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Throughout the fall of 2020, the New Hampshire Department of Health and Human Services (DHHS) underwent a review of operations and programs Adobe Acrobat Reader Symbol. This review was conducted by Alvarez & Marsal – Public Sector Services (A&M). The intent of the review was to identify opportunities for DHHS and its programs to more effectively and efficiently support the citizens of New Hampshire.

The DHHS Bureau of Developmental Services (BDS) worked with A&M to review the developmental disabilities service system in New Hampshire. The review included data collection, a review of policies and procedures, interviews with State staff, and a comparison of the current program structure to trends in developmental disability services across the country.

The review identified opportunities for BDS to update several areas key to how individuals and families access services and supports, as well as opportunities to ensure an adequate provider network to provide the supports necessary to serve individuals and families in New Hampshire. Specifically, the review identified the following areas:

  • Waiver Structure Changes
    Currently, BDS provides access to services for adults with developmental disabilities (primarily) through the Developmental Disability (DD) Waiver. While the DD Waiver provides access to all services to eligible individuals, in many cases, the services that someone needs are not always what they can access. This single waiver structure has led to concerns that some individuals are underserved by the system. In order to make sure the relationship between what an individual needs and what they can access is more aligned, BDS is looking to separate the DD Waiver into two waivers: a supports waiver – focused on supporting individuals whose needs are best served with more community-based services; and a comprehensive waiver – focused on supporting people who have complex needs, accessing 24/7 residential and/or community-based services. The goal is to improve access to the services that most effectively meet each individual’s needs and goals.
  • Reimbursement Rate Changes
    Reimbursing service providers appropriately is critical to ensuring an adequate provider network is in place to support individuals. BDS currently uses rates developed in 2007. This outdated rate system has led to challenges for providers in ensuring they are reimbursed for the true cost of services provided. This outdated rate system has also caused further misalignment in matching the needs of an individual with the right amount of funding and service, as well as the ability of individuals and/or family members to more easily choose from and switch to different providers within the network. BDS is looking to develop an updated and more transparent rate methodology that puts the direct support workforce at the core of rate development, while ensuring appropriate service costs are accurately accounted for.
  • Information System Updates
    BDS has long operated using outdated, siloed data and information systems. Effective systems are key to ensuring a smooth flow of information between BDS, Area Agencies and providers to promote service access and monitoring. BDS is looking to build a more robust information technology structure that is agile and robust for supporting case management functions, service authorizations and payment processes.

What Does This Mean For Individuals, Families And Providers?
While this review is not the first to look at the operations of the State’s developmental disability services system, BDS is excited to use the roadmap developed in this review as the starting point to update our service delivery system to best support individuals with developmental disabilities and their families throughout their lifespan, today and in the future.

BDS will focus throughout the process on helping to bring these opportunities into fruition. Critical to this process is the commitment of BDS to actively engage and inform stakeholders along the way. It is our intent to keep information on this page updated with key decisions or insights impacting our broader stakeholder community – including individuals, families, advocacy organizations and providers.

Venn diagram reading from top, moving right This work has a true opportunity to best align what each person needs for supports with the right type and level of support at the right time. New Hampshire has a long history of providing robust, person- and family-centered services that we need to preserve and improve; this work will help to build upon these principles while ensuring everyone has equal choice and access to sustainable, quality services rooted in our goal of supporting individuals and families to achieve their personally defined outcomes.

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If you are interested in receiving email updates about this work, please email Maureen DiTomaso at to be added to our mailing list.


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