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New Mexico - Respite Care Services — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

In New Mexico, Respite Care Services are primarily funded through the Developmental Disabilities (DD) Waiver, the Mi Via Waiver, and the Supports Waiver, all overseen by the New Mexico Health Care Authority (HCA) and the Department of Health (DOH) Developmental Disabilities Supports Division (DDSD). The service provides short-term relief to unpaid primary caregivers, ensuring the individual receiving care maintains necessary supervision and support.

To become an approved provider, agencies must navigate a multi-step process that includes obtaining a Provider Agreement with the DOH, completing required background checks, and enrolling through the New Mexico Medicaid portal. Providers must adhere to specific training and documentation standards set by the DDSD to ensure compliance and quality of care.

1. Service Definition and Scope

Respite Care Services in New Mexico offer temporary, short-term relief to unpaid primary caregivers of individuals enrolled in Medicaid waiver programs. This service ensures that the individual continues to receive necessary supervision, support, and assistance with activities of daily living while the primary caregiver is absent.

The service can be provided in the individual's home, the provider's home, or a community setting, depending on the specific waiver and the individual's approved Individual Service Plan (ISP). It is designed to prevent institutionalization and support the family unit.

2. Regulatory and Oversight Agencies

The primary oversight for Respite Care Services in New Mexico is shared between the New Mexico Health Care Authority (HCA) and the Department of Health (DOH). The HCA manages the Medicaid program overall, while the DOH's Developmental Disabilities Supports Division (DDSD) directly oversees the waiver programs that fund respite care.

Providers must interact with both agencies for enrollment, compliance, and billing. The HCA handles the Medicaid Provider Enrollment process, and the DDSD manages provider agreements, training requirements, and quality assurance.

3. Gatekeeping Prerequisites: Who Can Even Apply

Before applying to become a Respite Care Services provider in New Mexico, applicants must meet specific structural preconditions. There is no Certificate of Need required, but providers must secure a Provider Agreement with the DOH DDSD before they can enroll in Medicaid.

Additionally, providers must register their business entity with the New Mexico Secretary of State and obtain an Employer Identification Number (EIN) from the IRS. For certain waivers like Mi Via, providers may need to be selected directly by the participant or their family as an employee or vendor.

4. Licensure and Certification Requirements

New Mexico does not issue a distinct "Respite Care License." Instead, approval is granted through the DOH DDSD Provider Agreement process. Agencies must demonstrate the capacity to meet all DDSD standards, including staffing, training, and safety requirements.

If the respite care is provided in a facility or a specialized setting, additional facility licensure from the DOH Division of Health Improvement (DHI) may be required, depending on the setting type and the number of individuals served.

5. Medicaid Provider Enrollment

Once the DOH DDSD Provider Agreement is secured, agencies must enroll as a Medicaid provider through the New Mexico Medicaid Portal, managed by Conduent. The enrollment process requires submission of the Provider Agreement, business documentation, and completion of the online application.

Providers must select the appropriate provider type and specialty codes corresponding to Respite Care Services under the specific waiver programs they intend to serve.

6. Staffing, Training and Background Checks

All staff providing Respite Care Services must pass a comprehensive background check through the DOH Caregivers Criminal History Screening (CCHS) Program before having direct contact with individuals. This includes fingerprinting and a check of state and national registries.

Staff must also complete mandatory training as outlined in the DDSD Service Standards. This typically includes CPR/First Aid, abuse and neglect reporting, and specific training on the individual's ISP and health needs.

7. Documentation, Policies and Records

Providers must maintain detailed records for each individual served, including a copy of the ISP, emergency contact information, and daily service logs. Service logs must document the date, start and end times, and a description of the activities provided during the respite period.

Agencies are required to have written policies and procedures covering incident management, grievance processes, and quality assurance, which must be available for review by DDSD or HCA upon request.

8. Billing, Rates and Claims

Respite Care Services are billed using specific HCPCS procedure codes established by the HCA for each waiver program. Claims are submitted electronically through the New Mexico Medicaid Portal or a clearinghouse.

Rates are set by the HCA and are typically billed in 15-minute increments or per diem, depending on the duration of the service. Providers must ensure that billed hours do not exceed the authorized amount in the individual's ISP.

9. Approval Sequence and Timeline

The approval process begins with business registration and obtaining an EIN. Next, the agency applies for a Provider Agreement with the DOH DDSD, which involves a review of policies and capacity.

After DDSD approval, the agency submits the Medicaid enrollment application through the Conduent portal. The entire process, from initial application to receiving a Medicaid provider number, typically takes 3 to 6 months.

10. Common Denials and Survey Findings

Applications for Provider Agreements or Medicaid enrollment are frequently delayed or denied due to incomplete documentation, failure to pass background checks, or inadequate written policies.

During audits or surveys, common findings include missing or incomplete service logs, failure to complete required staff training prior to service delivery, and billing for hours that exceed the ISP authorization.

11. Key Contacts and Resources

Providers should utilize the official state websites for the most current applications, standards, and fee schedules. The DOH DDSD and HCA provide manuals and contact information for provider support.

The New Mexico Medicaid Portal is the central hub for enrollment and billing inquiries, managed by Conduent.

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