1. Program Definition and Services

Environmental Modification Services in New Mexico provide physical adaptations to the home to ensure the health, welfare, and safety of the individual, or which enable the individual to function with greater independence in the home. The program aims to help maintain individuals with disabilities in the community, averting the need for institutional or long-term services and supports. Services include:

• In-Home Personal Care: Individual support in the individual/family home or community (Accessibility Improvements, Bathroom Modifications, Kitchen Adaptations, Safety Enhancements, and Sensory Modifications)
• Residential Personal Care: Supervision and care in a licensed residential, community-based setting (Mobility Aids Installation, Home Automation Integration, Structural Modifications Oversight, Post-Installation Safety Monitoring, and Project Compliance 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 (Environmental Modifications Standards)
• Americans with Disabilities Act (ADA) Standards for Accessible Design

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. Because these services involve structural changes to real property, provider agencies must hold valid, applicable contractor licenses (such as a GB-2 or GB-98 residential/commercial building license) issued by the New Mexico Regulation and Licensing Department (RLD) Construction Industries Division (CID).

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 RLD Construction Industries Division, is responsible for reviewing applications, verifying structural contractor credentials, and certifying environmental modification 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 open-enrollment parameters and registering active construction licensing credentials.

6. Required Documentation

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

• Proof of compliance with state safety, RLD contractor licensing, and commercial operational rules
• Agency policies and procedures (including site risk assessment workflows, project cost-estimation protocols, and building inspector sign-off systems)
• Staff qualifications, Certified Aging-in-Place Specialist (CAPS) designations, and active trade certifications for specialized personnel
• Proof of comprehensive general liability, professional liability, and a minimum of $1,000,000 per occurrence in liability insurance naming the State of New Mexico Health Care Authority as an additional insured.

7. Timeline for Approval

The exact timeline for approval fluctuates based on agency capacity. The provider enrollment application review process typically takes approximately 90 days once a complete packet is submitted.

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, secure necessary federal identification numbers (such as an EIN and an applicable Type 2 NPI), and ensure all structural contracting licenses are fully active.

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 through the state's provider learning management system.

10. Additional Notes

• Providers must ensure that all completed home modifications adhere to local New Mexico building codes, municipal permitting rules, and ADA compliance standards.
• In-Home Personal Care adaptations (such as custom ramp construction or physical installation of sensory alerts) must be managed and executed directly by the certified agency's licensed personnel or approved subcontractors.
• All project managers, field contractors, and on-site technical installers must complete mandatory background clearances in alignment with New Mexico Medicaid rules.
• Providers must maintain detailed records of home safety assessments, architectural drawings, itemized materials invoices, individual service plans (ISP), and post-construction consumer satisfaction confirmations for Medicaid documentation and billing.

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