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New Hampshire - Skilled Nursing Services — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

New Hampshire regulates in-home skilled nursing services through the Department of Health and Human Services (DHHS) Health Facilities Administration, requiring licensure under He-P 809 as a Home Health Care Provider or He-P 822 as a Home Care Service Provider Agency. Services are delivered by Registered Nurses (RNs) and Licensed Practical Nurses (LPNs) under physician orders, covering assessments, medication administration, and skilled treatments funded by the Medicaid State Plan and Home and Community Based Care Waivers.

To bill New Hampshire Medicaid for these services, agencies must secure Medicare certification prior to enrollment, while independent registered nurses may only enroll if there is no licensed and certified home health provider in their area. Providers targeting the Developmental Disabilities (DD), In-Home Supports (IHS), or Acquired Brain Disorder (ABD) waivers must also establish operational agreements with the state's regional Area Agencies before delivering billable supports.

1. Service Definition and Scope

In New Hampshire, skilled nursing services include nutritional care, elimination assistance, medication administration by licensed personnel, and activities supporting skilled therapy. These services must be provided in the member's place of residence, which excludes hospitals or nursing facilities, though short-term acute care exceptions exist for ICF/IID settings.

Services must be ordered by a primary care physician and align with the individual's person-centered plan as described in NH Administrative Rule He-E 502. Care is delivered by RNs or LPNs working within the scope of the NH Nurse Practice Act (RSA 326-B).

2. Regulatory and Oversight Agencies

The New Hampshire Department of Health and Human Services (DHHS) is the primary umbrella agency overseeing licensure and Medicaid administration. Within DHHS, the Health Facilities Administration (HFA) handles the direct licensing of home health and home care agencies.

Waiver-specific oversight is managed by the Bureau of Developmental Services (BDS) for DD/ABD waivers and the Bureau of Elderly and Adult Services (BEAS) for older adult programs.

3. Gatekeeping Prerequisites: Who Can Even Apply

New Hampshire imposes strict structural prerequisites for skilled nursing providers depending on the target population and enrollment type. Agencies seeking standard Medicaid enrollment for home health services must obtain Medicare certification before their Medicaid application is approved.

For providers targeting the DD, IHS, or ABD waivers, applicants must secure affiliation with one of New Hampshire's designated regional Area Agencies. Independent RNs face a geographic gate: they may only enroll and provide services if there is no licensed and certified home health services provider operating in that specific area.

4. Licensure and Certification Requirements

Agencies must be licensed under RSA 151:2 and NH Administrative Rule He-P 809 (Home Health Care Providers) or He-P 822 (Home Care Service Provider Agencies). Individual providers may register as an Individual Home Care Service Provider under RSA 151:4.

The licensure application requires submission of the administrator's qualifications, Secretary of State business registration, and background check results. Applications must be submitted at least 120 days prior to the expiration of any current registration for renewals.

5. Medicaid Provider Enrollment

Medicaid enrollment is processed through the NH MMIS Health Enterprise Portal. All providers, including Area Agencies and their subcontractors, must be enrolled Medicaid providers regardless of whether they bill directly or use a third-party biller.

Providers must complete the NH Easy Provider enrollment form and undergo screening in accordance with 42 CFR 455.410. The state requires revalidation of enrollment at least every five years.

6. Staffing, Training and Background Checks

Skilled nursing services must be delivered by RNs or LPNs holding current, unencumbered licenses in New Hampshire. LPNs must operate under the supervision of an RN as dictated by the NH Nurse Practice Act.

All personnel must undergo criminal background checks and state registry checks through the Bureau of Elderly and Adult Services (BEAS) pursuant to RSA 161-F:49 before providing direct care.

7. Documentation, Policies and Records

Providers must maintain clinical and administrative records in accordance with He-W 553. Documentation must clearly link the skilled nursing interventions provided to the physician's orders and the member's person-centered plan.

Agencies are also required to distribute the Home Care Clients' Bill of Rights (RSA 151:21-b) to all clients and maintain signed acknowledgments in the patient record.

8. Billing, Rates and Claims

Claims are submitted through the NH MMIS Health Enterprise Portal using standard HIPAA-compliant formats. Providers must follow the guidelines detailed in the NH Medicaid Provider Billing Manuals.

Rates are established by the DHHS and vary based on the specific waiver or state plan authority funding the service. Providers must ensure services are not duplicative of other funded programs like Title III or Veterans Administration benefits.

9. Approval Sequence and Timeline

The approval sequence begins with business registration via the Secretary of State, followed by the submission of the licensure application to the Health Facilities Administration. Initial licensure requires a review of administrator qualifications and background checks.

Once licensed (and Medicare certified, if applicable), the agency applies for Medicaid enrollment via the MMIS portal. For waiver services, the final step is establishing a contract or agreement with the regional Area Agency.

10. Common Denials and Survey Findings

Licensure applications are frequently delayed or denied due to incomplete background checks or failure to provide the required BEAS registry check results. Missing Secretary of State business registration documentation is another common administrative failure.

During surveys, agencies often face citations for failing to maintain current, signed physician orders for all skilled treatments, or for inadequate documentation linking the daily nursing notes to the He-E 502 person-centered plan.

11. Key Contacts and Resources

Providers should utilize the DHHS website and the NH MMIS portal for official manuals, forms, and rule updates. The Health Facilities Administration handles all direct licensure inquiries.

For Medicaid billing and enrollment support, the Medicaid Provider Relations unit provides technical assistance and guidance on application requirements.

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