PRIVATE DUTY NURSING (PDN) SERVICES PROVIDER IN NEW MEXICO

DELIVERING PERSONALIZED MEDICAL CARE IN THE HOME AND COMMUNITY

Private Duty Nursing (PDN) Services in New Mexico provide continuous, skilled nursing care to individuals with complex medical needs. These services are delivered by licensed nurses in the patient’s home or community setting to support ongoing health and medical management. PDN 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 PDN Services and manages provider enrollment, service authorization, and reimbursement.

Agency: Developmental Disabilities Supports Division (DDSD)

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

Agency: New Mexico Department of Health (NMDOH)

Role: Licenses and regulates home healthcare agencies providing PDN services.

Agency: Centers for Medicare & Medicaid Services (CMS)

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

2. PRIVATE DUTY NURSING SERVICES OVERVIEW

Private Duty Nursing Services are designed for individuals who require continuous medical care due to chronic conditions, disabilities, or post-acute needs.

Approved providers may deliver:

• Continuous Skilled Nursing Care: 24/7 or intermittent nursing care based on medical necessity.

• Medication Administration: Oral, injectable, and intravenous medication management.

• Chronic Disease Management: Monitoring conditions like diabetes, respiratory issues, or cardiac problems.

• Ventilator and Tracheostomy Care: Monitoring and maintenance of respiratory devices.

• Wound and Ostomy Care: Dressing changes, infection control, and stoma care.

• Gastrostomy and Enteral Feeding: Administering tube feeding and monitoring nutritional intake.

• Seizure Monitoring: Observing and responding to seizure activity and providing emergency care.

• Patient and Family Education: Training on home care techniques and medical management.

• Emergency Response Planning: Developing protocols for medical emergencies.

All services are delivered according to the Individualized Service Plan (ISP) to meet the participant’s healthcare 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 PDN 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 patient safety.

• Ensure nursing staff meet background checks, health screenings, and 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 PDN Services under HCBS waivers.

Application and Documentation Submission:

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

Program Readiness Review:

• HSD and DDSD evaluate provider readiness, including clinical protocols, safety measures, and nursing qualifications.

Approval & Medicaid Enrollment:

• Upon approval, providers are authorized to bill Medicaid for PDN 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

• Private Duty Nursing Services Policy & Procedure Manual, including:

  • Clinical care protocols, medication administration, and emergency procedures

  • Nursing staff credentialing, background checks, and ongoing training records

  • Documentation standards for medical care tracking and Medicaid billing

  • HIPAA compliance, patient rights, and grievance handling

  • Safety protocols, infection control, and patient monitoring guidelines

  • Quality assurance and compliance monitoring

  • Patient and family education and support strategies

6. STAFFING REQUIREMENTS

Role: PDN Program Director

Requirements: Bachelor’s or Master’s degree in nursing; RN license in New Mexico; experience in home healthcare management.

Role: Registered Nurses (RNs)

Requirements: Valid RN license in New Mexico; experience in critical care, home healthcare, or PDN settings; CPR/First Aid certification; background clearance.

Role: Licensed Practical Nurses (LPNs)

Requirements: Valid LPN license in New Mexico; experience in long-term care or home health; background clearance.

All staff must complete:

• Training in clinical protocols, medication administration, and patient safety

• HIPAA compliance and patient rights education

• Annual competency evaluations and ongoing professional development

• CPR/First Aid and emergency response training

• Infection control and chronic disease management training

7. MEDICAID WAIVER PROGRAMS

Private Duty Nursing Services are available under the following New Mexico Medicaid Waivers:

• Developmental Disabilities (DD) Waiver

• Mi Via Waiver

• Medically Fragile Waiver

• Supports Waiver

• Home and Community-Based Services (HCBS) Waiver

Services may include:

• 24/7 skilled nursing care

• Respiratory therapy and ventilator management

• Medication administration and adherence support

• Chronic disease and seizure monitoring

• Patient education and caregiver support

8. TIMELINE TO LAUNCH

Phase: Business Formation and Compliance Preparation

Timeline: 1–2 months

Phase: Staff Hiring, Credentialing, and Program Development

Timeline: 2–3 months

Phase: New Mexico Medicaid Provider Enrollment and Readiness Review

Timeline: 60–90 days

Phase: Medicaid Billing Setup and PDN Service Launch

Timeline: 30–45 days

9. CONTACT INFORMATION

New Mexico Human Services Department (HSD)

Website: https://www.hsd.state.nm.us/

Developmental Disabilities Supports Division (DDSD)

Website: https://www.nmhealth.org/about/ddsd/

New Mexico Department of Health (NMDOH)

Website: https://www.nmhealth.org/

New Mexico Medicaid Provider Enrollment Portal

Website: https://nmmedicaid.portal.conduent.com/

Centers for Medicare & Medicaid Services (CMS)

Website: https://www.cms.gov/

WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — NEW MEXICO PRIVATE DUTY NURSING SERVICES PROVIDER

WCG supports agencies in launching Medicaid-compliant PDN Services in New Mexico, offering:

Scope of Work:

• Business registration, Medicaid enrollment, and licensing assistance

• Policy manual development for clinical care, safety, and patient management

• Staff credentialing, training program templates, and compliance documentation

• Medicaid billing setup and audit-prepared financial management

• Branding, website development, and community outreach strategies

• Quality assurance systems for clinical care and compliance monitoring

• Collaboration with healthcare providers and community organizations

Continue To Our Client Portal To Get Started

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