This form is only for approved New Mexico High-Fidelity Wraparound Provider Agencies to submit a request for a waiver or exception to be granted related to a specific policy or procedure in the Provider Manual and Implementation Guide. Requests will be routed to the appropriate authority and the sender will be notified of a decision within 2 weeks. If there is a time-sensitive urgency to the request please select the “urgent” box and your request will be expedited.

Name
Email
Urgency of request
X