DDSD Developmental Disability and Medically Fragile Waiver Applications

The Provider Enrollment Application and Renewal Packets are available for interested providers to download. Be sure that all paperwork in the application is filled out completely and accurately.

Please review the DDSD Waiver Standards for services about which you are inquiring, and review the other links that are provided under the Important Links portion below. Include all requested documentation with the application to avoid delay or denial of your application. If you have any questions about the application, please feel free to email us.If the email does not function, just cut and paste this email address (cpb.peu@state.nm.us) to your email program.

Provider Enrollment Application and Renewal Packets

You may obtain these forms below:

New Provider Application Packet click here

Renewal Provider Application Packet click here

Important Links for Provider Enrollment Application and Renewal Packets

Affiliated Computer Systems - Watts: 800-299-7308, Alb. (505) 746-9988
Billing Rates for DD and MF
 Commission on Accreditation of Rehabilitation Facilities (CARF)
DDSD Policy and Procedures
DDSD Regional Office Contacts
DDSD Standards Developmental Disabilities Waiver
DDSD Standards Medically Fragile Waiver
DHI Incident Management
DHI Incident Management Guide

Employee Abuse Registry

NMAC TITLE 7 CHAPTER 1 PART 12 EMPLOYEE ABUSE REGISTRY

NMAC TITLE 7 CHAPTER 1 PART 9 Caregivers Criminal History Screening Program (CCHSP)

NM Taxation and Revenue Department
OSHA

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