New Mexico - Adult Companion Services — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

The New Mexico Health Care Authority (HCA) does not enroll agencies under a standalone "Adult Companion Services" provider type; instead, non-medical supervision and socialization are delivered and billed as Personal Care Services (PCS) under the Agency-Based Community Benefit (ABCB) or as Customized In-Home Supports under the Developmental Disabilities (DD) Waiver. Providers seeking to offer these socialization and supervision supports must apply for the broader PCS or DD Waiver agency designations, which encompass companion-level care alongside other activities of daily living.

Approval requires securing a Medicaid provider agreement through the YES.NM portal and passing a comprehensive policy review by the Developmental Disabilities Supports Division (DDSD) Provider Enrollment Relations Unit (PERU). Agencies seeking to serve the managed care population must subsequently secure active network contracts with Turquoise Care managed care organizations (MCOs), which control access to the ABCB participant base and represent a mandatory structural precondition for reimbursement.

1. Service Definition and Scope

In New Mexico, companion services are not a distinct licensure category but are defined as a core component of broader waiver services. Under the New Mexico Administrative Code (NMAC 8.308.12.13), companion services are explicitly listed as a core service within Assisted Living and are functionally provided in the home through Personal Care Services (PCS) or Customized In-Home Supports.

These services focus on non-medical supervision, socialization, and prompting to help an adult remain safely in the community. They exclude skilled nursing tasks, wound care, and the administration of injections.

• Covered Tasks: Prompting and reminding for self-administered medications, socialization, and supervision for safety.
• Excluded Tasks: Splitting or crushing medications, filling medication boxes, wound care, and range of motion exercises.
• Service Vehicle (Managed Care): Personal Care Services (PCS) under the Agency-Based Community Benefit (ABCB).
• Service Vehicle (Waiver): Customized In-Home Supports under the Developmental Disabilities (DD) Waiver.
• Settings Requirement: Services must be integrated and support full access to the greater community to the same degree as individuals not receiving Medicaid HCBS.

2. Regulatory and Oversight Agencies

The New Mexico Health Care Authority (HCA) is the primary umbrella agency overseeing Medicaid and HCBS waivers. Within the HCA, specific divisions handle different aspects of provider enrollment, policy enforcement, and waiver management.

The Developmental Disabilities Supports Division (DDSD) manages the DD Waiver, while the Medical Assistance Division (MAD) oversees the managed care Turquoise Care program.

• New Mexico Health Care Authority (HCA): Oversees all Medicaid operations (https://www.hca.nm.gov/).
• Developmental Disabilities Supports Division (DDSD): Manages DD Waiver provider enrollment and policy (https://www.hca.nm.gov/provider-enrollment-relations/).
• Provider Enrollment Relations Unit (PERU): Processes DDSD provider applications and maintains subcontractor licensures (https://www.hca.nm.gov/provider-enrollment-relations/).
• YES.NM Portal: The official state portal for Medicaid enrollment and business license submission (https://yes.nm.gov/).
• Turquoise Care: The state's Medicaid Managed Care program overseeing the Agency-Based Community Benefit (https://www.hca.nm.gov/turquoise-care/).

3. Gatekeeping Prerequisites: Who Can Even Apply

New Mexico imposes strict structural preconditions before an agency can bill for companion-type services. For the Agency-Based Community Benefit, providers must secure network contracts with Turquoise Care MCOs; Medicaid enrollment alone does not guarantee the ability to bill.

For the DD Waiver, new provider agencies must demonstrate full compliance with the Centers for Medicare and Medicaid Services (CMS) HCBS Settings Requirements prior to being approved to provide waiver services. Settings Requirements must be addressed in the initial application responses and policies.

• MCO Contracting Requirement: ABCB providers must secure active contracts with Turquoise Care MCOs (e.g., Presbyterian, Blue Cross Blue Shield) to receive authorizations.
• HCBS Settings Compliance: DD Waiver applicants must prove compliance with CMS Settings Requirements before DDSD will approve the application.
• Business License Prerequisite: Applicants must obtain and submit a local business license for each city or county in which they intend to provide services.
• Self-Imposed Moratoriums: The state occasionally utilizes self-imposed moratorium forms for specific self-directed waiver consultants, though agency-based PCS generally remains open.
• Policy Manual Evaluation: Providers cannot simply submit a Medicaid application; they must first pass a comprehensive evaluation of their policy manuals by PERU.

4. Licensure and Certification Requirements

Because New Mexico does not issue an "Adult Companion" license, agencies must obtain the certification appropriate to the broader service they provide. PCS agencies electing to provide services under the ABCB must obtain agency certification and comply with the Medical Assistance Division (MAD) MCO policy manual.

Agencies must also maintain local jurisdictional authority to operate. Failure to maintain these local approvals results in the termination of the Medicaid provider number.

• PCS Agency Certification: Required for agencies providing Personal Care Services under the ABCB.
• Local Business Licenses: Required for each county and city where services are delivered, submitted annually to the YES.NM portal.
• Fidelity Bond: Required in an amount equal to 25% of the total Provider Agreement amount, or a minimum of $10,000 for agreements under $100,000.
• Liability Insurance: Minimum limits of $1,000,000 per occurrence covering bodily injury and property damage (reducible to $100,000 for small agreements).
• Board of Directors Roster: Agencies must submit an annual list of their Board of Directors to PERU.

5. Medicaid Provider Enrollment

Medicaid enrollment in New Mexico is bifurcated depending on the target population. General Medicaid enrollment and re-verification are processed through the YES.NM portal.

Agencies targeting the DD Waiver must submit a specific application packet to the Provider Enrollment Relations Unit (PERU), which includes the DD Waiver Provider Agreement and extensive policy documentation.

• Primary Enrollment Portal: YES.NM (https://yes.nm.gov/) is used for baseline Medicaid enrollment and business license uploads.
• DD Waiver Application: Submitted directly to PERU, requiring detailed responses to HCBS settings questions.
• Provider Agreement: Applicants must sign the DD Waiver Provider Agreement or Mi Via Provider Agreement.
• Insurance Submission: Copies of liability insurance and fidelity bonds must be sent to PERU within 30 days of the agreement's effective date.
• Annual Reporting: PERU sends a DDSD Distribution email four months prior to February 15th with web links for mandatory annual report submissions.

6. Staffing, Training and Background Checks

Direct care workers providing companion and personal care services must clear stringent state background checks before having direct contact with participants. Agencies are responsible for maintaining these records and ensuring ongoing compliance.

While PERU does not approve new subcontractor requests directly, agencies must submit licenses, education requirements, and resumes for certain coordinating roles to PERU annually.

• Background Studies: All direct care staff must undergo screening pursuant to the Caregivers Criminal History Screening Act.
• Abuse Registry: Staff must be cleared through the New Mexico Employee Abuse Registry prior to hire.
• Subcontractor Reporting: Agencies must send copies of new subcontractor licenses and start dates to PERU ([email protected]).
• Training Requirements: Staff must complete state-mandated training on abuse, neglect, and exploitation reporting.
• Role Limitations: Services provided by a person not meeting the qualifications of a personal care attendant (including missing background checks) are strictly non-reimbursable.

7. Documentation, Policies and Records

Agencies must maintain comprehensive records that prove both organizational compliance and individual service delivery. The state requires specific financial protections to indemnify the state against fraud or failure to perform.

Incident reporting is heavily regulated under NMAC 8.370.9, requiring agencies to have strict intake, processing, and training protocols for any allegations of abuse, neglect, or exploitation.

• Fidelity Bond Documentation: Must name the State of New Mexico Health Care Authority as a loss payee.
• Liability Insurance Documentation: Must name the State of New Mexico Health Care Authority as an additional insured.
• Incident Reporting Policy: Must comply with NMAC 8.370.9 for reporting abuse, neglect, and exploitation.
• Care Plan Alignment: All billed companion/PCS tasks must be explicitly approved in the member's Individualized Plan of Care (IPoC).
• Annual Board Submission: Name, address, phone number, and email address of all Board of Directors members must be faxed or emailed to PERU annually.

8. Billing, Rates and Claims

Because companion services are billed under broader categories like PCS or Customized In-Home Supports, providers must use the specific procedure codes dictated by the Turquoise Care MCOs or the DDSD waiver appendices.

Reimbursement for ABCB services is routed through the contracted MCOs, while DD Waiver claims are processed through the state's MMIS. Retroactive services and services provided to non-eligible household members are strictly prohibited.

• Billing System (Waiver): Claims are submitted through the state's Medicaid Management Information System (MMIS).
• Billing System (Managed Care): Claims are submitted directly to the authorizing Turquoise Care MCO.
• Non-Reimbursable Tasks: Pet care, childcare, and personal care for other household members cannot be billed.
• Prior Authorization: All services must be prior-authorized and tied to the functional level assessed in the member's Comprehensive Needs Assessment (CNA).
• Rate Setting: Rates are established by the HCA Medical Assistance Division and published in the MAD fee schedules.

9. Approval Sequence and Timeline

The enrollment process for DD Waiver services is managed by PERU and follows a structured timeline. Providers should not expect immediate approval upon submitting a Medicaid application.

Once approved, agencies are placed on a Freedom of Choice list, allowing newly allocated participants to select them for services.

• Application Processing Time: The DDSD provider application process takes approximately 90 days to be completed.
• Policy Review Phase: PERU evaluates the agency's policy manuals and HCBS settings compliance during the 90-day window.
• Insurance Verification: Must be completed and submitted within 30 days of the Provider Agreement effective date.
• Freedom of Choice Placement: Approved agencies are added to the Primary or Secondary Freedom of Choice (PFOC/SFOC) forms presented to participants.
• MCO Credentialing: For ABCB, MCO credentialing adds an additional 60 to 90 days after state Medicaid enrollment is secured.

10. Common Denials and Survey Findings

Applications are frequently delayed or denied due to incomplete documentation or failure to meet structural prerequisites. The state strictly enforces local licensing and insurance requirements.

During surveys or re-verification, agencies often face corrective actions for failing to maintain continuous compliance with background check rules or incident reporting timelines.

• Missing Business Licenses: Failure to submit local business licenses for every operating county to the YES.NM portal results in Medicaid number termination.
• HCBS Settings Failures: Applications are denied if the provider's policies do not demonstrate full compliance with CMS community integration rules.
• Insurance Lapses: Failure to submit annual liability and fidelity bond renewals to PERU.
• Unapproved Tasks: Billing for skilled nursing tasks (e.g., injections) under a PCS/companion authorization.
• Background Check Violations: Allowing staff to provide services before clearing the Caregivers Criminal History Screening.

11. Key Contacts and Resources

Providers must interact with multiple state portals and division contacts to maintain their enrollment and compliance. The Provider Enrollment Relations Unit is the primary contact for DD Waiver agencies.

For managed care, providers must maintain direct contact with the provider relations departments of their contracted Turquoise Care MCOs.

• Provider Enrollment Relations Unit (PERU): Tammy Barth, [email protected], Fax: (505) 476-8894 (https://www.hca.nm.gov/provider-enrollment-relations/).
• YES.NM Portal: For Medicaid enrollment and business license uploads (https://yes.nm.gov/).
• Turquoise Care Information: Managed care program details and MCO links (https://www.hca.nm.gov/turquoise-care/).
• Adult Abuse, Neglect & Exploitation Hotline: 866-654-3219 for mandatory incident reporting.
• Mi Via Program Manager: Elaine Hill, 505-506-6103 (https://www.hca.nm.gov/mi-via-self-directed-waiver/).

See all New Mexico services · New Mexico Medicaid consulting · book a consultation.