The New Hampshire Rural Health Transformation Program, managed by the Foundation for Healthy Communities and GO-NORTH and funded by CMS for 2026–2030, is in the implementation phase with active contracts and ongoing funding opportunities. The program operates through five regional hubs and emphasizes improving rural healthcare access, quality, workforce development, technology adoption, and financial sustainability. Current activities include the tracking of key initiatives aligned with population health, primary and behavioral care expansion, school-based oral health, and technology infrastructure, supported by targeted RFPs/RFAs and technical assistance. The structured plan continues to monitor progress toward strategic goals while maintaining active engagement with healthcare partners. Current structured plan tracks 26 key initiatives and 15 strategic goals.
County-level estimates averaged across New Hampshire — % of adults 18+ unless noted. Delta vs US county average shown in red/green.
7.2%
-4.2pp
Uninsured (18–64)
8.9%
-3.5pp
Diabetes
31.7%
-5.8pp
Obesity
11.7%
-4.4pp
Current smoking
31%
-5.1pp
High blood pressure
20.7%
-7pp
Physical inactivity
5.7%
-1.2pp
Heart disease
3%
-0.7pp
Stroke
pp = percentage points vs US county average
County Drilldown (10)
County
Pop
Poverty
Uninsured
Hillsborough County
426,378
6.7%
4.3%
Rockingham County
319,082
4.8%
3.0%
Merrimack County
155,967
7.6%
4.1%
Strafford County
132,575
8.7%
5.4%
Grafton County
92,120
10.4%
6.8%
Cheshire County
77,297
8.7%
4.4%
Belknap County
64,659
8.5%
6.3%
Carroll County
51,804
7.6%
4.8%
Sullivan County
43,715
10.1%
6.2%
Coos County
31,271
13.2%
10.2%
Rural population37.0%
509,527 rural residents
Demographics
Total population
1.4MCensus ACS5 2024
Rural population
510KUSDA ERS RUCC 2023
Rural population %
37.0%USDA ERS RUCC 2023
Poverty rate
7.2%Census ACS5 2024
Median household income
$99,031Census ACS5 2024
Uninsured rate
4.5%Census ACS5 2024
CAH count
13HRSA GIS (live)
Rural hospital facilities
0AI extracted
Primary care HPSA
5HRSA Data Warehouse (GIS)
Dental HPSA
3HRSA Data Warehouse (GIS)
Mental health HPSA
2HRSA Data Warehouse (GIS)
MUA count
10HRSA Data Warehouse (GIS)
MUP count
7HRSA Data Warehouse (GIS)
FQHC facilities
64HRSA Data Warehouse (GIS)
RHC facilities
18HRSA Data Warehouse (GIS)
AI source: NH - 2026 - GO-NORTH Contracts & Awards
AI auto-updated Sep 19, 2026
API refreshed May 7, 2026
RHTP Strategic Goals
1Expand access to high-quality rural health care through prevention, chronic disease management, behavioral, maternal, and oral health interventions
2Strengthen and expand the rural health workforce pipeline, apprenticeship, paraprofessional training, simulation-based clinical training, and experiential youth career exploration to reduce provider shortages
3Modernize care delivery by advancing telehealth, EMS (including MIH programs), regional partnerships, team-based models, and innovative technologies including AR/VR simulation and enterprise video solutions
4Rehabilitate and strengthen rural health infrastructure including transportation, childcare, housing, and capital improvements aligned with GO-NORTH plan initiatives
5Promote financial sustainability via value-based payment, operational efficiencies, and care integration
6Engage youth and paraprofessionals in rural health careers and support long-term workforce development, including the Governor's Health Scholars Awards Program
7Ensure program accountability, robust evaluation, performance reporting, compliance with CMS RHTP milestones, and administrative cost caps
8Support evidence-based opioid and pain management practices through provider adoption, monitoring, and evaluation
Enhance interoperability, cybersecurity, and digital capabilities of rural health organizations
Worth to Notice / Recent Updates (27)
Key signals are summarized here. Open the source for the supporting detail.
NH - 2026 - Community Development Finance Authority (CDFA).pdf
Migrated from duplicate federal row
Current Progress
Implementing
New Hampshire's Rural Health Transformation Program remains in the implementation phase. Multiple procurements are active, including school-based oral health expansion, planning grants, primary care transformation funding, youth career exploration workforce projects, and rural health infrastructure opportunities. Applications are open for these programs, with technical assistance provided and awards anticipated in late 2026. Funded activities and procurements continue to expand reach across rural communities. State opportunities: 6 active (3 open, 1 upcoming, 2 closing soon, 12 past/closed), $63.5M listed funding. Key opportunities: GO-NORTH Rural Primary Care Transformation Funding Opportunity; GO-NORTH Rural Primary Care Transformation Funding Opportunity; GO-NORTH Rural Community Health Infrastructure Program (RCHIP). Strategy alignment: supports telehealth, care access, workforce priorities.
RHTP Strategy
New Hampshire’s RHTP continues as a readiness-based, phased investment strategy managed via GO-NORTH and five regional hubs, coordinated by the Foundation for Healthy Communities. The program emphasizes competitive awards, data-driven evaluation, and evidence-based initiatives in EMS, primary care, workforce development, infrastructure, technology modernization, behavioral health integration, and program oversight. Sustainability, regional collaboration, measurable outcomes, administrative cost caps, and alignment to statewide priorities remain central.
Model
Collaborative hub-and-spoke model overseen by GO-NORTH, with milestone-based contracts, structured RFAs/RFPs, and five primary hubs. Hubs issue planning grants and infrastructure awards, fund technology and workforce initiatives, provide technical assistance, and invest in capital improvements, all under capped administrative costs and Executive Council oversight, with robust progress tracking.
Key Initiatives (26)
1Competitive subrecipient awards for EMS stabilization, transformation, and enhancement, including launch and expansion of Mobile Integrated Health (MIH) programs
2Expansion and modernization of telehealth, rural transportation (including mobile patient transport), and community health infrastructure via CDFA
3Renovations and targeted upgrades at county-run nursing homes, community mental health centers, and FQHCs
Timeline: 2026-2030
9
10Integrate behavioral health and substance use disorder care across rural settings
11Achieve measurable reductions in total cost of care, ED utilization, and readmissions across the network
12Build long-term sustainability for rural health providers and infrastructure beyond the initial award period
13Build organizational capacity and readiness for transformational change through planning grants and technical assistance
14Align all local and regional initiatives with statewide rural health transformation priorities
15Ensure compliance and continuous quality improvement for Medicaid managed care and dental organizations through rigorous external quality reviews, validation, and technical studies
Health Priority
Oral Health
Expanding preventative school-based oral health services in rural underserved areas to improve long-term sustainability and access.
Rural New Hampshire
Sep 20, 2026
Health Priority
Emergency Medical Services
GO-NORTH is advancing rural EMS systems through targeted grants and transformation technical assistance.
StatewideRural areas
Sep 20, 2026
Health Priority
Community Infrastructure
Infrastructure grants are directed toward improving rural healthcare facility capacity and community health resources.
StatewideRural towns
Sep 20, 2026
ReferencePDF2025-2026No amount extracted
NH - 2025 - RHTP - New Hampshire
Auto-grouped context match (38%)
SupportingPDF2026-2030Budget: $500.0M
NH - 2026 - RHT Fund (RHTF)
Auto-grouped context match (39%)
SupportingHTML2026-2030No amount extracted
NH - 2026 - GO-NORTH Contracts & Awards
Auto-grouped context match (37%)
ReferenceHTMLNo amount extracted
NH - 2025 - GO-NORTH Communications
Auto-grouped context match (37%)
SupportingPDF2025No amount extracted
NH - 2025 - RHTP - New Hampshire (nh-rhtc-project-narrative)
Auto-grouped context match (37%)
SupportingPDF2026-2031Award: $283.0M
NH - 2026 - New Hampshire RHTP (007B_GC_Agenda_030426)
Auto-grouped context match (38%)
SupportingPDF2026-2027No amount extracted
NH - 2026 - Memorandum of Understanding GO-NORTH & DHHS.pdf
Auto-grouped context match (37%)
SupportingPDF2026-2027Award: $204.0M
NH - 2026 - RHTP (Granite Strong. Future Ready.)
Auto-grouped context match (38%)
ReferencePDF2026-2030Award: $204.0M
NH - 2026 - RHTP - New Hampshire
Auto-grouped context match (38%)
SupportingPDFNo amount extracted
NH - 2026 - New Hampshire RHTP
Auto-grouped context match (37%)
SupportingDOCX2026-2030Award: $204.0M
NH - 2026 - Council Unanimously Passes 4 GO-NORTH Federal Rural Health Grants
Press coverage: Council passes 4 GO-NORTH grants (Mar 16 2026)
SupportingDOCX2026-2028Award: $130.0M
NH - 2026 - Executive Council approves first contracts for NH rural health program after calls for scrutiny
Press coverage: Executive Council approves first RHT contracts
SupportingDOCX2025Award: $204.0M
NH - 2025 - Big investment in N.H. rural health secures key approval
Press coverage: Big investment in NH rural health secures approval
SupportingDOCX2026-2030Award: $133.0M
NH - 2026 - Councilors OK rural health care contracts for NH
Press coverage: Councilors OK rural health care contracts
SupportingDOCX2026Award: $204.0M
NH - 2026 - Executive Council approves recipients of GO-NORTH federal funding
Press coverage: Executive Council approves GO-NORTH recipients
SupportingPDF2026-2030Award: $204.0M
NH - 2026 - University System of New Hampshire Rural Healthcare Workforce Initiative
New Hampshire Community Development Finance Authority (CDFA)
CDFA will manage and distribute RHTP funds to develop a Rural Community Health Infrastructure Program supporting minor renovations, equipment purchases, and infrastructure upgrades for rural healthcare, nursing, and community facilities to expand access to essential services and modernize aging facilities in rural New Hampshire.
$43.8M
Other
2026
New Hampshire Community Behavioral Health Association
Funds the long-term sustainability and expansion of access to integrated behavioral health, substance use treatment and primary care through the State’s community mental health system.
$21.0M
Population Health
2026
New Hampshire Community Behavioral Health Association
Implements the RHTP community mental health system initiative: (i) establishes shared EHR infrastructure for CMHCs and CCBHCs, (ii) modernizes statewide behavioral health workforce pathways, (iii) strengthens crisis response and integrated care, and (iv) expands access to behavioral health, substance use, and primary care services across rural NH.
$21.6M
Population Health
2026
Community Development Finance Authority
This program will provide resources to nonprofits and municipalities to support infrastructure improvements to health and community facilities across rural New Hampshire, aligned with the state's Rural Health Transformation plan.
$40.0M
Other
2026-2028
Community College System of New Hampshire
Handles workforce development projects aimed at improving rural health systems.
Not disclosed
Workforce
2026-2028
New Hampshire Community Development Finance Authority
Works on capital improvement projects for health and child care facilities in rural areas.
Not disclosed
Flex Fund
2026-2028
University System of New Hampshire
Handles workforce development projects aimed at improving rural health systems.
Not disclosed
Workforce
2026-2030
Community Development Finance Authority (CDFA)
Funds rural health capital improvement projects, including nursing home renovations in Merrimack and Coos Counties, childcare facility embedding, and facility upgrades to expand access and support rural healthcare provider financial sustainability.
$43.8M
Flex Fund
2026-2030
University System of New Hampshire
Expands statewide clinical simulation capacity and launches the Governor’s Health Scholars Awards Program with rural employers to grow the rural health workforce.
$15.6M
Workforce
2026-2030
University System of New Hampshire
Investment to establish a statewide interoperable network of clinical education simulation sites and mobile units, create the Governor’s Health Scholars Award Program to support healthcare students committing to rural NH practice, and support clinical and experiential learning in rural healthcare careers.
New Hampshire was awarded $204 million to implement its five-year Rural Health Transformation plan. The Community Development Finance Authority will administer the Rural Community Health Infrastructure Program, investing over $40 million annually to support infrastructure improvements across rural health facilities and related community services.
Event schedule:
- Program Design and Priority Setting - April–May 2026 - New Hampshire
- Application and Program Guide Development - May–June 2026 - Virtual webinars
- Application Launch and Technical Assistance - June–July 2026 - Virtual
- Application Review and Award Notices - July–October 2026 - New Hampshire
The 2024 Annual Report reflects on milestones reached, strengthened partnerships, and dedication toward improving rural health in New Hampshire. It acknowledges ongoing challenges such as workforce shortages and rising costs while emphasizing commitment to collaboration and teamwork.
This RFP from New Hampshire Department of Health and Human Services seeks qualified External Quality Review Organizations to provide rigorous, federally-required reviews of Medicaid managed care and dental organizations through 2030. Activities will include validation of performance measures, encounter data, provider network adequacy, focus studies, secret shopper surveys, and technical reporting. The procurement aims to strengthen care quality and access for Medicaid beneficiaries using a comprehensive, multi-component approach. Key contacts: Danielle L. Richey danielle.l.richey@dhhs.nh.gov
Event schedule:
- Solicitation Released - 09/15/2026 - ET
- Letter of Intent Submission Deadline - 09/22/2026 - ET
- Vendor Questions Submission Deadline - 09/22/2026 - 12:00 PM ET
- Department Response to Questions Published - 10/14/2026 - ET
- Vendor Solicitation Response Due Date - 12:00 PM ET
QUALITY_IMPROVEMENT · OTHER
Event Schedule
Solicitation Released - 09/15/2026 - ET
Letter of Intent Submission Deadline - 09/22/2026 - ET
Vendor Questions Submission Deadline - 09/22/2026 - 12:00 PM ET
Show all schedule items (5)
Solicitation Released - 09/15/2026 - ET
Letter of Intent Submission Deadline - 09/22/2026 - ET
Vendor Questions Submission Deadline - 09/22/2026 - 12:00 PM ET
Department Response to Questions Published - 10/14/2026 - ET
Vendor Solicitation Response Due Date - 12:00 PM ET
Contacts
Danielle L. Richey - <danielle.l.richey@dhhs.nh.gov> - Contract Specialist - statewide
Core Initiatives
Improve oversight and management of Medicaid managed care plans
Enhance quality, timeliness, and access to care for Medicaid beneficiaries
Conduct periodic reviews and rigorous assessments in compliance with federal requirements
New Hampshire DHHS issued an RFP for an External Quality Review Organization to conduct rigorous assessments of Medicaid managed care plans to improve healthcare quality and oversight. Key contacts: Danielle L. Richey Danielle.L.Richey@dhhs.nh.gov
Event schedule:
- Release Date - 09/15/2026
- Close Date/Time - 10/14/2026 - 12:00 PM
The GO-NORTH Planning Grant enables rural health organizations in New Hampshire to access up to $50,000 for planning and capacity-building efforts critical to RHTP implementation. The policy manual details eligibility, deliverable requirements, payment schedules, and allowable uses of funds. Focus is on supporting partnerships, organizational readiness, and alignment with federal rural health transformation priorities. Key contacts: GO-NORTH Lead Info@Go-North@NH.gov
Event schedule:
- Payment #3 - Final Project Plan Submission Deadline - 09/01/2027 - ET
The document lists multiple communications related to New Hampshire's RHTP efforts, including press releases announcing the submission of a rural health transformation plan and a subsequent award of over $204 million. It also includes information on Governor Ayotte's appointments and meetings related to the program.
Event schedule:
- These documents were created before , 2027, and are for reference or record keeping only. If you require an accommodation with any of these files, please contact the agency at info@go-north.nh.gov. - April 26 - Address: 107 Pleasant Street, Concord, NH 03301
This strategic plan outlines New Hampshire's ambitious approach for rural health transformation under RHTP. It prioritizes investments in workforce, quality improvement, EMS, health IT, and financial sustainability. The plan includes measurable objectives, innovative models, and the establishment of a dedicated Governor’s Office (GO-NORTH) for coordination.
New Hampshire’s Rural Health Transformation Program (RHTP) focuses on overcoming substantial rural health challenges such as geographic barriers, provider shortages, and higher disease and behavioral health burdens compared to urban regions. The strategy emphasizes technology modernization, workforce development, innovative care and payment models, and coordinated statewide frameworks to sustainably improve health access, outcomes, and equity for rural residents. EMS deserts, maternity care shortages, and food insecurity in rural regions are directly targeted, with integrated efforts spanning prevention, data sharing, workforce, and community partnerships.
Core Initiatives
Advance prevention and population health initiatives in rural NH, targeting behavioral health, perinatal health, chronic disease management, oral health, and unmet health needs.
Create sustainable long-term access to care for rural residents through innovative care models, partnerships, and expanded EMS and telehealth.
Attract, train, and retain a highly-skilled rural healthcare workforce through pathway programs, health scholar awards, and rural residency programs.
Show all initiatives (35)
Advance prevention and population health initiatives in rural NH, targeting behavioral health, perinatal health, chronic disease management, oral health, and unmet health needs.
Create sustainable long-term access to care for rural residents through innovative care models, partnerships, and expanded EMS and telehealth.
Attract, train, and retain a highly-skilled rural healthcare workforce through pathway programs, health scholar awards, and rural residency programs.
Develop innovative payment and care models to support rural system solvency, value-based care, and expanded telehealth/care-at-home.
Adopt and modernize health information technology, remote monitoring, and AI tools to enhance care coordination and access in rural communities.
Upgrade, enhance, and replace infrastructure to establish interoperable common EMR, RCM systems, AI tools, and patient engagement tools
Evaluate and implement cybersecurity initiatives to promote data security for rural health providers
Expand MIH services across rural NH to strengthen emergency and community-based care and establish the REACT system
Sustain long-term access to care for rural residents by transforming rural primary care through integrated behavioral health, SUD treatment, CHWs, and care coordination
Invest in workforce development, training, and recruitment to build a rural-ready healthcare workforce
Modernize care delivery through scalable, integrated technology tailored to rural needs
📄
DataApr 17, 2026PDF2024-2025
The report documents New Hampshire's Medicaid renewal outreach processes including ex-parte rates, continuous enrollment efforts, and targeted direct call campaigns, especially for children and vulnerable individuals who lost coverage for procedural reasons. Evaluations use claims and member characteristic data to prioritize outreach and improve redetermination rates. No new award announcements or funding distribution are described.
This is a vendor cost proposal template to solicit applications for conducting external quality review activities for Medicaid and Dental Organizations under the RHTP. Deliverables include validation of performance measures and improvement projects, provider network adequacy, encounter data, and the implementation of various quality and satisfaction studies. Activities span fiscal years 2027 through 2030.
Event schedule:
- Deliverables*,"Total Cost of Deliverable SFY 2027 (G & C approval - , 2027)","Total Cost of Deliverable SFY 2028 (July 1, 2027 - June 30, 2028)","Total Cost of Deliverable SFY 2029 (July 1, 2028 - June 30, 2029)","Tot...
Memorandum of Understanding between GO-NORTH and DHHS formalizes administration of the Rural Health Transformation program and defines roles and responsibilities in line with Executive Order 2025-06. GO-NORTH manages and expends RHT funds while DHHS acts as the CMS-recognized cognizant agency ensuring compliance with New Hampshire's RHT program obligations.
📄
OtherApr 23, 2026PDF2026-2031
The University System of New Hampshire received a $97 million sole-source RHTP contract to build rural health workforce pathways, career ladders, and expand simulation-based clinical training infrastructure. Program priorities include high-need fields like nursing, behavioral health, maternal, dental, substance use/emergency care, and rural hospital recruitment and retention. The initiative targets statewide impact and is tied to CMS milestones and rural service obligations.
Spreadsheets, data exports, and reference documents — available for download but excluded from the main activity feed. Showing the 40 most recent of 190.
Sort
NH - 2027 - Appendix C: Transmittal Letter and Vendor Information.pdf
PDF
NH - 2027 - Appendix E: Technical Response to Questions.docx
DOCX
NH - 2027 - Appendix D: Transmittal Letter and Vendor Information.docx
DOCX
NH - 2027 - Appendix H: IT Requirements Workbook.xlsx
XLSX
NH - 2027 - Appendix C: CLAS Requirements.docx
DOCX
NH - 2027 - Appendix D: Transmittal Letter and Vendor Information.docx
DOCX
NH - 2027 - Official Q&A.pdf
PDF
NH - 2027 - Official Q&A.pdf
PDF
NH - 2026 - Budget Template
XLSX
NH - 2026 - View as PDF
PDF
NH - 2027 - Appendix E: Technical Response to Questions.docx
DOCX
NH - 2027 - Appendix D: Transmittal Letter and Vendor Information.docx
NH - 2026 - Foundation For Healthy Communities Go-North Program Request For Applications (RFA) – Emergency Medical Services
Auto-linked process guidance fallback (9%) [ignored 2026-08-23: unrelated NH RHTP program, swept in by loose context-matching, not about School-Based Oral Health]
IgnoredPDF2026-2030Award: $204.0M
NH - 2026 - Rural Healthcare Workforce Initiative
Auto-linked by context [ignored 2026-08-23: unrelated NH RHTP program, swept in by loose context-matching, not about School-Based Oral Health]
IgnoredPDF2026-2027Award: $204.0M
NH - 2026 - Foundation for Health Communities Investing in New Hampshire’s Rural Health Providers
Auto-linked by context [ignored 2026-08-23: unrelated NH RHTP program, swept in by loose context-matching, not about School-Based Oral Health]
IgnoredPDF2026Award: $204.0M
NH - 2026 - New Hampshire Moves Forward with Critical Rural Health Funding
Auto-linked by context [ignored 2026-08-23: unrelated NH RHTP program, swept in by loose context-matching, not about School-Based Oral Health]
IgnoredPDF2026-2031Award: $131.6M
NH - 2026 - Coordination and Support for CMHCs/CCBHCs under New Hampshire's RHT Plan (RHTP)
Auto-linked by context [ignored 2026-08-23: unrelated NH RHTP program, swept in by loose context-matching, not about School-Based Oral Health]
IgnoredPDF2026Award: $204.0M
NH - 2026 - New Hampshire RHTP (NHRHTP)
Auto-linked by context [ignored 2026-08-23: unrelated NH RHTP program, swept in by loose context-matching, not about School-Based Oral Health]
IgnoredPDF2026Award: $204.0M
NH - 2026 - New Hampshire RHTP (771172)
Auto-linked by context [ignored 2026-08-23: unrelated NH RHTP program, swept in by loose context-matching, not about School-Based Oral Health]
IgnoredPDF2026-2030Budget: $500.0M
NH - 2026 - RHT Fund (RHTF)
Auto-linked by context [ignored 2026-08-23: unrelated NH RHTP program, swept in by loose context-matching, not about School-Based Oral Health]
IgnoredPDF2026No amount extracted
NH - 2026 - GO-NORTH and HUB Procurement Calendar for 2026
Auto-linked by context [ignored 2026-08-23: unrelated NH RHTP program, swept in by loose context-matching, not about School-Based Oral Health]
IgnoredPDF2026-2031Award: $37.8M
NH - 2026 - RHTP (NH RHTP Workforce Initiative)
Auto-linked by context [ignored 2026-08-23: unrelated NH RHTP program, swept in by loose context-matching, not about School-Based Oral Health]
Auto-linked by context [ignored 2026-08-23: unrelated NH RHTP program, swept in by loose context-matching, not about School-Based Oral Health]
ReferenceHTML2026Award: $66.5M
NH - 2026 - North Fhc
FHC GO-NORTH program source page
New Hampshire was awarded $204 million from CMS for the Rural Health Transformation plan. The Foundation for Healthy Communities was contracted to invest $66 million annually to expand rural health access and technology, support workforce development, and enhance financial sustainability.
Event schedule:
- Program design and RFP drafting webinars - April - June 2026 - virtual
- RFP issuance for EMS, rural providers, hospitals, and oral health - June - July 2026
- Digital health infrastructure work plan development - July - August 2026
- Budget Period 2 planning - July - August 2026
- Application review, award notices, and contracts for Budget Period 1 - July - October 2026
Award: $204.0MOTHER
Core Initiatives
Expand access to primary, behavioral, and specialty care in rural areas
Adopt innovative care models and technology
Support workforce development and financial sustainability
The document outlines multiple upcoming funding opportunities and RFPs for 2026 under New Hampshire's GO-NORTH Rural Health Transformation program. Key initiatives include capital improvement investments aligned with the state’s rural health plan, health IT adoption across community mental health centers, and workforce development through nursing program expansion.
Event schedule:
- Evaluation RFP bids close - 05/22/2026
- Medicaid Medication Risk Reduction Initiative posting anticipated - 06/2026
- Value-Based Hospital Payment Model posting anticipated - 07/2026
- Population Health RFP posting anticipated - 07/2026
- Community Development Finance Authority funding opportunity launch - 06/2026
- Community Development Finance Authority application review - 07-10/2026
- Health information technology assessment by NH Community Behavioral Health Association - 06/2026
- Governor’s Health Scholars Award Program RFP - 05-06/2026
FINANCE · POPULATION_HEALTH · HEALTH_INFORMATION_TECHNOLOGY · WORKFORCE · OTHER
Core Initiatives
Expand access to rural health services
Improve health IT infrastructure across behavioral health centers
Develop rural healthcare workforce
New Hampshire received a five-year Rural Health Transformation award exceeding $204 million annually, the largest in New England. Four contracts were approved to establish hubs that enhance rural health access, workforce development, infrastructure, and provider sustainability. Upcoming calls for applications will fund strategies aligned with the state's RHT plan. Key contacts: Ayotte.Press@governor.nh.gov
<Ayotte.Press@governor.nh.gov> - Press Contact - New Hampshire
Core Initiatives
Strengthen rural health care access
Improve quality of rural health services
Grow and sustain the rural health workforce
Show all initiatives (4)
Strengthen rural health care access
Improve quality of rural health services
Grow and sustain the rural health workforce
Ensure long-term sustainability of rural health systems
New Hampshire secured the largest federal rural health transformation grant in New England, $204 million/year through 2030 under the GO-NORTH program. Four initial contracts totaling over $132 million were awarded to expand clinical simulation, renovate rural health infrastructure, and grow workforce pipelines from high school through paraprofessional training. The initiative focuses on transforming rural care delivery, increasing access, and adopting innovative technology while promising rigorous oversight and transparency. Key contacts: Donnalee Lozeau; Kelly Ayotte
Event schedule:
- Governor and Executive Council Special Meeting - 03/15/2026 - ET - Concord, NH
- Next Council Vote for Fifth Contract (Community Behavioral Healthcare) - 03/25/2026 - ET - Concord, NH
Award: $204.0MQUALITY_IMPROVEMENT · FINANCE · WORKFORCE · HEALTH_INFORMATION_TECHNOLOGY · OTHER
Event Schedule
Governor and Executive Council Special Meeting - 03/15/2026 - ET - Concord, NH
Next Council Vote for Fifth Contract (Community Behavioral Healthcare) - 03/25/2026 - ET - Concord, NH
Contacts
Donnalee Lozeau - GO-NORTH Director - Statewide
Kelly Ayotte - Governor - Statewide
Core Initiatives
Transform rural health care delivery statewide
Expand access to primary care and preventive services
Support workforce recruitment and development
Show all initiatives (5)
Transform rural health care delivery statewide
Expand access to primary care and preventive services
Support workforce recruitment and development
Improve health infrastructure and sustainability
Increase adoption of innovative care and technology models
QUALITY_IMPROVEMENT
Event Schedule
Release Date - 09/15/2026
Close Date/Time - 10/14/2026 - 12:00 PM
Contacts
Danielle L. Richey - <Danielle.L.Richey@dhhs.nh.gov> - Contract Specialist - New Hampshire
Core Initiatives
Improve oversight and management of Medicaid managed care plans
Enhance performance of managed care plans through quality reviews
The University System of New Hampshire GO-NORTH Hub is offering $350,000 in funding for innovative programs that engage youth and young adults in healthcare and allied health career exploration. The initiative focuses on rural areas, aiming to build skills, mentorship, and workforce pathways. Projects must mainly serve rural youth and increase access to healthcare careers through experiential learning and partnership development. Key contacts: Kenneth La Valley ken.lavalley@unh.edu
Event schedule:
- Application Deadline - 10/02/2026 - 5:00 PM ET
- Award Notifications
- Project Start Date - 11/01/2026
Budget: $350KWORKFORCE · POPULATION_HEALTH · OTHER
Event Schedule
Application Deadline - 10/02/2026 - 5:00 PM ET
Award Notifications
Project Start Date - 11/01/2026
Contacts
Kenneth La Valley - <ken.lavalley@unh.edu> - Agency Point of Contact - GO-NORTH Initiative - USNH Hub
Core Initiatives
Strengthen New Hampshire's rural healthcare workforce pipeline
Increase awareness of healthcare and allied health careers
Expand experiential learning for youth in rural communities
Show all initiatives (4)
Strengthen New Hampshire's rural healthcare workforce pipeline
Increase awareness of healthcare and allied health careers
Expand experiential learning for youth in rural communities
Foster partnerships between educational and healthcare organizations
New Hampshire's Executive Council approved four major contracts totaling approximately $133 million out of a $204 million federal allocation from the Rural Health Transformation Program. These contracts focus on establishing rural health hubs to improve workforce development, finance, and population health initiatives across rural communities.
Event schedule:
- Executive Council Contract Approval - 05/01/2025 - Concord, NH
Executive Council Contract Approval - 05/01/2025 - Concord, NH
Core Initiatives
Expand rural health care access
Improve workforce training and retention
Enhance rural health care infrastructure and capital improvements
This document authorizes the Governor’s Office of New Opportunities & Rural Transformational Health (GO-NORTH) to use $2,000,000 in 100% federal CMS RHT funds to issue planning grants to eligible rural providers and organizations across New Hampshire. The funding will support planning and early implementation to prepare for transformational rural health care system changes statewide, focusing on population health, access, workforce, technology, and sustainability. This template agreement governs the process for local entities to apply for up to $50,000 in planning funds for capacity-building projects. Key contacts: Emily A. Larson Emily.A.Larson@go-north.nh.gov
Event schedule:
- , 2026 - July 10 - Requested Action
Expand the use of technology for high quality, cost-effective care
Support financial sustainability of rural healthcare providers
Core Initiatives
Make rural New Hampshire healthier through evidence-based interventions in disease prevention, chronic disease management, behavioral health, and perinatal care.
Create sustainable long-term access to care for rural residents through transformational care models and partnerships.
Attract, train, and retain a highly-skilled healthcare workforce in New Hampshire.
Show all initiatives (5)
Make rural New Hampshire healthier through evidence-based interventions in disease prevention, chronic disease management, behavioral health, and perinatal care.
Create sustainable long-term access to care for rural residents through transformational care models and partnerships.
Attract, train, and retain a highly-skilled healthcare workforce in New Hampshire.
Develop innovative care models to improve outcomes, coordinate care, and promote flexible payment arrangements.
Foster the use of innovative technologies and modernize care delivery in rural New Hampshire.
Strengthen financial stability of rural providers through innovative Medicaid VBP models and capital investments
Improve population health outcomes through prevention, coordinated care, and data-driven decision-making
Develop partnerships and governance structures inclusive of rural organizations statewide
Workforce development
Tech innovation
Sustainable access
Innovative care
Enhance primary care, care coordination, and prevention services for medically complex patients
Design value-based payments (VBPs) for children with complex behavioral health needs
Establish Medicaid VBP for behavioral health crisis stabilization and transitional housing
Strengthen county nursing home capacity and reduce inpatient days by expanding access to nursing facilities
Transform inter-facility transfer processes to reduce empty ambulance runs and improve patient care timing
Support financial sustainability of rural health investments through collaboration with payers on VBPs
Implement rural population health initiatives focusing on chronic disease prevention and management
Implement rural healthcare access initiatives including virtual first primary care, specialty telehealth, and MIH programs
Recruit, train, and retain rural healthcare workforce through education partnerships and training programs
Advance rural health technology solutions including common EMR, digital health tools, and unified ride sharing application
Improve rural financial solvency through hospital VBP models, coordinated interfacility redesign, and nursing home renovations
Lead multi-part rural health workforce strategy aligned across education and provider settings
Coordinate performance monitoring and evaluation aligned with CMS requirements
Ensure financial integrity and compliance with funding requirements for RHTP
Engage statewide stakeholders through governance and feedback structures
Implement robust multi-tier evaluation to monitor and guide program progress
Sustain rural health improvements through local control, workforce pipelines, technology, payment reform, and policy integration
Core Initiatives
Ensure continued Medicaid coverage for eligible rural populations
Reduce coverage loss for procedural reasons among vulnerable individuals
Improve accuracy and outreach for Medicaid redeterminations
The SFY 2026 Medicaid managed care contract amendments make use of federal and state funds to address rising acuity following return to pre-pandemic eligibility policies and to support rural health care activities under the 2025 federal budget. Maternity payment rates increase for Critical Access Hospitals, Medicaid performance targets are enhanced, and new pharmacy management practices are implemented. The amendments are pending approval by the Governor and Council, with a statewide service reach and attention to rural hospital support.
Award: $20.5M
Core Initiatives
Maintain actuarial soundness of Medicaid managed care rates
Increase payment rates for Critical Access Hospital maternity care
Improve adherence to department-specified drug targets
Show all initiatives (337)
Maintain actuarial soundness of Medicaid managed care rates
Increase payment rates for Critical Access Hospital maternity care
Improve adherence to department-specified drug targets
Support rural health care activities authorized in federal 2025 budget
Ensure adequate Participating Provider network to meet standards
Guarantee timely access to services for all Members
Provide specialized care access for Children with Special Health Care Needs
Ensure access to substance use disorder services at all ASAM Levels of Care
Maintain continuity of care during provider or plan transitions
Support Rural Health Care initiatives starting January 1, 2026
Develop, operate, and maintain a Utilization Management program based on evidence-based criteria.
Adopt evidence-based Practice Guidelines in compliance with federal regulations and NCQA requirements.
Promote wellness and prevention programs for Members aligned with Department initiatives.
Implement Member Healthy Behavior Incentive Programs and Reference-Based Pricing Incentive Programs.
Ensure transparency in cost information related to Participating Providers.
Adhere to all State and federal laws on Advance Directives and maintain related policies.
Ensure consistent application and communication of prior authorization and utilization management policies.
Improve care of Members
Improve health outcomes
Increase collaboration among the Member’s Providers
Reduce inpatient hospitalizations including readmissions
Improve Continuity of Care
Improve transition planning
Improve medication management
Improve USPSTF recommended Level A and B preventive screenings
Reduce utilization of unnecessary Emergency Services
Reduce unmet resource needs related to health-related social needs
Decrease total costs of care
Increase Member satisfaction with their health care experience
Improve health outcomes for Members through comprehensive assessment and care management
Ensure timely and person-centered comprehensive assessments for Members, especially Priority Population Members
Enhance coordination and integration of physical, behavioral health, and social services
Maintain continuity and coordination of care including transitional care management
Advance use of health information technology and data sharing for care coordination
Develop and support a qualified Care Management workforce
Strengthen Provider-Delivered Care Coordination with incentives and community linkages
Promote Integrated Care by ensuring physical and behavioral health providers provide co-located or Integrated Care as defined by SAMHSA’s Six Levels of Collaboration/Integration or the Collaborative Care Model.
Ensure trauma-informed models of care consistent with SAMHSA guidelines that focus on Recovery and resiliency.
Reduce psychiatric boarding and behavioral health readmissions and emergency department utilization.
Support the NH 10-Year Mental Health Plan.
Enhance behavioral health provider training and workforce capacity.
Promote suicide prevention awareness including Zero Suicide program incorporation.
Improve coordination and communication among behavioral health and physical health providers.
Ensure compliance with prior authorization requirements for behavioral health drugs and services.
Improve health outcomes for Members by ensuring delivery of services at appropriate intensity and duration
Support and sustain evidence-based practices that impact Providers and Member outcomes
Reduce psychiatric boarding frequency and duration
Ensure access to a full continuum of Community Mental Health Services
Promote whole health goals to address health disparities
Support quality improvement for Certified Community Behavioral Health Clinics (CCBHCs)
Enhance coordination and communication between MCO, CMH Programs, Providers, and the Department
Ensure immediate access to appropriate living situations upon discharge from State-Owned Hospitals and other State determined IMDs for mental illness instead of homeless shelters
Facilitate coordinated discharge planning for Members admitted to State-Owned Hospitals or other State determined IMDs
Collaborate with CMH Programs to expedite discharge and ongoing engagement in services
Ensure treatment in the least restrictive environment complying with ADA and regulations
Ensure timely provision of discharge progress notes and coordination with aftercare providers
Ensure Substance Use Disorder services comply with state and federal laws and provide full continuum of care
Contract with Substance Use Disorder programs and Providers to deliver necessary services
Support and sustain evidence-based Substance Use Disorder practices improving Provider and Member outcomes
Ensure care management and coordination for Members diagnosed with or at risk for Substance Use Disorders and Neonatal Abstinence Syndrome
Implement opioid prescribing requirements and oversight including naloxone availability and prescription monitoring
Improving the health status of Members
Maintaining Member’s current health status when condition is not amenable to improvement
Preventing further decline or deterioration of health status
Improving the quality of care provided to Members
Achieving health plan accreditation from NCQA including Medicaid Module
Conducting Quality Assessment and Performance Improvement (QAPI) program
Conducting Performance Improvement Projects (PIPs) including clinical and non-clinical
Administering Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys
Reporting required quality and administrative measures and deliverables
Collaborating with EQRO for external quality review
Maintaining an adequate provider network complying with state and federal requirements
Implement clinically and actuarially sound incentives designed to improve care quality and utilization
Provide the right care at the right time and place through high-quality, cost-effective care for the whole person
Expand use of Alternative Payment Models (APMs) aligned with Medicaid program goals
Align MCO APM offerings with other payers’ APM initiatives to minimize provider burden
Increase adoption of Qualifying APMs consistent with Department Medicaid APM Strategy
Promote provider engagement in primary and preventive care, care coordination, and integration with behavioral health
Address state priorities such as reducing unnecessary ED use, preventable admissions and readmissions, improving prenatal care timeliness, integrating physical and behavioral health, managing pharmacy utilization, enhancing access to substance use disorder medication treatment, and addressing health-related social needs
Address how the MCO has impacted Department priority issues
Address social determinants of health
Improvements to population health
Develop innovative programs
Provide culturally and linguistically appropriate services
Ensure ongoing, critical MCO operations during emergencies
Improve quality and oversight reporting
Achieve NCQA accreditation
Comply with CMS Core Sets and Federal mandates
Successful Completion and Review of Provider-based Health Risk Assessment Screenings
New Hampshire Hospital Discharges - Intake Appointments for New CMHC Patients within 7 Days of Discharge
Program Integrity Plan
Timeliness of MCO Comprehensive Assessments
Member Communications: Speed to Answer Within 30 Seconds
Adult CMHP Assertive Community Treatment (ACT) Service Utilization
Zero Suicide Plan
Improve quality of care for members
Enhance monitoring and oversight reporting
Ensure timely service authorizations
Increase provider credentialing efficiency
Monitor and reduce high opioid prescribing
Support substance use disorder treatment quality
Promote preventive wellness visits
Achieve Department specified minimum adherence targets for specific Department identified drugs' initial adherence targets measured from January 1, 2026 through June 30, 2026.
Support the Department's Rural Health Care activities authorized through the 2025 federal budget reconciliation bill beginning January 1, 2026.
Implement and maintain a Patient Access Application Programming Interface (API) required in 42 CFR 431.60 beginning July 1, 2026.
Implement outpatient procedure incentive program beginning as early as January 1, 2026.
Ensure timely reporting of Overpayments identified or recovered within 30 calendar days.
Manage pharmacy utilization better through Participating Provider incentive arrangements.
Implement physician incentive plans adhering to defined performance periods and specific quality improvement or performance metrics effective July 1, 2026.
Ensure appropriate use of emergency departments relative to low acuity non-emergent visits.
Provide timely prior authorization decisions and notices consistent with federal timeframes starting July 1, 2026.
Develop and implement evidence-based wellness and prevention programs
Promote personal responsibility through incentives and care management
Ensure timely utilization management decisions in accordance with federal regulations
Adopt and disseminate evidence-based clinical Practice Guidelines
Promote cost transparency to support informed Member provider selection
Support tobacco cessation initiatives through collaboration with state programs
Increase collaboration among the Member’s Providers, including Behavioral Health Services Providers
Improve U.S. Preventive Services Task Force (USPSTF) recommended Level A and B preventive screenings and State specified screenings
Implement Comprehensive Assessment tailored to Members' needs
Provide coordinated Care Management and Care Team engagement
Ensure effective Transitional Care Management to prevent readmissions and adverse outcomes
Maintain integrated Provider-Delivered Care Coordination linked with social and community services
Deliver full continuum of Behavioral Health Services consistent with State Medicaid requirements
Promotion of Integrated Care using SAMHSA's Six Levels of Collaboration/Integration or the Collaborative Care Model
Ensure trauma-informed models of care focusing on recovery and resiliency
Reduce psychiatric boarding, behavioral health readmissions, and emergency department utilization
Support the NH 10-Year Mental Health Plan
Ensure continuity and coordination between physical health and behavioral health services
Promote suicide prevention awareness programs including the Zero Suicide program
Develop and administer behavioral health training plans to strengthen service capacity and provider competence
Ensure compliance with Mental Health Parity and Addiction Equity Act
Ensure parity compliance with Mental Health Parity Law and applicable guidance
Support full continuum of Community Mental Health Services access
Maintain contracts and coordination with Community Mental Health (CMH) Programs and Providers
Promote evidenced-based practices and quality improvement in behavioral health services
Improve access and outcomes for Members with serious mental illness and substance use disorders
Reduce psychiatric boarding and improve discharge planning for behavioral health patients
Implement and support Certified Community Behavioral Health Clinic (CCBHC) model
Address housing instability and homelessness among Members
Promote supported employment, illness management and recovery, and peer support services
Ensure comprehensive assessment, care planning, and service coordination for Members
Ensure timely and effective discharge planning and follow-up for Members discharged from State-Owned Hospitals or other State determined IMDs for mental illness.
Provide a full continuum of Substance Use Disorder services in compliance with state and federal law and Medicaid State Plan requirements.
Maintain coordinated care and communication between MCO, CMH Programs, Substance Use Disorder Providers, and other stakeholders to support Member transitions and ongoing treatment.
Improve Substance Use Disorder service delivery through quality improvement projects, audits, and performance monitoring.
Increase access and support for Members who are homeless or at risk of homelessness.
Promote use of Peer Recovery Support Services and Naloxone availability for Members at-risk.
Meet prescribing and prior authorization guidelines for opioids and MAT treatments.
Improving the health status of Members and preventing further decline or deterioration of health status
Improving the quality of care provided to Members in collaboration with the Department, Members and Providers
Continuous quality assessment and performance improvement through a comprehensive QAPI program
Achieving and maintaining health plan accreditation including NCQA Medicaid Module
Monitoring and improving behavioral health services provided to Members
Increasing engagement in treatment services for substance use disorder and reducing overdoses
Ensuring adequate and accessible provider network for Members including those with LEP or disabilities
Ensure Participating Providers are enrolled with the Department as Medicaid Providers consistent with screening and enrollment requirements
Maintain a documented process for credentialing and re-credentialing Providers
Develop and provide Provider support services including training and assistance
Establish and facilitate a Provider Advisory Board to gather feedback
Ensure Provider contracts comply with State and federal laws including non-discrimination
Keep Providers informed and engaged in the QAPI program and related activities
Require Providers to comply with MCO policies, procedures, and quality guidelines
Maintain records for auditing and compliance as required by the Department
Ensure Providers comply with transition of care policies
Prohibit gag clauses and discrimination in provider participation and reimbursement
Ensure Providers comply with time, distance, and wait standards for access and availability
Negotiate Provider payment rates in accordance with Alternative Payment Models and Department specifications
Implement clinically and actuarially sound incentives designed to improve care quality and utilization.
Expand use of Alternative Payment Models (APMs) promoting right care, right time, right place, focusing on high-quality, cost-effective care for the whole person.
Support engaged primary and preventive care models and provider delivered care coordination.
Align MCO APM offerings to other payers’ initiatives to minimize Provider burden.
Increase adoption of Qualifying APMs including for behavioral health and substance use disorder treatment.
Reduce unnecessary service utilization, including emergency department visits for low acuity, non-emergent conditions.
Reduce preventable admissions and 30-day hospital readmission rates.
Improve timeliness of prenatal care and reduce infants born affected by substance use.
Better integrate physical and behavioral health, especially timely follow-up after mental illness or substance use disorder admissions.
Incentivize provider engagement with attributed members in primary/preventive care and care coordination.
Manage pharmacy utilization including preferred generic prescribing and reduce polypharmacy.
Enhance access to and effectiveness of medications for Substance Use Disorder treatment.
Address health-related social needs and reduce ED boarding for members best treated in the community.
Ensure interoperable systems complying with CMS Interoperability and Patient Access final rule
Maintain continuous operation and system availability of MCIS with disaster recovery and business continuity plans
Ensure accuracy, completeness, and timeliness of claims and encounter data submission
Comply with federal and state regulations including HIPAA, ADA, and Section 508
Implement and maintain APIs for patient access, provider directory, and payer-to-payer data exchange
Improve health outcomes through MCO-implemented interventions and addressing social needs
Maintain quality assurance and oversight reporting requirements
Ensure data security and controls for Confidential Data
Implementation of the expansion of Substance Use Disorder, Serious Mental Illness, and Serious Emotional Disturbance Treatment and Recovery Access 1115 Demonstration Waiver
Maintain actuarial soundness in capitation payment rates
Ensure Medicaid Care Management Services meet minimum Medical Loss Ratio (MLR) requirements
Implement risk mitigation strategies including High-Cost Pharmacy Risk Pool and Boston Children’s Hospital risk pool
Mitigate MCO and Department gains and losses related to the Community Mental Health (CMH) Program using risk corridors
Address DHHS Quality Improvement Priorities
Improve population health
Implement Alternative Payment Models
Assure behavioral health integration and reduce psychiatric boarding
Ensure provider engagement and care coordination
Ensure network compliance that all members under age 21 receive all the elements of the preventive health screenings recommended by the AAP’s Bright Futures guidelines in accordance with the EPSDT periodicity schedule.
Include written policies and procedures for the provision of a full range of EPSDT diagnostic and treatment services.
Address select MCO-specific findings/recommendations identified by NH EQRO quality reports through semi-annual reports.
Maintain submission of annual financial statements and fraud monitoring to DHHS.
Complete comprehensive assessments for required priority populations in a timely manner.
Improve member communications and responsiveness including call handling and follow-up.
Ensure cost-effective, safe, and accessible Non-Emergency Medical Transportation (NEMT) services to Members
Comply with all State and federal regulations including Medicaid State Plan requirements for NEMT
Implement robust pharmacy management including Prior Authorization, DUR, adherence to the Department’s Preferred Drug List (PDL), and medication management programs
Achieve specified adherence targets for pharmacy quality metrics
Facilitate effective data exchange and reporting for pharmacy and transportation services
Ensure comprehensive medication management for Children with Special Health Care Needs
Improve medication reconciliation and targeted medication reviews
Enhance Member engagement and counseling in medication management
Support monitoring and appropriate use of behavioral health medications in children
Maintain eligibility and enrollment accuracy and timely updates
Provide accessible Member services including clear communication and Member Handbook
Ensure non-discrimination and equitable auto-assignment and disenrollment procedures
Develop and implement Member Healthy Behavior Incentive Program
Develop and implement Reference-Based Pricing Incentive Program
Increase timeliness of prenatal care, especially for Members at risk of NAS
Address obesity
Prevent diabetes
Support nicotine smoking cessation
Increase lead screening rates in young children
Enhance Primary Care and Prevention Focused Care Model
Ensure effective care coordination and care management
Improve care, health outcomes, and reduce unnecessary utilization
Improve medication management and transitions of care
Promote tobacco cessation through collaboration with Tobacco Cessation Programs
Incentivizing the Provider’s use of closed-loop referrals for effective care coordination and reporting
Ensure Behavioral Health Services are delivered in a manner that is clinically and developmentally appropriate
Provide a full continuum of physical health and Behavioral Health Services ensuring coordination and collaboration
Promote Integrated Care between physical and behavioral health Providers
Implement trauma-informed models of care focusing on Recovery and resiliency
Develop and submit Behavioral Health Strategy Plan and Report including effectiveness analysis and improvement interventions
Collaborate with the Department on mental health and Substance Use Disorder updates and quality assurance
Promote suicide prevention awareness including the Zero Suicide program
Ensure timely and appropriate PCP screening and referral for Behavioral Health needs
Reduce Behavioral Health readmissions and emergency department utilization
Support communication and coordination among Behavioral Health Providers and PCPs
Conduct annual Behavioral Health Member Experience of Care Survey
Ensure provision and accessibility of Behavioral Health Emergency Services
Develop and implement an annual Behavioral Health training plan to strengthen services and workforce capacity
Reduce duplication of behavioral health training efforts
Increase provider competence and improve quality of care through training
Support full continuum of Community Mental Health Services
Improve Member health outcomes and support evidenced-based practices
Promote healthy behavior changes among Community Mental Health Service recipients
Reduce frequency and duration of psychiatric boarding
Reducing psychiatric boarding in emergency departments and inpatient settings
Implementing the Certified Community Behavioral Health Clinics (CCBHC) model
Ensuring seamless transitions of care for members discharged from state-owned hospitals and IMDs
Providing comprehensive and coordinated Substance Use Disorder (SUD) services
Improving discharge planning and post-stabilization care
Supporting quality improvement and compliance with reporting requirements for behavioral health and SUD services
Promoting availability and training on naloxone for overdose prevention
Enhancing communication and coordination among MCO, CMH programs, and providers
Improving the health status of Members and maintaining current health status by preventing decline or deterioration.
Improving the quality of care provided to Members consistent with MCO's quality improvement goals.
Achieving health plan accreditation from NCQA including Medicaid Module within required timeframes.
Operating an ongoing comprehensive QAPI program consistent with agreement and federal requirements.
Conducting required Performance Improvement Projects (PIPs) focused on Department objectives, Substance Use Disorder, and areas of low performance.
Administering annual CAHPS surveys for Member experience of care.
Ensuring quality and administrative reporting deliverables are submitted as required.
Integrating Medicare Confidential Data for dual Members into QAPI and Care Coordination quality programs.
Establish a mechanism for periodic reporting of QAPI activities.
Collaborate with the Department’s EQRO for external quality review activities.
Maintain and monitor a network of appropriate Participating Providers with adequate access.
Ensure credentialing, enrollment, and compliance of Participating Providers with state and federal requirements.
Develop and provide Provider support services and training.
Facilitate an active Provider Advisory Board for feedback and engagement.
Implement provider contracts that ensure compliance with regulations and non-discrimination.
Require Providers to comply with grievance, appeal processes, and overpayment return protocols.
Conduct background screening of Provider staff and enforce removal from service if on Exclusion Lists.
Expand use of Alternative Payment Models (APMs) promoting right care at the right time and place
Develop APMs consistent with the Department’s Medicaid APM Strategy and CMS guidance
Ensure 50% of covered services medical expenditures are in Qualifying APMs
Support providers with data sharing, transparency, and engagement to advance APM readiness
Promote integration of behavioral health with APM models
Incentivize primary care and preventive care through provider-delivered care coordination
Implement Qualifying APMs for substance use disorder treatment including coordinated care for affected birthing parents and infants
Appropriate use of emergency departments relative to low acuity non-emergent visits
Decrease unnecessary service utilization, particularly related to use of the ED for members with behavioral health needs and low-income children
Reduce preventable admissions and 30-day hospital readmission for all causes
Improve timeliness of prenatal care and reduce births affected by substance use exposure
Better integrate physical and behavioral health, especially follow-up after mental illness or Substance Use Disorder admission
Incentivize provider engagement in primary and preventive care and health needs assessments
Better manage pharmacy utilization to reduce polypharmacy
Enhance access to and effectiveness of medication to treat Substance Use Disorder
Address health-related social needs including 'ED boarding' where members remain in ED when better treated in the community
Ensure Physician Incentive Plans comply with applicable regulations and Department requirements
Reimburse providers timely, fairly, and in accordance with Medicaid fee schedules and Department directives
Address State priorities for the MCM Program as specified in RSA 126-AA and other State statutes, policies, and guidelines
Develop innovative programs and demonstrate associated outcomes
Address health-related social needs and demonstrate outcomes of MCO-implemented interventions
Improve health outcomes in the State
Ensure continuous operation and security of MCIS systems, including compliance with HIPAA, ADA, and federal regulations
Advance interoperability and patient access consistent with CMS Interoperability and Patient Access final rule and 21st Century Cures Act
Assure Participating Providers meet SAMHSA Standard Framework for Levels of Integrated Healthcare
Assure appropriateness of diagnosis, treatment, and referral of behavioral health disorders commonly seen by PCPs
Assure promotion of Integrated Care
Reduce Psychiatric Boarding
Reduce Behavioral Health Readmissions
Reduce Behavioral Health related emergency department utilization
Assure appropriateness of psychopharmacological medication
Assure access to appropriate services
Implement a training plan that includes Trauma-Informed Care and Integrated Care
Other information in accordance with Exhibit O: Quality and Oversight Reporting Requirements
Facilitate integrated Provider-Delivered Care Coordination and MCO-Delivered Care Management
Facilitate and operate systems of Provider-Delivered and MCO-Delivered health risk assessments screenings
Implement, administer and facilitate the Primary Care and Prevention Focused Care Model with authentic engagement between Members and PCPs
Take social determinants of health into account in Care Management for Required Priority Populations
Ensure timely and accurate claims processing
Comply with CMS Adult and Child Core Sets and CCBHC demonstration requirements
Cultural Competency Strategic Plan
Emergency Response Plan
MCO Annual Financial Statements
Ensure continuous operation of the Managed Care Information System (MCIS)
Complete comprehensive assessments for required priority populations
Timely completion and reporting of comprehensive assessments
Improve member communications responsiveness
Monitor mental health service utilization and follow-up
Maintain NEMT network adequacy and timeliness
Ensure quality and performance improvement for Opioid Treatment Programs
Increase member visits with designated PCP or provider team
Monitor private duty nursing services delivery and network adequacy
Improve medication adherence rates across multiple therapeutic areas
Improve medication management and monitoring for children and adults on psychotropic medications
Enhance data sharing between MCOs, PCPs, and behavioral health providers
Increase the timeliness and accuracy of service authorization determinations
Strengthen provider credentialing processes
Enhance quality assessment and performance improvement programs
Address social determinants of health impacting members
Improve provider communication and appeals processes
Monitor and improve Substance Use Disorder (SUD) treatment and outcomes
Increase tobacco cessation program effectiveness
Improve coordination of benefits and subrogation efforts
This document sets forth the comprehensive scope for external quality review services for both managed care and dental organizations in New Hampshire Medicaid. The contractor will annually validate performance measures, improvement projects, encounter data, and provider network adequacy for all contracted MCOs and DOs. Extensive reporting, survey work, and technical assistance are required to improve quality and address deficiencies.
Event schedule:
- Initial draft of Technical Report submission - 2027-12-01 - New Hampshire Department of Health and Human Services
- Final submission of Technical Report - 2028-04-01 - New Hampshire Department of Health and Human Services
- Plan for activities in Part A and Part B due - 2027-08-01 - New Hampshire Department of Health and Human Services
Initial draft of Technical Report submission - 2027-12-01 - New Hampshire Department of Health and Human Services
Final submission of Technical Report - 2028-04-01 - New Hampshire Department of Health and Human Services
Plan for activities in Part A and Part B due - 2027-08-01 - New Hampshire Department of Health and Human Services
Core Initiatives
Ensure compliance and improve quality across New Hampshire Medicaid managed care entities and dental organizations.
Validate performance and improvement measures, encounter data, provider network adequacy, and contractual compliance.
Support continuous quality improvement through technical assistance, studies, surveys, and corrective action plans.
Show all initiatives (10)
Ensure compliance and improve quality across New Hampshire Medicaid managed care entities and dental organizations.
Validate performance and improvement measures, encounter data, provider network adequacy, and contractual compliance.
Support continuous quality improvement through technical assistance, studies, surveys, and corrective action plans.
Improve quality of health care services delivered by MCOs and DOs
Validate contract compliance, performance measures, networks, and encounter data
Implement surveys and focus studies to assess access and quality
Develop and submit comprehensive annual technical reports meeting federal requirements
Enhance data security and confidentiality in compliance with federal and state standards
Ensure smooth transition of services and data at contract end
Comply with culturally and linguistically appropriate service requirements
The GO-NORTH program is managed by the Foundation for Healthy Communities (FHC) and focuses on improving population health, access to care, workforce development, financial sustainability, and technology in rural areas through five regional hubs. The program has received $66.5 million in its first year to support primary, behavioral, and specialty care expansion, workforce development, technology adoption, and financial sustainability efforts throughout rural New Hampshire. Key contacts: Travis Boucher travisboucher@healthynh.org
Event schedule:
- School-Based Oral Health Program Application Deadline - September 25, 2026 - 12:00 AM ET - New Hampshire
- School-Based Oral Health Program Information Session - August 24, 2026 - 10:30 AM - 11:30 AM ET - Webinar
- Primary Care Access RFA Initial Application Deadline - October 15, 2026 - 5:00 PM ET - New Hampshire
- Primary Care Access RFA Information Session - September 2, 2026 - 9:00 AM - 10:30 AM ET - Webinar
- Data and Reporting Consultant Application Deadline - August 31, 2026 - 5:00 PM ET - New Hampshire
Award: $204.0M
Event Schedule
School-Based Oral Health Program Application Deadline - September 25, 2026 - 12:00 AM ET - New Hampshire
School-Based Oral Health Program Information Session - August 24, 2026 - 10:30 AM - 11:30 AM ET - Webinar
Primary Care Access RFA Initial Application Deadline - October 15, 2026 - 5:00 PM ET - New Hampshire
Show all schedule items (5)
School-Based Oral Health Program Application Deadline - September 25, 2026 - 12:00 AM ET - New Hampshire
School-Based Oral Health Program Information Session - August 24, 2026 - 10:30 AM - 11:30 AM ET - Webinar
Primary Care Access RFA Initial Application Deadline - October 15, 2026 - 5:00 PM ET - New Hampshire
Primary Care Access RFA Information Session - September 2, 2026 - 9:00 AM - 10:30 AM ET - Webinar
Data and Reporting Consultant Application Deadline - August 31, 2026 - 5:00 PM ET - New Hampshire
Contacts
Travis Boucher - <travisboucher@healthynh.org> - Vice President, Rural Health Transformation - New Hampshire
Core Initiatives
Population Health
Access
Workforce
Show all initiatives (5)
Population Health
Access
Workforce
Financial Sustainability
Technology
Award: $96.9M
Core Initiatives
Strengthen rural health workforce pipeline
Expand access to high-need clinical training for rural healthcare careers
Reduce rural provider shortages via 'grow-your-own' strategies
Show all initiatives (9)
Strengthen rural health workforce pipeline
Expand access to high-need clinical training for rural healthcare careers
Reduce rural provider shortages via 'grow-your-own' strategies
Support implementation of New Hampshire's RHTP to achieve CMS milestones needed for continued funding
Sustainability of the Common Campus NH - RHT network beyond federal RHTP funding
Ensure timely and accurate performance reporting aligned with CMS RHTP requirements
Collaboration with GO-NORTH and rural healthcare employers to embed simulation learning and workforce initiatives
Maintain confidentiality and secure handling of State Confidential Information
Compliance with federal civil rights laws, including culturally and linguistically appropriate services
New Hampshire Medicaid is amending its managed care contracts for over $2.74B total through 2029 with major MCOs, with nearly $1.53B increase for SFY26 to reflect higher directed payments to hospitals (including rural and critical access hospitals) as DSH phases out. Additional quality incentive/withhold programs, pharmacy high-cost risk pools, and the addition of a new CCBHC improve rural behavioral health access. The contract innovations aim to maintain access and financial viability for Medicaid providers during state and federal payment transitions.
Budget: $2.7B
Core Initiatives
Transition away from DSH payments to hospital-directed payments via MCOs
Maintain actuarial soundness and quality incentives in Medicaid contracts
Expand behavioral health access, including addition of new Certified Community Behavioral Health Center
Show all initiatives (367)
Transition away from DSH payments to hospital-directed payments via MCOs
Maintain actuarial soundness and quality incentives in Medicaid contracts
Expand behavioral health access, including addition of new Certified Community Behavioral Health Center
Provide culturally and linguistically competent services to all Members, including those with LEP and disabilities
Ensure Members have access to comprehensive language assistance services
Guarantee Member rights, including access to information, respectful treatment, and grievance processes
Maintain high-quality Member communication supports and call center operations
Develop active Member engagement through advisory boards and regional meetings
Ensure accuracy, transparency, and compliance in Marketing Materials
Provide timely and effective grievance and appeal processes
Ensure network adequacy and timely access to care for all Medicaid Members
Maintain sufficient capacity and expertise among Participating Providers
Guarantee equal access to culturally and linguistically appropriate services
Provide specialized access to children with special health care needs and behavioral health services
Support continuous quality and oversight reporting
Develop and implement evidenced-based wellness and prevention programs
Promote personal responsibility through incentives and care management
Ensure comprehensive primary care and prevention focused care model administration
Support Member engagement in health risk assessment (HRA) screenings
Collaborate with New Hampshire Tobacco Cessation Program to promote nicotine cessation
Enhance Member cost transparency and Reference-Based Pricing Incentive Programs
Provide care coordination and care management services
Improve care of Members
Improve health outcomes
Increase collaboration among the Member's Providers
Reduce inpatient hospitalizations including readmissions
Improve Continuity of Care
Improve transition planning
Improve medication management
Improve U.S. Preventive Services Task Force recommended Level A and B preventive screenings; as well as State specified screenings
Reduce utilization of unnecessary Emergency Services
Reduce unmet resource needs related to health-related social needs
Decrease total costs of care
Increase Member satisfaction with their health care experience
Support continuity and coordination of care for transitions and enrollment of children in foster care
Ensure coordination between child/adolescent and adult mental health service delivery systems
Implement Provider-Delivered Care Coordination Program including reimbursement and incentives
Integrate behavioral health services in a clinically and developmentally appropriate manner
Promote trauma-informed models of care reflecting recovery and resiliency
Reduce behavioral health readmissions and emergency department utilization
Support suicide prevention awareness programs including the Zero Suicide program
Promote integrated care via co-located health and behavioral health providers
Ensure timely identification and referral for behavioral health needs by PCPs
Ensure compliance with prior authorization requirements for behavioral health drugs
Improve communication and coordination among behavioral health service providers
Provide accessible behavioral health emergency crisis response services
Strengthen behavioral health service and accessibility capacity for Members
Support efforts of Behavioral Health provider network to hire, retain, and train qualified staff
Reduce the number of suicides in NH
Ensure compliance with Mental Health Parity and Addiction Equity Act of 2008
Support Member access to full continuum of Community Mental Health Services
Improve health outcomes by ensuring service delivery at appropriate intensity and duration
Promote evidence-based practices in behavioral health services
Provide care to Members who are homeless or at risk of homelessness
Increase engagement in healthy behavior change initiatives
Reduce psychiatric boarding frequency and duration
Implement the Certified Community Behavioral Health Clinics (CCBHC) model in accordance with SAMHSA demonstration certification criteria
Ensure coordination and seamless transition of care for Members admitted to State-Owned Hospitals and IMDs for mental illness
Provide comprehensive Substance Use Disorder (SUD) services in compliance with state and federal laws and parity requirements
Conduct quality improvement activities to improve delivery of Substance Use Disorder services
Promote delivery of Peer Recovery Support Services through certified Peer Recovery Coaches
Ensure availability and provision of naloxone kits and training annually to Substance Use Disorder programs/providers
Monitor and enforce compliance with Prescription Drug Monitoring Program (PDMP) and opioid prescribing guidelines
Provide quality care with the primary goal of improving the health status of Members or maintaining the current health status to prevent decline
Collaborate with Department, Members, and Providers to improve quality of care consistent with quality improvement goals
Achieve and maintain health plan accreditation from NCQA including Medicaid Module
Implement ongoing comprehensive QAPI program per federal and contractual requirements
Conduct Performance Improvement Projects (PIPs), including clinical and non-clinical projects focused on substance use disorder and other priority areas
Administer the CAHPS surveys annually for adult and child populations with Department approval
Ensure robust network management and maintenance of appropriate Participating Providers to guarantee access and quality
Implement clinically and actuarially sound incentives to improve care quality and utilization
Expand use of Alternative Payment Models (APMs) that provide right care, right time, right place
Promote engaged primary and preventive care through APMs
Align Medicaid APM offerings with other payers to minimize Provider burden
Ensure 50% of Covered Services medical expenditures are in Qualifying APMs
Incentivize Providers for achieving quality outcomes and integration of behavioral health
Address state priorities including reducing unnecessary service utilization, preventable admissions, improving prenatal care, integrating physical and behavioral health, managing pharmacy utilization, and addressing health-related social needs
Implement timely reimbursement and fee schedule updates aligned with State Medicaid FFS fee schedules
Ensure compliance with State and Federal regulations regarding provider payments, overpayments, and preventable conditions
Support directed payments to various provider types including CMH programs, hospitals, and specialized providers
Facilitate quality improvement and reporting requirements
Promote access and appropriate reimbursement for services for vulnerable populations including mental health and substance use disorder patients
Ensure compliance with program integrity provisions including prevention and detection of Fraud, Waste and Abuse
Maintain effective administrative and management arrangements to detect and prevent Fraud, Waste and Abuse
Implement and maintain comprehensive Fraud, Waste and Abuse Compliance Plans and Program Integrity Plans
Cooperate fully with State and federal agencies in Fraud, Waste and Abuse investigations
Maintain detailed reporting and recovery processes for Overpayments due to Fraud, Waste and Abuse
Ensure provider and subcontractor compliance with all program integrity requirements
Implement timely suspensions and referrals related to credible allegations of Fraud
Maintain thorough documentation and transparency in Fraud, Waste and Abuse activities
Detect under and over utilization
Assess quality and appropriateness of care for members with special health care needs and disparities
Monitor, evaluate and improve quality of care for members receiving behavioral health services
Describe completed and ongoing quality management activities and performance trends
Ensure timely and clinically appropriate substance use disorder (SUD) services
Identify and intervene with providers with high opioid prescribing rates
Improve member access to preventive and ambulatory health services
Provide health care services to eligible and enrolled Medicaid participants through New Hampshire's Medicaid managed care program (MCM).
Implement Certified Community Behavioral Health Clinic (CCBHC) services meeting federal criteria.
Implement youth and adult community re-entry programs per Consolidated Appropriations Act of 2023 Section 5121.
Operationalize Quality and Oversight Reporting Requirements for MCM Program performance monitoring.
Use financial penalties and External Quality Review Contractor oversight to enforce contract and quality requirements.
Support regular MCO meetings to review program and contract performance.
Implement adult community re-entry benefit for Members under 1115 Medicaid Demonstration authority for Community Reentry (CRE)
Integrate and make available both adult and youth community re-entry program Covered Services
Implement unique Medicaid-specific BIN and PCN combination for pharmacy benefits
Maintain comprehensive Provider Directory including behavioral health Providers such as CCBHCs
Support and incentivize PCPs to engage Members to complete HRA Screening
Support reporting and Care Management for Required Priority Populations
Identify and timely refer Members needing Behavioral Health Services to regional CCBHCs or other providers
Develop referral process including warm hand-off for behavioral health transitions
Develop and implement annual behavioral health training plans supporting workforce development in behavioral health Providers
Implement and support CCBHC service delivery and payment models according to SAMHSA demonstration criteria
Ensure discharge instruction sheets are provided post-discharge for Members from State-Owned Hospitals or IMDs
Maintain individualized and updated treatment plans using ASAM criteria for substance use disorder treatment
Provide comparative prescribing data quarterly to Participating Providers
Implement prior authorization protocols with 24-hour clinician hotline for substance use disorder services
Maintain compliance with Physician Incentive Plan requirements tied to quality and performance metrics
Reimburse Community Mental Health Programs including CCBHCs according to directed payments and Medicaid fee schedules
Maintain standards-based publicly accessible API provider directory by July 1, 2025
Manage capitation payments and annual rate adjustments subject to actuarial certification and State appropriations
Provide health care services to eligible and enrolled Medicaid participants through New Hampshire's Medicaid managed care program known as New Hampshire Medicaid Care Management (MCM)
Promote optimal health and suitable access through a competitive procurement process
Implement primary and preventive service care models emphasizing authentic patient-provider relationships and care coordination
Strengthen alignment of Community Mental Health Center funding with behavioral health investments
Implement quality performance programs including Quality Withhold Program and performance monitoring
Ensure compliance with licensure and certification requirements for subcontractors performing utilization review and medical necessity determinations
Incentivize program performance via capitation withhold program and provider alternative payment models
Monitor and improve quality, safety, and operational efficacy of Medicaid managed care services
Promote and provide wellness and prevention programming aligned with Department initiatives including National Diabetes Prevention Program
Encourage members to take an active role in shared decision-making
Increase completion rates of Health Risk Assessment (HRA) Screening
Ensure comprehensive Primary Care and Prevention Focused Care Model
Improve care coordination and care management for all members
Reduce unnecessary emergency department utilization
Improve preventive screenings adherence
Increase member satisfaction with healthcare experience
Ensure coordinated care management for Required Priority Populations
Implement comprehensive assessments to identify and address special health care needs
Maintain Care Plans tailored to members with ongoing monitoring and updates
Support transitions of care to prevent unplanned readmissions and adverse outcomes
Integrate Provider-Delivered Care Coordination with social services and community care
Enhance provider and care team communication and collaboration
Utilize health information technology for data sharing and interoperability
Assure Participating Providers meet SAMHSA Standard Framework for Levels of Integrated Healthcare
Assure the appropriateness of diagnosis, treatment, and referral of behavioral health disorders commonly seen by PCPs
Assure the promotion of Integrated Care
Reduce Psychiatric Boarding
Reduce Behavioral Health Readmissions
Reduce Behavioral Health related emergency department utilization
Support the NH 10-Year Mental Health Plan
Assure the appropriateness of psychopharmacological medication
Assure access to appropriate services
Implement a training plan that includes Trauma-Informed Care and Integrated Care
Support and sustain evidenced-based practices with a profound impact on Providers and Member outcomes
Ensure Members have access to the full continuum of Community Mental Health Services
Improve health outcomes for Members and ensure appropriate intensity and duration of services
Support the implementation and quality improvement of Certified Community Behavioral Health Clinics (CCBHC) model
Reduce Psychiatric Boarding and improve discharge, treatment, and transfer protocols
Promote healthy behavior changes among Community Mental Health Service recipients
Improve health status of Members
Maintain current health status when improvement is not possible
Prevent further decline in condition or deterioration of health
Collaborate with Department, Members, and Providers to improve quality of care
Engage Member Advisory Board and Provider Advisory Board in quality improvement
Achieve and maintain NCQA Health Plan Accreditation including Medicaid Module
Conduct ongoing comprehensive QAPI program consistent with federal requirements
Complete required clinical and non-clinical Performance Improvement Projects (PIPs)
Administer annual Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys
Ensure network adequacy with appropriate Participating Providers
Ensure compliance with provider enrollment, credentialing, and screening requirements
Implementing clinically and actuarially sound incentives designed to improve care quality and utilization
Expand use of Alternative Payment Models (APMs) that promote the goals of the Medicaid program to provide the right care at the right time and place
Increase provider engagement with attributed members in primary and preventive care, health needs assessments, and care coordination
Promote integration of physical and behavioral health
Enhance effectiveness of medication for substance use disorder treatment
Address health-related social needs including ED boarding
Encourage alignment of MCO APM offerings with other payer initiatives to minimize provider burden
Achieve improved performance through incentives and/or penalties
Ensure timely and accurate claims payment
Maintain quality assurance through data accuracy and completeness
Comply with federal and state reporting requirements
Support program integrity and corrective action processes
Enhance encounter data quality and submission compliance
Ensure compliance with program integrity provisions including detection and prevention of Fraud, Waste and Abuse
Implement and maintain a Program Integrity Plan and Fraud, Waste and Abuse Compliance Plan
Establish internal controls, policies, and procedures to prevent and deter Fraud, Waste and Abuse
Maintain compliance with all federal and State Medicaid program integrity regulations
Collaborate with the Department and MFCU on program integrity issues and investigations
Conduct investigations and audits to detect improper payments and provider fraud
Recover overpayments related to Fraud, Waste and Abuse
Submit timely and accurate reporting on Fraud, Waste and Abuse activities
Ensure transparency and cooperation with State and federal agencies on fraud investigations
Maintain documentation and record retention in support of program integrity efforts
Successful Completion and Review of Provider-based Health Risk Assessment Screenings
Successful Completion, Review, and Referral or Follow-up as Needed on Provider-based Health Risk Assessment Screenings by Provider Group Practice
New Hampshire Hospital Discharges - Intake Appointments for New CMHC Patients within 7 Days of Discharge
New Hampshire Hospital Discharges - Aftercare Provider Contacted and Provided Discharge Plan within 72 Hours of Discharge
New Hampshire Hospital Discharges - Member Received Discharge Instruction Sheet
New Hampshire Hospital Discharges - Discharge Plan Provided to Aftercare Provider within 7 Days of Discharge
In Lieu of Services: New or Modified Services and Annual Report
Program integrity Plan
Program Integrity Compliance and Fraud, Waste, and Abuse Narrative Report
Pharmacy Lock-in Member Enrollment Log
Pharmacy Lock-in Activity Summary
Managed Care Information System Contingency Plans
MCO Comprehensive Assessments Completed for Total Membership
MCO Comprehensive Assessments Completed for Required Priority Populations
Timeliness of MCO Comprehensive Assessments
Care Management Comprehensive Assessment Results within 14 Calendar Days
Member Communications: Speed to Answer Within 30 Seconds
Member Communications: Calls Abandoned
Member Communications: Reasons for Telephone inquiries
Member Communications: Calls Returned by the Next Business Day
Member incentive Table
Member Incentive Plan
Adult CHHP Assertive Community Treatment (ACT) Service Utilization
ED Visits for Mental Health Preceded a State of NH IMD or Non-IMD DRF Hospital Stay in Past 30 Days
Follow-up Visits after Hospital Discharge for Mental Health-Related Conditions
Emergency Department Psychiatric Boarding Table
Mental Health Readmissions: Service Utilization Prior to Readmission
Readmissions for Mental Health Conditions within 30, 90 and 180 Days of Discharge
Zero Suicide Plan
Medical Loss Ratio Report
Monthly Operations Report
Medical Services inquiry Letter
NCQA Accreditation Review Results
NEMT Legs Delivered by Covered Medical Service Provider Type
Family and Friends Program NEMT Legs
Timeliness of Scheduled and Delivered NEMT Legs
NEMT Network Adequacy Report
Timely Processing of Electronic NEMT Claims: Thirty Days of Receipt
NEMT Network Adequacy Table
NEMT Complaint log
Timeliness of Scheduled NEMT Legs from Nursing Facilities
NEMT Legs Delivered
Scheduled NEMT Trips with issues Impacting Delivery
Comprehensive Provider Network and Equal and Timely Access Annual Filing
Corrective Action Plan to Restore Provider Network Adequacy
Access to Care Provider Survey
OTP Record Audits - Opioid Treatment Program Providers
Quality and Performance Improvement Monitoring Report for Opioid Treatment Program Providers
Quality Improvement Progress Report for Opioid Treatment Programs
Member Visits with Designated PGP or POP Provider Team In the Last 12 Months
Member Wellness visits with Designated PGP or POP Provider Team in the Last 12 Months
New Member Visits with Designated PGP or POP Provider Team within 90 Days of PGP Selection/Assignment
Private Duty Nursing: Authorized Hours for Children Delivered and Billed by Quarter
Private Duty Nursing: Authorized Hours for Adults Delivered and Billed by Quarter
Improve medication adherence for Medicaid members 18 years and older across various drug classes
Enhance provider communication and responsiveness
Ensure timely service authorization determinations for medical services, equipment, and pharmacy
Improve quality assessment and performance improvement for behavioral health and special health care needs
Monitor and reduce high opioid prescribing rates among providers
Increase access and follow-up care for adults with Serious Mental Illness (SMI)
Support comprehensive medication reviews for polypharmacy members
Maintain network adequacy and manage provider appeals and complaints
Provide health care services to eligible and enrolled Medicaid participants through New Hampshire's Medicaid Care Management (MCM) program
Ensure actuarial soundness and annual rate reviews for Medicaid managed care
Operationalize quality and oversight reporting requirements
Levy financial penalties through Liquidated Damages Matrix when appropriate
Use External Quality Review Contractor for contractual and quality requirements
Support regular MCO meetings to review program and contract performance
Implement youth and adult community re-entry programs as authorized by 1115 waiver and federal legislation
Expand targeted case management for beneficiaries with substance use disorders
Adjust Medicaid rates and reimbursement methodologies to reflect updated service codes, utilization, and cost projections
Promote optimal health and equitable access to services by better integrating physical and behavioral health-care
Introduce a Primary Care and Preventive Service Care Model built on authentic patient/provider relationships
Increase focus on priority populations such as behavioral health inpatient admissions, child welfare involved youth, foster care, low birth weight babies, neonatal abstinence syndrome, and incarcerated individuals eligible for community reentry programs
Implement pharmacy carve-in, high cost pharmacy risk pool, and funding for new therapies including gene therapy
Improve reliability, quality, and safety of Non-Emergency Medical Transportation (NEMT) services
Expand use of remedies and incentives for quality and program integrity objectives including fraud, waste, and abuse prevention
Ensure culturally and linguistically competent services to all Members.
Provide timely and accessible member communication supports.
Maintain a responsive member grievance and appeal system complying with federal and state regulations.
Promote member engagement through advisory boards and regional meetings.
Ensure access to qualified interpretation and translation services for members with LEP or disabilities.
Promote and provide wellness and prevention programming aligned with Department initiatives including the National Diabetes Prevention Program
Encourage Members to take an active role in shared decision-making
Develop and implement Member Healthy Behavior Incentive Programs and Reference-Based Pricing Incentive Programs
Support completion of Health Risk Assessment (HRA) Screening by Members and Providers
Ensure comprehensive PCP participation in Primary Care and Prevention Focused Care Model
Facilitate closed-loop referral processes for care coordination
Increase HRA Screening completion rates annually up to 75% by Year 4
Prohibit prior authorizations for preventive services to reduce barriers
Increase collaboration among the Member's Providers, including but not limited to Behavioral Health Services Providers
Improve U.S. Preventive Services Task Force (USPSTF) recommended Level A and B preventive screenings and State specified screenings
Promote continuity and coordination of care between physical health and Behavioral Health Services Providers
Reduce Behavioral Health readmissions and emergency department utilization
Promote suicide prevention awareness programs, including the Zero Suicide program
Promote integrated care through co-located or integrated health delivery models
Ensure trauma-informed models of care and training focusing on recovery and resiliency
Strengthen behavioral health service and accessibility capacity for Members within the state
Support Behavioral Health provider network to hire, retain and train qualified staff
Ensure behavioral health crisis response services are accessible and comprehensive
Ensure parity in mental health and Substance Use Disorder services
Support and sustain evidence-based practices impacting Providers and Member outcomes
Improve health outcomes and delivery of services at appropriate intensity and duration
Promote whole health goals to address health disparities among Community Mental Health Service recipients
Implement Certified Community Behavioral Health Clinics (CCBHC) model
Ensure coordinated discharge planning from State-Owned Hospitals and IMDs
Provide full continuum of care for Substance Use Disorder
Improve Substance Use Disorder service delivery via Performance Improvement Projects
Ensure availability and training for naloxone administration
Promote Peer Recovery Support Services
Monitor and manage opioid prescribing practices
Prevent decline in condition or deterioration of health status
Actively improve quality of care
Support continuous ongoing measurement of clinical and non-clinical health plan effectiveness
Support programmatic improvements based on data findings
Achieve and maintain NCQA health plan accreditation
Address health-related social needs and integrate physical and behavioral health
Ensure quality and administrative reporting as specified
Expand use of Alternative Payment Models (APMs) promoting high-quality, cost-effective care focused on primary and preventive care
Ensure transparency and alignment of APMs with Department requirements and other payers to minimize provider burden
Achieve 50% of Covered Services medical expenditures through Qualifying APMs
Incentivize provider engagement with Members in primary and preventive care and care coordination
Address state priorities to decrease unnecessary service utilization, prevent admissions and readmissions, improve prenatal care timeliness, integrate physical and behavioral health, manage pharmacy utilization, enhance substance use disorder treatment, and address health-related social needs
Advance interoperability for Medicaid and CHIP providers
Improve beneficiaries' access to their data
Ensure accuracy and timeliness in claims payment and encounters reporting
Maintain compliance with HIPAA and other federal/state regulations
Ensure financial accuracy of claims paid to providers
Ensure data quality and oversight in claims and encounter submissions
Ensure accuracy and completeness of confidential data for capitation rate determination
Implement and maintain a Contract Oversight Program to ensure compliance
Maintain and enforce Program Integrity Plans and Fraud, Waste and Abuse Compliance Plans
Detect and prevent Fraud, Waste, and Abuse through administrative and management procedures
Ensure timely reporting and resolution of non-compliance, fraud investigations, and overpayments
Promote cooperation with State and federal agencies in Fraud, Waste and Abuse investigations
Maintain proper documentation, training, and communication to support compliance and program integrity
Ensure accuracy, truthfulness, and completeness of encounter and financial data
Maintain program integrity through oversight and reporting
Implement withhold and incentive program to improve performance
Enforce compliance through remedies, sanctions, and corrective action plans
Provide transparency of MCO performance and compliance
Assure Participating Providers meet SAMHSA Standard Framework for integrated Healthcare levels
Assure appropriateness of diagnosis, treatment, and referral of behavioral health disorders commonly seen by PCPs
Promote Integrated Care
Assure appropriateness of psychopharmacological medication
Implement a training plan including Trauma-Informed Care and Integrated Care
Provide culturally and linguistically appropriate services
Improve quality and accuracy of claims processing
Enhance timely processing of claims and grievances
Increase immunization and preventive screening rates
Improve management and treatment of chronic and behavioral health conditions
Enhance opioid use disorder treatment and monitoring
Ensure emergency preparedness and effective EPSDT services
Address health disparities through race, ethnicity, and language data stratification
Update Medicaid Care Management program costs
Implement youth and adult community re-entry programs
Support Certified Community Behavioral Health Clinics (CCBHC) in Manchester and Nashua
Improve performance monitoring and reporting for Medicaid Care Management
Enhance quality improvement activities for substance use disorder treatment
Ensure actuarial soundness of MCM capitation rates
Maintain enrollment adjustments post continuous eligibility unwind
Implement pharmacy cost and utilization updates
Promote optimal health and equitable access to services by better integrating physical and behavioral health care through a more meaningful holistic delivery of care.
Increase focus on priority populations including individuals with recent behavioral health inpatient admissions, children involved in child welfare, babies with low birthweight or neonatal abstinence syndrome, incarcerated individuals eligible for reentry program.
Strengthen alignment of State’s Community Mental Health Center funding with behavioral health investments by restructuring capitation arrangements.
Improve reliability, quality, and safety of Non-Emergency Medical Transportation (NEMT) and reduce fraud, waste, and abuse.
Implement pharmacy carve-in and high-cost pharmacy risk pool.
Rebase administrative cost allowance and implement provider rate increases.
Operationalize quality and oversight reporting requirements, levy financial penalties, incentivize program performance, and support regular meetings with MCOs.