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New Hampshire - Environmental Accessibility Service — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

In New Hampshire, Environmental Accessibility Services (EAS) are funded primarily through the Choices for Independence (CFI) Waiver and the Developmental Disabilities (DD) Waiver, overseen by the Department of Health and Human Services (DHHS). The service covers physical adaptations to a participant's home or vehicle, such as ramps, grab bars, and widened doorways, that are tied to an assessed medical or functional need and prior authorized by the state.

To become an approved EAS provider, applicants must navigate a specific gatekeeping process: they must be enrolled as a New Hampshire Medicaid provider and, crucially, must hold the appropriate occupational licenses (such as a plumbing or electrical license) if the specific adaptation requires it. Providers must also submit competitive bids for projects over $5,000 and agree to accept the waiver reimbursement as payment in full.

1. Service Definition and Scope

Environmental Accessibility Services (EAS) in New Hampshire include physical adaptations to a participant's private residence or primary vehicle. These modifications must be necessary to ensure the health, welfare, and safety of the individual, or enable them to function with greater independence, thereby preventing institutionalization.

Covered adaptations include the installation of ramps, grab bars, widening of doorways for wheelchair access, and electronic aids to daily living. The service explicitly excludes improvements of general utility, adaptations that add square footage (unless necessary for entrance/egress or bathroom configuration), and the purchase of a motor vehicle.

2. Regulatory and Oversight Agencies

The New Hampshire Department of Health and Human Services (DHHS) is the single state Medicaid agency responsible for administering the state's 1915(c) HCBS waivers, including the Choices for Independence (CFI) and Developmental Disabilities (DD) waivers. Within DHHS, the Division of Long Term Supports and Services (DLTSS) and the Bureau of Developmental Services (BDS) oversee program operations.

The Office of Program Support (OPS) conducts certification and licensing visits to ensure compliance with state laws and regulations. Providers must also interact with the state's Medicaid Management Information System (MMIS) for enrollment and billing.

3. Gatekeeping Prerequisites: Who Can Even Apply

New Hampshire does not require a Certificate of Need or a specific regional office sponsorship letter to apply as an EAS provider. However, there are strict structural preconditions based on the nature of the work being performed.

The primary gatekeeping prerequisite is that the EAS provider must hold the appropriate state occupational license (e.g., electrician or plumber) if the adaptation requires such work. Additionally, providers must be registered with the NH Secretary of State to do business in New Hampshire.

4. Licensure and Certification Requirements

New Hampshire does not issue a distinct "Environmental Accessibility Service Provider" license. Instead, providers are approved based on their compliance with general business and occupational licensing requirements.

Under N.H. Admin. Code § He-E 801.17, providers must affirm knowledge of all applicable building codes and permit requirements, and ensure that any subcontractors involved are appropriately licensed. The work must meet the requirements of RSA 155-A:2.

5. Medicaid Provider Enrollment

To bill for EAS under the CFI or DD waivers, a provider must be formally enrolled with New Hampshire Medicaid. This process is managed through the state's MMIS provider portal.

Providers must submit an application, provide proof of their business registration and any required occupational licenses, and sign a Medicaid provider agreement stipulating that they will accept the waiver reimbursement as payment in full.

6. Staffing, Training and Background Checks

Because EAS providers are typically contractors rather than direct care staff, the staffing requirements focus on occupational competency rather than clinical training.

Providers must ensure that any staff or subcontractors performing electrical, plumbing, or structural work hold the necessary state licenses. While standard HCBS background checks may not apply to contractors who do not provide direct personal care, providers must adhere to all state business and labor regulations.

7. Documentation, Policies and Records

EAS providers must maintain detailed records of the adaptations performed, including blueprints, scaled drawings, and lists of supplies and materials. These documents are often required during the prior authorization process.

Providers must also keep on file written confirmation of whether state or local building permits were required, and statements affirming that the work was completed within the home's current electrical or plumbing capacity.

8. Billing, Rates and Claims

EAS is reimbursed based on the approved bid amount rather than a fixed fee schedule. For projects over $5,000, the participant's case manager must submit proposals from at least two EAS providers.

Providers must agree in writing that the reimbursement authorized through the waiver program is considered payment in full. Claims are submitted through the NH MMIS after the work is completed and inspected.

9. Approval Sequence and Timeline

The approval sequence begins with a NH Medicaid-enrolled licensed practitioner determining the need for the adaptation. The participant's case manager then requests prior authorization using Form 3715.

The provider submits their bid, including necessary documentation (blueprints, permit info). Once DHHS provides prior authorization, the provider completes the work, and the service is billed.

10. Common Denials and Survey Findings

Prior authorization requests for EAS are commonly denied if the proposed adaptation is deemed to be of general utility rather than providing a direct medical or remedial benefit.

Denials also occur if the adaptation adds square footage to the home (unless meeting specific exceptions), or if the provider fails to submit required documentation, such as proof of subcontractor licensure or a statement regarding electrical/plumbing capacity.

11. Key Contacts and Resources

Providers seeking to enroll or verify requirements should consult the NH DHHS website and the specific waiver manuals. The Office of Program Support and the Bureau of Developmental Services are key contacts for compliance and waiver specifics.

For billing and enrollment inquiries, providers must use the NH MMIS portal.

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