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

Last reviewed: 2026-09-10

New Hampshire Department of Health and Human Services (DHHS) reimburses Physical Therapy services under administrative rule He-W 568 for traditional Medicaid and He-M 504 for home and community-based waiver programs. The service delivers licensed evaluation and treatment addressing mobility, strength, balance, and fall risk for eligible beneficiaries.

Approval requires active licensure through the New Hampshire Office of Professional Licensure and Certification (OPLC) before submitting a Title XIX provider application through the NH MMIS Health Enterprise Portal. Performing-only physical therapists cannot enroll independently and must establish a formal affiliation with an enrolled NH Medicaid Group provider to bill for services.

1. Service Definition and Scope

Physical Therapy in New Hampshire Medicaid encompasses professional evaluation and therapeutic interventions designed to improve or restore physical function. Services are governed by specific administrative rules depending on whether they are delivered under traditional medical assistance or waiver programs.

The scope includes assessing mobility, strength, and balance, and implementing treatment plans to mitigate fall risks and enhance independence.

• Primary Authority: He-W 568 Physical Therapy Services
• Waiver Authority: He-M 504 Provider and Provider Agency Participation for developmental services
• Scope of Practice: Evaluation and treatment addressing mobility, strength, balance, and fall risk
• Eligible Rendering Providers: Licensed physical therapists and licensed physical therapy assistants operating under supervision

2. Regulatory and Oversight Agencies

The New Hampshire Department of Health and Human Services (DHHS) administers the Medicaid program and oversees provider enrollment. Professional licensure is managed separately by the state's centralized licensing office.

Providers serving managed care populations must also interact with contracted health plans under the Medicaid Care Management program.

• Medicaid Agency: NH Department of Health and Human Services (DHHS) (https://www.dhhs.nh.gov)
• Licensing Board: NH Office of Professional Licensure and Certification (OPLC) (https://www.oplc.nh.gov)
• Enrollment Portal: NH MMIS Health Enterprise Portal (https://nhmmis.nh.gov)
• Managed Care Oversight: NH Medicaid Care Management (MCM) (https://www.dhhs.nh.gov/programs-services/medicaid/medicaid-care-management)

3. Gatekeeping Prerequisites: Who Can Even Apply

New Hampshire imposes specific structural preconditions before a physical therapy provider can successfully enroll in Medicaid. There is no Certificate of Need (CON) program restricting the establishment of independent physical therapy practices in the state.

However, individual practitioners face strict affiliation rules, and waiver providers must undergo pre-enrollment screening.

• Professional Licensure: An applicant must hold an active New Hampshire physical therapy license before initiating the Medicaid enrollment application
• Group Affiliation Requirement: Performing-only providers cannot enroll independently and must be affiliated with a NH Medicaid enrolled Group provider
• Certificate of Need: None exists for physical therapy services in New Hampshire
• Waiver Screening: He-M 504.04 requires HCBS waiver provider agencies to contact the bureau to request a screening upon enrollment initiation

4. Licensure and Certification Requirements

Physical therapists must be licensed by the state in which they practice to qualify as a NH enrolled Title XIX provider. In New Hampshire, this is handled by the Physical Therapy Governing Board under the OPLC.

Applicants must meet educational standards and pass national examinations to secure this credential.

• Issuing Agency: NH OPLC Physical Therapy Governing Board
• License Types: Physical Therapist (PT) or Physical Therapist Assistant (PTA)
• Examination: Must pass the National Physical Therapy Examination (NPTE)
• Continuing Education: Maintenance of licensure requires completing mandated continuing education hours per the biennial renewal cycle

5. Medicaid Provider Enrollment

Enrollment is processed electronically through the state's Medicaid Management Information System. Providers must select the appropriate application type based on their business structure.

Changes in ownership or tax identification require immediate action to prevent disruptions in billing.

• System: NH MMIS Health Enterprise Portal
• Application Types: Group Provider Application or Individual/Performing Provider Application
• Required Agreement: NH Medicaid Program Provider Enrollment Agreement
• Change of Ownership (CHOW): Requires a completely new enrollment application submitted within 35 days of the change
• Service Locations: All physical service locations are required to be issued their own distinct Medicaid provider ID

6. Staffing, Training and Background Checks

New Hampshire Medicaid requires background checks for providers designated as high risk. Administrative rule He-W 520.06 outlines the specific fingerprinting and screening mandates.

Waiver providers must also comply with department-mandated training and orientation requirements.

• Background Check: State and federal criminal background check, including fingerprinting, is required for high-risk providers
• Background Exemption: Waived if a criminal background check was completed by a Medicare administrative contractor or another state's Medicaid agency within the previous 36 months
• Supervision: Physical therapy assistants must operate under the supervision of a fully licensed physical therapist
• Waiver Training: HCBS providers must participate in department screening and orientation per He-M 504

7. Documentation, Policies and Records

The NH Medicaid Program Provider Enrollment Agreement legally binds providers to strict record-keeping standards. Providers must maintain clinical and administrative records that fully justify the services billed.

Failure to produce these records upon request can result in immediate sanctions or enrollment termination.

• Record Retention: Must keep records necessary to fully disclose the extent of care or services provided to individuals under the NH Medicaid Program
• Disclosure Timeline: Must disclose requested records within 35 days of a request by the Secretary or the Department
• Administrative Reporting: Must report changes in ownership, board members, or Tax ID within 35 days
• Clinical Documentation: Must maintain comprehensive evaluation reports, plans of care, and daily treatment notes

8. Billing, Rates and Claims

Physical therapy services are billed using standard CPT codes through the state's electronic portal or directly to managed care organizations. Providers must ensure all rendering and billing identifiers are accurate.

Serving the majority of Medicaid beneficiaries requires secondary credentialing with managed care plans.

• Submission System: Electronic Claims Submission via the NH MMIS Health Enterprise System Web Portal
• NPI Requirement: Both the billing provider NPI and the rendering provider NPI must be included on the claim
• MCO Contracting: Providers wanting to serve Medicaid Care Management members must first enroll with the state, then contract and credential with the health plans
• ORP Rules: Ordering, referring, or prescribing providers listed on a Fee-for-Service claim must also be enrolled in NH Medicaid

9. Approval Sequence and Timeline

Becoming a fully billable physical therapy provider in New Hampshire follows a strict sequential path. Professional licensure must precede any Medicaid enrollment activity.

Managed care credentialing is the final step and cannot begin until the state issues a Medicaid ID.

• Step 1: Obtain professional Physical Therapy license from the NH OPLC
• Step 2: Obtain an NPI and register the business entity with the NH Secretary of State
• Step 3: Submit the Group or Individual application via the NH MMIS Health Enterprise Portal
• Step 4: Complete fingerprinting and background checks if designated as a high-risk provider
• Step 5: Execute the NH Medicaid Program Provider Enrollment Agreement to receive a Medicaid ID
• Step 6: Contract and credential with NH Medicaid Care Management MCOs

10. Common Denials and Survey Findings

Applications are frequently delayed or denied due to missing affiliations or failure to disclose required background information. The state strictly enforces timelines for reporting changes.

Auditors focus heavily on documentation availability and adherence to the 35-day reporting windows.

• Denial Reason: Attempting to enroll a performing-only provider without an established affiliation to a NH Medicaid enrolled Group provider
• Denial Reason: Applicant has an existing Medicaid overpayment or was excluded by the OIG within the past 10 years
• Audit Finding: Failure to provide required clinical or administrative documents to the department within the mandated 35-day window
• Audit Finding: Billing for services with an expired professional license or failing to report a Change of Ownership (CHOW) within 35 days

11. Key Contacts and Resources

Providers should utilize the official state portals and contact centers for application assistance and policy clarification. The MMIS portal serves as the primary hub for enrollment documents.

Managed care contracting requires direct outreach to the individual health plans.

• NH DHHS Provider Enrollment Phone: (603) 223-4774 or (866) 291-1674
• NH MMIS Health Enterprise Portal: https://nhmmis.nh.gov
• NH Office of Professional Licensure and Certification: https://www.oplc.nh.gov
• NH Medicaid Provider Relations: https://www.dhhs.nh.gov/programs-services/medicaid/medicaid-provider-relations

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