HOME HEALTH CARE SERVICES PROVIDER IN NEW MEXICO

Fatumata Kaba
Sep 5
4 min read

DELIVERING MEDICAL AND PERSONAL CARE IN THE COMFORT OF HOME

Home Health Care Services in New Mexico provide medical care, personal assistance, and therapeutic support for individuals with chronic conditions, disabilities, or age-related health needs. These services are delivered in the home, allowing individuals to receive high-quality care while maintaining independence. Home Health Care 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 Home Health Care Services and manages provider enrollment, service authorization, and reimbursement.

Agency: Developmental Disabilities Supports Division (DDSD)

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

Agency: New Mexico Department of Health (NMDOH)

Role: Licenses home health agencies and regulates the provision of skilled nursing and personal care services.

Agency: Centers for Medicare & Medicaid Services (CMS)

Role: Provides federal oversight ensuring Medicaid-funded Home Health Care Services meet HCBS quality, person-centered planning, and participant protection standards.

2. HOME HEALTH CARE SERVICES OVERVIEW

Home Health Care Services provide a combination of medical, personal, and supportive care delivered in the individual’s home to enhance quality of life and maintain independence.

Approved providers may deliver:

Skilled Nursing: Health assessments, wound care, medication management, and chronic disease monitoring.
Therapeutic Services: Physical, occupational, and speech therapy to improve mobility, function, and communication.
Personal Care Assistance: Support with bathing, grooming, dressing, and mobility.
Health Monitoring: Checking vital signs, glucose levels, and respiratory function.
Medication Administration: Administering oral, injectable, and IV medications as prescribed.
Post-Surgical Care: Monitoring recovery, pain management, and wound dressing changes.
Rehabilitation Support: Exercises and routines designed to restore physical function.
Patient and Family Education: Teaching care techniques and health management strategies.
Care Coordination: Collaborating with healthcare providers to ensure comprehensive care.
Emergency Response Planning: Preparing for health crises and establishing protocols.

All services are delivered according to the Individualized Service Plan (ISP) to meet the participant’s health and personal care 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 Home Health Care provider via the New Mexico Medicaid Provider Enrollment Portal.
Obtain a Home Health Agency License from the New Mexico Department of Health (NMDOH).
Maintain general liability and professional liability insurance.
Develop policies for clinical care, medication management, and personal care assistance.
Ensure staff meet background checks, health screenings, and professional licensure 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 Home Health Care Services under HCBS waivers.

Application and Documentation Submission:

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

Program Readiness Review:

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

Approval & Medicaid Enrollment:

Upon approval, providers are authorized to bill Medicaid for Home Health Care 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
Proof of general and professional liability insurance
Home Health Care Services Policy & Procedure Manual, including:
- Health assessment, care planning, and medication management protocols
- Personal care and hygiene assistance guidelines
- Staff credentialing, background checks, and ongoing training records
- Documentation standards for clinical care 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: Home Health Care 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 home healthcare; CPR/First Aid certification; background clearance.

Role: Licensed Practical Nurses (LPNs)

Requirements: Valid LPN license in New Mexico; experience in skilled nursing care; background clearance.

Role: Home Health Aides (HHAs)

Requirements: Certified as a Home Health Aide; experience in personal care and ADL assistance; background clearance.

Role: Therapists (Physical, Occupational, Speech)

Requirements: State licensure; experience in therapeutic home care; background clearance.

All staff must complete:

Training in clinical protocols, medication administration, and infection control
HIPAA compliance and patient rights education
Ongoing professional development and certification renewal
Annual competency evaluations and safety protocol updates
CPR/First Aid and emergency response training