SUD Provider Reports for FY25

90% Capacity

· Reported by “program” (detox, outpatient, residential) not as a whole organization

· FREQUENCY:  Only need to submit if one of your programs reaches capacity

· When you reach capacity answer questions 1, 2, 4 and 5 of the survey. 

· When you return below capacity, answer questions 1-5 and use the same date answer for question 1 that you used when you reported the initial capacity.

· LINK:  https://forms.office.com/Pages/ResponsePage.aspx?id=v1bjylL8i0qRf0zdUtwMVfKlo-N960JGn1bkUYTvt4hUQ0JTMzhBSEYxQ0FZNTRNM1NVWFRETk9PUiQlQCN0PWcu

Women’s Specialty Services

· Reported by organization as a whole even if offering multiple program/services

· This report should be completed by any Provider that bills the HD modifier and serves pregnant women, women with dependent children, women potentially losing a child and men who are primary caregiver, which is ALL NMRE SUD Providers

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· FREQUENCY:  Due annually at end of each Fiscal Year (Sept 30th)

· LINK:  https://forms.office.com/Pages/ResponsePage.aspx?id=v1bjylL8i0qRf0zdUtwMVfKlo-N960JGn1bkUYTvt4hUMVk1NEZYTlk0VjdHUldIMUlVRUs4Wkg0RyQlQCN0PWcu

Children’s Referral Report

· Reported by organization as a whole even if offering multiple program/services

· This report should be completed by any Provider that bills the HD modifier which is ALL NMRE SUD Providers

· Where the question references WSS it is referring to pregnant women, women with dependent children, women potentially losing a child and men who are primary caregiver

· FREQUENCY:  Due QUARTERLY and should be submitted the 15 of each month following the end of each quarter (EX:  October-December on January 15, January – March on April 15, etc)

· LINK:  https://forms.office.com/Pages/ResponsePage.aspx?id=v1bjylL8i0qRf0zdUtwMVfKlo-N960JGn1bkUYTvt4hUNDRURlE0WE9GTkoxVFFMUkpIRkpEVU04RyQlQCN0PWcu

Sentinel Event Report

· Only needs to be completed by RESIDENTIAL services Providers within NMRE Region

(If we are contracted with you for Residential Services but your location is outside of our 21 county region, you should be reporting this information to your home PIHP)

· For the question:  Total Number of Clients Served During the Report Period, the number reported should be the total number of clients regardless of funding stream (private pay, different PIHP

· FREQUENCY:  Semi annually 

· Report Period 1 = October 1  – March 31 due APRIL 15

· Report Period 2 = April 1 – September 30 due OCTOBER 15

· LINK:  https://forms.office.com/Pages/ResponsePage.aspx?id=v1bjylL8i0qRf0zdUtwMVfKlo-N960JGn1bkUYTvt4hURTQ2SjFWOTBJMDhTT0hKNlFUMzZJTk1CSSQlQCN0PWcu