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

Last reviewed: 2026-09-10

New Hampshire requires agencies providing hands-on assistance with activities of daily living to obtain a Home Care Service Provider Agency license under He-P 822 from the Department of Health and Human Services (DHHS) Health Facilities Administration before applying for Medicaid enrollment. Personal Care Services are funded primarily through the Choices for Independence (CFI) Waiver, the Developmental Disabilities (DD) Waiver, and the Acquired Brain Disorders (ABD) Waiver, as well as the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit for children.

Providers seeking to serve the DD or ABD waiver populations must secure a contract and designation from one of New Hampshire's ten regional Area Agencies, which control the local provider networks and authorize service agreements. Agencies targeting the CFI waiver or standard Medicaid populations must first enroll through the NH MMIS Provider Enrollment Portal as a Fee-for-Service provider to receive a Medicaid ID, and subsequently complete credentialing and contracting with the state's Managed Care Organizations (MCOs) to receive authorizations and reimbursement.

1. Service Definition and Scope

In New Hampshire, Personal Care Services encompass medically necessary assistance with Activities of Daily Living (ADLs) such as bathing, dressing, transferring, mobility, and toileting, as well as Instrumental Activities of Daily Living (IADLs). These services are delivered in the individual's home or community setting to prevent institutionalization.

Under the state's administrative rules (He-W 589 and He-P 822), personal care services must be authorized by a physician, advanced practice registered nurse (APRN), or other licensed clinician, and are integrated into a formal care plan or service agreement.

2. Regulatory and Oversight Agencies

The New Hampshire Department of Health and Human Services (DHHS) is the single state Medicaid agency and oversees all HCBS waivers. Within DHHS, specific divisions handle licensure, Medicaid enrollment, and waiver operations.

Managed Care Organizations (MCOs) and regional Area Agencies act as delegated oversight entities for specific populations, managing provider networks, credentialing, and care coordination.

3. Gatekeeping Prerequisites: Who Can Even Apply

New Hampshire imposes strict structural prerequisites depending on the target population. An applicant cannot simply enroll as a Medicaid provider without first securing the appropriate state license and, for certain waivers, a regional network contract.

For the DD and ABD waivers, the state utilizes a closed-network model managed by ten regional Area Agencies. Providers must be selected and contracted by an Area Agency before they can bill for services.

4. Licensure and Certification Requirements

Agencies providing personal care must be licensed as Home Care Service Provider Agencies under New Hampshire Administrative Code He-P 822. The licensure process involves submitting a detailed application, policies and procedures, and passing an initial on-site inspection by the Health Facilities Administration.

Licenses must be renewed annually, and agencies are subject to unannounced surveys to ensure ongoing compliance with health, safety, and administrative rules.

5. Medicaid Provider Enrollment

Once licensed, the agency must enroll in New Hampshire Medicaid as a Fee-for-Service provider through the NH MMIS portal. This step generates the NH Medicaid Provider ID necessary for all subsequent MCO credentialing.

The enrollment application requires disclosure of ownership, submission of the He-P 822 license, and completion of required screening based on the provider's risk level.

6. Staffing, Training and Background Checks

New Hampshire requires all personal care attendants and agency staff with direct client contact to undergo comprehensive background checks before providing services. Agencies must maintain personnel files documenting these clearances.

Staff must complete initial orientation and ongoing training specific to the needs of the waiver populations they serve, including training on the individual's specific care plan.

7. Documentation, Policies and Records

Providers must maintain exhaustive clinical and administrative records. Every service delivered must be backed by a written care plan or service agreement authorized by the managing entity (MCO or Area Agency).

Timekeeping and service documentation must align with Electronic Visit Verification (EVV) requirements to validate the date, time, location, and type of service provided.

8. Billing, Rates and Claims

Reimbursement for personal care services is dictated by the NH Medicaid Fee Schedule for Fee-for-Service populations, or by negotiated contracted rates with the MCOs for managed care members.

Claims must be submitted electronically through the NH MMIS portal or the respective MCO clearinghouses, utilizing standard HCPCS codes and modifiers.

9. Approval Sequence and Timeline

Becoming a fully billable provider is a sequential process that can take several months. The agency must first secure the physical location and develop policies to apply for the He-P 822 license.

Only after the license is issued can the agency apply to NH MMIS. Once the Medicaid ID is granted, the agency faces a 60- to 90-day credentialing cycle with the MCOs.

10. Common Denials and Survey Findings

Applications for licensure or Medicaid enrollment are frequently delayed or denied due to incomplete documentation, missing background checks, or failure to meet the specific administrator qualifications under He-P 822.

During HFA surveys or MCO audits, agencies are commonly cited for inadequate personnel files, missing EVV data, or delivering services outside the scope of the authorized care plan.

11. Key Contacts and Resources

Providers should rely on the official NH DHHS websites and the NH MMIS portal for the most current manuals, fee schedules, and application forms.

The MCO provider relations departments and the regional Area Agencies are the primary contacts for contracting and authorization questions.

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