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

Last reviewed: 2026-09-10

New Hampshire funds Environmental and Vehicle Modification Services through the Choices for Independence (CFI), Developmental Disabilities (DD), Acquired Brain Disorder (ABD), and In-Home Support (IHS) waivers to adapt participant homes for accessibility. The Bureau of Developmental Services (BDS) and the Bureau of Adult and Aging Services (BAAS) oversee these structural adaptations, which require prior authorization and adherence to local building codes.

Contractors seeking to provide these services in New Hampshire must either enroll directly as a Medicaid Group Billing Provider under provider type 236 (Developmental Services) or enter into a pass-through billing agreement with an Organized Health Care Delivery System (OHCDS). Direct enrollment requires submitting an application through the NH MMIS Health Enterprise Portal and completing a BDS screening process.

1. Service Definition and Scope

In New Hampshire, Environmental and Vehicle Modification Services encompass physical adaptations to a participant's private residence or vehicle that are necessary to ensure their health, welfare, and safety, or to enable them to function with greater independence. These services are authorized under the state's 1915(c) HCBS waivers.

The scope of work is strictly limited to modifications identified in the participant's person-centered care plan. General home repairs, aesthetic improvements, or modifications that add to the total square footage of the home are explicitly excluded from Medicaid reimbursement.

• Covered Adaptations: Ramps, grab bars, widened doorways, and specialized bathroom fixtures.
• Excluded Work: Roof repair, central air conditioning, and general home maintenance.
• Code Compliance: All modifications must meet local and state building codes.
• Assessment Requirement: Modifications require a prior assessment by a qualified professional, such as an occupational therapist.
• Waiver Limits: Services are subject to lifetime or annual financial caps as specified in the respective waiver appendices.

2. Regulatory and Oversight Agencies

The New Hampshire Department of Health and Human Services (DHHS) is the single state Medicaid agency responsible for overall program administration. Within DHHS, specific bureaus manage the day-to-day operations of the waivers that fund home modifications.

Providers interact primarily with the Bureau of Developmental Services (BDS) for DD, ABD, and IHS waivers, and the Bureau of Adult and Aging Services (BAAS) for the CFI waiver. The NH MMIS Health Enterprise Portal handles all provider enrollment and claims processing.

• State Medicaid Agency: New Hampshire Department of Health and Human Services (https://www.dhhs.nh.gov)
• Developmental Waivers Oversight: Bureau of Developmental Services (https://www.dhhs.nh.gov/programs-services/disability-care/developmental-services)
• Aging Waiver Oversight: Bureau of Adult and Aging Services (https://www.dhhs.nh.gov/programs-services/adult-aging-care)
• Enrollment Portal: NH MMIS Health Enterprise Portal (https://nhmmis.nh.gov/)
• Business Registration: New Hampshire Secretary of State (https://sos.nh.gov/)

3. Gatekeeping Prerequisites: Who Can Even Apply

New Hampshire requires home modification providers to establish a billing pathway before rendering services. Providers must either enroll directly in the state's MMIS or secure a subcontracting arrangement.

The state explicitly allows providers of Environmental and Vehicle Modification Services to enter into an agreement with an Organized Health Care Delivery System (OHCDS) to act as the qualified provider and bill on their behalf as a pass-through service. If a provider chooses not to use an OHCDS, they must enroll directly as a Group Billing Provider.

• Pass-Through Option: Providers may bypass direct Medicaid enrollment by contracting with an OHCDS.
• Direct Enrollment Requirement: Independent contractors must enroll as provider type 236 (Developmental Services) in MMIS.
• Business Registration: Applicants must register their business name with the NH Secretary of State prior to enrollment.
• BDS Screening: Direct enrollees must request and pass a screening from BDS via [email protected].
• NPI Exemption: Home modification contractors typically do not require a National Provider Identifier (NPI) unless they meet the definition of a health care provider under 45 CFR 160.103.

4. Licensure and Certification Requirements

New Hampshire does not issue a specific "Medicaid Home Modification License." Instead, providers must hold the standard occupational licenses and registrations required to perform construction and modification work in the state.

Contractors must comply with all local municipal permitting requirements for structural changes. The state relies on local building inspectors to certify that the completed work meets applicable safety and building codes.

• Trade Licensing: Plumbers and electricians must hold active New Hampshire state licenses for specialized work.
• Local Permits: Providers must obtain necessary building permits from the local municipality before commencing work.
• Business Standing: Must maintain a certificate of good standing from the NH Secretary of State.
• Insurance: Providers must carry standard commercial general liability and workers' compensation insurance.
• Inspection Sign-off: Final payment often requires a signed inspection report from the local municipal building inspector.

5. Medicaid Provider Enrollment

Providers choosing to bill directly must complete the online enrollment application via the NH MMIS Health Enterprise Portal. The application requires selecting the appropriate provider type and specialty codes corresponding to Environmental Modification Services.

During enrollment, providers must submit documentation of their business structure, tax identification, and attest to compliance with Medicaid regulations. The Provider Relations team from Conduent manages the technical aspects of the MMIS application.

• Portal Access: Applications are submitted through the NH MMIS Health Enterprise Portal.
• Provider Type: Must enroll under Developmental Services provider type (236).
• Group Billing: The business must apply as a group-billing provider, not as individual employees.
• Application Fee: Subject to the federal Medicaid application fee unless enrolled in Medicare or another state's Medicaid program.
• Welcome Letter: Upon approval, providers receive a welcome letter with their NH Medicaid ID.

6. Staffing, Training and Background Checks

While home modification contractors do not provide direct personal care, they interact with vulnerable populations and must adhere to state background check requirements. Agencies must ensure their staff do not appear on exclusionary lists.

Providers must attest during the BDS screening process that they conduct required background checks prior to hiring and annually thereafter, including monthly checks of the OIG exclusion list.

• OIG Exclusion Checks: Providers must check the federal OIG list monthly to ensure staff are not excluded from Medicaid participation.
• Criminal Background Checks: Required for all employees interacting with waiver participants, conducted prior to hire and annually.
• Training Attestation: Providers must submit policies describing required staff training during BDS Screening #2.
• Subcontractor Compliance: Primary contractors must ensure any subcontractors also meet background check requirements.
• Registry Checks: Must utilize the links provided on the NH DHHS New Provider and Onboarding Resources page.

7. Documentation, Policies and Records

Approved providers must maintain comprehensive records of all modifications performed, including initial assessments, itemized bids, permits, and final inspection reports. These records must be retained for a minimum of six years.

Documentation must clearly link the completed modification to the specific needs identified in the participant's approved care plan. Failure to maintain adequate records can result in recoupment of funds during state audits.

• Itemized Bids: Must provide detailed, itemized estimates for parts and labor prior to authorization.
• Permit Records: Copies of all local building permits must be kept in the participant's service file.
• Completion Certificates: Signed documents verifying the participant or case manager accepts the completed work.
• Photographic Evidence: Before and after photos of the modification are typically required for the service record.
• Record Retention: All service and billing records must be retained for at least six years per NH Medicaid rules.

8. Billing, Rates and Claims

Home modification services are reimbursed based on the authorized bid amount rather than a standard fee schedule. Claims must be submitted through the NH MMIS Health Enterprise Portal or via an approved trading partner.

Providers utilizing the OHCDS pass-through option submit their invoices directly to the OHCDS, which then bills Medicaid on their behalf. Direct billers must ensure claims match the prior authorization exactly.

• Prior Authorization: No work may commence or be billed without an approved prior authorization in MMIS.
• Bid-Based Pricing: Reimbursement is based on the lowest responsible bid approved by the waiver case manager.
• Claim Submission: Direct billers use the MMIS portal; pass-through providers invoice the OHCDS.
• Trading Partners: Providers may use enrolled trading partners to bill on their behalf for a fee.
• Waiver Caps: Billing cannot exceed the individual's lifetime or annual waiver cap for environmental modifications.

9. Approval Sequence and Timeline

The approval process begins with business registration and deciding between direct enrollment or OHCDS pass-through. Direct enrollment involves submitting the MMIS application and completing the BDS screening.

The entire enrollment process can take several weeks to a few months, depending on the completeness of the application and the speed of background check attestations. Providers are notified by Conduent if additional information is needed.

• Step 1: Register business with the NH Secretary of State.
• Step 2: Choose billing pathway (OHCDS agreement or direct MMIS enrollment).
• Step 3: Submit MMIS application (if enrolling directly).
• Step 4: Request and complete BDS screening via email.
• Step 5: Receive Medicaid ID and schedule consultation meeting with BDS if required.

10. Common Denials and Survey Findings

Applications for provider enrollment are frequently delayed or denied due to incomplete documentation or failure to respond to requests for additional information from the Provider Relations team.

During audits, common findings include missing local building permits, lack of before-and-after documentation, and billing for work that deviates from the approved prior authorization without a formal change order.

• Incomplete Applications: Missing tax documents or failure to complete the BDS screening.
• Unapproved Scope Changes: Billing for modifications not explicitly listed in the prior authorization.
• Missing Permits: Failure to obtain or retain copies of required local building permits.
• Background Check Lapses: Failure to document monthly OIG exclusion checks for staff.
• Address Errors: Listing a corporate out-of-state address as the primary service location instead of the NH administrative office.

11. Key Contacts and Resources

Providers should utilize the NH MMIS Health Enterprise Portal for enrollment and claims submission. The Provider Relations team at Conduent is the primary contact for technical assistance with the MMIS application.

For waiver-specific questions and screening requirements, providers must contact the Bureau of Developmental Services or the Bureau of Adult and Aging Services directly.

• NH MMIS Portal: https://nhmmis.nh.gov/
• Medicaid Provider Service Center: 1-866-291-1674
• Provider Relations Email: [email protected]
• BDS Provider Enrollment: [email protected]
• NH DHHS Main Site: https://www.dhhs.nh.gov

See all New Hampshire services · New Hampshire Medicaid consulting · book a consultation.