New Mexico - Integrated Employment — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

The New Mexico Department of Health (DOH) Developmental Disabilities Supports Division (DDSD) approves agencies to deliver Supported Employment under the state's 1915(c) Developmental Disabilities (DD) Waiver. Before an agency can bill the Medicaid Management Information System (MMIS), it must pass the DDSD Provider Enrollment Unit (PEU) application process and secure either national accreditation or a formal accreditation waiver from the state.

Supported Employment encompasses job development, placement, and on-site coaching to help individuals achieve competitive, integrated employment at prevailing wages. Approval requires submitting a comprehensive, strictly formatted policy packet to the DDSD PEU, followed by enrollment as a Medicaid provider through the New Mexico Health Care Authority (HCA).

1. Service Definition and Scope

In New Mexico, Supported Employment is designed to assist individuals on the DD Waiver in securing and maintaining competitive work in integrated community settings. The service moves away from segregated facility-based models to focus entirely on individualized community employment.

The service includes distinct phases such as job development, where staff help the individual find and negotiate a job, and job coaching, which provides on-site support to ensure retention and skill acquisition.

• Service Name: Supported Employment
• Target Population: Adults enrolled in the Developmental Disabilities (DD) Waiver seeking competitive work.
• Core Components: Job development, job coaching, and employment maintenance.
• Setting Requirement: Must strictly adhere to the HCBS Final Settings Rule, ensuring full integration into the broader community.
• Wage Standard: Participants must be paid at or above minimum wage, or the prevailing wage for the position, directly by the employer.

2. Regulatory and Oversight Agencies

The programmatic rules and initial provider approvals are managed by the Department of Health, while Medicaid enrollment and billing fall under the Health Care Authority. Ongoing compliance is monitored by a separate division within the DOH.

Providers must interact with all three entities to maintain their active status and pass triennial surveys.

• Program Authority: DOH Developmental Disabilities Supports Division (DDSD) (https://www.nmhealth.org/about/ddsd/)
• Medicaid Authority: New Mexico Health Care Authority (HCA) Medical Assistance Division (MAD) (https://www.hca.nm.gov)
• Survey and Oversight: DOH Division of Health Improvement (DHI) (https://www.nmhealth.org/about/dhi/)
• Medicaid Enrollment Portal: NM Medicaid Provider Portal (https://yes.nm.gov)

3. Gatekeeping Prerequisites: Who Can Even Apply

New Mexico operates a continuous, open enrollment process for DD Waiver providers, meaning there are no closed networks, moratoria, or Request for Proposal (RFP) procurement requirements to enter the market. However, strict sequential prerequisites exist.

An applicant cannot simply enroll in Medicaid; they must first clear the DDSD programmatic review and meet accreditation standards.

• Enrollment Model: Continuous, open enrollment overseen by the DDSD Provider Enrollment Unit.
• Primary Precondition: DDSD Provider Enrollment Unit (PEU) approval is strictly required before HCA Medicaid enrollment is permitted.
• Accreditation Gate: Agencies must hold current national accreditation (e.g., CARF) or submit a formal request for an Accreditation Waiver to the PEU during their initial term.
• Business Registration: Applicants must possess a Combined Reporting System (CRS) Certificate from the NM Taxation and Revenue Department before applying.

4. Licensure and Certification Requirements

New Mexico does not issue a traditional facility license for Supported Employment because it is a community-based service. Instead, agencies achieve certification through the DDSD Provider Application process.

The application process is highly prescriptive regarding formatting and submission methods, and failure to follow these physical formatting rules results in immediate return of the packet.

• Application Form: DDSD Provider Application, which must include the Provider Information Sheet and Service and County Request Form.
• Submission Method: Must be mailed or physically delivered to the DOH/DDSD Provider Enrollment Unit in Santa Fe.
• Formatting Rules: Applications must be single-sided, un-stapled, and unbound (no three-ring binders); only paper clips, binder clips, or rubber bands are permitted.
• Insurance Requirement: Proof of General or Professional Liability Insurance with a $1,000,000 minimum coverage limit.
• Corporate Documents: Must include Articles of Incorporation or Organization and a current roster of board members with contact information.

5. Medicaid Provider Enrollment

Once DDSD issues programmatic approval, the agency must enroll as a billing provider through the New Mexico Health Care Authority's Medicaid portal.

This step links the agency's National Provider Identifier (NPI) to the state's MMIS, allowing for claims submission.

• Provider Type: Enrolls as a DD Waiver Provider (PT 364) or Community Benefit Provider (PT 363) depending on the specific authorization.
• System: NM Medicaid Provider Portal accessed via yes.nm.gov.
• NPI Requirement: Must obtain a National Provider Identifier (NPI) and register the appropriate taxonomy codes for community-based employment services.
• Processing Time: Initial portal review of the submitted application and supporting documentation can take up to 96 business hours.

6. Staffing, Training and Background Checks

Direct support professionals and job developers must meet specific state training requirements before delivering billable services.

New Mexico centralizes much of its waiver training through university partnerships to ensure consistency across provider agencies.

• Background Checks: Consolidated Caregiver Criminal History Screening (CCHS) is required for all staff prior to client contact.
• Training Hub: Required DD Waiver training modules are typically coordinated through the UNM Center for Development and Disability (CDD).
• Specialized Certification: Job developers are generally expected to complete recognized employment training, such as ACRE or CESP certification.
• First Aid/CPR: Current certification is required for all job coaches prior to delivering unsupervised services in the community.

7. Documentation, Policies and Records

The DDSD application requires a comprehensive set of authoritative documents that prove the agency understands and can implement state rules.

Policies cannot simply parrot the regulations; they must detail the agency's specific operational procedures.

• Policy Format: Responses cannot be a cut-and-paste from NMAC criteria or service standards; a thoughtful, customized authoritative document is required.
• HCBS Settings Attestation: Providers must sign an attestation confirming their settings and practices meet the requirements of the Final HCBS Settings Rule.
• Incident Management: Policies must align with DOH DHI reporting requirements for abuse, neglect, and exploitation, utilizing the state's incident reporting systems.
• Person-Centered Planning: Documentation must reflect how the agency will implement the employment goals outlined in the participant's Individual Service Plan (ISP).

8. Billing, Rates and Claims

Supported Employment is billed on a fee-for-service basis for DD Waiver participants, utilizing specific HCPCS codes and modifiers.

All services must be prior-authorized and listed on the participant's approved budget before any claims can be submitted.

• Billing System: Claims are submitted through the Conduent MMIS portal.
• Prior Authorization: Services must be authorized by the Third Party Assessor (TPA) on the approved budget prior to service delivery.
• Unit Measurement: Job coaching and development are typically billed in 15-minute increments.
• Payment Method: The Medical Assistance Division (MAD) issues payments exclusively via Electronic Funds Transfer (EFT).

9. Approval Sequence and Timeline

The pathway to becoming a billable provider requires completing steps in a strict order, starting with state business registration and ending with Medicaid portal enrollment.

Skipping steps or submitting incomplete packets to DDSD will halt the entire process.

• Step 1: Obtain a CRS Certificate from the NM Taxation and Revenue Department.
• Step 2: Submit the strictly formatted DDSD Provider Application to the PEU in Santa Fe.
• Step 3: Receive DDSD programmatic approval and an Accreditation Waiver (if not already nationally accredited).
• Step 4: Complete HCA Medicaid Provider Enrollment via the yes.nm.gov portal.
• Step 5: Receive provider identification number and billing credentials.

10. Common Denials and Survey Findings

The DOH Division of Health Improvement (DHI) Quality Management Bureau (QMB) conducts routine provider surveys every three years.

Initial applications are most frequently delayed due to administrative and formatting errors rather than programmatic deficiencies.

• Application Rejection: Using staples, three-ring binders, or double-sided printing on the DDSD application packet.
• Policy Failures: Submitting policies that are merely copy-pasted NMAC rules instead of customized agency procedures.
• Survey Finding: Failure to maintain current CCHS background check clearances on file for all active job coaches.
• Settings Rule Violation: Delivering employment services in segregated, facility-based settings rather than integrated community environments.

11. Key Contacts and Resources

Providers must maintain active communication with the primary state divisions responsible for the DD Waiver.

These official portals and division pages contain the most current forms, manuals, and billing instructions.

• DOH DDSD Provider Enrollment Unit: https://www.nmhealth.org/about/ddsd/
• NM Health Care Authority (HCA): https://www.hca.nm.gov
• NM Medicaid Provider Portal: https://yes.nm.gov
• DOH Division of Health Improvement (DHI): https://www.nmhealth.org/about/dhi/

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