New Mexico provider enrollment
What New Mexico requires before you can deliver home and community-based waiver services, in the order the state actually requires it. Every claim links to the official page it came from.
Provider rules change often — confirm fees and deadlines against the linked sources before you rely on them.
New Mexico grades your application, and the number is public: you must score at least 86 percent to receive a Provider Agreement and provide DD Waiver services. Score under 75 percent in the Standard Program Description section and you get a full denial regardless of the rest. Anything below 86 goes back to you through a remediation process built on written Requests for Information, each with a ten-business-day turnaround. That structure means the application is a document to be drafted and reviewed like a proposal, not a form to be filled in. Approval is also granular — applications may be approved or denied as a whole or by service type, and a denial of one service type is not a denial of the application. Two hard requirements to settle before you write anything: liability coverage of at least one million dollars naming the Health Care Authority, and a surety bond (individual) or fidelity bond (group) of at least ten thousand dollars. Some services additionally require accreditation by CARF International or the Council on Quality and Leadership.
Receives and processes provider applications. Mail: P.O. Box 2611, Santa Fe, NM 87502-0110, or 1190 S. St. Francis Drive, Suite S1203, Santa Fe, NM 87505.
Visit siteThe agency DDSD sits in. Provider Agreements are subject to HCA regulations governing Medicaid waiver services and to the DD, Medically Fragile, and Supports Waiver Service Standards.
Visit siteNamed contact for help completing the application: Tammy M. Barth, Tammy.Barth@hca.nm.gov.
505-469-8480Visit siteProof of general or professional liability insurance with a one-million-dollar minimum, naming the Health Care Authority.
SourceProof of a surety bond for individuals, or a fidelity bond for groups, with a ten-thousand-dollar minimum.
SourceA Case Management Provider Agency may not be a provider agency for any other waiver service, may not provide guardianship services to someone it case-manages, and its case managers may not serve on a provider agency's board. Affinity arising solely from the caregiver relationship does not satisfy the standard.
SourceSubmit with all necessary information and forms. DDSD may request additional information, which must be submitted within the timelines DDSD sets.
SourceAssemble the DDSD application packet with the required forms, insurance, bond, and any accreditation, submit it to PERU, and score at least 86 percent on committee review to receive a Provider Agreement.
The DD Waiver Qualified Provider Application packet carries the application requirements, the format, the DDSD required forms, the accreditation requirements, and the documentation list.
SourceBeyond the core application, individual DD Waiver services carry additional service-specific questions — answer the ones relevant to what you are applying for.
SourceAgencies applying for the first time must provide a detailed plan outlining the timelines they will follow.
SourceThe Committee Chair assigns applications to a Regional Office Director or subject-matter-expert lead, who convenes a local committee. Reviewers have ten business days from receipt to review, unless the Chair grants an exception.
SourceA provider application must score at least 86 percent to receive a Provider Agreement. Below that, a first written Request for Information gives you ten business days to respond; if it comes back insufficient, a second RFI is issued with a referral for technical assistance and another ten business days.
SourceCase management providers must be accredited — through CARF International's Aging Services accreditation or the Council on Quality and Leadership's Quality Assurances accreditation.
SourceA Case Management Provider Agency may not be a provider agency for any other waiver service.
SourceThrough CARF's Employment and Community Services or Aging Services accreditation, or the Council on Quality and Leadership's Quality Assurances accreditation.
SourceApplications may be approved or denied as a whole or by service type, and denial of one service type does not constitute a full denial. Applying for fewer services narrows what can go wrong.
SourceReviewers get ten business days to review; you get ten business days to answer each Request for Information. Two rounds of RFI plus review time is the realistic shape of a remediated application.
SourceA million dollars of liability coverage naming HCA and a ten-thousand-dollar surety or fidelity bond have to be in place as part of the application, not after approval.
SourceProvider Agreements are subject to the Developmental Disabilities, Medically Fragile, and Supports Waiver Service Standards and to HCA's general provider requirements, on top of the waiver regulations themselves.
SourceThe Caregiver Criminal History Screening Program appears as a requirement across the service-type matrix in the application packet.
SourceNew Mexico does not publish these in a form we could verify, so we have not guessed at them. Ask directly — and if an answer here would help other providers, tell us and we will add it with its source.
Ask: DDSD Provider Enrollment Relations Unit, 505-469-8480
Ask: DDSD Provider Enrollment Relations Unit, 505-469-8480
Ask: New Mexico Health Care Authority
Ask: DDSD Provider Enrollment Relations Unit, 505-469-8480
The packet: requirements, forms, accreditation tables, insurance and bonding minimums, scoring, and remediation.
505-469-8480Visit siteThe division that reviews applications and administers the waiver.
Visit siteProgram overview and service information.
Visit siteYes. You must score at least 86 percent to receive a Provider Agreement and provide DD services. Scoring under 75 percent in the Standard Program Description section produces a full denial on its own.
The application returns to you through a remediation process: a first written Request for Information with ten business days to respond, and if that is insufficient, a second RFI accompanied by a referral for technical assistance and another ten business days.
For some services, yes — through CARF International or the Council on Quality and Leadership. The application packet contains a table showing which service types require it and which accreditation satisfies each.
No. A Case Management Provider Agency may not be a provider agency for any other waiver service, may not provide guardianship to someone it case-manages, and its case managers may not sit on a provider agency's board.
General or professional liability of at least one million dollars naming the Health Care Authority, plus a surety bond (individual) or fidelity bond (group) of at least ten thousand dollars.
Looking for the family-facing guide? Browse state waiver guides