New Mexico Department of Health
Crisis Care Credentialing Registration

On December 4 Governor Michelle Lujan Grisham issued Executive Order 2020-083 which introduced the concept of COVID-Credentialed Practitioners as part of the state’s effort to combat the relentless spread of the COVID -19 virus and the accompanying threat to the New Mexico healthcare delivery system. That document defined two practitioner groups COVID-19 Credentialed Physicians and COVID-19 Credentialed Advanced Practice Clinicians who after being designated by the Secretary of Health shall be considered public employees for the purposes of the Tort Claims Act. The Order also directed the Secretary of Health to develop a process by which these COVID-19 Credentialed Providers shall be identified and appointed.

The Public Health Order of December 9, 2020 issued by Acting Secretary Billy Jimenez provided additional detail to those definitions. The COVID-19 Credentialed Providers “…shall only be considered public employees for purposes of the Tort Claims Act to the limited extent and in the limited circumstances in which such Credentialed Providers provide medical care outside of their normal and privileged scope of practice in a hospital acute care setting to a person infected with the COVID-19 virus or to a person reasonably believed to be infected with the COVID-19 virus.” The December 9th Public Health Order also introduced the process by which qualified physicians and advanced practiced clinicians could apply for the designation of COVID-19 Credentialed Providers. That application form is attached, and this document serves as a guide for completion of that application process.

The December 9th PHO identifies the key determinants of whether the Secretary shall grant that designation as 1.) the applicant’s primary scope of practice, 2.) the nature of the proposed COVID-19 scope of practice, and 3.) the extent of deviation between the two. Thus, applicants should provide as much detail as possible about their current practices and the anticipated services to be provided. A listing of unique training, background, experiences, and/or procedural skills of the applicant will help clarify the value to be delivered. It will also be helpful for the applicant to estimate the available time that might be dedicated to the COVID-19 Credentialing practice.

Because one of the main purposes of the COVID Credentialing is to strengthen the ability of the health system to respond to the pandemic crisis, the application process requires proof of the alignment or agreement between the applicant’s anticipated clinical services and the needs of the facility in which the proposed clinical services shall be performed.

Contact Info
First Name
Last Name
Middle Name
Date Of Birth
Gender
Home Email Address
Home Phone Number
Pager/Answering Service
Home Street Address
City
State
Zip Code
Qualifications
Professional Degree
Other Degree

State License Number
NPI - Individual
Relevant Training, Skills, And/Or Experience
Usual Practice Location
Institution/Group/Clinic Name (if applicable)
Office Manager
Street Address
City
State
Zip Code
Phone Number
Fax Number
Usual Scope Of Practice
Proposed COVID-19 Practice Location
Institution/Group/Clinic Name (if applicable)
Office Manager
Street Address
City
State
Zip Code
Phone Number
Fax Number
Proposed COVID-19 Clinical Services
Certification

I certify that:

Applicant's Name
Date
Signature