COORDINATING CARE AND SUPPORT THROUGH INDIVIDUALIZED CASE MANAGEMENT

Case Management Services in New Hampshire support individuals with disabilities, chronic conditions, or long-term care needs by coordinating services, developing care plans, and facilitating access to resources. These services ensure that individuals receive comprehensive, person-centered care. Case Management Services are authorized under New Hampshire Medicaid Home and Community-Based Services (HCBS) Waiver programs.

1. GOVERNING AGENCIES

Agency: New Hampshire Department of Health and Human Services (DHHS)
Role: Administers Medicaid waiver funding for Case Management Services and manages provider enrollment, service authorization, and reimbursement

Agency: Bureau of Elderly and Adult Services (BEAS)
Role: Ensures quality standards, service delivery, and compliance for Case Management Services under HCBS waiver programs

Agency: Centers for Medicare & Medicaid Services (CMS)
Role: Provides federal oversight ensuring Medicaid-funded Case Management Services meet HCBS quality, person-centered planning, and participant protection standards

2. CASE MANAGEMENT SERVICES OVERVIEW

Case Management Services coordinate and manage care to enhance an individual’s ability to live independently and safely within the community.

Approved providers may deliver:

• Needs Assessment: Conducting comprehensive evaluations to identify care requirements
• Service Planning: Developing an Individualized Service Plan (ISP) tailored to each participant
• Care Coordination: Arranging healthcare, social, and community services
• Monitoring and Follow-Up: Regularly reviewing progress and updating care plans as needed
• Crisis Intervention: Providing support during emergencies and coordinating responses
• Resource Navigation: Assisting individuals in accessing community resources and financial support
• Advocacy: Supporting participants in obtaining necessary services and advocating for their rights

All services are delivered according to the ISP to meet the unique needs and preferences of the participant

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

• Register the business entity with the New Hampshire Secretary of State
• Obtain EIN from the IRS and NPI (Type 2)
• Enroll as a Medicaid Waiver Case Management provider via the New Hampshire Medicaid Provider Enrollment Portal
• Obtain any necessary licensure for case management services from DHHS if applicable
• Maintain general liability and professional liability insurance
• Develop policies for care coordination, crisis response, and documentation
• Ensure staff meet background checks, health screenings, and case management training requirements

4. NEW HAMPSHIRE PROVIDER ENROLLMENT PROCESS

Initial Interest and Application:

• Complete the Provider Enrollment Application through the New Hampshire Medicaid Provider Enrollment Portal for Case Management Services under HCBS waivers

Application and Documentation Submission:

• Submit Articles of Incorporation, proof of EIN/NPI, insurance certificates, staff qualifications, and policy manuals

Program Readiness Review:

• DHHS and BEAS evaluate provider readiness, including staff qualifications, service planning protocols, and safety measures

Approval & Medicaid Enrollment:

• Upon approval, providers are authorized to bill Medicaid for Case Management Services using designated billing codes

5. REQUIRED DOCUMENTATION

• Articles of Incorporation or Business License (New Hampshire Secretary of State)
• IRS EIN confirmation
• NPI confirmation
• Proof of general and professional liability insurance

Case Management Services Policy & Procedure Manual including:

• Participant intake, needs assessment, and care planning procedures
• Coordination of healthcare, social, and community-based services
• Crisis intervention and emergency response protocols
• Staff credentialing, background checks, and ongoing training records
• HIPAA compliance, participant rights, and grievance handling
• Documentation standards for service coordination and Medicaid billing
• Quality assurance and compliance monitoring

6. STAFFING REQUIREMENTS

Role: Case Management Program Director
Requirements: Bachelor’s or Master’s degree in social work, human services, or healthcare, certification in case management preferred, supervisory experience

Role: Case Managers
Requirements: Bachelor’s degree in social work, healthcare, or a related field, experience in care coordination and service planning, background clearance

Role: Case Management Assistants
Requirements: High school diploma or GED, experience in administrative support and data entry, background clearance

All staff must complete:

• Training in person-centered planning and case management practices
• HIPAA compliance and participant rights education
• Crisis management and de-escalation techniques
• Annual competency evaluations and continuing education
• Ongoing training in service coordination and resource management

7. MEDICAID WAIVER PROGRAMS

Case Management Services are available under the following New Hampshire Medicaid Waivers:

• Choices for Independence (CFI) Waiver
• Developmental Disabilities (DD) Waiver
• Acquired Brain Disorder (ABD) Waiver
• In-Home Support (IHS) Waiver for Children
• Home and Community-Based Services (HCBS) Waiver

Services may include:

• Coordinating healthcare and supportive services
• Developing and monitoring Individualized Service Plans (ISPs)
• Assisting with accessing community resources and financial aid
• Crisis intervention and emergency coordination
• Providing advocacy and support for participant needs

8. TIMELINE TO LAUNCH

Phase: Business Formation and Compliance Preparation
Timeline: 1–2 months

Phase: Staff Hiring, Credentialing, and Program Development
Timeline: 2–3 months

Phase: New Hampshire Medicaid Provider Enrollment and Readiness Review
Timeline: 60–90 days

Phase: Medicaid Billing Setup and Case Management Service Launch
Timeline: 30–45 days

9. CONTACT INFORMATION

New Hampshire Department of Health and Human Services (DHHS)
Website: https://www.dhhs.nh.gov/

Bureau of Elderly and Adult Services (BEAS)
Website: https://www.dhhs.nh.gov/programs-services/aging-and-adult-support

New Hampshire Medicaid Provider Enrollment Portal
Website: https://nhmmis.nh.gov/

Centers for Medicare & Medicaid Services (CMS)
Website: https://www.cms.gov/

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10. SCOPE OF WORK

• Business registration, Medicaid enrollment, and licensing support
• Policy manual development for care coordination and crisis management
• Staff credentialing, training program templates, and documentation guidance
• Medicaid billing setup and audit-prepared financial management
• Branding, website development, and client engagement strategies
• Quality assurance systems for service coordination and compliance
• Collaboration with healthcare and community organizations for resource sharing

WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — NEW HAMPSHIRE CASE MANAGEMENT SERVICES PROVIDER

We support agencies in launching Medicaid-compliant Case Management Services in New Hampshire.

To get started, click the link to request portal access