New Mexico Register / Volume XXXVI,
Issue 23 / December 9, 2025
Note: The above rule was filed and should have been
published in issue 22 on November 18, 2025.
Due to errors in our agency’s publishing process, that rule did not
publish. In order to correct that error
and in order to conform to Subsection A of Section 14-4-5 NMSA 1978, the
history notes for every section have been changed to 12/9/2025. The effective date in Section 5 will remain
December 1, 2025, as that would have been the correct effective date by your
agency, had this rule been properly published in issue 22.
TITLE 8 SOCIAL SERVICES
CHAPTER 321 SPECIALIZED BEHAVIORAL HEALTH SERVICES
PART 12 CERTIFIED COMMUNITY BEHAVIORAL
HEALTH CLINICS
8.321.12.1 ISSUING AGENCY: New Mexico Health Care Authority (HCA).
[8.321.12.1 NMAC -
N, 12/9/2025]
8.321.12.2 SCOPE: The rule applies to agencies certified as
New Mexico certified community behavioral health clinics (CCBHCs).
[8.321.12.2 NMAC -
N, 12/9/2025]
8.321.12.3 STATUTORY AUTHORITY: The New Mexico medicaid
program and other health care programs are administered pursuant to regulations
promulgated by the federal department of health and human services under Title
XIX of the Social Security Act as amended or by the state statute. See Section 27-2-12 et seq., NMSA 1978. New Mexico CCBHCs participating in the federal
CCBHC demonstration program are subject to Section 223 of the Protecting Access
to Medicare Act of 2022, Public Law 117-159.
[8.321.12.3 NMAC -
N, 12/9/2025]
8.321.12.4 DURATION: Permanent.
[8.321.12.4 NMAC -
N, 12/9/2025]
8.321.12.5 EFFECTIVE DATE: December 1, 2025, unless a later date is
cited at the end of a section.
[8.321.12.5 NMAC -
N, 12/9/2025]
8.321.12.6 OBJECTIVE: These rules establish the CCBHC program,
define the criteria and process that HCA and the New Mexico children, youth and
families department (CYFD) shall use to recognize and verify CCBHCs and provides
instruction for service provision under the New Mexico medical assistance
program (MAP). These rules specify the standards for the CCBHC application,
certification, payment and oversight.
[8.321.12.6 NMAC -
N, 12/9/2025]
8.321.12.7 DEFINITIONS:
A. “Access site” means a CCBHC alternative facility-based
location, that provides some CCBHC services, within a designated catchment
area.
B. “CCBHC” means a certified community behavioral
health clinic, a specialty designated clinic that provides a comprehensive
range of community-based and outpatient mental health, substance use disorder,
and primary care screening services across the lifespan. New Mexico CCBHCs must be certified by the HCA
and the CYFD.
C. “Catchment area” means a predetermined service area
that includes at least one New Mexico county.
D. “Certification” means the process the HCA and CYFD
use to determine if a program has substantially met the federal and state CCBHC
certification criteria.
E. “Certification team” means a multi-disciplinary team
that reviews a prospective or existing CCBHC’s readiness, including conducting
the site review and visit, performance, and reviews of any site improvement
plans.
F. “Certified” means the HCA and CYFD have affirmed
that a practice substantially meets the federal and New Mexico CCBHC
certification criteria and related standards.
G. “CLIA” means clinical laboratory improvement amendments
of 1988 as amended.
H. “Cost report” means the centers for medicare and medicaid services
(CMS) developed tool used by CCBHCs and HCA to determine the clinic-specific
prospective payment system (PPS) rate and to annually report demonstration
costs.
I. “CYFD” means the New Mexico children, youth and
families department.
J. “DCO” means designated collaborating organization.
It is a separate entity not under the direct supervision of a CCBHC that has a
contractual relationship with a CCBHC to provide any of the authorized core
services on behalf of the CCBHC.
K. “Eligible agency” means a provider that meets the
criteria set forth in 8.321.12.10 NMAC.
L. “HCA” means the New Mexico health care authority.
M. “MAP” means the New Mexico medical assistance program.
N. “MAT” means medication-assisted treatment, the use of
food and drug administration (FDA) approved medications for the treatment of
substance use disorder(s).
O. “MCO” means managed care organization.
P. “PPS” means prospective payment system and is a
reimbursement method where a CCBHC receives a fixed, clinic-specific cost-based
rate for delivering qualifying services to MAP eligible beneficiaries.
Q. “Satellite facility” means a facility, established by
a CCBHC after April 1, 2014, operated under the governance and financial
control of that CCBHC, which provides all or more of the following services;
crisis services; screening, diagnosis, and risk assessment; person and family
centered treatment planning; and outpatient mental health and substance use
services, as defined in the CCBHC certification criteria.
R. “SIP” means site improvement plan, a plan developed
by the CCBHC to address any deficiencies related to the certification criteria
identified during a site review or visit, or a tool used for ongoing CCBHC
performance monitoring and correction.
S. “SUD” means substance use disorder, which is a
pattern of use of substances leading to clinical or functional impairment, in
accordance with the definition in the diagnostic and statistical manual of
mental disorders (DSM-5 TR) of the American psychiatric association, or any
subsequent editions.
[8.321.12.7 NMAC -
N, 12/9/2025]
8.321.12.8 MISSION STATEMENT: We ensure New Mexicans attain their
highest level of health by providing whole-person, cost-effective, accessible,
and high-quality health care and safety-net services.
[8.321.12.8 NMAC -
N, 12/9/2025]
8.321.12.9 GENERAL PROVIDER INSTRUCTIONS:
A. CCBHCs are required to provide the full array of
outpatient mental health, substance use treatment and primary care screening
services outlined in Subsection C of 8.321.12.9 NMAC to all New Mexicans
seeking care.
B. CCBHC services and supports must
be responsive to the needs of the local community. The purpose of a CCBHC is to:
(1) Provide access to integrated, evidence-based
SUD and mental health services, including MAT and 24-hour seven days a week
crisis response services.
(2) Ensure timely access to integrated,
coordinated, and responsive treatment and services including during evenings
and weekends.
(3) Provide coordination of care across
settings and providers to ensure seamless transitions for individuals being
served across the full spectrum of health and social services.
C. CCBHCs must provide, at a minimum, all the following core
services:
(1) crisis services;
(2) outpatient mental health and
substance use services;
(3) person- and family-centered treatment
planning;
(4) community-based mental health care
for veterans;
(5) peer, family support, and counselor
services;
(6) targeted case management;
(7) outpatient primary care screening and
monitoring;
(8) psychiatric rehabilitation services;
and
(9) screening, diagnosis, and risk
assessment.
[8.321.12.9 NMAC -
N, 12/9/2025]
8.321.12.10 CERTIFIED COMMUNITY BEHAVIORAL HEALTH
CLINIC:
A. An eligible agency seeking to become a CCBHC must:
(1) meet and continuously meet HCA
published New Mexico CCBHC certification criteria.
(2) have the necessary certifications,
licenses, or enrollments to provide the specified MAP covered services and be
in good standing.
(3) be certified by the HCA and the CYFD
in accordance with the New Mexico CCBHC certification criteria. The CCBHC
certification criteria sets standards for service delivery and consists of six
program requirements:
(a) staffing;
(b) availability and accessibility
services;
(c) care coordination;
(d) scope of services;
(e) quality and other reporting; and
(f) organizational authority and
governance.
(4) provide or ensure the provision of
the nine core services, as defined in Subsection C of 8.321.12.9 NMAC, to all
individuals, of all ages, within their designated catchment area(s).
(5) provide services with fidelity to
evidence-based practice requirements, as published by HCA.
(6) serve catchment area(s) that are
defined as New Mexico county boundaries. CCBHCs may elect to serve more than one county
but must serve the entire county or counties.
(7) CCBHCs may provide services at
additional facility-based locations within their designated catchment areas,
known as “access sites.” Access sites must not meet the definition of a
“satellite facility,” as defined in Subsection Q of 8.321.12.7 NMAC.
(a) All access sites must be approved by
HCA and CYFD during the certification process.
(b) Agencies may request changes to
access sites during recertification.
(8) Ensure locations are accessible and
recipients receive care in a safe and functional environment.
(9) Complete a community needs assessment
and staffing plan prior to program implementation to identify and integrate
community-specific treatment needs to CCBHC strategic planning and service
delivery, ensuring services are delivered per the needs and preferences of the
population served. The community needs
assessment and the staffing plan must be updated every three years thereafter.
(10) Meet minimum staffing requirements
detailed in the CCBHC certification criteria.
(11) Regularly assess, train, and develop
skills and competencies of staff in accordance with a training plan in
alignment with the certification criteria and any training standards for
specialty behavioral health services required by the state.
(12) Provide primary care screening and
diagnostic services.
(a) The CCBHC medical director must
establish protocols that conform to screening recommendations with scores of A
and B per the U.S. preventative services task force, focusing on HIV, Hepatitis
C Virus, CCBHC quality measures, and community needs, as identified in the
needs assessment.
(b) CCBHCs must ensure developmentally
appropriate screenings for early childhood (ages zero to five), children and
youth, and other primary care screenings appropriate for the population served,
including appropriate screenings and preventative interventions for older
adults.
(c) All laboratory procedures will be
conducted in accordance with acceptable standards of practice. A CLIA
certificate, or waiver will be appropriately maintained if required by federal
CLIA standards.
(13) Establish care coordination agreements
across services and providers as indicated in the certification criteria, and
render care coordination in accordance with the certification criteria.
(14) Establish a sliding fee scale for
individuals not MAP enrolled, to ensure services are not denied or limited due
to an individual’s inability to pay for services.
(15) Report incidents for adults aged 18
years and above, such as adverse events, client safety issues, and breaches to
the appropriate authorities in accordance with adult protective services, and
pursuant to 8.370.9 NMAC and 8.308.21.13 NMAC. Report incidents for children ages zero up to
18 years of age such as adverse events, client safety issues, and breaches to
the appropriate authorities in accordance with CYFD, pursuant to 8.10.2.1 NMAC.
Reports must comply with all incident
intake, processing, training, and reporting requirements, as specified.
(a) CCBHCs must have protocols in place
for managing incidents, including conducting investigations, documenting
findings, and implementing corrective action.
(b) Protocols should be regularly
reviewed and updated to ensure they remain effective.
(16) Comply with quality assurance
reporting, quality improvement, and other reporting requirements as indicated
in 8.321.12.13 NMAC.
[8.321.12.10 NMAC -
N, 12/9/2025]
8.321.12.11 DESIGNATED COLLABORATING
ORGANIZATIONS (DCO): CCBHCs may partner
with a DCO to deliver any of the nine core services, identified in Subsection C
of 8.321.12.9 NMAC, through a formal agreement.
A. During certification, CCBHCs must submit a listing of
DCOs and a valid and current copy of a legally binding contractual agreement
that adheres to New Mexico’s CCBHC certification criteria.
B. The CCBHC must provide at least fifty-one percent of all
CCBHC encounters directly per year.
C. The CCBHC maintains programmatic, clinical, payments, and
regulatory responsibility for the services provided by the DCO to CCBHC
clients.
D. DCOs must secure the appropriate license(s),
certification(s), and approval(s) to provide the associated MAP reimbursable
services.
E. DCOs are prohibited from separately billing HCA or MCOs
for CCBHC services provided to CCBHC clients.
[8.321.12.11 NMAC -
N, 12/9/2025]
8.321.12.12 APPLICATION AND CERTIFICATION PROCESS:
A. HCA shall establish a process to receive and review
applications from eligible agencies interested in CCBHC certification.
B. Applicants seeking CCBHC certification must complete and
apply within the parameters and timelines set forth by HCA.
C. The CCBHC certification team will review all applications
submitted against the CCBHC certification criteria, see Subsection A of
8.321.12.10 NMAC.
(1) Applicants found to be in full or
substantial compliance with CCBHC certification criteria will be advanced to a
readiness review.
(2) Applicants that demonstrate a
reasonable plan to achieve compliance with CCBHC certification criteria within
designated timelines may receive a request for a readiness review site visit, at
HCA and CYFD discretion.
(3) Denial of advancing to a readiness
review may be issued if the applicant does not have the capacity or a
reasonable plan to meet CCBHC certification criteria or if there is a history
of revocation, suspension, non-renewal or denial of certification, sanction(s)
or penalties, or other similar disciplinary actions taken by regulatory bodies
in any state and country, regardless of whether any of those actions resulted
in a settlement in a lieu of a sanction.
D. The readiness review will assess fidelity to the CCBHC
model including, but not limited to, provision of the core services, coverage
of eligible populations, use of agreement(s) with DCOs, use and fidelity of
evidence-based practices, appropriate staffing, proposed location(s)
suitability and safety, and adherence to the CCBHC certification criteria.
(1) HCA will assign a preliminary
readiness assessment score and issue a written summary of the findings to the applicant
prior to the site visit.
(2) Applicants may dispute reviewer
findings or present additional information to substantiate compliance during
the site visit and up to 10 calendar days after the site visit.
(3) Applicants demonstrating a sufficient
level of readiness may be invited to complete a site improvement plan to
address how the CCBHC will remediate any areas of non-compliance noted during
the review.
(a) Site improvement plans must be
submitted within the format and timeliness expectations established by HCA.
(b) Agencies must submit regular updates
to site improvement plans demonstrating ongoing remediation or compliance on a
timeline dictated by HCA.
E. HCA and CYFD will render a joint certification decision.
(1) Approval will be issued if the
applicant is found to be ready to implement pursuant to the CCBHC certification
criteria, rating scale and submission and acceptance of the site improvement
plan.
(2) Denial of certification may be issued
if the agency does not sufficiently demonstrate readiness, capacity to
implement with fidelity, or a reasonable plan to meet CCBHC certification
criteria.
(a) A denial of certification does not
mean permanent denial of participation. With
HCA’s and CYFD’s agreement, an agency that was denied certification may submit
a site improvement plan to address areas of non-compliance and receive
technical assistance to support program readiness.
(b) HCA and CYFD reserves the right to
deny certification after all remediation steps are taken and the agency still,
at the determination of HCA and CYFD, does not meet the CCBHC certification
criteria.
F. Certification may be issued for one year or up to three
years depending on the agency’s demonstrated level of readiness.
G. Agencies must seek recertification from HCA and CYFD to
maintain CCBHC status and retain eligibility to receive a PPS payment.
H. HCA and CYFD may decertify a CCBHC in the event a
certified CCBHC no longer meets the performance,
fidelity, or certification criteria. HCA and CYFD must allow for corrective
action before decertification of a CCBHC that no longer meets the requirements
in Subsection E of 8.321.12.12 NMAC.
[8.321.12.12 NMAC -
N, 12/9/2025]
8.321.12.13 PERFORMANCE MEASUREMENT AND OVERSIGHT:
A. CCBHCs must work with the HCA, MCOs, CYFD, and any
designates, and participate in operation support, programmatic oversight and
monitoring. This includes, but is not
limited to:
(1) Participation in all performance
oversight and quality improvement efforts, including coordination on any
corrective action, performance oversight and quality improvement efforts,
quarterly monitoring, audits, onsite reviews, and certification or
re-certification.
(2) HCA and CYFD may conduct unannounced
site visits or reviews at any time to ensure compliance and the delivery of
high-quality care under the CCBHC model.
B. CCBHCs must:
(1) Provide accurate and timely reporting
of all CCBHC quality metrics and supporting information, as designated by HCA.
(2) Participate in the review of CCBHC
quality metrics, cost reports, level of care/service utilization data, or other
performance data.
(3) Implement continuous improvement
processes to identify and remediate deficiencies or areas of need and ensure
quality provision of services to CCBHC members.
(4) Ensure that all data or information
submissions are accurate, timely, and comply with established reporting
guidelines.
(5) Participate in training and technical
assistance activities to support expansion, quality improvement, and the
effective delivery of CCBHC services.
[8.321.12.13 NMAC,
N - 12/9/2025]
8.321.12.14 PAYMENT:
A. CCBHC PPS rates for newly certified CCBHCs shall be
established by HCA using a provider-specific rate based on the submission and
acceptance of the CMS cost report.
B. PPS rates are subject to review and approval by the HCA.
C. HCA shall reimburse CCBHCs for eligible services provided
to a MAP beneficiary on a per day basis for each day that an eligible service
is delivered using the CCBHC daily PPS rate. A CCBHC visit is eligible for
reimbursement if at least one of the CCBHC payment triggering services listed
in the CCBHC scope of services list, published on HCAs website, is furnished to
a MAP enrollee by a CCBHC or DCO.
D. HCA shall rebase CCBHC rates in accordance with federal
criteria. HCA shall allow a 30-day review period after notice of the results of
the rebasing.
E. Only agencies with an active CCBHC certification from HCA
are eligible to receive the CCBHC PPS.
[8.321.12.14 NMAC -
N, 12/9/2025]
8.321.12.15 RETENTION OF RECORDS AND PROGRAM
INTEGRITY:
A. CCBHCs shall maintain oversight of all activities and
shall maintain adequate records, documents, papers, and files specific to the
CCBHCs activities, including application, certification, and program
implementation. CCBHCs must comply with all HCA provider participation
agreement requirements and NMAC rules and requirements, including but not
limited to 8.302.1, 8.310.2, and 8.321.2 NMAC.
B. Eligible agencies and CCBHCs must submit to monitoring of
its activities by HCA, CYFD, or MCOs as necessary to ensure the CCBHC program
is operating in accordance with New Mexico policies, procedures, standards, and
federally established criteria.
C. Eligible agencies and CCBHCs shall permit HCA, CYFD, and
designees to have timely access to its records and financial statements as
necessary for monitoring, oversight, and audit.
[8.321.12.15 NMAC -
N, 12/9/2025]
History of
8.321.12 NMAC: [RESERVED]