Subject to appropriation, the department shall:
A. contract for behavioral health treatment and support services, including mental health, alcoholism and other substance abuse services;
B. establish standards for the delivery of behavioral health services, including quality management and improvement, performance measures, accessibility and availability of services, utilization management, credentialing and recredentialing, rights and responsibilities of providers, preventive behavioral health services, clinical treatment and evaluation and the documentation and confidentiality of client records;
C. ensure that all behavioral health services, including mental health and substance abuse services, that are provided, contracted for or approved are in compliance with the requirements of Section 9-7-6.4 NMSA 1978;
D. assume responsibility for and implement adult mental health and substance abuse services in the state in coordination with the children, youth and families department;
E. create, implement and continually evaluate the effectiveness of a framework for targeted, individualized interventions for individuals who are incarcerated in a county or municipal correctional facility and adult and juvenile offenders who have behavioral health diagnoses, which framework shall address those persons' behavioral health needs while they are incarcerated and connect them to resources and services immediately upon release;
F. establish criteria for determining individual eligibility for behavioral health services; and
G. maintain a management information system in accordance with standards for reporting clinical and fiscal information.
History: Laws 2007, ch. 325, § 4; 2019, ch. 211, § 1; 2019, ch. 222, § 1.
ANNOTATIONS2019 Multiple Amendments. Laws 2019, ch. 211, § 1, effective July 1, 2019, and Laws 2019, ch. 222, § 1, effective June 14, 2019, enacted different amendments to this section. Pursuant to 12-1-8 NMSA 1978, Laws 2019, ch. 222, § 1, as the last act signed by the governor, has been compiled into the NMSA 1978 as set out above, and Laws 2019, ch. 211, § 1, while not compiled pursuant to 12-1-8 NMSA 1978, is set out below.
Laws 2019, ch. 222, § 1 [set out above], effective June 14, 2019, required the behavioral health services division of the human services department to create, implement, and evaluate a framework of interventions for adult and juvenile offenders incarcerated in a county or municipal correctional facility to address offenders' needs while they are incarcerated and connect them to resources and services upon their release; added new Subsection E and redesignated former Subsections E and F as Subsections F and G, respectively.
Laws 2019, ch. 211, § 1 [set out below], effective July 1, 2019, required the behavioral health services division of the human services department to create, implement, and evaluate a framework of interventions for adult and juvenile offenders incarcerated in a state, county or municipal correctional facility to address offenders' needs while they are incarcerated and connect them to resources and services upon their release with the aim of reducing recidivism; added new Subsection E and redesignated former Subsections E and F as Subsections F and G, respectively.
"9-8-7.1. Behavioral health services division; powers and duties of the human services department.
Subject to appropriation, the department shall:
A. contract for behavioral health treatment and support services, including mental health, alcoholism and other substance abuse services;
B. establish standards for the delivery of behavioral health services, including quality management and improvement, performance measures, accessibility and availability of services, utilization management, credentialing and recredentialing, rights and responsibilities of providers, preventive behavioral health services, clinical treatment and evaluation and the documentation and confidentiality of client records;
C. ensure that all behavioral health services, including mental health and substance abuse services, that are provided, contracted for or approved are in compliance with the requirements of Section 9-7-6.4 NMSA 1978;
D. assume responsibility for and implement adult mental health and substance abuse services in the state in coordination with the children, youth and families department;
E. create, implement and continually evaluate the effectiveness of a framework for targeted, individualized interventions for adult and juvenile offenders with behavioral health diagnoses who are incarcerated in a state, county or municipal correctional facility, which framework shall address those persons' behavioral health needs while they are incarcerated and connect them to resources and services immediately upon release that reduce the likelihood of recidivism, detention and incarceration, such as supportive housing, public assistance, medical assistance, behavioral health treatment and employment training;
F. establish criteria for determining individual eligibility for behavioral health services; and
G. maintain a management information system in accordance with standards for reporting clinical and fiscal information."
Department's burden in an action to recover improper payments from providers. — In an action to recover improper payments to providers, the New Mexico human services department not only must provide by a preponderance of the evidence at the fair hearing that the identified claims failed, but also that its mathematical calculations of the overpayment were properly calculated and the methodology it used to choose the sample was valid. Counseling Center, Inc. v. N.M. Human Servs. Dep't, 2018-NMCA-063, cert. denied.
Provider's burden in a department action to recover improper payments. — If a health care provider wishes to challenge the methodology used to choose the sample size of an audit or to randomly select the claims for audit, the relevant regulation requires that, rather than merely choose a different sample size, or select a different set of claims for audit, the provider must audit the entire universe of claims at issue. Counseling Center, Inc. v. N.M. Human Servs. Dep't, 2018-NMCA-063, cert. denied.
The administrative law judge improperly shifted the burden of proof. — Where the New Mexico human services department (HSD) appealed the district court's reversal of an administrative decision requiring respondent, a behavioral health care provider, to reimburse HSD for claimed overpayments, and where the administrative law judge (ALJ) failed to reach any conclusion regarding the validity of the alleged failed claims because respondent had not performed a one-hundred percent audit of the universe of provider records, the ALJ improperly shifted the burden of proof to respondent, as respondent was not required to provide a one-hundred percent audit of the universe of providers before the ALJ could properly consider whether the claims used to extrapolate respondent's alleged overpayment actually failed. Counseling Center, Inc. v. N.M. Human Servs. Dep't, 2018-NMCA-063, cert. denied.
Substantial evidence of over payment of medicaid funds. — Where the New Mexico human services department (HSD) appealed the district court's reversal of an administrative decision requiring respondent, a behavioral health care provider, to reimburse HSD for claimed overpayments, and where the administrative law judge (ALJ) concluded that respondent was credited with medicaid funds, notwithstanding that respondent did not bill these claims to medicaid, the district court erred when it concluded that the ALJ's decision requiring respondent to return fees was not supported by substantial evidence, because the uncontroverted evidence established that respondent was paid with medicaid funds that were not eligible for payment by medicaid, and federal law requires that overpayments of medicaid funds must be returned. Counseling Center, Inc. v. N.M. Human Servs. Dep't, 2018-NMCA-063, cert. denied.