Current through Register Vol. 35, No. 18, September 24, 2024
A.
Agency-based service delivery model requirements for individual
employees, independent providers, provider agencies and vendors: All
supports waiver eligible providers under the agency-based model of service
delivery must be approved by the DOH or its designee and have an approved MAD
and DOH provider agreement. MAD through its designee, DOH/DDSD, must ensure
that its subcontractors or employees meet all required qualifications. The
provider agency must provide oversight of subcontractors and supervision of
employees to ensure that all required MAD and DOH/DDSD qualifications;
compliance with EVV requirements; all requirements outlined in the supports
waiver services standards, applicable New Mexico administrative code (NMAC)
rules, MAD supplements, and as applicable, the provider's New Mexico licensing
board's scope of practice and licensure are met.
B.
Participant directed service
delivery model requirements for individual employees, independent providers,
and vendors: In order to be approved to provide services under the
participant directed service delivery model, provider agency, employees,
vendors, or an independent provider, including non-licensed personal care or
direct support worker, must meet the general and service specific
qualifications set forth in this rule initially and continually meet licensure
requirements as applicable, and submit an employee or vendor enrollment packet,
specific to the provider or vendor type, for approval to the FMA. In addition,
to be an authorized provider for the supports waiver and receive payment for
delivered services, the provider must complete a vendor or employee provider
agreement and all required tax documents. The provider must have credentials
verified by the eligible recipient or the employee of record (EOR) and the FMA.
The provider agency is responsible to ensure that all agency employees meet the
required qualifications. Individual employees may not provide more than 40
hours of services in a consecutive seven-day work week.
(1) prior to rendering services to an
eligible supports waiver recipient as a personal care or direct support worker,
respite worker, customized community supports worker, or employment worker, an
individual seeking to provide these services must complete and submit a nature
of services questionnaire to the FMA. The FMA will determine, based on the
nature of services questionnaire if the relationship is that of an employee or
an independent contractor;
(2) an
authorized CSC provider must have a MAD approved provider participation
agreement (PPA) and the appropriate approved DOH/DDSD agreement.
C.
General Qualifications
agency-based and participant directed service delivery model providers:
(1) individual employees, independent
providers, provider agencies, excluding CSC provider agencies, who are employed
by a community supports waiver recipient to provide direct services shall:
(a) be at least 18 years of age;
(b) be qualified to perform the service and
demonstrate capacity to perform required tasks;
(c) be able to communicate successfully with
the eligible recipient;
(d) pass a
nationwide caregiver criminal history screening pursuant to NMSA 1978, Section
29-17-2 et seq.
and 7.1.9 NMAC and an abuse registry screen pursuant to NMSA 1978, Section
27-7a-1 et
seq. and 8.11.6 NMAC;
(e) complete
all trainings as required by DOH/DDSD and complete training specific to the
eligible recipient's needs as identified in the approved ISP;
(f) for participant directed, training needs
on items identified in the individual service plan (ISP), and the training plan
is determined by the eligible recipient or their legal representative for any
training specific to the employee in addition to trainings required by
DOH/DDSD; the eligible recipient is also responsible for providing and
arranging for employee training and supervising employee performance; training
expenses for paid employees cannot be paid for with the eligible recipient's
AAB; and
(g) meet any other service
specific qualifications, as specified in 8.314.7 NMAC and service
standards.
(2) vendors,
including those providing professional services:
(a) shall be qualified to provide the
service;
(b) shall possess a valid
business license, if applicable; and
(c) are required to follow the applicable
licensing regulations set forth by the profession; refer to the appropriate New
Mexico board of licensure for information regarding applicable
licenses;
(3) qualified
and approved relatives and legal guardians may be hired as employees and paid
for the provision, of supports waiver services except for CSC services,
customized community supports group services, non-medical transportation
services for a minor, environmental modifications services, vehicle
modifications services, behavior support consultation services, assistive
technology and employment supports. A spouse may not provide transportation for
adult participants. A relative or legal guardian may not provide services that
the legal responsible individual would ordinarily perform in the household for
individuals of the same age who did not have a disability or chronic illness. A
relative or legal guardian may not provide services that the legally
responsible individual would ordinarily perform in the household for
individuals of the same age who did not have a disability or chronic
illness;
(4) once enrolled,
providers, vendors and contractors receive a packet of information from the
eligible recipient or FMA including billing instructions, and other pertinent
materials. MAD makes available on the HSD/MAD website, on other
program-specific websites, or in hard copy format, information necessary to
participate in health care programs administered by HSD or its authorized
agents, including program rules, billing instructions, utilization review
instructions, and other pertinent materials. When enrolled, an eligible
recipient or legal representative, or provider, vendor or contractor receives
instruction on how to access these documents. It is the responsibility of the
eligible recipient or legal representative, or provider, vendor, or contractor
to access these instructions or ask for paper copies to be provided, to
understand the information provided and to comply with the requirements. The
eligible recipient or legal representative, or provider, vendor, or contractor
must contact HSD or its authorized agents to request hard copies of any program
rules manuals, billing and utilization review instructions, and other pertinent
materials and to obtain answers to questions on or not covered by these
materials;
(a) no provider of any type may be
paid in excess of 40 hours within the established work week for any one
eligible recipient or EOR when applicable;
(b) no provider agency is permitted to
perform both LOC assessments and provide any services for the eligible
recipients;
(c) providers may
market their services but are prohibited from soliciting eligible recipients
under any circumstances.
(5)
Employer of record: The EOR
is the individual responsible for directing the work of the eligible
recipient's employees under the participant directed service delivery model.
The EOR may be the eligible recipient or a legal representative of the
recipient. A recipient through the use of the support's waiver EOR
questionnaire will determine if an individual meets the requirements to serve
as an EOR. The recipient's CSC will provide him or her with the questionnaire.
The questionnaire shall be completed by the recipient with assistance from the
CSC upon request. The CSC shall maintain a copy of the completed questionnaire
in the recipient's file. The EOR does not have budget authority. When utilizing
both vendors and employees, an EOR is required for oversight of employees and
to sign payment request forms for vendors. The EOR must be documented with the
FMA whether the EOR is the eligible recipient or a designated qualified
individual.
(a) an eligible recipient that is
the subject of a plenary or limited guardianship or conservatorship may not be
their own EOR;
(b) a power of
attorney or other legal instrument may not be used to assign EOR
responsibilities, in part or in full, to another individual and may not be used
to circumvent the requirements of the EOR as designated in 8.316.7
NMAC;
(c) a person under the age of
18 years may not be an EOR;
(d) an
EOR who lives outside New Mexico shall reside within 100 miles of the New
Mexico state border. If the eligible recipient wants to have an EOR who resides
beyond this radius, the eligible recipient must obtain written approval from
the DOH prior to the EOR performing any duties. This written approval must be
documented in the ISP;
(e) the
eligible recipient's provider may not also be their EOR;
(f) an EOR whose performance compromises the
health, safety or welfare of the eligible recipient, may have their status as
an EOR terminated;
(g) an EOR must
be a legal representative if not the recipient; and
(h) an EOR may not be paid for any other
services utilized by the eligible recipient for whom they are EOR, whether as
an employee of the eligible recipient, a vendor, or an employee or contractor
of an agency. An EOR makes important determinations about what is in the best
interest of the eligible recipient and should not have any conflict of
interest. An EOR assists in the management of the eligible recipient's budget
and should have no personal benefit connected to the services requested or
approved in the budget.
D.
Qualifications of assistive
technology providers and vendors: Must hold a current business license
issued by the state, county or city government.
E.
Qualifications of behavior support
consultation providers: Behavior supports consultation provider agencies
shall have a current business license issued by the state, county or city
government, if required. Behavior supports consultation provider agencies shall
comply with all applicable federal, state, and waiver rules and procedures
regarding behavior support consultation, and must ensure that provider training
is in accordance with the DOH/DDSD training policy. Providers of behavior
support consultation must maintain a current New Mexico license with the
appropriate professional field licensing body and have a minimum of one year of
experience working with individuals with intellectual or developmental
disabilities. Providers of behavior support consultation services must possess
qualifications in at least one of the following areas:
(1) licensed clinical psychologist, licensed
psychologist associate, (masters or Ph.D. level);
(2) licensed independent social worker (LISW)
or a licensed clinical social worker (LCSW);
(3) licensed master social worker
(LMSW);
(4) licensed mental health
counselor LMHC);
(5) licensed
professional clinical counselor (LPCC);
(6) licensed marriage and family therapist
(LMFT); or
(7) licensed practicing
art therapist (LPAT).
F.
Qualifications of the community support coordinator providers: In
addition to general requirements, a CSC provider shall ensure that all
individuals hired, or contracted for CSC services meet the criteria specified
in this section in addition to all applicable rules and service standards.
Community supports coordinators shall:
(1) be
at least 21 years of age;
(2)
possess a bachelor's degree in social work, psychology, human services,
counseling, nursing, special education or related field; or have a minimum of
six-years direct experience related to the delivery of social services to
people with disabilities;
(3) have
at least one year of experience working with people with disabilities or
I/DD;
(4) complete all trainings as
required by DOH/DDSD;
(5)
verification of provider qualifications; and
(6) pass a national care giver criminal
history screening pursuant to Section
29-17-2 et seq.
NMSA 1978 and 7.1.9 NMAC and an abuse registry screen pursuant to Section 27a-4
et seq. NMSA 1978 and 8.11.6 NMAC.
G.
Qualifications for customized
community supports individual providers: For individual community
supports providers the worker must meet the following requirements:
(1) be 18 years of age or older;
(2) demonstrate the capacity to perform
required tasks;
(3) be able to
communicate successfully with the eligible recipient;
(4) complete all training requirements as
required by DOH/DDSD; and
(5) pass
a national care giver criminal history screening pursuant to Section
29-17-2 et seq.
NMSA 1978 and 7.1.9 NMAC and an abuse registry screen pursuant to Section 27a-4
et seq. NMSA 1978 and 8.11.6 NMAC; and
(6) meet any other service qualifications, as
specified in the regulations.
H.
Qualifications for customized
community supports group providers: Provider agencies must meet
requirements including a business license, accreditation with the commission on
accreditation of rehabilitation facilities (CARF) international, employment and
community services or the council on quality and leadership, quality
assurances, financial solvency, training requirements, records management,
quality assurance policy and processes. The agency staff must meet the
following requirements:
(1) be at least 18
years of age;
(2) have at least one
year of experience working with people with disabilities;
(3) be qualified to perform the service and
demonstrate capacity to perform required tasks;
(4) be able to communicate successfully with
the eligible recipient;
(5) pass a
national care giver criminal history screening pursuant to Section
29-17-2 et seq.
NMSA 1978 and 7.1.9 NMAC and an abuse registry screen pursuant to Section 27a-4
et seq. NMSA 1978 and 8.11.6 NMAC.
(6) complete specific training based on needs
identified in the ISP and by the recipient; and
(7) meet any other service qualifications, as
specified in the regulations.
I.
Qualifications of personal care
service providers: In addition to general MAD requirements, the direct
support providers must meet additional qualifications specific to the type of
services provided. Provider agencies must be homemaker/personal care agencies
certified by the MAD or its designee or a homemaker/personal care agency
holding a New Mexico homemaker/personal care agency license. A
homemaker/personal care agency must hold a current business license when
applicable, and meet financial solvency, training, records management, and
quality assurance rules and requirements. Personal care direct support workers
must:
(1) be at least 18 years of
age;
(2) demonstrate capacity to
perform required tasks;
(3) be able
to communicate successfully with the eligible recipient;
(4) complete all trainings as required by
DOH/DDSD; and
(5) pass a national
care giver criminal history screening pursuant to Section
29-17-2 et seq.
NMSA 1978 and 7.1.9 NMAC and an abuse registry screen pursuant to Section 27a-4
et seq. NMSA 1978 and 8.11.6 NMAC.
J.
Qualifications of employment
supports providers:
(1) A job
developer, whether an agency or individual provider, must:
(a) be at least 21 years of age;
(b) complete all training requirements by
DOH/DDSD;
(c) have a high school
diploma or GED;
(d) pass a national
care giver criminal history screening pursuant to Section
29-17-2 et seq.
NMSA 1978 and 7.1.9 NMAC and an abuse registry screen pursuant to Section 27a-4
et seq. NMSA 1978 and 8.11.6 NMAC;
(e) have experience in developing and using
job and task analysis;
(f) have
knowledge of the Americans with Disabilities Act (ADA);
(g) have knowledge and experience working
with the department of vocational rehabilitation (DVR) office; and
(h) have experience with or knowledge of the
purposes, functions, and general practices of entities such as department of
labor navigators one-stop career centers, business leadership network, chamber
of commerce job accommodation network, small business development centers,
retired executives, local business community agencies, and DDSD
resources.
(2) Job
coaches whether agency or individual provider, must:
(a) be at least 18 years of age;
(b) complete all training requirements by
DOH/DDSD;
(c) have a high school
diploma or GED; and
(d) pass a
national care giver criminal history screening pursuant to Section
29-17-2 et seq.
NMSA 1978 and 7.1.9 NMAC and an abuse registry screen pursuant to Section 27a-4
et seq. NMSA 1978 and 8.11.6 NMAC.
K.
Qualifications of environmental
modifications providers: Environmental modification providers must
possess an appropriate plumbing, electrician, contractor license; appropriate
technical certification to perform the modification; and, hold a current
business license issued by the state, county or city government.
L.
Qualifications of non-medical
transportation providers: Individual transportation providers must
possess a valid New Mexico driver's license with the appropriate
classification, be free of physical or mental impairment that would adversely
affect driving performance, have no driving while intoxicated (DWI) convictions
or chargeable (at fault) accidents within the previous two years, have a
current insurance policy and vehicle registration. Transportation vendors must
hold a current business license and tax identification number. Each agency will
ensure drivers meet the following qualifications:
(1) be at least 18 years old;
(2) possess a valid, appropriate New Mexico
driver's license;
(3) have a
current insurance policy and vehicle registration; and
(4) must complete all training requirements
as required by DOH/DDSD.
M.
Qualifications of respite
providers: Respite services may be provided by eligible individual
respite providers. Respite provider agencies must hold a current business
license, and meet financial solvency, training, records management and quality
assurance rules and requirements. In addition, for participant-directed
services, the eligible recipient or their representative evaluates training
needs based on the needs identified in the ISP and by the recipient, provides
or arranges for training, as needed, and supervises the worker. Respite worker
must:
(1) be 18 years of age or
older;
(2) demonstrate capacity to
perform required tasks;
(3) be able
to communicate successfully with the eligible recipient;
(4) pass a nationwide caregiver criminal
history screening pursuant to Section
29-17-2 et seq.
NMSA 1978 and 7.1.9 NMAC and an abuse registry screen pursuant to Section
27-7a-1 et
seq. NMSA 1978 and 8.11.6 NMAC; and
(5) complete all training requirements as
required by DOH/DDSD.
N.
Qualifications of vehicle modification providers: Vehicle
modification providers must possess an appropriate mechanic or body work
license; appropriate technical certification to perform the modification; and,
hold a current business license issued by the state, county or city
government.
