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The Health Care Authority’s mission is: We ensure that New Mexicans attain their highest level of health by providing whole-person, cost-effective, accessible, and high-quality health care and safety-net services.

Provider Enrollment & Relations

Thank you for your interest in becoming a provider with the Developmental Disabilities Supports Division (DDSD). This section of our website contains 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 documentation and information to renew your provider agency’s Provider Agreement and/or make changes to it.

PERU Contact Information

Provider Enrollment Unit
PO Box 26110
Santa Fe NM 87502-6100

Tammy Barth, Manager

Tammy.Barth@hca.nm.gov   505-469-8480

Theodore Jackson, Management Analyst

Theodore.Jackson@hca.nm.gov   505-365-3920

DD Waiver Application and Forms
Medically Fragile Waiver Application and Forms

Application Documents

The documents below will assist you with the application process.

Mi Via Waiver Application and Forms

Application Documents

The documents below will assist you with the application process.

Supports Waiver Application and Forms

Application Documents

The documents below will assist you with the application process.

Waiver Amendment and Moratorium Forms

The documents below will assist you with the amendment or moratorium process.

Frequently Asked Questions

How long does the application process take?

The application process takes approximately 90 days to be completed.

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).

How do the Centers for Medicare and Medicaid Services Settings Requirements relate to the provider application?

New provider agencies must be in compliance with the HCBS settings requirements prior to being approved to provide waiver services.

Settings Requirements must be addressed in your responses to questions and policies found within the application. To learn more, please visit the Centers for Medicare & Medicaid Services website at: CMS Newsroom Factsheets: Home and Community Based Services

Do I need to have liability and bond insurance and what details do I need to know?

Yes.  Per Articles 24 of your Provider Agreement, you are required to obtain a fidelity bond for indemnification of losses occasioned by (1) any fraudulent or dishonest act or acts committed by any of the PROVIDER’S employees or agents acting alone or in collusion with others; and (2) the failure of the PROVIDER or its employees to perform faithfully any duty or to properly account for all monies and property received or entrusted by virtue of the employee’s position or employment. The fidelity bond shall be in an amount equal to twenty five percent 25% of the total Provider Agreement amount unless the Provider Agreement amount is less than one hundred thousand dollars $100,000.00 per year. In such cases a minimum bond of ten thousand dollars $10,000.00 will be sufficient and must name the DEPARTMENT (i.e., State of New Mexico Health Care Authority) as a loss payee.

Per Article 25 of your Provider Agreement, you are required to obtain liability insurance, naming the State of New Mexico Health Care Authority as an additional insured with minimum limits of coverage: One million dollars ($1,000,000.00) per occurrence, single limit covering bodily injury and property damage. For Provider Agreements under one hundred thousand dollars ($100,000.00), the PROVIDER’S limits may be reduced to a single limit of one hundred thousand dollars ($100,000.00). The PROVIDER shall submit a copy of the liability insurance to the DEPARTMENT within thirty (30) days of the effective date of this Provider Agreement.

Insurance policies are to be sent to the Provider Enrollment Relations Unit annually to Tammy.Barth@hca.nm.gov or via fax at (505) 476-8894.

Does DDSD approve new subcontractor requests?

No, however, the Provider Enrollment Relations Unit (PERU) maintains licensures for all licensed professionals, education requirements and resumes for case managers, community supports coordinators, and consultants.

If your agency has hired a new subcontractor, please send a copy of their license and/or education requirements and their start date to Tammy.Barth@hca.nm.gov.  If you have lost a subcontractor, please contact Tammy, so she can update your record.

Licenses must be submitted to the PERU annually.

Am I required to submit my agency’s Board of Directors listing annually?

Yes. Please send in a list of your Board of Directors to include their name, address, phone number and email address to Tammy.Barth@hca.nm.gov or via fax to (505) 476-8894

Am I required to submit an Annual Report to the Provider Enrollment Relations Unit (PERU)?

No. PERU will send out a DDSD Distribution email to providers at least four (4) months prior to February 15th, which contains the web links to submit the annual report information.

Do I need a business license?

Yes.  New Mexico Medicaid Providers are required to obtain a business license for each of the counties/cities you provide services in. The license must be submitted annually to the YES.NM portal.  Failure to maintain and submit your business license(s) will result in the termination of your Medicaid 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.
Once approved, how will I be notified of participants who choose my agency?

The Primary Freedom of Choice (PFOC) form is presented to participants newly allocated to a waiver program and is signed by the participant selecting a DDW, MFW and Supports Waiver case management, consultant or community supports coordinator agency.

The Secondary Freedom of Choice (SFOC) form is utilized by case management provider agencies to present to registrants when selecting DDW, MFW and Supports Waiver services.