New Mexico - Personal Emergency Response System — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

Emergency Response Services (ERS) in New Mexico are funded through the Centennial Care 2.0 Agency-Based Community Benefit (ABCB) program, overseen by the Medical Assistance Division (MAD) of the Health Care Authority (HCA). Providers must first submit an application checklist and required forms to the HCA to obtain a Program Approval Letter before they are permitted to apply for a Provider Type 363 Medicaid ID through the state portal.

Securing this state-level program approval does not guarantee the ability to bill for services, as the ABCB program is entirely administered through managed care. An applicant must successfully negotiate and secure a network contract with at least one of the three Centennial Care 2.0 Managed Care Organizations (MCOs) to receive member authorizations and reimbursement.

1. Service Definition and Scope

Under the ABCB program, Emergency Response Services provide 24-hour monitoring and dispatch for individuals who live alone, are isolated, or are at high risk of falls.

The service ensures that elderly and disabled Medicaid members can remain safely in their homes by providing an immediate communication link to a response center during emergencies.

• Service Name: Emergency Response Services (ERS)
• Target Population: Elderly and disabled individuals meeting Nursing Facility Level of Care (NF LOC)
• Delivery Method: Installed base units or wearable devices with 24/7 monitoring center support
• Exclusions: Cannot be billed concurrently with 24-hour residential services like Assisted Living

2. Regulatory and Oversight Agencies

The New Mexico Health Care Authority (HCA) manages the Medicaid program and issues the initial program approval for ABCB providers.

Once approved by the state, providers are overseen by the Centennial Care 2.0 Managed Care Organizations that authorize the care plans.

• New Mexico Health Care Authority (HCA): https://www.hca.nm.gov
• HCA Provider Enrollment & Relations: https://www.hca.nm.gov/provider-enrollment-relations
• Blue Cross Blue Shield of New Mexico: https://www.bcbsnm.com/community-care
• Presbyterian Health Plan: https://www.phs.org
• Western Sky Community Care: https://www.westernskycommunitycare.com

3. Gatekeeping Prerequisites: Who Can Even Apply

New Mexico does not restrict ERS applications through a Certificate of Need or closed RFP process at the state level. However, the service is exclusively delivered via managed care.

Providers must obtain a specific approval letter from the state before the Medicaid enrollment portal will accept their application.

• Program Approval Letter: Must be obtained from HSD/MAD before Medicaid enrollment can begin
• MCO Contracting: Must secure a contract with BCBS, Presbyterian, or Western Sky to receive authorizations
• Business License: Required for each county/city of operation prior to application
• Provider Type: Must enroll specifically as Provider Type 363

4. Licensure and Certification Requirements

Unlike Adult Day Health or Assisted Living, ERS does not require a specific Department of Health (DOH) facility license in New Mexico.

Providers must instead meet strict insurance and local business registration requirements to maintain their Medicaid agreement.

• DOH License: Not required for Emergency Response Services
• Business License: Mandatory local requirement submitted annually to the YES.NM portal
• Fidelity Bond: Minimum $10,000 or 25% of agreement, naming the State of New Mexico Health Care Authority as loss payee
• Liability Insurance: $1,000,000 per occurrence, naming the HCA as an additional insured

5. Medicaid Provider Enrollment

Medicaid enrollment is processed through the YES.NM portal using the MAD 335 application.

Providers must upload their state-issued Program Approval Letter during this online process to be approved as an ABCB provider.

• Portal: YES.NM (https://yes.nm.gov)
• Form: MAD 335 Medicaid provider application
• Provider Type: 363 (Agency-Based Community Benefit)
• Required Upload: HSD/MAD Program Approval Letter

6. Staffing, Training and Background Checks

ERS providers must maintain a 24-hour response center capable of handling emergency signals immediately.

Staff who enter member homes for installation must pass background screenings and be trained on device operation.

• Response Center: Must be staffed 24/7/365 to receive and act on signals
• Background Checks: Required for all staff entering member homes for installation or maintenance
• Training: Installers must be trained on device operation and member instruction protocols
• Subcontractors: Must meet the same background and training standards as direct employees

7. Documentation, Policies and Records

Providers must maintain detailed records of installations, monthly testing, and emergency dispatches to comply with MCO audit requirements.

Corporate documentation must also be kept current with the HCA Provider Enrollment Relations Unit.

• Installation Records: Date, time, and member signature verifying instruction
• Testing Logs: Monthly signal verification records for each active unit
• Dispatch Reports: Documentation of all emergency button presses, response times, and outcomes
• Board of Directors: Annual submission of board member list to HCA via email or fax

8. Billing, Rates and Claims

Because ABCB is a managed care program, the state does not publish a set fee schedule for Emergency Response Services.

Rates are negotiated directly with the Centennial Care 2.0 MCOs, and claims are submitted to the MCOs rather than the state MMIS.

• Rate Setting: Negotiated directly with MCOs during the contracting phase
• Prior Authorization: Required from the MCO care coordinator before installation and billing
• Billing System: Claims submitted to the respective MCO clearinghouse
• NPI Requirement: Must include NPI and Taxonomy on all claims to avoid denials

9. Approval Sequence and Timeline

The approval process requires sequential steps through state program review, Medicaid enrollment, and MCO contracting.

Providers should contact MCOs early in the process to gauge network need before investing heavily in the state application.

• Step 1: Submit ABCB checklist to [email protected]
• Step 2: Receive Program Approval Letter from HCA
• Step 3: Submit MAD 335 via YES.NM portal to obtain active Medicaid ID
• Step 4: Negotiate and execute MCO contracts (can take 90-180 days)

10. Common Denials and Survey Findings

Applications are frequently delayed due to missing documentation or failure to follow the exact sequence of approvals.

Even with state approval, providers may be denied network entry by MCOs if the network is deemed adequate.

• Missing Approval Letter: Attempting MAD 335 enrollment without the prerequisite HCA letter
• Insurance Deficiencies: Failure to name the State of New Mexico Health Care Authority as loss payee or additional insured
• Local Licensing: Missing city/county business licenses for the service area
• MCO Rejection: State approval granted, but MCO network is closed for ERS providers

11. Key Contacts and Resources

The HCA Provider Enrollment unit handles the initial program approval and corporate document updates.

The YES.NM portal is used for the technical Medicaid ID enrollment and revalidation.

• ABCB Enrollment Email: [email protected]
• HCA Provider Enrollment: https://www.hca.nm.gov/provider-enrollment-relations
• YES.NM Portal: https://yes.nm.gov
• Centennial Care Policy Manual: https://www.hca.nm.gov/providers/managed-care-policy-manual

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