NURSING FACILITY TRANSITION SERVICES PROVIDER IN NEW MEXICO

SUPPORTING INDEPENDENCE THROUGH SAFE TRANSITIONS TO COMMUNITY LIVING

Nursing Facility Transition Services in New Mexico help individuals move from nursing facilities or institutional care back to community-based settings. These services aim to promote independence, improve quality of life, and reduce institutionalization by providing comprehensive transition planning and support. Nursing Facility Transition 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 Nursing Facility Transition Services and manages provider enrollment, service authorization, and reimbursement.

Agency: Developmental Disabilities Supports Division (DDSD)

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

Agency: Centers for Medicare & Medicaid Services (CMS)

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

2. NURSING FACILITY TRANSITION SERVICES OVERVIEW

Nursing Facility Transition Services help individuals plan and execute a move from institutional care to independent or supported community living.

Approved providers may deliver:

• Transition Planning: Developing a personalized plan for community reintegration.

• Housing Assistance: Identifying accessible housing and coordinating housing applications.

• Service Coordination: Linking individuals to community-based support services.

• Skill Building: Training in daily living skills to promote independence.

• Home Setup: Assistance with acquiring furniture, household items, and accessibility modifications.

• Healthcare Coordination: Arranging for medical care, personal care, and nursing support in the community.

• Peer Support and Counseling: Emotional support during the transition process.

• Transportation Assistance: Helping with mobility needs during and after the transition.

• Follow-Up and Monitoring: Ensuring stability and addressing challenges post-transition.

All services are delivered according to the Individualized Service Plan (ISP) to meet the participant’s transition and community living 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 Nursing Facility Transition provider via the New Mexico Medicaid Provider Enrollment Portal.

• Maintain general liability and professional liability insurance.

• Develop policies for transition planning, housing coordination, and community integration.

• Ensure staff meet background checks, health screenings, and training requirements for transition support.

4. NEW MEXICO PROVIDER ENROLLMENT PROCESS

Initial Interest and Application:

• Complete the Provider Enrollment Application through the New Mexico Medicaid Provider Enrollment Portal for Nursing Facility Transition Services under HCBS waivers.

Application and Documentation Submission:

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

Program Readiness Review:

• HSD and DDSD evaluate provider readiness, including transition planning protocols, safety measures, and staff qualifications.

Approval & Medicaid Enrollment:

• Upon approval, providers are authorized to bill Medicaid for Nursing Facility Transition Services using designated billing codes.

5. REQUIRED DOCUMENTATION

• Articles of Incorporation or Business License (New Mexico Secretary of State)

• IRS EIN confirmation

• NPI confirmation

• Proof of general and professional liability insurance

• Nursing Facility Transition Services Policy & Procedure Manual including:

  • Transition planning, housing support, and community integration protocols

  • Staff credentialing, background checks, and ongoing training records

  • Documentation standards for transition tracking and Medicaid billing

  • HIPAA compliance, participant rights, and grievance handling

  • Safety protocols, emergency response, and crisis management

  • Quality assurance and compliance monitoring

  • Client and family education on transition readiness and community living skills

6. STAFFING REQUIREMENTS

Role: Transition Program Director

Requirements: Bachelor’s degree in social work, healthcare administration, or human services; experience in community-based care.

Role: Transition Specialists

Requirements: Experience in care coordination, housing support, and community integration; background clearance.

Role: Social Workers

Requirements: Licensed Social Worker (LSW) or Licensed Clinical Social Worker (LCSW); experience in transition planning; background clearance.

Role: Peer Support Specialists

Requirements: Training in peer support and community reintegration; experience in advocacy and mentorship; background clearance.

All staff must complete:

• Training in transition planning and community integration

• HIPAA compliance and participant rights education

• Annual competency evaluations and ongoing professional development

• Safety and emergency preparedness training

• Cultural competency and person-centered planning education

7. MEDICAID WAIVER PROGRAMS

Nursing Facility Transition 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

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 Nursing Facility Transition 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 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 NURSING FACILITY TRANSITION SERVICES PROVIDER

WCG supports agencies in launching Medicaid-compliant Nursing Facility Transition Services in New Mexico, offering:

Scope of Work:

• Business registration, Medicaid enrollment, and licensing assistance

• Policy manual development for transition planning and community integration

• Staff credentialing, training program templates, and compliance documentation

• Medicaid billing setup and audit-prepared financial management

• Branding, website development, and client outreach strategies

• Quality assurance systems for transition readiness and community support

• Collaboration with healthcare providers, housing agencies, and community organizations

Continue To Our Client Portal To Get Started

Our Client Portal offers a wealth of resources that you can explore related to various programs and state requirements.