RESPITE CARE SERVICES PROVIDER IN NEW MEXICO

SUPPORTING CAREGIVERS AND PROMOTING WELL-BEING THROUGH TEMPORARY RELIEF SERVICES

Respite Care Services in New Mexico provide temporary relief for family caregivers of individuals with disabilities, chronic illnesses, or age-related conditions. These services allow primary caregivers to rest, attend to personal matters, or recover from caregiver fatigue while ensuring the participant’s safety and well-being. Respite 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 Respite 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 Respite Care Services under HCBS waiver programs.

Agency: Centers for Medicare & Medicaid Services (CMS)

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

2. RESPITE CARE SERVICES OVERVIEW

Respite Care Services offer planned or emergency relief for unpaid caregivers while ensuring participants receive appropriate supervision, personal care, and support services.

Approved providers may deliver:

• In-Home Respite Services: Care provided in the participant’s residence.

• Facility-Based Respite Care: Temporary care in licensed community settings.

• Day Respite: Supervision and support during daytime hours.

• Overnight or Weekend Respite: Extended care to accommodate caregiver breaks.

• Personal Care Assistance: Help with Activities of Daily Living (ADLs) such as bathing, grooming, feeding, mobility, and toileting.

• Medication Reminders: Non-skilled assistance with medication schedules.

• Social Engagement: Facilitating recreational or therapeutic activities based on the participant’s interests and care plan.

All respite care must align with the participant’s Individualized Service Plan (ISP) and reflect their health 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 Respite Care provider through the New Mexico Medicaid Provider Enrollment Portal.

• Obtain facility licensure (if providing facility-based respite) from HSD or NMDOH as applicable.

• Maintain general liability and professional liability insurance.

• Develop comprehensive policies for participant intake, caregiver communication, incident reporting, and emergency procedures.

• Ensure all direct care staff meet background screening, health screenings, and training requirements.

4. NEW MEXICO PROVIDER ENROLLMENT PROCESS

Initial Interest and Application:

• Submit Provider Enrollment Application through the New Mexico Medicaid Provider Enrollment Portal for Respite Care Services under appropriate HCBS waivers.

Application and Documentation Submission:

• Submit Articles of Incorporation, proof of EIN/NPI, liability insurance certificates, staff credentialing documentation, and service policies.

Program Readiness Review:

• HSD and DDSD review provider readiness, including staff qualifications, care and supervision protocols, participant safety plans, and documentation systems.

Approval & Medicaid Enrollment:

• Upon approval, providers are authorized to bill Medicaid for In-Home and/or Facility-Based Respite Services using assigned billing codes.

5. REQUIRED DOCUMENTATION

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

• IRS EIN confirmation

• NPI confirmation

• Facility License (for facility-based respite providers)

• Proof of general and professional liability insurance

• Respite Care Services Policy & Procedure Manual including:

  • Participant intake, care planning, and service scheduling procedures

  • Health and safety monitoring, medication reminders, and supervision protocols

  • Emergency preparedness, abuse prevention, and critical incident reporting policies

  • Participant rights, HIPAA confidentiality procedures, and grievance handling

  • Staff credentialing, background checks, first aid/CPR certification documentation

  • Medicaid billing, service tracking, and audit readiness procedures

6. STAFFING REQUIREMENTS

Role: Respite Services Program Director

Requirements: Bachelor’s degree in human services, healthcare, or related field; supervisory experience preferred.

Role: Respite Care Workers

Requirements: High school diploma or GED; CPR/First Aid certification; completion of respite-specific or direct care training; background screening and health clearance.

All staff must complete:

• Safety and emergency preparedness training

• HIPAA compliance and participant rights education

• Abuse prevention and exploitation awareness training

• Infection control and health monitoring training

• Annual competency evaluations and continuing education

7. MEDICAID WAIVER PROGRAMS

Respite Care 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:

• In-home or facility-based supervision and care

• Temporary support allowing unpaid caregivers to attend to personal needs

• Assistance with basic ADLs and wellness monitoring during respite periods

• Crisis respite services when caregiver availability is compromised

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 Respite Care 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 RESPITE CARE SERVICES PROVIDER

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

Scope of Work:

• Business registration, Medicaid enrollment, and facility licensure support

• Policy manual development for respite care planning and caregiver communication

• Staff credentialing templates, participant intake forms, and emergency planning templates

• Medicaid billing system setup and audit-ready claims management

• Branding, website development, and caregiver engagement strategies

• Quality assurance systems for incident reporting, service tracking, and compliance monitoring

Continue To Our Client Portal To Get Started

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