1.Program Definition and Services

Adult Health Services in New Mexico provide short-term support to children and adults with intellectual/developmental disabilities and chronic conditions. The program aims to help maintain individuals with disabilities in the community, averting the need for long-term services and supports. Services include:

• In-Home Personal Care: Individual support in the individual/family home or community (Primary Health Monitoring, Skilled Nursing Interventions, Chronic Disease Mitigation, Health and Self-Care Education, and Medication Administration Management)
• Residential Personal Care: Supervision and care in a licensed residential, community-based setting (Rehabilitation Support Coordination, Preventive Screening Tracking, Routine Physical Wellness Promotion, Care Coordination and Integration, and Personal Care Assistance with Medical Oversight)

2. Regulations

The program is governed by the following regulations:

• New Mexico Administrative Code, Title 8, Chapter 314, Part 5 (Developmental Disabilities Home and Community-Based Services Waiver)
• New Mexico Administrative Code, Title 8, Chapter 314, Part 3 (Medically Fragile Home and Community-Based Services Waiver)
• New Mexico Health Care Authority (HCA) Developmental Disabilities Supports Division (DDSD) Waiver Service Standards (Adult Nursing and Healthcare Support Provision Standards)
• New Mexico Nursing Practice Act (NMSA 1978, Chapter 61, Article 3, regarding clinical nursing standards and oversight)

3. Licensing or Certification

Providers must be certified by the New Mexico Health Care Authority (HCA) and the Developmental Disabilities Supports Division (DDSD), following all Home and Community-Based Services (HCBS) requirements.  Agencies delivering clinical monitoring, nursing care, or therapeutic support must also secure and maintain a valid Home Health Agency License issued by the New Mexico Health Care Authority's Division of Health Improvement (DHI).

4. Responsible State Agency

The New Mexico Health Care Authority (HCA), through its Medical Assistance Division and in coordination with the Department of Health (NMDOH) Developmental Disabilities Supports Division (DDSD) and the Division of Health Improvement (DHI), is responsible for reviewing applications, conducting provider readiness inspections, and certifying adult health services providers.

5. Application Process

The application process is conducted through the electronic New Mexico Medicaid Provider Enrollment Portal (YES.NM.GOV). Providers must submit forms online to initiate the application process after clearing regional DDSD enrollment guidelines and verifying current home health agency status.

6. Required Documentation

While specific documentation requirements vary based on the target waiver, providers typically need to submit:

• Proof of compliance with state safety, home health agency licensing, and adult health operational rules
• Agency policies and procedures (including medical assessment protocols, chronic condition tracking, and clinical escalation plans)
• Staff qualifications, nursing board registry verifications, and professional clinical training records
• Proof of general liability, professional clinical liability, and malpractice insurance

7. Timeline for Approval

The exact timeline for approval fluctuates based on agency capacity. Providers should contact their regional office for detailed information on current processing timeframes.

8. Pre-Application Process

Prospective providers must complete specific foundation tasks before applying. They must establish their business entity with the New Mexico Secretary of State and secure necessary federal identification numbers (such as an EIN and a Type 2 NPI).

9. Pre-Application Training

The state hosts mandatory administrative and compliance training sessions online. Access details are sent to qualified applicants once preliminary paperwork is reviewed.

10. Additional Notes

• Providers must ensure that administrative offices, clinical coordination spaces, and participant intake hubs meet all state accessibility and environmental safety guidelines
• In-Home Personal Care (such as skilled vital monitoring or therapeutic coaching) must be provided directly by the certified agency's employed personnel
• All medical staff, including RNs, LPNs, and licensed therapists, must possess active state licenses and clear background checks through the New Mexico Caregivers Criminal History Screening (CCHS) program
• Providers must maintain detailed records of face-to-face services, clinical daily shift logs, physician order tracking charts, and medication administration records (MAR) for Medicaid documentation and billing

Why Choose Waiver Consulting Group?

Starting or expanding your Medicaid waiver-funded agency can feel overwhelming, but it doesn't have to be. At Waiver Consulting Group, we simplify the process by guiding you through licensing, compliance, provider enrollment, policies & procedures, and regulatory approvals in any state.

With proven expertise, a structured process, and ongoing support, we take the guesswork out of launching your healthcare business. Whether you're a first-time entrepreneur or an established provider looking to expand, our team ensures you stay compliant, competitive, and fully operational.

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