New Mexico adult day care facility license: center vs. home, HCA rules and fees

Center, home, or “new or innovative” program

The rule recognizes three ways to be licensed ⁠¹:

Scroll the table sideways to see every column.

The home model is the low-cost entry point. A home does not have to submit floor plans, a certificate of occupancy, fire authority approval or New Mexico Environment Department approval with its application ⁠¹. It also skips several building rules that bind centers: exit signs, 36-inch exit doors, a manual fire alarm system, a posted evacuation plan and the accessibility requirements ⁠¹. The trade-off is a hard cap of five participants and an operator who lives in the house. Trailers and mobile homes cannot be used for adult day care under either model ⁠¹.

The third path is for professional organizations that can show a need for a program that does not fit the center or home model. Your proposal must include statistical data supporting the need, the special needs of the people you will serve, the sections of the rule your program conflicts with, and the alternative measures you will use instead, such as extra staffing or extra fire precautions. If HCA approves the proposal, at its sole discretion, it can issue a license with variances for those sections ⁠¹.

Who the rule covers, and where it stops

Several limits in 8.370.20 decide whether this is the right license:

• Participants. An “adult” under the rule is 18 or older and elderly or disabled, with impairments that keep the person from living independently without support ⁠¹.
• Mobility. Participants must be ambulatory or “mobile non-ambulatory.” In practice that means they can move on their own or in a wheelchair with minimal assistance ⁠¹. A program built around people who need hands-on transfers does not fit this rule as written.
• Hours. Hours of operation are limited to 6 a.m. to 9 p.m. ⁠¹
• Baseline services. Every facility must at least remind participants of medications and appointments, provide meals, and monitor their activities while they are on site ⁠¹.

Overnight care is outside this license. If adults will live on the premises, look at the New Mexico assisted living facility license, which starts at two adults who need help with daily living. Skilled services delivered in clients’ own homes fall under the home health agency license.

The HCA regulations page links 8.370.20 NMAC, but as of October 12, 2026 its facility table still listed “7 NMAC 13.2” for adult day care ⁠⁴. That is the old citation. Work from 8.370.20.

Starting with HCA: letter of intent and application packet

HCA does not post a downloadable adult day care application. The steps it publishes are ⁠³:

1. Send a letter of intent

   Email it to the licensing manager at [email protected], describing the type of facility you plan to open. Include a valid email address and a named contact person.

2. Receive the application packet

   Once HCA approves the letter of intent, it emails the packet to your contact. The packet and process vary by facility type. For help getting a packet, call 505-476-9093.

3. Write a program narrative

   It describes the population you will serve, the services and care you will provide, and any contract services you expect to use.

4. Submit annotated policies and procedures

   Send your manuals with a crosswalk to the rule, by mail to Department of Health – DHI/POB, Licensing Dept, P.O. Box H, Santa Fe, NM 87504, or by email to [email protected].

5. Talk to the Program Operations Bureau before you build

   Call 505-476-9093 before any construction starts, and give HCA’s architect your building plans for life safety code review.

HCA says the application, policy and procedure review, and plan review are good for one year from the date it receives your application fee. If no license has been issued by then, you may have to reapply and your survey moves to the end of the schedule list ⁠³.

What goes in the application

Under 8.370.20.9, the application form must be complete, printed or typed, dated, signed and notarized ⁠¹. The rule’s definition of applicant adds that the applicant must be the owner ⁠¹. The supporting documents differ by model:

Center floor plans must show the use and interior dimensions of every room, a wall section with finishes, door types and sizes, whether the building is air-conditioned, every sink, tub, shower and toilet, window sizes and sill heights, any level changes, and a site plan with parking, walks and ramps. Mark existing and new work separately ⁠¹. HCA reviews the plans against building and fire codes and sends back comments. It also gives new facilities advice on accessibility at this stage ⁠¹.

HCA requires Board of Pharmacy approval before licensure for any facility that handles drugs. The Board’s number is 505-841-9102 ⁠³.

Building and space rules

Activity space. Centers and homes both need 40 square feet of activity area for each participant on the license. Measure wall to wall and leave out kitchens, corridors, bathrooms, storage and closets ⁠¹. You must also have an outdoor activity area on the premises, designed so staff can supervise directly. HCA can require it to be fenced, with at least one latched gate for emergency exit ⁠¹.

Light and exits. Every activity area needs a window or skylight of at least 1/20 of its floor area. Each floor needs two exits remote from each other, and exit doors must open from the inside whenever you are open ⁠¹. Centers also need exit signs with letters at least 6 inches high and exit doors at least 36 inches wide. At a capacity of 50 or more, exit doors must open outward ⁠¹.

Toilets. A center needs, for each sex, one toilet for 1 to 15 participants plus one for each additional 15 or fraction, and lavatories at one per 40. A home needs at least one toilet and one lavatory ⁠¹.

Fire equipment.

All facilities must hold at least one fire drill a month, at different times of day, and keep a record of each ⁠¹. Centers must request an annual inspection from the local fire authority. If the authority does not do annual inspections, record when you asked and whom ⁠¹.

Accessibility (centers). The main entry must be at ground level or ramped. At least one toilet needs a 32-inch door clearance (36 inches is recommended) and a 60-inch turning circle. Ramps can be no steeper than 1 inch of rise per 12 inches of run, need a 5-by-5-foot landing at the door, and need handrails above a 6-inch rise ⁠¹.

Existing vs. new buildings. The building rules assume a one-story facility. Serving participants above or below ground level brings extra requirements from the building and fire authorities and from HCA ⁠¹. In an existing building, HCA may grant variances for requirements you cannot meet, as long as they do not conflict with building and fire codes. A newly constructed building must meet every requirement ⁠¹. Plans for any construction, addition or alteration go to HCA for approval before work starts ⁠¹. Homes are exempt from that plan-review rule, the accessibility rule and the other general building provisions in 8.370.20.29(A) to (D), but the ban on trailers and mobile homes still applies ⁠¹.

Shared buildings. A center inside a senior center or other multi-use building must be self-contained, with its own staff and a separate area. People from other groups in the building may not move through the day care area at will ⁠¹.

Director, operator and staff

Center program director. A center must have a full-time program director who ⁠¹:

• is 18 or older;
• holds at least a bachelor’s degree from a nationally accredited institution in geriatrics, or in a health-related course of study that includes care of the elderly, or is a registered nurse;
• has at least two years of experience and training in services to elderly or disabled adults;
• has demonstrated ability in supervision and administration.

Home operator. The licensee of a home must be 18 or older and have a high school diploma or equivalent and at least two years of full-time work experience serving elderly or disabled adults. The operator must also provide a written statement from a physician or health facility that they are free from communicable disease, and references that include former employers ⁠¹.

Both qualification sections also say the person must “meet the requirements of Section 53.” In the July 1, 2024 rule, section 53 covers centers in multi-use buildings, so the intended cross-reference is unclear. Ask HCA what it expects ⁠¹.

Ratios. Centers need one full-time-equivalent staff position responsible for direct care for every five participants. Homes need one FTE for no more than five ⁠¹. Ratios apply at all times, including meals. Only direct-care staff count; clerical, cooking and maintenance staff do not. Staff counted in the ratio must be 18 or older ⁠¹. Participants may never be left unattended ⁠¹. You must keep a list of two people you can call in to substitute, with their phone numbers and health certificates on file ⁠¹. HCA may require higher ratios for participants with special needs ⁠¹.

First aid. At least one staff member on duty at all times must hold a current first aid certificate and have completed an approved CPR course ⁠¹.

Training. Every staff member gets an orientation before starting work. It must cover your services, first aid and signs of illness and abuse, fire prevention and evacuation, the licensing regulations, special problems of the elderly and disabled, participant rights, and sanitation ⁠¹. After that:

• Centers. All staff, including the director, complete at least 40 documented clock hours of training a year. At least 20 of those hours must cover the physical, emotional, intellectual and social needs of adults ⁠¹.
• Homes. All staff complete at least 24 documented hours a year ⁠¹.

Separately, 8.370.9 NMAC requires adult day care centers to run an incident management training program covering abuse, neglect and exploitation, plus the division’s report form ⁠⁷.

Screening. Under 8.370.20, no one convicted of a felony or of a misdemeanor involving moral turpitude may work as director, operator, direct care staff or support staff. In a home, that includes family members who work or live there ⁠¹. Volunteers count as staff ⁠¹.

Adult day care centers are also covered by the Caregivers Criminal History Screening Requirements. Anyone you offer a job must consent to nationwide and statewide criminal history screening when you make the offer. Once the applicant has submitted the documents and fees, the rule allows supervised conditional employment until HCA gives written notice of the result ⁠⁵. Before you hire or contract with anyone, you must check HCA’s Employee Abuse Registry. You may not employ anyone it lists ⁠⁶. Staff and volunteers who work more than eight hours a week with participants need a record on file that includes a TB-free certificate ⁠¹.

Program, meals and medications

Activities. Activities are planned from individual plans of care and supervised by staff. Participants may decline any activity. You must distribute a monthly activity calendar and post the daily schedule ⁠¹. You need a living or multi-purpose room with reading lamps, tables, chairs and couches ⁠¹.

Meals. A center that serves meals must meet state and local food service establishment rules. A center not under Environment Department jurisdiction may serve only snacks that need no cooking. Homes are exempt from both ⁠¹. Each meal must supply at least one-third of an adult’s daily nutritional requirement. Offer a mid-morning and a mid-afternoon snack, and never let a participant go more than three hours without a meal or snack ⁠¹. No menu may repeat within a week, and you must consult a registered dietitian or nutritionist ⁠¹. Keep a bed available for a participant who becomes sick, in a spot where staff can watch them ⁠¹.

Medications. You may keep only medications that participants can self-administer, unless a licensed physician, dentist or nurse administers them. Over-the-counter drugs are allowed only under a written procedure approved by a physician. Medications must be locked and stored separately for each participant ⁠¹. Staff may not pre-pour doses. They may hold and open the original container and help the participant take the medication. The exception is registered nurses licensed in New Mexico, who may prepare and give doses ⁠¹.

Restraints. Physical restraints require a physician’s written authorization for a set period, or an emergency. Only a licensed nurse may apply them, with one-to-one supervision the whole time ⁠¹. Your policies must prohibit chemical restraint ⁠¹.

Transportation. If you provide rides, you are responsible for participants from pickup to drop-off. Vehicles need a fire extinguisher, a first aid kit and seatbelts. Load at the curb, and offer a rest stop at least every 30 minutes ⁠¹.

Records and policies. Each participant needs a signed enrollment agreement that lists your services and their costs. Records must be complete at admission, including for drop-ins, and kept at least six months after disenrollment ⁠¹. Written policies must cover emergencies, abuse and neglect reporting, admission and disenrollment, missing participants, medications, complaints, and restraints. You may adopt policies from other sources ⁠¹.

Fees

Paying the fee is a condition of licensure. Fees are prepaid and non-refundable, payable by check, money order or a state-approved electronic method to the State of New Mexico or the Health Care Authority ⁠². A change of ownership goes through the initial application and fee process ⁠².

Inspections, the temporary license, and opening

Under the rule, HCA schedules an initial survey once it receives a complete application with every supporting document. It issues the license if the survey finds you in compliance ⁠¹. HCA may also issue a temporary license, either before the initial survey or when it finds partial compliance. A temporary license lasts no more than 120 days, during which you must correct the cited deficiencies, and no more than two can be issued in a row ⁠¹.

HCA’s general instructions add the agency’s order of events ⁠³:

1. Life safety code inspection

   This comes after the packet, policies and narrative are approved and construction is finished. Before HCA’s architect authorizes it, they need your certificate of occupancy, the local fire department inspection and, if applicable, the Environment Department inspection.

2. Temporary license

   It is issued once you pass that inspection, and lets you begin serving a limited number of clients.

3. Initial health survey

   Once you are fully operating, request it in writing from the district office. Have staff TB test results and any required state licenses ready.

4. Annual license

   It is issued after you pass the survey.

HCA’s general instructions say life safety codes apply to every facility type except home health agencies and require a life safety code inspection before a temporary license ⁠³, while 8.370.20 exempts adult day care homes from fire authority approval and fire inspections ⁠¹. Neither source says which applies to a home, so ask the Program Operations Bureau (505-476-9093) in writing whether it will schedule a life safety code inspection for your home and what it will check before you buy or alter the house.

Renewal, changes and enforcement

• Renewal. File a notarized renewal application and the fee at least 30 days before the license expires. If you miss the expiration date, you must file a new initial application and stop operating until you are relicensed ⁠¹.
• Amended license. Apply within 10 working days of a change of director, facility name or capacity. You may not add participants or change the layout until HCA has visited and issued the amended license ⁠¹.
• New owner or new location. A license cannot be transferred. It becomes void when the owner, licensee or location changes, so file a new initial application at least 30 days before the change ⁠¹.
• Surveys and corrections. HCA surveys every facility at least once a year and may arrive unannounced. You have 10 working days after receiving the written report to submit a plan of correction ⁠¹. Someone who can give surveyors access to all records and locked areas must be on site at all times ⁠¹.
• Incidents. Report abuse, neglect or exploitation immediately to Adult Protective Services. Report incidents to HCA’s bureau within 24 hours, or the next business day on weekends and holidays ⁠⁷. The DHI complaint hotline is 1-800-752-8649 ⁠⁷.
• Sanctions. HCA can impose directed plans of correction, monitors or temporary managers (paid for by the facility), restricted admissions, capacity reductions, and civil monetary penalties of up to $5,000 per day ⁠⁸. Exceeding licensed capacity is itself grounds for action ⁠¹.

How adult day programs get paid by Medicaid

New Mexico pays for adult day health through Medicaid managed care, which has been called Turquoise Care since July 1, 2024. HCA’s Turquoise Care page names Blue Cross Blue Shield of New Mexico, Presbyterian Health Plan, Molina Healthcare and UnitedHealthcare as the plans from that date; confirm the current list with HCA ⁠¹⁰. Under 8.308.12 NMAC, adult day health is a covered community benefit for members who meet nursing facility level of care. It must be provided by a licensed community-based adult day care facility that offers health and social services ⁠⁹. Private duty nursing and skilled therapies delivered on site are billed separately from the adult day health service. Settings must meet Medicaid home and community-based services (HCBS) standards for community integration ⁠⁹. A state license is therefore the starting point for a Medicaid-funded program. The same rule says agency-based community benefit providers must apply and be approved as Medicaid (MAD) providers and then contract with the plans ⁠⁹.

Sources

1. 1
   New Mexico State Records Center and Archives (issuing agency HCA), 8.370.20 NMAC, Requirements for Adult Day Care Facilities Checked 12 Oct 2026 · Back to text ↑
2. 2
   New Mexico State Records Center and Archives (issuing agency HCA), 8.370.3 NMAC, Health Facility Licensure Fees and Procedures Checked 12 Oct 2026 · Back to text ↑
3. 3
   New Mexico Health Care Authority, Division of Health Improvement, Licensing a Healthcare Facility Checked 12 Oct 2026 · Back to text ↑
4. 4
   New Mexico Health Care Authority, Division of Health Improvement, DHI Regulations Checked 12 Oct 2026 · Back to text ↑
5. 5
   New Mexico State Records Center and Archives (issuing agency HCA), 8.370.5 NMAC, Caregivers Criminal History Screening Requirements Checked 12 Oct 2026 · Back to text ↑
6. 6
   New Mexico State Records Center and Archives (issuing agency HCA), 8.370.8 NMAC, Employee Abuse Registry Checked 12 Oct 2026 · Back to text ↑
7. 7
   New Mexico State Records Center and Archives (issuing agency HCA), 8.370.9 NMAC, Incident Reporting, Intake, Processing and Training Requirements Checked 12 Oct 2026 · Back to text ↑
8. 8
   New Mexico State Records Center and Archives (issuing agency HCA), 8.370.4 NMAC, Health Facility Sanctions and Civil Monetary Penalties Checked 12 Oct 2026 · Back to text ↑
9. 9
   New Mexico State Records Center and Archives (issuing agency HCA), 8.308.12 NMAC, Community Benefit (Medicaid managed care) Checked 12 Oct 2026 · Back to text ↑
10. 10
    New Mexico Health Care Authority, Turquoise Care Checked 12 Oct 2026 · Back to text ↑

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