New Mexico - Medical Supply Service — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

The New Mexico Health Care Authority (HCA) and its Developmental Disabilities Supports Division (DDSD) oversee the approval of Medical Supply and Durable Medical Equipment (DME) providers for the Mi Via, Medically Fragile, and Developmental Disabilities waivers. Providers furnish, fit, and service equipment and disposable supplies that exceed standard Medicaid state plan limits, requiring specific authorization under the participant's approved budget and plan.

Before the Provider Enrollment Relations Unit (PERU) will execute a waiver Provider Agreement, applicants must secure a fidelity bond of at least $10,000, a $1,000,000 liability insurance policy, and local business licenses for every county of operation. Enrollment also mandates active status in the New Mexico Medicaid Management Information System (MMIS) via the Conduent portal, which for DMEPOS suppliers typically requires prior Medicare accreditation.

1. Service Definition and Scope

In New Mexico's HCBS waivers, Medical Supply Services encompass durable medical equipment (DME) and disposable supplies furnished, fitted, and serviced for waiver participants. Under the Mi Via Self-Directed Waiver, these are often categorized under Related Goods and Services or specialized equipment.

These supplies must directly address the participant's qualifying condition, increase independence, or ensure health and safety, and are only covered when standard Medicaid state plan benefits are exhausted or inapplicable.

• Covered Items: Durable medical equipment, disposable medical supplies, and nutritional supplements not covered by the State Plan.
• Service Delivery: Items must be delivered directly to the participant's home or fitted at the provider's clinical location.
• Mi Via Specifics: Purchases must be explicitly detailed and approved in the participant's Service and Support Plan (SSP).
• Exclusions: Experimental items, general utility items, and supplies already covered by Turquoise Care managed care plans are prohibited.

2. Regulatory and Oversight Agencies

The New Mexico Health Care Authority (HCA) is the single state Medicaid agency responsible for overall program administration and funding. Within the HCA, the Developmental Disabilities Supports Division (DDSD) directly manages waiver provider enrollment and compliance.

The Provider Enrollment Relations Unit (PERU) handles the specific waiver Provider Agreements, while Conduent operates the state's MMIS portal for standard Medicaid billing enrollment.

• New Mexico Health Care Authority (HCA): https://www.hca.nm.gov/
• Developmental Disabilities Supports Division (DDSD): https://www.nmhealth.org/about/ddsd/
• Provider Enrollment Relations Unit (PERU): https://www.hca.nm.gov/provider-enrollment-relations/
• New Mexico Medicaid Portal (Conduent): https://nmmedicaid.portal.conduent.com/static/index.htm

3. Gatekeeping Prerequisites: Who Can Even Apply

New Mexico requires Medical Supply providers to establish foundational business and insurance prerequisites before DDSD will review a waiver application. There is no closed network or Certificate of Need required for DME in New Mexico, but strict financial protections are enforced.

Applicants must hold local business licenses for every jurisdiction they serve and must secure specific bonding and insurance levels mandated by the HCA Provider Agreement.

• Fidelity Bond: Providers must obtain a fidelity bond equal to 25 percent of the total Provider Agreement amount, or a minimum of $10,000, naming the State of New Mexico Health Care Authority as a loss payee.
• Liability Insurance: A minimum $1,000,000 per occurrence liability policy naming the HCA as an additional insured is required.
• Business Licensure: A valid business license for each city or county where services are provided must be uploaded annually to the YES.NM portal.
• Medicare Accreditation: Per CMS guidelines, DMEPOS suppliers generally must hold Medicare accreditation from an approved accrediting organization prior to Medicaid enrollment.

4. Licensure and Certification Requirements

New Mexico does not issue a distinct state-level "Medical Supply Agency" license through the Department of Health. Instead, providers operate under their standard business licenses and federal DMEPOS accreditation.

Waiver certification is achieved by executing the DDSD Provider Agreement and meeting the Mi Via Service Standards for vendor qualifications.

• State Licensure: No specific state health facility license is required for standard DME/supply vendors.
• Mi Via Service Standards: Vendors must meet the qualifications outlined in the Mi Via Service Standards (NMAC 8.314.6).
• Board of Directors: Agencies must submit an annual listing of their Board of Directors to PERU.
• HCBS Settings Rule: Providers must attest to compliance with the CMS HCBS Settings Requirements prior to approval.

5. Medicaid Provider Enrollment

Enrollment is a dual process: providers must enroll as a standard Medicaid provider through the Conduent portal and execute a waiver-specific Provider Agreement with DDSD's PERU.

Providers must also credential with the Turquoise Care managed care organizations (MCOs) if they intend to serve members whose supplies fall under managed care rather than fee-for-service waiver budgets.

• MMIS Portal: Applications are submitted via the New Mexico Medicaid Portal operated by Conduent.
• Provider Type: Enroll as Provider Type 330 (Medical Supply Company) or the specific DMEPOS designation.
• PERU Submission: Waiver agreements and insurance proofs must be emailed to [email protected] or faxed to 505-476-8894.
• Turquoise Care Contracting: Providers must separately complete credentialing with MCOs like Presbyterian or Blue Cross Blue Shield of New Mexico.

6. Staffing, Training and Background Checks

While Medical Supply providers do not provide direct hands-on care in the same manner as personal care agencies, staff who deliver, fit, or service equipment in a participant's home must meet basic safety and background requirements.

The agency must ensure that any technicians or delivery personnel are properly trained on the specific equipment they are dispensing.

• Background Checks: Employees entering participant homes must pass the New Mexico Department of Health Caregivers Criminal History Screening (CCHS).
• Technician Certification: Staff fitting specialized orthotics or complex rehab technology must hold appropriate RESNA or ABC certifications.
• Abuse and Neglect Training: Staff must be trained on reporting abuse, neglect, and exploitation to the state hotline (866-654-3219).
• Subcontractor Tracking: PERU does not approve subcontractors, but agencies must submit licenses and start dates for any licensed professional subcontractors annually.

7. Documentation, Policies and Records

Providers must maintain rigorous documentation linking the dispensed supplies to the participant's approved waiver budget and Service and Support Plan (SSP).

Records must be retained for a minimum of six years and be available for audit by the HCA, DDSD, or the Mi Via Third-Party Assessor (TPA).

• Delivery Tickets: Must include the participant's signature, date of delivery, and exact description of the item provided.
• SSP Alignment: Documentation must prove the item was explicitly authorized in the participant's Mi Via budget.
• Insurance Renewals: Copies of renewed liability and fidelity bonds must be sent to PERU annually.
• Annual Reporting: PERU sends a DDSD Distribution email four months prior to February 15th with web links for required annual report submissions.

8. Billing, Rates and Claims

Medical supplies under the Mi Via waiver are billed based on the approved budget utilizing the Financial Management Agency (FMA), currently Conduent. Standard Medicaid DME is billed directly to the MMIS or the Turquoise Care MCO.

Rates for waiver-specific goods are often manually priced based on invoice cost or established fee schedules published by the HCA Medical Assistance Division (MAD).

• Financial Management Agency: Mi Via claims for related goods are processed through the state's contracted FMA.
• Procedure Codes: Standard HCPCS codes (e.g., E-codes for DME, A-codes for supplies) are utilized.
• Manual Pricing: Unlisted or specialized waiver items may require invoice submission for manual pricing (often MSRP minus a standard percentage).
• Prior Authorization: The TPA must approve the SSP and budget before any goods are purchased or billed.

9. Approval Sequence and Timeline

The approval process begins with securing local business licenses and commercial insurance. The provider then applies through the Conduent Medicaid portal.

Once the MMIS application is approved, the provider submits the waiver-specific application and Provider Agreement to DDSD's PERU. The entire process typically takes 60 to 90 days.

• Step 1: Obtain local business licenses, $10k fidelity bond, and $1M liability insurance.
• Step 2: Submit the Medicaid enrollment application via the Conduent portal.
• Step 3: Submit the DDSD Provider Agreement and insurance proofs to PERU.
• Step 4: Complete credentialing with Turquoise Care MCOs if applicable.

10. Common Denials and Survey Findings

Applications are frequently delayed or denied due to missing local business licenses or failure to meet the exact insurance thresholds required by the HCA.

During audits, providers often face recoupments for dispensing items before the TPA has officially approved the participant's Service and Support Plan.

• Insurance Deficiencies: Failure to name the State of New Mexico Health Care Authority as a loss payee on the fidelity bond.
• Missing Business Licenses: Failure to upload current city/county business licenses to the YES.NM portal annually.
• Premature Dispensing: Billing for supplies delivered prior to the official start date of the approved SSP.
• Documentation Gaps: Missing participant signatures on delivery tickets.

11. Key Contacts and Resources

Providers should utilize the HCA and DDSD websites for the most current manuals, fee schedules, and enrollment forms.

The Provider Enrollment Relations Unit (PERU) is the primary contact for waiver agreement questions.

• Provider Enrollment Relations Unit (PERU): [email protected], Fax: 505-476-8894
• New Mexico Medicaid Portal: https://nmmedicaid.portal.conduent.com/static/index.htm
• Mi Via Program Manager: Elaine Hill, 505-506-6103
• Turquoise Care Information: https://www.hca.nm.gov/turquoise-care/

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