For evaluation, assessment, or therapy provided at my agency, I attest that only independently licensed practitioners provide services in compliance and for reimbursement for those services administered by the HSD medical assistance division (MAD).

Relevance:

NMAC 8.321.2.1 SPECIALIZED BEHAVIORAL HEALTH SERVICES and 8.321.2.9 B: “Services must be provided within the licensure for each facility and scope of practice for each provider and supervising or rendering practitioner. Services must be in compliance with the statutes, rules and regulations of the applicable practice act. Providers must be eligible for reimbursement as described in 8.310.2 NMAC and 8.310.3 NMAC.”

“Other than agencies as allowed in Subsections D and E of 8.321.2.9 NMAC, a behavioral health provider cannot himself or herself as a rendering provider bill for a service for which he or she was providing supervision and the service was in part or wholly performed by a different individual.”

Definitions:

Independently licensed practitioners include: physician, psychologist, LISW/LCSW, LPCC, LMFT, LADAC or CADC (substance use diagnoses only), CNS or CNP, LPAT and certified for independent practice by ATCB.

Nonindependently licensed practitioners include: LMSW, LMHC, LPC, LAMFT, psychologist associate, LSAA, RN, Physician Assistant certified by the State of NM working under supervision.

Nonlicensed practitioners include: master’s behavioral health interns, psychology interns, CPSW, CFPSW, provisional or temporary licensed master’s behavioral health practitioners.

For evaluation, assessment, or therapy provided at my agency, I attest that only independently licensed practitioners provide services in compliance and for reimbursement for those services administered by the HSD medical assistance division (MAD).

I understand and agree that, upon my agency employing any non-independently licensed practitioners or nonlicensed practitioners to provide evaluation, assessment, or therapy I must submit an application for BHSD Supervisory Certification attestation, and upon approval, receive a username and password for the online portal, and submit rosters as required for compliance and reimbursement for those services administered by the HSD medical assistance division (MAD).

Must be signed by person with authorization to act on behalf of agency (CEO), Clinical Manager or Supervisor