BDS System Work

BDS System Work


There are some potentially BIG changes coming to NH’s Developmental Service System over the next two years that individuals/families and providers should be aware of.

Background & Brief History


The NH Department of Health and Human Services (DHHS) Bureau of Developmental Services (BDS) contracted with Alvarez & Marsal (A&M) – Public Sector Services in the fall of 2020 to review the Developmental Services System.

A&M’s review primarily focused on improving efficiencies.  A&M interviewed state staff and from that collaboration and other data analysis, A&M proposed large-scale system reform to three primary areas:

  1. Waiver Structure Changes (redesign)
  2. Reimbursement Rate Changes (rate setting)
  3. IT System Changes (technology updates)

For more information about the BDS Systems Work visit:

What Does This Mean?

The BDS Systems Work 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 however, this part of the work has been temporarily paused until the Bureau has completed some of the other work.  BDS will move forward with creating two distinct waivers after the pause. The A&M report suggests budget caps. There has also been unclear and inconsistent responses from BDS around the idea of “capping” budget amounts related to each of the waivers. The two proposed waivers are:

  1. Supports Waiver – focused on supporting individuals served with more community-based services comprising of a fair amount of “natural” (ie: unpaid) supports. (most individuals will likely be served on this waiver).
  2. Comprehensive Waiver– focused on supporting people who have complex needs, accessing 24/7 residential services.

BDS is also developing a new rate methodology where each service type will have a set rate.  The Supports Intensity Scale (SIS) will be used to evaluate individuals and the level of support needed.  The SIS score may decide which waiver an individual can access and the budget amount. BDS has stated that the SIS assessment will be “part” of the criteria used to formulate a budget along with Person-Centered Planning, but to date how much weight will be given to the SIS scores remains unclear.

Three stakeholder workgroups were created by BDS.  These groups have been meeting since October 2021.  At the workgroup meetings, BDS and A&M representatives share updates, decisions, and information.  Workgroup stakeholders have been able to offer input and in some cases that input has been considered.  It is unknown at this time whether Stakeholders will have true decision-making power when final decisions are being made regarding the changes to the Waiver and Rates in the DD Service System. System.

How To Get Involved

BDS hosts Stakeholder Information Sessions every other month to inform stakeholders of the system changes being made or considered and the impact on individual services.  The upcoming BDS Stakeholder Session on July 7, has been CANCELLED by BDS due to the July 4th holiday.  The next session is likely in September 2022.  We will post the date/time and Zoom information as it is available.

For more information visit the BDS Systems Work Stakeholder Engagement website page at:

Attending the next BDS Information Session and other upcoming public forums is an important opportunity to learn more about the BDS System Work, ask questions, and provide your valuable input/feedback.

Upcoming Additional Public Forums & Education Advocacy Efforts:

STAY TUNED more information about additional upcoming public forums will be posted here as available.

ABLE NH BDS Redesign Committee

ABLE NH is forming a “BDS Redesign Committee” to be led by family members and individuals with a disability to respectfully create our list of recommendations to improve our local, community-based system of supports and services.  For more information go to and scroll down to the bottom of the home page.

ABLE NH Stakeholder Concerns:
  • The lack of meaningful and authentic family involvement prior to and during the redesign process
  • Future funding uncertainties and worries about cuts in existing services
  • The continued reliance on a lifetime of free family caregiving
  • The proposed reliance on residential/institutional care rather than support people with disabilities to live in their own homes and communities
  • Mixed messages and a lack of transparency leaves families feeling uncertain, confused, and mistrustful of the process.

Potential Questions To Ask

During BDS Stakeholder Information Sessions, BDS will present information about the System Work changes.  There will also be an opportunity for folks to ask questions to gain clarification about the state’s intentions regarding these changes.  We anticipate the format of the Stakeholder Session only allows participants to type in questions, input, and feedback into a chat box.

Here are some questions you may want to ask at BDS Information sessions or at other public forums:

  1. Under the new rate methodology BDS has stated “your services won’t change,” but will individuals still receive the same level of funding in their budget and cover the same amount of staffed hours?
  2. 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?
  3. What type of appeals process will there be when an individual/family disagrees with the rate they have been assigned?
  4. Given the extreme workforce crisis, why are we changing to an “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.)?
  5. Why was camp tuition, a long-time service category, taken off the list of eligible services currently being considered? (Jenn I think this may be going back in…maybe reframe the question to say “will camp tuition continue to be an eligible service?”
  6. BDS has stated it will “establish new services to expand the service array.”  Expanding and creating new services will may require a larger financial commitment on behalf of the state legislature. Without increased legislative financial commitment is it likely an Adult Waitlist will be needed?
  7. Will there need to be changes made to statutes and rules?  Can you give examples?
  8. How will BDS determine the financial impact to vendors and also to families utilizing the PDMS model?
  9. What criteria will BDS use to choose Area Agencies to serve as “the primary partners for capacity development?” How will BDS keep Area Agencies viable once the Direct Billing requirement from CMS is fully implemented and the AAs lose revenue?
  10. 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?
  11. How will BDS determine what services will be on the Supports Waiver and the Comprehensive Waiver and what services will be on both waivers?
  12. What criteria will be used to determine who can access the Supports Waiver and the Comprehensive Waiver?
  13. 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?
  14. Is BDS considering capping one or both waivers? What factors will BDS consider to determine whether or not to cap the waiver(s)?

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BDS Forum Stakeholder Questions

View some common BDS Forum Stakeholder Questions: Copy of 5-26-22 CC FSC BDS Forum Stakeholder Questions.

BDS Forum May Zoom Chat Transcript

View the BDS Forum May Zoom Chat Transcript: 5-26-22 CC FSC BDS Forum Zoom Chat Transcript.