Medicaid Specialty Provider Rate
New Mexico Evidence-Based Practice Specialty Provider Approval
As part of the State of New Mexico Evidence-Based Practice (EBP) Initiative, the Children, Youth & Families Department–Behavioral Health Services (CYFD-BHS), the New Mexico Health Care Authority (HCA), and the Centers for Medicare & Medicaid Services (CMS) have established specialized reimbursement rates for behavioral health providers who meet the required training and credentialing standards for five identified Evidence-Based Practices (EBPs).
Eligible providers may bill these New Mexico EBP Specialty Rates when providing approved EBP services to Medicaid beneficiaries. However, providers must receive state approval as an EBP Specialty Provider before completing the enrollment process and billing under these specialty rates.
The NMSU Center of Innovation for Behavioral Health and Wellbeing (COI) partners with the State of New Mexico to support this process by reviewing and verifying the training, credentials, and qualifications of behavioral health providers seeking EBP Specialty Provider approval. This process helps ensure that providers delivering these specialized services have completed the required training and meet established standards for implementing the identified EBPs with New Mexico Medicaid clients.
- Please see the Behavioral Health Fee Schedule for the established rates.
- Please see the Behavioral Health Policy & Billing Manual for further requirements and billing information.
New Mexico EBP Provider Training and Qualification Standards
Each EBP has its own approval criteria, which align with national training and certification standards. While EBP providers are in the process of being approved, they are still able to provide EBP services and bill under regular therapy codes until their specialty rate application is approved. If you already meet the qualifications for an EBP, you can complete the Provider Application on our website under the specific EBP (pages linked below). If you do not meet the qualifications, visit the EBP-specific page for more information on training opportunities.
What to Expect After Applying
Once the Center of Innovation has received an application, it will be reviewed, and qualifications will be verified by the COI team in consultation with EBP experts. Recommendations for approval of a provider's EBP qualifications will be made to the State, and once approved, a letter will be issued.
When clinicians are approved for the NM EBP Specialty Rate, they will receive an approval letter from the COI, via email, on behalf of CYFD and HCA. The letter will include the following instructions:
For those already established NM Medicaid BH Providers:
- Log in to your account in the Medicaid Portal Yes New Mexico
- Complete a "Provider Update Form."
- You will need the approval letters from the COI and a Certificate of Completion or certification document for the appropriate EBP.
For those not yet registered as a NM Medicaid BH Provider:
- Visit Yes New Mexico to create your account.
(Click to Zoom)
Click on an EBP to be taken to its application page.
DIALECTICAL BEHAVIOR THERAPY (DBT)
DBT is a comprehensive treatment for adolescents and adults who experience intense emotion dysregulation that is interfering with their daily lives, relationships, and personal goals.
EYE MOVEMENT DESENSITIZATION AND REPROCESSING THERAPY (EMDR)
EMDR is a structured therapy for children, adolescents, and adults who have experienced a trauma and are having symptoms associated with Post-Traumatic Stress Disorder (PTSD).
FUNCTIONAL FAMILY THERAPY (FFT)
FFT is a short-term, family-based treatment for youth exhibiting problematic behaviors and at-risk for justice system involvement or out-of-home placement.
MULTISYSTEMIC THERAPY (MST)
MST is an intensive home-, family-, and community-focused treatment for youth with serious externalizing, antisocial, or delinquent behavior.
TRAUMA-FOCUSED COGNITIVE BEHAVIORAL THERAPY (TF-CBT)
TF-CBT is a short-term treatment model for children and adolescents (ages 3-18) impacted by trauma and their parents or caregivers.
Medicaid Billing Information
- Behavioral Health Policy and Billing Manual
- New Mexico Administrative Code (NMAC) 8.321.2
- Medicaid Fee Schedule
New Mexico Turquoise Care Managed Care Organization Information:
The COI is not able to provide details about the Medicaid billing and enrollment processes. Please contact your managed care representative or use these contacts for questions about the Medicaid billing process and other provider inquiries.
- For questions related to Medical Assistance Division Provider Enrollment: nm.providers@hca.nm.gov
- For questions related to BHSD Provider Relations Support: bh.qualityteam@hca.nm.gov
