Introduction
Becoming a licensed Medicaid Waiver provider in New Hampshire allows you to offer Home and Community-Based Services (HCBS) to individuals who qualify for Medicaid, such as those with developmental disabilities, the elderly, or individuals needing long-term care. New Hampshire offers various Medicaid Waiver programs under the 1915(c) waiver, including services like personal care, respite, and home health services. The licensing process in New Hampshire involves meeting state-specific eligibility requirements, submitting an application, and undergoing a review and certification process.
This guide outlines the step-by-step process for obtaining a Medicaid Waiver provider license in New Hampshire, from understanding waiver programs to final approval.
Step 1: Understand New Hampshire’s Medicaid Waiver Programs
Description:
Before starting the licensing process, familiarize yourself with the specific Medicaid Waiver programs that New Hampshire offers. The state's waiver programs are designed to support populations such as individuals with developmental disabilities, acquired brain disorders, and seniors requiring long-term care.
Key Steps:
Research Waiver Programs: New Hampshire administers several Medicaid Waiver programs under the 1915(c) waiver. These include:
Choices for Independence (CFI) Waiver: Supports elderly adults and adults with chronic illnesses or disabilities.
Developmental Disabilities Waiver (DD Waiver): Offers services to individuals with intellectual and developmental disabilities.
Acquired Brain Disorder (ABD) Waiver: Provides services for individuals with brain injuries.
Identify Your Target Population: Determine which waiver program aligns with the services you plan to provide. For example, if you aim to serve seniors, you would focus on the CFI Waiver.
Review Services Offered: Each waiver covers specific services, including case management, personal care assistance, respite care, homemaker services, and nursing. Ensure the services you want to offer match the scope of the waiver program.
Tips:
Visit the New Hampshire Department of Health and Human Services (DHHS) website or contact their Medicaid office to learn more about available waiver programs and eligibility.
Step 2: Meet New Hampshire’s Provider Eligibility Requirements
Description:
To become a licensed Medicaid Waiver provider, you must meet New Hampshire’s specific eligibility criteria. This includes ensuring you have the appropriate legal structure, staffing, and insurance.
Key Steps:
Establish a Legal Business Entity: Register your business as a legal entity, such as an LLC, corporation, or sole proprietorship, with the New Hampshire Secretary of State. You’ll also need an Employer Identification Number (EIN) from the IRS for tax purposes.
Obtain Liability Insurance: Medicaid Waiver providers in New Hampshire must carry general and professional liability insurance. The required coverage amount will depend on the waiver program but typically includes general liability, worker’s compensation, and auto liability if transportation services are provided.
Ensure Appropriate Staffing: Staff must meet state qualifications, which vary depending on the services offered. Common requirements include:
Direct Care Workers: Must have certifications like Certified Nursing Assistant (CNA) or Personal Care Assistant (PCA), as well as CPR/First Aid certifications.
Clinical Staff: If offering nursing or therapeutic services, ensure that clinical staff such as Registered Nurses (RNs) or therapists are properly licensed and in good standing with New Hampshire’s licensing boards.
Conduct Background Checks: All employees providing direct care must pass a criminal background check and be free of disqualifying criminal convictions. This includes submitting to fingerprinting and checking against the state’s disqualification lists.
Tips:
Review the state’s Medicaid Provider Manual for detailed information on staffing requirements and qualifications.
Step 3: Prepare Your Policies and Procedures
Description:
Providers must submit detailed policies and procedures as part of their application. These documents demonstrate how your agency will comply with Medicaid Waiver regulations and deliver safe, high-quality care.
Key Steps:
Develop Service Delivery Plans: Create policies and procedures covering how services will be provided, including:
Client Intake and Assessments: How you will assess clients, determine service needs, and develop individualized care plans.
Service Documentation: Guidelines for documenting services rendered, including progress notes, incident reports, and time records.
Staff Training and Supervision: Procedures for onboarding, training, and supervising staff to ensure ongoing compliance with waiver requirements.
Client Rights and Grievances: Policies that ensure clients are informed of their rights, including the process for filing complaints or grievances.
Health and Safety Procedures: Include protocols for infection control, emergency preparedness, and handling incidents such as accidents, abuse, or medical emergencies.
Billing and Documentation Policies: Outline your agency’s billing processes, including compliance with Medicaid billing codes, documentation requirements, and submission timelines.
Tips:
Use New Hampshire’s provider resources and compliance guides to develop policies that meet all state requirements.
Step 4: Complete the Medicaid Waiver Provider Application
Description:
New Hampshire’s Medicaid Waiver provider application is a comprehensive form that collects detailed information about your agency, staff, services, and operational procedures. It also requires various supporting documents.
Key Steps:
Obtain the Application: Download the Medicaid Waiver provider application from the New Hampshire DHHS website or request one by contacting the DHHS Bureau of Developmental Services.
Submit Required Documents: Along with the completed application form, you must submit:
Proof of legal business structure and state registration.
Staff credentials, including licenses and certifications.
Proof of liability insurance coverage.
Background check and fingerprinting clearance for staff.
Detailed policies and procedures (from Step 3).
IRS W-9 form for tax identification.
Submit the Application: Once completed, submit the application and all required documentation to the appropriate department within DHHS. Many sections can be submitted electronically, though some documents may need to be mailed in.
Tips:
Ensure that all documentation is complete and accurate before submitting to avoid delays in processing.
Step 5: Prepare for Facility Inspections (If Applicable)
Description:
If your agency operates in a physical location, such as an adult day care center or group home, the facility must undergo a site inspection to ensure it complies with New Hampshire’s health and safety standards.
Key Steps:
Review Facility Standards: Ensure your facility meets all state requirements, including fire safety, ADA accessibility, and proper sanitation.
Prepare for On-Site Inspections: An inspector from DHHS or the state’s Health Facilities Licensing Unit will visit your facility to ensure it meets the required standards. Areas of focus include:
Fire exits, smoke detectors, and fire extinguishers.
Cleanliness and maintenance of the premises.
Accessibility features for clients with disabilities.
Proper medication storage and handling (if applicable).
Develop a Safety Plan: Ensure your facility has a documented safety and emergency response plan, including procedures for evacuations, medical emergencies, and disaster preparedness.
Tips:
Perform a self-inspection using the state’s facility checklists to ensure you’re fully prepared for the licensing visit.
Step 6: Undergo Final Review and Receive Licensing Approval
Description:
After submitting your application and passing any required inspections, your agency will undergo a final review by the DHHS licensing board. If approved, you will be licensed to provide Medicaid Waiver services in New Hampshire.
Key Steps:
Respond to Additional Information Requests: The licensing board may request additional information or documentation during the review process. Respond promptly to avoid delays.
Complete Any Required Training: Some waiver programs may require providers to attend a training session or orientation to ensure they understand Medicaid Waiver compliance and service delivery standards.
Receive Your Provider Identification Number (PID): Once licensed, you will receive a Medicaid Provider Identification Number (PID) that allows you to submit claims and receive reimbursement for services.
Activate Your Medicaid Provider Enrollment: Register with New Hampshire’s Medicaid billing system to submit claims and track payments electronically.
Tips:
Keep copies of your licensing approval and provider number on file for reference and audit purposes.
Step 7: Maintain Compliance and Prepare for Audits
Description:
Once licensed, you will need to maintain ongoing compliance with New Hampshire’s Medicaid Waiver regulations. This includes submitting to periodic inspections, maintaining accurate documentation, and ensuring your staff remains qualified.
Key Steps:
Conduct Internal Audits: Regularly review client documentation, billing practices, and staff credentials to ensure ongoing compliance. Address any issues before they become larger problems.
Submit Required Reports: Medicaid Waiver providers in New Hampshire must submit periodic reports to DHHS, including financial statements, client service reports, and employee training logs.
Keep Staff Training Current: Ensure that all staff certifications, such as CPR/First Aid and professional licenses, remain up to date. Track training completion and renewals using compliance software or tracking tools.
Prepare for Recertification: Medicaid Waiver providers must periodically recertify to maintain their license. Review state guidelines for recertification timelines and requirements.
Tips:
Stay informed of any changes in Medicaid Waiver regulations by subscribing to updates from DHHS or attending state-sponsored training sessions.
How Waiver Consulting Group Can Help
Waiver Consulting Group offers expert support to Medicaid Waiver providers in New Hampshire throughout the licensing and compliance process. Our services include:
Application Assistance: We guide you through the licensing application process, ensuring your documentation and policies meet state requirements.
Compliance Audits: We conduct internal audits to ensure your agency remains compliant with New Hampshire’s Medicaid Waiver standards.
Staff Training: We provide training programs to help your staff meet the qualifications required by state Medicaid regulations.
Policy and Procedure Development: Our team helps you create compliant policies and procedures for service delivery, documentation, and client rights.
For more information on how we can support your agency, get started with Waiver Consulting Group or schedule a consultation.
Conclusion
Navigating the licensing process for Medicaid Waiver services in New Hampshire requires a clear understanding of state-specific regulations, a commitment to compliance, and thorough preparation. By following this step-by-step guide, providers can successfully become licensed to offer critical services to Medicaid recipients while ensuring high-quality care. Waiver Consulting Group is here to help every step of the way.
For additional resources or support, visit Waiver Consulting Group Services.