Developmental Disabilities, Medically Fragile and Supports Waiver Provider Enrollment

This section provides all the details on applying to become a provider for either the Developmental Disability Waiver (DDW) or the Medically Fragile Waiver (MFW).

Application Documents

The documents below will assist you with the application process.

• Developmental Disabilities (DD) Waiver Provider Application
• Developmental Disabilities (DD) Waiver Provider Application Forms
• DDW/MFW/SW Provider Agreement Form
• DDW/MFW/SW Provider Agreement Amendment Form
• Supports Waiver (SW) Provider Application
• Supports Waiver (SW) Provider Application Forms
• DDW/MFW/SW Self-Imposed Moratorium Form
• Medically Fragile (MF) Waiver Provider Application
• Medically Fragile (MF) Waiver Provider Application Forms

Service Standards

The following links contain helpful information for both first-time and current providers.

Developmental Disabilities Waiver Service Standards

• DDW Service Standards

Medically Fragile Waiver Service Standards

• Medically Fragile Waiver Service Standards: Behavior Support Consultation (Current)
• Medically Fragile Waiver Service Standards: CM Standards (Current)
• Medically Fragile Waiver Service Standards: General Authority (Current)
• Medically Fragile Waiver Service Standards: General Provider Standards
• Medically Fragile Waiver Service Standards: HH Aide Standards
• Medically Fragile Waiver Service Standards: Nutritional Standards (Current)
• Medically Fragile Waiver Service Standards: OT Standards (Current)
• Medically Fragile Waiver Service Standards: PDN Standards (Current)
• Medically Fragile Waiver Service Standards: PT Standards (Current)
• Medically Fragile Waiver Service Standards: Respite Standards (Current)
• Medically Fragile Waiver Service Standards: SLP Standards (Current)
• Medically Fragile Waiver Service Standards: SME Standards (Current)

Billing

For billing assistance, contact Conduent (formally known as Xerox) at 1-800-299-7304.

• MFW Rate Table
• DDW Rate Table
• Supports Waiver Rate Table

Secondary Freedom of Choice

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

Please send email to cpb.peu@state.nm.us address if you need to request an SFOC form.

Policy and Procedure Exception Request

Pursuant to the SFOC Policy and Procedure, provider agencies cannot not deny services to any individual once a SFOC has been signed, unless they can demonstrate that they do not have the capability to ensure the health and safety of that individual.

If your agency has received a signed SFOC and is unable to accept the individual for the reasons outlined within the SFOC Policy and Procedure, please fax a copy of the SFOC Policy & Procedure Exception Request Form to one of our Regional Offices for review.