New Hampshire - Home Health Service — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-08-16

In New Hampshire, Home Health Services provide intermittent skilled nursing, physical therapy, occupational therapy, and speech-language pathology to individuals in their homes under a physician-ordered plan of care. These services are heavily utilized by Medicare beneficiaries and participants in New Hampshire's Medicaid Choices for Independence (CFI) Waiver program. The regulatory framework is overseen by the New Hampshire Department of Health and Human Services (DHHS) Health Facilities Administration (HFA) under administrative rule He-P 809.

The single biggest structural barrier to entry for a new Home Health Agency in New Hampshire is not a state-level quota—New Hampshire repealed its Certificate of Need (CON) program and does not cap licenses—but rather the sequential burden of Medicare certification and managed care contracting. To successfully bill Medicaid for skilled services, an agency must first obtain state licensure, secure Medicare certification (which can take up to a year), enroll in the state's Fee-for-Service MMIS portal, and finally negotiate network contracts with the Managed Care Organizations (MCOs) operating under the state's Medicaid Care Management (MCM) program.

1. Service Definition and Scope

Home Health Services in New Hampshire encompass skilled, intermittent medical care delivered in a patient's residence. This level of care is distinct from non-medical personal care or homemaker services, as it requires clinical oversight, specialized training, and a physician's authorization.

Under New Hampshire regulations, these services are designed to treat acute illnesses, manage chronic conditions, or provide rehabilitation, ensuring that vulnerable populations, including those on the Choices for Independence (CFI) waiver, can remain safely in their communities rather than institutional settings.

• Regulatory Classification: Licensed as a "Home Health Care Provider" under New Hampshire Administrative Rules He-P 809.
• Service Scope: Includes intermittent skilled nursing, physical therapy, occupational therapy, speech-language pathology, and medical social services.
• Care Plan Requirement: All skilled services must be delivered strictly according to a physician-ordered Individualized Service Plan (ISP) or Plan of Care.
• Clinical Supervision: Requires active clinical oversight and care coordination by a Registered Nurse (RN) or a qualified licensed therapist.
• Target Population: Seniors and adults with chronic illnesses or disabilities, including those enrolled in the Medicaid Choices for Independence (CFI) Waiver.

2. Regulatory and Oversight Agencies

The New Hampshire Department of Health and Human Services (DHHS) is the umbrella agency governing home health care. Within DHHS, distinct divisions handle facility licensure, Medicaid enrollment, and waiver administration.

Providers must interact with multiple state portals and boards to maintain compliance, from facility licensing to individual staff credentialing.

• Licensing Authority: NH DHHS Health Facilities Administration (HFA) [https://www.dhhs.nh.gov/doing-business-dhhs/licensing-certification/health-facilities-administration] issues facility licenses and conducts surveys.
• Medicaid Agency: NH DHHS Medicaid Provider Relations [https://www.dhhs.nh.gov/programs-services/medicaid/medicaid-provider-relations] oversees state Medicaid policy and enrollment.
• Waiver Administration: NH Bureau of Elderly and Adult Services (BEAS) [https://www.dhhs.nh.gov/programs-services/adult-aging-care/home-and-community-based-services-hcbs] manages the Choices for Independence (CFI) Waiver.
• Professional Licensing: NH Office of Professional Licensure and Certification (OPLC) [https://www.oplc.nh.gov/] licenses individual nurses and therapists.
• Medicaid Portal: NH MMIS Health Enterprise Portal [https://nhmmis.nh.gov/] is the system for Fee-for-Service enrollment and claims.

3. Gatekeeping Prerequisites: Who Can Even Apply

New Hampshire maintains an open market for home health licensure at the state level, meaning there are no artificial caps on the number of agencies that can open. However, structural prerequisites exist at the federal and payer levels that dictate market entry.

Before an agency can effectively operate and bill for Medicaid skilled services, it must clear several foundational hurdles, most notably Medicare certification and managed care network acceptance.

• Certificate of Need (CON): None exists; New Hampshire repealed its CON program in 2016, allowing direct application for licensure without facility need-review approvals.
• Moratoria and Caps: Genuinely none exist; there are no state-imposed moratoria or closed enrollment windows for He-P 809 Home Health Care Provider licensure.
• Medicare Certification: Required as a strict prerequisite for most skilled home health Medicaid enrollment; agencies must pass a CMS initial survey to bill for skilled nursing and therapy.
• Business Registration: Applicants must be registered and in good standing with the New Hampshire Secretary of State before HFA will accept a license application.
• NPI Requirement: The agency must obtain a Type 2 National Provider Identifier (NPI) prior to initiating the Medicaid enrollment process.
• MCO Network Contracting: While not a barrier to initial state licensure, contracting with NH Medicaid Care Management (MCM) plans is a strict prerequisite for serving most Medicaid beneficiaries; providers cannot bill MCOs as out-of-network entities without prior single-case agreements.

4. Licensure and Certification Requirements

To operate legally in New Hampshire, an agency must obtain a Home Health Care Provider license from the DHHS Health Facilities Administration (HFA). This process involves a detailed paper application, fee submission, and an on-site readiness survey.

Because RSA 151's definition of services 'in the home' is broad, agencies providing skilled care must ensure their application explicitly covers the skilled nursing and therapy components under He-P 809.

• Statutory Authority: Governed by New Hampshire RSA 151:2 and administrative rules He-P 809.
• Application Form: Submit the Initial Application for Home Health Care Provider License directly to DHHS HFA.
• Application Fee: A $550 initial application fee is required upon submission to HFA.
• Required Attachments: Must include Articles of Incorporation, proof of general and professional liability insurance, and a comprehensive business and clinical policy manual.
• Initial Survey: HFA conducts an on-site initial licensure inspection to verify physical office compliance, record-keeping systems, and policy adherence prior to issuing the license.
• Renewal Cycle: Licenses are valid for one year and must be renewed annually with HFA, accompanied by the renewal fee and updated documentation.

5. Medicaid Provider Enrollment

Enrolling as a Medicaid provider in New Hampshire is a bifurcated process. Agencies must first enroll with the state for Fee-for-Service (FFS) billing, and then separately credential with the Managed Care Organizations (MCOs).

State enrollment is handled entirely online through the state's Medicaid Management Information System (MMIS) portal.

• Enrollment System: Submit the provider enrollment application through the NH MMIS Health Enterprise Portal [https://nhmmis.nh.gov/].
• Provider Type: Enroll specifically as a Home Health Agency under the applicable HCBS/CFI waiver taxonomy codes.
• Application Fee: Subject to the federal Medicaid/Medicare institutional application fee (approximately $709 for 2024) unless proof of payment to Medicare is provided.
• Risk Screening: Home health agencies are categorized as moderate or high risk, requiring extensive database checks, fingerprint-based background checks for owners, and potential site visits.
• MCO Credentialing: After state FFS approval, providers must complete credentialing with MCM plans such as NH Healthy Families [https://www.nhhealthyfamilies.com/] and AmeriHealth Caritas NH [https://www.amerihealthcaritasnh.com/].
• Revalidation: Providers must revalidate their Medicaid enrollment every 5 years per CMS and NH DHHS regulations.

6. Staffing, Training and Background Checks

New Hampshire enforces strict personnel standards to protect vulnerable adults receiving care in their homes. Compliance with background check laws is heavily scrutinized during HFA surveys.

Agencies must ensure that all clinical staff hold active New Hampshire licenses and that all employees undergo state-specific registry clearances before client contact.

• Criminal Background Checks: Mandatory for all owners, administrators, and direct care workers under RSA 151:2-d prior to employment.
• Registry Checks: Mandatory screening against the NH Bureau of Elderly and Adult Services (BEAS) State Registry to ensure no history of abuse, neglect, or exploitation.
• Clinical Leadership: The agency must employ a qualified Clinical Director (typically an RN with home health experience) to oversee all skilled nursing and therapy services.
• Professional Licensing: All nurses (RN/LPN) and therapists (PT/OT/SLP) must hold active, unencumbered licenses issued by the NH Office of Professional Licensure and Certification (OPLC).
• Orientation Training: Agencies must provide and document orientation covering HIPAA, infection control, emergency procedures, and patient rights before staff provide direct care.
• Ongoing Education: Annual in-service training requirements must be met and documented in individual personnel files.

7. Documentation, Policies and Records

Thorough documentation is the cornerstone of compliance in New Hampshire. HFA surveyors and Medicaid auditors frequently review patient and personnel records to ensure adherence to He-P 809 and Medicaid billing rules.

Agencies must maintain comprehensive policy manuals that dictate clinical protocols, emergency management, and privacy standards.

• Patient Records: Must include the agency name, date of service, a brief summary of services provided, and the physician-ordered treatment plan.
• Visit Notes: Surveyors strictly enforce the requirement that home health staff leave or document clinical notes in the patient record immediately after every visit.
• Personnel Files: Must contain proof of completed background checks, OPLC license verification, orientation logs, and annual performance evaluations.
• Required Policies: Must maintain written, agency-specific policies for skilled care delivery, medication management, infection control, and home safety.
• HIPAA Compliance: Strict adherence to federal health information privacy regulations, requiring secure electronic health record (EHR) systems and encrypted communications.
• Record Retention: Clinical and billing records must be retained for a minimum of 6 years per state and federal Medicaid regulations.

8. Billing, Rates and Claims

Billing for Home Health Services requires precise coding and adherence to prior authorization rules. Claims are processed either through the state's MMIS for FFS clients or through MCO-specific clearinghouses for managed care members.

A critical requirement in New Hampshire is the enrollment of Ordering, Referring, and Prescribing (ORP) providers; claims will deny if the authorizing physician is not registered with the state.

• Billing System: FFS claims are submitted via the NH MMIS Health Enterprise Portal; MCO claims are routed through plan-specific electronic clearinghouses.
• Prior Authorization: Most skilled nursing and therapy visits require prior authorization from the MCO or BEAS (for CFI waiver participants) before services commence.
• Coding: Services are billed using standard HCPCS codes (e.g., G0299 for RN services, G0151 for PT) along with appropriate revenue codes.
• ORP Requirements: Ordering, Referring, and Prescribing (ORP) physicians must be enrolled in NH Medicaid; if an ORP provider's NPI is on a FFS claim and they are not enrolled, the claim will be denied.
• Rate Structure: FFS rates are published on the NH DHHS Medicaid Fee Schedule; MCO rates are negotiated individually but generally align with the state fee schedule floor.
• Electronic Visit Verification (EVV): Required for personal care components of home health; agencies must utilize the state-sponsored EVV system or an approved alternate vendor to capture visit data.

9. Approval Sequence and Timeline

Launching a Home Health Agency in New Hampshire is a multi-stage process that typically takes 9 to 18 months from business formation to billing the first Medicaid managed care claim.

Because Medicare certification is a prerequisite for most skilled Medicaid enrollment, the timeline is heavily dependent on federal survey schedules.

• Step 1: Business Formation: Register with the NH Secretary of State, obtain an EIN, and secure a Type 2 NPI (1-2 weeks).
• Step 2: HFA Licensure: Submit the He-P 809 application to DHHS HFA, prepare policies, and undergo the initial state survey (60-90 days).
• Step 3: Medicare Certification: Submit the CMS-855A enrollment application to the MAC and undergo the initial Medicare certification survey (6-12 months).
• Step 4: Medicaid FFS Enrollment: Apply through the NH MMIS Health Enterprise Portal once Medicare certification is obtained (30-60 days).
• Step 5: MCO Contracting: Apply for network participation and complete credentialing with NH Medicaid Care Management plans (90-120 days).

10. Common Denials and Survey Findings

New Hampshire HFA surveyors and Medicaid auditors frequently cite agencies for administrative oversights rather than clinical errors. Understanding these common pitfalls can prevent delayed licensure or recouped payments.

Strict adherence to documentation timelines and background check sequencing is essential to maintain good standing.

• Missing Visit Notes: HFA surveyors frequently cite agencies for failing to leave or document clinical notes in patient records after each visit, especially in residential care settings.
• Incomplete Background Checks: Allowing staff to provide direct care before BEAS registry and criminal background checks are fully returned and cleared.
• ORP Enrollment Failures: Medicaid claims denied because the ordering physician is not enrolled in NH Medicaid as an ORP provider.
• Care Plan Deviations: Providing services outside the scope, duration, or frequency of the physician-ordered Individualized Service Plan without a documented order change.
• Lapsed Professional Licenses: Failure of the agency to verify and document ongoing OPLC licensure renewals for nurses and therapists.
• EVV Non-Compliance: Claims denied due to missing or mismatched Electronic Visit Verification data for applicable in-home services.

11. Key Contacts and Resources

Providers must maintain active communication with several state divisions and managed care organizations. Utilizing the official portals and contact numbers is critical for resolving enrollment and compliance issues.

Bookmark the DHHS and MMIS portals, as rules and fee schedules are updated frequently.

• NH DHHS Health Facilities Administration (HFA): [https://www.dhhs.nh.gov/doing-business-dhhs/licensing-certification/health-facilities-administration] | 603-271-9039
• NH Medicaid Provider Relations: [https://www.dhhs.nh.gov/programs-services/medicaid/medicaid-provider-relations]
• NH MMIS Health Enterprise Portal: [https://nhmmis.nh.gov/] | Provider Enrollment: 866-291-1674
• NH Bureau of Elderly and Adult Services (BEAS): [https://www.dhhs.nh.gov/programs-services/adult-aging-care/home-and-community-based-services-hcbs]
• NH Office of Professional Licensure and Certification (OPLC): [https://www.oplc.nh.gov/]
• NH Healthy Families (MCO): [https://www.nhhealthyfamilies.com/] | Provider Services: 1-866-769-3085
• AmeriHealth Caritas New Hampshire (MCO): [https://www.amerihealthcaritasnh.com/]

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