These videos give an overview of the various Home and Community-Based Services (HCBS) available in New Mexico for providers who want to learn how to start or operate an HCBS agency in the state. Each video explains the purpose of the service, provider requirements, licensing process, and how the program functions. Use these videos to better understand the responsibilities, standards, and steps involved in becoming or working with approved HCBS providers in New Mexico. Explore each section to find the service that best matches your goals or area of interest.
Respite Care
RESPITE CARE SERVICES PROVIDER IN NEW MEXICO
SUPPORTING CAREGIVERS AND PROMOTING WELL-BEING THROUGH TEMPORARY RELIEF SERVICES
Respite Care Services in New Mexico provide temporary relief for family caregivers of individuals with disabilities, chronic illnesses, or age-related conditions. These services allow primary caregivers to rest, attend to personal matters, or recover from caregiver fatigue while ensuring the participant’s safety and well-being. Respite Care Services are authorized under New Mexico Medicaid Home and Community-Based Services (HCBS) Waiver programs.
1. GOVERNING AGENCIES
Agency: New Mexico Human Services Department (HSD)
Role: Administers Medicaid waiver funding for Respite Care Services and manages provider enrollment, service authorization, and reimbursement.
Agency: Developmental Disabilities Supports Division (DDSD)
Role: Ensures quality standards, service delivery, and compliance for Respite Care Services under HCBS waiver programs.
Agency: Centers for Medicare & Medicaid Services (CMS)
Role: Provides federal oversight ensuring Medicaid-funded Respite Care Services meet HCBS quality, person-centered planning, and participant protection standards.
2. RESPITE CARE SERVICES OVERVIEW
Respite Care Services offer planned or emergency relief for unpaid caregivers while ensuring participants receive appropriate supervision, personal care, and support services.
Approved providers may deliver:
In-Home Respite Services: Care provided in the participant’s residence.
Facility-Based Respite Care: Temporary care in licensed community settings.
Day Respite: Supervision and support during daytime hours.
Overnight or Weekend Respite: Extended care to accommodate caregiver breaks.
Personal Care Assistance: Help with Activities of Daily Living (ADLs) such as bathing, grooming, feeding, mobility, and toileting.
Medication Reminders: Non-skilled assistance with medication schedules.
Social Engagement: Facilitating recreational or therapeutic activities based on the participant’s interests and care plan.
All respite care must align with the participant’s Individualized Service Plan (ISP) and reflect their health and safety needs.
3. LICENSING & PROVIDER APPROVAL REQUIREMENTS
Prerequisites:
Register the business entity with the New Mexico Secretary of State.
Obtain EIN from the IRS and NPI (Type 2).
Enroll as a Medicaid Waiver Respite Care provider through the New Mexico Medicaid Provider Enrollment Portal.
Obtain facility licensure (if providing facility-based respite) from HSD or NMDOH as applicable.
Maintain general liability and professional liability insurance.
Develop comprehensive policies for participant intake, caregiver communication, incident reporting, and emergency procedures.
Ensure all direct care staff meet background screening, health screenings, and training requirements.
4. NEW MEXICO PROVIDER ENROLLMENT PROCESS
Initial Interest and Application:
Submit Provider Enrollment Application through the New Mexico Medicaid Provider Enrollment Portal for Respite Care Services under appropriate HCBS waivers.
Application and Documentation Submission:
Submit Articles of Incorporation, proof of EIN/NPI, liability insurance certificates, staff credentialing documentation, and service policies.
Program Readiness Review:
HSD and DDSD review provider readiness, including staff qualifications, care and supervision protocols, participant safety plans, and documentation systems.
Approval & Medicaid Enrollment:
Upon approval, providers are authorized to bill Medicaid for In-Home and/or Facility-Based Respite Services using assigned billing codes.
5. REQUIRED DOCUMENTATION
Articles of Incorporation or Business License (New Mexico Secretary of State)
IRS EIN confirmation
NPI confirmation
Facility License (for facility-based respite providers)
Proof of general and professional liability insurance
Respite Care Services Policy & Procedure Manual including:
Participant intake, care planning, and service scheduling procedures
Health and safety monitoring, medication reminders, and supervision protocols
Emergency preparedness, abuse prevention, and critical incident reporting policies
Participant rights, HIPAA confidentiality procedures, and grievance handling
Staff credentialing, background checks, first aid/CPR certification documentation
Medicaid billing, service tracking, and audit readiness procedures
6. STAFFING REQUIREMENTS
Role: Respite Services Program Director
Requirements: Bachelor’s degree in human services, healthcare, or related field; supervisory experience preferred.
Role: Respite Care Workers
Requirements: High school diploma or GED; CPR/First Aid certification; completion of respite-specific or direct care training; background screening and health clearance.
All staff must complete:
Safety and emergency preparedness training
HIPAA compliance and participant rights education
Abuse prevention and exploitation awareness training
Infection control and health monitoring training
Annual competency evaluations and continuing education
7. MEDICAID WAIVER PROGRAMS
Respite Care Services are available under the following New Mexico Medicaid Waivers:
Developmental Disabilities (DD) Waiver
Mi Via Waiver
Medically Fragile Waiver
Supports Waiver
Home and Community-Based Services (HCBS) Waiver
Services may include:
In-home or facility-based supervision and care
Temporary support allowing unpaid caregivers to attend to personal needs
Assistance with basic ADLs and wellness monitoring during respite periods
Crisis respite services when caregiver availability is compromised
8. TIMELINE TO LAUNCH
Phase: Business Formation and Compliance Preparation
Timeline: 1–2 months
Phase: Staff Hiring, Credentialing, and Program Development
Timeline: 2–3 months
Phase: New Mexico Medicaid Provider Enrollment and Readiness Review
Timeline: 60–90 days
Phase: Medicaid Billing Setup and Respite Care Service Launch
Timeline: 30–45 days
9. CONTACT INFORMATION
New Mexico Human Services Department (HSD)
Website: https://www.hsd.state.nm.us/
Developmental Disabilities Supports Division (DDSD)
Website: https://www.nmhealth.org/about/ddsd/
New Mexico Medicaid Provider Enrollment Portal
Website: https://nmmedicaid.portal.conduent.com/
Centers for Medicare & Medicaid Services (CMS)
Website: https://www.cms.gov/
WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — NEW MEXICO RESPITE CARE SERVICES PROVIDER
WCG supports agencies in launching Medicaid-compliant Respite Care Services in New Mexico, offering:
Scope of Work:
Business registration, Medicaid enrollment, and facility licensure support
Policy manual development for respite care planning and caregiver communication
Staff credentialing templates, participant intake forms, and emergency planning templates
Medicaid billing system setup and audit-ready claims management
Branding, website development, and caregiver engagement strategies
Quality assurance systems for incident reporting, service tracking, and compliance monitoring
Residential Support
RESIDENTIAL SUPPORT SERVICES PROVIDER IN NEW MEXICO
SUPPORTING INDEPENDENT LIVING AND COMMUNITY INTEGRATION THROUGH RESIDENTIAL CARE
Residential Support Services in New Mexico provide individuals with disabilities, chronic conditions, or age-related challenges with safe and supportive living environments. These services aim to promote independence, personal growth, and community integration. Residential Support Services are authorized under New Mexico Medicaid Home and Community-Based Services (HCBS) Waiver programs.
1. GOVERNING AGENCIES
Agency: New Mexico Human Services Department (HSD)
Role: Administers Medicaid waiver funding for Residential Support Services and manages provider enrollment, service authorization, and reimbursement.
Agency: Developmental Disabilities Supports Division (DDSD)
Role: Ensures quality standards, service delivery, and compliance for Residential Support Services under HCBS waiver programs.
Agency: Centers for Medicare & Medicaid Services (CMS)
Role: Provides federal oversight ensuring Medicaid-funded Residential Support Services meet HCBS quality, person-centered planning, and participant protection standards.
2. RESIDENTIAL SUPPORT SERVICES OVERVIEW
Residential Support Services provide safe, structured living environments for individuals who need assistance with daily living and community integration.
Approved providers may deliver:
24/7 Residential Care: Supervised living arrangements with staff support.
Assistance with Activities of Daily Living (ADLs): Personal care, mobility support, and health monitoring.
Skill Development: Teaching daily living skills like cooking, cleaning, and budgeting.
Community Engagement: Facilitating participation in social, recreational, and educational activities.
Health and Safety Monitoring: Ensuring a safe and supportive living environment.
Behavioral Support: Assistance with managing challenging behaviors.
Emergency and Crisis Intervention: Immediate support during emergencies.
Personalized Care Plans: Developing individualized plans tailored to the participant’s needs.
All services are delivered according to the Individualized Service Plan (ISP) to meet the participant’s residential and support needs.
3. LICENSING & PROVIDER APPROVAL REQUIREMENTS
Prerequisites:
Register the business entity with the New Mexico Secretary of State.
Obtain EIN from the IRS and NPI (Type 2).
Enroll as a Medicaid Waiver Residential Support provider via the New Mexico Medicaid Provider Enrollment Portal.
Obtain residential facility licensure from HSD, DDSD, or the New Mexico Department of Health (NMDOH).
Maintain general liability and professional liability insurance.
Develop policies for residential care, safety protocols, and staff training.
Ensure staff meet background checks, health screenings, and residential care training requirements.
4. NEW MEXICO PROVIDER ENROLLMENT PROCESS
Initial Interest and Application:
Complete the Provider Enrollment Application through the New Mexico Medicaid Provider Enrollment Portal for Residential Support Services under HCBS waivers.
Application and Documentation Submission:
Submit Articles of Incorporation, proof of EIN/NPI, residential facility licenses, insurance certificates, and policy manuals.
Program Readiness Review:
HSD and DDSD evaluate provider readiness, including facility safety, staff qualifications, and care protocols.
Approval & Medicaid Enrollment:
Upon approval, providers are authorized to bill Medicaid for Residential Support Services using designated billing codes.
5. REQUIRED DOCUMENTATION
Articles of Incorporation or Business License (New Mexico Secretary of State)
IRS EIN confirmation
NPI confirmation
Residential Facility License (if applicable)
Proof of general and professional liability insurance
Residential Support Services Policy & Procedure Manual including:
Participant intake, assessment, and individualized care planning procedures
Health and safety monitoring, medication management, and emergency preparedness
Staff credentialing, background checks, and ongoing training records
Documentation standards for residential care tracking and Medicaid billing
HIPAA compliance, participant rights, and grievance handling
Safety protocols, emergency response, and crisis intervention measures
Quality assurance and compliance monitoring
6. STAFFING REQUIREMENTS
Role: Residential Support Program Director
Requirements: Bachelor’s or Master’s degree in human services, social work, or healthcare administration; supervisory experience preferred.
Role: Direct Support Professionals (DSPs)
Requirements: High school diploma or GED; CPR/First Aid certification; training in personal care and ADL support; background clearance.
Role: Residential Care Supervisors
Requirements: Experience in residential care management; supervisory experience; background clearance.
Role: Behavioral Support Specialists (if applicable)
Requirements: Certification in behavioral health support or applied behavior analysis (ABA); background clearance.
All staff must complete:
Training in residential safety and emergency protocols
HIPAA compliance and participant rights education
Annual competency evaluations and ongoing professional development
Behavioral intervention and crisis management training
Infection control and wellness monitoring education
7. MEDICAID WAIVER PROGRAMS
Residential Support Services are available under the following New Mexico Medicaid Waivers:
Developmental Disabilities (DD) Waiver
Mi Via Waiver
Medically Fragile Waiver
Supports Waiver
Home and Community-Based Services (HCBS) Waiver
Services may include:
24-hour supervised residential care
Assistance with personal care and ADLs
Community participation and social skill development
Health and wellness monitoring
Behavioral support and crisis intervention
8. TIMELINE TO LAUNCH
Phase: Business Formation and Compliance Preparation
Timeline: 1–2 months
Phase: Facility Licensing and Compliance Documentation
Timeline: 2–3 months
Phase: Staff Hiring, Credentialing, and Training
Timeline: 2–3 months
Phase: New Mexico Medicaid Provider Enrollment and Readiness Review
Timeline: 60–90 days
Phase: Medicaid Billing Setup and Residential Support Service Launch
Timeline: 30–45 days
9. CONTACT INFORMATION
New Mexico Human Services Department (HSD)
Website: https://www.hsd.state.nm.us/
Developmental Disabilities Supports Division (DDSD)
Website: https://www.nmhealth.org/about/ddsd/
New Mexico Medicaid Provider Enrollment Portal
Website: https://nmmedicaid.portal.conduent.com/
Centers for Medicare & Medicaid Services (CMS)
Website: https://www.cms.gov/
WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — NEW MEXICO RESIDENTIAL SUPPORT SERVICES PROVIDER
WCG supports agencies in launching Medicaid-compliant Residential Support Services in New Mexico, offering:
Scope of Work:
Business registration, Medicaid enrollment, and facility licensure support
Policy manual development for residential care and community integration
Staff credentialing, training program templates, and documentation guidance
Medicaid billing setup and audit-prepared financial management
Branding, website development, and community outreach strategies
Quality assurance systems for residential care safety and compliance
Collaboration with healthcare and community organizations
Supported Employment
SUPPORTED EMPLOYMENT SERVICES PROVIDER IN NEW MEXICO
EMPOWERING INDIVIDUALS THROUGH VOCATIONAL SUPPORT AND COMMUNITY INTEGRATION
Supported Employment Services in New Mexico assist individuals with disabilities or chronic conditions in achieving and maintaining competitive, integrated employment. These services focus on developing job skills, securing employment opportunities, and providing on-the-job support to ensure long-term success. Supported Employment Services are authorized under New Mexico Medicaid Home and Community-Based Services (HCBS) Waiver programs.
1. GOVERNING AGENCIES
Agency: New Mexico Human Services Department (HSD)
Role: Administers Medicaid waiver funding for Supported Employment Services and manages provider enrollment, service authorization, and reimbursement.
Agency: Developmental Disabilities Supports Division (DDSD)
Role: Ensures quality standards, service delivery, and compliance for Supported Employment Services under HCBS waiver programs.
Agency: New Mexico Division of Vocational Rehabilitation (DVR)
Role: Provides employment support and vocational training for individuals with disabilities.
Agency: Centers for Medicare & Medicaid Services (CMS)
Role: Provides federal oversight ensuring Medicaid-funded Supported Employment Services meet HCBS quality, person-centered planning, and participant protection standards.
2. SUPPORTED EMPLOYMENT SERVICES OVERVIEW
Supported Employment Services offer individualized assistance for finding, securing, and maintaining meaningful employment within the community.
Approved providers may deliver:
Vocational Assessment: Identifying skills, interests, and employment goals.
Job Development: Assisting with job searches, applications, and interviews.
Job Placement: Matching individuals with suitable employment opportunities.
Job Coaching: On-site support to develop skills and adapt to workplace environments.
Soft Skills Training: Building interpersonal, communication, and problem-solving skills.
Job Retention Support: Ongoing assistance to maintain job performance and resolve challenges.
Career Counseling: Setting vocational goals and creating career pathways.
Employer Engagement: Educating employers on workplace accommodations and inclusion.
Follow-Up and Monitoring: Regular check-ins to support job stability and satisfaction.
All services are delivered according to the Individualized Service Plan (ISP) to meet the participant’s vocational goals and support needs.
3. LICENSING & PROVIDER APPROVAL REQUIREMENTS
Prerequisites:
Register the business entity with the New Mexico Secretary of State.
Obtain EIN from the IRS and NPI (Type 2).
Enroll as a Medicaid Waiver Supported Employment provider via the New Mexico Medicaid Provider Enrollment Portal.
Obtain necessary certifications for vocational support and job coaching.
Maintain general liability and professional liability insurance.
Develop policies for job placement, workplace safety, and support coordination.
Ensure staff meet background checks, health screenings, and vocational training requirements.
4. NEW MEXICO PROVIDER ENROLLMENT PROCESS
Initial Interest and Application:
Complete the Provider Enrollment Application through the New Mexico Medicaid Provider Enrollment Portal for Supported Employment Services under HCBS waivers.
Application and Documentation Submission:
Submit Articles of Incorporation, proof of EIN/NPI, insurance certificates, vocational training certifications, and policy manuals.
Program Readiness Review:
HSD, DDSD, and DVR evaluate provider readiness, including staff qualifications, vocational support protocols, and workplace safety measures.
Approval & Medicaid Enrollment:
Upon approval, providers are authorized to bill Medicaid for Supported Employment Services using designated billing codes.
5. REQUIRED DOCUMENTATION
Articles of Incorporation or Business License (New Mexico Secretary of State)
IRS EIN confirmation
NPI confirmation
Proof of general and professional liability insurance
Supported Employment Services Policy & Procedure Manual including:
Vocational assessment, job placement, and coaching procedures
Staff credentialing, background checks, and ongoing training records
Documentation standards for service tracking and Medicaid billing
HIPAA compliance, participant rights, and grievance handling
Safety protocols for workplace environments and community-based work sites
Follow-up and retention support procedures
Quality assurance and compliance monitoring
6. STAFFING REQUIREMENTS
Role: Supported Employment Program Director
Requirements: Bachelor’s degree in vocational rehabilitation, social work, or related field; supervisory experience in employment services.
Role: Job Coaches
Requirements: Experience in vocational support or rehabilitation; training in job coaching and support strategies; background clearance.
Role: Vocational Counselors
Requirements: Certification in vocational rehabilitation or employment support; experience in career counseling; background clearance.
Role: Employment Specialists
Requirements: Experience in job development and placement; training in community-based employment support; background clearance.
All staff must complete:
Training in job coaching, soft skills development, and client safety
HIPAA compliance and participant rights education
Annual competency evaluations and professional development
Ongoing training in community employment support and job retention strategies
7. MEDICAID WAIVER PROGRAMS
Supported Employment Services are available under the following New Mexico Medicaid Waivers:
Developmental Disabilities (DD) Waiver
Mi Via Waiver
Medically Fragile Waiver
Supports Waiver
Home and Community-Based Services (HCBS) Waiver
Services may include:
Job development and placement assistance
On-the-job training and coaching
Employment retention and follow-up support
Soft skills training for workplace success
Employer engagement and education
8. TIMELINE TO LAUNCH
Phase: Business Formation and Compliance Preparation
Timeline: 1–2 months
Phase: Staff Hiring, Credentialing, and Program Development
Timeline: 2–3 months
Phase: New Mexico Medicaid Provider Enrollment and Readiness Review
Timeline: 60–90 days
Phase: Medicaid Billing Setup and Supported Employment Service Launch
Timeline: 30–45 days
9. CONTACT INFORMATION
New Mexico Human Services Department (HSD)
Website: https://www.hsd.state.nm.us/
Developmental Disabilities Supports Division (DDSD)
Website: https://www.nmhealth.org/about/ddsd/
New Mexico Division of Vocational Rehabilitation (DVR)
Website: https://www.dvr.state.nm.us/
New Mexico Medicaid Provider Enrollment Portal
Website: https://nmmedicaid.portal.conduent.com/
Centers for Medicare & Medicaid Services (CMS)
Website: https://www.cms.gov/
WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — NEW MEXICO SUPPORTED EMPLOYMENT SERVICES PROVIDER
WCG supports agencies in launching Medicaid-compliant Supported Employment Services in New Mexico, offering:
Scope of Work:
Business registration, Medicaid enrollment, and licensing assistance
Policy manual development for vocational support and job coaching
Staff credentialing, training program templates, and compliance documentation
Medicaid billing setup and audit-prepared financial management
Branding, website development, and employer outreach strategies
Quality assurance systems for job retention and client satisfaction
Collaboration with vocational training centers and community organizations
Personal Care
PERSONAL CARE ATTENDANT (PCA) SERVICES PROVIDER IN NEW MEXICO
SUPPORTING INDEPENDENCE AND DAILY LIVING THROUGH PERSONAL ASSISTANCE
Personal Care Attendant (PCA) Services in New Mexico provide essential support with daily living activities for individuals with disabilities, chronic illnesses, or age-related conditions. These services help maintain independence and enhance quality of life by offering assistance tailored to each individual’s needs. PCA Services are authorized under New Mexico Medicaid Home and Community-Based Services (HCBS) Waiver programs.
1. GOVERNING AGENCIES
Agency: New Mexico Human Services Department (HSD)
Role: Administers Medicaid waiver funding for PCA Services and manages provider enrollment, service authorization, and reimbursement.
Agency: Developmental Disabilities Supports Division (DDSD)
Role: Ensures quality standards, service delivery, and compliance for PCA Services under HCBS waiver programs.
Agency: Centers for Medicare & Medicaid Services (CMS)
Role: Provides federal oversight ensuring Medicaid-funded PCA Services meet HCBS quality, person-centered planning, and participant protection standards.
2. PERSONAL CARE ATTENDANT SERVICES OVERVIEW
PCA Services assist individuals with Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs) to maintain independence and well-being.
Approved providers may deliver:
Personal Hygiene Assistance: Bathing, grooming, oral care, and dressing.
Mobility Support: Transfers, ambulation, and positioning assistance.
Toileting and Incontinence Care: Support with bathroom use and hygiene maintenance.
Meal Preparation and Feeding: Preparing balanced meals, feeding assistance, and hydration support.
Housekeeping and Laundry: Light cleaning, bed making, and laundry tasks.
Medication Reminders: Non-skilled support with medication schedules.
Companionship and Social Engagement: Providing social interaction and light emotional support.
Safety Monitoring: Ensuring a safe environment and preventing accidents.
All services are delivered according to the Individualized Service Plan (ISP) to meet the participant’s specific care and safety needs.
3. LICENSING & PROVIDER APPROVAL REQUIREMENTS
Prerequisites:
Register the business entity with the New Mexico Secretary of State.
Obtain EIN from the IRS and NPI (Type 2).
Enroll as a Medicaid Waiver PCA provider via the New Mexico Medicaid Provider Enrollment Portal.
Obtain a Personal Care Agency License from the New Mexico Department of Health (NMDOH).
Maintain general liability and professional liability insurance.
Develop policies for personal care planning, safety protocols, and staff training.
Ensure staff meet background checks, health screenings, and training requirements.
4. NEW MEXICO PROVIDER ENROLLMENT PROCESS
Initial Interest and Application:
Complete the Provider Enrollment Application through the New Mexico Medicaid Provider Enrollment Portal for PCA Services under HCBS waivers.
Application and Documentation Submission:
Submit Articles of Incorporation, proof of EIN/NPI, insurance certificates, staff qualifications, and policy manuals.
Program Readiness Review:
HSD and DDSD evaluate provider readiness, including staff training, care protocols, and safety measures.
Approval & Medicaid Enrollment:
Upon approval, providers are authorized to bill Medicaid for PCA Services using designated billing codes.
5. REQUIRED DOCUMENTATION
Articles of Incorporation or Business License (New Mexico Secretary of State)
IRS EIN confirmation
NPI confirmation
Personal Care Agency License
Proof of general and professional liability insurance
PCA Services Policy & Procedure Manual including:
Participant intake, assessment, and individualized care planning procedures
Personal care assistance, hygiene, and mobility support guidelines
Staff credentialing, background checks, and training requirements
Documentation standards for care tracking and Medicaid billing
HIPAA compliance, participant rights, and grievance handling
Safety protocols, emergency response, and infection control measures
Quality assurance and compliance monitoring
6. STAFFING REQUIREMENTS
Role: PCA Program Director
Requirements: Bachelor’s or associate degree in healthcare, social services, or a related field; supervisory experience preferred.
Role: Personal Care Attendants (PCAs)
Requirements: High school diploma or GED; CPR/First Aid certification; training in personal care and ADL support; background clearance.
Role: Direct Support Professionals (DSPs)
Requirements: Experience in personal care and hygiene assistance; basic healthcare training; background clearance.
All staff must complete:
Personal care skills training, including ADLs and IADLs
Safety and infection control training
HIPAA compliance and participant rights education
Annual competency evaluations and professional development
Ongoing training in client safety and wellness monitoring
7. MEDICAID WAIVER PROGRAMS
PCA Services are available under the following New Mexico Medicaid Waivers:
Developmental Disabilities (DD) Waiver
Mi Via Waiver
Medically Fragile Waiver
Supports Waiver
Home and Community-Based Services (HCBS) Waiver
Services may include:
Personal hygiene and grooming assistance
Mobility support and safety monitoring
Meal preparation and feeding assistance
Companionship and social support
Light housekeeping and personal environment maintenance
8. TIMELINE TO LAUNCH
Phase: Business Formation and Compliance Preparation
Timeline: 1–2 months
Phase: Staff Hiring, Credentialing, and Program Development
Timeline: 2–3 months
Phase: New Mexico Medicaid Provider Enrollment and Readiness Review
Timeline: 60–90 days
Phase: Medicaid Billing Setup and PCA Service Launch
Timeline: 30–45 days
9. CONTACT INFORMATION
New Mexico Human Services Department (HSD)
Website: https://www.hsd.state.nm.us/
Developmental Disabilities Supports Division (DDSD)
Website: https://www.nmhealth.org/about/ddsd/
New Mexico Department of Health (NMDOH)
Website: https://www.nmhealth.org/
New Mexico Medicaid Provider Enrollment Portal
Website: https://nmmedicaid.portal.conduent.com/
Centers for Medicare & Medicaid Services (CMS)
Website: https://www.cms.gov/
WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — NEW MEXICO PERSONAL CARE ATTENDANT SERVICES PROVIDER
WCG supports agencies in launching Medicaid-compliant PCA Services in New Mexico, offering:
Scope of Work:
Business registration, Medicaid enrollment, and licensing assistance
Policy manual development for personal care planning and safety management
Staff credentialing, training program templates, and compliance documentation
Medicaid billing setup and audit-prepared financial management
Branding, website development, and community engagement strategies
Quality assurance systems for personal care safety and compliance
Medical Supplies & Equipment
MEDICAL SUPPLY AND EQUIPMENT SERVICES PROVIDER IN NEW MEXICO
DELIVERING ESSENTIAL MEDICAL EQUIPMENT AND SUPPLIES FOR HOME AND COMMUNITY-BASED CARE
Medical Supply and Equipment Services in New Mexico provide individuals with disabilities, chronic conditions, or age-related health needs with necessary medical devices and supplies to enhance their quality of life. These services ensure that individuals have access to durable medical equipment (DME) and essential medical supplies, delivered and maintained in a timely manner. Medical Supply and Equipment Services are authorized under New Mexico Medicaid Home and Community-Based Services (HCBS) Waiver programs.
1. GOVERNING AGENCIES
Agency: New Mexico Human Services Department (HSD)
Role: Administers Medicaid waiver funding for Medical Supply and Equipment Services and manages provider enrollment, service authorization, and reimbursement.
Agency: Developmental Disabilities Supports Division (DDSD)
Role: Ensures quality standards, service delivery, and compliance for Medical Supply and Equipment Services under HCBS waiver programs.
Agency: Centers for Medicare & Medicaid Services (CMS)
Role: Provides federal oversight ensuring Medicaid-funded Medical Supply and Equipment Services meet HCBS quality, person-centered planning, and participant protection standards.
2. MEDICAL SUPPLY AND EQUIPMENT SERVICES OVERVIEW
Medical Supply and Equipment Services provide home-based delivery, maintenance, and training on medical equipment for individuals who need support for independent living or health management.
Approved providers may deliver:
Durable Medical Equipment (DME): Wheelchairs, hospital beds, walkers, and mobility aids.
Respiratory Equipment: Oxygen tanks, CPAP machines, ventilators, and related accessories.
Mobility Aids: Crutches, canes, scooters, and adaptive seating.
Orthotic and Prosthetic Devices: Braces, orthotic supports, and prosthetic limbs.
Daily Living Aids: Grab bars, shower chairs, and adaptive utensils.
Home Modifications: Ramps, lifts, and accessibility enhancements.
Wound Care Supplies: Dressings, bandages, and skin protectants.
Incontinence Supplies: Adult diapers, bed pads, and hygiene products.
Monitoring Devices: Blood glucose monitors, blood pressure cuffs, and pulse oximeters.
Training and Maintenance: Guidance on the safe use and upkeep of equipment.
All services are delivered according to the Individualized Service Plan (ISP) to meet the participant’s healthcare and accessibility needs.
3. LICENSING & PROVIDER APPROVAL REQUIREMENTS
Prerequisites:
Register the business entity with the New Mexico Secretary of State.
Obtain EIN from the IRS and NPI (Type 2).
Enroll as a Medicaid Waiver Medical Supply and Equipment provider via the New Mexico Medicaid Provider Enrollment Portal.
Obtain a DME Supplier License from the New Mexico Regulation and Licensing Department (RLD).
Maintain general liability and professional liability insurance.
Develop policies for equipment distribution, safety checks, and maintenance procedures.
Ensure staff meet background checks, health screenings, and technical training requirements.
4. NEW MEXICO PROVIDER ENROLLMENT PROCESS
Initial Interest and Application:
Complete the Provider Enrollment Application through the New Mexico Medicaid Provider Enrollment Portal for Medical Supply and Equipment Services under HCBS waivers.
Application and Documentation Submission:
Submit Articles of Incorporation, proof of EIN/NPI, DME Supplier License, insurance certificates, and policy manuals.
Program Readiness Review:
HSD and DDSD evaluate provider readiness, including equipment safety, staff qualifications, and distribution protocols.
Approval & Medicaid Enrollment:
Upon approval, providers are authorized to bill Medicaid for Medical Supply and Equipment Services using designated billing codes.
5. REQUIRED DOCUMENTATION
Articles of Incorporation or Business License (New Mexico Secretary of State)
IRS EIN confirmation
NPI confirmation
DME Supplier License
Proof of general and professional liability insurance
Medical Supply and Equipment Services Policy & Procedure Manual including:
Equipment assessment, procurement, and distribution protocols
Safety checks, maintenance procedures, and replacement policies
Staff credentialing, background checks, and training records
Documentation standards for equipment tracking and Medicaid billing
HIPAA compliance, participant rights, and grievance handling
Safety protocols for equipment use, repair, and maintenance
Quality assurance and compliance monitoring
6. STAFFING REQUIREMENTS
Role: DME Program Director
Requirements: Bachelor’s degree in healthcare administration, biomedical engineering, or a related field; supervisory experience preferred.
Role: DME Technicians
Requirements: Training in medical equipment setup, maintenance, and safety checks; background clearance.
Role: Delivery and Setup Specialists
Requirements: Valid driver’s license; training in safe transport and equipment assembly; background clearance.
Role: Customer Support Representatives
Requirements: Experience in client communication and support; training in product use and maintenance; background clearance.
All staff must complete:
Training in equipment safety, maintenance, and client education
HIPAA compliance and participant rights education
Annual competency evaluations and ongoing professional development
Safety training, including infection control and equipment sanitization
Emergency response training for equipment malfunctions
7. MEDICAID WAIVER PROGRAMS
Medical Supply and Equipment Services are available under the following New Mexico Medicaid Waivers:
Developmental Disabilities (DD) Waiver
Mi Via Waiver
Medically Fragile Waiver
Supports Waiver
Home and Community-Based Services (HCBS) Waiver
8. TIMELINE TO LAUNCH
Phase: Business Formation and Compliance Preparation
Timeline: 1–2 months
Phase: Staff Hiring, Credentialing, and Program Development
Timeline: 2–3 months
Phase: New Mexico Medicaid Provider Enrollment and Readiness Review
Timeline: 60–90 days
Phase: Medicaid Billing Setup and DME Service Launch
Timeline: 30–45 days
9. CONTACT INFORMATION
New Mexico Human Services Department (HSD)
Website: https://www.hsd.state.nm.us/
Developmental Disabilities Supports Division (DDSD)
Website: https://www.nmhealth.org/about/ddsd/
New Mexico Regulation and Licensing Department (RLD)
Website: https://www.rld.state.nm.us/
New Mexico Medicaid Provider Enrollment Portal
Website: https://nmmedicaid.portal.conduent.com/
Centers for Medicare & Medicaid Services (CMS)
Website: https://www.cms.gov/
WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — NEW MEXICO MEDICAL SUPPLY AND EQUIPMENT SERVICES PROVIDER
WCG supports agencies in launching Medicaid-compliant Medical Supply and Equipment Services in New Mexico, offering:
Scope of Work:
Business registration, Medicaid enrollment, and licensing assistance
Policy manual development for equipment distribution and maintenance
Staff credentialing, training program templates, and compliance documentation
Medicaid billing setup and audit-prepared financial management
Branding, website development, and community outreach strategies
Quality assurance systems for equipment safety and maintenance
Collaboration with healthcare providers and community organizations
Private Duty Nursing
PRIVATE DUTY NURSING (PDN) SERVICES PROVIDER IN NEW MEXICO
DELIVERING PERSONALIZED MEDICAL CARE IN THE HOME AND COMMUNITY
Private Duty Nursing (PDN) Services in New Mexico provide continuous, skilled nursing care to individuals with complex medical needs. These services are delivered by licensed nurses in the patient’s home or community setting to support ongoing health and medical management. PDN Services are authorized under New Mexico Medicaid Home and Community-Based Services (HCBS) Waiver programs.
1. GOVERNING AGENCIES
Agency: New Mexico Human Services Department (HSD)
Role: Administers Medicaid waiver funding for PDN Services and manages provider enrollment, service authorization, and reimbursement.
Agency: Developmental Disabilities Supports Division (DDSD)
Role: Ensures quality standards, service delivery, and compliance for PDN Services under HCBS waiver programs.
Agency: New Mexico Department of Health (NMDOH)
Role: Licenses and regulates home healthcare agencies providing PDN services.
Agency: Centers for Medicare & Medicaid Services (CMS)
Role: Provides federal oversight ensuring Medicaid-funded PDN Services meet HCBS quality, person-centered planning, and participant protection standards.
2. PRIVATE DUTY NURSING SERVICES OVERVIEW
Private Duty Nursing Services are designed for individuals who require continuous medical care due to chronic conditions, disabilities, or post-acute needs.
Approved providers may deliver:
Continuous Skilled Nursing Care: 24/7 or intermittent nursing care based on medical necessity.
Medication Administration: Oral, injectable, and intravenous medication management.
Chronic Disease Management: Monitoring conditions like diabetes, respiratory issues, or cardiac problems.
Ventilator and Tracheostomy Care: Monitoring and maintenance of respiratory devices.
Wound and Ostomy Care: Dressing changes, infection control, and stoma care.
Gastrostomy and Enteral Feeding: Administering tube feeding and monitoring nutritional intake.
Seizure Monitoring: Observing and responding to seizure activity and providing emergency care.
Patient and Family Education: Training on home care techniques and medical management.
Emergency Response Planning: Developing protocols for medical emergencies.
All services are delivered according to the Individualized Service Plan (ISP) to meet the participant’s healthcare needs.
3. LICENSING & PROVIDER APPROVAL REQUIREMENTS
Prerequisites:
Register the business entity with the New Mexico Secretary of State.
Obtain EIN from the IRS and NPI (Type 2).
Enroll as a Medicaid Waiver PDN provider via the New Mexico Medicaid Provider Enrollment Portal.
Obtain a Home Health Agency License from the New Mexico Department of Health (NMDOH).
Maintain general liability and professional liability insurance.
Develop policies for clinical care, medication management, and patient safety.
Ensure nursing staff meet background checks, health screenings, and licensure requirements.
4. NEW MEXICO PROVIDER ENROLLMENT PROCESS
Initial Interest and Application:
Complete the Provider Enrollment Application through the New Mexico Medicaid Provider Enrollment Portal for PDN Services under HCBS waivers.
Application and Documentation Submission:
Submit Articles of Incorporation, proof of EIN/NPI, nursing licenses, insurance certificates, and policy manuals.
Program Readiness Review:
HSD and DDSD evaluate provider readiness, including clinical protocols, safety measures, and nursing qualifications.
Approval & Medicaid Enrollment:
Upon approval, providers are authorized to bill Medicaid for PDN Services using designated billing codes.
5. REQUIRED DOCUMENTATION
Articles of Incorporation or Business License (New Mexico Secretary of State)
IRS EIN confirmation
NPI confirmation
Home Health Agency License
Proof of general and professional liability insurance
Private Duty Nursing Services Policy & Procedure Manual including:
Clinical care protocols, medication administration, and emergency procedures
Nursing staff credentialing, background checks, and ongoing training records
Documentation standards for medical care tracking and Medicaid billing
HIPAA compliance, patient rights, and grievance handling
Safety protocols, infection control, and patient monitoring guidelines
Quality assurance and compliance monitoring
Patient and family education and support strategies
6. STAFFING REQUIREMENTS
Role: PDN Program Director
Requirements: Bachelor’s or Master’s degree in nursing; RN license in New Mexico; experience in home healthcare management.
Role: Registered Nurses (RNs)
Requirements: Valid RN license in New Mexico; experience in critical care, home healthcare, or PDN settings; CPR/First Aid certification; background clearance.
Role: Licensed Practical Nurses (LPNs)
Requirements: Valid LPN license in New Mexico; experience in long-term care or home health; background clearance.
All staff must complete:
Training in clinical protocols, medication administration, and patient safety
HIPAA compliance and patient rights education
Annual competency evaluations and ongoing professional development
CPR/First Aid and emergency response training
Infection control and chronic disease management training
7. MEDICAID WAIVER PROGRAMS
Private Duty Nursing Services are available under the following New Mexico Medicaid Waivers:
Developmental Disabilities (DD) Waiver
Mi Via Waiver
Medically Fragile Waiver
Supports Waiver
Home and Community-Based Services (HCBS) Waiver
Services may include:
24/7 skilled nursing care
Respiratory therapy and ventilator management
Medication administration and adherence support
Chronic disease and seizure monitoring
Patient education and caregiver support
8. TIMELINE TO LAUNCH
Phase: Business Formation and Compliance Preparation
Timeline: 1–2 months
Phase: Staff Hiring, Credentialing, and Program Development
Timeline: 2–3 months
Phase: New Mexico Medicaid Provider Enrollment and Readiness Review
Timeline: 60–90 days
Phase: Medicaid Billing Setup and PDN Service Launch
Timeline: 30–45 days
9. CONTACT INFORMATION
New Mexico Human Services Department (HSD)
Website: https://www.hsd.state.nm.us/
Developmental Disabilities Supports Division (DDSD)
Website: https://www.nmhealth.org/about/ddsd/
New Mexico Department of Health (NMDOH)
Website: https://www.nmhealth.org/
New Mexico Medicaid Provider Enrollment Portal
Website: https://nmmedicaid.portal.conduent.com/
Centers for Medicare & Medicaid Services (CMS)
Website: https://www.cms.gov/
WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — NEW MEXICO PRIVATE DUTY NURSING SERVICES PROVIDER
WCG supports agencies in launching Medicaid-compliant PDN Services in New Mexico, offering:
Scope of Work:
Business registration, Medicaid enrollment, and licensing assistance
Policy manual development for clinical care, safety, and patient management
Staff credentialing, training program templates, and compliance documentation
Medicaid billing setup and audit-prepared financial management
Branding, website development, and community outreach strategies
Quality assurance systems for clinical care and compliance monitoring
Collaboration with healthcare providers and community organizations
Day Habilitation
DAY HABILITATION SERVICES PROVIDER IN NEW MEXICO
PROMOTING INDEPENDENCE AND SKILL DEVELOPMENT THROUGH STRUCTURED DAY PROGRAMS
Day Habilitation Services in New Mexico offer individuals with intellectual or developmental disabilities structured programs designed to build essential life skills, promote independence, and encourage community involvement. These services are delivered in community-based settings or specialized facilities, providing participants with social, educational, and recreational opportunities. Day Habilitation Services are authorized under New Mexico Medicaid Home and Community-Based Services (HCBS) Waiver programs.
1. GOVERNING AGENCIES
Agency: New Mexico Human Services Department (HSD)
Role: Administers Medicaid waiver funding for Day Habilitation Services and manages provider enrollment, service authorization, and reimbursement.
Agency: Developmental Disabilities Supports Division (DDSD)
Role: Ensures quality standards, service delivery, and compliance for Day Habilitation Services under HCBS waiver programs.
Agency: Centers for Medicare & Medicaid Services (CMS)
Role: Provides federal oversight ensuring Medicaid-funded Day Habilitation Services meet HCBS quality, person-centered planning, and participant protection standards.
2. DAY HABILITATION SERVICES OVERVIEW
Day Habilitation Services help individuals acquire, maintain, and improve self-help, socialization, and adaptive skills through structured, goal-oriented activities.
Approved providers may deliver:
Skill Development Activities: Training in self-care, communication, and daily living skills.
Community Integration: Participating in social, educational, and recreational activities within the community.
Social Skills Training: Building relationships, communication, and interpersonal skills.
Cognitive Enrichment: Engaging in activities that stimulate memory, problem-solving, and creative thinking.
Health and Wellness Programs: Exercise, nutrition education, and personal care routines.
Arts and Recreation: Creative projects, music, art therapy, and group exercises.
Vocational Skills Development: Pre-employment skills and task-oriented activities.
Safety and Mobility Training: Teaching safe navigation within the facility and community.
All services are delivered according to the Individualized Service Plan (ISP) to meet the participant’s needs and goals.
3. LICENSING & PROVIDER APPROVAL REQUIREMENTS
Prerequisites:
Register the business entity with the New Mexico Secretary of State.
Obtain EIN from the IRS and NPI (Type 2).
Enroll as a Medicaid Waiver Day Habilitation provider via the New Mexico Medicaid Provider Enrollment Portal.
Obtain facility licensure from HSD or NMDOH if providing site-based day habilitation.
Maintain general liability and professional liability insurance.
Develop policies for daily programming, safety protocols, and staff training.
Ensure staff meet background checks, health screenings, and habilitation training requirements.
4. NEW MEXICO PROVIDER ENROLLMENT PROCESS
Initial Interest and Application:
Complete the Provider Enrollment Application through the New Mexico Medicaid Provider Enrollment Portal for Day Habilitation Services under HCBS waivers.
Application and Documentation Submission:
Submit Articles of Incorporation, proof of EIN/NPI, facility licenses (if applicable), insurance certificates, and policy manuals.
Program Readiness Review:
HSD and DDSD evaluate provider readiness, including activity plans, safety measures, and staff qualifications.
Approval & Medicaid Enrollment:
Upon approval, providers are authorized to bill Medicaid for Day Habilitation Services using designated billing codes.
5. REQUIRED DOCUMENTATION
Articles of Incorporation or Business License (New Mexico Secretary of State)
IRS EIN confirmation
NPI confirmation
Facility License (if providing site-based services)
Proof of general and professional liability insurance
Day Habilitation Services Policy & Procedure Manual including:
Activity planning, skill development, and community engagement protocols
Staff credentialing, background checks, and training requirements
Documentation standards for activity tracking and Medicaid billing
HIPAA compliance, participant rights, and grievance handling
Safety protocols, emergency response, and infection control measures
Quality assurance and compliance monitoring
6. STAFFING REQUIREMENTS
Role: Day Habilitation Program Director
Requirements: Bachelor’s degree in human services, special education, or related field; experience managing day programs.
Role: Habilitation Specialists
Requirements: Experience in skill development and community integration; training in adaptive programming; background clearance.
Role: Direct Support Professionals (DSPs)
Requirements: High school diploma or GED; CPR/First Aid certification; experience in personal care and community activities; background clearance.
Role: Activity Coordinators
Requirements: Experience in planning and facilitating group activities; background clearance.
All staff must complete:
Training in day habilitation programming and individual support
HIPAA compliance and participant rights education
Annual competency evaluations and professional development
Safety training, including emergency preparedness and infection control
Ongoing training in adaptive skills and community engagement
7. MEDICAID WAIVER PROGRAMS
Day Habilitation Services are available under the following New Mexico Medicaid Waivers:
Developmental Disabilities (DD) Waiver
Mi Via Waiver
Medically Fragile Waiver
Supports Waiver
Home and Community-Based Services (HCBS) Waiver
Services may include:
Skill development in daily living and social interaction
Community-based activities and social integration
Health and wellness programs, including exercise and nutrition
Vocational and pre-employment training
Cognitive and creative activities to enhance skills and independence
8. TIMELINE TO LAUNCH
Phase: Business Formation and Compliance Preparation
Timeline: 1–2 months
Phase: Staff Hiring, Credentialing, and Program Development
Timeline: 2–3 months
Phase: New Mexico Medicaid Provider Enrollment and Readiness Review
Timeline: 60–90 days
Phase: Medicaid Billing Setup and Day Habilitation Service Launch
Timeline: 30–45 days
9. CONTACT INFORMATION
New Mexico Human Services Department (HSD)
Website: https://www.hsd.state.nm.us/
Developmental Disabilities Supports Division (DDSD)
Website: https://www.nmhealth.org/about/ddsd/
New Mexico Medicaid Provider Enrollment Portal
Website: https://nmmedicaid.portal.conduent.com/
Centers for Medicare & Medicaid Services (CMS)
Website: https://www.cms.gov/
WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — NEW MEXICO DAY HABILITATION SERVICES PROVIDER
WCG supports agencies in launching Medicaid-compliant Day Habilitation Services in New Mexico, offering:
Scope of Work:
Business registration, Medicaid enrollment, and licensing assistance
Policy manual development for day programming and safety management
Staff credentialing, training program templates, and compliance documentation
Medicaid billing setup and audit-prepared financial management
Branding, website development, and community engagement strategies
Quality assurance systems for program effectiveness and client satisfaction
Collaboration with healthcare providers and community organizations
Adult Health Services
ADULT HEALTH SERVICES PROVIDER IN NEW MEXICO
PROMOTING WELLNESS AND INDEPENDENCE THROUGH COMPREHENSIVE HEALTH SUPPORT
Adult Health Services in New Mexico provide a wide range of healthcare and wellness support for adults with disabilities, chronic conditions, or age-related health needs. These services focus on maintaining health, promoting wellness, and managing chronic conditions to support independent living. Adult Health Services are authorized under New Mexico Medicaid Home and Community-Based Services (HCBS) Waiver programs.
1. GOVERNING AGENCIES
Agency: New Mexico Human Services Department (HSD)
Role: Administers Medicaid waiver funding for Adult Health Services and manages provider enrollment, service authorization, and reimbursement.
Agency: Developmental Disabilities Supports Division (DDSD)
Role: Ensures quality standards, service delivery, and compliance for Adult Health Services under HCBS waiver programs.
Agency: New Mexico Department of Health (NMDOH)
Role: Licenses healthcare agencies providing adult health services and oversees quality compliance.
Agency: Centers for Medicare & Medicaid Services (CMS)
Role: Provides federal oversight ensuring Medicaid-funded Adult Health Services meet HCBS quality, person-centered planning, and participant protection standards.
2. ADULT HEALTH SERVICES OVERVIEW
Adult Health Services support individuals by providing medical care, wellness monitoring, and health education to promote independence and quality of life.
Approved providers may deliver:
Primary Health Monitoring: Regular assessments of vital signs, chronic condition management, and wellness checks.
Nursing Care: Skilled nursing services such as wound care, catheter maintenance, and medication administration.
Chronic Disease Management: Support for diabetes, hypertension, COPD, and other chronic conditions.
Health Education: Guidance on self-care, nutrition, medication management, and lifestyle changes.
Rehabilitation Support: Physical therapy, occupational therapy, and mobility training.
Medication Management: Assistance with medication adherence, prescription tracking, and side effect monitoring.
Preventive Care: Health screenings, immunizations, and routine physical examinations.
Health and Wellness Programs: Exercise classes, dietary guidance, and chronic disease self-management education.
Personal Care Assistance: Bathing, grooming, and hygiene support when combined with healthcare needs.
Care Coordination: Collaboration with healthcare providers to ensure integrated care.
All services are delivered according to the Individualized Service Plan (ISP) to meet the participant’s health and wellness needs.
3. LICENSING & PROVIDER APPROVAL REQUIREMENTS
Prerequisites:
Register the business entity with the New Mexico Secretary of State.
Obtain EIN from the IRS and NPI (Type 2).
Enroll as a Medicaid Waiver Adult Health Services provider via the New Mexico Medicaid Provider Enrollment Portal.
Obtain a Home Health Agency License from the New Mexico Department of Health (NMDOH) if providing medical care.
Maintain general liability and professional liability insurance.
Develop policies for healthcare planning, chronic disease management, and safety protocols.
Ensure staff meet background checks, health screenings, and healthcare training requirements.
4. NEW MEXICO PROVIDER ENROLLMENT PROCESS
Initial Interest and Application:
Complete the Provider Enrollment Application through the New Mexico Medicaid Provider Enrollment Portal for Adult Health Services under HCBS waivers.
Application and Documentation Submission:
Submit Articles of Incorporation, proof of EIN/NPI, healthcare agency licenses, insurance certificates, and policy manuals.
Program Readiness Review:
HSD and DDSD evaluate provider readiness, including healthcare protocols, staff qualifications, and safety measures.
Approval & Medicaid Enrollment:
Upon approval, providers are authorized to bill Medicaid for Adult Health Services using designated billing codes.
5. REQUIRED DOCUMENTATION
Articles of Incorporation or Business License (New Mexico Secretary of State)
IRS EIN confirmation
NPI confirmation
Home Health Agency License (if applicable)
Proof of general and professional liability insurance
Adult Health Services Policy & Procedure Manual, including:
Health assessment, chronic disease management, and medication administration protocols
Personal care and hygiene assistance guidelines when medically necessary
Staff credentialing, background checks, and ongoing training records
Documentation standards for healthcare tracking and Medicaid billing
HIPAA compliance, patient rights, and grievance handling
Safety protocols, emergency response, and infection control measures
Quality assurance and compliance monitoring
6. STAFFING REQUIREMENTS
Role: Adult Health Program Director
Requirements: Bachelor’s or Master’s degree in nursing, healthcare administration, or related field; RN license preferred.
Role: Registered Nurses (RNs)
Requirements: Valid RN license in New Mexico; experience in community health or chronic disease management; CPR/First Aid certification; background clearance.
Role: Licensed Practical Nurses (LPNs)
Requirements: Valid LPN license in New Mexico; experience in personal care and medical support; background clearance.
Role: Health Educators
Requirements: Certification in health education or chronic disease management; background clearance.
Role: Rehabilitation Specialists (PT, OT)
Requirements: State licensure; experience in adult health support; background clearance.
All staff must complete:
Training in chronic disease management, healthcare protocols, and client safety
HIPAA compliance and patient rights education
Ongoing professional development and certification renewal
Annual competency evaluations and safety protocol updates
CPR/First Aid and emergency response training
7. MEDICAID WAIVER PROGRAMS
Adult Health Services are available under the following New Mexico Medicaid Waivers:
Developmental Disabilities (DD) Waiver
Mi Via Waiver
Medically Fragile Waiver
Supports Waiver
Home and Community-Based Services (HCBS) Waiver
8. TIMELINE TO LAUNCH
Phase: Business Formation and Compliance Preparation
Timeline: 1–2 months
Phase: Staff Hiring, Credentialing, and Program Development
Timeline: 2–3 months
Phase: New Mexico Medicaid Provider Enrollment and Readiness Review
Timeline: 60–90 days
Phase: Medicaid Billing Setup and Adult Health Service Launch
Timeline: 30–45 days
9. CONTACT INFORMATION
New Mexico Human Services Department (HSD)
Website: https://www.hsd.state.nm.us/
Developmental Disabilities Supports Division (DDSD)
Website: https://www.nmhealth.org/about/ddsd/
New Mexico Department of Health (NMDOH)
Website: https://www.nmhealth.org/
New Mexico Medicaid Provider Enrollment Portal
Website: https://nmmedicaid.portal.conduent.com/
Centers for Medicare & Medicaid Services (CMS)
Website: https://www.cms.gov/
WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — NEW MEXICO ADULT HEALTH SERVICES PROVIDER
WCG supports agencies in launching Medicaid-compliant Adult Health Services in New Mexico, offering:
Scope of Work:
Business registration, Medicaid enrollment, and licensing assistance
Policy manual development for healthcare management and chronic disease support
Staff credentialing, training program templates, and compliance documentation
Medicaid billing setup and audit-prepared financial management
Branding, website development, and client outreach strategies
Quality assurance systems for healthcare quality and compliance monitoring
Assistive Technology
ASSISTIVE TECHNOLOGY SERVICES PROVIDER IN NEW MEXICO
ENHANCING INDEPENDENCE AND ACCESSIBILITY THROUGH TECHNOLOGY SOLUTIONS
Assistive Technology Services in New Mexico provides individuals with disabilities, chronic conditions, or age-related challenges with technology-based solutions to enhance daily living, communication, mobility, and independence. These services ensure that individuals can access adaptive devices and receive training to maximize their use. Assistive Technology Services are authorized under New Mexico Medicaid Home and Community-Based Services (HCBS) Waiver programs.
1. GOVERNING AGENCIES
Agency: New Mexico Human Services Department (HSD)
Role: Administers Medicaid waiver funding for Assistive Technology Services and manages provider enrollment, service authorization, and reimbursement.
Agency: Developmental Disabilities Supports Division (DDSD)
Role: Ensures quality standards, service delivery, and compliance for Assistive Technology Services under HCBS waiver programs.
Agency: Centers for Medicare & Medicaid Services (CMS)
Role: Provides federal oversight ensuring Medicaid-funded Assistive Technology Services meet HCBS quality, person-centered planning, and participant protection standards.
2. ASSISTIVE TECHNOLOGY SERVICES OVERVIEW
Assistive Technology Services provide specialized equipment and devices that help individuals perform daily tasks, enhance communication, and maintain independence.
Approved providers may deliver:
Adaptive Communication Devices: Speech-generating devices, communication boards, and voice amplifiers.
Mobility Aids: Electric wheelchairs, scooters, and powered transfer devices.
Environmental Control Units: Smart home systems, adaptive switches, and remote-controlled devices.
Sensory Aids: Visual or auditory alert systems, tactile feedback devices, and sensory enhancement tools.
Computer Access Aids: Alternative keyboards, adaptive mice, and screen readers.
Augmentative and Alternative Communication (AAC) Tools: Tablets and apps designed for communication.
Adaptive Feeding Devices: Modified utensils, plate guards, and specialized eating aids.
Home Accessibility Enhancements: Stair lifts, automatic door openers, and bed positioning systems.
Training and Support: Educating individuals and families on the effective use of devices.
Maintenance and Troubleshooting: Ensuring devices function properly and meet safety standards.
All services are delivered according to the Individualized Service Plan (ISP) to meet the participant’s assistive technology needs.
3. LICENSING & PROVIDER APPROVAL REQUIREMENTS
Prerequisites:
Register the business entity with the New Mexico Secretary of State.
Obtain EIN from the IRS and NPI (Type 2).
Enroll as a Medicaid Waiver Assistive Technology provider via the New Mexico Medicaid Provider Enrollment Portal.
Obtain necessary certifications for technology installation and training.
Maintain general liability and professional liability insurance.
Develop policies for technology assessment, installation, and user training.
Ensure staff meet background checks, health screenings, and training requirements related to assistive technology.
4. NEW MEXICO PROVIDER ENROLLMENT PROCESS
Initial Interest and Application:
Complete the Provider Enrollment Application through the New Mexico Medicaid Provider Enrollment Portal for Assistive Technology Services under HCBS waivers.
Application and Documentation Submission:
Submit Articles of Incorporation, proof of EIN/NPI, technology certification, insurance certificates, and policy manuals.
Program Readiness Review:
HSD and DDSD evaluate provider readiness, including device safety, staff qualifications, and installation protocols.
Approval & Medicaid Enrollment:
Upon approval, providers are authorized to bill Medicaid for Assistive Technology Services using designated billing codes.
5. REQUIRED DOCUMENTATION
Articles of Incorporation or Business License (New Mexico Secretary of State)
IRS EIN confirmation
NPI confirmation
Technology Certification (if applicable)
Proof of general and professional liability insurance
Assistive Technology Services Policy & Procedure Manual including:
Technology assessment, device installation, and user training procedures
Safety protocols for device use and maintenance
Staff credentialing, background checks, and ongoing training records
Documentation standards for technology tracking and Medicaid billing
HIPAA compliance, participant rights, and grievance handling
Safety and emergency response protocols
Quality assurance and compliance monitoring
6. STAFFING REQUIREMENTS
Role: Assistive Technology Program Director
Requirements: Bachelor’s or Master’s degree in rehabilitation engineering, occupational therapy, or related field; experience with adaptive technology.
Role: Assistive Technology Specialists
Requirements: Certification in assistive technology (e.g., RESNA ATP); experience in device assessment and training; background clearance.
Role: Installation Technicians
Requirements: Experience with adaptive device setup, safety protocols, and maintenance; background clearance.
Role: Client Support Specialists
Requirements: Experience in user training and technical support; background clearance.
All staff must complete:
Training in assistive device installation and maintenance
HIPAA compliance and participant rights education
Annual competency evaluations and ongoing professional development
Safety training, including emergency protocols and device troubleshooting
Training in client-centered technology education
7. MEDICAID WAIVER PROGRAMS
Assistive Technology Services are available under the following New Mexico Medicaid Waivers:
Developmental Disabilities (DD) Waiver
Mi Via Waiver
Medically Fragile Waiver
Supports Waiver
Home and Community-Based Services (HCBS) Waiver
Services may include:
Evaluation of assistive technology needs
Device installation and setup
Training for individuals and caregivers
Maintenance and safety checks
Upgrades and technology updates
8. TIMELINE TO LAUNCH
Phase: Business Formation and Compliance Preparation
Timeline: 1–2 months
Phase: Staff Hiring, Credentialing, and Program Development
Timeline: 2–3 months
Phase: New Mexico Medicaid Provider Enrollment and Readiness Review
Timeline: 60–90 days
Phase: Medicaid Billing Setup and Assistive Technology Service Launch
Timeline: 30–45 days
9. CONTACT INFORMATION
New Mexico Human Services Department (HSD)
Website: https://www.hsd.state.nm.us/
Developmental Disabilities Supports Division (DDSD)
Website: https://www.nmhealth.org/about/ddsd/
New Mexico Medicaid Provider Enrollment Portal
Website: https://nmmedicaid.portal.conduent.com/
Centers for Medicare & Medicaid Services (CMS)
Website: https://www.cms.gov/
WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — NEW MEXICO ASSISTIVE TECHNOLOGY SERVICES PROVIDER
WCG supports agencies in launching Medicaid-compliant Assistive Technology Services in New Mexico, offering:
Scope of Work:
Business registration, Medicaid enrollment, and licensing assistance
Policy manual development for technology assessment and client support
Staff credentialing, training program templates, and compliance documentation
Medicaid billing setup and audit-prepared financial management
Branding, website development, and community outreach strategies
Quality assurance systems for device safety and user satisfaction
Collaboration with healthcare providers and community organizations
Behavioral Support
BEHAVIORAL SUPPORT SERVICES PROVIDER IN NEW MEXICO
PROMOTING POSITIVE BEHAVIORAL OUTCOMES THROUGH INDIVIDUALIZED SUPPORT
Behavioral Support Services in New Mexico provide therapeutic interventions, counseling, and support to individuals with intellectual, developmental, or behavioral health challenges. These services aim to reduce challenging behaviors, enhance social skills, and promote emotional well-being. Behavioral Support Services are authorized under New Mexico Medicaid Home and Community-Based Services (HCBS) Waiver programs.
1. GOVERNING AGENCIES
Agency: New Mexico Human Services Department (HSD)
Role: Administers Medicaid waiver funding for Behavioral Support Services and manages provider enrollment, service authorization, and reimbursement.
Agency: Developmental Disabilities Supports Division (DDSD)
Role: Ensures quality standards, service delivery, and compliance for Behavioral Support Services under HCBS waiver programs.
Agency: Behavioral Health Services Division (BHSD)
Role: Monitors the quality of behavioral health care and supports provider compliance with state regulations.
Agency: Centers for Medicare & Medicaid Services (CMS)
Role: Provides federal oversight ensuring Medicaid-funded Behavioral Support Services meet HCBS quality, person-centered planning, and participant protection standards.
2. BEHAVIORAL SUPPORT SERVICES OVERVIEW
Behavioral Support Services help individuals manage challenging behaviors and develop coping strategies through therapeutic interventions, counseling, and personalized support.
Approved providers may deliver:
Behavioral Assessment: Identifying behavioral triggers and patterns through comprehensive evaluations.
Behavioral Intervention Planning: Developing structured, evidence-based plans to address challenging behaviors.
Skill-Building Activities: Teaching coping strategies, social skills, and emotional regulation.
Individual Counseling: Providing therapeutic support to address emotional and behavioral challenges.
Group Counseling: Facilitating peer interactions and group-based behavioral interventions.
Crisis Intervention: Immediate support during behavioral crises to ensure safety and stability.
Positive Behavior Support (PBS): Implementing strategies to reinforce positive behaviors.
Family Training and Support: Educating caregivers on managing and responding to behavioral issues.
Progress Monitoring: Regular evaluations to track progress and adjust intervention plans as needed.
All services are delivered according to the Individualized Service Plan (ISP) to meet the participant’s behavioral and emotional support needs.
3. LICENSING & PROVIDER APPROVAL REQUIREMENTS
Prerequisites:
Register the business entity with the New Mexico Secretary of State.
Obtain EIN from the IRS and NPI (Type 2).
Enroll as a Medicaid Waiver Behavioral Support provider via the New Mexico Medicaid Provider Enrollment Portal.
Obtain behavioral health licensure from the New Mexico Regulation and Licensing Department (RLD) if applicable.
Maintain general liability and professional liability insurance.
Develop policies for behavioral intervention planning, safety protocols, and crisis management.
Ensure staff meet background checks, health screenings, and behavioral health training requirements.
4. NEW MEXICO PROVIDER ENROLLMENT PROCESS
Initial Interest and Application:
Complete the Provider Enrollment Application through the New Mexico Medicaid Provider Enrollment Portal for Behavioral Support Services under HCBS waivers.
Application and Documentation Submission:
Submit Articles of Incorporation, proof of EIN/NPI, behavioral health licenses (if applicable), insurance certificates, and policy manuals.
Program Readiness Review:
HSD, DDSD, and BHSD evaluate provider readiness, including safety protocols, staff qualifications, and intervention strategies.
Approval & Medicaid Enrollment:
Upon approval, providers are authorized to bill Medicaid for Behavioral Support Services using designated billing codes.
5. REQUIRED DOCUMENTATION
Articles of Incorporation or Business License (New Mexico Secretary of State)
IRS EIN confirmation
NPI confirmation
Behavioral Health License (if applicable)
Proof of general and professional liability insurance
Behavioral Support Services Policy & Procedure Manual including:
Behavioral assessment, intervention planning, and crisis response protocols
Staff credentialing, background checks, and ongoing training records
Documentation standards for behavioral tracking and Medicaid billing
HIPAA compliance, participant rights, and grievance handling
Safety protocols, emergency response, and de-escalation techniques
Family involvement and caregiver support guidelines
Quality assurance and compliance monitoring
6. STAFFING REQUIREMENTS
Role: Behavioral Support Program Director
Requirements: Master’s degree in psychology, social work, or a related field; certification in behavioral analysis preferred; supervisory experience.
Role: Behavioral Therapists
Requirements: Licensure as a Board Certified Behavior Analyst (BCBA) or Licensed Professional Counselor (LPC); experience in behavioral interventions; background clearance.
Role: Behavioral Technicians
Requirements: Certification as a Registered Behavior Technician (RBT) or similar; training in behavioral support; background clearance.
Role: Crisis Intervention Specialists
Requirements: Certification in crisis management and de-escalation techniques; experience in behavioral support; background clearance.
All staff must complete:
Training in behavioral intervention, de-escalation, and crisis management
HIPAA compliance and participant rights education
Annual competency evaluations and ongoing professional development
Behavioral health best practices and safety training
Cultural competence and trauma-informed care education
7. MEDICAID WAIVER PROGRAMS
Behavioral Support Services are available under the following New Mexico Medicaid Waivers:
Developmental Disabilities (DD) Waiver
Mi Via Waiver
Medically Fragile Waiver
Supports Waiver
Home and Community-Based Services (HCBS) Waiver
Services may include:
Individual and group counseling
Crisis intervention and behavioral management
Skill-building activities to enhance coping and communication
Family training and education on behavioral management
Positive behavior support and ongoing progress monitoring
8. TIMELINE TO LAUNCH
Phase: Business Formation and Compliance Preparation
Timeline: 1–2 months
Phase: Staff Hiring, Credentialing, and Program Development
Timeline: 2–3 months
Phase: New Mexico Medicaid Provider Enrollment and Readiness Review
Timeline: 60–90 days
Phase: Medicaid Billing Setup and Behavioral Support Service Launch
Timeline: 30–45 days
9. CONTACT INFORMATION
New Mexico Human Services Department (HSD)
Website: https://www.hsd.state.nm.us/
Developmental Disabilities Supports Division (DDSD)
Website: https://www.nmhealth.org/about/ddsd/
Behavioral Health Services Division (BHSD)
Website: https://www.hsd.state.nm.us/Behavioral_Health_Services.aspx
New Mexico Medicaid Provider Enrollment Portal
Website: https://nmmedicaid.portal.conduent.com/
Centers for Medicare & Medicaid Services (CMS)
Website: https://www.cms.gov/
WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — NEW MEXICO BEHAVIORAL SUPPORT SERVICES PROVIDER
WCG supports agencies in launching Medicaid-compliant Behavioral Support Services in New Mexico, offering:
Scope of Work:
Business registration, Medicaid enrollment, and licensing assistance
Policy manual development for behavioral intervention and crisis management
Staff credentialing, training program templates, and compliance documentation
Medicaid billing setup and audit-prepared financial management
Branding, website development, and community outreach strategies
Quality assurance systems for behavioral support and compliance monitoring
Collaboration with healthcare providers and community organizations
Environmental Modification
ENVIRONMENTAL MODIFICATION SERVICES PROVIDER IN NEW MEXICO
ENHANCING SAFETY AND ACCESSIBILITY THROUGH HOME MODIFICATIONS
Environmental Modification Services in New Mexico provide essential home adaptations for individuals with disabilities or mobility challenges. These services help ensure that living environments are safe, accessible, and conducive to independent living. Environmental Modification Services are authorized under New Mexico Medicaid Home and Community-Based Services (HCBS) Waiver programs.
1. GOVERNING AGENCIES
Agency: New Mexico Human Services Department (HSD)
Role: Administers Medicaid waiver funding for Environmental Modification Services and manages provider enrollment, service authorization, and reimbursement.
Agency: Developmental Disabilities Supports Division (DDSD)
Role: Ensures quality standards, service delivery, and compliance for Environmental Modification Services under HCBS waiver programs.
Agency: Centers for Medicare & Medicaid Services (CMS)
Role: Provides federal oversight ensuring Medicaid-funded Environmental Modification Services meet HCBS quality, person-centered planning, and participant protection standards.
2. ENVIRONMENTAL MODIFICATION SERVICES OVERVIEW
Environmental Modification Services are designed to enhance home accessibility and safety for individuals with physical or cognitive disabilities.
Approved providers may deliver:
Accessibility Improvements: Installation of ramps, widened doorways, and handrails.
Bathroom Modifications: Roll-in showers, grab bars, accessible sinks, and raised toilet seats.
Kitchen Adaptations: Lowered countertops, accessible cabinets, and adapted appliances.
Safety Enhancements: Installation of safety alarms, improved lighting, and slip-resistant flooring.
Mobility Aids Installation: Stairlifts, vertical platform lifts, and grab bars.
Home Automation Integration: Smart home technologies for lighting, temperature, and security management.
Structural Modifications: Door widening, hallway adjustments, and entryway improvements.
Sensory Modifications: Visual and auditory signals for those with sensory impairments.
All modifications are delivered according to the Individualized Service Plan (ISP) and are based on a professional assessment of the participant’s needs.
3. LICENSING & PROVIDER APPROVAL REQUIREMENTS
Prerequisites:
Register the business entity with the New Mexico Secretary of State.
Obtain EIN from the IRS and NPI (Type 2).
Enroll as a Medicaid Waiver Environmental Modification provider via the New Mexico Medicaid Provider Enrollment Portal.
Obtain necessary contractor licenses from the New Mexico Regulation and Licensing Department (RLD).
Maintain general liability and professional liability insurance.
Develop policies for safety assessments, modification planning, and quality assurance.
Ensure contractors and subcontractors meet background checks and licensing requirements.
4. NEW MEXICO PROVIDER ENROLLMENT PROCESS
Initial Interest and Application:
Complete the Provider Enrollment Application through the New Mexico Medicaid Provider Enrollment Portal for Environmental Modification Services under HCBS waivers.
Application and Documentation Submission:
Submit Articles of Incorporation, proof of EIN/NPI, contractor licenses, insurance certificates, and policy manuals.
Program Readiness Review:
HSD and DDSD evaluate provider readiness, including safety procedures, modification protocols, and contractor qualifications.
Approval & Medicaid Enrollment:
Upon approval, providers are authorized to bill Medicaid for Environmental Modification Services using designated billing codes.
5. REQUIRED DOCUMENTATION
Articles of Incorporation or Business License (New Mexico Secretary of State)
IRS EIN confirmation
NPI confirmation
Contractor Licenses (if applicable)
Proof of general and professional liability insurance
Environmental Modification Services Policy & Procedure Manual including:
Safety and risk assessment protocols
Project planning and modification guidelines
Contractor vetting, background checks, and credential verification
Compliance with building codes, ADA standards, and safety regulations
Documentation standards for project tracking and Medicaid billing
Risk management and emergency preparedness procedures
Quality assurance and compliance monitoring
6. STAFFING REQUIREMENTS
Role: Environmental Modification Program Director
Requirements: Bachelor’s degree in construction management, rehabilitation technology, or related field; experience managing home accessibility projects.
Role: Licensed Contractors
Requirements: State contractor license; experience in home modifications for accessibility; background clearance.
Role: Accessibility Specialists
Requirements: Certification in home accessibility modifications (e.g., CAPS - Certified Aging-in-Place Specialist); background clearance.
All staff must complete:
Safety training and risk management education
HIPAA compliance and client rights training
Ongoing professional development and continuing education
Annual competency evaluations and safety protocol updates
7. MEDICAID WAIVER PROGRAMS
Environmental Modification Services are available under the following New Mexico Medicaid Waivers:
Developmental Disabilities (DD) Waiver
Mi Via Waiver
Medically Fragile Waiver
Supports Waiver
Home and Community-Based Services (HCBS) Waiver
Services may include:
Installation of wheelchair ramps and accessible doorways
Bathroom accessibility improvements (e.g., roll-in showers, grab bars)
Kitchen modifications to accommodate mobility aids
Safety enhancements and adaptive equipment installations
Smart home integration for individuals with mobility impairments
8. TIMELINE TO LAUNCH
Phase: Business Formation and Compliance Preparation
Timeline: 1–2 months
Phase: Staff Hiring, Credentialing, and Program Development
Timeline: 2–3 months
Phase: New Mexico Medicaid Provider Enrollment and Readiness Review
Timeline: 60–90 days
Phase: Medicaid Billing Setup and Environmental Modification Service Launch
Timeline: 30–45 days
9. CONTACT INFORMATION
New Mexico Human Services Department (HSD)
Website: https://www.hsd.state.nm.us/
Developmental Disabilities Supports Division (DDSD)
Website: https://www.nmhealth.org/about/ddsd/
New Mexico Regulation and Licensing Department (RLD)
Website: https://www.rld.state.nm.us/
New Mexico Medicaid Provider Enrollment Portal
Website: https://nmmedicaid.portal.conduent.com/
Centers for Medicare & Medicaid Services (CMS)
Website: https://www.cms.gov/
WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — NEW MEXICO ENVIRONMENTAL MODIFICATION SERVICES PROVIDER
WCG supports agencies in launching Medicaid-compliant Environmental Modification Services in New Mexico, offering:
Scope of Work:
Business registration, Medicaid enrollment, and licensing assistance
Policy manual development for accessibility planning and safety compliance
Staff credentialing, training program templates, and project documentation guidance
Medicaid billing setup and project management support
Branding, website development, and client engagement strategies
Quality assurance systems for safety monitoring and compliance
Collaboration with healthcare providers and community organizations for referrals
Nursing Facility Transition
NURSING FACILITY TRANSITION SERVICES PROVIDER IN NEW MEXICO
SUPPORTING INDEPENDENCE THROUGH SAFE TRANSITIONS TO COMMUNITY LIVING
Nursing Facility Transition Services in New Mexico help individuals move from nursing facilities or institutional care back to community-based settings. These services aim to promote independence, improve quality of life, and reduce institutionalization by providing comprehensive transition planning and support. Nursing Facility Transition Services are authorized under New Mexico Medicaid Home and Community-Based Services (HCBS) Waiver programs.
1. GOVERNING AGENCIES
Agency: New Mexico Human Services Department (HSD)
Role: Administers Medicaid waiver funding for Nursing Facility Transition Services and manages provider enrollment, service authorization, and reimbursement.
Agency: Developmental Disabilities Supports Division (DDSD)
Role: Ensures quality standards, service delivery, and compliance for Nursing Facility Transition Services under HCBS waiver programs.
Agency: Centers for Medicare & Medicaid Services (CMS)
Role: Provides federal oversight ensuring Medicaid-funded Nursing Facility Transition Services meet HCBS quality, person-centered planning, and participant protection standards.
2. NURSING FACILITY TRANSITION SERVICES OVERVIEW
Nursing Facility Transition Services help individuals plan and execute a move from institutional care to independent or supported community living.
Approved providers may deliver:
Transition Planning: Developing a personalized plan for community reintegration.
Housing Assistance: Identifying accessible housing and coordinating housing applications.
Service Coordination: Linking individuals to community-based support services.
Skill Building: Training in daily living skills to promote independence.
Home Setup: Assistance with acquiring furniture, household items, and accessibility modifications.
Healthcare Coordination: Arranging for medical care, personal care, and nursing support in the community.
Peer Support and Counseling: Emotional support during the transition process.
Transportation Assistance: Helping with mobility needs during and after the transition.
Follow-Up and Monitoring: Ensuring stability and addressing challenges post-transition.
All services are delivered according to the Individualized Service Plan (ISP) to meet the participant’s transition and community living needs.
3. LICENSING & PROVIDER APPROVAL REQUIREMENTS
Prerequisites:
Register the business entity with the New Mexico Secretary of State.
Obtain EIN from the IRS and NPI (Type 2).
Enroll as a Medicaid Waiver Nursing Facility Transition provider via the New Mexico Medicaid Provider Enrollment Portal.
Maintain general liability and professional liability insurance.
Develop policies for transition planning, housing coordination, and community integration.
Ensure staff meet background checks, health screenings, and training requirements for transition support.
4. NEW MEXICO PROVIDER ENROLLMENT PROCESS
Initial Interest and Application:
Complete the Provider Enrollment Application through the New Mexico Medicaid Provider Enrollment Portal for Nursing Facility Transition Services under HCBS waivers.
Application and Documentation Submission:
Submit Articles of Incorporation, proof of EIN/NPI, insurance certificates, staff qualifications, and policy manuals.
Program Readiness Review:
HSD and DDSD evaluate provider readiness, including transition planning protocols, safety measures, and staff qualifications.
Approval & Medicaid Enrollment:
Upon approval, providers are authorized to bill Medicaid for Nursing Facility Transition Services using designated billing codes.
5. REQUIRED DOCUMENTATION
Articles of Incorporation or Business License (New Mexico Secretary of State)
IRS EIN confirmation
NPI confirmation
Proof of general and professional liability insurance
Nursing Facility Transition Services Policy & Procedure Manual including:
Transition planning, housing support, and community integration protocols
Staff credentialing, background checks, and ongoing training records
Documentation standards for transition tracking and Medicaid billing
HIPAA compliance, participant rights, and grievance handling
Safety protocols, emergency response, and crisis management
Quality assurance and compliance monitoring
Client and family education on transition readiness and community living skills
6. STAFFING REQUIREMENTS
Role: Transition Program Director
Requirements: Bachelor’s degree in social work, healthcare administration, or human services; experience in community-based care.
Role: Transition Specialists
Requirements: Experience in care coordination, housing support, and community integration; background clearance.
Role: Social Workers
Requirements: Licensed Social Worker (LSW) or Licensed Clinical Social Worker (LCSW); experience in transition planning; background clearance.
Role: Peer Support Specialists
Requirements: Training in peer support and community reintegration; experience in advocacy and mentorship; background clearance.
All staff must complete:
Training in transition planning and community integration
HIPAA compliance and participant rights education
Annual competency evaluations and ongoing professional development
Safety and emergency preparedness training
Cultural competency and person-centered planning education
7. MEDICAID WAIVER PROGRAMS
Nursing Facility Transition Services are available under the following New Mexico Medicaid Waivers:
Developmental Disabilities (DD) Waiver
Mi Via Waiver
Medically Fragile Waiver
Supports Waiver
Home and Community-Based Services (HCBS) Waiver
8. TIMELINE TO LAUNCH
Phase: Business Formation and Compliance Preparation
Timeline: 1–2 months
Phase: Staff Hiring, Credentialing, and Program Development
Timeline: 2–3 months
Phase: New Mexico Medicaid Provider Enrollment and Readiness Review
Timeline: 60–90 days
Phase: Medicaid Billing Setup and Nursing Facility Transition Service Launch
Timeline: 30–45 days
9. CONTACT INFORMATION
New Mexico Human Services Department (HSD)
Website: https://www.hsd.state.nm.us/
Developmental Disabilities Supports Division (DDSD)
Website: https://www.nmhealth.org/about/ddsd/
New Mexico Medicaid Provider Enrollment Portal
Website: https://nmmedicaid.portal.conduent.com/
Centers for Medicare & Medicaid Services (CMS)
Website: https://www.cms.gov/
WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — NEW MEXICO NURSING FACILITY TRANSITION SERVICES PROVIDER
WCG supports agencies in launching Medicaid-compliant Nursing Facility Transition Services in New Mexico, offering:
Scope of Work:
Business registration, Medicaid enrollment, and licensing assistance
Policy manual development for transition planning and community integration
Staff credentialing, training program templates, and compliance documentation
Medicaid billing setup and audit-prepared financial management
Branding, website development, and client outreach strategies
Quality assurance systems for transition readiness and community support
Collaboration with healthcare providers, housing agencies, and community organizations
Family Living Services
FAMILY LIVING SERVICES PROVIDER IN NEW MEXICO
SUPPORTING INDIVIDUALS IN A FAMILY-LIKE ENVIRONMENT THROUGH INTEGRATED CARE
Family Living Services in New Mexico provide a structured, family-like living environment for individuals with intellectual or developmental disabilities. These services focus on community integration, personal care, and fostering independence while being embedded in a supportive family setting. Family Living Services are authorized under New Mexico Medicaid Home and Community-Based Services (HCBS) Waiver programs.
1. GOVERNING AGENCIES
Agency: New Mexico Human Services Department (HSD)
Role: Administers Medicaid waiver funding for Family Living Services and manages provider enrollment, service authorization, and reimbursement.
Agency: Developmental Disabilities Supports Division (DDSD)
Role: Ensures quality standards, service delivery, and compliance for Family Living Services under HCBS waiver programs.
Agency: Centers for Medicare & Medicaid Services (CMS)
Role: Provides federal oversight ensuring Medicaid-funded Family Living Services meet HCBS quality, person-centered planning, and participant protection standards.
2. FAMILY LIVING SERVICES OVERVIEW
Family Living Services offer individuals with disabilities the opportunity to live in a family setting, receiving care and support from caregivers while promoting independence and community involvement.
Approved providers may deliver:
24/7 Supervision and Support: Daily assistance with personal care and supervision in a home environment.
Personal Care Assistance: Help with Activities of Daily Living (ADLs) like bathing, grooming, dressing, and mobility.
Skill Building and Training: Teaching life skills such as cooking, personal hygiene, and money management.
Community Integration: Encouraging participation in social, recreational, and educational activities.
Health Monitoring: Ensuring medication management and tracking of health conditions.
Behavioral Support: Providing assistance with behavioral challenges and promoting positive interactions.
Emergency and Safety Planning: Creating a safe environment and preparing for emergencies.
Caregiver Support: Training and guidance for family caregivers to ensure consistent care.
All services are delivered according to the Individualized Service Plan (ISP) to meet the participant’s unique needs and goals.
3. LICENSING & PROVIDER APPROVAL REQUIREMENTS
Prerequisites:
Register the business entity with the New Mexico Secretary of State.
Obtain EIN from the IRS and NPI (Type 2).
Enroll as a Medicaid Waiver Family Living Services provider via the New Mexico Medicaid Provider Enrollment Portal.
Obtain facility licensure if the service is offered in a group home setting.
Maintain general liability and professional liability insurance.
Develop policies for family living care, safety protocols, and staff training.
Ensure caregivers and staff meet background checks, health screenings, and training requirements.
4. NEW MEXICO PROVIDER ENROLLMENT PROCESS
Initial Interest and Application:
Complete the Provider Enrollment Application through the New Mexico Medicaid Provider Enrollment Portal for Family Living Services under HCBS waivers.
Application and Documentation Submission:
Submit Articles of Incorporation, proof of EIN/NPI, insurance certificates, caregiver qualifications, and policy manuals.
Program Readiness Review:
HSD and DDSD evaluate provider readiness, including safety protocols, care plans, and caregiver qualifications.
Approval & Medicaid Enrollment:
Upon approval, providers are authorized to bill Medicaid for Family Living Services using designated billing codes.
5. REQUIRED DOCUMENTATION
Articles of Incorporation or Business License (New Mexico Secretary of State)
IRS EIN confirmation
NPI confirmation
Family Living Facility License (if applicable)
Proof of general and professional liability insurance
Family Living Services Policy & Procedure Manual including:
Participant intake, assessment, and care planning procedures
Safety and emergency preparedness protocols
Staff credentialing, background checks, and caregiver training records
Documentation standards for care tracking and Medicaid billing
HIPAA compliance, participant rights, and grievance handling
Infection control and wellness monitoring procedures
Quality assurance and compliance monitoring
6. STAFFING REQUIREMENTS
Role: Family Living Program Director
Requirements: Bachelor’s degree in human services, social work, or healthcare administration; experience in family or residential care.
Role: Family Caregivers
Requirements: Experience in personal care or support services; CPR/First Aid certification; background clearance.
Role: Direct Support Professionals (DSPs) (if applicable)
Requirements: High school diploma or GED; training in ADL support and community integration; background clearance.
Role: Behavioral Support Specialists (if applicable)
Requirements: Certification in behavioral health support or applied behavior analysis (ABA); background clearance.
All staff must complete:
Training in family-centered care and daily living support
HIPAA compliance and participant rights education
Annual competency evaluations and ongoing professional development
Emergency preparedness and safety training
Infection control and health monitoring education
7. MEDICAID WAIVER PROGRAMS
Family Living Services are available under the following New Mexico Medicaid Waivers:
Developmental Disabilities (DD) Waiver
Mi Via Waiver
Medically Fragile Waiver
Supports Waiver
Home and Community-Based Services (HCBS) Waiver
Services may include:
24-hour family-based care and supervision
Assistance with personal care and daily living tasks
Community engagement and social skill development
Health and safety monitoring
Behavioral support and crisis intervention
8. TIMELINE TO LAUNCH
Phase: Business Formation and Compliance Preparation
Timeline: 1–2 months
Phase: Caregiver Recruitment, Credentialing, and Training
Timeline: 2–3 months
Phase: New Mexico Medicaid Provider Enrollment and Readiness Review
Timeline: 60–90 days
Phase: Medicaid Billing Setup and Family Living Service Launch
Timeline: 30–45 days
9. CONTACT INFORMATION
New Mexico Human Services Department (HSD)
Website: https://www.hsd.state.nm.us/
Developmental Disabilities Supports Division (DDSD)
Website: https://www.nmhealth.org/about/ddsd/
New Mexico Medicaid Provider Enrollment Portal
Website: https://nmmedicaid.portal.conduent.com/
Centers for Medicare & Medicaid Services (CMS)
Website: https://www.cms.gov/
WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — NEW MEXICO FAMILY LIVING SERVICES PROVIDER
WCG supports agencies in launching Medicaid-compliant Family Living Services in New Mexico, offering:
Scope of Work:
Business registration, Medicaid enrollment, and licensing assistance
Policy manual development for family living care and safety management
Caregiver credentialing, training program templates, and compliance documentation
Medicaid billing setup and audit-prepared financial management
Branding, website development, and community engagement strategies
Quality assurance systems for family care and participant well-being
Supported Living
SUPPORTED LIVING SERVICES PROVIDER IN NEW MEXICO
PROMOTING INDEPENDENCE THROUGH SAFE, ASSISTED LIVING ENVIRONMENTS
Supported Living Services in New Mexico provide individuals with intellectual or developmental disabilities with safe, community-based living environments while promoting autonomy and inclusion. These services support individuals in their homes, offering personal care, skill development, and community integration. Supported Living Services are authorized under New Mexico Medicaid Home and Community-Based Services (HCBS) Waiver programs.
1. GOVERNING AGENCIES
Agency: New Mexico Human Services Department (HSD)
Role: Administers Medicaid waiver funding for Supported Living Services and manages provider enrollment, service authorization, and reimbursement.
Agency: Developmental Disabilities Supports Division (DDSD)
Role: Ensures quality standards, service delivery, and compliance for Supported Living Services under HCBS waiver programs.
Agency: Centers for Medicare & Medicaid Services (CMS)
Role: Provides federal oversight ensuring Medicaid-funded Supported Living Services meet HCBS quality, person-centered planning, and participant protection standards.
2. SUPPORTED LIVING SERVICES OVERVIEW
Supported Living Services offer individualized support to help individuals with disabilities maintain independence in a residential setting while fostering community participation.
Approved providers may deliver:
24/7 Staff Support: Assistance with personal care, safety, and daily activities.
Personal Care Assistance: Help with bathing, grooming, dressing, and mobility.
Skill Development: Training in daily living skills, personal care, and household management.
Community Integration: Facilitating social engagement, employment support, and recreational activities.
Health and Wellness Monitoring: Administering medication, monitoring health conditions, and promoting self-care.
Behavioral Support: Managing challenging behaviors and promoting positive interactions.
Emergency and Crisis Intervention: Ensuring safety during unexpected situations.
Individualized Planning: Developing and implementing tailored support plans.
All services are delivered according to the Individualized Service Plan (ISP) to meet the participant’s unique living and support needs.
3. LICENSING & PROVIDER APPROVAL REQUIREMENTS
Prerequisites:
Register the business entity with the New Mexico Secretary of State.
Obtain EIN from the IRS and NPI (Type 2).
Enroll as a Medicaid Waiver Supported Living provider via the New Mexico Medicaid Provider Enrollment Portal.
Obtain facility licensure from HSD or NMDOH if operating a group home.
Maintain general liability and professional liability insurance.
Develop policies for residential care, safety protocols, and staff training.
Ensure staff meet background checks, health screenings, and supported living training requirements.
4. NEW MEXICO PROVIDER ENROLLMENT PROCESS
Initial Interest and Application:
Complete the Provider Enrollment Application through the New Mexico Medicaid Provider Enrollment Portal for Supported Living Services under HCBS waivers.
Application and Documentation Submission:
Submit Articles of Incorporation, proof of EIN/NPI, facility licenses (if applicable), insurance certificates, and policy manuals.
Program Readiness Review:
HSD and DDSD evaluate provider readiness, including safety protocols, staff qualifications, and care plans.
Approval & Medicaid Enrollment:
Upon approval, providers are authorized to bill Medicaid for Supported Living Services using designated billing codes.
5. REQUIRED DOCUMENTATION
Articles of Incorporation or Business License (New Mexico Secretary of State)
IRS EIN confirmation
NPI confirmation
Facility License (if applicable)
Proof of general and professional liability insurance
Supported Living Services Policy & Procedure Manual including:
Participant intake, care planning, and individualized support protocols
Health and safety monitoring, medication administration, and wellness checks
Staff credentialing, background checks, and ongoing training records
Documentation standards for care tracking and Medicaid billing
HIPAA compliance, participant rights, and grievance handling
Safety protocols, emergency response, and crisis management
Quality assurance and compliance monitoring
6. STAFFING REQUIREMENTS
Role: Supported Living Program Director
Requirements: Bachelor’s degree in human services, social work, or healthcare administration; supervisory experience preferred.
Role: Direct Support Professionals (DSPs)
Requirements: High school diploma or GED; CPR/First Aid certification; training in personal care and community integration; background clearance.
Role: Residential Support Coordinators
Requirements: Experience in supported living management; supervisory experience; background clearance.
Role: Behavioral Support Specialists (if applicable)
Requirements: Certification in behavioral health support or applied behavior analysis (ABA); background clearance.
All staff must complete:
Training in residential care and personal safety
HIPAA compliance and participant rights education
Annual competency evaluations and ongoing professional development
Safety training, including emergency preparedness and behavioral management
Infection control and wellness monitoring education
7. MEDICAID WAIVER PROGRAMS
Supported Living Services are available under the following New Mexico Medicaid Waivers:
Developmental Disabilities (DD) Waiver
Mi Via Waiver
Medically Fragile Waiver
Supports Waiver
Home and Community-Based Services (HCBS) Waiver
Services may include:
24-hour assisted living with personal care support
Skill development in daily living and self-care
Community integration and social engagement activities
Health monitoring and medication administration
Behavioral support and crisis intervention
8. TIMELINE TO LAUNCH
Phase: Business Formation and Compliance Preparation
Timeline: 1–2 months
Phase: Facility Licensing and Compliance Documentation
Timeline: 2–3 months
Phase: Staff Hiring, Credentialing, and Training
Timeline: 2–3 months
Phase: New Mexico Medicaid Provider Enrollment and Readiness Review
Timeline: 60–90 days
Phase: Medicaid Billing Setup and Supported Living Service Launch
Timeline: 30–45 days
9. CONTACT INFORMATION
New Mexico Human Services Department (HSD)
Website: https://www.hsd.state.nm.us/
Developmental Disabilities Supports Division (DDSD)
Website: https://www.nmhealth.org/about/ddsd/
New Mexico Medicaid Provider Enrollment Portal
Website: https://nmmedicaid.portal.conduent.com/
Centers for Medicare & Medicaid Services (CMS)
Website: https://www.cms.gov/
WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — NEW MEXICO SUPPORTED LIVING SERVICES PROVIDER
WCG supports agencies in launching Medicaid-compliant Supported Living Services in New Mexico, offering:
Scope of Work:
Business registration, Medicaid enrollment, and facility licensure support
Policy manual development for supported living care and community integration
Staff credentialing, training program templates, and documentation guidance
Medicaid billing setup and audit-prepared financial management
Branding, website development, and community outreach strategies
Quality assurance systems for supported living safety and compliance
Case Management
CASE MANAGEMENT SERVICES PROVIDER IN NEW MEXICO
COORDINATING CARE AND SUPPORT FOR INDIVIDUALS IN HOME AND COMMUNITY SETTINGS
Case Management Services in New Mexico assist individuals with disabilities, chronic conditions, or age-related challenges by coordinating care, advocating for services, and facilitating access to community resources. These services are essential for ensuring that individuals receive comprehensive, person-centered care while maintaining independence. Case Management Services are authorized under New Mexico Medicaid Home and Community-Based Services (HCBS) Waiver programs.
1. GOVERNING AGENCIES
Agency: New Mexico Human Services Department (HSD)
Role: Administers Medicaid waiver funding for Case Management Services and manages provider enrollment, service authorization, and reimbursement.
Agency: Developmental Disabilities Supports Division (DDSD)
Role: Ensures quality standards, service delivery, and compliance for Case Management Services under HCBS waiver programs.
Agency: Centers for Medicare & Medicaid Services (CMS)
Role: Provides federal oversight ensuring Medicaid-funded Case Management Services meet HCBS quality, person-centered planning, and participant protection standards.
2. CASE MANAGEMENT SERVICES OVERVIEW
Case Management Services involve assessment, planning, coordination, and monitoring to ensure that individuals receive appropriate care and support.
Approved providers may deliver:
Comprehensive Assessment: Evaluating individual needs, preferences, and support requirements.
Care Planning: Developing personalized service plans in collaboration with participants and families.
Resource Coordination: Connecting individuals with community services and supports.
Service Monitoring: Tracking the effectiveness of care plans and adjusting as needed.
Crisis Intervention: Providing immediate support during emergencies or changes in health status.
Advocacy: Supporting individual rights and advocating for necessary services.
Referral Services: Linking individuals to healthcare providers, therapists, and social services.
Documentation and Reporting: Maintaining accurate records of care coordination and outcomes.
Care Transitions Support: Assisting with hospital discharges and transitions between care settings.
All services are delivered according to the Individualized Service Plan (ISP) to meet the participant’s unique needs and support goals.
3. LICENSING & PROVIDER APPROVAL REQUIREMENTS
Prerequisites:
Register the business entity with the New Mexico Secretary of State.
Obtain EIN from the IRS and NPI (Type 2).
Enroll as a Medicaid Waiver Case Management provider via the New Mexico Medicaid Provider Enrollment Portal.
Maintain general liability and professional liability insurance.
Develop policies for case management, service coordination, and client advocacy.
Ensure staff meet background checks, health screenings, and case management training requirements.
4. NEW MEXICO PROVIDER ENROLLMENT PROCESS
Initial Interest and Application:
Complete the Provider Enrollment Application through the New Mexico Medicaid Provider Enrollment Portal for Case Management Services under HCBS waivers.
Application and Documentation Submission:
Submit Articles of Incorporation, proof of EIN/NPI, insurance certificates, case management training documentation, and policy manuals.
Program Readiness Review:
HSD and DDSD evaluate provider readiness, including client assessment procedures, documentation standards, and staff qualifications.
Approval & Medicaid Enrollment:
Upon approval, providers are authorized to bill Medicaid for Case Management Services using designated billing codes.
5. REQUIRED DOCUMENTATION
Articles of Incorporation or Business License (New Mexico Secretary of State)
IRS EIN confirmation
NPI confirmation
Proof of general and professional liability insurance
Case Management Services Policy & Procedure Manual including:
Intake, assessment, and individualized care planning procedures
Service coordination, advocacy, and referral guidelines
Staff credentialing, background checks, and ongoing training records
Documentation standards for care tracking and Medicaid billing
HIPAA compliance, participant rights, and grievance handling
Emergency response, crisis management, and safety protocols
Quality assurance and compliance monitoring
6. STAFFING REQUIREMENTS
Role: Case Management Program Director
Requirements: Bachelor’s or Master’s degree in social work, human services, or healthcare administration; experience in case management and supervision.
Role: Case Managers
Requirements: Bachelor’s degree in social work, psychology, or a related field; case management certification preferred; experience with client advocacy; background clearance.
Role: Support Coordinators
Requirements: Experience in care coordination and client engagement; basic knowledge of community resources; background clearance.
All staff must complete:
Training in care coordination, person-centered planning, and advocacy
HIPAA compliance and participant rights education
Annual competency evaluations and ongoing professional development
Safety and emergency response training
Documentation and record-keeping best practices
7. MEDICAID WAIVER PROGRAMS
Case Management Services are available under the following New Mexico Medicaid Waivers:
Developmental Disabilities (DD) Waiver
Mi Via Waiver
Medically Fragile Waiver
Supports Waiver
Home and Community-Based Services (HCBS) Waiver
Services may include:
Individualized care planning and service coordination
Crisis management and emergency support
Advocacy and rights protection
Linking to medical, social, and community resources
Monitoring and adjusting care plans as needed
8. TIMELINE TO LAUNCH
Phase: Business Formation and Compliance Preparation
Timeline: 1–2 months
Phase: Staff Hiring, Credentialing, and Program Development
Timeline: 2–3 months
Phase: New Mexico Medicaid Provider Enrollment and Readiness Review
Timeline: 60–90 days
Phase: Medicaid Billing Setup and Case Management Service Launch
Timeline: 30–45 days
9. CONTACT INFORMATION
New Mexico Human Services Department (HSD)
Website: https://www.hsd.state.nm.us/
Developmental Disabilities Supports Division (DDSD)
Website: https://www.nmhealth.org/about/ddsd/
New Mexico Medicaid Provider Enrollment Portal
Website: https://nmmedicaid.portal.conduent.com/
Centers for Medicare & Medicaid Services (CMS)
Website: https://www.cms.gov/
WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — NEW MEXICO CASE MANAGEMENT SERVICES PROVIDER
WCG supports agencies in launching Medicaid-compliant Case Management Services in New Mexico, offering:
Scope of Work:
Business registration, Medicaid enrollment, and licensing assistance
Policy manual development for care coordination and client advocacy
Staff credentialing, training program templates, and compliance documentation
Medicaid billing setup and audit-prepared financial management
Branding, website development, and client outreach strategies
Quality assurance systems for service coordination and compliance monitoring
Collaboration with healthcare providers and community organizations
Non-Medical Transportation
NON-MEDICAL TRANSPORTATION SERVICES PROVIDER IN NEW MEXICO
FACILITATING COMMUNITY ACCESS THROUGH SAFE, RELIABLE TRANSPORTATION
Non-Medical Transportation (NMT) Services in New Mexico provide safe and reliable rides for individuals with disabilities or mobility challenges to access community resources, employment, social events, and other essential activities. These services promote independence and enhance quality of life by ensuring individuals can participate fully in their communities. NMT Services are authorized under New Mexico Medicaid Home and Community-Based Services (HCBS) Waiver programs.
1. GOVERNING AGENCIES
Agency: New Mexico Human Services Department (HSD)
Role: Administers Medicaid waiver funding for Non-Medical Transportation Services and manages provider enrollment, service authorization, and reimbursement.
Agency: Developmental Disabilities Supports Division (DDSD)
Role: Ensures quality standards, service delivery, and compliance for NMT Services under HCBS waiver programs.
Agency: New Mexico Department of Transportation (NMDOT)
Role: Oversees vehicle safety standards, driver qualifications, and transportation compliance.
Agency: Centers for Medicare & Medicaid Services (CMS)
Role: Provides federal oversight ensuring Medicaid-funded NMT Services meet HCBS quality, person-centered planning, and participant protection standards.
2. NON-MEDICAL TRANSPORTATION SERVICES OVERVIEW
NMT Services provide accessible and reliable transportation to enable individuals to participate in community activities, maintain employment, and access essential services.
Approved providers may deliver:
Community Access Transportation: Rides to community centers, social events, and support groups.
Employment Transportation: Safe travel to work or vocational training sites.
Recreational Transportation: Access to social, cultural, and community events.
Personal Errands: Transportation to grocery stores, pharmacies, and other essential locations.
Day Program Transportation: Rides to and from habilitation or day support services.
Door-to-Door Assistance: Helping passengers from their residence to the vehicle and destination.
Accessible Transportation: Vehicles equipped for wheelchairs, mobility aids, and accessible seating.
Escort or Companion Support: Assistance during travel for individuals needing additional help.
All transportation services are delivered according to the Individualized Service Plan (ISP) to meet the participant’s mobility and community integration needs.
3. LICENSING & PROVIDER APPROVAL REQUIREMENTS
Prerequisites:
Register the business entity with the New Mexico Secretary of State.
Obtain EIN from the IRS and NPI (Type 2).
Enroll as a Medicaid Waiver NMT provider via the New Mexico Medicaid Provider Enrollment Portal.
Obtain required permits and licenses from the New Mexico Motor Vehicle Division (MVD).
Maintain general liability, professional liability, and vehicle insurance.
Develop policies for passenger safety, vehicle maintenance, and driver training.
Ensure drivers meet background checks, health screenings, and defensive driving training requirements.
4. NEW MEXICO PROVIDER ENROLLMENT PROCESS
Initial Interest and Application:
Complete the Provider Enrollment Application through the New Mexico Medicaid Provider Enrollment Portal for NMT Services under HCBS waivers.
Application and Documentation Submission:
Submit Articles of Incorporation, proof of EIN/NPI, vehicle insurance certificates, driver qualifications, and policy manuals.
Program Readiness Review:
HSD and DDSD evaluate provider readiness, including vehicle safety, driver qualifications, and transportation protocols.
Approval & Medicaid Enrollment:
Upon approval, providers are authorized to bill Medicaid for NMT Services using designated billing codes.
5. REQUIRED DOCUMENTATION
Articles of Incorporation or Business License (New Mexico Secretary of State)
IRS EIN confirmation
NPI confirmation
Vehicle Registration and Safety Inspection Documents
Proof of general liability, professional liability, and vehicle insurance
Non-Medical Transportation Services Policy & Procedure Manual including:
Trip scheduling, passenger assistance, and route planning procedures
Driver credentialing, background checks, and training records
Safety protocols for transporting individuals with mobility aids
Vehicle maintenance, inspection, and cleanliness standards
HIPAA compliance, passenger rights, and grievance handling
Documentation standards for trip logs, billing, and compliance tracking
Emergency preparedness, accident reporting, and incident management
6. STAFFING REQUIREMENTS
Role: NMT Program Director
Requirements: Bachelor’s degree in transportation management or healthcare administration; experience in managing transportation services.
Role: Drivers/Transportation Aides
Requirements: Valid New Mexico driver’s license with a clean driving record; defensive driving and passenger assistance training; CPR/First Aid certification; background clearance.
Role: Dispatch Coordinators
Requirements: Experience in logistics, scheduling, and customer support; background clearance.
All staff must complete:
Training in safe driving practices and passenger assistance
HIPAA compliance and client rights education
Ongoing professional development and defensive driving courses
Annual vehicle safety inspections and maintenance training
Customer service and accessibility training
7. MEDICAID WAIVER PROGRAMS
NMT Services are available under the following New Mexico Medicaid Waivers:
Developmental Disabilities (DD) Waiver
Mi Via Waiver
Medically Fragile Waiver
Supports Waiver
Home and Community-Based Services (HCBS) Waiver
Services may include:
Transportation to employment, community programs, and recreational activities
Access to essential services like grocery shopping and social events
Door-to-door assistance for individuals with mobility challenges
Escort or companion support during travel
Safe and reliable accessible vehicle options
8. TIMELINE TO LAUNCH
Phase: Business Formation and Compliance Preparation
Timeline: 1–2 months
Phase: Staff Hiring, Credentialing, and Program Development
Timeline: 2–3 months
Phase: New Mexico Medicaid Provider Enrollment and Readiness Review
Timeline: 60–90 days
Phase: Medicaid Billing Setup and NMT Service Launch
Timeline: 30–45 days
9. CONTACT INFORMATION
New Mexico Human Services Department (HSD)
Website: https://www.hsd.state.nm.us/
Developmental Disabilities Supports Division (DDSD)
Website: https://www.nmhealth.org/about/ddsd/
New Mexico Motor Vehicle Division (MVD)
Website: https://www.mvd.newmexico.gov/
New Mexico Medicaid Provider Enrollment Portal
Website: https://nmmedicaid.portal.conduent.com/
Centers for Medicare & Medicaid Services (CMS)
Website: https://www.cms.gov/
WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — NEW MEXICO NON-MEDICAL TRANSPORTATION SERVICES PROVIDER
WCG supports agencies in launching Medicaid-compliant Non-Medical Transportation Services in New Mexico, offering:
Scope of Work:
Business registration, Medicaid enrollment, and licensing assistance
Policy manual development for transportation safety and client support
Staff credentialing, training program templates, and compliance documentation
Medicaid billing setup and audit-prepared financial management
Branding, website development, and community outreach strategies
Quality assurance systems for transportation safety and compliance
Collaboration with healthcare providers and community organizations
Home Health
HOME HEALTH CARE SERVICES PROVIDER IN NEW MEXICO
DELIVERING MEDICAL AND PERSONAL CARE IN THE COMFORT OF HOME
Home Health Care Services in New Mexico provide medical care, personal assistance, and therapeutic support for individuals with chronic conditions, disabilities, or age-related health needs. These services are delivered in the home, allowing individuals to receive high-quality care while maintaining independence. Home Health Care Services are authorized under New Mexico Medicaid Home and Community-Based Services (HCBS) Waiver programs.
1. GOVERNING AGENCIES
Agency: New Mexico Human Services Department (HSD)
Role: Administers Medicaid waiver funding for Home Health Care Services and manages provider enrollment, service authorization, and reimbursement.
Agency: Developmental Disabilities Supports Division (DDSD)
Role: Ensures quality standards, service delivery, and compliance for Home Health Care Services under HCBS waiver programs.
Agency: New Mexico Department of Health (NMDOH)
Role: Licenses home health agencies and regulates the provision of skilled nursing and personal care services.
Agency: Centers for Medicare & Medicaid Services (CMS)
Role: Provides federal oversight ensuring Medicaid-funded Home Health Care Services meet HCBS quality, person-centered planning, and participant protection standards.
2. HOME HEALTH CARE SERVICES OVERVIEW
Home Health Care Services provide a combination of medical, personal, and supportive care delivered in the individual’s home to enhance quality of life and maintain independence.
Approved providers may deliver:
Skilled Nursing: Health assessments, wound care, medication management, and chronic disease monitoring.
Therapeutic Services: Physical, occupational, and speech therapy to improve mobility, function, and communication.
Personal Care Assistance: Support with bathing, grooming, dressing, and mobility.
Health Monitoring: Checking vital signs, glucose levels, and respiratory function.
Medication Administration: Administering oral, injectable, and IV medications as prescribed.
Post-Surgical Care: Monitoring recovery, pain management, and wound dressing changes.
Rehabilitation Support: Exercises and routines designed to restore physical function.
Patient and Family Education: Teaching care techniques and health management strategies.
Care Coordination: Collaborating with healthcare providers to ensure comprehensive care.
Emergency Response Planning: Preparing for health crises and establishing protocols.
All services are delivered according to the Individualized Service Plan (ISP) to meet the participant’s health and personal care needs.
3. LICENSING & PROVIDER APPROVAL REQUIREMENTS
Prerequisites:
Register the business entity with the New Mexico Secretary of State.
Obtain EIN from the IRS and NPI (Type 2).
Enroll as a Medicaid Waiver Home Health Care provider via the New Mexico Medicaid Provider Enrollment Portal.
Obtain a Home Health Agency License from the New Mexico Department of Health (NMDOH).
Maintain general liability and professional liability insurance.
Develop policies for clinical care, medication management, and personal care assistance.
Ensure staff meet background checks, health screenings, and professional licensure requirements.
4. NEW MEXICO PROVIDER ENROLLMENT PROCESS
Initial Interest and Application:
Complete the Provider Enrollment Application through the New Mexico Medicaid Provider Enrollment Portal for Home Health Care Services under HCBS waivers.
Application and Documentation Submission:
Submit Articles of Incorporation, proof of EIN/NPI, home health agency licenses, insurance certificates, and policy manuals.
Program Readiness Review:
HSD and DDSD evaluate provider readiness, including care protocols, staff qualifications, and safety measures.
Approval & Medicaid Enrollment:
Upon approval, providers are authorized to bill Medicaid for Home Health Care Services using designated billing codes.
5. REQUIRED DOCUMENTATION
Articles of Incorporation or Business License (New Mexico Secretary of State)
IRS EIN confirmation
NPI confirmation
Home Health Agency License
Proof of general and professional liability insurance
Home Health Care Services Policy & Procedure Manual including:
Health assessment, care planning, and medication management protocols
Personal care and hygiene assistance guidelines
Staff credentialing, background checks, and ongoing training records
Documentation standards for clinical care tracking and Medicaid billing
HIPAA compliance, patient rights, and grievance handling
Safety protocols, emergency response, and infection control measures
Quality assurance and compliance monitoring
6. STAFFING REQUIREMENTS
Role: Home Health Care Program Director
Requirements: Bachelor’s or Master’s degree in nursing, healthcare administration, or related field; RN license preferred.
Role: Registered Nurses (RNs)
Requirements: Valid RN license in New Mexico; experience in home healthcare; CPR/First Aid certification; background clearance.
Role: Licensed Practical Nurses (LPNs)
Requirements: Valid LPN license in New Mexico; experience in skilled nursing care; background clearance.
Role: Home Health Aides (HHAs)
Requirements: Certified as a Home Health Aide; experience in personal care and ADL assistance; background clearance.
Role: Therapists (Physical, Occupational, Speech)
Requirements: State licensure; experience in therapeutic home care; background clearance.
All staff must complete:
Training in clinical protocols, medication administration, and infection control
HIPAA compliance and patient rights education
Ongoing professional development and certification renewal
Annual competency evaluations and safety protocol updates
CPR/First Aid and emergency response training
7. MEDICAID WAIVER PROGRAMS
Home Health Care Services are available under the following New Mexico Medicaid Waivers:
Developmental Disabilities (DD) Waiver
Mi Via Waiver
Medically Fragile Waiver
Supports Waiver
Home and Community-Based Services (HCBS) Waiver
Services may include:
Health monitoring and chronic disease management
Medication administration and adherence support
Rehabilitation and therapeutic exercises
Personal care and hygiene assistance
Health education and wellness planning
8. TIMELINE TO LAUNCH
Phase: Business Formation and Compliance Preparation
Timeline: 1–2 months
Phase: Staff Hiring, Credentialing, and Program Development
Timeline: 2–3 months
Phase: New Mexico Medicaid Provider Enrollment and Readiness Review
Timeline: 60–90 days
Phase: Medicaid Billing Setup and Home Health Care Service Launch
Timeline: 30–45 days
9. CONTACT INFORMATION
New Mexico Human Services Department (HSD)
Website: https://www.hsd.state.nm.us/
Developmental Disabilities Supports Division (DDSD)
Website: https://www.nmhealth.org/about/ddsd/
New Mexico Department of Health (NMDOH)
Website: https://www.nmhealth.org/
New Mexico Medicaid Provider Enrollment Portal
Website: https://nmmedicaid.portal.conduent.com/
Centers for Medicare & Medicaid Services (CMS)
Website: https://www.cms.gov/
WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — NEW MEXICO HOME HEALTH CARE SERVICES PROVIDER
WCG supports agencies in launching Medicaid-compliant Home Health Care Services in New Mexico, offering:
Scope of Work:
Business registration, Medicaid enrollment, and licensing assistance
Policy manual development for clinical care and patient safety
Staff credentialing, training program templates, and compliance documentation
Medicaid billing setup and financial management
Branding, website development, and client engagement strategies
Quality assurance systems for clinical care and compliance monitoring
Collaboration with healthcare providers and community organizations
Meal & Nutrition
MEAL AND NUTRITION SERVICES PROVIDER IN NEW MEXICO
PROMOTING HEALTH AND WELL-BEING THROUGH NUTRITIONAL SUPPORT
Meal and Nutrition Services in New Mexico provide essential nutritional support to individuals with disabilities, chronic conditions, or age-related dietary needs. These services ensure that individuals receive balanced, healthy meals tailored to their preferences and medical requirements. Meal and Nutrition Services are authorized under New Mexico Medicaid Home and Community-Based Services (HCBS) Waiver programs.
1. GOVERNING AGENCIES
Agency: New Mexico Human Services Department (HSD)
Role: Administers Medicaid waiver funding for Meal and Nutrition Services and manages provider enrollment, service authorization, and reimbursement.
Agency: Developmental Disabilities Supports Division (DDSD)
Role: Ensures quality standards, service delivery, and compliance for Meal and Nutrition Services under HCBS waiver programs.
Agency: Centers for Medicare & Medicaid Services (CMS)
Role: Provides federal oversight ensuring Medicaid-funded Meal and Nutrition Services meet HCBS quality, person-centered planning, and participant protection standards.
2. MEAL AND NUTRITION SERVICES OVERVIEW
Meal and Nutrition Services support individuals by offering prepared meals, meal planning, and dietary guidance to maintain health and well-being.
Approved providers may deliver:
Meal Preparation: Cooking and delivering nutritious meals based on individual dietary needs.
Meal Planning: Developing customized meal plans tailored to health conditions (e.g., diabetes, hypertension).
Nutritional Counseling: Guidance on maintaining a balanced diet.
Specialized Diets: Preparing meals that accommodate medical conditions (e.g., low-sodium, pureed, or allergen-free diets).
Home-Delivered Meals: Regular meal delivery for those unable to prepare food themselves.
On-Site Congregate Meals: Group meal settings for social engagement and community interaction.
Dietary Monitoring: Tracking dietary intake and ensuring nutritional adequacy.
Food Safety and Hygiene: Ensuring that meals are prepared and stored safely.
All services are delivered according to the Individualized Service Plan (ISP) to meet the participant’s dietary and health needs.
3. LICENSING & PROVIDER APPROVAL REQUIREMENTS
Prerequisites:
Register the business entity with the New Mexico Secretary of State.
Obtain EIN from the IRS and NPI (Type 2).
Enroll as a Medicaid Waiver Meal and Nutrition provider via the New Mexico Medicaid Provider Enrollment Portal.
Obtain a food establishment license from the New Mexico Environment Department (NMED).
Maintain general liability and professional liability insurance.
Develop policies for meal preparation, dietary planning, and food safety.
Ensure staff meet background checks, health screenings, and food safety training requirements.
4. NEW MEXICO PROVIDER ENROLLMENT PROCESS
Initial Interest and Application:
Complete the Provider Enrollment Application through the New Mexico Medicaid Provider Enrollment Portal for Meal and Nutrition Services under HCBS waivers.
Application and Documentation Submission:
Submit Articles of Incorporation, proof of EIN/NPI, food establishment license, insurance certificates, and policy manuals.
Program Readiness Review:
HSD and DDSD evaluate provider readiness, including meal planning protocols, safety measures, and staff qualifications.
Approval & Medicaid Enrollment:
Upon approval, providers are authorized to bill Medicaid for Meal and Nutrition Services using designated billing codes.
5. REQUIRED DOCUMENTATION
Articles of Incorporation or Business License (New Mexico Secretary of State)
IRS EIN confirmation
NPI confirmation
Food Establishment License (if applicable)
Proof of general and professional liability insurance
Meal and Nutrition Services Policy & Procedure Manual including:
Meal preparation, dietary planning, and food safety protocols
Staff credentialing, background checks, and food handler certifications
Documentation standards for meal tracking and Medicaid billing
HIPAA compliance, participant rights, and grievance handling
Safety protocols for food storage, preparation, and delivery
Nutritional assessment and monitoring procedures
Quality assurance and compliance monitoring
6. STAFFING REQUIREMENTS
Role: Meal and Nutrition Program Director
Requirements: Bachelor’s degree in nutrition, dietetics, or food service management; supervisory experience preferred.
Role: Dietitians/Nutritionists
Requirements: Licensed or registered dietitian; experience in meal planning and dietary counseling; background clearance.
Role: Food Service Workers
Requirements: High school diploma or GED; food safety certification (e.g., ServSafe); background clearance.
Role: Delivery Personnel
Requirements: Valid driver’s license; background clearance; training in food safety and delivery protocols.
All staff must complete:
Food safety and hygiene training
HIPAA compliance and participant rights education
Ongoing professional development in dietary management
Annual competency evaluations and food safety refresher courses
Training in dietary monitoring and nutrition tracking
7. MEDICAID WAIVER PROGRAMS
Meal and Nutrition Services are available under the following New Mexico Medicaid Waivers:
Developmental Disabilities (DD) Waiver
Mi Via Waiver
Medically Fragile Waiver
Supports Waiver
Home and Community-Based Services (HCBS) Waiver
Services may include:
Home-delivered meals for individuals with mobility or health challenges
Nutritional counseling for maintaining balanced diets
Specialized diet planning for chronic conditions
Group meal programs for social engagement
Regular dietary monitoring and health tracking
8. TIMELINE TO LAUNCH
Phase: Business Formation and Compliance Preparation
Timeline: 1–2 months
Phase: Staff Hiring, Credentialing, and Program Development
Timeline: 2–3 months
Phase: New Mexico Medicaid Provider Enrollment and Readiness Review
Timeline: 60–90 days
Phase: Medicaid Billing Setup and Meal and Nutrition Service Launch
Timeline: 30–45 days
9. CONTACT INFORMATION
New Mexico Human Services Department (HSD)
Website: https://www.hsd.state.nm.us/
Developmental Disabilities Supports Division (DDSD)
Website: https://www.nmhealth.org/about/ddsd/
New Mexico Environment Department (NMED)
Website: https://www.env.nm.gov/
New Mexico Medicaid Provider Enrollment Portal
Website: https://nmmedicaid.portal.conduent.com/
Centers for Medicare & Medicaid Services (CMS)
Website: https://www.cms.gov/
WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — NEW MEXICO MEAL AND NUTRITION SERVICES PROVIDER
WCG supports agencies in launching Medicaid-compliant Meal and Nutrition Services in New Mexico, offering:
Scope of Work:
Business registration, Medicaid enrollment, and food service licensing assistance
Policy manual development for meal preparation, dietary planning, and safety management
Staff credentialing, training program templates, and compliance documentation
Medicaid billing setup and audit-prepared financial management
Branding, website development, and community outreach strategies
Quality assurance systems for meal safety and dietary compliance
Collaboration with healthcare providers and nutrition experts
Our Client Portal offers a wealth of resources that you can explore related to various programs and state requirements.