New Mexico
New Mexico’s Medicaid agency and its state plan are the official source for these rules. This page summarizes them as researched in October 2026; check the state’s own documents, listed under Sources, before relying on them.
At a glance
- Rate method
- Other
- Case-mix level
- Resident-level
- Classification
- State index
- Rate updates
- Once a year
- Managed care (LTC)
- Yes
- Quality program
- HCQS-VBP + NF VBP
- Paid outside the rate
- Moderate
- Bed hold
- Hospital and leave
- Published rates
- Not published
- Assisted living
- Covered
- Personal needs allowance
- $94 / month
Overview
- Each home has two legacy, facility-specific per diems: a High NF rate and a Low NF rate.
- They come from the 1984 cost-related prospective system (8.312.3 NMAC: own cost up to 110% of the median operating cost, plus a capped facility-cost component) and the 1990 SNF/ICF conversion.
- In practice the rates are no longer reset to each home's current cost every three years.
- Instead they are rolled forward by uniform statewide steps: a CMS market basket increase each July 1 (4.7% for SFY2026), legislated flat increases (+$14.19 High / +$9.69 Low from 8/1/2024) and a uniform 9.23% '50% rebase' on 7/1/2025.
- Then a flat provider-tax (HCQS) add-on is placed on top ($26.75/day for homes with 60+ beds in SFY2026).
- Turquoise Care MCOs pay these rates as contract floors.
What matters in New Mexico
- Every home has two rates: High NF and Low NF. Each resident is paid one or the other based on an MCO level-of-care review.
- Rates are old home-specific cost rates moved forward by uniform steps: +9.23% rebase and +4.7% inflation on 7/1/2025.
- $26.75/day provider-tax add-on for homes with 60+ beds; homes under 60 beds get no add-on and pay no surcharge.
- Nearly all nursing home days are paid by Turquoise Care MCOs, which cannot pay less than the state fee-for-service rate.
- Quarterly quality money (HCQS-VBP and NF VBP directed payments) is paid on top of the per diem; pool sizes are not published.
- MCOs must pay full Medicare coinsurance on dual-eligible crossover claims, including Medicare Advantage cost sharing.
Frequently asked
Does New Mexico Medicaid use MDS case mix to set nursing home rates?
No. New Mexico uses two level-of-care tiers. Each home has a High NF and a Low NF rate, and each resident is paid one of them based on MCO review under the 2019 criteria. For example, High NF needs 2+ high-level needs or more than 300 therapy minutes a week.
How did New Mexico's 7/1/2025 nursing home 'rebase' change rates?
It was not a cost-report rebase per home. Each home's High and Low NF rate was raised by a uniform 9.23%, then by the 4.7% market basket. Homes with 60+ beds then got a $26.75 per Medicaid day add-on.
Which New Mexico nursing homes receive no provider-tax rate add-on?
Homes with fewer than 60 beds (Class 1, about 10 homes in July 2025) are exempt from the Health Care Quality Surcharge and get no add-on. Tribal 638 homes are paid the OMB rate instead. Out-of-state homes are also excluded.
How much is paid outside the posted rate in New Mexico?
Moderate, estimated: quarterly HCQS-VBP and NF VBP payments sit outside the posted rate; pool sizes are not published.
What does New Mexico Medicaid pay on Medicare coinsurance days?
Full: MCOs pay at least the full Medicare or Medicare Advantage coinsurance, deductible and copay.
Does New Mexico require a minimum share of spending on care?
None found for homes; the 80% HCQS fund rule limits how the state spends surcharge money.
How the rate is set
How the method got here
| Effective | From | To | Change | Headline | Source |
|---|---|---|---|---|---|
| 1984-07-01 | Retrospective cost reimbursement for SNFs and ICFs | Prospective facility-specific per diem: base-year operating cost (capped at 110% of median) + efficiency incentive + capped facility cost, rebased every three years | New Mexico adopted cost-related prospective rates with ceilings and a three-year rebasing cycle. | Prospective cost-related nursing facility rates adopted | https://www.law.cornell.edu/regulations/new-mexico/N-M-Admin-… |
| 1990-10-01 | Separate SNF and ICF rates | Two rates per nursing facility: High NF and Low NF, chosen per resident by level of care | With OBRA '87 ending the SNF/ICF split, each home got a High NF and a Low NF rate based on its old SNF and ICF rates. | High NF and Low NF rates replace SNF/ICF | https://www.law.cornell.edu/regulations/new-mexico/N-M-Admin-… |
| 2014-01-01 | Fee-for-service nursing facility payment (and earlier CoLTS managed LTSS for some members) | Centennial Care 1115 managed care: MCOs pay nursing facility care for nearly all members | Nursing home care moved into Centennial Care MCOs, with the state FFS rates as the floor. | Nursing home care moves into Centennial Care | https://www.hca.nm.gov/wp-content/uploads/files/8_038_12-NMAC… |
| 2020-01-01 | Legacy rates with discretionary inflation and no provider tax | Health Care Quality Surcharge: per non-Medicare day tax, mandatory annual MBI increase, flat add-on and quarterly quality payments via MCO directed payments | The 2019 Health Care Quality Surcharge Act created a nursing home provider tax that funds a yearly market basket increase, a per-day add-on and quality payments. | Health Care Quality Surcharge funds annual increases | https://www.nmlegis.gov/Sessions/19%20Regular/final/SB0246.pdf |
| 2024-07-01 | Centennial Care 2.0 MCOs | Turquoise Care MCOs (BCBS, Presbyterian, Molina, UnitedHealthcare), same NF floor and directed payments | Managed care moved from Centennial Care 2.0 to Turquoise Care; nursing home payment rules carried over through new LODs. | Turquoise Care replaces Centennial Care | https://www.hca.nm.gov/wp-content/uploads/FINAL-LOD-49-Nursin… |
Verified October 11, 2026
Cost basis
- Uses cost reports
Yes
- Cost report
N.M. Title XIX cost reporting form (state financial and statistical report), filed within 150 days of fiscal year end; step-down cost finding; desk audit of every report and field audit at least every 3 years (8.312.3.11 NMAC). Ventilator costs must be kept as a distinct part (8.312.2.13 NMAC).
- Base year and rebasing
Rule text: rebase every three years from the fiscal-year cost report in the calendar year before Year 1. Rebased costs are capped at 110% of the prior audited cost per diem x index. 'Pursuant to budget availability ... the decision to rebase rates will be at the department's discretion' (8.312.3.12 NMAC, amended 9/1/2021). In practice no facility-specific rebase was found in recent years. The SFY2026 '50% rebase' (2025 legislative appropriation) was a uniform 9.23% increase to every home's High and Low NF rate, effective 7/1/2025, called a 'permanent increase to NF negotiated base rates' (LOD 29-2).
- Components
Component Method Notes operating cost (all routine care: nursing, dietary, admin, supplies) Own allowable base-year operating cost per day, indexed, capped at 110% of the median of base-year allowable costs by category (state-owned vs non-state). Homes below the cap get an efficiency incentive of 1/2 x (ceiling - own cost) (8.312.3.12-13 NMAC). Rule text; current rates are the result of these formulas frozen at some past point and then trended by uniform factors. facility cost (depreciation, lease, long-term interest) Lower of actual allowable facility cost or the facility cost ceiling ($11.50 in 1984, trended annually by MBI). New homes are capped at the median; new construction is capped at R.S. Means median cost; leases are limited by a discounted cash flow test. 90% occupancy is imputed for new homes and bed additions since 1/1/1988 (8.312.3.14 NMAC). High NF / Low NF split Two rates per home since 10/1/1990. They were set from the home's 9/30/1990 SNF and ICF rates (plus or minus the statewide mean SNF/ICF operating differential), with reform add-ons of $3.69 (High) and $4.96 (Low) (8.312.3.16 NMAC). Private homes' Low NF rate +4% from 7/1/2015 (4.19-D p.11, TN 15-13). legislated flat increases From 8/1/2024: +$14.19/day to each in-state home's High NF FFS rate and +$9.69/day to its Low NF rate (SPA NM 24-0007, approved 12/18/2024). From 7/1/2025: uniform 9.23% '50% rebase' on both rates (LOD 29-2). HCQS market basket increase + per diem add-on Each July 1: rate x (1 + CMS SNF market basket), then + a uniform per Medicaid day add-on by HCQS class. SFY2026: MBI 4.7%; add-on $26.75 (Class 2) / $9.36 (Class 3) / $0 (Class 1). Earlier MBIs: 2.8% (1/1/2020), 2.8% (SFY21), 2.2% (SFY22), 2.7% (SFY23), 5.4% (SFY24), 6.6% (SFY25). The add-on is not applied to bed-hold days. It is applied to Medicaid hospice room-and-board days. - Inflation
CMS SNF market basket index (MBI), applied every July 1 to the whole rate (before the add-on) under the Health Care Quality Surcharge Act (§7-41-6 NMSA requires increases of 'at least the rate of nursing home inflation'). SFY2026 = 4.7%. The rule (8.312.3.12) also allows MBI at the department's discretion.
Verified October 11, 2026
Case mix
- System
State index
- Applied at
Resident-level
- How it works
There is no MDS case-mix index. Each resident is paid the home's High NF or Low NF per diem, depending on that resident's MCO level-of-care determination (2019 NF LOC Criteria; Policy Manual §6.4).
- Classification
Two-tier state level-of-care: Low NF = 2+ ADLs needing daily skilled, intermediate or assistance-level help; High NF = Low NF criteria plus at least 2 High NF factors (or more than 300 therapy minutes per week). The criteria say these are 'constructs for payment methodologies'. Not RUG or PDPM.
- Applies to
Whole per diem (separate High and Low NF rates per home).
- Acuity measured from
Not applicable. Authorization length: initial High NF up to 30 days, continued High NF up to 90 days; initial Low NF up to 90 days, continued Low NF up to 365 days. MCOs upgrade or downgrade requests that do not match the criteria.
- Updated
Per resident at each LOC review (High NF every 30-90 days; Low NF up to annually).
- Move to PDPM
None needed; New Mexico never used RUG-based Medicaid case mix for NF rates.
Verified October 11, 2026
Low-acuity residents
Yes. (1) Low NF: residents who meet only the Low NF criteria are paid the home's Low NF rate, not the High NF rate (8.312.3.16 NMAC; 2019 LOC criteria). From 8/1/2024 the legislated step was smaller for Low NF (+$9.69 vs +$14.19). (2) Discharge Status: residents who no longer meet NF level of care but have no community placement are kept at the Low NF rate for up to 90 days initially, then 180-365 days (Policy Manual §6.14). (3) Non-skilled, non-hospice short stays under 90 days (revenue code 0190) need no NF LOC and are paid the home's contracted Low NF rate (LOD 111, 2/26/2024; Policy Manual §6.20). (4) Therapy for Low NF residents is billed separately by therapy providers but is included in the High NF rate (8.312.2.13 NMAC). The High/Low gap per home was not found.
Verified October 11, 2026
Capital
Facility-cost component inside each home's legacy rate: lower of actual depreciation, lease and long-term interest or the facility cost ceiling ($11.50 in 1984, trended by MBI). New construction is capped at R.S. Means median cost, leases are limited by a discounted cash flow test, and 90% occupancy is imputed for new or expanded homes (8.312.3.11-14 NMAC). No fair rental value system. Capital is not reset with current costs because rates now move by uniform factors.
Verified October 11, 2026
Budget adjustment factor
No across-the-board cut factor found. Rebasing and MBI are formally 'pursuant to budget availability' (8.312.3.12 NMAC), but HCQS law requires at least MBI each year. The SFY2026 rebase was funded at 50% (uniform 9.23% instead of a full rebase).
Verified October 11, 2026
Add-ons and money outside the rate
Paid outside the posted rate
- Level
moderate
- Estimate
Estimated 5-20% of base, not measured. The HCQS add-on (about $27/day on a High/Low rate likely in the $200s) is inside the per diem. Off-rate money is the quarterly HCQS-VBP and NF VBP payments. Their pool sizes are not in the LODs; the first HCQS round (2020) was part of a $46.2M package. The level is a judgment and could be 'small'.
- Components
HCQS-VBP quality directed payment (quarterly, size not published); NF VBP directed payment incl. High Acuity pool (quarterly, size not published). No UPL/IGT program for public homes.
Verified October 11, 2026
Payments by owner type
- Applies
yes
- Detail
(1) Tribal 638 nursing facilities (e.g. Mescalero Care Center appears in the HCQS list) are paid the all-inclusive IHS/OMB outpatient per-visit rate as a daily rate for both High and Low NF since 8/18/2023, likely well above standard rates. They get no HCQS add-on or MBI but can earn HCQS quality payments. (2) State-owned and state-operated NFs (Fort Bayard Medical Center, NM State Veterans Home, NM Behavioral Health Institute) form a separate ceiling category under 8.312.3.13 NMAC. They are in HCQS Class 2 like private homes. No county or public IGT supplemental payment exists.
- Funding
Tribal OMB rate: federal 100% FMAP for IHS/638 services. No IGT arrangement found.
Verified October 11, 2026
Quality program
- Active
Yes
- Program
(1) HCQS quality payments, renamed the HCQS-VBP State Directed Payment for SFY2026, funded by the Health Care Quality Surcharge (§7-41-6 NMSA requires quarterly performance-based supplemental payments). (2) Nursing Facility Value Based Purchasing (NF VBP), an MCO directed payment effective 1/1/2020 (LOD 49 reissued for Turquoise Care 7/1/2024). Both are listed in Turquoise Care contract Attachment 10.
- Funding
HCQS-VBP: provider surcharge revenue plus federal match, paid through MCO capitation as a separate payment term (438.6(c) directed payment). NF VBP: added to LTSS capitation cohorts. No IGT.
- Size
Not published in the sources reviewed. First HCQS payments (April 2020) were part of $46.2M in new NF payments (HSD press release 5/1/2020).
- Paid as
Quarterly lump-sum payments from MCOs to homes, outside the per diem. NF VBP has foundational, secondary and per diem add-on payments based on Medicaid bed days and scores; unspent funds go to a High Acuity pool for days with defined diagnosis codes.
- Measures
Measure Source Weight How points are earned Long-stay prevalence of pressure ulcers MDS QM Scored by HCA data intermediary Long-stay falls with major injury MDS QM Scored by HCA data intermediary Long-stay weight loss MDS QM Scored by HCA data intermediary Long-stay worsened ADL function MDS QM Scored by HCA data intermediary Long-stay hospitalization claims/MDS Scored by HCA data intermediary Infection control program (structural) quarterly facility attestation Met / not met against auditable requirements Patient experience (structural) quarterly facility attestation Met / not met Behavioral health care coordination (structural) quarterly facility attestation Met / not met CMS Five-Star health inspection score survey Not stated in LOD - Scoring period
Quarterly. SFY2026 quarters paid about 4 months after quarter end (Q1 Jul-Sep 2025 -> 1/30/2026; Q4 Apr-Jun 2026 -> 10/30/2026), and only after CMS approves the directed payment; retroactive if approval is late.
- Payment formula
Not published in the LODs. Scores come from an HCA-selected data intermediary using MDS submissions and are paid per Medicaid bed day, split among MCOs by their share of each home's Medicaid days.
- Eligibility
In-state Medicaid-certified homes; out-of-state homes are excluded. NF VBP is voluntary: the home must have Medicaid days, contract with 1+ MCO, submit MDS to the data intermediary and sign a data use agreement. Tribal 638 homes may join the HCQS quality part only.
- Cadence
Quarterly.
- Scores published
No; dashboards and scorecards go to homes, MCOs and HCA through the data intermediary.
- Notes
SFY2025 HCQS quality measures were only four (LS falls with major injury, depression symptoms, flu vaccine, pneumococcal vaccine; LOD 29-1). SFY2026 replaced them with the nine above.
Verified October 11, 2026
Provider tax
- Charged
per non-Medicare day
- Standard amount
Uniform rate per non-Medicare bed day set by HCA by June each year for the fiscal year, so total revenue equals about 6% of aggregate prior-year net revenue (§7-41-4 NMSA; SB 246 (2019) §4). HCA sends each home's quarterly amount to the Taxation and Revenue Department, which collects it through the TAP portal (LOD 29-2). The dollar rate itself is not published. The per diem add-on mirrors it: §7-41-6(B)(1) says the fund's first use is to raise per diems by 'the medicaid share of the health care quality surcharge as a pass-through', LOD 29-2 calls the add-on the 'surcharge add-on amount', and the Class 3 add-on ($9.36) is exactly 35% of the Class 2 add-on ($26.75), matching the 65% exemption. This implies a SFY2026 surcharge of about $26.75 per non-Medicare day, which HCA has not stated directly.
- Tiers
Who Test Amount Class 1: homes with fewer than 60 beds (about 10 homes in the 7/1/2025 list) size exempt (and no per diem add-on) Class 2: 60+ beds and under 90,000 annual Medicaid bed days (about 56 homes) volume standard surcharge; add-on $26.75 per Medicaid day SFY2026 Class 3: 60+ beds and 90,000+ annual Medicaid bed days (none listed in 7/1/2025 classification) medicaid_utilization 65% exemption (pays 35%); add-on $9.36 per Medicaid day SFY2026 Tribal 638 nursing facilities paid the OMB rate other do not receive the HCQS add-on or MBI (LOD 118); surcharge status not stated Out-of-state facilities other not subject; no add-on - Lower for high-Medicaid homes
yes
- Returned in the rate
Flat per Medicaid bed day add-on placed on top of each home's (MBI-inflated) High and Low NF rates: Class 2 $26.75, Class 3 $9.36, Class 1 $0 in SFY2026 (SFY2025 $24.97/$8.74; SFY2024 $24.39/$8.54; SFY2023 $24.13/$8.45). Not applied to bed-hold days. Surcharge money also funds the annual MBI and quarterly quality payments (at least 80% of the fund must go to these uses, §7-41-6).
Verified October 11, 2026
Provider tax notes
Health Care Quality Surcharge (Health Care Quality Surcharge Act, §§7-41-1 to 7-41-8 NMSA, SB 246 of 2019; collected by the Taxation and Revenue Department; started January 2020, first payments April 2020). A uniform surcharge per non-Medicare bed day (including hospice days), set annually by HCA, targeted at 6% of aggregate net revenue. Homes under 60 beds are exempt; homes with 90,000+ Medicaid days get a 65% exemption. Returned as a flat per Medicaid day add-on ($26.75 / $9.36 in SFY2026), funding of the annual MBI increase and quarterly quality payments. The original act had a 1/1/2023 repeal date, but HCA continued the program into SFY2026 (LOD 29-2), so the repeal was presumably removed or extended.
Verified October 11, 2026
Supplemental payments
(1) HCQS-VBP quality directed payment, quarterly via MCOs. (2) NF VBP directed payment, quarterly via MCOs. No UPL or IGT supplemental program for county or state-owned nursing homes was found. MACPAC 2019 recorded 'There are no supplemental payments' (2014 source). The Miners Colfax directed payment (LOD 126) covers outpatient hospital services only. COVID add-ons (30% of High NF rate for COVID-positive residents, 1/1-6/30/2022, SPA 22-0002) have ended.
Verified October 11, 2026
Other add-ons
(1) HCQS per diem add-on ($26.75 Class 2 / $9.36 Class 3, SFY2026). (2) Ventilator add-on $305.66/day for ventilator-dependent residents in DOH-certified homes, prior-authorized every 90 days (Policy Manual §6.19; 8.312.2.13C NMAC, amended 3/1/2025). (3) 1990 nursing home reform add-ons ($3.69 High / $4.96 Low) built into base rates. No COVID add-on remains.
Verified October 11, 2026
Units paid separately
(1) Ventilator-dependent residents: home's per diem + $305.66/day all-inclusive add-on; criteria include 6+ hours/day on the ventilator and a tracheostomy. (2) Tribal 638 NFs (SPA 23-0013, effective 8/18/2023): one all-inclusive daily rate equal to the IHS/OMB outpatient per-visit rate for both High and Low NF. Reserve bed days are paid at half that rate; no HCQS add-on or MBI. (3) Non-skilled short stays (<90 days) at the Low NF rate. (4) State-owned homes (e.g. Fort Bayard Medical Center, NM State Veterans Home) form a separate ceiling category (8.312.3.13 NMAC).
Verified October 11, 2026
Payment rules
Managed care for long-term care
- Status
yes
- Detail
Turquoise Care MCOs (PSC contracts, 7/1/2024+) pay nursing facility care with no day limit, using LTSS, physical health and Other Adult Group capitation cohorts. Before that, Centennial Care (2014-2018) and Centennial Care 2.0 (2019-6/30/2024) did the same. MCOs also pay non-skilled short stays (<90 days) at the Low NF rate under the physical health benefit (LOD 111; Policy Manual §6.20).
Verified October 11, 2026
Who pays
managed_ltss (Turquoise Care, since July 1, 2024; Centennial Care / Centennial Care 2.0 from January 1, 2014 to June 30, 2024). Four MCOs: BCBS of NM, Presbyterian, Molina, UnitedHealthcare. MCOs pay both short-term and long-term NF stays. Fee-for-service remains for people not enrolled in managed care (e.g. some Native American members who opt out) and for retroactive or pending periods. The FFS share of NF days was not found.
Verified October 11, 2026
Managed care rate floor
Yes. The Turquoise Care contract §4.8.1: the MCO 'may negotiate different reimbursement amounts ... but shall not be negotiated to be less than HCA's FFS rate.' §4.10.4.1.2: out-of-network NFs get 100% of the Medicaid fee schedule rate. LOD 29-2 calls the High and Low NF rates 'fee-for-service floor rates' and 'negotiated base rates'. It orders MCOs to apply each July 1 increase (rebase %, MBI %, HCQS add-on) to those negotiated rates. Sources: https://www.hca.nm.gov/wp-content/uploads/Turquoise-Care-Mode… ; https://www.hca.nm.gov/wp-content/uploads/FINAL-LOD-29-2-SFY2…
Verified October 11, 2026
Included in the daily rate
Routine services: room, dietary, nursing, medical/surgical supplies, oxygen administration, incontinence care, OTC items, reusable equipment (walkers, wheelchairs), tube-feeding supplements, basic laundry (8.312.3.11 NMAC). DME is billed directly by DME suppliers. PT/OT/speech therapy is included for High NF residents but billed separately for Low NF residents (8.312.2.13 NMAC). Prescription drugs, physician and hospital services are billed separately.
Verified October 11, 2026
Bed hold
- Hospital stays
Paid: 6 reserve bed days per calendar year for hospitalization without prior approval, at 50% of the regular rate (FFS) or as negotiated with the MCO.
- Leave days
Paid: 3 reserve bed days per calendar year for a home visit without prior approval, plus 6 more with prior approval for trial placement as part of a discharge plan, at 50%.
- Occupancy rule
None.
- Notes
Paid at the rate for the resident's approved level of care (High or Low NF). The HCQS add-on is not applied to bed-hold days. A new LOC review is needed after more than 3 midnights away. Tribal 638 homes get half the OMB rate.
Verified October 11, 2026
Personal needs allowance
- Per month
94
- Effective
2024-07-01 (8.200.510.12 NMAC table, as amended eff. 4/1/2025)
- Notes
Adjusted each year by CPI (8.281.500.22B NMAC), so a 7/1/2025 or 7/1/2026 amount may be higher; not confirmed. Veterans or surviving spouses without dependents whose VA pension is reduced to $90 keep $90 (state veterans homes: $90). ICF-IID residents may keep up to $100 more of sheltered-work earnings.
Verified October 11, 2026
Medicare coinsurance days
- Method
full
- Rule
Turquoise Care contract §4.10.3.15.3: 'CONTRACTOR payments to NFs after payments by Medicare or a Medicare Advantage Plan cannot be less than the sum of the co-insurance, deductible, and copayment amounts calculated by Medicare or the Medicare Advantage Plan, less any applicable Member pay amount.' MCOs pay crossover claims for short-term NF stays of dual eligibles (§4.10.3.15.1-.4). Medical care credits (patient liability) also apply to crossover coinsurance (8.312.2.20 NMAC). Separate FFS crossover limits (MAD supplement 'Payment Limitation on Co-Insurance/Co-Payments') exist but were not reviewed. Nearly all NF duals are in MCOs.
- Effect
For MCO members, the home receives the full Medicare Part A day-21-100 coinsurance (and MA cost sharing) minus any resident liability, not a lesser-of $0.
Verified October 11, 2026
Required care spending
- Applies
no
- Rule
No rule found requiring homes to spend a share of Medicaid revenue on care or staff. The HCQS Act requires the STATE to use at least 80% of the health care facility fund for tax pass-through, at least MBI increases and quality payments, with up to 20% for other Medicaid purposes (§7-41-6 NMSA). This limits the state, not homes.
Verified October 11, 2026
Occupancy rules
- Applies
yes
- Rule
Narrow: allowable facility (capital) costs are computed at an imputed 90% occupancy for homes certified on or after 1/1/1988, existing homes that add beds (all beds), larger replacement homes, and replaced or closed homes re-entering Medicaid (8.312.3.14 NMAC). Operating costs use actual days. Because rates now move by uniform factors, this mainly affects rates set when a home enters or changes.
Verified October 11, 2026
MDS accuracy penalties
None tied to case mix (no MDS-based rate). Related: MCOs may assign unexcused 'late days' (no payment) when a home submits the NF LOC packet more than 30 days after admission or a redetermination late (Policy Manual §6.11). For HCQS, short stays must be coded as Medicaid (not 'Medicaid pending') in billing and MDS to count (LOD 111).
Verified October 11, 2026
Published rates and changes
How often rates change
- A home's rate changes
annual
- When
July 1 each year: MBI applied to the High and Low NF rates and the HCQS class add-on reset. Legislated steps can fall mid-year (8/1/2024 +$14.19/+$9.69) or coincide with July 1 (7/1/2025 9.23% rebase). Per-resident pay changes whenever an MCO LOC review moves a resident between High NF and Low NF.
Verified October 11, 2026
When rates change
July 1 state fiscal year (8.312.3.12E NMAC; HCQS LODs). LODs often come out late and are retroactive (e.g. SFY2025 LOD 29-1 issued 11/15/2024, retroactive to 7/1/2024). HCQS classification is set as of July 1.
Verified October 11, 2026
Posted rates
- Home-level rates published
No
- Where
No public facility-by-facility High/Low NF rate list was found on hca.nm.gov. HCA posts the HCQS facility classification (provider ID, NPI, FEIN, DOH license, beds, class) as an attachment to each annual HCQS LOD, plus the uniform increase factors.
- Format
pdf (LOD attachments)
- Cadence
Annual (July 1 LOD).
- History
HCQS LODs back to SFY2022 (LOD 65) found on hca.nm.gov / archive.org.
- Home identifier
HCQS lists use the NM Medicaid provider ID, NPI, FEIN and DOH license number.
Verified October 11, 2026
Rate build-ups
- Published
No
- Where
None found. LODs show the formula (prior rate x (1 + rebase %) x (1 + MBI) + class add-on) with worked examples, but not per-home figures.
- What they show
Formula and class add-on only; no per-home cost, ceiling or High/Low rate.
- Format
pdf
Verified October 11, 2026
Recent changes
| Effective | Change | Headline | Direction | Size | Source |
|---|---|---|---|---|---|
| 2023-07-01 | SFY2024 HCQS update: 5.4% market basket increase on all NF rates; add-on set at $24.39 (Class 2) and $8.54 (Class 3). | Rates raised 5.4% plus $24.39 surcharge add-on | increase | MBI 5.4%; add-on $24.13 -> $24.39 (Class 2) | https://www.hca.nm.gov/wp-content/uploads/Final-LOD-83-1-Heal… |
| 2023-08-18 | Tribal 638 nursing facilities are paid the federal OMB outpatient rate as one daily rate for High and Low NF, outside the HCQS add-on and MBI. | Tribal 638 homes paid OMB outpatient rate | structural | https://www.hca.nm.gov/wp-content/uploads/Final-LOD-118_Triba… | |
| 2024-02-26 | Non-skilled, non-hospice short stays under 90 days can be billed without an NF level of care and are paid at the home's Low NF rate. | Short non-skilled stays paid at Low NF rate | structural | https://www.hca.nm.gov/wp-content/uploads/Final-LOD-111-Nursi… | |
| 2024-07-01 | SFY2025 HCQS update: 6.6% market basket increase; add-on $24.97 (Class 2) and $8.74 (Class 3). Turquoise Care MCOs took over and reissued NF VBP (LOD 49). | Rates raised 6.6% plus $24.97 add-on | increase | MBI 6.6%; add-on $24.39 -> $24.97 (Class 2) | https://www.hca.nm.gov/wp-content/uploads/LOD-29-1-HCQS-Per-D… |
| 2024-08-01 | Legislated flat increase to every in-state home's FFS rates: +$14.19/day High NF and +$9.69/day Low NF. | Flat per diem increase of $14.19 High NF | increase | +$14.19/day High NF; +$9.69/day Low NF | https://www.hca.nm.gov/wp-content/uploads/NM-24-0007-Approved… |
| 2025-03-01 | 8.312.2 NMAC amended: ventilator per diem add-on written into rule (DOH-certified homes, MCO prior authorization every 90 days) and MCO bed-hold terms clarified. | Ventilator add-on codified in nursing facility rule | structural | $305.66/day ventilator add-on (Policy Manual) | https://www.hca.nm.gov/wp-content/uploads/8.312.2-NMAC-Nursin… |
| 2025-07-01 | SFY2026: legislature funded a '50% rebase' as a uniform 9.23% increase to every home's High and Low NF rate, then a 4.7% MBI, plus an add-on of $26.75 (Class 2) / $9.36 (Class 3). Quality measures expanded to nine. | Uniform 9.23% rebase plus 4.7% inflation | increase | +9.23% rebase, +4.7% MBI; add-on $24.97 -> $26.75 | https://www.hca.nm.gov/wp-content/uploads/FINAL-LOD-29-2-SFY2… |
Verified October 11, 2026
Assisted living
Medicaid assisted living
- Covered
yes
- Program
Community Benefit (Agency-Based Community Benefit) under the Turquoise Care 1115 demonstration (8.308.12 NMAC), delivered by MCOs. Members must meet at least Low NF level of care.
- What is paid
Services only: personal support, companion, medication oversight, 24-hour on-site response, social and recreational programming. 'Coverage does not include 24-hour skilled care or supervision or the cost of room or board' (8.308.12.13B NMAC). Residents pay room and board.
- Limits
Full-Medicaid members need no allocation. Members not otherwise Medicaid eligible need a Community Benefit allocation from the Central Registry (waitlist) managed by HCA/ADRC (Policy Manual §7). Turquoise Care MCOs must run a performance improvement project to 'Expand access to Assisted Living for Medicaid Members' (contract §4.12.2.10.1).
Verified October 11, 2026
Sources
- 8.312.3 NMAC Cost Related Reimbursement of Nursing Facilities (Cornell LII, eff. 9/1/2021) · regulation
- 8.312.2 NMAC Nursing Facilities (eff. 3/1/2025) · regulation
- LOD #29-2: SFY2026 50% NF Rebase and HCQS-VBP Per Diem and MBI Increase (7/2/2025) · agency page
- LOD #29-1: HCQS Per Diem and MBI Increase SFY2025 (11/15/2024) · agency page
- LOD #83-1: HCQS SFY2024 (9/28/2023) and LOD #83 SFY2023 · agency page
- LOD #49: Nursing Facility Value Based Purchasing (1/15/2025) · agency page
- LOD #111: Nursing Facility Short-Term Stays (2/26/2024) · agency page
- LOD #118: Reimbursement for Tribal 638 Nursing Facilities (4/7/2024) · agency page
- SPA NM 24-0007 approval (4.19-D p.11: +$14.19 High / +$9.69 Low eff. 8/1/2024) · state plan
- SPA 20-0018 Attachment 4.19-D Part 1 (proposed pages) · state plan
- SB 246 (2019) Health Care Quality Surcharge Act, final · statute
- HSD press release 5/1/2020: $46.2M new Medicaid payments to NFs (HCQS) · agency page
- Turquoise Care Model Contract, consolidated (8/31/2023) · agency page
- Turquoise Care BCBS contract Amendment 4 (Attachment 10 Directed Payments) · agency page
- MCO Policy Manual Section 6: Nursing Facilities (eff. 7/1/2024) · agency page
- MCO Policy Manual Section 7: Community Benefits (eff. 7/1/2024) · agency page
- NF Level of Care Criteria and Instructions (eff. 1/1/2019) · agency page
- 8.308.12.13 NMAC Community Benefit services (assisted living) · regulation
- 8.200.510.12 NMAC deductions (PNA $94 eff. 7/1/2024) · regulation
- 8.281.500.22 NMAC medical care credit / PNA CPI indexing and VA $90 · regulation
- LOD #126 Miners Colfax Medical Center directed payment (outpatient only) · agency page
- SPA 22-0002 Disaster Relief #14 (30% COVID NF increase, 1/1-6/30/2022) · state plan
- MACPAC 2019 compendium, New Mexico tab (baseline only) · secondary
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