1.Program Definition and Services
Personal Care Attendant (PCA) Services in New Mexico provide short-term support to children and adults with intellectual/developmental disabilities and chronic conditions.
- In-Home Personal Care: Individual support in the individual/family home or community (Personal Hygiene Assistance, Mobility Support, Toileting and Incontinence Care, Meal Preparation and Feeding, Housekeeping and Laundry, and Medication Reminders)
- Residential Personal Care: Supervision and care in a licensed residential, community-based setting (Companionship and Social Engagement, Safety Monitoring, Emergency Coordination, Overnight Support, and Care 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 New Mexico Administrative Code, Title 7, Chapter 8, Part 2 (Assisted Living Facilities Licensing Rules, if applicable to community residential models)
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. While a standalone facility license is generally not required for non-medical home care agencies, community-based group residential settings must secure appropriate facility licensure from the Division of Health Improvement (DHI).
4. Responsible State Agency
The New Mexico Health Care Authority (HCA), 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 readiness inspections, and certifying personal care attendant 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 regional DDSD open-enrollment requirements.
6. Required Documentation
While specific documentation requirements vary based on the target waiver, providers typically need to submit:
- Proof of compliance with state safety, physical site, and operational rules
- Agency policies and procedures (including participant intake, assessment, and individualized care planning procedures)
- Staff qualifications, training records, and Direct Support Professional certifications
- Proof of general and professional liability 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 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 intensive care settings, homes, and community living hubs meet all state accessibility and environmental safety guidelines
- In-Home Personal Care must be provided directly by the certified agency's employed personnel
- All direct care staff must conduct mandatory background clearances and fingerprinting screenings through the New Mexico Caregivers Criminal History Screening (CCHS) program
- Providers must maintain detailed records of face-to-face services, daily logs, and behavioral tracking charts for Medicaid documentation and billing
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