Provider Enrollment
Thank you for your interest in becoming a provider with the Developmental Disabilities Supports Division (DDSD). This section of our website contains the necessary documentation and information for Developmental Disabilities, Medically Fragile and Supports Waivers Provider Enrollment and Mi Via Self-Directed Waiver Consultant Enrollment. It also contains the documentation and information to renew your provider agency’s Provider Agreement and/or make changes to it.
Center for Medicare and Medicaid Services Final Rule
The intent of the CMS Final Rule is to ensure that individuals receiving long-term services and supports through the 1915(c) HCBS programs under Medicaid authorities have full access to benefits of community living and the opportunity to receive services in the most integrated setting appropriate and to enhance the quality of HCBS and provide protections to participants. Additional information on this rule can be found on the Home and Community-Based Services website.
The New Mexico Department of Health (NMDOH) and the Human Services Department (HSD)/Medical Assistance Division (MAD) are not approving new applications for service models that do not fully meet the requirements set forth by the Final Rule HCBS Settings Requirements for the DDW, MFW and Mi Via Waivers. The State is currently engaged in a systematic transition process; however, the Final Rule does not allow for a transition period for settings in which services were not being provided under an approved state plan as of March 17, 2014. New provider agencies must be in compliance with the HCBS settings requirements prior to being approved to provide waiver services.
The information below must be incorporated in your responses to questions and policies found within the application:
- CMS Final Rule: Requirements
- CMS Final Rule: Exploratory Questions for Non-Residential Settings
- CMS Final Rule: Exploratory Questions for Residential Settings
Frequently Asked Questions
The most common questions we answer appear below.
Do I need a business license?
Yes. A business license is required by the HSD/MAD for each of the counties and/or cities your agency has an office in. Failure to maintain your business license(s) will result in termination of your Medicaid billing number.
Do I need a Federal Employee Identification Number?
Yes, if:
- You have employees; your business operates as a corporation or a partnership; you withhold taxes on income other than wages paid to a nonresident alien; you have a Keogh Plan; or you’re involved with certain organizations listed on the IRS website.
- Beyond filing taxes, you may also need a FEIN to: Open a bank account in the name of your business; apply for a credit card in the name of your business; apply for business permits; or furnish independent contractors a Form 1099. (Check with your accountant or tax professional.)
- Another reason you may want a FEIN: privacy. For example, if you are a contractor who works with many clients, disclosing your Social Security Number may expose you to personal identity theft. Instead, apply for and provide a FEIN. This won’t eliminate your chances of falling victim to identity theft, but it will likely keep the thief from accessing your personal accounts.
Why do I need to have and maintain a dishonesty or surety bond?
The Centers for Medicare and Medicaid Services and the NMDOH require that all providers have bond insurance during which they have an active Provider Agreement with DDSD.
What is an insurance rider?
A rider is an add-on provision to an insurance policy that provides additional benefits to the policyholder at an additional cost. Every provider is required to have the NMDOH listed as an additional insured on their liability insurance and as a loss payee on their bond insurance.
Is there a set aggregate amount for general liability?
Yes. One million dollars ($1,000,000.00) per occurrence, single limit covering bodily injury and property damage. Please email cpb.peu@state.nm.us for additional information.
How long does the application process take?
New provider applications can take up 16 weeks depending on the number of requests for information the applicant receives during the review of their application with the NMDOH, and the amount of time it takes for HSD/Medicaid to process the applicant's provider application upon approval from the NMDOH.
Renewing provider applications can take up to 12 weeks depending on the number of requests for information the provider receives during the review of their application(s).
What happens when I receive my Medicaid Billing Number?
Once PEU receives confirmation from the HSD/MAD that your application has been approved, and your application is complete, your agency's name will be placed on the Secondary Freedom of Choice (SFOC) form. Newly allocated registrants or individuals requesting to switch providers will receive a SFOC form. Your caseloads will be established by individuals selecting your agency.
How often do I need to have a criminal background check?
Compliance with the Caregivers Criminal History Screening Act requires a criminal background check at the time employment is offered. Further circumstances could trigger a subsequent criminal background check.
Does DDSD approve Requests for Subcontractor Approval?
No, DDSD no longer approves these requests. We do however, maintain all licensure for licensed professionals and education requirements and resumes for case managers.
If your agency has hired a new subcontractor, please send a copy of their license and/or education requirements and their start date by email to cpb.peu@state.nm.us.
Who is required to have accreditation certification?
Provider agencies who provide Case Management, Customized Community Supports, Community Integrated Employment, Customized In-Home Supports, Living Supports-Family Living, Living Supports-Supported Living and Respite services must obtain and maintain accreditation from either CARF International or the Council on Quality and Leadership (CQL).
Am I required to submit my agency’s Board of Directors listing annually?
Yes. Please email a copy to cpb.peu@state.nm.us or fax a copy to .
Am I required to submit my agency’s liability and bond insurance annually?
Yes. Please email a copy to cpb.peu@state.nm.us or fax a copy to .
Am I required to submit my agency’s QA/QI Report to PEU?
No. PEU will send out an email to all providers at least four (4) months prior to February 15th, which contains the web links to submit the QA-QI information.
Am I required to submit a financial statement to PEU annually?
Yes, if your agency has a current Provider Agreement with DDSD and has received over $250,000 in Medicaid funds from the DD, MF, Supports or Mi Via Waivers. Please email a copy of the statement to cpb.peu@state.nm.us or via Therap to Tammy Barth.
Publications
Latest
- DDW/MFW/SW Provider Agreement Amendment Form (Form)
- DDW/MFW/SW Self-Imposed Moratorium Form (Form)
- Developmental Disabilities (DD) Waiver Provider Application (Form)