Waiver Consulting Group — Start any program. In any state.

New Hampshire - Integrated Employment — 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) funds Integrated Employment through the Developmental Disabilities (DD) and Acquired Brain Disorders (ABD) 1915(c) waivers under the umbrella of Supported Employment services. Providers deliver job development, placement, and on-site coaching to assist individuals in achieving competitive work in community settings at or above the prevailing wage.

To become an approved provider, an agency must first secure a vendor contract or service authorization alignment with one of New Hampshire's 10 designated regional Area Agencies, which control participant service plans and local network access, before enrolling in the NH MMIS Enterprise Portal as a Provider Type 236 (Developmental Services).

1. Service Definition and Scope

New Hampshire BDS defines Supported Employment as services that assist individuals with developmental disabilities or acquired brain disorders in obtaining and maintaining competitive, integrated employment. This service is designed to lead to employment at or above the state minimum wage in settings where the individual interacts with persons without disabilities to the same extent as workers without disabilities in comparable positions.

The scope of the service includes vocational assessment, job development, job placement, on-the-job training, and ongoing job coaching. Support is expected to fade over time as the individual gains independence in the workplace.

2. Regulatory and Oversight Agencies

The New Hampshire Department of Health and Human Services (DHHS) is the single state Medicaid agency responsible for overall waiver administration. Within DHHS, the Bureau of Developmental Services (BDS) manages policy, waiver operations, and provider enrollment for developmental services.

The DHHS Bureau of Licensing and Certification conducts site visits and enforces administrative rules, while the 10 regional Area Agencies act as the local oversight and service coordination entities.

3. Gatekeeping Prerequisites: Who Can Even Apply

New Hampshire operates a unique decentralized system where 10 regional Area Agencies serve as the gatekeepers for developmental services. A prospective provider cannot simply enroll in Medicaid and begin billing; they must be selected by an individual and authorized by the local Area Agency through the individual's Service Agreement.

Additionally, under recent Conflict-Free Case Management rules, an entity providing direct Supported Employment services cannot also provide case management/service coordination to the same individual.

4. Licensure and Certification Requirements

Providers of developmental services in New Hampshire are governed by the He-M 500 series of the New Hampshire Code of Administrative Rules. Specifically, He-M 518 governs employment and day services, outlining the standards for certification.

While integrated employment occurs in the community and does not require a facility license, the provider agency itself must undergo a certification review by the Bureau of Licensing and Certification to ensure compliance with staff qualifications, human rights, and HCBS settings requirements.

5. Medicaid Provider Enrollment

Following the state's transition to direct billing, all developmental services providers must enroll directly with NH Medicaid through the NH MMIS Enterprise Portal. Providers must enroll as a group-billing provider under Provider Type 236 (Developmental Services).

During enrollment, BDS Program Integrity reviews the application and assigns specific specialties based on the provider's certification and Area Agency authorizations. Individual job coaches do not enroll separately.

6. Staffing, Training and Background Checks

Direct Support Professionals (DSPs) and job coaches delivering Supported Employment must meet the minimum qualifications outlined in He-M 518. This includes completing required training before working independently with individuals.

Comprehensive background checks are mandatory for all staff prior to employment, utilizing state and federal databases to ensure participant safety.

7. Documentation, Policies and Records

Providers must maintain rigorous documentation to support Medicaid billing and demonstrate progress toward employment goals. All services must be explicitly authorized in the individual's Service Agreement developed by the Area Agency.

Daily visit logs and progress notes must be kept for audit purposes, detailing the date, start and end times, specific activities performed, and the staff member providing the service.

8. Billing, Rates and Claims

As of July 1, 2023, providers bill NH Medicaid directly through the MMIS portal rather than passing claims through the Area Agencies. Claims must include the Medicaid Billing ID corresponding to the specific service location.

Rates for Supported Employment are established by DHHS and published in the BDS rate schedule. Providers must set up Electronic Funds Transfer (EFT) during the enrollment process to receive payment.

9. Approval Sequence and Timeline

The approval process begins locally and ends at the state level. A provider must first negotiate a service arrangement with a regional Area Agency and obtain necessary certifications from the Bureau of Licensing and Certification.

Once certified and authorized, the provider submits the Medicaid enrollment application via the MMIS portal. BDS Program Integrity reviews the application, assigns specialties, and issues a Welcome Letter.

10. Common Denials and Survey Findings

Medicaid enrollment applications are frequently delayed or denied due to missing documentation, such as unsigned Provider Participation Agreements or mismatched IRS verification letters.

During certification surveys, common findings include failure to maintain up-to-date background checks, incomplete daily visit logs, and failure to document progress toward the specific employment goals outlined in the Service Agreement.

11. Key Contacts and Resources

Prospective providers should utilize the DHHS BDS website and the NH MMIS portal for the most current applications, rate schedules, and training materials.

The Area Agency directory is the critical first step for any new agency looking to enter the New Hampshire market.

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