1. Program Definition and Services 

Private Duty Nursing (PDN) 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 (Continuous Skilled Nursing Care, Medication Administration and IV Management, Chronic Disease Monitoring, Ventilator and Tracheostomy Care, and Wound and Ostomy Care) 
• Residential Personal Care: Supervision and care in a licensed residential, community-based setting (Gastrostomy and Enteral Feeding Monitoring, Seizure Tracking and Emergency Intervention, Patient and Family Health Education, Emergency Response Planning, and Clinical 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 3 (Medically Fragile Home and Community-Based Services Waiver) 
• New Mexico Health Care Authority (HCA) 
• Developmental Disabilities Supports Division (DDSD) 
• Waiver Service Standards 
• New Mexico Nursing Practice Act (NMSA 1978, Chapter 61, Article 3, regarding clinical delegation and nurse supervision) 

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 skilled clinical care 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 readiness inspections, and certifying private duty nursing 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 and verifying state home health agency licensure. 

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 clinical operational rules 
• Agency policies and procedures (including clinical care protocols, medication management, and patient hazard/emergency plans) 
• Staff qualifications, nursing board registry verifications, and professional 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 clinical operations hubs, administrative spaces, and client care locations 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 nursing staff, including RNs and LPNs, must possess active state licenses and clear mandatory background screenings 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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