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

Last reviewed: 2026-09-10

New Hampshire licenses Homemaker Service providers as Home Care Service Provider Agencies under administrative rule He-P 822, overseen by the Department of Health and Human Services (DHHS) Health Facilities Administration. This service is primarily funded through the Choices for Independence (CFI) Waiver, which supports adults aged 18 and older who meet nursing facility levels of care.

Agencies seeking Medicaid reimbursement must enroll through the NH MMIS portal to serve CFI waiver participants. Applicants must secure their He-P 822 license before the Medicaid enrollment application is accepted, which requires submitting comprehensive operational policies and passing an initial on-site inspection by state surveyors.

1. Service Definition and Scope

Under the Choices for Independence (CFI) Waiver, Homemaker Services provide general household support to individuals who are unable to perform these tasks independently due to physical or cognitive limitations. The service is designed to maintain a safe and sanitary home environment, preventing institutionalization.

The scope of the service is strictly non-medical. It focuses on environmental and nutritional support rather than hands-on personal care, though it is frequently delivered by agencies that also hold personal care designations.

• Covered Tasks: Meal preparation, laundry, light housekeeping, and grocery shopping.
• Excluded Tasks: Hands-on personal care (bathing, dressing), medication administration, and heavy chore services.
• Target Population: Adults aged 18 and older enrolled in the CFI Waiver who meet nursing facility level of care.
• Service Setting: The participant's private residence or family home; not permitted in licensed residential care facilities.
• Authorization: Services must be explicitly detailed in the participant's comprehensive care plan developed by their CFI Case Manager.

2. Regulatory and Oversight Agencies

The New Hampshire Department of Health and Human Services (DHHS) is the umbrella agency responsible for both licensure and Medicaid administration. Within DHHS, distinct bureaus handle facility licensing, waiver operations, and claims processing.

Providers must interact with multiple divisions to maintain compliance, from initial licensing to ongoing Medicaid billing and incident reporting.

• DHHS Health Facilities Administration (HFA): Licenses Home Care Service Provider Agencies under He-P 822 (https://www.dhhs.nh.gov/programs-services/health-care/health-facilities-administration).
• DHHS Bureau of Elderly and Adult Services (BEAS): Administers the Choices for Independence (CFI) Waiver and manages the BEAS State Registry (https://www.dhhs.nh.gov/programs-services/adult-aging-care).
• NH Medicaid Management Information System (NH MMIS): Processes provider enrollment and claims (https://nhmmis.nh.gov/).
• ServiceLink Aging and Disability Resource Centers: Serves as the local entry point for participant eligibility and options counseling (https://www.servicelink.nh.gov/).

3. Gatekeeping Prerequisites: Who Can Even Apply

New Hampshire operates an open enrollment model for Home Care Service Provider Agencies. There are no closed networks, moratoria, or competitive procurement (RFP) requirements to become a Homemaker provider under the CFI waiver.

The state does not require a Certificate of Need (CON) for home care agencies. The primary structural precondition is obtaining the He-P 822 license prior to Medicaid enrollment.

• Certificate of Need (CON): None required in New Hampshire for home care or homemaker services.
• Licensure Prerequisite: Applicants must obtain a Home Care Service Provider Agency license (He-P 822) from HFA before applying for Medicaid enrollment.
• Business Registration: Must be registered and in good standing with the New Hampshire Secretary of State.
• Network Affiliation: None required; providers enroll directly with NH Medicaid as fee-for-service providers for the CFI waiver.

4. Licensure and Certification Requirements

To operate legally in New Hampshire, agencies providing homemaker services must be licensed as Home Care Service Provider Agencies under administrative rule He-P 822. The application process requires submitting detailed operational policies, an organizational chart, and proof of administrator qualifications.

Following the document review, HFA conducts an initial on-site inspection to verify compliance with state rules before issuing the license.

• Application Form: Submit the Application for Initial License for a Home Care Service Provider Agency to HFA.
• Licensure Fee: A non-refundable fee of $250 is required with the initial application.
• Administrator Qualifications: The agency administrator must have a high school diploma or equivalent and at least one year of experience in business management or health care administration.
• Policy Manual: Must submit comprehensive policies covering client rights, infection control, emergency preparedness, and personnel records.
• On-Site Inspection: An HFA surveyor will conduct an initial inspection of the agency's physical office and administrative records.

5. Medicaid Provider Enrollment

Once licensed, the agency must enroll as a Medicaid provider through the NH MMIS portal. The enrollment process links the agency's He-P 822 license to their National Provider Identifier (NPI) for billing purposes.

Providers must select the appropriate provider type and specialty code corresponding to waiver services and complete the standard Medicaid provider agreement.

• Enrollment Portal: Applications are submitted electronically via the NH MMIS Provider Portal (https://nhmmis.nh.gov/).
• Provider Type: Enroll as a Waiver Service Provider (Provider Type 45) or applicable home care specialty.
• Application Fee: Subject to the federal Medicaid/Medicare institutional provider application fee (approx. $731 for 2024), unless waived by prior Medicare enrollment.
• Required Documents: Must upload the active He-P 822 license, W-9, and proof of liability insurance.
• Revalidation: Providers must revalidate their Medicaid enrollment every five years.

6. Staffing, Training and Background Checks

New Hampshire requires strict background screening for all personnel entering a client's home. Agencies must ensure that homemakers are cleared through both state police and adult abuse registries before providing services.

While homemakers do not require medical certifications like LNAs, they must complete agency-specific orientation and demonstrate competency in household tasks.

• Criminal Background Check: Must obtain a New Hampshire State Police criminal history record check for all direct care staff prior to client contact.
• BEAS Registry Check: Must verify staff against the Bureau of Elderly and Adult Services (BEAS) State Registry to ensure no findings of abuse, neglect, or exploitation.
• Initial Training: Staff must complete orientation covering client rights, infection control, emergency procedures, and confidentiality (HIPAA).
• Competency Evaluation: The agency must assess and document the homemaker's ability to perform assigned household tasks safely.
• Supervision: A designated supervisor must conduct in-home supervisory visits at least annually or as dictated by agency policy.

7. Documentation, Policies and Records

Providers must maintain meticulous records to satisfy both HFA licensing surveyors and Medicaid program integrity audits. Documentation must clearly link the services provided to the participant's authorized care plan.

Electronic Visit Verification (EVV) is required for personal care, but agencies should verify current DHHS guidance on EVV applicability to standalone homemaker services.

• Service Plan: A written plan detailing the specific homemaker tasks, frequency, and duration must be maintained in the client's file.
• Service Notes: Daily documentation must include the date, start and end times, specific tasks completed, and the signature of the staff member.
• Record Retention: Client and personnel records must be retained for a minimum of 6 years after the last date of service or termination of employment.
• Incident Reporting: Agencies must have policies to report adverse events, including suspected abuse or neglect, to BEAS and HFA within required timeframes.
• Personnel Files: Must contain proof of background checks, training certificates, performance evaluations, and job descriptions.

8. Billing, Rates and Claims

Homemaker services under the CFI waiver are billed to NH Medicaid using specific HCPCS codes. Claims are submitted electronically through the NH MMIS portal.

Services must be prior-authorized by the participant's Case Manager, and providers cannot bill for hours exceeding the authorized amount.

• Billing System: Claims are submitted via the NH MMIS portal (https://nhmmis.nh.gov/).
• HCPCS Code: Typically billed using S5130 (Homemaker service, NOS, per 15 minutes).
• Prior Authorization: Services must be authorized in the MMIS system based on the care plan before claims will pay.
• Rate Setting: Rates are established by DHHS and published in the Medicaid fee schedule; providers must accept the Medicaid rate as payment in full.
• Claim Format: Billed using the professional claim format (CMS-1500 or 837P electronic equivalent).

9. Approval Sequence and Timeline

The path to becoming a billing provider involves sequential approvals from the Secretary of State, HFA, and NH Medicaid. The process cannot be expedited by submitting applications concurrently.

Prospective providers should anticipate a multi-month process, heavily dependent on the completeness of their policy manuals and the scheduling availability of HFA surveyors.

• Step 1: Register the business entity with the NH Secretary of State (1-2 weeks).
• Step 2: Submit the He-P 822 license application and policy manual to HFA (30-60 days for review).
• Step 3: Complete the HFA on-site initial inspection and receive the license (30-45 days).
• Step 4: Submit the Medicaid provider enrollment application via NH MMIS (30-60 days).
• Total Timeline: Approximately 3 to 5 months from initial business registration to active Medicaid billing status.

10. Common Denials and Survey Findings

Licensure applications are frequently delayed due to incomplete or generic policy manuals that do not specifically address New Hampshire's He-P 822 requirements. Surveyors look for customized policies, not off-the-shelf templates.

During post-enrollment audits, Medicaid recoupments often stem from missing documentation or failure to complete background checks prior to the first date of service.

• Policy Deficiencies: Submitting generic policy manuals that lack required NH-specific procedures for incident reporting or client rights.
• Background Check Timing: Allowing staff to provide services before the state police and BEAS registry checks are fully returned and cleared.
• Incomplete Service Notes: Timesheets that lack specific start/stop times or fail to detail the actual tasks performed.
• Unapproved Tasks: Billing for personal care tasks under a homemaker authorization.
• Lapsed Authorizations: Providing and billing for services after a participant's prior authorization has expired.

11. Key Contacts and Resources

Providers should rely on official DHHS resources for the most current rules, rates, and forms. The HFA and NH MMIS help desks are the primary points of contact for licensing and billing inquiries, respectively.

Subscribing to DHHS provider bulletins is essential for staying informed about waiver renewals, rate changes, and regulatory updates.

• DHHS Health Facilities Administration: (603) 271-9039, https://www.dhhs.nh.gov/programs-services/health-care/health-facilities-administration
• NH MMIS Provider Relations: 1-866-291-1674, https://nhmmis.nh.gov/
• Bureau of Elderly and Adult Services (BEAS): https://www.dhhs.nh.gov/programs-services/adult-aging-care
• Administrative Rules (He-P 822): Available via the NH General Court website or HFA document library.
• ServiceLink: 1-866-634-9412, https://www.servicelink.nh.gov/

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