MFW Providers

Thank you for your support and service to the Medically Fragile Waiver participants!  Your service helps families keep their loved ones at home.  The following information is to assist you in becoming or maintaining your status as a Medically Fragile Waiver provider.

Important Notice

Medically Fragile Waiver Amendment

The Centers for Medicare & Medicaid Services (CMS) approved the 2020 amendment June 12, 2020 updating the development disabilities eligibility definition to functional versus categorical eligibility criteria. The change will support more individuals to gain access to the home and community-based waiver program.

CMS also approved a rate adjustment, effective July 1, 2020, resulting from the 2019 rate study conducted by the Public Consulting Group. The rate adjustment provides increased funding to support provider services rates including: Behavioral Support Consultation, Case Management, Home Health Aide, Nutritional Counseling, Occupational Therapy, Physical Therapy Speech Language Pathology, Nursing Services (RN & LPN and HHA) and Out of Home Respite. The updated MFW Fee Schedule may be found on the HSD Providers webpage.

Rate Study

New Mexico Department of Health, Developmental Disabilities Supports Division (DDSD), has contracted with Public Consulting Group, Inc. to perform a study to recommend reimbursement rates for individuals with Intellectual and Developmental Disabilities receiving services through the Developmental Disabilities (DD), Mi Via (MV), and Medically Fragile MF waiver programs. Please look for updates on the DDSD website for new information on this project.

Please see the important announcement Rate Study Training Communication (2018-11-01) for additional information.

Medically Fragile Waiver

The current MFW was renewed effective July 1, 2016.  The approval for the renewal was received by the New Mexico Department of Human Services in February 2017.

he Medically Fragile Waiver renews in July 2021. HSD and DOH are actively preparing for the renewal at this time. DOH and HSD welcomes input from New Mexicans regarding the Waiver..

Please see the MFW Town Hall Presentation and MFW Renewal- Notice of Opportunity to Comment for additional information.

Please submit comments to:
Lorie Pacheco, Staff Manager
Human Services Department / Medical Assistance Division
Exempt Services and Program Bureau
PO Box 2348
Santa Fe, NM 87504-2348
Fax: 505-827-7277 Loriea.pacheco2@state.nm.us

Contracting, Invoicing and Documentation

MFW providers follow the DDSD instructions for contracting, invoicing and documentation.  Please go to the DD & Medically Fragile Waiver Provider Enrollment section of our website for more information.  Medically Fragile Waiver Provider Enrollment Application and Renewal Packets are available for download.

Secondary Freedom of Choice

The Secondary Freedom of Choice (SFOC) form is used by the Medically Fragile Case Management Agency to present to registrants when selecting Medically Fragile services. It may also be used to create a provider report for a given county and service.

Request a Form

Please visit the Secondary Freedom of Choice website to request a form.

Questions

For questions or concerns regarding the SFOC website or the SFOC forms, please email the Provider Enrollment Unit (PEU) at their cpb.peu@state.nm.us address or call 505-469-8480 .

Medically Fragile Waiver Standards

The standards address each service covered by the Medically Fragile Waiver as amended July 1, 2019. Individuals should expect to receive services that meet these standards. For additional information, please visit the Human Services Department's Medical Assistance Division (MAD).

• Medically Fragile Waiver Service Standards: Behavior Support Consultation (Current)
• Medically Fragile Waiver Service Standards: CM Standards (Current)
• Medically Fragile Waiver Service Standards: Environmental Modification Services (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)