Families, individuals, guardians and providers are encouraged to stay informed about important public information session in Keene on BDS Systems work.

Updates, information and details are available on the DHHS website.

CANCELLED as of June 30
Public Information Session via Zoom
July 7, 2022


Monday, June 13th, 6-8 p.m. at MDS Keene
or attend by Zoom

This session will be presented by the Bureau of Developmental Services (BDS), and is a chance for you to ask questions, listen to concerns from other families, and hear about what BDS has planned. We encourage you to attend in person at MDS in Keene or by Zoom. Sponsored by the Monadnock Family Council, and presented by the Bureau of Developmental Services (BDS).

Zoom link:
Meeting ID: 970 7243 6164
Passcode: 566299

Questions? Talk to your Service Coordinator or Program Manager.


Update (5/16/22): 

Two opportunities to listen in to Family Council Forum presented by BDS:

Tune in VIA ZOOM - TUESDAY, May 17, 7-9pm LRCS meeting.
Zoom link: https://us02web.zoom.us/j/9823668622
Meeting ID: 982 366 8622 Passcode: LRCS

Tune in VIA ZOOM - THURSDAY, May 19, 6:30-8:30pm Gateways meeting.
Zoom Link: https://zoom.us/j/99483047004?pwd=SFpWQm05Wkh6MXA0U0d1U250VGpvdz09
Meeting ID: 994 8304 7004
Passcode: 263128

Coming up in JUNE (date TBD), the Region V Family Council of the Monadnock Region and MDS will host a hybrid forum (in person and via Zoom), details to come.

What is this BDS Systems Work?

The Bureau of Developmental Services is conducting a revamp of the Disability Services system, using work groups for the process. Bimonthly informational sessions convene virtually on the first Thursday of every other month. This is a very important time for the Developmental Services community to learn and ask questions about how changes to the waivers, rates, and technology might impact them. Details and progress will be posted to the BDS Systems Work webpage on the DHHS website.

Three key areas are being reworked by Work Groups:ThreeAreas
Waivers (eligibility and levels of services)
Rates (how services are paid for)
IT Systems (modernizing, integrating)

Links to explore:

BDS Systems Work page:

BDS Systems Work FAQ

If you have any general questions and want to email BDS directly,
here is the email link for that: This email address is being protected from spambots. You need JavaScript enabled to view it.

Here’s an overview of the why's and what's happening with the BDS Systems work.

Conflict Free Case Management
The Center for Medicaid and Medicare Services (CMS) states that an individual may not get both direct service and case management (service coordination) from the same agency. Specifically, anyone who receives traditional service from MDS-ISO or MDS-MCST now must choose either a new service coordination company or a new provider agency. The deadline for full compliance is July 2023. Currently MDS is at 95% compliance so we are well on our way!

Direct Billing
CMS also requires that all provider agencies be allowed to bill Medicaid directly. Our current system is designed with all provider agencies contracting through area agencies which do all billing. In the future, all provider agencies will have the option of doing their own billing or choosing to have the area agency provide their billing service.

Statewide Rate Development
In order to come into compliance with direct billing, the way in which funding is allocated to individuals must change. The current rate structure is outdated and does not always align with the needs of the individuals being supported. The goal is to create a rate structure that will have a more transparent methodology and ensure service costs are accurately accounted for.

Waiver Redesign
Currently the waiver system in New Hampshire offers only one Developmental Disability waiver. Moving forward, BDS is looking to separate the current DD Waiver into two waivers: a Supports Waiver – focused on supporting individuals whose needs are best served with more community-based services; and a Comprehensive Waiver – focused on supporting people who have complex needs, and need to access 24/7 residential and/or community-based services. BDS states the goal is to “improve access to the services that most effectively meet each individual’s needs and goals”.

More information and additional links can be found at https://www.dhhs.nh.gov/programs-services/disability-care/developmental-services/bds-systems-work

Learn more:

Visit the DHHS BDS Systems Work page for details and meeting notes.

DHHS FAQ by Topic

Recording of the January session on YouTube here.

It's important to find out about these potential changes and to ask questions while the system work is being developed.

From CSNI (February 28, 2022) -- in preparation for the March 3 Listening Session:

Background on the A&M work:
In 2020, the firm of Alvarez & Marsal (A&M) was contracted by the State of New Hampshire to assess the operations of the Department of Health and Human Services’ (DHHS) programs. A&M’s primary focus was on improving efficiencies. One of the five programmatic areas analyzed was the developmental disabilities service system overseen by the Bureau of Developmental Services (BDS). A&M worked with BDS (no individuals, families or Area Agencies were consulted) and from that collaboration, A&M proposed large scale system reform to three areas with the goal of “strengthening the BDS service delivery system”:
• Waiver structure redesign
• Reimbursement rate redesign
• Comprehensive overhaul to information technology system

The system changes that may be of greatest interest to folks are the waiver and the reimbursement rate changes.
BDS has made the decision to separate the DD Waiver into two waivers:
1. a supports waiver, focused on supporting individuals whose needs are best served with more community-based services;
2. a comprehensive waiver, focused on supporting people who have complex needs, accessing 24/7 residential and/or community-based services. BDS is also developing a new rate methodology that will “align reimbursement with level of support/need.”

Three stakeholder work groups convened by BDS have been meeting since October 2021. At the work group meetings BDS and A&M representatives share updates and information. Recently, they have shared decisions on system changes made by BDS. Work group stakeholders may offer some input but have no decision-making authority.

These system changes will affect individuals and families in various ways and we encourage you to understand the impact. We will provide regular information about how you can stay informed and be involved.

For more information visit BDS’s website at:https://www.dhhs.nh.gov/dcbcs/bds/systems.htm

Potential Questions to Ask:

As you attend the public information sessions there may be questions you will want to ask for clarification on the state’s intention and the outcome of the current efforts. Some examples of questions are:

1. Why do we need 2 waivers? Can you give concrete examples of how the current single waiver is not working and how the proposed 2 waiver system will address the issue?

2. What criteria will be used to determine who can access the Supports Waiver and the Comprehensive Waiver?

3. How will BDS determine what services will be on the Supports Waiver and the Comprehensive Waiver and what services will be on both waivers?

4. How easily will it be to move from one waiver to the other (i.e. From the Supports Waiver to the Comprehensive Waiver) when there is a change in an individual/family’s situation/circumstance?

5. What type of appeals process will there be when an individual/family disagrees with the budget in which they have been assigned? How is that appeals process different from our current appeals process? Will it be easier for families or more difficult?

6. Is BDS considering capping one or both waivers? What factors will BDS consider to determine whether or not to cap the waiver(s)?

7. Under the new rate methodology BDS has stated “your services won’t change,” but will individuals still receive the same level of funding?

8. Given the extreme workforce crisis, why are we changing to “assessment-based rates” approach (i.e. additional service qualification requirements) right now? Won’t that create barriers and make it harder for families and vendors to find workers (i.e. DSPs, PCAs, etc.)?

9. Why was camp tuition, a long-time service category, taken off the list of eligible services currently being considered?

10. BDS has stated it will “establish new services to expand the service array.” Expanding and creating new services will require a larger financial commitment on behalf of the state legislature. Without increased legislative financial commitment an Adult Waitlist could result. What then?

11. Describe the process BDS is developing “to ensure families will have access to the same services.” How is that different than what is done now?

12. Will there need to be changes made to statutes and rules? Can you give examples?

13. How will BDS determine the financial impact to vendors and also to families utilizing the PDMS model?

14. What criteria will BDS use to choose Area Agencies to serve as “the primary partners for capacity development?”


From the DHHS website:

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

The DHHS Bureau of Developmental Services (BDS) worked with A&M to review the developmental disabilities service system in New Hampshire. The review included data collection, a review of policies and procedures, interviews with State staff, and a comparison of the current program structure to trends in developmental disability services across the country.
The review identified opportunities for BDS to update several areas key to how individuals and families access services and supports, as well as opportunities to ensure an adequate provider network to provide the supports necessary to serve individuals and families in New Hampshire. Specifically, the review identified the following areas:
Waiver Structure Changes

Currently, BDS provides access to services for adults with developmental disabilities (primarily) through the Developmental Disability (DD) Waiver. While the DD Waiver provides access to all services to eligible individuals, in many cases, the services that someone needs are not always what they can access. This single waiver structure has led to concerns that some individuals are underserved by the system. In order to make sure the relationship between what an individual needs and what they can access is more aligned, BDS is looking to separate the DD Waiver into two waivers: a supports waiver – focused on supporting individuals whose needs are best served with more community-based services; and a comprehensive waiver – focused on supporting people who have complex needs, accessing 24/7 residential and/or community-based services. The goal is to improve access to the services that most effectively meet each individual’s needs and goals.

Reimbursement Rate Changes
Reimbursing service providers appropriately is critical to ensuring an adequate provider network is in place to support individuals. BDS currently uses rates developed in 2007. This outdated rate system has led to challenges for providers in ensuring they are reimbursed for the true cost of services provided. This outdated rate system has also caused further misalignment in matching the needs of an individual with the right amount of funding and service, as well as the ability of individuals and/or family members to more easily choose from and switch to different providers within the network. BDS is looking to develop an updated and more transparent rate methodology that puts the direct support workforce at the core of rate development, while ensuring appropriate service costs are accurately accounted for.

Information System Updates
BDS has long operated using outdated, siloed data and information systems. Effective systems are key to ensuring a smooth flow of information between BDS, Area Agencies and providers to promote service access and monitoring. BDS is looking to build a more robust information technology structure that is agile and robust for supporting case management functions, service authorizations and payment processes.

What Does This Mean For Individuals, Families And Providers?

While this review is not the first to look at the operations of the State’s developmental disability services system, BDS is excited to use the roadmap developed in this review as the starting point to update our service delivery system to best support individuals with developmental disabilities and their families throughout their lifespan, today and in the future.
BDS will focus throughout the process on helping to bring these opportunities into fruition. Critical to this process is the commitment of BDS to actively engage and inform stakeholders along the way. This work has a true opportunity to best align what each person needs for supports with the right type and level of support at the right time.

New Hampshire has a long history of providing robust, person- and family-centered services that we need to preserve and improve; this work will help to build upon these principles while ensuring everyone has equal choice and access to sustainable, quality services rooted in our goal of supporting individuals and families to achieve their personally defined outcomes.