N.M. Admin. Code § 7.20.11.9

Current through Register Vol. 35, No. 23, December 10, 2024

Section 7.20.11.9 - ISSUANCE OF CERTIFICATION

A. Application for initial certification:

(1) Applications for the initial certification of a new program offering case management services, behavior management skills development services, day treatment services, group home services, all residential treatment services, or treatment foster care services are submitted to the LCA for review and approval. The application for initial certification of a program includes, but is not limited to, the following:

(a) a letter of intent naming the service for which the agency is requesting initial certification and describing how and where the proposed service will be delivered.

(b) policies and procedures showing that the agency complies with both the general provisions and the service-specific requirements of the program for which the agency is requesting initial certification; and an index that references each policy and procedure by the applicable certification requirement that the policy is designed to meet.

(c) job descriptions, required qualifications, resumes, current licenses, proof of credentials, and criminal records clearances for professional staff;

(d) job descriptions, required qualifications and criminal records clearances for direct service staff; and

(e) a complete set of the forms that will be used to document the services being provided.

(2) At the discretion of the LCA, the application process may include interviews with staff, administrators, or program directors.

(3) When applicant agencies have an established in-state or out-of-state history of providing mental health or substance abuse services for children and adolescents, whether or not the agency is currently providing such services, the agency's record with regulatory compliance will be considered during review of the new application;

(4) Applications will be reviewed by the LCA within 15 business days and a written response will be sent to the agency. The findings of the review will determine which of the following responses will be issued by the LCA:

(a) Complete applications that comply with all the requirements of these certification requirements will be issued an initial certification for a period of up to 120 days.

(b) Incomplete applications will be returned with a letter detailing what elements of the application are missing. initial certification will not be issued.

(c) When an application is complete, but fails to show that the agency has fully or substantially complied with all of these certification requirements, the LCA will issue a letter detailing the findings of the review, with a list of the changes required to show the new program to be in compliance with these certification requirements. An initial certification will not be issued.

(5) If, three months subsequent to the issuance of an LCA letter detailing missing or insufficient elements of an application, the agency has not responded with a completed application or has not achieved compliance with these certification requirements sufficient to warrant initial certification, the application will be considered void. The agency may reapply for certification of the service, but will be required to begin a new application process.

(6) COA/CARF/JCAHO Accreditation does not confer state certification status on a program.

B. Types of certification:

(1) FULL CERTIFICATION: Full certification is granted to a program currently serving clients and found by the LCA to be in substantial compliance with these certification requirements. At the discretion of the LCA, the duration of full certification status is 12 to 24 months.

(2) EXEMPLARY STATUS is a type of full certification that may be granted to a program that has no history of temporary certification, sanctions or loss of certification in the previous two years and that, based on a determination made by the LCA, adheres to these certification requirements with only minor deficiencies, which pose no health and safety risks to clients. Exemplary status may be granted for up to 24 months.

(3) FULL CERTIFICATION: This certification is granted to a program currently serving clients and found to be in substantial compliance with these certification requirements, when only minor and few deficiencies, none of which compromise client health and safety, are identified in the LCA certification report. The program submits an action plan for the LCA's approval within the time frame specified by the LCA, detailing the measures that will be used to correct the deficiencies. At the discretion of the LCA, the program may also be required to implement a directed action(s) within specified time frames; or may be required to comply with monitoring as specified by the LCA during the period of certification. Based on a determination made by the LCA, the program produces proof of correction of deficiencies and/or compliance with directed action(s) and/or monitoring through submission of relevant documentation and/or by subsequent on-site review. The terms and the time frames for monitoring are established in writing in the certification report.

(a) The LCA provides written notification indicating whether the program's action plan is approved. Action plans may be approved with amendments recommended and/or required within a time frame specified by the LCA. If an action plan is not approved, the LCA will specify items that require revision or supplementation in order to receive LCA approval.

(b) If another survey reveals additional deficiencies, the LCA may require amendment of the action plan, and/or issue new written directed actions, and/or implement a revised monitoring plan, and/or sanction the program based on new deficiencies identified.

(4) TEMPORARY CERTIFICATION: Temporary certification is granted to a program currently serving clients that is found by the LCA to be in partial compliance with the certification requirements, or to a program that has been on inactive status and is returning to active status.

(a) The LCA determines the duration of a temporary certification. Temporary certification may be granted for a period of up to 180 days. The LCA determines the duration of temporary certification based on factors that may include severity of deficiencies and the program's history of compliance with certification requirements.

(b) The program submits an action plan for the LCA's approval within 14 days of receipt of the LCA certification report detailing its findings of deficiencies, unless otherwise specified by the LCA. At the discretion of the LCA, the program may also be required to implement directed action(s) within specified time frames. The program may be required to comply with terms of monitoring specified by the LCA during the period of temporary certification, based on a determination made by the LCA.

(c) Items 9.B(3)(a) and (b) above are applicable for action plans that accompany temporary certification.

(d) For programs returning to active status, an action plan, directed action, and/or monitoring are not required unless specified by the LCA.

(e) If the program does not achieve substantial compliance with these certification requirements at the end of a temporary certification period, a sanction(s) may be imposed including non-renewal of certification.

(f) At the discretion of the LCA, a second consecutive temporary certificate may be issued for a period of up to 180 days, or certification may be allowed to expire without renewal.

(5) INITIAL CERTIFICATION: This certification is granted for a period of 120 days to a program that has met the minimum requirements to provide child and adolescent mental health or substance abuse services as determined by the application process described in certification requirement 9. A above. If the program has no clients at the end of 120 days, a second 120-day initial certification may be granted. If the program remains without clients beyond 240 days, the program's initial certificate expires and re-application for certification is required; or, at the discretion of the LCA, inactive status may be granted.

(6) INACTIVE STATUS: This certification is granted to a program not presently serving clients, but which has served clients within the current period of certification. A certificate of inactive status covers a period of time not to exceed 180 days from the date of issue. If the program continues without clients beyond 180 days, a second 180-Day certificate of inactive status may be granted upon request. If the program remains without clients beyond 365 days, the program's inactive status expires and re-application for initial certification is required.

(a) To return to active status from inactive status for a certified service, the program must notify the LCA in writing at least two weeks prior to its intended admission of clients. In addition to the written notice, the agency must submit the following to the LCA: information on any changes in personnel or agency policies and procedures during inactive status; proof of criminal records clearances, qualifications, and, as applicable, licensure for new supervisory and direct service staff of the certified program.

(b) Upon review of the submitted information, the LCA may grant temporary certification. The agency will not admit any client(s) until the LCA issues and the program receives temporary certification.

(7) AMENDED CERTIFICATE: This certification is granted to a program currently serving clients that has had a change of ownership or licensee, or that chooses to change its name. The agency submits a written request for an amended certificate to the LCA ten business days prior to the change.

(8) DEEMED CERTIFICATION: The LCA has discretion to grant deemed certification when a program is accredited by the council on accreditation (COA), the council on accreditation of rehabilitation facilities (CARF), or for residential treatment services, by the joint commission on accreditation of health care organizations (JCAHO), and the LCA determines that the standards of the accrediting body apply substantially to the program for which deemed certification is being considered. A certified program that is accredited by one of these organizations and wishes to request deemed certification must provide a copy of the accreditation report to the LCA within 30 days of receipt of the report, and must provide any other accreditation-related documentation to the LCA upon request. Upon receipt and review of the COA, CARF or JCAHO survey reports, the LCA, at its discretion, may issue deemed certification status effective for up to 24 months. For those intervening years that the above-mentioned accrediting bodies do not conduct on-site visits, the LCA may conduct annual or biennial certification on-site surveys.

(a) EXCEPTION: The deemed certification may not apply when COA, CARF or JCAHO identify any condition that the LCA, at its sole discretion, determines to be a significant violation of certification or accreditation standards, or that requires follow-up by the accrediting body; or when any condition reported to the LCA appears to pose a threat to health and/or safety; or when there is any other information indicating the existence of such a threat.

(b) All agencies and programs that receive deemed certification must comply with all applicable provisions of the Children's Health Act of 2000 and these certification requirements.

C. AUTOMATIC EXPIRATIONS OF A CERTIFICATION:

(1) A certificate automatically expires at midnight on the day a certified program discontinues or suspends operation or changes location.

(2) A certificate automatically expires at midnight on the tenth day after a certified program is sold, leased, or otherwise changes ownership and/or licensee, unless the agency has made a timely written request for amended certification. In such a case, the automatic expiration is stayed, and previous certification remains in effect if the agency has until the LCA acts on the application or takes other certification action.

D. WAIVERS AND/OR VARIANCES: Upon written request of the agency and at the discretion of the LCA, the LCA may issue a waiver and/or variance

E. CERTIFICATION REVIEWS: When possible, the LCA schedules on-site program reviews prior to expiration of certification. If the LCA does not perform a certification on-site review of a program prior to the expiration of its certification, and the program has not received a written report from the LCA recommending that the program's certification be allowed to expire, the certification continues in effect until the LCA performs a certification review.

F. The LCA, at its sole discretion, may extend any certification for a period of up to 12 months.

G. In the event that a program's certification is revoked, suspended, denied, or not renewed, the medicaid provider agreement terminates on the date of the revocation, suspension or denial.

N.M. Admin. Code § 7.20.11.9

7.20.11.9 NMAC - Rp 7 NMAC 20.11.9, 03/29/02; A, 04/14/05