1. Program Definition and Services

Day Habilitation 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 (Skill Development Activities, Community Integration Activities, Social Skills Training, Cognitive Enrichment Programs, and Health and Wellness Support)
• Residential Personal Care: Supervision and care in a licensed residential, community-based setting (Arts and Recreation Coordination, Vocational Skills Development Oversight, Safety and Mobility Training, Facility Safety Monitoring, and Program Progress Documentation)

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 6 (Mi Via Home and Community-Based Services Waiver)
• New Mexico Health Care Authority (HCA) Developmental Disabilities Supports Division (DDSD) Waiver Service Standards (Customized Community Supports and Day Habilitation Standards)
• Centers for Medicare & Medicaid Services (CMS) Home and Community-Based Services (HCBS) Settings Final Rule

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. Specialized day centers, regional training facilities, and community hubs must also secure and maintain valid facility licensure or applicable occupancy and operation permits from the New Mexico Regulation and Licensing Department (RLD) or local public health authority.

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), is responsible for reviewing applications, verifying facility guidelines compliance, and certifying day habilitation services providers

5. Application Process

The application process is conducted through the electronic New Mexico Medicaid Provider Enrollment Portal. Providers must submit forms online to initiate the application process after clearing background criteria and demonstrating capacity to meet New Mexico state-approved adaptive programming, community inclusion, and safety benchmarks.

6. Required Documentation

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

• Proof of compliance with state safety, facility licensing, and commercial operational rules
• Agency policies and procedures (including program curriculum, incident management, and individual plan accommodation systems)
• Staff qualifications, habilitation specialist training records, and certifications for supervising support personnel
• Proof of general liability, professional liability, and facility property 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 an applicable 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 programming hubs, recreational spaces, and facility structures meet all state safety, sanitation, and physical environmental safety guidelines
• In-Home Personal Care (such as direct life skills training or structured routine adjustment) must be provided directly by the certified agency's employed personnel
• All direct support professionals, habilitation specialists, and administrative staff must conduct mandatory background clearances and screening evaluations in accordance with New Mexico Medicaid rules
• Providers must maintain detailed records of face-to-face services, participant goal tracking logs, individual service plans (ISP), and attendance confirmations 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.

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