New Hampshire - Adult Health Transportation — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

The New Hampshire Department of Health and Human Services (DHHS) authorizes Adult Health Transportation as a direct-bill waiver service under the Choices for Independence (CFI), Developmental Disabilities (DD), and Acquired Brain Disorder (ABD) waivers. Providers must enroll through the NH MMIS Health Enterprise Portal and obtain a National Provider Identifier (NPI) to bill for non-emergency medical and community transportation.

Standard Medicaid non-emergency medical transportation (NEMT) is managed through managed care health plan transportation brokers, requiring providers to secure network contracts with the brokers for WellSense, NH Healthy Families, and AmeriHealth Caritas. Waiver transportation providers must complete the Bureau of Developmental Services (BDS) direct-billing enrollment process and pass federal Program Integrity screenings before receiving authorization to transport waiver participants.

1. Service Definition and Scope

In New Hampshire, Medicaid transportation services encompass Non-Emergency Medical Transportation (NEMT) to covered medical appointments and specialized transportation authorized under Home and Community-Based Services (HCBS) waivers. NEMT is strictly for individuals with no other means of transportation to receive Medicaid-covered services.

Waiver transportation extends beyond medical appointments to include community access, employment transportation, and recreational travel as outlined in a participant's Individualized Service Plan (ISP). Services must be provided in the least costly and most appropriate mode.

• Non-Emergency Medical Transportation (NEMT): Rides to Medicaid-covered medical appointments, therapies, and healthcare services.
• Community Access Transportation: Travel to community centers, social events, and support groups authorized under HCBS waivers.
• Employment Transportation: Rides to work or vocational training for waiver participants.
• Specialized Transport: Vehicles equipped for wheelchairs, mobility aids, and accessible seating.
• Family and Friends Mileage Reimbursement: A program allowing enrolled friends or family to be reimbursed for mileage by the health plan's broker.

2. Regulatory and Oversight Agencies

The New Hampshire Department of Health and Human Services (DHHS) oversees all Medicaid services, with specific waiver operations managed by the Bureau of Developmental Services (BDS) and the Bureau of Elderly and Adult Services (BEAS).

Provider enrollment and claims processing are managed through the NH MMIS Health Enterprise Portal, operated by the state's fiscal agent, Conduent.

• New Hampshire Department of Health and Human Services (DHHS): Administers Medicaid and oversees program integrity. https://www.dhhs.nh.gov/
• Bureau of Developmental Services (BDS): Manages the DD, ABD, and IHS waivers. https://www.dhhs.nh.gov/programs-services/disability-care/developmental-services
• Bureau of Elderly and Adult Services (BEAS): Manages the Choices for Independence (CFI) waiver. https://www.dhhs.nh.gov/programs-services/adult-aging-care
• NH MMIS Health Enterprise Portal (Conduent): Processes provider enrollment applications and Medicaid claims. https://nhmmis.nh.gov/portals/wps/portal/ProviderEnrollment
• WellSense Health Plan: Managed care organization utilizing a transportation broker for NEMT. https://www.wellsense.org/

3. Gatekeeping Prerequisites: Who Can Even Apply

New Hampshire does not issue a distinct "Adult Health Transportation" facility license; instead, market entry is gated by managed care broker contracting and waiver direct-bill mandates. To provide standard NEMT, an agency must be accepted into the closed network of the transportation brokers contracted by the state's Medicaid Care Management (MCM) plans.

For waiver transportation, providers must comply with the BDS direct-billing mandate implemented in 2023. Providers must obtain an NPI and enroll directly in the NH MMIS, even if they choose to use a third-party billing entity.

• Managed Care Broker Contracting: Standard NEMT providers must secure a contract with the transportation brokers managing rides for WellSense, NH Healthy Families, and AmeriHealth Caritas.
• BDS Direct Bill Mandate: Waiver providers must enroll for direct billing through the NH MMIS Enterprise Portal to serve DD, ABD, and IHS waiver participants.
• National Provider Identifier (NPI): Organizations must obtain a Type 2 NPI from NPPES before applying to NH Medicaid.
• Business Registration: Entities must be registered and in good standing with the New Hampshire Secretary of State.

4. Licensure and Certification Requirements

Because DHHS does not license transportation providers as health facilities, compliance defaults to standard commercial transportation regulations enforced by the New Hampshire Department of Safety. Providers must maintain appropriate commercial vehicle registrations, inspections, and insurance.

Waiver providers must also meet the specific certification standards outlined in the respective HCBS waiver appendices, which require adherence to DHHS safety, training, and vehicle maintenance policies.

• Vehicle Registration: All transport vehicles must be registered commercially with the NH Department of Safety.
• Safety Inspections: Vehicles must pass standard and commercial NH state safety inspections.
• Insurance Requirements: Providers must maintain general liability, professional liability, and commercial auto insurance.
• Waiver Certification: Providers must be certified by BDS or BEAS to provide services under specific HCBS waivers.

5. Medicaid Provider Enrollment

Enrollment is conducted entirely online via the NH MMIS Health Enterprise Portal. Applicants must select the "Developmental Services Group" provider type and add the specific transportation specialty codes they intend to bill.

The application requires submission of a signed Provider Participation Agreement (PPA), a W-9, and Electronic Funds Transfer (EFT) documentation. All enrolling providers undergo a federally mandated comprehensive screening.

• NH MMIS Portal: The central hub for submitting the provider enrollment application. https://nhmmis.nh.gov/portals/wps/portal/ProviderEnrollment
• Provider Participation Agreement (PPA): Must be signed and uploaded with the application.
• IRS Verification: A copy of a signed W-9 and an FEIN/IRS verification letter must be provided.
• Electronic Funds Transfer (EFT): Providers must submit an EFT Agreement Form, EFT Application Form, and a bank letter or voided check.
• Specialty Selection: Applicants must accurately select transportation specialties under the Developmental Services Group.

6. Staffing, Training and Background Checks

Transportation providers must ensure all drivers meet strict background and training requirements. This includes criminal background checks, driving record checks, and specialized training for handling mobility aids.

Crucially, providers are federally required to search all employees and contractors against the HHS-OIG List of Excluded Individuals/Entities (LEIE) on a monthly basis.

• LEIE Screening: Monthly checks of all staff against the HHS-OIG List of Excluded Individuals/Entities are mandatory.
• Background Checks: Drivers must pass state and federal criminal background checks.
• Driving Records: Clean motor vehicle records (MVR) are required for all active drivers.
• Defensive Driving: Drivers must complete approved defensive driving courses.
• Passenger Assistance Training: Required for drivers operating specialized transport vehicles or assisting individuals with mobility aids.

7. Documentation, Policies and Records

Providers must maintain comprehensive records to survive DHHS Program Integrity audits. This includes detailed trip logs, vehicle maintenance records, and staff credentialing files.

Policies must clearly outline trip scheduling, passenger assistance protocols, HIPAA compliance, and grievance handling procedures.

• Trip Logs: Must document the date, time, pickup/drop-off locations, participant name, and driver signature for every billed ride.
• Maintenance Records: Logs of all vehicle inspections, repairs, and routine maintenance.
• Staff Files: Must contain current licenses, training certificates, and proof of monthly LEIE screenings.
• Policy Manual: Must include safety protocols, passenger rights, and emergency procedures.
• Change Reporting: Providers must submit change forms to MMIS when ownership, managing employees, or contact information changes.

8. Billing, Rates and Claims

Claims for waiver transportation are submitted directly into the NH MMIS for real-time adjudication, or through an authorized third-party billing vendor using an Electronic Remittance Advice (ERA) application.

Providers must verify client eligibility for Medicaid and specific waivers through the MMIS portal prior to providing services. Rates are established by DHHS and published in the Medicaid fee schedules.

• MMIS Direct Submission: Electronic claims can be submitted directly into the MMIS portal.
• Trading Partner Agreement: Required if using a third-party billing agent or vendor software.
• ERA Application: Must be submitted to receive 835 electronic remittance transactions.
• Eligibility Verification: Providers must verify active Medicaid and waiver status via the MMIS portal or call center before transport.
• Revalidation: All providers must revalidate their Medicaid enrollment every 5 years.

9. Approval Sequence and Timeline

The approval process begins with business formation and obtaining an NPI, followed by securing any necessary broker contracts or submitting the MMIS application for waiver services.

After MMIS submission, DHHS and Conduent conduct federal screenings. Approved providers receive a welcome letter via US mail containing their effective date and MMIS portal access instructions.

• Step 1: Obtain EIN and Type 2 NPI.
• Step 2: Register business with NH Secretary of State and secure commercial insurance.
• Step 3: Submit application and required forms via NH MMIS Health Enterprise Portal.
• Step 4: Undergo DHHS Program Integrity federal screening.
• Step 5: Receive DHHS Welcome Letter and MMIS portal access credentials.

10. Common Denials and Survey Findings

Applications are frequently delayed or denied due to missing documentation, such as unsigned PPAs, missing W-9s, or failure to provide IRS FEIN verification.

During post-enrollment audits, the most common Program Integrity findings involve failure to conduct or document monthly LEIE screenings and inadequate trip log documentation.

• Missing Signatures: Failure to sign the Provider Participation Agreement or application signature page.
• LEIE Failures: Employing sanctioned individuals or failing to document monthly LEIE checks.
• Incomplete Trip Logs: Missing pickup/drop-off times or driver signatures on billed claims.
• EFT Errors: Mismatched bank letters or voided checks delaying electronic payment setup.
• Lapsed Credentials: Expired driver licenses or vehicle registrations found during audits.

11. Key Contacts and Resources

Providers should utilize the NH MMIS portal for application tracking and claims submission. The NH Medicaid Provider Relations call center is the primary contact for enrollment and billing issues.

For program integrity concerns or to report sanctioned individuals, providers must contact the DHHS Program Integrity unit directly.

• NH Medicaid Provider Relations (Conduent): 1-866-291-1674 or [email protected]
• NH MMIS Provider Enrollment Portal: https://nhmmis.nh.gov/portals/wps/portal/ProviderEnrollment
• DHHS Program Integrity: [email protected]
• Bureau of Developmental Services (BDS): https://www.dhhs.nh.gov/programs-services/disability-care/developmental-services
• NPPES (NPI Registry): https://nppes.cms.hhs.gov/

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