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

Last reviewed: 2026-09-10

New Hampshire licenses agencies providing intermittent skilled nursing and therapy under a physician-ordered plan of care as Home Health Care Providers (HHCPs) through the Department of Health and Human Services (DHHS) Health Facilities Administration under administrative rule He-P 809.

Approval requires securing local zoning and fire safety approvals prior to submitting the $250 initial application, followed by obtaining Medicare certification to enroll as a Medicaid Home Health Agency via the NH MMIS portal.

1. Service Definition and Scope

In New Hampshire, a Home Health Care Provider (HHCP) is defined as an organization that provides skilled nursing, physical therapy, occupational therapy, speech therapy, or home health aide services directly to patients in their residences.

The scope of practice is governed by state administrative rules which distinguish these skilled, intermittent medical services from non-medical personal care or homemaker services, though an HHCP license permits the delivery of both.

• Statutory Authority: RSA 151:2, I(b)
• Regulatory Code: He-P 809 Home Health Care Providers
• Service Name: Home Health Care Provider (HHCP)
• Core Services: Intermittent skilled nursing, physical therapy, occupational therapy, speech therapy, and home health aide services
• Exemptions: Entities delivering only home medical supplies or equipment without skilled services are exempt from this specific license

2. Regulatory and Oversight Agencies

The New Hampshire Department of Health and Human Services (DHHS), specifically the Health Facilities Administration (HFA), is the primary regulatory body responsible for licensing and surveying HHCPs.

Medicaid enrollment and claims processing are managed by NH Medicaid through the state's fiscal agent portal, NH MMIS.

• Licensing Agency: NH DHHS Health Facilities Administration (https://www.dhhs.nh.gov/doing-business-dhhs/licensing-certification/health-facilities-administration)
• Medicaid Agency: NH DHHS Medicaid (https://www.dhhs.nh.gov/programs-services/medicaid)
• Enrollment Portal: NH MMIS Provider Enrollment (https://nhmmis.nh.gov)
• Background Check Agency: NH Department of Safety (https://www.nh.gov/safety/)

3. Gatekeeping Prerequisites: Who Can Even Apply

New Hampshire does not have a Certificate of Need (CON) program for home health agencies, meaning market entry is not restricted by state need-review boards.

However, structural prerequisites exist at the local and federal levels. Applicants must secure written local municipal approvals before the state will accept a licensure application, and Medicare certification is a strict prerequisite for enrolling as a Medicaid Home Health Agency.

• Certificate of Need: None exists; New Hampshire repealed its CON program
• Local Approvals: Written approval from the local fire chief and local health/zoning official must be obtained before submitting the He-P 809 application
• Corporate Registration: Certificate of Authority or Certificate of Formation from the NH Secretary of State is required to do business in the state
• Medicaid Prerequisite: Medicare certification (Title XVIII) is required to enroll as a Medicaid Home Health Agency for skilled services

4. Licensure and Certification Requirements

The initial licensure process requires submitting a complete application package to the DHHS Office of Legal and Regulatory Services, Health Facilities Administration.

Licenses are issued only after a successful review of the application, administrator qualifications, and a physical inspection of the agency's administrative office.

• Application Form: Initial License Application for Home Health Care Providers
• Licensure Fee: $250 payable to the Treasurer, State of New Hampshire
• Administrator Resume: Must submit a resume identifying qualifications and copies of applicable licenses for the HHCP administrator
• Physical Location: Must maintain a physical administrative office to store records and coordinate care

5. Medicaid Provider Enrollment

Once licensed by HFA and certified by Medicare, the agency must enroll as a Medicaid provider through the NH MMIS portal.

Providers must maintain active licensure and Medicare certification to remain enrolled, and must complete revalidation every five years.

• System: NH MMIS Provider Enrollment portal
• Provider Type: Home Health Agency
• Application Fee: Subject to the federal Medicaid/Medicare application fee unless already paid to Medicare for the current enrollment cycle
• NPI Requirement: Must obtain and register an Organizational Type 2 NPI

6. Staffing, Training and Background Checks

New Hampshire requires HHCPs to appoint specific leadership roles, including an Administrator and a Director of Patient Services, to oversee operations and clinical care.

All personnel must undergo comprehensive background screening before providing direct patient care.

• Administrator: Must be appointed to manage and operate the HHCP and designate an alternate in writing
• Director of Patient Services: Must be a NH-licensed or compact RN, or have a bachelor's degree in a health-related field, with at least 2 years of supervisory or direct care experience
• Criminal Records Check: Required from the NH Department of Safety for the applicant, licensee, and administrator
• Abuse Registry: Must screen staff against the NH BEAS (Bureau of Elderly and Adult Services) State Registry

7. Documentation, Policies and Records

Agencies must maintain comprehensive written policies governing patient rights, emergency preparedness, and clinical records in accordance with He-P 809.14.

Patient records must be securely stored and include specific intake documentation, consents, and advance directives.

• Patient Rights: Must provide the Home Care Clients' Bill of Rights pursuant to RSA 151:21-b
• Admission Records: Must collect emergency contacts, primary care provider info, and copies of legal directives (durable power of attorney, living will)
• Emergency Plan: Must develop and annually review an emergency preparedness plan
• Firearms Policy: Must have a written policy ensuring safety if firearms are permitted on the licensed premises

8. Billing, Rates and Claims

Medicaid claims for home health services are submitted electronically via the NH MMIS portal using standard institutional claim formats.

Agencies must provide transparent pricing to patients upon admission and provide advance notice of any fee changes.

• Claim Format: Institutional claims (UB-04/837I) for home health services
• Fee Notice: Must give patients 30 days written notice before any increase in costs or fees (exempting Medicaid standard of need)
• Admission Disclosure: Must provide a listing of all applicable HHCP charges and what is included at the time of admission
• Prior Authorization: Certain skilled therapy visits beyond initial evaluations require prior authorization through NH Medicaid's utilization management vendor

9. Approval Sequence and Timeline

The approval process is sequential, beginning with local municipal sign-offs before state licensure can commence.

Following state licensure, agencies must achieve Medicare certification before they can finalize Medicaid enrollment.

• Step 1: Obtain local fire and zoning approvals
• Step 2: Submit He-P 809 application, $250 fee, and NH Department of Safety background checks to DHHS HFA
• Step 3: Pass initial HFA licensing inspection
• Step 4: Complete Medicare certification survey (often via deemed status accreditation)
• Step 5: Submit Medicaid enrollment application via NH MMIS

10. Common Denials and Survey Findings

Licensure applications are frequently delayed due to missing local approval forms or incomplete background check results.

During HFA surveys, common deficiencies relate to incomplete personnel files and failure to properly document patient rights disclosures.

• Incomplete Applications: Missing local fire/zoning approval forms (He-P 809.04(a)(5))
• Personnel Records: Failure to document pre-employment physical exams or health screenings
• Policy Deficiencies: Missing or outdated emergency preparedness plans
• Patient Rights: Failure to obtain written confirmation acknowledging receipt of the Home Care Clients' Bill of Rights

11. Key Contacts and Resources

Prospective providers should utilize the official DHHS and NH MMIS portals for the most current forms, fee schedules, and rule adoptions.

The Health Facilities Administration is the primary point of contact for all licensure inquiries.

• NH DHHS Health Facilities Administration: https://www.dhhs.nh.gov/doing-business-dhhs/licensing-certification/health-facilities-administration
• NH MMIS Provider Enrollment: https://nhmmis.nh.gov
• NH Administrative Rules (He-P 809): https://www.dhhs.nh.gov/doing-business-dhhs/licensing-certification/health-facilities-administration/administrative-rules
• NH Department of Safety (Background Checks): https://www.nh.gov/safety/

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