ADULT HEALTH SERVICES PROVIDER IN NEW MEXICO

Fatumata Kaba
Sep 5
4 min read

PROMOTING WELLNESS AND INDEPENDENCE THROUGH COMPREHENSIVE HEALTH SUPPORT

Adult Health Services in New Mexico provide a wide range of healthcare and wellness support for adults with disabilities, chronic conditions, or age-related health needs. These services focus on maintaining health, promoting wellness, and managing chronic conditions to support independent living. Adult Health Services are authorized under New Mexico Medicaid Home and Community-Based Services (HCBS) Waiver programs.

1. GOVERNING AGENCIES

Agency: New Mexico Human Services Department (HSD)

Role: Administers Medicaid waiver funding for Adult Health Services and manages provider enrollment, service authorization, and reimbursement.

Agency: Developmental Disabilities Supports Division (DDSD)

Role: Ensures quality standards, service delivery, and compliance for Adult Health Services under HCBS waiver programs.

Agency: New Mexico Department of Health (NMDOH)

Role: Licenses healthcare agencies providing adult health services and oversees quality compliance.

Agency: Centers for Medicare & Medicaid Services (CMS)Role: Provides federal oversight ensuring Medicaid-funded Adult Health Services meet HCBS quality, person-centered planning, and participant protection standards.

2. ADULT HEALTH SERVICES OVERVIEW

Adult Health Services support individuals by providing medical care, wellness monitoring, and health education to promote independence and quality of life.

Approved providers may deliver:

Primary Health Monitoring: Regular assessments of vital signs, chronic condition management, and wellness checks.
Nursing Care: Skilled nursing services such as wound care, catheter maintenance, and medication administration.
Chronic Disease Management: Support for diabetes, hypertension, COPD, and other chronic conditions.
Health Education: Guidance on self-care, nutrition, medication management, and lifestyle changes.
Rehabilitation Support: Physical therapy, occupational therapy, and mobility training.
Medication Management: Assistance with medication adherence, prescription tracking, and side effect monitoring.
Preventive Care: Health screenings, immunizations, and routine physical examinations.
Health and Wellness Programs: Exercise classes, dietary guidance, and chronic disease self-management education.
Personal Care Assistance: Bathing, grooming, and hygiene support when combined with healthcare needs.
Care Coordination: Collaboration with healthcare providers to ensure integrated care.

All services are delivered according to the Individualized Service Plan (ISP) to meet the participant’s health and wellness needs.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Register the business entity with the New Mexico Secretary of State.
Obtain EIN from the IRS and NPI (Type 2).
Enroll as a Medicaid Waiver Adult Health Services provider via the New Mexico Medicaid Provider Enrollment Portal.
Obtain a Home Health Agency License from the New Mexico Department of Health (NMDOH) if providing medical care.
Maintain general liability and professional liability insurance.
Develop policies for healthcare planning, chronic disease management, and safety protocols.
Ensure staff meet background checks, health screenings, and healthcare training requirements.

4. NEW MEXICO PROVIDER ENROLLMENT PROCESS

Initial Interest and Application:

Complete the Provider Enrollment Application through the New Mexico Medicaid Provider Enrollment Portal for Adult Health Services under HCBS waivers.

Application and Documentation Submission:

Submit Articles of Incorporation, proof of EIN/NPI, healthcare agency licenses, insurance certificates, and policy manuals.

Program Readiness Review:

HSD and DDSD evaluate provider readiness, including healthcare protocols, staff qualifications, and safety measures.

Approval & Medicaid Enrollment:

Upon approval, providers are authorized to bill Medicaid for Adult Health Services using designated billing codes.

5. REQUIRED DOCUMENTATION

Articles of Incorporation or Business License (New Mexico Secretary of State)
IRS EIN confirmation
NPI confirmation
Home Health Agency License (if applicable)
Proof of general and professional liability insurance
Adult Health Services Policy & Procedure Manual, including:
- Health assessment, chronic disease management, and medication administration protocols
- Personal care and hygiene assistance guidelines when medically necessary
- Staff credentialing, background checks, and ongoing training records
- Documentation standards for healthcare tracking and Medicaid billing
- HIPAA compliance, patient rights, and grievance handling
- Safety protocols, emergency response, and infection control measures
- Quality assurance and compliance monitoring

6. STAFFING REQUIREMENTS

Role: Adult Health Program Director

Requirements: Bachelor’s or Master’s degree in nursing, healthcare administration, or related field; RN license preferred.

Role: Registered Nurses (RNs)

Requirements: Valid RN license in New Mexico; experience in community health or chronic disease management; CPR/First Aid certification; background clearance.

Role: Licensed Practical Nurses (LPNs)

Requirements: Valid LPN license in New Mexico; experience in personal care and medical support; background clearance.

Role: Health Educators

Requirements: Certification in health education or chronic disease management; background clearance.

Role: Rehabilitation Specialists (PT, OT)

Requirements: State licensure; experience in adult health support; background clearance.

All staff must complete: