Plans of Safe Care Infants With Prenatal Substance Exposure and Their Families - New Mexico

Definitions
Citation: Stat. Ann. § 32A-1-4; Admin. Code § 8.10.5.7

The term 'plan of care' means a plan created by a health-care professional intended to ensure the safety and well-being of a substance-exposed newborn by addressing the treatment needs of the child and any of the child's parents, relatives, guardians, family members, or caregivers to the extent those treatment needs are relevant to the safety of the child.

In regulation: 'Substance exposed newborn' is any newborn exposed in utero to an illicit substance such as methamphetamine or heroin or prescribed medication such as opioids, methadone, buprenorphine, and marijuana.

Notification/Reporting Requirements
Citation: Ann. Stat. §§ 32A-3A-13; 32A-4-3(G)-(I); Admin. Code § 8.10.5.8

Reports made pursuant to this section shall be collected by the Children, Youth and Families Department (the department) as distinct and separate from any child abuse report as captured and held or investigated by the department, such that the reporting of a plan of care shall not constitute a report of suspected child abuse and neglect and shall not initiate an investigation by the department or a report to law enforcement.

Reports made pursuant to the requirements in this section shall not be construed to relieve a person of the requirement to report to the department knowledge of or a reasonable suspicion that a child is an abused or neglected child based on criteria as defined by § 32A-4-2.

A finding that a pregnant woman is using or abusing drugs made pursuant to an interview, self-report, clinical observation, or routine toxicology screen shall not alone form a sufficient basis to report child abuse or neglect to the department. A volunteer, contractor, or staff of a hospital or freestanding birthing center shall not make a report based solely on that finding and shall make a notification. Nothing in this subsection shall be construed to prevent a person from reporting to the department a reasonable suspicion that a child is an abused or neglected child based on other criteria as defined by § 32A-4-2 or a combination of criteria that includes a finding pursuant to this subsection.

A volunteer, contractor, or staff of a hospital or freestanding birthing center shall do the following:

• Complete a written plan of care (POC) for a substance-exposed newborn
• Provide notification to the department

Notification by a health-care provider shall not be construed as a report of child abuse or neglect. As used in this section, 'notification' means informing the department that a substance-exposed newborn was born and providing a copy of the POC that was created for the child, provided that notification shall comply with Federal guidelines and shall not constitute a report of child abuse or neglect.

In regulation: The notification of newborn substance exposure is documented in one of the following ways:

• Submission of a Comprehensive Addictions and Recovery Act (CARA) POC for the newborn and family
• Submission of the notification of CARA newborn status form, which documents the following:
  • Substance exposure was identified by cord or meconium toxicology screening and the newborn was discharged from the health-care facility before the family was informed
  • The newborn with substance exposure has transferred to a health-care facility for a higher level of care
  • The caregiver of the newborn with substance exposure has refused a CARA POC

Families shall be informed that they may request a referral for services at a later time, even if they have declined these services, by communicating with their health insurance care coordinator or the CARA navigator, whose contact information shall be provided by the health-care provider.

Assessment of the Infant and Family
Citation: Ann. Stat. § 32A-3A-13; Admin. Code § 8.10.5.9

The rules developed by the department shall include guidelines to hospitals, birthing centers, medical providers, Medicaid managed care organizations, and private insurers regarding definitions and evidence-based screening tools, based on standards of professional practice, to be used by health-care providers to identify a child born affected by substance use, withdrawal symptoms resulting from prenatal drug exposure, or a fetal alcohol spectrum disorder (FASD).

In regulation: The parents, domestic partners, and key household members shall also be assessed for substance use disorders. If it is determined they have a substance use disorder, it shall be documented in the POC. If there is substance use present, the parents, domestic partners, and key household members shall be offered services to address treatment and recovery goals of each individual. A copy of the POC will be provided to individuals for whom such referrals are made.

Responsibility for Development of the Plan of Safe Care
Citation: Ann. Stat. § 32A-3A-13

By January 1, 2020, the department, in consultation with Medicaid managed care organizations, private insurers, the Office of Superintendent of Insurance, the Human Services Department, and the Department of Health, shall develop rules to guide hospitals, birthing centers, medical providers, Medicaid managed care organizations, and private insurers in the care of newborns who exhibit physical, neurological, or behavioral symptoms consistent with prenatal drug exposure, withdrawal symptoms from prenatal drug exposure, or FASD.

The rules shall include guidelines to hospitals, birthing centers, medical providers, Medicaid managed care organizations, and private insurers regarding participation in the discharge planning process, including the creation of a written POC that shall be sent to the following:

• The child's primary care physician
• A Medicaid-managed care organization insurance plan care coordinator who will monitor the implementation of the plan of care after discharge, if the child is insured, or to a care coordinator in the Children's Medical Services of the Family Health Bureau of the Public Health Division of the Department of Health who will monitor the implementation of the plan of care after discharge, if the child is uninsured
• The child's parent, relative, guardian, or caregiver who is present at discharge shall receive a copy upon discharge 

The POC shall be signed by an appropriate representative of the discharging hospital and the child's parent, relative, guardian, or caregiver who is present at discharge.

Services for the Infant
Citation: Ann. Stat. § 32A-3A-13

The rules also may provide for the engagement of the child's relatives, parents, guardians, or caregivers in order to identify the need for access to treatment for any substance use disorder or other physical or behavioral health condition that may impact the safety, early childhood development, and well-being of the child.

Services for the Parents or Other Caregivers
Citation: Ann. Stat. § 32A-3A-13

The rules shall include guidelines to hospitals, birthing centers, medical providers, Medicaid managed care organizations, and private insurers regarding the identification of appropriate agencies to be included as supports and services in the plan of care, based on an assessment of the needs of the child and the child's relatives, parents, guardians, or caregivers, performed by a discharge planner prior to the child's discharge from the hospital or birthing center. Agencies that may provide services may include the following:

• Public health agencies
• Maternal and child health agencies
• Home visitation programs
• Substance-use disorder prevention and treatment providers
• Mental health providers
• Public and private children and youth agencies
• Early intervention and developmental services
• Courts
• Local education agencies
• Managed care organizations
• Hospitals and medical providers

Monitoring Plans of Safe Care
Citation: Ann. Stat. § 32A-3A-13

The rules shall include guidelines to hospitals, birthing centers, medical providers, Medicaid managed care organizations, and private insurers regarding the collection and reporting of data to meet Federal and State reporting requirements, including the following:

• Data provided by hospitals and birthing centers to the department when a POC has been developed and a family has been referred for a POC
• Information pertaining to a child born and diagnosed by a health-care professional as affected by substance abuse, withdrawal symptoms resulting from prenatal drug exposure, or FASD
• Data collected by hospitals and birthing centers for use by the Children's Medical Services of the Family Health Bureau of the Public Health Division of the Department of Health in epidemiological reports and to support and monitor a plan of care

Information reported pursuant to this subparagraph shall be coordinated with the insurance carrier care coordinators to facilitate access to services for children and parents, relatives, guardians, or caregivers identified in a plan of care.

The department shall summarize and report data received at intervals as needed to meet Federal regulations.