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

Last reviewed: 2026-08-16

In New Hampshire, Transitional Assistance Services (frequently billed as Community Transition Services) provide critical financial and logistical support to Medicaid beneficiaries moving from institutional settings—such as nursing facilities or hospitals—into their own community-based homes. Funded primarily through the Choices for Independence (CFI), Developmental Disabilities (DD), and Acquired Brain Disorders (ABD) 1915(c) waivers, this service covers one-time, non-recurring setup expenses like security deposits, utility activation fees, essential furnishings, and moving costs.

The single biggest structural barrier to entry for prospective providers in New Hampshire is the state's decentralized, regional gatekeeping system. For the DD and ABD waivers, the state operates a closed-network model managed by 10 designated regional Area Agencies. A provider cannot simply apply to the state to become a Medicaid transition vendor; they must first negotiate a contract and be sponsored by an Area Agency. Similarly, for the CFI waiver, providers must secure service authorizations from state-certified Case Management agencies before any billing can occur.

1. Service Definition and Scope

Transitional Assistance Services in New Hampshire are strictly defined as non-recurring set-up expenses for individuals transitioning from an institutional or provider-operated setting to a private residence where the individual is directly responsible for their own living expenses.

This service is administrative and financial in nature, focusing on the procurement of goods and moving services rather than direct clinical care. Funds are highly restricted and cannot be used for ongoing living expenses.

• Covered Expenses: Security deposits, utility set-up fees, essential household furnishings, window coverings, and professional moving expenses.
• Excluded Costs: Monthly rental or mortgage payments, food, regular utility charges, and recreational or entertainment items.
• Funding Authority: 1915(c) HCBS Waivers, specifically the Choices for Independence (CFI), Developmental Disabilities (DD), and Acquired Brain Disorders (ABD) waivers.
• Financial Caps: Services are typically capped at a specific lifetime or per-transition amount (e.g., up to $3,000 under the CFI waiver, subject to individual care plan limits).
• Target Population: Medicaid beneficiaries transitioning from nursing facilities, hospitals, or Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IIDs) to independent community homes.

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. However, day-to-day oversight is bifurcated based on the specific waiver population being served.

Providers must interact with different bureaus and regional entities depending on whether they are serving older adults and individuals with physical disabilities, or individuals with developmental disabilities and brain disorders.

• State Medicaid Agency: NH DHHS, which administers the overarching Medicaid program and the Medicaid Management Information System (MMIS).
• CFI Waiver Oversight: Bureau of Elderly and Adult Services (BEAS), responsible for older adults and adults with physical disabilities.
• DD/ABD Waiver Oversight: Bureau of Developmental Services (BDS), responsible for developmental and brain disorder services.
• Regional Gatekeepers: 10 Designated Area Agencies (e.g., Community Crossroads, The Moore Center) that manage local networks for BDS waivers.
• Provider Enrollment Unit: The NH MMIS Provider Enrollment team, which processes the actual Medicaid ID applications and revalidations.

3. Gatekeeping Prerequisites: Who Can Even Apply

New Hampshire does not operate an open-enrollment, direct-to-consumer market for most HCBS waiver services. The state relies heavily on regional entities to manage network adequacy and provider quality.

Before a provider can even submit an application to the NH MMIS portal, they must clear strict structural preconditions. If a provider applies directly to the state without these local affiliations, the application will be summarily rejected.

• BDS Waiver Prerequisite: Applicants must secure a subcontract or vendor agreement with at least one of the 10 regional Area Agencies; Area Agencies dictate network adequacy and will not sponsor unneeded vendors.
• CFI Waiver Prerequisite: Applicants must establish referral relationships and receive service authorizations from a BEAS-certified Case Management agency.
• Business Registration: The entity must be registered and in good standing with the New Hampshire Secretary of State.
• NPI Requirement: The provider must obtain a Type 2 National Provider Identifier (NPI) from the federal NPPES system prior to initiating the NH MMIS application.
• HCBS Settings Rule Compliance: The destination setting for the transition must pass a site-specific assessment to ensure it meets CMS HCBS Final Rule characteristics, or the transition funds cannot be authorized.

4. Licensure and Certification Requirements

New Hampshire does not issue a specific "Transitional Assistance Provider" license through the DHHS Health Facilities Administration (HFA). Because the service involves purchasing goods, paying deposits, and moving logistics rather than direct clinical care, standard facility licensure does not apply.

Instead, providers are approved through waiver-specific certification standards and must ensure that any subcontractors (like moving companies) hold standard commercial licenses.

• Facility Licensure: Exempt; no clinical HFA license is required to provide transitional assistance or community transition services.
• BDS Certification: Providers must comply with the He-M 500 series of administrative rules for developmental services providers.
• BEAS Certification: Providers must comply with the He-E 800 series of administrative rules for CFI waiver providers.
• Commercial Licensing: Any moving companies utilized must hold valid US DOT numbers and New Hampshire commercial transport registrations.
• Insurance Requirements: Providers must maintain a minimum of $1,000,000 in general liability and professional liability insurance, submitting certificates during enrollment.

5. Medicaid Provider Enrollment

Once authorized by an Area Agency or BEAS case manager, providers must enroll directly through the NH MMIS Health Enterprise Portal to receive a Medicaid ID and bill for services.

The state requires all enrolling providers to undergo a federally mandated comprehensive screening before approval, and all providers must revalidate their enrollment every five years.

• Enrollment Portal: Applications must be submitted online via the NH MMIS Health Enterprise Portal.
• Provider Type/Specialty: Applicants must select "Developmental Services Group" or the applicable CFI provider type, followed by the specific specialty code for Transition Services.
• Required Form 1: A signed Provider Participation Agreement (PPA) must be uploaded with the application.
• Required Form 2: A signed W-9 and an FEIN/IRS verification letter (or Social Security Number verification for sole proprietors).
• Required Form 3: Electronic Funds Transfer (EFT) Application and Agreement Form, accompanied by a bank letter or voided check.
• Application Fee: Subject to the ACA institutional provider application fee (approximately $709 for 2024) unless the provider is enrolled strictly as a non-billing rendering vendor under an Area Agency.

6. Staffing, Training and Background Checks

Because Transitional Assistance is primarily an administrative and logistical service, the stringent clinical training required for direct care workers (such as Licensed Nursing Assistants) is not required.

However, any staff member or contractor who will be entering a Medicaid participant's home or interacting directly with them must clear comprehensive state and federal background checks.

• Criminal Background Check: Required via the NH Department of Safety, State Police for all personnel interacting with waiver participants.
• Registry Checks: Staff must be screened against the NH BEAS State Registry (for abuse, neglect, or exploitation) and the federal OIG List of Excluded Individuals/Entities (LEIE).
• Basic Training: Staff must receive orientation on HCBS settings rules, participant rights, and incident reporting protocols as mandated by the contracting Area Agency or BEAS.
• Driver Qualifications: Any staff providing moving or transport services must hold a valid New Hampshire driver's license and commercial auto insurance.

7. Documentation, Policies and Records

Providers of Transitional Assistance must maintain meticulous financial records to prove that Medicaid funds were used exclusively for allowable, authorized transition expenses.

Receipts, invoices, and lease agreements are the primary clinical documentation for this service, and failure to produce them during an audit will result in immediate recoupment of funds.

• Financial Records: Providers must retain original receipts, itemized invoices, and lease agreements for all purchased goods, deposits, and moving services.
• Service Authorization: Providers must keep on file the approved Individual Service Agreement (ISA) or CFI Care Plan that explicitly authorizes the transition budget.
• Record Retention: NH DHHS requires all Medicaid provider records to be retained for a minimum of six years from the date of service.
• Incident Reporting: Providers must maintain policies aligning with He-M 1202 (for BDS) or He-E 800 (for BEAS) regarding the mandatory reporting of critical incidents or financial exploitation.
• Proof of Delivery: Documentation must include signed delivery receipts or participant sign-offs confirming that furnishings and goods were successfully delivered to the new community home.

8. Billing, Rates and Claims

Transitional Assistance is billed as a one-time or milestone-based reimbursement rather than an hourly rate. Providers are reimbursed for the exact cost of the goods or services procured, up to the authorized cap.

Claims are submitted electronically through the NH MMIS portal, and 100% of these services require a prior authorization to be loaded into the system before a claim will pay.

• Billing System: Claims are submitted via Direct Data Entry on the NH MMIS Health Enterprise Portal or through 837P EDI batch transactions.
• HCPCS Codes: Typically billed using T2038 (Community Transition, waiver; per service), though exact modifiers depend on the specific waiver.
• Reimbursement Structure: Cost-reimbursement model; providers bill the exact cost of the security deposit or furnishings up to the authorized limit.
• Prior Authorization: The Area Agency or BEAS case manager must load a Prior Authorization (PA) into MMIS; claims submitted without a matching PA will deny automatically.
• Payment Method: Reimbursement is issued exclusively via Electronic Funds Transfer (EFT), accompanied by an Electronic Remittance Advice (ERA).

9. Approval Sequence and Timeline

The end-to-end process for becoming a Transitional Assistance provider requires securing local approval before state enrollment. The timeline is heavily dependent on the Area Agency's onboarding schedule.

Providers should expect the entire process to take several months, with the state MMIS screening portion taking up to 60 days once the local contract is secured.

• Step 1: Register the business with the NH Secretary of State and obtain a Type 2 NPI (1-2 weeks).
• Step 2: Conduct outreach, negotiate, and sign a vendor contract with a regional Area Agency or establish BEAS case management relationships (1-3 months).
• Step 3: Submit the Provider Enrollment Application and upload the PPA and EFT forms via the NH MMIS Portal (1 day).
• Step 4: Undergo DHHS Program Integrity comprehensive screening and background checks (30-60 days).
• Step 5: Receive the NH Medicaid ID, verify that Prior Authorizations are loaded into MMIS, and commence services (1-2 weeks).

10. Common Denials and Survey Findings

Applications and claims for Transitional Assistance are most frequently denied due to procedural errors, lack of local sponsorship, or billing for unallowable expenses.

Because this is a highly scrutinized financial service, exact receipt matching is critical. Auditors frequently target transition claims to ensure funds were not used for ongoing living expenses.

• Gatekeeper Denial: Submitting an application directly to NH MMIS without an existing Area Agency contract or BEAS authorization.
• Unallowable Costs: Billing Medicaid for ongoing rent, groceries, or entertainment items instead of allowable one-time setup costs.
• Missing Documentation: Failure to upload the signed Provider Participation Agreement (PPA), W-9, or EFT forms in the MMIS portal during initial enrollment.
• Cap Exceedance: Submitting claims that exceed the lifetime or waiver-specific monetary cap for transition services, resulting in partial or total claim denial.
• Setting Non-Compliance: Attempting to authorize transition funds for a move into a setting that fails the CMS HCBS Final Rule site-specific assessment (e.g., moving into another institutional setting).

11. Key Contacts and Resources

Prospective providers should begin by contacting the Area Agency in their target region or the specific DHHS bureau managing the waiver they wish to serve.

For technical issues with the enrollment application itself, the NH MMIS Provider Enrollment help desk is the primary point of contact.

• NH MMIS Provider Enrollment: Call (603) 223-4774 or (866) 291-1674 (Monday-Friday, 8 AM - 5 PM EST) for portal and application status inquiries.
• Bureau of Developmental Services (BDS): The DHHS division that oversees the DD and ABD waivers and manages the Area Agency system.
• Bureau of Elderly and Adult Services (BEAS): The DHHS division that oversees the CFI waiver and certifies case management agencies.
• NH Secretary of State: Visit quickstart.sos.nh.gov for mandatory business entity registration.
• Area Agencies: The 10 regional non-profits (e.g., Community Crossroads, The Moore Center) that serve as the mandatory entry point for BDS waiver providers.

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