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New Hampshire - Case Management Service — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

The New Hampshire Bureau of Developmental Services (BDS) funds Service Coordination and Targeted Case Management (TCM) through the Developmental Disabilities (DD), Acquired Brain Disorder (ABD), and In-Home Supports (IHS) waivers. Prospective providers must secure a Medicaid Provider ID through the NH MMIS Health Enterprise Portal and subsequently contract with one of the state's designated Area Agencies or Managed Care Organizations (MCOs) to receive authorizations and referrals.

Approval requires registering the business with the NH Secretary of State, obtaining applicable certification from the Health Facilities Administration (HFA), and enrolling under Provider Type 236 for waiver services or the distinct TCM provider type. The state is actively transitioning to conflict-free case management, requiring direct-bill enrollment for all entities providing these coordination services rather than routing all billing exclusively through Area Agencies.

1. Service Definition and Scope

In New Hampshire, case management across the HCBS waivers is formally designated as Service Coordination or Targeted Case Management (TCM). This service encompasses comprehensive assessment, person-centered service planning, referral, and ongoing monitoring of the individual's full service package.

The state is currently implementing conflict-free case management rules mandated by the Centers for Medicare and Medicaid Services (CMS), which require the separation of service coordination functions from the delivery of direct waiver services.

2. Regulatory and Oversight Agencies

The New Hampshire Department of Health and Human Services (DHHS) oversees all Medicaid and HCBS programs. Within DHHS, the Bureau of Developmental Services (BDS) directly manages the waivers and sets policy for Service Coordination.

Facility and agency certification is handled by the Health Facilities Administration (HFA), while provider enrollment and claims are processed through the NH MMIS Health Enterprise Portal.

3. Gatekeeping Prerequisites: Who Can Even Apply

New Hampshire utilizes a highly structured regional system for developmental services. While the state is opening up direct billing, providers must still navigate established regional and managed care networks to operate.

Before submitting a Medicaid application, entities must register their business with the state. Furthermore, access to clients requires affiliation with regional Area Agencies or contracting with the state's designated MCOs.

4. Licensure and Certification Requirements

Providers must comply with the General Court of NH Chapter He-M Administrative Rules, which govern developmental services and service coordination standards.

Depending on the exact corporate structure and service location, providers must work with the Health Facilities Administration (HFA) to obtain necessary agency certifications after initiating Medicaid enrollment.

5. Medicaid Provider Enrollment

Enrollment is conducted entirely online through the NH MMIS Health Enterprise Portal. Providers must submit a Group Provider Enrollment Application as a Facility or Entity.

Waiver service coordinators enroll under a specific provider type, while State Plan TCM providers use a different designation. The system generates an Application Tracking Number (ATN) to monitor status.

6. Staffing, Training and Background Checks

Agencies must ensure that all individual staff members rendering Service Coordination meet state qualifications and are properly affiliated with the group practice in the MMIS system.

Staff must undergo comprehensive background checks and complete training aligned with BDS policies, including the Settings Rule for the Statewide Transition Plan.

7. Documentation, Policies and Records

Providers must maintain rigorous documentation of person-centered service plans, ensuring that all assessments, referrals, and monitoring activities are recorded and accessible for state and MCO audits.

MCO contracts impose additional reporting requirements, including fraud logging and quality oversight metrics.

8. Billing, Rates and Claims

Historically, Area Agencies billed for all developmental services. Under new CMS compliance rules, providers must have the option to bill directly through the MMIS or use a third-party biller (Trading Partner).

For clients enrolled in managed care, claims must be submitted directly to the member's contracted MCO rather than the state fee-for-service system.

9. Approval Sequence and Timeline

The approval process is sequential, beginning with corporate registration and culminating in MCO credentialing. Providers cannot finalize MCO contracts without a state-issued Medicaid ID.

Applicants should expect the process to take several months, factoring in HFA certification timelines and MCO credentialing committees.

10. Common Denials and Survey Findings

Applications are frequently delayed or denied due to administrative errors in the MMIS portal, particularly regarding provider types, addresses, and staff affiliations.

Program Integrity reviews will reject applications that fail to demonstrate the required structural separation for conflict-free case management.

11. Key Contacts and Resources

Providers should utilize the DHHS Provider Relations team and the specific MCO provider portals for guidance through the enrollment and credentialing phases.

The BDS office serves as the primary policy contact for waiver-specific service coordination questions.

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