The following information is an overview of IOP programming and the IOP application process. Please refer to the New Mexico Administrative Code (NMAC) 8.321.2.25 Intensive Outpatient Program for Substance Use Disorders and NMAC 8.321.2.26 Intensive Outpatient Program for Mental Health Conditions, as well as, the Behavioral Health Policy and Billing Manual for further information.

Service Description
Intensive outpatient (IOP) services provide a time-limited, multi-faceted approach to treatment for eligible recipients who require structure and support to achieve and sustain recovery. The IOP model is based on research and evidence-based practices that target specific behaviors with individualized behavioral interventions.
Services are culturally sensitive and incorporate recovery and resiliency values into all service interventions. Services address SMI, SED, co-occurring mental health disorders, and substance use disorders. Treatment is provided through an integrated multi-disciplinary team and approach. Core services include individual therapy, group therapy (membership to not exceed 15 in number), and psychoeducation to the client and the client’s family.
The duration of IOP treatment services is typically three to six months. The program must provide a minimum of 6 hours for adolescents and a minimum of 9 hours for adults. The total amount of weekly services is dependent upon the goals and objectives outlined in the client’s treatment plan. Medication management may be part of the IOP program.

Eligible Provider Types
Federally Qualified Health Center (FQHC), Indian Health Service (IHS) hospital or clinic, PL 93-638 tribally operated hospital or clinic, Medical Assistance Division (MAD) enrolled Core Services Agency (CSA), MAD enrolled Behavioral Health Agency (BHA) with a supervisory certification, MAD designated CareLink NM health home, or Community Mental Health Center (CMHC).

Target Population
Substance use disorder (SUD) IOP services are provided to children and adolescents (ages 11-17), transitional age youth, or adults diagnosed with SUD or with co-occurring disorders (mental illness and substance abuse) or that meet the American Society of Addiction Medicine (ASAM) patient placement criteria for level 2.1 – intensive outpatient treatment; or have been mandated for an assessment by the local judicial system as an option of least restrictive level of care. Services are not covered if the recipient is in detention or incarcerated. Mental health (MH) IOP Services are provided to adolescents (ages 11-17) diagnosed with a Severe Emotional Disturbance (SED) or adults diagnosed with a Severe Mental Illness (SMI). IOP participants must also be screened for SUD.

IOP Clinical Supervisor
An IOP clinical supervisor must have two years relevant experience with an IOP program or approved exception by the interdepartmental council, have one year demonstrated supervisory experience, and have expertise in both mental health and substance abuse treatment.
Clinical supervisors must adhere to all state board regulations and maintain active licensure in one of the follow categories psychiatrist, psychologist, LISW, LPCC, LMFT, psychiatrically certified clinical nurse specialist or clinical nurse practitioner practicing under the scope of their NM licensure. Clinical supervisors must adhere their respective New Mexico Regulation and Licensing Department (NMRLD) board’s requirements for supervisors.

Medicaid ID and NPI
All providers who will be rendering services for Medicaid eligible recipients must have acquired, or be able to acquire after approval, their own Medicaid ID through MAD enrollment process. An individual must have an active National Provider Identifier (NPI) number through the National Plan & Provider Enumeration System (NPPES). This also is required for all providers independent of the agency NPI. All providers must be registered for their own individual Medicaid ID number using their individual NPI.

Documentation Requests and Site Visits
The BHSD or any of its designated payers may request the agency’s policies and procedures pertaining to IOP at any time. These documents must be made available upon request. BHSD will conduct initial site visits 180 days from the start of services and ongoing annual site visits. BHSD will notify the agency in advance to schedule a visit.

Ethical and Legal Obligations
CCSS and supervision practices must follow the appropriate guidelines for each licensure type as set forth by the respective NMRLD boards , NM Statute Scope of Practice Policy, and respective ethics standards, including the American Psychological Association (APA), American Counseling Association (ACA), and the National Association of Social Workers (NASW). Ethical codes must be incorporated in accordance with relevant guidelines by APA, ACA, and the NASW.

Application Timeline

1. The agency will review all pre-application information.
2. The agency will complete the online application for IOP including, the supporting documentation.
3. The IDC will review the application and respond to the provider within 30 days with a request for more information or an approval letter. BHSD may continue to request more information until all items in the application are addressed to meet all regulations and policy requirements.
4. Once the application is approved, BHSD will issue a provisional approval letter to render IOP services.
5. The agency will start IOP services and notify within 90 days of receiving the provisional approval letter, or notify BHSD with reasoning for the delay.
6. A site visit date will be scheduled 180 days from the start of services and the provider will be notified of the proposed site visit date.
7. Once the site visit is complete and all documents are in order, final approval will be sent to the agency. The agency will send the final approval to the Medicaid Assistance Division.