RESIDENTIAL SUPPORT SERVICES PROVIDER IN NEW MEXICO

SUPPORTING INDEPENDENT LIVING AND COMMUNITY INTEGRATION THROUGH RESIDENTIAL CARE

Residential Support Services in New Mexico provide individuals with disabilities, chronic conditions, or age-related challenges with safe and supportive living environments. These services aim to promote independence, personal growth, and community integration. Residential Support 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 Residential Support Services and manages provider enrollment, service authorization, and reimbursement.

Agency: Developmental Disabilities Supports Division (DDSD)

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

Agency: Centers for Medicare & Medicaid Services (CMS)

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

2. RESIDENTIAL SUPPORT SERVICES OVERVIEW

Residential Support Services provide safe, structured living environments for individuals who need assistance with daily living and community integration.

Approved providers may deliver:

• 24/7 Residential Care: Supervised living arrangements with staff support.

• Assistance with Activities of Daily Living (ADLs): Personal care, mobility support, and health monitoring.

• Skill Development: Teaching daily living skills like cooking, cleaning, and budgeting.

• Community Engagement: Facilitating participation in social, recreational, and educational activities.

• Health and Safety Monitoring: Ensuring a safe and supportive living environment.

• Behavioral Support: Assistance with managing challenging behaviors.

• Emergency and Crisis Intervention: Immediate support during emergencies.

• Personalized Care Plans: Developing individualized plans tailored to the participant’s needs.

All services are delivered according to the Individualized Service Plan (ISP) to meet the participant’s residential and support 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 Residential Support provider via the New Mexico Medicaid Provider Enrollment Portal.

• Obtain residential facility licensure from HSD, DDSD, or the New Mexico Department of Health (NMDOH).

• Maintain general liability and professional liability insurance.

• Develop policies for residential care, safety protocols, and staff training.

• Ensure staff meet background checks, health screenings, and residential care 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 Residential Support Services under HCBS waivers.

Application and Documentation Submission:

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

Program Readiness Review:

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

Approval & Medicaid Enrollment:

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

5. REQUIRED DOCUMENTATION

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

• IRS EIN confirmation

• NPI confirmation

• Residential Facility License (if applicable)

• Proof of general and professional liability insurance

• Residential Support Services Policy & Procedure Manual including:

  • Participant intake, assessment, and individualized care planning procedures

  • Health and safety monitoring, medication management, and emergency preparedness

  • Staff credentialing, background checks, and ongoing training records

  • Documentation standards for residential care tracking and Medicaid billing

  • HIPAA compliance, participant rights, and grievance handling

  • Safety protocols, emergency response, and crisis intervention measures

  • Quality assurance and compliance monitoring

6. STAFFING REQUIREMENTS

Role: Residential Support Program Director

Requirements: Bachelor’s or Master’s degree in human services, social work, or healthcare administration; supervisory experience preferred.

Role: Direct Support Professionals (DSPs)

Requirements: High school diploma or GED; CPR/First Aid certification; training in personal care and ADL support; background clearance.

Role: Residential Care Supervisors

Requirements: Experience in residential care management; supervisory experience; background clearance.

Role: Behavioral Support Specialists (if applicable)

Requirements: Certification in behavioral health support or applied behavior analysis (ABA); background clearance.

All staff must complete:

• Training in residential safety and emergency protocols

• HIPAA compliance and participant rights education

• Annual competency evaluations and ongoing professional development

• Behavioral intervention and crisis management training

• Infection control and wellness monitoring education

7. MEDICAID WAIVER PROGRAMS

Residential Support 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-hour supervised residential care

• Assistance with personal care and ADLs

• Community participation and social skill development

• Health and wellness monitoring

• Behavioral support and crisis intervention

8. TIMELINE TO LAUNCH

Phase: Business Formation and Compliance Preparation

Timeline: 1–2 months

Phase: Facility Licensing and Compliance Documentation

Timeline: 2–3 months

Phase: Staff Hiring, Credentialing, and Training

Timeline: 2–3 months

Phase: New Mexico Medicaid Provider Enrollment and Readiness Review

Timeline: 60–90 days

Phase: Medicaid Billing Setup and Residential Support 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 RESIDENTIAL SUPPORT SERVICES PROVIDER

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

Scope of Work:

• Business registration, Medicaid enrollment, and facility licensure support

• Policy manual development for residential care and community integration

• Staff credentialing, training program templates, and documentation guidance

• Medicaid billing setup and audit-prepared financial management

• Branding, website development, and community outreach strategies

• Quality assurance systems for residential care safety and compliance

• Collaboration with healthcare and community organizations

Continue To Our Client Portal To Get Started

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