New Hampshire - Personal Assistance Services — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-08-16

In New Hampshire, Personal Assistance Services (often referred to as Personal Care Services) provide essential hands-on help with activities of daily living (ADLs) such as bathing, dressing, transferring, and toileting. These services are primarily delivered through the state's Medicaid Home and Community Based Services (HCBS) waivers, including the Choices for Independence (CFI) waiver for older adults and adults with physical disabilities, and the Developmental Disabilities (DD), Acquired Brain Disorder (ABD), and In-Home Supports (IHS) waivers.

The single biggest structural barrier to entry for new providers in New Hampshire depends on the target population. For the DD, ABD, and IHS waivers, the state operates a closed-network gatekeeping model: providers cannot simply enroll in Medicaid and bill; they must be selected by and subcontract under one of New Hampshire's 10 designated regional Area Agencies. For the CFI waiver, providers face a dual-enrollment barrier, requiring both state Medicaid enrollment and subsequent credentialing and contracting with the state's Medicaid Care Management (MCM) health plans (Managed Care Organizations) to receive authorizations and payment.

1. Service Definition and Scope

Personal Assistance Services in New Hampshire are designed to support individuals in their own homes or community settings, preventing institutionalization. The service encompasses hands-on assistance with basic needs that the individual cannot perform independently due to physical or cognitive impairments.

Services must be delivered strictly according to an approved Individualized Service Plan (ISP) developed by a case manager or Area Agency service coordinator.

• Service Nomenclature: Personal Care Services or Personal Assistance Services.
• Covered ADLs: Hands-on assistance with bathing, dressing, grooming, toileting, transferring, and mobility.
• Covered IADLs: Light homemaking, meal preparation, and medication reminders, provided they are incidental to the personal care tasks.
• Primary Waiver Authorities: Choices for Independence (CFI) Waiver, Developmental Disabilities (DD) Waiver, Acquired Brain Disorder (ABD) Waiver, and In-Home Supports (IHS) Waiver.
• Delivery Setting: The participant's private home or community setting; services cannot be billed while the participant is in a hospital or nursing facility.
• Exclusions: Skilled nursing tasks, medication administration (unless performed by a licensed nurse or specifically delegated under NH nursing rules), and sterile procedures.

2. Regulatory and Oversight Agencies

Oversight of Personal Assistance Services in New Hampshire is divided among several bureaus within the Department of Health and Human Services (DHHS). Licensing is centralized, while waiver administration is split by target population.

Providers must interact with both the state agencies for compliance and the managed care plans or Area Agencies for service authorization and payment.

• Licensing Agency: NH DHHS Health Facilities Administration (HFA) (https://www.dhhs.nh.gov/doing-business-dhhs/licensing-certification/health-facilities-administration).
• Elderly/Physical Disability Waiver Oversight: NH DHHS Bureau of Elderly and Adult Services (BEAS) (https://www.dhhs.nh.gov/programs-services/adult-aging-care/home-and-community-based-services-hcbs).
• Developmental Disability Waiver Oversight: NH DHHS Bureau of Developmental Services (BDS) (https://www.dhhs.nh.gov/programs-services/disability-care/developmental-services).
• Medicaid Enrollment Portal: NH MMIS Health Enterprise Portal (https://nhmmis.nh.gov/portals/wps/portal/ProviderEnrollment).
• Managed Care Plan (MCO): NH Healthy Families (https://www.nhhealthyfamilies.com/providers/become-a-provider.html).
• Managed Care Plan (MCO): WellSense Health Plan (https://www.wellsense.org/providers/nh).

3. Gatekeeping Prerequisites: Who Can Even Apply

New Hampshire enforces strict structural preconditions before a provider can actively bill for Personal Assistance Services. A Medicaid provider ID alone does not grant access to patients or funding.

Applicants must secure the necessary business registrations, state licenses, and network affiliations before they can receive service authorizations.

• Area Agency Affiliation (DD/ABD/IHS Waivers): Providers targeting developmental disability waivers must negotiate and contract with one of the 10 regional Area Agencies; Medicaid enrollment is required, but the Area Agency controls network access and referrals.
• MCO Credentialing (CFI Waiver): Providers serving the Choices for Independence waiver must contract and credential with NH Medicaid Care Management health plans (e.g., NH Healthy Families, WellSense) after state enrollment.
• State Licensure Prerequisite: An applicant must obtain a Home Health Care Provider license (He-P 809) or Individual Home Care Service Provider license (He-P 822) from the Health Facilities Administration before Medicaid enrollment is approved.
• Business Registration: The business entity must be registered and in good standing with the NH Secretary of State (https://quickstart.sos.nh.gov/online).
• Federal Identifiers: Applicants must obtain a Type 2 National Provider Identifier (NPI) and an Employer Identification Number (EIN) prior to initiating the MMIS application.

4. Licensure and Certification Requirements

Agencies providing hands-on personal care in New Hampshire must be licensed by the DHHS Health Facilities Administration (HFA). Most agencies fall under the Home Health Care Provider rules.

The licensure process involves a detailed application, policy review, and an on-site readiness inspection to ensure compliance with state health and safety standards.

• Rule Citation: NH Code of Administrative Rules Chapter He-P 809 (Home Health Care Providers) or He-P 822 (Individual Home Care Service Providers).
• Application Form: Submit the Initial License Application to HFA along with required organizational documents and policy manuals.
• Application Fee: Typically $250 plus $25 per full-time equivalent (FTE) employee, subject to the current HFA fee schedule.
• Administrator Qualifications: The agency must designate an administrator who meets the specific educational and supervisory experience requirements outlined in He-P 809.
• Insurance Requirements: Providers must secure and maintain general liability and professional liability insurance.
• Readiness Inspection: HFA surveyors will conduct an initial on-site inspection of the agency's office and records system before issuing the license.

5. Medicaid Provider Enrollment

Once licensed by HFA, providers must enroll in New Hampshire Medicaid through the NH MMIS Health Enterprise Portal. This step is mandatory for all waiver providers, including those who will ultimately bill through an Area Agency or MCO.

The enrollment process verifies the provider's licensure, ownership structure, and federal exclusions status.

• Enrollment Portal: Applications are submitted exclusively through the NH MMIS Health Enterprise Portal (https://nhmmis.nh.gov/portals/wps/portal/ProviderEnrollment).
• Provider Type/Specialty: Applicants must select the appropriate HCBS Waiver provider type and specialty code corresponding to Personal Care Services.
• Application Fee: Providers must pay the federal Medicaid application fee (approximately $709 for 2024) unless they provide proof of payment to Medicare or another state's Medicaid program.
• Required Uploads: A signed W-9, NH Secretary of State certificate of good standing, HFA license, and NPI confirmation letter.
• Background Screening: Owners with 5% or more direct or indirect interest must undergo fingerprint-based criminal background checks if the provider type is categorized as high risk by CMS.
• Revalidation: Enrolled providers must revalidate their Medicaid enrollment every 5 years to maintain active status.

6. Staffing, Training and Background Checks

Direct care staff (Personal Care Attendants or Home Health Aides) must meet rigorous background and training standards before providing hands-on care to vulnerable adults.

Agencies are responsible for maintaining continuous proof of compliance for every employee in their personnel files.

• Criminal Background Checks: Mandatory NH State Police criminal history record check for all direct care staff prior to client contact.
• BEAS Registry Check: Agencies must verify that staff are not listed on the Bureau of Elderly and Adult Services (BEAS) State Registry of perpetrators of abuse, neglect, or exploitation.
• Health Screening: Staff must undergo a tuberculosis (TB) risk assessment and screening prior to providing in-home care.
• Initial Training: Staff must complete a comprehensive orientation covering client rights, infection control, emergency procedures, and specific ADL assistance techniques.
• Competency Evaluation: Direct care workers must pass a hands-on competency evaluation administered by a Registered Nurse (RN) before working independently.
• Ongoing Training: A minimum of 12 hours of annual in-service training is required for all personal care staff.

7. Documentation, Policies and Records

Providers must maintain comprehensive operational policies and client records in strict compliance with He-P 809 and federal HCBS Settings Rules.

Documentation must clearly link the services provided to the goals and authorizations in the participant's Individualized Service Plan (ISP).

• Individualized Service Plan (ISP): All personal care tasks must be explicitly authorized and delivered according to the participant's approved ISP.
• Service Notes: Daily documentation must include the date, exact start and stop times, specific ADLs assisted with, and the caregiver's signature.
• Personnel Files: Must contain documented proof of background checks, BEAS registry clearance, TB screening, RN competency evaluations, and annual training logs.
• Incident Reporting Policy: Must have a written policy for reporting adverse events, abuse, neglect, or exploitation to BEAS or BDS within 24 hours.
• HCBS Settings Compliance: Policies must demonstrate adherence to 42 CFR 441.301(c)(4)-(5), ensuring participant privacy, dignity, respect, and freedom from coercion.
• Record Retention: Clinical and billing records must generally be retained for a minimum of 6 years, or longer if required by specific MCO contracts.

8. Billing, Rates and Claims

Billing pathways in New Hampshire depend entirely on the participant's waiver and managed care status. Claims may go to the state MMIS, an MCO, or an Area Agency.

Providers must utilize Electronic Visit Verification (EVV) for all personal care services to ensure compliance with the 21st Century Cures Act.

• Billing Systems: Claims are submitted via the NH MMIS Health Enterprise Portal for Fee-for-Service, through MCO clearinghouses for managed care, or invoiced to Area Agencies for DD/ABD waivers.
• Procedure Codes: Personal care is typically billed using standard HCPCS codes such as T1019 (Personal care services, per 15 minutes).
• Prior Authorization: Absolutely all personal care services require prior authorization from BEAS, BDS, the Area Agency, or the MCO before care is rendered.
• Electronic Visit Verification (EVV): Providers must use a compliant EVV system to electronically capture the date, time, location, and caregiver identity for every visit.
• Timely Filing (FFS): Fee-for-Service claims must generally be submitted within 365 days of the date of service.
• Timely Filing (MCO): Managed Care Organizations often enforce much stricter timely filing limits, frequently 90 to 120 days from the date of service.

9. Approval Sequence and Timeline

The end-to-end process from business formation to billing can take 4 to 8 months. The timeline is heavily dependent on HFA inspection scheduling and MCO credentialing delays.

Providers cannot expedite the process by skipping steps; Medicaid enrollment will not proceed without the HFA license, and MCO credentialing will not proceed without Medicaid enrollment.

• Step 1: Business Registration and NPI/EIN acquisition (1-2 weeks).
• Step 2: Submit HFA License Application and policy manuals (30-60 days for initial state review).
• Step 3: HFA On-Site Readiness Inspection (scheduled within 30-45 days of application acceptance).
• Step 4: NH MMIS Medicaid Enrollment (30-60 days processing by Provider Relations after license is uploaded).
• Step 5: Area Agency Contracting or MCO Credentialing (60-90 days, conducted concurrently with or immediately after Medicaid enrollment).

10. Common Denials and Survey Findings

Applications and licensure surveys are frequently delayed or denied due to incomplete documentation or failure to adhere to strict background check timelines.

During post-payment audits, recoupments are common if EVV data does not perfectly match billed claims.

• Missing BEAS Registry Checks: Allowing staff to provide care before the BEAS abuse registry check is fully cleared and documented in the file.
• Incomplete Competency Evals: Failure to have a Registered Nurse (RN) sign off on the direct care worker's hands-on competency evaluation prior to independent work.
• EVV Non-Compliance: Failing to consistently capture required EVV data elements (e.g., manual time entries instead of GPS-verified clock-ins), leading to claim denials.
• Policy Deficiencies: Submitting generic, purchased policy manuals that do not specifically reference NH He-P 809 rules or NH mandatory reporting statutes.
• Lapsed Training: Missing documentation of the required 12 hours of annual in-service training for personal care staff.
• Unauthorized Services: Billing for hours or tasks that exceed the limits specified in the participant's approved ISP.

11. Key Contacts and Resources

Use these official state resources for applications, rule references, and enrollment support. Relying on third-party summaries can lead to compliance failures.

For specific billing or authorization questions, providers should contact the relevant MCO or Area Agency directly.

• NH Medicaid Provider Enrollment: (603) 223-4774 or (866) 291-1674, https://nhmmis.nh.gov/portals/wps/portal/ProviderEnrollment
• NH DHHS Health Facilities Administration (HFA): https://www.dhhs.nh.gov/doing-business-dhhs/licensing-certification/health-facilities-administration
• NH Bureau of Elderly and Adult Services (BEAS): https://www.dhhs.nh.gov/programs-services/adult-aging-care/home-and-community-based-services-hcbs
• NH Bureau of Developmental Services (BDS): https://www.dhhs.nh.gov/programs-services/disability-care/developmental-services
• NH Area Agencies Directory: https://www.dhhs.nh.gov/programs-services/disability-care/area-agencies
• NH Healthy Families (MCO Provider Portal): https://www.nhhealthyfamilies.com/providers/become-a-provider.html
• WellSense Health Plan (MCO Provider Portal): https://www.wellsense.org/providers/nh

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