1. Program Definition and Services
Case Management Services (often referred to as Targeted Case Management or Service Coordination under state waiver guidelines) in New Hampshire provide comprehensive care coordination for individuals with developmental disabilities, physical challenges, or complex chronic conditions.
- In-Home Personal Care: Direct, person-centered coordination, care plan architecture, and family support tracking executed within the individual's home environment (Comprehensive Biopsychosocial Needs Assessment, Person-Centered Individualized Service Plan (ISP) Development, Regular Health Stability Check-ins, and In-Home Caregiver Alignment)
- Residential Personal Care: Continuous monitoring, inter-agency navigation, and placement advocacy across day habilitation, community living, and clinical settings (Interdisciplinary Care Coordination, Monthly Telephone Contacts, Face-to-Face Quality Reviews every 60 days, Crisis Intervention/De-escalation Coordination, Benefit/Financial Assistance Navigation, and Individual Rights Advocacy)
2. Regulations
The program is governed by the following regulations:
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New Hampshire Code of Administrative Rules, Part He-E 805 (Targeted Case Management Services for the CFI Program)
- New Hampshire Code of Administrative Rules, Part He-M 503 (Eligibility and Service Coordination for Developmental Services and ABD)
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New Hampshire Code of Administrative Rules, Part He-M 426.15 (Targeted Case Management Services for Mental Health)
- Federal Home and Community-Based Services Settings Final Rule (42 CFR § 441.301)
3. Licensing or Certification
Providers must achieve certified case management agency status through the Bureau of Developmental Services (BDS) or the Bureau of Elderly and Adult Services (BEAS). To satisfy federal conflict-free case management mandates, agencies operating in this space must maintain structurally distinct lines of business or operate solely as an independent case management entity to ensure no conflict of interest with direct service delivery.
4. Responsible State Agency
The New Hampshire Department of Health and Human Services (DHHS), operating through the Division of Long Term Supports and Services (DLTSS), the Bureau of Adult and Aging Services (BAAS), and the Bureau of Developmental Services (BDS), is responsible for administering agency enrollment, monitoring person-centered care plan metrics, and validating ongoing compliance.
5. Application Process
The application process uses a rigorous multi-stage credentialing design. Agencies must first clear programmatic reviews by submitting their operational policies, conflict-of-interest declarations, and supervisor qualification portfolios to BDS or BAAS enrollment specialists. Once an agency clears these preliminary evaluations, it registers as an active vendor through the New Hampshire Medicaid Provider Portal (NHMMIS.nh.gov).
6. Required Documentation
While requirements vary based on the target waiver, providers typically must submit:
- Corporate organization records and business registration in good standing with the New Hampshire Secretary of State
- Comprehensive policy manuals (person-centered planning toolsets, conflict-free operations policies, crisis handling guidelines, sentinel event reporting, and client grievance mechanisms)
- Proof of academic and professional background validation for all proposed service coordinators and supervisors
- Certificates of insurance confirming active commercial general liability, professional/errors & omissions liability, and statutory workers' compensation coverages
7. Timeline for Approval
The exact timeline fluctuates based on agency capacity. Because of conflict-of-interest checks, extensive policy manual reviews, and structural readiness verifications executed by state waiver managers, the approval and NHMMIS billing credentialing window typically spans 60 to 90 days from the submission of a complete application packet.
8. Pre-Application Process
Prospective providers must complete specific foundation tasks before applying. They must establish their state business entity structure, secure an IRS Employer Identification Number (EIN), and obtain a Type 2 Organizational National Provider Identifier (NPI) mapped precisely to targeted case management or case management taxonomy sets.
9. Pre-Application Training
The state hosts mandatory administrative and compliance training sessions online. All prospective case managers and supervisors must complete the formal state training series, "Foundations for Person Centered Service Planning, Service Coordination and Case Management," hosted through the UNH Canvas Extend learning platform, to establish core competency credentials before active service billing occurs.
10. Additional Notes
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In compliance with New Hampshire rule He-E 805, case managers must record face-to-face or telephonic interactions meticulously, documenting specific start and stop times or the exact unit duration for every individual entry
- Case managers are responsible for initiating and reviewing the Medical Eligibility Assessment (MEA) needs list to build out a compliant care strategy within 20 working days of an assignment notification
- All administrative executives, clinical coordinators, and case management assistants must clear mandatory criminal history background checks and the BEAS/BDS State Abuse Registry screenings
- Agencies must maintain electronic or physical records detailing contact progress notes, annual ISP updates, and documented risk mitigation strategies for state compliance reviews and federal Medicaid audits
Why Choose Waiver Consulting Group?
Starting or expanding your Medicaid waiver-funded agency can feel overwhelming, but it doesn't have to be. At Waiver Consulting Group, we simplify the process by guiding you through licensing, compliance, provider enrollment, policies & procedures, and regulatory approvals in any state.
With proven expertise, a structured process, and ongoing support, we take the guesswork out of launching your healthcare business. Whether you're a first-time entrepreneur or an established provider looking to expand, our team ensures you stay compliant, competitive, and fully operational.
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