Home care billing in New Hampshire

Both, split by service. CMS's 2024 state tables show New Hampshire Medicaid Care Management, a statewide MCO program since December 1, 2013, covering home health, state plan personal care, private duty nursing and hospice, plus 1915(j) reimbursement to family caregivers for personal care attendant services, but not HCBS waiver services. The participating plans are AmeriHealth Caritas of New Hampshire, WellSense Health Plan and New Hampshire Healthy Families, and enrollment is mandatory for aged, blind or disabled members and full duals, with Maximus as enrollment broker.² The waivers stay with the state. WellSense's provider manual, cited below, lists HCBS waivered services among the benefits managed and paid for directly by New Hampshire Medicaid and says these wraparound benefits must be billed directly to DHHS, and NH Healthy Families' waiver payment policy says LTSS waiver services are not reimbursable by the plan when the member is on the corresponding waiver.

Open vendor model. CMS's December 1, 2022 letter granting New Hampshire a one-year good faith effort exemption for home health EVV records that the state chose an open vendor model, changed its MMIS quality assurance vendor's contract to include EVV and selected a vendor, and the exemption kept federal match reductions off home health spending for 2023 only.³ Personal care came under the requirement first: CMS's January 4, 2021 letter found the 1905(a)(24) state plan benefit and the 1915(c) waivers out of compliance while the state sought funding for a system. For home health, CMS's January 8, 2024 letter found the 1905(a)(7) benefit and the 1915(c) waivers out of compliance, with the state expecting compliance by March 18, 2024, and CMS's compliance table now lists New Hampshire compliant for home health as of January 1, 2024. CMS's personal care compliance table still lists New Hampshire as not compliant.

Services under EVV⁴

• Home health care services under the section 1905(a)(7) state plan benefit
• Home health care services delivered under the 1915(c) waivers
• Personal care services under the 1905(a)(24) state plan benefit and the 1915(c) waivers, named in CMS's January 4, 2021 letter

Split by payer. For plan members, home health care is on WellSense's prior authorization list, with requests made through its HealthTrio provider portal at least 7 calendar days before the requested date of service, and WellSense points providers to its prior authorization matrix for the full list. Waiver services are not plan services: WellSense's manual says New Hampshire Medicaid manages and funds the HCBS waivered programs, and the plan only helps coordinate them.⁷ So a CFI member can have a waiver service authorized outside the plan and billed to DHHS on the same day that a home health visit for the same member needs the plan's authorization. WellSense also lets a provider be credentialed while its DHHS Medicaid ID is pending, but eligibility for every plan is set by DHHS first, and WellSense updates its own records within 48 hours of a DHHS change.

Two destinations. Plan claims go to the member's plan: WellSense requires NH Medicaid claims within 120 calendar days of the date of service, and NH Healthy Families' 2024 billing manual, cited below, stops accepting claims 120 days after the date of service for dates of service from September 1, 2019, or 120 days after the primary payer's final determination when it is secondary. Waiver services and the other wraparound benefits must be billed directly to DHHS.⁷ NH Healthy Families' waiver payment policy, cited below, lists the CFI, DD, ABD and IHS waiver services with their procedure codes and modifiers as services paid under the LTSS waivers and managed care carve-outs. WellSense wants corrected claims within 120 calendar days of the original paid date, and a UB-04 home health claim to WellSense must carry the appropriate bill type under its home health reimbursement policy.

Jurisdiction K's A/B MAC, National Government Services, Inc., processes Medicare home health and hospice claims for New Hampshire within an HH+H list of Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island and Vermont.¹⁰ In Medicaid, home health and hospice are Medicaid Care Management benefits in CMS's 2024 tables, and home health care sits on WellSense's prior authorization list. CMS lists New Hampshire compliant with the Cures Act home health EVV requirement as of January 1, 2024, after the 2023 good faith exemption and the January 2024 non-compliance letter described above.