New Mexico home health agency license: HCA rules, the 100-mile limit and Medicare

Does your agency need this license?

You need the license if you provide at least one medically directed service in clients’ homes. The rule lists ten examples: skilled nursing, physical therapy, occupational therapy, inhalation therapy, infusion therapy, speech language pathology, social work, home health aide, personal care attendant and homemaker.⁠¹

The key term is defined narrowly. “Medically directed services” are in-home services “provided in accordance with a patient/client’s plan or level of care which is reviewed and approved by a physician at least annually.”⁠¹ The rule defines “level of care” as the long-term care assessment abstract that medically qualifies a person for Medicaid waiver services.⁠¹ So homemaker or personal care work can fall under the license when it is delivered against a physician-approved plan or a Medicaid level of care. The same work, done for a private-pay client with no physician involvement, does not.

The rule also excludes three groups:⁠¹

• independent or sole practitioners working under their own professional practice act (a nurse or therapist billing on their own license);
• medical suppliers that do not provide any of the listed services;
• family, friends, volunteers and paid individuals who are not under a home health agency’s direct control.

The definition section adds that the term does not cover “any business, entity or organization providing non-medically directed services” in a client’s home.⁠¹ That is why New Mexico has no license for a purely private-pay companion or homemaker agency.

Unsettled: the published sources do not say whether an agency that delivers Medicaid personal care services under a member’s level of care must hold this license. The Community Benefit rule only requires personal care services agencies to be enrolled Medicaid providers and to follow the MAD MCO policy manual, and it does not mention an HCA home health license.⁠⁹ Because the licensing rule defines “level of care” as the Medicaid waiver assessment, ask HCA’s licensing office in writing, before you apply or enroll, whether your planned personal care service falls under 8.370.22.

Once licensed, an agency may also provide non-medically directed services.⁠¹ You must deliver at least one listed service “in its entirety” through your own employees. Any other service may be provided under contract with another agency or provider.⁠¹

Where you can operate: the 100-mile rule, branches and work stations

Every client must live within 100 miles of your licensed office. HCA may grant a temporary exception only when no other home health agency within that distance can or will serve the client.⁠¹ Pick your office location with this in mind. In a large, rural state, the 100-mile radius drawn from that office sets your entire market.

Branch offices. A branch is a separately licensed location. You may not apply for one until the parent agency has operated for at least one year, has had an annual survey from HCA and was found in substantial compliance.⁠¹ The branch must:⁠¹

• be within 100 miles of the parent agency’s licensed location;
• have a qualified on-site administrator supervised by the parent agency’s administrator;
• offer the same services as the parent;
• produce original client records within two hours if HCA asks for them and the records are kept at the parent.

Auxiliary work stations. You may set up an unlicensed, unstaffed work station where staff store supplies and do paperwork. It may not carry the agency’s name on signage, advertise its phone number, admit clients, take physician orders or hold any client or personnel records. It may not be used to extend your service area.⁠¹

Your main office must have posted hours of operation and be able to store and safeguard agency records. Your original license must be posted there.⁠¹ HCA’s licensing page says life safety code requirements, and the plan review and inspection that go with them, apply to every facility type except home health and home health hospice agencies.⁠² That means no architect’s drawings and no life safety inspection before your temporary license.

Ownership, governing body and advisory group

The applicant must be the owner. When an organization applies, the person who signs must have authority from that organization.⁠¹ The license cannot be transferred. It becomes void on a change of ownership, a change of licensee, a move of the office, or a closure. To keep operating after one of those changes, you file a new initial application at least 30 days in advance.⁠¹ The fee rule also says a change of ownership goes through the initial application and fee process.⁠³

Before you apply, set up two bodies, because your policies have to describe them:

• Governing body. It has full legal authority over the agency. It may include the licensee. It appoints the administrator, oversees management and finances, adopts bylaws or policies and reviews them at least once a year. It must meet at least annually and keep dated minutes.⁠¹
• Advisory group. It needs at least three people, including someone representing at least one of your services and at least one person who is neither an owner nor an employee. Governing body members may also serve. The group meets at least twice a year to review your policies and quality improvement program, take part in the annual program evaluation and advise on professional issues. Its minutes must be kept on file.⁠¹

HCA can revoke, suspend or deny a license if anyone “active in the operation” of the agency has a felony conviction or is under the influence of alcohol or narcotics.⁠¹

Administrator and supervising staff

The governing body appoints an on-site administrator who is one of the following:⁠¹

• a licensed physician;
• a registered nurse; or
• a person with at least a high school diploma or GED, training and experience in health services administration, and at least one year of supervisory or administrative experience in home health care.

The administrator may also be your supervising physician or RN. A qualified person must be authorized in writing to act when the administrator is absent.⁠¹ Changing administrators requires an amended license within 10 working days.⁠¹ The amended license fee is $300.⁠³

A licensed professional or a qualified staff member must supervise your medically directed services. That person, or an equally qualified alternate, must be available at all times during your operating hours.⁠¹ The rule then sets supervision rules by discipline:

For aides, attendants and homemakers, one supervisory visit covers a client served by several workers, and the worker does not have to be present.⁠¹ Every nurse, therapist, social worker or other professional you employ or contract with must hold a current New Mexico license, registration or certification, with proof kept on file.⁠¹

Training your aides, attendants and homemakers

New Mexico sets its own training rules for non-licensed staff. Each agency chooses how to meet them: you can run approved training yourself, or you can document a competency method for workers trained elsewhere.

If you train in-house. You must notify HCA in writing and have your curriculum approved before training starts. HCA can bar an agency in substantial noncompliance from training or competency testing for up to two years.⁠¹

Home health aides. The program must total at least 75 hours of classroom and supervised practical training. At least 16 hours must be supervised practical training under an RN or LPN, and trainees must complete 16 classroom hours before the practical part begins. The curriculum covers 14 listed subjects, including vital signs, infection control, CPR and first aid, transfers, range of motion, nutrition and client rights. Training is given by or under an RN with at least two years of nursing experience, one of them in home health. A competency evaluation consists of a written test plus a skills demonstration observed by an RN or LPN. After hire, each aide needs 12 documented in-service hours a year (prorated in the first year) and an annual performance review with a skills demonstration.⁠¹

Homemakers and personal care attendants. Each needs at least 40 hours of training in the first year of employment. Ten of those hours must be completed before the worker’s first placement in a client’s home: up to two hours may be agency orientation, and eight must be specific to client services. The curriculum covers nine areas, including communication, meal preparation, housekeeping, care of people with disabilities, emergency response with CPR and first aid, infection control and home safety. After that, each worker needs 10 in-service hours a year.⁠¹

Staff and contractors involved in client care must be at least 18, and anyone with client contact, volunteers included, needs a TB test.⁠¹ Before hiring, two state checks apply:

• Criminal history screening. Home health agencies are “care providers” under the caregiver criminal history screening rule. Applicants and caregivers must consent to fingerprint-based nationwide and statewide screening when they receive an offer, and the agency submits the fees and paperwork. A worker can start in conditional, supervised employment once all documents and fees are in, while the results are pending.⁠⁴
• Employee abuse registry. You must check HCA’s registry before hiring or contracting with anyone. You may not employ a person listed with a substantiated incident of abuse, neglect or exploitation.⁠⁵

Policies HCA reviews before you open

HCA approves your paperwork before it issues any license, so the policy manual is the core of your application. You submit your policies together with a copy of 8.370.22 NMAC annotated so that each regulation shows the page or policy number that meets it.⁠¹ HCA’s licensing page calls this an “annotated policy and procedure manual with a crosswalk to the rules.”⁠²

The manual must cover at least the following:⁠¹

• scope of services;
• services provided under contract;
• admission and discharge;
• job descriptions for every category of staff;
• personnel policies;
• staff training;
• emergency and after-hours care;
• client records;
• quality improvement;
• complaints and grievances.

Several other rules shape what those policies must say:

• Client rights. You must tell clients in writing about New Mexico’s home health hotline (1-800-752-8649, 8:00 a.m. to 5:00 p.m., Monday to Friday), all charges and any changes to them, and advance directives before care starts.⁠¹
• Gifts. Accepting gifts worth more than $25, or more than $300 in total in a year, counts as exploitation. Any gift that is accepted must be documented and acknowledged by both the giver and the recipient.⁠¹
• Plans of care. Medically directed care follows a physician-established plan, reviewed by the physician and the agency at least annually. Non-medically directed care follows a plan set and reviewed at least annually by agency staff.⁠¹
• Records. You keep original client records for at least 10 years after discharge, even if the agency closes. You send a copy to a receiving provider within 24 hours of a signed request, and you produce staff records within four hours of HCA asking.⁠¹
• Contracts. Every contracted service needs a written contract covering seven listed points. One of them is that only your agency admits clients.⁠¹
• Quality improvement. You must document activity every quarter and compile an annual report that the governing body and advisory group approve.⁠¹
• Complaints and incidents. You must start investigating a complaint within three working days.⁠¹ Abuse, neglect or exploitation must be reported immediately to Adult Protective Services. Reportable incidents go to HCA on its incident form within 24 hours, or the next business day on weekends and holidays, and you report your investigation results within five days.⁠⁶

If you will handle drugs, you need Board of Pharmacy approval before licensure. Any Board of Pharmacy certificates go in your agency files.⁠¹⁠²

Applying: the order HCA follows

1. Letter of intent

   Email a letter of intent to [email protected], to the attention of the licensing manager. Describe the type of facility and give a valid email address and a contact person. HCA’s Program Operations Bureau can be reached at 505-476-9093.⁠²

2. Application packet

   Once HCA approves the letter, it emails an application packet. The packet varies by facility type and is sent by email rather than posted on HCA’s page, as of October 12, 2026.⁠²

3. Application, fee and functional program outline

   Submit the application with the non-refundable fee.⁠¹ Include a functional program outline listing your services, the estimated number of clients you will serve each month, any services you will contract out (the rule gives homemaker and IV therapy as examples) and your hours and days of operation.⁠¹ HCA’s page also asks for a program narrative describing the population you will serve, your services and your planned contractors.⁠² The mailing address on HCA’s page is Department of Health – DHI/POB, Licensing Dept, P.O. Box H, Santa Fe, NM 87504. Policy manuals may also be emailed to the licensing address.⁠²

4. Annotated policies

   Submit the policy manual cross-referenced to the rule, as described above.⁠¹⁠²

5. Temporary license

   When HCA approves your documents, it issues a temporary license. You may admit clients from that point.⁠¹ A temporary license lasts no more than 120 days, and no more than two can be issued in a row.⁠¹ The first one is included in the initial fee; the fee schedule charges again before a second temporary license is issued.⁠³

6. Request the initial survey

   Once you are fully operational and have accepted a client, request the initial survey in writing.⁠¹ HCA says to wait until you have served enough clients to use your full range of services. At the survey, have TB skin test or chest X-ray results ready for all staff with client contact, plus current licenses for licensed staff.⁠²

7. Annual license

   If the survey finds you in compliance, HCA issues a one-year license.⁠¹

HCA states one deadline: the application, policy manual and plan review stay valid for one year from the date HCA receives your application fee. If you have no license by then, you may have to start over, and your survey goes to the end of the schedule.⁠² No other processing times are published. No certificate of need requirement appears in the home health rules.

Fees as published

Fees are paid by check, money order or the state’s electronic payment process, payable to the State of New Mexico or the Health Care Authority. They are prepaid and not refundable.⁠³ The fee schedule has been in effect since January 28, 2025. The rule also lists a $300 fee for a change of physical address, but under 8.370.22 a move of a home health office voids the license and requires a new initial application.⁠¹⁠³

Surveys, renewal and penalties

Applying for a license counts as permission for HCA to enter and survey your agency. Surveys are unannounced and may include visits to clients’ homes. After a deficiency statement, you have 10 working days to submit a plan of correction.⁠¹

Submit your renewal application and fee at least 30 days before the license expires. HCA issues the new license after an on-site survey, if you are in substantial compliance. If the license lapses, you must stop operating and go back through initial licensure.⁠¹

HCA can also impose civil monetary penalties. The base penalty ranges from $100 to $500 for a class C deficiency, $300 to $3,000 for class B and $500 to $5,000 for class A. Repeat class A or B deficiencies within 24 months double the base penalty, and total penalties are capped at $5,000 per day.⁠⁷ Hearings on adverse actions follow 8.370.2 NMAC. If HCA finds an immediate threat to health and safety, it can suspend a license before a hearing, provided the hearing is held within five working days.⁠¹

Medicaid, Medicare and the 2026 moratorium

A state license does not by itself let you bill public payers, and New Mexico’s Medicaid rule ties home health billing to Medicare. Under 8.325.9 NMAC, a home health agency can be paid by Medicaid only if it:⁠⁸

• meets the federal conditions of participation in 42 CFR 484;
• is licensed and certified by HCA to Medicare standards (“any provider participating only in medicaid must be licensed and certified to comply with the standards for medicare participation”);
• is primarily engaged in skilled nursing plus at least one other therapeutic service.

Medicaid home health services beyond the initial evaluation visits need prior approval.⁠⁸ An agency that offers only homemaker or personal care services cannot qualify under this rule. Personal care in the Community Benefit runs through enrolled personal care services agencies instead.⁠⁹

On the Medicare side, CMS stopped enrolling new home health agencies, branches and practice locations nationwide effective May 13, 2026, for an initial six months. Only applications that a Medicare contractor received before that date continue.⁠¹⁰ CMS’s survey memo adds three rules:⁠¹¹

• initial applications filed during the moratorium are denied;
• there are no exceptions for individual providers;
• accreditation will not give a new agency Medicare deemed status while the moratorium lasts.

Buying a recently enrolled agency does not get around it: an agency that undergoes a non-exempt change in majority ownership within 36 months of its initial enrollment must re-enroll as new, and the moratorium blocks that.⁠¹⁰ Agencies that apply within six months after the moratorium is lifted are assigned the “high” screening level.⁠¹⁰

The initial six months run to about November 13, 2026. The moratorium can be extended in six-month increments, and no extension or lifting notice had been published as of October 12, 2026. Check CMS’s moratoria page before you plan around a date.⁠¹² Because New Mexico requires even Medicaid-only home health agencies to meet Medicare standards, it is not clear how a new agency can reach Medicaid home health billing while the moratorium is in place. The published sources do not say whether HCA will certify a new Medicaid-only home health agency to Medicare standards while the moratorium lasts; ask HCA and the Medicaid agency before you build a business plan on Medicaid home health billing. A private-pay agency can still be licensed and operate under 8.370.22.

Related New Mexico licenses

If you plan to care for people in a facility rather than in their homes, see the New Mexico assisted living facility license, which applies from two adults, and the New Mexico adult day care facility license. Both are issued by the same HCA office under the same fee rule. For all New Mexico care licenses, see New Mexico.

Sources

1. 1
   New Mexico State Records Center and Archives, 8.370.22 NMAC, Requirements for Home Health Agencies Checked 12 Oct 2026 · Back to text ↑
2. 2
   New Mexico Health Care Authority, Health Facility Licensing and Certification: licensing a health facility Checked 12 Oct 2026 · Back to text ↑
3. 3
   New Mexico State Records Center and Archives, 8.370.3 NMAC, Health Facility Licensure Fees and Procedures Checked 12 Oct 2026 · Back to text ↑
4. 4
   New Mexico State Records Center and Archives, 8.370.5 NMAC, Caregivers Criminal History Screening Requirements Checked 12 Oct 2026 · Back to text ↑
5. 5
   New Mexico State Records Center and Archives, 8.370.8 NMAC, Employee Abuse Registry Checked 12 Oct 2026 · Back to text ↑
6. 6
   New Mexico State Records Center and Archives, 8.370.9 NMAC, Incident Reporting, Intake, Processing and Training Requirements Checked 12 Oct 2026 · Back to text ↑
7. 7
   New Mexico State Records Center and Archives, 8.370.4 NMAC, Health Facility Sanctions and Civil Monetary Penalties Checked 12 Oct 2026 · Back to text ↑
8. 8
   New Mexico State Records Center and Archives, 8.325.9 NMAC, Home Health Services (Medicaid) Checked 12 Oct 2026 · Back to text ↑
9. 9
   New Mexico State Records Center and Archives, 8.308.12 NMAC, Community Benefit Checked 12 Oct 2026 · Back to text ↑
10. 10
    Centers for Medicare & Medicaid Services, Federal Register, Announcement of Nationwide Temporary Moratorium on the Medicare Enrollment of Home Health Agencies Checked 12 Oct 2026 · Back to text ↑
11. 11
    Centers for Medicare & Medicaid Services, QSO-26-11: Home health agency and hospice enrollment moratorium Checked 12 Oct 2026 · Back to text ↑
12. 12
    Centers for Medicare & Medicaid Services, Provider Enrollment Moratoria Checked 12 Oct 2026 · Back to text ↑

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