New Hampshire - Respite Care Services — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

New Hampshire funds Respite Care Services through the Bureau of Developmental Services (BDS) under the Developmental Disabilities (DD), Acquired Brain Disorder (ABD), and In Home Support (IHS) waivers. Providers must secure authorization and qualification verification from one of the state's ten designated regional Area Agencies before delivering services, alongside enrolling as a Direct Bill provider through the NH MMIS portal.

Out-of-home respite provided in a facility setting requires formal licensure under He-P 800 rules as a Residential Care Facility, while in-home respite relies on BDS certification and Area Agency credentialing. Following a recent system overhaul, all BDS service providers must now hold their own Medicaid Provider ID under Provider Type 236 and bill the state directly rather than passing claims through the Area Agency.

1. Service Definition and Scope

Respite care services consist of short-term assistance provided to individuals unable to care for themselves, furnished because of the absence or need for relief of the unpaid caregiver normally providing the care.

The service can be delivered in the participant's home or in an out-of-home setting, provided it does not duplicate services regularly provided by a facility-based setting.

• Waiver Authorities: Funded under the DD, ABD, and IHS 1915(c) waivers.
• In-Home Scope: Provided in the eligible individual's home for the temporary relief and support of the family.
• Out-of-Home Scope: May be provided in a licensed facility, hotel, motel, or other community setting.
• Capacity Limit: Providers giving care in their own homes shall serve no more than 2 persons at one time.

2. Regulatory and Oversight Agencies

The New Hampshire Department of Health and Human Services (DHHS) oversees the Medicaid program and delegates waiver operations to specific bureaus.

Facility-based providers must also interact with the Health Facilities Administration for physical site licensure.

• Operating Agency: NH Bureau of Developmental Services (BDS) (https://www.dhhs.nh.gov/programs-services/disability-care/developmental-services)
• Licensing Authority: NH Health Facilities Administration (HFA) (https://www.dhhs.nh.gov/programs-services/health-care/health-facilities-certification-licensing)
• Medicaid Agency: NH Department of Health and Human Services (DHHS) (https://www.dhhs.nh.gov)
• Claims Portal: NH MMIS Provider Enrollment (https://nhmmis.nh.gov/portals/wps/portal/ProviderEnrollment)

3. Gatekeeping Prerequisites: Who Can Even Apply

New Hampshire utilizes a regional Area Agency system to manage developmental services. While providers now bill the state directly, they cannot deliver services without Area Agency coordination.

Providers must establish their business entity in the state and obtain federal identifiers before initiating the Medicaid enrollment process.

• Regional Designation: Providers must coordinate with the designated Area Agency for the participant's region, as the Area Agency authorizes the service plan.
• Qualification Verification: The Area Agency verifies provider qualifications prior to the delivery of services.
• Business Registration: Applicants must hold a Certificate of Authority or Certificate of Formation from the NH Secretary of State.
• NPI Requirement: Respite providers must obtain a National Provider Identifier (NPI) before applying for Medicaid enrollment.

4. Licensure and Certification Requirements

In-home respite providers do not require a distinct facility license, but out-of-home respite provided in a facility must be licensed by the HFA.

Facility applicants must submit comprehensive documentation proving local compliance and administrative competency.

• Rule Citation: Out-of-home facility providers must comply with He-P 800 Residential Care and Health Facility Rules.
• Application Fee: A $250 fee payable to the Treasurer, State of New Hampshire is required for He-P 800 licensure.
• Local Approvals: Facility applicants must submit written local fire, health, and zoning approvals per He-P 809.04.
• Administrator Qualifications: Facility applicants must submit a resume and applicable licenses for the facility administrator.

5. Medicaid Provider Enrollment

All BDS service providers must enroll for Direct Billing through the NH MMIS portal. The state no longer permits Area Agencies to bill on behalf of all subcontracted providers.

Applicants must select the correct provider type and specialty to ensure claims process correctly under the developmental waivers.

• Provider Type: Applicants must select "Developmental Services Group" (Provider Type 236) from the drop-down list.
• Specialty Selection: Applicants must click "Add Specialty" and select "Respite" on the Licensure/Certification page.
• Required Forms: Applications must include a signed Provider Participation Agreement (PPA) and a signed W-9.
• Revalidation: All enrolled providers are required to revalidate every 5 years by completing a new application.

6. Staffing, Training and Background Checks

Direct care staff must complete specific training modules mandated by the waiver appendices before delivering care.

Background checks are required based on the risk level assigned to the provider type by DHHS.

• Core Training: Staff must be trained in emergency first aid, the nature of developmental disabilities, behavior management, and communicable diseases.
• Medication Administration: Must comply with NH RSA 326, requiring delegation of tasks by a nurse to unlicensed providers.
• Background Checks: Fingerprint-based Criminal Background Check (FCBC) is required based on DHHS risk level notification.
• Custom Skills: Area Agencies may require other specialized skills determined in consultation with the family receiving respite.

7. Documentation, Policies and Records

Providers must maintain rigorous records to survive annual audits conducted by BDS and to comply with MMIS payment rules.

Facility-based providers must also report any changes in location or ownership immediately to the HFA.

• Audit Compliance: BDS conducts on-site service audit and record reviews annually to verify ongoing compliance.
• Address Changes: Physical location changes require a letter containing the license number, new address, move date, and new local approvals.
• EFT Documentation: Providers must maintain an Electronic Funds Transfer (EFT) Agreement and a Bank Letter or voided check for payment processing.
• Ownership Changes: A new He-P 800 application and license certificate must be obtained prior to any change in ownership.

8. Billing, Rates and Claims

Following the CMS compliance transition, providers must bill for services directly through the State's MMIS or utilize a third-party biller.

Providers cannot bill for services until they receive their official Welcome Letter and reach the authorized effective date.

• Direct Bill Mandate: Providers must bill directly through NH MMIS; Area Agencies no longer process these claims.
• Electronic Payment: Providers must complete Section 4 of the enrollment application for EFT to receive electronic payments.
• Taxonomy Code: Providers must register and use the correct taxonomy code matching their NPI and Respite specialty.
• Claim Submission: Claims cannot be billed until the effective date issued in the DHHS Welcome Letter is reached.

9. Approval Sequence and Timeline

The approval process requires sequential clearance through the Secretary of State, HFA (if facility-based), and the MMIS portal.

Program Integrity conducts a comprehensive screening before any Medicaid ID is issued.

• Step 1: Register the business entity with the NH Secretary of State and obtain an EIN and NPI.
• Step 2: Obtain a He-P 800 facility license from HFA (only required if providing out-of-home facility respite).
• Step 3: Submit the Provider Type 236 application via the NH MMIS portal with all required attachments.
• Step 4: Undergo a federally mandated comprehensive screening by the Program Integrity team before approval.

10. Common Denials and Survey Findings

Applications are frequently delayed when providers select the wrong provider type or fail to upload mandatory local approvals.

During annual audits, BDS commonly cites providers for failing to maintain current training records or proper nurse delegation documentation.

• Missing Local Approvals: Facility applications are rejected if written fire, health, or zoning approvals are absent.
• Incorrect Provider Type: Applying under the CFI waiver instead of Provider Type 236 for BDS waivers (DD/ABD/IHS).
• Training Deficiencies: Failing to document required first aid, behavior management, or communicable disease training in staff files.
• Medication Errors: Unlicensed staff administering medication without documented nurse delegation under RSA 326.

11. Key Contacts and Resources

Providers should utilize the official DHHS and MMIS portals for the most current manuals, forms, and fee schedules.

The BDS website hosts the specific waiver appendices detailing exact service limitations.

• NH DHHS Bureau of Developmental Services: https://www.dhhs.nh.gov/programs-services/disability-care/developmental-services
• NH MMIS Provider Portal: https://nhmmis.nh.gov/portals/wps/portal/ProviderEnrollment
• NH Health Facilities Administration: https://www.dhhs.nh.gov/programs-services/health-care/health-facilities-certification-licensing
• NPPES NPI Registry: https://nppes.cms.hhs.gov/

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