioral risk factors; and

                   

(3)     the development and promotion

of preventive strategies and use of less restrictive alternatives.

                C.            Agency policy and procedures

identify qualified staff authorized to approve the protocols and apply the

criteria for use of therapeutic hold, personal restraint and seclusion.

                D.            Performance-improvement processes

identify opportunities to reduce or eliminate the use of personal restraint or

seclusion.

                E.             The agency establishes and follows

policies and procedures for the safe, effective, limited, and least restrictive

use of behavior management practices. 

The policies and procedures include measures to ensure that treatment

planning includes regular review of the necessity for, type and frequency of

behavior management practices used in individual cases.

                F.             When behavior management practices

are used, the agency protects the safety, dignity, and privacy of clients to

the maximum extent possible at all times during each procedure.

                G.            Treatment plans document the

use of seclusion, personal restraint and therapeutic holds and include:

consideration of the client’s medical condition(s); the role of the client’s

history of trauma in his/her behavioral patterns; the treatment team’s

solicitation and consideration of specific suggestions from the client regarding prevention of future physical

interventions.

                H.            Seclusion, personal restraint

and therapeutic holds are implemented only by staff who have been trained and

certified by a state recognized body in the prevention and use of therapeutic

holds, personal restraint and seclusion. This training emphasizes de-escalation

techniques and alternatives to physical contact with clients as a means of

managing behavior.  Clients do not

participate in the therapeutic holding, personal restraint or seclusion of

other clients.

                I.              Mechanical and chemical restraints

are prohibited in all programs except the program created under the Adolescent

Treatment Hospital Act, which has been mandated by NMSA 1978 Sections 23-9-1

et.seq., to serve adolescents who are violent or have a history of violence, and

which provides 24-hour on-site professional medical services in accordance with

Section 3207 of the Children’s Health Act of 2000.

                J.             Personal restraint and seclusion,

as defined in these certification requirements, are used in JCAHO-accredited or

non-JCAHO-accredited residential treatment centers and group homes; in

emergency circumstances to ensure the immediate physical safety of the client,

other clients, staff member(s) or others; and when less restrictive

interventions have been determined to be ineffective. Personal restraint and

seclusion are used in accordance with these provisions and with federal law,

rule or regulation which may supersede state or accreditation regulations.  Personal restraint and seclusion are imposed

only by an individual trained and certified by a state-recognized body in the

prevention and use of personal restraint and seclusion and in the curriculum

that may be set forth in federal regulations to be promulgated under Title V of

the Public Health Service Act (42 U.S.C. 290aa et seq. as amended by section

3208, Part I, section 595).  When federal

regulations are promulgated under Title V as described above, the curriculum

set forth there shall be included in the training.

                K.            Physical escort is allowed as a safe

means of moving a client to a safe location.

                L.             Personal restraint or seclusion are

not to be used for staff convenience and/or as coercion, discipline, or

retaliation by staff.

                M.           This sub-section (M) applies, for

personal restraint, to facilities accredited by JCAHO, and to all residential

treatment centers for seclusion.  These

entities require orders that are consistent with Department regulation, agency

policy, and regulations of the centers for medicare and medicaid services (CMS)

42 CFR, Parts 441 and 483.  These orders

are issued by a restraint/seclusion clinician within one hour of initiation of

personal restraint or seclusion, and include documented clinical justification

for the use of personal restraint or seclusion.

                   

(1)     If the client has a

treatment team physician and he or she is available, only he or she can order

personal restraint or seclusion.

                   

(2)     If personal restraint or

seclusion is ordered by someone other than the client’s treatment team

physician, the restraint/seclusion clinician will consult with the client’s

treatment team physician as soon as possible and inform him or her of the

situation requiring the client to be restrained or placed in seclusion and

document in the client’s record the date and time the treatment team physician

was consulted and the information imparted.

                   

(3)     The restraint/seclusion

clinician must order the least restrictive emergency safety intervention that

is most likely to be effective in resolving the situation.

                   

(4)     If the order for personal

restraint is verbal, the verbal order must be received by a restraint/seclusion

clinician or a New Mexico licensed registered nurse (RN) or practical nurse

(LPN).  The restraint/seclusion clinician

must verify the verbal order in a signed, written form placed in the client’s

record within 24 hours after the order is issued.

                   

(5)     A restraint/seclusion

clinician’s order must be obtained by a restraint/seclusion clinician or New

Mexico licensed RN or LPN prior to or while the personal restraint or seclusion

is being initiated by staff, or immediately after the situation ends.

                   

(6)     Each order for personal

restraint or seclusion must be documented in the client’s record and will

include:

                             

(a)     the name of the

restraint/seclusion clinician ordering the personal restraint or seclusion;

                             

(b)     the date and time the

order was obtained;

                              (c)     the emergency safety intervention ordered,

including the length of time;

                             

(d)     the time the emergency

safety intervention actually began and ended;

                             

(e)     the time and results of

any one-hour assessment(s) required; and

                             

(f)     the emergency safety

situation that required the client to be restrained or put in seclusion; and

                             

(g)     the name, title, and credentials

of staff involved in the emergency safety intervention.

                   

(7)     Supervision and assessment

of personal restraint or seclusion

                             

(a)     The restraint/seclusion

clinician must be available to staff for consultation, at least by telephone,

throughout the period of the emergency safety intervention.

                             

(b)     A New Mexico registered

nurse or a restraint/seclusion clinician other than a doctoral level

psychologist, must conduct a face-to-face assessment of the physical well being

of the client within one hour of the initiation of the emergency safety

intervention and immediately after the personal restraint is removed or the

client is removed from seclusion.  A

restraint/seclusion clinician or a New Mexico registered nurse must conduct a

face-to-face assessment of the psychological well being of the client within

one hour of the initiation of the emergency safety intervention and immediately

after the personal restraint is removed or the client is removed from

seclusion. When the personal restraint or seclusion is less than one hour in

duration, and the restraint/seclusion clinician is not immediately available at

the end of the period of restraint or seclusion, the restraint/seclusion

clinician will evaluate the client’s well-being as soon as possible after the

conclusion of the restraint/seclusion, but in no case later than one hour after

its initiation.

                             

(c)     If the situation requiring

emergency safety intervention continues beyond the time limit of the order for

the use of personal restraint or seclusion, the New Mexico RN or LPN must

immediately contact the ordering restraint/seclusion clinician or the client’s

treatment team physician to receive further instructions.  If clinical circumstances justify renewal of

personal restraint or seclusion, then the renewal order must be obtained within

the time frames outlined in 24.O (1) below.

                N.            This sub-section (N) applies to

personal restraint in residential treatment services not accredited by

JCAHO.  In these residential treatment

services, personal restraint requires the following, which is consistent with

department regulation and agency policy.

                   

(1)     A New Mexico licensed

independent practitioner, licensed professional mental health counselor (LPC),

licensed master social worker (LMSW), or registered nurse must be available to

staff for consultation, at least by telephone, throughout the period of the

emergency safety intervention.

                   

(2)     A New Mexico licensed

independent practitioner, or a licensed professional mental health counselor

(LPC), licensed master social worker (LMSW), in consultation with a licensed

independent practitioner, or a registered nurse trained in the use of emergency

safety interventions must conduct a face-to-face assessment of the well-being

of the client within one hour of the initiation of the emergency safety

intervention and immediately after the personal restraint is removed or the

client is removed from seclusion. When the personal restraint or seclusion is

less than one hour in duration, and the restraint/seclusion clinician is not

immediately available at the end of the period of restraint or seclusion, the

restraint/seclusion clinician will evaluate the client’s well-being as soon as

possible after the conclusion of the restraint/seclusion, bu in no case later

than one hour after its initiation.

                O.            The

following sub-section (O) applies to all residential treatment centers and group

homes.

                   

(1)     The personal restraint or

seclusion is limited to a maximum of two hours for clients age of 17 and one

hour for clients under nine years of age.

                   

(2)     Post-intervention

debriefings with the client will take place after each emergency safety

intervention and the staff will document in the client’s record that the

debriefing sessions took place.

                   

(3)     The agency will have

affiliations or written transfer agreements in effect with one or more

hospitals approved for participation under the medicaid program that reasonably

ensure that:

                             

(a)     A client will be

transferred from the facility to the hospital and admitted in a timely manner

when a transfer is medically necessary for medical care or acute psychiatric

care;

                             

(b)     Medical and other

information needed for care of the client in light of such transfer will be

exchanged between the organizations in accordance with state medical privacy

law, including any information needed to determine whether the appropriate care

can be provided in a less restrictive setting; and

                             

(c)    Services will be available

to each client 24 hours a day, seven days a week.

                   

(4)     The agency will document

in the client’s record all client injuries that occur as a result of an

emergency safety intervention.

                   

(5)     All agencies will attest

in writing that the facility is in compliance with CMS standards governing the

use of personal restraint and seclusion. 

This attestation will be signed by the agency director.

                   

(6)     If the client is a minor,

the agency will notify the parent(s) or legal guardian(s) that personal

restraint or seclusion has been ordered as soon as possible after the

initiation of each emergency safety intervention. This will be documented in

the client’s record, including the date and time of notification, the name of

the staff person providing the notification, and who was notified.

                   

(7)     Agencies will provide for

client health and safety by requiring direct service staff to demonstrate

competencies related to the use of emergency safety interventions on a

semiannual basis.  Direct service staff

will demonstrate, on an annual basis, their competency in the use of

cardiopulmonary resuscitation.  The

agency will document in the staff personnel records that the training required

was successfully completed.

                    (8)    

The agency must maintain an aggregate record of all situations requiring

emergency safety intervention, the interventions used and their outcomes.

                   

(9)     Programs must report the

death of any client to the CMS regional office by no later than close of

business the next business day after the client’s death.  The report must include the name of the

client and the name, street address and telephone number of the agency.  The parent or legal guardian will also be

notified.  Staff must document in the

client’s record that the death was reported to the CMS regional office.

[7.20.11.24 NMAC - N, 03/29/02]

 

7.20.11.25             MEDICATIONS:

                A             The agency establishes and follows

policies and procedures governing the storage, handling, use, administration

and disposal of all medications that are consistent with applicable laws,

regulations, and accepted professional practices.

                B.            Prescription orders are verified and

individuals are identified before medications are administered or self-administered.

                C.            Medications are administered only by

qualified, licensed medical staff, or are self-administered by the client with

supervision of staff who have been trained in assisting with

self-administration.

                D.            Policies and procedures support

self-administration of medications. Staff trained in these procedures provide

supervision of self-administration of medications and document the time

the medications are taken, the side effects observed, and client response, as well as any medications refused or

held.  When medications are

self-administered by clients, a staff member may hold the container for the

client and/or assist with opening the container, but may not place the

medication in the client’s hand or mouth.

                E.             The agency has controls in place

for locked storage of medication and for access by authorized personnel.

                F.             The agency has controls in place to

ensure that medications are properly labeled with name of person served,

dosage, name of medication, name of prescribing physician, and number or code

identifying the written order.

                G.            The agency has controls in place for

the destruction of out-of-date medications and proper disposal of unused

medication and syringes.

                H.            When adverse or unusual conditions

are observed, appropriate consultation and/or medical response must be sought

in a timely manner.

                I.              Medication monitoring may include

input from various disciplines and the client and family.  This information is used to maintain and

improve the outcomes of medication therapy while minimizing any drug-related

problems or adverse effects.

                J.             When medications that

require periodic testing of drug levels are used, such laboratory test results

are accurately recorded in the client record, as applicable.

                K.            The physician documents in

the client record the indication for, response to, and the potential and

observed side effects of any prescription medication(s).

[7.20.11.25 NMAC - Rp 7 NMAC 20.11.30.2, 03/29/02]

 

7.20.11.26             COMPREHENSIVE COMMUNITY SUPPORT SERVICES:

                A.            Comprehensive community support services

(CCSS) shall coordinate and provide necessary services and resources to

eligible clients and families to promote recovery, rehabilitation and

resiliency.

                B.            These culturally sensitive services

shall identify and address the barriers that impede the development of skills

necessary for independent functioning in the community as well as strengths,

goals and measurable objectives, which may aid the client or family in the

recovery or resiliency process.

                C.            CCSS shall address goals as

identified by the client or family specifically to meet recovery and resilience

based outcomes in the areas of independent living, learning, working,

socializing and recreation.

                D.            CCSS shall be provided to children,

youth and adults with significant behavioral health disorders and who meet

other criteria as identified by the collaborative.

                E.             CCSS shall be provided in

compliance with the medical assistance division (MAD) definition of medical

necessity and shall be furnished within the MAD benefits.

                F.             CCSS shall be furnished within the

scope and practice of the provider’s respective profession as defined by state

law, and in accordance with applicable federal, state and local laws and

regulations.

                G.            An assessment of baseline

functioning shall be performed within 10 working days of the client’s admission

into CCSS services. The assessment shall evaluate and document the client’s

specific functional effectiveness in multiple skill domains based on the

desired outcomes of the client or family.

                   

(1)    Functional level

determination  shall identify domains in

which functional limitations precipitated by the behavioral health disorder are

present. The diagnoses and assessments shall be the basis for the comprehensive

client or family driven goal directed, measurable service plan

                   

(2)     CCSS eligible clients

shall have one designated agency that will have the primary responsibility of

partnering with the client and family for the purpose of implementing the

comprehensive service plan.

                H.            Within the CCSS agency, a primary

community support worker (CSW), under the documented supervision of the CCSS

supervisor, shall be identified on the comprehensive service plan and shall

partner with the client and family for the purpose of coordinating and

facilitating recovery and resiliency directed team meetings. The CCSS

supervisor shall sign, with name, credentials, and date, the initial service

plan indicating that he has reviewed and approved the comprehensive service

plan and each revision as it occurs.

                I.              Community support activities and

relevant providers shall be clearly identified in the comprehensive service

plan. The primary CSW shall coordinate the service plan without duplication by

the other service providers. The CCSS comprehensive service plan shall be

completed no later than 30 calendar days of the client’s admission into CCSS

services and specify recovery and resiliency strategies to include:

                   

(1)     the community support(s)

and any other rehabilitative and treatment interventions needed for the client

to achieve his specified service goals and to meet recovery and resiliency

outcomes;

                   

(2)     the CCSS staff responsible

for each recovery and resiliency intervention and the frequency of the planned

interventions;

                   

(3)     the client’s relevant

diagnoses and other risk factors that place him at risk of further diagnoses;

                   

(4)     measurable goals and

objectives identified by the client and family as their comprehensive service

plan priorities to meet desired recovery and resiliency outcomes;

                   

(5)     a recovery/ resiliency

management plan;

                   

(6)     a crisis management plan

to address after-hours crisis situations including actions to be taken by

client, family and natural supports;

                   

(7)     potential service plan

barriers and applicable strategies; and

                   

(8)     if requested, advanced

directives related to client’s behavioral healthcare.

                J.             CCSS shall  include the development of crisis plan

interventions, as defined in an individual crisis plan, as a component of

overall CCSS comprehensive service plan. 

If the client has or requests an advance directive, the crisis plan may

be incorporated into the advance directive. The individualized crisis plan

shall support the client and family in the management of crisis situations

outside of regular business hours to develop or enhance the client’s ability to

make informed and independent choices.

                   

(1)     the crisis plan shall

include the following requirements, which shall be formulated on admission to

CCSS by the CCSS team, client, family, legal guardian and other interested

parties.

                             

(a)     Risk assessment: Specify a

process to assess potential risk and specify an algorithm of community

resources to address by risk level that ranges from immediate (i.e. 911 or

first responders) to intermediate (e.g. call to crisis line) to moderate (call

for a clinic appointment).Specify a process to identify benchmarks that

indicate when a crisis is appropriate reconciled.

                             

(b)     Client/family education:

Provide the client and family education on community resources to be accessed

during crisis situations.  Each family

and client shall be provided basic verbal communication techniques to help

de-escalate a potential crisis situation.

                             

(c)     Internal

communication:  Crisis events are

discussed in the CCSS team meeting to ensure all risk factors are identified

and known by all team members.

                             

(d)     Face-to-face assessment:

CCSS team member shall make a face-to-face visit as soon as possible, but no

more than 48 hours after notification of a crisis, and complete an updated

assessment for presentation to the team.

                             

(e)     Research past crisis

situations for antecedent, precipitant, and consequent behaviors and discuss

with the client or family to identify strategies or objectives likely to

prevent crises.

                             

(f)     Identify alternative

interventions that may be initiated during crisis situations, including

pre-crisis or crisis instructions identified by the client or family.

                             

(g)     Incorporate client and

family outcomes as benchmarks or measures of when the crisis is over.

                             

(h)     Revise crisis plan over

time based on newly identified triggers and what is known to be effective.

                             

(i)     Document behavioral

benchmarks (e.g., number of runs, self-injury, assaults, etc., and what

worked).

                   

(2)   The negotiated crisis plan

shall triage for differing levels of intensity and severity of crisis events

and may identify other types of interventions that may include:

                             

(a)     residential services for

stabilization;

                             

(b)     crisis respite services;

                         

    (c)     wrap around services;

                             

(d)     increased family and

community support specialist capacity to manage crisis situations;

                             

(e)     activation of advance

directive instruction; and

                              (f)     utilization of emergency room (ER) and

other emergency response supports.

                K.            Every 90 days after implementation

of the comprehensive service plan, the CCSS team, in partnership with the

client and family, shall track and provide detailed documentation demonstrating

progress made over time relating to the CCSS service goals, objectives and

client/family designated recovery or resiliency outcomes. These shall be

documented in the service plan updates with modifications made based upon

barriers identified or redefined goals and objectives and future needs.

                L.             The follow up assessment shall

document the current status of the client and family designated measurable

recovery or resiliency functional outcomes.

                M.           Individualized CCSS interventions

shall address the following objectives, as indicated in the assessment and

comprehensive service plan:

                   

(1)   community services and

resources available to support the client’s achievement of his functional CCSS

service goals and objectives;

                   

(2)   assistance in the

development of interpersonal, community coping and functional skills (i.e.,

adaptation to home, school and work environments), utilizing evidence-based

practices to support the skills development in the following domains:

                             

(a)     socialization skills;

                             

(b)     developmental issues as

identified in the assessment;

                             

(c)     daily living skills;

                              (d)     school and work readiness activities; and

                             

(e)     education and management

of co-occurring illness;

                   

(3)     facilitating the

development and eventual succession of natural supports in the workplace,

housing/home, and social and school environments;

                   

(4)     provision of client and

family education as appropriate regarding:

                             

(a)     self-management of symptom

monitoring, illness management, and recovery and resiliency skills;

                             

(b)     relapse prevention skills;

                             

(c)     knowledge of medication

and potential side effects;

                             

(d)     motivational and skill development

in taking medication as prescribed;

                             

(e)     ability to identify and

minimize the negative effects of symptoms which potentially interfere with the

client’s activities of daily living; and

                           

  (f)     as indicated, supports to the client to

maintain employment and school or community tenure;

                   

(5)     facilitating the client’s

abilities to obtain and maintain stable housing;

                   

(6)     any necessary follow-up by

the CSW to determine if the services accessed have adequately met the client’s

needs.

                N.            Cultural competence shall be

demonstrated by the CCSS provider through the agency’s policies, procedures,

training, outreach and advocacy efforts, and throughout the array of service

delivery framework.

                O.            The CCSS provider shall demonstrate

through a documented internal quality monitoring process that on average (60%

or more) of CCSS services are delivered face-to-face and in vivo (where client

is in the community).

                P.             The CSW shall provide routine

follow-up to determine if the services accessed have adequately met the

client’s rehabilitative, recovery, resiliency, and treatment needs and document

findings.

                Q.            CCSS shall be offered at convenient

times and locations to meet the needs of the client and family; the CCSS

provider will actively work to eliminate language, financial, and other

barriers to service.

                R.            For clients and their families: The

CSW shall make every effort to engage and partner with the client and family in

achieving rehabilitative, recovery, and resiliency goals. Barriers to engaging

the client or achievement of the service goals will be identified and utilized

to amend the service plan interventions.

                S.             When CCSS is provided by a

certified peer or family specialist, CCSS functions shall be performed with a

special emphasis on recovery and resiliency values and process, such as:

                   

(1)    empowering the client to

have hope for, and participate in, his own recovery;

                    (2)   

assisting the client to identify strengths and needs related to

attainment of independence in terms of skills, resources and supports, and to

use available strengths, resources and supports to achieve independence;

                   

(3)    assisting the client to identify and achieve

his personalized recovery and resiliency goals; and

                   

(4)    promoting the client’s

responsibility related to illness self-management.

                T.            CCSS shall be subject to the

limitations and coverage restrictions as defined by 8.315.6 NMAC, Comprehensive

Community Support Services.

                U.            Behavior management skills

development service (BMS) interventions are distinct and different from CCSS

and shall not be considered to be CCSS.

                V.            Eligible

providers: CCSS shall be delivered by a certified mental health agency.

                   

(1)    The agency shall be a

legally recognized entity in the United States, qualified to do business in New

Mexico, and shall meet standards established by the state of New Mexico or its

designee, and requirements of the funding source.

                   

(2)    CCSS shall be provided in

the following type of entities:

                             

(a)     federally qualified health

center (FQHC);

                          

   (b)     Indian health service (IHS) hospital or

clinic;

                             

(c)     tribal-638 hospital or

clinic;

                             

(d)     community mental health

center

                             

(e)     core service agency (CSA);

or

                             

(f)     an agency otherwise

certified as a CCSS agency by New Mexico children, youth and families

department (CYFD) or New Mexico department of health (DOH)

                   

(3)    Eligible clients who are 18

through 20 years of age may be served by an agency certified for CCSS by CYFD

or DOH, as indicated.

                W.           Staff

qualifications: Clinical services and supervision by licensed behavioral

health practitioners shall be in accordance with their respective licensing board

regulations.

                   

(1)     Minimum staff

qualifications for the CSW:

                             

(a)     shall be a minimum of 18

years of age; and

                             

(b)     shall hold a bachelor’s

degree in a human service field from an accredited university and one (1) year

relevant experience working with the target population; or

                             

(c)     shall hold an associate’s

degree in a human service field from an accredited college and have a minimum

of two (2) years of experience working with the target population; or

                             

(d)     shall be a high school

graduate or have a general education development (GED) and shall have a minimum

of three years of experience working with the target population; or

                             

(e)     shall be certified as a

certified peer specialist (CPS) or certified family specialist (CFS).

                   

(2)     Minimum staff

qualifications for the CCSS program supervisor:

                              (a)     shall hold a bachelor’s degree in human

services field from an a accredited university;

                             

(b)     shall have a four (4)

years relevant experience working with the target population; and

                              (c)     shall have one year demonstrated

supervisory experience.

                   

(3)     Minimum staff

qualifications for the clinical supervisor (The clinical supervisor and the

CCSS program supervisor may be the same individual):

                              (a)     shall be a licensed independent

practitioner (i.e., psychiatrist, psychologist, LISW LPCC, LMFT,

psychiatrically certified CNS) practicing within the scope of their New Mexico

licensure;

                             

(b)     shall have one year

documented supervisory experience; and

                             

(c)     shall provide documented

clinical supervision on a regular basis to the CSW, CPS and CFS.

                   

(4)     Minimum staff

qualifications for CPS:

                              (a)     shall be a minimum of 18 years of age;

                             

(b)     shall have a minimum  of high school diploma or GED;

                             

(c)     shall be self-identified

as a current or former consumer of mental health or substance abuse services

and have at least one year of mental health or substance abuse recovery; and

                             

(d)     shall have received

certification as CPS.

                   

(5)     Minimum staff qualifications

for CFS:

                             

(a)     shall be a minimum of 18

years of age;

                             

(b)     shall have a minimum  of high school diploma or GED;

                             

(c)     shall have personal

experience navigating any of the child-family-serving systems or advocating for

family members who are involved with the behavioral health systems; shall have

an understanding of how these systems operate in New Mexico;

                             

(d)     if the individual is a

current or former consumer, he shall be well- grounded in his symptom

self-management; and

                             

(e)     shall have received

certification as a CFS.

                X.            Staff

training requirements:

                   

(1)     The minimum CCSS staff

training completed for all CSWs shall be documented in the personnel record and

include:

                             

(a)    an initial training

comprised of 20 hours of documented training or education drawn from an array

of the following areas, to be completed within the first 90 days of employment

as a CSW:

                                       

(i)    clinical and psychosocial

needs of the target population, including cultural competency with regard to

race, religion, national origin, sex, physical disability and other community-

specific characteristics;

                                       

(ii)     psychotropic medications

and possible side effects;

                                       

(iii)     drugs of abuse and

related symptoms;

                                       

(iv)     crisis management;

                                       

(v)     principles of recovery,

resiliency and empowerment;

                                       

(vi)     ethical and cultural

considerations;

                                       

(vii)     community resources and

services, including pertinent referral criteria;

                                       

(viii)     client and family

support networking;

                                        (ix)     mental health or developmental disabilities

code;

                                       

(x)     children’s code;

                                       

(xi)    client and family centered

practice;

                                       

(xii)     behavioral management;

                                       

(xiii)     treatment and discharge

planning with an emphasis on recovery and crisis planning.

                             

(b)     documentation of ongoing

training is required and maintained in the personnel record and comprised of 20

hours per year, commencing after the first year of hire, with content of the

education based upon agency assessment of staff’s needs. Such assessment shall

be monitored and documented through the agency’s continuous quality improvement

program and annual plan.

                   

(2)     Minimum staff training

requirements for supervisors shall be documented in the personnel record and

include:

                             

(a)     the same 20 hours of

documented training or continued education as required for the CCSS CSW;

                             

(b)     a minimum of eight hours

of training specific to supervisory activities; and

                             

(c)     documentation of ongoing

training comprised of 20 hours is required of a CCSS supervisor every year,

commencing after the first year of hire, with content of the education based

upon agency assessment of staff’s needs. Such assessment shall be monitored and

documented through the agency’s continuous quality improvement functions.

                Y.            Case

loads:

                   

(1)     Caseloads, on average,

shall not exceed a ratio of 1:20 (one CSW to 20 clients receiving CCSS).

                   

(2)     Clients participating in

medication management as the primary focus of service are not subject to the

client- staff ratio.

                   

(3)     CSW caseloads, of client

to staff ratio of 1:20 on average, shall be monitored and documented through

the agency’s internal continuous quality improvement program through defined

periodic review activities such as peer chart reviews to ensure the agency is

in caseload compliance. The agency will implement timely corrective action when

it is identified that staff ratio averages are not in compliance.

                    (4)    

Detailed case notes document all CCSS service intervention activities

and locations of services provided for each service span delivered and include

the CCSS worker’s name, credential and date of the service delivery.

                Z.            Documentation

requirement:

                   

(1)     The CCSS provider shall be

responsible for consistent documentation of all service delivery. Each service

delivery case note shall include but not be limited to:

                             

(a)     date of service;

                              (b)     service location;

                             

(c)     duration of service span

(e.g., 1:00-2:00pm);

                             

(d)     description of the service

provided with reference to the comprehensive service plan and related service

goal and objective; and

                             

(e)     the client’s name, and

signature and credential of the individual delivering the service.

                                       

(i)    All CCSS file documentation

shall be legible.

                                       

(ii)    All CCSS service delivery

shall be consistent with the service definition requirements.

                   

(2)     CCSS comprehensive service

plan and service delivery documentation shall be internally monitored through

the agency’s continuous quality improvement functions at least quarterly to

ensure compliance with all of the certification requirements.

[7.20.11.26 NMAC - Rp 7 NMAC 20.11.25, 03/29/02; A,

12/31/08]

 

7.20.11.27             DAY TREATMENT SERVICES:

                A.            Day treatment services as defined

herein are provided in a school or other community setting and are distinct

from partial hospitalization services provided

in a psychiatric hospital.  Education

services are provided through the public school system or through a New Mexico

accredited private school in coordination with the day treatment services.

                B.            Personnel:

                   

(1)     Direct service staff may

be unlicensed or uncertified paraprofessionals such as teacher aides, mental

health workers, psychiatric technicians or similar direct service workers. At

least one staff member who has received all training required in 27.B (a)

through (f) is present during program hours. The direct service staff receives

documented clinical supervision for a minimum of two hours per month.  The agency’s direct service staff must have

at least a high school education or GED and 20 hours of documented pre-service

training, including, but not limited to crisis management/intervention,

behavior management, and emergency procedures, that include current CPR and

first aid certificates. Within 90 days of hire, the staff will receive an

additional 20 hours of documented training, including but not be limited to:

                             

(a)     etiology and symptoms of

emotional disturbances and neurobiological disorders;

                             

(b)     family systems;

                             

(c)     basic communication and

problem solving skills;

                             

(d)     child and adolescent

development;

                             

(e)     issues related to ethnic and cultural considerations of

the clients served; and

                             

(f)     action and potential side

effects of medications.

                    (2)     Clinical director:

                             

(a)     Clinical director

qualifications: The clinical director possesses one of the following New Mexico

licenses; physician (physicians must be board-certified in psychiatry or

eligible to attain such certification), psychologist, licensed independent

social worker (LISW), licensed master social worker (LMSW), clinical nurse

specialist in child psychiatric nursing, registered nurse (RN) with a master’s

degree in psychiatric nursing, licensed professional clinical mental health

counselor (LPCC), licensed marriage and family therapist (LMFT), or licensed

independent school psychologist.

                             

(b)     In addition to having one

of the above licenses, the clinical director is required to have a minimum of

two years of experience in clinical practice with children, adolescents and

families.

                             

(c)    Clinical director

responsibilities: The responsibilities of the clinical director are to provide

clinical oversight of the services, as well as to provide supervision, support,

and consultation to all agency direct service staff.

                   

(3)     Clinical supervisor:

                             

(a)     Clinical supervisor

qualifications: The clinical supervisor possesses one of the following New

Mexico licenses: physician (physicians must be board-certified in psychiatry or

eligible to attain such certification), psychologist, licensed independent

social worker (LISW), clinical nurse specialist in child psychiatric nursing,

registered nurse (RN) with a master’s degree in psychiatric nursing, licensed

professional clinical mental health counselor (LPCC), licensed marriage and

family therapist (LMFT), or licensed independent school psychologist.

                              (b)     In addition to having one of the above

licenses, the clinical supervisor is required to have a minimum of two years of

experience in clinical practice with children, adolescents and families.

                   

(4)     Therapist: Therapist

qualifications: The therapist possesses one of the following New Mexico

licenses:  Physician (physicians must be

board-certified in psychiatry or eligible to attain such certification),  psychologist, licensed independent social

worker (LISW), licensed master social worker (LMSW), clinical nurse specialist

in child psychiatric nursing, registered nurse (RN) with a master’s degree in

psychiatric nursing, licensed professional clinical mental health counselor

(LPCC), licensed marriage and family therapist (LMFT), licensed independent

school psychologist, licensed professional mental health counselor (LPC),

licensed professional art therapist (LPAT), licensed entry level school

psychologist, or licensed mental health counselor (LMHC).

                C.            Services:

                    (1)     Assessment and treatment planning conform

to Section 23 of these certification requirements.

                   

(2)     The agency provides

adequate care and continuous supervision of the client at all times in

accordance with the client’s developmental and clinical needs.

                   

(3)     The structured program of

care is scheduled for a minimum of four hours per day, two to five days per

week based on the acuity and the clinical needs of the client and family. The

agency provides the following, pursuant to the client’s treatment plan:

                             

(a)     individual, family, group

or other therapy, in whatever combination is appropriate to meet the needs of

the client;

                             

(b)     other services as provided in the treatment plan;

                             

(c)     development of life skills activities;

                             

(d)     crisis intervention;

                             

(e)     therapeutic recreation,

when indicated by the child’s needs;

                             

(f)     documentation of services

provided, and of the client’s progress or lack thereof on each day that service is

provided.

                   

(4)     The agency documents that:

                              (a)     the child has access to the appropriate

educational services;

                             

(b)     the child has

opportunities for involvement in community, social, athletic and recreational

programs;

                            

 (c)     the child has opportunities to pursue

personal, ethnic or cultural interests; and

                             

(d)     advance schedules are

posted for structured and supervised activities which include individual, group

and family therapy, and other planned activities appropriate to the age,

behavioral and emotional needs of the client

pursuant to the treatment plan.

                   

(5)     The agency maintains a

written agreement with the public school district or private school so that

appropriate educational services are provided to clients in the day treatment

services program.

[7.20.11.27 NMAC - Rp 7 NMAC 20.11.26, 03/29/02]

 

7.20.11.28             BEHAVIOR MANAGEMENT SKILLS

DEVELOPMENT SERVICES:

                A.            Behavior management skill

development services are delivered through an individualized behavior

management skills development service plan designed to develop,

restore, or maintain skills and behaviors that result in improved function or

which prevent deterioration of function. 

Behavior management skills development services are delivered to clients

up to age 21 who:

                   

(1)     are in need of behavior

management skills development intervention to avoid inpatient

hospitalization, residential treatment or separation from his/her family; or

                   

(2)     require continued

intensive or supportive services following hospitalization or out-of-home

placement as a transition to maintain the client in the least restrictive

environment possible.

                B.            Personnel

                   

(1)     The behavior management skills development specialist

meets the following criteria:

                             

(a)     is at least 21 years of

age; and

                             

(b)     demonstrates the ability

to independently implement and document the outcome of the goals, measurable

objectives and interventions as defined in a behavioral management skills

development service plan.

                   

(2)     The behavior management

skills development specialist receives 20 hours of documented pre-service

training, to include, but not limited to:

                             

(a)     crisis

management/intervention;

                             

(b)     behavior management;

                             

(c)     emergency procedures,

which include current CPR and first aid certificates.

                   

(3)     Within 90 days of hire,

the behavior management skills development specialist receives an additional

20 documented hours of training, including but not limited to:

                       

      (a)     etiology and symptoms of emotional

disturbances and neurobiological disorders;

                             

(b)     family systems;

                             

(c)     basic communication and

problem solving skills;

                      

       (d)     child and adolescent development;

                             

(e)     issues related to ethnic

and cultural interests of the clients served;

                             

(f)     action and potential side

effects of medications.

                    (4)     Behavior management skills development specialists

receive supervision by a New Mexico licensed practitioner with a doctoral or

master’s degree from an accredited institution in a human service related field

who has at least two years experience working with children, adolescents and families.  Exception: 

If a supervisor with the above qualifications cannot be recruited, the

supervisor must possess, at a minimum, a B.S.W., B.A., B.S., or B.U.S. in a

human service related field plus four years experience working with seriously

emotionally disturbed or neurobiological disordered children and adolescents.

                   

(5)     Supervision is provided

for a minimum of two hours per month depending upon the complexity of the needs

presented by clients and the supervisory needs of the behavior management

skills development specialist. 

Supervision is documented with dates, times, and content of contacts.

                C.            Services:

                   

(1)     Behavior management skills

development services focus on acquisition of skills and improvement of the

client and/or family’s performance related to targeted behaviors.  The agency:

                             

(a)     conducts a clinical

assessment, or acquires clinical information that guides the development of the

behavior management skills development services plan;

                             

(b)     documents clinical review

of information that enables the agency to complete the behavior management

skills development service plan;

                              (c)     develops a behavior management skills

development service plan, including: client needs, measurable goals,

interventions, discharge criteria, and a discharge plan, within 14 days of

admission to the service;

                              (d)    

reviews the behavior management skills development service plan every 30

days and revises as necessary; and

                             

(e)     works in partnership with

other agencies or individuals involved in the client’s care to implement the

discharge plan and link the client to aftercare, as indicated;

                             

(f)     provides services to one

or more child(ren) from the same or different home(s), provided that a

staff-to-client ratio of 1:1 is maintained at all times.

                   

(2)     The behavior management

skills development specialist provides the following services:

                             

(a)     participation in the

development, review and revision of the behavior management service plan;

                              (b)     implementation of the behavior management

skills development service plan to include teaching of behavior enhancing

skills;

                             

(c)     documentation of each

client contact, including date, time, duration, and the client’s progress

and/or response to the interventions each day service is provided,

stated in terms of service plan goals and objectives; and

                             

(d)     coordinating with the

family and school personnel, if appropriate, to assist the client to achieve

and/or to maintain appropriate behavior management.

[7.20.11.28 NMAC - Rp 7 NMAC 20.11.27, 03/29/02]

 

7.20.11.29             TREATMENT FOSTER CARE SERVICES:

                A.            Treatment foster care services,

Level I and Level II, are specifically designed to accommodate the needs of

psychologically or emotionally disturbed and/or behaviorally disordered

clients.  Eligible clients are those who are

at risk for failure or have failed in regular foster homes, are unable to live

with their own families, or are going through a transitional period from

residential care as part of the process of return to family and community.

                   

(1)     Treatment foster care

services, level I and II, are targeted to children who meet the following

criteria:

                             

(a)     are at risk for placement

in a higher level of care or are returning from a higher level of care and are

appropriate for a lower level of care; or

                             

(b)     have complex and difficult

psychiatric, psychological, neurobiological, behavioral, psychosocial problems;

and

                             

(c)     require, and would

optimally benefit from, the behavioral health services and supervision provided

in a treatment foster home setting.

                   

(2)     Treatment foster care

services level II (TFC II) Services are targeted to children who, besides,

meeting the criteria in 29.A.1. (A). (c), also meet one of the following

criteria:

                             

(a)     have successfully

completed treatment foster care services level I (TFC I), as indicated by the

treatment team; or

                             

(b)     require the initiation or

continuity of the treatment and support of the treatment foster family to

secure or maintain therapeutic gains; or

                             

(c)     require this treatment

modality as  an appropriate entry level

service from which the client will optimally benefit.

                   

(3)     A client eligible for

treatment foster care services, level I or level 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.

                B.            Personnel qualifications and

responsibilities:

                   

(1)     Treatment coordinator

qualifications: The treatment coordinator possesses one of the following: a

master’s degree from an accredited program in social work or another

human-services field; or a bachelor’s degree in social work or another related

human-service field and two years experience with this population.

                    (2)     Treatment coordinator responsibilities:

                             

(a)     Treatment planning: Under

supervision, and in coordination with the rest of the treatment team, the

treatment coordinator:

                                       

(i)     prepares the initial and

comprehensive treatment plans in accordance with the timelines established in

these certification requirements;

                                       

(ii)     coordinates the

implementation of the treatment plan;

                                        (iii)     monitors the client and his/her situation

for events related to the treatment plan or otherwise significant to provision

of treatment;

                                       

(iv)     documents revisions to

the treatment plan;

                                       

(v)     assures that all members

of the treatment team, including the client as clinically indicated,  participate in the treatment planning

process, as documented by the signatures of treatment team members on the

treatment planning documents; and

                                       

(vi)     involves the client’s

parents or legal guardians in treatment team meetings and in all plans and

decisions affecting the client and keeps them informed of the client’s progress

in the program unless prohibited by the court or otherwise contraindicated

according to documentation in the client’s record.

                             

(b)     Contact with client: The

treatment coordinator has a private face-to-face visit with the client within

the first two weeks of placement, and at least twice monthly thereafter for TFC

I clients and once monthly for TFC II clients. 

These contacts are conducted both in-home and out-of-home.

                             

(c)     Contact with treatment

foster parent(s): The treatment coordinator has a face-to-face interview with

the client’s treatment foster parents within the first two weeks of placement

and at least twice monthly thereafter TFC I clients and once monthly for TFC II

clients.  The treatment coordinator has a

minimum of one phone contact with the treatment foster parent(s) weekly.  Phone contact is not necessary in the same

week that face-to-face contact has been made.

                             

(d)     All contacts are documented

in the client’s record and include a summary related to the treatment plan,

significant events and the communications between treatment coordinator,

client, treatment parent(s) and the biological/adoptive family.  All documentation includes the date, time,

location of the contact, and names of persons present.

                             

(e)     Support of the client’s

relationship with his or her biological/adoptive family: The treatment

coordinator supports and enhances the client’s relationship with his or her

family to the extent determined by the treatment team.  The treatment team reviews any restrictions

at the time of the writing of the comprehensive treatment plan or at the time

the restriction is imposed.  The

treatment coordinator documents in the client’s case record the reason(s) for

any restriction, and the treatment team’s involvement. Thereafter, the

restriction is reviewed at least every 30 days and documented in the treatment

plan review.

                             

(f)     Assistance to treatment

foster parents: The treatment coordinator assists the treatment foster parents

in the implementation and development of treatment

strategies, including goal-setting and planned interventions.  This assistance is done through the

following:

                                       

(i)     the provision of ongoing

client-specific training and problem solving;

                                       

(ii)     facilitation of

professional development training for the treatment foster parents as described in Section 29.B(10) of

these certification requirements;

                                       

(iii)     observation/assessment

of family interactions;

                                       

(iv)     assessment of safety

issues involving the client(s) in the home.

                             

(g)     Community liaison and

advocacy:  Based upon an assessment of

the client’s and biological/adaptive family’s

needs, the treatment coordinator advocates for and coordinates the provision of

community-based services, as related

to identified goals, and provides

technical assistance to community providers as needed to maximize the

utilization of services by the client and family.

                             

(h)     A treatment coordinator is

physically available within 60 minutes of a treatment foster home so that

quality of care, appropriate supervision and timely responsiveness to the

treatment foster family are possible.

                   

(3)     Clinical supervisor

qualifications: An individual providing supervision to the treatment

coordinator possesses one of the following New Mexico licenses:  Physician (physicians must be board-certified

in psychiatry or eligible to attain such certification), psychologist, registered nurse (RN) with a masters degree in

psychiatric nursing, clinical nurse specialist in a related field, licensed

independent social worker (LISW), licensed professional clinical mental health

counselor (LPCC), licensed marriage and family therapist (LMFT) or other

licensed independent practitioner in a related field. In addition to having one

of the above licenses, the clinical supervisor is required to have a minimum of

three years experience in clinical practice with children, adolescents and families.

                   

(4)     Clinical supervisor

responsibilities: The role of the clinical supervisor is to provide support,

consultation and oversight to the treatment coordinator(s) and therapist(s) through a minimum of four hours of

supervision each month.

                       

      (a)     The clinical supervisor is responsible for

supervising ongoing treatment planning and implementation of the treatment plan

for each client. The clinical supervisor evaluates progress in treatment and

signs the treatment plan documents.

                              (b)     The clinical supervisor provides

coordination and back up coverage allowing for 24-hour on-call crisis

intervention services for treatment parents, clients and their families.

                             

(c)     The clinical supervisor

monitors the caseload of each treatment coordinator, and monitors each

treatment coordinator in fulfilling his/her responsibilities.  The maximum number of treatment foster care

Services client(s) that maybe

assigned to a single treatment coordinator shall not exceed eight.  Caseloads are reduced based on case complexity,

travel times and non-direct service times. 

The actual number of clients in a single caseload is based upon the

ability of the treatment coordinator and/or agency to meet all applicable

regulations as well as on the following considerations:

                                       

(i)     the difficulty of the

total client caseload; including the amount of time needed for support of,

contact with, and assistance to the treatment foster parent(s) based on the

complexity of client needs;

                                       

(ii)     the availability of

paraprofessional support and assistance;

                                       

(iii)     the skills and abilities

of the treatment foster parent(s);

                                       

(iv)     geographical areas to be

served; and

                                       

(v)     additional duties assigned

to the treatment coordinator.

                   

(5)     Therapist qualifications:

Therapists providing individual, family, and/or group therapy meet either the

necessary licensing qualifications as listed for clinical supervisor

or possess one of the following New Mexico licenses: Licensed master social

worker (LMSW), licensed professional mental health counselor (LPC), licensed

art therapist (LAT) or licensed mental health counselor (LMHC).

                   

(6)     Therapist

responsibilities: The therapist provides individual, family and/or group

psychotherapy to clients as described in the treatment plan.  The therapist documents all therapeutic

contacts in the client’s record. Therapy notes will be kept current and

submitted to the treatment coordinator for inclusion in the client’s record

within one week of the session date.  The

therapist is an active treatment team member and participates fully in the

treatment planning process.

                   

(7)     Supervision/consultation:

An independently-licensed therapist consults with the supervisor for a minimum

of two times per month.  A

non-independently licensed therapist receives supervision from the supervisor

at a minimum of two times per month.  All

consultation/supervision is documented with the date, time, duration, and

topics discussed.

                   

(8)     Staff training:

                             

(a)     Therapists, treatment

coordinators, and other professional staff participate in knowledge/skill based

pre-service training relevant to the services provided including:

                            

           (i)     child and adolescent development;

                                       

(ii)     prevention and

de-escalation of aggressive behavior and the use of therapeutic holds;

                                       

(iii)     crisis management,

and  intervention;

                                       

(iv)     grief and loss issues for

client(s) in foster care;

                                       

(v)     cultural competence and

knowledge of the means for obtaining and providing culturally responsive

services;

                                       

(vi)     specific agency policies

and procedures including documentation;

                                       

(vii)     recognition of

abuse/neglect symptoms and state abuse/neglect/exploitation reporting

requirements;

                                       

(viii)     actions and potential

side-effects of medications;

                                       

(ix)     certification in

emergency first aid and CPR; and

                           

            (x)     behavior management.

                             

(b)      Professional staff who

can provide verifiable documentation of previous training in one or more of the

above areas are not required to repeat the training if the staff and the clinical

supervisor agree in writing as to which specific training is equivalent and

therefore not required.  This exception

does not apply to training regarding an agency’s policies and procedures.

                             

(c)     All professional staff

attend annual, ongoing professional development/ training relevant to the

agency’s treatment foster care model and to their individual job

responsibilities.

                   

(9)     Treatment parent

qualifications/requirements: Prior to hiring or contracting with prospective

treatment foster parents, the agency documents that each prospective treatment

foster parent, including those who provide therapeutic leave,

meets and conforms to the certification requirements set forth in 8.27.3 NMAC

(Licensing Requirements for Treatment Foster Care Services), as well as the

following qualifications and requirements:

                             

(a)     hold a current and valid

license as treatment foster parent issued by an agency licensed by the

department as a child placement agency. 

No home can be licensed for treatment foster care services until any previous foster care license

is surrendered to the issuing agency;

                             

(b)     have signed a release of

information that permits the department to share with the treatment foster care

services agency a summary of any substantiated complaints involving

abuse/neglect pertaining to the prospective treatment foster family;

                             

(c)     have signed a release to

allow the agency to read prior foster home and prior treatment foster home

records that exist through any previous foster home licensure or certification;

                             

(d)     understand the placement

in treatment foster care services as temporary, except when adoption by the

treatment foster parents has become the permanency plan;

                             

(e)     have access to reliable

transportation, and when driving a car have a valid New Mexico driver’s license

and liability insurance;

                             

(f)      have read, expressed

understanding of, and agreed in writing to fulfill the requirements and

responsibilities of a treatment foster parent;

                             

(g)     prior to hiring or

contracting with prospective treatment foster parent(s), the agency documents

that it has requested and reviewed the prospective parent(s)’ substantiated

reports of abuse/neglect, if any, and previous foster-parent records, if any,

and determined that such history does not disqualify the prospective parent(s)

from becoming treatment foster parent(s); the agency will inquire about any

previous treatment foster care services or regular foster care experience

applicant families may have had.

                   

(10)     Treatment parent

training: The training of treatment foster parents is systematic, planned,

documented and may include modalities other than didactic

instruction.  Training is consistent with

the program’s treatment philosophy and methods and equips treatment foster

parents with the skills to carry out their responsibilities as agents of the

treatment process.  Prospective treatment

foster parents are provided with a written list of duties clearly detailing

their responsibilities prior to their approval by the program.  The written professional development plan is

placed in the treatment foster parent(s) record.

                             

(a)     All treatment foster

parents receive 40 hours of training, at least 30 hours of which are

completed prior to placement of client(s). Any remaining hours are completed

within two months of first placement. The training, at a minimum, includes:

                                       

(i)     first aid and CPR

training, provided by a certified instructor before receiving a client for

placement;

                                       

(ii)     child and adolescent

development;

                                       

(iii)    behavioral management;

                                       

(iv)     prevention and

de-escalation of aggressive behavior and the use of therapeutic holds;

                                       

(v)     crisis

management/intervention;

                                       

(vi)     grief and loss issues for

client(s) in foster care;

                                        (vii)     cultural competence and culturally

responsive services;

                                       

(viii)     specific agency

policies and procedures including documentation,

                                       

(ix)     recognition of

abuse/neglect symptoms, and State abuse/neglect/exploitation reporting

requirements;

                                       

(x)     side-effects of

psychotropic medication; and

                                       

(xi)     role of treatment foster

parent in treatment planning.

                             

(b)     Treatment foster parents

who can provide verifiable documentation of previous training in one or more of

the above areas are not required to repeat the training if the staff and the

clinical supervisor agree in writing which specific training is equivalent and

therefore not required.  This exception

does not apply to training regarding an agency’s policies and procedures.

                             

(c)     Twenty-four hours of inservice training is required annually after receiving a client for

placement.  The 24 hours may include:

                                       

(i)     up to four hours of video

when supplemented by discussion in a classroom or clinical training setting;

                                       

(ii)     up to four hours of

supplemental reading may be part of the 24-hour annual inservice training when

supplemented by by discussion in a classroom or clinical training setting.

                   

(11)     Treatment foster parent

responsibilities: The treatment foster parents works with the treatment team

and with agency supervision to develop and implement the treatment plan.

Treatment foster parents provide front-line

treatment interventions. The family living experience is the basic service to

which individualized treatment interventions are added.  Treatment foster parents are responsible for

meeting the client’s basic needs, and providing daily care and supervision.  In addition to their basic foster parenting

responsibilities, treatment foster parents perform the following tasks and

functions:

                             

(a)     Treatment planning:

Treatment foster parents actively participate in the treatment planning process

and implement specified provisions of the treatment plan.

                             

(b)     Treatment foster parents

work with the treatment team to maximize the likelihood that all services are

provided in a culturally competent and culturally proficient manner.

                              (c)     Contact with the client’s family: Unless

contraindicated in the client’s treatment 

plan, or by court order, 

treatment foster parents assist the client in maintaining contact with

his or her family, and actively work to support and enhance those

relationships.  When reunification with

the client’s family is planned, the treatment foster parents work in

conjunction with the treatment team toward the accomplishment of the

reunification objectives outlined in the treatment plan.

                              (d)     Permanency planning assistance: The

treatment foster parents assist with efforts specified in the treatment plan to

meet the client’s permanency planning goal(s).

                             

(e)     Record keeping: The

treatment foster parents systematically record information and document client

behaviors/activities and significant events related to the treatment plan.  Documentation occurs on a weekly basis at a

minimum, and more often in response to the occurrence of significant

events.  Daily logging is preferable.

                             

(f)     Agency contact:  The treatment foster parents keep the agency

informed of the occurrence of significant events.  Daily logging is preferable.

                             

(g)     Confidentiality:  Treatment foster parents maintain agency

standards of confidentiality.

                             

(h)     Incident reporting:  Treatment foster parents report all serious

incidents to the agency, consistent with agency policy and certification

requirements.

                             

(i)     Availability: At least one

treatment foster parent is readily accessible at all times and is able to be

physically present, if necessary, to meet the client’s emotional and behavioral

needs; e.g., a treatment foster parents responds if the school requires

immediate parental attention.  A single

treatment foster parent may not schedule work hours when a client is normally

at home.

                             

(j)     Care and supervision: Treatment

foster parents ensure that proper and adequate supervision is provided at all

times. Guardians ad litem, court-appointed special advocates, and CYFD

employees may meet privately with clients as necessary.  Clients are not left in the care or unsupervised

presence of friends, relatives, neighbors, or others who have not received both

criminal records clearance and training. 

Treatment teams determine that all out-of-home activities are

appropriate for the client’s level of need, including the need for supervision.

                             

(k)     Community-based

resources:  The treatment foster parents

work with all appropriate and available community-based resources to secure

services for and/or advocate for the client(s).

                B.            Assessment, pre-placement, and

placement:  Prior to placement of any

treatment foster care client in any home, including therapeutic leave or

interim placement, the agency will determine that the placement is

therapeutically appropriate.  The

placement process includes documented consideration of the home and all

residents.

                   

(1)     The comprehensive

assessment includes face-to-face interviews with the client; with the client’s

biological or adoptive family whenever possible and when not contraindicated;

and contact with any previous care providers. 

The comprehensive assessment meets the following requirements, in

addition to those listed in the general provisions:

                             

(a)     the client’s and his/her

family’s priorities and concerns, as appropriate, are documented; and

                             

(b)     if the client is in

department custody, the agency requests information from the client’s social

worker, including the permanency plan, collateral assessment(s), and any known

or suspected history of abuse/neglect.

                   

(2)     Placement does not occur

until

after a comprehensive assessment of how the prospective treatment

foster family can meet the client’s needs and preferences, and a

documented determination by the agency that the prospective placement is a

reasonable “match” for the client.

                   

(3)     A documented match

assessment includes, but is not limited to:

                             

(a)     the identified needs of

the client;

                              (b)     the strengths of the treatment foster

parents to implement the client’s specific services and treatment plan;

                             

(c)     composition of the

treatment foster family; including the name, age, and gender of each person

residing in the home or visiting on a regular basis;

                             

(d)     treatment foster parents’

specific knowledge, skills, abilities and attitudes as related to the specific

needs of each client including high risk behaviors or the potential for

such;

                              (e)     treatment foster family’s ability to speak

the primary language of the client;

                             

(f)     treatment foster family’s

willingness and ability to work with the client’s family;

                             

(g)     proximity of the treatment

foster parent to the client’s family, friends and school.  If the client is placed more than an hour’s

driving time from the family, the justification is documented in the client’s

record;

                             

(h)     client and client’s

family’s (if applicable) preference for placement;

                             

(i)     availability of, and

access to, community resources required to meet the client’s needs; and

                              (j)     a summary/rationale of the client’s

placement in the particular treatment foster home chosen; the clinical

rationale includes consideration of all residents of the home, including

anticipated effects of the placement on all clients present and potential

health and safety risks, and is documented in each client record prior to the

placement.

                    (4)    

Pre-placement processes:

                              (a)      Prior to placement, the client’s family of

origin meets with his or her child’s prospective treatment foster parent(s) unless

clinically contraindicated, prohibited by court order, or prevented by

refusal or unavailability.  If

a pre-placement meeting does not occur, the reasons are documented in the

client’s record.

                             

(b)     Following completion of

the match assessment, the client visits with the treatment foster family for a

full 72 hours.  The dates and times of

the visit are documented in the client’s record.  At the end of the 72 hours, the treatment

coordinator documents an assessment of the visit and the therapeutic appropriateness

of the match, including the client’s reaction and the treatment foster

parent(s) response.  When it is

clinically indicated, the client may remain in the placement at the end of the

72-hour visitation, provided that the clinically-based reasons are documented

in the client’s record.

                             

(c)     All information that the

treatment foster care services agency receives concerning a client waiting for

placement is explained to the prospective treatment foster family prior to

placement. Prospective treatment foster parents are responsible for maintaining

agency standards of confidentiality regarding such information.

                             

(d)     For all clients in the

custody of the department, the treatment foster care services agency shares the

home study of a prospective licensed treatment foster family with the client’s

department social worker and invites the social worker to meetings in which the

prospective placement is discussed.

                             

(e)     The treatment foster

parent(s) can refuse placement of any treatment foster client whom they

consider inappropriate for the home or to protect the safety of any children

currently in the home.

                             

(f)     Treatment home composition

and capacity, including capacity for therapeutic leave:  Prior to any placement, the agency determines

that the match is consistent with the following limits:

                                       

(i)     A Treatment foster family

is eligible to care for level I and level II treatment foster clients,

non-treatment siblings of treatment clients, and/or children who were

previously treatment foster clients in the same home, but are no longer

qualified for TFC.  Non-treatment regular

foster or shelter care children may be temporarily placed in the home for

therapeutic leave or shelter care for up to 30 days, after the agency assesses

and documents that such a temporary placement will not compromise the treatment

of any current client.  Regular foster

care children who were in the home previously or foster children who are

siblings or children of treatment foster clients currently in the treatment

foster home may be placed without the 30 day limit pertaining to therapeutic

leave or shelter care clients. Arrangements pertaining to placement of regular

foster children are made with the department social worker.

                                        (ii)    

The total number of children in a treatment foster care services home,

including treatment foster care clients, therapeutic leave children, and any

other children,  may not exceed six,

except in rare circumstances such as placing sibling groups together.  Such exceptions are approved in advance by

the treatment teams, guardians of all children, and by the agency’s clinical

director.  The clinical rationale for the

exception is documented in each client’s record.

                                        (iii)     The total number of treatment foster

clients placed in a two-parent treatment foster care home is limited to

three.  At no time may more than two TFC

I children be placed in the same home, except when they are siblings. In the

case of multiple treatment foster care children placements, at least one

treatment foster care parent will not be employed outside the home.

                                       

(iv)     The total number of

treatment foster care clients placed in a single-parent treatment foster care

home cannot exceed two.  No more than one

level I treatment foster care client may be placed in a single-parent treatment

foster care home, unless both are siblings.

                             

(g)     The agency obtains written

agreement of the treatment team, including Guardians ad Litem (GALs), and legal

guardians, for all placements.

                             

(h)     A client with a history of

more than one incident of substantiated sexual aggression may not be placed in

a home with any other client, including client(s) temporarily present for

therapeutic leave or shelter purposes, without prior written approval by the

treatment teams of all treatment clients in the home.  In the case of non-treatment minors, written

permission must be obtained from the legal guardian(s) prior to such

placement.  The rationale for such

placement will distinguish the sexually reactive from the sexually aggressive

client.  The sexually reactive child may

have presented with a history of symptoms such as public masturbation, sex play

and/or developmentally incongruent preoccupation with sexual matters or

topics.  This behavior by itself should

not present a barrier to the placement of other children.  The sexually aggressive child has had more

than one incident of using force or intimidation to make another child comply

with a sexual activity.  The treatment

team is responsible for evaluating all collateral information, evaluating

any high risk behaviors or the potential for such, regardless of when it

occurred or when an evaluation was performed, and the severity of the

force or intimidation, regardless of how recently it occurred, prior to placing

the child in a home where there are other children.

                             

(i)     The agency trains the

treatment foster family in cultural and physical care issues related to the

client’s race and culture prior to

the client’s placement.

                   

(5)     Therapeutic leave:  Agency policy and practice provide for

treatment foster parent(s)’ access to therapeutic leave, both planned and

crisis-based.

                             

(a)     Treatment foster parents

providing therapeutic leave placements are licensed and trained by the agency,

are given a copy of the client’s treatment plan, and are supervised by the

treatment coordinator in the implementation of the

in-home strategies.

                             

(b)     Therapeutic leave

placements may be provided by a licensed and appropriately trained treatment

foster family from another licensed and certified treatment foster care

services agency, provided that the placing agency ensures the client’s

treatment plan is implemented appropriately.

                             

(c)     It is the treatment foster

care services agency’s responsibility to determine that treatment foster

parents into whose home a therapeutic leave client has been placed are

sufficiently skilled to work with the mix of treatment clients in their home,

and document this determination in their records prior to placement.

                             

(d)     If a treatment foster care

services agency cannot secure a trained and licensed treatment foster care

family to provide therapeutic leave for a client, the agency may place the

client in a licensed residential treatment services or licensed group home

services, if clinically appropriate and documented, for a period not to exceed

seven days. The residential treatment services or group home services program must

adhere to the client’s treatment plan and document the services provided and

the client’s behavior, consistent with these certification requirements for

treatment foster parent documentation.

                             

(e)     Therapeutic leave

placements comply with all certification requirements stated herein, including

capacity limits. The agency documents assessment of treatment home/family

composition, physical and sexual safety issues, and language(s) spoken, prior

to therapeutic leave placement.

                D.            Service planning and

provision:

                    (1)     All treatment foster care services, as

described in these certification requirements, are the responsibility of the

treatment foster care services agency. 

Services are furnished either through agency staff or contracted

persons.

                    (2)    

The treatment foster care services agency provides intensive support,

technical assistance, and supervision of all

treatment foster parents.

                   

(3)      The agency provides

clinically appropriate therapy services to the client, and involves the

treatment foster parents and the client’s family to achieve the goals of the

treatment plan.  Each treatment client

receives regularly scheduled therapy, including family therapy, as clinically

indicated and specified in the client’s treatment plan.  Family involvement in treatment, including

family therapy is not required when contraindicated by court order,

or temporarily contraindicated by the clinical judgement of the department’s

legal guardian or treatment team.

                      

       (a)     Therapy cannot be suspended or terminated

unless there is concurrence by the treatment team that therapy is not presently

indicated.

                             

(b)     All efforts are made to

place a client in close enough proximity to biological/adoptive family so that

family therapy will not be hindered.

                             

(c)     Family therapy is required

when reunification is the goal.

                             

(d)     In cases where family

involvement is contraindicated, the agency documents the clinical or legal

basis for that determination and documents regular review of the determination.

                   

(4)     The professional/clinical

staff provide or locate resources most suited to the individual needs of the

client in treatment foster care services

and helps the client, his or her parent(s) and the treatment foster

families to make effective use of them.

                   

(5)     Client’s access to agency

staff: An agency staff person, who is a member of the client’s treatment team,

is designated as a contact person for

each client.  The client has direct access

to that staff member.  The client is

informed of his or her designated staff person and how to reach that

person.  The means for such communication

is available to the client for his or her use at all times.  This is documented in the client’s record at

admission, and each time a change is made.

                   

(6)     Crisis on call:  The treatment coordinator, or another professional

clinical staff member or contractor who meets the qualifications for treatment

coordinator, is on-call to treatment foster parents, client(s) and their

families on a 24-hour, seven-day-per-week basis.

                   

(7)     The agency works with the

local school district to access for the client the most appropriate educational

services in the least restrictive setting.

                   

(8)     The agency facilitates the

creation of formal and/or informal support networks for its treatment foster

parents through coordination of parent support groups and/or other systems.

                   

(9)      Documentation:

                             

(a)     All contacts between

agency staff and clients’ biological/adoptive parents, and/or treatment foster

parent(s) are documented in the client’s records.

                             

(b)     All therapy notes are

documented and placed in the client’s record within one week of the session

date.

                             

(c)     Therapy notes explicitly

address the goals/objectives identified in the treatment plan.

                   

(10)     The treatment foster care

services agency provides intensive support, technical assistance and supervision to all treatment

foster parents. The agency trains the treatment foster family in cultural and

physical care issues related to the client’s race and culture prior to

placement and throughout its duration, with the intention of the treatment

foster family becoming culturally competent.

                   

(11)     The agency is responsible

for determining that the treatment foster parent(s) effectively manage the

individual treatment needs, acuity-based safety needs, and cultural needs of

all clients placed in the home.

                   

(12)     The agency develops and

implements a plan to connect the treatment foster client with other children

and adults in the community who share the same culture, race and ethnicity.

                   

(13)     Services are provided to

each client as determined by the treatment team.  No one member of the

treatment team has veto power except for those provision set forth in the

Children’s Code regarding change of placement notification.  No services are terminated and/or suspended

without the review and concurrence of the team. 

This certification requirement does not limit a managed care entity’s

right to determine, or the agency’s or legal guardian’s right to appeal, based

on medical necessity criteria, the authorization of continued placement of a

treatment foster care services client.

                   

(14)     The treatment plan is

developed through a process that utilizes a treatment team comprised of the

following individuals, as applicable and appropriate: the client, the client’s

family, treatment foster parent(s), treatment coordinator, department social

worker, juvenile probation/parole officer, education agency, guardian ad litem

and other significant individuals in the client’s life.

                   

(15)     The agency ensures that

all treatment plans adhere to the treatment planning requirements

contained in the general provisions section of these certification

requirements.

                   

(16)     The initial treatment

plan includes specific tasks to be carried out by the treatment team within the

first 14 days of placement.

                   

(17)     The initial and

comprehensive treatment plans address strategies to ease the

client’s adjustment to the treatment home and to assess directly the client’s

strengths, skills, interests and needs for treatment within the home.

                   

(18)     The treatment plan

reviews address discharge planning and strategies to prepare for the

client’s return to the biological, or adoptive, regular foster care home or

independent living as appropriate.

                    (19)     The treatment plan is reviewed every 30

days by the treatment team, in accordance with the general provisions, and revised

when clinically indicated.  The review

occurs face-to-face, telephonically or through teleconference.

                E.             Agency oversight:

                    (1)     Except in emergencies, a client is removed

from a treatment foster care services home only after the treatment team has

documented that the move is in the client’s best interest.  When such a move is necessary, the agency

complies with pre-placement, placement and treatment planning requirements.

                   

(2)     In the event that the

treatment foster parents request that a treatment foster client be removed from

their home, a treatment team meeting is held and there is agreement that a move

is in the best interest of the involved client. 

Any treatment foster parent(s) who demands removal of a treatment foster

client from his or her home without first discussing with and obtaining

consensus of the treatment team will have their license revoked.

                   

(3)     If treatment foster

parent(s) wish to transfer between agencies, there must be written

documentation from both agencies that the transfer is in the best interest of

any client(s) currently in the home, including consideration of change of

treatment team members, and a written statement from the previous agency that

the transferring treatment foster family is in good standing.

                             

(a)     If any clients are

currently placed in the transferring treatment home, the receiving agency will

evaluate the appropriateness of the match and update the treatment plan.

                             

(b)     The receiving agency

completes a new home study, or an addendum to the original home

study reflecting any changes that have occurred in the composition of the home

since the date of the client’s admission.

                             

(c)     The receiving agency

notifies the previous agency that the treatment foster parent(s) has been hired,

and the previous agency, upon receipt of that notice, cancels its previous

license.

                   

(4)     At the time of new

licensure of a treatment foster care home, if non-treatment foster care

client(s) placed through prior licensing arrangements must be removed, the

process is conducted through an orderly and purposeful plan which is approved in

writing by the previous licensing agency as meeting the best interests of the

clients.

                F.             Property damage and liability:

                   

(1)     Written plan:  The agency providing treatment foster care

services has a written policy concerning compensation for damages to a

treatment foster family’s property by client(s) placed in their care.  A copy of the written plan is provided and

explained to the prospective treatment foster parents during the pre-service

training.

                   

(2)     Liability insurance:  Treatment foster parent(s) document and

verify on a regular basis that they continuously maintain liability insurance for

automobiles, home and persons, including owner and occupants of the home.

                   

(3)     Property damage caused by

client(s) in CYFD custody may be reimbursed by the protective services division

of the department, consistent with protective services “maintenance payments to

substitute care providers” PR 8.10.22.10.9 Property Loss and Damage.

                G.            Transition to independent living:

                   

(1)     Older adolescents in

treatment foster care are provided with a series of developmental activities and

supportive services designed to enable them to prepare to lead self-sufficient

adult lives, in accord with their treatment plan. For those clients 16-20 years

old for whom family reunification, placement with extended family or with

previous caretakers, or adoption has been found to be infeasible or

inappropriate, the agency provides or arranges for a set of service components

to be delivered which are designed to enable the client to prepare for a

successful transition to independent 

living.

                    (2)    

The services provided or coordinated address the client’s identified

needs for:

                             

(a)     life skills training;

                             

(b)     education with regard to

health concerns including human sexuality;

                             

(c)     vocational and technical

training;

                             

(d)     housing needs during

transition and after discharge;

                             

(e)     legal services;

                             

(f)     arrangements for support

services, aftercare services and socialization, and

                             

(g)     cultural, religious and

recreational activities, as appropriate to the client’s needs.

[7.20.11.29 NMAC - Rp 7 NMAC 20.11.28, 03/29/02]

 

7.20.11.30             RESIDENTIAL TREATMENT SERVICES AND

GROUP HOME SERVICES:

                A.            Residential treatment services are

provided to children/adolescents with severe behavioral, psychological,

neurobiological, or emotional problems, who are in need of psychosocial rehabilitation

in a residential setting.  They require

active residential psychotherapeutic intervention and a 24-hour therapeutic

group living setting to meet their developmental, psychological, social, and

emotional needs.

                B.            Group home services are provided to

children/adolescents with moderate behavioral, psychological, neurobiological,

or emotional problems, who are in need of active psychotherapeutic

intervention, who require a twenty-four hour therapeutic group living setting

to meet their developmental, social and emotional needs, and/or who are in

transition from a higher level of care to a lower level of care.

                C.            The agency maintains and follows

policies and procedures for emergency and non-emergency admissions.  Admission policies and criteria are based on

the client’s identified need for residential treatment services or group home

services.

                D.            At the time of admission or transfer

to residential treatment services or group home services, the client is

informed of the reasons for the placement/transfer and his/her treatment

options.  This discussion with the client

is documented in the client’s record by the admitting professional.

                E.             Personnel:

                   

(1)     Direct service staff

providing residential treatment services and/or group home services receive a

minimum of twenty hours of pre-service training, including training in:

                             

(a)     crisis

management/intervention, behavioral management, personal restraint and

seclusion;

                             

(b)     the agency’s emergency

procedures, which include CPR and first aid.

                   

(2)     The direct service staff

possess a high school diploma or G.E.D and one or more of the following:

                             

(a)     two years experience

working with clients and adolescents with severe psychological/ emotional disturbances/neurobiological disorders; or

                             

(b)    two years of post-secondary

education in a human service related field; or

                         

    (c)     a minimum of 40 hours of documented

training, including the twenty hours of pre-service training described in E

above, and twenty additional hours including the following topics:

                                       

(i)     etiology and symptoms of

emotional disturbances and neurobiological disorders;

                                       

(ii)     family systems;

                                       

(iii)     basic communication and

problem solving;

                                        (iv)    

child and adolescent development;

                                       

(v)     ethnic and cultural

considerations related to the clients served; and

                                       

(vi)     action and potential side

effects of medications.

                   

(3)     The training in (c) (i)

through (vi) above, when required, must be provided within three months of

hire.

                    (4)     Those direct service staff who, prior to

beginning direct service work, can provide documentation of a current

certificate of training in one or more of these specified areas are not

required to repeat that training; their training requirements may be adjusted

as justified and documented by the clinical director or designee.

                    (5)    

Clinical director:

                             

(a)     Clinical director

qualifications: The clinical director possesses one of the following New Mexico

licenses: physician (physicians must be board-certified in psychiatry or

eligible to attain such certification); 

psychologist; licensed independent social worker (LISW); clinical nurse

specialist in child psychiatric nursing; registered nurse (RN) with a master’s

in psychiatric nursing; licensed professional clinical mental health counselor

(LPCC); and licensed marriage and family therapist (LMFT);

                             

(b)     In addition to having one

of the above licenses, the clinical director is required to have a minimum of

two years of experience in clinical practice with clients, adolescents, and

families.

                             

(c)     Clinical director

responsibilities: The responsibilities of the clinical director are to provide

clinical oversight of the services, as well as to provide supervision, support,

and consultation to all agency staff.

                   

(6)     Clinical supervisor

qualifications: The clinical supervisor possesses one of the following New

Mexico licenses: physician (physicians must be board-certified in psychiatry or

eligible to obtain such certification); psychologist; licensed independent

social worker (LISW) or other licensed independent practitioner in a related

field; clinical nurse specialist in child psychiatric nursing; registered nurse

(RN) with a master’s in psychiatric nursing; licensed professional clinical

mental health counselor (LPCC); or licensed marriage and family therapist

(LMFT).  In addition to having one of the

above licenses, the clinical supervisor is required to have a minimum of two

years of experience in clinical practice with clients, adolescents and

families.

                   

(7)     Therapists qualifications:

Therapists providing individual, family and/or group therapy must meet either

the necessary licensed requirements as listed for clinical supervisor or

possess one of the following New Mexico licenses: licensed professional mental

health counselor (LPC); licensed master’s social worker (LMSW); licensed art

therapist (LAT); or licensed mental health counselor (LMHC).

                F.             Services:

                   

(1)     Residential treatment

services are provided through a treatment team approach and the roles,

responsibilities and leadership of the team are clearly defined.

                   

(2)     The agency provides a

daily structured program that meets clients’ needs as identified in the

comprehensive assessment and as prescribed in the treatment plan. The following

services are provided:

                             

(a)     individual, family, and

group therapy, at the level of frequency documented in the treatment plan;

                             

(b)     access to timely and

necessary medical care;

                             

(c)     supervision of

self-administered medication, if appropriate;

                             

(d)     crisis intervention;

                              (e)     educational services;

                             

(f)     activities of daily

living;

                             

(g)     recreation, leisure time

and other planned therapeutic activities; and

                             

(h)     planning of discharge and

aftercare services; to facilitate timely and appropriate post discharge care,

regular assessments are conducted to support discharge planning and effect

successful discharge with clinically appropriate aftercare services; this

discharge planning begins when the client is admitted to residential treatment

services and is updated and documented in the client’s record at every

treatment plan review, or more frequently as needed.

                   

(3)     The agency provides services,

care, and supervision at all times, including:

                             

(a)     the provision of, or

access to, medical services on a 24-hour basis;

                             

(b)     maintenance of a

staff-to-client ratio appropriate to the level of care and needs of the

clients.

                                       

(i)     for residential treatment

services, the minimum ratios are one to six during the day and evening shifts

and one awake staff to twelve clients during the night shift.

                                       

(ii)     for group home services,

the minimum ratios are one to eight during the day and evening shifts and one

awake staff to twelve clients during the night shift.

                                       

(iii)     additional staff must be

provided if the clinical needs of the client population are high.

                                       

(iv)     a written schedule must

be maintained by the agency to document the staffing ratios.

                             

(c)     arrangements for, and

provision of, supervision for off-grounds activities, including transportation,

in accordance with minimum and need-based ratios; and

                             

(d)     arrangements for, and

provision of responses to significant life events that may affect the client’s

treatment when out of the facility.

                   

(4)     Services and activities

are appropriate to the age, behavioral, and emotional development level of the

client.

                   

(5)     When not therapeutically

or legally contraindicated, the agency encourages parent/client contact and

makes efforts at family reunification. 

Such contacts and efforts are documented as they occur.  If reunification is contraindicated, the

reason is documented in the client’s record at the time that determination is

made, and the issue is reconsidered

when indicated.

                   

(6)     The following factors will

be considered in determining the appropriate level of services and supervision.

                              (a)     risk of victimizing others;

                             

(b)     risk of inappropriate

consensual activity;

                             

(c)     risk of being victimized

by others;

                   

(7)     The treatment plans contain

all the elements outlined in Section 23 of these certification requirements.

                G.            Residential treatment services and

group home services may be provided in the same licensed facility when the

agency ensures the health and safety of all clients present.

                   

(1)     A program certified for

residential treatment services may provide group home services in accordance

with these certification requirements without requesting or receiving a

separate certification for group home services.

                    (2)     When residential treatment services and

group home services are provided in the same facility, the agency’s policies

and procedures specify clinically-based criteria under which the populations

may be mixed.

                   

(3)     When residential treatment services and group

home services populations are mixed, the agency documents that the

clinically-based criteria have been met to address safety issues.

                   

(4)     When residential treatment

services and group home services populations are mixed, the minimum staffing

ratios for residential treatment services apply.

[7.20.11.30 NMAC - Rp 7 NMAC 20.11.29, 03/29/02]

 

7.20.11.31             JCAHO

ACCREDITED RESIDENTIAL TREATMENT SERVICES:  Residential treatment services programs that

are accredited by JCAHO comply with the general provisions and residential

treatment services sections of these requirements, and the following standards:

                A.            The

agency provides services, care, and supervision at all times, including

maintenance of a minimum staff-to-child ratio of one to five during the day and

evening shifts and one awake staff to ten clients during the night shift.  Additional staff is provided when warranted

by client acuity or other conditions.

                B.            A physical

examination is completed by a licensed independent medical practitioner within

one week of admission, and includes medical history, physical examination,

assessment of pain, motor and sensorimotor functioning, speech, hearing, and

language functioning, vision, immunizations, oral health, history of

psychotropic medication use, and, when indicated an AIMS test.  If a comprehensive medical history and

physical examination have been completed within 30 days before admission, a

durable, legible copy of this report may be used in the clinical record as a

physical examination, but any subsequent changes must be recorded at the time

of admission.

                C.            The agency

evaluates the need for the following assessments, and when such assessments are

indicated, they are completed in a thorough and timely manner: psychological,

psychiatric, educational, vocational, legal, nutritional, developmental

disabilities, and substance abuse.

                D.            The agency

has a written plan to provide all necessary medical histories, physical

examinations, and laboratory tests that the agency does not directly provide.

                E.             Infection

control

                    (1)     The agency has a comprehensive and

functioning infection-control program based on proven epidemiological methods

for surveillance and prevention of adverse outcomes related to infection.

                    (2)     The agency uses preventive processes such

as universal precautions to reduce risks for endemic and epidemic infections in

clients and staff.

                    (3)     Infection control policies, procedures,

and practices include surveillance, identification, and control of infection,

and required reporting to staff and public health authorities.

                    (4)     A current certification stating that the

employee is free from tuberculosis in a transmissible form, obtained prior to

the first date of direct service.

[7.20.11.31 NMAC - Rp 7 NMAC 20.11.30, 03/29/02; A,

10/29/04]

 

7.20.11.32             [Reserved]

[7.20.11.32 NMAC - N, 03/29/02; Repealed 04/14/05]

 

7.20.11.33             COMPREHENSIVE COMMUNITY SUPPORT

SERVICES:

                A.            Agencies certified for case

management under these regulations or agencies receiving children’s behavioral

health contract funding for case management services as of 01/01/08 will

receive provisional certification as a comprehensive community support services

provider.

                B.            The provisional certification will

be valid until the expiration of the agencies case management certification at

which time a survey will be completed by the licensing and certification

authority.  Children’s behavioral health

contract agencies will have a survey completed within twelve (12) months of the

issuance of the provisional certification.

                C.            All comprehensive community support

services providers will have to meet the general provisions of these

requirements and requirements in medicaid regulation Title 8, Chapter 315, Part

6.

[7.20.11.33 NMAC - N, 01/01/08]

 

HISTORY OF 7.20.11 NMAC:

Pre-NMAC Filing History:

OMCI, Purpose and Definitions

Relating to Certification Regulations, 11-23-93.

A.O., Agency in the Community,

11-23-93.

B.O., Agency Governance and

Administration, 11-23-93.

C.O., Personnel, 11-23-93.

D.O., Client Rights and

Protection, 11-23-93.

H.O., Intake, Assessment and

Treatment Planning, 11-23-93;

I.O., Client Information,

Confidentiality and Case Review, 11-23-93.

AA.O., Group Home Services,

11-23-93.

BB.O., Residential Treatment

Centers, 11-23-93.

DD.O, Treatment Foster Care,

11-23-93.

EE.O., Day Treatment Centers,

11-23-93.

GG.O., Behavior Management

Skills Development Services, 8-16-94.

 

NMAC History:

7 NMAC 20.11, Certification

Requirements for Child and Adolescent Mental Health Services, 6-16-98.

7 NMAC 20.11, Certification

Requirements for Child and Adolescent Mental Health Services, 10-27-99.

 

History of Repealed Material:

7 NMAC 20.1, General Provisions

- Repealed 7-1-98.

7 NMAC 20.A, Agency in The

Community - Repealed 7-1-98.

7 NMAC 20.B, Agency Governance

and Administration - Repealed 7-1-98.

7 NMAC 20.C; Personnel -

Repealed 7-1-98.

7 NMAC 20.D, Quality Assurance

and Utilization Review - Repealed 7-1-98.

7 NMAC 20.E, Regulatory

Compliance for Program Operation Including Health, Safety and Physical Plant

Requirements - Repealed 7-1-98.

7 NMAC 20.F, Client Rights and

Protection - Repealed 7-1-98.

7 NMAC 20.G, Intake,

Assessment and Treatment Planning - Repealed 7-1-98.

7 NMAC 20.H, Client

Information, Confidentiality and Case Review - Repealed 7-1-98.

7 NMAC 20.AA, Case Management

- Repealed 7-1-98.

7 NMAC 20.BB, Day Treatment -

Repealed 7-1-98.

7 NMAC 20.CC, Behavior

Management Skills Development Services - Repealed 7-1-98.

7 NMAC 20.DD, Treatment Foster

Care - Repealed 7-1-98.

7 NMAC 20.EE, Residential

Treatment Centers - Repealed 7-1-98.

7 NMAC 20.11, Certification

Requirements for Child and Adolescent Mental Health Services - Repealed,

11-15-99.

7 NMAC 20.11, Certification

Requirements for Child and Adolescent Mental Health Services - Repealed,

3-29-02

7.20.11 NMAC, Section 32,

Home-Based Services - Repealed 04-15-05