New Hampshire - I/DD Services — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

The New Hampshire Department of Health and Human Services (DHHS) Bureau of Developmental Services (BDS) administers the Developmental Disabilities (DD) Waiver, requiring all prospective agencies to enroll as Provider Type 236 through the MMIS Health Enterprise Portal [New Provider and Onboarding Resources](https://www.dhhs.nh.gov/programs-services/disability-care/developmental-services/new-provider-and-onboarding-resources). The state operates under a regional Area Agency system, meaning new providers must coordinate with one of the ten designated regional Area Agencies to receive service authorizations and connect with individuals seeking supports.

Recent federal compliance mandates have shifted New Hampshire from an Area Agency pass-through billing model to a direct-bill system, requiring all waiver providers to hold their own Medicaid ID and bill directly or via a third-party trading partner [Contents](https://www.dhhs.nh.gov/sites/g/files/ehbemt476/files/documents2/provider-enrollment-faq-fall-2022.pdf). Facility-based services, such as residential habilitation, require subsequent certification through the Health Facilities Administration (HFA) under He-M administrative rules before operations can commence.

1. Service Definition and Scope

The Developmental Disabilities (DD) Waiver provides home and community-based services to individuals meeting the level of care and developmental disability criteria under NH Law RSA 171-A:2 [State of New Hampshire Department of Health and ...](https://www.dhhs.nh.gov/sites/g/files/ehbemt476/files/documents2/dltssddwaiveroverview.pdf). The service array spans residential habilitation, community participation services (CPS), community support services (CSS), supported employment, and crisis response.

The waiver incorporates the core belief that individuals with developmental disabilities should have access to the broader community, build relationships, and meet personal goals through qualified providers.

• Target Population: Individuals with intellectual disabilities, cerebral palsy, epilepsy, autism, or specific learning disabilities meeting RSA 171-A:1-a criteria.
• Community Participation Services (CPS): Day programming and community integration supports requiring an NPI for enrollment.
• Residential Habilitation: 24-hour support provided in certified group homes or staffed residences.
• Supported Employment: Job coaching and vocational supports to maintain competitive community employment.
• Participant Directed and Managed Services (PDMS): A service delivery method allowing individuals or guardians budget and employment authority over their supports.

2. Regulatory and Oversight Agencies

Oversight of I/DD services in New Hampshire is divided between programmatic management and facility certification. The Bureau of Developmental Services (BDS) manages the waiver programs and provider specialties, while the Health Facilities Administration (HFA) conducts life-safety and facility certifications.

Medicaid enrollment and claims processing are handled through the state's MMIS portal, managed by Conduent, while local care coordination is delegated to regional non-profit entities.

• Bureau of Developmental Services (BDS): Manages the DD, ABD, and IHS waivers and determines authorized provider specialties (https://www.dhhs.nh.gov/bureau-developmental-services).
• Health Facilities Administration (HFA): Conducts licensing and certification for physical facility locations (https://www.dhhs.nh.gov/doing-business-dhhs/licensing-certification/health-facilities-administration).
• NH MMIS Health Enterprise Portal: The Conduent-operated system for Medicaid provider enrollment and direct billing (https://nhmmis.nh.gov/portals/wps/portal/ProviderEnrollment).
• Area Agencies: Ten regional non-profit entities designated by the state to coordinate care and issue service authorizations (https://www.dhhs.nh.gov/programs-services/disability-care/area-agencies).

3. Gatekeeping Prerequisites: Who Can Even Apply

New Hampshire utilizes a decentralized, regional intake and care management model governed by ten designated Area Agencies [New Provider and Onboarding Resources](https://www.dhhs.nh.gov/programs-services/disability-care/developmental-services/new-provider-and-onboarding-resources). While any qualified entity can apply for Medicaid enrollment as a Developmental Services provider, securing actual billable work requires establishing a relationship with the regional Area Agency that controls the service authorizations for local participants.

Additionally, providers must secure a National Provider Identifier (NPI) for specific core services and register their business with the state before the MMIS portal will accept an enrollment application.

• Area Agency Coordination: Providers must work with one of the ten regional Area Agencies to advertise their services and receive participant referrals.
• Business Registration: Applicants must register their business name with the NH Secretary of State prior to Medicaid enrollment.
• NPI Requirement: Entities must obtain a National Provider Identifier (NPI) and taxonomy code (via nucc.org) before applying for core specialties like CPS or Residential Habilitation.
• Single Provider ID: Providers must enroll under the single Developmental Services provider type (236) rather than holding separate IDs for DD, ABD, and IHS waivers.

4. Licensure and Certification Requirements

New Hampshire separates Medicaid enrollment from physical site certification. Providers must first become enrolled Medicaid providers, after which the Health Facilities Administration (HFA) evaluates and certifies specific programs, such as residential group homes, against the He-M administrative rules [New Provider and Onboarding Resources](https://www.dhhs.nh.gov/programs-services/disability-care/developmental-services/new-provider-and-onboarding-resources).

Certification requires passing physical site inspections and demonstrating compliance with federal community integration standards.

• He-M Administrative Rules: The statutory framework governing developmental services, including He-M 1001 for certification of community residences.
• HFA Certification: Required for facility-based services after the agency obtains its Medicaid Provider ID.
• Life Safety Code: Physical sites must pass fire marshal and local zoning clearances before HFA issues a certificate to operate.
• Settings Rule Compliance: All sites must demonstrate compliance with the HCBS Final Rule (42 CFR 441.301(c)(4)) regarding community integration and participant rights.

5. Medicaid Provider Enrollment

Following a CMS corrective action plan, New Hampshire transitioned to a direct-bill model, requiring all I/DD providers to enroll directly through the NH MMIS Health Enterprise Portal [Contents](https://www.dhhs.nh.gov/sites/g/files/ehbemt476/files/documents2/provider-enrollment-faq-fall-2022.pdf). BDS Program Integrity reviews the application materials to assign specific approved specialties under the umbrella Provider Type 236.

Providers must submit a single application for Developmental Services, which covers the DD, ABD, and IHS waivers under one Medicaid ID.

• Provider Type 236: The mandatory classification for all Developmental Services providers across the DD, ABD, and IHS waivers.
• Application Portal: Submissions are processed exclusively through the NH MMIS Health Enterprise Portal managed by Conduent.
• Specialty Assignment: BDS Program Integrity determines which specific services (e.g., Respite, Crisis Response) the provider is authorized to bill based on the application packet.
• EFT Authorization: Providers must select Yes under the Electronic Funds Transfer section to receive direct payments, even if an Area Agency generates the service authorization.

6. Staffing, Training and Background Checks

Direct support professionals (DSPs) and program managers must meet qualifications outlined in the He-M rules and the approved DD Waiver appendix. Training mandates focus on health, safety, and individual rights, with specific modules required before unsupervised participant contact.

Agencies are responsible for maintaining current training logs and background check clearances for all personnel.

• Criminal Background Checks: Mandatory state and federal background screening for all staff providing direct waiver services.
• Medication Administration: Staff administering medications must complete the state-approved He-M 1201 medication administration training curriculum.
• HCBS Settings Training: Mandatory staff instruction on participant rights, dignity, and the HCBS Settings Rule requirements.
• Incident Reporting: Personnel must be trained on the state's critical incident reporting protocols and timelines.

7. Documentation, Policies and Records

Providers must maintain comprehensive administrative and clinical records that align with BDS policies and He-M regulations. Documentation must support the direct-bill claims submitted to the MMIS and demonstrate adherence to the participant's individualized service agreement.

State surveyors and BDS Program Integrity audit these records to ensure services are delivered as authorized and billed correctly.

• Service Authorizations: Records must include the active authorization generated by the regional Area Agency for each participant.
• Conflict of Interest Policy: Agencies must maintain policies demonstrating compliance with CMS conflict-free case management regulations.
• Budget Templates: Providers utilizing specific funding models must maintain BDS-approved budget templates for their programs.
• Progress Notes: Daily or shift-level documentation detailing the delivery of authorized waiver services and progress toward individualized goals.

8. Billing, Rates and Claims

The transition to direct billing means providers no longer submit invoices to Area Agencies for pass-through payment [Contents](https://www.dhhs.nh.gov/sites/g/files/ehbemt476/files/documents2/provider-enrollment-faq-fall-2022.pdf). Instead, claims are submitted directly to the NH MMIS, either manually through the portal or via an approved third-party trading partner using EDI 837 transactions.

While the state sets the rates and processes the payments, the Area Agencies still control the generation of the underlying service authorizations required for a claim to pay.

• Direct Bill Mandate: Providers must bill the state's MMIS directly; Area Agencies no longer process payments for waiver services.
• Trading Partners: Agencies using a third-party biller or clearinghouse must complete the direct-bill enrollment process and link the trading partner in the MMIS.
• Prior Authorization: While the Supports Intensity Scale (SIS) and Health Risk Screening Tool (HRST) no longer require prior authorization to bill, core waiver services require an active Area Agency authorization.
• Remittance Advice: Payments and claim denials are communicated through the MMIS portal via electronic remittance advice (835 transactions).

9. Approval Sequence and Timeline

The critical path to becoming a billable provider in New Hampshire starts with business registration and NPI acquisition, followed by Medicaid enrollment, and concludes with facility certification and Area Agency networking. Because certification depends on Medicaid enrollment, the sequence is strictly linear.

Providers cannot bypass the MMIS enrollment step, as HFA will not certify a facility without an active Medicaid Provider ID.

• Step 1: Register the business entity with the NH Secretary of State and obtain an NPI/taxonomy code.
• Step 2: Submit the Provider Type 236 enrollment application through the NH MMIS Health Enterprise Portal.
• Step 3: Await BDS Program Integrity review and assignment of authorized service specialties.
• Step 4: Apply to the Health Facilities Administration (HFA) for site certification (if providing facility-based services like residential habilitation).
• Step 5: Coordinate with regional Area Agencies to advertise services and secure participant referrals and authorizations.

10. Common Denials and Survey Findings

Enrollment delays typically stem from applying for the wrong provider type or failing to secure an NPI for required specialties. Post-enrollment, HFA surveyors frequently cite providers for physical plant deficiencies or incomplete staff training records during initial site visits.

Failure to align application materials with the specific requirements of Provider Type 236 will result in immediate rejection by BDS Program Integrity.

• Incorrect Provider Type: Applications are rejected if submitted under generic HCBS codes instead of the mandatory Developmental Services Provider Type 236.
• Missing NPI: Applications for core services (e.g., CPS, Residential) stall if the provider fails to supply a valid NPI and matching taxonomy code.
• Life Safety Violations: HFA certification is frequently delayed by local fire marshal or zoning compliance issues at residential sites.
• Settings Rule Non-Compliance: Sites exhibiting institutional characteristics or failing to guarantee participant privacy and autonomy face certification denial.

11. Key Contacts and Resources

Prospective providers must navigate multiple state portals and rule sets. The primary hubs for information are the BDS onboarding page, the MMIS enrollment portal, and the General Court's repository of He-M administrative rules.

Providers should establish direct contact with their regional Area Agency early in the process to understand local needs and referral pathways.

• Bureau of Developmental Services (BDS): Programmatic oversight and onboarding resources (https://www.dhhs.nh.gov/bureau-developmental-services).
• NH MMIS Health Enterprise Portal: The Conduent system for Medicaid enrollment and billing (https://nhmmis.nh.gov/portals/wps/portal/ProviderEnrollment).
• Health Facilities Administration (HFA): Facility licensing and certification (https://www.dhhs.nh.gov/doing-business-dhhs/licensing-certification/health-facilities-administration).
• NH Area Agencies Directory: Contact information for the ten regional entities controlling service authorizations (https://www.dhhs.nh.gov/programs-services/disability-care/area-agencies).
• He-M Administrative Rules: The official state regulations governing developmental services (https://www.gc.nh.gov/rules/state_agencies/he-m.html).

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