How to start a private duty nursing agency in New Mexico

New Mexico requires a Licensed nursing agency approved by the Medical Assistance Division (or an FQHC); Medicare home health certification not required from New Mexico Health Care Authority — Medical Assistance Division to operate a private duty nursing agency.

License required

Yes

License

Licensed nursing agency approved by the Medical Assistance Division (or an FQHC); Medicare home health certification not required

Issuing agency

New Mexico Health Care Authority — Medical Assistance Division

Regulation

8.320.2 NMAC (EPSDT services) — private duty nursing

1. Hold a license as a nursing agency (or operate as an FQHC)
2. Enroll with New Mexico Medicaid as a MAD-approved PDN agency
3. Staff with RNs/LPNs meeting MAD requirements
4. Obtain PCP orders, an approved treatment/service plan and prior authorization for recipients under 21

Staffing

• RN or LPN meeting MAD requirements

Program

New Mexico Medicaid / Turquoise Care (New Mexico Health Care Authority, Medical Assistance Division)

Enrollment portal

Provider & PED Enrollment System at YES.NM.GOV

Application fee

Under the federal rule (42 CFR 455.460), institutional providers pay the CMS application fee when they first enroll, re-enroll or revalidate. The fee is $750 for calendar year 2026. Individual physicians and non-physician practitioners do not pay it. A fee already paid to Medicare or to another state's Medicaid program counts. HCA's enrollment pages do not list a separate state fee.

Fingerprinting

HCA's Provider Enrollment Matrix flags fingerprints as mandatory for home health agencies, DME/medical supply providers, prosthetists/orthotists, and private and state nursing facilities. Under federal rules (42 CFR 455.434 and 455.450), the state places provider types in 'limited', 'moderate' or 'high' risk levels. High-risk providers, and anyone who owns 5% or more of one, must submit fingerprints for a criminal background check.

Site visit

HCA's Provider Enrollment Matrix flags a mandatory site visit for some entries of these types: ground ambulance, home health agencies, hospice, clinical and diagnostic laboratories, DME/medical supply providers, physical therapists, LMFTs, and prosthetists/orthotists. Under federal rule (42 CFR 455.432), the state must visit moderate- and high-risk providers before and after enrollment. Every enrolled provider must allow unannounced on-site inspections.

Revalidation

New Mexico revalidates every three years, which is more often than the federal 5-year minimum. Revalidation is rolling and restarted in June 2026. A selected provider gets a 60-day notice, logs in to YES.NM.GOV, updates the record, uploads the documents listed in the Provider Enrollment Matrix, and submits. A provider who does not revalidate can be disenrolled. Expiring licenses and certifications are updated separately through a Recertification application.

Full New Mexico Medicaid enrollment guide →

CON program

No

Agency

New Mexico Health Care Authority, Division of Health Improvement (facility licensing only)

New Mexico certificate of need details →

Model

state-sponsored

State vendor

Fiserv AuthentiCare

Services in scope

• personal care
• respite
• home health

Alternate EVV allowed

Yes

Program

https://www.hca.nm.gov/wp-content/uploads/Final-LOD-58-EVV-Aggregator.pdf

New Mexico EVV requirements →

State minimum wage

$12.00 an hour

Effective

2023-01-01

Scheduled increases

No scheduled change found in the official sources reviewed.

HCBS 80/20 rule

Federal baseline: 42 CFR 441.302(k) requires the state to show that each provider spends at least 80% of Medicaid payments for homemaker, home health aide and personal care services under 1915(c) waivers on direct care worker pay and benefits. Compliance starts 2030-07-09 (for managed care, the first rating period starting on or after that date); annual payment-adequacy reporting under 441.311(e) starts 2028-07-09. A state may set a lower share for state-defined small providers and exempt providers facing hardship, each only through a public notice-and-comment process. The eCFR text has not changed since 2024-07-09. No state-published 80/20 implementation step (small-provider criteria, hardship exemption or reporting guidance) was found for this state in the official sources reviewed.

Nursing care agencies (private duty nursing) — active organization NPIs (NPPES)

56 (as of Sep 13, 2026)

Total Medicaid and CHIP enrollment (latest reported month)

673,265 (as of Jun 1, 2026)

All New Mexico Private duty nursing Medicaid rates, ranked →

• NM Developmental Disabilities Waiver Program (1915(c))
• NM Medically Fragile Waiver (1915(c))
• NM Mi Via - ICF/IDD Waiver (1915(c))
• New Mexico Turquoise Care (formerly New Mexico Centennial Care 2.0) (1115)

New Mexico waivers and waiting lists →