PERSONAL CARE ATTENDANT (PCA) SERVICES PROVIDER IN NEW MEXICO

Fatumata Kaba
Sep 5
4 min read

SUPPORTING INDEPENDENCE AND DAILY LIVING THROUGH PERSONAL ASSISTANCE

Personal Care Attendant (PCA) Services in New Mexico provide essential support with daily living activities for individuals with disabilities, chronic illnesses, or age-related conditions. These services help maintain independence and enhance quality of life by offering assistance tailored to each individual’s needs. PCA 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 PCA Services and manages provider enrollment, service authorization, and reimbursement.

Agency: Developmental Disabilities Supports Division (DDSD)

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

Agency: Centers for Medicare & Medicaid Services (CMS)

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

2. PERSONAL CARE ATTENDANT SERVICES OVERVIEW

PCA Services assist individuals with Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs) to maintain independence and well-being.

Approved providers may deliver:

Personal Hygiene Assistance: Bathing, grooming, oral care, and dressing.
Mobility Support: Transfers, ambulation, and positioning assistance.
Toileting and Incontinence Care: Support with bathroom use and hygiene maintenance.
Meal Preparation and Feeding: Preparing balanced meals, feeding assistance, and hydration support.
Housekeeping and Laundry: Light cleaning, bed making, and laundry tasks.
Medication Reminders: Non-skilled support with medication schedules.
Companionship and Social Engagement: Providing social interaction and light emotional support.
Safety Monitoring: Ensuring a safe environment and preventing accidents.

All services are delivered according to the Individualized Service Plan (ISP) to meet the participant’s specific care and safety 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 PCA provider via the New Mexico Medicaid Provider Enrollment Portal.
Obtain a Personal Care Agency License from the New Mexico Department of Health (NMDOH).
Maintain general liability and professional liability insurance.
Develop policies for personal care planning, safety protocols, and staff training.
Ensure staff meet background checks, health screenings, and 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 PCA 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 staff training, care protocols, and safety measures.

Approval & Medicaid Enrollment:

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

5. REQUIRED DOCUMENTATION

Articles of Incorporation or Business License (New Mexico Secretary of State)
IRS EIN confirmation
NPI confirmation
Personal Care Agency License
Proof of general and professional liability insurance
PCA Services Policy & Procedure Manual including:
- Participant intake, assessment, and individualized care planning procedures
- Personal care assistance, hygiene, and mobility support guidelines
- Staff credentialing, background checks, and training requirements
- Documentation standards for care tracking and Medicaid billing
- HIPAA compliance, participant rights, and grievance handling
- Safety protocols, emergency response, and infection control measures
- Quality assurance and compliance monitoring