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

Last reviewed: 2026-08-16

In New Mexico, Personal Emergency Response System (PERS) services provide 24-hour electronic monitoring and dispatch for Medicaid Home and Community-Based Services (HCBS) waiver participants who live alone or are at high risk of falls. This service is primarily funded through the Mi Via, Developmental Disabilities (DD), and Supports waivers, requiring providers to navigate a complex enrollment process managed by the New Mexico Health Care Authority (HCA) and the Department of Health (DOH).

The single biggest structural barrier to entry for new PERS providers in New Mexico is the closed-network vendor model utilized by the traditional Developmental Disabilities (DD) Waiver. Rather than allowing open, direct-to-Medicaid enrollment for PERS under this waiver, the state utilizes a contracted vendor (HealthGenics) to manage PERS equipment and support. Consequently, new agencies seeking to serve traditional DD Waiver participants must secure a subcontract with this designated entity rather than enrolling as standalone billers, while those serving the self-directed Mi Via waiver must be credentialed directly through the state's Financial Management Agency.

1. Service Definition and Scope

New Mexico defines PERS as an electronic device that enables waiver participants to secure help in an emergency. The system is connected to the participant's phone or operates via cellular/GPS technology and is programmed to signal a response center once a help button is activated. The service is designed to maintain the independence of individuals who live alone, are alone for significant parts of the day, or have no regular caregiver.

The scope of the service includes the initial installation of the equipment, participant training, monthly monitoring, and ongoing equipment maintenance. PERS cannot be billed concurrently with 24-hour residential services, such as Supported Living, where staff are already mandated to be present.

• Service Modalities: Includes traditional landline units, cellular-enabled base stations, and GPS-enabled wearable fall-detection devices.
• Target Population: Authorized for participants on the Mi Via, DD, and Supports waivers who require continuous risk monitoring.
• Response Center: Must operate 24 hours a day, 7 days a week, 365 days a year with trained emergency dispatchers.
• Equipment Maintenance: The provider is strictly responsible for routine testing, battery replacement, and repairing faulty equipment.
• Service Exclusions: Cannot be authorized for participants receiving 24-hour Supported Living or Family Living services.

2. Regulatory and Oversight Agencies

Oversight of PERS providers in New Mexico is bifurcated between the agency that manages Medicaid funds and the agency that manages waiver programs. The New Mexico Health Care Authority (HCA), formerly the Human Services Department, controls the Medicaid Management Information System (MMIS) and overall provider enrollment.

Programmatic oversight, including provider readiness and waiver policy enforcement, is handled by the Department of Health (DOH) Developmental Disabilities Supports Division (DDSD). Providers must satisfy the requirements of both departments to operate and bill successfully.

• New Mexico Health Care Authority (HCA): The umbrella agency that oversees Medicaid provider enrollment, re-enrollment, and re-validation via the [Providers Overview – New Mexico Health Care Authority](https://www.hca.nm.gov/providers).
• Medical Assistance Division (MAD): The division within HCA that sets Medicaid policy, establishes fee schedules, and dictates billing rules.
• DOH Developmental Disabilities Supports Division (DDSD): Conducts programmatic oversight, issues provider agreements, and manages the traditional DD and Supports waivers.
• NM Taxation and Revenue Department: Issues the mandatory state tax identification required for all Medicaid providers.
• Financial Management Agency (FMA): Currently contracted to Conduent, this entity processes payments and credentials providers for the self-directed [Mi Via - New Mexico Health Care Authority](https://www.hca.nm.gov/lookingforinformation/mi-via/) waiver.

3. Gatekeeping Prerequisites: Who Can Even Apply

New Mexico imposes strict structural preconditions that block applicants before a Medicaid application is even reviewed. The state does not operate a fully open network for PERS across all its waivers, meaning providers must navigate specific contracting pathways depending on the waiver they intend to serve.

For out-of-state or new corporate entities, tax registration is a hard stop. The Medicaid portal will automatically reject applications that lack specific New Mexico state tax identifiers, regardless of federal tax status.

• DD Waiver Subcontracting: Direct PERS enrollment is restricted; providers must subcontract through the state's designated vendor (HealthGenics) to provide equipment and support for the traditional DD Waiver, as noted in the [NM DOH DDSD Technology Task Force Meeting](https://api.realfile.rtsclients.com/PublicFiles/6c91aefc960e463485b3474662fd7fd2/14e49071-0c5e-4686-8d1d-ffe1f0740092/DDW-Tech-Electronic-Caregiver-Presentation_2024.02.pdf).
• Mi Via FMA Credentialing: To serve the self-directed Mi Via waiver, providers cannot simply enroll in MMIS; they must be selected by a participant and credentialed through the state's Financial Management Agency.
• CRS Number Mandate: Applicants must obtain a Combined Reporting System (CRS) tax number from the NM Taxation and Revenue Department; lacking this unique local identifier will stall enrollment before it reaches a reviewer, according to [A Guide to New Mexico Medicaid Provider Enrollment](https://veracityeg.com/a-guide-to-new-mexico-medicaid-provider-enrollment/).
• Business License Requirement: Providers must obtain and annually submit a local business license for each city or county in which they provide services to the YES.NM portal.
• NPI Requirement: Even as atypical providers, PERS agencies must possess a Type 2 National Provider Identifier (NPI) to register in the state portal.

4. Licensure and Certification Requirements

New Mexico does not issue a distinct "PERS Provider License" or "Home Health Agency License" specifically for emergency response systems. Because PERS does not involve hands-on clinical care, it falls outside the standard DOH Health Facility Licensing regulations.

Instead, approval is based on corporate registration, local business licensing, and programmatic certification through the DDSD. Providers must prove financial solvency, maintain adequate insurance, and sign a specific HCBS Provider Agreement.

• State Licensure Exemption: No distinct DOH health facility license is required to operate a PERS agency in New Mexico.
• Secretary of State Registration: The business entity must be registered as a foreign or domestic corporation or LLC in good standing with the New Mexico Secretary of State.
• Local Jurisdiction Licensing: City or county business licenses must be obtained and uploaded annually to the YES.NM portal, as failure to maintain these results in Medicaid termination per [Provider Enrollment & Relations - New Mexico Health Care Authority](https://www.hca.nm.gov/provider-enrollment-relations).
• Insurance Minimums: Providers must maintain general liability and professional liability insurance, typically requiring $1 million per occurrence and $3 million aggregate.
• DDSD Provider Agreement: Agencies must execute a specific HCBS Provider Agreement with the DOH DDSD outlining waiver compliance.

5. Medicaid Provider Enrollment

Medicaid enrollment is processed through the New Mexico Medicaid Provider Enrollment Portal, managed by the state's fiscal agent, Conduent. The system requires specific nomenclature and forms, and operates on a strict timeline.

Providers must ensure their taxonomy codes match their federal NPI registry exactly. Any discrepancy between the federal record and the state application will result in an immediate "missing info" flag and delay the process.

• Enrollment Portal: Applications must be submitted electronically via the Conduent/YES.NM Medicaid web portal.
• Form MAD 335: Billing entities must complete the MAD 335 form to receive Fee-For-Service reimbursement.
• EFT Mandate: Under NMAC 8.302.1, enrollment in Electronic Funds Transfer (EFT) is a strict mandate, not a suggestion, to receive reimbursement.
• Taxonomy Code Matching: The primary taxonomy and effective date submitted in the portal must match exactly what is on file with the federal NPI registry.
• Tracking System: The portal issues a Web Reference Number and a Tracking Number upon submission; these must be saved as they are the only way to check status with the Conduent help desk.

6. Staffing, Training and Background Checks

While PERS is primarily an equipment-based service, the personnel who install the devices and the agents who monitor the response center must meet strict state standards. New Mexico requires comprehensive background screening for anyone with access to vulnerable waiver participants.

Response center staff must be trained in medical triage and emergency escalation, while field technicians must be competent in device installation and participant education.

• Background Checks: All staff interacting with participants must clear a background check under the New Mexico Caregivers Criminal History Screening Act (CCHSA).
• Response Center Qualifications: Dispatchers must be trained in emergency escalation, medical triage, and dispatch protocols, often holding credentials like CNA or Medical Assistant.
• Installation Technicians: Field staff must complete documented training on device setup, signal testing, and instructing participants on proper use.
• HIPAA Training: Mandatory annual training on protected health information and participant privacy is required for all staff.
• Incident Management: Staff must be trained on NM DOH Critical Incident Reporting requirements and protocols to ensure proper documentation of emergencies.

7. Documentation, Policies and Records

PERS providers must maintain comprehensive policy manuals and participant records that are subject to audit by the DDSD and HCA. Documentation must prove that the equipment is functioning and that the provider is responding to emergencies appropriately.

The state requires strict adherence to critical incident reporting. Any time a PERS device results in an emergency dispatch, the provider must log the event and coordinate with the participant's case manager.

• Participant Records: Providers must maintain copies of the Individualized Service Plan (ISP) and the Secondary Freedom of Choice forms signed by the participant.
• Testing Logs: Agencies must maintain monthly electronic logs demonstrating successful device pings and battery status checks.
• Emergency Protocols: Written policies must detail the exact escalation tree and dispatch procedures when a participant activates the device.
• Maintenance Policy: Documented procedures must guarantee the replacement of faulty equipment within 24 hours of a reported failure.
• Critical Incident Reports: Records of all emergency dispatches must be logged and reported in accordance with DOH Critical Incident Reporting protocols.

8. Billing, Rates and Claims

PERS is billed on a monthly basis using specific HCPCS codes, but the billing pathway depends entirely on the waiver. Traditional waiver claims are submitted directly to the MMIS, while self-directed waiver claims go through a Financial Management Agency.

Providers cannot bill for services until a prior authorization is generated based on the participant's approved Individualized Service Plan (ISP) and budget.

• HCPCS Codes: Services are typically billed using standard codes such as S5160 for initial installation and S5161 for the monthly monitoring fee.
• Fee-for-Service Claims: Claims for traditional waivers are submitted directly to the MMIS via the Conduent portal.
• Mi Via Billing: Claims for the self-directed Mi Via waiver must be submitted to the Financial Management Agency (Conduent) rather than directly to MMIS.
• Prior Authorization: All monthly billing requires an approved budget and prior authorization tied directly to the participant's ISP.
• Payer ID: Electronic claims submitted to the state must use the designated NM Medicaid Payer ID 87748, as noted in [New Mexico Medicaid: Requirement to enroll with state delayed to October | UHCprovider.com](https://www.uhcprovider.com/en/resource-library/news/2026/nm-medicaid-enrollment-req-claims-update.html).

9. Approval Sequence and Timeline

The enrollment process in New Mexico operates on a strict timeline, often taking up to 90 days for initial Medicaid portal approval. This clock does not start until the provider has already secured their state tax registration and local business licenses.

Providers should expect a multi-step review where the fiscal agent (Conduent) verifies administrative compliance before the DDSD conducts a programmatic review.

• Step 1: Obtain the NM CRS tax number from the Taxation and Revenue Department and secure local city/county business licenses (1-3 weeks).
• Step 2: Submit the MAD 335 form and all supporting documentation via the YES.NM Medicaid Provider Enrollment Portal.
• Step 3: Conduent conducts an initial screening for missing information and taxonomy mismatches (15-30 days).
• Step 4: DOH DDSD conducts a programmatic review and executes the HCBS Provider Agreement (30-60 days).
• Step 5: Final Medicaid ID issuance and EFT activation, completing the standard 90-day wait period.

10. Common Denials and Survey Findings

Applications are frequently delayed or denied due to administrative errors in the portal or a failure to understand New Mexico's specific tax and licensing requirements. The state's system is notoriously sensitive to missing information.

Out-of-state providers often fall into a "black hole" of pending applications because they fail to save their tracking numbers or attempt to bypass the local tax registration mandate.

• Missing CRS Number: Out-of-state providers are frequently denied for lacking the NM Taxation and Revenue CRS number, which is a hard stop for enrollment.
• Taxonomy Mismatch: Applications are immediately rejected if the primary taxonomy code in the portal does not exactly match the federal NPI registry.
• Missing Local Licenses: Failure to upload city or county business licenses for the specific jurisdictions where services are provided results in application stalling.
• EFT Non-Compliance: Applications are flagged and delayed for failing to complete the mandatory Electronic Funds Transfer setup required by NMAC 8.302.1.
• Lost Tracking Numbers: Providers frequently lose their Web Reference Number, making it impossible to track or appeal pending applications with the Conduent help desk.

11. Key Contacts and Resources

Providers must interact with multiple state helpdesks and divisions to successfully enroll and maintain compliance. The primary point of contact for portal issues is the fiscal agent, Conduent.

For programmatic questions, waiver rules, and provider agreements, agencies must coordinate directly with the DOH Developmental Disabilities Supports Division.

• Provider Enrollment Helpdesk: Conduent support can be reached at 1-800-299-7304 (option 6, then option 3) for portal and MAD 335 issues, per the [New Mexico Medicaid Portal](https://owcprx.dol.gov/static/providerlogin.htm).
• NM Health Care Authority (HCA): Oversees Medicaid policy, fee schedules, and the Medical Assistance Division.
• DOH DDSD Provider Enrollment Unit: Manages waiver-specific provider agreements, readiness reviews, and programmatic oversight.
• NM Taxation and Revenue Department: The agency responsible for issuing the required Combined Reporting System (CRS) numbers.
• Financial Management Agency (FMA): Conduent handles billing, credentialing, and payment processing for the Mi Via self-directed waiver.

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