Adult Day Care Regulations in New Mexico

Who regulates adult day care in New Mexico

The New Mexico Health Care Authority (HCA) licenses adult day care facilities under 8.370.20 NMAC, Requirements for Adult Day Care Facilities, which took effect July 1, 2024. The rule treats these programs as health facilities that must be licensed under the state Public Health Act. The older adult day care rule at 7.13.2 NMAC is now listed as repealed.

HCA also runs New Mexico Medicaid. Its community benefit rule, 8.308.12 NMAC, covers adult day health for managed care members who meet nursing facility level of care.

Types of adult day programs in New Mexico

The licensing rule applies to public or private facilities that care for three or more non-resident adults for less than 24 hours of any day. Participants must be ambulatory, or mobile non-ambulatory and able to move on their own or in a wheelchair with minimal assistance.

• Adult day care center: A commercial building where care, services and supervision are provided to three or more adults with diminished mental or physical capacity. Centers have no maximum licensed capacity.
• Adult day care home: A private residence licensed to serve at least three but not more than five adults.
• New or innovative programs: Programs for three or more adults with special needs that fit neither model. HCA may license them at its sole discretion, with variances, after reviewing a proposal.

How to get licensed in New Mexico

Under 8.370.20.9 NMAC, an initial license application includes:

1. A complete application that is typed or printed, dated, signed and notarized, with the required fee.
2. For centers, floor plans, zoning and building approvals, fire authority approval and, where applicable (for example, kitchens), New Mexico Environment Department approval. Adult day care homes are exempt from these items.
3. Health certificates for the licensee, caregivers and staff, plus a custodial drug permit if the facility will supervise or safeguard medications.
4. An equipment list and a description of activities and the daily schedule.
5. An initial survey. HCA issues the license if the survey shows compliance.

An annual license runs for one year. A temporary license can be issued for up to 120 days, with no more than two in a row. Renewal applications, notarized and with the fee, are due at least 30 days before expiration, and a facility that misses renewal must stop operating and apply again as a new facility.

Key requirements

• Staffing ratio: Centers need one full-time-equivalent direct care staff position for each five participants, and homes one for no more than five participants. Ratios must be maintained at all times (8.370.20.59 NMAC).
• Supervision: Participants must never be left unattended, and staff must be physically present with them at all times (8.370.20.60 NMAC).
• Director: A center needs a full-time program director who is at least 18, holds a baccalaureate in geriatrics or a related health field or is a registered nurse, and has at least two years of experience and training in services to elderly or handicapped adults (8.370.20.55 NMAC).
• Staff screening and training: Qualifications, references and employment history must be verified before employment. The rule sets at least 40 documented clock hours of training per year of employment for centers and 24 per year of licensure for homes (8.370.20.54 and 8.370.20.58 NMAC).
• First aid: At all times, one staff member on duty must hold a current first aid certificate and have completed an approved CPR course (8.370.20.66 NMAC).
• Space and meals: At least 40 square feet of activity area for each adult in the licensed capacity. Each meal must provide at least one-third of an adult's daily nutritional requirement, and participants may not go more than three hours without being offered a meal or snack (8.370.20.30 and 8.370.20.73 NMAC).
• Medications: A facility that supervises self-administration or safeguards medications needs a custodial drug permit from the state Board of Pharmacy (8.370.20.76 NMAC).
• Surveys: HCA surveys each facility at least once a year and may make unannounced visits. A plan of correction is due within 10 working days of receiving the survey report (8.370.20.20 NMAC).

Medicaid funding for adult day in New Mexico

Turquoise Care is the New Mexico Medicaid managed care program that began July 1, 2024. Its four managed care organizations (MCOs) all cover the same long-term services and supports, and members must meet nursing facility level of care to receive community benefit services.

Under 8.308.12 NMAC, adult day health is a covered service in the agency-based community benefit (ABCB), the option for members who do not self-direct. A licensed community-based adult day care facility provides structured therapeutic, social and rehabilitative services that are part of the member's care plan. Private duty nursing and skilled maintenance therapies may be provided in the adult day health setting but are reimbursed separately.

Adult day health settings must be integrated and support full access to the greater community for people receiving Medicaid home and community-based services. The member's care plan goes to the MCO for review and approval.

Billing basics

Because adult day health is a Turquoise Care benefit, centers work with each member's MCO. The official sources reviewed for this guide did not list procedure codes, billing units or claim formats for adult day health, so confirm them with each MCO before billing.

8.308.12 NMAC requires electronic visit verification (EVV) for payment of personal care services. The rule does not mention EVV for adult day health.

Other ways centers are paid

Enrolled veterans who meet VA eligibility and clinical criteria can get Adult Day Health Care through the VA, which may be provided at VA medical centers, State Veterans Homes or community organizations.

Official resources

• New Mexico Health Care Authority
• 8.370.20 NMAC: Requirements for Adult Day Care Facilities
• 8.308.12 NMAC: Community Benefit
• HCA: Turquoise Care
• HCA: Community Benefit Program
• VA Adult Day Health Care

Frequently asked questions

Do I need a license to open an adult day center in New Mexico?

Yes, if you care for three or more non-resident adults for less than 24 hours a day. HCA licenses adult day care centers, adult day care homes and approved new or innovative programs under 8.370.20 NMAC.

Does New Mexico Medicaid pay for adult day care?

Yes. Adult day health is an agency-based community benefit service in Turquoise Care for members who meet nursing facility level of care, delivered through the member's MCO.

Who inspects adult day centers in New Mexico?

HCA surveys each licensed facility at least once a year and may make unannounced visits.