N.H. Code Admin. R. Ann. He-W — Former Division of Human Services

Chapter He-W 400 Support of Dependent Children

Part He-W 401 Definitions

N.H. Code Admin. R. Ann. He-W 401.01 Support of Dependent Children {#sec-he-w-401.01 omnilex-key=us-nh-regs-official--agency-he-w--He-W 401.01}

Definitions.

(a) “Annual” means the recurring one year period that coincides with the federal fiscal year, which begins on October 1 and ends on September 30.

(b) “Arrearage” means “arrearage” as defined in RSA 458-B:1, I namely, “the total amount of unpaid support which has accrued since the effective date of a legal order which stipulates a periodic support amount due, and shall include any amount of unreimbursed assistance accumulated prior to the issuance of the legal order of support”.

(c) “Assistance debt” means the amount of unreimbursed assistance that accrued prior to the issuance of a legal order which makes the payor liable for that debt.

(d) “Assistance expended” means the amount of financial aid provided to an individual under Title IV-A, Title IV-E, or Title XIX of the Social Security Act.

(e) “Assistance reimbursed” means payments disbursed to the state as reimbursement for assistance provided.

(f) “Child support monthly support obligation (CSMSO)” means the amount derived from multiplying the ordered child support obligation amount by the number of payment due dates during the month.

(g) “Conditionally assigned arrearages” means arrearages:

(1) Which were temporarily assigned to the state prior to 10/01/2009 as a condition of eligibility for IV-A services, and became conditionally assigned to the state when the family stopped receiving IV-A services, thereby ending the temporary assignment; and

(2) Are paid to the family unless they are collected through federal income tax refund offset, in which case the collected amount is retained by the state.

(h) “Current assistance case” means any child support case where the family is also receiving temporary assistance to needy families (TANF) benefits under Title IV-A of the Social Security Act or foster care provided under Title IV-E of the Social Security Act.

(i) “Debt type” means child support, spousal support, medical support, assistance debt, miscellaneous, or another state’s arrearages.

(j) “Disbursement” means the payment of money to a payee, individual, state, or other entity.

(k) “Distribution” means the allocation of receipts to obligations.

(l) “Family” means, for a child support case that is currently receiving TANF, the TANF casehead and all dependents included in that TANF case irrespective of the number of child support cases, or the payee for the individual member obligations, or the check recipient for the individual obligations.

(m) “Former assistance case” means any child support case where the family formerly received aid to families with dependent children (AFDC) or TANF benefits.

(n) “Futures” means money held by the department that either represents payment on the required support obligation(s) for future months and is applied to future months, or is non-distributable.

(o) “Medical support monthly support obligation (MSMSO)” means the amount derived from multiplying the ordered medical support obligation amount by the number of payment due dates during the month.

(p) “Never-assigned arrearages” means all arrearages in never-assistance cases, and all arrearages that accrue in former assistance cases after the family’s most recent period of assistance ends.

(q) “Never-assistance case” means any child support case where the family has never received AFDC, TANF, or foster care IV-E benefits.

(r) “Non-distributable” means any received amount that remains after satisfying the monthly support obligation for the current month and all arrearages, for which no allocation obligation exists, and which is therefore refundable.

(s) “Non-IV-D case” means a case that is not being enforced by the bureau of child support services, is subject to an income assignment pursuant to RSA 458-B, and where ordered support payments are monitored, collected, and disbursed through the IV-D state disbursement unit.

(t) “Obligation” means any combination of case member and debt type as specified in a legally enforceable order to pay support.

(u) “Obligee” means “obligee” as defined in RSA 458-B:1, VII namely, “the person found to be legally entitled to receive child support, spousal support, or combination child and spousal support”. This term includes “payee”.

(v) “Obligor” means “obligor” as defined in RSA 458-B:1, VIII namely, “the person found to be legally liable for child support, spousal support, or combination child and spousal support”. This term includes “payor”.

(w) “Overpayment” means a disbursed support payment that becomes monies presumably owed to the state of New Hampshire as a result of:

(1) A misdirected child support payment resulting from a posting error or distribution error;

(2) An adjustment being made by the U.S. Department of Treasury to a previously filed tax return, reducing the refund, after the division collected support arrearages through the Federal Offset Program;

(3) A paying government entity, for example the Social Security Administration, requiring that the division return all or part of a payment; or

(4) A child support payment check that has been returned, or electronic payment reversed by the financial institution from which it was issued, for either insufficient funds, a closed account, stop-payment order, marked as “refer to maker”, or other reason by the financial institution.

(x) “Payment type” means the classification of an obligation to a specific category, such as TANF, medicaid-only, IV-E foster care, or non-TANF.

(y) “Permanently assigned arrearages” means those arrearages which are assigned to the department of health and human services under an assignment entered into prior to 10/1/1997, and all arrearages which accrue on or after 10/1/1997, while a family is receiving TANF benefits.

(z) “Recoupment” means the process of recovering from a payee a monetary loss arising from an overpayment.

(aa) “Recovery” means the process of recovering from a payor or an employer a monetary loss arising from an overpayment.

(ab) “Temporarily assigned arrearages” means the sum of never-assigned arrearages, unassigned pre-assistance arrearages, and unassigned during-assistance arrearages which was temporarily assigned to the department of health and human services before 10/01/2009, as a condition of eligibility for IV-A services.

(ac) “Title IV-A” means the joint federal-state program described in Title IV-A of the Social Security Act, “Block Grants to States for Temporary Assistance for Needy Families,” and administered in New Hampshire by the division of family assistance.

(ad) “Title IV-D” means the joint federal-state program described in Title IV-D of the Social Security Act, “Child Support and Establishment of Paternity,” and administered in New Hampshire by the division of child support services.

(ae) “Title IV-E” means the joint federal-state program described in Title IV-E of the Social Security Act, “Federal Payments for Foster Care and Adoption Assistance,” and administered in New Hampshire by the division for children, youth and families.

(af) “Title XIX” means the joint federal-state program described in Title XIX of the Social Security Act, “Grants to States for Medical Assistance Programs,” and administered in New Hampshire under the medicaid program.

(ag) “Total arrearages” means the sum of the difference between life-to-date owed and life-to-date paid for each obligation.

(ah) “Unassigned arrearages” means all arrearages except permanently or temporarily assigned arrearages.

(ai) “Unassigned during-assistance arrearages” means all previously assigned arrearages which exceed the cumulative amount of unreimbursed assistance when the family leaves the assistance program and which accrued during the receipt of assistance.

(aj) “Unassigned pre-assistance arrearages” means all previously assigned arrearages which exceed the cumulative amount of unreimbursed assistance when the family leaves the assistance program and which accrued prior to the receipt of assistance.

(ak) “Unreimbursed assistance (URA)” means the difference between the AFDC,TANF, or IV-E foster care assistance expended and assistance reimbursed.

History

#2396, eff 6-30-83; amd by #2437, eff 8-1-83; ss by #2920, eff 12-4-84, EXPIRED: 12-4-90
#9206, eff 7-19-08; ss by #9549, eff 10-1-09; ss by #10677, eff 9-26-14, EXPIRED: 9-26-24
#14125, INTERIM, eff 11-26-25, EXPIRES: 5-25-25 (Remains in effect per RSA 541-A:14-a); ss by #14274, eff 6-24-25, EXPIRES: 6-24-35

Part He-W 403 Distribution and Disbursement of Support Payments

N.H. Code Admin. R. Ann. He-W 403.01 Distribution {#sec-he-w-403.01 omnilex-key=us-nh-regs-official--agency-he-w--He-W 403.01}

(a) In TANF cases, child support payment amounts received shall be distributed in the following order:

(1) To satisfy the child support monthly support obligation (CSMSO), amounts shall be retained by the state as reimbursement for the assistance expended for the month;

(2) Portions of the CSMSO that exceed the assistance expended for the month shall be distributed in the following order:

a. Retained by the state as assistance reimbursed, up to the amount of unreimbursed assistance (URA); and

b. Paid to the family when the URA is satisfied;

(3) Amounts collected in excess of the CSMSO, up to the amount of URA, shall be retained by the state to reduce temporarily assigned arrearages;

(4) Amounts collected in excess of temporarily assigned arrearages, up to the amount of URA, shall be retained by the state and applied to reduce permanently assigned arrearages;

(5) Amounts collected in excess of permanently assigned arrearages shall be applied to reduce conditionally assigned arrearages, as follows:

a. Amounts received through federal tax intercept, up to the amount of URA, shall be retained by the state; and

b. Amounts not received through federal tax intercept shall be paid to the obligee;

(6) Amounts collected in excess of conditionally assigned arrearages, up to the amount of URA, shall be retained by the state and applied to reduce IV-E foster care arrearages;

(7) Amounts collected in excess of IV-E foster care arrearages shall be paid to the obligee and applied to reduce never-assigned arrearages;

(8) Amounts collected in excess of never-assigned arrearages shall be paid to the obligee and applied to reduce unassigned pre-assistance arrearages;

(9) Amounts collected in excess of unassigned pre-assistance arrearages shall be paid to the obligee and applied to reduce unassigned during assistance arrearages; and

(10) Amounts collected in excess of all arrearages shall be held as futures.

(b) In IV-E foster care cases, child support amounts received shall be distributed in the following order:

(1) To satisfy the CSMSO, amounts collected up to the IV-E assistance expended for the month, but less than the CSMSO, shall be retained by the state as reimbursement for the IV-E assistance expended for the month;

(2) Amounts collected above the IV-E assistance expended for the month, but less than the CSMSO, shall be retained by the state and applied to reduce the URA;

(3) Amounts collected in excess of the CSMSO, up to the amount of URA, shall be retained by the state and applied to reduce IV-E foster care arrearages;

(4) Amounts collected in excess of foster care arrearages, up to the amount of URA, shall be retained by the state and applied to reduce permanently assigned arrearages;

(5) Amounts collected in excess of permanently assigned arrearages shall be applied to reduce conditionally assigned arrearages, as follows:

a. Amounts received through federal tax intercept, up to the amount of URA, shall be retained by the state; and

b. Amounts not received through federal tax intercept shall be paid to the obligee;

(6) Amounts collected in excess of conditionally assigned arrearages shall be paid to the obligee and applied to reduce never-assigned arrearages;

(7) Amounts collected in excess of never-assigned arrearages shall be paid to the obligee and applied to reduce unassigned pre-assistance arrearages;

(8) Amounts collected in excess of unassigned pre-assistance arrearages shall be paid to the obligee and applied to reduce unassigned during-assistance arrearages; and

(9) Amounts collected in excess of all arrearages shall be held as futures.

(1) To satisfy the CSMSO, amounts applied to the CSMSO shall be paid to the obligee;

(2) Amounts collected in excess of the CSMSO shall be paid to the obligee and applied to reduce never-assigned arrearages;

(3) Amounts collected in excess of never-assigned arrearages shall be paid to the obligee and applied to reduce unassigned pre-assistance arrearages;

(4) Amounts collected in excess of unassigned pre-assistance arrearages shall be applied to reduce conditionally assigned arrearages, as follows:

a. Amounts received through federal tax intercept, up to the amount of URA, shall be retained by the state; and

b. Amounts not received through federal tax intercept shall be paid to the obligee;

(5) Amounts collected in excess of conditionally assigned arrearages shall be retained by the state, up to the amount of URA, and applied to reduce permanently assigned arrearages;

(6) Amounts collected in excess of permanently assigned arrearages, up to the amount of URA, shall be retained by the state and applied to reduce IV-E foster care arrearages;

(7) Amounts collected in excess of IV-E foster care arrearages shall be paid to the obligee and applied to reduce unassigned during-assistance arrears; and

(8) Amounts collected in excess of all arrearages shall be held as futures.

(d) In never-assistance cases, child support amounts received shall be distributed as follows:

(1) To satisfy the CSMSO, amounts applied to the CSMSO shall be paid to the obligee;

(2) Amounts collected in excess of the CSMSO shall be paid to the obligee and applied to reduce never-assigned arrearages; and

(3) Amounts collected in excess of all arrearages shall be held as futures.

(e) In TANF, medicaid, and foster care cases, medical support payment amounts shall be distributed in the following order:

(1) To satisfy the medical support monthly support obligation (MSMSO), amounts up to the MSMSO shall be retained by the state as reimbursement for the medical assistance expended for the month;

(2) Amounts collected in excess of the MSMSO shall be retained by the state and applied to reduce permanently assigned arrearages;

(3) Amounts collected in excess of permanently assigned arrearages shall be paid to the obligee and applied to reduce never-assigned arrearages; and

(4) Amounts collected in excess of all arrearages shall be held as futures.

(f) In never-assistance and former assistance cases, medical support payment amounts shall be distributed in the following order:

(1) To satisfy the medical support monthly support obligation (MSMSO), amounts applied to the MSMSO shall be paid to the obligee;

(2) Amounts collected in excess of the MSMSO shall be paid to the obligee and applied to reduce never-assigned arrearages;

(3) Amounts collected in excess of never-assigned arrearages shall be retained by the state and applied to reduce permanently assigned arrearages; and

(4) Amounts collected in excess of all arrearages shall be held as futures.

(g) In all cases:

(1) Payments shall be distributed consistently and in the sequence outlined in He-W 403.01(a)-(f) above, based on payment type, payment due dates, and arrearages;

(2) If a obligor has multiple obligations within a case, payments received shall be allocated proportionally among the obligor’s obligations;

(3) If a obligor who is in multiple cases makes a payment without specifying that the payment is for a specific case, the payment shall be allocated proportionally among all the obligor’s obligations and arrearages, and distributed for each case according to case type;

(4) If a payment adjustment is made to a case, distribution shall be based on the obligee’s case type at the time the adjustment is made; and

(5) Payments received prior to the establishment of a legal obligation shall be:

a. Counted as assistance reimbursed, thereby reducing URA;

b. Distributed at case or obligor level and affect no other obligor balances; and

c. Disbursed normally based on case type.

History

#2671, eff 4-13-84; ss by #2920, eff 12-4-84, EXPIRED: 12-4-90
#5090, eff 3-11-91; amd by #6390, INTERIM, eff 12-1-96; amd by #6446, eff 2-1-96; ss by #6465, INTERIM, eff 3-10-97, EXPIRES: 7-8-97; ss by #6537, eff 7-8-97; amd by #6600, INTERIM, eff 10-8-97, EXPIRES: 2-5-98; ss by #6707, eff 3-3-98; ss by #7125, eff 11-1-99; ss by #9020, eff 11-1-07; renumbered by #9206 (formerly He-W 403.02); ss by #9549, eff 10-1-09; ss by #10677, eff 9-26-14, EXPIRED: 9-26-24
#14126, INTERIM, eff 11-26-24, EXPIRES: 5-25-25 (Remains in effect per RSA 541-A:14-a); ss by #14275, eff 6-24-25, EXPIRES: 6-24-35

N.H. Code Admin. R. Ann. He-W 403.02 Disbursement {#sec-he-w-403.02 omnilex-key=us-nh-regs-official--agency-he-w--He-W 403.02}

(a) All child support payments shall be disbursed by the state disbursement unit (SDU) to a debit card account provided to obligees.

(b) Use of the child support debit card shall be subject to the transaction fees as detailed in the informational enrollment package sent to obligees by the department.

(1) Elect to receive direct deposit into their checking or savings accounts;

(2) Request payment by paper check due to qualifying for a hardship exemption, as described in (h) below; or

(3) Subsequently change their payment method.

(d) Obligees shall mail written requests to:

State Disbursement Unit

P.O. Box 9504

Manchester, NH 03108.

(e) Obligees electing payment by direct deposit or requesting payment by paper check shall submit their written request to the SDU within 30 days of receipt of the enrollment notice to avoid issuance of a debit card.

(f) Obligees electing payment by direct deposit shall provide the SDU with a voided check or letter from the obligee’s bank stating the obligee’s bank account number and routing number.

(g) Obligees requesting payment by paper check shall indicate in their written request the hardship exemption reason preventing them from accessing an electronically transferred payment.

(h) A hardship exemption shall be accepted if:

(1) A physical or other disability imposes a hardship for the obligee in accessing an electronically transferred payment;

(2) A language or literacy barrier imposes a hardship for the obligee in accessing an electronically transferred payment;

(3) The obligee lives and works more than 5 miles from an automated teller machine and more than 5 miles from a financial institution where the funds may be accessed; or

(4) Other individual circumstances exist that impose a hardship for the obligee in accessing an electronically transferred payment.

(i) Intercepted federal tax refunds made to satisfy a non-IV-A debt that are associated with a joint tax return shall be held for a period of 6 months, or until the department of health and human services is notified by the secretary of the United States treasury that the unobligated spouse’s proper share of the refund has been paid, whichever is earlier.

History

#2671, eff 4-13-84; ss by #2920, eff 12-4-84, EXPIRED: 12-4-90
#5090, eff 3-11-91; ss by #6465, INTERIM, eff 3-10-97, EXPIRES: 7-8-97; ss by #6537, eff 7-8-97; ss by #6707, eff 3-3-98; ss by #7125, eff 11-1-99; ss by#9020, eff 11-1-07; renumbered by #9206 (formerly He-W 403.03); ss by #9663, eff 5-1-10; amd by #10467, eff 11-26-13; ss by #12585, eff 7-24-18; ss by #13349, eff 3-2-22; ss by #14275, eff 6-24-25, EXPIRES: 6-24-35

N.H. Code Admin. R. Ann. He-W 403.03 Recoupment of Overpayments {#sec-he-w-403.03 omnilex-key=us-nh-regs-official--agency-he-w--He-W 403.03}

(a) Child support obligees shall indicate on Form BCSS 152, “Important Notice Regarding Overpayment of Child Support and Authorization to Withhold” (June 2025), whether or not they authorize BCSS to recoup overpayments by withholding a percentage of future child support payments, as described in paragraph (b) below, that are collected on their behalf until the overpayment is repaid.

(b) When an overpayment occurs, BCSS shall initiate withholding of 20% of future child support payments if the obligee has checked the applicable box on Form BCSS 152, “Important Notice Regarding Overpayment of Child Support and Authorization to Withhold” (June 2025), authorizing such withholding to recoup the overpayment. When the overpayment occurs from a federal tax offset adjustment, the rate of withholding of future child support payments shall be 50%. Prior to withholding, BCSS shall provide the obligee with Form BCSS 153, “Notice of Overpayment of Child Support” (June 2025).

(c) BCSS shall inform the obligee that the overpayment may be repaid by sending a check or money order for the full amount of the overpayment to BCSS.

(d) If the obligee has not authorized withholding of future child support payments by checking the box on Form DCSS 152 BCSS shall provide the obligee with Form BCSS 621A, “Notice of Overpayment of Child Support and Request for Repayment” (June 2025).

(e) The obligee shall complete, sign, and return the repayment agreement section of Form BCSS 621A selecting an agreement to either:

(1) Repay the full overpayment amount within 30 days; or

(2) Let BCSS keep 20% of all future child support collected until the overpayment is repaid to BCSS. If the overpayment occurred from a federal tax offset adjustment, the rate of withholding of future child support payments shall be 50% until the overpayment is repaid to BCSS.

(f) If the obligee returns the repayment agreement section of Form BCSS 621A authorizing withholding of child support payments, BCSS shall initiate the authorized withholding.

(g) If the obligee does not return the repayment agreement section of Form BCSS 621A within 10 days of the date the form was mailed to the obligee, BCSS shall provide the obligee with Form BCSS 621B, “Second Notice of Overpayment of Child Support and Request for Repayment” (June 2025).

(h) The obligee shall complete, sign and return the repayment agreement section of Form BCSS 621B selecting an agreement to either:

(1) Repay the full overpayment amount within 20 days; or

(i) If the obligee returns the repayment agreement section of Form BCSS 621B authorizing withholding of child support payments, BCSS shall initiate the authorized withholding.

(j) If the obligee does not return the repayment agreement section of Form BCSS 621B within 10 days of the date the form was mailed to the obligee, BCSS shall provide the obligee with Form BCSS 621C, “Final Notice of Overpayment of Child Support and Request for Repayment” (June 2025).

(k) The obligee shall complete, sign and return the Repayment Agreement section of Form BCSS 621C selecting an agreement to either:

(1) Repay the full overpayment amount with 10 days; or

(l) If the obligee returns the repayment agreement section of Form BCSS 621C authorizing withholding of child support payments, BCSS shall initiate the authorized withholding.

(m) If the obligee does not return the repayment agreement section of Form BCSS 621C within 10 days of the date the form was mailed to the obligee, or does not notify BCSS verbally or in writing that the obligee does not authorize the withholding of support payments, then permission to recoup the overpayment by withholding child support payments shall be assumed.

(n) Once initiated, withholding of child support payments shall continue until the overpayment is fully recouped.

History

#5341, eff 3-3-92; EXPIRED: 3-3-98
#6741, eff 4-28-98, EXPIRED: 4-28-06; ss by #8602, INTERIM, eff 4-28-06, EXPIRES: 10-25-06; ss by #8685, eff 7-21-06; amd and renumbered by #9206, eff 7-19-08 (former paragraph (a) deleted) (formerly He-W 403.04); ss by #10467, eff 11-26-13; ss by #10760, eff 1-19-15; ss by #14275, eff 6-24-25, EXPIRES: 6-24-35

N.H. Code Admin. R. Ann. He-W 403.04 Recovery of Payments for Returned Child Support Payment Checks and Reversed Electronic Payments Made by a Obligor {#sec-he-w-403.04 omnilex-key=us-nh-regs-official--agency-he-w--He-W 403.04}

(a) Upon discovering that a obligor’s child support payment check has been returned, or that electronic payment has been reversed by the financial institution from which it was issued, for either insufficient funds, a closed account, stop-payment order, marked as “refer to maker” or any other reason, BCSS shall provide the obligor with Form BCSS 149A, “Notice of Returned Check and Demand for Repayment” (June 2025).

(b) If the obligor fails to replace the returned check or reversed electronic payment by bank check or money order and send payment and the “Returned Check Repayment Coupon” provided on the Form BCSS 149A within 10 calendar days of the date on Form BCSS 149A, BCSS shall provide the obligor with Form BCSS 149B, “Second Notice of Returned Check and Demand for Repayment” (June 2025).

(c) In order to receive credit for a recovery payment on the debt owed to the state, the obligor shall submit to BCSS the recovery payment by bank check or money order with the “Returned Check Repayment Coupon” provided on Form BCSS 149A or Form BCSS 149B.

(d) When it is determined that a bank error has occurred, a recovery payment submitted by personal check without the “Returned Check Repayment Coupon” shall not be accepted as a recovery payment and shall be returned to the obligor.

(e) Payments for returned checks that are submitted by bank check or money order without the “Returned Check Repayment Coupon” shall be processed as a regular child support payment pursuant to He-W 403.01 and He-W 403.02, and shall not be credited as a recovery payment of the returned check or electronic reversal.

(f) Upon receipt of a partial recovery payment of a returned check or electronic reversal, BCSS shall provide the obligor with Form BCSS 150, “Notice of Receipt of Partial Repayment of Returned Check” (June 2025).

(g) Upon receipt of repayment in full of the returned check or electronic payment, BCSS shall provide the obligor with Form BCSS 155 “Notice of Receipt of Repayment of Returned Check” (June 2025).

(h) If full recovery payment is not received by BCSS within 14 days of the date on either Form BCSS 149B “Second Notice of Returned Check and Demand for Repayment” or Form BCSS 150 “Notice of Receipt of Partial Repayment of Returned Check” then BCSS shall file with the appropriate court to establish a legal order against the obligor for the debt.

(i) If full recovery payment is not received by BCSS within 14 days of the date on either Form BCSS 149B “Second Notice of Returned Check and Demand for Repayment” or Form BCSS 150 “Notice of Receipt of Partial Repayment of Returned Check” then BCSS shall refer the obligor’s case to the appropriate law enforcement agency for investigation and possible criminal prosecution.

(j) BCSS shall continue to accept the obligor’s child support payments by check or electronic transfer if full recovery payment is received by BCSS within 10 calendar days of the date on Form BCSS 149A, “Notice of Returned Check and Demand for Repayment” using the provided “Returned Check Repayment Coupon” and either:

(1) The obligor provides evidence the check was returned or electronic payment reversed due to an error by the financial institution or other circumstances beyond the check issuer’s control; or

(2) No other child support payments received by BCSS from the check issuer in the preceding year have been returned or electronically reversed.

(k) If the obligor fails to replace the returned check or reversed electronic payment in full to BCSS within 10 calendar days of the date on Form BCSS 149A, “Notice of Returned Check and Demand for Repayment” the obligor shall be required to pay by bank check or money order until the following conditions have been met, at which time the obligor may pay support by personal check or electronic payment:

(1) A minimum of one calendar year has gone by beginning 10 days from the date of Form BCSS 149A, “Notice of Returned Check and Demand for Repayment;”

(2) BCSS has received full recovery payment for the returned check or electronic reversal; and

(3) The obligor has been in compliance with the legal order for support during the one year period described in (1) above.

History

#8685, eff 7-21-06; renumbered by #9206 (formerly He-W 403.05); ss by #10639, INTERIM, eff 7-21-14, EXPIRES: 1-19-15; ss by #10760, eff 1-19-15; ss by #14275, eff 6-24-25, EXPIRES: 6-24-35

N.H. Code Admin. R. Ann. He-W 403.05 Recovery of Payments for Returned Child Support Payment Checks and Reversed Electronic Payments Made by an Employer {#sec-he-w-403.05 omnilex-key=us-nh-regs-official--agency-he-w--He-W 403.05}

(a) Upon discovering that a child support payment check submitted by an employer pursuant to RSA 458-B has been returned, or that an electronic payment has been reversed by the financial institution from which it was issued, for either insufficient funds, a closed account, stop-payment order, marked as “refer to maker,” or any other reason BCSS shall provide the employer with Form BCSS 149C, “Notice of Returned Check and Demand for Repayment” (June 2025). BCSS shall provide the obligor with a copy of Form BCSS 149C.

(b) If the employer fails to replace the returned check or reversed electronic payment by bank check or money order and the “Returned Check Repayment Coupon” provided on Form BCSS 149C within 10 calendar days of the date on Form 149C, BCSS shall provide the employer with Form BCSS 149D, “Second Notice of Returned Check and Demand for Repayment” (June 2025).

(c) In order to receive credit for a recovery payment on the debt owed to the state, the employer shall submit the recovery payment with the “Returned Check Repayment Coupon” provided on Form BCSS 149C or Form BCSS 149D.

(d) When it is determined that a bank error has occurred, a recovery payment submitted by personal or business check without the “Returned Check Repayment Coupon” shall not be accepted as a recovery payment and shall be returned to the employer.

(e) Recovery payments for returned checks that are submitted by bank check or money order without a provided “Returned Check Repayment Coupon” shall be processed as a regular child support payment pursuant to He-W 403.01 and He-W 403.02, and shall not be credited as a recovery payment of the returned check or electronic reversal.

(f) Upon receipt of a partial recovery payment of a returned check or electronic reversal, BCSS shall provide the employer with Form BCSS 150, “Notice of Receipt of Partial Repayment of Returned Check” (June 2025).

(g) Upon receipt of repayment in full of the returned check or electronic payment, BCSS shall provide the employer with Form BCSS 155 “Notice of Receipt of Repayment of Returned Check” (June 2025).

(h) If full recovery payment is not received by BCSS within 14 days of the date on Form BCSS 149D “Second Notice of Returned Check and Demand for Repayment” or Form BCSS 150 “Notice of Receipt of Partial Repayment of Returned Check” BCSS shall file with the appropriate court to establish a legal order against the obligor for the debt.

(i) If full recovery payment is not received, and the statute of limitations provided in the NH Criminal Code has not expired, BCSS shall refer the obligor’s case to the appropriate law enforcement agency for investigation and possible criminal prosecution.

(j) BCSS shall continue to accept the employer’s child support payments by check or electronic transfer if full recovery payment is received by BCSS within 10 calendar days of the date on Form BCSS 149C “Notice of Returned Check and Demand for Repayment” using the provided “Returned Check Repayment Coupon” and either:

(1) The employer provides evidence that the check was returned or electronic payment was reversed due to an error by the financial institution or other circumstances beyond the check issuer’s control; or

(2) No other child support payments received by BCSS from the employer in the preceding year have been returned or electronically reversed.

(k) If the employer fails to replace the returned check or reversed electronic payment in full to BCSS within 10 calendar days of the date on Form BCSS 149C, “Notice of Returned Check and Demand for Repayment” the employer shall be required to pay by bank check or money order until the following conditions have been met, after which time the employer may pay support by business check or electronic payment:

(1) A minimum of one calendar year has gone by beginning 10 days from the date of Form BCSS 149C, “Notice of Returned Check and Demand for Repayment” and

(2) BCSS has received full recovery payment for the returned check or electronic reversal.

History

#8685, eff 7-21-06; renumbered by #9206 (formerly He-W 403.06); ss by #10639, INTERIM, eff 7-21-14, EXPIRES: 1-19-15; ss by #10760, eff 1-19-15; ss by #14275, eff 6-24-25, EXPIRES: 6-24-35

N.H. Code Admin. R. Ann. He-W 403.06 Recovery of Payments Resulting from an Adjusted Federal Tax Return {#sec-he-w-403.06 omnilex-key=us-nh-regs-official--agency-he-w--He-W 403.06}

(a) Whenever the federal Internal Revenue Service (IRS) requires BCSS to return all or part of a tax refund that was intercepted through the federal offset program, BCSS shall recover the amount returned to the IRS as follows:

(1) In cases where a portion of a obligor’s intercepted federal tax refund remained after applying the intercepted amount to all certified arrearages, and the remaining balance of the refund was sent to the obligor upon request, BCSS shall provide the obligor with Form BCSS 154, “Notice of Adjusted Tax Return and Demand for Repayment” (June 2025);

(2) In order to receive credit for repayment of the debt amount, the obligor shall return the payment with the “Adjusted Tax Refund Intercept Repayment Coupon” provided on Form BCSS 154;

(3) Payments that are submitted without an adjusted tax refund intercept repayment coupon shall be processed as a regular child support payment, and shall not be credited as a repayment of the debt amount;

(4) If full recovery payment is not received by BCSS within 14 days of the date on Form BCSS 154 “Notice of Adjusted Tax Return and Demand for Repayment” BCSS shall file with the appropriate court to establish a legal order against the obligor for the debt; and

(5) In cases where the intercepted tax refund was disbursed to an obligee, the recoupment process described in He-W 403.03 shall be used to recover the debt amount.

History

#8685, eff 7-21-06; renumbered by #9206 (formerly He-W 403.07); ss by #10467, eff 11-26-13; ss by #10760, eff 1-19-15; ss by #14275, eff 6-24-25, EXPIRES: 6-24-35

N.H. Code Admin. R. Ann. He-W 403.07 Appeals and Review Process {#sec-he-w-403.07 omnilex-key=us-nh-regs-official--agency-he-w--He-W 403.07}

(a) An individual against whom recovery action pursuant to section He-W 403.04 and He-W 403.05 has been initiated, shall only request an administrative appeal on the basis of mistake of fact, which includes but is not limited to:

(1) The individual is not the right person; or

(2) The individual’s child support payment was not returned or electronically reversed.

(b) An individual subject to recoupment or recovery action pursuant to sections He-W 403.03 or He-W 403.06, may request an administrative appeal only on the basis of mistake of fact, or a substantial change of circumstance resulting in economic hardship, which includes but is not limited to:

(1) The individual is not the right person;

(2) The individual obligee did not authorize withholding of future child support payments exclusively pursuant to He-W 403.03(a) or (b); or

(3) The individual claims a substantial change in circumstance resulting in economic hardship.

(1) Supervisory review; and

(2) Administrative hearing.

(d) An individual may seek judicial review in the court of appropriate jurisdiction when they seek to:

(1) Modify or amend a legal obligation of support;

(2) Amend the legal obligation of support, support order, or administrative determination of support responsibility made by another state; or

(3) Appeal the results of a final administrative hearing decision.

(e) A supervisory review shall:

(1) Be requested from BCSS within 30 days of the date on the respective notice of recovery action, Form BCSS 149A or Form BCSS 149C;

(2) Be requested from BCSS within 20 days of the date on the respective notice of recovery action, Form BCSS 149B or Form BCSS 149D; and

(3) Consist of a face-to-face meeting between the individual and the district office supervisor for the purpose of determining if there has been a mistake of fact pursuant to He-W 403.07(a) (1)-(2), and if there has been a mistake of fact or substantial change in circumstances pursuant to He-W 403.07(b)(1)-(3).

(f) An individual who is dissatisfied with the results of a supervisory review may file an appeal to request an administrative hearing pursuant to He-C 200.

(g) An individual shall request an administrative hearing within 30 days of the date on the finding issued as a result of the supervisory review.

(h) An individual who is dissatisfied with the results of an administrative hearing may appeal the final administrative hearing decision to the appropriate New Hampshire court.

History

#8685, eff 7-21-06; renumbered by #9206 (formerly He-W 403.08); ss by #10639, INTERIM, eff 7-21-14, EXPIRES: 1-19-15; ss by #10760, eff 1-19-15; ss by #14275, eff 6-24-25, EXPIRES: 6-24-35

Part He-W 404 New Hampshire Lottery Intercept for Collection of Child Support Arrears

N.H. Code Admin. R. Ann. He-W 404.01 Identification, Confirmation, and Interception of Child Support Arrearages {#sec-he-w-404.01 omnilex-key=us-nh-regs-official--agency-he-w--He-W 404.01}

(a) Pursuant to RSA 284:21-v, the New Hampshire lottery commission (NHLC), shall intercept lottery prizes controlled by NHLC from prize winners who have child support arrearages in cases for which the New Hampshire bureau of child support services (BCSS) is responsible.

(b) NHLC shall confirm that the prize winner is an obligor in an open case through their limited access to the child support case management system, and if confirmed, contact BCSS. Any personally identifiable information obtained by NHCL shall be protected pursuant to Lot 902.04.

(1) Whether the prize winner has a child support arrearage; and

(2) The amount of any arrearage.

(d) BCSS shall provide written confirmation to NHLC by Form 743, “Confirmation of Child Support Arrearage,” (June 2025) of the individual who has a child support arrearage.

(e) NHLC shall complete and provide to each individual whose lottery prize has been intercepted BCSS Form 742, “Notice of Intercept of Lottery Winnings for Child Support,” (June 2025) using information provided by BCSS in Form 743.

(f) The amount intercepted shall be the amount of the child support arrearage or the full amount of the prize, whichever is less.

History

#6393, eff 12-4-96, EXPIRED: 12-04-04
#8416, INTERIM, eff 8-23-05, EXPIRES: 2-19-06; ss by #8541, eff 2-20-06; renumbered by #9206 (formerly He-W 404.02); ss by #10645, eff 7-22-14, EXPIRED: 7-22-24
#14127, INTERIM, eff 11-26-24, EXPIRES: 5-25-25 (Remains in effect per RSA 541-A:14-a); ss by #14276, eff 6-24-25, EXPIRES: 6-24-35

N.H. Code Admin. R. Ann. He-W 404.02 Appeal Process {#sec-he-w-404.02 omnilex-key=us-nh-regs-official--agency-he-w--He-W 404.02}

(a) An individual whose lottery prize has been intercepted may request a formal appeal only on the basis of a mistake in fact, which includes, but is not limited to:

(1) The individual whose prize was intercepted is not the right person;

(2) The individual does not have a child support arrearage; or

(3) The amount intercepted was not correct.

(b) There shall be 3 levels of appeal, as follows:

(1) Supervisory review;

(2) Administrative hearing; and

(3) Judicial review.

(c) An individual whose lottery prize has been intercepted shall exhaust each level of appeal according to the sequence given in (b) above before proceeding to the next higher level.

(d) A supervisory review shall be requested from BCSS within 15 days of the date on Form 742.

(e) The individual shall not be required to appear at the scheduled review, but they shall provide BCSS with documentation in support of their claim that there has been a mistake of fact pursuant to He-W 404.02(a)(1)-(3).

(f) An individual who is dissatisfied with the results of a supervisory review may request an administrative hearing pursuant to He-C 200.

(g) An individual shall request an administrative hearing within 30 days of the date on the finding issued as a result of the supervisory review.

(h) An individual who is dissatisfied with the results of an administrative hearing may appeal the administrative hearing decision to the New Hampshire superior court, pursuant to He-W 410.01(g).

History

#6393, eff 12-4-96, EXPIRED: 12-04-04
#8416, INTERIM, eff 8-23-05, EXPIRES: 2-19-06; ss by #8541, eff 2-20-06; renumbered by #9206 (formerly He-W 404.03); ss by #10645, eff 7-22-14; amd by #12611, eff 8-23-18; amd by #14127, INTERIM, eff 11-26-24, EXPIRES: 5-25-25 (Remains in effect per RSA 541-A:14-a); ss by #14276, eff 6-24-25, EXPIRES: 6-24-35

N.H. Code Admin. R. Ann. He-W 404.03 Distribution of Intercepted Lottery Prizes {#sec-he-w-404.03 omnilex-key=us-nh-regs-official--agency-he-w--He-W 404.03}

Intercepted amounts shall be distributed in accordance with He-W 403.

History

#6393, eff 12-4-96, EXPIRED: 12-04-04
#8416, INTERIM, eff 8-23-05, EXPIRES: 2-19-06; ss by #8541, eff 2-20-06; renumbered by #9206 (formerly He-W 404.04); ss by #10645, eff 7-22-14, EXPIRED: 7-22-24
#14127, INTERIM, eff 11-26-24, EXPIRES: 5-25-25 (Remains in effect per RSA 541-A:14-a); ss by #14276, eff 6-24-25, EXPIRES: 6-24-35

N.H. Code Admin. R. Ann. He-W 404.04 Refund of Erroneously Intercepted Lottery Prizes {#sec-he-w-404.04 omnilex-key=us-nh-regs-official--agency-he-w--He-W 404.04}

BCSS shall refund any portion of intercepted lottery winnings that a BCSS supervisory review, administrative hearing, or judicial review determines was erroneously withheld from a prize winner.

History

#6393, eff 12-4-96, EXPIRED: 12-04-04
#8416, INTERIM, eff 8-23-05, EXPIRES: 2-19-06; ss by #8541 eff 2-20-06; renumbered by #9206 (formerly He-W 404.05); ss by #10645, eff 7-22-14, EXPIRED: 7-22-24
#14127, INTERIM, eff 11-26-24, EXPIRES: 5-25-25 (Remains in effect per RSA 541-A:14-a); ss by #14276, eff 6-24-25, EXPIRES: 6-24-35

Part He-W 405 Fees

N.H. Code Admin. R. Ann. He-W 405.01 Annual Fee for Services {#sec-he-w-405.01 omnilex-key=us-nh-regs-official--agency-he-w--He-W 405.01}

(a) In all never-assistance cases where DCSS has collected and disbursed at least $550.00 of support, DCSS shall impose an annual fee of $35.00 pursuant to RSA 161-B:3, IV.

(b) The fee shall be retained by DCSS from the support collected on behalf of the payee, but not from the first $550.00 so collected.

(c) DCSS shall distribute to the payee the portion of the amount so collected that remains after withholding the fee in accordance with He-W 403.01.

(d) In all cases where the annual fee is retained from a support collection, the payor’s child support account shall be credited for the entire amount of the collected support payment.

History

#9029, eff 11-17-07; renumbered by #9206 (formerly He-W 405.02); ss by #10955, eff 10-22-15; amd by #12612, eff 8-23-18

N.H. Code Admin. R. Ann. He-W 405.02 Child Support Disbursement Fee {#sec-he-w-405.02 omnilex-key=us-nh-regs-official--agency-he-w--He-W 405.02}

REPEALED

History

#9759, eff 8-1-10; amd by #9925, eff 7-1-11; rpld by #12551, eff 6-20-18

Part He-W 408 Case Initiation

N.H. Code Admin. R. Ann. He-W 408.01 Prioritization of Child Support Cases {#sec-he-w-408.01 omnilex-key=us-nh-regs-official--agency-he-w--He-W 408.01}

(a) A11 child support cases shall be assigned a priority number from one, which shall be the highest priority, to 3, which shall be the lowest priority.

(b) The priority number assigned to a case shall be based upon the following criteria:

(1) A case shall be assigned priority one status when the DCSS has the following minimum information to initiate paternity, support order establishment or support order enforcement action:

a. The absent parent's name; and

b. The absent parent's current address and/or the name and address of the absent parent's current employer;

(2) A case shall be assigned priority 2 status when DCSS does not have all the information required in (1) above, but has the following minimum information to initiate locate action:

a. The absent parent's name; and

b. The absent parent's social security number and/or date of birth; and

(3) A case shall be assigned priority 3 status when DCSS cannot take any actions because:

a. The absent parent is receiving temporary assistance to needy families (TANF);

b. The absent parent is incarcerated and paternity has already been established; or

c. There is not enough information in the case record to take any required action.

(d) Whenever case circumstances change and new information is received for a child support case, the priority status of that case shall be reassessed and, if warranted by the reassessment, a new priority number shall be assigned.

History

#5743, eff 11-24-93; ss by #7137, INTERIM, eff 11-24-99, EXPIRED: 3-23-00
#7244, eff 4-27-00, EXPIRED: 4-27-08
#9206, eff 7-19-08, EXPIRED: 7-19-16

Part He-W 409 Closure of Child Support Cases

N.H. Code Admin. R. Ann. He-W 409.01 Criteria for Case Closure {#sec-he-w-409.01 omnilex-key=us-nh-regs-official--agency-he-w--He-W 409.01}

(a) In addition to cases meeting closure criteria defined in RSA 161-B:3, II and federal regulations at 45 CFR 303.11, child support cases which meet the following criteria shall be subject to closure:

(1) There is no longer an order for support enforceable under New Hampshire law and the arrearage owed is less than $2,500.00;

(2) The case is a refugee assistance or TANF intact family case where the father is the responsible parent for all of the children in the case;

(3) The case is a TANF case where the client has completed an affidavit attesting that she does not know who the father of her child is;

(4) The client has moved out of New Hampshire, paternity has not been established, and paternity testing has not been initiated or completed;

(5) Another state has authorized or requested closure of the case; or

(6) The case was opened erroneously.

(b) A case which has been closed shall be reopened pursuant to 45 CFR 303.11(c) if the client provides additional or new information which would enable the division of child support services (DCSS) to establish paternity or a support order or enforce an order.

History

#5743, eff 11-24-93; ss by #7137, INTERIM, eff 11-24-99, EXPIRED: 3-23-00
#7244, eff 4-27-00, EXPIRED: 4-27-08
#9206, eff 7-19-08, EXPIRED: 7-19-16

Part He-W 410 Appeals of Bureau of Child Support Services Actions and Decisions

N.H. Code Admin. R. Ann. He-W 410.01 Appeals of Bureau of Child Support Services Actions and Decisions {#sec-he-w-410.01 omnilex-key=us-nh-regs-official--agency-he-w--He-W 410.01}

(a) A party may appeal any action or decision in accordance with (b) – (g) below unless the criterial for appeals for that action or decision is otherwise specified in state statute or other department rules.

(b) There shall be three levels of appeal available to parties wishing to contest a child support establishment or enforcement action or decision:

(1) Supervisory review;

(2) Administrative hearing, pursuant to He-C 200 and He-C 201; and

(3) Judicial review.

(c) A party wishing to appeal shall sequentially exhaust each level of appeal in (b) above, starting with (b)(1) before proceeding to the next level of appeal.

(d) A supervisory review shall:

(1) Be requested by the party within 30 days of the date on the notice of decision of the action;

(2) Be requested by the party in writing, including electronic methods available through the department of health and human services; and

(3) Be conducted for the sole purpose of determining if a mistake of fact has occurred, or as otherwise stated in other department rules or state statute.

(e) Mistake of fact in (d)(3) above shall include:

(1) Misidentification of the party;

(2) An incorrect arrearage amount calculated;

(3) The incorrect date of an action;

(4) An incorrect foreign exchange rate used in a currency conversion; or

(5) Any other material mistake of fact.

(f) A party who is dissatisfied with the results of a supervisory review may request an administrative hearing, pursuant to He-C 201.03.

(g) A party may request judicial review from the New Hampshire Superior Court:

(1) Within 30 calendar days of the date on the notice of decision from the administrative hearing; or

(2) Within 30 calendar days of the date on the notice of decision from the rehearing or denial of a request for a rehearing of an administrative hearing.

APPENDIX

Rule

Specific State Statute the Rule Implements

He-W 401

RSA 161:4-a, V

He-W 401.01

RSA 161:4-a, V

He-W 403.01

Section 457 of the SSA (42 USC 657); 45 CFR 302.51;

45 CFR 302.52

He-W 403.02

Section 454B of the SSA [42 USC 654B(c)]

He-W 403.03

RSA 161:4-a; 42 USC 657

He-W 403.04

RSA 161-4-a VIII-a; 42 USC 657; 42 USC 654 (b)(c)

He-W 403.05

RSA 161:4-a, VIII-a; 42 USC 657; 42 USC 654(b)(c)

He-W 403.06

RSA 161:4-a, VIII-a; 42 USC 657

He-W 403.07

RSA 161:4-a, VIII-a

He-W 404.01 – He-W 404.04

42 USC 666(c)(1)(G)(II); RSA 284:21-v

He-W 405.01

Section 454(6)(B)(ii) [42 USC 654(6)(B)(ii)]; RSA 161-B:3, IV; and RSA 161-B:8, II

He-W 405.02 - Repealed

RSA 161-B:8, II; RSA 161-B:3, IV

He-W 408.01

RSA 161:4, IX

He-W 409.01

RSA 161:4-a, IX, 45 CFR 303.11

He-W 410

RSA 126-A:5, VIII, RSA 161-B:11, RSA 161-C:27, RSA 541:6;

45 CFR 303.35

History

#12611, eff 8-23-18

Chapter He-W 500 Medical Assistance

Part He-W 501 General Medical Eligibility - Expired

N.H. Code Admin. R. Ann. He-W 501.01 Definitions {#sec-he-w-501.01 omnilex-key=us-nh-regs-official--agency-he-w--He-W 501.01}

History

(See Revision Note at chapter heading He-W 500); ss by #5806, eff 3-30-94; amd by #5941, eff 12-22-94, all EXPIRED: 3-30-00, except paragraph (c) EXPIRED: 12-22-02

N.H. Code Admin. R. Ann. He-W 501.02 Medical Assistance {#sec-he-w-501.02 omnilex-key=us-nh-regs-official--agency-he-w--He-W 501.02}

History

(See Revision Note at chapter heading He-W 500); ss by #5806, eff 3-30-94, EXPIRED: 3-30-00

N.H. Code Admin. R. Ann. He-W 501.03 Medical Assistance {#sec-he-w-501.03 omnilex-key=us-nh-regs-official--agency-he-w--He-W 501.03}

History

(See Revision Note at chapter heading He-W 500); ss by #5806, eff 3-30-94; amd by #5941, eff 12-22-94, all EXPIRED: 3-30-00, except paragraph (a)(3) EXPIRED: 12-22-02

N.H. Code Admin. R. Ann. He-W 501.04 Medical Assistance {#sec-he-w-501.04 omnilex-key=us-nh-regs-official--agency-he-w--He-W 501.04}

501.12

History

(See Revision Note at chapter heading He-W 500); ss by #5806, eff 3-30-94, EXPIRED: 3-30-00

N.H. Code Admin. R. Ann. He-W 502.01 Definitions {#sec-he-w-502.01 omnilex-key=us-nh-regs-official--agency-he-w--He-W 502.01}

(a) “Aid to the needy blind (ANB)” means a category of assistance for which eligibility is determined by the New Hampshire (NH) department of health and human services, in accordance with RSA 167:6, IV.

(b) “Blindness” means “blindness” as defined in Sections 216(i)(1) and 1614(a)(2) of the Social Security Act, 42 USC 416(i)(1)(B) and 42 USC 1382c(a)(2).

(d) “Medicaid” means the Title XIX and Title XXI programs administered by the department, which makes medical assistance available to eligible individuals.

(e) “Ophthalmologist” means a physician who specializes in the diagnosis and treatment of disorders of the eye.

(f) “Optometrist” means a doctor of optometry (OD), who is a primary health care provider who diagnoses, manages, and treats conditions and diseases of the eye.

(g) “Recipient” means an individual who is eligible for and receiving medical assistance under the medicaid program.

(h) “Title XIX” means the joint federal-state program described in Title XIX of the Social Security Act and administered in NH by the department under the medicaid program.

(i) “Title XXI” means the joint federal-state program described in Title XXI of the Social Security Act and administered in NH by the department under the medicaid program.

History

(See Revision Note at chapter heading He-W 500); ss by #6112, eff 11-4-95; ss by #7132, eff 11-23-99; ss by #9011, eff 10-25-07; amd by #10139, eff 7-1-12; ss by #11027, eff 1-26-16; ss by #14416, eff 10-28-2025, EXPIRES 10-28-2036

N.H. Code Admin. R. Ann. He-W 502.02 Recipient Eligibility {#sec-he-w-502.02 omnilex-key=us-nh-regs-official--agency-he-w--He-W 502.02}

ANB shall be available to recipients who:

(a) Meet the financial, categorical, technical, and other eligibility requirements, pursuant to He-W 800, as applicable; and

(b) Meet the definition of blindness in He-W 502.01.

History

(See Revision Note at chapter heading He-W 500); amd by #5272, eff 11-15-91; ss by #6112, eff 11-4-95; ss by #7132, eff 11-23-99; ss by #9011, eff 10-25-07; ss by #11027, eff 1-26-16; ss by #14416, eff 10-28-2025, EXPIRES 10-28-2036

N.H. Code Admin. R. Ann. He-W 502.03 Blindness Evaluation {#sec-he-w-502.03 omnilex-key=us-nh-regs-official--agency-he-w--He-W 502.03}

(a) The applicant, recipient, or the recipient’s family member or authorized representative shall complete the “Authorization for Release of Medical Information” section on Form 901, “Report of Eye Examination” (October 2025) acknowledging the following:

“I understand that the Department of Health and Human Services may use the disclosed information to the extent permitted by state and federal law and may no longer be protected by the HIPAA federal privacy rule (45 CFR Part 164.508(c)).

Specific description of information that may be used/disclosed: Information specifying the history of my visual impairment, physical examination of my eyes, diagnosis, prognosis, and recommendations.

The information will be used/disclosed for the following purposes: Information will be used to determine my eligibility for Aid to the Needy Blind (ANB) cash and medical assistance.

I understand that this authorization is voluntary and that I may refuse to sign this authorization. I further understand that my refusal to sign this authorization may result in a determination that I am not eligible for ANB cash or medical assistance. I understand that I may revoke this authorization at any time by notifying DHHS in writing, to the above-noted address, except to the extent that the authorization has already been used to request information prior to my revocation.

This authorization expires: 12-months from the date this form is signed.”

(b) The recipient’s optometrist or ophthalmologist shall complete, sign, and date the applicable sections of Form 901 “Report of Eye Examination” (October 2025) and submit the form to the department accompanied by the recipient’s field chart, if it is determined by the optometrist or ophthalmologist that the recipient’s field measurements are abnormal.

(c) The department shall review the information provided on Form 901 in (a) and (b) above, to determine if the criteria in He-W 502.02 have been met.

History

(See Revision Note at chapter heading He-W 500); ss by #6112, eff 11-4-95; ss by #7132, eff 11-23-99; ss by #9011, eff 10-25-07; ss by #11027, eff 1-26-16; ss by #14416, eff 10-28-2025, EXPIRES 10-28-2036

Part He-W 504 Medicaid for Employed Adults with Disabilities

N.H. Code Admin. R. Ann. He-W 504.01 Definition {#sec-he-w-504.01 omnilex-key=us-nh-regs-official--agency-he-w--He-W 504.01}

(a) “Medicaid for employed adults with disabilities (MEAD)” means a category of eligibility that allows certain individuals who are working to either retain or obtain medicaid eligibility.

History

#7644, eff 2-8-02; ss by #8292, eff 2-24-05; ss by #10321, eff 4-25-13

N.H. Code Admin. R. Ann. He-W 504.02 Medical Eligibility {#sec-he-w-504.02 omnilex-key=us-nh-regs-official--agency-he-w--He-W 504.02}

To be medically eligible for MEAD:

(a) An individual who is currently a medicaid recipient shall:

(1) Have been determined eligible for aid to the permanently and totally disabled (APTD) according to RSA 167:6, VI, or aid to the needy blind (ANB) according to RSA 167:6, IV, within the 12 months prior to application for MEAD; and

(2) Not have been terminated from APTD or ANB due to medical improvement during the previous 12 months; or

(b) An individual who is not currently an APTD or ANB recipient shall:

(1) Be employed, or self-employed, for pay, pursuant to the provisions of He-W 641.03(b)-(c), on the date of application and during the time eligibility for MEAD is being determined;

(2) Have a medical impairment that meets the Social Security Administration’s Listing of Impairments in accordance with 20 CFR 404, Subpart P, Appendix I; and

(3) Have a medical impairment that has persisted or is expected to persist for a minimum of 48 consecutive months.

History

#7644, eff 2-8-02; ss by #8292, eff 2-24-05; ss by #10321, eff 4-25-13

Part He-W 505 - Reserved

N.H. Code Admin. R. Ann. He-W 505.01 Medical Assistance {#sec-he-w-505.01 omnilex-key=us-nh-regs-official--agency-he-w--He-W 505.01}

– He-W 505.04 – REPEALED

History

(See Revision Note at chapter heading He-W 500); ss by #5623, eff 5-13-93, EXPIRED: 5-13-99
#7134, eff 11-23-99; rpld by #8973, eff 9-11-07

Part He-W 506 Medicaid Care Management (mcm)

N.H. Code Admin. R. Ann. He-W 506.01 Purpose {#sec-he-w-506.01 omnilex-key=us-nh-regs-official--agency-he-w--He-W 506.01}

The purpose of this part is to prescribe the requirements of the New Hampshire medicaid care management program as they pertain to medicaid recipients, including individuals determined eligible for medicaid coverage through the granite advantage health care program (granite advantage) in accordance with RSA 126-AA:2.

History

#10410, eff 9-13-13; ss by #10631, eff 7-1-14; ss by #13474, eff 10-24-22

N.H. Code Admin. R. Ann. He-W 506.02 Scope {#sec-he-w-506.02 omnilex-key=us-nh-regs-official--agency-he-w--He-W 506.02}

This part shall apply to all medicaid recipients insofar as they are required to enroll in managed care. Those recipients who are not enrolled in managed care shall receive medicaid services on a fee-for-service basis in accordance with applicable rules in He-W 500.

History

#10410, eff 9-13-13; ss by #10965, eff 11-1-15; ss by #13474, eff 10-24-22

N.H. Code Admin. R. Ann. He-W 506.03 Definitions {#sec-he-w-506.03 omnilex-key=us-nh-regs-official--agency-he-w--He-W 506.03}

(a) “Action” means a managed care organization (MCO) activity including, but not limited to, the following activities identified in the definition of “adverse benefit determination” in 42 CFR 438.400(b):

(1) The denial or limited authorization of a requested service, including the type or level of service, including determinations based on the type or level of service, requirements for medical necessity, appropriateness, setting, or effectiveness of a covered benefit;

(2) The reduction, suspension, or termination of a previously authorized service;

(3) The denial, in whole or in part, of payment for a service except when denial for payment for a service is solely because the claim does not meet the definition of a “clean claim”;

(4) The failure to provide services in a timely manner, as described in the contracts between the department and the MCO;

(5) The failure of an MCO to act within the timeframes required for a service authorization, disposition of a grievance, standard resolution of an appeal, or expedited resolution of an appeal, as described in the contracts between the department and the MCO; or

(6) The denial of a member’s request to dispute a financial liability, including cost sharing, copayments, premiums, deductibles, coinsurance, or other enrollee financial liabilities.

(b) “Alternative Benefit Plan (ABP) services” means the Secretary-approved coverage described in section 1937 of the Social Security Act and which aligns with and includes the traditional medicaid state plan services.

(d) “Clean claim” means a claim that does not have any defect, impropriety, lack of any required substantiating documentation, or particular circumstance requiring special treatment that prevents timely payment.

(e) “Department” means the New Hampshire department of health and human services.

(f) “Fair hearing” means an administrative appeal under He-C 200.

(g) “Fee-for-service” means the reimbursement method used by the department:

(1) For all services to recipients who are not enrolled in managed care; and

(2) For those services excluded from managed care for all recipients.

(h) “Granite Advantage Health Care Program (Granite Advantage)” means the granite advantage health care program established under RSA 126-AA, which authorizes medical assistance for individuals described in 42 U.S.C §1396a(a)(10)(A)(i)(VIII).

(i) “Grievance” means an expression of dissatisfaction about any matter other than an action that is communicated to the MCO, such as with regard to the quality of care or services provided, and aspects of interpersonal interactions with the MCO employees.

(j) “Managed care organization (MCO)” means an entity that has a comprehensive risk-based contract with the department to provide managed medicaid health care services.

(k) “MCO grievance system” means the system through which members can complain, express dissatisfaction, or challenge an action made by the MCO, including:

(1) An MCO grievance process;

(2) An MCO appeal process; and

(3) Access to the department’s fair hearing process after (k)(2) above has been exhausted.

(l) “Medicaid” means the Title XIX and Title XXI programs administered by the department which makes medical assistance available to eligible individuals.

(m) “Member” means a recipient who has selected or who has been passively enrolled into an MCO.

(n) “Recipient” means any individual who is eligible for and is receiving medical assistance under the New Hampshire medicaid program.

(o) “Title XIX” means the joint federal-state program described in Title XIX of the Social Security Act and administered in New Hampshire by the department under the medicaid program.

(p) “Title XXI” means the joint federal-state program described in Title XXI of the Social Security Act and administered in New Hampshire by the department under the medicaid program.

History

#10410, eff 9-13-13; amd by #10631, eff 7-1-14; amd by #10965, eff 11-1-15; ss by #12537, eff 5-24-18; ss by #13474, eff 10-24-22

N.H. Code Admin. R. Ann. He-W 506.04 Covered Services {#sec-he-w-506.04 omnilex-key=us-nh-regs-official--agency-he-w--He-W 506.04}

(a) Covered services provided through an MCO shall include all covered state plan and ABP services except the following:

(1) Dental services provided in the dental setting;

(2) Intermediate care facility for individuals with intellectual disabilities;

(3) Medicaid to schools program;

(4) Skilled nursing facility;

(5) Skilled nursing facility atypical care;

(6) Inpatient hospital swing beds, intermediate care facility;

(7) Inpatient hospital swing beds, skilled nursing facility;

(8) Intermediate care facility nursing home;

(9) Intermediate care facility atypical care;

(10) Glencliff Home;

(11) Early supports and services;

(12) The following services which are only offered to children involved with the division for children, youth, and families:

a. Home based therapy;

b. Child health support service;

c. Placement services;

d. Intensive home and community services;

e. Private non-medical institutional care for children; and

f. Crisis intervention; and

(13) Section 1915(i) of the Social Security Act, state plan home and community based services for high risk children with severe emotional disturbances.

(b) The services excluded in (a) above shall be covered by medicaid on a fee-for-service basis except the dental services which are covered under He-W 566.

(c) Covered services shall be provided by the MCO starting the same business day as a member’s selection of or passive enrollment in an MCO.

(d) Covered state plan and ABP services provided through an MCO shall be furnished in an amount, duration, and scope that is no less than the amount, duration, and scope for the same services furnished to recipients under fee-for-service.

(e) Covered services provided through a DO shall include all covered state plan, Section 1915(b) of the Social Security Act, Section 1915(c) of the Social Security Act, and Section 1115 of the Social Security Act, and ABP dental services.

History

#10410, eff 9-13-13; ss by #10631, eff 7-1-14; amd by #11107, eff 7-1-16; amd by #12016, eff 10-25-16; ss by #13474, eff 10-24-22; ss by #13879, eff 2-21-24; ss by #14240, eff 4-22-25, EXPIRES: 4-22-35

N.H. Code Admin. R. Ann. He-W 506.05 Enrollment in Managed Care {#sec-he-w-506.05 omnilex-key=us-nh-regs-official--agency-he-w--He-W 506.05}

(a) All medicaid recipients shall be enrolled in managed care unless the recipient is excluded from managed care as described in (b) below.

(b) The following individuals shall not be allowed to enroll in managed care:

(1) Recipients receiving certain financial benefits from the U.S. Department of Veterans Affairs;

(2) Recipients receiving in and out medically needy assistance in accordance with 42 CFR 435.301 and He-W 878.01;

(3) Recipients who are eligible under the qualified medicare beneficiary (QMB), specified low-income medicare beneficiary (SLMB), or qualified disabled working individual (QDWI) benefits only, and are not eligible for full medicaid coverage;

(4) Recipients who are eligible under the family planning expansion category (FPEC) in accordance with 1902(a)(10)(A)(ii) of the Social Security Act, 42 U.S.C. 1396a(a)(10)(A)(ii) and He-W 509;

(5) Individuals during a presumptive eligibility period; and

(6) Individuals in a retroactive eligibility period.

History

#10410, eff 9-13-13; ss by #10631, eff 7-1-14; ss by #10965, eff 11-1-15; ss by #13474, eff 10-24-22

N.H. Code Admin. R. Ann. He-W 506.06 Selection of a Managed Care Organization {#sec-he-w-506.06 omnilex-key=us-nh-regs-official--agency-he-w--He-W 506.06}

(a) Recipients shall be passively enrolled in an MCO if they do not select a plan at application.

(b) Recipients shall select an MCO at application by:

(1) Utilizing the on-line NH Electronic Application System (NH EASY);

(2) A personal interview, as required in He-W 636.01 and He-W 644.01;

(3) A telephone application pursuant to He-W 802.03; or

(4) Calling the medicaid service center.

(c) The department shall send a notice to all recipients not excluded from managed care per He-W 506.05(b) specifying which MCO the recipient has been enrolled into.

(d) Passive enrollment shall be based on the following criteria:

(1) MCO participation of a primary care provider with whom the recipient has a pre-existing relationship as demonstrated by past claims history;

(2) MCO participation of a specialty care provider with whom the enrollee has a pre-existing relationship as demonstrated by past claims history;

(3) Family affiliation to an MCO;

(4) Previous enrollment with an MCO prior to a loss of medicaid eligibility;

(5) Provider-member relationship, to the extent obtainable; or

(6) If enrollment cannot be made utilizing (1)-(5) above, enrollment shall be based on the terms of the contract agreed to by the department and the MCO.

(e) A member may request to change his or her MCO selection without cause, by making a written or oral request to the department at any of the following times:

(1) Once during the 90 days following the date of the member’s initial medicaid eligibility;

(2) During the first 12 months of enrollment, if the member has an established relationship with a primary care provider that is only in-network of a non-assigned MCO;

(3) During annual open enrollment periods and enrollments related to renegotiation and re-procurement; and

(4) When the department imposes an intermediate sanction specified in 42 CFR 438.702(a)(3).

(f) A member may request to change his or her MCO with cause after seeking redress through the MCO’s grievance system, by making a written or oral request to the department at any time for any of the following reasons:

(1) The member requires related services simultaneously that are not available in the MCO’s network and bifurcation of the care creates unnecessary risk to the member as determined by the member’s treating provider;

(2) Due to moral or religious objections of the MCO, the MCO does not provide the covered service the member needs;

(3) Poor quality of care;

(4) Lack of access to covered services;

(5) The member has experienced a violation of his or her member rights, as established in 42 CFR 438.100; or

(6) The MCO’s network providers are not experienced in the member’s unique healthcare needs.

(g) If a request made pursuant to (e) or (f) above does not include the selection of a different MCO, the department shall not act on the request unless there are only 2 MCOs.

(h) A member may request a department fair hearing of a denial of (e) or (f) above in accordance with He-C 200 without first exhausting the MCO appeal process.

(i) A member shall be locked into an MCO for a period of 12 months or until the next open enrollment period, whichever comes first, unless the member changes his or her MCO selection in accordance with (e)(1)-(3) or (f) above.

(j) A member shall disenroll from an MCO when the member has moved out of state and is no longer NH medicaid eligible or becomes exempt as described in He-W 506.05(b).

(k) An MCO may request the department to disenroll a member who is threatening or abusive such that the health or safety of other members, MCO staff, or providers is jeopardized.

(l) The department shall approve a request for disenrollment in (j) above when no other option is available that would ensure the health and safety of other members, MCO staff, or providers.

(m) If the department approves an MCO request for involuntary disenrollment, the member may request a department fair hearing of the disenrollment in accordance with He-C 200 without first exhausting the MCO appeal process.

(n) Members appealing involuntary disenrollment may request a continuation of services pending appeal as outlined in 42 CFR 431.230.

History

#10410, eff 9-13-13; ss by #10965, eff 11-1-15; ss by #13474, eff 10-24-22

N.H. Code Admin. R. Ann. He-W 506.07 MCO Grievance Process {#sec-he-w-506.07 omnilex-key=us-nh-regs-official--agency-he-w--He-W 506.07}

(a) A member who is dissatisfied with any matter other than an action, as defined in He-W 506.03(a), shall utilize the MCO grievance process exclusively.

(b) The MCO grievance process shall address members’ expression of dissatisfaction about any matter other than an action including, but not limited to:

(1) The quality of care or services provided;

(2) Aspects of interpersonal interactions with providers or MCO employees; or

(3) Failure to respect the member’s rights.

(c) Actions, as defined in He-W 506.03(a), shall be subject to the MCO appeal process but not subject to the MCO grievance process.

(d) A member, or the member’s authorized representative, appointed in accordance with He-W 803.01, shall file a grievance with the MCO either orally or in writing.

(e) Members shall be notified of the disposition of grievances as follows:

(1) Either orally or in writing for grievances not involving clinical issues; and

(2) In writing for grievances involving clinical issues.

(f) Members shall not have the right to a department fair hearing in regard to the disposition of a grievance.

(g) The MCO grievance process shall not preclude a member’s ability to pursue client rights protection under He-M 204.

History

#10410, eff 9-13-13; ss by #13474, eff 10-24-22

N.H. Code Admin. R. Ann. He-W 506.08 MCO Appeal Process {#sec-he-w-506.08 omnilex-key=us-nh-regs-official--agency-he-w--He-W 506.08}

(a) The MCO appeal process shall address members’ requests for the appeal of any adverse benefit determination or action taken by the MCO.

(b) A member who wants to appeal an action taken by the MCO shall utilize the MCO appeal process.

(c) A member, the member’s authorized representative, the member’s legal guardian appointed in accordance with He-W 803.01, or the member’s provider acting on behalf of the member and with the member’s written consent may file an appeal with the MCO. However, a provider acting as an authorized representative shall not request continuation of benefits pending the appeal even with written consent.

(d) All requests for appeals shall be made within 60 calendar days of the date on the MCO’s notice of action.

(e) All requests for appeals shall be made either orally or in writing. An oral request for an appeal shall be followed by a written request, unless the request is for expedited resolution as described in (g) below.

(f) The MCO shall resolve standard appeals within 30 calendar days from the day the MCO receives the appeal.

(g) A person in (c) above may request an expedited resolution of an appeal when taking the time needed for a standard resolution could seriously jeopardize the member’s life, physical or mental health, or ability to attain, maintain, or regain maximum function.

(h) The MCO shall resolve an expedited appeal within 72 hours of receiving the appeal.

(i) The MCO may extend the timeframes to resolve standard and expedited appeals up to 14 calendar days if:

(1) The member requests the extension; or

(2) The MCO demonstrates that there is a need for additional information in order to resolve the appeal and the extension is in the member’s interest.

(j) If the MCO extends the timeframes not at the request of the member in accordance with (i)(2) above, then the MCO shall:

(1) Make reasonable efforts to give the member prompt oral notice of the delay by providing a minimum of 3 oral attempts to contact the member at various times of the day, on different days within 2 calendar days of the MCO’s decision to extend the timeframe;

(2) Within 2 calendar days of the MCO’s decision to extend, give the member written notice of the reason for the decision to extend the timeframe and inform the member of the right to file a grievance if he or she disagrees with that decision; and

(3) Resolve the appeal as expeditiously as the member’s health condition requires and no later than the date the extension expires.

(k) A member’s benefits shall be continued during an appeal if:

(1) The member requests a continuation of benefits on or before the later of the following:

a. Within 10 calendar days of the date the MCO mails the notice of action; or

b. The intended effective date of the MCO’s proposed action;

(2) The appeal involves the termination, suspension, or reduction of previously authorized services;

(3) The services were ordered by an authorized provider; and

(4) The period covered by the original authorization has not expired.

(l) If the MCO’s action is upheld in a hearing, the MCO may institute recovery procedures against the member to recoup the cost of any continued benefits furnished to the member.

(m) The MCO grievance process shall not preclude a member’s ability to pursue client rights protection under He-M 204.

History

#10410, eff 9-13-13; ss by #12537, eff 5-24-18; ss by #13474, eff 10-24-22

N.H. Code Admin. R. Ann. He-W 506.09 Department Fair Hearing Process {#sec-he-w-506.09 omnilex-key=us-nh-regs-official--agency-he-w--He-W 506.09}

(a) A member shall exhaust the MCO appeal process prior to filing a request for a fair hearing with the department, subject to the following:

(1) Grievances shall not be the subject of a department fair hearing; and

(2) The MCO shall have resolved an appeal under He-W 506.08 and provided notice of that resolution prior to the member requesting a fair hearing with the department, except that a member shall be deemed to have exhausted the MCO’s appeal process if the MCO fails to adhere to the notice and timing for expedited and standard appeals as described in He-W 506.08(f), (h), and (j).

(b) If the member does not agree with the MCO’s resolution of an appeal, the member may file a request, in accordance with He-C 200, for a department fair hearing.

(c) Requests for a department fair hearing shall be made in writing within 120 calendar days of the date of the MCO’s notice of the resolution of the appeal.

(d) A member in (b) above may request an expedited resolution of a department fair hearing if the department determines that the time otherwise permitted for a hearing could seriously jeopardize the member’s life, physical or mental health, or ability to attain, maintain, or regain maximum function, and:

(1) The MCO adversely resolved the member’s appeal, wholly or partially; or

(2) The MCO failed to resolve the appeal within 72 hours and failed to extend the 72-hour deadline in accordance with 42 CFR 438.408(c) and He-W 506.08(i).

(e) The department shall notify the member as expeditiously as possible as to whether the request for an expedited department fair hearing is granted or denied. If oral notice is provided, the department shall follow up with written notice, which might be made through electronic means.

(f) If the department denies the member’s request for an expedited department fair hearing, the department shall schedule a department fair hearing within 90 days from the date the member filed an MCO appeal not including the number of days the member took to subsequently file for a department fair hearing.

(g) If the department grants the member’s request for an expedited department fair hearing, then the department shall resolve the appeal within 3 business days after the department receives from the MCO the case file and any other necessary information. The MCO shall have no more than 3 days from the date the department notifies the MCO that it has granted the member’s expedited appeal, to provide the case file to the department.

(h) A member’s benefits shall be continued during a department fair hearing if:

(1) The member received benefits pending the MCO appeal; and

(2) The member requests a department fair hearing and continuation of benefits within 10 calendar days of the date the MCO sends the notice of adverse decision of an MCO appeal to the member.

(i) If the member did not receive benefits pending the MCO appeal, then a member’s benefits shall be continued during a department fair hearing if:

(1) The member requests a department fair hearing within 10 calendar days of the date the MCO mails the notice of decision adverse to the member;

(2) The member requests continuation of benefits pending the department fair hearing;

(3) The department fair hearing involves the termination, suspension, or reduction of a previously authorized service;

(4) The service was ordered by an authorized provider; and

(5) The original authorization period for the service has not expired.

(j) Only the member, the member’s authorized representative, or the member’s legal guardian may request benefits pending a department fair hearing of a MCO decision.

(k) Providers acting as an authorized representative shall not request continuation of benefits pending the appeal even with written consent.

(l) If the MCO’s adverse decision is upheld in a department fair hearing, the MCO may institute recovery procedures against the member to recoup the cost of any continued benefits furnished to the member.

History

#10410, eff 9-13-13; ss by #12537, eff 5-24-18; ss by #13474, eff 10-24-22

Part He-W 507 Medical Assistance for Children with Severe Disabilities

N.H. Code Admin. R. Ann. He-W 507.01 Definitions {#sec-he-w-507.01 omnilex-key=us-nh-regs-official--agency-he-w--He-W 507.01}

(a) “Department” means the New Hampshire department of health and human services.

(b) “Medical review team (MRT)” means a team of medical professionals, comprised of physicians and registered nurses with expertise in the care of children with special health care needs, developmental disabilities and behavioral issues, who determine medical eligibility for healthy kids-gold medical assistance in accordance with the criteria set forth in He-W 507 and He-W 508.

(c) “Medicaid” means the Title XIX and Title XXI programs administered by the department which makes medical assistance available to eligible individuals.

(d) “Recipient” means any individual who is eligible for and receiving medical assistance under the medicaid program.

(e) “Title XIX” means the joint federal-state program described in Title XIX of the Social Security Act and administered in New Hampshire by the department under the medicaid program.

(f) “Title XXI” means the joint federal-state program described in Title XXI of the Social Security Act and administered in New Hampshire by the department under the medicaid program.

History

(See Revision Note at chapter heading He-W 500); ss by #5941, eff 12-22-94, EXPIRED: 12-22-02
#7867, eff 4-10-03; ss by #9866, eff 2-11-11; amd by #10139, eff 7-1-12

N.H. Code Admin. R. Ann. He-W 507.02 Recipient Eligibility {#sec-he-w-507.02 omnilex-key=us-nh-regs-official--agency-he-w--He-W 507.02}

Title XIX services shall be available to children with disabilities who:

(a) Are under the age of 19;

(b) Meet the requirements of He-W 641.04;

(c) Are chronically ill or impaired, whose illness or disability does not require the level of care provided in an inpatient facility, but whose condition requires ongoing and regular medical monitoring and treatment; and

(d) Have a severe disability which includes at least one of the following:

(1) A developmental disability as defined in RSA 171-A:2,V;

(2) A chronic, degenerative, progressive, or life-threatening condition causing impairment of a vital organ function which requires ongoing and regular medical monitoring;

(3) A sensory impairment which is expected to continue indefinitely, including a hearing loss established by audiometry which functionally impacts the child;

(4) A mental illness, emotional disturbance or behavioral disorder which functionally impacts his or her psychosocial adjustment and the diagnosis for which is recognized by the American Psychiatric Association;

(5) An acquired childhood disease which functionally impacts the child; or

(6) A genetic disorder or congenital anomaly requiring ongoing medical monitoring.

History

(See Revision Note at chapter heading He-W 500); ss by #5941, eff 12-22-94, EXPIRED: 12-22-02
#7867, eff 4-10-03; ss by #9866, eff 2-11-11

N.H. Code Admin. R. Ann. He-W 507.03 Continued Eligibility {#sec-he-w-507.03 omnilex-key=us-nh-regs-official--agency-he-w--He-W 507.03}

(a) The MRT shall conduct periodic redeterminations of medical eligibility for Title XIX benefits based on current evidence of the child’s disability.

(b) At the time of redetermination, the MRT shall first determine whether the recipient meets the eligibility criteria in accordance with He-W 507.02.

(d) If an adverse eligibility determination is made, the written notice to the recipient shall include the following information:

(1) The recipient’s identifying information;

(2) A listing of the medical and non-medical reports considered during the disability determination process;

(3) A statement of the department’s action;

(4) The reasons for the department’s action;

(5) Citations from federal and state statutes and regulations supporting the department’s actions; and

(6) An explanation of the individual’s rights to appeal the department’s disability determination and to reapply for medical assistance.

(e) The department shall continue the recipient’s medical eligibility after an adverse medical eligibility determination is made when the recipient:

(1) Submits a hearing request to the local district office within 30 days from the date on the written notice of adverse decision; and

(2) Submits a request to the local district office for a continuation of benefits during the appeal process within 10 days of the date on the written notice of adverse decision.

History

(See Revision Note at chapter heading He-W 500); ss by #5941, eff 12-22-94, EXPIRED: 12-22-02
#7867, eff 4-10-03; ss by #9866, eff 2-11-11

N.H. Code Admin. R. Ann. He-W 507.04 Termination of Medical Eligibility {#sec-he-w-507.04 omnilex-key=us-nh-regs-official--agency-he-w--He-W 507.04}

The department shall terminate medical eligibility after an adverse medical eligibility determination is made when:

(a) The MRT determines that the recipient no longer meets the eligibility criteria specified in He-W 507.02; and

(b) The recipient fails to submit a continuation of benefits request to the local district office within 10 days from the date of written notice of adverse decision.

History

#7867, eff 4-10-03; ss by #9866, eff 2-11-11

N.H. Code Admin. R. Ann. He-W 507.05 Appeals {#sec-he-w-507.05 omnilex-key=us-nh-regs-official--agency-he-w--He-W 507.05}

(a) Individuals may appeal an adverse disability determination, pursuant to RSA 541-A:31, III and He-C 200.

(b) Individuals must submit the written request for a hearing to the local district office pursuant to RSA 541-A:31, III and He-C 200 within 30 days from the date of the notice of decision.

History

#7867, eff 4-10-03; ss by #9866, eff 2-11-11

Part He-W 508 Medical Assistance for Home Care of Certain Children with Severe Disabilities

N.H. Code Admin. R. Ann. He-W 508.01 Purpose {#sec-he-w-508.01 omnilex-key=us-nh-regs-official--agency-he-w--He-W 508.01}

The purpose of family centered community-based home care shall be to support, but not supplant, the recipient’s family as the primary caregiver.

History

(See Revision Note at chapter heading He-W 500); ss by #5941, eff 12-22-94, EXPIRED: 12-22-02
#8196, INTERIM, eff 10-29-04, EXIRED: 7-1-05
#9291, eff 7-1-09

N.H. Code Admin. R. Ann. He-W 508.02 Definitions {#sec-he-w-508.02 omnilex-key=us-nh-regs-official--agency-he-w--He-W 508.02}

(a) “Degree of care” means the level of intensity or extent of medical care, treatment, or intervention required by the child as determined by the medical setting in which the child is being evaluated.

(b) “Department” means the New Hampshire department of health and human services.

(c) “Family centered community-based home care” means an organized network of integrated and coordinated services delivered at the local level which promotes normal patterns of living and which recognizes the pivotal role of families with respect to the provision of services for their children.

(d) “Joint medical review team (MRT)” means a team of medical professionals, comprised of physicians and registered nurses with expertise in the care of children with special health care needs, developmental disabilities, and behavioral issues, that determines if home care services are medically appropriate in accordance with RSA 167:3-f, VI, and the most appropriate level of care under which to evaluate the child in accordance with RSA 167:3-g, III–VI.

(e) “Medicaid” means the Title XIX and Title XXI programs administered by the department which makes medical assistance available to eligible individuals.

(f) “Recipient” means any individual who is eligible for and receiving medical assistance under the medicaid program.

(g) “Title XIX” means the joint federal-state program described in Title XIX of the Social Security Act and administered in New Hampshire by the department under the medicaid program.

(h) “Title XXI” means the joint federal-state program described in Title XXI of the Social Security Act and administered in New Hampshire by the department under the medicaid program.

History

(See Revision Note at chapter heading He-W 500); ss by #5941, eff 12-22-94; amd by #6198, eff 2-28-96, all EXPIRED: 12-22-02 except (b)(3) EXPIRED: 2-28-04
#8196, INTERIM, eff 10-29-04, EXIRED: 7-1-05
#9291, eff 7-1-09 (from He-W 508.01); amd by #10139, eff 7-1-12

N.H. Code Admin. R. Ann. He-W 508.03 Recipient Eligibility {#sec-he-w-508.03 omnilex-key=us-nh-regs-official--agency-he-w--He-W 508.03}

(a) In accordance with RSA 167:3-e, III, and RSA 167:3-f, III (a)–(f), recipients shall be eligible for medical assistance for home care of children with severe disabilities (HC-CSD), if the recipient:

(1) Resides in a place maintained as the recipient’s home community;

(2) Is able to receive services in the home as defined in 45 CFR 233.90(c)(1)(v)(B);

(3) Meets the program criteria described in Section 1902(e)(3) of the Social Security Act;

(4) Meets the criteria described in He-W 641.04, except that, pursuant to the prohibition in Section 1614(f)(2)(B) of the Social Security Act, the criteria described in He-W 641.04(b)-(e) on the deeming of parental income shall not apply;

(5) Has an impairment, or combination of impairments, that meets, medically equals, or functionally equals the criteria for an impairment as described in 20 CFR, Part 404, Subpart P, App. 1;

(6) Meets the medical criteria pursuant to RSA 167:3-f, III(e); and

(7) Requires the same degree of care that is typically provided in a hospital, psychiatric hospital, nursing facility, or intermediate care facility for the mentally retarded (ICF-MR), in accordance with He-W 508.04.

(b) In addition to (a) above, recipients shall be eligible only if the services proposed for the recipient are:

(1) Medically appropriate in accordance with He-W 508.05; and

(2) Cost effective in accordance with He-W 508.06.

History

(See Revision Note at chapter heading He-W 500); ss by #5941, eff 12-22-94, EXPIRED: 12-22-02
#8196, INTERIM, eff 10-29-04, EXIRED 7-1-05
#9291, eff 7-1-09 (from He-W 508.02)

N.H. Code Admin. R. Ann. He-W 508.04 Degree of Care {#sec-he-w-508.04 omnilex-key=us-nh-regs-official--agency-he-w--He-W 508.04}

The most appropriate degree of care under which to evaluate the recipient’s eligibility per He-W 508.03(a)(7) above shall be determined as follows:

(a) The MRT shall review, in accordance with RSA 167:3-g, II, the recipient’s medical condition and community care needs; and

(b) Based upon the review in (a) above, the MRT shall:

(1) Determine that the degree of care provided by a hospital is appropriate for the recipient, if all of the criteria in RSA 167:3-g, III, are met;

(2) Determine that the degree of care provided by a psychiatric hospital is appropriate for the recipient, if all of the criteria in RSA 167:3-g, IV, are met;

(3) Determine that the degree of care provided by a nursing facility is appropriate for the recipient, if any one of the criteria in RSA 167:3-g, V, is met; or

(4) Determine that the degree of care provided by an ICF-MR is appropriate for the recipient, if all of the criteria in RSA 167:3-g, VI, are met.

History

#9291, eff 7-1-09 (from He-W 508.03)

N.H. Code Admin. R. Ann. He-W 508.05 Medically Appropriate Services {#sec-he-w-508.05 omnilex-key=us-nh-regs-official--agency-he-w--He-W 508.05}

(a) The medical services proposed for a recipient shall be medically appropriate if the MRT, upon certification by the recipient’s physician, determines in accordance with (b) below, that it is medically appropriate for the recipient to receive family centered, community-based home care as opposed to institutional care.

(b) In accordance with RSA 167:3-f, VI, family centered, community-based home care shall be medically appropriate if each of the following conditions is met:

(1) The care can be provided in the home without jeopardizing the medical needs of the recipient;

(2) Medical and psychological support services are available in the community;

(3) The recipient’s treating physician recommends home care and certifies the safety of home placement in accordance with (c) below;

(4) The recipient’s family or guardian has expressed a willingness and desire to assume responsibility as the primary caregiver for the recipient in order to maintain the recipient at home; and

(5) The family and household members have been trained to support the recipient’s needs in the home and have the ability to be primary caregivers.

(c) The treating physician’s recommendation of home care and certification of the safety of home placement shall be submitted in writing by mail, electronic mail, or facsimile to the department or via direct telephone conversation with the MRT.

(d) The written certification in (c) above, or MRT documentation of direct telephone conversation with the treating physician as per (c) above, shall be maintained in the recipient’s case file at the department.

History

#9291, eff 7-1-09

N.H. Code Admin. R. Ann. He-W 508.06 Monitoring and Determination of Cost Effectiveness {#sec-he-w-508.06 omnilex-key=us-nh-regs-official--agency-he-w--He-W 508.06}

(a) In accordance with RSA 167:3-e, IV, the medical services proposed for a recipient shall be cost effective if the estimated cost of care outside an institution is no higher than the estimated medicaid cost of appropriate institutional care.

(b) For each recipient, cost effectiveness shall be monitored monthly and determined annually by the department as follows:

(1) The department shall obtain Title XIX payment data on the costs paid by Title XIX for the recipient’s home care from the department’s cost reports generated for each recipient from the Medicaid Management Information System (MMIS);

(2) For each recipient, the items or services included in the home care cost data in (1) above shall include only those items or services listed in (c) below;

(3) The items or services included in (d) below shall not be included in home care cost data for (1) above, or in institutional cost of care data in (c) below;

(4) The department shall utilize, as institutional cost of care data, the most recently published inpatient per diem Title XIX rates for hospitals, psychiatric hospitals, nursing facilities, or ICF-MR;

(5) The department shall determine the per diem rate to use as the recipient’s institutional cost of care by selecting the rate for the facility in (4) above that most closely corresponds to the degree of care determined and utilized for the recipient’s eligibility determination pursuant to He-W 508.04; and

(6) The department shall compare the costs of the recipient’s home care to the recipient’s institutional cost of care, as determined in He-W 508.06(b)(1)–(b)(5).

(c) The costs associated with the following categories of service, which are included in an institution’s per diem rate, shall be the only costs utilized in determining the costs incurred for the recipient’s home care in accordance with He-W 508.06(b)(1) and (2) above:

(1) Mental health services, including psychotherapy and community mental health center services;

(2) Family planning services;

(3) Drugs which are included in the per diem of the institution in (b)(4) above that is utilized in the calculation in (b)(6) above;

(4) Durable medical equipment;

(5) Medical supplies;

(6) Dental services;

(7) Private duty nursing services;

(8) Physical therapy;

(9) Occupational therapy;

(10) Speech therapy;

(11) Care provided through the Home and Community Based Care for the Developmentally Disabled waiver in accordance with He-M 517, with the exception of assistive technology support services, environmental modifications, employment services, respite and specialty services that would not otherwise be included in the institutional per diem rate;

(12) Home and community-based care provided through the In Home Supports Waiver for Children with Developmental Disabilities in accordance with He-M 524, with the exception of environmental modifications, respite, and consultative services not otherwise included in the institutional per diem rate;

(13) Case management services;

(14) Home health; and

(15) Early supports and services.

(d) Costs associated with the following categories of service, which are not included in an institution’s per diem rate, shall not be included in home care cost data in (b)(1) above or in institutional cost of care data in (c) above:

(1) Inpatient services, including acute psychiatric admissions;

(2) Outpatient services;

(3) Laboratory services;

(4) X-ray services;

(5) Medical assistance services provided by education agencies in accordance with He-M 1301;

(6) Ambulance services;

(7) Wheelchair van services;

(8) Audiology services;

(9) Ophthalmology services;

(10) Podiatry services;

(11) Chiropractic services;

(12) Physician services, including services of a psychiatrist;

(13) Advanced registered nurse practitioner services;

(14) DCYF/DJSS medicaid funded services to include private non-medical institutional placement services (PNMI) and residential placement;

(15) Youth development center or other youth detention center placements;

(16) Rural health clinics and federally qualified health centers;

(17) Short term stays of 30 days or less in an intermediate care facility for the mentally retarded or in a nursing facility;

(18) Services provided on an acute or short-term basis, in response to an illness or injury, rather than care for the chronic condition which is the basis for the home care;

(19) Mileage reimbursement; and

(20) Medicaid health insurance premium payments.

History

#9291, eff 7-1-09

N.H. Code Admin. R. Ann. He-W 508.07 Recipient Notification of Cost Effectiveness Monitoring and Determination Results {#sec-he-w-508.07 omnilex-key=us-nh-regs-official--agency-he-w--He-W 508.07}

(a) When the department’s monthly monitoring of cost effectiveness results in an estimated, projected annual home care cost for a recipient which is higher than the appropriate type of institutional care cost, the department shall notify the recipient in writing.

(b) The notification in (a) above shall include:

(1) A reminder of the requirement to maintain annual home care costs at or below the cost of care for the appropriate type of institution pursuant to state and federal law in order to maintain HC-CSD eligibility;

(2) Medicaid payment data showing the recipient’s monitored home care costs and estimated, projected annual home care costs, including a copy of the report used;

(3) The calculated cost of care in an appropriate type of institution for the same time period as in (2) above and the projected annual institutional costs, including identification of the appropriate type of institution; and

(4) Contact information for the department’s care coordination services unit.

(1) For an explanation of the information included in the notification pursuant to (b) above;

(2) To report costs they believe the department should not include in the home care costs; and

(3) To request assistance with reducing the costs of home care or achieving cost effectiveness pursuant to He-W 508.06(a).

(d) For each state fiscal year ending June 30, the department shall complete an annual determination of cost effectiveness for each recipient pursuant to He-W 508.06(b).

(e) If the department’s annual determination of cost effectiveness indicates that home care costs are higher than the costs of the appropriate type of institutional care, the department shall provide written notice to the recipient within 30 days of the determination.

(f) The written notice pursuant to (e) above shall include:

(1) A statement that annual cost effectiveness has not been demonstrated;

(2) A statement that the recipient is required to reduce and maintain annual home care costs at or below the cost of care for the appropriate type of institution pursuant to state and federal law in order to maintain HC-CSD eligibility;

(3) Medicaid payment data showing the recipient’s annual home care costs and a copy of the report used;

(4) The calculated annual cost of care in an appropriate type of institution, including identification of the appropriate type of institution;

(5) A statement that the recipient’s family or guardian shall submit and implement a written plan for reducing costs in accordance with (f)(2) within 3 months of the date of the notice in (e) above;

(6) Contact information for the department’s care coordination services unit which the recipient’s family or guardian may use for assistance in identifying any billing errors and in developing the cost reduction plan in (5) above; and

(7) Information that a fair hearing on the requirement to reduce costs may be requested within 30 calendar days of the date on the cost effectiveness annual determination notice, in accordance with He-C 200.

(g) If the recipient’s family or guardian requests assistance in accordance with (f)(6) above, the department shall assign a care coordination manager to assist the recipient’s family or guardian.

History

#9291, eff 7-1-09

N.H. Code Admin. R. Ann. He-W 508.08 Cost Reduction Plans {#sec-he-w-508.08 omnilex-key=us-nh-regs-official--agency-he-w--He-W 508.08}

(a) The department shall continue to monitor cost effectiveness monthly and determine it annually in accordance with He-W 508.06, for recipients who submit and implement a cost reduction plan in accordance with He-W 508.07(f)(5).

(b) The department shall terminate a recipient’s medical eligibility for HC-CSD if:

(1) The recipient submits a cost reduction plan that does not demonstrate cost effectiveness in accordance with He-W 508.07(f)(2);

(2) The recipient submits a cost reduction plan that demonstrates cost effectiveness, but does not implement the cost effectiveness plan in accordance with He-W 508.07(f)(5); or

(3) The recipient does not submit a cost reduction plan in accordance with He-W 508.07(f)(5).

(c) A recipient’s termination of medical eligibility for HC-CSD, in accordance with (b) above, shall be effective 30 days after the due date of the written plan in He-W 508.07(f)(5).

(d) The recipient shall receive a written notice of termination of medical eligibility on department Form 272hc, “Termination of Medical Eligibility for HC-CSD,” including:

(1) The reason for, and legal basis of, the termination;

(2) Information that a fair hearing on the termination may be requested within 30 calendar days of the date on the notice of termination, in accordance with He-C 200.

(e) The department shall continue the recipient’s medical eligibility after the termination date of medical eligibility in accordance with (b) above when the recipient submits to the local district office both a request for a fair hearing and for a continuation of benefits during the appeal process not later than 10 calendar days from the date on the written notice of termination.

History

#9291, eff 7-1-09

N.H. Code Admin. R. Ann. He-W 508.09 Continued Medical Eligibility for HC-CSD {#sec-he-w-508.09 omnilex-key=us-nh-regs-official--agency-he-w--He-W 508.09}

(a) The MRT shall conduct reviews of continued medical eligibility for Title XIX benefits based on current evidence of the recipient’s disability or based upon changes in eligibility.

(b) At the time of medical eligibility review, the MRT shall determine whether the recipient meets the eligibility standards in accordance with He-W 508.03 and He-W 508.04.

(c) The department shall issue a written notice to the recipient when a denial of continued medical eligibility is made following a medical eligibility review.

(d) The written notice in (c) above shall include:

(1) The recipient’s identifying information:

(2) A listing of the medical and non-medical reports used for consideration during the medical eligibility review process;

(3) A description of the impairments used for consideration during the medical eligibility review process;

(4) The reasons for the department’s decision;

(5) The legal basis supporting the department’s decision(s);

(6) Information that a fair hearing on the denial of continued medical eligibility may be requested within 30 calendar days of the date on the notice of denial, in accordance with He-C 200; and

(7) Information on how to reapply for medical assistance.

(e) The department shall continue the recipient’s medical eligibility after a denial of continued medical eligibility in accordance with (c) above when the recipient submits to the local district office both a request for a fair hearing and for a continuation of benefits during the appeal process not later than 10 calendar days from the date on the written notice of denial.

History

#9291, eff 7-1-09

N.H. Code Admin. R. Ann. He-W 508.10 Denial or Termination of Medical Eligibility for HC-CSD {#sec-he-w-508.10 omnilex-key=us-nh-regs-official--agency-he-w--He-W 508.10}

The department shall deny or terminate medical eligibility for HC-CSD if:

(a) The MRT, in accordance with He-W 508.09(b), determines that the recipient does not meet the eligibility criteria specified in He-W 508.03 and 508.04; or

(b) Both the following occur:

(1) A cost reduction plan is not acceptable in accordance with He-W 508.08(b); and

(2) The recipient fails to submit a request for a fair hearing and for a continuation of benefits during the appeals process to the local district office within 10 calendar days from the date of written notice of adverse decision or termination.

History

#9291, eff 7-1-09

Part He-W 509 Family Planning Expansion Category (fpec)

N.H. Code Admin. R. Ann. He-W 509.01 Purpose {#sec-he-w-509.01 omnilex-key=us-nh-regs-official--agency-he-w--He-W 509.01}

The purpose of this part is to describe the family planning and family planning-related services and supplies available to individuals who are determined eligible, in accordance with He-W 626, for this expanded Title XIX eligibility category. In accordance with Section 1902(a)(10)(A)(ii) of the Social Security Act, 42 U.S.C. 1396a(a)(10)(A)(ii), FPEC recipients shall not be eligible for any other Title XIX services, except as provided for in this part.

History

#10357, eff 7-1-13

N.H. Code Admin. R. Ann. He-W 509.02 Definitions {#sec-he-w-509.02 omnilex-key=us-nh-regs-official--agency-he-w--He-W 509.02}

(a) “Department” means the New Hampshire department of health and human services.

(b) “Family planning expansion category” means a category of recipients who meet the technical eligibility requirements established by the department for the family planning services and/or family planning-related services specified in this part, but who are not eligible for any other Title XIX services not specified in He-W 509.

(c) “Family planning-related services” means certain medical diagnosis and treatment services and pharmaceutical supplies that are provided pursuant to a family planning service in a family planning setting and that do not receive an enhanced rate of 90% federal match.

(d) “Family planning services” means family planning services and supplies described in section 1905(a)(4)(c) of the Social Security Act, 42 U.S.C. 1396d(a)(4)(c), including medical services, medical procedures, and pharmaceutical supplies and devices provided by or under the supervision of a physician or other health professional that allow an individual to prevent or delay pregnancy or to otherwise control family size, and which receive an enhanced match rate of 90% federal match.

(e) “Hysterectomy” means a surgical procedure for the purpose of removing the uterus.

(f) “Institutionalized individual” means “institutionalized individual” as defined in 42 CFR 441.251.

(g) “Mentally incompetent individual” means “mentally incompetent individual” as defined in 42 CFR 441.251.

(h) “Sterilization” means any medical procedure, treatment, or surgical procedure which is intended to render an individual permanently incapable of reproducing.

(i) “Title XIX program” means the joint federal-state program described in Title XIX of the Social Security Act.

History

#10357, eff 7-1-13

N.H. Code Admin. R. Ann. He-W 509.03 Eligibility {#sec-he-w-509.03 omnilex-key=us-nh-regs-official--agency-he-w--He-W 509.03}

(a) Individuals shall be eligible for family planning services and family planning-related services, as described in He-W 509.06(b) and (c) below, respectively, and in accordance with He-W 509 if the individual:

(1) Meets the division of family assistance eligibility requirements specified in He-W 626;

(2) Once determined eligible in accordance with (1) above, the FPEC recipient has reached reproductive maturity; and

(3) If female, is not known to be pregnant.

(b) Acceptance of any family planning services shall be voluntary on the part of the individual.

(c) FPEC recipients shall not be considered to be Title XIX recipients for the purposes of receipt of services other than those as described in He-W 509.

History

#10357, eff 7-1-13

N.H. Code Admin. R. Ann. He-W 509.04 Provider Participation {#sec-he-w-509.04 omnilex-key=us-nh-regs-official--agency-he-w--He-W 509.04}

All participating family planning providers shall be:

(a) Licensed by the state in which s/he practices or be a NH certified midwife; and

(b) A New Hampshire enrolled Title XIX provider.

History

#10357, eff 7-1-13

N.H. Code Admin. R. Ann. He-W 509.05 Service Limits {#sec-he-w-509.05 omnilex-key=us-nh-regs-official--agency-he-w--He-W 509.05}

Family planning services and family planning-related services for FPEC recipients shall be subject to the limits described in He-W 530.

History

#10357, eff 7-1-13

N.H. Code Admin. R. Ann. He-W 509.06 Covered Services {#sec-he-w-509.06 omnilex-key=us-nh-regs-official--agency-he-w--He-W 509.06}

(a) The services in (b) and (c) below shall be covered as family planning services and family planning-related services, respectively, only if the services, supplies, and procedures are clearly provided or performed for family planning purposes.

(b) The following services shall be covered as family planning services:

(1) Those physician services in accordance with He-W 531, certified midwife services in accordance with He-W 538, and advanced registered nurse practitioner services in accordance with He-W 534, provided for family planning purposes;

(2) Contraceptive devices or drugs, both prescription and non-prescription, in accordance with He-W 570;

(3) Pregnancy tests and screening for a sexually transmitted disease (STD) only when performed routinely as part of an initial, regular, or follow-up family planning visit; and

(4) Sterilization, in accordance with 42 CFR 441.253 and 42 CFR 441.254, as follows:

a. The FPEC recipient shall be at least 21 years old at the time consent is obtained;

b. The FPEC recipient shall not be a mentally incompetent individual;

c. The FPEC recipient shall not be an institutionalized individual;

d. The FPEC recipient shall voluntarily give informed consent in accordance with the requirements at 42 CFR 441.257 through 42 CFR 441.258;

e. The provider shall submit a sterilization consent form meeting the requirements of 42 CFR 441, Subpart F, to the department prior to the department’s payment for the sterilization claim;

f. At least 30 days, but not more than 180 days, shall have passed between the date of informed consent and the date of sterilization, with the exception of cases of premature delivery or emergency abdominal surgery as described in g. below;

g. A FPEC recipient may consent to be sterilized at the time of an emergency abdominal surgery if at least 72 hours have passed since he or she gave informed consent for the sterilization; and

h. Treatment of surgical or anesthesia-related complications resulting from or during a covered sterilization procedure shall be covered; and

(5) Family planning-related services that were provided as part of, or as follow-up to, a family planning visit in which a sterilization procedure took place.

(1) Services to treat adverse reactions to, or medical complications of, family planning procedures, services, treatments, or therapies including, but not limited to:

a. Treatment of perforated uterus due to an intrauterine device insertion; and

b. Treatment of severe menstrual bleeding caused by Depo-Provera injection;

(2) Drugs, in accordance with the following:

a. Drugs shall be for the treatment of STDs, except for HIV/AIDS and hepatitis, when the STD is identified or diagnosed during a routine or periodic family planning visit; and

b. Title XIX providers shall comply with the provisions of He-W 570 regarding pharmaceutical services when prescribing or dispensing drugs covered in a. above;

(3) A follow-up visit after prescribing drugs for the treatment of an STD, including a re-screen for the STD;

(4) Drugs and other treatment for lower genital tract and genital skin infections/disorders, and urinary tract infections, when the infection/disorder is identified/diagnosed during a routine/periodic family planning visit;

(5) A follow-up visit for drugs and other treatment of the lower genital tract and genital skin infections or disorders where the infections or disorder is identified during a family planning visit; and

(6) Vaccinations to prevent cervical cancer that are routinely provided pursuant to a family planning service in a family planning setting.

History

#10357, eff 7-1-13

N.H. Code Admin. R. Ann. He-W 509.07 Non-Covered Services {#sec-he-w-509.07 omnilex-key=us-nh-regs-official--agency-he-w--He-W 509.07}

The following services shall not be covered as family planning or family planning-related services:

(a) Sterilizations which do not meet the requirements of He-W 509.06(b)(4) above;

(b) Hysterectomies;

(d) Medical, surgical, or pharmaceutical treatment for the purpose of enhancing, promoting, or restoring fertility;

(e) Diagnostic examination of the cervix or vagina by means of a special microscope, colposcopy, biopsy, or cryotherapy of the cervix or vagina; and

(f) Any medical service, procedure, or pharmaceutical supply or device provided to a FPEC recipient who is known to be pregnant.

History

#10357, eff 7-1-13

N.H. Code Admin. R. Ann. He-W 509.08 Transportation {#sec-he-w-509.08 omnilex-key=us-nh-regs-official--agency-he-w--He-W 509.08}

(a) FPEC recipients shall be ensured assistance with locating or being reimbursed for transportation to Title XIX providers in order to access necessary family planning and family planning-related services described in He-W 509.

(b) FPEC recipients who wish to be reimbursed for transportation shall:

(1) Enroll in the transportation provider system in accordance with He-W 574.10(b)–(e); and

(2) Be known as a recipient driver only for enrollment and payment purposes.

(1) Transportation shall be to in-state or border Title XIX enrolled providers, except as described in (2) below;

(2) Transportation to out-of-area providers shall be authorized in advance in accordance with He-W 574.08;

(3) There is no transportation available free of charge or payable by any other agency;

(4) Only one trip per day, whether one-way or round-trip, shall be covered;

(5) Only the actual number of miles driven from the individual’s residence to the Title XIX provider and return to individual’s residence shall be reimbursed; and

(6) Transportation shall be to the nearest available provider of the necessary covered family planning services or family planning-related services via the shortest, most economical route, as described in He-W 574.14(b).

(d) FPEC recipients shall submit transportation claims in accordance with He-W 574.06.

(e) The above transportation claims shall be paid in accordance with He-W 574.07.

(f) The provisions of He-W 574.12 and He-W 574.14 regarding hearings and utilization review and control shall apply to FPEC recipients.

(g) FPEC recipients who request transportation assistance via wheelchair van in order to access family planning services or family planning-related services shall qualify for wheelchair van transportation if they meet the requirements in He-W 573.02(a)(1) and (2), except that eligibility as an FPEC recipient shall be substituted for the requirements in He-W 573.02(a) to be a Title XIX recipient.

(h) FPEC recipients utilizing wheelchair van transportation shall be subject to the provisions of He-W 573.04, He-W 573.10, He-W 573.11, and He-W 573.12 regarding service limits, prior authorization to exceed service limits, utilization review and control, and third party liability.

(i) FPEC recipient shall utilize Title XIX enrolled wheelchair van providers who meet the requirements of He-W 573.

(j) FPEC recipients shall be eligible to be transported by volunteer drivers in accordance with He-W 574 only for the purpose of accessing family planning services or family planning-related services.

History

#10357, eff 7-1-13

N.H. Code Admin. R. Ann. He-W 509.09 Co-Payments {#sec-he-w-509.09 omnilex-key=us-nh-regs-official--agency-he-w--He-W 509.09}

Co-payments for family planning pharmaceutical products shall not be required.

History

#10357, eff 7-1-13

N.H. Code Admin. R. Ann. He-W 509.10 Utilization Review and Control {#sec-he-w-509.10 omnilex-key=us-nh-regs-official--agency-he-w--He-W 509.10}

The department’s surveillance and utilization review of subsystems unit (SURS) shall monitor utilization of family planning services in accordance with 42 CFR 455 and 42 CFR 456.

History

#10357, eff 7-1-13

N.H. Code Admin. R. Ann. He-W 509.11 Third Party Liability {#sec-he-w-509.11 omnilex-key=us-nh-regs-official--agency-he-w--He-W 509.11}

All third party obligations shall be exhausted before Title XIX shall be billed, in accordance with 42 CFR 433.139.

History

#10357, eff 7-1-13

N.H. Code Admin. R. Ann. He-W 509.12 Payment for Services {#sec-he-w-509.12 omnilex-key=us-nh-regs-official--agency-he-w--He-W 509.12}

(a) Rates of payment for family planning and family planning-related services shall be established by the department in accordance with RSA 161:4, VI(a).

(b) The provider shall submit claims for payment to the department’s fiscal agent.

History

#10357, eff 7-1-13

Part He-W 511 Health Insurance Premium Payment Program (hipp)

N.H. Code Admin. R. Ann. He-W 511.01 Purpose {#sec-he-w-511.01 omnilex-key=us-nh-regs-official--agency-he-w--He-W 511.01}

The purpose of this part is to describe the requirements for enrollment in the health insurance premium payment program (HIPP), which uses medicaid funds to purchase employer group health plan coverage on behalf of a medicaid recipient, as allowed by 42 USC §1396e.

History

#10632, eff 7-1-14; ss by #14075, eff 9-20-24, EXPIRES: 9-20-34

N.H. Code Admin. R. Ann. He-W 511.02 Scope {#sec-he-w-511.02 omnilex-key=us-nh-regs-official--agency-he-w--He-W 511.02}

This part shall apply to all medicaid and children’s health insurance program (CHIP) members. Enrollment in HIPP shall be voluntary for all medicaid recipients.

History

#10632, eff 7-1-14; ss by #14075, eff 9-20-24, EXPIRES: 9-20-34

N.H. Code Admin. R. Ann. He-W 511.03 Definitions {#sec-he-w-511.03 omnilex-key=us-nh-regs-official--agency-he-w--He-W 511.03}

(a) “Cost effective” means that the cost to enroll an individual in an employer group health plan is likely to be less than the average medicaid expenditures for medicaid recipients with the same category of assistance, age, and sex.

(b) “Cost effectiveness test” means the method by which the department determines if a recipient’s employer group health plan costs less than the expected medicaid expenditure.

(d) “Employer group health plan” means any plan of, or contributed to by, an employer, including a self-insured plan, to provide health care to the employer’s employees, former employees, or the families of employees or former employees, and which meets section 5000(b)(1) of the Internal Revenue Code of 1986, and includes continuation coverage pursuant to Title XXII of the Public Health Services Act, section 4980B of the Internal Revenue Code of 1986, or Title VI of the Employee Retirement Income Security Act of 1974.

(e) “Health insurance premium payment program (HIPP)” means a state and federal cost savings program administered by the department consistent with 42 U.S.C 1396e , which permits the use of medicaid funds to purchase employer group health plan coverage on behalf of eligible medicaid recipients if deemed cost effective.

(f) “Medicaid” means the Title XIX and Title XXI programs administered by the department, which makes medical assistance available to eligible individuals.

(g) “Policyholder” means the family member who owns the employer group health plan policy and is responsible for premium payment.

(h) “Wrap-around services” means to the extent that an employer group health plan does not cover a benefit contained in the NH state medicaid benefit package, the service is covered by traditional medicaid so that the individual has access to the same services to which they are entitled if they were only covered by the state’s medicaid program.

History

#10632, eff 7-1-14; ss by #14075, eff 9-20-24, EXPIRES: 9-20-34

N.H. Code Admin. R. Ann. He-W 511.04 Recipient Participation {#sec-he-w-511.04 omnilex-key=us-nh-regs-official--agency-he-w--He-W 511.04}

(a) Participation in HIPP shall be voluntary and determined to be cost effective for the state medicaid program.

(b) Pending the determination of cost effectiveness, the medicaid recipient shall be eligible to receive medicaid covered services through the medicaid fee-for-service program, or through the managed care program.

(1) The insurance plan is an indemnity plan that pays only a predetermined amount for covered services, such as dental or vision only plans, or long-term care plans;

(2) The insurance plan is a school-based plan offered based on attendance or school enrollment;

(3) The individual is only eligible for medicaid through in and out medical assistance in accordance with He-W 878.01;

(4) The insurance plan is only offered for a temporary time period;

(5) The eligible individual does not qualify for full medicaid benefits;

(6) The insurance plan is through New Hampshire’s high-risk pool;

(7) The insurance plan is a medicare supplemental policy, if the HIPP application was filed after March 1, 1996;

(8) The insurance plan is COBRA;

(9) The medicaid recipient is or becomes eligible for medicare;

(10) No portion of the insurance plan premiums is paid for by the employer; or

(11) The employer benefit package is a cafeteria plan and the employer does not contribute a percentage of the benefit package to the employer group health plan premium that the employee contributes.

(d) Premiums for dental plans shall not be covered by HIPP unless the employer plan premium does not separate the dental portion.

(e) The policyholder of the insurance plan shall provide information necessary to establish the cost effectiveness of the employer group health plan including but not limited to the following:

(1) Health plan information, such as the plan name and policy number;

(2) Premium liability, which is the portions of the premium that is paid by the policyholder and employer;

(3) Co-insurance, which is the policyholder’s share of the cost of a covered health care services, and is generally calculated as a percentage of the total charge for the service;

(4) Deductible, which is the amount the policyholder must pay for health care services before the employer group health plan begins to pay;

(5) Co-pay liability, which is a fixed amount the policyholder pays for a health care service, and generally paid for at the time the services are rendered;

(6) Covered benefits and services;

(7) Any service limits applied to the benefit and service use by the health plan; and

(8) Demographic information relative to other individuals on the policyholder’s plan, including name, gender, and age.

(f) In addition to the information listed in (e)(1)-(8) above, the policyholder shall also provide employer and employment information to the department to include:

(1) The employer’s business name; and

(2) Contact information for the employer's human resource department.

(g) A HIPP application shall not be processed until all information in (e) and (f) above are submitted.

(h) If the department or the department’s vendor determines that the employer group health plan is cost effective, the medicaid recipient shall:

(1) Enroll in the health plan within 15 days of receiving notification from the department or the department’s vendor that the plan is cost effective, if not already enrolled; and

(2) Upon enrollment, provide the department or the department’s vendor with confirmation of the start date of coverage.

(i) In the event that the mediciad recipient is already enrolled in cost effective group health plan prior to applying for HIPP, then the HIPP premium payments shall begin the month following HIPP approval notification.

(j) If the department or the department’s vendor determines that the group health plan is not cost effective, the medicaid recipient shall remain enrolled in their medicaid care management program or fee for service program in accordance with He-W 506.

(k) The department shall not pay premiums when the department determines the employer group health plan is not cost effective, even if the non-medicaid members are not able to change the employer group health plan.

(l) Enrollment in an employer group health plan shall not change the individual’s eligibility for medicaid benefits.

History

#10632, eff 7-1-14; ss by #14075, eff 9-20-24, EXPIRES: 9-20-34

N.H. Code Admin. R. Ann. He-W 511.05 Cost Effectiveness Determination {#sec-he-w-511.05 omnilex-key=us-nh-regs-official--agency-he-w--He-W 511.05}

(a) Cost effectiveness shall be determined by the department utilizing managed care rates.

(b) The cost effectiveness calculation shall be determined as follows:

(1) The average medicaid cost which is the managed care capitation payment at the time a completed HIPP application is received for the category of assistance, age, and gender of the medicaid recipient in the employer group health plan; and

(2) Any additional cost added for the conditions in a. through d. below, paid for under fee for service or additional managed care rates:

a. Blood disorders;

b. Hepatitis C;

c. Disorder of urea cycle metabolism; and

d. Maternity and newborn.

(d) The medicaid cost for included services shall be the percent of the managed care capitation payment, as determined by the actuarial vendor and noted in (b)(1) above, for medicaid only covered services included in the employer group health plan.

(e) Adjustment of coinsurance and deductible shall be 30% of the managed care capitation payment after the reduction for the medicaid only covered services in (b)(2) above.

(f) An employer group health plan shall be considered cost effective when the cost of the employer group health plan is lower than the cost under the medicaid managed care program.

(g) The employer group health plan cost shall be the employee’s share of the premium plus the coinsurance and deductible amount calculated in (e) above.

(h) The medicaid cost shall be determined by the managed care capitation payment in (b)(2) above.

History

#10632, eff 7-1-14; ss by #14075, eff 9-20-24, EXPIRES: 9-20-34

N.H. Code Admin. R. Ann. He-W 511.06 Cost Effectiveness Redetermination {#sec-he-w-511.06 omnilex-key=us-nh-regs-official--agency-he-w--He-W 511.06}

(a) Cost effectiveness shall be redetermined annually concurrent with the policyholder’s annual open enrollment in the employer group health plan, or any time there is a change in the group health plan.

(b) It shall be the responsibility of the policyholder to submit the current employer group health plan, as described in He-W 511.04(e) and (f) above, when employer open enrollment starts, there is a change in the employer group health plan, or there is a change in the family status on the employer group health plan.

History

#10632, eff 7-1-14; ss by #14075, eff 9-20-24, EXPIRES: 9-20-34

N.H. Code Admin. R. Ann. He-W 511.07 Wrap Around Coverage. {#sec-he-w-511.07 omnilex-key=us-nh-regs-official--agency-he-w--He-W 511.07}

(a) If the employer group health plan does not cover the full range of medicaid services, the medicaid recipient shall receive wrap-around services through fee-for-service medicaid.

(b) Non-medicaid eligible family members, covered by the employer group health plan, shall not be eligible to receive wrap around services.

History

#10632, eff 7-1-14; ss by #14075, eff 9-20-24, EXPIRES: 9-20-34

(a) Recipient cost sharing, co-pays, and deductible obligations shall be either paid directly by medicaid to the providers or reimbursed to the recipient or person who paid, if the recipient is a minor.

(b) If the provider is a NH medicaid provider, then the provider shall be required to directly bill NH medicaid for any recipient obligation after the employer group health plan processes the claim in accordance with 42 CFR 433.139.

(c) The recipient, or person who paid, if recipient is a minor, shall be directly reimbursed by the department for services provided by providers not enrolled in medicaid, but in network with the employer group health plan, in which the recipient was unable to obtain the service from a medicaid provider or prescriptions obtained from a mail order pharmacy required by the employer group health plan.

(d) The recipient, or person who paid, if recipient is a minor, shall not be reimbursed for services:

(1) Not covered by NH medicaid; and

(2) If the provider is not in either the medicaid network or employer group health plan network.

(e) The HIPP program shall pay the premium for the minimum coverage group option that allows the medicaid-eligible recipient to be covered.

(f) If a non-medicaid family member is enrolled in the employer group health plan, then medicaid funds shall be expended for payment of premiums, but not for any other cost sharing expenses attributable to the non-medicaid family members.

(g) When more than one cost effective employer group health plan is available, the department shall pay the premium for only one plan, but the policyholder may choose the cost effective plan in which to enroll.

(h) If the medicaid recipient’s health plan offers more services than what is covered under medicaid, the medicaid recipient shall be responsible for any deductibles, coinsurance, and other cost sharing obligations attributable to those services not covered by medicaid.

(i) The medicaid recipient shall be responsible for payment of any nominal medicaid cost sharing amounts permitted under section 1916 of the Social Security Act (SSA).

History

#10632, eff 7-1-14; ss by #14075, eff 9-20-24, EXPIRES: 9-20-34

N.H. Code Admin. R. Ann. He-W 511.09 Loss of Eligibility and Discontinuation of Premium Payments {#sec-he-w-511.09 omnilex-key=us-nh-regs-official--agency-he-w--He-W 511.09}

(a) When the medicaid recipient loses medicaid eligibility, premium payments shall be discontinued as of the month of medicaid ineligibility.

(b) Coverage of any medicaid benefits provided outside the employer group health plan, including any wrap around services, shall end on the date the medicaid recipient loses medicaid eligibility.

(c) If the department determines that the employer group health plan is no longer cost effective, HIPP premium payment shall be discontinued the month following the date of the termination letter or for redeterminations on the renewal date of the employer group health plan.

(d) If the policyholder fails to provide the information necessary to establish ongoing HIPP eligibility within 30 calendar days prior to employer group health plan renewal date, the policyholder shall be terminated from the HIPP program on the date when the insurance plan annually ends.

(e) If the policyholder does not have the employer group health plan renewal information 30 days prior, then the medicaid recipient or policyholder shall notify the department and submit the information within 2 business days of receiving the renewal information.

(f) If the policyholder disenrolls from their cost effective employer group health plan, the premium payments shall be discontinued as of the date of disenrollment.

(g) If the employer group health plan is no longer available or the policy has lapsed, premium payments shall be discontinued as of the effective date of the termination of the coverage.

(h) If the policyholder does not inform the department of the loss of the employer group health plan for any reason or any change in the employer group health plan and received premiums beyond the termination or change of the employer group health plan, the policyholder shall be required to refund to the department any premium and cost sharing over payments.

History

#10632, eff 7-1-14; ss by #14075, eff 9-20-24, EXPIRES: 9-20-34

N.H. Code Admin. R. Ann. He-W 511.10 Third Party Liability {#sec-he-w-511.10 omnilex-key=us-nh-regs-official--agency-he-w--He-W 511.10}

All third party obligations shall be exhausted before claims shall be submitted to the department’s fiscal agent in accordance with 42 CFR 433.139.

History

#10632, eff 7-1-14; ss by #14075, eff 9-20-24

N.H. Code Admin. R. Ann. He-W 511.11 Utilization Review & Control {#sec-he-w-511.11 omnilex-key=us-nh-regs-official--agency-he-w--He-W 511.11}

The department’s provider program integrity unit shall monitor utilization of services to identify, prevent, and correct potential occurrences of fraud, waste, and abuse in accordance with He-W 520, He-W 521, 42 CFR 455, and 42 CFR 456.

History

#10632, eff 7-1-14; ss by #14075, eff 9-20-24, EXPIRES: 9-20-34

N.H. Code Admin. R. Ann. He-W 511.12 Appeals {#sec-he-w-511.12 omnilex-key=us-nh-regs-official--agency-he-w--He-W 511.12}

Notice and appeal rights under 42 CFR 431 subpart E, shall not apply to the HIPP program.

History

#14075, eff 9-20-24, EXPIRES: 9-20-34

Part He-W 512 Alternative Benefit Plan (abp) and Premium Assistance Program

N.H. Code Admin. R. Ann. He-W 512.01 Purpose {#sec-he-w-512.01 omnilex-key=us-nh-regs-official--agency-he-w--He-W 512.01}

The purpose of this part is to describe the alternative benefit plan (ABP) services and the premium assistance program (PAP) available through the medicaid program to the newly eligible population in accordance with the New Hampshire Health Protection Program, RSA 126-A:5, XXIV.

History

#10656, eff 8-15-14; ss by #11012, INTERIM, eff 1-1-16, EXPIRES: 6-29-16; ss by #11119, eff 6-29-16

N.H. Code Admin. R. Ann. He-W 512.02 Definitions {#sec-he-w-512.02 omnilex-key=us-nh-regs-official--agency-he-w--He-W 512.02}

(a) “Alternative benefit plan (ABP)” means the medicaid benchmark or benchmark equivalent coverage described in section 1937 of the Social Security Act.

(b) “Department” means the New Hampshire department of health and human services.

(c) “Medicaid” means the Title XIX and Title XXI programs administered by the department, which makes medical assistance available to eligible individuals.

(d) “Medically frail” means a newly eligible individual who is exempt from mandatory enrollment in the ABP or PAP in accordance with the conditions set forth in 42 CFR § 440.315(f).

(e) “Newly eligible adult” means adults who are eligible for medicaid under the New Hampshire health protection program and the provision of section 1902(a)(10)(A)(i)(VIII) of the Social Security Act of 1935 as amended, 42 USC §1396a(a)(10)(A)(i)(VIII).

(f) “Premium Assistance Program (PAP)” means the Marketplace Premium Assistance Program, established by RSA 126-A:5 which requires that adults eligible for medical assistance under 42 USC § 1396a(a)(10)(A)(i)(VIII) enroll in a cost-effective Qualified Health Plan offered on New Hampshire’s federally facilitated Marketplace, authorized through the Section 1115(a) research and demonstration waiver, # 11-W-00298/1 by the Centers for Medicare and Medicaid Services on March 4, 2015.

(g) “Premium Assistance Program participants (PAP participants)” means those newly eligible adults who are mandatorily required to enroll in a qualified health plan, and those who voluntarily enroll in a qualified health plan.

(h) “Qualified Health Plan (QHP)” means an individual health insurance policy certified by the Centers for Medicare and Medicaid Services (CMS) for sale through New Hampshire’s individual health insurance Marketplace.

(i) “Subluxation” means an incomplete dislocation, off centering, misalignment, fixation, or abnormal spacing of the vertebrae.

(j) “Title XIX” means the joint federal-state program described in Title XIX of the Social Security Act and administered in New Hampshire by the department.

(k) “Title XXI” means the joint federal-state program described in Title XXI of the Social Security Act and administered in New Hampshire by the department.

(l) “Wrap benefits” means:

(1) Non-emergency medical transportation;

(2) Early Periodic Screening Diagnosis and Treatment (EPSDT) services as described in He-W 546, for individuals who are under the age of 21; and

(3) Family planning services and supplies from a medicaid enrolled provider, and adult dental in accordance with He-W 566.04(e) and adult vision services in accordance with He-W 530.03(g).

History

#10656, eff 8-15-14; ss by #11012, INTERIM, eff 1-1-16, EXPIRES: 6-29-16; ss by #11119, eff 6-29-16

N.H. Code Admin. R. Ann. He-W 512.03 Eligibility {#sec-he-w-512.03 omnilex-key=us-nh-regs-official--agency-he-w--He-W 512.03}

(a) All newly eligible individuals shall receive services under the ABP, unless they are medically frail or identify as pregnant after application and opt to receive Medicaid state plan services.

(b) Individuals who are eligible for medicaid through the New Hampshire Health Protection Program (NHHPP) shall be in the PAP unless the individual is exempt or voluntary as described in He-W 512.04(b) and (c) below.

History

#10656, eff 8-15-14; ss by #11012, INTERIM, eff 1-1-16, EXPIRES: 6-29-16; ss by #11119, eff 6-29-16

N.H. Code Admin. R. Ann. He-W 512.04 Enrollment {#sec-he-w-512.04 omnilex-key=us-nh-regs-official--agency-he-w--He-W 512.04}

(a) For individuals who are eligible for PAP, enrollment in a QHP shall be mandatory unless the individual is determined to be exempt as described in (b) below or voluntary as described in (c) and (d) below.

(b) Individuals who are determined to be medically frail as defined in 42 CFR § 440.315(f) shall be exempt from mandatory enrollment with a QHP.

(1) Individuals who are members of a federally recognized Indian tribe or Alaskan natives; and

(2) Individuals who are enrolled in PAP who identify as pregnant after the point of application for medicaid.

(d) The following shall apply to voluntary individuals described in (c) above:

(1) Voluntary individuals shall be enrolled in a QHP unless the individual identifies to the department that he or she is in a voluntary eligibility group as noted in (c) above; and

(2) If, after identifying as being in a voluntary eligibility group, a voluntary individual chooses not to enroll in a QHP, the individual shall be notified by the department and required to choose a medicaid managed care organization (MCO) as described in He-W 506.

(e) The department shall send a notice of QHP plan selection to all individuals eligible for PAP enrollment as indicated in (a) above except those who are exempted from enrollment.

(f) PAP participants shall have 30 days from the date of the QHP plan selection notice in (e) above to select a QHP and to respond to the department’s notice by using the on-line portal NH Electronic Application System (NH EASY) at www.nheasy.nh.gov, calling via telephone at 1-888-901-4999, or contacting the department in person.

(g) Except for voluntary individuals described in (c) and (d) above, PAP participants who fail to select a QHP within 30 days from the date of the notice in (f) above shall be auto-assigned to a QHP.

(h) Auto-assignments with a QHP shall be based on the following criteria:

(1) Personal or family affiliation to a QHP or MCO, if the MCO offers a complementary QHP;

(2) Primary care provider affiliation with a QHP; or

(3) If no assignment can be made utilizing (1)-(2) above, assignment shall be equally distributed among the available QHPs.

(i) PAP participants may request to change the QHP selection without cause, by making a written or oral request to the department at any of the following times:

(1) During the first 30 days following the date of the member’s initial selection of or the auto-assignment to the QHP, or the date the department sends the member confirmation of the individual’s selection or auto-assignment, whichever is later; and

(2) During annual open enrollment.

(j) PAP participants may request to change the QHP selection for cause, by making a written or oral request to the department within 60 days of the occurrence of one of the following events:

(1) PAP participant loses access to the QHP he or she is currently enrolled in because of a permanent move to a county where that QHP is not available;

(2) PAP participant gains or becomes a dependent through marriage, birth, adoption, foster care, child support order, or court order;

(3) PAP participant loses a dependent or is no longer considered a dependent through divorce or legal separation as defined by state law in the state in which the divorce or legal separation occurs, or if the enrollee’s dependent dies;

(4) The department confirms based on a PAP participant’s complaint that the QHP in which the PAP participant is enrolled violated a material provision of its contract in relation to the PAP participant; or

(5) PAP participant’s enrollment or non-enrollment in a QHP is unintentional, inadvertent, or erroneous and is the result of the error, misrepresentation, misconduct, or inaction of an officer, employee, or agent of the department, its instrumentalities, or a non-departmental entity providing enrollment assistance or conducting enrollment activities.

(k) PAP participants shall be dis-enrolled from the PAP program if they identify as medically frail after they were previously determined eligible.

(l) Medically frail individuals shall have the option to enroll with a medicaid MCO to receive the ABP benefit or the state plan medicaid benefit.

(m) Individuals who are voluntary as described in (c) and (d) above shall be enrolled as follows:

(1) Individuals who are enrolled in PAP and identify as pregnant after the point of application for medicaid shall elect to receive either state plan medicaid benefits delivered through a medicaid MCO or remain enrolled in the PAP with a QHP; and

(2) Individuals who are members of a federally recognized Indian tribe or Alaskan natives who elect to dis-enroll from their QHP shall receive ABP benefits delivered through a medicaid MCO.

(n) For PAP participants eligible for medicaid after October 1, 2015, the PAP participant shall receive coverage through fee-for-service medicaid from the date of the eligibility determination until the individual’s enrollment in the QHP becomes effective.

(o) If a PAP participant selects or is auto-assigned to a QHP on or before the 15th of the month, coverage in the QHP shall be begin the first day of the month following the month in which the selection or auto-assignment was made.

(p) If a PAP participant selects or is auto-assigned to a QHP any time after the 15th of the month, coverage in the QHP shall be begin the first day of the second month following the month in which the selection or auto-assignment was made.

History

#10656, eff 8-15-14; ss by #11012, INTERIM, eff 1-1-16, EXPIRES: 6-29-16; ss by #11119, eff 6-29-16

N.H. Code Admin. R. Ann. He-W 512.05 Covered Services {#sec-he-w-512.05 omnilex-key=us-nh-regs-official--agency-he-w--He-W 512.05}

(a) ABP services for NHHPP participants who are medically frail or identify as members of federally recognized Indian tribes or Alaskan natives who choose to opt-out of the PAP shall include the following:

(1) Services described in He-W 506.04(a) and (b);

(2) Substance use disorder (SUD) services as described in He-W 513; and

(3) Chiropractor services, which shall be provided as follows:

a. Chiropractic services shall consist of spinal manipulation and manual medical intervention services, including:

Office visits for:

(i) Assessment;

(ii) Evaluation;

(iii) Spinal adjustments;

(iv) Manipulation; and

(v) Physiological therapy before or in conjunction with spinal adjustments; and

Medically necessary diagnostic laboratory and x-ray tests;

b. Chiropractic services shall not include wellness care; and

c. Chiropractic services shall be limited to 12 visits per recipient, per state fiscal year.

(b) Covered services for PAP participants enrolled with a QHP shall include the following categories of services from a QHP:

(1) Ambulatory patient services;

(2) Emergency services;

(3) Hospitalization;

(4) Maternity and newborn care;

(5) Mental health and substance use disorder services, including behavioral health treatment;

(6) Prescription drugs;

(7) Rehabilitative and habilitate services and devices;

(8) Laboratory services;

(9) Preventive and wellness services and chronic disease management; and

(10) Pediatric services including oral and vision care.

(c) PAP participants shall receive benefits described in (b) above from a QHP, and shall be restricted to using the QHP provider networks except that PAP participants shall not be restricted in their choice of family planning providers if the family planning provider is enrolled with medicaid.

(d) PAP participants shall receive fee for service wrap benefits as defined in He-W 512.02(l) above.

History

#10656, eff 8-15-14; ss by #11012, INTERIM, eff 1-1-16, EXPIRES: 6-29-16; ss by #11119, eff 6-29-16

N.H. Code Admin. R. Ann. He-W 512.06 Co-payments {#sec-he-w-512.06 omnilex-key=us-nh-regs-official--agency-he-w--He-W 512.06}

(a) Except as prohibited by 42 USC § 1396o-1(b)(3)(B), newly eligible individuals who have an income greater than 100 percent of the FPL and are PAP participants shall be subject to the following co-payments:

(1) A co-payment in the amount of $8.00 for each non-preferred drug prescription and refill dispensed;

(2) A co-payment in the amount of $4.00 for each preferred drug prescription and refill dispensed;

(3) A co-payment in the amount of $5.00 for each primary care provider visit to treat illness or injury;

(4) A co-payment in the amount of $125.00 for each inpatient mental health admission, inpatient substance use disorder treatment admission or hospital admission, excluding maternity admissions;

(5) A co-payment in the amount of $50.00 for high-cost imaging such as CT/PET scans, and MRIs;

(6) A co-payment in the amount of $5.00 for each mental health outpatient visit;

(7) A copayment in the amount of $5.00 for each substance use disorder outpatient visit;

(8) A co-payment in the amount of $8.00 for each physical therapy visit;

(9) A co-payment in the amount of $8.00 for each occupational therapy visit;

(10) A co-payment in the amount of $8.00 for each speech therapy visit;

(11) A co-payment in the amount of $5.00 for each chiropractor visit;

(12) A co-payment in the amount of $8.00 for each specialty physician visit;

(13) A co-payment in the amount of $5.00 for each visit to other medical professionals such as an advanced practice registered nurse or a physician’s assistant; and

(14) A co-payment in the amount of $5.00 for each laboratory outpatient visit.

(b) Co-payment obligations shall be suspended for the remainder of the calendar year quarter when the total co-payments made out of pocket by the newly eligible individual reach 5 percent of the individual’s household income for that quarter. Co-payment obligations shall resume at the beginning of the next quarter. “Quarter” means one of 4 calendar periods ending March 31, June 30, September 30, and December 31.

History

#10656, eff 8-15-14; ss by #11012, INTERIM, eff 1-1-16, EXPIRES: 6-29-16 (from He-W 512.05); ss by #11119, eff 6-29-16; ss by #12438, eff 1-1-18

N.H. Code Admin. R. Ann. He-W 512.07 Appeals Process for the Premium Assistance Program {#sec-he-w-512.07 omnilex-key=us-nh-regs-official--agency-he-w--He-W 512.07}

(a) The appeals process for the PAP shall address PAP participants’ requests for the appeal of any adverse decisions made by the QHP related to a PAP participant’s QHP covered benefits and decisions made by the department related to eligibility or wrap benefits related to the PAP.

(b) PAP participants who want to appeal a decision made by the QHP regarding a QHP’s covered benefits shall exhaust all private market appeals processes applicable under RSA 420-J:5 and RSA 420-J:5-a through 5-e prior to requesting a state fair hearing with the department. The private market appeals processes include internal review conducted by the QHP under RSA 420-J:5 with respect to both medical necessity and coverage issues, and an independent external review conducted by an independent review organization (IRO) under RSA 420-J:5-a through 5-e with respect to medical necessity issues only.

(c) PAP participants shall have the right to a state fair hearing in accordance with (d) and (e) below when the enrollee has exhausted the private market appeals processes without having the issue under appeal resolved in his or her favor. PAP enrollees shall file a request for a fair hearing in accordance with He-C 200.

(d) PAP participants shall have the right to a state fair hearing for the following issues:

(1) For medical necessity issues, at the conclusion of the external review process as provided in RSA 420-J:5-a-5-e;

(2) For issues not related to medical necessity, at the conclusion of a QHP internal review process as provided in RSA 420-J:5; and

(3) For decisions related to eligibility for medicaid or decisions made regarding wrap benefits made by the department, without first exhausting any private market appeals processes.

(e) Requests for a department fair hearing shall be made in writing within 30 calendar days of the date of the notice of the resolution of the appeal through the private market appeals process.

(f) A PAP participant’s benefits shall be continued during a department fair hearing if:

(1) The individual requests a department fair hearing within 10 calendar days of the notice of the disposition of the private market appeals process or the notice of the department’s decision on eligibility or wrap benefits;

(2) The individual requests continuation of benefits; and

(3) The individual identifies a medicaid enrolled provider to provide the benefit requested.

(g) If the QHP’s adverse decision is upheld in a department fair hearing, the member shall be liable for the cost of continued benefits.

History

#10656, eff 8-15-14; ss by #11012, INTERIM, eff 1-1-16, EXPIRES: 6-29-16; ss by #11119, eff 6-29-16

N.H. Code Admin. R. Ann. He-W 512.08 Utilization Review and Control {#sec-he-w-512.08 omnilex-key=us-nh-regs-official--agency-he-w--He-W 512.08}

The department’s provider program integrity unit shall monitor utilization of ABP services to identify, prevent, and correct potential occurrences of fraud, waste and abuse in accordance with in accordance with He-W 520, 42 CFR 455, and 42 CFR 456.

History

#11012, INTERIM, eff 1-1-16, EXPIRES: 6-29-16 (from He-W 512.06); ss by #11119, eff 6-29-16

N.H. Code Admin. R. Ann. He-W 512.09 Third Party Liability {#sec-he-w-512.09 omnilex-key=us-nh-regs-official--agency-he-w--He-W 512.09}

All third party obligations shall be exhausted before claims shall be submitted to the department’s fiscal agent in accordance with 42 CFR 433.139.

History

#11012, INTERIM, eff 1-1-16, EXPIRES: 6-29-16 (from He-W 512.07); ss by #11119, eff 6-29-16

Part He-W 513 Substance Use Disorder (sud) Treatment and Recovery Support Services

N.H. Code Admin. R. Ann. He-W 513.01 Purpose {#sec-he-w-513.01 omnilex-key=us-nh-regs-official--agency-he-w--He-W 513.01}

The purpose of this part is to establish the procedures and requirements for age and clinically appropriate substance use disorders (SUDs) treatment and recovery support services that are provided to the individuals who are eligible for medicaid.

History

#10655, INTERIM, eff 8-15-14, EXPIRES: 2-11-15; ss by #10779, eff 2-11-15; ss by #10922, eff 9-1-15; ss by #11107, eff 7-1-16; ss by #12681, eff 11-27-18

N.H. Code Admin. R. Ann. He-W 513.02 Definitions {#sec-he-w-513.02 omnilex-key=us-nh-regs-official--agency-he-w--He-W 513.02}

(a) “Collaborative service model” means a model whereby SUD treatment and recovery support services, health care services, and mental health services are provided by practitioners from different programs who work together via formalized relationships.

(b) “Comprehensive SUD program” means:

(1) An agency under contract with or agreement with the department which provides specialty SUD treatment and recovery support services on a residential and outpatient basis and whose facility is:

a. Licensed as a residential treatment and rehabilitation facility in accordance with He-P 807; or

b. A state-owned SUD residential treatment and rehabilitation facility which is exempt from licensure in accordance with RSA 151:2, II (i)and He-P 807;

(2) A hospital enrolled in medicaid both as a hospital in accordance with He-W 543 and as a comprehensive SUD program in accordance with He-W 513, which provides specialty SUD treatment and recovery support services on a residential and outpatient basis; or

(3) Providers enrolled in medicaid in the state in which they practice to provide residential services consistent with criteria as set forth in the American Society of Addiction Medicine (ASAM) Criteria: Treatment Criteria for Substance-Related, Addictive, and Co-Occurring Conditions, Third Edition (2013), henceforth referred to as “ASAM Criteria (2013)” available as noted in Appendix A, and who are also enrolled in NH medicaid.

(c) “Crisis intervention” means a response to a crisis or emergency situation experienced by an individual, family member, or significant other(s) related to a recipient’s SUD.

(d) “Department” means the New Hampshire department of health and human services.

(e) “Direct supervision” means that the supervisor meets with the individual to review his or her clinical practice in order to evaluate his or her performance.

(f) “Evaluation” means a clinical interview conducted by a qualified individual using one or more standardized, evidence based evaluation tools to determine the existence and severity of substance use and specific problem areas.

(g) “Family treatment” means outpatient individual or group treatment services provided by a clinician to assist recipients and their families to achieve treatment objectives through the exploration of SUDs and their ramifications, including an examination of attitudes and feelings, and consideration of alternative solutions and decision making with regard to substance misuse.

(h) “Integrated service model” means a model whereby SUD treatment and recovery support services, health care services, and mental health services are provided by a team of practitioners within a single program.

(i) “Intensive outpatient SUD services” means intensive and structured individual and group alcohol or other drug treatment services and activities that are provided at least 9 hours a week for recipients age 21 and over, and at least 6 hours a week for recipients under age 21, according to an individualized treatment plan that include a range of outpatient treatment services and other ancillary alcohol or other drug services.

(j) “Licensed mental health provider” means a psychotherapist licensed by the NH board of mental health practice or the NH board of psychologists, or an advanced practice registered nurse (APRN) with a psychiatric specialty.

(k) “Lived Experience” means that an individual has direct, personal experience with either their own recovery from a substance use disorder or that of a family member.

(l) “Medicaid” means the Title XIX and Title XXI programs administered by the department, which makes medical assistance available to eligible individuals.

(m) “Office-based medication assisted substance use disorder treatment” means medication prescription and monitoring by a licensed prescriber for the purpose of treating a SUD, including clinically appropriate referral to, and coordination with, SUD treatment providers within the prescriber’s practice or externally.

(n) “Opioid treatment services” means treatment for opioid use disorders using a combination of approved medications, limited to methadone and buprenorphine, and behavioral health services which is delivered by an agency certified as an opioid treatment program in accordance with He-A 304.03.

(o) “Outpatient, group treatment” means services provided by a clinician to assist 2 or more individuals to achieve treatment objectives through the exploration of substance use disorders and their ramifications, including an examination of attitudes and feelings, and consideration of alternative solutions and decision making with regard to substance misuse.

(p) “Outpatient, individual treatment” means services provided by a clinician to assist an individual to achieve treatment objectives through the exploration of substance use disorders and their ramifications, including an examination of attitudes and feelings, and consideration of alternative solutions and decision making with regard to substance misuse.

(q) “Outpatient SUD program” means an agency which provides specialty SUD treatment and recovery support services on an outpatient basis and which is:

(1) Under contract with or agreement with the department;

(2) A hospital enrolled in medicaid both as a hospital in accordance with He-W 543 and as an outpatient SUD program in accordance with He-W 513;

(3) A provider enrolled in medicaid in the state in which they practice to provide intensive outpatient services consistent with Level 2.1, as set forth in ASAM Criteria (2013), available as noted in Appendix A, or partial hospitalization consistent with Level 2.5, as set forth in ASAM Criteria (2013), available as noted in Appendix A, and who is also enrolled in NH Medicaid;

(4) Under current primary care services contract obligation with the maternal and child health section of the NH division of public health services;

(5) A medicaid enrolled community mental health center;

(6) A medicaid enrolled Federally Qualified Health Center (FQHC), as defined in section 1905(l)(2)(B) of the Social Security Act, or a medicaid enrolled Rural Health Clinic (RHC), as defined in section 1905(l)(1) of the Social Security Act; or

(7) An opioid treatment program which is certified as such in accordance with He-A 304.03.

(r) “Partial hospitalization services” means intensive and structured individual and group treatment of moderate to severe co-occurring substance use and other mental health disorder(s) that are provided at least 20 hours per week.

(s) “Peer recovery coach” means an individual who meets the requirements set out in He-W 513.05(r)(4).

(t) “Peer recovery program” means a recovery community organization or program that is accredited by the Council on Accreditation of Peer Recovery Support Services (CAPRSS), is accredited by Clubhouse International, is under contract with the department’s contracted facilitating organization, or is under contract with the department’s BDAS to provide peer recovery support services.

(u) “Peer recovery support services” means non-clinical recovery support services which are recipient directed and delivered by peers who have common life experiences with the recipients they are serving.

(v) “Recipient” means any individual who is eligible for and receiving medical assistance under the medicaid program.

(w) “Recovery support services” means non-clinical services that are provided to recipients to support their recovery from substance use disorders and prevent relapse.

(x) “Rehabilitative services” means 24-hour per day non-acute care in a non-hospital, residential treatment program where a planned program of professionally directed evaluation, care, and treatment for the restoration of functioning for persons with substance use disorders occurs.

(y) “Screening” means a brief process designed to identify an individual who is misusing substances, or is at risk for developing a substance use disorder, by using a screening instrument and evaluating responses to questions about alcohol and other drug use.

(z) “Screening, brief intervention, and referral to treatment (SBIRT)” means a comprehensive, integrated public health approach for early identification and intervention with patients whose alcohol or drug use may put their health at risk.

(aa) “Substance use disorder (SUD)” means a cluster of symptoms meeting the criteria for SUD as set forth in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) (2013), available as noted in Appendix A.

(ab) “Title XIX” means the joint federal-state program described in Title XIX of the Social Security Act and administered in New Hampshire by the department under the medicaid program.

(ac) “Title XXI” means the joint federal-state program described in Title XXI of the Social Security Act and administered in New Hampshire by the department under the medicaid program.

(ad) “Treatment plan” means an action plan, written in behavioral terms, which:

(1) Is consistent with the competencies described in Section 2: Practice Dimensions, II. Treatment Planning of the “Addiction Counseling Competencies, TAP 21” (2017 revision), available as noted in Appendix A;

(2) Is based on evaluation data;

(3) Identifies the recipient’s clinical needs, treatment goals, and objectives;

(4) Defines the strategy for providing services to meet those needs, goals, and objectives;

(5) Provides the criteria for terminating specific interventions; and

(6) Includes specification and description of the indicators to be used to assess the individual’s progress.

History

#10655, INTERIM, eff 8-15-14, EXPIRES: 2-11-15; ss by #10779, eff 2-11-15; ss by #10922, eff 9-1-15; ss by #11107, eff 7-1-16; amd by #12012, INTERIM, eff 10-25-16, EXPIRES: 4-23-17; amd by #12131, eff 3-10-17; ss by #12681, eff 11-27-18

N.H. Code Admin. R. Ann. He-W 513.03 Recipient Eligibility {#sec-he-w-513.03 omnilex-key=us-nh-regs-official--agency-he-w--He-W 513.03}

(a) All recipients shall be eligible for SUD treatment and recovery support services in accordance with this part and He-W 506.

(b) In order to receive SUD treatment and recovery support services, other than SBIRT pursuant to He-W 513.05(c), substance use screenings pursuant to He-W 513.05(d), crisis intervention pursuant to He-W 513.05(q), peer recovery support pursuant to He-W 513.05(r), non-peer recovery support pursuant to He-W 513.05(s), continuous recovery monitoring pursuant to He-W 513.05(t), and evaluations pursuant to He-W 513.05(u), the recipient shall have been determined to have a SUD by undergoing a clinical evaluation in accordance with He-W 513.05(u) to determine the level of care and ensuing treatment plan to be followed.

History

#10655, INTERIM, eff 8-15-14, EXPIRES: 2-11-15; ss by #10779, eff 2-11-15; ss by #10922, eff 9-1-15; ss by #11107, eff 7-1-16; ss by #12681, eff 11-27-18

N.H. Code Admin. R. Ann. He-W 513.04 Provider Participation {#sec-he-w-513.04 omnilex-key=us-nh-regs-official--agency-he-w--He-W 513.04}

(a) All SUD treatment and recovery support service providers shall be enrolled as a New Hampshire medicaid provider.

(b) SUD treatment and recovery support service practitioners shall meet the provider requirements in He-W 531.05 for the services they are enrolling to provide.

(c) Individual practitioners delivering services as part of a medicaid enrolled outpatient SUD program or medicaid enrolled comprehensive SUD program shall be allowed to delegate, in accordance with scope of law and practice, the performance of SUD treatment and recovery support services to individuals under their supervision in such program, and subject to the following restrictions:

(1) With the exception of those licensed alcohol and drug counselors (LADCs) who are permitted to engage in independent practice in accordance with Chapter Law 189:2, II, Laws of 2008, and Chapter Law 249:24, V, Laws of 2010, LADCs shall only provide SUD treatment and recovery support services under the supervision of:

a. A master licensed alcohol and drug counselor (MLADC) who is on the staff of a medicaid enrolled outpatient SUD program or comprehensive SUD program;

b. A LADC who is permitted to engage in independent practice in accordance with Chapter Law 189:2, II, Laws of 2008, and Chapter Law 249:24, V, Laws of 2010, who also is a licensed clinical supervisor (LCS), and who is on the staff of a medicaid enrolled outpatient SUD program or comprehensive SUD program; or

c. A licensed mental health provider who is on the staff of a medicaid enrolled outpatient SUD program or comprehensive SUD program;

(2) Supervision requirements for SUD recovery support services shall be as follows:

a. A certified recovery support worker (CRSW) shall be supervised by one of the following:

An MLADC who is on the staff of or under contract with a medicaid enrolled outpatient SUD program, comprehensive SUD program, or peer recovery program;

2 A LADC who is permitted to engage in independent practice in accordance with Chapter Law 189:2, II, Laws of 2008, and Chapter Law 249:24, V, Laws of 2010, who also is an LCS and who is on the staff of or under contract with a medicaid enrolled outpatient SUD program, comprehensive SUD program, or peer recovery program;

A LADC who is on the staff of or under contract with a medicaid enrolled outpatient SUD program, comprehensive SUD program, or peer recovery program;
A CRSW who has been certified for one year and has taken 6 hours of supervisory training and 6 hours of practical training which has been approved by the board pursuant to Alc 409.01; or
A licensed mental health provider who is on the staff of or under contract with a medicaid enrolled outpatient SUD program, comprehensive SUD program, or peer recovery program;

b. A LADC delivering recovery support services shall be supervised by an MLADC who is on the staff of or under contract with a medicaid enrolled outpatient SUD program, comprehensive SUD program, or peer recovery program; and

c An MLADC delivering recovery support services shall not require supervision;

(3) Individuals who meet the following criteria shall only provide services under the supervision of an MLADC or licensed mental health provider who is on the staff of a medicaid enrolled outpatient SUD program or comprehensive SUD program:

a. The individual shall be enrolled in a formal internship for at least a master’s degree in a clinical discipline that meets the requirements for initial licensing as an MLADC pursuant to RSA 330-C:16, I, or

b. The individual shall:

Have completed at least one year of work in the field of substance use disorders treatment under the supervision of an MLADC or licensed mental health provider;
Have at least a master’s degree in a clinical discipline that meets the requirements for initial licensing as an MLADC pursuant to RSA 330-C:16, I; and
Be working to accumulate the work experience required for licensure;

(4) Individuals who meet the criteria below shall only provide services under the supervision of a psychologist who is on the staff of a medicaid enrolled outpatient SUD program or comprehensive SUD program:

a. The individual shall be enrolled in a formal internship for at least a master’s program that meets the requirements for initial licensure by the NH board of psychologists pursuant to RSA 329-B; or

b. The individual shall:

Have completed at least one year of work in the field of substance use disorders treatment under the supervision of a person licensed by the NH board of psychologists;
Have at least a master’s degree that meets the requirements for initial licensure by the NH board of psychologists pursuant to RSA 329-B; and
Be working to accumulate the work experience required for licensure;

(5) Individuals who meet the criteria below shall only provide services under the supervision of a psychotherapist who is on the staff of a medicaid enrolled outpatient SUD program or comprehensive SUD program:

a. The individual shall be enrolled in a formal internship for at least a master’s program that meets the requirements for initial licensure by the NH board of mental health practice pursuant to RSA 330-A; or

b. The individual shall:

Have completed at least one year of work in the field of substance use disorders treatment under the supervision of a psychotherapist;
Have at least a master’s degree that meets the requirements for initial licensure by the NH board of mental health practice pursuant to RSA 330-A; and
Be working to accumulate the work experience required for licensure;

(6) Individuals who qualify to provide services pursuant to He-W 513.04(c)(3) – (5) above and who hold at least a master’s degree shall have ongoing supervision of at least 2 hours per month as follows:

a. There shall be direct, individual, or group supervision of at least one hour per month by the supervising practitioner noted in (3) -(5) above; and

b. The second hour of supervision may be peer review or case review, such as client-centered conferences;

(7) Individuals who qualify to provide services pursuant to He-W 513.04(c)(3) – (5) above and who are enrolled in a formal internship shall receive direct supervision as follows:

a. There shall be direct supervision of at least one hour per week;

b. The supervisor shall write and sign a weekly note in the intern’s supervisory record stating his or her observations and recommendations relative to the intern’s performance; and

c. The supervisor shall write and sign a monthly note in the intern’s supervisory record summarizing his or her evaluation;

(8) The medicaid program shall reimburse the outpatient or comprehensive SUD program only if the supervision required in accordance with He-W 513.04(c)(3) - (7) occurs and is documented;

(9) The delegated services shall be billed by the outpatient or comprehensive SUD program; and

(10) A LADC who is permitted to engage in independent practice in accordance with Chapter Law 189:2, II, Laws of 2008, and Chapter Law 249:24, V, Laws of 2010, shall not provide supervision to an MLADC for the purposes of providing services under He-W 513.

(d) SUD treatment and recovery support service providers shall ensure that the recipient has undergone a clinical evaluation, as required by He-W 513.03(b) above, prior to the provider’s delivery of other SUD treatment and recovery support services.

(e) SUD treatment and recovery support service providers shall ensure that all SUD treatment and recovery support services are provided and documented in accordance with the Health Insurance Portability and Accountability Act (HIPAA) of 1996, 45 CFR 160, 45 CFR 164, Subparts A and E, and 42 CFR, Part II.

(f) SUD treatment and recovery support service providers shall ensure that any SUD group treatment and recovery support services described in He-W 513.05 below are delivered in accordance with the following:

(1) Services shall only be covered when 2 or more individuals are present for a group service;

(2) SUD treatment groups shall include no more than 12 individuals with one licensed practitioner present or no more than 16 individuals when that licensed practitioner is joined by a CRSW or a second licensed practitioner;

(3) Recovery support groups shall include no more than 8 individuals with one CRSW present or no more than 12 individuals when that CRSW is joined by a second CRSW; and

(4) Peer recovery support groups shall include no more than 8 individuals with one peer recovery coach present or no more than 12 individuals when that peer recovery coach is joined by a second peer recovery coach.

(g) SUD treatment service providers shall ensure that all covered services are provided in accordance with criteria as set forth in ASAM Criteria (2013), available as noted in Appendix A, except for SBIRT services provided in accordance with He-W 513.05(c), substance use screening provided in accordance with He-W 513.05(d), crisis intervention provided in accordance with He-W 513.05(q), and evaluations provided in accordance with He-W 513.05(u).

(h) All SUD treatment and recovery support service providers shall treat co-occurring disorders in accordance with scope of law and practice.

(i) Except as in (j) below, LADCs, and MLADCs who are delivering or supervising SUD treatment and recovery support services shall be licensed by the NH board of licensing for alcohol and other drug use professionals.

(j) Providers who hold a reciprocal international certification and reciprocity consortium/alcohol and other drug abuse (IC&RC) license shall be considered to have met the requirement in (i) above for the purpose of He-W 513.

(k) New Hampshire enrolled out of state providers whose license or certification allows them to provide SUD services in the state in which they practice shall be considered to have met the requirements in (i) above.

(l) Hospitals enrolled in medicaid as a hospital in accordance with He-W 543 shall also be enrolled in medicaid as an outpatient or comprehensive SUD program in order to provide outpatient or comprehensive SUD services in accordance with He-W 513.05.

(m) Providers who are enrolled in other states and who meet the definition of outpatient or comprehensive SUD programs in accordance with He-W 513.02 (b) or (q) shall also be enrolled in NH medicaid in order to provide outpatient or comprehensive SUD services in accordance with He-W 513.05.

(n) Providers who are employed by, or under contract with, a comprehensive or outpatient SUD program shall be considered to be on the staff of that program.

History

#10655, INTERIM, eff 8-15-14, EXPIRES: 2-11-15; ss by #10779, eff 2-11-15; ss by #10922, eff 9-1-15; ss by #11107, eff 7-1-16; amd by #12131, eff 3-10-17; ss by #12681, eff 11-27-18

N.H. Code Admin. R. Ann. He-W 513.05 Covered Services {#sec-he-w-513.05 omnilex-key=us-nh-regs-official--agency-he-w--He-W 513.05}

(a) SUD treatment and recovery support services shall be covered in accordance with this section.

(b) In order for the services described in this section to be covered, they shall:

(1) Be delivered in accordance with appropriate guidelines that are consistent with generally accepted standards of care in the ASAM Criteria (2013), available as noted in Appendix A;

(2) Include continuing care, transfer, and discharge plans that address all domains in ASAM Criteria (2013), available as noted in Appendix A, as follows:

a. Plans shall include the process of transfer and discharge planning at the time of the recipient’s intake to the program;

b. Plans for continuing care shall include at least one of the 3 following criteria for continuing services:

The recipient is making progress but has not yet achieved the goals articulated in the individualized treatment plan, and continued treatment at the present level of care is assessed as necessary to permit the recipient to continue to work toward his or her treatment goals;
The recipient is not yet making progress, but has the capacity to resolve his or her problems, is actively working toward the goals articulated in the individualized treatment plan, and continued treatment at the present level of care is assessed as necessary to permit the recipient to continue to work toward his or her treatment goals; or
New problems have been identified that are appropriately treated at the present level of care and that requires services at a frequency and intensity that can only safely be delivered by the recipient’s continued stay in the current level of care; and

c. Plans for transfer or discharge planning shall include at least one of the 4 following criteria:

The recipient has achieved the goals articulated in the individualized treatment plan thus resolving the problem or problems that justified admission to the present level of care and continuing chronic disease management of the recipient’s condition at a less intensive level of care is indicated;
The recipient has been unable to resolve the problem or problems that justified the admission to the present level of care despite amendments to the treatment plan and has been determined to have met the maximum possible benefit from engagement in services at the current level of care, so transfer or discharge from treatment is indicated;
The recipient has demonstrated a lack of capacity due to diagnostic or co-occurring conditions that limit his or her ability to resolve his or her problem, so treatment at a qualitatively different level of care or type of service, or discharge from treatment is indicated; or
The recipient has experienced an intensification of his or her problem or problems or has developed a new problem or problems and can be treated effectively at a more intensive level of care;

(3) Be evidence based, as demonstrated by meeting one of the following criteria:

a. The service shall be included as an evidence-based mental health and substance abuse intervention on the SAMHSA Evidence-Based Practices Resource Center available at https://www.samhsa.gov/ebp-resource-center;

b. The services shall be published in a peer-reviewed journal and found to have positive effects; or

c. The SUD treatment and recovery support service provider shall be able to document the services’ effectiveness based on the following:

The service is based on a theoretical perspective that has validated research; or
The service is supported by a documented body of knowledge generated from similar or related services that indicate effectiveness;

(4) When clinically appropriate, include referral to, and assistance in accessing, medication assisted SUD treatment either on site or off site;

(5) Include an assessment of all recipients for risk of self-harm at all phases of treatment, such as at initial contact, during screening, intake, admission, on-going treatment services, and at discharge;

(6) With the exception of peer and non-peer recovery and continuous recovery monitoring, be consistent with the “Addiction Counseling Competencies, TAP 21” (2017 revision), available as noted in Appendix A;

(7) Be provided in accordance with the ASAM Level of Care service descriptions, as applicable, noted in He-W 513.11; and

(8) Be provided at a length of time and frequency of care based on individual client need in accordance with ASAM Criteria (2013), available as noted in Appendix A, and not on predetermined time or frequency limits.

(c) Screening, brief intervention, and referral to treatment (SBIRT) shall be a covered service when provided as follows:

(1) The screening shall be provided for the purpose of identifying individuals who have an alcohol or drug use problem or who are at risk for developing one;

(2) The screening shall be conducted by evaluating responses to questions as described in (3) below about the context, frequency, and amount of alcohol and other drug use;

(3) The screening shall be performed using a screening instrument listed in Appendix E of “Systems-Level Implementation of Screening, Brief Intervention, and Referral to Treatment, TAP 33” (2013 edition), available as noted in Appendix A;

(4) SBIRT shall be provided with and billed with another medical service;

(5) SBIRT shall be conducted by a provider who has been trained in the SBIRT model and is either:

a. A medicaid enrolled physician or APRN;

b. A medicaid enrolled physician assistant, or other practitioner under a physician’s supervision; or

c. A practitioner working in an outpatient SUD program as defined in He-W 513.02(q)(4) or He-W 513.02(q)(6) who is either:

A physician or APRN; or
A physician assistant or other practitioner under a physician’s supervision;

(6) SBIRT shall be performed in the primary care practitioner’s office or other health care settings not specific to the delivery of SUD treatment and recovery support services;

(7) The services provided by the providers described in (5)a. above shall be billed by the medicaid enrolled practitioner; and

(8) The services provided by the providers described in (5)b. above shall be billed by the supervising physician.

(d) SUD screening shall be a covered service when provided as follows:

(1) The screening shall be provided for the purpose of identifying individuals who have an alcohol or drug use problem or who are at risk for developing one;

(2) The screening shall be conducted by evaluating responses to questions as described in (3) below about the context, frequency, and amount of alcohol and other drug use;

(4) Except as allowed in (5) and (6) below, the screening shall be performed by medicaid enrolled psychotherapy providers licensed by the NH board of mental health practice, medicaid enrolled psychotherapy providers licensed by the NH board of psychology, medicaid enrolled MLADCs licensed by the NH board of licensing for alcohol and other drug use professionals, LADCs who are permitted to engage in independent practice in accordance with Chapter Law 189:2, II, Laws of 2008, and Chapter Law 249:24, V, Laws of 2010, medicaid enrolled outpatient SUD programs, or medicaid enrolled comprehensive SUD programs; and

(5) The screening may be performed by individuals who are allowed to do such screenings under the supervision of the providers in (4) above in accordance with RSA 329-B, RSA 330-A, or RSA 330-C as follows:

a. The restrictions described in He-W 513.04(c) shall not apply; and

b. Such screenings shall be billed by the supervising practitioner or the outpatient or comprehensive SUD program.

(e) Opioid treatment services shall be a covered service when provided as follows:

(1) Opioid treatment services shall be provided by medicaid enrolled providers who meet the medical services clinic requirements in He-W 536 and are certified as an opioid treatment program in accordance with He-A 304.03;

(2) Opioid treatment providers shall operate and provide services in accordance with He-A 304;

(3) Opioid treatment services shall be delivered in accordance with a treatment plan;

(4) Opioid treatment services shall be limited to treatment with methadone or buprenorphine;

(5) Opioid treatment services shall be inclusive of the necessary components of the daily opioid treatment services, such as intake services, medication counseling, administration, medical supervision of vitals, observation afterwards, urine testing, and blood and lab work;

(6) SUD treatment and recovery support services may be provided in conjunction with the opioid treatment services and may be billed separately from the opioid treatment service; and

(7) Except as specified in (5) above, opioid treatment services shall be billed in accordance with He-W 536.

(f) Pharmaceuticals prescribed for SUD treatment services shall be covered in accordance with He-W 570.

(g) Office-based medication assisted SUD treatment shall be a covered service when provided as follows:

(1) Office-based medication assisted SUD treatment via buprenorphine shall be provided by medicaid enrolled providers who:

a. Have obtained a waiver in accordance with the Drug Addiction Treatment Act of 2000 (DATA 2000), Title XXXV, Section 3502 of the Children’s Health Act of 2000, to treat opioid addiction with Schedule III, IV, and V narcotic medications; and

b. Provide services in accordance with TIP 63: Medications for Opioid Use Disorder (2018), available at https://store.samhsa.gov/product/tip-63-medications-opioid-use-disorder-%E2%80%93-full-document-including-executive-summary-parts-1-5 and as noted in Appendix A;

(2) Office-based medication assisted SUD treatment shall be provided by medicaid enrolled providers who meet the physician requirements in He-W 531 or the advanced practice registered nurse requirements in He-W 534;

(3) Office-based medication assisted SUD treatment shall be delivered in accordance with a treatment plan;

(4) The writing of the prescription shall be a component of an office visit;

(5) The provider shall:

a. Refer the recipient to clinically appropriate SUD treatment and recovery services as described in He-W 513; and

b. Coordinate care with the SUD treatment and recovery provider within or external to the office based practice;

(6) Office-based medication assisted SUD shall be billed by the prescribing provider, outpatient SUD program, or comprehensive SUD program; and

(7) The prescribing provider shall be listed as the rendering provider on the claim.

(h) Outpatient, individual treatment consistent with Level 1, as set forth in ASAM Criteria (2013), available as noted in Appendix A, shall be a covered service when provided as follows:

(1) Outpatient, individual treatment shall be delivered in accordance with a treatment plan;

(2) Outpatient, individual treatment shall be covered when provided by medicaid enrolled psychotherapists licensed by the NH board of mental health practice or the NH board of psychologists, medicaid enrolled MLADCs licensed by the NH board of licensing for alcohol and other drug use professionals, LADCs who are permitted to engage in independent practice in accordance with Chapter Law 189:2, II, Laws of 2008, and Chapter Law 249:24, V, Laws of 2010, medicaid enrolled physicians or advanced practice registered nurses (APRNs), medicaid enrolled outpatient SUD programs, or medicaid enrolled comprehensive SUD programs; and

(3) Outpatient, individual treatment shall be billed by the medicaid enrolled individual or group practitioner or by the outpatient or comprehensive SUD program.

(i) Group treatment consistent with Level 1, as set forth in ASAM Criteria (2013), available as noted in Appendix A, shall be a covered service when provided as follows:

(1) Group treatment shall meet the requirements in He-W 513.04(f);

(2) Group treatment shall be delivered in accordance with a treatment plan;

(3) Group treatment shall be covered when provided by medicaid enrolled psychotherapists licensed by the NH board of mental health practice or the NH board of psychologists, medicaid enrolled MLADCs licensed by the NH board of licensing for alcohol and other drug use professionals, LADCs who are permitted to engage in independent practice in accordance with Chapter Law 189:2, II, Laws of 2008, and Chapter Law 249:24, V, Laws of 2010, medicaid enrolled physicians or APRNs, medicaid enrolled outpatient SUD programs, or medicaid enrolled comprehensive SUD programs; and

(4) Group treatment shall be billed by the medicaid enrolled individual or group practitioner or by the outpatient or comprehensive SUD program.

(j) Family treatment consistent with Level 1, as set forth in ASAM Criteria (2013), available as noted in Appendix A, shall be a covered service when provided as follows:

(1) Family treatment shall be provided to either:

a. The recipient; or

b. The recipient’s family members or significant others, either with or without the recipient present, if treatment is related to the recipient’s SUD;

(2) Family treatment shall be delivered in accordance with a treatment plan;

(3) Family treatment shall be covered when provided by medicaid enrolled psychotherapists licensed by the NH board of mental health practice or the NH board of psychologists, medicaid enrolled MLADCs licensed by the NH board of licensing for alcohol and other drug use professionals, LADCs who are permitted to engage in independent practice in accordance with Chapter Law 189:2, II, Laws of 2008, and Chapter Law 249:24, V, Laws of 2010, medicaid enrolled physicians or APRNs, medicaid enrolled outpatient SUD programs, or medicaid enrolled comprehensive SUD programs; and

(4) Family treatment shall be billed by the medicaid enrolled individual or group practitioner or by the outpatient or comprehensive SUD program.

(k) Intensive outpatient SUD services consistent with Level 2.1, as set forth in ASAM Criteria (2013), available as noted in Appendix A, shall be a covered service when provided as follows:

(1) Intensive outpatient SUD services shall be covered when they are:

a. Provided by medicaid enrolled outpatient or comprehensive SUD programs; and

b. Delivered by the following practitioners:

Psychotherapists licensed by the NH board of mental health practice or the NH board of psychologists; or
MLADCs licensed by the NH board of licensing for alcohol and other drug use professionals;

(2) Intensive outpatient SUD services shall be comprised of a combination of individual and group treatment services at least 9 hours per week for recipients age 21 and over and at least 6 hours per week for recipients under age 21;

(3) Group treatment shall meet the requirements in He-W 513.04(f);

(4) Intensive outpatient SUD services shall be delivered in accordance with a treatment plan;

(5) Intensive outpatient SUD services shall be comprised of a range of outpatient treatment services and other ancillary alcohol or drug treatment services to include all of the following:

a. Evaluation;

b. Individual, group, or family treatment;

c. Crisis intervention;

d. Activity therapies; and

e. Substance use prevention education; and

(6) Intensive outpatient SUD services shall be billed by the outpatient or comprehensive SUD program.

(l) Partial hospitalization services consistent with Level 2.5, as set forth in ASAM Criteria (2013), available as noted in Appendix A, shall be a covered service when provided as follows:

(1) Partial hospitalization services shall be:

a. Provided to recipients with moderate to severe co-occurring SUD and mental health disorders as described in DSM-5 (2013), available as noted in Appendix A;

b. Provided by a medicaid enrolled outpatient or comprehensive SUD treatment program; and

c. Delivered by the following practitioners:

For all partial hospitalization services, except medication management:

(i) Psychotherapists licensed by the NH board of mental health practice or the NH board of psychologists; or

(ii) MLADCs licensed by the NH board of licensing for alcohol and other drug use professionals; and

For medication management services:

(i) Psychiatrists licensed by the NH board of medicine; or

(ii) APRNs with a psychiatric specialty;

(2) Partial hospitalization shall address both disorders and be comprised of a range of outpatient treatment services and other ancillary mental health and alcohol or drug treatment services to include all of the following:

a. Evaluation;

b. Individual, group, or family treatment;

c. Crisis intervention;

d. Activities therapies;

e. Medication management, which shall include psychiatric services, including psychotropic medication management services as applicable; and

f. Substance use prevention education;

(3) Services shall be provided at least 20 hours per week;

(4) Group sessions shall meet the requirements in He-W 513.04(f); and

(5) Services shall be billed by the outpatient or comprehensive SUD program.

(m) Rehabilitative services shall be a covered service when provided as follows:

(1) Rehabilitative services shall be:

a. Provided by a medicaid enrolled comprehensive SUD program;

b. Delivered by the following practitioners:

Psychotherapists licensed by the NH board of mental health practice or the NH board of psychologists;
MLADCs licensed by the NH board of licensing for alcohol and other drug use professionals;
Physicians; or
Advanced practice registered nurses (APRN); and

c. Provided as a planned program of professionally directed evaluation, care, and treatment for the restoration of functioning for persons with SUDs;

(2) Recipients who are being treated at an ASAM 3.5 level of care shall be present in the facility at least 22 hours per day; and

(3) Recipients who are being treated at an ASAM 3.1 level of care shall receive at least 5 hours of clinical service per week..

(n) Medically monitored outpatient withdrawal management (WM) consistent with Level 1-WM, as set forth in ASAM Criteria (2013), available as noted in Appendix A, shall be a covered service when provided as follows:

(1) Medically monitored outpatient withdrawal management services shall be provided by a medicaid enrolled outpatient or comprehensive SUD program and supervised by a licensed physician or APRN who is on the staff of, or under contract with, the outpatient or comprehensive SUD program;

(2) Medically monitored outpatient withdrawal management services shall be organized and delivered by SUD treatment and mental health personnel and other health care providers who provide a planned regimen of care in the outpatient setting;

(3) Personnel required in (2) above shall be:

a. Psychotherapists licensed by the NH board of mental health practice or the NH board of psychologists on the staff of, or under contract with, the outpatient or comprehensive SUD program;

b. MLADCs licensed by the NH board of licensing for alcohol and other drug use professionals on the staff of, or under contract with, the outpatient or comprehensive SUD program;

c. Licensed physicians on the staff of, or under contract with, the outpatient or comprehensive SUD program; or

d. Licensed APRNs on the staff of, or under contract with, the outpatient or comprehensive SUD program;

(4) Medically monitored outpatient withdrawal management services shall be delivered in accordance with a treatment plan;

(5) Medically monitored outpatient withdrawal management services shall be provided in regularly scheduled sessions in accordance with defined policies and procedures consistent with ASAM Criteria (2013) standards, available as noted in Appendix A;

(6) Medically monitored outpatient withdrawal management services shall be provided under an integrated or collaborative service model; and

(7) Medically monitored outpatient withdrawal management services shall be billed by the outpatient or comprehensive SUD program.

(o) Medically monitored residential withdrawal management consistent with Level 3.7-WM, as set forth in ASAM Criteria (2013), available as noted in Appendix A, shall be a covered service when provided as follows:

(1) Medically monitored residential withdrawal management services shall be provided by a medicaid enrolled comprehensive SUD program;

(2) Medically monitored residential withdrawal management services shall be organized and delivered by SUD treatment and mental health personnel and other health care providers who provide a planned regimen of care in a 24-hour live-in setting;

(3) Personnel required in (2) above shall be:

a. Psychotherapists licensed by the NH board of mental health practice or the NH board of psychologists on the staff of, or under contract with, the comprehensive SUD program;

b. MLADCs licensed by the NH board of licensing for alcohol and other drug use professionals on the staff of, or under contract with, the comprehensive SUD program;

c. Licensed physicians on the staff of, or under contract with, the comprehensive SUD program; or

d. Licensed APRNs on the staff of, or under contract with, the comprehensive SUD program; and

(4) Medically monitored residential withdrawal management services shall be billed by the comprehensive SUD program.

(p) Medically managed withdrawal in an acute care setting shall be covered for recipients in accordance with the provisions of He-W 543.

(q) Crisis intervention shall be a covered service when provided as follows:

(1) Crisis intervention shall be covered when a recipient, family member, or significant other is facing a crisis or emergency situation and the crisis intervention is related to the recipient’s SUD;

(2) Crisis intervention shall be covered when provided by medicaid enrolled psychotherapists licensed by the NH board of mental health practice or the NH board of psychologists, medicaid enrolled MLADCs licensed by the NH board of licensing for alcohol and other drug use professionals, LADCs who are permitted to engage in independent practice in accordance with Chapter Law 189:2, II, Laws of 2008 and Chapter Law 249:24, V, Laws of 2010, medicaid enrolled physicians or APRNs, medicaid enrolled outpatient SUD programs, or medicaid enrolled comprehensive SUD programs; and

(3) Crisis intervention shall be billed by the medicaid enrolled individual or group practitioner or by the outpatient or comprehensive SUD program.

(r) Peer recovery support shall be a covered service when provided as follows:

(1) Peer recovery support services shall include non-clinical services delivered by peers who self-identify as having lived experience to help recipients age 12 and above and families identify and work toward strategies and goals around stabilizing and sustaining recovery and, as applicable, providing links to professional treatment and community supports;

(2) Peer recovery support services shall include:

a. Skill restoration therapy intended to reduce or remove barriers to achieving and maintaining recovery;

b. Emergency or crisis services available by telephone;

c. Assistance in accessing transportation services for individuals who lack safe transportation;

d. Individual skills development and restoration to prevent continuation or recurrence of substance misuse;

e. Psychoeducation interventions to support recovery;

f. Development and periodic revision of a specific recovery plan based on the information collected through the assessment that shall specify the goals and actions to address the recovery goals and other services needed by the individual; and

g. Working with the individual to develop and refine recovery goals;

(3) Peer recovery support services shall be provided by a medicaid enrolled peer recovery program;

(4) Peer recovery support services shall be delivered by a peer recovery coach who shall have:

a. Completed 30 contact hours of recovery coach training approved by:

NH Training Institute on Addictive Disorders;
The NH Board of Licensing for Alcohol and Other Drug Use Professionals;
NAADAC, the Association for Addiction Professionals;
AdCare Education Institute, Inc., of New England;
Addiction Technology Transfer Center; or
Connecticut Communities for Addiction Recovery (CCAR) Recovery Coach Academy (RCA);

b. Completed a minimum of sixteen contact hours of training in ethics approved by any of the providers in (r)(4)a.1.-6.;

c. Completed a minimum of 6 contact hours of training in suicide prevention approved by any of the providers in (r)(4)a.1.-6.; and

d. Completed a minimum of 3 contact hours of training on co-occurring mental health and substance use disorders approved by any of the providers in (r)(4)a.1.-6.;

(5) The individual providing the services shall be supervised by a practitioner in accordance with He-W 513.04 (c)(2) who is on the staff of, or under contract with, the peer recovery program who shall have:

a. Completed the training described in He-W 513.05(r)(4); and

b. Completed 6 contact hours of training in the supervision of individuals delivering peer recovery support services approved by:

NH Training Institute on Addictive Disorders;
The NH Board of Licensing for Alcohol and Other Drug Use Professionals;
NAADAC, the Association for Addiction Professionals;
AdCare Education Institute, Inc., of New England;
Addiction Technology Transfer Center; or
Connecticut Communities for Addiction Recovery (CCAR) Recovery Coach Academy (RCA);

(6) Peer recovery support services shall be billed by the peer recovery program; and

(7) The supervising practitioner in (5) above shall be listed as the rendering provider when billing for services.

(s) Recovery support services shall be a covered service when provided as follows:

(1) Recovery support services shall include non-clinical group or individual services consistent with a recipient’s treatment plan that help to prevent relapse and promote recovery and community integration for the individual being served;

(2) Recovery support services shall include:

a. Skill restoration therapy intended to reduce or remove barriers to achieving and maintaining recovery;

b. Emergency and crisis services available by telephone;

c. Assistance in accessing transportation services for individuals who lack safe transportation;

d. Individual skills development and restoration to prevent continuation or recurrence of substance misuse;

e. Psychoeducation interventions to support recovery;

g. Working with the individual to develop and refine recovery goals;

(3) Recovery support services shall be provided by a medicaid enrolled outpatient, comprehensive SUD treatment program, or peer recovery program;

(4) Recovery support services shall be provided by a CRSW certified by the NH board of licensing for alcohol and other drug use professionals, by a LADC or MLADC licensed by the board of licensing for alcohol and other drug use professionals, or by a psychotherapist licensed by the NH board of mental health practice or the NH board of psychologists;

(5) The individual providing the services shall be supervised by a practitioner in accordance with He-W 513.04(c)(2);

(6) Recovery support shall be billed by the outpatient, comprehensive SUD program, or peer recovery program; and

(7) The supervising practitioner in (5) above shall be listed as the rendering provider when billing for services.

(t) Continuous recovery monitoring shall be a covered service when provided as follows:

(1) Continuous recovery monitoring shall include recovery check-ups with recipients on a regular basis, evaluations of the status of the recipient’s recovery, consideration of a broad array of recipient needs, and provision of active referral to community resources as applicable;

(2) Continuous recovery monitoring shall be provided by a medicaid enrolled outpatient or comprehensive SUD treatment program or a peer recovery program;

(3) When provided in a peer recovery program, continuous recovery monitoring shall be provided by an individual described in He-W 513.05(r)(4) above who is supervised in accordance with He-W 513.04(c)(2) above;

(4) When provided in an outpatient or comprehensive SUD program, continuous recovery monitoring shall be provided by an individual described in He-W 513.05(s)(4) who is supervised in accordance with He-W 513.04(c)(2) above;

(5) Continuous recovery monitoring shall be billed by the outpatient or comprehensive SUD program or peer recovery program; and

(6) The supervising practitioner in (3) above shall be listed as the rendering provider when billing for services.

(u) Evaluations to determine the existence and severity of the SUD and appropriate level of care for the recipient shall be a covered service when provided as follows:

(1) An evaluation shall be covered when provided by a medicaid enrolled psychotherapist licensed by the NH board of mental health practice or the NH board of psychologists, medicaid enrolled MLADCs licensed by the NH board of licensing for alcohol and other drug use professionals, LADCs who are permitted to engage in independent practice in accordance with Chapter Law 189:2, II, Laws of 2008 and Chapter Law 249:24, V, Laws of 2010, or medicaid enrolled outpatient or comprehensive SUD programs;

(2) The results of the evaluation, which shall include the following, shall be maintained in the recipient’s file:

a. Client identified problem(s);

b. Summary of data gathered;

c. Diagnostic evaluation interpretive summary, including signs, symptoms, and progression of the recipient’s involvement with alcohol and other drugs;

d. Statement regarding provision of an HIV/AIDS screening and referrals made; and

e. Documentation of the level of care recommended in accordance with ASAM Criteria (2013), available as noted in Appendix A;

(3) Evaluations shall be billed by the medicaid enrolled individual or group practitioner or by the outpatient or comprehensive SUD program; and

(4) Evaluations shall be completed within 3 sessions or within 3 days of client admission to services, whichever is longer.

History

#10655, INTERIM, eff 8-15-14, EXPIRES: 2-11-15; ss by #10779, eff 2-11-15; ss by #10922, eff 9-1-15; ss by #11107, eff 7-1-16; amd by #12012, INTERIM, eff 10-25-16, EXPIRES: 4-23-17; amd by #12131, eff 3-10-17; ss by #12681, eff 11-27-18

N.H. Code Admin. R. Ann. He-W 513.06 Non-Covered Services {#sec-he-w-513.06 omnilex-key=us-nh-regs-official--agency-he-w--He-W 513.06}

(a) Services that are delivered at a higher level than the recipient’s level of care, as described in ASAM Criteria (2013), available as noted in Appendix A, shall not be covered.

(b) Services that are non-evidence based in accordance with He-W 513.05(b) shall not be covered.

History

#10655, INTERIM, eff 8-15-14, EXPIRES: 2-11-15; ss by #10779, eff 2-11-15; ss by #10922, eff 9-1-15; ss by #11107, eff 7-1-16; ss by #12681, eff 11-27-18

N.H. Code Admin. R. Ann. He-W 513.07 Utilization Review and Control {#sec-he-w-513.07 omnilex-key=us-nh-regs-official--agency-he-w--He-W 513.07}

(a) The department’s provider program integrity unit shall monitor utilization of SUD treatment services to identify, prevent, and correct potential occurrences of fraud, waste, and abuse, in accordance with 42 CFR 455, 42 CFR 456, and He-W 520.

(b) Failure to maintain records in accordance with He-W 520 and He-W 513 shall entitle the department to recoupment of state and federal medicaid payments made as permitted by 42 CFR 455, 42 CFR 447, and 42 CFR 456.

History

#10655, INTERIM, eff 8-15-14, EXPIRES: 2-11-15; ss by #10779, eff 2-11-15; ss by #10922, eff 9-1-15; ss by #11107, eff 7-1-16; ss by #12681, eff 11-27-18; ss by #12681, eff 11-27-18

N.H. Code Admin. R. Ann. He-W 513.08 Third Party Liability {#sec-he-w-513.08 omnilex-key=us-nh-regs-official--agency-he-w--He-W 513.08}

All third party obligations shall be exhausted before medicaid may be billed, in accordance with 42 CFR 433.139.

History

#10655, INTERIM, eff 8-15-14, EXPIRES: 2-11-15; ss by #10779, eff 2-11-15; ss by #10922, eff 9-1-15; ss by #11107, eff 7-1-16; ss by #12681, eff 11-27-18

N.H. Code Admin. R. Ann. He-W 513.09 Payment for Services {#sec-he-w-513.09 omnilex-key=us-nh-regs-official--agency-he-w--He-W 513.09}

(a) Payment for SUD treatment and recovery support services shall be made in accordance with rates of reimbursement established by the department in accordance with RSA 161:4, VI(a).

(b) The rate of reimbursement for rehabilitative services in a comprehensive SUD program shall:

(1) Be on a per diem basis that takes into account the ASAM level of care and is inclusive of all component services rendered;

(2) Not include room and board; and

(3) Be established by the department in accordance with RSA 161:4, VI(a).

(c) The rate of reimbursement established by the department in accordance with RSA 161:4, VI(a) for partial hospitalization, medical monitored residential withdrawal management, and intensive outpatient SUD services shall be on a per diem basis inclusive of all component services rendered.

(d) The rate of reimbursement established by the department in accordance with RSA 161:4, VI(a), for medically monitored outpatient withdrawal management shall be on a per visit basis inclusive of all component services rendered.

(e) SUD providers may bill separately for drug testing utilizing rapid read tests, except when in conjunction with opioid treatment services in accordance with He-W 513.05(e).

(f) The SUD treatment and recovery support services provider shall submit claims for payment to the department’s fiscal agent.

History

#10655, INTERIM, eff 8-15-14, EXPIRES: 2-11-15; ss by #10779, eff 2-11-15; ss by #10922, eff 9-1-15; ss by #11107, eff 7-1-16; ss by #12681, eff 11-27-18

N.H. Code Admin. R. Ann. He-W 513.10 Documentation {#sec-he-w-513.10 omnilex-key=us-nh-regs-official--agency-he-w--He-W 513.10}

(a) With the exception of peer recovery programs, SUD treatment and recovery support services providers shall maintain supporting records, in accordance with He-W 520 and (b) - (f) below.

(b) Supporting documentation shall include:

(1) A complete record of all physical examinations, laboratory tests, and treatments including drug and counseling therapies, whether provided directly or by referral;

(2) A progress note for each treatment session, including:

a. The treatment modality and duration;

b. The signature of the primary therapist for each entry;

c. The primary therapist’s professional discipline; and

d. The date of each treatment session; and

(3) A copy of the treatment plan that is:

a. Updated at least every 4 sessions or 4 weeks, whichever is less frequent;

b. Signed by the provider and the recipient prior to treatment being rendered; and

c. Signed by the clinical supervisor, prior to treatment being rendered, if the service is an outpatient or comprehensive SUD program.

(1) The recipient’s name, date of birth, address, and phone number; and

(2) A copy of the evaluation described in He-W 513.05(u)(2).

(d) SUD providers that close their treatment and recovery support programs shall arrange for continued management of all medicaid recipient records as follows:

(1) The provider shall notify the department in writing of the address where records will be stored;

(2) The provider shall specify to the department the person who will be managing the records and the person’s contact information; and

(3) The provider shall arrange for storage of each record through one or more of the following measures:

a. The provider shall continue to manage the records and give written assurance to the department that it will respond to authorized requests for copies of client records within 10 working days;

b. The provider shall transfer records of clients who have given written consent to another medicaid enrolled provider; or

c. The provider shall enter into an agreement with a medicaid enrolled provider to store and manage records.

(e) All electronic or written documentation shall be legible and written in English.

(f) The SUD treatment and recovery support services provider shall provide documentation to the department upon request.

(g) Peer recovery programs shall maintain supporting records in accordance with He-W 520 and(d), (e), and (f) above, and shall include the following supporting documentation:

(1). Progress on goals for each recovery contact including:

a. The type of support received and duration;

b. The topics addressed with the recipient;

c. The signature of the person delivering services; and

d. The date of each recovery contact;

(2) Where applicable, a copy of the recovery plan that is:

a. Updated a every session; and

b. Signed by the provider and the recipient prior to services being rendered; and

(3) The recipient’s name, date of birth, address, and phone number.

History

#10655, INTERIM, eff 8-15-14, EXPIRES: 2-11-15; ss by #10779, eff 2-11-15; ss by #10922, eff 9-1-15; ss by #11107, eff 7-1-16; ss by #12681, eff 11-27-18

N.H. Code Admin. R. Ann. He-W 513.11 ASAM Level of Care Service Descriptions {#sec-he-w-513.11 omnilex-key=us-nh-regs-official--agency-he-w--He-W 513.11}

The covered services in He-W 513.05 above that are required to be provided in accordance with the levels of care in ASAM Criteria (2013), available as noted in Appendix A, shall include the following:

(a) Services required to be provided consistent with Level 1, ASAM Criteria (2013), shall include:

(1) Affiliation with other levels of care, including:

a. Other levels of specialty substance use disorder treatment for additional problems identified through a comprehensive biophysical assessment; and

b. Coordination of services and service planning within a provider agency, with other providers, and with other human service agencies and systems such as local health and social services departments;

(2) Continued treatment planning individualized to the recipient’s needs;

(3) Medical, psychiatric, psychological, laboratory, and toxicology services on-site or through consultation or referral, and in accordance with He-W 513.11(h);

(4) Coordinating discharge or transfer planning an referrals for counseling and community recovery support groups;

(5) Random drug screening to monitor and reinforce treatment gains as appropriate to the recipient’s treatment plan;

(6) Stabilization of imminent risk;

(7) Services in an amount, frequency, and intensity appropriate to the objectives of the treatment plan;

(8) For recipients with mental health conditions, the addressing of the issues of psychotropic medication, mental health treatment, and their relationship to substance use and addictive disorders as the need arises;

(9) Skill restoration therapy to reduce or remove barriers to recipients who are achieving and maintaining recovery;

(10) Emergency services by telephone 24 hours a day, 7 days a week;

(11) Assistance in accessing transportation services for recipients who lack transportation;

(12) Motivational enhancement and engagement strategies appropriate to the recipient’s stage of readiness and desire to change;

(13) Family therapy for the direct benefit of the recipient in accordance with the recipient’s needs and treatment goals identified in the treatment plan and for the purpose of assisting in the recipient’s recovery; and

(14) Skilled treatment services which may include evaluation, individual and group counseling, motivational enhancement, family therapy with recipient present, psychoeducational groups, psychotherapy, addiction pharmacotherapy, medication management, or other skilled therapies;

(b) Services required to be provided consistent with Level 2.1, ASAM Criteria (2013), shall include:

(1) The services in (a)(1) - (13) above;

(2) A planned format of therapies delivered on an individual and group basis and adapted to the recipient’s developmental stage and comprehension level; and

(3) Skilled treatment services which:

a. May include evaluation, individual and group counseling, motivational enhancement, family therapy with individual present, psychoeducational groups, psychotherapy, addiction pharmacotherapy, medication management, or other skilled therapies; and

b. Shall be provided a minimum of 9 hours per week for individuals age 21 and over and a minimum of 6 hours per week for individuals under age 21;

(1) The services in (a)(1) - (13) above;

(2) A planned format of therapies delivered on an individual and group basis and adapted to the patient’s developmental stage and comprehension level; and

(3) Skilled treatment services which:

b. Shall be provided a minimum of 20 hours per week;

(d) Services required to be provided consistent with Level 3.1, ASAM Criteria (2013), shall include:

(1) The services in (a)(1) - (9) and (a)(12) - (13) above;

(2) A planned format of therapies delivered on an individual and group basis and adapted to the patient’s developmental stage and comprehension level;

(3) Daily clinical services to improve the individual’s ability to structure and organize tasks of daily living and recovery to include individual skills development and restoration to prevent continuation or recurrence of substance misuse;

(4) Planned clinical program activities which:

a. Shall be adapted to the individual’s developmental stage, level of comprehension, level of understanding, and physical abilities for the purpose of stabilizing and maintaining the stability of the individual’s substance use disorder symptoms and to help him or her develop and apply recovery skills;

b. May include relapse prevention, exploring interpersonal choices, medication education and management, addiction pharmacotherapy, psychoeducational groups, skill development services, health education, family reintegration, recovery support services, or development of a social network supportive of recovery; and

c. Consist of at least 5 hours per week of professionally directed treatment; and

(5) Monitoring of the individual’s adherence to taking any prescribed medications or permitted over the counter medications or supplements;

(e) Services required to be provided consistent with Level 3.5, ASAM Criteria (2013), available as noted in Appendix A, shall include:

(1) The services in (a)(1) - (9) and (a)(12) - (13) above;

(2) A planned format of therapies delivered on an individual and group basis and adapted to the patient’s developmental stage and comprehension level;

(4) Planned clinical program activities which:

(5) Monitoring of the individual’s adherence to taking any prescribed medications or permitted over the counter medications or supplements;

(f) Services required to be provided consistent with Level 1-WM, ASAM Criteria (2013), available as noted in Appendix A, shall include:

(1) The services in (a)(1) - (8) and (a)(10) - (11) above;

(2) A comprehensive medical history and physical examination of the individual at admission;

(3) A range of cognitive, behavioral, medical, mental health, and other skilled therapies administered to the individual on a group or individual basis which:

a. Shall be designed to enhance the individual’s understanding of addiction, the completion of the withdrawal management process, and referral to an appropriate level of care for continuing treatment;

b. Shall be clinically necessary based on the individual’s progress through withdrawal management and the assessed needs in ASAM Dimensions 2 through 6; and

c. May include multidisciplinary individualized assessment and treatment, health education services, and medical nursing care and observation;

(4) Family involvement in the withdrawal management process for the direct benefit of the individual in accordance with the individual’s needs and treatment goals identified in the individual’s treatment plan and for the purpose of assisting in the individual’s recovery;

(5) Individual assessment, medication or non-medication methods of withdrawal management, patient education, non-pharmacological clinical support, and involvement of family members or significant others in the withdrawal management process with the individual present; and

(6) Inclusion in therapies of physician or nurse monitoring, assessment, and management of signs and symptoms of intoxication and withdrawal;

(g) Services required to be provided consistent with Level 3.7-WM, ASAM Criteria (2013), available as noted in Appendix A, shall include:

(1) The services in (a)(1) - (8) above;

(2) A comprehensive medical history and physical examination of the individual at admission;

(3) A range of cognitive, behavioral, medical, mental health, and other skilled therapies administered to the individual on a group or individual basis which:

b. Shall be clinically necessary based on the individual’s progress through withdrawal management and the assessed needs in ASAM Dimensions 2 through 6; and

c. May include multidisciplinary individualized assessment and treatment, health education services, and medical nursing care and observation;

(5) Daily clinical services to assess and address the needs of each individual which may include:

a. Appropriate medical services;

b. Individual and group therapies; and

c. Withdrawal support; and

(6) Hourly nurse monitoring of the individual’s progress and medication administration as needed; and

(h) Services described in He-W 513.11(a)(3) shall be provided in accordance with the following:

(1) Medical and psychiatric consultation shall be available within 24 hours by telephone or, if in person, within a time frame appropriate to the severity and urgency of the consultation requested for services provided at Level 1, ASAM Criteria (2013), available as noted in Appendix A;

(2) Psychiatric and other medical consultation shall be available within 24 hours by telephone and within 72 hours in person for services provided at Level 2.1, ASAM Criteria (2013), available as noted in Appendix A;

(3) Psychiatric and other medical consultation shall be available within 8 hours by telephone and within 48 hours in person for services provided at Level 2.5, ASAM Criteria (2013), available as noted in Appendix A; and

(4) Telephone or in-person consultation with a physician or any other practitioner licensed to perform the duties designated for a physician shall be available 24 hours a day, 7 days a week for emergency services provided at Level l-WM and Level 3.7-WM, ASAM Criteria (2013), available as noted in Appendix A.

History

#12681, eff 11-27-18

N.H. Code Admin. R. Ann. He-W 513.12 Waivers {#sec-he-w-513.12 omnilex-key=us-nh-regs-official--agency-he-w--He-W 513.12}

(a) Medicaid providers or the director of the bureau of drug and alcohol services (BDAS) seeking waivers of specific rules in He-W 513 shall submit a written request for a waiver to the commissioner that shall include:

(1) The specific reference to the rule for which a waiver is being sought;

(2) A full explanation of why a waiver is necessary;

(3) The time period for which the waiver is requested and a full explanation of why this time period is being requested; and

(4) A full explanation of alternatives proposed which shall detail how the intent of the rule will be satisfied if the waiver is granted.

(b) A request for waiver shall be granted if the commissioner determines that the waiver would:

(1) Meet the objective or intent of the rule;

(2) Rectify problems unforeseen by the rule;

(3) Meet the provider requirements of the federal regulations and the medicaid state plan; and

(4) Not waive or modify any state statute or federal requirement unless such statute or requirement allows for such waiver.

(d) The medicaid provider’s or BDAS’ subsequent compliance with the alternatives approved in the waiver shall be considered equivalent to complying with the rule from which the waiver was sought.

(e) Waivers shall not be transferable.

(f) When a medicaid provider or BDAS wishes to renew a non-permanent waiver beyond the approved period of time, they shall apply for a new waiver at least 60 days prior to the expiration of the existing waiver by submitting the information required by (a) above.

(g) The request to renew a waiver shall be subject to (b) through (f) above.

PARTS He-W 514 THROUGH He-W 518 RESERVED

History

#12681, eff 11-27-18

Part He-W 520 General Program Information

N.H. Code Admin. R. Ann. He-W 520.01 Definitions {#sec-he-w-520.01 omnilex-key=us-nh-regs-official--agency-he-w--He-W 520.01}

(a) “Department” means the New Hampshire (NH) department of health and human services.

(b) “Direct ownership interest” means the possession of equity of 5% or greater in capital, stock, or profits of the provider or provider applicant.

(c) “Early and periodic screening, diagnosis, and treatment (EPSDT)” means a program pursuant to 42 CFR 440.40(b), designed to provide medical care to recipients under the age of 21.

(d) “High risk provider or high risk provider applicant” means an individual or entity which meets one of the criteria in He-W 520.06(i).

(e) “Indirect ownership interest” means an ownership interest of 5% or greater in an entity that has a direct ownership interest in the provider or provider applicant.

(f) “Medicaid” means the Title XIX and Title XXI programs administered by the department, which makes medical assistance available to eligible individuals.

(g) “Medicaid management information system (MMIS)” means the general system for mechanized claims processing and information retrieval recommended by the Centers for Medicare and Medicaid Services (CMS) for the implementation of the requirements of state fiscal administration pursuant to 42 CFR 433, Subpart C.

(h) “Presumptive eligibility” means an eligibility period as described in Sections 1920 through 1920C of the Social Security Act during which eligibility for an individual is determined for the medicaid program.

(i) “Provider” means an entity or individual who furnishes health care services or supplies to medicaid recipients under an agreement with the department.

(j) “Provider applicant” means an individual or entity who is undergoing the provider enrollment or re-enrollment process to become a NH medicaid provider.

(k) “Qualified entity” means an entity authorized and trained by the department to determine presumptive eligibility pursuant to the provisions of Sections 1920 through 1920C of the Social Security Act, including providers that are:

(1) Title V-funded family and community health agencies;

(2) Title X family planning agencies;

(3) Hospitals;

(4) Agencies authorized to determine eligibility for the head start program;

(5) Agencies authorized to determine eligibility for child care services provided under the child care and development block grant;

(6) Agencies participating in the early intervention program; and

(7) Agencies participating in the special supplemental nutrition program for women, infants, and children (WIC).

(l) “Recipient” means an individual who is eligible for and receiving medical assistance under the medicaid program.

(m) “Revalidation” means the process through which the provider verifies the accuracy of, and updates if necessary, its current provider enrollment information.

(n) “Termination” means that the department revoked a provider’s medicaid billing privileges.

(o) “Title XIX” means the joint federal-state program described in Title XIX of the Social Security Act and administered in NH by the department under the medicaid program.

(p) “Title XXI” means the joint federal-state program described in Title XXI of the Social Security Act and administered in NH by the department under the medicaid program.

(q) “Utilization review and control” means the monitoring of medicaid program services pursuant to 42 CFR 455 and 42 CFR 456.

History

(See Revision Note at chapter heading He-W 500); ss by #6574, eff 9-12-97; ss by #6745, eff 5-1-98, EXPIRED: 12-31-98; ss by #6925, eff 1-1-99; amd by #7666, eff 4-1-02; ss by #8781, eff 1-1-07; amd by #10139, eff 7-1-12; paras (a), (b), (d), (g), (j), & (k), EXPIRED: 1-1-15; amd by #10776, INTERIM, eff 1-31-15; ss by #10887, eff 7-17-15; amd by #12023, INTERIM, eff 11-1-16, EXPIRES: 4-30-17; amd by #12166, eff 4-29-17; ss by #14415, eff 10-22-25, EXPIRES: 10-22-35

N.H. Code Admin. R. Ann. He-W 520.02 Program Administration {#sec-he-w-520.02 omnilex-key=us-nh-regs-official--agency-he-w--He-W 520.02}

(a) The department shall:

(1) Administer and maintain the medicaid state plan, pursuant to 42 CFR 430.10 and RSA 161:2, VI;

(2) Provide the mandatory medicaid services pursuant to 42 CFR 440.210 and 42 CFR 440.220;

(3) Provide the medicaid optional services which are specified in the medicaid state plan;

(4) Describe the provider and recipient requirements for the medicaid services found in chapter He-W 500, and pursuant to RSA 161:4-a, X; and

(5) Authorize and train qualified entities to determine presumptive eligibility.

(b) The provider shall:

(1) Be a NH enrolled medicaid provider; and

(2) Request and obtain prior authorization from the department before providing any medicaid covered services requiring prior authorization.

History

(See Revision Note at chapter heading He-W 500); ss by #6574, eff 9-12-97; ss by #6745, eff 5-1-98, EXPIRED: 12-31-98; ss by #6925, eff 1-1-99; ss by #8781, eff 1-1-07, EXPIRED: 1-1-15
#10776, INTERIM, eff 1-31-15, EXPIRES: 7-30-15; ss by #10887, eff 7-17-15; ss by 14415, eff 10-22-25, EXPIRES 10-22-35

N.H. Code Admin. R. Ann. He-W 520.03 Record Keeping Requirements {#sec-he-w-520.03 omnilex-key=us-nh-regs-official--agency-he-w--He-W 520.03}

Providers shall maintain clinical records to support claims submitted for reimbursement for a period of at least 6 years from the date of service or until the resolution of any legal action(s) commenced in the 6-year period, whichever is longer.

History

(See Revision Note at chapter heading He-W 500); ss by #6574, eff 9-12-97; ss by #6925, eff 1-1-99; ss and moved by #8781, eff 1-1-07 (from He-W 520.05), EXPIRED: 1-1-15
#10776, INTERIM, eff 1-31-15, EXPIRES: 7-30-15; ss by #10887, eff 7-17-15; ss by 14415, eff 10-22-25, EXPIRES 10-22-35

N.H. Code Admin. R. Ann. He-W 520.04 Surveillance and Utilization Review and Control {#sec-he-w-520.04 omnilex-key=us-nh-regs-official--agency-he-w--He-W 520.04}

(a) The purpose of a surveillance and utilization review and control program is for the department to:

(1) Assess the quality of the care, services, and supplies received by recipients and for which a medicaid program has reimbursed providers;

(2) Detect, correct, and prevent occurrences of unnecessary or inappropriate medical care, service, or supply usage by recipients, or provision by providers, for which a medicaid program has reimbursed providers; and

(3) Ensure that accurate and proper reimbursement has been made for the care, services, or supplies provided.

(b) The department or managed care organization (MCO) shall be responsible for surveillance and utilization review and control activities by:

(1) Performing the utilization reviews directly, or contracting with professional organizations for the performance of reviews; and

(2) Monitoring the results of reviews to ensure appropriate corrective action has been taken.

(1) Reviewing recipient utilization and provider service profiles in accordance with 42 CFR 456.23;

(2) Reviewing provider claims selected randomly;

(3) Reviewing claims for all or selected services for a given period of time;

(4) Application of the Centers for Medicare and Medicaid Services’ National Correct Coding Initiative (CMS NCCI) to review claims processed by the fiscal agent or MCO to ensure:

a. That the provider has coded claims properly; and

b. That the claims processing system has made proper payment through application of edits based upon the CMS NCCI;

(5) An on-site review of hospital, office, or other provider records to establish the accuracy of claims data and to ensure other documentation supports the claim for services rendered;

(6) Contacting recipients to verify that services or supplies claimed for reimbursement by providers were actually rendered;

(7) Contacting providers to recover overpayments or correct underpayments; and

(8) Referring cases of potential fraud for further investigation and possible criminal action, pursuant to 42 CFR 455.15.

History

(See Revision Note at chapter heading He-W 500); ss by #6574, eff 9-12-97; ss by #6925, eff 1-1-99; ss and moved by #8781, eff 1-1-07 (from He-W 520.06); ss by #9365, eff 1-17-09; ss by #12188, eff 5-25-17; ss by 14415, eff 10-22-25, EXPIRES 10-22-35

N.H. Code Admin. R. Ann. He-W 520.05 Fraud Detection and Investigation {#sec-he-w-520.05 omnilex-key=us-nh-regs-official--agency-he-w--He-W 520.05}

(a) In accordance with 42 CFR 455.14, if the department or MCO receives a complaint of medicaid fraud or abuse from any source or identifies any questionable practices, they shall conduct a preliminary investigation.

(b) Cases where potential fraud has been detected as a result of a preliminary investigation pursuant to (a) above, shall be referred for a full investigation to the appropriate agency, in accordance with 42 CFR 455.15.

History

(See Revision Note at chapter heading He-W 500); ss by #6574, eff 9-12-97; ss by #6925, eff 1-1-99; ss by #8781, eff 1-1-07, EXPIRED: 1-1-15
#10776, INTERIM, eff 1-31-15, EXPIRES: 7-30-15; ss by #10887, eff 7-17-15; ss by 14415, eff 10-22-25, EXPIRES 10-22-35

N.H. Code Admin. R. Ann. He-W 520.06 Provider Requirements {#sec-he-w-520.06 omnilex-key=us-nh-regs-official--agency-he-w--He-W 520.06}

(a) NH medicaid providers and provider applicants shall meet the provider participation requirements contained in chapter He-W 500, as applicable, for providers of the type of services they will be providing, as well as requirements in this section.

(b) The following individuals and entities shall be subject to a risk determination:

(1) NH medicaid provider applicants;

(2) NH medicaid providers who are applying to enroll a new practice location(s);

(3) NH medicaid providers who are re-enrolling; and

(4) NH medicaid providers being revalidated in accordance with 42 CFR 455.414.

(d) For provider types that exist in both medicare and medicaid, the department shall assign the same risk category as medicare.

(e) Any new provider type not defined by medicare shall be assigned as moderate risk for one year. At one year, the department shall determine if the provider or provider type should remain at moderate risk or be moved to limited risk.

(f) Limited provider types shall be subject to all federally required database checks of those with a 5% or greater ownership and controlling interest, and managing directors of the provider, for each location, as defined under 42 CFR 455.101 and described in 42 CFR 102 and 42 CFR 104. Limited provider types include the following:

(1) Physician or non-physician practitioners, including nurse practitioners, certified registered nurse anesthetists, occupational therapists, speech or language pathologists, and audiologists, and medical groups or clinics;

(2) Ambulatory surgical centers (ASCs);

(3) Competitive acquisition program/Part B vendors;

(4) End-stage renal disease facilities (ESRDs);

(5) Federally qualified health centers (FQHCs);

(6) Histocompatibility laboratories;

(7) Home infusion therapy suppliers;

(8) Hospitals, including critical access hospitals (CAHs), Department of Veterans Affairs hospitals, and other federally-owned hospital facilities;

(9) Health programs operated by an Indian Health Program, as defined in section 4(12) of the Indian Health Care Improvement Act, or an urban Indian organization, as defined in section 4(29) of the Indian Health Care Improvement Act, that receives funding from the Indian Health Service pursuant to Title V of the Indian Health Care Improvement Act;

(10) Mammography screening centers;

(11) Mass immunization roster billers;

(12) Opioid treatment programs, if 42 CFR 424.67(b)(3)(ii) applies;

(13) Organ procurement organizations (OPOs);

(14) Pharmacies newly enrolling or revalidating via the CMS-855B application;

(15) Radiation therapy centers (RTCs);

(16) Religious non-medical health care institutions (RNHCIs); and

(17) Rural health clinics (RHCs).

(g) Moderate risk providers are subject to the database checks described in (f) but also subject to a provider site visit. Moderate provider types include the following:

(1) Ambulance service suppliers;

(2) Community mental health centers (CMHCs);

(3) Comprehensive outpatient rehabilitation facilities (CORFs);

(4) Independent clinical laboratories (ICLs);

(5) Independent diagnostic testing facilities (IDTFs);

(6) Physical therapists enrolling as individuals or as group practices;

(7) Portable x-ray suppliers (PXRSs);

(8) Prospective, newly enrolling, and revalidating opioid treatment programs (OTP) that have been fully and continuously certified by the Substance Abuse and Mental Health Services Administration (SAHMSA) since October 23, 2018;

(9) Revalidating durable medical equipment, prosthetic devices, prosthetics, orthotics, and supplies (DMEPOS) suppliers;

(10) Revalidating home health agencies (HHAs);

(11) Revalidating medicare diabetes prevention program (MDPP) suppliers;

(12) Revalidating skilled nursing facilities (SNFs); and

(13) Revalidating hospices.

(h) High risk providers are subject to (f) and (g) above, and a criminal background check including fingerprinting as described in (j) below.

(i) Individuals and entities in (f) and (g) above who meet either of the following criteria shall be determined to be high-risk providers or high-risk provider applicants:

(1) The individual or entity, with the exception of those who are undergoing revalidation in accordance with 42 CFR 455.414, provides home health services, nursing facilities, or durable medical equipment services; or

(2) The individual’s or entity’s risk level was adjusted to high by the department as required by 42 CFR 455.450(e)(1) because any of the following occurred:

a. The department imposed a payment suspension on the individual or entity based on credible allegation of fraud, waste, or abuse;

b. The individual or entity has an existing medicaid overpayment;

c. The individual or entity was excluded from participation in a federally funded program by the office of inspector general or another state’s medicaid program within the 10 years preceding the date of application or date of revalidation; or

d. In accordance with 42 CFR 455.450(e)(2), NH medicaid or the Centers for Medicare and Medicaid Services (CMS) in the previous 6 months lifted a temporary moratorium for the particular provider type and a provider that was prevented from enrolling based on the moratorium applies for enrollment as a provider within 6 months from the date the moratorium was lifted.

(j) The following individuals and entities shall be subject to a state and federal criminal background check, including fingerprinting, in accordance with this section:

(1) Persons with a direct or indirect ownership interest in a high-risk provider or high-risk provider applicant described in (i)(1) above; and

(2) High-risk providers or high-risk provider applicants described in (i)(2) above.

(k) Those who meet the criteria in (h) above shall not be subject to an additional criminal background check, including fingerprinting, if, within the previous 36 months, they have undergone a criminal background check as required by:

(1) A Medicare administrative contractor;

(2) NH medicaid;

(3) Any other state’s medicaid agency, and the department is able to access the information from the other state’s medicaid agency; or

(4) Any other state’s children’s health insurance program (CHIP), and the department is able to access the information from the other state’s CHIP.

(l) Those who meet the criteria in (j) above, and who are not excluded in (k) above, shall be notified in writing of the following by the department:

(1) That a state and federal criminal background check, including fingerprinting, is required;

(2) Where the criminal background check, including fingerprinting, can be conducted as specified in (n)(1) below; and

(3) The deadline by which the criminal background check, including fingerprinting, shall be conducted as specified in (m) below.

(m) The deadline for undergoing a criminal background check, including fingerprinting, shall be 30 days from the date of the notification in (l) above.

(n) Those who meet the criteria in (j) above, and who are not excluded in (k) above, shall undergo a state and federal criminal background check by:

(1) Having a complete set of electronic fingerprints taken at any location maintained by the NH state police criminal records unit that has electronic fingerprinting capability, or by any other in or out of state law enforcement agency that conducts fingerprinting electronically; and

(2) Completing and submitting to the location in (1) above a notarized department of safety’s Form DSSP 417, “New Hampshire Health and Human Services Criminal History Record Information Authorization, New Hampshire Medicaid Program” incorporated by reference in Saf-C 5703.10, Table 5700-1, which authorizes the release of the individual’s criminal history record, if any, to the department.

(o) Those who meet the criteria in (j) above shall be terminated from, or denied enrollment in, the NH medicaid program if:

(1) The individual fails to get fingerprinted by the deadline in (m) above, as applicable; or

(2) The results of the criminal background check indicate that the individual has been convicted of any of the following federal or state felony offenses within the 10 years preceding the date of application or date of revalidation of enrollment:

a. Felony crimes against persons, such as murder, sexual assault, assault, interference with freedom, destruction of property, unauthorized entries, robbery and theft, fraud and corruption, and other similar crimes for which the individual was convicted, including guilty pleas;

b. Financial crimes, such as extortion, embezzlement, income tax evasion, insurance fraud, and other similar crimes for which the individual was convicted, including guilty pleas; or

c. Any felony that placed the medicaid program or its recipients at immediate risk, such as a malpractice suit that resulted in a conviction of criminal neglect or misconduct.

(p) An individual or entity being terminated from, or denied enrollment in, the NH medicaid program in accordance with (o) above shall receive a written notice from the department of the denial or termination.

(q) The notice in (p) above shall contain:

(1) The reason for, and legal basis of, the denial or termination; and

(2) Information that an appeal of the denial or termination may be requested, in accordance with He-C 200, within 30 calendar days of the date on the notice of the denial or termination.

(r) Appeals of the results of the criminal background check shall be made in accordance with the department of safety rules at Saf-C 5703.12.

History

#12023, INTERIM, eff 11-1-16, EXPIRES: 4-30-17; ss by #12166, eff 4-29-17; ss by 14415, eff 10-22-25, EXPIRES 10-22-35

Part He-W 521 General Payment Information

N.H. Code Admin. R. Ann. He-W 521.01 Definitions {#sec-he-w-521.01 omnilex-key=us-nh-regs-official--agency-he-w--He-W 521.01}

(a) “Applicant” means a person on whose behalf application is being made for any of the department of health and human service's program.

(b) “Co-insurance” means the percentage of the other insurance or Medicare allowed charge that is not paid by the other insurance or Medicare, but is the responsibility of the recipient.

(d) “Deductible” means a set dollar amount that is the out-of-pocket expense an individual is responsible to pay, within a specific time frame, before insurance pays a claim.

(e) “Department” means the New Hampshire department of health and human services.

(f) “Formal provider bulletin” means official medicaid notices sent to the providers and maintained on the medicaid management information system website.

(g) “Managed care organization (MCO)” means an entity that has a comprehensive risk-based contract with the department to provide managed medicaid health care services.

(h) “Medicaid” means the Title XIX and Title XXI programs administered by the department which makes medical assistance available to eligible individuals.

(i) “Medicaid allowable” means the maximum amount medicaid shall pay for a service. Medicaid allowables are in the medicaid fee schedules on the medicaid management information system website.

(j) “Medicaid management information system (MMIS)” means the fee for the service system for mechanized claims processing and information retrieval recommended by the Centers for Medicare and Medicaid Services (CMS) for the implementation of the requirements of state fiscal administration pursuant to 42 CFR 433, Subpart C.

(k) “Medicare” means the health insurance program under Title XVIII of the Social Security Act for people who are age 65 or older, disabled, or both, regardless of income, obtained through the U.S. Department of Health and Human Services, Social Security Administration.

(l) “Provider” means “provider” as defined in RSA 167:58, V, namely “any individual, partnership, corporation or entity furnishing services under a written contract with the department.”

(m) “Recipient” means any individual who received or receives medical assistance under the medicaid program.

(n) “Recoupment” means medicaid recovers funds paid in error by reducing future payments until the recovery is complete.

(o) “Responsible party” means a person or organization who is wholly, or in part, responsible for paying for the medical services of an individual. Individual responsible parties are usually relatives such as a parent or spouse. Organization responsible parties are usually insurance carriers or Medicare.

(p) “Third party” means the process as described in RSA 167:4-b whereby any private insurer, health maintenance organization, hospital service organization, medical service or health services corporation, governmental agency, or any individual, organization, entity, or agency is authorized or under legal obligation to pay for medical services for an eligible recipient.

(q) “Third party liability” means the obligation of any private insurance, Medicare, individual, institution, corporation, or agency that is liable to pay all or part of the medical cost of illness, injury, disease, or disability of a recipient.

(r) “Third party payor” means the third party that pays or insures health or medical expenses on behalf of a recipient or recipients.

(s) “Self-audit” means an examination, review, or other inspection performed both by and within a given health care professional’s practice or business. It can be initiated by the entity or by an external entity.

History

(See Revision Note at chapter heading for He-W 500) (See also part heading for He-W 521) #13884, eff 2-22-24

N.H. Code Admin. R. Ann. He-W 521.02 Applicant, Recipient, and Recipient’s Responsible Party Responsibilities {#sec-he-w-521.02 omnilex-key=us-nh-regs-official--agency-he-w--He-W 521.02}

(a) A medicaid recipient or recipient’s responsible party shall:

(1) Inform the provider of the recipient’s medicaid coverage and third party insurance coverage, if applicable, prior to receiving services;

(2) Present the recipient’s medicaid identification (ID) card and third party insurance card, if applicable, to the service provider at the time of service;

(3) Comply with all requirements of the recipient’s private insurance for payment of any item, supply, or service, if the recipient is covered under another third party insurance or Medicare;

(4) Inform the department of any other medical insurance coverage or changes to insurance coverage; and

(5) Report any changes in circumstance to the department that may affect the recipient’s eligibility or access to care, such as a change of name, address, or income, within 10 days of the change taking effect.

(b) The recipient or recipient’s responsible party shall be responsible for payment of an item, supply, or service if:

(1) The recipient was not eligible for medicaid on the date of service(s);

(2) The recipient selects an item, supply, or service that is not covered under the medicaid program and the provider has informed the recipient prior to service that the item, supply, or service shall not be covered by medicaid;

(3) It is an ancillary services not associated with a covered service paid by medicaid;

(4) The recipient receives an item, supply, or service from an individual or entity that is not an enrolled medicaid provider, unless the managed care organization (MCO) approves the provider as an out-of-network provider and approves the service for payment or it was an emergency service in which the recipient was unable to go to an in-network provider with medicaid, such as an out-of-state accident;

(5) A provider enrolled in medicaid informs the recipient in writing that the provider shall not accept the recipient as a medicaid patient, but the recipient still requests the item, supply, or service from the provider;

(6) The recipient is enrolled with a third party insurance and the recipient’s failure to comply with all requirements of that insurance carrier, as required by (a)(3) above, results in the third party coverage being denied; or

(7) The recipient otherwise requests that the item, supply, or service not be processed through medicaid.

(1) Notify the department or MCO of any third party insurance coverage, or any accidental or work related injury:

a. At the time of application for medical assistance;

b. At the time of redetermination of medical assistance eligibility;

c. Within 10 business days of the start of insurance coverage;

d. Within 10 business days of the accident or injury date; or

e. Within 10 business days of the effective date of any changes in insurance coverage;

(2) Supply the department or MCO with the following information regarding third party insurance:

a. Name of medicaid recipient covered by insurance policy;

b. Name of the insurance company;

c. Insurance policy number;

d. Insurance group number, if applicable;

e. Date the insurance became active;

f. Type of insurance coverage;

g. Subscriber’s name of the insurance; and

h. Copies, front and back, of the insurance cards, if requested; and

(3) Notify the department of coverage, or a change in coverage, by contacting the department or MCO.

History

(See Revision Note at chapter heading for He-W 500) (See also part heading for He-W 521) #13884, eff 2-22-24

N.H. Code Admin. R. Ann. He-W 521.03 Provider Responsibilities {#sec-he-w-521.03 omnilex-key=us-nh-regs-official--agency-he-w--He-W 521.03}

(a) Prior to the delivery of items, supplies, or services, the provider shall verify the recipient’s medicaid coverage and other insurance information on the date of service.

(b) When an item, supply, or service requires prior authorization, the provider shall obtain approval from the department, the third party insurance, if applicable, or the recipient’s MCO prior to the delivery of said items, supplies, or services.

(1) The individual is not eligible for medicaid on the date of services;

(2) The recipient chooses to receive an item, supply, or service, from a provider who does not accept medicaid recipients. This also includes providers that accept third party insurance, but not medicaid, unless the recipient is on the health insurance premium payment (HIPP) program;

(3) The item, supply, or service is not covered under medicaid or exceeds the allowed limits and when providing an item, supply, or service not covered by medicaid, the provider has advised the recipient in writing and the recipient has declined alternative treatments that are covered by medicaid; or

(4) The provider informs the recipient in writing and the recipient agrees in writing prior to services being performed, including payment of charges for co-pays and deductibles of third party insurers. The written acknowledgement shall include, but is not limited to, the following information:

a. The provider’s name;

b. The provider’s medicaid ID number;

c. The recipient’s name;

d. The recipient’s medicaid ID number;

e. The date on which the item, supply, or service is requested;

f. A description of the item, supply, or service being requested; and

g. Certification by signature of the recipient that the recipient understands that:

The medicaid program shall not cover the item, supply, or service being requested; and
The recipient shall be responsible for payment if the recipient still chooses to receive the item, supply, or service.

(d) If the recipient is a minor or is incapacitated and unable to sign the written acknowledgement described in (c) above, the parent, guardian, or legal representative may sign on behalf of the recipient.

(e) When the provider accepts a patient into the practice as a medicaid patient, the provider shall accept medicaid payment as payment in full, less any medicaid cost-sharing requirement.

(f) The provider shall not bill medicaid recipients for any of the following:

(1) The difference between the provider’s usual and customary charge and the medicaid payment for services rendered, except any medicaid cost sharing;

(2) Missed, also known as no shows, or cancelled appointments;

(3) Costs associated with supplying copies of the recipient’s medical records to another health care provider;

(4) Any goods or services provided to the recipient that are offered to other individuals free of charge;

(5) Additional fees, such as membership, boutique, or concierge fees; or

(6) Any third party remaining co-insurance, co-payment, or deductible not paid by medicaid.

(g) If a recipient has paid for a service and then becomes retroactively eligible for medicaid, the provider may refund the recipient the amount paid and then bill medicaid for the covered services that were rendered.

(h) If the provider refuses to repay the recipient for a medical item, service, or prescribed medication, and the recipient wishes to be reimbursed, then the recipient may request reimbursement from the department.

(i) If the recipient wishes to pursue reimbursement from the department as described in (h) above, the recipient shall contact their district office and provide a statement signed by the provider stating that the provider refuses to refund the recipient and directly bill medicaid. In addition to the statement, the recipient shall also provide to the district office the following information:

(1) For each medical item:

a. The receipt verifying the recipient’s name who received the medical item;

b. The date on which the medical item was purchased;

c. The name of the medical item;

d. The amount charged for the medical item;

e. The amount paid for the medical item; and

f. The name of the individual who paid the bill;

(2) For each service provided:

a. The receipt verifying the recipient’s name who received the service;

b. The date on which the service was received;

c. The type of service received

d. The amount charged for the service;

e. The amount paid for the service; and

f. The name of the individual who paid the bill; or

(3) For each prescribed medication:

a. The name of the licensed professional prescribing the medication;

b. The receipt verifying the recipient’s name on the prescribed medication;

c. The date on which the medication was prescribed;

d. The specifics of the prescribed medication including:

The name of the medication;
The category of the medication;
The quantity of each medication;
The prescription number of each medication;
The refill number of each medication; and
The national drug code of the medication;

e. The amount charged for the prescribed medication;

f. The amount paid for the prescribed medication; and

g. The name of individual who paid for the prescribed medication.

(j) In order for the recipient to be reimbursed for services, as described in (h) above, the date of service shall have been after the recipient’s retroactive eligibility start date.

(k) If the recipient is reimbursed after complying with (i) and (j) above, the recipient shall only be reimbursed up to the medicaid allowable amount.

(l) The provider shall maintain accurate and complete medical, financial, and administrative records as required by the specific program state rules in chapters He-A 400, He-C 6000, He-E 800, He-M 300 - 500, He-M 1000, He-P 600, He-P 800, He-P 4000, and He-W 500, including relevant medical and third party records for payment from medicaid to justify the provision of and support for any items, supplies, or services supplied to medicaid recipients. Providers shall maintain complete records for at least 6 years from the date of service, or until the resolution of any personal action(s) commenced during the 6-year period, or whichever is longer.

(m) At a minimum, all medical records required in (l) above shall:

(1) Be typed or legibly written, recorded on paper, or in electronic format;

(2) Be dated;

(3) Clearly identify the recipient with full legal name and medicaid ID;

(4) Document the medical necessity of the service(s) billed;

(5) Document that the service(s) provided are consistent with the diagnosis of the recipient’s condition;

(6) Document that the service(s) are consistent with professionally recognized standards of care;

(7) Document the name of the performing or rendering provider and supervising provider, if required, and their credentials;

(8) Document all complaints and symptoms, medical history, examination findings, diagnostic test results, assessment results, clinical impressions or diagnosis, plans for care, dates of services, and the identity of the observing medical practitioner;

(9) Document all specific procedures or treatments performed;

(10) Document any medications administered or medical supplies utilized or provided;

(11) Record each item of service provided on the claim and include all supporting documentation;

(12) Include all physician orders; and

(13) Include a signature of a licensed qualified medical professional.

(n) The provider shall provide the records described in (l) above to the department, MCO, federal auditors, medicaid fraud control unit (MFCU), or the department’s designated representatives, upon request, as allowed by the Health Insurance Portability and Accountability Act (HIPAA) and 45 CFR 164.512(d). If records are not available, or do not support items, supplies, or service supplied, or the provider refuses to cooperate with the request, then payment for items, supplies, or service supplied shall be denied or shall be recovered, if already paid and recovery shall be done by the department or MCO by recoupment of future payments or direct billing.

(o) The provider shall report to the department within 35 days any changes related to the provider’s practice that may impact medicaid payments, including, but not limited to:

(1) A change of name or address;

(2) A lapse of licensure;

(3) A change in ownership; or

(4) A change in affiliations per 42 CFR 455.104(c)(1).

(p) If the changes described in (o) above are not reported, provider enrollment and payment shall be suspended if the provider is not in contact with the department, the provider is not responding to department inquiries, the provider does not submit the proper information, or the change precludes the department from paying claims, such as a lapse of license, until the issue is rectified.

(q) Providers shall maintain active licensure or certification per appropriate licensure board for services provided and any facility licensure or certification as required by state law.

(r) Providers shall follow all requirements outlined in the provider participation agreement upon enrollment and revalidation.

History

(See Revision Note at chapter heading for He-W 500) (See also part heading for He-W 521) #13884, eff 2-22-24

N.H. Code Admin. R. Ann. He-W 521.04 Claim Submission {#sec-he-w-521.04 omnilex-key=us-nh-regs-official--agency-he-w--He-W 521.04}

(a) Except as allowed by (f) and (h) below, a provider shall submit fee-for-service claims for payment to the department’s fiscal agent within 12 months of the earliest date of service, as required by 42 CFR 447.45.

(b) Claims may be submitted electronically using the X-12 format.

(c) Paper claims shall be submitted using the most current version of the following forms as required in 42 CFR 424.32 and are available as noted in Appendix A:

(1) The Centers for Medicare and Medicaid Services (CMS) form CMS-1500, “Health Insurance Claim Form” (2/2012), for billing professional services;

(2) The uniform billing (UB) form CMS-1450 “UB-04” (January 2023) for billing services provided in institutional settings; and

(3) The American Dental Association (ADA) form, “ADA Dental Claim Form” (2024), for billing all dental services.

(d) Providers shall follow provider billing manual requirements and formal provider bulletins when submitting claims.

(e) The CMS current and approved diagnosis and treatment codes shall be used on all claims submitted for payment.

(f) A non-enrolled provider may submit a fee-for-service claim for emergency services, such as an out-of-state accident. The provider shall submit a NH provider application with the claims for processing under the NH medicaid fee schedule for only the emergency dates of service. The provider shall pass all federally mandated screenings for payment.

(g) If a provider submitted a claim within the time period required as described in (a) above, and the claim is denied by the department’s fiscal agent or MCO, but the cause for the denial can be corrected, the provider may resubmit the fee-for-service claim within 12 months from the earliest date of service for payment to be made, or for MCO claims per the MCO contract obligation.

(h) When a provider is resubmitting a denied fee-for-service claim beyond the 15 months from the earliest date of service as allowed by (g) above, the submission shall include the following:

(1) A completed form 957, “Override Request” (February 2024), located on the NH MMIS health enterprise portal website at www.nhmmis.nh.gov; and

(2) A copy of the remittance advice, which is the notice to the provider of the original denied claim with the denial circled.

(i) If a claim was not previously denied and the date of service is more than 15 months from the date of submission of the claim, the claim shall only be approved for payment if:

(1) There was a delay in determining the recipient’s eligibility for medicaid;

(2) The claim is for a medicaid covered item, supply, or service provided during a retroactive eligibility period;

(3) The claim was submitted within 6 months of the date that retroactive medicaid eligibility was determined; or

(4) The claim could not be processed due to a department or MCO system issue or error.

(j) For MCO claims submission and processing, providers shall follow the MCO contract and billing manuals.

History

(See Revision Note at chapter heading for He-W 500) (See also part heading for He-W 521) #13884, eff 2-22-24

N.H. Code Admin. R. Ann. He-W 521.05 Provider {#sec-he-w-521.05 omnilex-key=us-nh-regs-official--agency-he-w--He-W 521.05}

Payments.

(a) Payment for a medical item, supply, or service shall be made for a recipient if:

(1) The recipient is eligible for medicaid on the date(s) of service(s);

(2) The medical item, supply, or service is covered under the medicaid program, in accordance with He-W 500;

(3) The provider is an enrolled medicaid provider at the time the service is provided; and

(4) A claim has been properly completed and submitted to the department’s fiscal agent or MCO for payment.

(b) A claim shall be denied when all of the requirements described in (a) above are not met.

(1) Fee-for-service claims rate as established by the department in accordance with RSA 161:4, VI(a);

(2) The provider’s usual and customary charge; or

(3) The third party’s patient liability up to the medicaid allowable amount.

(d) Reimbursement for any item, supply, or service that is first paid by Medicare shall be as follows:

(1) The full co-pay or deductible for hospital inpatient and outpatient claims; or

(2) The co-pay, deductible, or co-insurance up to the medicaid allowable amount less the Medicare payment for all other medical services and supplies. If the Medicare payment is greater than the medicaid allowable, then medicaid shall pay zero.

(e) Except for inpatient hospitalization and nursing facilities, payment for out-of-state hospitals, as defined by He-W 543.01(n), not in the medicaid network, shall be made:

(1) At the allowable medicaid rate in the state in which the services are provided; or

(2) In the absence of a medicaid program, at the approved Medicare rate.

(f) Payment for inpatient hospital services shall be made in accordance with He-W 543.13.

(g) The provider shall not deny services to any eligible individual due to the individual’s inability to pay the cost sharing amount imposed by medicaid in accordance with 42 CFR 447.15, and 42 CFR 447.52-54.

(h) The following items or services shall not be reimbursable by medicaid:

(1) All services or supplies that are not determined to be medically necessary, as defined in He-W 530.01(e) and He-W 546.01(e);

(2) Experimental or investigational drugs, biological agents, procedures, devices, or equipment, unless authorized prior by the department;

(3) Elective cosmetic surgeries or procedures;

(4) Service units beyond authorized service limits, as defined in He-W 530.01;

(5) Charges for missed, also known as no show, appointments or cancelled appointments;

(6) Anything prohibited in He-W 500; and

(7) All items or services that are considered to be part of the cost of doing business, including, but not limited:

a. Time involved in completing necessary forms, claims, or reports;

b. Copying of records;

c. Making referrals;

d. Renewing prescriptions; and

e. Providing medical documents for schools, sports, and camps.

(i) If a claim is paid in error, funds shall be recovered by the department or MCO through recoupment of future payments or direct billing.

(j) Medicaid co-payments shall be required for services specified in He-W 570 and implemented in accordance with 42 CFR 447.52-56.

History

(See Revision Note at chapter heading for He-W 500) (See also part heading for He-W 521) #13884, eff 2-22-24

N.H. Code Admin. R. Ann. He-W 521.06 Self-Audits {#sec-he-w-521.06 omnilex-key=us-nh-regs-official--agency-he-w--He-W 521.06}

(a) Self-audits may be performed either:

(1) Voluntarily by a provider and unsolicited by the department; or

(2) In response to a request by the department as follows:

a. A notice shall be sent to the provider identifying a specific matter to be addressed via the self-audit; and

b. At a minimum the notice shall provide the timeframe of the claims to audit, specific claims to audit, and the allotted period of time in which to conduct and complete the self-audit.

(b) The provider shall submit, at a minimum, the following information, for all audits initiated by (a) above:

(1) Billing provider name;

(2) Billing provider address;

(3) Billing provider medicaid ID number;

(4) Provider type;

(5) Billing provider tax ID number;

(6) Name, title, address, and telephone number of the designated contact for the provider regarding the self-audit;

(7) Date of service;

(8) Rendering or performing provider name;

(9) Procedure code and description;

(10) Number of units billed as defined in He-W 530.01;

(11) Recipient name and ID number;

(12) Internal control number; and

(13) Description of the non-compliance, for example, services not rendered, up-coding, brand drugs for generics, unqualified staff performing service, incorrect dates of service, incorrect recipient, duplicate services, unbundling, and services not documented.

(c) The provider shall submit all requested documentation to the department within 30 days from the last day of the allotted period of time to complete the audit referenced in (a)(2) above.

(d) Upon completion of department’s review of the self-audit, the self-audit shall either be accepted or declined and result in the following:

(1) Accepted self-audits shall result in the issuance of a final findings or action letter stating the amount of money to be repaid and shall provide repayment instructions;

(2) Self-audits that are not accepted shall be returned to the provider for corrections, with an explanation regarding why the self-audit could not be accepted; and

(3) If the documentation in (2) above is found to be incomplete or not submitted as stated in (c) above, the department shall conduct an on-site audit of the provider’s records.

(e) Participation in a self-audit does not eliminate the possibility of further review by the department and shall not affect in any manner the department or other regulatory or law enforcement agencies’ ability to pursue criminal, civil, or administrative remedies.

(f) The provider shall maintain copies of all self-audit information and documentation for 6 years from date of the department approval of the self-audit results.

History

(See Revision Note at chapter heading for He-W 500) (See also part heading for He-W 521) #13884, eff 2-22-24

N.H. Code Admin. R. Ann. He-W 521.07 Adjustments {#sec-he-w-521.07 omnilex-key=us-nh-regs-official--agency-he-w--He-W 521.07}

to Payments.

(a) In response to all payment errors identified by the department, MCO, MFCU, CMS, U.S. Department of Health and Human Services Office of Inspector General (OIG), providers, or other reviewers, the provider shall repay medicaid or MCO, either through direct payment or recoupment, the total amount of overpayment identified. Payment errors may include incorrect claim submissions, payments in excess of the amount allowed, and fraudulently claimed payments identified.

(b) An adjustment to a payment may be requested by a provider when a claim for payment was billed in error, the bill was incorrect, or overpayment was detected.

(c) The provider shall submit a written request to the department’s fiscal agent for fee-for-service claims or the MCO for managed care claims for an adjustment or recoupment.

(d) The department’s fiscal agent or MCO shall process the adjustment and make any additional payment as necessary or recoup over payments from future claims.

History

(See Revision Note at chapter heading for He-W 500) (See also part heading for He-W 521) #13884, eff 2-22-24

N.H. Code Admin. R. Ann. He-W 521.08 Third {#sec-he-w-521.08 omnilex-key=us-nh-regs-official--agency-he-w--He-W 521.08}

Party Liability.

(a) Acceptance of medical assistance by the recipient shall constitute assignment of rights to third party medical support in accordance with RSA 167:14-a.

(b) Third party liability shall be treated as the primary resource in the determination of payment of medical service claims.

(c) Except as allowed by (g) below, the provider shall determine if third party coverage exists at the time the item, supply, or service is provided, and file a proper and complete claim, following all of the third party’s policies, with the third party carrier before billing medicaid.

(d) Except as allowed by (g) below, medicaid shall not pay unless providers comply with third party coverage requirements, such as primary insurance prior authorizations, referrals, and service restrictions, when providing services.

(e) Except as allowed by (g) below, payments shall not be made for any services until all available third party benefits are exhausted.

(f) Failure by a provider to comply with the requirements for payment of any third party coverage, as described in (c), (d), and (e) above, shall result in non-payment of the item, supply, or service by medicaid.

(g) Providers may bill medicaid, prior to billing a known third party carrier, under the following circumstances:

(1) If the provider has confirmed with the department, a recipient has established good cause through the department for not cooperating and not utilizing third party coverage in accordance with 42 CFR 433.145 (a) and 42 CFR 433.147 (c); or

(2) For all preventive pediatric services in accordance with 42 CFR 433.139 (b).

(h) If the provider receives a denial from the third party for administrative reasons or non-compliance with third party procedures, then the provider shall be required to correct the error with the third party for payment. Medicaid shall not pay unless the claim correction is accepted by the third party and processed for payment.

(i) If any third party coverage is known to the department or MCO to provide coverage for a recipient’s medical service needs, that information may be obtained from the medicaid fiscal agent or the MCO.

(j) Providers shall not seek payment from a third party once they have submitted a claim to medicaid, unless they have received a rejection or denial from medicaid.

(k) If the provider has filed a proper claim with the liable third party, and a payment or denial is not forthcoming within 100 days from the date of service, the provider may submit a claim to medicaid and indicate the name and address of the possible third party payment source.

(l) If the provider receives a third party payment after receiving a medicaid payment due to (k) above for the same item, supply, or service, the provider shall reimburse the department or the MCO for the overpayment by submitting payment directly to the department or the MCO from which they were paid.

History

(See Revision Note at chapter heading for He-W 500) (See also part heading for He-W 521) #13884, eff 2-22-24

(a) Pursuant to RSA 167:14-a, IV, the recipient or the recipient's legal representative shall notify the department or MCO of any accident or injury in which a liable third party is responsible for expenses.

(b) Upon notification of a personal injury of a medicaid recipient, the department or MCO shall determine if there is a claim for third party liability recovery.

(c) The department or MCO shall request accident related information regarding third party liability to the medicaid recipient. If the recipient or the recipient’s legal representative fails to respond to the department's notice of claim, the department or MCO shall withhold the processing of or deny the claim for medicaid payment until the department or MCO receives a response from the recipient or the recipient’s legal representative.

(d) Upon the department or MCO’s request, the recipient or the recipient’s legal representative shall provide the department or MCO with the following information and completed documents:

(1) The date and location of when and where the injury occurred;

(2) The type of injuries incurred due to the accident;

(3) A description of how the injury happened;

(4) The involved insurance company or other liable party;

(5) The amount of a proposed or anticipated offer of settlement made by the liable third party; and

(6) The letter of representation and completed and notarized authorization to release records if the recipient has legal representation.

(e) When the department or MCO makes a claim for recovery of medical expenses paid on behalf of a recipient, the recipient or the recipient's legal representative shall, within 15 business days of receipt of notification of the department or MCO's claim, submit a written statement to the department or MCO which:

(1) Acknowledges the department or MCO's claim; and

(2) Includes a proposed distribution of the recovery.

(f) In addition to the statement in (e) above, a disbursement of any award, judgment, or settlement shall not be made to a recipient without the recipient or the recipient's legal representative first providing at least 30-days written notice of any scheduled trial, alternative dispute resolution hearing, or settlement to the department or MCO per RSA 167:14-a, IV. The recipient or the recipient’s legal representative shall include the department or MCO in all settlement negotiations.

(g) Pursuant to RSA 167:14-a, III, when a recipient receives a settlement or an award from a liable third party prior to notifying the department or MCO, the recipient shall repay the amount of medical assistance furnished by the department or MCO.

(h) If the recipient or the recipient’s legal representative fails to respond to the department or MCO’s notice of lien, the department shall suspend further payments related to the incident until a response is received from the recipient or the recipient’s legal representative unless the recipient is a minor. Claims shall not be suspended when the recipient is under 18 years of age.

(i) If any injury is the result of a work-related accident, and the employer, the insurance carrier, or both, deny the injured employee medical expenses for the periods the injury requires, the recipient may request a hearing from the NH department of labor worker's compensation division, in accordance with Lab 204.01.

(j) Pursuant to RSA 167:14-a, III, when a recipient receives a settlement or an award from worker’s compensation or a liable third person or party, the recipient shall repay the amount of medical assistance furnished by the department to the extent that the amount of the recovery makes repayment possible.

History

(See Revision Note at chapter heading for He-W 500) (See also part heading for He-W 521) #13884, eff 2-22-24

N.H. Code Admin. R. Ann. He-W 521.10 Medicare {#sec-he-w-521.10 omnilex-key=us-nh-regs-official--agency-he-w--He-W 521.10}

(a) Providers shall enroll with medicaid to receive payment of Medicare crossover claims. Providers shall not submit claims to medicaid or the MCOs if the provider submitted claims to Medicare and received payment. These claims shall be automatically submitted by Medicare to medicaid and MCO as crossover claims for processing.

(b) Providers shall not bill qualified medicare beneficiaries (QMB) for co-payments or deductibles. Sections 1902(n)(3)(B), 1902(n)(3)(C), 1905(p)(3), 1866(a)(1)(A), and 1848(g)(3)(A) of the Social

Security Act, prohibits providers from balance billing QMBs for Medicare cost-sharing.

History

(See Revision Note at chapter heading for He-W 500) (See also part heading for He-W 521) #13884, eff 2-22-24

N.H. Code Admin. R. Ann. He-W 521.11 Third Party Payment {#sec-he-w-521.11 omnilex-key=us-nh-regs-official--agency-he-w--He-W 521.11}

(a) All third party payors shall comply with RSA 167:4-b.

(b) If third party coverage is determined after a medicaid claim is processed, then the third party payor shall reimburse medicaid even if the third party’s plan policies and procedures were not performed at time of service.

(c) Third party payors shall not deny medicaid’s or MCO’s claim for reimbursement for claim type, claim format, or failure to comply with the third party’s plan policies and procedures, which include, but are not limited to:

(1) No prior authorization obtained;

(2) Not submitted on Health Care Financing Administration or UB red forms;

(3) Claim not submitted electronically;

(4) No National Provider Identification number provided for medicaid;

(5) Medicaid is not a participating provider;

(6) Not submitting reimbursement within the third party payors’ time limit; and

(7) Not having subscriber information on payment request.

(d) If a third party payor has reimbursed medicaid, and then a provider requests payment on the same claim, the third party payor cannot reverse payment made to medicaid to pay the provider.

(e) If a third party payor has reimbursed medicaid or the MCO, then the third party payor requests a payment reversal or adjustment, such requests shall be received within 12 months of initial payment to medicaid or MCO. All reversal or adjustment requests after 12 months shall be denied, and the third party payor cannot recover those payments on future payments to medicaid or MCO.

(f) Third party payors cannot make a payment to a provider after paying medicaid or MCO and reverse or adjust the payment made to medicaid or MCO.

History

(See Revision Note at chapter heading for He-W 500) (See also part heading for He-W 521) #13884, eff 2-22-24

Part He-W 529 Independent Coverage Review - Reserved

N.H. Code Admin. R. Ann. He-W 529.01 Medical Assistance {#sec-he-w-529.01 omnilex-key=us-nh-regs-official--agency-he-w--He-W 529.01}

– He-W 529.07

History

#8983, INTERIM, eff 9-21-07, EXPIRES: 3-19-08; ss by #9103, eff 3-12-08; rpld by #10031, eff 11-19-11

Part He-W 530 Service Limits, Co-Payments, and Non-Covered Services

N.H. Code Admin. R. Ann. He-W 530.01 Definitions {#sec-he-w-530.01 omnilex-key=us-nh-regs-official--agency-he-w--He-W 530.01}

(a) “Co-payment” means an amount to be paid by the recipient to an enrolled New Hampshire medicaid provider.

(b) “Department” means the New Hampshire department of health and human services.

(c) “Generally accepted standards of medical practice” means standards that are based on credible scientific evidence published in peer-reviewed medical literature generally recognized by the relevant medical community, or the recommendations of physician specialists practicing in relevant clinical areas or of various physician specialty societies.

(d) “Medicaid” means the Title XIX and Title XXI programs administered by the department, which makes medical assistance available to eligible individuals.

(e) “Medically necessary” means health care services that a licensed health care provider, exercising prudent clinical judgment, would provide, in accordance with generally accepted standards of medical practice, to a recipient for the purpose of evaluating, diagnosing, preventing, or treating an acute or chronic illness, injury, disease, or its symptoms, and that are:

(1) Clinically appropriate in terms of type, frequency of use, extent, site, and duration, and consistent with the established diagnosis or treatment of the recipient’s illness, injury, disease, or its symptoms;

(2) Not primarily for the convenience of the recipient or the recipient’s family, caregiver, or health care provider;

(3) No more costly than other items or services which would produce equivalent diagnostic, therapeutic, or treatment results as related to the recipient’s illness, injury, disease, or its symptoms; and

(4) Not experimental, investigative, cosmetic, or duplicative in nature.

(f) “Multi-source pharmaceutical product” means a product which is available from more than one manufacturer.

(g) “Non-preferred prescription drug” means a medication that has been determined to have an alternative drug available that is clinically equivalent and has been clinically reviewed and approved by the NH Pharmacy and Therapeutics Committee or the NH Drug Use Review Board established in He-C 5010 and has been included in the department’s preferred drug list as non-preferred.

(h) “Preferred prescription drug” means a medication that has been clinically reviewed and approved by the NH Pharmacy and Therapeutics Committee or the NH Drug Use Review Board established in He-C 5010 and has been included in the department’s preferred drug list based on its proven clinical and cost effectiveness.

(i) “Preferred Drug List (PDL)” means a formal published list of specific prescription drug products by brand and generic name divided into 2 separate categories as either preferred or non-preferred.

(j) “Provider” means an entity or individual who furnishes health care services or supplies to medicaid recipients under an agreement with the department, and is licensed or certified pursuant to applicable state law to provide such services and supplies.

(k) “Recipient” means any individual who is eligible for and receiving medical assistance under the medicaid program.

(l) “Service” means medical care or a medical product for which payment is made by New Hampshire medicaid.

(m) “Service limit” means a finite number of visits or units of service per recipient per specified time period for which payment is made by New Hampshire medicaid.

(n) “Single source pharmaceutical product” means a brand name product which is available from only one manufacturer.

(o) “State fiscal year” means July 1 through June 30.

(p) “Third party entity” means the agency under contract with the department to collect and process premium payments for medicaid recipients.

(q) “Title XIX” means the joint federal-state program described in Title XIX of the Social Security Act and administered in New Hampshire by the department under the medicaid program.

(r) “Title XXI” means the joint federal-state program described in Title XXI of the Social Security Act and administered in New Hampshire by the department under the medicaid program.

(s) “Unit” means a determinate quantity for which a particular service is rendered.

(t) “Visit” means all services provided to a recipient per appointment or encounter with a provider.

History

(See Revision Note at chapter heading He-W 500); ss by #5914, eff 11-1-94; ss by #6745, eff 5-1-98, EXPIRED: 12-31-98; ss by #6925, eff 1-1-99; ss by #8780, INTERIM, eff 1-1-07, EXPIRES: 6-30-07; ss by #8929, eff 6-30-07; amd by #8983, INTERIM, eff 9-21-07, EXPIRES: 3-19-08; ss by #9103, eff 3-12-08; amd by #10139, eff 7-1-12; ss by #11101, eff 5-25-16

N.H. Code Admin. R. Ann. He-W 530.02 Recipients Subject to Service Limits, Co-Payments, and Non-Covered Services {#sec-he-w-530.02 omnilex-key=us-nh-regs-official--agency-he-w--He-W 530.02}

(a) All recipients shall be subject to service limits in accordance with He-W 530.03.

(b) All recipients shall be subject to the co-payments specified in He-W 530.04, except for:

(1) Recipients with income at or below 100% of the federal poverty level (FPL);

(2) Recipients residing in a nursing facility, hospital, intermediate care facility for individuals with intellectual disabilities, or other medical institution;

(3) Recipients participating in the home and community based care (HCBC) waiver programs;

(4) Recipients receiving services that relate to pregnancy, in accordance with 42 CFR 447.53(b)(2), or any other medical condition that might complicate the pregnancy;

(5) Recipients under the age of 18;

(6) Women eligible through the Breast and Cervical Cancer Treatment Program, pursuant to 42 CFR 435.213;

(7) Recipients receiving hospice care pursuant to He-W 544; and

(8) Individuals who are members of a federally recognized Indian tribe or Alaskan natives who have ever been served through the Indian Health Services Programs, pursuant to 42 CFR 447.56(a)(x).

History

(See Revision Note at chapter heading He-W 500); ss by #4863, eff 7-12-90, EXPIRED: 7-12-96
#6745, eff 5-1-98, EXPIRED: 12-31-98; ss by #6925, eff 1-1-99; ss by #8780, INTERIM, eff 1-1-07, EXPIRES: 6-30-07; ss by #8929, eff 6-30-07; amd by #10016, eff 11-1-11; amd by #10716, eff 11-18-14; ss by #10915, eff 8-26-15; ss by #11101, eff 5-25-16

N.H. Code Admin. R. Ann. He-W 530.03 Service Limits {#sec-he-w-530.03 omnilex-key=us-nh-regs-official--agency-he-w--He-W 530.03}

The following service limits shall apply to each recipient who is subject to service limits, per state fiscal year, with exceptions noted:

(a) The hearing aid evaluation or a hearing aid consultation shall be limited to one service every 2 years since the last date of service;

(b) Hospital services shall be limited as follows:

(1) Outpatient hospital services shall be limited to 12 visits per state fiscal year;

(2) Services provided in an emergency department (ED) or an urgent care setting shall not be considered outpatient hospital services, and shall not apply toward the limit established in (1) above;

(3) Physician services shall be unlimited except when associated with an outpatient hospital visit, in which case they shall be limited to 12 visits per state fiscal year; and

(4) Services that are described individually in component parts of this chapter, such as therapy services or radiology services, and that are associated with an outpatient hospital, ED or urgent care visit shall be subject to the service limits which apply to that individual service;

(c) Physician and advanced practice registered nurse (APRN) services performed in the inpatient hospital setting shall be limited to one visit per each day of stay approved by the department or its designated quality improvement organization (QIO) as defined in He-W 531.01(h);

(d) Podiatry services shall be limited to 4 visits;

(e) Therapy services, including physical, occupational and speech therapy, shall be limited to 80, 15-minute units per recipient. The 80 units may be used for one type of therapy or for any combination of therapies;

(f) Vision care services shall be limited as follows:

(1) One refraction to determine the need for glasses, no more frequently than every 12 months;

(2) Replacement of lenses or at the discretion of the recipient, lenses and frames, when the refractive error changes .50 diopter or more in both eyes;

(3) Replacement of nickel frames after 12 months, if the recipient has a documented allergy to nickel demonstrated by skin irritation and wearing down of the frame in the affected area; and

(4) One repair of glasses every 12 months, including replacement of the broken part(s) only;

(g) Wheelchair van services shall be limited to 24 trips, either one-way or round trip;

(h) X-ray services shall be limited as follows:

(1) X-ray services for diagnostic purposes shall be limited to 15 x-rays; and

(2) X-ray services provided for radiation therapy shall not be limited; and

(i) If a recipient is covered by medicare and medicare pays at least half the medicaid program rate for a covered service which is subject to limits, that service shall not be counted against such limits.

History

(See Revision Note at chapter heading He-W 500); ss by #4863, eff 7-12-90; amd He-W 530.03(d) by #5714, eff 10-1-93; amd He-W 530.03(f) by #6050, eff 6-17-95; ss by #6925, eff 1-1-99; ss by #8780, INTERIM, eff 1-1-07, EXPIRES: 6-30-07; ss by #8929, eff 6-30-07; amd by #8983, INTERIM, eff 9-21-07, EXPIRES: 3-19-08; amd by #9103, eff 3-12-08; amd by #9366, eff 1-17-09; amd by #9622, eff 1-1-10; amd by #9736, eff 6-25-10; amd by #10017, eff 11-1-11; amd by #10090, eff 3-1-12; amd by #10427, eff 9-28-13; amd by #10657, eff 8-15-14; ss by #10915, eff 8-26-15; amd by #12818, eff 7-1-19

N.H. Code Admin. R. Ann. He-W 530.04 Co-Payments {#sec-he-w-530.04 omnilex-key=us-nh-regs-official--agency-he-w--He-W 530.04}

(a) Recipients subject to co-payments shall make co-payments to the pharmacy provider for pharmaceutical products as follows, except as noted in (3) below:

(1) For recipients eligible for medicaid through the New Hampshire Health Protection Program (NHHPP) co-payments as required in He-W 512.

(2) For all other recipients subject to co-payments as required by this part:

a. A co-payment in the amount of $1.00 shall be required for each preferred prescription drug and each refill of a preferred prescription drug dispensed;

b. A co-payment in the amount of $2.00 shall be required for each non-preferred prescription drug and each refill of a non-preferred prescription drug dispensed unless the prescribing provider determines that a preferred drug will be less effective for the recipient, will have adverse effects for the recipient, or both, in which case, the co-payment shall be $1.00; and

c. A co-payment in the amount of $1.00 shall be required for a prescription drug that is not identified as either a preferred or non-preferred prescription drug; and

(3) Co-payments for pharmaceutical products shall not be required:

a. Of recipients exempt from co-payments in accordance with He-W 530.02(b);

b. For family planning products; and

c. For Clozaril (Clozapine) prescriptions.

(b) Recipients subject to co-payments shall make co-payments to the provider for services as follows, except as noted in (2) below:

(1) For recipients eligible for medicaid through the NHHPP, co-payments as described in He-W 512; and

(2) Recipients shall not be responsible for a co-payment for the following services:

a. Emergency services needed to evaluate or stabilize an emergency medical condition as defined in 42 CFR 438.114(a);

b. Provider-preventable services as described in 42 CFR §447.26(b);

c. Services furnished to pregnant women, including counseling and pharmacotherapy for cessation of tobacco use;

d. Family planning services and supplies; and

e. Preventive services.

(c) Pursuant to 42 CFR 447.56(f), co-payment obligations shall be suspended for the remainder of the calendar year quarter when the total co-payments made out of pocket by the recipient reaches 5 percent of the recipient’s household income.

(d) All recipients subject to co-payments required by this part shall not be denied services by any medicaid enrolled provider on account of the recipient’s inability to pay the co-payments required by this part.

History

(See Revision Note at chapter heading He-W 500); ss by #4863, eff 7-12-90, EXPIRED: 7-12-96
#6925, eff 1-1-99; ss by #7976, eff 10-22-03; ss by #8780, INTERIM, eff 1-1-07, EXPIRES: 6-30-07; ss by #8929, eff 6-30-07; amd by #10017, eff 11-1-11; ss by #10716, eff 11-18-14; ss by #11101, eff 5-25-16

N.H. Code Admin. R. Ann. He-W 530.05 Non-Covered Services {#sec-he-w-530.05 omnilex-key=us-nh-regs-official--agency-he-w--He-W 530.05}

(a) Non-covered services shall be those services for which the Medicaid program shall make no payment.

(b) Non-covered services shall include:

(1) Acupuncture;

(2) Services ancillary to, or directly related to, a non-covered service or procedure;

(3) Biofeedback;

(4) Experimental or investigational procedures described as such in the National Coverage Determinations (NCD) found in the Centers for Medicare and Medicaid Services “Medicare Coverage Database” at http://www.cms.gov/medicare-coverage-database/ (under the “Quick Search” function, select “National Coverage Documents”, optionally enter a filter by entering a “keyword” to narrow the search results, and select the “Search by Type” button, or, if a keyword is not entered, the entire list of NCD titles will appear alphabetically and may be selected), including thermogenic therapy and electrosleep therapy;

(5) Reversal of voluntary sterilization;

(6) Operations for impotency;

(7) Operations, devices, and procedures for the purpose of contributing to or enhancing fertility or procreation;

(8) Plastic surgery, to include cosmetic surgery, for the purpose of preserving or improving appearance or disfigurement, except when required for the prompt repair of accidental injury or for the improvement in functioning of a malformed body part;

(9) Hypnosis, except when performed by a psychiatrist as part of an established treatment plan;

(10) Routine foot care, except as described in He-W 532;

(11) Services or items that are free to the public;

(12) Physician care in a non-medical government or public institution;

(13) Dietary services, including commercial weight loss, nutritional counseling, and exercise programs, except as otherwise allowed in He-W 500;

(14) Homemaker services, except when provided as part of an authorized Choices for Independence (CFI) program support plan to CFI recipients as described in He-E 801;

(15) Academic performance testing not related to a medical condition;

(16) Detoxification services provided outside an acute care facility or a medical services clinic;

(17) Services provided by halfway houses;

(18) Hospital inpatient care which is not medically necessary;

(19) Autopsies;

(20) Auditory training, except for auditory trainer devices which are covered;

(21) Respite, except as a service under a home and community based care waiver in accordance with 42 CFR 400.180 and 440.181;

(22) Child care;

(23) Chiropractor services;

(24) Institutions for Mental Diseases, in accordance with Section 1905(a)(24)(B) of the Social Security Act;

(25) Duplicative services, which are services that deliver the same functionality to the same recipient during the same period of time, regardless of whether those services are provided solely under medicaid or by medicaid in combination with another program or entity;

(26) Services provided outside the United States and its territories;

(27) Vaccinations for out of country travel;

(28) Services provided by individuals who are not licensed, certified or otherwise recognized by the provisions of He-W 500 to provide such services;

(29) Personal clothing or footwear;

(30) Service and therapy animals;

(31) Equine-assisted psychotherapy;

(32) Any service which is not specifically listed elsewhere in He-W 522 through He-W 589 as covered, or covered with prior authorization, and which is not covered as follows:

a. The service is not covered by Medicare, as indicated by the National Coverage Determinations (NCD) found in the Centers for Medicare and Medicaid Services “Medicare Coverage Database” at http://www.cms.gov/medicare-coverage-database/ (under the “Quick Search” function, select “National Coverage Documents”, optionally enter a filter by entering a “keyword” to narrow the search results, and select the “Search by Type” button, or, if a keyword is not entered, the entire list of NCD titles will appear alphabetically and may be selected); or

b. The service is not covered by New Hampshire or New England commercial insurance policies and coverage criteria as follows:

Anthem Medical Policies and Clinical UM Guidelines, http://www.anthem.com/wps/portal/ahpprovider?content_path=provider/wi/f5/s1/t4/pw_ad080065.htm&state=wi&rootLevel=0&label=Anthem%20Medical%20Policies (select the “Continue” button to confirm that the page has been read and proceed to the “Overview” page, then select the “Click Here to Search” button in the middle of this page to continue to the search engine, enter search criteria for the specific coverage policy, and then select the specific coverage policy);
Cigna Coverage Policies, https://cignaforhcp.cigna.com (select “RESOURCES” at the top of the page, then select “Coverage Policies”, then select “Medical A-Z Index” for an alphabetical list of policies, and then select the specific coverage policy); or
Aetna Clinical Policy Bulletins, http://www.aetna.com/healthcare-professionals/policies-guidelines/cpb_alpha.html (select specific bulletin from the alphabetical listing of clinical policy bulletins); and

(33) Any service for which coverage is not specified within the New Hampshire Medicaid State Plan, and as such the department is unable to claim federal financial participation (FFP) for said service.

History

#6745, eff 5-1-98, EXPIRED: 12-31-98; ss by #6925, eff 1-1-99; ss by #8780, INTERIM, eff 1-1-07, EXPIRES: 6-30-07; ss by #8929, eff 6-30-07; amd by #9103, eff 3-12-08; amd by #9366, eff 1-17-09; amd by #9622, eff 1-1-10; amd by #9836, eff 12-18-10; ss by #10504, eff 1-9-14; amd by #10561, eff 3-29-14

N.H. Code Admin. R. Ann. He-W 530.06 Recipient Responsibility for Payment {#sec-he-w-530.06 omnilex-key=us-nh-regs-official--agency-he-w--He-W 530.06}

(a) The recipient shall be responsible for payment of the entire cost of a service if:

(1) The individual is not eligible for medicaid on the date of service;

(2) The service is not covered by medicaid;

(3) The provider is not a NH enrolled medicaid provider; or

(4) The provider is no longer taking additional medicaid recipients, but the recipient chooses to receive the service anyway as a private patient.

(b) The recipient shall be informed of these provisions verbally at the initial determination of eligibility and at each redetermination of eligibility by the department.

History

(See Revision Note at chapter heading He-W 500); ss by #5874, eff 8-1-94; ss by #6925, eff 1-1-99; ss by #8780, INTERIM, eff 1-1-07, EXPIRES: 6-30-07; ss by #8929, eff 6-30-07; ss by #10915, eff 8-26-15

N.H. Code Admin. R. Ann. He-W 530.07 Prior Authorization of Services Which Exceed Service Limits {#sec-he-w-530.07 omnilex-key=us-nh-regs-official--agency-he-w--He-W 530.07}

(a) When the individual medical care plan of a recipient who is under 21 years of age indicates the need for services in excess of the service limits described in He-W 530.03, authorization to exceed the service limit shall be requested in accordance with He-W 546.

(b) When the individual medical care plan of a recipient who is 21 years of age or older indicates the need for services in excess of the service limits described in He-W 530.03, the provider shall request from the department additional visits or units of covered service(s).

(c) All requests in (b) above shall be in advance of the service(s) being rendered, except that services provided during a retroactive eligibility period shall be exempt from this requirement.

(d) Requests for additional units of covered service(s) may be made by the following providers:

(1) Advanced practice registered nurses;

(2) Associate psychologists;

(3) Occupational therapists;

(4) Optometrists;

(5) Osteopathic physicians;

(6) Psychotherapy providers licensed by the board of mental health practice;

(7) Physicians;

(8) Physician’s assistants;

(9) Podiatrists;

(10) Psychologists;

(11) Physical therapists; and

(12) Speech and language therapists.

(e) Providers shall direct requests for prior authorization of services in excess of the limits described in He-W 530.03 to the department.

(f) Prior to payment by the department, requests for prior authorization of covered services in excess of the limits described in He-W 530.03 shall:

(1) With the exception of services provided during a retroactive eligibility period, be submitted in advance of rendering additional services;

(2) Be submitted in writing to the department via mail, e-mail or fax;

(3) Be signed by a provider described in (d) above; and

(4) Be based on the provider’s medical care plan developed for the recipient.

(g) Except as allowed by He-W 573.10, requests for prior authorization shall include, at a minimum:

(1) The recipient’s name;

(2) The recipient’s Title XIX program identification number;

(3) The recipient’s diagnosis;

(4) A copy of the recipient’s medical care plan;

(5) The number of additional visits or units of service being requested;

(6) The provider number of the individuals or agencies to whom the recipient is being referred for these additional services;

(7) Clinical documentation that addresses how the requested additional services meet the definition of medically necessary;

(8) Except as provided by (9) below, if the requested additional services do not meet the definition of medically necessary, clinical documentation that addresses:

a. Any extenuating circumstances unique to the recipient that would make denial of the additional services clinically contraindicative; or

b. Any new scientific evidence in the medical literature or by experts in the field about the efficacy or medical appropriateness of the services;

(9) If the requested additional services are for therapy services, as described in He-W 568, documentation demonstrating that the request meets the clinical criteria set forth in the Milliman Care Guidelines, 17th edition (February/March 2013), available as noted in Appendix A;

(10) A statement of the anticipated medical outcome if the requested additional services are provided; and

(11) A statement of the anticipated medical outcome, and either the estimated cost of such outcome or a description of medical services that might be required as the result of such outcome, if the requested additional services are not provided.

(h) Except as allowed by He-W 573.10, prior authorization requested in accordance with (b) through (g) above shall be approved by the department if the department determines that the requested additional services meet the definition of medically necessary or that coverage is supported by clinical documentation provided in accordance with (g)(8) above.

(i) If the department approves the prior authorization request in accordance with (h) above, the state’s fiscal agent shall send written confirmation of the approval to the provider.

(j) The provider shall be responsible for determining that the recipient is Title XIX eligible on the date of service.

(k) Providers may monitor the number of services used by a recipient based on claims processed and paid by contacting the department’s fiscal agent for this information.

(l) With the exception of requests for services provided during a retroactive eligibility period and wheelchair van services requested in accordance with He-W 573.10, requests for retroactive authorization for services rendered prior to the authorization request shall be denied by the department.

(m) Except as allowed by He-W 573.10, the department shall deny a prior authorization request when the department determines that the requested additional services do not meet the definition of medically necessary and that the coverage is not supported by clinical documentation provided in accordance with (g)(8) or (9) above.

(n) If the department denies the prior authorization request, the department shall forward a notice of denial to the recipient and the wheelchair van provider.

(o) The notice of denial shall contain the information required by 42 CFR 431.210, including:

(1) The reason for, and legal basis of, the denial; and

(2) Information that an appeal of the denial may be requested, in accordance with He-C 200, within 30 calendar days of the date on the notice of the denial.

History

(See Revision Note at chapter heading He-W 500); ss by #4863, eff 7-12-90, EXPIRED: 7-12-96
#6745, eff 5-1-98, EXPIRED: 12-31-98; ss by #6925, eff 1-1-99; ss by #8780, INTERIM, eff 1-1-07, EXPIRES: 6-30-07; ss by #8929, eff 6-30-07; ss by #9366, eff 1-17-09; amd by #9622, eff 1-1-10; amd by #10017, eff 11-1-11; amd by #10031, eff 11-19-11; amd by #10342, eff 6-1-13; ss by #10605, eff 5-23-14; amd by #11101, eff 5-25-16

Part He-W 531 Physician Services

N.H. Code Admin. R. Ann. He-W 531.01 Definitions {#sec-he-w-531.01 omnilex-key=us-nh-regs-official--agency-he-w--He-W 531.01}

(a) “Cosmetic purpose” means a procedure done for the sole purpose of changing a physical appearance.

(b) “Current procedural terminology (CPT) code” means a unique identifying code in the field of medical nomenclature and designated by the United States Department of Health and Human Services as the national coding standard utilized in government and private health insurance programs for reporting medical services and procedures.

(d) “Healthcare Common Procedure Coding System (HCPCS)” means a standardized coding system used by Medicare that describes services and procedures. HCPCS includes CPT codes that are used primarily to identify products, supplies, and services not included in the normal CPT code list, such as ambulance services and durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS), when used outside a physician’s office.

(e) “Medicaid” means the Title XIX and Title XXI programs administered by the department which makes medical assistance available to eligible individuals.

(f) “National Correct Coding Initiative (NCCI) edits” means standardized coding edits developed by the Centers for Medicare and Medicaid Services (CMS) to reduce improper coding and prevent inappropriate payments when incorrect code combinations are reported.

(g) “Prior authorization agent” means an individual or organization contracted by the department, responsible for reviewing all prior authorization requests.

(h) “Quality improvement organization (QIO)” means an organization or agency established in accordance with 42 CFR 475 that performs utilization and quality control peer reviews in accordance with 42 CFR 476 when contracted by the department for the performance of such reviews.

(i) “Recipient” means any individual who is eligible for and receiving medical assistance under the medicaid program.

(j) “Title XIX” means the joint federal-state program described in Title XIX of the Social Security Act and administered in New Hampshire by the department under the medicaid program.

(k) “Title XXI” means the joint federal-state program described in Title XXI of the Social Security Act and administered in New Hampshire by the department under the medicaid program.

History

(See Revision Note at chapter heading He-W 500); ss by #6051, eff 6-17-95; ss by #7895, eff 5-21-03; ss by #9915, INTERIM, eff 5-15-11, EXPIRES: 11-14-11; ss by #10018, eff 11-14-11; amd by #10139, eff 7-1-12; amd by #10561, eff 3-29-14; amd by #12818, eff 7-1-19; ss by #12999, eff 3-5-20

N.H. Code Admin. R. Ann. He-W 531.02 Recipient Eligibility {#sec-he-w-531.02 omnilex-key=us-nh-regs-official--agency-he-w--He-W 531.02}

All medicaid recipients shall be eligible for physician services in accordance with He-W 531.

History

(See Revision Note at chapter heading He-W 500); ss by #6051, eff 6-17-95; ss by #7895, eff 5-21-03; ss by #9915, INTERIM, eff 5-15-11, EXPIRES: 11-14-11; ss by #10018, eff 11-14-11; ss by #12999, eff 3-5-20

N.H. Code Admin. R. Ann. He-W 531.03 Provider Participation {#sec-he-w-531.03 omnilex-key=us-nh-regs-official--agency-he-w--He-W 531.03}

(a) Each participating physician provider shall:

(1) Be licensed to practice by the state in which he or she practices;

(2) Be a New Hampshire enrolled medicaid provider; and

(3) Request and obtain prior authorization in accordance with He-W 531.07.

(b) Medicaid enrolled physicians and physician practices shall not charge a membership fee to medicaid recipients or a recipient’s parent, family member, agent or legal guardian.

History

(See Revision Note at chapter heading He-W 500); ss by #6051, eff 6-17-95; ss by #7895, eff 5-21-03; ss by #9915, INTERIM, eff 5-15-11, EXPIRES: 11-14-11; ss by #10018, eff 11-14-11; ss by #12999, eff 3-5-20

N.H. Code Admin. R. Ann. He-W 531.04 Service Limits {#sec-he-w-531.04 omnilex-key=us-nh-regs-official--agency-he-w--He-W 531.04}

All physician services shall be subject to the service limits set forth in He-W 530.03.

History

(See Revision Note at chapter heading He-W 500); ss by #6051, eff 6-17-95; ss by #7895, eff 5-21-03; ss by #9915, INTERIM, eff 5-15-11, EXPIRES: 11-14-11; ss by #10018, eff 11-14-11; ss by #12999, eff 3-5-20

N.H. Code Admin. R. Ann. He-W 531.05 Covered Services {#sec-he-w-531.05 omnilex-key=us-nh-regs-official--agency-he-w--He-W 531.05}

(a) The following physician services, subject to the prior authorization requirements in He-W 531.07, as applicable, shall be covered services:

(1) Anesthesia not administered by the operating surgeon;

(2) Care provided by 2 or more physicians on the same day for unrelated diagnoses regardless of the setting, for example, inpatient or outpatient;

(3) Consultation services, as documented in a written report, provided by a physician whose opinion or advice regarding evaluation and management of a specific problem is requested by another physician or health care professional;

(4) Second opinion;

(5) Eye care provided by ophthalmologists as described in He-W 565;

(6) Family planning services as described in He-W 541;

(7) Inpatient hospital visits for acute care days of stay approved in accordance with He-W 543.11;

(8) Laboratory and radiology services as described in He-W 577 and He-W 569;

(9) Obstetrical or gynecological procedures that relate to care and treatment of pregnant women and the female reproductive system, except for those procedures for which the sole purpose is to contribute to, promote, or restore fertility, procreation, or sexual activity;

(10) Face-to-face services rendered by a physician in any setting, including walk-in clinics, urgent care centers, emergency departments, outpatient hospital settings, nursing facilities, and recipients’ homes;

(11) Surgical procedures, subject to the prior authorization requirements in He-W 531.07, as applicable, including:

a. Operative procedures for the treatment of illnesses, injuries and congenital anomalies;

b. The treatment of fractures and dislocations;

c. The treatment of burns; and

d. Invasive diagnostic and treatment services;

(12) Services in addition to those usually and customarily carried out to treat preoperative or postoperative complications, provided that the physician has followed the procedures described in He-W 531.07;

(13) The following tissue transplants:

a. Cornea transplants;

b. Skin transplants with the exception of hairplasty; and

c. Bone grafts; and

(14) Immunizations.

(b) The following organ transplants from a human donor to a recipient performed at facilities described in He-W 543.05(f) shall be covered subject to the prior authorization requirements in He-W 531.07 and in accordance with the applicable coverage criteria in Interqual Connect Clinical Guidelines, 2019 Edition, available as noted in Appendix A:

(1) Kidney transplants;

(2) Heart transplants;

(3) Heart and lung transplants;

(4) Lung transplants;

(5) Allogenic bone marrow transplants;

(6) Autologous bone marrow transplants;

(7) Liver transplants;

(8) Pancreas transplants; and

(9) Pancreas and kidney transplants.

(c) Bariatric surgical procedures shall be covered, subject to the prior authorization requirements in He-W 531.07 and in accordance with the coverage criteria in Interqual Connect Clinical Guidelines, 2019 Edition , available as noted in Appendix A, except that the recipient shall also have lost at least 15% of body weight prior to scheduling bariatric surgery as documented in the recipient’s medical record.

(d) Breast reduction surgery shall be covered, subject to the prior authorization requirements in He-W 531.07 and in accordance with the coverage criteria in Interqual Connect Clinical Guidelines, 2019 Edition , available as noted in Appendix A.

(e) Blepharoplasty shall be covered, subject to the prior authorization requirements in He-W 531.07 and in accordance with the coverage criteria in Interqual Connect Clinical Guidelines, 2019 Edition , available as noted in Appendix A.

(f) Panniculectomy shall be covered, subject to the prior authorization requirements in He-W 531.07 and in accordance with the coverage criteria in Interqual Connect Clinical Guidelines, 2019 Edition , available as noted in Appendix A.

(g) Septoplasty and rhinoplasty shall be covered, subject to the prior authorization requirements in He-W 531.07 and in accordance with the coverage criteria in Interqual Connect Clinical Guidelines, 2019 Edition, available as noted in Appendix A.

(h) Coverage of routine visits to nursing facilities for non-acute services shall be limited to one visit per calendar month.

History

(See Revision Note at chapter heading He-W 500); ss by #6051, eff 6-17-95; ss by #7895, eff 5-21-03; ss by #9915, INTERIM, eff 5-15-11, EXPIRES: 11-14-11; ss by #10018, eff 11-14-11; amd by #10091, eff 2-24-12; ss by #10561, eff 3-29-14; ss by #12999, eff 3-5-20

N.H. Code Admin. R. Ann. He-W 531.06 Non-Covered Services {#sec-he-w-531.06 omnilex-key=us-nh-regs-official--agency-he-w--He-W 531.06}

(a) Physician services for the surgery, inpatient hospital services for the surgical admission(s), and organ procurement services related to the following types of transplants shall be non-covered services:

(1) Any type of organ transplant not specified in He-W 531.05(b) or tissue transplant not specified in He-W 531.05(a)(13);

(2) Organ transplants requiring prior authorization but which are not prior authorized; or

(3) More than 2 transplants of the same type of organ per recipient per lifetime.

(b) Psychiatric services when provided at or through a community mental health center shall be non-covered as a physician service.

(c) Treatment shall be non-covered when the sole purpose is to contribute to, promote, or restore fertility, procreation, or sexual activity.

(d) Procedures or surgery for the sole purpose of preserving or improving appearance shall be non-covered, except when required for the prompt repair of accidental injury or for the improvement of the functioning of a malformed body member.

(e) With the exception of procedures covered in accordance with the coverage criteria in He-W 531.05(b)-(g), experimental or investigational procedures described as such in the National Coverage Determinations (NCD) found in the Centers for Medicare and Medicaid Services “Medicare Coverage Database” at http://www.cms.gov/medicare-coverage-database/ (under the “Quick Search” function, select “National Coverage Documents”, optionally enter a filter by entering a “keyword” to narrow the search results, and select the “Search by Type” button, or, if a keyword is not entered, the entire list of NCD titles will appear alphabetically and may be selected) shall be non-covered.

(f) Thermogenic therapy, which treats certain types of resistant infectious diseases through the production of artificial fever, shall be non-covered.

(g) Electrosleep therapy, which consists of the application of pulses of direct current to the recipient’s brain through external electrodes, shall be non-covered.

(h) Any services directly related to a non-covered service or procedure shall be non-covered.

(i) Inpatient hospital visits for non-acute inpatient stays shall be non-covered, including but not limited to:

(1) Visits to recipients who are in an inpatient hospital setting awaiting placement to a long term care facility; and

(2) Visits for days that have not been approved by the department or its designated Quality Improvement Organization (QIO) in accordance with He-W 543.

(j) Components of surgical preparatory regimens that are not described as covered services in accordance with He-W 520 through He-W 577 shall be non-covered, including:

(1) Services rendered by dieticians or nutritionists; and

(2) Exercise regimens.

History

(See Revision Note at chapter heading He-W 500); ss by #6051, eff 6-17-95; ss by #7895, eff 5-21-03; ss by #9915, INTERIM, eff 5-15-11, EXPIRES: 11-14-11; ss by #10018, eff 11-14-11; ss by #10561, eff 3-29-14; amd by #12403, eff 10-20-17; amd by #12818, eff 7-1-19; ss by #12999, eff 3-5-20

N.H. Code Admin. R. Ann. He-W 531.07 Prior Authorization {#sec-he-w-531.07 omnilex-key=us-nh-regs-official--agency-he-w--He-W 531.07}

(a) The following services and procedures, as described in He-W 531.05, shall require prior authorization from the department’s prior authorization agent:

(1) All organ transplants, except kidney transplants;

(2) Bariatric surgical procedures;

(3) Breast reduction surgery;

(4) Blepharoplasty;

(5) Panniculectomy; and

(6) Septoplasty and rhinoplasty.

(b) Prior to payment by the department, requests for prior authorization of services and procedures described in He-W 531.05 shall:

(1) Be submitted in advance of rendering the service;

(2) Be submitted in writing to the department’s prior authorization agent via mail or fax on Form 273S “Physician Request for Prior Authorization for Certain Surgical Procedures, Including Organ Transplants” (02/2020), along with any supporting documentation;

(3) Be signed by the provider; and

(4) Be based on the provider’s medical care plan developed for the recipient.

(c) Requests for prior authorization shall include a physician’s order, letter of medical necessity, and clinical notes to enable the department’s prior authorization agent to evaluate the request.

(d) Prior authorization requested in accordance with (a) through (c) above shall be approved by the department’s prior authorization agent if the department’s prior authorization agent determines that the submitted documentation supports the applicable requirements in He-W 531.05.

(e) If the department approves the prior authorization request, the department’s fiscal agent shall send written confirmation of the approval to the provider.

(f) The provider shall be responsible for determining that the recipient is Title XIX eligible on the date of service.

(g) If the department’s prior authorization agent denies the prior authorization request, the department’s prior authorization agent shall forward a notice of denial to the recipient and the ordering provider on the department Form 272a, “Medical Assistance Program Denial for Prior Authorized Services,” including the following:

(1) The reason for, and legal basis of, the denial; and

(2) Information that a fair hearing on the denial may be requested within 30 calendar days of the date on the notice of the denial, in accordance with He-C 200.

History

(See Revision Note at chapter heading He-W 500); ss by #6051, eff 6-17-95; ss by #7895, eff 5-21-03; ss by #9915, INTERIM, eff 5-15-11, EXPIRES: 11-14-11; ss by #10018, eff 11-14-11; ss by #10561, eff 3-29-14; ss by #12999, eff 3-5-20

N.H. Code Admin. R. Ann. He-W 531.08 Utilization Review and Control {#sec-he-w-531.08 omnilex-key=us-nh-regs-official--agency-he-w--He-W 531.08}

(a) The department’s provider integrity unit shall monitor utilization of physician services, to identify, prevent, and correct potential occurrences of fraud, waste, and abuse, in accordance with 42 CFR 455, CFR 456, 42 CFR 1001, and He-W 520.

(b) The department shall recoup state and federal medicaid payments as permitted by 42 CFR 455, 42 CFR 447, and 42 CFR 456 for a provider’s failure to maintain supporting records in accordance with He-W 520 and He-W 531.

History

(See Revision Note at chapter heading He-W 500); ss by #6051, eff 6-17-95; ss by #7895, eff 5-21-03; ss by #9915, INTERIM, eff 5-15-11, EXPIRES: 11-14-11; ss by #10018, eff 11-14-11; ss by #10561, eff 3-29-14; ss by #12999, eff 3-5-20

N.H. Code Admin. R. Ann. He-W 531.09 Third Party Liability {#sec-he-w-531.09 omnilex-key=us-nh-regs-official--agency-he-w--He-W 531.09}

All third party obligations shall be exhausted before medicaid shall be billed, in accordance with 42 CFR 433.139.

History

#10018, eff 11-14-11; ss by #12999, eff 3-5-20

N.H. Code Admin. R. Ann. He-W 531.10 Payment for Services {#sec-he-w-531.10 omnilex-key=us-nh-regs-official--agency-he-w--He-W 531.10}

(a) Payment to physicians shall be made in accordance with rates established by the department in accordance with RSA 161:4, VI(a).

(b) The payment rates for surgery, established by the department in accordance with RSA 161:4, VI(a), shall be at a global rate in accordance with the CPT codes and National Correct Coding Initiative (NCCI) edits, inclusive of the following:

(1) Local infiltration, metacarpal/metatarsal/digital block, or topical anesthesia;

(2) Subsequent to the decision for surgery, any related evaluation and management encounter that occurs up to 5 days prior to or on the date of procedure, including history and physical;

(3) Immediate postoperative care, including dictating operative notes, and talking with the family and other physicians;

(4) Writing orders;

(5) Evaluating the patient in the post anesthesia recovery area; and

(6) Typical post-operative follow-up care up to 30 days post surgery.

(c) Rates established by the department in accordance with (a) above shall be considered to include all costs of doing business including, but not limited to:

(1) Missed or cancelled appointments; and

(2) Administrative services such as:

a. Copying records;

b. Referrals;

c. Renewing prescriptions; and

d. Providing medical documents for schools, sports, and camps.

(d) Payment for second surgical opinions shall be made in accordance with rates established by the department in accordance with RSA 161:4, VI(a).

(e) Physicians who request reimbursement for clinical laboratory services, in accordance with He-W 577, shall receive reimbursement provided that a contract or agreement exists between the physician and the laboratory and requests for reimbursement shall be made by the physician.

(f) The provider shall use CPT and HCPCS procedure codes when billing.

(g) The provider shall submit claims for payment to the department’s fiscal agent.

(h) The provider shall maintain supporting records in accordance with He-W 520.

History

#10018, eff 11-14-11 (from He-W 531.08); ss by #10561, eff 3-29-14; ss by #12999, eff 3-5-20

Part He-W 532 Podiatry Services

N.H. Code Admin. R. Ann. He-W 532.01 Definitions {#sec-he-w-532.01 omnilex-key=us-nh-regs-official--agency-he-w--He-W 532.01}

(a) “Current procedural terminology (CPT) code” means a unique identifying code in the field of medical nomenclature and designated by the United States Department of Health and Human Services as the national coding standard utilized in government and private health insurance programs for reporting medical services and procedures.

(b) “Department (DHHS)” means the New Hampshire department of health and human services.

(c) “Medicaid” means the Title XIX and Title XXI programs administered by the department which makes medical assistance available to eligible individuals.

(d) “Mycotic nail” means a fungus infection of a toenail.

(e) “Pathological condition” means any disease, trauma, tumors, or deformities affecting anatomy or physiology.

(f) “Podiatry service” means the diagnosis and treatment of ailments of the human foot and lower leg by any medical, mechanical, electrical, and surgical means available and performed by a podiatrist.

(g) “Recipient” means any individual who is eligible for and receiving medical assistance under the medicaid program.

(h) “Routine foot care” means preventive and hygienic maintenance of the feet, of the type which is ordinarily considered self-care, including observation and cleansing of the feet, and the use of skin creams to maintain skin tone.

(i) “State fiscal year” means July 1 through June 30.

(j) “Title XIX” means the joint federal-state program described in Title XIX of the Social Security Act and administered in New Hampshire by the department under the medicaid program.

(k) “Title XXI” means the joint federal-state program described in Title XXI of the Social Security Act and administered in New Hampshire by the department under the medicaid program.

(l) “Visit” means all podiatry services provided to a recipient on one day by one podiatrist.

History

(See Revision Note at chapter heading He-W 500); ss by #4818, eff 6-1-90, EXPIRED: 6-1-96
#6756, eff 5-22-98, EXPIRED: 5-22-06
#8642, INTERIM, eff 5-26-06, EXPIRES: 11-22-06; ss by #8745, eff 10-24-06; amd by #10139, eff 7-1-12; ss by #10814, eff 4-21-15; ss by #14327, eff 7-23-25, EXPIRES: 7-23-35

N.H. Code Admin. R. Ann. He-W 532.02 Recipient Eligibility {#sec-he-w-532.02 omnilex-key=us-nh-regs-official--agency-he-w--He-W 532.02}

All medicaid recipients, including those confined to medical care institutions, including hospitals or nursing facilities, shall be eligible for podiatry services in accordance with this part.

History

(See Revision Note at chapter heading He-W 500); ss by #4818, eff 6-1-90, EXPIRED: 6-1-96
#6756, eff 5-22-98, EXPIRED: 5-22-06
#8642, INTERIM, eff 5-26-06, EXPIRES: 11-22-06; ss by #8745, eff 10-24-06; ss by #10814, eff 4-21-15; ss by #14327, eff 7-23-25, EXPIRES: 7-23-35

N.H. Code Admin. R. Ann. He-W 532.03 Provider Participation {#sec-he-w-532.03 omnilex-key=us-nh-regs-official--agency-he-w--He-W 532.03}

Each participating podiatrist shall:

(a) Be licensed by the state in which they practice; and

(b) Be a NH enrolled medicaid provider.

History

(See Revision Note at chapter heading He-W 500); ss by #4818, eff 6-1-90, EXPIRED: 6-1-96
#6756, eff 5-22-98, EXPIRED: 5-22-06
#8642, INTERIM, eff 5-26-06, EXPIRES: 11-22-06; ss by #8745, eff 10-24-06; ss by #10814, eff 4-21-15; ss by #14327, eff 7-23-25, EXPIRES: 7-23-35

N.H. Code Admin. R. Ann. He-W 532.04 Service Limits {#sec-he-w-532.04 omnilex-key=us-nh-regs-official--agency-he-w--He-W 532.04}

Podiatry services shall be limited to 4 visits per recipient per state fiscal year.

History

(See Revision Note at chapter heading He-W 500); ss by #4818, eff 6-1-90, EXPIRED: 6-1-96
#6756, eff 5-22-98, EXPIRED: 5-22-06
#8642, INTERIM, eff 5-26-06, EXPIRES: 11-22-06; ss by #8745, eff 10-24-06; ss by #9736, eff 6-25-10; ss by #10814, eff 4-21-15; ss by #14327, eff 7-23-25, EXPIRES: 7-23-35

N.H. Code Admin. R. Ann. He-W 532.05 Covered Services {#sec-he-w-532.05 omnilex-key=us-nh-regs-official--agency-he-w--He-W 532.05}

The following podiatry services shall be covered only if they are medical or surgical treatments of the human foot or lower leg for pathological conditions of the foot due to localized illness, injury, or symptoms involving the foot:

(a) Routine foot care, and trimming and burring of nails, including mycotic nails, performed by a podiatrist, provided that:

(1) The recipient’s primary health care provider has documented in the recipient’s medical record that the recipient’s current medical condition justifies the need for such foot care to be performed by a podiatrist;

(2) The recipient’s primary health care provider has written a referral to a podiatrist for such care, documenting in the recipient’s medical record that the referral was made; and

(3) The referral is documented as received by, and is retained by, the podiatrist in the recipient’s medical record;

(b) Prevention and reduction of corns, calluses, and warts shall be covered by cutting or surgical means only; and

(c) Casting, strapping, and taping when performed by a podiatrist for the treatment of fractures, dislocations, sprains, strains, and open wounds of the ankle, foot, and toes.

History

(See Revision Note at chapter heading He-W 500); ss by #4818, eff 6-1-90, EXPIRED: 6-1-96
#6756, eff 5-22-98, EXPIRED: 5-22-06
#8642, INTERIM, eff 5-26-06, EXPIRES: 11-22-06; ss by #8745, eff 10-24-06; ss by #10814, eff 4-21-15; ss by #14327, eff 7-23-25, EXPIRES: 7-23-35

N.H. Code Admin. R. Ann. He-W 532.06 Non-Covered Services {#sec-he-w-532.06 omnilex-key=us-nh-regs-official--agency-he-w--He-W 532.06}

The following podiatry services shall not be covered:

(a) Routine foot care, and trimming and burring of nails, except as described in He-W 532.05;

(b) Prevention and reduction of corns, calluses, and warts other than by cutting or surgical means only;

(d) Any podiatry service performed in the absence of pathological conditions of the foot due to localized illness, injury, or symptoms involving the foot; and

(e) Office visits occurring on the same date of service as a podiatry surgical procedure, except where additional non-podiatry related medical conditions are addressed.

History

(See Revision Note at chapter heading He-W 500); ss by #4818, eff 6-1-90, EXPIRED: 6-1-96
#6756, eff 5-22-98, EXPIRED: 5-22-06
#8642, INTERIM, eff 5-26-06, EXPIRES: 11-22-06; ss by #8745, eff 10-24-06; ss by #10814, eff 4-21-15; ss by #14327, eff 7-23-25, EXPIRES: 7-23-35

N.H. Code Admin. R. Ann. He-W 532.07 Documentation {#sec-he-w-532.07 omnilex-key=us-nh-regs-official--agency-he-w--He-W 532.07}

The podiatrist shall maintain:

(a) Supporting clinical records in accordance with He-W 520;

(b) Specific written documentation in the recipient’s medical record justifying the need for podiatry care in accordance with He-W 532.05(a);

(c) Specific written documentation in the recipient’s medical record, by the podiatrist, specifying the frequency of the podiatry service(s) being performed;

(d) Specific written documentation in the recipient’s podiatry medical record of all podiatry services performed; and

(e) A completed recipient medical history maintained in the recipient’s podiatry medical record.

History

(See Revision Note at chapter heading He-W 500); ss by #4818, eff 6-1-90, EXPIRED: 6-1-96
#6756, eff 5-22-98, EXPIRED: 5-22-06
#8642, INTERIM, eff 5-26-06, EXPIRES: 11-22-06; ss by #8745, eff 10-24-06; ss by #10814, eff 4-21-15; ss by #14327, eff 7-23-25, EXPIRES: 7-23-35

N.H. Code Admin. R. Ann. He-W 532.08 Utilization Review and Control {#sec-he-w-532.08 omnilex-key=us-nh-regs-official--agency-he-w--He-W 532.08}

(a) The department’s bureau of program integrity shall monitor utilization of podiatry services to identify, prevent, and correct potential occurrences of fraud, waste, and abuse, in accordance with 42 CFR 455, 42 CFR 456, and He-W 520.

History

(See Revision Note at chapter heading He-W 500); ss by #4818, eff 6-1-90, EXPIRED: 6-1-96
#6756, eff 5-22-98, EXPIRED: 5-22-06
#8642, INTERIM, eff 5-26-06, EXPIRES: 11-22-06; ss by #8745, eff 10-24-06; ss by #10814, eff 4-21-15; ss by #14327, eff 7-23-25, EXPIRES: 7-23-35

N.H. Code Admin. R. Ann. He-W 532.09 Third Party Liability {#sec-he-w-532.09 omnilex-key=us-nh-regs-official--agency-he-w--He-W 532.09}

(a) All third party obligations shall be exhausted before claims shall be submitted to the department’s fiscal agent in accordance with 42 CFR 433.139.

(b) Podiatry service providers shall request information from the recipient regarding other insurance coverage.

(c) If other insurance coverage is available, providers shall contact the insurer to verify benefits initially and at least annually thereafter or when the insurance carrier changes.

(d) Podiatry service providers shall maintain a record of any other insurance verifications in the recipient’s medical record in accordance with He-W 520.

History

(See Revision Note at chapter heading He-W 500); ss by #4818, eff 6-1-90, EXPIRED: 6-1-96
#6756, eff 5-22-98, EXPIRED: 5-22-06
#8642, INTERIM, eff 5-26-06, EXPIRES: 11-22-06; ss by #8745, eff 10-24-06; ss by #10814, eff 4-21-15; ss by #14327, eff 7-23-25, EXPIRES: 7-23-35

N.H. Code Admin. R. Ann. He-W 532.10 Payment for Services {#sec-he-w-532.10 omnilex-key=us-nh-regs-official--agency-he-w--He-W 532.10}

(a) Rates of payment for podiatry services shall be established by the department in accordance with RSA 161:4, VI(a).

(b) The payment rates for podiatry surgical procedures shall include:

(1) Pre-operative visits and consultations, regardless of the treatment location;

(2) The podiatry surgical procedure;

(3) Casting at the time of surgery, if required; and

(4) Normal uncomplicated follow-up for 30 days following the podiatry surgical procedure, regardless of treatment location.

(d) Providers of podiatry services shall bill for podiatry services utilizing CPT codes.

History

(See Revision Note at chapter heading He-W 500); ss by #4818, eff 6-1-90, EXPIRED: 6-1-96
#6756, eff 5-22-98, EXPIRED: 5-22-06
#8642, INTERIM, eff 5-26-06, EXPIRES: 11-22-06; ss by #8745, eff 10-24-06; ss by #10814, eff 4-21-15; ss by #14327, eff 7-23-25, EXPIRES: 7-23-35

Part He-W 533 - Reserved

N.H. Code Admin. R. Ann. He-W 533.01 Medical Assistance {#sec-he-w-533.01 omnilex-key=us-nh-regs-official--agency-he-w--He-W 533.01}

– He-W 533.09

History

(See Revision Note at chapter heading He-W 500); ss by #4817, eff 6-1-90, EXPIRED: 6-1-96
#6700, eff 2-28-98, EXPIRES: 2-29-05; ss by #8573, eff 2-24-06; rpld by #9622, eff 1-1-10

Part He-W 534 Advanced Registered Nurse Practitioner Services

N.H. Code Admin. R. Ann. He-W 534.01 Definitions {#sec-he-w-534.01 omnilex-key=us-nh-regs-official--agency-he-w--He-W 534.01}

(a) “Advanced practice registered nurse (APRN)” means a registered nurse currently licensed by the New Hampshire board of nursing under RSA 326-B:18 or, in states other than New Hampshire, a registered professional nurse practitioner who, in accordance with 42 CFR 440.166, meets that state’s advanced educational and clinical practice requirements, if any, beyond the 2 to 4 years of basic nursing education required of all registered nurses.

(b) “Current procedural terminology (CPT) code” means a unique identifying code in the field of medical nomenclature and designated by USDHHS as the national coding standard utilized in government and private health insurance programs for reporting medical services and procedures.

(e) “Medicaid” means the Title XIX and Title XXI programs administered by the department, which makes medical assistance available to eligible individuals.

(f) “Recipient” means any individual who is eligible for and receiving medical assistance under the medicaid program.

(g) “Title XIX” means the joint federal-state program described in Title XIX of the Social Security Act and administered in New Hampshire by the department under the medicaid program.

(h) “Title XXI” means the joint federal-state program described in Title XXI of the Social Security Act and administered in New Hampshire by the department under the medicaid program.

History

(See Revision Note at chapter heading He-W 500); ss by #4793, eff 3-30-90, EXPIRED: 3-30-96
#6701, eff 2-28-98, EXPIRES: 2-28-05; ss by #8574, eff 2-24-06; amd by #10139, eff 7-1-12; ss by #10512, eff 1-24-14

N.H. Code Admin. R. Ann. He-W 534.02 Recipient Eligibility {#sec-he-w-534.02 omnilex-key=us-nh-regs-official--agency-he-w--He-W 534.02}

All NH medicaid recipients shall be eligible to receive APRN services, in accordance with He-W 534.

History

(See Revision Note at chapter heading He-W 500); ss by #4793, eff 3-30-90, EXPIRED: 3-30-96
#6701, eff 2-28-98, EXPIRES: 2-28-05; ss by #8574, eff 2-24-06; ss by #10512, eff 1-24-14

N.H. Code Admin. R. Ann. He-W 534.03 Provider Participation {#sec-he-w-534.03 omnilex-key=us-nh-regs-official--agency-he-w--He-W 534.03}

Each participating APRN shall:

(a) Be a New Hampshire (NH) enrolled medicaid provider;

(b) If practicing in NH, be licensed as an APRN by the NH board of nursing in accordance with RSA 326-B:18; and

(c) If practicing in another state, submit current proof of meeting that state’s advanced education and clinical requirements to practice as a registered nurse in an advance practice role.

History

(See Revision Note at chapter heading He-W 500); ss by #4793, eff 3-30-90, EXPIRED: 3-30-96
#6701, eff 2-28-98, EXPIRES: 2-28-05; ss by #8574, eff 2-24-06; ss by #10512, eff 1-24-14

N.H. Code Admin. R. Ann. He-W 534.04 Service Limits {#sec-he-w-534.04 omnilex-key=us-nh-regs-official--agency-he-w--He-W 534.04}

All services shall be subject to the service limits set forth in He-W 530.

History

(See Revision Note at chapter heading He-W 500); ss by #4793, eff 3-30-90, EXPIRED: 3-30-96
#6701, eff 2-28-98, EXPIRES: 2-28-05; ss by #8574, eff 2-24-06; ss by #10512, eff 1-24-14; ss by #10657, eff 8-15-14

N.H. Code Admin. R. Ann. He-W 534.05 Covered Services {#sec-he-w-534.05 omnilex-key=us-nh-regs-official--agency-he-w--He-W 534.05}

Covered services shall be those services set forth in Nur 304.05.

History

(See Revision Note at chapter heading He-W 500); ss by #4793, eff 3-30-90, EXPIRED: 3-30-96
#6701, eff 2-28-98, EXPIRES: 2-28-05; ss by #8574, eff 2-24-06; ss by #10512, eff 1-24-14

N.H. Code Admin. R. Ann. He-W 534.06 Utilization Review & Control {#sec-he-w-534.06 omnilex-key=us-nh-regs-official--agency-he-w--He-W 534.06}

The department’s provider program integrity unit shall monitor utilization of APRN services to identify, prevent, and correct potential occurrences of fraud, waste and abuse in accordance with in accordance with He-W 520, 42 CFR 455, and 42 CFR 456.

History

(See Revision Note at chapter heading He-W 500); ss by #4793, eff 3-30-90, EXPIRED: 3-30-96
#6701, eff 2-28-98, EXPIRES: 2-28-05; ss by #8574, eff 2-24-06; ss by #10512, eff 1-24-14

N.H. Code Admin. R. Ann. He-W 534.07 Third Party Liability {#sec-he-w-534.07 omnilex-key=us-nh-regs-official--agency-he-w--He-W 534.07}

All third party obligations shall be exhausted before medicaid may be billed, in accordance with 42 CFR 433.139.

History

(See Revision Note at chapter heading He-W 500); ss by #4793, eff 3-30-90, EXPIRED: 3-30-96
#6701, eff 2-28-98, EXPIRES: 2-28-05; ss by #8574, eff 2-24-06; ss by #10512, eff 1-24-14

N.H. Code Admin. R. Ann. He-W 534.08 Payment for Services {#sec-he-w-534.08 omnilex-key=us-nh-regs-official--agency-he-w--He-W 534.08}

(a) The payment rates for APRN services shall be established by the department in accordance with RSA 161:4, IV.

(b) The APRN shall submit claims for payment to the department’s fiscal agent.

(c) The APRN shall use CPT and HCPCS codes and coding guidelines established for use with these procedure codes when billing.

(d) The APRN shall maintain supporting records, in accordance with He-W 520.

History

(See Revision Note at chapter heading He-W 500); ss by #4793, eff 3-30-90, EXPIRED: 3-30-96
#6701, eff 2-28-98, EXPIRES: 2-28-05; ss by #8574, eff 2-24-06; ss by #10512, eff 1-24-14

Part He-W 536 Medical Services Clinic

N.H. Code Admin. R. Ann. He-W 536.01 Definitions {#sec-he-w-536.01 omnilex-key=us-nh-regs-official--agency-he-w--He-W 536.01}

(a) “Department” means the New Hampshire department of health and human services.

(b) “Medicaid” means the Title XIX and Title XXI programs administered by the department which makes medical assistance available to eligible individuals.

(c) “Medical services clinic” means a facility or a mobile immunization provider that is not part of a hospital but is organized to provide preventive, diagnostic, therapeutic, rehabilitative, or palliative services to outpatients.

(d) “Mobile immunization provider” means an agency organized to provide immunizations at host facilities.

(e) “Recipient” means any individual who is eligible for and receiving medical assistance under the medicaid program.

(f) “Title XIX” means the joint federal-state program described in Title XIX of the Social Security Act and administered in New Hampshire by the department under the medicaid program.

(g) “Title XXI” means the joint federal-state program described in Title XXI of the Social Security Act and administered in New Hampshire by the department under the medicaid program.

History

(See Revision Note at chapter heading He-W 500); ss by #6133, eff 11-30-95; ss by #7825, eff 2-8-03; ss by #9860, eff 2-8-11; amd by #10139, eff 7-1-12; ss by #12732, INTERIM, eff 2-22-19, EXPIRED: 8-21-19
#12877, eff 9-25-19

N.H. Code Admin. R. Ann. He-W 536.02 Recipient Eligibility {#sec-he-w-536.02 omnilex-key=us-nh-regs-official--agency-he-w--He-W 536.02}

All recipients shall be eligible for services delivered by a medical services clinic in accordance with He-W 536.

History

(See Revision Note at chapter heading He-W 500); ss by #6133, eff 11-30-95; ss by #7825, eff 2-8-03; ss by #9860, eff 2-8-11, EXPIRED: 2-8-19
#12732, INTERIM, eff 2-22-19, EXPIRED: 8-21-19
#12877, eff 9-25-19

N.H. Code Admin. R. Ann. He-W 536.03 Provider Participation {#sec-he-w-536.03 omnilex-key=us-nh-regs-official--agency-he-w--He-W 536.03}

All participating medical services clinics shall meet the following criteria in either (a) or (b) below:

(a) Medical services clinics that are not mobile immunization providers shall meet the following criteria:

(1) Be composed of New Hampshire licensed practitioners who meet the provider requirements for the particular medical service being performed as set forth in He-W 511 through He-W 577;

(2) Provide recipient care that is under the supervision of a licensed physician affiliated with the clinic which shall mean that:

a. The physician is readily available to provide direction either by phone or in person;

b. The physician has seen the recipient as a patient at least once and assesses the need for continuing care as necessary; and

c. The physician assumes professional responsibility for the services provided to the recipient;

(3) Provide medical care on an outpatient basis;

(4) Be organized and operated independently from a hospital pursuant to 42 CFR 440.90;

(5) Be an enrolled New Hampshire medicaid provider; and

(6) Request and obtain prior authorization from the department before providing services which require prior authorization as specified in He-W 511 through He-W 577; or

(b) Medical services clinics that are mobile immunization providers shall meet the following criteria:

(1) Be composed of, and provide immunizations by, New Hampshire licensed practitioners whose licensure allows them to provide immunizations;

(2) Be under contract with, or have a current vaccine provider agreement with, the department’s division of public health services;

(3) Provide immunizations to recipients in settings such as walk-in clinics, retail stores and outlets, pharmacies, and schools;

(4) Provide immunizations as medicaid services only in those settings and for those types or ages of recipients addressed in the contract or agreement in (2) above;

(5) Provide services “under the direction of a physician”, which means through standing orders or other indirect supervision where the physician is not necessarily on site but who assumes professional responsibility for the services provided to the recipient;

(6) Affiliate with the directing physician through a contractual agreement or any other formal arrangement which obligates the physician to supervise the care provided to the recipient by the clinic;

(7) Be organized and operated independently from a hospital pursuant to 42 CFR 440.90; and

(8) Be an enrolled New Hampshire medicaid provider.

History

(See Revision Note at chapter heading He-W 500); ss by #6133, eff 11-30-95; ss by #7825, eff 2-8-03; ss by #9860, eff 2-8-11, EXPIRED: 2-8-19
#12732, INTERIM, eff 2-22-19, EXPIRES: 8-21-19

N.H. Code Admin. R. Ann. He-W 536.04 Service Limits {#sec-he-w-536.04 omnilex-key=us-nh-regs-official--agency-he-w--He-W 536.04}

The services provided by a medical services clinic shall be subject to each of the specific service limits and provider requirements for the services delivered and which are set forth in He-W 511 through He-W 577.

History

(See Revision Note at chapter heading He-W 500); ss by #6133, eff 11-30-95; ss by #7825, eff 2-8-03; ss by #9860, eff 2-8-11; ss by #9860, eff 2-8-11, EXPIRED: 2-8-19
#12732, INTERIM, eff 2-22-19, EXPIRED: 8-21-19
#12877, eff 9-25-19

N.H. Code Admin. R. Ann. He-W 536.05 Covered Services {#sec-he-w-536.05 omnilex-key=us-nh-regs-official--agency-he-w--He-W 536.05}

(a) Except for those clinic providers who meet the mobile immunization criteria in He-W 536.03(b), covered services provided by a medical services clinic shall include medicaid covered services that are referenced in He-W 511 through He-W 577.

(b) Covered services provided by clinic providers who meet the mobile immunization criteria in He-W 536.03(b) shall include only medically necessary immunizations ordered by the directing physician.

History

(See Revision Note at chapter heading He-W 500); ss by #6133, eff 11-30-95; ss by #7825, eff 2-8-03; ss by #9860, eff 2-8-11; ss by #9860, eff 2-8-11, EXPIRED: 2-8-19
#12732, INTERIM, eff 2-22-19, EXPIRED: 8-21-19
#12877, eff 9-25-19

N.H. Code Admin. R. Ann. He-W 536.06 Utilization Review and Control {#sec-he-w-536.06 omnilex-key=us-nh-regs-official--agency-he-w--He-W 536.06}

(a) The department’s program integrity unit shall monitor utilization of medical services clinics to identify, prevent, and correct potential occurrences of fraud, waste, and abuse in accordance with 42 CFR 455, 42 CFR 456, 42 CFR 1001, and He-W 520.

History

(See Revision Note at chapter heading He-W 500); ss by #6133, eff 11-30-95; ss by #7825, eff 2-8-03; ss by #9860, eff 2-8-11, EXPIRED: 2-8-19
#12732, INTERIM, eff 2-22-19, EXPIRED: 8-21-19
#12877, eff 9-25-19

N.H. Code Admin. R. Ann. He-W 536.07 Third Party Liability {#sec-he-w-536.07 omnilex-key=us-nh-regs-official--agency-he-w--He-W 536.07}

All third party obligations shall be exhausted before medicaid shall be billed in accordance with 42 CFR 433.139.

History

(See Revision Note at chapter heading He-W 500); ss by #6133, eff 11-30-95; ss by #7825, eff 2-8-03; ss by #9860, eff 2-8-11, EXPIRED: 2-8-19
#12732, INTERIM, eff 2-22-19, EXPIRED: 8-21-19
#12877, eff 9-25-19

N.H. Code Admin. R. Ann. He-W 536.08 Payment for Services {#sec-he-w-536.08 omnilex-key=us-nh-regs-official--agency-he-w--He-W 536.08}

(a) Payment for the services provided to recipients shall be made in accordance with the rates established by the department for the individual services provided in accordance with RSA 161:4, VI(a).

(b) The provider shall submit claims for payment to the department’s fiscal agent.

History

(See Revision Note at chapter heading He-W 500); ss by #6133, eff 11-30-95; ss by #7825, eff 2-8-03; ss by #9860, eff 2-8-11, EXPIRED: 2-8-19
#12732, INTERIM, eff 2-22-19, EXPIRED: 8-21-19
#12877, eff 9-25-19

Part He-W 537 Rural Health Clinics/Federally Qualified Health Centers

N.H. Code Admin. R. Ann. He-W 537.01 Definitions {#sec-he-w-537.01 omnilex-key=us-nh-regs-official--agency-he-w--He-W 537.01}

(a) “Encounter code” means a procedure code assigned to each provider by the medicaid administration bureau which reflects the individual payment rate and is utilized by the rural health clinic and federally qualified health center service providers for billing purposes.

(b) “Federally qualified health center (FQHC)” means “federally qualified health center” as described in 42 CFR 491, Subpart A, which is located in a rural or urban area that is designated as either a shortage area or an area that has a medically underserved population.

(c) “Hospital based rural health clinic” means “rural health clinic” as described in 42 CFR 491, Subpart A, which is an integral part of a hospital that is participating in medicare, and is licensed, governed, and supervised with other departments of the hospital.

(d) “Independent rural health clinic” means “rural health clinic” as described in 42 CFR 491, Subpart A, which is a freestanding facility not administered by another facility.

(e) “Medically underserved population” means a population of an urban or rural area which ahs a shortage of personal health services as described in 42 CFR 491, Subpart A.

(f) “Rural health clinic (RHC),” means a primary care facility or agency, either independent or hospital based, which is not a rehabilitation agency nor a facility primarily for the care and treatment of mental diseases and which is certified by medicare pursuant to 42 CFR 491, Subpart A.

(g) “Shortage area” means “shortage area” as defined by 1302(7) of the Public Health Services Act.

(h) “Visit” means a face-to-face encounter which takes place on a single day, at a single location, between a recipient and a health professional in a rural health clinic or FQHC.

History

(See Revision Note at chapter heading He-W 500); ss by #4884, eff 8-1-90, EXPIRED: 8-1-96
#6725, eff 4-1-98, EXPIRED: 4-1-06

N.H. Code Admin. R. Ann. He-W 537.02 Recipient Eligibility {#sec-he-w-537.02 omnilex-key=us-nh-regs-official--agency-he-w--He-W 537.02}

All medicaid recipients shall be eligible for services delivered by a RHC or FQHC, in accordance with He-W 537.

History

(See Revision Note at chapter heading He-W 500); ss by #4884, eff 8-1-90, EXPIRED: 8-1-96
#6725, eff 4-1-98, EXPIRED: 4-1-06

N.H. Code Admin. R. Ann. He-W 537.03 Provider Participation {#sec-he-w-537.03 omnilex-key=us-nh-regs-official--agency-he-w--He-W 537.03}

All participating RHCs and FQHCs shall:

(a) Be composed of licensed and N.H. board certified practitioners;

(b) Be certified to participate in medicare as RHC and FQHC;

(d) Be an enrolled New Hampshire medicaid provider; and

(e) Request and obtain prior authorization from the medicaid administration bureau before providing service which requires prior authorization, as specified in He-W 521.

History

(See Revision Note at chapter heading He-W 500); ss by #4884, eff 8-1-90, EXPIRED: 8-1-96
#6725, eff 4-1-98

N.H. Code Admin. R. Ann. He-W 537.04 Service Limits {#sec-he-w-537.04 omnilex-key=us-nh-regs-official--agency-he-w--He-W 537.04}

The individual services which compromise a RHC and a FQHC visit shall be subject to the applicable limits, in accordance with He-W 530.

History

(See Revision Note at chapter heading He-W 500); ss by #4884, eff 8-1-90, EXPIRED: 8-1-96
#6725, eff 4-1-98, EXPIRED: 4-1-06

N.H. Code Admin. R. Ann. He-W 537.05 Covered Services {#sec-he-w-537.05 omnilex-key=us-nh-regs-official--agency-he-w--He-W 537.05}

(a) Covered services for FQHCs and independent RHCs shall include the following outpatient services:

(1) The services of a physician, when the physician has an agreement to be paid by the clinic for such services;

(2) The services of a nurse practitioner, or physician assistant, provided within the scope of his/her training or certification;

(3) The services and supplies that are furnished as incidental to the professional services of a physician, nurse practitioner, or physician assistant;

(4) Laboratory services essential to the immediate diagnosis and treatment of the patient; and

(5) Other ambulatory services provided within the scope of the FQHC or RHC practice.

(b) Covered services for hospital-based RHCs shall include the following outpatient services:

(1) The services of a physician, when the physician has an agreement to be paid by the clinic for such services;

(2) The services of a nurse practitioner, or physician assistant, provided within the scope of his/her training or certification; and

(3) The services and supplies that are furnished as incidental to the professional services of a physician, nurse practitioner, or physician assistant.

History

(See Revision Note at chapter heading He-W 500); ss by #4884, eff 8-1-90, EXPIRED: 8-1-96
#6725, eff 4-1-98, EXPIRED: 4-1-06

N.H. Code Admin. R. Ann. He-W 537.06 Utilization Review and Control {#sec-he-w-537.06 omnilex-key=us-nh-regs-official--agency-he-w--He-W 537.06}

The department of health and human services shall monitor utilization of RHC and FQHC services, in accordance with He-W 520.

History

(See Revision Note at chapter heading He-W 500); ss by #4884, eff 8-1-90, EXPIRED: 8-1-96
#6725, eff 4-1-98, EXPIRED: 4-1-06

N.H. Code Admin. R. Ann. He-W 537.07 Third Party Liability {#sec-he-w-537.07 omnilex-key=us-nh-regs-official--agency-he-w--He-W 537.07}

All third party obligations shall be exhausted before medicaid may be billed in accordance with He-W 521.

History

(See Revision Note at chapter heading He-W 500); ss by #4884, eff 8-1-90, EXPIRED: 8-1-96
#6725, eff 4-1-98, EXPIRED: 4-1-06

N.H. Code Admin. R. Ann. He-W 537.08 Payment for Services {#sec-he-w-537.08 omnilex-key=us-nh-regs-official--agency-he-w--He-W 537.08}

(a) Payment for the RHC and FQHC services described in He-W 537.05 above shall be made on the basis of an all-inclusive rate per visit.

(b) RHC and FQHC providers shall bill for the services described in He-W 537.05 above utilizing the encounter code assigned by the department of health and human services.

(c) RHC and FQHC providers shall bill for services other than the outpatient RHC/FQHC services described in He-W 537.05 above utilizing the appropriate procedure code listed in the current edition of Current Procedural Terminology.

(d) Recipient encounters with more than one health professional, or multiple encounters with the same health professional, which take place on the same day for the same diagnosis or treatment, shall be counted as one visit.

(e) RHCs and FQHCs shall bill for only one visit per recipient per day, except for cases in which the patient, subsequent to the first visit, suffers an illness or injury requiring additional diagnosis and treatment.

(f) Payment shall be made in accordance with encounter code rates established by the department of health and human services.

(g) Independent RHCs and RQHCs shall submit claims for payment to the department of health and human services’ fiscal agent on form HCFA 1500.

(h) Hospital-based RHCs shall submit claims for payment to the department of health and human services’ fiscal agent on form UB 92, also known as HCFA 1450.

(i) The RHC and FQHC shall maintain supporting records, in accordance with He-W 520.

(j) The form HCFA 1500 in (g) above, and the form UB 92, also know as HCFA 1450 in (h) above, pursuant to 42 CFR 424.32, shall include:

(1) Patient and insured information;

(2) Physician or supplier information; and

(3) Carrier information.

History

(See Revision Note at chapter heading He-W 500); ss by #4884, eff 8-1-90, EXPIRED: 8-1-96
#6725, eff 4-1-98, EXPIRED: 4-1-06

Part He-W 538 Certified Midwife Services

N.H. Code Admin. R. Ann. He-W 538.01 Definitions {#sec-he-w-538.01 omnilex-key=us-nh-regs-official--agency-he-w--He-W 538.01}

(a) “Department” means the NH department of health and human services.

(b) “Medicaid” means the Title XIX and Title XXI programs administered by the department which makes medical assistance available to eligible individuals.

(c) “Midwifery” means the practice of providing the necessary supervision, care, and advice to women during pregnancy, labor, and the postpartum period, pursuant to RSA 326-D:2, V.

(d) “New Hampshire certified midwife (NHCM)” means a person who is certified to practice midwifery in accordance with RSA 326-D:6.

(e) “Recipient” means any individual who is eligible for and receiving medical assistance under the medicaid program.

(f) “Title XIX” means the joint federal-state program described in Title XIX of the Social Security Act and administered in New Hampshire by the department under the medicaid program.

(g) “Title XXI” means the joint federal-state program described in Title XXI of the Social Security Act and administered in New Hampshire by the department under the medicaid program.

History

#7657, eff 3-5-02, EXPIRED: 3-5-10
#9737, eff 6-25-10; amd by #10139, eff 7-1-12, paras (a), (c), (d), and (g) EXPIRED: 6-25-18; ss by #12783, eff 5-21-19

N.H. Code Admin. R. Ann. He-W 538.02 Recipient Eligibility {#sec-he-w-538.02 omnilex-key=us-nh-regs-official--agency-he-w--He-W 538.02}

All recipients shall be eligible for NHCM services, in accordance with this part.

History

#7657, eff 3-5-02, EXPIRED: 3-5-10
#9737, eff 6-25-10, EXPIRED: 6-25-18
#12783, eff 5-21-19

N.H. Code Admin. R. Ann. He-W 538.03 Provider Participation {#sec-he-w-538.03 omnilex-key=us-nh-regs-official--agency-he-w--He-W 538.03}

All NHCM providers shall:

(a) Be enrolled New Hampshire medicaid providers; and

(b) Be certified to practice midwifery in New Hampshire pursuant to RSA 326-D:6.

History

#7657, eff 3-5-02, EXPIRED: 3-5-10
#9737, eff 6-25-10, EXPIRED: 6-25-18
#12783, eff 5-21-19

N.H. Code Admin. R. Ann. He-W 538.04 Covered Services {#sec-he-w-538.04 omnilex-key=us-nh-regs-official--agency-he-w--He-W 538.04}

Pursuant to RSA 326-D:2, V, covered NHCM services shall include:

(a) Providing supervision and advice during the recipient's:

(1) Pregnancy;

(2) Labor; and

(3) Postpartum period;

(b) Providing care during the recipient's:

(1) Pregnancy, including:

a. Preventive care;

b. The detection of abnormal conditions of the mother and fetus; and

c. The execution of emergency measures in the absence of medical help;

(2) Labor, including:

a. The conduction of vaginal deliveries on their own responsibility; and

b. The execution of emergency measures in the absence of medical help; and

(3) Postpartum period, including:

a. Preventive care for the mother and newborn;

b. The detection of abnormal conditions of the mother and newborn; and

c. The execution of emergency measures for the mother and newborn in the absence of medical help; and

History

#7657, eff 3-5-02, EXPIRED: 3-5-10
#9737, eff 6-25-10, EXPIRED: 6-25-18
#12783, eff 5-21-19

N.H. Code Admin. R. Ann. He-W 538.05 Non-Covered Services {#sec-he-w-538.05 omnilex-key=us-nh-regs-official--agency-he-w--He-W 538.05}

Non-covered services shall be those services which a NHCM is not legally recognized to perform, pursuant to RSA 326-D:1, V, including:

(a) Operative obstetrics;

(b) Cesarean sections;

(d) Contraction stress tests;

(e) Treatment to enhance fertility or procreation;

(f) Any artificial, forcible, or mechanical means to assist the delivery; and

(g) Induced abortions.

History

#7657, eff 3-5-02, EXPIRED: 3-5-10
#9737, eff 6-25-10, EXPIRED: 6-25-18
#12783, eff 5-21-19

N.H. Code Admin. R. Ann. He-W 538.06 Utilization Review and Control {#sec-he-w-538.06 omnilex-key=us-nh-regs-official--agency-he-w--He-W 538.06}

(a) The department’s provider integrity unit shall monitor utilization of NHCM services to identify, prevent, and correct potential occurrences of fraud, waste, and abuse in accordance with 42 CFR 455, 42 CFR 456, 42 CFR 1001, and He-W 520.

(b) Failure to maintain supporting records in accordance with He-W 520 and He-W 538 shall entitle the department to recoupment of state and federal medicaid payments pursuant to 42 CFR 455, 42 CFR 447, and 42 CFR 456.

History

#7657, eff 3-5-02, EXPIRED: 3-5-10
#9737, eff 6-25-10, EXPIRED: 6-25-18
#12783, eff 5-21-19

N.H. Code Admin. R. Ann. He-W 538.07 Third Party Liability {#sec-he-w-538.07 omnilex-key=us-nh-regs-official--agency-he-w--He-W 538.07}

All third party obligations shall be exhausted before medicaid shall be billed, in accordance with 42 CFR 433.139.

History

#7657, eff 3-5-02, EXPIRED: 3-5-10
#9737, eff 6-25-10, EXPIRED: 6-25-18
#12783, eff 5-21-19

N.H. Code Admin. R. Ann. He-W 538.08 Payment for Services {#sec-he-w-538.08 omnilex-key=us-nh-regs-official--agency-he-w--He-W 538.08}

(a) Payment for services to NHCM’s shall be made in accordance with rates established by the department in accordance with RSA 161:4, VI(a).

(b) The NHCM shall submit claims for payment to the department’s fiscal agent.

(d) All electronic or written documentation shall be legible and written in English.

(e) All NHCM’s shall provide documentation to the department upon request.

History

#7657, eff 3-5-02, EXPIRED: 3-5-10
#9737, eff 6-25-10, EXPIRED: 6-25-18
#12783, eff 5-21-19

Part He-W 540 Private Duty Nursing Services

N.H. Code Admin. R. Ann. He-W 540.01 Definitions {#sec-he-w-540.01 omnilex-key=us-nh-regs-official--agency-he-w--He-W 540.01}

(a) “Clinically appropriate” means care that is:

(1) Provided in a timely manner and meets professionally recognized standards of acceptable medical care;

(2) Delivered in the appropriate medical setting; and

(3) The least costly of multiple, equally effective alternative treatments or diagnostic modalities.

(b) “Department” means the New Hampshire department of health and human services.

(c) “Medicaid” means the Title XIX and Title XXI programs administered by the department which makes medical assistance available to eligible individuals.

(d) “Order” means a written authorization issued by a licensed practitioner for medications, treatments, recommendations, and referrals, and signed by the licensed practitioner using terms such as authorized by, authenticated by, approved by, reviewed by, or any other term that denotes approval by the licensed practitioner.

(e) Licensed practitioner” means:

(1) Physician;

(2) Physician's assistant;

(3) Advanced practice registered nurse (APRN); or

(4) Any practitioner with diagnostic and prescriptive powers licensed by the appropriate state licensing board.

(f) “Plan of care” means a plan of care prepared in accordance with 42 CFR 484.60.

(g) “Prior authorization agent” means an individual or organization contracted by the department, responsible for reviewing prior authorization requests.

(h) “Private duty nursing (PDN)” means the provision of skilled nursing services for recipients who require more individual and continual skilled nursing observation, judgment, assessment, or interventions than are available from a visiting nurse, in contrast to part-time or intermittent care, such as wound care.

(i) “Reasonable attempt” means such action taken to accomplish the purpose as may be customary, appropriate, and suitable to the circumstances and that is in the best interests of the recipient.

(j) “Recipient” means any individual who is eligible for and receiving medical assistance under the medicaid program.

(k) “Skilled nursing services” means services that are provided by a registered nurse (RN) or a licensed practical nurse (LPN) because the nature of the service is inherently complex or the recipient’s condition is such that the service can be safely and effectively provided only by a licensed nurse in accordance with the nurse practice act, RSA 326-B.

(l) “Title XIX program” means the joint federal-state program described in Title XIX of the Social Security Act (SSA) and administered in New Hampshire by the department under the medicaid program.

(m) “Title XXI” means the joint federal-state program described in Title XXI of the Social Security Act and administered in New Hampshire by the department under the medicaid program.

History

(See Revision Note at chapter heading He-W 500); ss by #6134, eff 11-30-95, EXPIRED: 11-30-03
#8069, eff 4-17-04; ss by #10107, INTERIM, eff 4-17-12, EXPIRES: 10-15-12; amd by #10139, eff 7-1-12; ss by #10186, eff 10-15-12; ss by #13544, eff 1-28-23

N.H. Code Admin. R. Ann. He-W 540.02 Recipient Eligibility {#sec-he-w-540.02 omnilex-key=us-nh-regs-official--agency-he-w--He-W 540.02}

All recipients shall be eligible for PDN in accordance with He-W 540 if the recipient:

(a) Requires continual skilled nursing observation, judgment, assessment, or interventions for more than a 2 hour duration which can only be provided by an RN or LPN, to maintain or improve the recipient’s health status; and

(b) Is receiving nursing care under a written plan of care established or approved by the recipient’s physician or other licensed practitioner.

History

(See Revision Note at chapter heading He-W 500); ss by #6134, eff 11-30-95, EXPIRED: 11-30-03
#8069, eff 4-17-04; ss by #10107, INTERIM, eff 4-17-12, EXPIRES: 10-15-12; ss by #10186, eff 10-15-12; ss by #13544, eff 1-28-23

N.H. Code Admin. R. Ann. He-W 540.03 Provider Participation {#sec-he-w-540.03 omnilex-key=us-nh-regs-official--agency-he-w--He-W 540.03}

Each participating provider of PDN shall:

(a) Be a home health care provider licensed in accordance with RSA 151:2, and He-P 809;

(b) Require all staff providing PDN to be an RN or an LPN licensed by the state in which the RN or LPN practices;

(c) Request and obtain prior authorization from the department or its prior authorization agent, in accordance with He-W 540.07, before providing PDN; and

(d) Provide to each recipient, or the recipient’s caregiver if the recipient is a minor, the home health care provider’s written grievance policy that includes the phone number of the department’s ombudsman’s office upon the initiation of PDN.

History

(See Revision Note at chapter heading He-W 500); ss by #6134, eff 11-30-95, EXPIRED: 11-30-03
#8069, eff 4-17-04; ss by #10107, INTERIM, eff 4-17-12, EXPIRES: 10-15-12; ss by #10186, eff 10-15-12; ss by #10186, eff 10-15-12; ss by #13544, eff 1-28-23

N.H. Code Admin. R. Ann. He-W 540.04 Covered Services {#sec-he-w-540.04 omnilex-key=us-nh-regs-official--agency-he-w--He-W 540.04}

PDN shall be a covered service when:

(a) It is part of the recipient’s medical regimen and rendered under the order and general direction of the recipient’s physician or other licensed practitioner;

(b) It is provided in one of the following locations:

(1) The recipient’s home; or

(2) In locations other than the recipient’s home when routine life activities take the recipient outside of the home if the services would have otherwise been provided in the recipient’s home; and

History

(See Revision Note at chapter heading He-W 500); ss by #6134, eff 11-30-95, EXPIRED: 11-30-03
#8069, eff 4-17-04; ss by #10107, INTERIM, eff 4-17-12, EXPIRES: 10-15-12; ss by #10186, eff 10-15-12; ss by #13544, eff 1-28-23

N.H. Code Admin. R. Ann. He-W 540.05 Non-covered Services {#sec-he-w-540.05 omnilex-key=us-nh-regs-official--agency-he-w--He-W 540.05}

(a) PDN shall not be a covered service when the recipient resides in any one of the following:

(1) A nursing facility licensed pursuant to RSA 151:2 and He-P 803;

(2) A hospital licensed pursuant to RSA 151:2 and He-P 802;

(3) An assisted living residence-supported residential health care (ALR-SRHC) facility licensed pursuant to RSA 151:2 and He-P 805;

(4) A private non-medical institution as defined in 42 CFR 434.2, and licensed pursuant to RSA 151:2 and He-P 800;

(5) An intermediate care facility for individuals with intellectual disabilities (ICF/IID) as defined in 42 CFR 440.150; and

(6) An institution for mental diseases (IMD) as defined in 42 CFR 435.1010.

(b) Services that consist only of assistance with activities of daily living or other non-skilled services needed to live at home that do not require a nurse, including but not limited to assistance with grooming, toileting, eating, dressing, getting into or out of a bed or chair, and walking shall not be covered as PDN.

History

(See Revision Note at chapter heading He-W 500); ss by #6134, eff 11-30-95, EXPIRED: 11-30-03
#8069, eff 4-17-04; ss by #10107, INTERIM, eff 4-17-12, EXPIRES: 10-15-12; ss by #10186, eff 10-15-12; ss by #13544, eff 1-28-23

N.H. Code Admin. R. Ann. He-W 540.06 Required Documentation {#sec-he-w-540.06 omnilex-key=us-nh-regs-official--agency-he-w--He-W 540.06}

For each recipient, PDN service providers shall maintain complete and timely records as follows:

(a) A written, signed, and dated physician’s or other licensed practitioner’s order for care provided, updated and signed every 60 days, which shall include:

(1) The recipient’s diagnosis, with a description of the severity of the illness or condition; and

(2) A detailed explanation of the medical need for PDN, including:

a. The specific nursing services that are required; and

b. A description of the specific medical complications necessitating PDN;

(b) A nursing assessment with information that supports the need for PDN including, but not limited to, the following:

(1) Recipient identification information including:

a. Recipient name;

b. Medicaid identification number (MID); and

c. Date of birth;

(2) Contact information of the recipient’s parent, guardian, or primary caregiver including addresses and phone numbers;

(3) Private health insurance information including coverage dates;

(4) Information regarding the recipient’s participation in any medicaid program, including medicaid to schools, waiver programs, and licensed nursing assistant (LNA) services, or participation in the special medical services program;

(5) Name and contact information of the recipient’s treating physician or other licensed practitioner, including the primary care physician, and any specialists;

(6) A summary of the recipient's physical and behavioral health status including:

a. A list of the recipient’s current conditions; and

b. A history of the conditions leading to the need for PDN;

(7) An assessment of the recipient’s body systems including a medication profile;

(8) A functional assessment of the recipient’s physical and cognitive status including a list of any durable medical equipment being utilized;

(9) A description of the household make-up including the nature of the household member’s relationship with the recipient and their ability and availability to provide care and support to the recipient;

(10) Information about the recipient’s school participation including the number of hours per week the recipient attends and whether a nurse or aide is available to assist the recipient while at school;

(11) The recipient’s emergency plan in the event that the primary caregiver is unable to provide care; and

(12) Any additional medical or social information, such as family stressors and their impact on the mental and emotional health of the recipient that the recipient wants to provide that supports the need for PDN.

(c) A plan of care documenting the extent of the recipient’s nursing needs, prepared by the PDN service provider, signed and dated by the recipient’s physician or other licensed practitioner, and updated every 60 days in accordance with 42 CFR 484.60(c)(1);

(d) Nurses’ notes that fully document, for each date of service, the provision of services and the care and treatment provided to the recipient, including:

(1) The location of where the care was provided, and the time that the nursing shift began and ended;

(2) A description of each nursing service provided, including the type of nursing service, the time of the service delivery, and the recipient’s response to the service so that an independent reviewer can replicate what happened during the shift;

(3) Details showing that the nursing services are consistent with the care plan and orders of the recipient’s physician or other licensed practitioner;

(4) Any adverse findings and, if so, a plan of action to address those findings; and

(5) The recipient’s progress towards established goals; and

(e) Documentation of a face-to-face encounter between the recipient’s physician or other licensed practitioner and the recipient within 90 days prior to, or within 30 days following the start of, the PDN service provision, as established in 42 USC 1395n of the SSA and in accordance with 42 CFR 440.

History

(See Revision Note at chapter heading He-W 500); ss by #6134, eff 11-30-95, EXPIRED: 11-30-03
#8069, eff 4-17-04; ss by #10107, INTERIM, eff 4-17-12, EXPIRES: 10-15-12; amd by #10139, eff 7-1-12; ss by #10186, eff 10-15-12; ss by #13544, eff 1-28-23

N.H. Code Admin. R. Ann. He-W 540.07 Prior Authorization and Review {#sec-he-w-540.07 omnilex-key=us-nh-regs-official--agency-he-w--He-W 540.07}

(a) All requests for PDN shall require written prior authorization from the department or its prior authorization agent before the recipient receives PDN.

(b) The PDN service provider shall submit a prior authorization request to the department or its prior authorization agent, along with sufficient current medical and psychosocial information to enable the department or its prior authorization agent to evaluate the request and make a determination.

(1) A written, signed, and dated physician’s or other licensed practitioner’s order, as described in He-W 540.06(a);

(2) The nursing assessment, as described in He-W 540.06(b); and

(3) The plan of care, as described in He-W 540.06(c).

(d) If further medical information is necessary, the department or its prior authorization agent shall contact the recipient’s physician, other licensed practitioner, or PDN service provider directly by letter, fax, or telephone and request the additional information.

(e) The department or its prior authorization agent shall determine if PDN is appropriate, and if so, the number of hours authorized and the start and end date of the PDN authorization period, based on an evaluation of the following clinical information provided or gathered in accordance with (b)-(d) above:

(1) The order and direction of the recipient’s physician or other licensed practitioner;

(2) The frequency of the recipient’s need for skilled nursing observation, judgment, assessment, or interventions;

(3) The nursing assessment;

(4) The identified problems and goals in the plan of care; and

(5) For authorization extensions in (o) below, as applicable, the assessment of needs based on the face-to-face nursing visit in (k) and (l) below.

(f) The term of prior authorized services shall be valid for no less than 6 months, unless a shorter term is identified by the practitioner ordering the PDN services, from the start date and may be longer based on the clinical prognosis of the recipient,

(g) Requests for prior authorization shall be denied by the department or its prior authorization agent if, based on the evaluation in (e) above:

(1) Any of the requirements in He-W 540 are not met, including eligibility requirements in He-W 540.02, coverage requirements in He-W 540.04 and 540.05, documentation requirements in He-W 540.06, or prior authorization requirements in He-W 540.07; or

(2) It is determined that:

a. The recipient does not require skilled nursing services;

b. The recipient does not require continual skilled nursing observation, judgment, assessment, or interventions for more than a 2 hour duration; or

c. There are less costly and equally effective alternatives available, such as care provided by alternative providers including personal care attendants, licensed nursing assistants, or homemakers, which will provide the recipient with the same level of service.

(h) If a request for prior authorization is denied by the department or its prior authorization agent, notice of denial shall be forwarded to the recipient, to include:

(1) The reason for, and legal basis of, the denial; and

(2) Information that an administrative appeal on the denial may be requested within 30 calendar days of the date on the notice of the denial, in accordance with He-C 200.

(i) If an initial request for authorization is approved, the department or its prior authorization agent shall issue a temporary initial authorization for a 90-day period.

(j) Notice of the initial authorization in (h) above shall be sent to the recipient and the PDN service provider and include a face-to-face or virtual nursing visit between the department, or its designated party, and the recipient shall be completed within a 90-day period

(k) If the department or its prior authorization agent approves the prior authorization request, then the PDN service provider shall receive notification, which confirms the approval, includes the number of hours authorized and, documents the start and end date of the PDN authorization period.

(l) Within the 90 days in (i) above, and at least once annually for all approved authorization requests, the department or its designated party shall conduct a face-to-face or virtual nursing visit with the recipient in order to:

(1) Assess the recipient’s needs;

(2) Identify other supports in the home;

(3) Verify the clinical appropriateness of the initial authorization or subsequent authorization extensions made based on the clinical evaluation in (e) above; and

(4) Provide education to the recipient.

(m) The face-to-face nursing visit may be conducted in person virtually by electronic means.

(n) The requirements of (i) through (m) above shall not apply to recipients being discharged from any of the locations listed in He-W 540.05(a) when the department has participated in the recipient’s discharge planning, except that the requirements for an annual nursing visit as described in (l) above shall still apply.

(o) The department shall review subsequent authorization requests within 90 days for continued approval.

(p) If the face-to-face or virtual nursing visit confirms the initial authorization was clinically appropriate, the department or its prior authorization agent shall issue notification which confirms the approval, includes the number of hours authorized, and documents the start and end date of the PDN authorization period.

(q) For PDN to extend beyond the authorized duration, the PDN service provider shall request and obtain prior authorization in accordance with this section.

History

(See Revision Note at chapter heading He-W 500); ss by #6134, eff 11-30-95, EXPIRED: 11-30-03
#8069, eff 4-17-04; ss by #10107, INTERIM, eff 4-17-12, EXPIRES: 10-15-12; ss by #10186, eff 10-15-12; ss by #13544, eff 1-28-23

N.H. Code Admin. R. Ann. He-W 540.08 Utilization Review and Control {#sec-he-w-540.08 omnilex-key=us-nh-regs-official--agency-he-w--He-W 540.08}

(a) The department’s program integrity unit shall monitor utilization of PDN, in accordance with 42 CFR 455, 42 CFR 456, 42 CFR 1001 and He-W 520; and

History

(See Revision Note at chapter heading He-W 500); ss by #6134, eff 11-30-95, EXPIRED: 11-30-03
#8069, eff 4-17-04; ss by #10107, INTERIM, eff 4-17-12, EXPIRES: 10-15-12; ss by #10186, eff 10-15-12; ss by #13544, eff 1-28-23

N.H. Code Admin. R. Ann. He-W 540.09 Third Party Liability {#sec-he-w-540.09 omnilex-key=us-nh-regs-official--agency-he-w--He-W 540.09}

(a) All third party obligations shall be exhausted before medicaid shall be billed, in accordance with 42 CFR 433.139.

(b) PDN service providers shall request information from the recipient regarding other insurance coverage.

(c) If other insurance coverage is available, providers shall contact the insurer to verify benefits initially and at least annually thereafter or when the insurance carrier changes.

(d) PDN service providers shall maintain a record of any other insurance verifications in the recipient’s medical record in accordance with He-W 520.

History

(See Revision Note at chapter heading He-W 500); ss by #6134, eff 11-30-95, EXPIRED: 11-30-03
#8069, eff 4-17-04; ss by #10107, INTERIM, eff 4-17-12, EXPIRES: 10-15-12; ss by #10186, eff 10-15-12; ss by #13544, eff 1-28-23

N.H. Code Admin. R. Ann. He-W 540.10 Payment for Services {#sec-he-w-540.10 omnilex-key=us-nh-regs-official--agency-he-w--He-W 540.10}

(a) Payment for PDN shall be made in accordance with rates established by the department in accordance with RSA 161:4, VI(a).

(b) Payments for services billed shall be for direct care only, and shall not include administrative work or travel time.

(d) The provider shall maintain supporting records, in accordance with He-W 520.

History

(See Revision Note at chapter heading He-W 500); ss by #6134, eff 11-30-95, EXPIRED: 11-30-03
#8069, eff 4-17-04; ss by #10107, INTERIM, eff 4-17-12, EXPIRES: 10-15-12; ss by #10186, eff 10-15-12; ss by #13544, eff 1-28-23

Part He-W 541 Family Planning Services

N.H. Code Admin. R. Ann. He-W 541.01 Definitions {#sec-he-w-541.01 omnilex-key=us-nh-regs-official--agency-he-w--He-W 541.01}

(a) “Clean claim(s)” means a claim that can be processed without obtaining additional information from the provider or from a third party, including a claim with errors originating in the state’s claims system, but not including a claim from a dispensing provider who is under investigation for fraud or abuse or a claim under review for medical necessity.

(b) “Department” means the New Hampshire department of health and human services.

(c) “Family planning services” means medical services, medical procedures, and pharmaceutical supplies and devices provided by or under the supervision of a physician or other health professional that allow a recipient to prevent or delay pregnancy or to otherwise control family size, and which receive an enhanced match rate of 90% federal match.

(d) “Hysterectomy” means a surgical procedure for the purpose of removing the uterus.

(e) “Institutionalized individual” means an individual who:

(1) Is involuntarily confined or detained under a civil or criminal statute, in a correctional or rehabilitative facility, including a mental hospital or other facility for the care and treatment of mental illness; or

(2) Is confined under a voluntary commitment in a mental hospital or other facility for the care and treatment of mental illness.

(f) “Medicaid” means the Title XIX and Title XXI programs administered by the department which makes medical assistance available to eligible individuals.

(g) “Mentally incompetent individual” means a mentally incompetent individual as defined in 42 CFR 441.251.

(h) “Recipient” means any individual who is eligible for and receiving medical assistance under the medicaid program.

(i) “Sterilization” means any medical procedure, treatment or surgical procedure which is intended to render an individual permanently incapable of reproducing.

(j) “Title XIX program” means the joint federal-state program described in Title XIX of the Social Security Act and administered in New Hampshire by the department under the medicaid program.

(k) “Title XXI” means the joint federal-state program described in Title XXI of the Social Security Act and administered in New Hampshire by the department under the medicaid program.

History

(See Revision Note at chapter heading He-W 500); ss by #5874, eff 8-1-94; ss by #7329, eff 8-1-00, EXPIRED: 8-1-08
#9272, eff 9-19-08; amd by #10139, eff 7-1-12; ss by #12053, eff 11-19-16

N.H. Code Admin. R. Ann. He-W 541.02 Recipient Eligibility {#sec-he-w-541.02 omnilex-key=us-nh-regs-official--agency-he-w--He-W 541.02}

(a) All Medicaid recipients of child bearing age and not known to be pregnant shall be eligible for family planning services, in accordance with He-W 541.

(b) Acceptance of any family planning services shall be voluntary on the part of the recipient and shall not be a prerequisite or impediment to eligibility for any other service or assistance program administered by the department.

History

(See Revision Note at chapter heading He-W 500); ss by #5874, eff 8-1-94; ss by #7329, eff 8-1-00, EXPIRED: 8-1-08
#9272, eff 9-19-08; ss by #12053, eff 11-19-16

N.H. Code Admin. R. Ann. He-W 541.03 Provider Participation {#sec-he-w-541.03 omnilex-key=us-nh-regs-official--agency-he-w--He-W 541.03}

All family planning providers shall be:

(a) Licensed by the state in which she or he practices or be a NH certified midwife; and

(b) A New Hampshire enrolled Medicaid provider.

History

(See Revision Note at chapter heading He-W 500); ss by #5874, eff 8-1-94; ss by #7329, eff 8-1-00, EXPIRED: 8-1-08
#9272, eff 9-19-08; ss by #12053, eff 11-19-16

N.H. Code Admin. R. Ann. He-W 541.04 Service Limits {#sec-he-w-541.04 omnilex-key=us-nh-regs-official--agency-he-w--He-W 541.04}

Family planning services for recipients shall be subject to the limits described in He-W 530.

History

(See Revision Note at chapter heading He-W 500); ss by #5874, eff 8-1-94; ss by #7329, eff 8-1-00, EXPIRED: 8-1-08
#9272, eff 9-19-08; ss by #12053, eff 11-19-16

N.H. Code Admin. R. Ann. He-W 541.05 Covered Services {#sec-he-w-541.05 omnilex-key=us-nh-regs-official--agency-he-w--He-W 541.05}

The following services shall be covered as family planning services only if the items and procedures are clearly provided or performed for family planning purposes:

(a) Physician services, in accordance with He-W 531, certified midwife services in accordance with He-W 538, and advanced practice registered nurse services in accordance with He-W 534;

(b) Contraceptive devices or drugs, both prescription and non-prescription, in accordance with He-W 570;

(c) Pregnancy tests and screening for sexually transmitted diseases only when performed routinely as part of an initial, regular, or follow-up family planning visit; and

(d) Sterilization, in accordance with 42 CFR 441.253 and 42 CFR 441.254, as follows:

(1) The recipient shall be at least 21 years old at the time consent is obtained;

(2) The recipient shall not be a mentally incompetent individual;

(3) The recipient shall not be an institutionalized individual;

(4) The recipient shall voluntarily give informed consent in accordance with the requirements at 42 CFR 441.257 through 42 CFR 441.258;

(5) The provider shall submit the federal health and human services office of management and budget form HHS-687 “Consent for Sterilization” (OMB No. 0937-0166) to the department prior to the department’s payment for the sterilization claim;

(6) At least 30 days, but not more than 180 days, shall have passed between the date of informed consent and the date of sterilization, with the exception of cases of premature delivery or emergency abdominal surgery as described in (7) below; and

(7) A recipient may consent to be sterilized at the time of a premature delivery or emergency abdominal surgery if at least 72 hours have passed since the recipient gave informed consent for the sterilization and, in the case of premature delivery, if the informed consent was given at least 30 days before the expected date of delivery.

History

(See Revision Note at chapter heading He-W 500); ss by #5874, eff 8-1-94; ss by #7329, eff 8-1-00, EXPIRED: 8-1-08
#9272, eff 9-19-08; ss by #12053, eff 11-19-16

N.H. Code Admin. R. Ann. He-W 541.06 Non-Covered Services {#sec-he-w-541.06 omnilex-key=us-nh-regs-official--agency-he-w--He-W 541.06}

(a) The following services shall not be covered as family planning services:

(1) Sterilizations which do not meet the requirements of He-W 541.05(d) above;

(2) Hysterectomies;

(3) Medical, surgical, or pharmaceutical treatment for the purpose of enhancing, promoting or restoring fertility;

(4) Medical procedures performed for medical reasons such as the removal of an IUD due to an infection, diagnostic examination of the cervix or vagina by means of a special microscope, colposcopy, biopsy, or cryotherapy of the cervix or vagina;

(5) Treatment of medical complications caused by, or following, a family planning procedure;

(6) Any medical service, procedure, or pharmaceutical supply or device provided to a recipient who is known to be pregnant; and

(7) Pregnancy and sexually transmitted disease tests, except for those performed as part of an initial or annual family planning examination.

(b) The services in (a)(2) and (a)(4) through (a)(7) above which are non-covered as family planning services shall be covered in accordance with He-W 531, He-W 534, He-W 538, He-W 570, and 42 CFR 441, Subpart F.

History

(See Revision Note at chapter heading He-W 500); ss by #5874, eff 8-1-94; ss by #7329, eff 8-1-00, EXPIRED: 8-1-08
#9272, eff 9-19-08; ss by #12053, eff 11-19-16

N.H. Code Admin. R. Ann. He-W 541.07 Co-Payments {#sec-he-w-541.07 omnilex-key=us-nh-regs-official--agency-he-w--He-W 541.07}

In accordance with He-W 570, co-payments for family planning pharmaceutical products shall not be required.

History

(See Revision Note at chapter heading He-W 500); ss by #5874, eff 8-1-94; ss by #7329, eff 8-1-00, EXPIRED: 8-1-08
#9272, eff 9-19-08; ss by #12053, eff 11-19-16

N.H. Code Admin. R. Ann. He-W 541.08 Utilization Review and Control {#sec-he-w-541.08 omnilex-key=us-nh-regs-official--agency-he-w--He-W 541.08}

The department’s program integrity unit shall monitor utilization of family planning services to identify, prevent, and correct potential occurrences of fraud, waste, and abuse, in accordance with 42 CFR 455, 42 CFR 447, 42 CFR 456, and He-W 520.

History

(See Revision Note at chapter heading He-W 500); ss by #5874, eff 8-1-94; ss by #7329, eff 8-1-00, EXPIRED: 8-1-08
#9272, eff 9-19-08 (from He-W 541.07); ss by #12053, eff 11-19-16

N.H. Code Admin. R. Ann. He-W 541.09 Third Party Liability {#sec-he-w-541.09 omnilex-key=us-nh-regs-official--agency-he-w--He-W 541.09}

All third party obligations shall be exhausted before medicaid shall be billed, in accordance with 42 CFR 433.

History

(See Revision Note at chapter heading He-W 500); ss by #5874, eff 8-1-94; ss by #7329, eff 8-1-00, EXPIRED: 8-1-08
#9272, eff 9-19-08 (from He-W 541.08); ss by #12053, eff 11-19-16

N.H. Code Admin. R. Ann. He-W 541.10 Payment for Services {#sec-he-w-541.10 omnilex-key=us-nh-regs-official--agency-he-w--He-W 541.10}

(a) Rates of payment for family planning services shall be established by the department in accordance with RSA 161:4, VI(a).

(b) The provider shall submit clean claims for payment.

(c) The provider shall maintain supporting records in accordance with He-W 520 and shall keep documentation supporting claims and records necessary to disclose the extent of services the provider furnishes to medicaid recipients in accordance with He-W 520.

History

#9272, eff 9-19-08 (from He-W 541.09); ss by #12053, eff 11-19-16

Part He-W 543 Hospital Services

N.H. Code Admin. R. Ann. He-W 543.01 Definitions {#sec-he-w-543.01 omnilex-key=us-nh-regs-official--agency-he-w--He-W 543.01}

(a) “Acute care” means those services provided to recipients, other than swing bed patients, in a hospital.

(b) “Budget neutrality factors” means adjustments applied to rate-setting methodology to reduce spending growth.

(c) “Centers for Medicare and Medicaid Services (CMS)” means the division of the federal Department of Health and Human Services that administers medicare, medicaid, the children’s health insurance program, and the health insurance marketplace.

(d) “Day outlier” means those cases for which the actual length of stay exceeds the trim point per diagnosis related group.

(e) “Department” means the New Hampshire (NH) department of health and human services.

(f) “Diagnosis related group (DRG)” means the taxonomy of diagnoses as classified in the medicare DRG classification system which groups hospital inpatient cases according to factors such as principal diagnosis, age, and sex, and assigns a relative weight which represents hospital resource use associated with treatment for the diagnosis, pursuant to 42 CFR 412.60.

(g) “Generally accepted standards of medical practice” means standards that are based on credible scientific evidence published in peer-reviewed medical literature generally recognized by the relevant medical community, or the recommendations of physician specialists practicing in relevant clinical areas or of various physician specialty societies.

(h) “Hospital” means any facility providing acute care services, to include acute care rehabilitation services, not operating as a psychiatric hospital or an institution for mental diseases and which provides the inpatient hospital services defined in 42 CFR 440.10.

(i) “In-state hospital” means a hospital which is located within the physical boundaries of NH.

(j) “Medicaid” means the Title XIX and Title XXI programs administered by the department which makes medical assistance available to eligible individuals.

(k) “Medically necessary” means:

(1) For individuals under age 21, reasonably calculated to prevent, diagnose, correct, cure, alleviate, or prevent the worsening of conditions that endanger life, cause pain, result in illness or infirmity, threaten to cause or aggravate a handicap, or cause physical deformity or malfunction, and no other equally effective course of treatment is available or suitable for the early and periodic screening, diagnosis, and treatment services (EPSDT) recipient requesting a medically necessary service; and

(2) For individuals age 21 and over, health care services that a licensed health care provider, exercising prudent clinical judgment, would provide, in accordance with generally accepted standards of medical practice, to a recipient for the purpose of evaluating, diagnosing, preventing, or treating an acute or chronic illness, injury, disease, or its symptoms, and that are:

a. Clinically appropriate in extent, site, and duration, and consistent with the established diagnosis or treatment of the recipient’s illness, injury, disease, or its symptoms;

b. Not primarily for the convenience of the recipient or the recipient’s family, caregiver, or health care provider;

c. No more costly than other items or services which would produce equivalent diagnostic, therapeutic, or treatment results as related to the recipient’s illness, injury, disease, or its symptoms; and

d. Not experimental, investigative, cosmetic, or duplicative in nature.

(l) “Observation services” means services furnished by a hospital on the hospital’s premises, including the use of a bed and periodic monitoring by a hospital’s nursing or other staff, which are reasonable and necessary to evaluate an outpatient’s condition or determine the need for a possible admission to the hospital as an inpatient.

(m) “Out-of-state hospital” means a hospital located outside of NH.

(n) “Recipient” means an individual who is eligible for and receiving medical assistance under the medicaid program.

(o) “Title XIX” means the joint federal-state program described in Title XIX of the Social Security Act and administered in NH by the department under the medicaid program.

(p) “Title XXI” means the joint federal-state program described in Title XXI of the Social Security Act and administered in NH by the department under the medicaid program.

History

(See Revision Note at chapter heading He-W 500); ss by #5897, eff 9-19-94; amd by #6548, eff 7-26-97; ss by #7399, eff 11-2-00, EXPIRED: 11-2-08
#9324, eff 11-21-08; amd by #10139, eff 7-1-12; ss by #12103, eff 2-9-17; amd by #12818, eff 7-1-19; ss by #14384, eff 9-20-25, EXPIRES: 9-20-35

N.H. Code Admin. R. Ann. He-W 543.02 Recipient Eligibility {#sec-he-w-543.02 omnilex-key=us-nh-regs-official--agency-he-w--He-W 543.02}

All recipients shall be eligible to receive inpatient and outpatient hospital services in accordance with He-W 543, and within the service limits described in He-W 530.

History

(See Revision Note at chapter heading He-W 500); ss by #5897, eff 9-19-94, EXPIRED: 9-19-00
#7399, eff 11-2-00, EXPIRED: 11-2-08
#9324, eff 11-21-08; ss by #12103, eff 2-9-17; ss by #14384, eff 9-20-25, EXPIRES: 9-20-35

N.H. Code Admin. R. Ann. He-W 543.03 Provider Participation {#sec-he-w-543.03 omnilex-key=us-nh-regs-official--agency-he-w--He-W 543.03}

All in-state and out-of-state hospital providers shall:

(a) Be licensed by the department in accordance with RSA 151, or by the relevant state licensing authority in the state within which the provider operates;

(b) Meet medicare participation requirements; and

(1) In-state hospitals shall be enrolled as in-state hospital providers; and

(2) Out-of-state hospitals shall be enrolled as out-of-state hospital providers.

History

(See Revision Note at chapter heading He-W 500); ss by #5897, eff 9-19-94, EXPIRED: 9-19-00
#7399, eff 11-2-00, EXPIRED: 11-2-08
#9324, eff 11-21-08; ss by #12103, eff 2-9-17; ss by #14384, eff 9-20-25, EXPIRES: 9-20-35

N.H. Code Admin. R. Ann. He-W 543.04 Covered Services {#sec-he-w-543.04 omnilex-key=us-nh-regs-official--agency-he-w--He-W 543.04}

(a) Covered services shall include those services described in the various service component rules found in He-W 500 which might be provided in a hospital setting as either an inpatient or outpatient hospital service.

(b) Inpatient hospital services shall be covered when those services are rendered:

(1) By or under the direction of a licensed clinician within their scope of practice;

(2) To a recipient who has been admitted to a hospital as an inpatient;

(3) For a continuous period of 24 hours or longer;

(4) By a hospital offering room, board, and professional services; and

(5) By a NH medicaid participating hospital which meets the requirements set forth in He-W 543.03.

(1) As preventive, diagnostic, therapeutic, rehabilitative, emergency, or palliative outpatient services;

(2) Within the service limits set forth in He-W 530;

(3) By or under the direction of a licensed clinician within their scope of practice;

(4) To a recipient who has not been admitted as an inpatient;

(5) For a period of time less than 24 hours; and

(6) By a NH medicaid participating hospital which meets the requirements set forth in He-W 543.03.

(d) Observation services, as defined in He-W 543.01, shall be covered in accordance with He-W 543.04(c), above.

(e) Organ transplant procedures and procurements shall be covered when performed as an inpatient service at an organ transplant facility approved by CMS and in accordance with the requirements and limits in He-W 531.

History

(See Revision Note at chapter heading He-W 500); ss by #5897, eff 9-19-94, EXPIRED 9-19-00
#7399, eff 11-2-00, EXPIRED: 11-2-08
#9324, eff 11-21-08 (from He-W 543.04); ss by #12103, eff 2-9-17; ss by #14384, eff 9-20-25 (formerly He-W 543.05), EXPIRES: 9-20-35

N.H. Code Admin. R. Ann. He-W 543.05 Non-Covered Services {#sec-he-w-543.05 omnilex-key=us-nh-regs-official--agency-he-w--He-W 543.05}

(a) Services which are not described in the various service component rules in He-W 500 shall be non-covered in a hospital setting as either inpatient or outpatient hospital services.

(b) Services provided to recipients by psychiatric hospitals or in institutions for mental diseases shall be non-covered services under He-W 543.

History

(See Revision Note at chapter heading He-W 500); ss by #5897, eff 9-19-94, EXPIRED 9-19-00
#7399, eff 11-2-00, EXPIRED: 11-2-08
#9324, eff 11-21-08; ss by #12103, eff 2-9-17; ss by #14384, eff 9-20-25 (formerly He-W 543.06), EXPIRES: 9-20-35

N.H. Code Admin. R. Ann. He-W 543.06 Readmission to Hospital {#sec-he-w-543.06 omnilex-key=us-nh-regs-official--agency-he-w--He-W 543.06}

A separate payment shall not be made for readmission to any hospital for the same diagnosis if the readmission occurs within 30 days of discharge, except for those cases where the department has determined the readmission was medically necessary as defined in He-W 543.01.

History

(See Revision Note at chapter heading He-W 500); ss by #5897, eff 9-19-94, EXPIRED 9-19-00
#7399, eff 11-2-00, EXPIRED: 11-2-08
#9324, eff 11-21-08 (from He-W 543.05); ss by #12103, eff 2-9-17; ss by #12818, eff 7-1-19; ss by #14384, eff 9-20-25 (formerly He-W 543.07), EXPIRES: 9-20-35

N.H. Code Admin. R. Ann. He-W 543.07 Transfer of Recipient {#sec-he-w-543.07 omnilex-key=us-nh-regs-official--agency-he-w--He-W 543.07}

(a) A hospital which transfers or discharges a recipient from a unit in a hospital to the same type of unit in another hospital for continued inpatient hospital services shall be paid 100 percent of the per diem for each day of care, not to exceed the DRG rate, except for rehabilitative cases, which shall be paid in accordance with He-W 543.12(a).

(b) A hospital which transfers or discharges a recipient to a different type of unit in another hospital, or different type of unit within the same hospital for continued inpatient hospital services, shall be paid according to the DRG payment designated for the type of services provided, plus day outlier payments, if applicable.

(c) The receiving hospital which does not transfer a recipient to another hospital shall be paid the DRG rate, plus day outlier payments, if applicable, when the recipient is discharged.

(d) If a recipient is transferred back or readmitted to the original admitting hospital unit for continuing treatment, only one DRG payment, plus day outlier payments if applicable, shall be paid for the combined initial admission and subsequent readmission to that hospital unit.

(e) The hospital unit which receives and then transfers a recipient back to the original admitting hospital unit shall also be considered a transferring hospital and shall be paid in accordance with He-W 543.07(a) or He-W 543.07(b), as applicable, above.

History

(See Revision Note at chapter heading He-W 500); ss by #5897, eff 9-19-94, EXPIRED 9-19-00
#7399, eff 11-2-00, EXPIRED: 11-2-08
#9324, eff 11-21-08; ss by #12103, eff 2-9-17; ss by #14384, eff 9-20-25 (formerly He-W 543.08), EXPIRES: 9-20-35

N.H. Code Admin. R. Ann. He-W 543.08 Split Eligibility {#sec-he-w-543.08 omnilex-key=us-nh-regs-official--agency-he-w--He-W 543.08}

When a recipient is eligible for only part of a hospital stay, the medicaid payment shall be made at 100 percent of the per diem for each day of care on which the recipient is medicaid eligible, not to exceed the DRG rate, except for rehabilitative cases, which shall be paid in accordance with He-W 543.12(a).

History

(See Revision Note at chapter heading He-W 500); ss by #5897, eff 9-19-94, EXPIRED 9-19-00
#7399, eff 11-2-00, EXPIRED: 11-2-08
#9324, eff 11-21-08 (from He-W 543.07); ss by #12103, eff 2-9-17; ss by #14384, eff 9-20-25 (formerly He-W 543.09), EXPIRES: 9-20-35

N.H. Code Admin. R. Ann. He-W 543.09 Medicare Participation {#sec-he-w-543.09 omnilex-key=us-nh-regs-official--agency-he-w--He-W 543.09}

For inpatient services, the 60-day lifetime reserve medicare inpatient hospital benefit for medicare-eligible recipients shall be used before medicaid inpatient hospital payments are made.

History

(See Revision Note at chapter heading He-W 500); ss by #5897, eff 9-19-94, EXPIRED 9-19-00
#7399, eff 11-2-00, EXPIRED: 11-2-08
#9324, eff 11-21-08 (from He-W 543.08); ss by #12103, eff 2-9-17; ss by #14384, eff 9-20-25 (formerly He-W 543.10), EXPIRES: 9-20-35

N.H. Code Admin. R. Ann. He-W 543.10 Utilization Review {#sec-he-w-543.10 omnilex-key=us-nh-regs-official--agency-he-w--He-W 543.10}

(a) Evaluations of the quality, medical necessity, appropriateness of care, and length of stay determinations for all inpatient hospital services shall be made by the department in accordance with 42 CFR 456.100 and those sections of 42 CFR 456 described therein.

(b) The department’s bureau of program integrity shall monitor utilization of hospital services to identify, prevent, and correct potential occurrences of fraud, waste, and abuse, in accordance with 42 CFR 455, 42 CFR 447, 42 CFR 456, and He-W 520.

History

(See Revision Note at chapter heading He-W 500); ss by #5897, eff 9-19-94; amd by #6548, eff 7-26-97; ss by #7399, eff 11-2-00; ss by #7558, eff 10-1-01; ss by #9324, eff 11-21-08 (from He-W 543.09); ss by #12103, eff 2-9-17; amd by #12818, eff 7-1-1-19; ss by #14384, eff 9-20-25 (formerly He-W 543.11), EXPIRES: 9-20-35

N.H. Code Admin. R. Ann. He-W 543.11 Third Party Liability {#sec-he-w-543.11 omnilex-key=us-nh-regs-official--agency-he-w--He-W 543.11}

All third party obligations shall be exhausted before medicaid may be billed, in accordance with 42 CFR 433.139

History

#9324, eff 11-21-08 (from He-W 543.10); ss by #12103, eff 2-9-17; ss by #14384, eff 9-20-25 (formerly He-W 543.12), EXPIRES: 9-20-35

N.H. Code Admin. R. Ann. He-W 543.12 Payment for Services {#sec-he-w-543.12 omnilex-key=us-nh-regs-official--agency-he-w--He-W 543.12}

(a) Payment for hospital services shall be made at rates established by the department in accordance with RSA 161:4, VI(a).

(b) Hospital providers shall submit claims for payment to the department’s fiscal agent using the form currently designated and approved by CMS for this purpose.

(c) Hospital providers billing for newborns who do not have their own medicaid identification number shall complete the claim form as follows:

(1) The newborn’s name shall be entered in the patient field;

(2) The medicaid identification number field shall be left blank; and

(3) The mother’s name and medicaid identification number shall be entered in the remarks section.

(d) Payment for inpatient hospital services made for acute care days of stay shall be subject to a post-payment review by the department.

(e) All outpatient hospital services rendered to a medicaid recipient within 3 calendar days prior to their inpatient admission, with a calendar day beginning at 12:00 AM and ending at 11:59 PM, shall be inclusive of the inpatient payment and not be billed separately, with the exception of:

(1) Prenatal outpatient services; and

(2) Diagnostic and nondiagnostic outpatient services that are unrelated to the recipient’s inpatient hospital admission.

History

#9324, eff 11-21-08 (from He-W 543.11); ss by #12103, eff 2-9-17; amd by #12818, eff 7-1-19; ss by #14384, eff 9-20-25 (formerly He-W 543.13), EXPIRES: 9-20-35

Part He-W 544 Hospice Services

N.H. Code Admin. R. Ann. He-W 544.01 Definitions {#sec-he-w-544.01 omnilex-key=us-nh-regs-official--agency-he-w--He-W 544.01}

(a) “Agent” means an adult to whom authority to make health care decisions is delegated under an activated durable power of attorney for health care in accordance with RSA 137-J, or a surrogate decision-maker in accordance with RSA 137-J:35.

(b) “Bereavement counseling” means emotional, psychosocial, and spiritual support and services provided before and after death of the recipient to assist with issues related to grief, loss, and adjustment.

(c) "Care plan" means a written guide developed by the licensee, or its personnel, in consultation with the patient, guardian, agent, or personal representative, if any, as a result of the assessment process for the provision of care and services.

(d) “Continuous home care” means hospice care consisting of primarily nursing care provided by hospice personnel on a continuous basis at home.

(e) “Day” means the 24-hour period starting at 12:00AM and ending at 11:59PM of the same calendar date.

(f) “Department” means the New Hampshire (NH) department of health and human services.

(g) “Dietary counseling” means education and interventions provided to the recipient and family regarding appropriate nutritional intake as the recipient’s condition progresses and provided by qualified individuals including a registered nurse, dietician, or nutritionist, when identified in the recipient’s care plan.

(h) “Election period” means one or more periods for which a recipient may elect to receive medicaid coverage for hospice care during one or more of the following:

(1) An initial 90-day period;

(2) A subsequent 90-day period; or

(3) An unlimited number of subsequent 60-day periods.

(i) “Employee” means:

(1) A person who is hired by a hospice organization;

(2) A person of the agency, if the agency or organization is a subdivision of a hospice organization, who has been appropriately trained and assigned to the hospice unit; or

(3) A volunteer under the jurisdiction of the hospice.

(j) “General inpatient care” means hospice care received in an inpatient facility, for pain control or symptom management, which cannot be managed in other settings.

(k) "Guardian" means a person appointed in accordance with RSA 464-A to make informed decisions relative to the patient’s health care and other personal needs.

(l) "Home hospice care provider (HHCP)” means an agency which provides hospice services to patients and their families in the patient's residence.

(m) “Hospice” means a specialized program of care and supportive services, which provides a combination of medical, social, and spiritual services to terminally ill patients and their families.

(n) “Hospice care” means a comprehensive set of services described in 1861(dd)(1) of the Social Security Act, identified and coordinated by an interdisciplinary group to provide for the physical, psychosocial, spiritual, and emotional needs of a terminally ill patient and family members, as delineated in a specific patient care plan.

(o) “Interdisciplinary group” (IDG) means the team responsible for the holistic care of the hospice recipient.

(p) "License" means the document issued by the department to an applicant at the start of operation as an HHCP which authorizes operation in accordance with RSA 151 and He-P 823, and includes the name of the licensee, the name of the business, the physical address, the license classification, the effective date, and license number.

(q) "Licensed practitioner" means a:

(1) Medical doctor;

(2) Licensed practitioner's assistant;

(3) Advanced practice registered nurse (APRN); or

(4) Any other practitioner with diagnostic and prescriptive powers licensed by the appropriate state licensing board.

(r) “Medicaid” means the Title XIX and Title XXI programs administered by the department which makes medical assistance available to eligible individuals.

(s) “Palliative care” means recipient and family-centered care that optimizes quality of life by anticipating, preventing, and treating suffering. Palliative care throughout the continuum of illness involves addressing physical, intellection, emotional, social, and spiritual needs and to facilitate recipient autonomy, access to information, and choice.

(t) “Quarter” means one of 4 calendar periods ending March 31, June 30, September 30, and December 31.

(u) “Recipient” means any individual who is eligible for and receiving medical assistance under the medicaid program.

(v) “Respite care” means short-term inpatient care provided to the recipient only when necessary to relieve the family members or other persons caring for the recipient.

(w) “Room and board services” includes performance of personal care services, including assistance in the activities of daily living, in socializing activities, administration of medication, maintaining the cleanliness of a resident’s room, and supervision and assistance in the use of durable medical equipment and prescribed therapies.

(x) “Routine home care” means hospice care received at the place of residence and which is not continuous home care as defined in (d) above.

(y) “Terminally ill” means that the recipient has a medical prognosis with a life expectancy of 6 months or less if the illness runs its normal course.

(z) “Title XIX” means the joint federal-state program described in Title XIX of the Social Security Act (SSA) and administered in NH by the department under the medicaid program.

(aa) “Title XXI” means the joint federal-state program described in Title XXI of the Social Security Act (SSA) and administered in NH by the department under the medicaid program.

History

#9726-A, eff 7-1-10; amd by #10139, eff 7-1-12, EXPIRED 7-1-18 in paragraphs (a)-(k), (m), (n), (o), and (q)-(t), and EXPIRED 7-1-22 in paragraphs (l), (p), (u), and (v).
(See Revision Note at part heading for He-W 544) #13847, eff 1-6-24

N.H. Code Admin. R. Ann. He-W 544.02 Recipient Eligibility Requirements {#sec-he-w-544.02 omnilex-key=us-nh-regs-official--agency-he-w--He-W 544.02}

(a) To be eligible to receive hospice care, recipients age 21 and over shall:

(1) Be certified as terminally ill in accordance with He-W 544.06;

(2) Elect hospice care in accordance with He-W 544.04; and

(3) Upon election of hospice care pursuant to (2) above, agree to waive all rights to the following medicaid services:

a. Hospice care provided by a hospice other than the one designated by the recipient, unless provided under arrangements made by the designated hospice;

b. Medicaid services that are:

Related to the treatment of the terminal illness for which hospice care was elected;
Related to the treatment of a condition or complication related to the terminal illness for which hospice care was elected; or
Equivalent to, or duplicative of, hospice services; and

c. Medicaid home and community-based care waiver services that are equivalent to, or duplicative of, hospice services.

(b) To be eligible to receive hospice care, recipients under the age of 21:

(1) Shall be certified as terminally ill in accordance with He-W 544.06;

(2) Shall elect hospice care in accordance with He-W 544.04; and

(3) Shall not, in accordance with 42 U.S.C. 1395d(d)(2), be required to waive rights to medicaid services that are related to treatment of the recipient's condition for which a diagnosis of terminal illness has been made.

(c) A recipient shall not be required to waive rights to the following services, which shall be covered in addition to hospice services:

(1) Services provided by the recipient’s medicaid licensed practitioner if that licensed practitioner is not an employee of the designated hospice or is not receiving compensation from the hospice for those services; and

(2) Room and board services provided by a residential care facility or a nursing facility if the recipient meets the facility’s level of care.

History

#9726-A, eff 7-1-10; ss by #9867-A, eff 2-11-11, EXPIRED: 2-11-19
(See Revision Note at part heading for He-W 544) #13847, eff 1-6-24

N.H. Code Admin. R. Ann. He-W 544.03 Provider Participation {#sec-he-w-544.03 omnilex-key=us-nh-regs-official--agency-he-w--He-W 544.03}

Each participating hospice provider shall:

(a) Be medicare certified as a hospice provider;

(b) Be an NH enrolled medicaid provider;

(c) Hold a current NH state license as a home hospice care provider or hospice house in accordance with RSA 151:2 and He-P 823 or He-P 824 or be licensed as such by the state in which they practice; and

(d) Notify the department of a recipient’s discharge from the hospice provider within 5 business days of the discharge.

History

#9726-A, eff 7-1-10, EXPIRED 7-1-18
(See Revision Note at part heading for He-W 544) #13847, eff 1-6-24

N.H. Code Admin. R. Ann. He-W 544.04 Election of Hospice Care {#sec-he-w-544.04 omnilex-key=us-nh-regs-official--agency-he-w--He-W 544.04}

(a) If a recipient seeks to elect hospice care, the hospice provider shall obtain an election statement signed and dated by the recipient or the recipient’s agent or legal guardian.

(b) The election statement obtained by the hospice provider shall:

(1) Specify the hospice provider designated by the recipient to provide care;

(2) Specify the effective date of the election, which shall not be earlier than the date the recipient or the recipient’s agent or legal guardian signs the election statement; and

(3) Specify that by waiving rights in accordance with He-W 544.02(a)(3), the recipient or the recipient’s agent or legal guardian acknowledges that the recipient has been given a full understanding of the explanation of palliative rather than curative nature of hospice care, as it relates to the recipient’s terminal illness.

(c) If a recipient elects hospice care in accordance with (a) and (b) above, the designated hospice provider shall notify the department of the effective date of the election in (b)(2) above, within 5 business days of the election.

(d) All hospice care and services offered to medicaid recipients and their families shall follow an individualized written care plan that meets the recipient’s needs. The hospice interdisciplinary group establishes the care plan together with the attending licensed practitioner, the recipient, or the recipient’s representative, and the primary caregiver.

History

#9726-A, eff 7-1-10, EXPIRED 7-1-18
(See Revision Note at part heading for He-W 544) #13847, eff 1-6-24

N.H. Code Admin. R. Ann. He-W 544.05 Hospice Election Periods {#sec-he-w-544.05 omnilex-key=us-nh-regs-official--agency-he-w--He-W 544.05}

(a) The recipient shall be allowed hospice coverage divided into election periods as follows:

(1) An initial 90-day period;

(2) A subsequent 90-day period; and

(3) An unlimited number of subsequent 60-day periods.

(b) The recertification associated with a hospice patient’s third benefit period, and every subsequent recertification, as referenced in (a)(3) above, shall include documentation that a hospice licensed practitioner or a hospice nurse practitioner had a face-to-face (FTF) encounter with the patient, and that the FTF encounter shall document the clinical findings supporting a life expectancy of 6 months or less.

(c) Election of hospice care in accordance with He-W 544.04 shall be considered to continue through the election periods specified in (a) above without a break in care if the recipient:

(1) Remains in the care of the hospice provider; and

(2) Does not revoke the election under the provisions of He-W 544.09.

History

#9726-A, eff 7-1-10, EXPIRED 7-1-18
(See Revision Note at part heading for He-W 544) #13847, eff 1-6-24

N.H. Code Admin. R. Ann. He-W 544.06 Certification of Terminal Illness {#sec-he-w-544.06 omnilex-key=us-nh-regs-official--agency-he-w--He-W 544.06}

(a) The hospice provider shall obtain certification of terminal illness as follows:

(1) For the first 90-day election period, the hospice provider shall obtain, within 2 calendar days after hospice care is initiated, written certification of terminal illness signed and dated by:

a. The medical director of the hospice provider or the licensed practitioner member of the hospice interdisciplinary group; and

b. The recipient’s medicaid attending licensed practitioner.

(2) For subsequent election periods of coverage specified in He-W 544.05(a)(2) and (3) above, within 2 calendar days after the beginning of each election period, a written certification of terminal illness signed and dated by the medical director of the hospice provider or the licensed practitioner member of the hospice interdisciplinary group;

(3) A hospice licensed practitioner or hospice nurse practitioner shall have a FTF encounter with each hospice recipient whose total stay across all hospices is anticipated to reach the 3rd benefit period. The FTF encounter shall occur prior to, but no more than 30 calendar days prior to, the 3rd benefit period recertification, and every benefit period recertification thereafter, to gather clinical findings to determine continued eligibility for hospice care; and

(4) If the written certification in (a) above cannot be obtained within 2 days, a verbal certification shall be considered acceptable and be:

a. Documented in the recipient’s medical records;

b. Followed by a written certification pursuant to (a)(1) and (2) above prior to submission of claim for payment;

c. Completed no more than 15 calendar days prior to the effective date of election; and

d. Completed no more than 15 calendar days prior to the start of the subsequent benefit period.

(b) A medicaid payment shall be made only after the agency has provided certification in accordance with (a)(1) – (a)(4) above.

History

#9726-A, eff 7-1-10, EXPIRED 7-1-18
(See Revision Note at part heading for He-W 544) #13847, eff 1-6-24

N.H. Code Admin. R. Ann. He-W 544.07 Change in Designated Hospice Provider {#sec-he-w-544.07 omnilex-key=us-nh-regs-official--agency-he-w--He-W 544.07}

(a) The recipient or the recipient’s agent or legal guardian may change the designated hospice provider once in each of the election periods specified in He-W 544.05(a).

(b) The recipient or the recipient’s agent or legal guardian shall provide written notification of a change of the designated provider to the current hospice provider and to the newly designated hospice provider.

(c) The recipient’s current hospice provider shall notify the department within 5 business days of a recipient changing the recipient’s designated hospice provider.

(d) The recipient’s current hospice provider shall forward the following to the newly designated hospice provider:

(1) A copy of the election statement obtained by the current hospice provider in accordance with He-W 544.04; and

(2) A copy of the certification of terminal illness obtained by the current hospice provider in accordance with He-W 544.06.

(e) The newly designated hospice provider shall comply with all requirements of He-W 544.

History

#9726-A, eff 7-1-10, EXPIRED 7-1-18
(See Revision Note at part heading for He-W 544) #13847, eff 1-6-24

N.H. Code Admin. R. Ann. He-W 544.08 Discharge from Hospice Care {#sec-he-w-544.08 omnilex-key=us-nh-regs-official--agency-he-w--He-W 544.08}

All medicaid recipients discharged from hospice care shall have a discharge planning process in accordance with 42 CFR 418.26.

History

(See Revision Note at part heading for He-W 544) #13847, eff 1-6-24

N.H. Code Admin. R. Ann. He-W 544.09 Revocation of Hospice Care {#sec-he-w-544.09 omnilex-key=us-nh-regs-official--agency-he-w--He-W 544.09}

(a) The recipient or the recipient’s agent or legal guardian may revoke the recipient’s election of hospice care at any time in accordance with 42 CFR 418.28.

(b) To revoke the election of hospice care, the following shall occur:

(1) The recipient or the recipient’s agent or legal guardian shall provide a signed and dated written statement of revocation to the recipient’s election of hospice care;

(2) If a signed statement cannot be obtained, a verbal statement shall be obtained, and the date of which shall be documented in the recipient’s medical record; and

(3) If a verbal statement is obtained pursuant to (b) above, then the recipient or the recipient’s agent or legal guardian shall provide the written statement described in (a) above at a later date.

(c) A recipient or the recipient’s agent or legal guardian shall not designate a revocation effective date earlier than the date the revocation is made as allowed in (a) and (b) above.

(d) Within 5 business days of a recipient revoking the recipient’s election of hospice care, the designated hospice shall notify the department of the date that the revocation is to be effective.

(e) Effective with the revocation date specified, the recipient shall no longer be covered under the hospice benefit and shall resume eligibility for all medicaid benefits previously waived pursuant to He-W 544.02(a)(4).

(f) A recipient who revokes the recipient’s election of hospice care shall be eligible to elect hospice care for any remaining election periods in accordance with He-W 544.04.

History

#9726-A, eff 7-1-10, EXPIRED: 7-1-18
(See Revision Note at part heading for He-W 544) #13847, eff 1-6-24 (formerly He-W 544.08)

N.H. Code Admin. R. Ann. He-W 544.10 Covered Hospice Services {#sec-he-w-544.10 omnilex-key=us-nh-regs-official--agency-he-w--He-W 544.10}

(a) The designated hospice provider shall create a care plan for the recipient in accordance with 42 CFR 418.56(c) that specifies the services to be provided to the recipient, which are reasonable and necessary for the palliation or management of the symptoms of the terminal illness and conditions or complications related to the terminal illness.

(b) Services covered as part of the hospice benefit shall include:

(1) Nursing care provided by or under the supervision of a registered nurse;

(2) Medical social services provided by a social worker who has at least a bachelor’s degree from a school accredited or approved by the council on social work education, and licensed practitioner;

(3) The following services performed by hospice licensed practitioner:

a. General supervisory services of the medical director;

b. Participation in the establishment of plans of care, supervision of care and services, periodic review and updating of plans of care, and establishment of governing policies by the licensed practitioner member of the interdisciplinary group; and

c. Licensed practitioner services described in He-W 544.16(b)(2);

(4) Counseling services, including bereavement, spiritual, and dietary counseling, provided to the recipient, family members, and others caring for the recipient for the purpose of training the recipient’s family or caregivers to provide care;

(5) General inpatient care as follows:

a. Such care shall be provided in a medicaid enrolled hospice house, licensed in accordance with RSA 151 and He-P 824, hospital, or nursing facility that meets the requirements in 42 CFR 418.100 (a) and (e) regarding staffing and patient areas; and

b. Care shall be for pain control or symptom management which cannot be provided in another setting;

(6) Inpatient respite care provided to the recipient as follows:

a. Only for recipients who are not residing in a nursing facility;

b. Only when necessary to relieve the family members or other caregivers of caring for the recipient;

c. Not for more than one period of 5 consecutive days at a time per election period, except that the sixth and any subsequent consecutive days shall be covered and paid at the routine home care rate; and

d. Only in those intermediate care facilities that meet the requirements of 42 CFR 418.100 (a) and (e) regarding 24-hour nursing and patient areas;

(7) Durable medical equipment and supplies for self-help and personal comfort related to the palliation or management of the recipient’s terminal illness or conditions related to the terminal illness while the recipient is under hospice care;

(8) Drugs for the palliation and management of the recipient’s terminal illness or conditions related to the terminal illness;

(9) Home health aide and homemaker services;

(10) Physical therapy, occupational therapy, and speech language pathology services for the purpose of symptom control or to enable the recipient to maintain activities of daily living and basic functional skills;

(11) Transportation;

(12) Any other service that is specified in the recipient’s care plan as reasonable and necessary for the palliation and management of the recipient’s terminal illness and related conditions; and

(13) Continuous home care, which shall be:

a. Provided in the community setting of the recipient’s place of residence;

b. Provided only during a period of crisis, which is a period in which a recipient requires continuous care which is primarily nursing care to achieve palliation or management of acute medical symptoms;

c. Provided by a registered nurse or licensed practical nurse, who shall provide care for more than half the period of care; and

d. Only for brief periods of crisis and only as needed to maintain the recipient’s care in the home.

(c) The recipient’s care plan shall include bereavement counseling for the recipient’s family after the recipient’s death.

(d) Bereavement counseling in (c) above shall not be billable to medicaid nor to the recipient’s family.

History

#9726-A, eff 7-1-10, EXPIRED: 7-1-18
(See Revision Note at part heading for He-W 544) #13847, eff 1-6-24 (formerly He-W 544.09)

N.H. Code Admin. R. Ann. He-W 544.11 Documentation of Hospice Services {#sec-he-w-544.11 omnilex-key=us-nh-regs-official--agency-he-w--He-W 544.11}

(a) Documentation of hospice services shall be completed promptly and accurately in accordance with 42 CFR 418.56 (c) and (d).

(b) Hospice providers shall maintain documentation in their records to fully support each claim billed for services.

(d) Within 30 days following the end of each quarter, for each recipient who died within that quarter, hospice providers shall notify the department of hospice service utilization incorporated by reference in He-W 544.12, except for those who are dual-eligible hospice recipients who reside in a nursing facility.

History

#9726-A, eff 7-1-10, EXPIRED: 7-1-18
(See Revision Note at part heading for He-W 544) #13847, eff 1-6-24 (formerly He-W 544.10)

N.H. Code Admin. R. Ann. He-W 544.12 Utilization Review and Control {#sec-he-w-544.12 omnilex-key=us-nh-regs-official--agency-he-w--He-W 544.12}

The department’s surveillance and utilization review of subsystems unit shall monitor utilization of hospice services in accordance with 42 CFR 455, 42 CFR 456, He-W 520, and documentation of hospice services as required by He-W 544.

History

#9726-A, eff 7-1-10, EXPIRED: 7-1-18
(See Revision Note at part heading for He-W 544) #13847, eff 1-6-24 (formerly He-W 544.11)

N.H. Code Admin. R. Ann. He-W 544.13 Third Party Liability {#sec-he-w-544.13 omnilex-key=us-nh-regs-official--agency-he-w--He-W 544.13}

(a) All third party obligations shall be exhausted before medicaid shall be billed, in accordance with 42 CFR 433.139.

(b) Recipients who elect or revoke the medicaid hospice benefit shall also elect or revoke the hospice benefit under medicare and other insurance, as applicable.

History

#9726-A, eff 7-1-10, EXPIRED: 7-1-18
(See Revision Note at part heading for He-W 544) #13847, eff 1-6-24 (formerly He-W 544.12)

N.H. Code Admin. R. Ann. He-W 544.14 Payment for Hospice Services {#sec-he-w-544.14 omnilex-key=us-nh-regs-official--agency-he-w--He-W 544.14}

(a) Hospice providers shall submit claims for payment to the department.

(b) Payment for hospice care, with the exception of licensed practitioner services which are paid in accordance with He-W 544.17, shall be at a per diem rate for each day that the recipient is under the care of the hospice provider.

(1) Be determined in accordance with 42 U.S.C. 1395f(i)(1)(C)(ii) and 42 USC 1396a(13)(B); and

(2) Be based upon the level of care as follows:

a. Routine home care;

b. Continuous home care;

c. Inpatient respite care; and

d. General inpatient care.

(d) Payment for inpatient respite care shall be limited to one period of no more than 5 consecutive days in each election period.

(e) Inpatient respite care provided in excess of the 5-day limit per election period shall be paid at the routine home care rate.

(f) If there is a change in designated provider, admission status, or level of care, payment shall be made as follows:

(1) If admission occurs on the same day as discharge, revocation or death, the day shall be considered a hospice care day and the hospice shall be paid in accordance with (c) above;

(2) If the level of care changes, payment shall be made for the new level of care beginning with the day it commences;

(3) If a change of hospice provider occurs, payment shall not be made to the discharging hospice for the day of discharge, but payment shall be made to the newly designated hospice; and

(4) If the recipient is discharged from an inpatient unit, the routine home care rate shall be paid, unless the recipient dies as an inpatient, in which case the general inpatient or respite care rate shall be paid for the discharge date.

(g) If certification is not obtained in accordance with the provisions of He-W 544.06(a) and (b) payment shall not be made for days prior to certification.

(h) Bereavement counseling pursuant to He-W 544.10(c) shall not be billable to medicaid nor to the recipient’s family pursuant to He-W 544.10(d).

History

#9726-A, eff 7-1-10, EXPIRED: 7-1-18
(See Revision Note at part heading for He-W 544) #13847, eff 1-6-24 (formerly He-W 544.13)

N.H. Code Admin. R. Ann. He-W 544.15 Hospice Payment Limitations and Adjustments {#sec-he-w-544.15 omnilex-key=us-nh-regs-official--agency-he-w--He-W 544.15}

(a) Hospice payments for inpatient care shall be limited and paid in accordance with 42 CFR 418.302 (a), (b), (c), and (g).

(b) Hospice payments for inpatient care shall be considered to be interim payments with adjustments made for any payments over the limit.

(c) Hospice providers shall refund any excess reimbursement as determined and requested by the department in accordance with (a) and (b) above.

History

#9726-A, eff 7-1-10, EXPIRED: 7-1-18
(See Revision Note at part heading for He-W 544) #13847, eff 1-6-24 (formerly He-W 544.14)

N.H. Code Admin. R. Ann. He-W 544.16 Hospice Payment for Recipients in Nursing Facilities {#sec-he-w-544.16 omnilex-key=us-nh-regs-official--agency-he-w--He-W 544.16}

(a) No medicaid payments shall be made directly to a residential care or nursing facility.

(b) When hospice services are provided to a recipient residing in a nursing facility, the hospice provider shall:

(1) Bill for, in addition to routine or continuous home care, room, and board; and

(2) Be reimbursed by medicaid at a room and board rate which is, in accordance with 42 U.S.C. 1396d, at least 95% of the per diem rate that would have been paid to the nursing facility for the recipient for the same dates of service under rates established in accordance with He-P 803.

History

#9726-A, eff 7-1-10, EXPIRED: 7-1-18
(See Revision Note at part heading for He-W 544) #13847, eff 1-6-24 (formerly He-W 544.15)

N.H. Code Admin. R. Ann. He-W 544.17 Payment for Licensed Practitioners’ Services {#sec-he-w-544.17 omnilex-key=us-nh-regs-official--agency-he-w--He-W 544.17}

(a) If a recipient’s attending licensed practitioner, who is not an employee of the designated hospice or providing services under arrangement with the designated hospice, provides licensed practitioner services related or unrelated to the treatment of the terminal illness:

(1) These licensed practitioner services shall not be considered as part of the per diem rate described in He-W 544.14; and

(2) The licensed practitioner shall bill for these licensed practitioner services separately and be reimbursed at the regular licensed practitioner services rate in accordance with He-W 531.

(b) If a recipient does not have an attending licensed practitioner at the time of electing the hospice benefit, the medical director of the designated hospice provider or the licensed practitioner member of the hospice interdisciplinary group shall:

(1) Be the recipient’s attending licensed practitioner; and

(2) Bill and receive payment as follows:

a. Licensed practitioner services that are related to the treatment of the terminal illness shall be considered hospice services and be included in the per diem rate described in He-W 544.14; and

b. Licensed practitioner services that are unrelated to treatment of the terminal illness shall be considered licensed practitioner services and shall be billed separately by the licensed practitioner and be reimbursed at the regular licensed practitioner services rate in accordance with He-W 531. These services shall not be billed by the hospice provider.

(c) If a recipient’s attending licensed practitioner, who is not an employee of the designated hospice or providing services under arrangement with the designated hospice, requests through an order that the medical director or hospice licensed practitioner provide licensed practitioner services not described in He-W 544.10 these licensed practitioner services shall be billed as in (a)(1) and (a)(2) above.

History

#9726-A, eff 7-1-10, EXPIRED: 7-1-18
(See Revision Note at part heading for He-W 544) #13847, eff 1-6-24 (formerly He-W 544.16)

Part He-W 546 Early and Periodic Screening, Diagnosis, and Treatment Services

N.H. Code Admin. R. Ann. He-W 546.01 Definitions {#sec-he-w-546.01 omnilex-key=us-nh-regs-official--agency-he-w--He-W 546.01}

(a) “Department” means the New Hampshire (NH) department of health and human services.

(b) “Early and periodic screening, diagnosis and treatment (EPSDT) services” means a program, as defined in 42 CFR 440.40(b), designed to provide preventative health care, diagnostic services, and early detection and treatment of disease or abnormalities to medicaid eligible individuals under age 21.

(c) “Medicaid” means the Title XIX and Title XXI programs administered by the department which makes medical assistance available to eligible individuals.

(d) “Medical” means related to the following:

(1) Treatment of disease;

(2) Maintenance of health; or

(3) Prevention, alleviation, or curing of disease.

(e) “Medically necessary” means reasonably calculated to prevent, diagnose, correct, cure, alleviate, or prevent the worsening of conditions that endanger life, cause pain, result in illness or infirmity, threaten to cause or aggravate a handicap, or cause physical deformity or malfunction, and no other equally effective course of treatment is available or suitable for the EPSDT recipient .

(f) “Periodicity schedule” means a regularly recurring schedule of preventive health care, dental care, or screening services as determined by standards of practice.

(g) “Primary care physician” means the physician who routinely provides health care to the recipient.

(h) “Recipient” means an individual who is eligible for and is receiving medical assistance under the medicaid program.

(i) “Title XIX program” means the joint federal-state program described in Title XIX of the Social Security Act and administered in NH by the department under the medicaid program.

(j) “Title XXI” means the joint federal-state program described in Title XXI of the Social Security Act and administered in NH by the department under the medicaid program.

(k) “Treating physician” means the physician who is managing a present illness or condition, in conjunction with or aside from the recipient’s primary care physician.

History

(See Revision Note at chapter heading He-W 500); ss by #5532, eff 12-17-92, EXPIRED: 12-17-98
#6940, eff 1-30-99; ss by #8782, eff 1-1-07; amd by #10139, eff 7-1-12; ss by #10829, eff 5-19-15; ss by #14383, eff 9-20-25, EXPIRES: 9-20-35

N.H. Code Admin. R. Ann. He-W 546.02 Recipient Eligibility {#sec-he-w-546.02 omnilex-key=us-nh-regs-official--agency-he-w--He-W 546.02}

All recipients under the age of 21 shall be eligible for EPSDT services.

History

(See Revision Note at chapter heading He-W 500); ss by #5532, eff 12-17-92, EXPIRED: 12-17-98
#6940, eff 1-30-99; ss by #8782, eff 1-1-07; ss by #10829, eff 5-19-15; ss by #14383, eff 9-20-25, EXPIRES: 9-20-35

N.H. Code Admin. R. Ann. He-W 546.03 Provider Participation {#sec-he-w-546.03 omnilex-key=us-nh-regs-official--agency-he-w--He-W 546.03}

All participating EPSDT providers shall:

(a) Meet the state licensing or board certification requirements, of the state in which they practice, to provide medical or dental care;

(b) Be a NH enrolled medicaid provider;

(d) Request and obtain prior authorization from the department before providing services which require prior authorization, in accordance with He-W 530 and He-W 546.06.

History

(See Revision Note at chapter heading He-W 500); ss by #5532, eff 12-17-92, EXPIRED: 12-17-98
#6940, eff 1-30-99; ss and moved by #8782, eff 1-1-07 (from He-W 546.04); ss by #10829, eff 5-19-15; ss by #14383, eff 9-20-25, EXPIRES: 9-20-35

N.H. Code Admin. R. Ann. He-W 546.04 Informing Requirements {#sec-he-w-546.04 omnilex-key=us-nh-regs-official--agency-he-w--He-W 546.04}

The department shall carry out the informing requirements specified in 42 CFR 441.56 as follows:

(a) The department or its designee shall inform all pregnant women and children who are eligible for a medicaid program, or the parent(s) or legal representative(s) of eligible children, about EPSDT services within 60 days of the individual’s initial eligibility determination for a medicaid program, and, in the case of families which have not utilized EPSDT services, annually thereafter, pursuant to 42 CFR 441.56(a)(4);

(b) The department or its designee shall complete the requirements set out in this section through written communications, oral communications, or any combination of both; and

(c) The department or its designee shall provide to recipients, or their parent(s) or legal representative(s), information about:

(1) The services available under the EPSDT program;

(2) The location of, and the requirements to obtain and use, the health care or dental services available under the EPSDT program;

(3) The benefits of preventative health and dental care;

(4) The availability of medicaid payment for medical and dental services provided under the EPSDT program;

(5) The existence of other medical or social agencies available to assist a recipient, or to which a recipient might be referred, such as the department’s bureau of maternal and child health services or bureau of special medical services;

(6) The availability of assistance in locating and accessing medical and dental services, upon request; and

(7) The availability of assistance with scheduling of medical or dental appointments and obtaining transportation, upon request.

History

(See Revision Note at chapter heading He-W 500); ss by #5532, eff 12-17-92, EXPIRED: 12-17-98
#6940, eff 1-30-99; ss and moved by #8782, eff 1-1-07 (from He-W 546.03); ss by #10829, eff 5-19-15; ss by #14383, eff 9-20-25, EXPIRES: 9-20-35

N.H. Code Admin. R. Ann. He-W 546.05 Covered Services {#sec-he-w-546.05 omnilex-key=us-nh-regs-official--agency-he-w--He-W 546.05}

(a) The department shall cover the following EPSDT screening services:

(1) Comprehensive and age-appropriate medical assessments and screenings of a child’s physical and mental status in accordance with the American Academy of Pediatrics’ 2023 periodicity schedule entitled “Recommendations for Preventive Pediatric Health Care”, available as noted in Appendix A, including:

a. Comprehensive health and developmental history;

b. Comprehensive unclothed physical examination;

c. Developmental and behavioral assessment with a standardized validated tool of the provider’s choice;

d. Measurements of the child’s height, weight, head circumference, and blood pressure;

e. Appropriate immunizations;

f. Appropriate laboratory tests to include:

Testing for lead toxicity for EPSDT eligible children at 12 and 24 months of age; and
Testing for lead toxicity for EPSDT eligible children between 36 and 72 months of age, if not previously screened for lead toxicity;

g. Appropriate vision testing;

h. Appropriate hearing testing;

i. Assessment of nutritional status;

j. Health education about the benefits of healthy lifestyles and practices; and

k. Anticipatory guidance about child safety and injury prevention; and

(2) Dental screening services furnished by direct referral to a dentist for diagnosis and treatment, and in accordance with the periodicity schedule contained in the American Academy of Pediatric Dentistry’s “Periodicity of Examination, Preventive Dental Services, Anticipatory Guidance/Counseling, and Oral Treatment for Infants, Children, and Adolescents” (2022 revision), available as noted in Appendix A.

(b) The department shall cover EPSDT diagnostic and treatment services, if medically necessary as a result of assessment and screening.

(c) Any services not listed in He-W 522 through He-W 589 as covered services, including experimental or investigational services which are medically necessary and given prior authorization, shall be given independent review by the department for coverage based on medical necessity in accordance with He-W 546.06.

(d) Transportation services, pursuant to He-W 574, 42 CFR 431.53, and 42 CFR 441.62, shall be covered:

(1) For EPSDT-eligible children;

(2) For any person who needs to accompany an eligible child to the child’s medical service; and

(3) If a child is receiving residential or facility-based care, for a parent, family member, or caregiver if their presence is necessary to actively participate in the treatment or intervention for the direct benefit of the child, without the child present.

(e) Services in excess of the service limits in He-W 530 shall be covered for EPSDT-eligible children, if medically necessary, in accordance with the requirements in He-W 546.06.

History

(See Revision Note at chapter heading He-W 500); ss by #5532, eff 12-17-92, EXPIRED: 12-17-98
#6940, eff 1-30-99; ss by #8437, eff 9-24-05; ss by #8782, eff 1-1-07; ss by #10829, eff 5-19-15; ss by #14383, eff 9-20-25, EXPIRES: 9-20-35

N.H. Code Admin. R. Ann. He-W 546.06 Prior Authorization for Coverage Based on Medical Necessity {#sec-he-w-546.06 omnilex-key=us-nh-regs-official--agency-he-w--He-W 546.06}

(a) Prior authorization shall be required for services described in He-W 546.05(c) and (e).

(b) Requests for prior authorization shall include the following:

(1) The recipient’s name, address, and medicaid identification number;

(2) The recipient’s diagnosis and prognosis, including an indication of whether the diagnosis is a pre-existing condition or a presenting condition;

(3) An estimation of the effect on the recipient if the requested service is not provided;

(4) The medical justification for the services or equipment being requested;

(5) The recommended timetable of the prescribed treatment;

(6) A discussion of why the service is medically necessary as defined in He-W 546.01;

(7) The expected outcome of providing the requested service;

(8) The recommended timeframe to achieve the expected outcome;

(9) A summary of any previous treatment plans, including outcomes, which were used to treat the diagnosed condition for which the requested service is being recommended;

(10) Listings of individuals or agencies to whom the recipient is being referred; and

(11) Assurance that the requested service is the least restrictive, most cost-effective service available to meet the recipient’s needs.

(c) Requests for prior authorization shall include a statement signed by a provider acting within their scope of practice indicating that they concur with the request.

(d) Prior authorizations for coverage of services requested in accordance with He-W 546.06 shall be approved by the department if the department determines that the information provided in (b) above demonstrates medical necessity.

(e) Confirmation of department approvals shall be sent to the treating provider in writing.

(f) Providers shall be responsible for determining that the recipient is medicaid eligible on the date of service.

(g) If the requested service is denied, or denied in part, by the department, the department shall forward a notice of denial to the recipient and the treating provider with the following information:

(1) The reason for, and the legal basis of, the denial; and

(2) Instructions that a fair hearing on the denial may be requested by the recipient within 30 calendar days of the date on the notice of the denial, in accordance with He-C 200.

(h) Decisions made by the department in accordance with (d) and (g) above shall not be superseded by the treating or consultative provider’s prescription, orders, or recommendations.

History

(See Revision Note at chapter heading He-W 500); ss by #5532, eff 12-17-92, EXPIRED: 12-17-98
#6940, eff 1-30-99; ss by #8782, eff 1-1-07; ss by #10829, eff 5-19-15; ss by #14383, eff 9-20-25, EXPIRES: 9-20-35

N.H. Code Admin. R. Ann. He-W 546.07 Support Services {#sec-he-w-546.07 omnilex-key=us-nh-regs-official--agency-he-w--He-W 546.07}

The department shall provide support services to enhance recipients’ participation in the EPSDT program, including, but not limited to:

(a) Inter- or intra-departmental coordination of programs;

(b) Providing information to recipients about other available community services;

(c) Making recipient referrals to human service agencies or social services, as requested by the recipient or as appropriate; and

(d) Assisting the recipient with accessing health care or dental services.

History

(See Revision Note at chapter heading He-W 500); ss by #5532, eff 12-17-92, EXPIRED: 12-17-98
#6940, eff 1-30-99; ss by #8782, eff 1-1-07; ss by #10829, eff 5-19-15; ss by #14383, eff 9-20-25, EXPIRES: 9-20-35

N.H. Code Admin. R. Ann. He-W 546.08 Non-Covered Services {#sec-he-w-546.08 omnilex-key=us-nh-regs-official--agency-he-w--He-W 546.08}

(a) The following services shall not be covered:

(1) Any service for which there is no medical necessity or for which the medical necessity has not been established;

(2) Services which are not medical or dental in nature, except that transportation shall be covered in accordance with He-W 546.05(d);

(3) Services that have not been proven to be safe or effective, as documented in medical peer review literature; and

(4) Services which are more costly than other services which could be expected to provide the recipient with the same outcome.

(b) Services listed in He-W 522 through He-W 589 as non-covered services shall not be covered unless the service is determined to be medically necessary for the recipient pursuant to He-W 546.06.

History

(See Revision Note at chapter heading He-W 500); ss by #5532, eff 12-17-92, EXPIRED: 12-17-98
#6940, eff 1-30-99; ss by #8782, eff 1-1-07; ss by #10829, eff 5-19-15; ss by #14383, eff 9-20-25, EXPIRES: 9-20-35

N.H. Code Admin. R. Ann. He-W 546.09 Utilization Review and Control {#sec-he-w-546.09 omnilex-key=us-nh-regs-official--agency-he-w--He-W 546.09}

(a) The department’s bureau of program integrity shall monitor utilization of EPSDT services to identify, prevent, and correct potential occurrences of fraud, waste, and abuse, in accordance with 42 CFR 455, 42 CFR 456, and He-W 520.

History

(See Revision Note at chapter heading He-W 500); ss by #5532, eff 12-17-92, EXPIRED: 12-17-98
#6940, eff 1-30-99; ss by #8782, eff 1-1-07; ss by #10829, eff 5-19-15; ss by #14383, eff 9-20-25, EXPIRES: 9-20-35

N.H. Code Admin. R. Ann. He-W 546.10 Third Party Liability {#sec-he-w-546.10 omnilex-key=us-nh-regs-official--agency-he-w--He-W 546.10}

(a) All third party obligations shall be exhausted before medicaid is billed, in accordance with 42 CFR 433.139, except as noted in (b) below.

(b) The following services shall be exempt from third party billing requirements:

(1) Services provided to children who are covered by third party liability enforced by the department’s bureau of child support services; and

(2) All preventive pediatric care services, in accordance with 42 CFR 433.139(b)(3)(i).

(c) Providers may bill medicaid directly for the services described in (b) above and medicaid shall then seek reimbursement from the third party.

History

(See Revision Note at chapter heading He-W 500); ss by #5532, eff 12-17-92, EXPIRED: 12-17-98
#6940, eff 1-30-99; ss by #8782, eff 1-1-07; ss by #10829, eff 5-19-15; ss by #14383, eff 9-20-25, EXPIRES: 9-20-35

N.H. Code Admin. R. Ann. He-W 546.11 Payment for Services {#sec-he-w-546.11 omnilex-key=us-nh-regs-official--agency-he-w--He-W 546.11}

(a) Payment for services provided to recipients participating in the EPSDT program shall be made in accordance with rates established by the department in accordance with RSA 161:4, VI(a).

(b) The provider shall submit claims for payment to the department’s fiscal agent.

(d) Payment for transportation services pursuant to He-W 546.05(d) shall be made in accordance with He-W 574.

History

(See Revision Note at chapter heading He-W 500); ss by #5532, eff 12-17-92, EXPIRED: 12-17-98
#6940, eff 1-30-99; ss by #8782, eff 1-1-07; ss by #10829, eff 5-19-15; ss by #14383, eff 9-20-25, EXPIRES: 9-20-35

Part He-W 547 Home Visit for Postpartum and Newborn Assessment

N.H. Code Admin. R. Ann. He-W 547.01 Definitions {#sec-he-w-547.01 omnilex-key=us-nh-regs-official--agency-he-w--He-W 547.01}

(a) “Department” means the New Hampshire (NH) department of health and human services.

(b) “Health promotion and anticipatory guidance” means services provided by a registered nurse (RN) to a newborn’s parent or guardian within 60 days of the newborn’s birth in accordance with He-W 547.04(c).

(c) “Home visit for postpartum and newborn assessment (home visit) services” means the services rendered to newborns and their birth mothers, at their residence, within 60 days of the newborn’s birth, in accordance with He-W 547.04.

(d) “Maternal postpartum assessment” means services provided by an RN to a woman within 60 days postpartum, in accordance with He-W 547.04(b).

(e) “Medicaid” means the Title XIX and Title XXI programs administered by the department, which makes medical assistance available to eligible individuals.

(f) “Newborn health assessment” means the services provided by an RN to a newborn within 60 days of birth, which includes a determination of whether or not the newborn’s health is within normal limits, in accordance with He-W 547.04(a).

(g) “Recipient” means an individual who is eligible for and receiving medical assistance under the medicaid program.

(h) “Title XIX” means the joint federal-state program described in Title XIX of the Social Security Act and administered in NH by the department under the medicaid program.

(i) “Title XXI” means the joint federal-state program described in Title XXI of the Social Security Act and administered in NH by the department under the medicaid program.

History

(See Revision Note at chapter heading He-W 500); ss by #6018, eff 4-1-95, EXPIRED: 4-1-03
#8446, eff 10-7-05; amd by #10139, eff 7-1-12; ss by #10428, eff 10-7-13; ss by #14334, eff 8-1-25, EXPIRES: 8-1-35

N.H. Code Admin. R. Ann. He-W 547.02 Recipient Eligibility {#sec-he-w-547.02 omnilex-key=us-nh-regs-official--agency-he-w--He-W 547.02}

Recipients who are within 60 days postpartum shall be eligible for home visit services.

History

(See Revision Note at chapter heading He-W 500); ss by #6018, eff 4-1-95, EXPIRED: 4-1-03
#8446, eff 10-7-05; ss by #10428, eff 10-7-13; ss by #14334, eff 8-1-25, EXPIRES: 8-1-35

N.H. Code Admin. R. Ann. He-W 547.03 Provider Participation {#sec-he-w-547.03 omnilex-key=us-nh-regs-official--agency-he-w--He-W 547.03}

All providers of home visit services shall:

(a) Be licensed as a home health care provider by the department’s health facilities administration in accordance with RSA 151:2, I(b) and He-P 809;

(b) Be a NH enrolled medicaid provider;

(d) Require the RNs in (c) above to have one year of maternal and child health care experience which may have included community health experience.

History

(See Revision Note at chapter heading He-W 500); ss by #6018, eff 4-1-95, EXPIRED: 4-1-03
#8446, eff 10-7-05; ss by #10428, eff 10-7-13; ss by #14334, eff 8-1-25, EXPIRES: 8-1-35

N.H. Code Admin. R. Ann. He-W 547.04 Covered Services {#sec-he-w-547.04 omnilex-key=us-nh-regs-official--agency-he-w--He-W 547.04}

The following services shall be covered when provided during a home visit:

(a) Newborn health assessment of the:

(1) Skin, including color, condition, and birthmarks;

(2) Head, including fontanelles;

(3) Neck, including mobility;

(4) Eyes, including appearance, movement, and evidence of sight;

(5) Ears, including evidence of hearing;

(6) Nose, including patency and septum;

(7) Mouth, including lips, mucosa, palate, and gums;

(8) Chest and lungs, including appearance, respiration, auscultation, and breasts;

(9) Heart, including rate and rhythm;

(10) Abdomen, including appearance, palpation, umbilicus, and femoral pulses;

(11) Skeleton, including upper and lower structure, and range of upper and lower motion;

(12) Genitourinary system, including genitalia, urine stream, and circumcision;

(13) Back, including spine and anus;

(14) Neurological and behavioral systems, including general appearance, cry, motor system, reflexes, and signs and symptoms of neonatal abstinence syndrome; and

(15) Weight;

(b) Maternal postpartum assessment services including:

(1) A determination of whether the following health characteristics and functions are within normal limits:

a. Diet;

b. Rest, activity, and exercise;

c. Breast feeding;

d. Abdominal cramping and tenderness;

e. Urinating and bowels;

f. Emotional response, including postpartum depression screening;

g. Bonding;

h. General appearance;

i. Blood pressure;

j. Temperature;

k. Heart and lungs;

l. Breasts and nipples;

m. Abdomen and fundus;

n. Perineum and episiotomy;

o. Lochia;

p. Wound care and healing; and

q. Substance use, including:

Alcohol;
Tobacco; and
Illicit and illegal drug use;

(2) Postpartum education including, but not limited to:

a. Family planning;

b. Breast care;

c. Hygiene;

d. Sexuality;

e. Perineal care for stitches and hemorrhoids;

f. Psychological adjustment and postpartum depression;

g. Exercising;

h. Sleep safety measures as recommended by the American Academy of Pediatrics; and

i. Reactions to medications and vaccinations;

(3) The provision of referrals to other community agencies as appropriate, including, but not limited to:

a. The special supplemental nutrition program for women, infants, and children (WIC);

b. Mental health services;

c. Domestic violence resources;

d Breastfeeding support;

e. The department’s home visiting programs for continued support;

f. Local family resource centers; and

g. Safe transportation programs to include car seat fitting; and

(4) The discussion of other health, social, or environmental concerns; and

(1) Nutrition, including:

a. Breastfeeding;

b. Preparation and storage of formula;

c. Feeding problems; and

d. Supplements;

(2) Behavioral issues, including:

a. Crying patterns;

b. Colic;

c. Consolability;

d. Sleep patterns;

e. Elimination; and

f. Individuality;

(3) Family relationships and interactions, including:

a. Parent or guardian to child;

b. Sibling rivalry;

c. Parent or guardian to parent or guardian; and

d. Relatives;

(4) Safety and injury prevention, including:

a. Home environment;

b. Use and placement of an appropriate infant car seat;

c. Poison control;

d. Safe water temperature;

e. Drowning;

f. Falling;

g. Crib safety, including safe sleeping environment;

h. Pets;

i. Sleep positioning and current safe sleep practices;

j. Choking;

k. Younger siblings;

l. Abusive head trauma, including shaken baby syndrome; and

m. Sudden infant death syndrome (SIDS) risk prevention and sudden unexplained infant death (SUID) safe sleep initiatives;

(5) Resources, including:

a. The special supplemental nutrition program for women, infants, and children (WIC);

b. Family planning programs;

c. Respite care;

d. Support from family and friends;

e. Mental health services;

f. Domestic violence programs;

g. Breastfeeding support services;

h. Home visiting programs for continued support;

i. Family resource centers, and

j. Programs that assist with car seat selection and fitting;

(6) Health promotion and related concerns, including:

a. Immunizations;

b. Rashes and jaundice;

c. When to call the child’s primary health care provider for advice and concerns;

d. The importance of keeping appointments with the primary health care provider for the child’s health check-ups, in accordance with the recommendations set forth in the American Academy of Pediatrics’, “Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents,” (4th edition, February 2017), available as noted in Appendix A;

e. The medicaid program and the importance of maintaining continued medicaid coverage through the child’s first birthday;

f. Bathing and skin care;

g. Urinary tract infections;

h. Temperature taking;

i. The care of the umbilical cord and circumcision; and

j. Oral health care and the importance of bringing the child for their first dental visit with a dental provider no later than the child’s first birthday, in accordance with the periodicity schedule contained in the American Academy of Pediatric Dentistry’s, “Periodicity of Examination, Preventive Dental Services, Anticipatory Guidance/Counseling, and Oral Treatment for Infants, Children, and Adolescents”, (2022 revision), available as noted in Appendix A;

(7) Identifying if the newborn is at risk for, or has, a nutritional problem or unstable housing;

(8) Ensuring follow-up appointments are scheduled with their primary health care providers; and

(9) Information regarding early and periodic screening, diagnosis, and treatment services, as described in He-W 546.

History

(See Revision Note at chapter heading He-W 500); ss by #6018, eff 4-1-95, EXPIRED: 4-1-03
#8446, eff 10-7-05; ss by #10428, eff 10-7-13; ss by #14334, eff 8-1-25, EXPIRES: 8-1-35

N.H. Code Admin. R. Ann. He-W 547.05 Non-Covered Services {#sec-he-w-547.05 omnilex-key=us-nh-regs-official--agency-he-w--He-W 547.05}

(a) Medical services covered under the NH medicaid program pursuant to He-W 530 through He-W 590 and He-M 400 through He-M 700 shall not be covered as part of a home visit.

(b) If during the home visit a medical necessity for other services is assessed, those services shall be billed separately from the home visit service.

History

(See Revision Note at chapter heading He-W 500); ss by #6018, eff 4-1-95, EXPIRED: 4-1-03
#8446, eff 10-7-05; ss by #10428, eff 10-7-13; ss by #14334, eff 8-1-25, EXPIRES: 8-1-35

N.H. Code Admin. R. Ann. He-W 547.06 Required Documentation {#sec-he-w-547.06 omnilex-key=us-nh-regs-official--agency-he-w--He-W 547.06}

(a) Providers shall document home visit referrals in the recipient’s medical record.

(b) Providers conducting home visits shall document the results of newborn health assessments, health promotion, and anticipatory guidance, describing the assessment results and the provision of the services provided, and report them to the child’s primary health care provider within 5 business days of the home visit.

(c) Providers conducting home visits shall document the results of the maternal postpartum assessments, describing the assessment results, and report the results to the mother’s primary health care provider or obstetrics and gynecology provider within 5 business days of the home visit.

History

(See Revision Note at chapter heading He-W 500); ss by #6018, eff 4-1-95, EXPIRED: 4-1-03
#8446, eff 10-7-05; ss by #10428, eff 10-7-13; ss by #14334, eff 8-1-25, EXPIRES: 8-1-35

N.H. Code Admin. R. Ann. He-W 547.07 Utilization Review and Control {#sec-he-w-547.07 omnilex-key=us-nh-regs-official--agency-he-w--He-W 547.07}

The department’s bureau of program integrity shall monitor utilization of home visit services to identify, prevent, and correct potential occurrences of fraud, waste, and abuse in accordance with 42 CFR 455, 42 CFR 456, and He-W 520.

History

(See Revision Note at chapter heading He-W 500); ss by #6018, eff 4-1-95, EXPIRED: 4-1-03
#8446, eff 10-7-05; ss by #10428, eff 10-7-13; ss by #14334, eff 8-1-25, EXPIRES: 8-1-35

N.H. Code Admin. R. Ann. He-W 547.08 Third Party Liability {#sec-he-w-547.08 omnilex-key=us-nh-regs-official--agency-he-w--He-W 547.08}

(a) All third party obligations shall be exhausted before medicaid may be billed, in accordance with 42 CFR 433.139.

(b) Home visit service providers shall request information from the recipient regarding other insurance coverage.

(d) Home visit service providers shall maintain a record of any other insurance verifications in the recipient’s medical record in accordance with He-W 520.

History

(See Revision Note at chapter heading He-W 500); ss by #6018, eff 4-1-95, EXPIRED: 4-1-03
#8446, eff 10-7-05; ss by #10428, eff 10-7-13; ss by #14334, eff 8-1-25, EXPIRES: 8-1-35

N.H. Code Admin. R. Ann. He-W 547.09 Payment for Services {#sec-he-w-547.09 omnilex-key=us-nh-regs-official--agency-he-w--He-W 547.09}

(a) Payment rates of home visit services shall be established by the department in accordance with RSA 161:4, VI(a).

(b) Home visit service providers shall submit claims for payment to the department’s fiscal agent.

(d) The department shall recoup state and federal medicaid payments as permitted by 42 CFR 455, 42 CFR 447, and 42 CFR 456 for a provider’s failure to maintain supporting records of services and screening of all employees in accordance with He-W 547.

History

(See Revision Note at chapter heading He-W 500); ss by #6018, eff 4-1-95, EXPIRED: 4-1-03
#8446, eff 10-7-05; ss by #10428, eff 10-7-13; ss by #14334, eff 8-1-25, EXPIRES: 8-1-35

Part He-W 548 Extended Services to Pregnant Women

N.H. Code Admin. R. Ann. He-W 548.01 Definitions {#sec-he-w-548.01 omnilex-key=us-nh-regs-official--agency-he-w--He-W 548.01}

(a) “Department” means the New Hampshire department of health and human services.

(b) “Extended services” means services rendered to pregnant and postpartum women in addition to routine medical prenatal and postpartum care with the purpose of improving birth outcomes and parenting skills.

(c) “Medicaid” means the Title XIX and Title XXI programs administered by the department, which makes medical assistance available to eligible individuals.

(d) “Postpartum period” means the period that begins on the last day of pregnancy and extends through the end of the month in which the 60-day period following termination of pregnancy ends.

(e) “Recipient” means any individual who is eligible for and receiving medical assistance under the medicaid program.

(f) “Title XIX” means the joint federal-state program described in Title XIX of the Social Security Act and administered in New Hampshire by the department under the medicaid program.

(g) “Title XXI” means the joint federal-state program described in Title XXI of the Social Security Act and administered in New Hampshire by the department under the medicaid program.

History

(See Revision Note at chapter heading He-W 500); ss by #5578, eff 2-11-93; ss by #6939, Interim, eff. 1-30-99, EXPIRED 5-30-99
#7036, eff 6-25-99; ss by #8904, eff 6-25-07; amd by #10139, eff 7-1-12; ss by #10914, eff 8-26-15

N.H. Code Admin. R. Ann. He-W 548.02 Recipient Eligibility {#sec-he-w-548.02 omnilex-key=us-nh-regs-official--agency-he-w--He-W 548.02}

All medicaid recipients shall be eligible for extended services during pregnancy and through the postpartum period.

History

(See Revision Note at chapter heading He-W 500); ss by #5578, eff 2-11-93; ss by #6939, Interim, eff. 1-30-99, EXPIRED 5-30-99
#7036, eff 6-25-99; ss by #8904, eff 6-25-07; ss by #10914, eff 8-26-15

N.H. Code Admin. R. Ann. He-W 548.03 Provider Participation {#sec-he-w-548.03 omnilex-key=us-nh-regs-official--agency-he-w--He-W 548.03}

All providers of extended services shall:

(a) Be under current contract obligation with the maternal and child health section, division of public health services as a prenatal program or as a primary care agency providing prenatal care; and

(b) Be a NH enrolled medicaid provider.

History

(See Revision Note at chapter heading He-W 500); ss by #5578, eff 2-11-93; ss by #6939, Interim, eff. 1-30-99, EXPIRED 5-30-99
#7036, eff 6-25-99; ss by #8904, eff 6-25-07; ss by #10914, eff 8-26-15

N.H. Code Admin. R. Ann. He-W 548.04 Covered Services {#sec-he-w-548.04 omnilex-key=us-nh-regs-official--agency-he-w--He-W 548.04}

The following services shall be covered, rendered singularly or in any combination during a calendar month, and in accordance with the recipient’s plan of care:

(a) Social services including:

(1) An initial assessment;

(2) Assisting the recipient in identifying her ongoing needs and referring her to appropriate services; and

(3) Home visits;

(b) Care coordination between a recipient and any other individuals or agencies involved in the recipient’s care, including:

(1) Communicating outcomes or status to appropriate providers;

(2) Providing liaison assistance during the transition process to ongoing health, mental health, or social services;

(3) Assisting with arrangements for transportation, childcare, or community services;

(4) Making referrals to other agencies, programs, and community services, including the federal special supplemental food program for women, infants and children;

(5) Follow-up to ensure the delivery of necessary services, including tracking missed appointments, rescheduling, and the identification and resolution of care barriers; and

(6) Intra-agency consultations concerning the recipient’s care needs;

(1) Education about the health implications of risk behavior, such as smoking, and use of alcohol and other drugs;

(2) Education about infant health, mental health, and development, including positive parenting and its role in infant and child development; and

(3) Individual instruction about the course of pregnancy, delivery and child care; and

(d) Nutritional services including:

(a) An initial assessment of the recipient’s current nutritional status;

(b) Nutritional counseling; and

History

(See Revision Note at chapter heading He-W 500); ss by #5578, eff 2-11-93; ss by #6939, Interim, eff. 1-30-99, EXPIRED 5-30-99
#7036, eff 6-25-99; ss by #8904, eff 6-25-07; ss by #10914, eff 8-26-15

N.H. Code Admin. R. Ann. He-W 548.05 Non-Covered Services {#sec-he-w-548.05 omnilex-key=us-nh-regs-official--agency-he-w--He-W 548.05}

Any other medical services that are covered under the NH medicaid program, pursuant to He-W 522 through 577 or He-M 426 through 701 shall not be covered as part of extended services to pregnant women.

History

(See Revision Note at chapter heading He-W 500); ss by #5578, eff 2-11-93; ss by #6939, Interim, eff. 1-30-99, EXPIRED 5-30-99
#7036, eff 6-25-99; ss by #8904, eff 6-25-07; ss by #10914, eff 8-26-15

N.H. Code Admin. R. Ann. He-W 548.06 Required Documentation {#sec-he-w-548.06 omnilex-key=us-nh-regs-official--agency-he-w--He-W 548.06}

The provider shall maintain the following documentation for all extended services care provided:

(a) A plan of care containing:

(1) The initial assessment, which shall contain:

a. The recipient’s name and medicaid identification number;

b. The date of entry into clinic service;

c. The number of weeks of gestation at the date of entry;

d. The recipient’s medical, nutritional, and social needs and risks;

e. A listing of services and types of providers to be used, to address the recipient’s needs and risks, as well as the frequency of services;

f. A dated signature on the plan of care by the physician or advanced practice registered nurse, or a physician assistant if so delegated by a physician in accordance with Med 603.01, along with the signature of the recipient, approving the plan of care;

g. A statement signed by the recipient which gives the agency staff permission to discuss the recipient’s needs with other medical and social service caregivers; and

h. The date of, and reason for, discharge from the program;

(2) Ongoing plan of care notes, relating to the original plan of care, containing:

a. Date(s) of service(s); and

b. Description of service(s); and

(3) Changes to the original plan of care described in (1)d. and (1)e. above, to be attached to the original plan of care;

(b) Attendance records for any group education attended by a recipient;

(c) An extended services summary sheet listing the recipient’s name and medicaid identification number, and the date(s) and type(s) of extended service(s) rendered;

(d) Supporting records in accordance with He-W 520 and this part, and failure to maintain records in accordance with He-W 520 and this part shall entitle the department to recoupment of state and federal medicaid payments made as permitted by 42 CFR 455 and 42 CFR 447; and

(e) Documentation required by He-W 520 and this part for a minimum of 6 years or until the resolution of any legal action(s) commenced within the 6 year period, whichever is longer.

History

(See Revision Note at chapter heading He-W 500); ss by #5578, eff 2-11-93; ss by #6939, Interim, eff. 1-30-99, EXPIRED 5-30-99
#7036, eff 6-25-99; ss by #8904, eff 6-25-07; ss by #10914, eff 8-26-15

N.H. Code Admin. R. Ann. He-W 548.07 Utilization Review and Control {#sec-he-w-548.07 omnilex-key=us-nh-regs-official--agency-he-w--He-W 548.07}

The department’s provider integrity unit shall monitor utilization of extended services to pregnant women to identify, prevent, and correct potential occurrences of fraud, waste, and abuse, in accordance with 42 CFR 455, 42 CFR 456, and He-W 520.

History

(See Revision Note at chapter heading He-W 500); ss by #5578, eff 2-11-93; ss by #6939, Interim, eff. 1-30-99, EXPIRED 5-30-99
#7036, eff 6-25-99; ss by #8904, eff 6-25-07; ss by #10914, eff 8-26-15

N.H. Code Admin. R. Ann. He-W 548.08 Third Party Liability {#sec-he-w-548.08 omnilex-key=us-nh-regs-official--agency-he-w--He-W 548.08}

All third party obligations shall be exhausted before the medicaid program is billed, in accordance with 42 CFR 433.139.

History

(See Revision Note at chapter heading He-W 500); ss by #5578, eff 2-11-93; ss by #6939, Interim, eff. 1-30-99, EXPIRED 5-30-99
#7036, eff 6-25-99; ss by #8904, eff 6-25-07; ss by #10914, eff 8-26-15

N.H. Code Admin. R. Ann. He-W 548.09 Payment for Services {#sec-he-w-548.09 omnilex-key=us-nh-regs-official--agency-he-w--He-W 548.09}

Payment for extended services to pregnant women shall be made as follows:

(a) Rates of payment shall be at a monthly rate established by the department in accordance with RSA 161:4, VI(a);

(b) At least one of the services described in He-W 548.04 shall be provided each month, in order for the monthly rate to be billed by the provider;

(d) The provider shall maintain supporting records, in accordance with He-W 520 and He-W 548.06, and the department shall be entitled to recoupment of state and federal medicaid payments made in violation of 42 CFR 455 and 42 CFR 447.

History

(See Revision Note at chapter heading He-W 500); ss by #5578, eff 2-11-93; ss by #6939, Interim, eff. 1-30-99, EXPIRED 5-30-99
#7036, eff 6-25-99; ss by #8904, eff 6-25-07; ss by #10914, eff 8-26-15

Part He-W 549 Home Visiting New Hampshire and Child/Family Health Care Support Services

N.H. Code Admin. R. Ann. He-W 549.01 Definitions {#sec-he-w-549.01 omnilex-key=us-nh-regs-official--agency-he-w--He-W 549.01}

(a) “Caregiver” means a parent, grandparent or any other individual identified as having primary responsibility for the child.

(b) “Child/family health care support” means services that are rehabilitative and preventive in nature and which, in addition to medical care, are rendered to recipients for the purpose of improving their health status and function within the family and community.

(d) “First time mother” means a pregnant woman who has had no previous live births.

(e) “Home Visiting New Hampshire (HVNH)” means the maternal and child health preventive program that provides health education, support and linkages to community services to Title XIX eligible, pregnant women together with their families in their homes.

(f) “Low birth weight” means an infant weighed 2500 grams or less at birth.

(g) “Medicaid” means the Title XIX and Title XXI programs administered by the department which makes medical assistance available to eligible individuals.

(h) “Premature” means an infant born before 37 weeks gestation.

(i) “Recipient” means any individual who is eligible for and receiving medical assistance under the medicaid program.

(j) “Special health care needs” means having or being at risk for chronic physical, developmental, behavioral, or emotional conditions requiring health and related services of a type or amount beyond what is generally required.

(k) “Title V” means the program described in Title V of the Social Security Act, and administered by the maternal and child health section (MCH) of the NH division of public health services or by the special medical services (SMS) section of the NH division of community based care services as part of the health resources and services administration, United States department of health and human services.

(l) “Title XIX” means the joint federal-state program described in Title XIX of the Social Security Act and administered in New Hampshire by the department under the medicaid program.

(m) “Title XXI” means the joint federal-state program described in Title XXI of the Social Security Act and administered in New Hampshire by the department under the medicaid program.

(n) “Unit” means a 15-minute period of time for which a service is rendered.

History

#7775, eff 10-8-02; ss by #9768, eff 10-8-10; ss by #10092, eff 3-1-12; amd by #10139, eff 7-1-12; amd by #10398, eff 8-20-13

N.H. Code Admin. R. Ann. He-W 549.02 Recipient Eligibility {#sec-he-w-549.02 omnilex-key=us-nh-regs-official--agency-he-w--He-W 549.02}

(a) The following individuals shall be eligible for HVNH, as described in He-W 549.05(a):

(1) A medicaid recipient who:

a. Is a first time mother; and

b. Is under age 21 at the time of enrollment;

(2) An infant, up to one year of age, who is born to a recipient in (1) above; and

(3) An infant, up to one year of age, who:

a. Is no older than 2 weeks of age at the time of enrollment in the program; and

b. Is born to a first time mother who is under the age of 21 at the time of the infant’s enrollment in the program.

(b) All Title XIX recipients who are under age 21 shall be eligible to receive child/family health care support services, as specified in He-W 549.05(b), if any one of the following 4 conditions are met:

(1) At least 2 primary criteria outlined in (c) below;

(2) At least 3 secondary criteria outlined in (d) below;

(3) At least one primary and 2 secondary criteria outlined in (c) and (d) below; or

(4) The recipient is eligible for Title V services through the special medical services section, in accordance with He-M 520.03 and He-M 520.04(b).

(1) The caregiver, child or a household member has:

a. A diagnosed mental illness;

b. Known substance abuse; or

c. A disability or developmental delay, except that a child shall not be a recipient of family-centered early supports and services pursuant to He-M 510;

(2) The caregiver has been referred by a protective services agency or has a finding of child neglect or abuse;

(3) The caregiver or child has special health care needs;

(4) The child’s family is homeless; or

(5) One of the child’s parents or parent’s partner is absent for circumstances including, but not limited to, death, missing, incarceration, military deployment, or as a result of a protective/restraining order.

(d) For child/family health care support services, secondary criteria for eligibility shall include:

(1) The child’s caregiver is under 21 years of age;

(2) The caregiver is a first time parent;

(3) The caregiver has limited English proficiency;

(4) The caregiver is single without any identified social supports;

(5) The caregiver has less than a high school education;

(6) The child was premature or had a low birth weight and is not a recipient of family-centered early supports and services pursuant to He-M 510;

(7) There is documentation of family trauma, including, but not limited to:

a. An unexpected or untimely death in the family;

b. Domestic violence in the family;

c. Caregiver is an adult victim of child abuse or neglect; or

d. The family has been the victim of a crime;

(8) There is documentation of a disrupted or problematic parent-child relationship, such as, but not limited to, insecure attachment;

(9) The family’s income is less than 125% of the most recent federal poverty level as published annually in the Federal Register by the Secretary of the U.S. Department of Health and Human Services; or

(10) One or more grandparents is raising the child.

History

#7775, eff 10-8-02; ss by #9768, eff 10-8-10; ss by #10092, eff 3-1-12; amd by #10398, eff 8-20-13

N.H. Code Admin. R. Ann. He-W 549.03 Amount {#sec-he-w-549.03 omnilex-key=us-nh-regs-official--agency-he-w--He-W 549.03}

of Services.

(a) Child/family health care support services shall consist of 12 units of service per state fiscal year, including the units making up the assessment visits in He-W 549.05(a)(2).

(b) Recipients identified in He-W 549.02(b)(4) shall be eligible for 16 units of service per state fiscal year, including the units making up the assessment visits in He-W 549.05(a)(2).

History

#7775, eff 10-8-02; ss by #9768, eff 10-8-10; ss by #10092, eff 3-1-12

N.H. Code Admin. R. Ann. He-W 549.04 Provider Participation {#sec-he-w-549.04 omnilex-key=us-nh-regs-official--agency-he-w--He-W 549.04}

(a) Each participating provider shall:

(1) Be under current services contract obligation:

a. With the maternal and child health (MCH) section of the NH division of public health services;

b. With the special medical services (SMS) section of the NH division of community based care services, as a Title V agency; or

c. With the department’s division for children, youth, and families (DCYF);

(2) Be a New Hampshire enrolled Title XIX provider; and

(3) Deliver HVNH or child/family health care support services through the following health care providers:

a. Advanced practice registered nurses (APRN) licensed to practice by the states in which they practice;

b. Registered nurses (RN) licensed to practice by the states in which they practice;

c. Licensed practical nurses (LPN) licensed to practice by the states in which they practice;

d. Licensed dietitians who are licensed under RSA 326-H:12;

e. Social workers with a baccalaureate or master’s degree in social services, psychology, education or public health; or

f. Para-professionals who:

Have a high school diploma or general equivalency diploma;
Have 2 years’ experience working with families in a health care support capacity; and
Work in coordination with a licensed multidisciplinary team, including but not limited to APRNs, licensed clinical social workers (LCSW), licensed marriage and family therapists, and/or other licensed health care professionals.

(b) Participating providers under current services contract obligation with SMS in accordance with (a)(1)b. above shall bill only for nutrition-related services identified in He-W 549.05(b)(5)a.

History

#7775, eff 10-8-02; ss by #9768, eff 10-8-10; ss by #10092, eff 3-1-12 (from He-W 549.03); amd by #11124, eff 6-22-16

N.H. Code Admin. R. Ann. He-W 549.05 Covered Services {#sec-he-w-549.05 omnilex-key=us-nh-regs-official--agency-he-w--He-W 549.05}

Covered HVNH and child/family health care support services shall include the following services delivered in accordance with a plan of care as described in He-W 549.07:

(a) HVNH services which shall:

(1) Focus on healthy birth outcomes;

(2) Include initial assessment, not to exceed 2 visits, and subsequent visits;

(3) Be conducted through face-to-face visits at:

a. The pregnant woman’s or child’s home;

b. The participating provider or health care provider agency; or

c. Any other location, as documented in the pregnant woman’s or child’s progress notes; and

(4) Include the following:

a. Prenatal assessment, support and education including, but not limited to:

Nutrition assessment and education;
Networking with social support services;
Accessing and receiving continuous prenatal care; and
Health implications of risk behavior, such as smoking;

b. Parenting skills and child development education;

c. Parental assessment, support and education to encourage parental coping and the parent’s ability to develop attachment and nurturing skills;

d. Family planning;

e. Community support guidance for the purpose of securing and maintaining a safe and healthy home;

f. Education and support to assure recipient has access to, and obtains, preventive and acute health care; and

g. Follow-up activities related to any of the above services; and

(b) Child/family health care support services which:

(1) Shall include initial assessment and subsequent visits;

(2) Shall be family-centered and child-focused;

(3) Shall be conducted through a face-to-face visit with the recipient’s parent or guardian at:

a. The recipient’s home;

b. The participating provider or health care provider agency; or

c. Any other location, as documented in the recipient’s progress notes;

(4) May be conducted on a limited basis by telephone or via a video conference in lieu of a face-to-face visit if the service can be provided over the phone or via a video conference and provision of the service over the phone or via a video conference would not compromise the intent or anticipated result of the service; and

(5) Shall include any of the following:

a. Nutrition assessment and education;

b. Family support activities geared towards developing and maintaining family support systems, including, but not limited to, education and consultation;

c. Child-focused, family-centered education to a recipient’s parents or guardians in the areas of physical and behavioral health, social support, parenting education, and household and environmental safety;

d. Child development screening, education, and guidance;

e. Community support guidance for the purpose of securing and maintaining a safe and healthy home;

f. Parental assessment, support and education to encourage parental coping and the parent’s ability to develop attachment and nurturing skills;

g. Education and support to assure recipient has access to, and obtains, preventive and acute health care; and

h. Follow-up activities related to any of the above services.

History

#7775, eff 10-8-02; ss by #9768, eff 10-8-10; ss by #10092, eff 3-1-12 (from He-W 549.04)

N.H. Code Admin. R. Ann. He-W 549.06 Non-Covered Services {#sec-he-w-549.06 omnilex-key=us-nh-regs-official--agency-he-w--He-W 549.06}

The following services shall be non-covered as HVNH and child/family health care support services:

(a) Any covered service listed in He-W 549.05, or component thereof, which duplicates a service already being provided, such as, but not limited to:

(1) Services provided though other Title XIX-funded department programs;

(2) Services provided through private programs such as a health maintenance organization (HMO); and

(3) Services which are free to the public;

(b) Travel;

(d) Administrative services; and

(e) Services that do not meet the documentation requirements in He-W 549.07.

History

#7775, eff 10-8-02; ss by #9768, eff 10-8-10; ss by #10092, eff 3-1-12 (from He-W 549.05)

N.H. Code Admin. R. Ann. He-W 549.07 Required Documentation {#sec-he-w-549.07 omnilex-key=us-nh-regs-official--agency-he-w--He-W 549.07}

Each participating provider shall develop and maintain on file the following documentation for each recipient:

(a) A plan of care which shall be developed following the initial assessment, in accordance with the following:

(1) The plan of care shall include:

a. The recipient’s name, date of birth and Title XIX identification number;

b. The recipient’s identified needs and/or risk factors;

c. The recommended HVNH or child/family health care support services; and

d. The frequency of the recommended HVNH or child/family health care support services;

(2) The plan of care shall be approved, dated, and signed by:

a. A physician or APRN, when the plan of care contains a nursing or SMS nutrition component; or

b. A physician, APRN, LCSW, psychologist, associate psychologist, licensed clinical mental health counselor, or licensed marriage and family therapist, when the plan of care does not contain a nursing component; and

(3) The plan of care shall be reviewed and updated at least annually and as necessary, including being approved, dated, and signed in accordance with (2) above;

(b) A family support plan which shall:

(1) Be required only of participating HVNH providers;

(2) Be developed, in conjunction with the family, based on initial assessment and the plan of care;

(3) Be updated at least quarterly, in conjunction with the family, based on the health care provider’s assessment of progress or lack of progress towards the goals in (4) below; and

(4) Specify family-specific goal information including, but not limited to:

a. Family-specific goals, including the date each goal is identified;

b. Action steps to achieve each family-specific goal;

c. Frequency of services required to achieve each family-specific goal;

d. Sources of support resources for the family to utilize to achieve each family-specific goal;

e. Name and goal-related role of each anticipated and involved health care provider;

f. Dates on which progress toward each goal is to be reviewed, which shall be at least quarterly; and

g. Status of goal at review date;

(c) Progress notes, which shall be prepared at the time of each visit, or at the time of a telephone call made or video conference conducted in lieu of a face-to-face visit, by the health care provider, to include, but not be limited to:

(1) The date of each visit, telephone call or video conference;

(2) The location of each visit, if other than the recipient’s home or the participating provider or health care provider agency, and the reason therefor;

(3) The reason for a telephone call or video conference if in lieu of a visit;

(4) The individuals present at the time of the visit;

(5) The start time and end time of each visit, telephone call or video conference;

(6) For HVNH only, documentation of the service(s) provided at each visit, or via telephone call or video conferencing and how the service(s) provided relates to a specific goal contained in the family support plan;

(7) For MCH providers of child/family health care support services, documentation of which service(s) specified in He-W 549.05(b)(5), as related to the plan of care, were provided at each visit, or via telephone call or video conference;

(8) For participating providers under contract obligation with SMS, documentation of the service(s) provided at each visit or via telephone call or via video conference; and

(9) The dated signature and credentials of the health care provider;

(d) For HVNH only, documentation in the recipient’s chart as follows:

(1) Family/household information, including, but not limited to:

a. Names of family members;

b. Dates of birth of family members; and

c. Relationship of family members to recipient;

(2) Family support team information, including, but not limited to the name and role of each health care provider providing services; and

(3) The names and types of other sources of support being received by the recipient, such as, but not limited to:

a. Primary care, dental, and mental health providers; and

b. Support from such programs as women, infants and children nutrition services, and the division for children, youth and families; and

(e) For child/family health care support services only, documentation verifying that the recipients served met the eligibility criteria in He-W 549.02(b).

History

#7775, eff 10-8-02; ss by #9768, eff 10-8-10; ss by #10092, eff 3-1-12 (fr5om He-W 549.06); amd by #11124, eff 6-22-16

N.H. Code Admin. R. Ann. He-W 549.08 Utilization Review and Control {#sec-he-w-549.08 omnilex-key=us-nh-regs-official--agency-he-w--He-W 549.08}

The department shall monitor utilization of HVNH and child/family health care support services, in accordance with 42 CFR 455, 42 CFR 456, and He-W 520.

History

#7775, eff 10-8-02; ss by #9768, eff 10-8-10; ss by #10092, eff 3-1-12 (from He-W 549.07)

N.H. Code Admin. R. Ann. He-W 549.09 Third Party Liability {#sec-he-w-549.09 omnilex-key=us-nh-regs-official--agency-he-w--He-W 549.09}

(a) All third party obligations shall be exhausted before Title XIX shall be billed, in accordance with 42 CFR 433.139, with the exception of the following:

(1) Pregnant women and children who are covered by third party liability, enforced by the New Hampshire division of child support services, shall be exempt from third party billing practices; and

(2) All preventive pediatric and prenatal care services shall be exempt from third party billing practices.

(b) Participating providers may bill medicaid directly for (a)(1) and (a)(2) above, and medicaid shall then seek reimbursement from the third party.

History

#7775, eff 10-8-02; ss by #9768, eff 10-8-10; ss by #10092, eff 3-1-12 (from He-W 549.08)

N.H. Code Admin. R. Ann. He-W 549.10 Payment for Services {#sec-he-w-549.10 omnilex-key=us-nh-regs-official--agency-he-w--He-W 549.10}

(a) Payment for HVNH and child/family health care support services shall be made, per 15 minute unit of service, in accordance with rates established by the department in accordance with RSA 161:4, VI(a).

(b) For billing purposes:

(1) Any period of time that consists of 8 minutes or less shall not be billed; and

(2) Any period of time that consists of more than 8 minutes shall be billed as one unit.

(d) The participating provider shall maintain supporting records, in accordance with He-W 520.

History

#10092, eff 3-1-12 (from He-W 549.09)

Part He-W 550 ADULT MEDICAL DAY CARE SERVICES - EXPIRED (Now He-E 803)

N.H. Code Admin. R. Ann. He-W 550.01 Medical Assistance {#sec-he-w-550.01 omnilex-key=us-nh-regs-official--agency-he-w--He-W 550.01}

– He-W 550.08 - EXPIRED

History

(See Revision Note at chapter heading He-W 500); ss by #5889, eff 8-31-94; ss by #7355, INTERIM, eff 8-31-00, EXPIRED: 2-27-01

Part He-W 552 Personal Care Attendant Services

N.H. Code Admin. R. Ann. He-W 552.01 Purpose {#sec-he-w-552.01 omnilex-key=us-nh-regs-official--agency-he-w--He-W 552.01}

The purpose of this chapter is to set forth the procedures and requirements of personal care attendant services provided by personal care attendants to the severely physically disabled pursuant to RSA 161-E.

History

(See Revision Note at chapter heading He-W 500); ss by #4993, eff 11-30-90, EXPIRED: 11-30-96
#6742, eff 4-30-98; ss by #7941, eff 8-23-03; ss by #8597, eff 3-30-06; amd by #10139, eff 7-1-12; ss by #10562, INTERIM, eff 3-30-14, EXPIRES: 9-26-14; ss by #10676, eff 9-26-14

N.H. Code Admin. R. Ann. He-W 552.02 Definitions {#sec-he-w-552.02 omnilex-key=us-nh-regs-official--agency-he-w--He-W 552.02}

(a) “Chronically wheelchair mobile” means the recipient, due to a physical disability, must use a wheelchair for mobility.

(b) “Department” means the New Hampshire department of health and human services.

(c) “Legally responsible relative” means a spouse, or the parent(s) of a minor child, including step-parents, foster parents and legal guardians, who are legally responsible to provide care for another person.

(d) “Medicaid” means the Title XIX and Title XXI programs, administered by the department, which make medical assistance available to eligible individuals.

(e) “Member of the recipient’s family” means an individual related to the recipient within the second degree of kinship, including:

(1) A spouse, parent, step-parent, sister, or brother; or

(2) A grandparent, aunt, or uncle residing in the same household.

(f) “Natural supports” means the help and care that an individual receives from his or her family, friends, significant others, roommates, neighbors, and other community resources, including unpaid voluntary services.

(g) “Personal care attendant (PCA)” means a person who meets the requirements set forth in He-W 552.04(b) and is an employee of or is under contract with a personal care service provider(s) to provide personal care attendant services.

(h) “Personal care attendant services (PCA services)” means medically oriented personal care services as more fully described in He-W 552.05(b) which are provided by a personal care attendant in the recipient’s home, workplace, or other non-institutional setting to gain greater control over his or her life in accordance with RSA 161-E.

(i) “Provider” means an entity that employs or contracts with the personal care attendant to provide PCA services and meets the requirements set forth in He-W 552.04(a).

(j) “Recipient” means any individual who is eligible for and receiving medical assistance under the medicaid program.

(k) “Title XIX” means the joint federal-state program described in Title XIX of the Social Security Act and administered in New Hampshire by the department under the medicaid program.

(l) “Title XXI” means the joint federal-state program described in Title XXI of the Social Security Act and administered in New Hampshire by the department under the medicaid program.

History

(See Revision Note at chapter heading He-W 500); ss by #4993, eff 11-30-90, EXPIRED: 11-30-96
#6742, eff 4-30-98; ss by #8597, eff 3-30-06; ss by #10562, INTERIM, eff 3-30-14, EXPIRES: 9-26-14; ss by #10676, eff 9-26-14 (from He-W 552.01)

N.H. Code Admin. R. Ann. He-W 552.03 Recipient Eligibility {#sec-he-w-552.03 omnilex-key=us-nh-regs-official--agency-he-w--He-W 552.03}

(a) Medicaid recipients shall be eligible for PCA services when the recipient:

(1) Is at least 18 years of age;

(2) Is his/her own legal guardian;

(3) Is chronically wheelchair-mobile;

(4) Is approved to participate in an independent living program by provider of PCA services;

(5) Is able to participate fully in activities of daily living (ADLs), which are the basic self-care tasks of everyday life, such as eating, bathing, dressing, toileting, and transferring;

(6) Is able to self direct, which means the recipient is capable of:

a. Making informed choices about his or her PCA services; and

b. Selecting, directing, supervising and managing the personal care attendant in the implementation of a plan of care;

(7) Is living in a non-institutional environment, but requires a minimum of 2 hours of medically oriented PCA services per day; and

(8) Has a demonstrated need for PCA services as required by (c) below.

(b) The requirements in (a)(6) above shall not preclude the recipient from obtaining assistance with the task of selecting and directing the personal care attendant.

(1) Documentation from the recipient’s physician that includes:

a. A statement certifying that, based on the physician’s assessment of the recipient’s abilities and of the frequency and scope of the acute medical interventions needed by the recipient, PCA services are necessary and appropriate;

b. A description of the specific PCA services and tasks that the recipient needs assistance with; and

c. The number of hours of PCA services needed on a daily or weekly basis; and

(2) Documentation signed by the recipient indicating that the recipient’s needs cannot be fully met with natural supports, and includes:

a. A statement attesting that the PCA services are intended to assist, not replace or supplant the help already available to the recipient from family members, community resources, or other natural supports; and

b. Information detailing why the legally responsible relative is not able to provide the care that is needed, such as physical limitations or a work schedule that limits their availability.

History

(See Revision Note at chapter heading He-W 500); ss by #4993, eff 11-30-90, EXPIRED: 11-30-96
#6742, eff 4-30-98; ss by #8597, eff 3-30-06; ss by #10562, INTERIM, eff 3-30-14, EXPIRES: 9-26-14; ss by #10676, eff 9-26-14 (from He-W 552.02)

N.H. Code Admin. R. Ann. He-W 552.04 Provider Participation {#sec-he-w-552.04 omnilex-key=us-nh-regs-official--agency-he-w--He-W 552.04}

(a) All providers of PCA services shall be enrolled as a New Hampshire medicaid provider to provide PCA services.

(b) All personal care attendants shall:

(1) Be employed by or under contract with a New Hampshire medicaid provider in (a) above;

(2) Meet the training and experience requirements specified in He-W 552.07; and

(3) Not be a member of the recipient’s family, per 42 CFR 440.167(a)(2).

History

(See Revision Note at chapter heading He-W 500); ss by #4993, eff 11-30-90, EXPIRED: 11-30-96
#6742, eff 4-30-98; ss by #7941, eff 8-23-03; ss by #8597, eff 3-30-06; ss by #10562, INTERIM, eff 3-30-14, EXPIRES: 9-26-14; ss by #10676, eff 9-26-14 (from He-W 552.03)

N.H. Code Admin. R. Ann. He-W 552.05 Covered Services {#sec-he-w-552.05 omnilex-key=us-nh-regs-official--agency-he-w--He-W 552.05}

(a) PCA services shall be covered when they are:

(1) PCA services as defined by He-W 552.02(h) and as further described in (b) below;

(2) Documented by the recipient’s physician who certifies to the necessity of the PCA services in accordance with He-W 552.03(c);

(3) Part of a plan of care developed by a registered nurse as provided for in He-W 552.09(b);

(4) Provided in the home or in locations other than the home, such as school and work, if the PCA services would have otherwise been provided in the home;

(5) Of a type, frequency, and duration that is consistent with the recipient’s demonstrated needs for PCA services as documented in the plan of care; and

(6) Provided in accordance with the requirements of this part.

(b) PCA services, provided in accordance with the plan of care, shall include, as applicable:

(1) Personal hygiene, such as providing or assisting an individual with bathing, washing hair, grooming, shaving, nail care, foot care, skin care, mouth care, and oral hygiene, including special mouth care;

(2) Assistance with toileting, or a bowel and bladder care program, such as assisting the recipient getting to and from the bathroom, on and off the toilet, or assistive device used for toileting, changing incontinence supplies, following a toileting schedule, cleansing an individual or adjusting clothing relate to toileting, emptying a catheter drainage bag or assistive device, ostomy care, and bowel care;

(3) Assistance with movement and mobility, transfers or repositioning, such as transferring a recipient from a bed to a wheelchair, turning an individual or adjusting padding for physical comfort or pressure relief, and assisting with range-of-motion exercises;

(4) Under the direction of the recipient, assistance with medications to the extent allowable under RSA 326-B;

(5) Assistance with dressing;

(6) Meal preparation and clean-up when such activities are not otherwise being provided, and may include preparing meals for modified diets, assisting with eating, and monitoring to prevent choking or aspiration; and

(7) The performance of light household tasks related to the recipient’s needs, such as but not limited to, changing and washing the recipient’s bed linens, doing the recipient’s laundry, cleaning of recipient occupied space, or moving furniture to remove obstacles and hazards to enable the recipient to move easily in the home.

(c) The recipient shall be responsible for informing the personal care attendant about his or her preferences regarding the PCA services, and how they are to be performed.

History

(See Revision Note at chapter heading He-W 500); ss by #4993, eff 11-30-90, EXPIRED: 11-30-96
#6742, eff 4-30-98; ss by #8597, eff 3-30-06; ss by #10562, INTERIM, eff 3-30-14, EXPIRES: 9-26-14; ss by #10676, eff 9-26-14 (from He-W 552.04)

N.H. Code Admin. R. Ann. He-W 552.06 Non-covered Services {#sec-he-w-552.06 omnilex-key=us-nh-regs-official--agency-he-w--He-W 552.06}

(a) Non-covered services shall be those services for which the NH Medicaid program shall make no payment.

(b) The following activities shall not be considered PCA services:

(1) Services that are not medically oriented, including:

a. Shopping, except for grocery shopping;

b. Managing finances;

c. Care, grooming, or feeding of pets or other animals, with the exception of service animals as defined by the Americans with Disabilities Act (ADA), Title III Subpart A 36.104, or assistance animals as defined by the Fair Housing Act Section 504; and

d. Social integration activities, such as accompanying the recipient to a restaurant, to the movies, to a ball game or to any other community or social activity;

(2) Chore services, which are tasks that exceed light housekeeping and include:

a. Cleaning of floors, shampooing carpets, cleaning walls, and cleaning furniture in areas not occupied by the recipient, such as cleaning the entire home rather than the area the recipient occupies;

b. Doing laundry, other than the recipient’s personal laundry, such as doing laundry for the household as opposed to just the recipient’s personal laundry;

c. Cleaning windows; and

d. Doing yard work, gardening, home repairs, or shoveling snow unless needed to ensure the recipient’s and the PCA’s safe access to and from the recipient’s home when the recipient has no natural supports;

(3) Services provided outside the recipient’s home for the convenience of the personal care attendant, such as care provided at the personal care attendant’s home, or any other location where the recipient would not normally go within the community;

(4) Services performed for the convenience of the recipient, or the recipient’s family member(s), or intended to otherwise replace assistance available through the recipient’s natural supports system;

(5) Time spent with the recipient when no actual hands on care or other covered services are being provided, including but not limited to supervision, companion care, baby-sitting the recipient’s dependents, or social visits;

(6) Services provided to a recipient while the recipient is:

a. An inpatient or resident of a hospital, nursing facility, intermediate care facility for the mentally retarded, or institution for mental disease, in accordance with 42 CFR 440.167;

b. An inmate of a public institution in accordance with 1905(a)(27)(A) of the Social Security Act; or

c. Attending a program for which personal care services are already provided, such as adult medical day care;

(7) Services provided to the recipient outside the United States;

(8) Duplicative PCA services;

(9) Any services not listed as covered under He-W 552.05;

(10) Services which are not included in the approved plan of care;

(11) Services provided to someone other than the recipient; and

(12) Care requiring the technical or professional skill that a state statute or regulation mandates must be performed by a health care professional licensed or certified by the state.

History

(See Revision Note at chapter heading He-W 500); ss by #4993, eff 11-30-90, EXPIRED: 11-30-96
#6742, eff 4-30-98; ss by #8597, eff 3-30-06; ss by #10562, INTERIM, eff 3-30-14, EXPIRES: 9-26-14; ss by #10676, eff 9-26-14 (from He-W 553.06)

N.H. Code Admin. R. Ann. He-W 552.07 Training Requirements {#sec-he-w-552.07 omnilex-key=us-nh-regs-official--agency-he-w--He-W 552.07}

(a) The provider shall ensure that, within 30 days of the date of hire, the personal care attendant has, through training or experience, the skills required to perform the PCA services including competency in the following areas:

(1) Roles, responsibilities and expectations of a personal care attendant, including knowledge of activities that do and do not qualify as PCA services;

(2) Personal care and nutrition;

(3) Infection control and universal precautions designed to prevent the transmission of infectious diseases;

(4) Safety and emergency procedures, including basic first aid and 911 protocols;

(5) Proper lifting techniques;

(6) Recipient rights, and reporting of abuse and neglect; and

(7) Record-keeping and documentation, including the penalties associated with improper recordkeeping and documentation.

(b) The provider shall maintain documentation in the personnel file indicating that the personal care attendant meets the requirements of (a) above, including the name and signature of the person making the competency determination.

History

(See Revision Note at chapter heading He-W 500); ss by #4993, eff 11-30-90, EXPIRED: 11-30-96
#6742, eff 4-30-98; ss by #8597, eff 3-30-06; ss by #10562, INTERIM, eff 3-30-14, EXPIRES: 9-26-14; ss by #10676, eff 9-26-14

N.H. Code Admin. R. Ann. He-W 552.08 Provider and PCA Responsibilities {#sec-he-w-552.08 omnilex-key=us-nh-regs-official--agency-he-w--He-W 552.08}

(a) The provider shall:

(1) Ensure that the recipient receives independent living skills training as stated in the recipient’s individualized independent living plan of care;

(2) Coordinate independent living resources and supports; and

(3) Perform on-going assessments to evaluate the recipient’s psychosocial, physical, and environmental status to prevent hospitalization and to promote wellness.

(b) The personal care attendant shall document a detailed written daily record to include:

(1) Specific tasks performed;

(2) Condition and changes in condition or status of the recipient, such as a reported change in sleep patterns, an injury, or development of a decubitus ulcer; and

(3) The dates worked, total number of hours and/or 15 minute units worked for each day, including the in and out times.

(1) Raise the concerns with the recipient;

(2) Note the concerns in their daily report; and

(3) If raising the issue with the recipient does not alleviate the concern, bring the concern to the attention of the registered nurse employed by the provider to oversee the recipient’s care.

(d) When the personal care attendant brings a concern to the nurse’s attention in accordance with (c)(3), the nurse shall follow-up and document the outcome in the provider’s record for the recipient.

History

#10676, eff 9-26-14 (from He-W 552.03)

N.H. Code Admin. R. Ann. He-W 552.09 Personal Care Assessments and the Plan of Care {#sec-he-w-552.09 omnilex-key=us-nh-regs-official--agency-he-w--He-W 552.09}

(a) A personal care assessment shall be conducted by the provider’s licensed registered nurse and used to develop the plan of care.

(b) The personal care assessment shall include the following:

(1) The recipient’s functional level;

(2) The adaptability of the recipient’s place of residence to the provision of PCA services;

(3) The capability of the recipient to participate in his or her own care and to determine the degree of support needed; and

(4) The extent of, and need for, any natural supports taking into account the potential contributions of natural supports.

(1) Be based on the recipient’s physician’s documentation described in He-W 552.03(c) and the personal care assessment as described in (a) above;

(2) Include the information from the personal case assessment as well as the following:

a. Diagnosis;

b. Recipient status, including:

Behavioral health status;
Physical health status;
Functional limitations; and
Rehabilitative prognosis;

c. PCA services needed, including:

The type, frequency, and number of hours and/or 15 minute units per day or week;
Any equipment requirements;
Any nutritional requirements; and
Medications;

d. Discharge planning or referral; and

e. Other identified appropriate PCA services;

(3) Be signed by the licensed registered nurse responsible for the oversight of the recipient’s care, and incorporated in the provider’s record for the recipient; and

(4) Be reviewed by the provider’s licensed registered nurse who is responsible for the oversight of the recipient’s care every 3 months, and the prescribing physician every 6-months, or more often if warranted by the severity of the recipient’s functional limitations.

(d) The provider’s licensed registered nurse who is responsible for the oversight of the recipient’s PCA services shall make a face-to-face visit to the recipient’s residence at least once every 3-months to:

(1) Reassess the PCA services in light of the recipient’s needs as described in the plan of care, and note any need for changes to the plan of care;

(2) Confirm that the recipient is satisfied with the PCA services being provided;

(3) Verify that the PCA services being provided in accordance with the recipient’s needs, preferences and the plan of care; and

(4) Ensure that documentation and recordkeeping are being performed in an accurate and appropriate manner.

(e) All assessments required in (a) and (d) above shall be conducted using a standardized assessment tool of the provider’s choice, which has been reviewed by the department.

(f) Any revisions to the plan of care as a result of a review as described in (d) above, shall be in writing, and approved by the recipient’s physician.

History

#10676, eff 9-26-14

N.H. Code Admin. R. Ann. He-W 552.10 Utilization Review and Control {#sec-he-w-552.10 omnilex-key=us-nh-regs-official--agency-he-w--He-W 552.10}

The department’s provider program integrity unit shall monitor utilization of the PCA services to identify, prevent, and correct potential occurrences of fraud, waste and abuse, in accordance with 42 CFR 455 and 42 CFR 456 and He-W 520.

History

#10676, eff 9-26-14 (from He-W 552.05)

N.H. Code Admin. R. Ann. He-W 552.11 Third Party Liability {#sec-he-w-552.11 omnilex-key=us-nh-regs-official--agency-he-w--He-W 552.11}

All third party obligations shall be exhausted before medicaid may be billed, in accordance with 42 CFR 433.139.

History

#10676, eff 9-26-14 (from He-W 552.06)

N.H. Code Admin. R. Ann. He-W 552.12 Payment for Services {#sec-he-w-552.12 omnilex-key=us-nh-regs-official--agency-he-w--He-W 552.12}

Payment for PCA services shall be made as follows:

(a) Payment for PCA services shall be made in accordance with fee schedules established by the department in accordance with RSA 161:4, VI(a); and

(b) The provider shall submit claims for payment to the department’s fiscal agent.

History

#10676, eff 9-26-14 (from He-W 552.07)

N.H. Code Admin. R. Ann. He-W 552.13 Documentation. {#sec-he-w-552.13 omnilex-key=us-nh-regs-official--agency-he-w--He-W 552.13}

(a) The provider shall maintain supporting records, in accordance with He-W 520.

(b) The supporting records described in (a) above shall include, but not be limited to:

(1) Documentation from the recipient’s physician that includes documentation of the need for PCA services in accordance with He-W 552.03(c);

(2) Results of the personal care assessment completed in accordance with He-W 552.09;

(3) The plan of care, as described in He-W 552.09(b);

(4) Documentation describing any changes in either the type of PCA services to be provided or the number of hours of PCA services provided, including an explanation of the basis for the change;

(5) Documentation of the time during which PCA services were provided to each recipient, including the date of service, number of hours and/or units worked, including specific in and out times, and confirmed by the recipient in writing, verbally, or electronically that PCA services were performed;

(6) Documentation of the PCA services for which reimbursement has been requested, including a detailed description of the specific PCA services provided;

(7) Documentation of the face-to-face visits conducted in accordance with He-W 552.09(c), including any related notes and outcomes; and

(8) Documentation of oversight measures taken by the provider to ensure PCA services are being provided when they are being provided outside the state of New Hampshire for longer than a 30-day period of time.

(c) All electronic or written documentation submitted in accordance with (b) above shall be legible and written in English.

(d) The provider shall provide such documentation to the department upon request.

History

#10676, eff 9-26-14 (from He-W 553.04)

Part He-W 553 Home Health Services

N.H. Code Admin. R. Ann. He-W 553.01 Purpose {#sec-he-w-553.01 omnilex-key=us-nh-regs-official--agency-he-w--He-W 553.01}

The purpose of this part is to prescribe the requirements of home health services under the New Hampshire medicaid state plan.

History

(See Revision Note at part heading for He-W 553) #11127, eff 7-1-16

N.H. Code Admin. R. Ann. He-W 553.02 Definitions {#sec-he-w-553.02 omnilex-key=us-nh-regs-official--agency-he-w--He-W 553.02}

(a) “Department” means the New Hampshire department of health and human services.

(b) “Direct care time” means the time a licensed nursing assistant (LNA), registered nurse (RN), or licensed practical nurse (LPN) spends with one recipient during which home health services are provided only to that individual recipient during a visit.

(d) “Home health aide services” means services provided to a recipient which constitute hands-on care and are required to maintain the recipient’s health, facilitate treatment of the recipient’s medical condition, illness, or injury, and when performed by a LNA, provided under the supervision of a RN or LPN.

(e) “Home health care provider” means any organization or business entity engaged in arranging for or providing home health services as described in RSA 151:2-b(I) and 42 CFR 440.70(d) and which is a NH enrolled medicaid provider in accordance with He-W 553.04.

(f) “Home health services” means skilled nursing services, home health aide services, and physical therapy, occupational therapy, speech pathology, and audiology services provided by a licensed therapy provider in accordance with He-W 568.

(g) “Independent nurse” means an RN who is not an employee with or an independent contractor of a home health care provider and is qualified to provide skilled nursing services.

(h) “Light housekeeping” means preparing meals for the recipient, cleaning the recipient’s bedroom and bathroom, and changing the recipient’s bed linens.

(i) “Medicaid” means the Title XIX and Title XXI programs administered by the department, which makes medical assistance available to eligible individuals.

(j) “Non-routine supplies” means those supplies necessary to complete specific medical treatments ordered by a physician, such as ostomy supplies, IV supplies, catheters and catheter supplies, syringes and needles, sterile dressings, and wound care supplies, and does not include routine supplies.

(k) “Recipient” means an individual who is eligible for and receiving medical assistance under the medicaid program.

(l) “Routine supplies” means those supplies used incidentally in the course of a visit and include gloves, alcohol wipes, blood drawing supplies, adhesive and paper tape, and non-sterile dressings.

(m) “Skilled nursing services” means services that must be provided by an RN or a LPN because the nature of the service is inherently complex or the recipient’s condition is such that the service can be safely and effectively provided only by a RN or LPN.

(n) “Title XIX” means the joint federal-state program described in Title XIX of the Social Security Act and administered in New Hampshire by the department under the medicaid program.

(o) “Title XXI” means the joint federal-state program described in Title XXI of the Social Security Act and administered in New Hampshire by the department under the medicaid program.

(p) “Unit” means 15 minutes.

(q) “Visit” means a personal encounter with the recipient by staff of a home health care provider for the purpose of providing a covered service(s).

History

(See Revision Note at chapter heading He-W 500); ss by #5342, eff 3-3-92, EXPIRED: 3-3-98
#8972, eff 9-11-07; amd by #9105, eff 3-18-08; amd by #10139, eff 7-1-12; ss by #11127, eff 7-1-16 (formerly He-W 553.01) (See Revision Note at part heading for He-W 553)

N.H. Code Admin. R. Ann. He-W 553.03 Recipient Eligibility {#sec-he-w-553.03 omnilex-key=us-nh-regs-official--agency-he-w--He-W 553.03}

A recipient shall be eligible to receive home health services in accordance with 42 CFR 441.15(c) if all of the following criteria are met:

(a) The recipient is under the care of a physician;

(b) The recipient requires home health services as ordered by his or her physician and documented in a written plan of care; and

(c) The recipient resides in his or her primary or temporary residence, excluding a hospital, nursing facility, or intermediate care facility for individuals with intellectual disabilities (ICF/IID), in accordance with 42 CFR 440.70(c).

History

#8972, eff 9-11-07; ss by #11127, eff 7-1-16 (formerly He-W 553.02) (See Revision Note at part heading for He-W 553)

N.H. Code Admin. R. Ann. He-W 553.04 Provider Participation {#sec-he-w-553.04 omnilex-key=us-nh-regs-official--agency-he-w--He-W 553.04}

(a) All home health care providers shall:

(1) Hold a current New Hampshire state license as a home health care provider, in accordance with RSA 151:2-b, I, and He-P 809;

(2) Be certified to participate in the medicare program; and

(3) Be a New Hampshire enrolled medicaid provider.

(b) When there is no licensed and certified home health care provider in the area, an independent nurse may provide skilled nursing services if the independent nurse:

(1) Is currently licensed to practice in the state in which he or she practices;

(2) Receives written orders from the recipient’s physician;

(3) Documents the care and services provided in accordance with He-W 553.05; and

(4) Is a NH enrolled medicaid provider.

History

#8972, eff 9-11-07; ss by #11127, eff 7-1-16 (formerly He-W 553.03) (See Revision Note at part heading for He-W 553)

N.H. Code Admin. R. Ann. He-W 553.05 Required Documentation {#sec-he-w-553.05 omnilex-key=us-nh-regs-official--agency-he-w--He-W 553.05}

(a) Home health care providers and independent nurses shall maintain complete and timely records for each recipient receiving services in accordance with He-W 520, and this part.

(b) Where a home health care provider or independent nurse has failed to maintain records pursuant to (a) above , the department shall be entitled to recoupment of state or federal medicaid payments made, as permitted by 42 CFR 455, 42 CFR 456 and 42 CFR 447.

(c) In addition to the requirement set forth in (a) above, home health care providers and independent nurses shall maintain the documentation required by this part and He-W 520 to support claims submitted for reimbursement for a minimum of 6 years or until the resolution of any legal action(s) commenced within the 6 year period, whichever is longer.

(d) Recipient records shall include all of the following:

(1) Written orders for initial home health services and certification of the need for home health services signed by the recipient’s physician specifying:

a. The frequency of medication and treatment to be administered; and

b. The period of time to be covered by the orders;

(2) Documentation of the occurrence of a face-to-face encounter which is related to the primary reason the recipient requires home health services indicating the time frame the encounter took place, the date, the practitioner who conducted the encounter, and the practitioner’s findings in accordance with He-W 553.06(a) below;

(3) For recipients under the age of 21, a recipient history and a health assessment with an appropriate pediatric tool completed upon admission by the RN or appropriate rehabilitation skilled professional in accordance with 42 CFR 484.55;

(4) For recipients over the age of 21, a recipient history and a health assessment, completed upon admission by the RN or appropriate rehabilitation skilled professional in accordance with 42 CFR 484.55, except that the homebound assessment of 42 CFR 484.55 is not required;

(5) Documentation at least every 60 days to indicate review of the recipient’s health assessment by the RN or appropriate rehabilitation skilled professional in accordance with 42 CFR 484.55;

(6) A written individualized plan of care which shall include the following:

a. The diagnosis related to the recipient’s need for home health services;

b. Other diagnoses;

c. An assessment of the recipient’s mental alertness and cognitive level;

d. Measurable recipient goals;

e. Types of services and equipment required;

f. Frequency of home health services;

g. Anticipated length of treatment;

h. General prognosis;

i. Rehabilitation potential;

j. Functional limitations including activities of daily living;

k. Activities permitted;

l. Nutritional requirements;

m. Medications;

n. Treatments;

o. Safety measures required to protect the recipient from potential injury;

p. Services being provided by non-paid caregivers involved in the recipient’s treatment and any related education or training needs of the caregivers; and

q. Discharge plans;

(7) Documentation at least every 60 days, to indicate review of the written plan of care by the recipient’s physician;

(8) Documentation at least every 60 days that indicates the locations of service delivery other than the recipient’s home for services already provided;

(9) Auditable, paper, or electronic service notes for each service provided to the recipient identifying:

a. Name of recipient;

b. Date of service;

c. Location(s) where service was provided, if other than the recipient’s primary residence;

d. Primary purpose of the home health services;

e. Description of services provided;

f. Amount of direct care time spent providing each home health service;

g. Condition of the recipient at the time the service was provided, and any significant change in recipient’s mental or physical condition;

h. Any progress the recipient has made towards goals identified on the written plan of care;

i. An explanation of any variation from the written plan of care; and

j. Name, title, and written or electronic signature of the individual providing the home health service; and

(10) Documentation of any consults or meetings regarding the recipient’s care, which also indicates the results of the consult or meeting.

(e) Home health care providers and independent nurses shall make the documentation required by this part and He-W 520 available for review to the department upon the request of the department.

History

#8972, eff 9-11-07; ss by #11127, eff 7-1-16 (formerly He-W 553.04) (See Revision Note at part heading for He-W 553)

N.H. Code Admin. R. Ann. He-W 553.06 Covered Services {#sec-he-w-553.06 omnilex-key=us-nh-regs-official--agency-he-w--He-W 553.06}

(a) Services shall be covered when:

(1) A physician orders services as part of a written plan of care; and

(2) A face-to-face encounter with the recipient, which may occur within 90 days before the initial start of the home health services or within 30 days after the start of services, is documented in compliance with He-W 553.05(d)(2) above, and is performed by one of the following medicaid enrolled providers:

a. The recipient’s physician; or

b. The following non-physician practitioners when the requirements in (b) below are met:

(i) A nurse practitioner or clinical nurse specialist working in collaboration with the recipient’s physician;

(ii) A certified nurse midwife; or

(iii) A physician assistant under the supervision of the recipient’s physician.

(b) Non-physician practitioners in (a)(2)b. above who perform the face-to-face encounter shall communicate the clinical findings of the face-to-face encounter to the recipient’s physician who shall incorporate the clinical findings into the recipient’s medical record.

(c) Covered services shall be those home health services, regardless of diagnosis, the need for which is consistent with the nature of the recipient’s condition and accepted standards of medical and nursing practice.

(d) Covered home health services shall include:

(1) Skilled nursing services in accordance with the written plan of care including:

a. Skilled observation and assessment of the recipient’s status, including available support system and physical environment;

b. Administration of medications, including intramuscular and intravenous medications;

c. Insertion and irrigation of indwelling urinary catheters;

d. Administration of enemas, providing ostomy care, and other related procedures to provide assistance with bowel evacuation;

e. Skilled respiratory care including suctioning, tracheostomy care, administration of inhalation therapies, and chest physiotherapy;

f. Wound care, care of decubitus ulcers, and treatment of other extensive skin disorders;

g. Administration of enteral feedings;

h. Rehabilitative nursing procedures such as the initiation and supervision of bowel and bladder training programs;

i. Education, specific to the recipient’s condition, provided to the recipient and significant others involved with the recipient;

j. Pre-filling of medication administration devices such as pill planners;

k. Medication reconciliation; and

l. Education about medication therapeutic effects, side effects, and adherence to prescribed regimen;

(2) Home health aide services, in accordance with the written plan of care, including assistance provided to a recipient for the following:

a. Personal hygiene, including bathing, grooming, dressing, and changing bed linens, when there is a medical need and it is documented in the care plan;

b. Ambulation and movement, including range of motion exercises, turning, positioning, and transferring;

c. Nutritional care, including feeding and hydration;

d. Elimination, including toileting and bowel or bladder training;

e. Assistance with the use of adaptive prosthetic and orthotic devices;

f. Assistance with self-administering medications, when the assistance provided by the aide does not require the skill of a licensed nurse;

g. Administration of medications by a medication LNA or by an LNA if delegated by a RN in accordance with RSA 326-B:14, II-a;

h. Activities that are directly supportive of skilled therapy services;

i. Other medically related activities which can safely and effectively be provided by a LNA, including simple dressing changes;

j. Light housekeeping when there is documentation that no other support in the home exists at the time of the visit, and when such services are directly related to the recipient’s medical condition and care needs and is documented in the written plan of care; and

k. Tasks properly delegated to the LNA by the supervising RN pursuant to RSA 326-B:28;

(3) Physical therapy, speech therapy, occupational therapy, speech pathology and audiology services provided a licensed therapy provider and subject to the limits specified in He-W 530;

(4) Durable medical equipment, medical supplies, prosthetics, and orthotic devices, when prescribed by the attending physician and in accordance with the requirements in He-W 571; and

(5) Office visits, when the recipient receives services provided by an advanced practice registered nurse (APRN) at the location of the home health care provider as an alternative to visiting a physician’s office for treatment.

History

#8972, eff 9-11-07; ss by #11127, eff 7-1-16 (formerly He-W 553.05) (See Revision Note at part heading for He-W 553)

N.H. Code Admin. R. Ann. He-W 553.07 Non-Covered Services {#sec-he-w-553.07 omnilex-key=us-nh-regs-official--agency-he-w--He-W 553.07}

Non-covered home health services shall include:

(a) Physician services;

(b) Social worker services;

(d) Visits provided solely for the purpose of supervising the LNA;

(e) Services provided by an LNA, RN, or LPN or other licensed therapy provider which are not medically related and which constitute routine household activities, day care, or recreational services;

(f) Services rendered without a physician’s signed order;

(g) Any service whose primary purpose is providing emotional support;

(h) Any service whose primary purpose is the care or supervision that would be required by any individual of the recipient’s chronological age;

(i) Drugs and biologicals;

(j) Meals delivered to the home; and

(k) Homemaker services considered to be general household activities, except as described in He-W 553.06(d)(2)j., including:

(1) Keeping a safe environment in areas of the home used by the recipient;

(2) Performing house cleaning;

(3) Rearranging furniture to assure that the recipient can safely reach necessary supplies or medication;

(4) Completing laundry tasks; and

(5) Assisting the recipient with purchasing food and helping with the preparation of meals and special diets.

PARTS He-W 554 and He-W 555 - RESERVED

History

#8972, eff 9-11-07; ss by #11127, eff 7-1-16 (formerly He-W 553.06) (See Revision Note at part heading for He-W 553)

Part He-W 558 Home and Community-Based Services for the Elderly and Chronically Ill - Expired

N.H. Code Admin. R. Ann. He-W 558.01 Medical Assistance {#sec-he-w-558.01 omnilex-key=us-nh-regs-official--agency-he-w--He-W 558.01}

– He-W 558.09

History

(See Revision Note at chapter heading He-W 500); ss by #5890, eff 8-31-94; ss by #7356, INTERIM, eff 8-31-00, EXPIRED: 2-27-01

Part He-W 559 Case Management of Advance Care Planning and Directives - Expired

N.H. Code Admin. R. Ann. He-W 559.01 Medical Assistance {#sec-he-w-559.01 omnilex-key=us-nh-regs-official--agency-he-w--He-W 559.01}

– He-W 559.02

History

(See Revision Note at chapter heading He-W 500); ss by #5891, eff 8-31-94, EXPIRED: 8-31-00
#7700, eff 7-1-02, EXPIRED: 7-1-10

N.H. Code Admin. R. Ann. He-W 559.03 Medical Assistance {#sec-he-w-559.03 omnilex-key=us-nh-regs-official--agency-he-w--He-W 559.03}

– He-W 559.08

PARTS He-W 560 through He-W 564 - RESERVED

History

#7700, eff 7-1-02, EXPIRED: 7-1-10

Part He-W 565 Vision Care Services

N.H. Code Admin. R. Ann. He-W 565.01 Definitions {#sec-he-w-565.01 omnilex-key=us-nh-regs-official--agency-he-w--He-W 565.01}

(a) “Department” means the New Hampshire department of health and human services.

(b) “Medicaid” means the Title XIX and Title XXI programs administered by the department, which makes medical assistance available to eligible individuals.

(d) “Optometrist” means a doctor of optometry (OD), a primary health care provider who diagnoses, manages, and treats conditions and diseases of the eye.

(e) “Optician” means “ophthalmic dispenser/optician” as defined in RSA 327-A:1,VII, namely “anyone who sells or dispenses, upon prescription, spectacles, eyeglasses or contact lenses.”

(f) “Recipient” means any individual who is eligible for and receiving medical assistance under the medicaid program.

(g) “Title XIX” means the joint federal-state program described in Title XIX of the Social Security Act and administered in New Hampshire under the medicaid program.

(h) “Title XXI” means the joint federal-state program described in Title XXI of the Social Security Act and administered in New Hampshire by the department under the medicaid program.

History

(See Revision Note at chapter heading He-W 500); ss by #4819, eff 6-1-90, EXPIRED: 6-1-96
#6705, eff 3-3-98, EXPIRED: 3-3-06
#8603, eff 4-10-06; amd by #10139, eff 7-1-12; ss by #10638, eff 7-12-14; ss by #14080, eff 9-25-24

N.H. Code Admin. R. Ann. He-W 565.02 Recipient Eligibility {#sec-he-w-565.02 omnilex-key=us-nh-regs-official--agency-he-w--He-W 565.02}

All medicaid recipients shall be eligible to receive vision care services, in accordance with He-W 565.

History

(See Revision Note at chapter heading He-W 500); ss by #4819, eff 6-1-90, EXPIRED: 6-1-96
#6705, eff 3-3-98, EXPIRED: 3-3-06
#8603, eff 4-10-06; ss by #10638, eff 7-12-14; ss by #14080, eff 9-25-24

N.H. Code Admin. R. Ann. He-W 565.03 Provider Participation {#sec-he-w-565.03 omnilex-key=us-nh-regs-official--agency-he-w--He-W 565.03}

Vision care providers shall meet the criteria specified below:

(a) Ophthalmologists and optometrists shall be licensed by the state in which they practice;

(b) Opticians practicing in New Hampshire (NH) shall be registered in accordance with RSA 327-A:2, or, if practicing in another state, meet the requirements of the state in which they practice;

(c) Opticians who fit contact lenses shall have a statement of delegation from an ophthalmologist or optometrist in accordance with RSA 327-A:2;

(d) Ophthalmologists, optometrists, and opticians shall be NH-enrolled medicaid providers; and

(e) Ophthalmologists, optometrists, and opticians shall request and obtain prior authorization from the department before providing services which require prior authorization.

History

(See Revision Note at chapter heading He-W 500); ss by #4819, eff 6-1-90, EXPIRED: 6-1-96
#6705, eff 3-3-98, EXPIRED: 3-3-06
#8603, eff 4-10-06; ss by #10638, eff 7-12-14; ss by #14080, eff 9-25-24

N.H. Code Admin. R. Ann. He-W 565.04 Service Limits {#sec-he-w-565.04 omnilex-key=us-nh-regs-official--agency-he-w--He-W 565.04}

Vision care services shall be subject to the limits described in He-W 565 and He-W 530.

History

(See Revision Note at chapter heading He-W 500); ss by #4819, eff 6-1-90, EXPIRED: 6-1-96
#6705, eff 3-3-98, EXPIRED: 3-3-06
#8603, eff 4-10-06; ss by #10638, eff 7-12-14; ss by #14080, eff 9-25-24

N.H. Code Admin. R. Ann. He-W 565.05 Covered Services {#sec-he-w-565.05 omnilex-key=us-nh-regs-official--agency-he-w--He-W 565.05}

Covered services shall include:

(a) Eye examination procedures to diagnose and monitor medical conditions of the eye, including:

(1) Complete eye examinations including:

a. Visual acuity testing;

b. Gross visual fields;

c. Muscle balance;

d. Slit lamp examinations; and

e. Ophthalmoscopy and tonometry;

(2) Interior extended testing of visual fields only;

(3) Ophthalmoscopy, fundoscopy only; and

(4) Routine tonometry;

(b) Eye examinations, performed in:

(1) A provider’s office;

(2) A recipient’s home; or

(3) A nursing facility in which the recipient resides;

(d) One pair of single vision lenses with frames, following an eye examination as described in (a) and (b) above, provided that the refractive error is at least plus or minus .50 diopter according to the type of refractive error, which may be calculated as a combined total of the spherical and cylindrical errors, in each eye;

(e) One pair of eyeglasses with bifocal corrective lenses or one pair of eyeglasses with corrective lenses for close vision and one pair of eyeglasses with corrective lenses for distant vision if there is a refractive error of at least .50 diopter for both close and distant vision;

(f) Transition lenses for recipients with ocular albinism;

(g) Contact lenses for ocular pathology in cases where the visual acuity is not correctable to 20/70 or better without contact lenses, or when required to correct aphakia or to treat corneal disease;

(h) Replacement of the component eyeglasses parts due to breakage or damage, subject to the following:

(1) Replacements may be in the form of a single lens, both lenses, frame only, or a complete pair of corrective lenses;

(2) Each component part or complete pair of corrective lenses may only be replaced one time within a 12-month period; and

(3) When the recipients has 2 pairs of eyeglasses in lieu of bifocals as allowed in (e) above, each pair of eyeglasses is subject to replacement in accordance with (1) and (2) above;

(i) Only one replacement of lost eyeglasses per lifetime for recipients under 21 years of age;

(j) Trifocal lenses provided that the recipient:

(1) Is employed and the trifocal lenses are required for the work involved in the recipient’s employment;

(2) Is a full time student and the trifocal lenses are required for the work involved in the recipient’s education; or

(3) Currently has trifocals;

(k) Progressive lenses;

(l) Ocular prostheses including:

(1) Artificial eyes; and

(2) Replacing the lens of an eye; and

(m) Replacement of nickel frames after 12 months, if the recipient has a documented allergy to nickel demonstrated by skin irritation and wearing down of the frame in the effected area.

History

(See Revision Note at chapter heading He-W 500); ss by #4819, eff 6-1-90, EXPIRED: 6-1-96
#6705, eff 3-3-98, EXPIRED: 3-3-06
#8603, eff 4-10-06; amd by #10342, eff 6-1-13; ss by #10638, eff 7-12-14; ss by #14080, eff 9-25-24

N.H. Code Admin. R. Ann. He-W 565.06 Non-Covered Services {#sec-he-w-565.06 omnilex-key=us-nh-regs-official--agency-he-w--He-W 565.06}

Non-covered services shall include:

(a) Replacement of lost eyeglasses, as follows:

(1) For recipients age 21 and over; and

(2) More than once per lifetime for recipients under age 21, except in accordance with He-W 546.06;

(b) Photochromatic lenses, including transition lenses, except for recipients diagnosed with ocular albinism or for other recipients with prior authorization;

(d) Orthoptics and vision therapy, such as muscle training;

(e) Low vision aids, such as magnifying glasses;

(f) Sunglasses and eyeglass tinting, except with prior authorization;

(g) Polarized lenses and anti-reflective coatings, except with prior authorization;

(h) Titanium frames;

(i) High-index lenses, except with prior authorization;

(j) LASIK surgery;

(k) Low vision aids;

(l) Items or services for which a less costly alternative is available; and

(m) Any other item or service not listed in He-W 565.05.

History

(See Revision Note at chapter heading He-W 500); ss by #4819, eff 6-1-90, EXPIRED: 6-1-96
#6705, eff 3-3-98, EXPIRED: 3-3-06
#8603, eff 4-10-06; ss by #10342, eff 6-1-13; ss by #10638, eff 7-12-14; ss by #14080, eff 9-25-24

N.H. Code Admin. R. Ann. He-W 565.07 Utilization Review and Control {#sec-he-w-565.07 omnilex-key=us-nh-regs-official--agency-he-w--He-W 565.07}

(a) The department’s bureau of program integrity shall monitor utilization of vision care services to identify, prevent, and correct potential occurrences of fraud, waste, and abuse in accordance with 42 CFR 455, 42 CFR 456, and He-W 520.

History

(See Revision Note at chapter heading He-W 500); ss by #4819, eff 6-1-90, EXPIRED: 6-1-96
#6705, eff 3-3-98, EXPIRED: 3-3-06
#8603, eff 4-10-06; ss by #10638, eff 7-12-14; ss by #14080, eff 9-25-24

N.H. Code Admin. R. Ann. He-W 565.08 Third Party Liability {#sec-he-w-565.08 omnilex-key=us-nh-regs-official--agency-he-w--He-W 565.08}

(a) All third party obligations shall be exhausted before NH medicaid may be billed, in accordance with 42 CFR 433.139.

(b) Vision care service providers shall request information from the recipient regarding other insurance coverage.

(c) If other insurance coverage is available, providers shall contact the insurer to verify benefits initially and at least annually thereafter or when the insurance carrier changes.

(d) Vision care service providers shall maintain a record of any other insurance verifications in the recipient’s medical record in accordance with He-W 520.

History

(See Revision Note at chapter heading He-W 500); ss by #4819, eff 6-1-90, EXPIRED: 6-1-96
#6705, eff 3-3-98, EXPIRED: 3-3-06
#8603, eff 4-10-06; ss by #10638, eff 7-12-14; ss by #14080, eff 9-25-24

N.H. Code Admin. R. Ann. He-W 565.09 Payment for Services {#sec-he-w-565.09 omnilex-key=us-nh-regs-official--agency-he-w--He-W 565.09}

(a) Payment for vision care services shall be made in accordance with rates established by the department in accordance with RSA 161:4, VI(a).

(b) The vision care provider shall submit claims for payment to the department’s fiscal agent.

(d) The provider shall maintain supporting records, in accordance with He-W 520.

History

(See Revision Note at chapter heading He-W 500); ss by #4819, eff 6-1-90, EXPIRED: 6-1-96
#6705, eff 3-3-98, EXPIRED: 3-3-06
#8603, eff 4-10-06; ss by #10638, eff 7-12-14; ss by #14080, eff 9-25-24

Part He-W 566 Dental Services

N.H. Code Admin. R. Ann. He-W 566.01 Definitions {#sec-he-w-566.01 omnilex-key=us-nh-regs-official--agency-he-w--He-W 566.01}

(a) “By report” means a written description of the service provided and the medical necessity of same as required by the department to be submitted with certain claims for payment of such claims.

(b) “Comprehensive orthodontic treatment” means diagnosis, long-term treatment, periodic evaluations, and retention, leading to improvement of a recipient’s malocclusion.

(c) “Deciduous teeth”, also known as primary teeth, means the 20 teeth that erupt first and are normally shed and replaced by secondary teeth.

(d) “Department” means the New Hampshire department of health and human services.

(e) “Destruction of tissue” means demonstrable, traumatic alteration of soft or hard tissue architecture with history of treatment of pain.

(f) “Diagnostic model” means a model or representation that demonstrates all erupted teeth, the gingival tissue surrounding the anterior and posterior arches, and the true occlusal relationships of the teeth and tissues.

(g) “Differential diagnosis” means a condition or disorder consistent with and reasonably thought to be the cause of the history, signs, and symptoms presented by the recipient which is determined by a process that differentiates it from other conditions or disorders with similar signs or symptoms.

(h) “Early and Periodic Screening, Diagnosis and Treatment (EPSDT) services” means a program, pursuant to 42 CFR 440.40, designed to provide preventative health care, diagnostic services, and early detection and treatment of disease or abnormalities to Title XIX eligible individuals under age 21.

(i) “Interceptive orthodontic treatment” means an intervention in the initial stages of a developing problem related to the dentition, to lessen severity of the malformation and to eliminate its cause.

(j) “Limited orthodontic treatment” means orthodontic treatment not involving the entire dentition.

(k) “Malocclusion” means improper alignment of the biting or chewing surfaces of upper and lower teeth that results from a deviation of the alignment of the teeth from the ideal alignment.

(l) “Medicaid” means the Title XIX and Title XXI programs administered by the department which makes medical assistance available to eligible individuals.

(m) “Medically necessary” means:

(1) For individuals under age 21, reasonably calculated to prevent, diagnose, correct, cure, alleviate, or prevent the worsening of conditions that endanger life, cause pain, result in illness or infirmity, threaten to cause or aggravate a handicap, or cause physical deformity or malfunction, and no other equally effective course of treatment is available or suitable for the EPSDT recipient requesting a medically necessary service; and

a. Clinically appropriate in terms of type, frequency of use, extent, site, and duration, and consistent with the established diagnosis or treatment of the recipient’s illness, injury, disease, or its symptoms;

b. Not primarily for the convenience of the recipient or the recipient’s family, caregiver, or health care provider;

d. Not experimental, investigative, cosmetic, or duplicative in nature.

(n) “Palliative treatment” means minor treatment to reduce the pain of a disease, illness, or injury of the tooth or teeth excluding non-treatment activities such as writing a prescription, dispensing a drug or medication, or telephone consultation with or about a recipient.

(o) “Radiograph” means an image or picture produced by exposure to ionizing radiation of a radiation-sensitive film, phosphorous plate, emulsion, or digital sensor.

(p) “Recipient” means any individual who is eligible for and receiving medical assistance under the medicaid program.

(q) “Severe handicapping malocclusion” means a malocclusion resulting from severe skeletal discrepancies that can be objectively documented as causing the following:

(1) Tissue injury;

(2) Significantly impaired speech, mastication, breathing or swallowing; or

(3) Severe psychological trauma or severe antisocial behavior.

(r) “Title XIX” means the joint federal-state program described in Title XIX of the Social Security Act and administered in New Hampshire by the department under the medicaid program.

(s) “Title XXI” means the joint federal-state program described in Title XXI of the Social Security Act and administered in New Hampshire by the department under the medicaid program.

History

(See Revision Note at chapter heading He-W 500); ss by #5639, eff 6-17-93; ss by #7012, eff 6-15-99; ss by #7912, eff 7-1-03; ss by #9902, eff 6-1-11; amd by #10139, eff 7-1-12; ss by #12782, INTERIM, eff 5-21-19, EXPIRED: 11-18-19
#12937, eff 12-7-19

N.H. Code Admin. R. Ann. He-W 566.02 Recipient Eligibility {#sec-he-w-566.02 omnilex-key=us-nh-regs-official--agency-he-w--He-W 566.02}

All Title XIX recipients shall be eligible to receive dental services, in accordance with He-W 566.

History

(See Revision Note at chapter heading He-W 500); ss by #5639, eff 6-17-93; ss by #7012, eff 6-15-99; ss by #7912, eff 7-1-03; ss by #9902, eff 6-1-11; ss by #12782, INTERIM, eff 5-21-19, EXPIRED: 11-18-19
#12937, eff 12-7-19

N.H. Code Admin. R. Ann. He-W 566.03 Provider Participation {#sec-he-w-566.03 omnilex-key=us-nh-regs-official--agency-he-w--He-W 566.03}

Each participating dental provider shall:

(a) Hold an active license to practice dentistry in the state in which he or she practices;

(b) Be a New Hampshire enrolled Title XIX provider; and

History

(See Revision Note at chapter heading He-W 500); ss by #5639, eff 6-17-93; ss by #7012, eff 6-15-99; ss by #7912, eff 7-1-03; ss by #9902, eff 6-1-11; ss by #12782, INTERIM, eff 5-21-19, EXPIRED: 11-18-19
#12937, eff 12-7-19

N.H. Code Admin. R. Ann. He-W 566.04 Covered Services {#sec-he-w-566.04 omnilex-key=us-nh-regs-official--agency-he-w--He-W 566.04}

(a) The following dental services shall be covered for recipients who are under 21 years of age:

(1) Prophylaxis, no more frequently than every 150 days;

(2) Restorative treatment;

(3) Periodic examinations, no more frequently than every 150 days, unless they are medically necessary to diagnose an illness or condition;

(4) Vital pulpotomy, which consists of removal of diseased or involved pulp in an effort to retain the remaining pulp in a healthy, vital condition;

(5) Extractions of symptomatic teeth associated with diagnosed pathology, such as tumor, cyst, or infection, except third molars as described in (7) below;

(6) Extractions of asymptomatic teeth, except third molars as described in (7) below, subject to prior authorization in accordance with He-W 566.07, as follows:

a. When associated with diagnosed pathology, such as tumor, cyst, or infection; or

b. When extraction is part of an orthodontic treatment plan that has been approved through prior authorization by the department in accordance with He-W 566.07;

(7) Third molar extraction, subject to prior authorization in accordance with He-W 566.07;

(8) General anesthesia when medically necessary and documented in the recipient’s dental records;

(9) Nitrous oxide analgesia and intravenous therapy sedation;

(10) Comprehensive orthodontic treatment for severe handicapping malocclusion in accordance with He-W 566.05(a), subject to prior authorization in accordance with He-W 566.07;

(11) Interceptive orthodontic treatment in accordance with He-W 566.05(b), subject to prior authorization in accordance with He-W 566.07;

(12) Space maintainers when medically necessary to replace a prematurely lost deciduous or permanent molar or bicuspid;

(13) Limited orthodontic treatment in accordance with He-W 566.05(c);

(14) Radiographs as follows:

a. Complete series or panographic survey, once every 5 years;

b. Bitewings every 12 months if medically necessary; and

c. All types of dental radiographs regardless of limits in a. and b. above, as may be required to complete a differential diagnosis;

(15) Palliative treatment when the claim is submitted in accordance with He-W 566.10(f);

(16) Removable prosthetic replacement of permanent teeth subject to prior authorization in accordance with He-W 566.07;

(17) Topical fluoride treatment applied twice per year until age 21;

(18) If moderate or high risk of caries is documented, 2 applications of silver diamine per tooth, provided that no more than 18 total silver diamine treatments shall be administered per year and no application of silver diamine shall be administered after the recipient reaches the age of 21;

(19) Endodontia, including root canal therapy, excluding third molars, when the claim is accompanied by a radiograph, and the endodontia treatment is deemed complete when all radiographs demonstrate that the canals are completely filled to the apex of the root(s) of the tooth in accordance with He-W 566.10(e);

(20) Crowns;

(21) Periodontal treatment limited to prophylaxis, scaling, and root planing;

(22) Surgical periodontal treatment subject to prior authorization in accordance with He-W 566.07;

(23) Sealants for permanent and deciduous molars every 5 years, until age 21;

(24) Diagnostic and preventive dental services, with the exception of orthodontic treatment as allowed in (b) below, available for EPSDT-eligible children in accordance with He-W 546.05; and

(25) Other services determined by the department to be medically necessary, in accordance with He-W 546.06.

(b) Orthodontic treatment for malocclusions that do not meet the criteria set forth in He-W 566.05(b) shall be considered for orthodontic treatment under the EPSDT prior authorization for coverage based on medical necessity provisions at He-W 546 when documentation of the following is submitted to the department:

(1) Principal diagnosis;

(2) Prognosis with and without treatment;

(3) Date of onset of the illness or condition and etiology, if known;

(4) Clinical significance or functional impairment or pathology caused by the illness or condition resulting from the malocclusion;

(5) Demonstration of evidence of the degree to which the malocclusion contributes to the illness or condition;

(6) Specific types of services to be rendered by each discipline associated with the total treatment plan;

(7) Therapeutic goals to be achieved by each discipline and anticipated time for achievement of goals;

(8) Explanation of any existing conditions that are likely to limit efficacy of treatment;

(9) Extent to which health care services have been previously provided to address the illness or condition and summary of results demonstrated by prior care;

(10) Orthodontic records as described in He-W 566.05(g)(1), (2) and (4); and

(11) Any additional documentation in accordance with He-W 546.06(b) or any other documentation available which might assist in making a determination of medical necessity of the proposed orthodontic treatment.

(c) The documentation submitted in accordance with (b) above shall be completed by health professionals who are sufficiently trained and duly licensed to diagnose and treat the illness or condition arising from the malocclusion and creating the medical necessity for treatment.

(d) The documentation described in (b) and (c) above shall be submitted to the department by the medicaid enrolled provider who will complete the orthodontic treatment along with a request for prior authorization in accordance with He-W 546.06.

(e) The following dental services shall be covered for recipients 21 years of age or over for relief of acute pain or elimination of acute infection or diagnosed pathology:

(1) Palliative treatment when the claim is submitted in accordance with He-W 566.10(f);

(2) Extraction of the causative tooth or teeth and biopsy of the tooth or teeth;

(3) Treatment of severe trauma, when a determination is made by the attending clinician using standard medical parameters for emergency conditions, which shall include, but not be limited to:

a. Hemorrhage;

b. Laceration requiring suturing;

c. Abrasion requiring debridement; or

d. Bone fracture requiring reduction; and

(4) Radiographs and examinations as necessary to assess conditions described in (1)-(3) above.

History

(See Revision Note at chapter heading He-W 500); ss by #5639, eff 6-17-93; ss by #7012, eff 6-15-99; ss by #7912, eff 7-1-03; ss by #9902, eff 6-1-11; ss by #12782, INTERIM, eff 5-21-19, EXPIRED: 11-18-19
#12937, eff 12-7-19

N.H. Code Admin. R. Ann. He-W 566.05 Orthodontic Treatment {#sec-he-w-566.05 omnilex-key=us-nh-regs-official--agency-he-w--He-W 566.05}

(a) Comprehensive orthodontic treatment shall be covered for recipients under 21 years of age who demonstrate severe handicapping malocclusion, which limits function and if left untreated would result in damage to the dental structures or surrounding tissue, due to one or more of the following conditions:

(1) Crowding of teeth greater than 12 mm in a single arch;

(2) Deep impinging overbite with destruction of tissue;

(3) Crossbite of anterior teeth with destruction of tissue;

(4) Overjet greater than 9 mm;

(5) Reverse overjet greater than 3.5 mm; or

(6) Severe traumatic deviations demonstrated by gross pathology.

(b) Interceptive orthodontic treatment shall be covered for recipients under 21 years of age who have at least one of the following conditions:

(1) Constricted palate;

(2) Deep impinging overbite with demonstration of destruction of tissue;

(3) Anterior crossbite; or

(4) Dentition exhibiting results of harmful habits.

(c) Limited orthodontic treatment shall be covered for recipients under 21 years of age, by report, and no more than once per arch per recipient per lifetime.

(d) Comprehensive and interceptive orthodontic treatment shall:

(1) Each be covered once per recipient per lifetime; and

(2) Require prior authorization in accordance with He-W 566.07.

(e) Sealants shall be present on all permanent molars prior to the provider requesting prior authorization in (d)(2) above.

(f) Any dental provider who undertakes orthodontic treatment for children with severe handicapping malocclusions shall be qualified by training and experience in accordance with Den 302.04.

(g) In addition to the information required at He-W 566.07, prior authorization requests for comprehensive and interceptive orthodontic treatment shall include the following:

(1) A treatment plan, which shall address and include the following:

a. Diagnosis and explanation describing the nature of the severe handicapping malocclusion or functional limitation associated with the malocclusion with sufficient detail and documentation to support and demonstrate the existence of conditions described in (a)-(b) above or He-W 546.05;

b. Justification for early treatment if the request is for comprehensive treatment and deciduous teeth are present or not all of the permanent teeth have erupted;

c. Name of the referring dentist;

d. Description of the chief complaint expressed by the referring dentist or the recipient or legal representative;

e. Specific treatment objectives;

f. Description of the plan for comprehensive oral care during orthodontic treatment;

g. Signed statement from the provider attesting that:

The recipient has received an oral examination and was found to be free of untreated oral disease;
The recipient demonstrates oral hygiene habits consistent with being able to prevent inflammation and dental decay during orthodontic treatment; and
Sealants are in place on all of the recipient’s unrestored erupted molars; and

h. Signed statement from the recipient or legal representative acknowledging the recipient’s understanding and acceptance:

Of the provider’s treatment plan including, but not limited to, the recipient’s willingness to adhere to an oral hygiene regimen necessary to prevent inflammation and decay, to attend any scheduled appointments, and to properly wear and maintain the appliance;
Of the provider’s right to discontinue treatment for non-compliance, including, but not limited to, the recipient’s failure to adhere to oral hygiene expectations, missed appointments, and failure to properly wear or maintain appliances;
That the Title XIX program will not pay for the cost of orthodontic treatment beyond the recipient’s 21st birthday; and
That the Title XIX program will not pay for the cost of orthodontic treatment more than once per recipient per lifetime if treatment is terminated due to non-compliance with the treatment plan as documented by the provider;

(2) Diagnostic model taken within 30 days of submitting the prior authorization request;

(3) Treatment cost estimate;

(4) Except as allowed by (h) below, radiographs that are current and of adequate quality to allow for an accurate diagnosis of the malocclusion; and

(5) Assurance that the requested treatment is the least restrictive, most cost-effective treatment for the malocclusion.

(h) When requesting interceptive treatment, photographs may be submitted in lieu of radiographs, provided the photographs clearly demonstrate the criteria being considered for approval.

(i) Banding shall occur within 60 days of the receipt of the prior authorization approval.

(j) Comprehensive orthodontic treatment shall be covered only if the recipient adheres to the treatment plan of care specified at (g)(1) above.

(k) Treatment may be terminated by the provider for non-compliance, including, but not limited to, the recipient’s failure to adhere to oral hygiene expectations, missed appointments, and failure to properly wear or maintain appliances.

(l) Providers shall supply the department with treatment progress reports at the following intervals:

(1) A progress report immediately following the 12th month of treatment, including a description of recipient compliance with the provider’s treatment plan and a report of objectives achieved to date;

(2) A final treatment report, including diagnostic models or post treatment photographs of the dentition in centric relation from center, right and left sides, submitted at the conclusion of treatment which demonstrate that the treatment goals have been met; and

(3) Immediate report of any patterns of non-compliance, if applicable.

History

(See Revision Note at chapter heading He-W 500); ss by #5639, eff 6-17-93; ss by #7012, eff 6-15-99; ss by #7912, eff 7-1-03; ss by #9902, eff 6-1-11; ss by #12782, INTERIM, eff 5-21-19, EXPIRES: 11-18-19
#12937, eff 12-7-19

N.H. Code Admin. R. Ann. He-W 566.06 Non-Covered Services {#sec-he-w-566.06 omnilex-key=us-nh-regs-official--agency-he-w--He-W 566.06}

Non-covered services shall include:

(a) A dental procedure, which is attempted but cannot be completed;

(b) Behavior management or the administration of psychotropic medication to modify the recipient’s behavior in the dental office;

(d) Dental and orthodontic treatment or surgery for the purpose of preserving or improving appearance, except when required for the prompt repair of accidental injury;

(e) Services that have not been proven to be safe or effective, as documented in dental peer review literature;

(f) Fixed prostheses of more than one unit;

(g) Implants and procedures associated with implants such as bone grafting;

(h) Dental services rendered in locations other than the dental office, such as in outpatient hospital settings or ambulatory surgical centers, when such services could be performed in a dentist’s office and there is no medical need for the use of an acute care, outpatient hospital, or ambulatory facility;

(i) Orthodontic treatment for recipients who have failed to comply with a prescribed treatment plan that has been approved through prior authorization by the department, including non-compliance with appointments, hygiene, or care of appliances, with such failure documented by the provider;

(j) Periodic examinations for recipients age 21 or over;

(k) Services that are not dental in nature;

(l) Services that are more costly than other services but are expected to provide the recipient with the same functional outcome;

(m) Replacement or repair of dental appliances required as a result of recipient neglect, wrongful disposition, intentional misuse or abuse;

(n) Extractions of asymptomatic teeth and third molars, unless prior authorized in accordance with He-W 566.07;

(o) Periodontal treatment consisting of subgingival placement of biological materials or chemotherapeutic agents;

(p) Periodontal surgery, unless prior authorized in accordance with He-W 566.07;

(q) The portion of the orthodontic treatment plan carried out after the recipient reaches 21 years of age;

(r) Any treatment, such as extractions, radiographs, examinations, and other services, that are ancillary to an orthodontic treatment plan that has not been prior authorized for medicaid coverage;

(s) Dental records, including casts and radiographs, when such records do not meet the criteria set forth in He-W 566.05(a)-(b) above or He-W 546.05; and

(t) Endodontics, including root canal therapy, that has not been deemed complete in accordance with He-W 566.04(a)(18) and He-W 566.10(e).

History

(See Revision Note at chapter heading He-W 500); ss by #5639, eff 6-17-93; ss by #7012, eff 6-15-99; ss by #7912, eff 7-1-03; ss by #9902, eff 6-1-11; ss by #12782, INTERIM, eff 5-21-19, EXPIRES: 11-18-19
#12937, eff 12-7-19

N.H. Code Admin. R. Ann. He-W 566.07 Prior Authorization {#sec-he-w-566.07 omnilex-key=us-nh-regs-official--agency-he-w--He-W 566.07}

(a) The following dental services and procedures, as described in He-W 566.04, shall require prior authorization from the department:

(1) Comprehensive and interceptive orthodontic treatment;

(2) Dental orthotic device;

(3) Surgical periodontal treatment;

(4) Extraction of asymptomatic teeth and third molars; and

(5) Removable prosthesis.

(b) Procedures for prior authorization shall be as follows:

(1) The prior authorization shall be for the item or treatment requested and be obtained prior to providing the item or treatment;

(2) Notwithstanding (1) above, for extractions that warrant immediate action, both the prior authorization request and the claim for payment shall be submitted to the address in (4) below after the extraction is performed;

(3) The recipient shall have the primary responsibility for obtaining prior authorization and may do this with the assistance of the provider, who requests authorization on behalf of the recipient; and

(4) Requests for dental prior authorizations shall be addressed to:

New Hampshire Department of Health and Human Services

Office of Medicaid Business and Policy

Dental Director’s Office

Attn: Dental Consultant

129 Pleasant Street

Concord, NH 03301

(c) Requests for prior authorization shall include sufficient, current medical information to enable the department to evaluate the request.

(d) Prior authorization requests for services in (a) above, shall include:

(1) An explanation describing the illness, special care, or specific condition, to enable the department to understand the physical and/or emotional problem of the recipient and the specified goal for which the item or treatment is being requested;

(2) Assurance that the required treatment is the least restrictive, most cost-effective alternative;

(3) Cost of the treatment, if known;

(4) Diagnosis;

(5) Expected outcome and recommended timetable of the prescribed item or treatment;

(6) Name and address of the intended provider;

(7) Name and address of person or agency making the request;

(8) Radiographs;

(9) Periodontal charting when surgical periodontal treatment is requested; and

(10) Recipient name, address, date of birth, and medicaid identification number (MID).

(e) In addition to (d) above, prior authorization requests for the extraction of third molars and asymptomatic teeth shall also include an explanation describing the specific conditions or illness that requires tooth removal and a radiograph supporting the rationale for removal, and shall include the diagnosed pathology, if present, for each tooth requested.

(f) Prior authorization requests for comprehensive and interceptive orthodontic treatment shall include, in addition to the information specified in (c) and (d) above, information specified in He-W 566.05(g).

(g) Prior authorizations shall be approved by the department upon determination that the treatment requested is appropriate, cost effective and supported by the documentation submitted in accordance with (b) through (f) above.

(h) If the department approves the prior authorization request, the state’s fiscal agent shall send written notification of the approval to the provider.

(i) Prior authorization requests for comprehensive and interceptive orthodontic treatment that do not have enough information as required in accordance with He-W 566.05(g) and (c) through (f) above for an approval or denial decision shall be returned to the provider.

(j) All prior authorizations approved shall be provider-specific and shall be non-transferable between providers.

(k) Prior authorization requests for services and procedures specified in (a)(2)-(5) above that do not have enough information as required in accordance with (c) through (e) above for an approval or denial decision shall be returned to the provider.

(l) Providers shall be responsible for determining that the recipient is medicaid eligible on the date of service.

(m) If the department denies the prior authorization request, the department shall forward a notice of denial to the recipient and the provider on the department’s Form 272a, “Medical Assistance Program Denial for Prior Authorized Services,” which includes the following information:

(1) The reason for, and legal basis of, the denial; and

(2) Information that a fair hearing on the denial may be requested within 30 calendar days of the date on the notice of the denial, in accordance with He-C 200.

(n) Decisions made by the department in accordance with (g)-(i) and (k) above shall not be superseded by the treating or consultative health care professional’s prescription, orders, or recommendations.

History

(See Revision Note at chapter heading He-W 500); ss by #5639, eff 6-17-93; ss by #7012, eff 6-15-99; ss by #7912, eff 7-1-03; ss by #9902, eff 6-1-11; amd by #10031, eff 11-19-11; ss by #12782, INTERIM, eff 5-21-19, EXPIRED: 11-18-19
#12937, eff 12-7-19

N.H. Code Admin. R. Ann. He-W 566.08 Utilization Review and Control {#sec-he-w-566.08 omnilex-key=us-nh-regs-official--agency-he-w--He-W 566.08}

(a) The department’s program integrity unit shall monitor utilization of dental services to identify, prevent, and correct potential occurrences of fraud, waste, and abuse in accordance with 42 CFR 455, 42 CFR 456, 42 CFR 1001, and He-W 520.

History

(See Revision Note at chapter heading He-W 500); ss by #5639, eff 6-17-93; ss by #7012, eff 6-15-99; ss by #7912, eff 7-1-03; ss by #9902, eff 6-1-11; ss by #12782, INTERIM, eff 5-21-19, EXPIRED: 11-18-19
#12937, eff 12-7-19

N.H. Code Admin. R. Ann. He-W 566.09 Third Party Liability {#sec-he-w-566.09 omnilex-key=us-nh-regs-official--agency-he-w--He-W 566.09}

All third party obligations shall be exhausted before the Title XIX program shall be billed, in accordance with 42 CFR 433.139, except that if the recipient is under age 21 and is an EPSDT participant or has other medical insurance provided by an absent parent, the Title XIX program shall pay the provider for the service rendered and pursue reimbursement from the other medical insurance.

History

(See Revision Note at chapter heading He-W 500); ss by #5639, eff 6-17-93; ss by #7012, eff 6-15-99; ss by #7912, eff 7-1-03; ss by #9902, eff 6-1-11; ss by #12782, INTERIM, eff 5-21-19, EXPIRESD 11-18-19
#12937, eff 12-7-19

N.H. Code Admin. R. Ann. He-W 566.10 Payment for Services {#sec-he-w-566.10 omnilex-key=us-nh-regs-official--agency-he-w--He-W 566.10}

(a) Payment for dental services shall be made in accordance with rates established by the department in accordance with RSA 161:4, VI(a).

(b) Dental providers shall submit claims for payment to the department’s fiscal agent.

(c) Pursuant to He-W 566.07(b)(2), for extractions that warrant immediate action, both the prior authorization request and the claim for payment shall be submitted to the address in He-W 566.07(b)(4).

(d) Dental providers shall maintain supporting records, in accordance with He-W 520 and this part.

(e) Payments for endodontic treatments, including root canal treatment, shall be made only when the provider submits a radiograph that demonstrates that the endodontic therapy was successful, effective, and complete when completely filled to the apex of the root(s) of the tooth.

(f) Payment for palliative treatments shall be made only when the provider submits documentation by report that demonstrates that the treatment was completed and the services provided were consistent with palliative treatment as defined in He-W 566.01(n).

(g) Payment for comprehensive orthodontic treatment shall be inclusive of, but not limited to:

(1) All examinations associated with the orthodontic treatment including periodic and emergency examinations;

(2) All periodic adjustments associated with the orthodontic treatment;

(3) All radiographs, diagnostic models, images, and other records associated with the orthodontic treatment;

(4) Space maintenance, when performed by the orthodontic provider within 2 years of the banding;

(5) Appliances as applied;

(6) Application and removal of appliances;

(7) Replacement and repair of brackets, bands, and arch wires;

(8) Retainers and follow-up examinations;

(9) Treatment ancillary to the orthodontia, including, but not limited to, separators and radiographs;

(10) Orthodontically related palliative treatment; and

(11) Closing records.

(h) Payment for interceptive orthodontic treatment shall be inclusive of, but not limited to:

(1) All examinations associated with the orthodontic treatment including periodic and emergency examinations;

(2) All periodic adjustments associated with the orthodontic treatment;

(3) All radiographs, diagnostic models, images, and other records associated with the orthodontic treatment;

(4) Space maintenance, if applicable;

(5) Appliances as applied;

(6) Application and removal of appliances;

(7) Replacement and repair of brackets, bands, and arch wires;

(8) Retainers and follow-up examinations, if applicable;

(9) Treatment ancillary to the orthodontia, including but not limited to separators and radiographs;

(10) Orthodontically related palliative treatment; and

(11) Closing records.

(i) Payments for comprehensive orthodontic treatment for services prior authorized shall be made to the provider in 3 equal installments upon the department’s receipt of an orthodontic claim and as follows:

(1) A payment shall be made following the application of appliances;

(2) A payment shall be made following the completion of the 12th month of treatment and the submission of a progress report as described in He-W 566.05(l)(1); and

(3) A payment shall be made following case completion and the submission of the final treatment report and photographs as described in He-W 566.05(l)(2).

(j) In the event of termination, provider payment for comprehensive treatment shall be prorated as follows:

(1) If the appliances have been applied and the recipient is terminated or transferred before completing 12 months of treatment, the provider shall receive payment in accordance with (i)(1) above plus a payment equal to the reimbursement rate for each periodic adjustment the recipient received; and

(2) If the recipient has completed 12 months of treatment and is terminated prior to case completion, the provider shall receive payment in accordance with (i)(1)-(2) above plus a payment equal to the reimbursement rate for each periodic adjustment the recipient received following the 12th month of treatment, up to 10 adjustments.

(k) If treatment of the recipient is transferred to another provider, the new provider shall:

(1) Request prior authorization for treatment in accordance with He-W 566.07; and

(2) Receive payment based on the terms of the treatment plan that has been approved through prior authorization by the department in accordance with He-W 566.07.

(l) Prior to terminating orthodontic treatment of a recipient, the provider shall remove the appliances and provide retention.

History

#7012, eff 6-15-99; ss by #7912, eff 7-1-03; ss by #9902, eff 6-1-11; ss by #12782, INTERIM, eff 5-21-19, EXPIRED: 11-18-19
#12937, eff 12-7-19

Part He-W 567 Hearing Aid Services

N.H. Code Admin. R. Ann. He-W 567.01 Definitions {#sec-he-w-567.01 omnilex-key=us-nh-regs-official--agency-he-w--He-W 567.01}

(a) “Audiogram” means a specific hearing test which charts a person’s hearing sensitivity utilizing an audiometer or other specialized equipment, such as:

(1) Pure tone air audiometry;

(2) Bone conduction testing;

(3) Speech audiometry, including speech reception threshold and speech recognition; and

(4) Auditory brainstem response (ABR) testing which includes measurements of frequency specific thresholds.

(b) “Department” means the New Hampshire department of health and human services.

(c) “Hearing aid” means “hearing aid” as defined in RSA 137-F:2, IV, namely “any wearable instrument or device designed for or offered for the purpose of or represented as aiding or compensating for impaired human hearing and any parts or attachments, including ear molds, but excluding batteries and cords or accessories thereto, or equipment, devices, and attachments used in conjunction with services provided by a public utility company.”

(d) “Hearing aid consultation” means discussion with an audiologist of hearing aid options regarding degree, type, and configuration of hearing loss to determine an appropriate make and model of hearing aid.

(e) “Hearing aid evaluation” means real ear evaluation of the current aids to determine if the aids are adequate to meet the recipient’s needs, or sound field evaluation for devices that cannot be measured via real ear, such as cochlear implants, bone anchored or bone conduction hearing aids.

(f) “Medicaid” means the Title XIX and Title XXI programs administered by the department which makes medical assistance available to eligible individuals.

(g) “Pocket talker” means a portable, personal amplification device that is used to amplify sound and speech or to adjust tone to enhance comprehension of speech, including, but not limited to, a generic device or a device with the brand name “Pocketalker”, “Riezen”, “Listen Up”, or “Super Ear”.

(h) “Recipient” means any individual who is eligible for and receiving medical assistance under the medicaid program.

(i) “Statutory blindness” means “blindness” as defined in Sections 216(i)(1) and 1614(a)(2) of the Social Security Act, 42 USC 416, and 42 USC 1382c.

(j) “Title XIX” means the joint federal-state program described in Title XIX of the Social Security Act and administered in New Hampshire by the department under the medicaid program.

(k) “Title XXI” means the joint federal-state program described in Title XXI of the Social Security Act and administered in New Hampshire by the department under the medicaid program.

History

(See Revision Note at chapter heading He-W 500); ss by #6157, eff 12-29-95, EXPIRED: 12-29-03
#9480, eff 5-23-09, amd by #10139, eff 7-1-12; paras (a)-(e), (g), and (i); EXPIRED 5-23-17; ss by #12538, eff 5-25-18

N.H. Code Admin. R. Ann. He-W 567.02 Recipient Eligibility {#sec-he-w-567.02 omnilex-key=us-nh-regs-official--agency-he-w--He-W 567.02}

All medicaid recipients shall be eligible for hearing aid services, in accordance with He-W 567.

History

(See Revision Note at chapter heading He-W 500); ss by #6157, eff 12-29-95, EXPIRED: 12-29-03
#9480, eff 5-23-09, EXPIRED: 5-23-17
#12538, eff 5-25-18

N.H. Code Admin. R. Ann. He-W 567.03 Provider Participation {#sec-he-w-567.03 omnilex-key=us-nh-regs-official--agency-he-w--He-W 567.03}

Each participating hearing aid services provider shall be:

(a) One of the following:

(1) An audiologist licensed in accordance with RSA 137-F:11 or licensed by the state in which he or she practices; or

(2) A hearing aid dealer registered in accordance with RSA 137-F:8 or credentialed in accordance with applicable law in the state in which he or she practices; and

(b) A New Hampshire enrolled medicaid provider.

History

(See Revision Note at chapter heading He-W 500); ss by #6157, eff 12-29-95, EXPIRED: 12-29-03
#9480, eff 5-23-09, EXPIRED: 5-23-17
#12538, eff 5-25-18

N.H. Code Admin. R. Ann. He-W 567.04 Service Limits {#sec-he-w-567.04 omnilex-key=us-nh-regs-official--agency-he-w--He-W 567.04}

All hearing aid services shall be subject to the limits set forth in He-W 567 and He-W 530.03.

History

(See Revision Note at chapter heading He-W 500); ss by #6157, eff 12-29-95, EXPIRED: 12-29-03
#9480, eff 5-23-09, EXPIRED: 5-23-17
#12538, eff 5-25-18

N.H. Code Admin. R. Ann. He-W 567.05 Covered Services {#sec-he-w-567.05 omnilex-key=us-nh-regs-official--agency-he-w--He-W 567.05}

With the exception of those items specified in He-W 567.06, the following hearing aid services and items shall be covered:

(a) When provided by an audiologist or hearing aid dealer:

(1) The hearing aid evaluation or a hearing aid consultation, which shall be limited to one service every 2 years since the last date of service for recipients age 21 or over and as needed for recipients under age 21;

(2) The ear mold(s);

(3) The least costly hearing aid(s) or pocket talker as determined by the audiologist or hearing aid dealer to achieve appropriate access to speech in all of the recipient’s communication settings;

(4) The dispensing or fitting of the hearing aid(s) or pocket talker, including real ear verification for conventional hearing aids, adjustment, and instruction;

(5) Follow-up to include verification of hearing aid or pocket talker performance, if not completed at the fitting, and monitoring of hearing thresholds, as needed; and

(6) The audiogram;

(b) Monaural hearing aids:

(1) For recipients under 21 years of age when:

a. The audiogram indicates a unilateral hearing loss of one or more thresholds of 25 decibels (dB) hearing level (HL) or poorer at any frequency from 1000 hertz (Hz) to 4000 Hz; and

b. The audiologist or hearing aid dispenser deems the loss communicatively significant; and

(2) For recipients 21 years of age or over when the audiogram indicates a bilateral hearing loss with an average threshold of 35 dBHL or poorer for 1000 Hz, 2000 Hz, 3000 Hz, and 4000 Hz by pure tone air conduction;

(1) For recipients under 21 years of age when:

a. The audiogram indicates a bilateral hearing loss of one or more thresholds of 25 dBHL or poorer at any frequency from 1000 Hz to 4000 Hz; and

b. The audiologist or hearing aid dispenser deems the loss communicatively significant; and

(2) For recipients 21 years of age or over, when:

a. A prior authorization has been requested and obtained from the department in accordance with He-W 567.07 in advance of the hearing aid(s) being rendered; and

b. One of the following applies:

The coverage criteria for monaural hearing aids per He-W 567.05(b), and one of the following criteria have been met:

(i) The recipient is attending post-secondary school at any educational level for the purpose of obtaining employment or is receiving vocational training, as documented in accordance with He-W 567.08(d); or

(ii) The recipient is employed and is likely to be determined as unable to meet the audiometric requirements of the job without the use of binaural hearing aids, as documented in accordance with He-W 567.08(c); or

The recipient meets the definition of statutory blindness per He-W 567.01(i) and as documented in accordance with He-W 567.08(b), and an audiogram indicates a unilateral hearing loss with an average threshold of 35 dBHL or poorer for 1000 Hz, 2000 Hz, 3000 Hz, and 4000 Hz by pure tone air conduction;

(d) Hearing aid batteries for the life span of the hearing aid(s);

(e) Replacement of hearing aids:

(1) If there is an increase in the recipient’s hearing loss, as established by the most recent audiogram, which makes the existing hearing aid ineffective;

(2) If an audiologist or hearing aid dealer determines that the hearing aid can no longer be repaired, or that it is not cost effective to do so; or

(3) If the replacement is due to loss and is coverable under He-W 546 for recipients under age 21;

(f) Hearing aid repairs, which shall not require:

(1) A physician referral; or

(2) An initial purchase by medicaid;

(g) Frequency modulation (FM) systems for recipients under age 21, when a hearing aid on its own does not meet the recipient’s personal amplification needs, or when a traditional hearing aid is not an appropriate option, as determined by an audiologist;

(h) Pocket talkers, to accommodate hearing loss and enhance communications, when:

(1) The audiogram indicates that a recipient has a bilateral hearing loss with an average threshold of 35 dBHL or poorer for 1000 Hz, 2000 Hz, 3000 Hz, and 4000 Hz by pure tone air conduction; and

(2) A hearing aid is not already covered by medicaid;

(i) Replacement of a pocket talker:

(1) With hearing aid(s) or a more effective pocket talker if there is an increase in the recipient’s hearing loss, as established by the most recent audiogram, which makes the existing pocket talker ineffective; or

(2) Once every 5 years; and

(j) Replacement of a headset, earbuds, or neckloop for a pocket talker once every year if an audiologist determines that such accessories are malfunctioning.

History

(See Revision Note at chapter heading He-W 500); ss by #6157, eff 12-29-95, EXPIRED: 12-29-03
#9480, eff 5-23-09; ss by #9739, eff 6-25-10; amd by #10342, eff 6-1-13; ss by #12538, eff 5-25-18

N.H. Code Admin. R. Ann. He-W 567.06 Non-Covered Services {#sec-he-w-567.06 omnilex-key=us-nh-regs-official--agency-he-w--He-W 567.06}

Non-covered services shall include, but not be limited to:

(a) Replacement of hearing aids due to loss, misuse, or abuse, except as noted in He-W 567.05(e)(3);

(b) FM systems, if the systems are for the sole purpose of recipient use in an educational setting and are coverable under He-M 1301;

(d) Pocket talker repairs, batteries, accessories, except those listed in He-W 567.05(j) above, and optional telelinks;

(e) A pocket talker if a hearing aid is already covered by medicaid;

(f) A hearing aid if a pocket talker is already covered by medicaid, unless the criterion in He-W 567.05(i)(1) is met; and

(g) Binaural hearing aids for recipients 21 years of age or over when the requirements set forth in He-W 567.05(c)(2) or He-W 567.07 have not been met.

History

(See Revision Note at chapter heading He-W 500); ss by #6157, eff 12-29-95, EXPIRED: 12-29-03
#9480, eff 5-23-09; amd by #10342, eff 6-1-13; ss by #12538, eff 5-25-18

N.H. Code Admin. R. Ann. He-W 567.07 Prior Authorization of Binaural Hearing Aids for Recipients 21 Years of Age or Older {#sec-he-w-567.07 omnilex-key=us-nh-regs-official--agency-he-w--He-W 567.07}

(a) Providers shall direct requests for prior authorization, as required in He-W 567.05(c)(2)a. above, to the department.

(b) Requests for prior authorization shall be submitted in writing and include, at a minimum:

(1) The recipient’s name;

(2) The recipient’s medicaid program identification number;

(3) The recipient’s diagnosis;

(4) The provider’s medicaid ID number;

(5) Clinical documentation that addresses how the request for binaural hearing aids meets the criteria outlined in He-W 567.05(c)(2)b.; and

(6) The signature of the provider.

(c) Prior authorization requested in accordance with (b) above shall be approved by the department if the department determines that the request demonstrates the criteria outlined in He-W 567.05(c)(2)b. have been met.

(d) If the department approves the prior authorization request in accordance with (c) above, the state’s fiscal agent shall send written confirmation of the approval to the provider.

(e) If the department denies the prior authorization request, the department shall forward a notice of denial to the recipient and the provider on the department’s Form 272a, “Medical Assistance Program Denial for Prior Authorized Services,” which includes the following information:

(1) The reason for, and legal basis of, the denial; and

(2) Information that an appeal of the denial may be requested, in accordance with He-C 200, within 30 calendar days of the date on the notice of the denial.

(f) The provider shall be responsible for determining that the recipient is medicaid eligible on the date of service.

History

#10342, eff 6-1-13; ss by #12538, eff 5-25-18

N.H. Code Admin. R. Ann. He-W 567.08 Documentation {#sec-he-w-567.08 omnilex-key=us-nh-regs-official--agency-he-w--He-W 567.08}

The hearing aid services provider shall maintain supporting records, including:

(a) An audiogram;

(b) Audiological and medical data, documenting the required criteria, as established in accordance with He-W 567, to support the request for the hearing aid(s) or pocket talker;

(c) For those recipients 21 years of age or over requesting binaural hearing aids in accordance with He-W 567.05(c)(2)b.1.(ii):

(1) A statement from the recipient’s employer verifying the recipient’s employment status, and including the employer's audiometric requirements for the particular position in which the recipient is employed;

(2) A statement from the audiologist that the recipient cannot meet the employer’s audiometric requirements in (1) without the use of binaural hearing aids; and

(3) An audiogram which supports the audiologist's statement in (2) above; and

(d) A letter from the recipient’s school verifying attendance or documentation confirming the recipient is receiving vocational training, if applicable.

History

(See Revision Note at chapter heading He-W 500); ss by #6157, eff 12-29-95, EXPIRED: 12-29-03
#9480, eff 5-23-09; ss by #9739, eff 6-25-10; renumbered by #10342 (from He-W 567.07); ss by #12538, eff 5-25-18

N.H. Code Admin. R. Ann. He-W 567.09 Utilization Review and Control {#sec-he-w-567.09 omnilex-key=us-nh-regs-official--agency-he-w--He-W 567.09}

The department’s program integrity unit shall monitor utilization of hearing aid services to identify, prevent, and correct potential occurrences of fraud, waste, and abuse, in accordance with 42 CFR 455, 42 CFR 456, and He-W 520.

History

(See Revision Note at chapter heading He-W 500); ss by #6157, eff 12-29-95, EXPIRED: 12-29-03
#9480, eff 5-23-09, EXPIRED: 5-23-17; renumbered by #10342 (from He-W 567.08); ss by #12538, eff 5-25-18

N.H. Code Admin. R. Ann. He-W 567.10 Third Party Liability {#sec-he-w-567.10 omnilex-key=us-nh-regs-official--agency-he-w--He-W 567.10}

All third party obligations shall be exhausted before medicaid shall be billed, in accordance with 42 CFR 433.139.

History

(See Revision Note at chapter heading He-W 500); ss by #6157, eff 12-29-95, EXPIRED: 12-29-03
#9480, eff 5-23-09, EXPIRED: 5-23-17; renumbered by #10342 (from He-W 567.09); ss by #12538, eff 5-25-18

N.H. Code Admin. R. Ann. He-W 567.11 Payment for Services {#sec-he-w-567.11 omnilex-key=us-nh-regs-official--agency-he-w--He-W 567.11}

(a) Payment for hearing aid services shall be made in accordance with rates established by the department in accordance with RSA 161:4, VI(a).

(b) The hearing aid services provider shall submit claims for payment to the department’s fiscal agent.

History

(See Revision Note at chapter heading He-W 500); ss by #6157, eff 12-29-95, EXPIRED: 12-29-03
#9480, eff 5-23-09, EXPIRED: 5-23-17; renumbered by #10342 (from He-W 567.10); ss by #12538, eff 5-25-18

Part He-W 568 Physical Therapy, Occupational Therapy and Services for Individuals with Speech, Hearing and Language Disorders

N.H. Code Admin. R. Ann. He-W 568.01 Definitions {#sec-he-w-568.01 omnilex-key=us-nh-regs-official--agency-he-w--He-W 568.01}

(a) “Department” means the New Hampshire department of health and human services.

(b) “Medicaid” means the Title XIX and Title XXI programs administered by the department which makes medical assistance available to eligible individuals.

(d) “Occupational therapy (OT)” means “occupational therapy” as defined in RSA 326-C:1, III.

(e) “Occupational therapy assistant” means “occupational therapy assistant” as defined in RSA 326-C:1, IV.

(f) “Physical therapy (PT)” means the “practice of physical therapy” as defined in RSA 328-A:2, XI.

(g) “Physical therapy assistant” means “physical therapy assistant” as defined in RSA 328-A:2, VIII.

(h) “Recipient” means any individual who is eligible for and receiving medical assistance under the medicaid program.

(i) “Services for speech, hearing and language disorders” means diagnostic, screening, preventive, or corrective speech-language pathology.

(j) “Speech-language pathology (SLP)” means “speech-language pathology” as defined in RSA 326-F:1, IV.

(k) “Speech-language assistant” means “speech-language assistant” as defined in RSA 326-F:1, II-a.

(l) “Title XIX” means the joint federal-state program described in Title XIX of the Social Security Act and administered in New Hampshire by the department under the medicaid program.

(m) “Title XXI” means the joint federal-state program described in Title XXI of the Social Security Act and administered in New Hampshire by the department under the medicaid program.

(n) “Visits” are defined as a meeting scheduled by an individual to see an occupational therapist, physical therapist, or a speech-language pathologist for evaluation, treatment, or advice.

History

(See Revision Note at chapter heading He-W 500); ss by #4995, eff 11-30-90, EXPIRED: 11-30-96
#7909, eff 6-24-03; ss by #9929, INTERIM, eff 6-19-11, EXPIRES: 12-16-11; ss by #10042, eff 12-16-11; amd by #10139, eff 7-1-12; ss by #13355, eff 3-19-22

N.H. Code Admin. R. Ann. He-W 568.02 Recipient Eligibility {#sec-he-w-568.02 omnilex-key=us-nh-regs-official--agency-he-w--He-W 568.02}

All Title XIX recipients shall be eligible for physical therapy, occupational therapy, and services for speech, hearing and language disorders, in accordance with He-W 568.

History

(See Revision Note at chapter heading He-W 500); ss by #4995, eff 11-30-90, EXPIRED: 11-30-96
#7909, eff 6-24-03; ss by #9929, INTERIM, eff 6-19-11, EXPIRES: 12-16-11; ss by #10042, eff 12-16-11; ss by #13355, eff 3-19-22

N.H. Code Admin. R. Ann. He-W 568.03 Provider Participation {#sec-he-w-568.03 omnilex-key=us-nh-regs-official--agency-he-w--He-W 568.03}

(a) Each participating physical therapist, occupational therapist, and speech-language pathologist shall:

(1) Be licensed by the state in which they practice; and

(2) Be a NH enrolled Title XIX provider.

(b) Occupational therapy assistants, physical therapy assistants, and speech-language assistants shall not be eligible to enroll as a Title XIX provider but may provide services to Title XIX recipients in accordance with He-W 568.05 below.

History

(See Revision Note at chapter heading He-W 500); ss by #4995, eff 11-30-90, EXPIRED: 11-30-96
#7909, eff 6-24-03; ss by #9929, INTERIM, eff 6-19-11, EXPIRES: 12-16-11; ss by #10042, eff 12-16-11; ss by #13355, eff 3-19-22

N.H. Code Admin. R. Ann. He-W 568.04 Service Limits {#sec-he-w-568.04 omnilex-key=us-nh-regs-official--agency-he-w--He-W 568.04}

(a) The service limits for physical therapy, occupational therapy, and services for speech, hearing and language disorders shall apply to all such services, regardless of whether these services are provided through a hospital outpatient department, another provider, such as a home health agency, or by the individual therapists.

(b) Physical therapy, occupational therapy, and services for speech, hearing and language disorders shall be limited to 20 visits per recipient per state fiscal year.

(c) The 20 visits described in (b) above may be used for physical therapy, occupational therapy, services for speech, hearing and language disorders, or any combination of these services.

History

(See Revision Note at chapter heading He-W 500); ss by #4995, eff 11-30-90, EXPIRED: 11-30-96
#7909, eff 6-24-03; ss by #9929, INTERIM, eff 6-19-11, EXPIRES: 12-16-11; ss by #10042, eff 12-16-11; ss by #13355, eff 3-19-22

N.H. Code Admin. R. Ann. He-W 568.05 Covered Services {#sec-he-w-568.05 omnilex-key=us-nh-regs-official--agency-he-w--He-W 568.05}

(a) Physical therapy, occupational therapy and services for individuals with speech, hearing and language disorders shall be covered when prescribed, in writing, by a physician or other licensed practitioner, for each recipient treated.

(b) Services in (a) above shall be covered:

(1) When performed by the physical therapist, occupational therapist, or speech-language pathologist; or

(2) When performed by a physical therapy assistant, an occupational therapy assistant, or a speech-language assistant working under the direction of a physical therapist, occupational therapist, or a speech-language pathologist, as applicable and in accordance with applicable requirements in Phy 400, Occ 400, or Spe 600.

(c) When services are provided in accordance with (b)(2) above, the individual responsible for the oversight of the assistant shall, in addition to any applicable requirements in Phy 400, Occ 400, or Spe 600:

(1) See the recipient first to conduct the initial assessment and develop a plan of care;

(2) See the recipient periodically thereafter;

(3) Specify the type of care to be provided by the physical therapy assistant, occupational therapy assistant, or speech-language assistant;

(4) Review the need for continued services;

(5) Assume professional responsibility for services provided by the physical therapy assistant, occupational therapy assistant, or speech-language assistant; and

(6) Ensure that services provided are within the scope of the prescribed services.

(d) Hearing aid services and related auditory devices shall be covered subject to the requirements and limits in He-W 567.

History

(See Revision Note at chapter heading He-W 500); ss by #4995, eff 11-30-90, EXPIRED: 11-30-96
#7909, eff 6-24-03; ss by #9929, INTERIM, eff 6-19-11, EXPIRES: 12-16-11; ss by #10042, eff 12-16-11; ss by #13355, eff 3-19-22

N.H. Code Admin. R. Ann. He-W 568.06 Prior Authorization {#sec-he-w-568.06 omnilex-key=us-nh-regs-official--agency-he-w--He-W 568.06}

(a) The provider shall request prior authorization, as specified in He-W 530, for therapy services prescribed in excess of the limits described in He-W 568.04.

(b) Providers of hearing aid services and devices shall request prior authorization in accordance with He-W 567.

History

(See Revision Note at chapter heading He-W 500); ss by #4995, eff 11-30-90, EXPIRED: 11-30-96
#7909, eff 6-24-03; ss by #9929, INTERIM, eff 6-19-11, EXPIRES: 12-16-11; ss by #10042, eff 12-16-11; ss by #13355, eff 3-19-22

N.H. Code Admin. R. Ann. He-W 568.07 Utilization Review and Control {#sec-he-w-568.07 omnilex-key=us-nh-regs-official--agency-he-w--He-W 568.07}

The department’s program integrity unit shall monitor utilization of physical therapy, occupational therapy and services for individuals with speech, hearing and language disorders, in accordance with 42 CFR 455, 42 CFR 456, 42 CFR 1001, and He-W 520.

History

(See Revision Note at chapter heading He-W 500); ss by #4995, eff 11-30-90, EXPIRED: 11-30-96
#7909, eff 6-24-03; ss by #9929, INTERIM, eff 6-19-11, EXPIRES: 12-16-11; ss by #10042, eff 12-16-11; ss by #13355, eff 3-19-22

N.H. Code Admin. R. Ann. He-W 568.08 Documentation {#sec-he-w-568.08 omnilex-key=us-nh-regs-official--agency-he-w--He-W 568.08}

(a) Therapy service described in He-W 568.05 above shall be documented, including:

(1) The date of each therapy service provided;

(2) The amount of time spent rendering each therapy service;

(3) A description of the therapeutic modality used during the therapy service;

(4) Measurable short-term and long-term goals;

(5) Objectives of the therapy service provided;

(6) Modalities to be utilized during the therapy service;

(7) Frequency of therapy services prescribed;

(8) An estimation of the duration of treatment;

(9) Ongoing progress notes evaluating the recipient’s progress in relation to the established goals and estimated duration of treatment; and

(10) An indication as to whether the services provided were for individual or group therapy.

(b) The provider shall maintain records to support claims submitted for reimbursement for a period of at least 6 years from the date of service, or until the resolution of any legal action(s) commenced in the 6-year period, whichever is longer.

History

(See Revision Note at chapter heading He-W 500); ss by #4995, eff 11-30-90, EXPIRED: 11-30-96
#7909, eff 6-24-03; ss by #9929, INTERIM, eff 6-19-11, EXPIRES: 12-16-11; ss by #10042, eff 12-16-11; ss by #13355, eff 3-19-22

N.H. Code Admin. R. Ann. He-W 568.09 Third Party Liability {#sec-he-w-568.09 omnilex-key=us-nh-regs-official--agency-he-w--He-W 568.09}

All third party obligations shall be exhausted before Title XIX shall be billed in accordance with 42 CFR 433.139.

History

(See Revision Note at chapter heading He-W 500); ss by #4995, eff 11-30-90, EXPIRED: 11-30-96
#7909, eff 6-24-03; ss by #9929, INTERIM, eff 6-19-11, EXPIRES: 12-16-11; ss by #10042, eff 12-16-11; ss by #13355, eff 3-19-22

N.H. Code Admin. R. Ann. He-W 568.10 Payment for Services {#sec-he-w-568.10 omnilex-key=us-nh-regs-official--agency-he-w--He-W 568.10}

(a) Reimbursement to providers of physical therapy, occupational therapy and services for individuals with speech, hearing and language disorders shall be made in accordance with fee schedules established by the department, in accordance with RSA 161:4, VI(a).

(b) The provider shall bill with a therapy procedure code as defined by the American Medicaid Association’s “Current Procedural Terminology (CPT) 2022 Professional Edition” available as noted in Appendix A, and submit claims for payment to the department’s fiscal agent.

(d) Providers shall submit claims for payment for services in accordance with the following:

(1) Only direct treatment by a therapist or a physical therapy assistant, occupational therapy assistant, or speech-language assistant shall be billed, meaning the time the therapist or physical therapy assistant, occupational therapy assistant, or speech-language assistant spends providing direct treatment to one recipient;

(2) Therapists working as a team to treat one or more recipients shall not each bill separately for the same or different service provided at the same time to the same recipient; and

(3) If a recipient requires co-treatment simultaneously by 2 therapists, visits shall be billed separately by each provider for the total time the recipient was receiving actual therapy services.

(e) The time a recipient spends not being treated, for any reason, shall not be billed.

(f) Services provided by a physical therapy assistant, occupational therapy assistant, or speech-language assistant, in accordance with He-W 568.05(b) and (c) above, shall be billed by the enrolled therapist providing oversight of the physical therapy assistant, occupational therapy assistant, or speech-language assistant.

History

(See Revision Note at chapter heading He-W 500); ss by #4995, eff 11-30-90, EXPIRED: 11-30-96
#7909, eff 6-24-03; ss by #9929, INTERIM, eff 6-19-11, EXPIRES: 12-16-11; ss by #10042, eff 12-16-11; ss by #13355, eff 3-19-22

Part He-W 569 Radiological Services

N.H. Code Admin. R. Ann. He-W 569.01 Definitions {#sec-he-w-569.01 omnilex-key=us-nh-regs-official--agency-he-w--He-W 569.01}

(a) “Current procedural terminology (CPT) code” means a unique identifying code in the field of medical nomenclature and designed by US Department of Health and Human Services as the national coding standard utilized in government and private health insurance programs for reporting medical services and procedures.

(b) “Department” means the New Hampshire (NH) department of health and human services, unless otherwise specified.

(c) “Medicaid” means the Title XIX and Title XXI programs administered by the department, which makes medical assistance available to eligible individuals.

d) “Recipient” means an individual who is eligible for and receiving medical assistance under the medicaid program.

(e) “Title XIX” means the joint federal-state program described in Title XIX of the Social Security Act and administered in NH by the department under the medicaid program.

(f) “Title XXI” means the joint federal-state program described in Title XXI of the Social Security Act and administered in NH by the department under the medicaid program.

History

(See Revision Note at chapter heading He-W 500); ss by #6575, eff 9-12-97; ss by #8400, INTERIM, eff 8-20-05, EXPIRES: 2-16-06; ss by #8562, eff 2-7-06; amd by #10139, eff 7-1-12; ss by #10517, eff 2-7-14, EXPIRED: 2-7-24
14277, eff 6-24-25, EXPIRES: 6-24-35

N.H. Code Admin. R. Ann. He-W 569.02 Recipient Eligibility {#sec-he-w-569.02 omnilex-key=us-nh-regs-official--agency-he-w--He-W 569.02}

All medicaid recipients shall be eligible for radiological services, in accordance with He-W 569.

History

(See Revision Note at chapter heading He-W 500); ss by #6575, eff 9-12-97; ss by #8400, INTERIM, eff 8-20-05, EXPIRES: 2-16-06; ss by #8562, eff 2-7-06; ss by #10517, eff 2-7-14, EXPIRED: 2-7-24
#14277, eff 6-24-25; EXPIRES: 6-24-35

N.H. Code Admin. R. Ann. He-W 569.03 Provider Participation {#sec-he-w-569.03 omnilex-key=us-nh-regs-official--agency-he-w--He-W 569.03}

All participating radiological service providers shall:

(a) Be licensed by the states in which they practice;

(b) Provide radiological services under the direction of a physician in accordance with 42 CFR 440.30; and

History

(See Revision Note at chapter heading He-W 500); ss by #6575, eff 9-12-97; ss by #8400, INTERIM, eff 8-20-05, EXPIRES: 2-16-06; ss by #8562, eff 2-7-06; ss by #10517, eff 2-7-14, EXPIRED: 2-7-24
14277, eff 6-24-25, EXPIRES: 6-24-35

N.H. Code Admin. R. Ann. He-W 569.04 Service Limits {#sec-he-w-569.04 omnilex-key=us-nh-regs-official--agency-he-w--He-W 569.04}

Radiological services shall be subject to the limits set forth in He-W 530.

History

(See Revision Note at chapter heading He-W 500); ss by #6575, eff 9-12-97; ss by #8400, INTERIM, eff 8-20-05, EXPIRES: 2-16-06; ss by #8562, eff 2-7-06; ss by #10517, eff 2-7-14, EXPIRED: 2-7-24
#14277, eff 6-24-25, EXPIRES: 6-24-35

N.H. Code Admin. R. Ann. He-W 569.05 Covered Services {#sec-he-w-569.05 omnilex-key=us-nh-regs-official--agency-he-w--He-W 569.05}

The following radiological services shall be covered when ordered by a physician or other licensed practitioner within the scope of their practice:

(a) Therapeutic radiological services, such as radiation therapy; and

(b) Diagnostic radiological services in accordance with the prior authorization requirements of He-W 569.06.

History

(See Revision Note at chapter heading He-W 500); ss by #6575, eff 9-12-97; ss by #8400, INTERIM, eff 8-20-05, EXPIRES: 2-16-06; ss by #8562, eff 2-7-06; ss by #10517, eff 2-7-14; ss by #10517, eff 2-7-14, EXPIRED: 2-7-24
#14277, eff 6-24-25, EXPIRES: 6-24-35

N.H. Code Admin. R. Ann. He-W 569.06 Prior Authorization and Review {#sec-he-w-569.06 omnilex-key=us-nh-regs-official--agency-he-w--He-W 569.06}

(a) The following diagnostic radiological services shall require prior authorization:

(1) Computerized tomography (CT);

(2) Magnetic resonance imaging (MRI);

(3) Magnetic resonance angiography (MRA);

(4) Positive emission tomography (PET); and

(5) Nuclear cardiology.

(b) Diagnostic radiological services specified in (a) above shall be exempt from prior authorization requirements when services are provided:

(1) As part of a hospital emergency department visit;

(2) As part of a recipient’s inpatient hospitalization; or

(3) Concurrently with, or on the same day as, an urgent care facility visit.

(1) Completing and submitting Form 272X, “Request for Service Authorization for Diagnostic Imaging” (June 2025) and certifying that they have obtained and attached a physician’s order and a letter of medical necessity (LMN) in addition to attaching medical records to support the medical necessity of the diagnostic imaging; and

(2) Submitting the clinical information supporting the medical necessity for the request, including, but not limited to, the medical care plan, relevant diagnostic tests, and progress notes, to the department by mail, fax, or e-mail.

(d) When a completed prior authorization request is submitted in accordance with (c) above, the department shall send a written notice of decision to the recipient and the ordering practitioner within 2 business days of the decision being made.

(e) If the department denies the prior authorization request, the written denial notice, provided in accordance with (d) above shall include the following:

(1) The reason for, and the legal basis of, the denial;

(2) A copy of the clinical guidelines used to make the decision; and

(3) Information that a fair hearing on the denial may be requested within 30 calendar days of the date on the notice of the denial, in accordance with He-C 200.

History

(See Revision Note at chapter heading He-W 500); ss by #6575, eff 9-12-97; ss by #8400, INTERIM, eff 8-20-05, EXPIRES: 2-16-06; ss by #8562, eff 2-7-06; amd by #10342, eff 6-1-13; ss by #10517, eff 2-7-14, EXPIRED: 2-7-24
#14277, eff 6-24-25, EXPIRES: 6-24-35

N.H. Code Admin. R. Ann. He-W 569.07 Utilization Review and Control {#sec-he-w-569.07 omnilex-key=us-nh-regs-official--agency-he-w--He-W 569.07}

(a) The department’s bureau of program integrity shall monitor utilization of radiological services, to identify, prevent, and correct potential occurrences of fraud, waste, and abuse, in accordance with 42 CFR 455, 42 CFR 456, He-W 520, and He-W 521.

History

(See Revision Note at chapter heading He-W 500); ss by #6575, eff 9-12-97; ss by #8400, INTERIM, eff 8-20-05, EXPIRES: 2-16-06; #8562, eff 2-7-06; ss by #10517, eff 2-7-14, EXPIRED: 2-7-24
#14277, eff 6-24-25, EXPIRES: 6-24-35

N.H. Code Admin. R. Ann. He-W 569.08 Third Party Liability {#sec-he-w-569.08 omnilex-key=us-nh-regs-official--agency-he-w--He-W 569.08}

(a) All third party obligations shall be exhausted before medicaid may be billed, in accordance with 42 CFR 433.139.

(b) Radiological service providers shall request information from the recipient regarding other insurance coverage.

(c) If other insurance coverage is available, providers shall contact the insurer to verify benefits initially and at least annually thereafter or when the insurance carrier changes.

(d) Radiological service providers shall maintain a record of any other insurance verifications in the recipient’s medical record in accordance with He-W 520 and He-W 521.

History

(See Revision Note at chapter heading He-W 500); ss by #6575, eff 9-12-97; ss by #8400, INTERIM, eff 8-20-05, EXPIRES: 2-16-06; #8562, eff 2-7-06; ss by #10517, eff 2-7-14, EXPIRED: 2-7-24
#14277, eff 6-24-25, EXPIRES: 6-24-35

N.H. Code Admin. R. Ann. He-W 569.09 Payment for Services {#sec-he-w-569.09 omnilex-key=us-nh-regs-official--agency-he-w--He-W 569.09}

(a) Radiological services providers shall bill utilizing the complete radiological examination CPT code to include the following modifiers as described below:

(1) The radiological professional CPT code modifier, which shall include supervision, interpretation, and written report of the radiological examination only;

(2) The technical CPT code modifier which shall include the taking of the radiological examination film only; and

(3) Informational modifiers, if more than one procedure code is billed per day.

(b) Payments to radiological services providers shall be made in accordance with rates established by the department pursuant to RSA 161:4, VI.

(d) Radiological services providers shall maintain supporting documentation, in accordance with He-W 520 and He-W 521.

History

#8562, eff 2-7-06; ss by #10517, eff 2-7-14; ss by #10517, eff 2-7-14, EXPIRED: 2-7-24
#14277, eff 6-24-25, EXPIRES: 6-24-35

Part He-W 570 Pharmaceutical Services

N.H. Code Admin. R. Ann. He-W 570.01 Definitions {#sec-he-w-570.01 omnilex-key=us-nh-regs-official--agency-he-w--He-W 570.01}

(a) “Actual acquisition cost (AAC)” means actual acquisition cost as defined at 42 CFR 447.502, namely, the agency’s determination of the pharmacy providers’ actual prices paid to acquire drug products marketed or sold by specific manufacturers.

(b) “Compound drug” means a drug product prepared by the pharmacist using more than one ingredient.

(d) “Co-payment” means the amount paid by a recipient to a NH medicaid enrolled pharmacy provider for each prescription filled.

(e) “Department” means the New Hampshire department of health and human services.

(f) “Dispensing fee” means a payment for the pharmacist’s service of dispensing drugs.

(g) “Drug efficacy study implementation (DESI) drugs” means drugs found to lack substantial evidence of effectiveness as determined by the Food and Drug Administration (FDA) and also includes identical, related, or similar (IRS) drugs.

(h) “Federal upper limit (FUL)” means the maximum cost allowed by the federal government for certain multiple source drugs.

(i) “General public” means individuals purchasing drugs at the usual and customary retail price.

(j) “Generic equivalent” means an equivalent AB rated drug product that is suitable for drug interchange, approved by the FDA as safe and effective, with the same established generic name, active ingredient, strength, quantity, and dosage form as the drug product identified in the prescription.

(k) “Healthcare common procedure coding system (HCPCS)” means a uniform method for health care providers and medical suppliers to report professional services, procedures, and supplies.

(l) “Identical, related, or similar (IRS) drugs” means a drug interchange or substitution as it applies to DESI drugs.

(m) “Legend drug” means a drug which is dispensed only with a prescription from a licensed practitioner.

(n) “Licensed practitioner” means any person who is lawfully entitled to prescribe, administer, dispense, or distribute legend drugs to patients.

(o) “Maintenance medication” means a drug prescribed for routine continuous daily therapy for at least 120 days.

(p) “Medicaid” means the Title XIX and Title XXI programs administered by the department which makes medical assistance available to eligible individuals.

(q) “National average drug acquisition cost (NADAC)” means a national price benchmark that represents the national average invoice price derived from retail community pharmacies for drug products based on invoices from wholesalers and manufacturers, and which is updated and published weekly by the Centers for Medicare and Medicaid Services (CMS) and available at https://www.medicaid.gov/medicaid/prescription-drugs/pharmacy-pricing/index.html.

(r) “National drug code (NDC)” means the unique 11-digit code number assigned to any drug by the manufacturer identifying drug manufacturer or distributor, drug name, and package size.

(s) “New Hampshire maximum allowable cost (NHMAC)” means the maximum cost allowed by the department for certain multiple source drugs.

(t) “Non-legend drug” means a drug prescribed by a licensed practitioner which is normally purchased over the counter.

(u) “Non-preferred prescription drug” means a drug that has been determined to have an alternative drug available that is clinically equivalent and more cost effective, and which has been clinically reviewed and approved by the NH drug use review board established in He-C 5010 and has been included on the department’s preferred drug list as non-preferred.

(v) “Parenteral” means drug administration other than by the mouth or rectum, such as by injection, infusion, or implantation.

(w) “Patient profile” means a record, whether paper or electronic, of each recipient’s drug history.

(x) “Pharmacist” means “pharmacist” as defined in RSA 318:1, VII.

(y) “Pharmacy benefit manager (PBM)” means the representative designated by the department to administer the drug plan for the medicaid population.

(z) “Pharmacy lock-in program” means a program established to prevent recipients from obtaining excessive quantities of, or from inappropriately using, prescription drugs through multiple pharmacies.

(aa) “Preferred drug list (PDL)” means a formal published list of specific prescription drug products by brand and generic name divided into 2 separate categories as either preferred or non-preferred.

(ab) “Preferred prescription drug” means a drug that has been clinically reviewed and approved by the NH drug use review board established in He-C 5010 and has been included on the department’s preferred drug list based on its proven clinical and cost effectiveness.

(ac) “Prescription” means “prescription” as defined in RSA 318:1, XVI.

(ad) “Primary pharmacy” means the sole pharmacy that is responsible for dispensing and, in accordance with Ph 706, monitoring the drug utilization of a recipient assigned to the pharmacy lock-in program.

(ae) “Prior authorization” means the process by which a prescriber seeks approval from the department, through its designated agent, to make payments for drugs which are considered to have a high potential for misuse or abuse, are high cost, or should be monitored for correct adherence to clinical protocols.

(af) “Recipient” means any individual who is eligible for and receiving medical assistance under the medicaid program.

(ag) “Title XIX” means the joint federal-state program described in Title XIX of the Social Security Act and administered in New Hampshire by the department under the medicaid program.

(ah) “Title XXI” means the joint federal-state program described in Title XXI of the Social Security Act and administered in New Hampshire by the department under the medicaid program.

(ai) “Unit dose drug” means the individually packaged dosage form of a drug.

(aj) “Usual and customary” means “usual and customary” as defined in RSA 126-A:3 III(b).

(ak) “Wholesale acquisition cost (WAC)” means the drug manufacturer’s list price to wholesale distributors or direct purchasers, not including prompt pay or other discounts, rebates, or reductions in price, as reported in wholesale price guides or other publications of drug or biological pricing data.

History

(See Revision Note at chapter heading He-W 500); ss by #5742, eff 12-1-93, EXPIRED: 12-1-99
#7392, eff 10-28-00; ss by #7680, eff 4-20-02; ss by #7712, INTERIM, eff 6-22-02, EXPIRED: 12-19-02
#7805, eff 12-21-02; ss by #9831, eff 12-21-10; amd by #10139, eff 7-1-12; amd by #11101, eff 5-25-16; amd by #12140, eff 4-1-17; ss by #12529, eff 5-22-18

N.H. Code Admin. R. Ann. He-W 570.02 Recipient Eligibility {#sec-he-w-570.02 omnilex-key=us-nh-regs-official--agency-he-w--He-W 570.02}

All medicaid recipients shall be eligible for pharmaceutical services, in accordance with He-W 570.

History

(See Revision Note at chapter heading He-W 500); ss by #5742, eff 12-1-93, EXPIRED: 12-1-99
#7392, eff 10-28-00; ss by #7680, eff 4-20-02; ss by #7712, INTERIM, eff 6-22-02, EXPIRED: 12-19-02
#7805, eff 12-21-02; ss by #9831, eff 12-21-10; ss by #12529, eff 5-22-18

N.H. Code Admin. R. Ann. He-W 570.03 Provider Participation {#sec-he-w-570.03 omnilex-key=us-nh-regs-official--agency-he-w--He-W 570.03}

Each participating pharmacy provider shall be:

(a) One of the following:

(1) A registered or licensed pharmacy in the state in which the pharmacy is located; or

(2) A mail-order pharmacy registered or licensed in a state outside New Hampshire that is registered in New Hampshire and has been issued a permit by the NH pharmacy board pursuant to RSA 318:37, II;

(b) A licensed practitioner authorized to dispense drugs, pursuant to RSA 318 or applicable state law in which the pharmacy is located; and

History

(See Revision Note at chapter heading He-W 500); ss by #5742, eff 12-1-93, EXPIRED: 12-1-99
#7392, eff 10-28-00; ss by #7680, eff 4-20-02; ss by #7712, INTERIM, eff 6-22-02, EXPIRED: 12-19-02
#7805, eff 12-21-02; ss by #9831, eff 12-21-10; ss by #12529, eff 5-22-18

N.H. Code Admin. R. Ann. He-W 570.04 Covered Items {#sec-he-w-570.04 omnilex-key=us-nh-regs-official--agency-he-w--He-W 570.04}

With the exception of those items specified in He-W 570.05, the following FDA approved drugs, if rated effective, and if produced by manufacturers who are participating in the United States Department of Health and Human Services' (USDHHS) drug rebate agreement, shall be covered when prescribed by a licensed practitioner and subject to the prior authorization requirements in He-W 570.06:

(a) Legend drugs, only when prescribed as part of the course of medical treatment for a specific illness, injury, or disease for use specified by the FDA, or for non-experimental purposes, as supported by accepted medical practice, and in accordance with He-W 570.08;

(b) Select non-legend drugs, with the exception of those specified in He-W 570.05 and, only when prescribed as part of the course of medical treatment for a specific illness, injury, or disease for use specified by the FDA, or for non-experimental purposes, as supported by accepted medical practice, and in accordance with (c) below and He-W 570.08;

(1) Antihistamines;

(2) Antacids and H2-Receptor Agonists;

(3) Analgesics, salicylates, and antipyretics;

(4) Magnesium, iron, niacin, and calcium;

(5) Ganglionic stimulants;

(6) Laxatives and cathartics;

(7) Hyperglycemics;

(8) Topical steroids;

(9) Vaginal and topical antifungals;

(10) Topical antimicrobials;

(11) Lice treatments; and

(12) Oral contraceptives;

(d) Opioid rescue, both brand and generic;

(e) Compound drugs when at least one ingredient can be identified by a rebatable NDC; and

(f) Nutritional supplements when needed to sustain life.

History

(See Revision Note at chapter heading He-W 500); ss by #5742, eff 12-1-93, EXPIRED: 12-1-99
#7392, eff 10-28-00; ss by #7680, eff 4-20-02; ss by #7712, INTERIM, eff 6-22-02, EXPIRED: 12-19-02
#7805, eff 12-21-02; ss by #8372, eff 8-1-05; ss by #9586, eff 11-4-09, EXPIRED: 11-4-17
#12421, INTERIM, eff 11-21-17, EXPIRED: 5-20-18
#12529, eff 5-22-18; ss by #13880, eff 2-21-24

N.H. Code Admin. R. Ann. He-W 570.05 Non-Covered Items {#sec-he-w-570.05 omnilex-key=us-nh-regs-official--agency-he-w--He-W 570.05}

Non-covered items shall include:

(a) Experimental or investigational drugs not approved by the FDA;

(b) Drugs listed by the FDA as being DESI drugs or IRS drugs;

(d) Non-legend drugs when:

(1) A legend drug effecting the same health outcome is available and:

a. Is more clinically effective; or

b. Is therapeutically equivalent and more cost effective; or

(2) The non-legend drug is being used to primarily treat discomfort or to maintain comfort, including, but not limited to:

a. Antidiarrheals;

b. Antiflatulants;

c. Nasal decongestants;

d. Eye and ear preparations; and

e. Topical antipruitics;

(e) Non-legend drugs and supplies, which are household and medicine chest items, including, but not limited to:

(1) Band-aids;

(2) Corn plasters;

(3) Contact lens products;

(4) Cough drops and lozenges;

(5) Mouthwash;

(6) Nursery supplies;

(7) Nutritional supplements when not needed to sustain life;

(8) Odor barrier products;

(9) Personal hygiene items;

(10) Sunscreen;

(11) Soaps and cleansers;

(12) Acne products;

(13) Products to mitigate seborrheic dermatitis; and

(14) Fluoride preparations;

(f) Legend and non-legend drugs used for the symptomatic relief of cough and colds, pursuant to Section 1396r-8(d)(2)(D) of the Social Security Act;

(g) Legend and non-legend drugs used for cosmetic purposes or hair growth, pursuant to Section 1396r-8(d)(2)(C) of the Social Security Act;

(h) Legend and non-legend drugs which enhance or promote fertility or procreation, or for which the labeled use is ovulation stimulation, pursuant to Section 1396r-8(d)(2)(B) of the Social Security Act;

(i) Legend and non-legend drugs without a prescription from a licensed practitioner;

(j) Legend and non-legend drugs when used for the treatment of sexual or erectile dysfunction, unless such agents are used to treat a condition, other than sexual or erectile dysfunction, for which the agents have been approved by the FDA, pursuant to Section 1396r-8(d)(2)(k); and

(k) Items which are free to the general public.

History

(See Revision Note at chapter heading He-W 500); ss by #5742, eff 12-1-93; amd by #5874, eff 8-1-94; ss by #7392, eff 10-28-00; ss by #7680, eff 4-20-02; ss by #7712, INTERIM, eff 6-22-02, EXPIRED: 12-19-02
#7805, eff 12-21-02; ss by #8372, eff 8-1-05; ss by 8628, eff 5-6-06; ss by #9831, eff 12-21-10; ss by #12529, eff 5-22-18

N.H. Code Admin. R. Ann. He-W 570.06 Prior Authorization {#sec-he-w-570.06 omnilex-key=us-nh-regs-official--agency-he-w--He-W 570.06}

(a) Coverage of drugs subject to prior authorization shall be in accordance with this section.

(b) Drugs shall be subject to prior authorization based on the following:

(1) The recommendations of the NH drug use review board made pursuant to He-C 5010.07;

(2) The abuse potential of the drug;

(3) Whether the drug is new to the market;

(4) The possibility for off-label use of the drug;

(5) The cost of the drug; and

(6) Any other safety or efficacy concerns.

(d) Prior authorization requests for a drug shall be approved or denied based on the following:

(1) Diagnosis;

(2) Whether or not the drug is prescribed for on or off label use;

(3) Dosage;

(4) The recipient’s age;

(5) The drug class; and

(6) Any other factor concerning safety, efficacy, or individual recipient medical concerns.

(e) The criteria in (d) above shall be posted on the department’s website.

(f) The procedure for requesting prior authorization shall be as follows:

(1) The licensed practitioner or their designated agent shall initiate the prior authorization process on behalf of the recipient by contacting the PBM by telephone or other telecommunication device;

(2) The certified pharmacy technician at the PBM shall collect information from the requestor in (f)(1) above regarding the drug prescribed, to determine whether the criteria for approval have been met;

(3) The certified pharmacy technician at the PBM shall then either:

a. Grant immediate approval when all criteria, as approved by the department, in accordance with (d) above have been met; or

b. Transfer the request to a pharmacist at the PBM when the information furnished does not satisfy the criteria approved by the department in (d) above or when it cannot be determined whether the criteria approved by the department in (d) above have been met; and

(4) If the request or caller is transferred to the pharmacist at the PBM pursuant to (f)(3)b. above, the pharmacist shall further discuss the recipient’s specific needs with the requestor in (f)(1) above and either:

a. Grant immediate approval when all criteria approved by the department in (d) above have been met; or

b. Issue a denial in accordance with (i) below.

(g) The PBM shall respond to prior authorization requests by telephone or other telecommunication device within 24 hours of the initial request, in accordance with Section 1927(d)(5) of the Social Security Act.

(h) While the prior authorization is being considered, a 72-hour supply of medication shall be provided to the recipient in an emergency, in accordance with Section 1927(d)(5) of the Social Security Act.

(i) When a prior authorization request is denied, the department shall forward a written letter of denial to the recipient and the licensed practitioner that states the following:

(1) The drug being denied;

(2) The reason for the denial;

(3) The legal basis for the denial;

(4) Information on how the recipient can file an appeal in accordance with He-C 200; and

(5) That a denial may be appealed by the recipient within 30 calendar days from the date the denial was issued.

(j) When a subsequent prior authorization request is denied for a drug for which a prior authorization was granted in accordance with (g)(1) above, the department shall forward a written notice of denial to the recipient and the prescribing, licensed practitioner that states the following:

(1) The drug being denied;

(2) The reason for the denial;

(3) The legal basis for the denial;

(4) Information on how the recipient can file an appeal in accordance with He-C 200;

(5) That a denial may be appealed by the recipient within 30 calendar days from the date the denial was issued; and

(6) That the recipient has 10 days from the date of the written notification to request the continuation of the original drug for which an initial prior authorization request was granted, pending the completion of the appeal process.

History

(See Revision Note at chapter heading He-W 500); ss by #5742, eff 12-1-93; ss by #5875, eff 7-27-94, EXPIRED: 7-27-00
#7392, eff 10-28-00; ss by #7680, eff 4-20-02; ss by #7712, INTERIM, eff 6-22-02, EXPIRED: 12-19-02
#7805, eff 12-21-02; ss by #9586, eff 11-4-09, EXPIRED: 11-4-17
#12421, INTERIM, eff 11-21-17, EXPIRED: 5-20-18
#12529, eff 5-22-18

N.H. Code Admin. R. Ann. He-W 570.07 Pharmacy Lock-In Program {#sec-he-w-570.07 omnilex-key=us-nh-regs-official--agency-he-w--He-W 570.07}

(a) The department shall conduct recipient utilization reviews in accordance with He-W 520.04 and in consideration of the recommendations of the DUR board pursuant to He-C 5010.07(j) to determine if prescribed drugs are being utilized at a frequency or amount that results in a demonstrated pattern of excessive or inappropriate utilization of services.

(b) If it is determined from the utilization review in (a) above that the recipient utilized excessive or inappropriate pharmaceutical services, the recipient shall be enrolled into the pharmacy lock-in program pursuant to 42 CFR 431.54(e), for a 12-month period.

(c) Recipients shall be notified by the department in writing of their enrollment into the pharmacy lock-in program at least 30 days prior to the effective date of their enrollment.

(d) The written notification to the recipient shall include:

(1) The date of their enrollment into the pharmacy lock-in program;

(2) Instructions for the recipient to choose a primary pharmacy, within 21 days of the date of the written notification, as their only source for obtaining all prescribed drugs;

(3) Notification that if the recipient fails to choose a primary pharmacy in accordance with (d)(2) above, or if the pharmacy is unwilling or unable to be the primary pharmacy, the department shall select a primary pharmacy for the recipient based on the recipient’s previous pharmacy use and geographical location; and

(4) The recipient's rights to appeal pharmacy lock-in and request a fair hearing within 30 days of the date on the written notification, pursuant to 42 CFR 431.54(e), and in accordance with He-C 200, if the recipient disagrees with the department’s decision.

(e) If the primary pharmacy is selected by the recipient pursuant to (d)(2) above, the department shall notify the primary pharmacy in writing of its selection at least 7 business days prior to the effective date of the recipient's enrollment into the pharmacy lock-in program.

(f) If the primary pharmacy is selected by the department pursuant to (d)(3) above, the department shall notify the recipient and the primary pharmacy in writing of its selection at least 7 business days prior to the effective date of the recipient's enrollment into the pharmacy lock-in program.

(g) Recipients enrolled in the pharmacy lock-in program shall have the following service restrictions:

(1) Recipients shall be identified through a claims transaction from the PBM to the non-primary pharmacy as having a service restriction that states “Medication Control. Recipient Restricted to Primary Pharmacy”;

(2) Except as set forth in (g)(3) below, only the recipient’s primary pharmacy may receive payment from the department for drugs dispensed to a recipient with the restriction set forth in (g)(1) above; and

(3) If a pharmacy other than the primary pharmacy determines that a recipient is unable to access his or her primary pharmacy due to the recipient being out of area, or due to the primary pharmacy not being open or not having the prescribed drug available, the non-primary pharmacy may contact the PBM to request permission to dispense a 72-hour emergency supply of a drug to a restricted recipient in accordance with 42 CFR 431.54(e)(3).

(h) Recipients enrolled in the pharmacy lock-in program may change their primary pharmacy only:

(1) Upon the request of the primary pharmacy;

(2) If the recipient moves; or

(3) If the primary pharmacy disenrolls from the medicaid program.

(i) If the department implements a change pursuant to (h) above, the department shall notify the new primary pharmacy and the recipient, in writing, of the effective date of the change.

(j) Eligible recipients who become ineligible for medicaid services during their 12-month pharmacy lock-in enrollment period, shall be reinstated into the pharmacy lock-in program for the balance of the enrollment period, lasting until the originally calculated ending date, should they again become eligible for medicaid services prior to the originally calculated lock-in end date.

(k) Within the last 3 months of the 12 month lock-in period, the department shall conduct a review of the recipient's prior 6 months of utilization of pharmaceutical services pursuant to (a) above and in consideration of the recommendations of the DUR board pursuant to He-C 5010.07(j), to determine whether the recipient has continued to utilize excessive or inappropriate pharmaceutical services.

(l) If the utilization review in (k) above no longer shows a demonstrated pattern of excessive or inappropriate utilization of pharmacy services, the recipient shall be released from the lock-in.

(m) Recipients shall be notified by the department in writing of their release from the pharmacy lock-in program within 30 days after the end date of their lock-in.

(n) The written notification to the recipient shall include:

(1) The date that the recipient’s lock-in ended; and

(2) Notification that the recipient may utilize any medicaid enrolled pharmacy.

(o) If the utilization review in (k) above shows no improvement in the recipient’s pattern of excessive or inappropriate utilization of pharmacy services, the recipient shall continue to be enrolled in the lock-in program for an additional 24 months.

(p) Recipients shall be notified by the department in writing of of their continued enrollment into the pharmacy lock-in program in accordance with He-W 570.07(c) and (d).

(q) Within the last 3 months of the 24 month lock-in period, the department shall conduct a review in accordance with (k) above.

(r) If the utilization review in (k) above shows some improvement in the recipient’s pattern of excessive or inappropriate utilization of pharmacy services, the recipient shall continue to be enrolled in the lock-in program for an additional 12 months after completion of the prior 12-month lock-in.

(s) Recipients shall be notified by the department in writing of their continued enrollment into the pharmacy lock-in program in accordance with He-W 570.07(c) and (d).

(t) Within the last 3 months of the 12 month lock-in period, the department shall conduct a review in accordance with (k) above.

History

(See Revision Note at chapter heading He-W 500); ss by #5742, eff 12-1-93, EXPIRED: 12-1-99
#7392, eff 10-28-00; ss by #7680, eff 4-20-02; ss by #7712, INTERIM, eff 6-22-02, EXPIRED: 12-19-02
#7805, eff 12-21-02; ss by #8636, eff 5-26-06; ss by #9586, eff 11-4-09, EXPIRED: 11-4-09
#12421, INTERIM, eff 11-21-17, EXPIRED: 5-20-18
#12529, eff 5-22-18

N.H. Code Admin. R. Ann. He-W 570.08 Prescription Drug Dispensing Limitations {#sec-he-w-570.08 omnilex-key=us-nh-regs-official--agency-he-w--He-W 570.08}

The following dispensing limitations shall apply to prescriptions drugs:

(a) Pharmacists shall follow current standards of practice in accordance with Ph 501.01;

(b) Non-controlled drug prescriptions shall be refilled pursuant to Ph 704.14;

(d) Controlled drug substances shall follow refill requirements pursuant to 21 CFR 1306.22;

(e) Refill extensions authorized by the prescribing, licensed practitioner shall be treated as a new prescription; and

(f) Maintenance drugs shall be dispensed in a quantity sufficient to treat the recipient as follows:

(1) Solid oral drugs shall be dispensed as:

a. A minimum supply of 28 days and a maximum supply of 12 months for oral contraceptives; and

b. A minimum supply of 30 days and a maximum supply of 90 days for solid oral drugs with the exception of oral contraceptives, as described in (f)(1)a. above;

(2) If the prescribing, licensed practitioner’s professional judgment indicates possession of the minimum supply of solid oral drugs, as described in (f)(1) above, would not be in the patient’s best medical interest, the prescribing, licensed practitioner shall clearly indicate, on the prescription, that an exception to the minimum supply is being made; and

(3) For non-solid drugs, such as ointments, aerosols, injectables, and liquids, the drug shall be dispensed in the most commonly dispensed sized container to cover a minimum of 7 days of therapy.

History

(See Revision Note at chapter heading He-W 500); ss by #5742, eff 12-1-93, EXPIRED: 12-1-99
#7392, eff 10-28-00; ss by #7680, eff 4-20-02; ss by #7712, INTERIM, eff 6-22-02, EXPIRED: 12-19-02
#7805, eff 12-21-02; ss by #9831, eff 12-21-10; ss by #12529, eff 5-22-18; amd by #12698, eff 12-28-18

N.H. Code Admin. R. Ann. He-W 570.09 Certification of Prescriptions {#sec-he-w-570.09 omnilex-key=us-nh-regs-official--agency-he-w--He-W 570.09}

Certification for specific brand, NHMAC, and FUL drugs, shall conform to the following:

(a) The certification shall be in the licensed practitioner’s own handwriting, or the pharmacist’s own handwriting if a telephone order;

(b) The hand-written certification shall state the term “brand necessary” or “brand medically necessary”;

(d) Drugs certified as “brand necessary” or “brand medically necessary” shall be subject to prior authorization in accordance with He-W 570.06.

History

(See Revision Note at chapter heading He-W 500); ss by #5742, eff 12-1-93, EXPIRED: 12-1-99
#7392, eff 10-28-00; ss by #7680, eff 4-20-02; ss by #7712, INTERIM, eff 6-22-02, EXPIRED: 12-19-02
#7805, eff 12-21-02; ss by #9831, eff 12-21-10; ss by #12529, eff 5-22-18

N.H. Code Admin. R. Ann. He-W 570.10 Documentation and Retention {#sec-he-w-570.10 omnilex-key=us-nh-regs-official--agency-he-w--He-W 570.10}

The following requirements shall apply to documentation maintained for pharmaceutical services pursuant to RSA 318:47:

(a) The pharmacy provider shall maintain supporting records for all drugs dispensed, in accordance with He-W 520, including specific refill orders documented at the time of original fill; and

(b) Prescription documentation and retention shall meet the requirements of RSA 318:47-c, except that such records shall be retained for at least 6 years.

History

(See Revision Note at chapter heading He-W 500); ss by #5742, eff 12-1-93, EXPIRED: 12-1-99
#7392, eff 10-28-00; ss by #7680, eff 4-20-02; ss by #7712, INTERIM, eff 6-22-02, EXPIRED: 12-19-02
#7805, eff 12-21-02; ss by #9831, eff 12-21-10; ss by #12529, eff 5-22-18

N.H. Code Admin. R. Ann. He-W 570.11 Utilization Review and Control {#sec-he-w-570.11 omnilex-key=us-nh-regs-official--agency-he-w--He-W 570.11}

The department’s provider integrity unit shall monitor utilization of pharmaceutical services to identify, prevent, and correct potential occurrences of fraud, waste, and abuse in accordance with 42 CFR 455, 42 CFR 456, and He-W 520.

History

(See Revision Note at chapter heading He-W 500); ss by #5742, eff 12-1-93, EXPIRED: 12-1-99
#7392, eff 10-28-00; ss by #7680, eff 4-20-02; ss by #7712, INTERIM, eff 6-22-02, EXPIRES: 12-19-02
#7805, eff 12-21-02; ss by #9831, eff 12-21-10; ss by #12529, eff 5-22-18

N.H. Code Admin. R. Ann. He-W 570.12 Third Party Liability {#sec-he-w-570.12 omnilex-key=us-nh-regs-official--agency-he-w--He-W 570.12}

All third party obligations shall be exhausted before claims shall be submitted to the department’s PBM or its fiscal agent.

History

(See Revision Note at chapter heading He-W 500); ss by #5742, eff 12-1-93, EXPIRED: 12-1-99
#7392, eff 10-28-00; ss by #7680, eff 4-20-02; ss by #7712, INTERIM, eff 6-22-02, EXPIRED: 12-19-02
#7805, eff 12-21-02; ss by #9831, eff 12-21-10; ss by #12529, eff 5-22-18

N.H. Code Admin. R. Ann. He-W 570.13 Prescription Co-payment {#sec-he-w-570.13 omnilex-key=us-nh-regs-official--agency-he-w--He-W 570.13}

Recipients shall make co-payments to the pharmacy provider for drug products as follows:

(a) A co-payment in the amount of $1.00 shall be required for each preferred prescription drug and each refill of a preferred prescription drug dispensed;

(b) A co-payment in the amount of $2.00 shall be required for each non-preferred prescription drug and each refill of a non-preferred prescription drug dispensed unless the prescribing provider determines that a preferred prescription drug will be less effective for the recipient, will have adverse effects for the recipient, or both, in which case the co-payment shall be $1.00;

(c) A co-payment in the amount of $1.00 shall be required for a prescription drug that is not identified as either a preferred or non-preferred prescription drug; and

(d) Co-payments for drug products shall not be required:

(1) Of recipients with income at or below 100% of the federal poverty level (FPL);

(2) Of recipients in a nursing facility, hospital, intermediate care facility for individuals with intellectual disabilities, or other medical institution;

(3) Of recipients participating in the home and community based care (HCBC) waiver programs;

(4) Of recipients receiving services that relate to pregnancy in accordance with 42 CFR 447.53 (b)(2), or any other medical condition that might complicate the pregnancy;

(5) Of recipients under the age of 18;

(6) For family planning products;

(7) For clozaril or clozapine prescriptions;

(8) Of women eligible through the Breast and Cervical Cancer Treatment Program, pursuant to 42 CFR 435.213;

(9) Of recipients receiving hospice care pursuant to He-W 544; and

(10) Of individuals who are members of a federally recognized Indian tribe or Alaskan natives who have ever been served through the Indian Health Services Program, pursuant to 42 CFR 447.56(a)(x).

History

(See Revision Note at chapter heading He-W 500); ss by #5742, eff 12-1-93, EXPIRED: 12-1-99
#7392, eff 10-28-00; ss by #7680, eff 4-20-02; ss by #7712, INTERIM, eff 6-22-02, EXPIRED: 12-19-02
#7805, eff 12-21-02; ss by #7976, eff 10-22-03; ss by #9831, eff 12-21-10; ss by #10716, eff 11-18-14; ss by #11101, eff 5-25-16; ss by #12529, eff 5-22-18; ss by #12698, eff 12-28-18

N.H. Code Admin. R. Ann. He-W 570.14 Payment for Drugs {#sec-he-w-570.14 omnilex-key=us-nh-regs-official--agency-he-w--He-W 570.14}

(a) Payment for drugs shall be:

(1) Made for products whose manufacturer has a signed rebate agreement with the USDHHS, or for single or innovator multiple-source products exempt from such agreements, pursuant to Section 4401 of P.L. 101-508, OBRA ‘90;

(2) Reimbursed at the lesser of the following:

a. The AAC using NADAC files when available, plus the dispensing fee;

b. The WAC, when a NADAC is not available, plus the dispensing fee;

c. The usual and customary charge to the general public;

d. The NHMAC plus the dispensing fee; or

e. The FUL plus the dispensing fee; and

(3) Subject to the following conditions and restrictions:

a. The payment for multiple source drugs, listed as having a FUL by the USDHHS, shall be reimbursed at a rate which does not exceed the FUL plus the dispensing fee, except as determined by the CMS of the USDHHS;

b. The payment for multiple source drugs, listed as having a NHMAC by the department, shall be reimbursed at a rate which does not exceed the maximum allowable cost plus the dispensing fee;

c. The NHMAC and FUL shall not apply when a licensed practitioner certifies on the face of the prescription in his or her own handwriting, pursuant to He-W 570.09, that a specific brand of drug, which is a NHMAC or FUL drug, is medically necessary for a particular recipient;

d. The payment for any refill prescriptions for the same recipient for solid oral maintenance drugs within a time period that does not allow for usage of 75% of the supply of the drug shall be only for the cost of the drug unless the reason for the exception is documented on the prescription or the licensed practitioner’s order; and

e. The payment for compound drugs and sterile preparations for parenteral use shall be at the rate established by the department in accordance with RSA 161:4, VI(a).

(b) For a unit dose drug:

(1) The unit dose form of tablets and capsules shall be reimbursable only for medicaid recipients residing in nursing facilities and other facilities licensed under RSA 151;

(2) Unused portions of unit dose drugs shall be returned by the licensed facility in (b)(1) above to the pharmacy provider when allowed in accordance with 21 CFR 1306 or applicable state law;

(3) Unit dose credit shall be submitted by the pharmacy provider to the department, within 90 days of such return;

(4) The original claim shall be voided by the pharmacy provider and a new claim submitted for the actual amount used;

(5) A pharmacy provider shall use the manufacturer’s unit dose package or his or her own unit dose package which meets the requirements of US pharmacopoeia dispensing information (USPDI) unit dose packages; and

(6) Claims for unit dose packages shall be submitted only at the end of any monthly period.

(d) The pharmacy provider shall submit medical supply and equipment claims with NDCs for payment to the PBM.

(e) The pharmacy provider shall submit medical supply and equipment claims with HCPCS codes for payment to the department’s fiscal agent.

(f) The pharmacy provider shall make available to the department the following documents for utilization and review purposes:

(1) All prescriptions for both medicaid recipients and non-medicaid recipients filled during the time period specified by the department, with all identifying information blocked out;

(2) All price lists that were in effect for such time period; and

(3) Invoices showing the actual acquisition cost of the drugs and supplies.

History

#7680, eff 4-20-02; ss by #7712, INTERIM, eff 6-22-02, EXPIRED: 12-19-02
#7805, eff 12-21-02; ss by #9831, eff 12-21-10; amd by #12140, eff 4-1-17; ss by #12529, eff 5-22-18

Part He-W 571 Durable Medical Equipment, Prosthetic and Orthotic Devices, and Medical Supplies

N.H. Code Admin. R. Ann. He-W 571.01 Definitions {#sec-he-w-571.01 omnilex-key=us-nh-regs-official--agency-he-w--He-W 571.01}

(a) “Apnea of prematurity” means that one of the following has occurred to an infant:

(1) The sudden cessation of breathing that lasts for at least 20 seconds;

(2) The sudden cessation of breathing for any length of time, which is accompanied by bradycardia, which means a heart rate less than 80 beats per minute;

(3) O2 desaturation, which means O2 saturation of less than 90% with cyanosis or pallor in an infant younger than 37 weeks gestation; or

(4) The presence of marked hypotonia.

(b) “Apparent life-threatening event (ALTE)” means one or more of the following conditions affecting an infant:

(1) Apnea;

(2) Change in skin color;

(3) Marked change in muscle tone, usually marked limpness; or

(4) Choking and gagging.

(c) “Clean claim(s)” means a claim that can be processed without obtaining additional information from the dispensing provider or from a third party, including a claim with errors originating in the state’s claims system, and not including a claim from a dispensing provider who is under investigation for fraud or abuse or a claim under review for medical necessity.

(d) “Date of service” means the date that the item is delivered to or received by the recipient except:

(1) For custom wheelchairs, the date the custom wheelchair is ordered;

(2) For custom fabricated prosthetic and orthotic devices, the date of fabrication;

(3) For frame and seating systems to pediatric and adult wheelchairs, the date of the order; or

(4) For medical supplies that are dropped shipped, the date of shipment.

(e) “Department” means the New Hampshire department of health and human services.

(f) “Dispensing provider” means the company or the company’s authorized representative providing the item to the recipient.

(g) “Durable medical equipment (DME)” means a type of item that is:

(1) Non-disposable and able to withstand repeated use;

(2) Primarily used to serve a medical purpose for the treatment of an acute or chronic medically diagnosed health condition, illness, or injury; and

(3) Not useful to an individual in the absence of an acute or chronic medically diagnosed health condition, illness, or injury.

(h) “Item(s)” means any DME, prosthetic devices, mobility devices, orthotic devices, or medical supplies.

(i) “Letter of medical necessity (LMN)” means a letter, signed by the ordering physician, physician assistant, or advanced practice registered nurse (APRN) certifying the need for the item being requested.

(j) “Life sustaining” means medical interventions that utilize mechanical or other artificial means to sustain, restore, or supplant a vital function, which serve only or primarily to prolong the moment of death, and where, in the judgment of the attending and consulting physicians, as reflected in the recipient’s medical records, death is imminent if such interventions are not utilized.

(k) “Medicaid” means the Title XIX and Title XXI programs administered by the department, which makes medical assistance available to eligible individuals.

(l) “Medical supplies” means a type of consumable or disposable item appropriate for relief or treatment of a specific medically diagnosed health condition, illness, or injury.

(m) “Mobility devices” means a type of item specifically designed for use by individuals with a mobility-related injury, illness, or disability that helps the individual walk or move from place to place, and includes manual and power wheelchairs, strollers, scooters, walkers, gait trainers, crutches, canes, or similar devices.

(n) “Monthly quantity” means the amount of medical supplies allowed per month.

(o) “Orthotic devices” means a type of orthopedic item that is applied externally to the limb or body to:

(1) Protect against injury;

(2) Support a weak or deformed portion of the body; or

(3) Prevent or correct a physical deformity or malfunction.

(p) “Prosthetic devices” means a non-dental, artificial type of replacement, corrective or supportive device or part of a device used to:

(1) Replace a missing portion of the body; or

(2) Replace a missing function of the body.

(q) “Provider” means a New Hampshire licensed ordering physician, APRN, physician assistant, or an ordering occupational or physical therapist specializing in rehabilitation medicine.

(r) “Recipient” means any individual who is eligible for and receiving medical assistance under the medicaid program.

(s) “Title XIX” means the joint federal-state program described in Title XIX of the Social Security Act and administered in New Hampshire by the department under the medicaid program.

(t) “Title XXI” means the joint federal-state program described in Title XXI of the Social Security Act and administered in New Hampshire by the department under the medicaid program.

History

(See Revision Note at chapter heading He-W 500); ss by #6158, eff 12-29-95, EXPIRED: 12-29-03
#8961, eff 8-20-07; amd by, INTERIM, #8983, eff 9-21-07, EXPIRES: 3-19-08 (deletion of former paras. (d) & (h) and renumbering remaining paragraphs); amd by #10139, eff 7-1-12; ss by #11046, eff 2-27-16

N.H. Code Admin. R. Ann. He-W 571.02 Recipient Eligibility {#sec-he-w-571.02 omnilex-key=us-nh-regs-official--agency-he-w--He-W 571.02}

(a) Except as specified in (b) below, all NH medicaid recipients shall be eligible to receive items in accordance with and subject to the limitations set forth in this part.

(b) Medicaid recipients residing in nursing facilities shall be eligible to receive only customized items not already included in the nursing facility rate, which is determined in accordance with He-E 806.

History

(See Revision Note at chapter heading He-W 500); ss by #6158, eff 12-29-95, EXPIRED: 12-29-03
#8961, eff 8-20-07; ss by #11046, eff 2-27-16

N.H. Code Admin. R. Ann. He-W 571.03 Dispensing Provider Participation {#sec-he-w-571.03 omnilex-key=us-nh-regs-official--agency-he-w--He-W 571.03}

Each dispensing provider shall be enrolled with NH medicaid.

History

(See Revision Note at chapter heading He-W 500); ss by #6158, eff 12-29-95, EXPIRED: 12-29-03
#8961, eff 8-20-07; ss by #11046, eff 2-27-16

N.H. Code Admin. R. Ann. He-W 571.04 Covered Services {#sec-he-w-571.04 omnilex-key=us-nh-regs-official--agency-he-w--He-W 571.04}

(a) The purchase of medical supplies, except incontinence supplies, for continuous use or on an as-needed basis, shall not require prior authorization and shall be covered when prescribed, except as follows:

(1) Specialty formulas and food products shall only be covered in accordance with (b)(3)a. and b. below;

(2) Enteral formulas and supplies shall only be covered in accordance with (b)(3)c. below; and

(3) Medical supplies that are listed as non-covered services in He-W 571.06 shall not be covered.

(b) The following items shall be covered when prescribed and supported by an LMN:

(1) The purchase of, or repairs to, prosthetic devices, including prosthetic fingers, thumbs, and toes when they are part of a covered prostheses except as prohibited in He-W 571.06(v);

(2) The purchase of, or repairs to, orthotic devices;

(3) The purchase of the following medical supplies:

a. Specialty formulas prescribed for life-sustaining purposes;

b. Specialty formulas and food products prescribed for metabolic diseases described in RSA 415:6-c;

c. Enteral formulas and supplies when oral feeds are contraindicated; and

d. Disposable incontinence products for recipients between 3 and 20 years of age;

(4) The purchase of one standard manual breast pump per pregnancy;

(5) Bed cradle when necessary to prevent contact with the bed covering for conditions such as burns, decubitis, diabetic ulcers, and gout; and

(6) Except as specified in (c)(5) below, repairs to a purchased, non-rental, wheelchair when such repairs do not exceed a total of $800 within a given state fiscal year, which begins July 1st and ends June 30th.

(c) Unless a requested item is considered non-covered as specified in He-W 571.06, all items that are not otherwise indicated as covered in (a)-(b) above, shall be covered when prescribed, supported by an LMN, and prior authorized in accordance with He-W 571.05, and as follows:

(1) Infant home apnea monitors shall be covered when at least one of the following criteria is met:

a. Within the past 30 days from the date the completed PA request is submitted to the department, the infant has experienced an ALTE; and

b. The infant has one or more of the following conditions:

Tracheostomy or anatomic abnormalities of the face, tongue, jaw, or airway that make the infant vulnerable to airway compromise;
Neurologic or metabolic disorders affecting respiratory control;
Chronic lung disease, such as bronchopulmonary dysplasia, which requires supplemental oxygen (O2), continuous positive airway pressure, or mechanical ventilation;
Apnea of prematurity;
Bradycardia on caffeine, theophylline, or similar agents;
Diagnosis of pertussis, with positive laboratory results;
Diagnosis of gastroesophageal reflux disease (GERD) that results in apnea of at least 20 seconds, bradycardia, or O2 saturation; or
Discharged home on a schedule of weaning narcotics;

(2) A PA approved for an infant home apnea monitor shall be issued as follows:

a. The initial approval shall be valid for 3 months;

b. PA requests for additional coverage beyond the initial 3-month period shall be granted until the infant is ALTE-free for 2 months or until the child reaches 12 months of age, whichever comes first; and

c. PA requests for coverage after the infant reaches 12 months of age shall be granted when supported by physician documentation recommending the continuation of monitoring based on the child’s condition;

(3) An external insulin pump for the treatment of insulin-dependent diabetes (Type 1) shall be limited to one pump per recipient every 4 years or more frequently if technology evolves so that the pump can no longer be used, and shall be approved when the following criteria are met:

a. The recipient has received 3 or more daily insulin injections for at least 6 consecutive months;

b. The recipient has self-monitored his or her own blood sugar at least 4 times per day for the past 2 consecutive months;

c. The recipient and the recipient’s family demonstrate to the recipient’s physician or to the recipient’s diabetic educator the ability to carbohydrate count using insulin-to-carbohydrate ratios as well as insulin correction factors;

d. The recipient has a documented history of recurrent hypoglycemia with wide fluctuations in blood glucose, despite recipient compliance;

e. The recipient has dawn phenomenon with fasting sugars frequently exceeding 200 mg/dl;

f. The recipient has a history of severe glycemic excursions; and

g. An endocrinologist, or a physician with similar skills and training as an endocrinologist in the management of external insulin pumps, prescribes the pump and is involved with the medical care of the recipient;

(4) The purchase of a wig shall be covered with approval being subject to RSA 415:18-d;

(5) The purchase of any wheelchair or wheelchair accessory, as well as all repairs and modifications made to purchased wheelchairs that exceed the $800 limit set forth in (b)(6) above, shall be covered when the following criteria are met:

a. The need for a wheelchair, accessory, repair, or modification has been evaluated by a physical therapist (PT) or occupational therapist (OT), in consultation with the ordering physician;

b. The recipient has a condition for which there is a disease process, injury, or disability:

That would contraindicate weight bearing or ambulation; and
Where there is a decrease in neuromuscular function that prevents the recipient from being able to ambulate without assistance;

c. When the PA request is for a power wheelchair, the recipient:

Is unable to propel a manual wheelchair because of a disease process, injury, or disability; and
Is able to safely and independently operate a power wheelchair;

d. The wheelchair is not solely for the convenience of the recipient, or the recipient’s family or caregivers;

e. The recipient does not already have another mobility device that meets the recipient’s mobility needs; and

f. When the PA request is to replace an existing wheelchair, the following criteria are met:

It is not possible to repair or modify the existing wheelchair or replacement of the existing wheelchair is found to be the least costly alternative;
The current wheelchair no longer meets the recipient’s mobility needs; and
The request is not being made solely as a result of changing technology, age of the current wheelchair, or a desire for a new wheelchair;

(6) Customized strollers shall be covered only for recipients who:

a. Are non-ambulatory;

b. Meet the criteria for wheelchair approval as set forth in (5) above;

c. Do not already have a wheelchair or customized stroller, and are not expected to be prescribed a wheelchair within 24 months; and

d. Have mobility needs that will not be met by a commercially available stroller with adaptations;

(7) Gait trainers shall be covered only for recipients who:

a. Are able to stand upright with assistance and have some lower-extremity and trunk strength to be supported in the gait trainer;

b. Are not able to ambulate independently due to a condition such as, but not limited to, neuromuscular or congenital disorders, including acquired skeletal abnormalities;

c. Do not have lower-extremity contractures that would preclude ambulation, and have adequate range of motion to support mobility;

d. Have alignment of the lower extremities such that the foot and ankle can tolerate a standing or upright position as well as reciprocal movement;

e. Do not have complete paralysis of the lower extremities;

f. Have demonstrated improved mobility, ambulation, function, or physiologic symptoms, or have maintained status with the use of the selected gait trainer, and are able to follow a home therapy program incorporating the use of the gait trainer, as documented by a clinical program or home trial with the requested gait trainer; and

g. Have a written home therapy plan outlining the use of the requested gait trainer and for whom there is a caretaker who can appropriately supervise use of the gait trainer;

(8) Standers shall be covered only for recipients who:

a. Do not already have a stander or gait trainer;

b. Are unable to stand or ambulate independently due to a condition such as, but not limited to, a neuromuscular or congenital disorder, including acquired skeletal abnormalities;

c. Are at high risk for lower extremity contractures that cannot be appropriately managed by other treatment modalities, such as stretching, active therapy, and home programs;

d. Have an alignment of the lower extremities such that they can tolerate a standing or upright position;

e. Do not have complete paralysis of the lower extremities;

f. Do not have orthostatic hypotension, postural tachycardia syndrome, osteogenesis imperfecta, osteoporosis or other brittle bone diseases, or hip and knee flexion contractures of more than 20°;

g. Have demonstrated improved mobility, function, and physiologic symptoms, or have maintained status with the use of the requested stander, when other alternatives have failed, and are able to follow a home standing program incorporating the use of the stander, as documented by clinical standing program or home trial with the requested stander;

h. Are unable to stand or ambulate with caregiver assistance or an ambulatory assistive device at sufficient duration or distance to achieve a medical benefit;

i. Have a home therapy plan outlining the use of the requested stander; and

j. Have a request for a stander using code E0642, and are able to self-propel the stander;

(9) Cranial remolding helmets shall be covered when the following criteria are met:

a. The recipient is at least 3 months of age, but not older than 18 months of age;

b. The recipient has marked asymmetry that has not been substantially improved following conservative therapy of at least 2 months duration with cranial repositioning therapy and/or physical therapy; and

c. The asymmetry of the cranial base is documented by one of the following:

Skull base asymmetry of at least 6 mm right or left discrepancy, measured subnasally to the tragus, which is the cartilaginous projection of the auricle at the front of the ear; or
Cranial vault asymmetry of at least 10 mm right or left discrepancy, measured obliquely from the supraorbital point to the parietooccipital scalp at the midpoint of maximal convexity and from the supraorbital point to the parietooccipital scalp at the midpoint of the flattened area, or a ratio of these 2 measurements is greater than 1:1;

(10) A continuous positive air pressure (CPAP) machine to treat obstructive sleep apnea (OSA) in recipients up to the age of 21 shall be covered when all of the following criteria are met:

a. Adenotonsillectomy is contraindicated, delayed, or unsuccessful in relieving symptoms of OSA;

b. There is an OSA diagnosis established by polysomnography (PSG) performed by a medicare certified sleep study center, or a children’s hospital; and

c. The recipient is 7 years of age or older and weighs 40 pounds or more;

(11) A CPAP machine to treat OSA in a recipient 21 years of age or older shall be covered when all of the following criteria are met:

a. The recipient has a diagnosis of OSA established by PSG performed by a medicare certified sleep study center; and

b. At least one of the following clinical criteria has been met:

The apnea-hypopnea index (AHI), which assesses the severity of sleep apnea, is moderate to severe, which is defined as 15 or more events per hour; or
The AHI is from 5 to 14 events per hour with documentation of symptoms of daytime sleepiness, impaired cognition, mood disorders, or insomnia that impairs the recipient’s ability to carry out activities of daily living, and one of the following conditions is met:

(i) A diagnosis of hypertension, ischemic heart disease, or a history of stroke; or

(ii) More than 20 episodes of O2 desaturation, measuring less than 85%, or any one episode of O2 desaturation, measuring less than 70%, during a full-night sleep study;

(12) A CPAP machine covered in accordance with (10) or (11) above shall be prior authorized as follows:

a. The initial authorization shall be limited to a 2-month trial rental of the CPAP machine to ensure the recipient uses the machine daily and will receive a sufficient benefit from use of the machine;

b. The recipient’s daily use shall be documented by a compliance report indicating that the recipient is gaining sufficient benefit from the CPAP machine, as evidenced by a downloaded recording from the machine showing usage of a daily minimum of 4 hours per night;

c. Following the 2-month trial period, if the recipient demonstrates daily use as described in b. above during the 2-month trial rental period, the requesting dispensing provider may submit a subsequent PA request, which shall include the documentation described in b. above, for the purchase of the CPAP machine;

d. If the recipient does not use the machine as required in b. above during the trial period, but the non-compliance is correctable, such as by adjusting the fit of the mask, the requesting dispensing provider may submit a subsequent PA request for an additional rental period; and

e. Following the trial rental period, if it is demonstrated that the CPAP machine is not providing a sufficient benefit to the recipient, and the failure is not due to non-compliance, abuse, or neglect, the requesting dispensing provider may submit a PA request for a bi-level positive airway pressure (BiPAP) machine;

(13) The department shall approve a request for a BiPAP machine when it has been determined, in accordance with (12) above, that a CPAP machine is not effective in treating the recipient’s OSA;

(14) A BiPAP machine shall be covered as follows:

a. The initial authorization shall be limited to a 2-month trial rental of the BiPAP machine to ensure the recipient uses the machine daily and will receive a sufficient benefit from use of the machine;

b. The recipient’s daily use shall be documented by a compliance report indicating that the recipient is gaining sufficient benefit from the BiPAP machine, as evidenced by a downloaded recording from the machine showing usage of a daily minimum of 4 hours per night; and

c. Following the 2-month trial period, if the recipient demonstrates daily use during the trial rental period as required in b. above, the requesting item provider may submit a subsequent PA request, which shall include the documentation described in b. above, for the purchase of the BiPAP machine;

(15) High-frequency chest compression (HFCC) devices shall be covered when the following criteria are met:

a. The recipient is at least 2 years of age at the time the device is being used;

b. The recipient has a documented need of airway clearance;

c. The recipient has one of the following documented diagnoses:

Cystic fibrosis;
Chronic bronchiectasis that:

(i) Is characterized by a daily productive cough that has been confirmed by high resolution, spiral, or a standard CT scan;

(ii) Lasts for at least 6 consecutive months; or

(iii) Results in exacerbation, at least 2 times in a one year period, that requires antibiotic therapy; or

Chronic neuromuscular disorder affecting the ability to cough or clear respiratory secretions with a prior history of pneumonia or other significant worsening of pulmonary function, which exists when at least 2 of the following criteria are met:

(i) Forced expiration capacity (FEC) of 80% predicted;

(ii) Forced vital capacity (FVC) of less than 50% predicted;

(iii) Small airway score (FEP 25-75%) decrease in one year of 25% or more;

(iv) Pattern of annual or more hospitalizations for acute pulmonary exacerbations; or

(v) Demonstration of reduction of pulmonary function while on steroids for a year;

d. The recipient’s physician provides documentation demonstrating that standard treatments have failed to adequately mobilize retained secretions, as indicated by one of the following:

Other airway clearance therapies, including chest physical therapy or the use of a flutter device, cannot be performed at least twice daily, or as would be appropriate for the recipient’s age, because:

(i) There are no available parental or partner resources to perform chest physical therapy;

(ii) The caregiver is physically or mentally incapable of performing chest physical therapy at the required frequency; or

(iii) There are 2 or more individuals with cystic fibrosis, chronic bronchiectasis, or chronic neuromuscular disorder in the same household; or

There is a significant deterioration of the recipient’s clinical conditions, as described in c.3. above; and

e. The recipient is under the care of a pulmonologist;

(16) A HFCC device covered in accordance with (15) above shall be prior authorized as follows:

a. The initial authorization shall be limited to a 2-month trial rental of the HFCC device to ensure the recipient uses the device daily and will receive a sufficient benefit from use of the device;

b. The recipient’s daily use and sufficient benefit from usage during the 2-month trial rental period shall be documented by:

A report completed by a pulmonologist documenting the recipient’s comfort, tolerance, and willingness to use the device;
A report completed by a pulmonologist demonstrating that the recipient has sufficiently benefited from the use of the HFCC device as evidenced by clinical indications, including:

(i) Improvement in forced expiratory volume (FEV1); or

(ii) A reduction in the number of hospitalizations per year;

A statement signed by the pulmonologist, which may be part of the report in 2. above, stating that the recipient has sufficiently benefited from the use of the HFCC device, and that the pulmonologist recommends continued usage of the HFCC device; and
A usage meter report generated by the dispensing provider documenting usage at least 67% of the prescribed time;

c. Following the 2-month trial rental period specified in a. above, the requesting dispensing provider may submit a prior authorization request for an additional rental period, not to exceed one year, by submitting a prior authorization request along with documentation demonstrating the recipient’s use as described in b. above;

d. A request for an additional rental period or to purchase the device through a rent-to-own arrangement, submitted in accordance with c. above, shall be approved by the department when the clinical evidence of the recipient’s use and sufficient benefit supports continued use of the HFCC device; and

e. Approvals shall be limited to only one HFCC device and one vest per size per family;

(17) Oximeters shall be covered when the recipient has been assessed by his or her physician or pulmonary specialist to determine if supplemental O2 is required, and either:

a. The recipient has been on supplemental O2 and an oximeter is requested to determine if he or she can be weaned from the supplemental O2; or

b. The recipient is receiving supplemental O2 and is experiencing widely fluctuating O2 saturation levels and an oximeter is required to assist in determining the cause, frequency, and duration of the fluctuation to properly determine the O2 flow rate;

(18) Disposable incontinence supplies, including chux underpads, incontinence briefs, pull-ups, diapers, pads or liners, and gloves and toileting wipes used for this condition, for recipients 21 years of age or older shall be covered in accordance with the following:

a. The PA shall be approved for a period of one year if the recipient’s type of incontinence is:

Secondary to a disease process or injury to the bladder, which results in irreversible loss of control of the urinary bladder and/or rectal sphincter;
Secondary to an injury to the brain or spinal cord;
Secondary to a disease or condition that causes incontinence; or
Attributed to a profound cognitive disability or progressive neurological disorder, such as severe intellectual disability, dementia, or tardive dyskinesia, that results in an inability to achieve continence through bladder training;

b. The PA shall be approved for a period of 6-months if the recipient’s type of incontinence is:

Secondary to a surgical procedure, such as prostatectomy, resulting in temporary urinary incontinence; or
Secondary to an injury to the bladder and/or urinary sphincter, including nerve injury and detrusor muscle instability, resulting in temporary urinary incontinence; and

c. The following quantity limits shall apply, unless the prior authorization request specifies and medically justifies a greater quantity:

Disposable chux underpads shall be limited to a total of 3 per day, up to 93 per month, except that if package sizes necessitate dispensing a greater monthly quantity, the monthly quantity shall not exceed 105 per month;
Incontinence briefs, pull-ups, and diapers shall be limited to a total of 6 per day, up to 186 per month, except as follows:

(i) If package sizes necessitate dispensing a monthly quantity which is greater than 186, the monthly quantity shall not exceed 216 per month; and

(ii) The dispensing provider shall dispense the fewest number of packages that result in a quantity as close as possible to the 186 limit without going under, for example, if a package size is 10 diapers per package, then 19 packages equaling 190 diapers shall be dispensed, not 20 nor 21 packages; and

Pads and liners used to line undergarments shall be limited to a total of 3 per day, up to 93 per month, except as follows:

(i) If package sizes necessitate dispensing a monthly quantity which is greater than 93, the monthly quantity shall not exceed 144 per month; and

(ii) The dispensing provider shall dispense the fewest number of packages that result in a quantity as close as possible to the 93 limit without going under, for example, if a package size is 16 liners per package, then 6 packages equaling 96 liners shall be dispensed, not 17, 18, nor 19 packages;

(19) Functional electric stimulation (FES), which is used to enable a recipient with spinal cord injury to ambulate, shall be covered when the recipient meets all of the following:

a. Has intact lower motor units, L1 and below, both muscle and peripheral nerve;

b. Can bear weight on upper and lower extremities to maintain an upright posture independently;

c. Demonstrates brisk muscle contraction in response to neuromuscular electrical stimulation through a trial use of the equipment by the recipient’s physical therapist, and has sensory perception of electrical stimulation sufficient for muscle contraction;

d. Is motivated and has the cognitive ability to use such devices for walking;

e. Can transfer independently and stand for at least 3 continuous minutes;

f. Possesses hand and finger function to manipulate the controls;

g. Is at least 6-months post-recovery of spinal cord injury and restorative surgery;

h. Does not have hip or knee degenerative disease and has no history of long bone fracture secondary to osteoporosis; and

i. Has successfully completed a training program, which consists of at least 32 physical therapy sessions with the device over a 3-month period;

(20) Pediatric specialty beds shall be covered for infants and children up to the age of 12, as follows:

a. The recipient has one or more of the following diagnoses:

Traumatic brain injury;
Moderate or severe cerebral palsy;
Seizure disorder with daily seizure activity, characterized by loss of consciousness or lack of awareness to surroundings;
Pervasive developmental disorder;
Psychiatric, neurological, or metabolic diagnosis with documented risk of self-injury; or
Severe behavioral disorder;

b. The recipient has cognitive and communication impairment;

c. There is documentation of medical necessity that includes at least one of the following:

Daily seizure activity as described in a.3. above;
Uncontrolled perpetual involuntary movement related to a medical diagnosis; or
Self-injurious behavior, such as head banging, where a helmet was tried and was not successful at reducing the self-injurious behavior;

d. There is evidence of a safety risk that includes at least one of the following:

The recipient demonstrates unsafe mobility that will put the recipient at risk for serious injury, not just a possibility of injury, such as climbing out of bed;
The recipient has balance problems or vertigo; or
The recipient has history of injury that has occurred prior to the request;

e. There is documented use of more cost effective alternatives for which the outcomes were unsuccessful, such as:

Positional aids and side rails with padding around the regular bed;
Alternative bedding, such as moving the mattress to the floor with surrounding padding;
Management of seizure disorder;
Pharmacotherapy;
Helmet for head protection;
Behavioral therapy;
Environmental assessment and removal of safety hazards and use of appropriate child protective devices, such as on the door knob or use of a baby gate to prevent the child from leaving the room; or
Use of portable monitoring devices, such as a baby monitor to listen in on the child’s activities; and

f. The LMN includes the following:

The recipient’s medical, psychiatric, neurological, metabolic, and behavioral diagnosis;
The recipient’s needs that are a result of the diagnosis that shows the medical need for the specialty bed;
The specific name, type, and bed model that addresses each of the recipient’s needs with specific requirements such as full safety rails, height required for safety, or the necessity of articulation to raise the head or feet of the child to feed, medicate, or provide mobility;
Documentation as to how the recipient’s current bed or crib or modifications to the bedroom fail to address the clinical need and which states whether the recipient has the capacity to climb;
Current and previous treatment modalities, including an explanation why these modalities were not successful;
Assessment of cognitive function including developmental age equivalent for motor function, cognitive function, and habilitation potential; and
Detailed history of safety issues including incidence and resulting injury;

(21) Coverage of other items that are not specifically listed elsewhere in this rule, such as those listed below, shall be based on the National Coverage Determinations (NCD) criteria published in the Medicare Coverage Database (MCD) at the time of the coverage determination, as found at http://www.cms.gov/medicare-coverage-database/, including:

a. Pressure-reducing surfaces;

b. Enteral feeding pumps;

c. Hospital beds and accessories;

d. External infusion pumps, with the exception of insulin pumps, which shall be subject to the criteria set forth in He-W 571.04(c)(3) above;

e. Negative pressure wound therapy pumps;

f. Pneumatic compression devices;

g. Hoyer type lifts and other patient lift transfer systems;

h. Transcutaneous electrical nerve stimulators (TENS);

i. Trapeze bars;

j. Osteogenesis stimulators;

k. Parenteral nutrition pumps;

l. Suction machines;

m. Airway clearance devices, such as inexsufflators;

n. Voice activated home glucose monitors;

o. Seat lift mechanisms that are not part of a wheelchair;

p. Continuous passive motion machines; and

q. Oxygen compressors and humidification devices; and

(22) For items that are not specifically listed elsewhere in this rule and are also not listed in the MCD, the department shall review the recipient’s medical information and shall cover the item when the department determines that coverage of the item:

a. Is clinically appropriate in terms of type, frequency of use, extent, site, and duration, and consistent with the established diagnosis or treatment of the recipient’s illness, injury, disease, or its symptoms as determined by a review of the coverage criteria set forth in the New Hampshire or New England commercial insurance coverage as listed in He-W 530.05(b)(32)b.;

b. Is not primarily for the convenience of the recipient or the recipient’s family, caregiver, or health care provider;

c. Is no more costly than other items or services that would produce equivalent diagnostic, therapeutic, or treatment results as related to the recipients’ illness, injury, disease, or its symptoms;

d. Is not experimental, investigative, cosmetic, or duplicative in nature; and

e. Is allowable under Medicaid and does not otherwise conflict with the New Hampshire Medicaid State Plan.

(d) All items billed with any Healthcare Common Procedure Coding System (HCPCS) miscellaneous procedure code shall be covered when prescribed, supported by an LMN, and prior authorized in accordance with He-W 571.05, and as follows:

(1) Customized car seats shall be covered for recipients who have a neuromotor diagnosis and whose needs cannot be met by a commercially available car seat with minor adaptations that do not reduce the effectiveness or safety of the car seat nor make the manufacturer’s warranty null and void; and

(2) Protective helmets for recipients with drop seizures or severe head-banding disorders.

History

(See Revision Note at chapter heading He-W 500); ss by #6158, eff 12-29-95, EXPIRED: 12-29-03
#8961, eff 8-20-07; amd by #8983, INTERIM, eff 9-21-07, EXPIRES: 3-19-08 (deletion of former paragraphs (b)-(f) and renumbering remaining paragraph (a) as (a)-(f)); amd by #9103, eff 3-12-08; ss by #11046, eff 2-27-16

N.H. Code Admin. R. Ann. He-W 571.05 Prescription, LMN, and Prior Authorization Requirements {#sec-he-w-571.05 omnilex-key=us-nh-regs-official--agency-he-w--He-W 571.05}

(a) The prescription required in He-W 571.04(a)-(c) above shall be written by the provider and include the following:

(1) The recipient’s name, address, date of birth, and NH medicaid identification number (MIN);

(2) The specific monthly quantity(s) to be dispensed, not to exceed the limits set forth in this rule;

(3) The specific type of item(s) to be dispensed;

(4) The frequency of use for the medical supply(s) being dispensed; and

(5) The dated signature or electronic signature of the provider.

(b) The LMN required in He-W 571.04(b)-(c) above shall be written by the provider and include the following:

(1) The recipient’s name, address, date of birth, and NH MIN;

(2) A narrative description of the recipient’s medically diagnosed health condition, illness, or injury, including an indication of whether the diagnosis is a pre-existing condition or a presenting condition;

(3) The recipient’s prognosis;

(4) An estimation of the effect on the recipient if the requested item(s) is not provided;

(5) The medical justification for the item(s) being requested, including its contribution to the treatment of the recipient’s illness or injury or to the improvement of the recipient’s physical condition;

(6) The anticipated length of time the item(s) is expected to be needed;

(7) The expected outcome of providing the requested item(s);

(8) The recommended timeframe to achieve the expected outcome;

(9) A summary of any previous treatment plans, including outcomes, which were used to treat the diagnosed condition for which the requested item(s) is being recommended;

(10) A statement, with supporting documentation, assuring that the requested item(s) is the least restrictive, least costly item available to meet the recipient’s needs;

(11) Supporting documentation that demonstrates the medical need for the item(s); and

(12) The dated signature, or electronic signature, of the provider.

(1) Not be written retroactively; and

(2) Be valid for one year from the date written so long as the medical treatment remains unchanged.

(d) All PA requests shall be sent to the department for review and approval, and include the following documentation:

(1) A copy of the prescription, as described in (a) above;

(2) An LMN containing all of the information specified in (b) above; and

(3) A completed PA form specific to the item being requested, as follows:

a. For all DME, a completed Form 272D, “Durable Medical Equipment Prior Authorization Request” form (January 2016) shall be signed and dated by an authorized representative of the NH medicaid enrolled dispensing provider;

b. For all disposable incontinence supplies, a completed Form 272DIA, “Incontinence Products Prior Authorization Request Form” (January 2016) shall be completed by an authorized representative of the NH medicaid enrolled dispensing provider;

c. In addition to submitting the forms required by a. above, requests for all wheelchairs, scooters, and customized strollers must also include a completed Form 272M, “Mobility Evaluation Form” (January 2016), including the following:

A dated signature and printed name of the provider completing the evaluation;
A dated signature and printed name of the recipient or the recipient’s parent or legal guardian, if applicable;
A dated signature and printed name of an authorized representative of the NH medicaid enrolled dispensing provider; and
A copy of the manufacturer’s invoice or quote, which includes the Manufacturer’s Suggested Retail Price (MSRP) and acquisition cost;

d. In addition to the requirements specified in (3)c. above, PA request for the purchase of accessories for a wheelchair shall also include the following documentation from the ordering physician:

Documentation that the ordering physician has assessed the recipient for the accessory within 60 days of making the PA request;
A written diagnosis, including a brief medical history justifying the need for the accessory; and
When applicable, an estimate of the length of time the accessory will be required; and

e. In addition to submitting the form required by a. above, requests for all standers, gait trainers, and bath and toileting items shall also include a completed Form 272EQ, “Medical Equipment Request Evaluation Form Non-Wheelchair” (January 2016), including the following:

A dated signature and printed name of the provider completing the evaluation;
A dated signature and printed name of the recipient or the recipient’s parent or legal guardian, if applicable;
A dated signature and printed name of an authorized representative of the NH Medicaid enrolled dispensing provider; and
A copy of the manufacturer’s invoice or quote, which includes the MSRP and acquisition cost.

(e) A dispensing provider may complete and submit Form 272REV “Incontinence Products Prior Authorization Revision Request Form” (October 2015) in order to provide products which better suit a recipient’s needs when such changes are to:

(1) Product size that will result in a new T-code or modifier;

(2) Product absorbency that will result in a new T-code or modifier; or

(3) Product style that will result in a new T-code or modifier.

(f) Requests for PA shall be approved by the department if the department determines the following:

(1) With the exception of disposable incontinence supplies, the item meets the definition of DME, prosthetic devices, medical supplies, or orthotic devices as defined in He-W 571.01;

(2) The medical documentation was completed and submitted in accordance with (d) above;

(3) The PA request demonstrates that the item is consistent with the established diagnosis or treatment of the recipient’s illness, injury, disease, or its symptoms as determined by a review of the coverage criteria set forth in He-W 571.04 above; and

(4) The item is cost effective, as determined by a finding that:

a. There is no other less costly item, as identified by the department that would effectively meet the recipient’s needs; or

b. Less expensive, appropriate alternatives are not covered or generally not available.

(g) A dispensing provider shall request and obtain prior authorization from the department before providing the item(s).

(h) A provider shall conduct and document a face-to-face encounter with the recipient no earlier than 60 days prior to submitting a prior authorization request and the provider’s written order shall include the date of the encounter and the primary clinical reason the recipient needs the item(s).

(i) Requests for a PA shall be denied by the department if the department determines that the requirements set forth in (f) above have not been met.

(j) Decisions made by the department in accordance with this section shall not be superseded by the treating, ordering, or consultative health care provider’s prescription, orders, or recommendations.

(k) If the department approves the PA request, the state’s fiscal agent shall send written confirmation of the approval to the dispensing provider.

(l) If the department denies the PA request or partially denies it, the state’s fiscal agent shall forward a notice of denial to the recipient and the provider, which includes the following information:

(1) The reason for, and legal basis of, the denial or partial denial; and

(2) Information that a fair hearing on the denial may be requested within 30 days of the date on the notice of the denial, in accordance with He-C 200.

(m) The dispensing provider shall be responsible for determining that the recipient is eligible for NH medicaid on the date of service as defined in He-W 571.01(a).

History

(See Revision Note at chapter heading He-W 500); ss by #6158, eff 12-29-95, EXPIRED: 12-29-03
#8961, eff 8-20-07; amd by #8983, INTERIM, eff 9-21-07, EXPIRES: 3-19-08 (deletion of former subparagraph (b)(6) and renumbering remaining subparagraphs); ss by #11046, eff 2-27-16

N.H. Code Admin. R. Ann. He-W 571.06 Non-Covered Services {#sec-he-w-571.06 omnilex-key=us-nh-regs-official--agency-he-w--He-W 571.06}

The following items shall not be covered:

(a) Items that do not meet the coverage criteria set forth in He-W 571.04;

(b) Specialty formulas when not needed for life-sustaining purposes, or as the sole source of nutrition, except as allowed under He-W 546;

(c) Common, over-the-counter, household and medicine-chest items that can be purchased without a prescription, including, but not limited to:

(1) Corn plasters and foot pads;

(2) Nursery supplies;

(3) Hand cleaners or sanitizers, such as Hygenall or Purell;

(4) Personal hygiene items including body lotions, toothbrushes, electric shavers, razors, and other hair removal devices and services;

(5) Thermometers;

(6) Odor barrier products;

(7) Toileting wipes, except as allowed by He-W 571.04(c)(18) above;

(8) First aid kits and supplies, including adhesive bandages and scissors;

(9) Mechanical heated water circulating pads and pumps, including hydrocollator heating units;

(10) Non-legend medications specified in accordance with He-W 570.05(d); and

(11) Nutritional supplements or formula as follows:

a. Dietary or food supplements;

b. Lactose-free foods or products that aid in lactose digestion;

c. Gluten-free products;

d. Low carbohydrate diets;

e. Weight-loss foods, formulas, and related products intended to aid in weight loss;

f. Normal grocery items, including over-the counter infant formulas;

g. Baby food and banked breast milk;

h. Grocery items that can be prepared in a blender and used with an enteral feeding system;

i. High protein powders and mixes;

j. Medical food products that:

Are prescribed without a diagnosis requiring such foods;
Used for convenience purposes;
Have no proven therapeutic benefit without an underlying disease, condition, or disorder;
Used as a substitute for acceptable standard dietary interventions; or
Are used exclusively for nutritional supplementation; and

k. Enteral nutrition when the recipient has food allergies or dental problems, but has the ability to meet his or her nutritional requirements through an alternative store-bought food source;

(d) Environmental modifications and controls, including:

(1) Wheelchair ramps;

(2) Tub rails;

(3) Space heaters and heat lamps;

(4) Air conditioners and fans;

(5) Air purifiers, including HEPA and vacuum filters;

(6) Vaporizers, humidifiers, and dehumidifiers;

(7) Aromatherapy;

(8) Stairway lifts and elevators;

(9) Lifting devices including electric patient lifts and hydraulics and ceiling tract lifting devices;

(10) Power generators; and

(11) Adaptive or computer switch toys;

(e) Items typically not used by the general public for a medical purpose, including:

(1) Furniture for non-mobility purposes including, but not limited to:

a. Corner seats;

b. Positioning chairs;

c. High chairs or other feeding type chairs;

d. All beds, except hospital beds as allowed by He-W 571.04(c)(20)c., and the pediatric specialty beds as allowed in He-W 571.04(c)(20) above;

e. Toddler beds, bassinets, portable cribs, or playpens; and

f. Massage and therapy tables and related equipment;

(2) Lumbar support cushions;

(3) Bedding, including electric or weighted blankets;

(4) Clothing items, including sportswear such as neoprene shorts;

(5) Hot Tubs, whirlpool equipment, aqua massagers, and sauna baths;

(6) Recreational, therapeutic, or exercise equipment including, but not limited to, bicycles, treadmills, weights, tables, mats, and swings; and

(7) Video, computer games, or computer applications intended for the purpose of exercise, recreation, education, or instruction;

(f) Items that contribute to or enhance fertility or procreation;

(g) Items typically used by the general public for preventing injury or ensuring safety, including:

(1) Car seats, except as allowed by He-W 571.04(d)(1);

(2) Helmets, including protective helmets used for sports and recreation, except as allowed by He-W 571.04(d)(2); and

(3) Pneumatic vests and lumbar supports;

(h) Disposable incontinence supplies for:

(1) Recipients younger than 3 years of age, except as allowed by He-W 546; and

(2) Recipients 21 years of age or older who do not meet the criteria set forth in He-W 571.04(c)(18);

(i) Bed wetting alarms;

(j) Sleep positioning wraps;

(k) Computer controlled and programmable lateral rotation therapy bed systems;

(l) Chewelry, and similar non-toxic jewelry, intended to be chewed;

(m) Magnets, crystals, gemstones, and similar non-evidenced based, experimental, or investigational healing items;

(n) Glucowatches;

(o) Auto-feeders;

(p) Automated medication reminder systems;

(q) Cast bags, such as Aquashield;

(r) Electric resuscitators and portable defibrillators;

(s) Bi-directional static progressive stretch devices, including, but not limited to, Joint Active Systems (JAS) splints;

(t) Service or therapy animals and related expenses;

(u) Apnea monitors, except when the criteria in He-W 571.04(c)(2) have been met;

(v) Prosthetic fingers, thumbs, and toes when not part of a covered prosthesis;

(w) Commercially available strollers;

(x) Wheelchairs requested within 24 months of the purchase of a customized stroller;

(y) The following accessories and options for wheelchairs, customized strollers, or other mobility devices:

(1) Wheelchair remote controls and attendant control switches;

(2) Power assist devices or equipment to modify a manual wheelchair into a power wheelchair;

(3) Air suspension systems;

(4) Power standers and seat lift mechanisms;

(5) Grade aids and anti-roll devices for manual wheelchairs;

(6) Wheelchairs with stair climbing options;

(7) Titanium framed and sport-type wheelchairs;

(8) Custom wheels for off-road use or for sport and recreational purposes;

(9) Any wheelchair accessory or option for purposes of allowing the recipient to perform leisure, social, or recreational activities;

(10) Lights, horns, mirror, baskets, pouches, backpacks, and similar accessories; and

(11) Back-up or spare wheelchairs for recipients who already have a wheelchair, power scooter, or customized stroller;

(z) Any back-up or spare equipment, with the exception of ventilators;

(aa) Replacement, repair, or modifications of an item when the need for which is the result of:

(1) Recipient abuse, misuse, or neglect;

(2) Failure to protect the item from the elements;

(3) Using the item inappropriately or contrary to its designed and intended use;

(4) Making improper repairs to the item, which would void any manufacturer’s warranty;

(5) Loss of the item when basic safeguarding measures could have been instituted;

(6) Failure to maintain the item through proper routine maintenance by an authorized dealer; or

(7) Taking any action that would otherwise void the manufacturer’s written warranty or is contrary to the manufacturer’s recommendations for care, use, and maintenance;

(ab) Repairs, modifications, or adjustments to any rented item, including wheelchairs;

(ac) Repairs to recipient owned items, when the recipient does not meet the criteria for coverage of the item, or when such repairs, modifications, or adjustments are:

(1) Within the dispensing provider’s or manufacturer’s warranty; or

(2) Within one year of the purchase of the item or accessory, unless written documentation from the provider demonstrates a significant change in the recipient’s medical condition that meets the coverage criteria for the item and the repair or modification is warranted;

(ad) Upgrades to or replacement of any functioning item that still meets the recipient’s needs, but is being requested solely as a result of changing technology;

(ae) Items which are more costly than other available items which could be expected to provide the same, similar, or duplicate outcome;

(af) Any items that are primarily intended for use at a school, are part of a child’s care plan at school, and could be obtained through the “Medicaid to Schools” program in accordance with He-M 1301, and the child and the child’s school participate in the “Medicaid to Schools” program; and

(ag) Any items that are experimental, investigational, or non-FDA approved.

History

(See Revision Note at chapter heading He-W 500); ss by #6158, eff 12-29-95, EXPIRED: 12-29-03
#8961, eff 8-20-07; amd by #8983, INTERIM, eff 9-21-07, EXPIRES: 3-19-08; amd by #9103, eff 3-12-08; amd by #9637, eff 1-16-10; amd by #9836, eff 12-18-10; ss by #11046, eff 2-27-16 (from He-W 571.05)

N.H. Code Admin. R. Ann. He-W 571.07 Requirements for Maintaining Documentation {#sec-he-w-571.07 omnilex-key=us-nh-regs-official--agency-he-w--He-W 571.07}

(a) The dispensing provider shall maintain supporting records in accordance with He-W 520 and this part, and failure to maintain records in accordance with He-W 520 and this part shall entitle the department to recoupment of state or federal medicaid payments made as permitted by 42 CFR 455, 42 CFR 447, and 42 CFR 456.

(b) In addition to the requirement set forth in (a) above, the dispensing provider shall maintain the following documentation for a minimum of 6 years or until the resolution of any legal action(s) commenced within the 6 year period, whichever is longer:

(1) All letters of medical necessity (LMN) described in He-W 571.05(b);

(2) Documentation of adjustments made to and inspections of items or related accessories;

(3) Documentation showing:

a. The date and proof of delivery of all items to the recipient;

b. For custom wheelchairs and customized strollers, the date of the order;

c. For custom prosthetic and orthotic devices, the date of fabrication;

d. For frame and seating systems to pediatric and adult wheelchairs, the date of order; and

e. For medical supplies shipped, the date of shipment;

(4) Documentation of a face-to-face encounter between the recipient and the recipient’s provider no earlier than 60 days of the PA request as described in He-W 571.05(h) above; and

(5) All other supporting documentation needed to justify monthly quantity(s) and type of item(s) dispensed.

History

(See Revision Note at chapter heading He-W 500); ss by #6158, eff 12-29-95, EXPIRED: 12-29-03
#8961, eff 8-20-07; amd by #9103, eff 3-12-08; amd by #9637, eff 1-16-10; amd by #10031, eff 11-19-11; ss by #11046, eff 2-27-16

N.H. Code Admin. R. Ann. He-W 571.08 Third Party Liability {#sec-he-w-571.08 omnilex-key=us-nh-regs-official--agency-he-w--He-W 571.08}

(a) All third party obligations shall be exhausted before medicaid shall be billed, in accordance with 42 CFR 433.

(b) Dispensing providers shall request information from the recipient regarding other insurance coverage.

(c) If other insurance coverage is available, dispensing providers shall contact the insurer to verify benefits initially and at least annually thereafter or when the insurance carrier changes.

(d) Dispensing providers shall maintain a record of any other insurance verifications in the recipient’s medical record.

History

(See Revision Note at chapter heading He-W 500); ss by #6158, eff 12-29-95, EXPIRED: 12-29-03
#8961, eff 8-20-07; ss by #11046, eff 2-27-16 (from He-W 571.09)

N.H. Code Admin. R. Ann. He-W 571.09 Utilization Review and Control {#sec-he-w-571.09 omnilex-key=us-nh-regs-official--agency-he-w--He-W 571.09}

The department’s provider program integrity unit shall monitor utilization of items to identify, prevent, and correct potential occurrences of fraud, waste, and abuse, in accordance with 42 CFR 455, 42 CFR 456, and He-W 520.

History

(See Revision Note at chapter heading He-W 500); ss by #6158, eff 12-29-95, EXPIRED: 12-29-03
#8961, eff 8-20-07; ss by #11046, eff 2-27-16 (from He-W 571.10)

N.H. Code Admin. R. Ann. He-W 571.10 Payment for Items {#sec-he-w-571.10 omnilex-key=us-nh-regs-official--agency-he-w--He-W 571.10}

(a) The department shall establish rates for all items in accordance with RSA 161:4, VI(a).

(b) All dispensing providers shall submit clean claim(s) as defined in He-W 571.01(c).

(c) All dispensing providers shall submit clean claims for payment to the department’s fiscal agent, and the department shall be entitled to recoupment of state and federal medicaid payments as permitted in 42 CFR 455, 42 CFR 456, and 42 CFR 447.

(d) All dispensing providers shall maintain supporting records supporting submitted claims in accordance with He-W 520 and He-W 571.07.

(e) Payment shall not be made for items that require prior authorization when prior authorization was not received and approved before the items were provided, in accordance with He-W 571.05. Retroactive prior authorization requests shall be denied.

(f) Payment for disposable incontinence supplies, including gloves and toileting wipes used for this condition, provided to recipients shall be made only for supplies obtained from the exclusive supplier of incontinence supplies contracted through the department.

(g) Billing of and payment for items and repair parts shall be made at the lesser of:

(1) The dispensing provider’s usual and customary charge to the public, as defined in RSA 126-A:3, III(b);

(2) The lowest amount the dispensing provider accepts from any other third party payor; or

(3) The rate established by the department in accordance with RSA 161:4, VI(a).

(h) Payment for labor costs for repairs shall be at a rate established by the department in accordance with RSA 161:4, VI(a).

(i) Payment shall be denied or recouped if the dispensing provider bills for and is paid for disposable incontinence supplies, including gloves and toileting wipes used for such condition, which are not obtained from the exclusive supplier of incontinence supplies contracted through the department.

(j) Except as allowed by (k) below, payment shall be denied if the recipient is not eligible on the date of service, even when a prior authorization request has been approved.

(k) For the following items only, payment shall be denied if the recipient is not medicaid eligible on the date of service as defined in He-W 571.01(a).

(l) No item shall be paid for prior to delivery to the recipient and dispensing providers shall maintain documentation in accordance with He-W 571.07 and 571.10 which demonstrates that the items were delivered to the recipient.

(m) No payment shall be made for items left unattended which results in the item(s) destruction or damage to the item so that it is unusable.

(n) In accordance with the payment rates established in (a) above, the rate for wheelchairs shall include the following required services:

(1) Delivery and assembly of the wheelchair;

(2) Training to the recipient and recipient’s family and other caregiver(s) in the use of the equipment, maintenance care, and equipment diagnostics; and

(3) Wheelchair adjustments and any follow-up training within 30 days following the delivery of the chair.

(o) Dispensing providers shall supply a comparable substitute wheelchair at no additional cost for 2 weeks during the repair of the original wheelchair. For repairs that require more than 2 weeks to complete, the dispensing provider may request PA for a rental fee.

History

(See Revision Note at chapter heading He-W 500); ss by #6158, eff 12-29-95, EXPIRED: 12-29-03
#8961, eff 8-20-07; ss by #11046, eff 2-27-16 (formerly He-W 571.11)

Part He-W 572 Ambulance Services

N.H. Code Admin. R. Ann. He-W 572.01 Definitions {#sec-he-w-572.01 omnilex-key=us-nh-regs-official--agency-he-w--He-W 572.01}

(a) “Acute care hospital” means a hospital that provides short-term medical treatment for patients who have an acute illness or injury, or who are recovering from surgery.

(b) “Advanced life support (ALS) services” means “advanced life support (ALS)” as defined by Saf-C 5901.05, namely, “medical procedures and the scope of practice rendered by advanced emergency medical care providers in accordance with RSA 153-A:12.”

(c) “Air ambulance” means a fixed-wing or rotary-wing aircraft that is certified by the Federal Aviation Administration as an air ambulance and which is designed and equipped for the provision of medically necessary supplies and services.

(d) “Ambulance” means any vehicle designed, equipped, and used for the transport of sick or injured individuals and which are licensed to do so in the state in which they operate.

(e) “Basic life support (BLS) services” means “basic life support (BLS)” as defined by Saf-C 5901.10, namely, “fundamental medical procedures and the scope of practice in which emergency medical care providers at any of the following licensing levels are trained:

(1) Emergency medical responder;

(2) New Hampshire emergency medical technician-basic (NH-EMT-B); or

(3) Emergency medical technician (EMT).”

(f) “Department” means the New Hampshire department of health and human services.

(g) “Emergency medical condition” means:

(1) A medical condition manifesting itself by acute symptoms of sufficient severity, including severe pain, such that a prudent layperson, with an average knowledge of health and medicine, could reasonably expect the absence of immediate medical attention to result in:

a. Placing the health of the recipient, or, with respect to a pregnant woman, the health of the woman or her unborn child, in serious jeopardy;

b. Serious impairment to bodily functions; or

c. Serious dysfunction of any bodily organ or part; or

(2) With respect to a pregnant woman who is having contractions:

a. That there is inadequate time to effect a safe transfer to another hospital before delivery; or

b. That transfer may pose a threat to the health or safety of the woman or unborn child.

(h) “Medicaid” means the Title XIX and Title XXI programs administered by the department which makes medical assistance available to eligible individuals.

(i) “Prior authorization agent” means an individual or agency contracted by the department responsible for reviewing all scheduled and routine ambulance transportation requests.

(j) “Recipient” means an individual who is eligible for and receiving medical assistance under the medicaid program.

(k) “Scheduled and routine ambulance transportation” means transportation by an ambulance for the purpose of attending an appointment to obtain a medicaid covered service from a medicaid enrolled provider when the use of any other mode of transportation would likely endanger the health and safety of the recipient and when the medicaid covered service is not to treat an emergency medical condition as defined in (g) above.

(l) “Title XIX” means the joint federal-state program described in Title XIX of the Social Security Act and administered in New Hampshire by the department under the medicaid program.

(m) “Title XXI” means the joint federal-state program described in Title XXI of the Social Security Act and administered in New Hampshire by the department under the medicaid program.

History

(See Revision Note at chapter heading He-W 500); ss by #6641, eff 11-27-97; EXPIRED: 11-27-05
#8502, INTERIM, eff 12-2-05, EXPIRES: 5-31-06; ss by #8638, eff 5-30-06; amd by #10139, eff 7-1-12; ss by #10294, eff 12-1-13; ss by #13840, INTERIM, eff 12-29-23;ss by #14007, eff 6-25-24

N.H. Code Admin. R. Ann. He-W 572.02 Recipient Eligibility {#sec-he-w-572.02 omnilex-key=us-nh-regs-official--agency-he-w--He-W 572.02}

All recipients shall be eligible for ambulance services, in accordance with He-W 572.

History

(See Revision Note at chapter heading He-W 500); ss by #6641, eff 11-27-97; EXPIRED: 11-27-05
#8502, INTERIM, eff 12-2-05, EXPIRES: 5-31-06; ss by #8638, eff 5-30-06; ss by #10294, eff 12-1-13; ss by #13840, INTERIM, eff 12-29-23; ss by #14007, eff 6-25-24

N.H. Code Admin. R. Ann. He-W 572.03 Provider Participation {#sec-he-w-572.03 omnilex-key=us-nh-regs-official--agency-he-w--He-W 572.03}

All participating ambulance providers shall:

(a) Be licensed in the state in which they operate; and

(b) Be an enrolled New Hampshire medicaid provider.

History

(See Revision Note at chapter heading He-W 500); ss by #6641, eff 11-27-97; EXPIRED: 11-27-05
#8502, INTERIM, eff 12-2-05, EXPIRES: 5-31-06; ss by #8638, eff 5-30-06; ss by #10294, eff 12-1-13; ss by #13840, INTERIM, eff 12-29-23; ss by #14007, eff 6-25-24

N.H. Code Admin. R. Ann. He-W 572.04 Covered Services {#sec-he-w-572.04 omnilex-key=us-nh-regs-official--agency-he-w--He-W 572.04}

(a) The following ambulance services, in the case of an emergency medical condition, shall be covered:

(1) Transportation to the nearest acute care hospital with appropriate treatment facilities, including loaded mileage and routine disposable supplies used en-route;

(2) Transportation from an acute care hospital inpatient bed or acute care hospital emergency department to an inpatient psychiatric facility or a designated receiving facility for admission; and

(3) Transportation from one acute care hospital to another acute care hospital when the necessary treatment or diagnostic testing cannot be provided by the originating hospital and the recipient is discharged from the originating hospital.

(b) Air ambulance services, in the case of an emergency medical condition, shall be covered if the recipient’s condition is such that:

(1) The recipient cannot be safely transported in a timely basis via an ALS ground transportation with appropriate staff; and

(2) The recipient is at imminent risk of losing life or limb if the fastest means of transport is not utilized to move the recipient to the nearest facility capable of treating the recipient.

(c) Scheduled and routine ambulance transportation, as defined in He-W 572.01(k), to and from the destination, including loaded mileage and routine disposable supplies used en-route, shall be covered when the service has been determined medically necessary in accordance with He-W 572.06.

(d) Waiting time for scheduled and routine ambulance transportation authorized pursuant to He-W 572.06 shall be covered up to a maximum of 2 hours, rounded to the nearest half hour.

History

(See Revision Note at chapter heading He-W 500); ss by #6641, eff 11-27-97; EXPIRED: 11-27-05
#8502, INTERIM, eff 12-2-05, EXPIRES: 5-31-06; ss by #8638, eff 5-30-06; ss by #10294, eff 12-1-13; ss by #10294, eff 12-1-13; ss by #13840, INTERIM, eff 12-29-23; ss by #14007, eff 6-25-24

N.H. Code Admin. R. Ann. He-W 572.05 Non-Covered Services {#sec-he-w-572.05 omnilex-key=us-nh-regs-official--agency-he-w--He-W 572.05}

Non-covered ambulance services shall include:

(a) Transportation for a recipient whose condition permits transport in any type of vehicle other than an ambulance, such as a private vehicle or a wheelchair van, without endangering the recipient’s health;

(b) Transportation in an ambulance, except for the following which are covered services pursuant to He-W 572.04:

(1) Scheduled and routine ambulance transportation, as defined in He-W 572.01(k);

(2) For an emergency medical condition, as defined in He-W 572.01(g); or

(3) Transportation of a recipient from one hospital to another inpatient facility such as a hospital or inpatient psychiatric facility, wherein the recipient is coming from the emergency department of the originating hospital or has been discharged from the originating hospital;

(d) Transportation from one acute care hospital to another acute care hospital for necessary treatment or diagnostic testing while the recipient maintains inpatient status with the originating hospital; and

(e) Waiting time that exceeds 2 hours.

History

(See Revision Note at chapter heading He-W 500); ss by #6641, eff 11-27-97; EXPIRED: 11-27-05
#8502, INTERIM, eff 12-2-05, EXPIRES: 5-31-06; ss by #8638, eff 5-30-06; ss by #10294, eff 12-1-13; ss by #13840, INTERIM, eff 12-29-23; ss by #14007, eff 6-25-24

N.H. Code Admin. R. Ann. He-W 572.06 Mobility Determination Requirements for Scheduled and Routine Ambulance Transportation {#sec-he-w-572.06 omnilex-key=us-nh-regs-official--agency-he-w--He-W 572.06}

(a) Medical necessity of a scheduled and routine ambulance transportation shall be documented using the “Mobility Determination for Non-Emergency Medical Transportation Universal Form for All Medicaid Plans” (June 2024), to be a covered service.

(b) A “Mobility Determination for Non-Emergency Medical Transportation Universal Form for All Medicaid Plans” (June 2024) shall be completed, signed, and submitted by a healthcare professional such as a registered nurse, medical doctor, care manager, or case manager to the department or its designee by either fax or mail.

(d) The department or its designee shall utilize the “Mobility Determination for Non-Emergency Medical Transportation Universal Form for All Medicaid Plans” to determine the most appropriate vehicle type to meet the recipient’s medical needs and notify the recipient and the health care provider who submitted the form of the determination, including information that the recipient may appeal the department or designee’s decision as to the most appropriate vehicle type for transportation according to medical necessity, in accordance with He-C 200.

History

(See Revision Note at chapter heading He-W 500); ss by #6641, eff 11-27-97; EXPIRED: 11-27-05
#8502, INTERIM, eff 12-2-05, EXPIRES: 5-31-06; ss by #8638, eff 5-30-06; ss by #10294, eff 12-1-13; ss by #13840, INTERIM, eff 12-29-23; ss by #14007, eff 6-25-24

N.H. Code Admin. R. Ann. He-W 572.07 Documentation {#sec-he-w-572.07 omnilex-key=us-nh-regs-official--agency-he-w--He-W 572.07}

(a) Each ambulance provider shall maintain supporting records in accordance with He-W 520 and He-W 521.

(b) Each ambulance provider shall maintain documentation in their records to fully support each claim billed for services, including:

(1) For emergency transportation, documentation of the nature of the recipient’s emergency medical condition; and

(2) For all ambulance transportation, documentation that justifies the level of service, whether ALS or BLS, claimed.

(c) For each trip billed in (b) above, the ambulance provider shall maintain a run sheet or patient care report that includes at a minimum the following information, which is legibly written:

(1) Recipient name and medicaid identification number;

(2) Date of service;

(3) Origin and destination;

(4) Recipient vital signs;

(5) Recipient signs and symptoms upon arrival at the point of pick-up;

(6) Recipient status en-route;

(7) Services provided;

(8) The name of the person who provided the service or care in the ambulance, including signature and credentials; and

(9) The response code that indicates the mode of response for the ambulance making the trip.

History

(See Revision Note at chapter heading He-W 500); ss by #6641, eff 11-27-97; EXPIRED: 11-27-05
#8502, INTERIM, eff 12-2-05, EXPIRES: 5-31-06; ss by #8638, eff 5-30-06; ss by #10294, eff 12-1-13 (from He-W 572.06); ss by #13840, INTERIM, eff 12-29-23; ss by #14007, eff 6-25-24

N.H. Code Admin. R. Ann. He-W 572.08 Utilization Review and Control {#sec-he-w-572.08 omnilex-key=us-nh-regs-official--agency-he-w--He-W 572.08}

The department shall monitor utilization of ambulance services, in accordance with 42 CFR 455, 42 CFR 456, He-W 520, and He-W 521.

History

(See Revision Note at chapter heading He-W 500); ss by #6641, eff 11-27-97; EXPIRED: 11-27-05
#8502, INTERIM, eff 12-2-05, EXPIRES: 5-31-06; ss by #8638, eff 5-30-06; ss by #10294, eff 12-1-13 (from He-W 572.06); ss by #13840, INTERIM, eff 12-29-23; ss by #14007, eff 6-25-24

N.H. Code Admin. R. Ann. He-W 572.09 Third Party Liability {#sec-he-w-572.09 omnilex-key=us-nh-regs-official--agency-he-w--He-W 572.09}

All third party obligations shall be exhausted before medicaid may be billed, in accordance with 42 CFR 433.139.

History

#8638, eff 5-30-06; ss by #10294, eff 12-1-13 (from He-W 572.08); ss by #13840, INTERIM, eff 12-29-23; ss by #14007, eff 6-25-24

N.H. Code Admin. R. Ann. He-W 572.10 Payment for Services {#sec-he-w-572.10 omnilex-key=us-nh-regs-official--agency-he-w--He-W 572.10}

(a) Payment for ambulance services shall be made in accordance with the rates established by the department in accordance with RSA 161:4, VI(a).

(b) Payment shall consist of the following separate components, as applicable:

(1) A base rate;

(2) A mileage rate, which shall be paid for the most direct route to and from a destination and for loaded miles only, which:

a. Shall be the distance traveled while transporting a recipient from a pick-up point to a drop-off point; and

b. Does not include mileage incurred on the way to pick up a recipient or after dropping off a recipient;

(3) Payment for waiting time, as allowed by He-W 572.04(d); and

(4) Payment for routine disposable supplies used en-route.

(d) Payment shall be based on the level of service provided, not on the vehicle used, even if the local government requires an ALS response for all calls.

(e) The ambulance provider shall not bill medicaid for transporting a recipient from an acute care hospital to another acute care hospital or medical provider to obtain necessary treatment or diagnostic testing not available while the recipient is still an inpatient of the originating acute care hospital.

(f) The ambulance provider shall submit claims for payment to the department’s fiscal agent.

History

#10294, eff 12-1-13 (from He-W 572.09); ss by #13840, INTERIM, eff 12-29-23; ss by #14007, eff 6-25-24

Part He-W 573 Wheelchair Van Services

N.H. Code Admin. R. Ann. He-W 573.01 Definitions {#sec-he-w-573.01 omnilex-key=us-nh-regs-official--agency-he-w--He-W 573.01}

(a) “Department” means the New Hampshire department of health and human services.

(b) “Medicaid” means the Title XIX and Title XXI programs administered by the department, which makes medical assistance available to eligible individuals.

(d) “Round trip” means transportation from a pick-up point, to a medical provider waiting for the recipient, and transporting the recipient back to the point of pick-up.

(e) “Title XIX program” means the joint federal-state program described in Title XIX of the Social Security Act and administered in New Hampshire by the department under the medicaid program.

(f) “Title XXI program” means the joint federal-state program described in Title XXI of the Social Security Act and administered in New Hampshire by the department under the medicaid program.

(g) “Wait time” means the time a wheelchair van drivers may have to wait for a recipient to complete a medical appointment.

History

(See Revision Note at chapter heading He-W 500); ss by #6598, eff 10-8-97; ss by #8401, INTERIM, eff 8-20-05, EXPIRES: 2-16-06; ss by #8563, eff 2-7-06; amd by #10139, eff 7-1-12; ss by #10605, eff 5-23-14

N.H. Code Admin. R. Ann. He-W 573.02 Recipient Eligibility {#sec-he-w-573.02 omnilex-key=us-nh-regs-official--agency-he-w--He-W 573.02}

All medicaid recipients, including all home and community-based care (HCBC) waiver recipients and recipients residing in nursing facilities, shall be eligible to receive wheelchair van services, in accordance with this part, when:

(a) The recipient is confined to a wheelchair for mobility, which means:

(1) At the time of a wheelchair van service, the recipient is unable to ambulate without the use of a wheelchair; and

(2) The recipient is unable to be transported in a private vehicle without special equipment or modifications to the vehicle; and

(b) The wheelchair van services are required as certified on Form 975 “Documentation to Support the Use of Wheelchair Van Services” (May 2014) by the signature of the recipient’s treating physician, physician assistant (PA), advanced practice registered nurse (APRN), or registered nurse (RN).

History

(See Revision Note at chapter heading He-W 500); ss by #6598, eff 10-8-97; ss by #8401, INTERIM, eff 8-20-05, EXPIRES: 2-16-06; ss by #8563, eff 2-7-06; ss by #10605, eff 5-23-14

N.H. Code Admin. R. Ann. He-W 573.03 Provider Participation {#sec-he-w-573.03 omnilex-key=us-nh-regs-official--agency-he-w--He-W 573.03}

All participating wheelchair van service providers shall:

(a) Be enrolled as a NH medicaid provider;

(b) At the time of enrollment, provide proof of vehicle registration in accordance with He-W 573.07(a);

(d) Comply with all applicable requirements of RSA 153-A:1, Saf-C 5919, 49 CFR 37, and 49 CFR 38.

History

(See Revision Note at chapter heading He-W 500); ss by #6598, eff 10-8-97; ss by #8401, INTERIM, eff 8-20-05, EXPIRES: 2-16-06; ss by #8563, eff 2-7-06; ss by #10605, eff 5-23-14

N.H. Code Admin. R. Ann. He-W 573.04 Service Limits {#sec-he-w-573.04 omnilex-key=us-nh-regs-official--agency-he-w--He-W 573.04}

(a) Except as provided by He-W 573.10 below, wheelchair van services shall be limited to 24 trips, per recipient per state fiscal year.

(b) A one way trip and a round trip each shall count as one trip towards the service limit described in (a) above.

History

(See Revision Note at chapter heading He-W 500); ss by #6598, eff 10-8-97; ss by #8401, INTERIM, eff 8-20-05, EXPIRES: 2-16-06; ss by #8563, eff 2-7-06; amd by #10016, eff 11-1-11; ss by #10605, eff 5-23-14

N.H. Code Admin. R. Ann. He-W 573.05 Covered Services {#sec-he-w-573.05 omnilex-key=us-nh-regs-official--agency-he-w--He-W 573.05}

(a) Wheelchair van services shall be covered to transport eligible recipients to and from an enrolled NH Medicaid provider to receive necessary medical and dental services that are covered by the NH Medicaid program.

(b) Wait times shall be covered for round trips only and for up to a maximum of 2 hours, rounded to the nearest half hour.

(c) Transportation shall be to the nearest available NH medicaid enrolled provider of the necessary medical or dental service, unless the department determines that:

(1) The cost to transport the recipient is less than double the cost to transport the recipient to the nearest available NH medicaid enrolled provider; or

(2) The recipient has an established relationship with a provider.

History

(See Revision Note at chapter heading He-W 500); ss by #6598, eff 10-8-97; ss by #8401, INTERIM, eff 8-20-05, EXPIRES: 2-16-06; ss by #8563, eff 2-7-06; amd by #9622, eff 1-1-10; ss by #10605, eff 5-23-14

N.H. Code Admin. R. Ann. He-W 573.06 Non-Covered Services {#sec-he-w-573.06 omnilex-key=us-nh-regs-official--agency-he-w--He-W 573.06}

The following services shall not be covered as wheelchair van services:

(a) Transportation for purposes of recipient or provider convenience;

(b) Transportation that is otherwise available free of charge or payable by another agency, or when the item can be obtained using a free delivery service;

(c) Transportation for any purpose other than to receive NH medicaid covered services from an enrolled NH medicaid provider;

(d) Transportation that does not meet the requirements of He-W 573.05(c);

(e) Any wait time associated with one way trips;

(f) Wait time that exceeds 2 hours for round trips;

(g) The payment of tolls; and

(h) The payment of parking fees and fines.

History

(See Revision Note at chapter heading He-W 500); ss by #6598, eff 10-8-97; ss by #8401, INTERIM, eff 8-20-05, EXPIRES: 2-16-06; ss by #8563, eff 2-7-06; ss by #10605, eff 5-23-14

N.H. Code Admin. R. Ann. He-W 573.07 Provider Requirements {#sec-he-w-573.07 omnilex-key=us-nh-regs-official--agency-he-w--He-W 573.07}

Wheelchair van service providers shall:

(a) Ensure that all vehicles used for wheelchair van services are registered in accordance with RSA 261:40 and have been inspected in accordance with RSA 266:1;

(b) Obtain and maintain vehicle insurance for general and professional liability in accordance with Saf-C 5919.01(a)(1)b;

(c) Ensure that all drivers they employ, or otherwise engage, possess a valid NH driver’s license in accordance with RSA 263:1 and RSA 263:1-a; and

(d) Provide proof of compliance with (a)-(c) above, when requested by the department or the medicaid fraud control unit (MFCU) of the New Hampshire department of justice (NHDOJ).

History

(See Revision Note at chapter heading He-W 500); ss by #6598, eff 10-8-97; ss by #8401, INTERIM, eff 8-20-05, EXPIRES: 2-16-06; ss by #8563, eff 2-7-06; ss by #10605, eff 5-23-14

N.H. Code Admin. R. Ann. He-W 573.08 Documentation {#sec-he-w-573.08 omnilex-key=us-nh-regs-official--agency-he-w--He-W 573.08}

(a) When wheelchair van services are required, a Form 975, “Documentation to Support the Use of Wheelchair Van Services” (May 2014), shall be completed prior to the services being provided, and as follows:

(1) The wheelchair van provider shall complete section 1 of the form by providing information specific to the wheelchair van provider;

(2) The recipient’s treating physician, doctor of osteopathic (DO), physician assistant (PA), advanced practice registered nurse (APRN), or registered nurse (RN) shall complete section 2 of the form and certify by signature that the services are necessary; and

(3) When submitting a request for a service limit override, the wheelchair van provider shall complete section 3 of the form, and submit the form in accordance with He-W 573.10 below.

(b) Wheelchair van service providers shall obtain and retain copies of the signed and completed Form 975 “Documentation to Support the Use of Wheelchair Van Services” (May 2014), and provide copies of said documentation upon request to the department or the MFCU.

(c) Wheelchair van service providers shall retain, and provide when requested by the department or MFCU, copies of the trip logs, which shall contain the following documentation for each trip:

(1) Origin;

(2) Destination;

(3) Date of service;

(4) Driver’s name;

(5) Time of pick-up and drop off;

(6) Whether the trip was one-way or round-trip;

(7) Amount of wait time if applicable;

(8) Loaded mileage incurred; and

(9) Names and number of recipients transported concurrently during each trip.

(d) Wheelchair van service providers shall retain, and provide when requested by the department or MFCU, the following documentation concerning the safety of wheelchair vans used for transporting recipients:

(1) Proof that the vehicle was registered in accordance with RSA 261:40 and inspected in accordance with RSA 266:1, during the time of medicaid wheelchair van service; and

(2) Proof of insurance in accordance with He-W 573.07(b) during the time period that services were delivered.

History

(See Revision Note at chapter heading He-W 500); ss by #6598, eff 10-8-97; ss by #8401, INTERIM, eff 8-20-05, EXPIRES: 2-16-06; ss by #8563, eff 2-7-0606; ss by #10605, eff 5-23-14

N.H. Code Admin. R. Ann. He-W 573.09 Safety Requirements {#sec-he-w-573.09 omnilex-key=us-nh-regs-official--agency-he-w--He-W 573.09}

Wheelchair van providers shall comply with all of the applicable parts of Saf-C 5919.19 and 49 CFR 38.23 to ensure that all wheelchair vans are properly equipped and supplied.

History

#8563, eff 2-7-06; ss by #10605, eff 5-23-14

N.H. Code Admin. R. Ann. He-W 573.10 Service Limit Override and Review {#sec-he-w-573.10 omnilex-key=us-nh-regs-official--agency-he-w--He-W 573.10}

(a) All requests for consideration of additional wheelchair van services beyond the 24 trip limit shall require prior authorization from the department before the recipient receives the additional services in accordance with He-W 530.07(a)-(f) and this section.

(b) The wheelchair van provider shall make requests for additional wheelchair van services beyond the 24 trip limit by submitting a copy of Form 975 “Documentation to Support the Use of Wheelchair Van Services” (May 2014), completed in accordance with He-W 573.08(a) above, to the department’s prior authorization agent.

(c) A request for a service limit override submitted in accordance with (a) through (b) above shall be approved by the department’s prior authorization agent when the department’s prior authorization agent determines that the recipient meets the eligibility requirements described in He-W 573.02.

(d) If the department’s prior authorization agent approves the service limit override request in accordance with (c) above, the state’s fiscal agent shall send written confirmation of the approval to the provider.

(e) The department’s prior authorization agent shall deny a request for a service limit override when the department's prior authorization agent determines that the recipient does not meet the eligibility requirements of He-W 573.02.

(f) If the department’s prior authorization agent denies the request for a service limit override, the department’s prior authorization agent shall forward a notice of denial to the recipient and the wheelchair van provider.

(g) The notice of denial shall contain the information required by 42 CFR 431.210, including:

(1) The reason for, and legal basis of, the denial; and

(2) Information that an appeal of the denial may be requested, in accordance with He-C 200, within 30 calendar days of the date on the notice of the denial.

History

#8563, eff 2-7-06; amd by #10016, ef 11-1-11; ss by #10605, eff 5-23-14

N.H. Code Admin. R. Ann. He-W 573.11 Utilization Review and Control {#sec-he-w-573.11 omnilex-key=us-nh-regs-official--agency-he-w--He-W 573.11}

The department’s provider program integrity unit shall monitor utilization of wheelchair van services, to identify, prevent, and correct potential occurrences of fraud, waste and abuse, in accordance with 42 CFR 455, 42 CFR 456, and He-W 520.

History

#8563, eff 2-7-06; ss by #10605, eff 5-23-14

N.H. Code Admin. R. Ann. He-W 573.12 Third Party Liability {#sec-he-w-573.12 omnilex-key=us-nh-regs-official--agency-he-w--He-W 573.12}

All third party obligations shall be exhausted before medicaid may be billed, in accordance with 42 CFR 433.139.

History

#8563, eff 2-7-06; ss by #10605, eff 5-23-14

N.H. Code Admin. R. Ann. He-W 573.13 Payment for Services {#sec-he-w-573.13 omnilex-key=us-nh-regs-official--agency-he-w--He-W 573.13}

(a) Payments for wheelchair van services shall be made in accordance with rates established by the department, in accordance with RSA 161:4, VI(a).

(b) Payments for wheelchair van services shall consist of the following components:

(1) A base rate, which shall:

a. Include the first 5 miles of travel;

b. Be paid once only for a single one-way trip or round trip; and

c. Be paid twice for 2 one-way trips for the same recipient on the same day;

(2) A mileage rate, which shall:

a. Be based on the most direct route to and from a destination, and not necessarily the route used;

b. Be paid for loaded miles only, which:

Shall be the distance traveled while transporting recipients from a pick-up point to a drop-off point; and
Does not include mileage incurred on the way to pick up a recipient or after dropping off a recipient;

c. Not include the first 5 miles; and

d. Be paid only once per trip regardless of the number of recipients transported; and

(3) A payment for the wait time described in He-W 573.05(b).

(d) The wheelchair van provider shall maintain supporting records, in accordance with He-W 573.08 and He-W 520.03.

History

#8563, eff 2-7-06; ss by #10605, eff 5-23-14

Part He-W 574 Non-Emergency Medical Transportation

N.H. Code Admin. R. Ann. He-W 574.01 Definitions {#sec-he-w-574.01 omnilex-key=us-nh-regs-official--agency-he-w--He-W 574.01}

(a) “Assistance group” means the individuals living together with or without benefit of a dwelling pursuant to He-W 830.01(a), whose needs, income, and resources are considered and combined together when determining eligibility or the amount of benefits for financial or medical assistance.

(b) “Broker” means a person or entity, contracted by the department, that arranges non-emergency medical transportation for recipients through contracts with drivers or transportation companies.

(d) “Driver(s)” means a person, company, or entity that provides non-emergency medical transportation services for a recipient.

(e) “Family and friends driver” means a recipient’s family member or friend who is able to transport the recipient.

(f) “Medicaid” means the Title XIX and Title XXI programs administered by the department which makes medical assistance available to eligible individuals.

(g) “Medicaid address” means the recipient’s residence as listed in the recipient’s eligibility file at the department.

(h) “Non-emergency medical transportation” means non-emergency transportation for the purpose of accessing medicaid covered medical, dental, or behavioral health services via motorized public or private transportation pursuant to 42 CFR 441.62(a), 42 CFR 431.53, and 42 CFR 440.170.

(i) “Private transportation” means transportation via a recipient’s own vehicle or family and friend’s vehicle that does not meet the definition of public transportation.

(j) “Public transportation” means transportation via commercial buses, boats, airplanes, helicopters, or trains.

(k) “Recipient” means any individual who is eligible for and receiving medical assistance under the medicaid program.

(l) “Round trip” means transportation from a point of pick-up to a medical, dental, or behavioral health provider waiting for the recipient, and back to the point of pick-up.

(m) “Title XIX” means the joint federal-state program described in Title XIX of the Social Security Act and administered in NH by the department under the medicaid program.

(n) “Title XXI” means the joint federal-state program described in Title XXI of the Social Security Act and administered in NH by the department under the medicaid program.

(o) “Transportation company” means an entity that provides transportation.

(p) “Usual and customary” means “usual and customary” as defined in RSA 126-A:3, III(b).

(q) “Wait time” means the time a driver might have to wait for a recipient to complete a medical, dental, or behavioral health appointment.

History

(See Revision Note at chapter heading He-W 500); ss by #6163, eff 1-4-96, EXPIRED: 1-4-04
#8732, eff 9-30-06; amd by #10139, eff 7-1-12; ss by #10810, eff 4-9-15; ss by #14393, eff 10-1-25, EXPIRES: 10-1-35

N.H. Code Admin. R. Ann. He-W 574.02 Recipient Eligibility {#sec-he-w-574.02 omnilex-key=us-nh-regs-official--agency-he-w--He-W 574.02}

(a) All recipients shall be ensured assistance to locate transportation or be reimbursed for miles traveled to access medicaid covered medical, dental, and behavioral health services as required by 42 CFR 441.62(a), 42 CFR 431.53, and 42 CFR 440.170.

(b) All recipients, including all home and community-based waiver service recipients and recipients residing in nursing facilities, shall be eligible to receive non-emergency medical transportation services by wheelchair van, when:

(1) The recipient is confined to a wheelchair for mobility, which means:

a. At the time of service, the recipient is unable to ambulate without the use of a wheelchair; and

b. The recipient is unable to be transported in a private vehicle without special equipment or modifications to the vehicle; and

(2) The use of a wheelchair van is required as certified on a completed “Mobility Determination for Non-Emergency Medical Transportation Universal Form for All Medicaid Plans” (September 2025), completed by a health care professional and submitted to the broker prior to the wheelchair van ride.

History

(See Revision Note at chapter heading He-W 500); ss by #6163, eff 1-4-96, EXPIRED: 1-4-04
#8732, eff 9-30-06; ss by #10810, eff 4-9-15; ss by #14393, eff 10-1-25, EXPIRES: 10-1-35

N.H. Code Admin. R. Ann. He-W 574.03 Broker Participation. {#sec-he-w-574.03 omnilex-key=us-nh-regs-official--agency-he-w--He-W 574.03}

Brokers shall:

(a) Be enrolled with the department with an active medicaid provider number;

(b) Comply with the provisions of 42 CFR 440.170(a)(4)(ii);

(c) Screen all drivers, upon hire and monthly thereafter, for exclusions against the Office of Inspector General (OIG) exclusion and sanction database found at https://exclusions.oig.hhs.gov pursuant to section 1866(j)(2) of the Social Security Act, section 1903(i) of the Social Security Act, and 42 CFR 1001.1901; and

(d) Ensure that all vehicles used for transportation services:

(1) Are registered in accordance with RSA 261:40; and

(2) Are properly equipped and supplied in accordance with 49 CFR 38.23.

History

#14393, eff 10-1-25, EXPIRES: 10-1-35

N.H. Code Admin. R. Ann. He-W 574.04 Driver Participation {#sec-he-w-574.04 omnilex-key=us-nh-regs-official--agency-he-w--He-W 574.04}

(a) All transportation company drivers shall be participants with the broker.

(b) The broker shall acquire and store the following required documentation for all family and friend drivers:

(1) A copy of the driver’s license of the driver(s);

(2) A completed “Family and Friends Mileage Reimbursement Program New Driver Enrollment Sheet” (September 2025) agreeing to the following:

a. “Participation in the Family and Friends Program is both voluntary and a privilege and that failure to comply with any of the rules of the program may result in my immediate termination from this milage reimbursement program;

b. Medicaid fraud is a serious crime and fraudulent submissions for reimbursement under this program can result in criminal penalties up to 7 years in State prison;

c. If I move I must update and provide proof of my new address to Medicaid before I submit my next reimbursement form;

d. Driver must have a valid driver’s license in order to receive reimbursement under this program;

e. Driving without a license, driving with a suspended license, or driving while designated as a habitual offender are all crimes in New Hampshire and submissions made under this program can and will be used against me in criminal proceedings;

f. If the New Hampshire Department of Health and Human Service or its partners has reason to suspect any potential violations of the Family and Friends Program, I understand that my driver’s history, motor vehicle records, and/or my criminal background may be checked;

g. Having a criminal history or driving records does not necessarily prevent me from participating in this program;

h. My participation in this program will be governed in accordance with the Department of Health and Human Services’ Administrative Rule He-W 574.”; and

i. “That all information contained in this application and the information in the accompanying documents is true and accurate and that any material falsities contained herein may result in a prosecution for false swearing under RSA 641:3.”;

(3) A completed “Request for Reimbursement of Medical Transportation by Private Car” (September 2025) signed by:

a. The member and certifying that:

“The information on this form is true, accurate, and complete. I understand that payment of this claim may be from Federal and State funds and that any false or altered claims, statements, documents, or the concealment of material fact may be prosecuted under applicable Federal and State laws. I agree to accept transportation payment as payment in full but understand that I have the right to appeal the reimbursement amount”; and

b. The medicaid provider and certifying that:

“The patient named above visited my office/clinic/pharmacy for non-emergency medical appointment(s) or Medicaid covered pharmaceuticals on the date(s) as noted.”; and

(4) A copy of a review of the Office of Inspector General list of excluded individuals and entities, pursuant to He-W 574.03(c), at start of service and monthly thereafter.

(c) The broker shall acquire and store the following documentation for all transportation company drivers for a period of 6 years:

(1) A completed, signed, and dated credentialing packet from the transportation company;

(2) Proof of a valid driver’s license;

(3) A copy of the document received from the IRS which provided the driver’s federal tax ID number;

(4) A completed IRS W-9 form at the time of enrollment;

(5) A copy of the document received from the IRS which indicates the applicant’s non-profit tax-exempt status, if applicable;

(6) Proof of automobile liability insurance;

(7) Updated proof of insurance at the time it is renewed, and at any other time when a change in status has occurred;

(8) Review of the Office of Inspector General list of excluded individuals and entities upon hire and monthly checks;

(9) Background checks;

(10) Records of recipient complaints including actions taken to investigate and resolve complaint;

(11) Training records;

(12) Dispatch travel logs including driver name, transportation company name, recipient name, and date of service, with signature log of all parties;

(13) Billing and payment records; and

(14) Proof that the vehicle is safe for transporting passengers.

(d) Wheelchair van drivers shall:

(1) Retain and submit the following documentation when requested, to the broker:

a. Proof that the vehicle was registered in accordance with RSA 261:40 during the time of medicaid wheelchair van service; and

b. Proof of vehicle insurance during the time period that services were delivered; and

(2) Comply with all applicable requirements of 49 CFR 37 and 49 CFR 38.

History

(See Revision Note at chapter heading He-W 500); ss by #6163, eff 1-4-96, EXPIRED: 1-4-04
#8732, eff 9-30-06; ss by #10810, eff 4-9-15; ss by #14393 (formerly He-W 574.03), eff 10-1-25, EXPIRES: 10-1-35

N.H. Code Admin. R. Ann. He-W 574.05 Covered Services {#sec-he-w-574.05 omnilex-key=us-nh-regs-official--agency-he-w--He-W 574.05}

(a) Non-emergency medical transportation shall be covered for the purpose of allowing a recipient to access medicaid covered medical, dental, or behavioral health services from a medicaid enrolled provider pursuant to 42 CFR 441.62(a) and 42 CFR 440.170.

(b) The covered service shall be the least costly available to meet the recipient’s needs.

(d) Only the actual number of miles traveled to and from the medicaid address and medicaid covered services shall be reimbursable and as described in He-W 574.08(a).

(e) Non-emergency medical transportation shall be to the nearest appropriate medicaid enrolled provider of the covered medical, dental, or behavioral health service, as determined by the department.

(f) Transportation shall be provided via the least costly route, as described in He-W 574.10(c).

(g) Wait times shall be covered for round trips only and for up to a maximum of 2 hours, rounded to the nearest half hour.

(h) Transportation via ambulance shall be covered as non-emergency medical transportation when medically necessary and pursuant to the requirements in He-W 572.06.

(i) Non-emergency medical transportation shall be covered, pursuant to He-W 546.05(d):

(1) For EPSDT-eligible children;

(2) For any person who needs to accompany an eligible child to the child’s medical, dental, or behavioral health service; and

History

(See Revision Note at chapter heading He-W 500); ss by #6163, eff 1-4-96, EXPIRED: 1-4-04
#8732, eff 9-30-06; ss by #10810, eff 4-9-15; ss by #14393 (formerly He-W 574.04), eff 10-1-25, EXPIRES: 10-1-35

N.H. Code Admin. R. Ann. He-W 574.06 Non-Covered Services {#sec-he-w-574.06 omnilex-key=us-nh-regs-official--agency-he-w--He-W 574.06}

(a) Non-emergency medical transportation shall be a non-covered service when it:

(1) Is being provided for a purpose other than for the recipient to access medicaid covered medical, dental, or behavioral health services;

(2) Is to a medicaid enrolled provider who transports the recipient to their own location of service unless the provider is participating with the broker as a transportation driver;

(3) Is for purposes of recipient or provider convenience; or

(4) Was performed by a driver who has not complied with the requirements of He-W 574.04.

(b) The following shall not be covered:

(1) Any wait time associated with one-way trips; and

(2) Wait time that exceeds 2 hours for round trips.

History

(See Revision Note at chapter heading He-W 500); ss by #6163, eff 1-4-96, EXPIRED: 1-4-04
#8732, eff 9-30-06; ss by #10810, eff 4-9-15; ss by #14393 (formerly He-W 574.05), eff 10-1-25, EXPIRES: 10-1-35

N.H. Code Admin. R. Ann. He-W 574.07 Submission of Claims {#sec-he-w-574.07 omnilex-key=us-nh-regs-official--agency-he-w--He-W 574.07}

(a) The broker shall submit to the department an invoice identifying the monthly reimbursement amount for family and friends drivers.

(b) Submission of claims for multiple trips in one day shall be limited to the submission of one claim per trip regardless of the number of passengers.

History

(See Revision Note at chapter heading He-W 500); ss by #6163, eff 1-4-96, EXPIRED: 1-4-04
#8732, eff 9-30-06; ss by #10810, eff 4-9-15; ss by #14393 (formerly He-W 574.06), eff 10-1-25, EXPIRES: 10-1-35

N.H. Code Admin. R. Ann. He-W 574.08 Payment for Services {#sec-he-w-574.08 omnilex-key=us-nh-regs-official--agency-he-w--He-W 574.08}

(a) Except as provided by (d) below, claims for family and friends non-emergency medical transportation delivered via private transportation shall be reimbursed at the lesser amount of:

(1) Actual number of miles billed multiplied by rate per mile; or

(2) The maximum allowable mileage for the trip, multiplied by the rate per mile.

(b) Public transportation shall be coordinated by the broker and the broker shall be responsible for reimbursement.

(c) Reimbursement for tolls and parking fees shall be paid if receipts are submitted with the family and friends reimbursement claim.

(d) Reimbursement for family and friends drivers when a trip includes multiple passengers shall be as follows:

(1) For multiple trips in one day this shall be limited to the submission of one claim per trip regardless of the number of passengers;

(2) For the total miles from the medicaid address of the first recipient to the final destination and return to the original pickup address; and

(3) For total miles in the claim submission described in (2) above shall be paid at the actual mileage traveled or the maximum mileage allowance per trip, in accordance with He-W 574.10(b), whichever is less.

(e) Reimbursement shall not be made:

(1) For trips provided prior to the date the provider was enrolled with the broker, unless prior authorized by the broker;

(2) For claims submitted 90 days or more from the date of the trip;

(3) If the medicaid enrolled provider’s signature is missing on the “Request for Reimbursement of Medical Transportation by Private Car” (September 2025); or

(4) If the signature of the driver or the recipient, or both, is missing on the “Request for Reimbursement of Medical Transportation by Private Car” (September 2025).

(f) Reimbursement shall be made to the recipient who then shall be responsible for paying the family and friends driver.

History

(See Revision Note at chapter heading He-W 500); ss by #6163, eff 1-4-96, EXPIRED: 1-4-04
#8732, eff 9-30-06; ss by #10810, eff 4-9-15; ss by #14393 (formerly He-W 574.07), eff 10-1-25, EXPIRES: 10-1-35

N.H. Code Admin. R. Ann. He-W 574.09 Prior Authorization {#sec-he-w-574.09 omnilex-key=us-nh-regs-official--agency-he-w--He-W 574.09}

(a) The broker shall contact the department to obtain prior authorization for non-emergency medical transportation services when transportation is needed outside of the mileage limits in He-W 574.10(b).

(b) The recipient shall receive prior authorization for transportation outside the mileage limits as described in (a)(1) above, based on the following information:

(1) The recipient’s name and address;

(2) The recipient’s medicaid identification (MID) number;

(3) Details describing the illness or condition sufficient to enable the department to understand the physical or emotional condition of the recipient and the reason(s) for which the medical, dental, or behavioral health service is required;

(4) That the needed medical, dental, or behavioral health services cannot be obtained within the mileage limits in He-W 574.10(b);

(5) The expected outcome and recommended timetable of the prescribed medical, dental, or behavioral health service; and

(6) The name and address of the medicaid enrolled provider.

(1) All of the required information described in (b) above is received; and

(2) The department determines, based on the information provided, that the transportation is necessary and appropriate for the recipient’s medical, dental, or behavioral health condition, as supported by the information provided in the request.

(d) The department shall deny requests for prior authorization if:

(1) The provisions set forth in (c) above are not met; or

(2) The department determines that the recipient does not meet the eligibility requirements of He-W 574.02.

(e) If prior authorization is approved, payment for non-emergency medical transportation shall still comply with all of the provisions of He-W 574.

(f) If prior authorization is denied, the department shall forward a notice of denial to the recipient and the provider.

(g) The notice of denial shall contain the information required by 42 CFR 431.210, including:

(1) The reason for, and legal basis of, the denial; and

(2) Information that an appeal of the denial may be requested, in accordance with He-C 200, within 30 calendar days of the date on the notice of the denial.

History

(See Revision Note at chapter heading He-W 500); ss by #6163, eff 1-4-96, EXPIRED: 1-4-04
#8732, eff 9-30-06; ss by #10810, eff 4-9-15; ss by #14393 (formerly He-W 574.08), eff 10-1-25, EXPIRES: 10-1-35

N.H. Code Admin. R. Ann. He-W 574.10 Mileage Limits and Rate {#sec-he-w-574.10 omnilex-key=us-nh-regs-official--agency-he-w--He-W 574.10}

(a) The rate paid shall be that established by the commissioner in accordance with RSA 161:4, VI(a).

(b) The maximum allowed traveled round trip mileage to medicaid enrolled providers by drivers shall not exceed the following limits:

(1) 90 miles to a hospital;

(2) 50 miles to a physician or behavioral health provider;

(3) 300 miles to a dentist;

(4) 90 miles to a physical, speech, or occupational therapist;

(5) 90 miles to a dialysis provider;

(6) 400 miles to a specialty provider; and

(7) 30 miles to a pharmacy.

(c) Determination of the least costly route shall be by the use of a web-based mapping tool containing a mileage calculator, which has the functionality to allow the input of addresses and the calculation of distance between them and to identify toll roads.

(d) Payments for wheelchair van services shall consist of the following components:

(1) A base rate, which shall:

a. Be paid once only for a single one-way trip or each way of a round trip; and

b. Be paid twice for 2 one-way trips for the same recipient on the same day;

(2) A mileage rate, which shall:

a. Be based on the most direct route to and from a destination, and not necessarily the route used;

b. Be paid for loaded miles only, which shall:

Be the distance traveled while transporting recipients from a pick-up point to a drop-off point; and
Not include mileage incurred on the way to pick up a recipient or after dropping off a recipient;

c. Include all miles traveled; and

d. Be paid only once per trip regardless of the number of recipients transported; and

(3) A payment for the wait time described in He-W 574.05(f).

History

(See Revision Note at chapter heading He-W 500); ss by #6163, eff 1-4-96, EXPIRED: 1-4-04
#8732, eff 9-30-06; ss by #10810, eff 4-9-15; ss by #14393, eff 10-1-25, EXPIRES: 10-1-35

N.H. Code Admin. R. Ann. He-W 574.11 Hearings {#sec-he-w-574.11 omnilex-key=us-nh-regs-official--agency-he-w--He-W 574.11}

Any recipient who has been denied reimbursement for non-emergency medical transportation services may appeal an adverse decision by requesting a fair hearing in accordance with He-C 200. Requests for fair hearings shall be submitted no later than 30 days after the date the notice of decision being appealed is issued.

History

(See Revision Note at chapter heading He-W 500); ss by #6163, eff 1-4-96, EXPIRED: 1-4-04
#8732, eff 9-30-06; ss by #10810, eff 4-9-15; ss by #14393, eff 10-1-25, EXPIRES: 10-1-35

N.H. Code Admin. R. Ann. He-W 574.12 Third Party Liability {#sec-he-w-574.12 omnilex-key=us-nh-regs-official--agency-he-w--He-W 574.12}

All third party obligations shall be exhausted before the NH medicaid program may be billed, in accordance with 42 CFR 433.139.

History

(See Revision Note at chapter heading He-W 500); ss by #6163, eff 1-4-96, EXPIRED: 1-4-04
#8732, eff 9-30-06; ss by #10810, eff 4-9-15; ss by #14393, eff 10-1-25, EXPIRES: 10-1-35

N.H. Code Admin. R. Ann. He-W 574.13 Utilization Review and Control {#sec-he-w-574.13 omnilex-key=us-nh-regs-official--agency-he-w--He-W 574.13}

The department’s bureau of program integrity shall monitor utilization of non-emergency medical transportation services to identify, prevent, and correct potential occurrences of fraud, waste, and abuse, in accordance with 42 CFR 455, 42 CFR 456, and He-W 520.

History

(See Revision Note at chapter heading He-W 500); ss by #6163, eff 1-4-96, EXPIRED: 1-4-04
#8732, eff 9-30-06; ss by #10810, eff 4-9-15 (formerly He-W 574.14); ss by #14393, eff 10-1-25, EXPIRES: 10-1-35

Part He-W 575 Augmentative and Alternative Communication Aid Services

N.H. Code Admin. R. Ann. He-W 575.01 Definitions {#sec-he-w-575.01 omnilex-key=us-nh-regs-official--agency-he-w--He-W 575.01}

(a) “Augmentative and alternative communication (AAC)” means all forms of communication other than oral speech that are used to express thoughts, needs, wants, and ideas.

(b) “Augmentative and alternative communication (AAC) aids” means electronic or non-electronic aids, devices or systems that assist an individual to overcome or ameliorate the communication limitations that preclude or interfere with meaningful participation in current and projected daily activities, such as communication boards or books, speech amplifiers, electronic devices that produce speech and/or written output.

(c) “Augmentative and alternative communication (AAC) consultant” means the speech language pathologist who participates in the AAC evaluation and who provides ongoing consultation to the recipient regarding AAC implementation.

(d) “Augmentative and alternative communication (AAC) evaluation” means an evaluation that assesses the recipient’s communication skills and abilities, and their AAC needs.

(e) “Date of service” means the date the AAC provider orders the prior authorized AAC aid or accessory.

(f) “Department” means the NH department of health and human services.

(g) “Functionally communicate” means to share information, to impart knowledge, and/or to have interchanges of thoughts.

(h) “Medicaid” means the Title XIX and Title XXI programs administered by the department, which makes medical assistance available to eligible individuals.

(i) “Recipient” means any individual who is eligible for and receiving medical assistance under the medicaid program.

(j) “Title XIX” means the joint federal-state program described in Title XIX of the Social Security Act and administered in New Hampshire by the department under the medicaid program.

(k) “Title XXI” means the joint federal-state program described in Title XXI of the Social Security Act and administered in New Hampshire by the department under the medicaid program.

History

#10636, eff 7-12-14

N.H. Code Admin. R. Ann. He-W 575.02 Recipient Eligibility {#sec-he-w-575.02 omnilex-key=us-nh-regs-official--agency-he-w--He-W 575.02}

A recipient shall be eligible to receive AAC aids as prescribed by a physician when:

(a) The recipient has a significant, expressive communication or language comprehension impairment such as apraxia of speech, dysarthria, and cognitive communication disabilities, and the impairment or disability either temporarily or permanently causes communication limitations that preclude or interfere with the recipient's meaningful participation in current and projected daily activities; and

(b) The prescribed AAC aid is coverable in accordance with this rule.

History

#10636, eff 7-12-14

N.H. Code Admin. R. Ann. He-W 575.03 Provider Participation {#sec-he-w-575.03 omnilex-key=us-nh-regs-official--agency-he-w--He-W 575.03}

All participating AAC providers shall:

(a) Be an enrolled New Hampshire Medicaid durable medical equipment (DME) provider;

(b) Request and obtain prior authorization from the department in accordance with He-W 575.06 below; and

(c) Provide the recipient and caregiver with equipment training and related supports, including equipment set-up, training in the use and maintenance of the AAC aid, and technical support.

History

#10636, eff 7-12-14

N.H. Code Admin. R. Ann. He-W 575.04 Covered Services {#sec-he-w-575.04 omnilex-key=us-nh-regs-official--agency-he-w--He-W 575.04}

The following AAC aids, accessories, and services shall be covered:

(a) The purchase, repair, and modifications of AAC aids and accessories when they:

(1) Meet the definition of durable medical equipment (DME) per He-W 571.01;

(2) Are medically necessary;

(3) Are the most clinically appropriate and least costly alternative;

(4) Are a dedicated communication device used only for communication purposes;

(5) Are to be used solely by the recipient; and

(6) Have been prior authorized in accordance with He-W 575.06 below;

(b) Rental of AAC aids for up to 2 months when prior authorized in accordance with He-W 575.06 below, and at least one of the following is true:

(1) Time is needed to assess the appropriateness of the AAC aid, and whether it will meet the person’s current needs and accommodate reasonable anticipated future needs;

(2) Rental is needed because the recipient’s AAC aid is out for authorized repair and no loaner equipment is available from the AAC provider or manufacturer; or

(3) Rental is needed during the time period between order and delivery of the aid approved for purchase, and no loaner equipment is available from the AAC provider or manufacturer; and

(1) Identified in the AAC evaluation, conducted in accordance with He-W 575.07 below, as the recipient’s only AAC aid allowing for functional communication;

(2) Are medically necessary;

(3) Are the most clinically appropriate and least costly alternative;

(4) Are a dedicated communication device used only for communication purposes;

(5) Are to be used solely by the recipient; and

(6) Have been prior authorized in accordance with He-W 575.06 below.

History

#10636, eff 7-12-14

N.H. Code Admin. R. Ann. He-W 575.05 Non-Covered Services {#sec-he-w-575.05 omnilex-key=us-nh-regs-official--agency-he-w--He-W 575.05}

The following equipment, accessories, items, and services shall not be covered:

(a) Computer equipment and accessories that do not meet the criteria in He-W 575.04(c) above;

(b) Software or computer equipment that is not specifically integral to communication devices;

(c) Multiple AAC aids and accessories unless such items together expand the functional capability of the aid, such as increased recording time or vocabulary, and represent the most clinically appropriate and least costly alternative in equipment options for the recipient;

(d) Equipment that duplicates equipment already funded by medicaid, per He-W 530.05(b)(25);

(e) More than one charger per AAC aid;

(f) Extended warranty and maintenance agreements;

(g) Shipping and handling fees on purchased equipment, except as allowed by He-W 575.11(e)-(f) below;

(h) Repair of original AAC aids once a replacement has been provided;

(i) Replacement or repair of rented AAC aids;

(j) Replacement of AAC aids when the replacement is requested solely as a result of changing technology, or when the existing device effectively addresses the beneficiary’s needs;

(k) Replacement of AAC aids when the replacement occurs within 5 years from the date of purchase of the original equipment unless there is a clinical justification for a replacement in less time, such as a significant change in the recipient’s needs and abilities relative to AAC use such that the current aid limits communication, or no longer provides access to communication;

(l) Environmental control equipment;

(m) Equipment or appliances that are not considered medical equipment in nature, such as tape recorders, fans, lights, radios, and toys, with the exception of computer equipment and accessories covered in accordance with He-W 574.04(c) above;

(n) Internet access, including costs associated with initial and recurring internet service provider fees, purchase or rental of modems, mobile device data plans, or network access for mobile devices;

(o) Subscriptions for mobile device applications, also known as “apps”; and

(p) Replacement, repair, or modifications of an item when the need is the result of:

(1) Abuse, misuse, or inappropriate use or neglect of the AAC aid;

(2) Failure to protect the item from the elements;

(3) Using the item inappropriately or contrary to its designed and intended use;

(4) Making improper repairs to the item, which would void any manufacturer’s warranty;

(5) Loss of the item when basic safeguarding measures could have been instituted;

(6) Failure to maintain the item through proper routine maintenance by an authorized dealer; or

(7) Taking any action that would otherwise void the manufacturer’s written warranty or is contrary to the manufacturer’s recommendations for care, use, and maintenance.

History

#10636, eff 7-12-14

N.H. Code Admin. R. Ann. He-W 575.06 Prior Authorization {#sec-he-w-575.06 omnilex-key=us-nh-regs-official--agency-he-w--He-W 575.06}

(a) An AAC provider shall request and obtain a prior authorization from the department on behalf of a recipient for the purchase, rental, or repair of AAC aids and accessories.

(b) Prior authorization requests for purchases and rentals shall include the following:

(1) A statement from the recipient’s physician that includes:

a. An explanation of the medical need of the AAC aid being requested;

b. A statement that the physician concurs with the recommendation of the AAC evaluation, conducted in accordance with He-W 575.07; and

c. When the request is for a rental, an indication of which of the coverage criteria has been met per He-W 575.04(b) above;

(2) An AAC evaluation as described in He-W 575.07; and

(3) A completed Form #288-Q, “Quote for Augmentative and Alternative Communication (AAC) Aids Funding Request” (June 2014), completed and signed by a NH Medicaid DME provider.

(1) The all-inclusive cost of the repair;

(2) Replacement cost of the current AAC aid;

(3) A letter from a licensed speech language pathologist (SLP) that establishes the recipient’s prognosis for continued use of the current AAC aid, including the expected life-span of the AAC aid with repair;

(4) A copy of the safeguarding plan, as described in He-W 575.07(c)(10)b., that is less than one year old and contains current contact information; and

(5) A signed statement from the recipient attesting that the need for the repair is not the result of any of the condition listed in He-W 575.05(q).

(d) Prior authorization requests for modification of an existing AAC aid shall include the following:

(1) The all-inclusive cost of the modification;

(2) A justification of need, as described in He-W 575.07(c)(6), from a licensed SLP, including updated clinical information; and

(3) The results of an AAC evaluation completed in accordance with He-W 575.07 within the last 3 years.

(e) In addition to the requirements of (c) and (d) above, prior authorization requests for the repair or modification of an existing AAC aid shall include current clinical information regarding the recipient’s use of the AAC aid, as well as current contact information of the individuals listed in He-W 575.07(c)(2).

(f) Prior authorization requests shall be approved when the department’s prior authorization agent determines that the purchase, rental, or repair of the AAC aid being requested is determined to be the most clinically appropriate and least costly alternative, as supported by the documentation submitted in accordance with (b), (c), or (d) above.

(g) The department’s prior authorization agent shall forward written confirmation of the department’s approval of a prior authorization request to the provider.

(h) The AAC provider shall be responsible for determining that the recipient is Medicaid eligible on the date of service.

(i) The department’s prior authorization agent shall deny a PA request if the agent determines that the requirements set forth in this part have not been met.

(j) If the department’s prior authorization agent denies the prior authorization request, the department’s prior authorization agent shall forward a notice of denial to the recipient and the AAC provider.

(k) The notice of denial shall contain the information required by 42 CFR 431.210, including:

(1) The reason for, and legal basis of, the denial; and

(2) That a fair hearing on the denial may be requested within 30 calendar days of the date on the notice of the denial.

History

#10636, eff 7-12-14

N.H. Code Admin. R. Ann. He-W 575.07 AAC Evaluation {#sec-he-w-575.07 omnilex-key=us-nh-regs-official--agency-he-w--He-W 575.07}

(a) An AAC evaluation shall be required for prior authorization of all AAC aids.

(b) An AAC evaluation shall be completed by a SLP licensed as such by the state in which he or she practices, and who has one of the following credentials:

(1) Has at least 3 years’ experience in the provision of AAC aids; or

(2) Has completed an accredited training in AAC.

(1) The recipient’s identifying information including name and medicaid identification (MID) number;

(2) A Form #288-F, “Augmentative and Alternative Communication (AAC) Aids Funding Information” (June 2014) that has been signed by the SLP who conducted the AAC evaluation;

(3) The recipient’s medical and communication diagnoses;

(4) An explanation of the medical need of the recommended AAC aid, and how it will allow the recipient the ability to functionally communicate, including the recipient’s communication prognosis both with and without the use of the AAC aid;

(5) The recipient’s past and current communication skills, including information about past AAC use;

(6) A justification of need which indicates the need for modified equipment including information about any of the following areas:

a. The recipient’s environment;

b. The recipient’s behavior, cognitive skills, motor skills, perceptual skills, and sensory impairments;

c. The recipient’s ability to access and activate the AAC aid including activation through touch, eye gaze, or scanning; and

d. The need for the AAC aid to be positioned and mounted;

(7) A comparison of at least 3 different AAC aids from the same device code category using features match, simulation, or trial, and the results of the comparison including:

a. Identification of the chosen aid and the rationale as to why it was chosen over the others;

b. An explanation of how the chosen aid meets the recipient’s communication needs including data demonstrating improvement over baseline using the selected equipment; and

c. An explanation as to how the AAC aid represents the least costly, most clinically appropriate alternative given the recipient’s demonstrated cognitive and linguistic abilities;

(8) Except as allowed by (d) below, the results of a one-month long trial of the AAC aid identified in (7)a. above, which shall be provided on Form #288-T, “Augmentative and Alternative Communication (AAC) Aids Trial Summary” (June 2014), showing that the recipient’s ability to communicate has been maintained or has improved over baseline, and signed by a SLP who completed the evaluation;

(9) A detailed list of recommended AAC aids and accessories to be ordered as a result of the completed evaluation;

(10) A plan of care for the recipient’s use of the AAC aid, which shall include:

a. Training of the recipient and the caregiver(s) in the use, maintenance, and care of the AAC aid;

b. A safeguarding plan, which shall be provided on Form #288-SG, “Augmentative and Alternative Communication (AAC) Aids Safeguarding Plan” (June 2014), and signed by the SLP who completed the evaluation; and

c. The frequency of direct treatment and/or consultation by the licensed SLP responsible for integration of the AAC aid or by the AAC consultant;

(11) Documentation indicating that the use of the AAC aid will be supported in the home, school, and work settings as applicable;

(12) Signature of the SLP who completed the evaluation who attests to his or her agreement with the findings of the evaluation and its recommendations; and

(13) Signatures of any individuals who, as part of the plan of care, are responsible for ensuring that the plan is effectively implemented at home, at school, or at work, and their acknowledgement that they understand their role in the implementation of the plan.

(d) When an AAC aid has 8 minutes of recording time or less and can be accessed by direct selection or scanning and light tech materials, a trial period shall not be required.

(e) None of the individuals signing the evaluation in (c) above shall have any financial affiliation with the manufacturer or the supplier of the AAC aids.

(f) The AAC evaluation shall be valid for 3 years from the date it was completed.

History

#10636, eff 7-12-14

N.H. Code Admin. R. Ann. He-W 575.08 Documentation {#sec-he-w-575.08 omnilex-key=us-nh-regs-official--agency-he-w--He-W 575.08}

(a) In accordance with He-W 520, the AAC provider shall maintain supporting records to substantiate claims submitted for reimbursement for a period of at least 6 years from the date of service or until the resolution of any legal action(s) commenced in the 6 year period, whichever is longer.

(b) The AAC provider shall maintain records of equipment training and related support provided in accordance with He-W 575.03(c) above.

History

#10636, eff 7-12-14

N.H. Code Admin. R. Ann. He-W 575.09 Third Party Liability {#sec-he-w-575.09 omnilex-key=us-nh-regs-official--agency-he-w--He-W 575.09}

All third party obligations shall be exhausted before medicaid may be billed in accordance with 42 CFR 433.129.

History

#10636, eff 7-12-14

N.H. Code Admin. R. Ann. He-W 575.10 Utilization Review and Control. {#sec-he-w-575.10 omnilex-key=us-nh-regs-official--agency-he-w--He-W 575.10}

The department’s provider integrity unit shall monitor utilization of AAC aids and services to identify, prevent, and correct potential occurrences of fraud, waste, and abuse in accordance with 42 CFR 455, 42 CFR 456, and He-W 520.

History

#10636, eff 7-12-14

N.H. Code Admin. R. Ann. He-W 575.11 Payment for AAC Aids {#sec-he-w-575.11 omnilex-key=us-nh-regs-official--agency-he-w--He-W 575.11}

Payment for AAC aids shall be made as follows:

(a) The DME provider of AAC aids shall submit claims for payment to the department’s fiscal agent;

(b) Claims shall not be submitted prior to the date the AAC aid is delivered to the recipient;

(d) Payment for the purchase of AAC aids shall be made at the lesser of the following amounts:

(1) Usual and customary charge to the public, as established by the provider; or

(2) Provider acquisition cost, plus a mark-up, which shall be determined as follows:

a. For purchases from providers who have a program in place for ongoing education and technical support for the use of the AAC aid(s) after purchase, the mark-up shall be no greater than 35%; and

b. For purchases from providers who do not have a program in place for ongoing education and technical support for the use of the AAC aid(s) after purchase, the mark-up shall be as follows:

For AAC aids with a total cost of less than $301, the mark up shall be no greater than 35%;
For AAC aids with a total cost from $301 to $750, the mark-up shall be no greater than 30%;
For AAC aids with a total cost from $751 to $1,200, the mark-up shall be no greater than 25%; and
For AAC aids with a total cost of $1,201 and above, the mark-up shall be no greater than 20%;

(e) Payment as calculated in (d) above shall not include shipping costs, except for cases in which the AAC aids are purchased from multiple vendors, or the provider would receive less than $35 per vendor over their cost when shipping is included;

(f) When the AAC provider receives less than $35 over the acquisition cost when shipping is included, then an amount shall be included in the total payment to account for the cost of shipping;

(g) In the case of an AAC aid that has been rented before purchase, the cost of one month’s rental shall be deducted from the purchase amount computed in (d) above;

(h) For rental of AAC aids:

(1) No prepayment shall be made; and

(2) The provider shall submit claims at the end of the rental period;

(i) Payment for repairs of purchased AAC aids shall be the all-inclusive usual and customary charge to the public, except that:

(1) The allowable labor costs shall not exceed $50.00/hour; and

(2) Payment shall not include the cost of shipping and handling;

(j) Recipients shall not be liable for shipping and handling costs associated with repairs, rentals, and purchases; and

(k) Payment shall be denied if the recipient is not eligible for NH Medicaid on the date the authorized AAC aid is ordered.

History

#10636, eff 7-12-14

Part He-W 576 Managed Care Organizations - Expired

N.H. Code Admin. R. Ann. He-W 576.01 Medical Assistance {#sec-he-w-576.01 omnilex-key=us-nh-regs-official--agency-he-w--He-W 576.01}

– He-W 576.05

History

(See Revision Note at chapter heading He-W 500); ss by #4907, eff 9-1-90, EXPIRED: 9-1-96
#6926, eff 12-30-98

N.H. Code Admin. R. Ann. He-W 576.06 Medical Assistance {#sec-he-w-576.06 omnilex-key=us-nh-regs-official--agency-he-w--He-W 576.06}

– He-W 576.09

History

(See Revision Note at chapter heading He-W 500); ss by #5165, eff 6-17-91, EXPIRED: 6-17-97
#6926, eff 12-30-98

Part He-W 577 Laboratory Services

N.H. Code Admin. R. Ann. He-W 577.01 Definitions {#sec-he-w-577.01 omnilex-key=us-nh-regs-official--agency-he-w--He-W 577.01}

(a) “Current procedural terminology (CPT) code” means a unique identifying code in the field of medical nomenclature and designated by the United States department of health and human services as the national coding standard utilized in government and private health insurance programs for reporting medical services and procedures.

(b) “Department” means the New Hampshire (NH) department of health and human services.

(c) “Medicaid” means the Title XIX and Title XXI programs administered by the department, which makes medical assistance available to eligible individuals.

(d) “Recipient” means an individual who is eligible for and receiving medical assistance under the medicaid program.

(e) “Title XIX” means the joint federal-state program described in Title XIX of the Social Security Act and administered in NH by the department under the medicaid program.

(f) “Title XXI” means the joint federal-state program described in Title XXI of the Social Security Act and administered in NH by the department under the medicaid program.

History

#8564, eff 2-7-06; amd by #10139, eff 7-1-12; ss by #10513, eff 1-24-14; ss by #14414, eff 10-22-2025, EXPIRES: 10-22-2035

N.H. Code Admin. R. Ann. He-W 577.02 Recipient Eligibility {#sec-he-w-577.02 omnilex-key=us-nh-regs-official--agency-he-w--He-W 577.02}

All medicaid recipients shall be eligible for laboratory services, in accordance with He-W 577.

History

#8564, eff 2-7-06; ss by #10513, eff 1-24-14; ss by #14414, eff 10-22-2025, EXPIRES: 10-22-2035

N.H. Code Admin. R. Ann. He-W 577.03 Provider Participation {#sec-he-w-577.03 omnilex-key=us-nh-regs-official--agency-he-w--He-W 577.03}

(a) All participating laboratory service providers shall:

(1) Be licensed by the states in which they practice;

(2) Be certified to participate in the medicare program if the provider is an independent laboratory;

(3) Be clinical laboratory improvement amendments (CLIA) certified in accordance with 42 USC 263a; and

(4) Be an enrolled New Hampshire medicaid provider.

(b) If a laboratory test cannot be performed within the capabilities of the participating laboratory services provider, the specimens may be referred to another laboratory that is certified in the appropriate specialties and subspecialties of services in accordance with the requirements of 42 CFR 493.

History

#8564, eff 2-7-06; ss by #10513, eff 1-24-14; ss by #14414, eff 10-22-2025, EXPIRES: 10-22-2035

N.H. Code Admin. R. Ann. He-W 577.04 Covered Services {#sec-he-w-577.04 omnilex-key=us-nh-regs-official--agency-he-w--He-W 577.04}

Laboratory services shall be covered when:

(a) Ordered and provided under the direction of a physician or other licensed practitioner within the scope of their practice; or

(b) Ordered by a physician but provided by a referral laboratory in accordance with 42 CFR 440.30.

History

#8564, eff 2-7-06; ss by #10513, eff 1-24-14; ss by #14414, eff 10-22-2025, EXPIRES: 10-22-2035

N.H. Code Admin. R. Ann. He-W 577.05 Utilization Review and Control {#sec-he-w-577.05 omnilex-key=us-nh-regs-official--agency-he-w--He-W 577.05}

(a) The department’s bureau of program integrity shall monitor utilization of laboratory services to identify, prevent, and correct potential occurrences of fraud, waste, and abuse, in accordance with 42 CFR 455, 42 CFR 456, and He-W 520.

History

#8564, eff 2-7-06; ss by #10513, eff 1-24-14; ss by #14414, eff 10-22-2025, EXPIRES: 10-22-2035

N.H. Code Admin. R. Ann. He-W 577.06 Third Party Liability {#sec-he-w-577.06 omnilex-key=us-nh-regs-official--agency-he-w--He-W 577.06}

(a) All third party obligations shall be exhausted before medicaid can be billed, in accordance with 42 CFR 433.139.

(b) Laboratory service providers shall request information from the recipient regarding other insurance coverage.

(c) If other insurance coverage is available, providers shall contact the insurer to verify benefits initially and at least annually thereafter or when the insurance carrier changes.

(d) Providers shall maintain a record of any other insurance verifications in the recipient’s medical record in accordance with He-W 520.

History

#8564, eff 2-7-06; ss by #10513, eff 1-24-14; ss by #14414, eff 10-22-2025, EXPIRES: 10-22-2035

N.H. Code Admin. R. Ann. He-W 577.07 Payment for Services {#sec-he-w-577.07 omnilex-key=us-nh-regs-official--agency-he-w--He-W 577.07}

(a) Laboratory service providers shall bill:

(1) Utilizing the appropriate CPT code and code guidelines established for use with these procedure codes;

(2) For services referred to and provided by another laboratory in accordance with He-W 577.03(b); and

(3) For tests performed as groups and combinations utilizing the CPT codes for automated multichannel procedures.

(b) All laboratory tests shall be included in the panel if:

(1) A panel procedure code is utilized for billing; and

(2) The panel procedure code is listed in the National Correct Coding Initiative (NCCI), found at the Centers for Medicare and Medicaid Services, at www.cms.hhs.gov.

(c) Payments to laboratory service providers shall be made in accordance with rates established by the department pursuant to RSA 161:4, VI.

(d) The department shall directly reimburse a physician for laboratory services provided by a laboratory service provider with which the physician has a contract or agreement.

(e) Laboratory service providers shall submit claims for payment to the department’s fiscal agent and in accordance with He-W 521.04.

(f) Laboratory service providers shall maintain supporting documentation, in accordance with He-W 520.

PARTS He-W 578 through He-W 588 - RESERVED

History

#8564, eff 2-7-06; ss by #10513, eff 1-24-14; ss by #14414, eff 10-22-2025, EXPIRES: 10-22-2035

Part He-W 589 Medical Assistance Services Provided by Education Agencies

N.H. Code Admin. R. Ann. He-W 589.01 Purpose {#sec-he-w-589.01 omnilex-key=us-nh-regs-official--agency-he-w--He-W 589.01}

The purpose of these rules is to describe the services provided by school districts and school administrative units that are reimbursable under NH medicaid for which federal financial participation (FFP) can be claimed and to describe the required qualifications of clinicians, licensed by a board under the office of professional licensure and certification for healthcare professionals, delivering reimbursable services in schools and preschools. Reimbursable services include both the NH medicaid state plan services, and other optional services that are not covered under the NH medicaid state plan, but covered pursuant to 1905(a) of the Social Security Act through the early and periodic screening, diagnostic, and treatment (EPSDT) benefit. Requesting FFP for medicaid services is optional for school districts and school administrative units. These service descriptions are established to allow students to receive medically necessary services within the least restrictive environment. Participation in medicaid is discretionary on the part of school districts and school administrative units. These rules are not intended to impose upon school districts and school administrative units the responsibility to provide any services that they are not otherwise legally responsible to provide under RSA 186-C or other law.

History

#4925, INTERIM, eff 8-31-90; ss by #5038, eff 12-28-90; ss by #5456, eff 9-1-92, EXPIRED: 9-1-98
#6861, INTERIM, eff 10-2-98, EXPIRED: 1-30-99
#6987, eff 4-27-99; ss by #8874, INTERIM, eff 4-25-07, EXPIRED: 10-22-07
#9035, eff 11-22-07; ss by #11025, eff 1-23-16
#12994, eff 2-21-20 (formerly He-M 1301.01) (See Revision Note at part heading for He-W 589); ss by #14432, eff 11-25-25, EXPIRES: 11-25-35

N.H. Code Admin. R. Ann. He-W 589.02 Definitions {#sec-he-w-589.02 omnilex-key=us-nh-regs-official--agency-he-w--He-W 589.02}

(a) “Activities of daily living (ADL)” means basic self-care tasks such as personal hygiene, grooming, eating, dressing, transferring, mobility, and toileting.

(b) “Applied behavior analysis (ABA)” means a treatment modality that employs the process of systematically applying interventions based on the principles of learning theory to improve socially significant behaviors, and is covered through the EPSDT benefit pursuant to He-W 546 and in accordance with He-W 589.04(at).

(c) “Augmentative and alternative communication (AAC) aids” means electronic or non-electronic aids, devices, or systems ordered by a licensed speech-language pathologist, including a certified speech- language specialist as described in RSA 326-F:3, IV(b), that assist a student to overcome or ameliorate the communication limitations that preclude or interfere with meaningful participation in current and projected daily activities, such as communication boards or books, speech amplifiers, and electronic devices that produce speech, written output, or both. This term includes “AAC devices”.

(d) “Care plan” means a written health care plan, including, but not limited to, an individualized education program or a 504 plan, which is maintained in the student’s file and documents and supports the medical necessity of all claims to NH medicaid for FFP.

(e) “Carry-over tasks” means tasks, therapies, or activities that a rehabilitative assistant performs as instructed by the licensed clinician in support of the care plan’s goals or the licensed clinician’s treatment plan.

(f) “Durable medical equipment (DME)” means a type of item pursuant to He-W 571 that is:

(1) Non-disposable and able to withstand repeated use;

(2) Primarily used to serve a medical purpose for the treatment of an acute or chronic medically diagnosed health condition, illness, or injury; and

(3) Not useful to an individual in the absence of an acute or chronic medically diagnosed health condition, illness, or injury.

(g) “Early and periodic screening, diagnosis, and treatment (EPSDT) services” means a benefit pursuant to 42 CFR 440.40 and He-W 546, designed to provide preventative health care, diagnostic services, and early detection and treatment of disease or abnormalities to medicaid enrolled individuals under age 21.

(h) “Enrolled school provider” means a NH local education agency (LEA) or school administrative unit (SAU) that has agreed to participate in NH medicaid pursuant to these rules and has enrolled with NH medicaid.

(i) “Federal financial participation (FFP)” means the federal share of costs for services.

(j) “Group” means 2 or more persons.

(k) “Individualized education plan (IEP)” means a written statement for a child with a disability that is developed, reviewed, and revised in accordance with 34 CFR 300.320 through 300.324, Ed 1109.01, and Ed 1109.03.

(l) “Instrumental activities of daily living” (IADL) means personal hygiene, light housework, laundry, meal preparation, transportation, grocery shopping, using the telephone, medication management, and money management.

(m) “Local education agency (LEA)” means a local school district.

(n) “Medical assistance” means the federally financed medical assistance program established pursuant to Title XIX and Title XXI of the Social Security Act also known as the medicaid program.

(o) “Medically necessary” means reasonably calculated to prevent, diagnose, correct, cure, alleviate, or prevent the worsening of conditions that endanger life, cause pain, result in illness or infirmity, threaten to cause or aggravate a handicap, or cause physical deformity or malfunction, and no other equally effective course of treatment is available or suitable for the student requesting the medically necessary service.

(p) “Order” means a written authorization for the provision of services issued by an advance practice registered nurse (APRN), physician assistant, physician, or other licensed clinician with ordering privileges.

(q) “Other licensed clinician” means any person licensed under state law and practicing within the scope of their licensure as authorized by the appropriate board, commission, or council responsible for licensing and regulating health care professions under the NH office of professional licensure and certification.

(r) “Performing-only provider” means a health care provider that the medicaid program does not allow to independently enroll with medicaid and is affiliated with an enrolled school provider. The term includes healthcare providers such as rehabilitative assistants pursuant to this part, personal care service workers for individuals under the age of 21, and board certified behavior analysts.

(s) “Personal care services” means medically necessary services related to assistance with ADL or IADL due to a student’s illness, injury, or disability which are furnished to a student who is not an inpatient or resident of a hospital, nursing facility, intermediate care facility for people with developmental disabilities, or institution for mental illness, and are covered through the EPSDT benefit pursuant to He-W 546 and in accordance with He-W 589.04(aw).

(t) “Physician” means a person licensed to practice medicine in NH or the state in which they practice.

(u) “Private duty nursing” means the provision of skilled nursing services for students who require more individual and continual skilled nursing observation, judgment, assessment, or interventions than are available from a visiting nurse, in contrast to part-time or intermittent care, such as wound care.

(v) “Psychologist” means a person licensed to practice psychotherapy in NH pursuant to RSA 329-B or an equivalent licensing board in the state in which they practice.

(w) “Psychotherapist” means a licensed clinical social worker, pastoral psychotherapist, clinical mental health counselor, or marriage and family therapist licensed under RSA 330-A who provides mental health services. This term includes psychiatrists licensed as physicians under RSA 329, advanced practice registered nurse (APRN) licensed under RSA 326-B:18 as psychiatric nurse practitioners, and psychologists, school psychologists, or associate school psychologists licensed by the board of psychology under RSA 329-B. This term also includes “mental health practitioner”.

(x) “Psychotherapy” means the professional treatment, assessment, or counseling of a mental or emotional illness, symptom, or condition.

(y) “Rehabilitative assistance services” means non-skilled interventions covered through the EPSDT benefit and ordered by a physician, physicians’ assistant, APRN, or other licensed clinician, as listed in the student’s care plan.

(z) “School administrative unit (SAU)” means a legally organized administrative body responsible for one or more school districts pursuant to RSA 194-C:1.

(aa) “Section 504 plan (504 plan)” means a plan for services for a student in accordance with Section 504 of the Rehabilitation Action of 1973 as amended.

(ab) “Signature” means:

(1) A person’s name handwritten by that person, excluding any photocopy, stamp, or other facsimile of such name; or

(2) An electronic signature that complies with RSA 294-E.

(ac) “Student” means a person who is eligible for and receiving medical assistance under medicaid pursuant to He-W 589.03.

(ad) “Under the direction” means that, except as prohibited by state law, the licensed clinician, whether or not they are physically present at the time that services are provided:

(1) Assumes professional responsibility for the services provided;

(2) Assures that the services are medically appropriate and performed safely; and

(3) Assures compliance with the clinical oversight requirements as required by law or rule adopted by the appropriate board, commission, or council responsible for licensing and regulating health care professions under the NH office of professional licensure and certification.

History

#4925, INTERIM, eff 8-31-90; ss by #5038, eff 12-28-90; ss by #5456, eff 9-1-92, EXPIRED: 9-1-98
#6861, INTERIM, eff 10-2-98, EXPIRED: 1-30-99
#6987, eff 4-27-99; ss by #8874, INTERIM, eff 4-25-07, EXPIRED 10-22-07
#9035, eff 11-22-07; amd by #10278, eff 2-23-13; EXPIRED: 11-22-15 in paras. (a)-(g) and (i)-(s); amd by #11045-A, INTERIM, eff 2-25-16, EXPIRES: 8-23-16; ss by #11165, eff 8-23-16; ss by #12607, EMERGENCY RULE, eff 8-20-19, EXPIRED: 2-16-19 (and #11165 effective again pursuant to RSA 541-A:18, V); ss by #12861, EMERGENCY RULE, eff 8-28-19
#12994, eff 2-21-20 (formerly He-M 1301.02) (See Revision Note at part heading for He-W 589); ss by #14432, eff 11-25-25, EXPIRES: 11-25-35

N.H. Code Admin. R. Ann. He-W 589.03 Student Eligibility {#sec-he-w-589.03 omnilex-key=us-nh-regs-official--agency-he-w--He-W 589.03}

To be eligible for medicaid reimbursement for covered services, a student shall:

(a) Have a care plan;

(b) Be between the ages of 3 and 22, provided that the students aged 21 through 22 are not eligible for medicaid reimbursement for services covered only under the EPSDT benefit;

(d) Be served by an LEA or SAU that is an enrolled school provider.

History

#4925, INTERIM, eff 8-31-90; ss by #5038, eff 12-28-90; ss by #5456, eff 9-1-92, EXPIRED: 9-1-98
#6861, INTERIM, eff 10-2-98, EXPIRED: 1-30-99
#6987, eff 4-27-99; ss by #8874, INTERIM, eff 4-25-07, EXPIRED 10-22-07
#9035, eff 11-22-07; ss by #11025, eff 1-23-16; ss by #12607, EMERGENCY RULE, eff 8-20-19, EXPIRED: 2-16-19 (and #11025 effective again pursuant to RSA 541-A:18, V); ss by #12861, EMERGENCY RULE, eff 8-28-19
#12994, eff 2-21-20 (formerly He-M 1301.03) (See Revision Note at part heading for He-W 589); ss by #14432, eff 11-25-25, EXPIRES: 11-25-35

N.H. Code Admin. R. Ann. He-W 589.04 Covered Services and Provider Qualifications {#sec-he-w-589.04 omnilex-key=us-nh-regs-official--agency-he-w--He-W 589.04}

(a) All enrolled school providers shall:

(1) Be enrolled with NH medicaid for the purposes of administration and billing;

(2) Verify the qualifications, licensure, and certifications, as applicable, of performing-only providers upon hire and at the time of any licensure or certification renewal and maintain proof of verification;

(3) Screen all providers, employees, contractors, and school personnel that are involved with administering or delivering medicaid services, upon hire and on a monthly basis thereafter, for exclusions against the Office of Inspector General (OIG) exclusion and sanction database pursuant to section 1866(j)(2) of the Social Security Act, section 1903(i) of the Social Security Act, and 42 CFR 1001.1901. The OIG exclusion and sanction database may be found at https://exclusions.oig.hhs.gov; and

(4) Ensure all providers have knowledge in the following areas:

a. Medicaid recipient rights, and the reporting of abuse and neglect; and

b. Record keeping and documentation requirements pursuant to this part, including the penalties associated with improper recordkeeping and documentation.

(b) All covered services shall be:

(1) Provided through a student's LEA or SAU;

(2) Medically necessary;

(3) Included and documented in the student’s care plan in accordance with this part;

(4) Provided in a variety of locations and settings as specified in a student’s care plan and might occur outside the hours of the usual school day;

(5) Provided by qualified clinicians pursuant to this part and who comply with the scope of their board licensure for their clinical practice including supervision and ordering requirements; and

(6) Prior authorized if required by the NH medicaid state plan, federal or state law, or the rules adopted thereunder.

(c) Covered services may be provided by staff employed or subcontracted by the enrolled school provider and who shall be:

(1) Either licensed by the applicable clinical boards to provide the services provided or otherwise under the direction of the appropriate licensed clinician to provide the services as permitted by applicable licensure law; or

(2) Board certified behavior analysts (BCBA) appropriately certified by the national Behavior Analyst Certification Board, and if supervising others, have a supervisory certification issued by the national board and be acting within the scope of that certification.

(d) Covered supplies and equipment described under He-W 589.04 shall:

(1) Be acquired for the use of a specific student;

(2) When purchased, be the property of the student and their family; and

(3) When rented or acquired through a used equipment exchange program, be the property of the student and their family during the period used.

(e) DME shall be provided by a qualified DME provider, and in accordance with the requirements pursuant to He-W 571.

(f) AAC devices and aids shall be provided by a qualified DME provider, and in accordance with the requirements of He-W 575.

(g) A medical evaluation shall be covered when performed to address a recipient complaint or illness and shall include the following:

(1) An initial evaluation conducted by a physician, APRN, or physician assistant; and

(2) The opinion or advice of a physician, APRN, or physician assistant regarding the evaluation or treatment of the student’s condition including services rendered.

(h) If after the initial evaluation in (g) above the physician, APRN, or physician assistant assumes the continuing care of the student, any service(s) provided subsequent to the initial evaluation by such physician, APRN, or physician assistant shall not be considered an evaluation but might be coverable as another service pursuant to this part.

(i) The following medical evaluation services performed by the providers in (g) above shall be billable under the category of medical evaluation:

(1) Examination of a single organ system, including:

a. Documentation of complaint(s);

b. Physical examination and diagnosis of current illness; and

c. Establishment of a plan of management relating to a specific problem; and

(2) In-depth evaluation with development and documentation of medical data, including:

a. Chief complaint;

b. Present illness;

c. Family history;

d. Medical history;

e. Personal history;

f. System review; and

g. Physical examination.

(j) Any consult service for which the student was present at least 51% of the time shall be a covered consultation service.

(k) Nursing services shall be medically necessary to meet the health needs of a student and include:

(1) Any assessments or treatments performed by a licensed registered nurse, licensed practical nurse (LPN), or APRN for a student; and

(2) Supplies and equipment necessary for the provision of the covered nursing services as determined by the licensed registered nurse, LPN, or APRN.

(l) Nursing services shall be performed by the following:

(1) An APRN licensed to practice in NH by the NH board of nursing in accordance with RSA 326-B:18 or the state in which they practice as a registered nurse in an advance practice role;

(2) A registered nurse who is:

a. Licensed to practice in NH or the state in which they practice in accordance with RSA 326-B; and

b. Acting under the direction of a physician, APRN, or physician assistant for those activities that require an order; or

(3) A LPN who is:

a. Licensed to practice in NH under RSA 326-B or the state in which they practice; and

b. Acting under the direction of a physician, APRN, registered nurse, or physician assistant.

(m) Nursing services shall include the following:

(1) Administration of medication(s);

(2) Positioning or repositioning;

(3) Assistance with specialized feeding programs;

(4) Management and care of specialized medical equipment such as:

a. Colostomy bags:

b. Nasogastric tubes;

c. Tracheostomy tubes; and

d. Related medical devices;

(5) Observation of students with chronic medical illnesses in order to assure that medical needs are being appropriately identified, addressed, and monitored; and

(6) Other services determined by a registered nurse, LPN, or APRN to be medically necessary and appropriate.

(n) Billable categories of nursing services shall include the following:

(1) Nursing assessment;

(2) Nursing treatment; and

(3) Supplies and equipment necessary to provide covered nursing services.

(o) Private duty nursing services shall be:

(1) Covered services when they are part of the student’s medical regimen and rendered under the order and under the direction of the student’s physician; and

(2) Covered and delivered in accordance with the requirements of He-W 540.

(p) Occupational therapy services shall be covered if the services are medically necessary to implement a program of activities to develop or maintain adaptive skills necessary to achieve adequate and appropriate physical and mental functioning of a student including:

(1) Any evaluations, treatment, or assessments performed by an occupational therapist of students whose abilities to carry out age appropriate tasks are threatened or impaired by physical illness, injury, or disease, mental illness, emotional disorder, or congenital or developmental disability;

(2) Supplies and equipment necessary to provide the covered occupational therapy services as recommended by an occupational therapist; and

(3) Occupational therapy services performed by an occupational therapy assistant carrying out a therapy plan developed by the occupational therapist.

(q) Occupational therapy services shall be provided by:

(1) An occupational therapist who is licensed to practice in NH or the state in which they practice; or

(2) An occupational therapy assistant as defined in RSA 326-C:1, III working under the direction of a licensed occupational therapist.

(r) Occupational therapy services shall include:

(1) Task-oriented activities to correct physical or emotional deficits or to minimize the disabling effect of these deficits in the life of the student;

(2) Evaluations of:

a. Sensorimotor abilities;

b. Self-care activities;

c. Capacity for independence;

d. Physical capacity for prevocational and work tasks; and

e. Play and leisure performance;

(3) Specific occupational therapy techniques involving:

a. Improving skills for ADLs;

b. The fabrication and application of splinting devices;

c. Sensorimotor activities;

d. The use of specifically designed manual and creative activities;

e. Guidance in the selection and use of adaptive equipment; and

f. Specific exercises to enhance functional performance and physical capabilities needed for work activities; and

(4) Other services determined by an occupational therapist to be medically necessary and appropriate.

(s) Billable categories of occupational therapy services shall include the following:

(1) Occupational therapy, evaluation;

(2) Occupational therapy, individual;

(3) Occupational therapy, group; and

(4) Supplies and equipment necessary for the provision of covered occupational therapy services.

(t) Physical therapy services shall include:

(1) Any evaluations to determine a student's level of physical functioning, including performance tests to measure strengths, balance, endurance, and range of motion;

(2) Any treatment services, evaluations, or assessments which might utilize therapeutic exercises or the modalities of heat, cold, water, and electricity, for the purpose of preventing, restoring, or alleviating a lost or impaired physical function;

(3) Other services, including supplies and equipment, determined by a physical therapist to be medically necessary and appropriate for a student's physical therapy; and

(4) Physical therapy services performed by a physical therapy assistant carrying out a therapy plan developed by the physical therapist.

(u) Physical therapy services shall be provided by:

(1) A physical therapist who is a graduate of a program of physical therapy approved by the Committee on Allied Health Education and Accreditation of the American Medical Association and the American Physical Therapy Association or its equivalent and licensed to practice in the state of NH or the state in which they practice; or

(2) A physical therapy assistant as defined in RSA 328-A:2, VIII who is under the direction of a licensed physical therapist pursuant to (1) above.

(v) Physical therapy services shall be medically necessary.

(w) Billable categories of physical therapy services shall include the following:

(1) Physical therapy, evaluation;

(2) Physical therapy, individual;

(3) Physical therapy, group; and

(4) Supplies and equipment necessary for the provision of covered physical therapy services.

(x) Psychiatric services shall be medically necessary for the evaluation, assessment, diagnosis, and treatment of mental or emotional conditions.

(y) Psychiatric services shall be provided by:

(1) A psychiatrist who is a physician licensed to practice in NH as defined in RSA 135-C:2, XIII, or the state in which they practice and either board certified or board eligible according to the most recent regulations of the American Board of Psychiatry and Neurology, Inc. or its successor organization; or

(2) An APRN with a psychiatric specialty pursuant to RSA 326-B:18.

(z) Billable categories of psychiatric services shall include the following:

(1) Psychiatric evaluation and diagnosis; and

(2) Psychiatric treatment.

(aa) Psychological services shall require an order and be medically necessary for the evaluation, diagnosis, treatment, and counseling of mental or emotional illnesses, symptoms, or conditions.

(ab) Psychological services shall be provided by:

(1) A psychologist who is a school psychologist or associate school psychologist certified by the state board of education in NH or in the state in which they practice and licensed by the NH board of psychologists or another state’s board of psychology;

(2) A psychologist or associate psychologist licensed by the NH board of psychologists or licensed by another state’s board of psychology;

(3) A physician;

(4) APRNs with a psychiatric specialty pursuant to RSA 326-B:18;

(5) Psychotherapists acting within the scope of their licensure; or

(6) A master licensed alcohol and drug counselor (MLADC) for co-occurring mental health and substance use disorders.

(ac) Billable categories of psychological services shall include the following:

(1) Psychological testing and evaluation;

(2) Psychodiagnostic testing;

(3) Psychological counseling, individual treatment;

(4) Psychological counseling, group treatment; and

(5) Family counseling, during which the student shall be present at 51% of the counseling session.

(ad) Mental health services, other than psychiatric and psychological services, shall:

(1) Be covered if they are medically necessary and ordered; and

(2) Include, but not be limited to:

a. Behavior management;

b. Individual counseling;

c. Group counseling;

d. Family counseling, during which the student shall be present at 51% of the counseling session; and

e. Crisis intervention.

(ae) Persons providing mental health services shall be:

(2) A mental health practitioner or a psychotherapist as defined in RSA 330-A:2, VII and VIII, respectively;

(3) A psychologist licensed by the board of psychologists pursuant to RSA 329-B; or

(4) An APRN with a psychiatric specialty pursuant to RSA 326-B:18.

(af) Substance use disorder (SUD) treatment and recovery support services shall be provided by the licensed qualified providers described in He-W 513, and in accordance with the requirements in He-W 513.

(ag) Applied behavior analysis (ABA) shall be covered for individuals with the following diagnoses:

(1) Autism spectrum disorder; or

(2) Pervasive developmental disability.

(ah) ABA shall be provided by:

(1) A BCBA appropriately certified by the national Behavior Analyst Certification Board, and if supervising others, have a supervisory certification issued by the national Behavior Analyst Certification Board and be acting within the scope of that certification;

(2) A rehabilitation assistant, as defined by (al), under the appropriate supervision of (1) above;

(3) A board certified assistant behavior analyst (BCABA), under the appropriate supervision of (1) above; or

(4) A registered behavior technician (RBT), under the appropriate supervision of (1) above.

(ai) Billable categories of ABA shall include the following:

(1) Behavior identification assessment; and

(2) Adaptive behavior treatment.

(aj) ABA services shall be recommended by a licensed clinician who has experience in the diagnosis and treatment of autism spectrum disorder or pervasive developmental disorder and holds at least one of the following educational degrees and valid license:

(1) Physician;

(2) Psychologist;

(3) Nurse practitioner specializing in developmental medicine; or

(4) Physician’s associate specializing in developmental medicine.

(ak) Rehabilitative assistance services shall include the following:

(1) Mobility assistance such as positioning, transfers, correct application of ankle-foot orthosis, bracing or orthotic devices, range of motion, fall prevention, safety risk precautions, and physical therapy carry-over tasks as directed by the licensed physical therapist;

(2) Communication assistance such as assistance with sign language, prompting to facilitate expressive and receptive language, assistance with AAC devices and other such devices that ameliorate communication limitations, and speech language carry-over tasks as directed by the licensed speech language pathologist;

(3) Assistance with the implementation of behavioral management plans to increase adaptive behavioral functioning and carry-over tasks as directed by the mental health practitioner or BCBA;

(4) Nutrition such as assistance with eating, cutting food, food preparation, and safe eating plan carry-over tasks as directed by the speech language pathologist or occupational therapist;

(5) Cueing, prompting, and guiding, when provided as part of the assistance with ADLs, communication, or behavior management;

(6) Assistance with adaptive or assistive devices when linked to the student’s medical condition;

(7) Assistance with the use of DME when linked to the student’s medical condition;

(8) Medication administration to the extent allowable under RSA 326-B and pursuant to Nur 404.07 when the rehabilitative assistant has been trained by a nurse in medication administration, and the nurse has delegated the task of medication administration to the rehabilitative assistant;

(9) Personal care services such assistance with ADL and IADL and assistance with occupational therapy, physical therapy, or speech language carry-over tasks;

(10) Carry-over of therapy skills training as delegated by a speech language pathologist, physical therapist, and occupational therapist;

(11) Observation and reporting of signs of distress in the student’s medical condition as trained by a registered nurse;

(12) Implementation of safe eating plans and g-tube feedings as delegated by a registered nurse with applicable training;

(13) Maintaining a safe environment to assure the student’s safety concerns are met for the student, other students, and staff; and

(14) Any other remedial services that are included in the student’s care plan as medically necessary for the maximum reduction of a student's physical or mental disabilities, excluding educational and social activities such as classroom instruction and academic tutoring.

(al) Rehabilitative assistants shall:

(1) Either:

a. Be certified pursuant to Ed 504.05 or Ed 504.06, requirements and certification for paraeducators;

b. Have qualifications determined by the department to be equivalent to the requirements for certification under Ed 504.05 or 504.06; or

c. Be other licensed clinicians; and

(2) If applicable for the tasks delegated to the rehabilitative assistant or if required by law have knowledge in the following areas:

a. Personal care and nutrition;

b. Infection control and universal precautions designed to prevent the transmission of infectious diseases;

c. Safety and emergency procedures, including basic first aid and 911 protocols; and

d. Proper lifting techniques.

(am) Rehabilitative assistants shall provide rehabilitation assistance services in accordance with Ed 1113.12.

(an) Rehabilitative assistance services shall be medically necessary and require an order.

(ao) Provision of rehabilitative assistance services shall be reviewed by a licensed clinician designated by the enrolled school provider’s care plan team every 30 days. Documentation for the 30-day review shall include:

(1) The type of contact including face to face, observation, or telephone call;

(2) Areas covered such as duties and expectations, and skills development;

(3) A list of trainings completed within the past 30 days;

(4) Issues identified, if any, and action to be taken;

(5) Date of current session;

(6) Date of next session;

(7) Attestation that the services were provided; and

(8) Licensed clinician signature and attestation that the services were conducted in accordance with the care plan.

(ap) Speech and language services shall be covered services if they are services, supplies, or equipment ordered by a licensed audiologist or licensed speech-language pathologist or a speech-language specialist certified by the department of education, as described in RSA 326-F:3, IV(b) to be medically necessary for the evaluation, diagnosis, or treatment of speech, language, and hearing disorders which result in communication disabilities.

(aq) Speech and language services shall include services performed by speech language assistants listed in (ar) below carrying out a therapy plan developed by the speech language pathologist and speech-language specialists certified by the department of education, as described in RSA 326 F:3, IV(b).

(ar) Speech and language services shall be provided by:

(1) A speech-language pathologist who is either:

a. Licensed pursuant to RSA 326-F to practice in NH, which shall be considered equivalent to having met the requirements for the American Speech-Language-Hearing Association (ASHA) Certificate of Clinical Competence in Speech-Language Pathology; or

b. Licensed in the state in which they practice and have one of the following:

1 A Certificate of Clinical Competence from the ASHA;

2 Completed the equivalent educational requirements and work experience necessary for the certificate; or

3 Completed the academic program and is acquiring supervised work experience to qualify for the certificate;

(2) A speech-language assistant as defined in RSA 326-F:1, XI working under the direction of a licensed speech-language pathologist pursuant to (2) above; or

(3) A certified speech-language specialist as described at RSA 326-F:3, IV(b).

(as) Billable categories of speech and language services shall include the following:

(1) Individual speech or language evaluation;

(2) Speech or language, individual treatment;

(3) Speech or language, group treatment; and

(4) Supplies and equipment necessary for the provision of covered speech and language services.

(at) Audiology services shall be medically necessary for the prevention or rehabilitation of hearing impairment or restoration of a student with a hearing impairment to their best possible functional level and be provided by an audiologist.

(au) Billable categories of audiology services shall include the following:

(1) Individual hearing evaluation;

(2) Hearing therapy, individual treatment;

(3) Hearing therapy, group treatment; and

(4) Supplies and equipment necessary for the provision of covered hearing services.

(av) Vision services shall be medically necessary for the prevention or rehabilitation of visual impairment or restoration of a student with a visual impairment to their best possible functional level and be provided by an optometrist licensed under RSA 327, a physician licensed under RSA 329 with a specialty in ophthalmology, or an optician licensed under RSA 327-A.

(aw) EPSDT comprehensive and age-appropriate medical assessments and screenings of a student’s physical and mental status, including vision and hearing screenings shall be provided in accordance with the requirements pursuant to He-W 546.05.

(ax) Services that are not covered or have coverage limits under the NH medicaid state plan shall be covered through the EPSDT benefit when medically necessary, coverable under Section 1905(a) of the Social Security Act, and requested in accordance with the requirements of He-W 546.

(ay) Except as indicated in (ba) below, the following shall be examples of services subject to the requirements of He-W 546:

(1) Rehabilitative assistance services;

(2) Applied behavior analysis;

(3) Personal care services for individuals under the age of 21;

(4) Wrap around services;

(5) Case management services; and

(6) Other optional services listed in 1905(a) of the Social Security Act and not included in the NH medicaid state plan or included as a covered service under this part.

(az) The following services shall not be subject to the prior authorization requirements of He-W 546:

(1) Rehabilitative assistance services;

(2) Applied behavior analysis; and

(3) Personal care services for individuals under the age of 21.

(ba) Any services not listed as covered under the NH medicaid state plan or services with coverage limits shall be given independent review by the department for coverage based on medical necessity in accordance with the EPSDT benefit pursuant to He-W 546.

(bb) Specialized transportation shall be a billable service as follows:

(1) Transportation shall be listed in the student’s IEP as a required service and the student shall be physically in the vehicle for the transportation to be billable to medicaid;

(2) Transportation shall be considered a required service if:

a. The student requires transportation in a vehicle specially adapted to serve the needs of the disabled student, including a specially adapted school bus; or

b. The student resides in an area that does not have school bus transportation, such as those areas in close proximity to a school, but has a medical need for transportation that is noted in the IEP;

(3) The following transportation may be billed as a medicaid service:

a. Transportation to and from school only on a day when the student receives a medicaid coverable service at school during the school day; and

b. Transportation to and from a medicaid coverable service in the community during the school day;

(4) The medicaid coverable service in (3)a. and (3)b. above shall be listed in the student’s IEP as a required service; and

(5) In addition to the documentation required by He-W 589.06, transportation providers shall maintain a daily transportation log to include:

a. Student’s name;

b. Date of service;

c. Clear indication that the student is being transported either one-way or round-trip;

d. The total number of students on the bus, both in the morning and the afternoon;

e. The total miles the bus traveled, both in the morning and the afternoon;

f. Driver’s name; and

g. Driver’s signature.

History

#4925, INTERIM, eff 8-31-90; ss by #5038, eff 12-28-90; ss by #5456, eff 9-1-92, EXPIRED: 9-1-98
#6861, INTERIM, eff 10-2-98, EXPIRED: 1-30-99
#6987, eff 4-27-99; ss by #8874, INTERIM, eff 4-25-07, EXPIRED 10-22-07
#9035, eff 11-22-07; amd by #10278, eff 2-23-13; EXPIRED: 11-22-15 in paras. (a)-(d), (f)-(h), (j), (k), (m), (n), (p), (r), (t), (v)-(x), (z)-(ad) and (af); amd by #11045-A, INTERIM, eff 2-25-16, EXPIRES: 8-23-16; ss by #11165, eff 8-23-16; ss by #12607, EMERGENCY RULE, eff 8-20-19, EXPIRED: 2-16-19 (and #11165 effective again pursuant to RSA 541-A:18, V); ss by #12861, EMERGENCY RULE, eff 8-28-19
#12994, eff 2-21-20 (formerly He-M 1301.04) (See Revision Note at part heading for He-W 589); ss by #14432, eff 11-25-25, EXPIRES: 11-25-35

N.H. Code Admin. R. Ann. He-W 589.05 Non-Covered Services {#sec-he-w-589.05 omnilex-key=us-nh-regs-official--agency-he-w--He-W 589.05}

The following shall be non-covered services and shall not be eligible for reimbursement:

(a) Services not listed in a student’s care plan;

(b) Services that are not coverable under the Social Security Act and for which no FFP is available for said service;

(c) Services performed by unqualified individuals pursuant to the Social Security Act, or services delivered by provider types not approvable under the Social Security Act to provide medicaid services;

(d) Consultations, visits, trainings, meetings, or discussions between healthcare providers or individuals in which the student was not physically present for at least 51% of the time;

(e) Services which are non-covered pursuant to He-W 500 and are not covered under EPSDT;

(f) Supported employment such as vocational goals and job tasks;

(g) Services which are solely educational, remedial education, or vocational instruction or tutoring;

(h) Services performed by educators or individuals who are not licensed clinicians such as teachers of the visually impaired or deaf unless:

(1) The individual has a valid license issued by the appropriate licensing board, commission, or council and is acting within the scope of their license;

(2) The individual is a rehabilitative assistant providing rehabilitative assistance services pursuant to He-W 589.04(ak)-(ao); or

(3) The individual currently holds a certification as a BCBA;

(i) Leisure and social activities that are non-medical;

(j) General supervision of a student as required for any student based on the student’s development and for non-medical reasons;

(k) Services that are solely personal care services delivered by a legally responsible family member pursuant to 42 CFR 440.167;

(l) Performance of tasks for the sole purpose of assistance with completion of educational assignments;

(m) Services under a Centers for Medicare and Medicaid Services (CMS) NH medicaid waiver;

(n) Medicaid state plan services only provided under the 1915(i) provisions of the Social Security Act;

(o) Day care;

(p) Teaching parenting skills;

(q) Review of records, documentation development, or report writing;

(r) Attending meetings, including individualized education program meetings and IEP team meetings;

(s) Parent consultations, contacts, or trainings;

(t) School guidance counselor services unless:

(1) The individual has a valid clinical license issued by the appropriate licensing board, commission, or council and is acting within the scope of their license;

(2) The individual is a rehabilitative assistant providing rehabilitative assistance services pursuant to He-W 589.04(ak)-(ao); or

(3) The individual currently holds a certification as a BCBA;

(u) Services by individuals not having a current license for the practice specialty area for the service area being provided; and

(v) Services requiring the technical or professional skill that a state statute or regulation mandates shall be performed by a clinician licensed or certified by the state.

History

#4925, INTERIM, eff 8-31-90; ss by #5038, eff 12-28-90; amd by #5132, eff 5-1-91; ss by #5456, eff 9-1-92, EXPIRED: 9-1-98
#6861, INTERIM, eff 10-2-98, EXPIRED: 1-30-99
#6987, eff 4-27-99; ss by #8874, INTERIM, eff 4-25-07, EXPIRED 10-22-07
#9035, eff 11-22-07; amd by #10278, eff 2-23-13; EXPIRED: 11-22-15 in paras. (a), (b)(1)-(7), and (b)(9)-(14); amd by #11045-A, INTERIM, eff 2-25-16, EXPIRES: 8-23-16; ss by #11165, eff 8-23-16; ss by #12607, EMERGENCY RULE, eff 8-20-19, EXPIRED: 2-16-19 (and #11165 effective again pursuant to RSA 541-A:18, V); ss by #12861, EMERGENCY RULE, eff 8-28-19
#12994, eff 2-21-20 (formerly He-M 1301.05) (See Revision Note at part heading for He-W 589); ss by #14432, eff 11-25-25, EXPIRES: 11-25-35

N.H. Code Admin. R. Ann. He-W 589.06 Documentation and Payment for Services {#sec-he-w-589.06 omnilex-key=us-nh-regs-official--agency-he-w--He-W 589.06}

(a) Reimbursement to enrolled school providers shall be the lesser of the following:

(1) One half of the actual cost; or

(2) The rate established by the department, in accordance with RSA 161:4, VI(a).

(b) Enrolled school providers shall bill by unit of service, using the current procedural code for the service delivered, and submit claims for payment that include the actual cost of the service to the department’s fiscal agent.

(c) Enrolled school providers shall submit claims for medicaid covered services consistent with this chapter and with federal medicaid law pursuant to 42 CFR 455, 42 CFR 456, 42 CFR 431, and 42 CFR 1001.

(d) Enrolled school providers shall maintain documentation in accordance with He-W 520 and this part for the delivered services in each student's individual record, with such documentation to include:

(1) A copy of the care plan and, if an IEP, evidence of implementation of the IEP as required by Ed 1109.04(b);

(2) The name of the student, the medical assistance ID number, and documentation demonstrating receipt of each unit of the covered service;

(3) The names, qualifications, and credentials of all performing providers for each service delivered for which the school sought FFP;

(4) The documentation of the qualifications, names, and signatures of persons directing or supervising the individuals providing the covered services if direction or supervision is required under this part or applicable law, and the date of supervisory approval;

(5) Date(s) of each service delivered and the location where the services were performed;

(6) The type of covered service provided and a description of each service provided;

(7) The duration of the provision of the each covered service, number of units performed, and the number of minutes for each delivered service;

(8) The start and stop times of the delivered services, and whether there was a break in services or time away by the performing provider;

(9) Indication whether the services were delivered in a group setting or individually;

(10) Indication of whether the student was actually present for the service and indication whether the student was present for at least 51% of the time;

(11) In the case of group services, documentation of the number of participants in the group who received the covered service regardless of the participants’ medicaid eligibility;

(12) A copy of a physician's or other licensed clinician’s order if required; and

(13) Documentation of the qualifications and a digitally signed electronic or handwritten signature of the individual(s) attesting to the medical non-academic nature of the covered rehabilitative assistance services.

(e) Enrolled school providers shall submit claims for physical, occupational, and speech-language therapy services in accordance with the following:

(1) Only units of direct treatment performed by a physical therapist, occupational therapist, speech language pathologist (SLP), a physical therapy assistant, occupational therapy assistant, or speech-language assistant shall be billed, meaning the time the therapist or physical therapy assistant, occupational therapy assistant, or speech-language assistant spends providing direct treatment to one student;

(2) Therapists working as a team to treat one or more students shall not each bill separately for the same or different service provided at the same time to the same student; and

(3) If a student requires co-treatment simultaneously by 2 therapists, the total number of units shall be divided between the therapists and billed separately by each therapist to equal the total time the student was receiving actual therapy services.

(f) Enrolled school providers shall only bill covered service time provided simultaneously by more than one licensed clinician and a rehabilitative assistant as follows:

(1) If rehabilitative assistance is provided simultaneously with another covered service, the rehabilitative assistance shall be billed in addition to the covered service; or

(2) If rehabilitative assistance is provided by more than one rehabilitative assistant simultaneously, each assistant’s service shall be billed separately.

(g) In calculating the cost for transportation, the enrolled school providers may include the following actual costs related to the trip:

(1) Fuel;

(2) Insurance;

(3) Driver’s salary and benefits;

(4) Salary and benefits of other persons working on the bus;

(5) Depreciation, and

(6) Maintenance.

(h) The total cost calculated in (g) above shall then be divided by the total number of miles for the trip both ways, and then divided by the total number of students on the bus, regardless of the students’ medicaid eligibility, to determine the cost per mile per student.

(i) In accordance with 34 CFR 300.154(d)(2)(iv) and Ed 1120.08, informed parental consent shall be obtained prior to the enrolled school provider billing the student’s medicaid.

(j) Enrolled school providers shall maintain records in support of claims submitted for reimbursement for a period of at least 6 years from the date of service or until the resolution of any legal action(s) commenced in the 6-year period, whichever is longer.

(k) As applicable, the creation, storage, retention, disclosure, and destruction of documentation required by this part shall comply with all federal and state privacy and security laws and rules including the substance use disorder patient records regulations pursuant to 42 CFR Part 2, Family Educational Rights and Privacy Act, and the Health Insurance Portability and Accountability Act of 1996.

History

#4925, INTERIM, eff 8-31-90; ss by #5038, eff 12-28-90; ss by #5456, eff 9-1-92, EXPIRED: 9-1-98
#6861, INTERIM, eff 10-2-98, EXPIRED: 1-30-99
#6987, eff 4-27-99; ss by #8874, INTERIM, eff 4-25-07, EXPIRED 10-22-07
#9035, eff 11-22-07; amd by #10278, eff 2-23-13; EXPIRED: 11-22-15 in paras. (a)-(d) and (f)-(l); amd by #11045-A, INTERIM, eff 2-25-16, EXPIRES: 8-23-16; ss by #11165, eff 8-23-16; ss by #12607, EMERGENCY RULE, eff 8-20-19, EXPIRED: 2-16-19 (and #11165 effective again pursuant to RSA 541-A:18, V); ss by #12861, EMERGENCY RULE, eff 8-28-19
#12994, eff 2-21-20 (formerly He-M 1301.06) (See Revision Note at part heading for He-W 589); ss by #14432, eff 11-25-25, EXPIRES: 11-25-35

N.H. Code Admin. R. Ann. He-W 589.07 Utilization Review and Control {#sec-he-w-589.07 omnilex-key=us-nh-regs-official--agency-he-w--He-W 589.07}

(a) The department’s program integrity unit shall monitor utilization of medical services delivered in schools to identify, prevent, and correct potential occurrences of fraud, waste, and abuse in accordance with 42 CFR 455, 42 CFR 456, 42 CFR 1001, and He-W 589.

(b) The department shall recoup state and federal medicaid payments as permitted by 42 CFR 455, 42 CFR 447, and 42 CFR 456 for an enrolled school provider’s failure to comply with these rules and to maintain supporting records in accordance with He-W 520 and He-W 589.

History

#12607, EMERGENCY RULE, eff 8-20-19, EXPIRED: 2-16-19
#12861, EMERGENCY RULE, eff 8-28-19
#12994, eff 2-21-20 (formerly He-M 1301.07) (See Revision Note at part heading for He-W 589); ss by #14432, eff 11-25-25, EXPIRES: 11-25-35

N.H. Code Admin. R. Ann. He-W 589.08 Documentation of Expenditure of Non-Federal Funds {#sec-he-w-589.08 omnilex-key=us-nh-regs-official--agency-he-w--He-W 589.08}

(a) The enrolled school provider shall provide documentation annually regarding all services rendered pursuant to these rules.

(b) Such documentation shall:

(1) Demonstrate that:

a. The percentage of federal medical assistance reimbursed, as required by section 1905(b) of the Social Security Act, does not exceed 50% of the actual cost of covered services claimed under medicaid; and

b. Services that are reimbursable under medicaid, but paid by other federal funding, are not claimed by the enrolled school provider under NH medicaid;

(2) Be reviewed and signed by the enrolled school provider’s superintendent;

(3) Be submitted to the department no later than October 30 of each year for the preceding fiscal year period; and

(4) Be accompanied by a completed form “Documentation of Expenditure of Non-Federal Funds” (November 2025) for a specific July 1 through June 30 time period which includes an attestation signed and dated by the superintendent stating:

“I hereby certify that all Medicaid funds paid to the above named districts under He-W 589.08, Medical Assistance Services Provided by Educational Agencies for the period July 1, xxxx through June 30, xxxx have been supplemented with LEA/SAU and/or non-federal funds to total 100% of the cost of services rendered and that the Medicaid reimbursement does not exceed 50% of the total cost of the services rendered.”

History

#4925, INTERIM, eff 8-31-90; ss by #5038, eff 12-28-90; ss by #5456, eff 9-1-92, EXPIRED: 9-1-98
#6861, INTERIM, eff 10-2-98, EXPIRED: 1-30-99
#6987, eff 4-27-99; ss by #8874, INTERIM, eff 4-25-07, EXPIRED 10-22-07
#9035, eff 11-22-07; amd by #10278, eff 2-23-13; EXPIRED: 11-22-15 in paras. (a), (b)(1), and (b)(2); amd by #11045-A, INTERIM, eff 2-25-16, EXPIRES: 8-23-16; ss by #11165, eff 8-23-16; renumbered by #12607, EMERGENCY RULE, (formerly He-M 1301.07) (renumbered as He-M 1301.07 again pursuant to RSA 541-A:18, V upon expiration 2-16-19 of #12607); ss by #12861, EMERGENCY RULE, eff 8-28-19 (formerly He-M 1301.07)
#12994, eff 2-21-20 (formerly He-M 1301.08) (See Revision Note at part heading for He-W 589); ss by #14432, eff 11-25-25, EXPIRES: 11-25-35

N.H. Code Admin. R. Ann. He-W 589.09 Waivers {#sec-he-w-589.09 omnilex-key=us-nh-regs-official--agency-he-w--He-W 589.09}

(a) An enrolled school provider may request a waiver of specific procedures outlined in He-W 589 by writing to the department.

(b) The waiver shall be requested in writing to the department, detailing which rule provision is to be waived and how the school plans to meet the objective or intent of the rule.

Department of Health and Human Services

Office of Medicaid Medical Services

Hugh J. Gallen State Office Park

129 Pleasant Street, Brown Building

Concord, NH 03301

(d) No federally mandated requirement and no provision or procedure prescribed by state statute shall be waived.

(e) The request for a waiver shall be granted by the commissioner or their designee within 30 days if the waiver:

(1) Meets the objective or intent of the rule;

(2) Does not negatively impact the health or safety of the student(s); and

(3) Does not affect the quality of services to students.

(f) Upon receipt of approval of a waiver request, the enrolled school provider’s subsequent compliance with the alternative provisions or procedures approved in the waiver shall be considered compliance with the rule for which waiver was sought.

(g) Waivers shall be effective for a maximum of 2 years if requested by the provider and the waiver addresses the reason for the waiver.

(h) An enrolled school provider may request a renewal of a waiver from the department. Such request shall be made at least 30 days prior to the expiration of a current waiver. A request for renewal of a waiver shall be approved in accordance with the criteria specified in (e) above.

History

#4925, INTERIM, eff 8-31-90; ss by #5038, eff 12-28-90; ss by #5456, eff 9-1-92, EXPIRED: 9-1-98
#6861, INTERIM, eff 10-2-98, EXPIRED: 1-30-99
#6987, eff 4-27-99; ss by #8874, INTERIM, eff 4-25-07, EXPIRED 10-22-07
#9035, eff 11-22-07; ss by #11025, eff 1-23-16; renumbered by #12607, EMERGENCY RULE, (formerly He-M 1301.08) (renumbered as He-M 1301.08 again pursuant to RSA 541-A:18, V upon expiration 2-16-19 of #12607); ss by #12861, EMERGENCY RULE, eff 8-28-19 (formerly He-M 1301.08)
#12994, eff 2-21-20 (formerly He-M 1301.09) (See Revision Note at part heading for He-W 589); ss by #14432, eff 11-25-25, EXPIRES: 11-25-35

Part He-W 590 Nursing Facility Services

N.H. Code Admin. R. Ann. He-W 590.01 Definitions {#sec-he-w-590.01 omnilex-key=us-nh-regs-official--agency-he-w--He-W 590.01}

History

(See Revision Note at chapter heading He-W 500); ss by #5085, eff 3-5-91; amd by #6159, eff 12-29-95; rpld by #7749, eff 8-17-02

N.H. Code Admin. R. Ann. He-W 590.02 Recipient Eligibility {#sec-he-w-590.02 omnilex-key=us-nh-regs-official--agency-he-w--He-W 590.02}

EXPIRED

History

(See Revision Note at chapter heading He-W 500); ss by #4908, eff 8-17-90; amd by #5164, eff 6-12-91, EXPIRED: 8-17-96 and 6-12-97

N.H. Code Admin. R. Ann. He-W 590.03 Medical Assistance {#sec-he-w-590.03 omnilex-key=us-nh-regs-official--agency-he-w--He-W 590.03}

through He-W 590.14 - EXPIRED

History

(See Revision Note at chapter heading He-W 500); ss by #4908, eff 8-17-90, EXPIRED: 8-17-96

N.H. Code Admin. R. Ann. He-W 590.15 Absence from the Facility {#sec-he-w-590.15 omnilex-key=us-nh-regs-official--agency-he-w--He-W 590.15}

History

(See Revision Note at chapter heading He-W 500); ss by #5965, eff 1-27-95; rpld by #7749, eff 8-17-02

N.H. Code Admin. R. Ann. He-W 590.16 Resident Assessment System {#sec-he-w-590.16 omnilex-key=us-nh-regs-official--agency-he-w--He-W 590.16}

History

(See Revision Note at chapter heading He-W 500); ss by #6159, eff 12-29-95; rpld by #7749, eff 8-17-02

Part He-W 592 Nursing Assistant Training Reimbursement

N.H. Code Admin. R. Ann. He-W 592.01 Definitions {#sec-he-w-592.01 omnilex-key=us-nh-regs-official--agency-he-w--He-W 592.01}

EXPIRED

History

(See Revision Note at chapter heading He-W 500); ss by #5618, eff 8-1-93, EXPIRED: 8-1-99

N.H. Code Admin. R. Ann. He-W 592.02 Requirements, Conditions and Limitations {#sec-he-w-592.02 omnilex-key=us-nh-regs-official--agency-he-w--He-W 592.02}

History

(See Revision Note at chapter heading He-W 500); ss by #5618, eff 4-28-93; amd by #6033, eff 5-1-95; rpld by #7750, eff 8-17-02

N.H. Code Admin. R. Ann. He-W 592.03 Payment to CAN {#sec-he-w-592.03 omnilex-key=us-nh-regs-official--agency-he-w--He-W 592.03}

History

(See Revision Note at chapter heading He-W 500); ss by #5618, eff 4-28-93; amd by #6033, eff 5-1-95; rpld by #7750, eff 8-17-02

Chapter He-W 600 Financial Assistance and Eligibility for Medical Care

Part He-W 601 Definitions

N.H. Code Admin. R. Ann. He-W 601.01 Definitions A {#sec-he-w-601.01 omnilex-key=us-nh-regs-official--agency-he-w--He-W 601.01}

(a) “Adoptive parent” means, for the purposes of deprivation of support or care, an individual who has legally adopted a child and has therefore assumed the same parental rights and responsibilities for such child as a biological parent.

(b) “Adult” means any individual age 18 or older, except as modified by various program policies.

(c) “Adult category” means the financial assistance program under old age assistance (OAA), aid to the needy blind (ANB), and aid to the permanently and totally disabled (APTD).

(d) “Advance notice” means a written decision which is generated by the department and provided to a casehead prior to a negative change in benefits.

(e) “Advance notice period (ANP)” means the period of time from the date a notice of decision denying, decreasing, or terminating benefits is generated to a casehead to the date the change takes effect.

(f) “Aid and attendance” means a veterans affairs allowance.

(g) “Aid to the needy blind (ANB)” means the financial assistance program as described in RSA 167:6, IV.

(h) “Aid to the permanently and totally disabled (APTD)” means the financial assistance program as described in RSA 167:6, VI.

(i) “Alien” means an individual who is not a citizen of the United States (U.S.).

(j) “Alimony” means payments for maintenance and care made to and on behalf of a former or estranged spouse.

(k) “Allowable deduction” means an amount subtracted from case income which represents an expense that is or was paid by an assistance group (AG) member or other person whose income is counted in the determination of eligibility.

(l) “Annuity” means any monetary source of fixed or periodic payments, either for life or for a term of years.

(m) “Applicant” means a person on whose behalf an application for assistance is being made for any of the New Hampshire (NH) department of health and human services (department) programs.

(n) “Applicant spouse” means the spouse of an OAA, ANB, or APTD individual who lives with the OAA, ANB, or APTD individual in an independent living arrangement and is also applying for or receiving OAA, ANB, or APTD financial assistance.

(o) “Application” means a formal request for assistance or services pursuant to RSA 167:8, which is signed and dated by an individual or authorized representative (AR).

(p) “Assets” means all income and resources of a financial applicant or recipient and the applicant’s or recipient’s spouse.

(q) “Assignment of rights to child support” means a process whereby the right to receive and collect an individual's financial child support is transferred to the department for the purpose of reimbursing payments made on behalf of children who receive financial assistance to needy families (FANF).

(r) “Assistance payment” means the negotiable bank warrant issued to recipients of financial assistance.

(s) “Assistance group (AG)” means the individuals living together, whose needs, income, and resources are considered and combined together when determining eligibility or the amount of benefits for financial assistance.

(t) “Asylee” means an alien that has been granted political asylum by the U.S. Attorney General.

(u) “Authorized representative (AR)” means an individual acting on behalf of the casehead in some or all of the aspects of initial and continuing eligibility.

(v) “Available income” means all income which is regular and recurring and income which is treated as available for use regardless of actual receipt.

History

(See Revision Note #1 and Revision Note #2 at Chapter Heading He-W 600); ss by #10399, eff 10-21-13; ss by #13836, eff 12-28-23

N.H. Code Admin. R. Ann. He-W 601.02 Definitions B–C {#sec-he-w-601.02 omnilex-key=us-nh-regs-official--agency-he-w--He-W 601.02}

(a) “Basic maintenance needs allowance (BMNA)” means, for FANF financial assistance, the dollar amount that is included in the standard of need for monthly basic needs, excluding shelter costs.

(b) “Beneficiary” means any individual or individuals, designated in a trust instrument as benefiting in some way from the trust.

(c) “Boarding arrangement” for the FANF program means that the AG makes, at a minimum, one fixed payment for lodging and meals or makes one payment for lodging and another for meals, regardless of whether the AG lives in a relative's home or another person's home.

(d) “Burial plot” means a conventional gravesite, crypt, mausoleum, urn, or other repository which is customarily and traditionally used for the remains of a deceased person.

(e) “Caretaker relative” means an individual who is not the parent, but is the specified relative of the children in an AG.

(f) “Case” means the group of programs associated with a particular casehead, including financial assistance, medical assistance, child care, or the supplemental nutrition assistance program (SNAP), or any combination of the above.

(g) “Casehead” means the individual under whose name the case is listed.

(h) “Case income” means the combined countable income of all AG members.

(i) “Category of assistance” means the types of financial assistance offered by the department, such as FANF, OAA, ANB, or APTD.

(j) “Child” means a biological, adoptive, or step-dependent.

(k) “Citizen” means an individual born in the U.S. or born overseas to a parent born in the U.S., or an individual who becomes a citizen through the naturalization process.

(l) “Community residence” means a:

(1) Residential facility which:

a. Provides housing on a 24-hour basis to individuals with a mental illness or developmental impairment; and

b. Receives funds or applies to receive funds from the department, community mental health programs, or area agencies; or

(2) Residential facility which houses individuals with a mental illness or developmental impairment who receive or might be eligible to receive the monthly allowance for shared homes and community living home residents, established pursuant to RSA 126-A:19.

(m) “Corrective payment” means the payment of money to a recipient who received less than the recipient was entitled to receive as determined by the department, including determinations by the department's administrative appeals officer.

(n) “Countable income” means available income less excluded income and adjustments for determining the gross amount.

(o) “Countable resources” means real or personal property which is considered in determining eligibility.

History

(See Revision Note #1 and Revision Note #2 at Chapter Heading He-W 600); ss by #10399, eff 10-21-13; ss by #13836, eff 12-28-23

N.H. Code Admin. R. Ann. He-W 601.03 Definitions D–E {#sec-he-w-601.03 omnilex-key=us-nh-regs-official--agency-he-w--He-W 601.03}

(a) “Date of application” means the date on which a signed application for assistance is received by the department.

(b) “Deemed income” means income which is considered available for use regardless of actual receipt.

(c) “Deemed resources” means that real and personal property which is considered to be available to an AG whether or not the property is owned by a member of the AG.

(d) “Deep subsidy” means any federally assisted housing, rental subsidy program in which the tenant pays only a certain percentage of household income, or, for FANF recipients, pays an amount equal to the maximum FANF shelter allowance towards the fair market rent of the housing unit.

(e) “Department” means the NH department of health and human services (DHHS).

(f) “Dependent child” means “dependent child” as defined in RSA 167:78, VI, namely “a child under the age of 18, or under the age of 20 if a full-time student in a secondary school or the equivalent, living in the home of a specified relative.”

(g) “Deprivation” means the interruption or termination of one or both parent's function as a provider of maintenance, physical care, and guidance for the child due to death, continued absence, or physical or mental incapacity.

(h) “Desk review” means verification of a reported or discovered change in an eligibility factor or case circumstance and the resultant adjustments to case eligibility or benefits, if any.

(i) “Disregard” means an amount subtracted from an individual or total combined AG income and is not counted in the determination of eligibility or the amount of assistance.

(j) “Documentary evidence” means written supportive information which authenticates and confirms that certain conditions or circumstances upon which good cause is predicated do, in fact, exist.

(k) “Earned income” means a monetary source or in-kind benefit received as payment for work performed either as an employee, through the receipt of wages, salaries, tips, or commissions, or as a self-employed individual.

(l) “Earned income disregard (EID)” means an amount which is computed and subtracted from earned income.

(m) “Earned income-in-kind” means compensation received for work performed in place of or as a supplement to wages, salary, commissions, profit or payment in cash, or otherwise received as the result of work performed, either employed by another or self-employed.

(n) “Electronic benefit transfer (EBT)” means the method of issuing financial assistance benefits to an account, which is accessed by an individual with a debit card.

(o) “Electronic benefit transfer cash account” means the EBT account established by the department into which funds are deposited for the purpose of providing assistance payments to individuals eligible for any of the department’s financial assistance programs.

(p) “Electronic funds transfer (EFT)” means the method of issuing financial assistance benefits as a direct deposit into the individual’s personal bank account.

(q) “Employment expense disregard (EED)” means an amount subtracted from earned income which represents a flat monthly amount or actual expenses which are reasonably attributable to the earning of income.

(r) “Employment-related disregard” means the EED, the child or dependent care disregard, and the EID.

(s) “Employment requirements” means the work, training, and education requisites under NHEP.

(t) “Equity value” means the current redemption rate or fair market value of a resource, less any financial claims against the resource.

(u) “Excluded income” means specific types of income which are not counted in the determination of eligibility or the amount of assistance.

(v) “Excluded resources” means real or personal property which is not counted in determining eligibility.

History

(See Revision Note #1 and Revision Note #2 at Chapter Heading He-W 600); ss by #10399, eff 10-21-13; ss by #13836, eff 12-28-23

N.H. Code Admin. R. Ann. He-W 601.04 Definitions: F–H {#sec-he-w-601.04 omnilex-key=us-nh-regs-official--agency-he-w--He-W 601.04}

(a) “Face value” means the death benefit of a life insurance policy exclusive of dividend additions or additional amounts payable because of accidental death or under other special provisions.

(b) “Fair market value” means, for purposes of this chapter:

(1) For all assets other than automobiles and trucks, the price at which a willing seller and a willing buyer will trade; or

(2) For automobiles and trucks, the trade-in value in the National Automobile Dealers Association’s (NADA) Official Used Car Guide, also known as the Kelley Blue Book, unless information is not available in the Kelley Blue Book, or unless the applicant or recipient proves the value of the vehicle is different.

(1) One or more adults and children, if any, related by blood, marriage, or adoption, who reside in the same home;

(2) Separate groups of related adults, other than spouses, or unrelated adults residing together;

(3) Minor siblings living with non-legally responsible relatives; or

(4) Minor siblings living under the care of unrelated persons.

(d) “Family assistance program (FAP)” means the financial assistance program, as described in RSA 167:84, administered by the department.

(e) “Families with older children (FWOC)” means the category of financial assistance for families with at least one dependent child who is at least age 19 and up to age 20, and a full-time student in a secondary school or the equivalent level of vocational or technical training.

(f) “Family member” means any individual who can be included in an AG, such as a parent or caretaker relative, child, or incapacitated spouse.

(g) “FANF standard of need” means, the amount of income necessary to meet full need in accordance with RSA 167:7, II.

(h) “Financial assistance to needy families (FANF)” means the financial assistance provided under:

(1) Temporary Assistance to Needy Families (TANF), which includes NHEP and FAP; and

(2) The non-TANF financial assistance programs, which include the FWOC program.

(i) “Good cause” means a substantiated reason which justifies the parent or caretaker relative's refusal to cooperate and still retain eligibility for FANF financial assistance.

(j) “Good faith effort to sell real property” means that the individual is making a genuine attempt to sell the property and can provide evidence to the department that the property has been put up for sale, is currently for sale, and that no reasonable offer for the property has been refused.

(k) “Grant” means a monthly dollar amount determined by subtracting net income from the payment standard for the AG.

(l) “Grantor” means any individual who creates a trust, such as:

(1) The individual;

(2) The individual's spouse;

(3) A person, including a court or administrative body, with legal authority to act in place of, or on behalf of, the individual or the individual's spouse; or

(4) A person, including a court or administrative body, acting at the direction or upon the request of the individual, or the individual's spouse.

(m) “Gross earned income for an individual employed by another” means the total amount, prior to payroll deductions.

(n) “Gross earned income for self-employed individuals” means the total monetary value or the dollar value of in-kind benefits received by a self-employed individual as compensation for work performed minus the cost of doing business.

(o) “Gross income” means the total amount of countable earned and unearned income or in-kind benefits received by AG members prior to any disregards or deductions.

(p) “HUD 236 housing” means low income rental housing for which the private developer or owner received a low mortgage interest rate from the U.S. Department of Housing and Urban Development (HUD) in return for agreeing to specified operating conditions.

History

(See Revision Note #1 and Revision Note #2 at Chapter Heading He-W 600); ss by #10399, eff 10-21-13; ss by #13836, eff 12-28-23

N.H. Code Admin. R. Ann. He-W 601.05 Definitions: I–N {#sec-he-w-601.05 omnilex-key=us-nh-regs-official--agency-he-w--He-W 601.05}

(a) “Immigrant” means an alien lawfully admitted for permanent residence in the U.S. who entered the country with the express purpose of maintaining permanent residence.

(b) “Income” means a monetary source that is either earned or unearned.

(c) "Income-in-kind" means goods, commodities, or services which are provided as compensation or contribution in lieu of cash and is considered either earned or unearned.

(d) “Independent living arrangement” means the form of housing for OAA, ANB, and APTD individuals who do not reside in a residential care facility, a community residence, or a licensed and certified nursing facility.

(e) “Inmate” means an individual living in a public institution as described in RSA 167:78, XI, with the exception of those who are described in He-W 624.01.

(f) “Institutionalized individual” means, for purposes of asset transfers, an individual who is an inpatient in a medical institution, as described in 42 CFR 435.1009, and with respect to whom payment is based on a level of care provided in a nursing facility, or who is a home and community-based care applicant or recipient.

(g) “Insured” means the individual on whose life the insurance policy is taken out.

(h) “Investigation” means an inquiry made by the department regarding the circumstances upon which a good cause claim is based when documentary evidence is not sufficient.

(i) “Interim disabled parent (IDP)” means the category of financial assistance for single or 2-parent families in which one or both of the parents are temporarily incapacitated.

(j) “Irrevocable trust” means a trust that cannot in any way be revoked by the grantor.

(k) “Liable relative” means a person who by law or regulation might be required to contribute to the support of an applicant or recipient of financial assistance.

(l) “Licensed” means approved by the department as meeting federal or state standards.

(m) “Maximum allowable age” means the maximum age of a child who is living in the home of a specified relative as follows:

(1) For the purposes of the New Hampshire employment program (NHEP), family assistance program (FAP), and interim disabled parent (IDP) categories of financial assistance, a child under the age of 18, or under the age of 19 who is also a full-time student in a secondary school or in the equivalent level of vocational training or technical training; or

(2) For the purposes of the families with older children (FWOC) category of financial assistance, a child at least 19 years of age and up to age 20 who is also a full-time student in a secondary school or in the equivalent level of vocational training or technical training.

(n) “Medicaid” means the Title XIX and Title XXI programs administered by the department, which makes medical assistance available to eligible individuals.

(o) “Minor casehead” means an individual who is receiving FANF financial assistance, lives with their parents, and whose parents' income and resources are deemed until the casehead reaches the age of 18.

(p) “Needy essential person” means a person who lives with the applicant or recipient, does not qualify for assistance in their own right, and is essential to the well-being of the applicant or recipient.

(q) “Net earned income” means an individual's monthly gross earned income minus all allowable employment-related disregards.

(r) “Net income” means gross income minus all allowable disregards and deductions.

(s) “New Hampshire employment program (NHEP)” means the financial assistance program, as described in RSA 167:79, and the NHEP work program, as described in RSA 167:85, administered by the department.

(t) “Nonapplicant spouse” means the spouse of an OAA, ANB, or APTD individual who lives with the individual in an independent living arrangement and who is:

(1) Not applying for nor receiving OAA, ANB, or APTD financial assistance; or

(2) Applying for or currently receiving financial assistance offered by the department other than OAA, ANB, or APTD.

(u) “Notice of decision (NOD)” means a computer-generated or manually-prepared form which advises applicants and recipients of the results of eligibility determinations, increase and decreases in the amount of assistance, level of eligibility, or other changes.

(v) “Nursing facility" means a licensed or certified medical facility which provides health-related care and services on a daily in-patient basis in accordance with He-W 500.

History

(See Revision Note #1 and Revision Note #2 at Chapter Heading He-W 600); ss by #10399, eff 10-21-13; ss by #13836, eff 12-28-23

N.H. Code Admin. R. Ann. He-W 601.06 Definitions: O–Q {#sec-he-w-601.06 omnilex-key=us-nh-regs-official--agency-he-w--He-W 601.06}

(a) “Overpayment” means financial assistance received by an AG which is in excess of what the AG is actually entitled to receive.

(b) “Parent” includes the biological, adoptive, or stepparent, unless otherwise specified.

(d) “Payment from a trust” means any disbursal from the corpus of a trust, or from income generated by a trust, which benefits the party receiving it, regardless of whether the benefit is monetary, or nonmonetary, or property disbursements, such as the right to use and occupy real property.

(e) “Payment period” means the semi-monthly period from the first to the 15th of the month, which is covered by the payroll payment of the 15th, and from the 16th through the last day of the month, which is covered by the payroll payment dated the 30th or the last day of the month.

(f) “Payment standard” for FANF financial assistance means the dollar amount from which net income is subtracted when determining eligibility and the level of benefits.

(g) “Penalty period” means the length of time during which payment for services are denied.

(h) “Period of ineligibility” means the length of time an individual is ineligible for assistance due to excess resources or receipt of a lump sum.

(i) “Permanently and totally disabled” means permanent physical or mental impairment, disease, or combination thereof, which substantially precludes an individual from engaging in useful occupations within the individual’s competence, as determined by the department, in accordance with RSA 167:6,VI.

(j) “Personal identification number (PIN)” means the 4 digit number used by an individual to activate and control the use of the EBT card.

(k) “Personal interview” means a conference between the applicant, recipient, or AR and the department staff member, in order to:

(1) Discuss all circumstances which have a bearing on eligibility;

(2) Advise the applicant, recipient, or AR of the eligibility requirements and their rights and responsibilities; and

(3) Afford the applicant, recipient, or AR the opportunity to ask any questions about the department's programs.

(l) “Personal property” for purposes of reimbursement means “personal property resources" and personal effects such as furnishings, tools, and equipment.

(m) “Personal property resources” means a form of cash or an item which can readily be converted to cash, including such items as bank accounts, stocks, or bonds.

(n) “Plan to achieve self support (PASS)” means a time-limited arrangement or accomplishing financial independence, which is approved by the Social Security Administration and allows a recipient who is visually impaired, disabled, or elderly to set aside income and resources for a work goal.

(o) “Private institution” means a facility which provides shelter, custody, or care to 2 or more individuals and is managed entirely or partially by private funds.

(p) “Protective payee” means an individual who receives the recipient's entire assistance payment and pays the recipient's bills according to a budget planned with the recipient.

(q) “Protective payments” means assistance payments made to a protective payee on behalf of a recipient or dependent children.

(r) “Public institution” means a facility, other than a child care or medical institution, which affords shelter, custody, or care to 2 or more individuals and is managed entirely or partially by or through any public instrumentality, official, or employee acting in an official capacity.

(s) “Questionable” means, with regard to verifying factors of eligibility, any verbal or written statement made by an applicant or recipient, which is inconsistent with other statements made by the same individual, inconsistent with information provided on current or past applications for assistance, or inconsistent with any information received by the department from any other source.

History

(See Revision Note #1 and Revision Note #2 at Chapter Heading He-W 600); ss by #10399, eff 10-21-13; ss by #13836, eff 12-28-23

N.H. Code Admin. R. Ann. He-W 601.07 Definitions R–S {#sec-he-w-601.07 omnilex-key=us-nh-regs-official--agency-he-w--He-W 601.07}

(a) “Real property resources” means resources that are in the form of real estate, including land and buildings.

(b) “Recipient” means any individual currently receiving benefits under any of the department’s programs.

(c) “Recoupment” means the collection or recovery by the department for the value of assistance erroneously paid to an individual regardless of the cause.

(d) “Rental housing” means a home, apartment, or other housing unit, other than HUD 236 housing, regardless of whether it is owner occupied, that an AG rents based on a written or verbal tenant and landlord agreement, and the AG receives no government rental subsidies.

(e) “Resident” means an individual who lives in the state voluntarily, pursuant to RSA 21:6.

(f) “Resources” means property owned by an individual, and includes both personal and real property resources.

(g) “Responsible parent” means a biological parent, adoptive parent, stepparent, or grandparent who, by state law, is liable for the support of a child who receives FANF financial assistance.

(h) “Revocable trust” means a trust which can be revoked by the grantor, including trusts that are called irrevocable but which will terminate if some action is taken by the grantor.

(i) “Rooming arrangement” for FANF, means the AG has furnished lodging in a rooming house or hotel, a relative's home, or another individual's home, but the AG receives no meals for compensation.

(j) “Sanction” means a penalty which might result in the reduction or loss of the FANF assistance payment.

(k) “Similar legal device” means any instrument, device, or arrangement which cannot be called a trust under state law, but which exhibits the general characteristics of a trust as defined in He-W 601.08(f), such as escrow accounts, investment accounts, pension funds, annuities, and other similar instruments managed by an individual or entity with fiduciary responsibilities.

(l) “Specified relative” means “specified relative” as defined in RSA 167:78, XXIII.

(m) “Standard disregard” for adult category assistance means a flat amount which is subtracted from unearned income.

(n) “Standard of need” means the amount of income necessary for recipients to have a reasonable level of subsistence for each category of financial assistance in accordance with RSA 167:7.

(o) “Stepparent” means an individual who is currently legally married to a child's biological or adoptive parent but has no biological or adoptive parental relationship to the child.

(p) “Strike” means a concerted stoppage of work by employees, including reasons due to the expiration of a collective bargaining agreement, and any concerted slowdown or other concerted interruption of operations by employees.

(q) “Student” means an individual who is officially enrolled in and regularly attending, an elementary or secondary school, college, university, or a technical or vocational training program which has the main objective of training individuals for gainful employment.

(r) “Sworn statement” means a statement made under oath or affirmation reciting facts which are personally known by the signer, and which are sworn to and notarized by either a notary public or justice of the peace.

History

(See Revision Note #1 and Revision Note #2 at Chapter Heading He-W 600); ss by #10399, eff 10-21-13; ss by #13836, eff 12-28-23

N.H. Code Admin. R. Ann. He-W 601.08 Definitions: T–V {#sec-he-w-601.08 omnilex-key=us-nh-regs-official--agency-he-w--He-W 601.08}

(a) “Temporary absence” means “temporary absence” as defined in RSA 167:78, XXIV, namely “any assistance group member who is temporarily away from the home for, but not limited to, the following reasons: school attendance, vacation, illness, or work.”

(b) “Temporary adjustment period” means the automatic eligibility period afforded to an AG when:

(1) An absent parent returns while receiving FANF assistance;

(2) An incapacitated parent recovers while receiving FANF assistance; or

(3) A visually impaired recipient recovers while receiving ANB financial assistance.

(c) “Termination” means the discontinuance of assistance or benefits received by an individual or AG when the conditions of eligibility for receipt of such assistance are no longer met.

(d) “Title IV-D requirements (IV-D)” means the assignment of rights to child support and cooperation in establishing paternity and obtaining support as a condition of eligibility for NHEP and FAP financial assistance, as established under 42 USC 608.

(e) “Title XX funds” means federal money provided pursuant to 42 USC 1397 through a block grant to provide social services for specific goals.

(f) “Trust” means any arrangement in which a grantor transfers property to a trustee(s) with the intention that it be held, managed, or administered by the trustee(s) for the benefit of the grantor or certain designated beneficiaries, which is valid under state law and manifested by a valid trust instrument or agreement, and where the trustee(s) hold a fiduciary responsibility to manage the trust's corpus and income for the benefit of the beneficiaries.

(g) “Trustee(s)” means any individual, individuals, or entity, such as an insurance company or bank, who manage a trust, or similar device, and who has fiduciary responsibilities.

(h) “Uncompensated value” means the difference between the fair market value at the time of transfer, less any outstanding loans, mortgages, or other financial claims against the asset, and the amount received for the asset.

(i) “Underpayment” means the amount of the financial assistance payment received by an AG is less than the amount to which the AG was rightfully entitled, or for failure by the department to issue benefits to an eligible AG.

(j) “Unearned income” means all contributions, payments, pensions, benefits, loans, awards, or other income which are not received as compensation for work performed.

(k) "Unearned income-in-kind" means a contribution which does not represent compensation for a job performed.

(l) “Vendor payee” means an individual providing goods or services to the recipient who is paid directly by the department for such goods or services.

History

(See Revision Note #1 and Revision Note #2 at Chapter Heading He-W 600); ss by #10399, eff 10-21-13; ss by #13836, eff 12-28-23

Part He-W 602 Program Coverages and Limitations

N.H. Code Admin. R. Ann. He-W 602.01 General Applicability of Rules in This Chapter {#sec-he-w-602.01 omnilex-key=us-nh-regs-official--agency-he-w--He-W 602.01}

(a) Unless otherwise specified, all the rules in this chapter shall apply to financial assistance to needy families (FANF) financial and medical assistance and to the adult categories financial and medical assistance.

(b) For each category of financial assistance, except where otherwise specified or specifically prohibited, all general, categorical, technical, and financial requirements, whether based on federal or state law, federal regulation, or published department rules shall apply to that category of medical assistance.

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #6531, INTERIM, eff 6-27-97, EXPIRES: 10-25-97; ss by #6614, eff 10-24-97; ss by #8452, eff 10-22-05; ss by #9123, eff 4-3-08; ss by #9275, eff 9-20-08; ss by #10163, eff 7-26-12; ss by #13563, eff 2-22-23

N.H. Code Admin. R. Ann. He-W 602.02 Applicability of Federal Statutes and Regulations {#sec-he-w-602.02 omnilex-key=us-nh-regs-official--agency-he-w--He-W 602.02}

(a) Any rule in this chapter which specifies a reference to the Social Security Act (SSA), shall refer to those sections of the SSA in effect prior to, or otherwise not affected by, the enactment on August 22, 1996 of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA), unless the rule specifically makes reference to a section of the SSA amended by PRWORA or the Deficit Reduction Act of 2005 (DRA).

(b) Any rule in this chapter which specifies a reference to, or does not reference but has been established in accordance with 45 CFR 205, 45 CFR 206, and 45 CFR 233-235 in effect on September 30, 1996, shall be considered the currently effective requirements until changed by rulemaking, state law, federal law, or court decisions.

(c) Adults in the following categories of financial assistance shall meet all the requirements and be held to all provisions set forth in (a) and (b) above and the rules adopted in this chapter associated with:

(1) New Hampshire employment program (NHEP) financial assistance for the categories of unemployed parent (UP) medical assistance and interim disabled parent (IDP) financial and medical assistance; or

(2) NHEP and family assistance program (FAP) financial assistance for the categories of families with older children (FWOC) financial and medical assistance.

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #6446, eff 2-1-97; ss by #8271, eff 2-1-05; ss by #8740 INTERIM, eff 10-13-06, EXPIRED: 4-11-07
#8869, eff 4-19-07; ss by #9123, eff 4-3-08; ss by #9275, eff 9-20-08; ss by #10163, eff 7-26-12; ss by #13563, eff 2-22-23

N.H. Code Admin. R. Ann. He-W 602.03 Telephone Application {#sec-he-w-602.03 omnilex-key=us-nh-regs-official--agency-he-w--He-W 602.03}

(a) Applicants for any program of financial assistance who request assistance via the telephone, shall be considered to have submitted an application as described in He-W 601.01(p).

(b) The telephone application process pursuant to (a) above shall only be available as funding and resources within the current state fiscal year are available.

(c) All the application requirements that apply when an individual submits a written application shall apply when an individual requests assistance via (a) above, including:

(1) Verification requirements described in He-W 606;

(2) Interview requirements described in He-W 636.01 and He-W 644.01; and

(3) All program requirements as described in He-W 600.

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #6531, INTERIM, eff 6-27-97, EXPIRES: 10-25-97; ss by #6614, eff 10-24-97, EXPIRED: 10-24-05
#9697, eff 4-23-10; ss by #12552, eff 6-20-18

N.H. Code Admin. R. Ann. He-W 602.04 Financial Assistance and Eligibility for Medical Care {#sec-he-w-602.04 omnilex-key=us-nh-regs-official--agency-he-w--He-W 602.04}

RESERVED

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #6531, INTERIM, eff 6-27-97, EXPIRES: 10-25-97; ss by #6614, eff 10-24-97; amd by #6745, (HB 32), eff 5-1-98, EXPIRED: 12-31-98; amd by #6925, eff 1-1-99; amd by #8452, eff 10-22-05; amd by #8783, INTERIM, eff 12-30-06, EXPIRES: 6-28-07; amd by #8903, eff 6-28-07; ss by #10471, eff 11-26-13; rpld by #13833, eff 12-23-23

N.H. Code Admin. R. Ann. He-W 602.05 60-Month Lifetime Limit on Financial Assistance {#sec-he-w-602.05 omnilex-key=us-nh-regs-official--agency-he-w--He-W 602.05}

(a) Unless the assistance group meets one or more of the hardship criteria described in He-W 602.07 or He-W 602.08, financial assistance benefits shall not be available to an assistance group that includes an adult who has received financial assistance for more than 60 months from any combination of the financial assistance to needy families (FANF) programs.

(b) The counting of the 60 months described in (a)(1) above shall commence October 1, 1996.

(1) One month shall equal 2 semi-monthly payroll payments, as defined in He-W 601.06(f);

(2) 60 months shall equal 120 semi-monthly payroll payments; and

(3) Months shall not have to be consecutive.

(d) In determining the number of months for which an individual has received FANF financial assistance, any payment period for which such assistance was provided to the individual shall be disregarded if the individual was:

(1) A dependent child; or

(2) Not the head of household, or his/her spouse.

(e) The total number of extensions to FANF financial assistance granted by the department due to hardship, as specified in He-W 602.07 or He-W 602.08, shall not, at any point in time, exceed 20 percent of the average monthly number of families receiving TANF assistance during the current or immediately preceding federal fiscal year pursuant to 45 CFR 264.1(c) and (d).

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #6446, eff 2-1-97; amd by #7192, eff 2-1-00; ss by #7470, eff 4-1-01; paragraph (a) amd by #8740, INTERIM, eff 10-13-06, EXPIRED: 4-11-07; paragraph (a) amd by #8869, eff 4-19-07; ss by #9123, eff 4-3-08; ss by #9275, eff 9-20-08; ss by #10163, eff 7-26-12

N.H. Code Admin. R. Ann. He-W 602.06 New Hampshire Employment Program (NHEP) and Family Assistance Program (FAP) Financial {#sec-he-w-602.06 omnilex-key=us-nh-regs-official--agency-he-w--He-W 602.06}

Assistance.

(a) A parent or caretaker relative receiving financial assistance to needy families (FANF) shall engage in work pursuant to RSA 167:85.

(b) A parent or caretaker relative shall be considered to be engaged in work if the parent or caretaker relative is engaged in paid employment or in employment related activities as defined in RSA 167:85.

(c) A parent or caretaker relative shall be considered as ready to engage in work if the parent or caretaker relative is not:

(1) Exempt from participation under the criteria for exemptions as described in RSA 167:82 and He-W 637.04; or

(2) Receiving FAP financial assistance.

History

(See Revision Note #1 at Chapter Heading He-W 600) #6446, eff 2-1-97; amd by #8271, eff 2-1-05, EXPIRED: 2-1-13
#10275, eff 2-21-13; ss by #13538, eff 1-26-23

N.H. Code Admin. R. Ann. He-W 602.07 Financial Assistance and Eligibility for Medical Care {#sec-he-w-602.07 omnilex-key=us-nh-regs-official--agency-he-w--He-W 602.07}

RESERVED

History

#7470, eff 4-1-01; ss by #7561, eff 10-1-01; rpld by #9433, eff 4-1-09

N.H. Code Admin. R. Ann. He-W 602.08 Criteria for Extensions to the 60-Month Lifetime Limit {#sec-he-w-602.08 omnilex-key=us-nh-regs-official--agency-he-w--He-W 602.08}

(a) To be eligible to receive an extension to the 60-month lifetime limit on receipt of financial assistance to needy families (FANF) assistance, the assistance group (AG) shall:

(1) Be categorically and financially eligible for FANF assistance except that the AG includes an adult who has received FANF financial assistance for 60 months; or

(2) Be currently receiving FANF financial assistance and an adult AG member has received FANF financial assistance for at least 54 months.

(b) The AG shall:

(1) Verify the existence of a current hardship pursuant to (c) below;

(2) Request an extension pursuant to (d) below;

(3) Participate in a face-to-face interview with a department representative;

(4) Provide the verification required in He-W 602.10 within 10 days of the date of the request;

(5) Not have voluntarily quit or refused suitable employment without good cause pursuant to RSA 167:82,III(c) within 60 days of the request for extension;

(6) Not be in sanction status pursuant to He-W 637.08:

a. At the time of applying for an extension to the 60-month lifetime limit;

b. Any time while eligibility for the extension to the 60-month lifetime limit is being processed; or

c. At the time financial assistance was closed due to reaching the 60-month lifetime limit, unless the AG has remedied the sanction that was imposed due to non-compliance pursuant to He-W 637.08(c);

(7) Not be disqualified from receiving FANF financial assistance due to commission of an intentional program violation, as described at He-W 693:

a. At the time of applying for an extension to the 60-month lifetime limit;

b. Any time while eligibility for the extension to the 60-month lifetime limit is being processed;

c. At the time the 60-month lifetime limit was reached; or

d. Any time after eligibility for the extension to the 60-month lifetime limit has been approved; and

(8) Comply with all NHEP work program requirements pursuant to He-W 637.05 after eligibility for the extension to the 60-month lifetime limit has been approved, unless good cause exists pursuant to He-W 637.07.

(c) AGs that meet the criteria in (a) and (b) above, shall verify the existence of at least one of the following hardship reasons that would allow the department to grant an extension to the 60-month lifetime limit on receipt of FANF financial assistance:

(1) The AG includes an individual who has been battered or subjected to extreme cruelty as described in 42 USC 608(a)(7)(C);

(2) The AG includes an adult who:

a. Is unable to obtain adequate child care as described in He-W 637.07(d), provided that the individual has made an effort to explore other child care providers and options for obtaining adequate child care pursuant to He-W 637.07(c);

b. Is unable to participate in any of the employment activities described in He-W 637.09 through He-W 637.23 due to a physical or mental condition pursuant to RSA 167:82,II(f);

c. Is unable to participate in any of the work activities described in He-W 637.09 through He-W 637.23 because:

He or she must provide care to another relative or assistance group member who resides in the same household due to that member’s illness, incapacity, or disability pursuant to RSA 167:82,II(g); and
No alternative care is available or feasible;

d. Is participating in an alcohol or other drug abuse or mental health program that prevents or limits participation in any of the work activities described in He-W 637.09 through He-W 637.23;

e. Is unemployed for a reason other than the reasons stated in RSA 167:82,III(c) and (d), and meets one of the requirements below:

Has applied for unemployment compensation benefits but is not yet receiving them, but in the meantime is actively seeking employment; or
Is not eligible for unemployment compensation benefits and is actively seeking employment;

f. Is experiencing a life-threatening circumstance as described in He-W 654.03(h)(1)-(3) or an emergency situation as described in He-W 699.05(d)(2);

g. Has a learning disability that has been identified by a:

State certified education professional licensed to certify for learning disabilities; or
A licensed psychologist; or

h. Is engaged in unsubsidized employment for at least 30 hours per week;

(3) New Hampshire department of employment security has determined that the state:

a. Is eligible for the federal/state cooperative extended benefit program pursuant to the Federal-State Extended Benefit Unemployment Compensation Act of 1970 or any other temporary federal supplemental unemployment benefit program in effect in the state; or

b. Has a statewide unemployment rate of 7% or more;

(4) The AG lives in an area designated by the United States Department of Labor as a labor surplus area;

(5) The AG is receiving FAP or is eligible for FAP financial assistance except that the AG has received FANF financial assistance for 60 months; or

(6) The AG is participating in NHEP pursuant to He-W 637.03 and complying with all participation requirements pursuant to He-W 637.05.

(d) The AG shall request an extension by providing the following information to the department:

(1) The casehead’s printed name, address, and case number;

(2) The reasons for the request; and

(3) The signature of the casehead and the current date.

History

#7470, eff 4-1-01; amd by #7918, eff 8-1-03; ss by #9433, eff 4-1-09; ss by #9775, eff 9-1-10; ss by #12676, eff 11-20-18

N.H. Code Admin. R. Ann. He-W 602.09 Duration of Extensions to the 60-Month Time Limit {#sec-he-w-602.09 omnilex-key=us-nh-regs-official--agency-he-w--He-W 602.09}

(a) An assistance group (AG) that is granted an extension pursuant to He-W 602.08 shall continue to receive FANF for 6 months or until any adult in the AG who has received FANF for 60 months no longer meets the criteria for an extension under that section, whichever occurs first.

(b) Families receiving FAP financial assistance at the time an adult in the AG has received FANF for 60 months, or families that request an extension pursuant to He-W 602.08 and are eligible to receive FAP financial assistance, shall remain eligible for FAP financial assistance for so long as all other FAP financial and non-financial eligibility requirements are met and the AG is otherwise eligible for FAP financial assistance.

(c) FAP AGs eligible for an extension of benefits as described in (b) above shall not be required to make a written request for an extension of benefits pursuant to He-W 602.08, but shall participate in a face-to-face redetermination of eligibility between month 54 and month 60.

(d) AGs that are granted an extension pursuant to He-W 602.08 shall inform the department no later than 10 days after the AG’s circumstances change in any way that might affect their eligibility or benefit level pursuant to He-W 603.03.

(e) If the department has not issued a decision on the hardship extension at the time any adult in the AG has received FANF for 60 months, the AG shall have its financial assistance benefits continued beyond the 60th month of financial assistance receipt pending the department’s decision.

(f) AGs whose benefits have been continued pursuant to (e) above shall not be required to repay the benefits if the department determines that the AG does not meet one of the extension criteria in He-W 602.08.

(g) An AG that meets more than one criterion for extension shall receive only one 6-month extension at a time and shall not be able to combine hardship criteria in order to lengthen the extension beyond 6 months.

(h) Whenever an AG that has been granted an extension becomes ineligible for FANF prior to the end of the extension period, it shall not be eligible to carry over any time remaining towards a future extension.

(i) Extensions granted pursuant to He-W 602 shall be terminated if the AG notifies the department that it no longer meets any of the hardship criteria or if the department becomes aware that the AG no longer meets any of the hardship criteria for the extension.

History

#7470, eff 4-1-01; ss by #7561, eff 10-1-01; amd by #7918, eff 8-1-03; ss by #9548, eff 9-19-09; ss by #12402, eff 10-20-17

N.H. Code Admin. R. Ann. He-W 602.10 Required Verification {#sec-he-w-602.10 omnilex-key=us-nh-regs-official--agency-he-w--He-W 602.10}

(a) A financial assistance to needy families (FANF) assistance group (AG) requesting an extension of financial assistance beyond the 60-month lifetime limit shall provide the verification described below within 10 days of the date the AG signed the request for an extension described in He-W 602.08(d):

(1) For an extension pursuant to He-W 602.08(c)(1), the casehead shall participate in:

a. An individualized assessment pursuant to 45 CFR 260.55; and

b. The development of the service plan which is completed by a person trained in domestic violence as specified in 45 CFR 260.55(c), and either:

Provide the following corroborative evidence that verifies the claim:

(i) Court, medical, criminal, child protective services, psychological or law enforcement records, or a statement from a social service provider;

(ii) A written statement from a social worker from a public or private social service agency;

(iii) A written statement from a social worker from a public or private social service agency providing domestic violence services; or

(iv) Sworn statements from an individual other than AG members with knowledge of the circumstances; or

If not able to provide corroborative evidence as described in b.1. above, submit a signed, written statement that indicates:

(i) The existence of the battering or extreme cruelty and that compliance with the FANF financial assistance lifetime limit would make it more difficult for the AG to escape the domestic violence;

(ii) That the FANF financial assistance lifetime limit would unfairly penalize the AG which is or has been victimized by such violence; or

(iii) That the FANF financial assistance lifetime limit would put the AG at further risk of domestic violence;

(2) For an extension pursuant to He-W 602.08(c)(2)a., documentation pursuant to He-W 637.07(e) along with a signed, written statement describing the specific actions the AG has taken to obtain adequate child care;

(3) For an extension pursuant to He-W 602.08(c)(2)b., the financial AG shall provide:

a. Documentation pursuant to RSA 167:82,II(f) stating the duration and limitations of the AG member’s disability; and

b. For a subsequent extension request per He-W 602.16(c), verification that the casehead has applied for the aid to the permanently and totally disabled program, Supplemental Security Income (SSI), Social Security Disability Income (SSDI), and/or all other potential disability benefits pursuant to He-W 652.07;

(4) For an extension pursuant to He-W 602.08(c)(2)c., documentation pursuant to RSA 167:82,II(g) that indicates the nature of the relative’s physical or mental condition and the expected duration of the condition, and a separate written and signed statement indicating that no alternate care is available or feasible;

(5) For an extension pursuant to He-W 602.08(c)(2)d., the AG shall provide documentation that the applicant is currently an active participant in the treatment program, signed by the drug, alcohol, or mental health program director or his or her designee;

(6) For an extension pursuant to He-W 602.08(c)(2)e., the AG shall provide:

a. Verification that the individual has applied for or is not eligible to receive unemployment compensation benefits; and

b. Verification that the job loss was not due to reasons described at RSA 167:82,III(c) and (d);

(7) For an extension pursuant to He-W 602.08(c)(2)f., the AG shall provide verification pursuant to He-W 606.104(b) or any other documentation that establishes the existence of an emergency or life-threatening circumstance; and

(8) For an extension pursuant to He-W 602.08(c)(2)g., the AG shall provide a signed and dated statement from a state certified education professional licensed to certify for learning disabilities or a licensed psychologist indicating that the adult in the case who has received FANF financial assistance for 60 months has a learning disability that prevents the adult from working, participating in work-related activities, or preparing for work.

(b) If a member of the AG is convicted pursuant to RSA 167:17-c of knowingly providing false material information on a signed, written statement pursuant to He-W 602.08(d), the AG's hardship extension shall be terminated pursuant to RSA 167:17-b,II.

History

#7470, eff 4-1-01; amd by #7918, eff 8-1-03; ss by #9433, eff 4-1-09; ss by #9775, eff 9-1-10; ss by #12676, eff 11-20-18

N.H. Code Admin. R. Ann. He-W 602.11 Financial Assistance and Eligibility for Medical Care {#sec-he-w-602.11 omnilex-key=us-nh-regs-official--agency-he-w--He-W 602.11}

RESERVED

History

#7470, eff 4-1-01; amd by #7918, eff 8-1-03; rpld by #9433, eff 4-1-09

N.H. Code Admin. R. Ann. He-W 602.12 Financial Assistance and Eligibility for Medical Care {#sec-he-w-602.12 omnilex-key=us-nh-regs-official--agency-he-w--He-W 602.12}

RESERVED

History

#7470, eff 4-1-01; rpld by #9433, eff 4-1-09

N.H. Code Admin. R. Ann. He-W 602.13 Financial Assistance and Eligibility for Medical Care {#sec-he-w-602.13 omnilex-key=us-nh-regs-official--agency-he-w--He-W 602.13}

RESERVED

History

#7470, eff 4-1-01; ss by #7918, eff 8-1-03; rpld by #9775, eff 9-1-10

N.H. Code Admin. R. Ann. He-W 602.14 Required Participation in the NHEP Work Program for Families Granted an Extension of FANF Financial Assistance {#sec-he-w-602.14 omnilex-key=us-nh-regs-official--agency-he-w--He-W 602.14}

(a) FANF financial assistance recipients granted an extension pursuant to He-W 602.08 shall participate in and comply with all requirements of the NHEP work program described in He-W 637, unless otherwise exempt pursuant to He-W 637.04.

(b) An NHEP representative shall determine in which activity or activities pursuant to He-W 637.03 an AG shall participate, and shall modify an existing employability plan or complete a new employability plan pursuant to He-W 637.12 with the recipient.

(c) FAP AGs granted an extension pursuant to He-W 602.08 shall not be required to participate in the NHEP, but may volunteer to participate.

(d) Extended benefits shall be terminated for the entire AG if any adult AG member required to participate in NHEP work program requirements pursuant to He-W 637 fails to comply with participation requirements identified on the individual’s employability plan pursuant to He-W 637.12, unless the individual has good cause pursuant to He-W 637.07.

History

#7470, eff 4-1-01; ss by #7561, eff 10-1-01; ss by #9548, eff 9-19-09; ss by #12402, eff 10-20-17

N.H. Code Admin. R. Ann. He-W 602.15 Extension Review Process {#sec-he-w-602.15 omnilex-key=us-nh-regs-official--agency-he-w--He-W 602.15}

(a) The department’s decision to approve or deny a request for a hardship extension shall be based on the AG:

(1) Fulfilling the hardship extension criteria pursuant to He-W 602.08;

(2) Providing required verification pursuant to He-W 602.10; and

(3) Being otherwise categorically and financially eligible for FANF financial assistance.

(b) The casehead shall be informed of the department’s decision to approve or deny the request for a hardship extension, pursuant to He-W 604.02, and of the casehead’s right to request an administrative appeal, pursuant to He-C 200, as follows:

(1) AGs currently receiving FANF financial assistance shall be issued a written notice of the hardship extension decision no later than 30 days following the AG having met all the conditions in (a) above; and

(2) AGs that are not currently receiving FANF financial assistance shall be issued a written notice of the hardship extension decision no later than the 45th day after the date on which an application for FANF financial assistance is filed at the department of health and human services (DHHS).

(c) If the AG is currently receiving FANF financial assistance and is denied a hardship extension, the AG shall be provided a continuation of FANF financial assistance when the following occurs:

(1) The AG requests an administrative appeal of the hardship extension decision, pursuant to He-C 200;

(2) The AG requests that FANF benefits continue; and

(3) The request for continuation of FANF benefits is made within the advance notice period, pursuant to 45 CFR 205.10.

(d) FANF financial assistance described in (c) above, shall continue until whichever of the following occurs first:

(1) The duration of the extension is reached pursuant to He-W 602.09; or

(2) The date the administrative appeals unit renders a finding, if the administrative appeals unit does not find in favor of the recipient.

History

#7470, eff 4-1-01; amd by #7918, eff 8-1-03; ss by #9433, eff 4-1-09; ss by #9775, eff 9-1-10; ss by #12676, eff 11-20-18

N.H. Code Admin. R. Ann. He-W 602.16 Eligibility for Additional Hardship Extensions {#sec-he-w-602.16 omnilex-key=us-nh-regs-official--agency-he-w--He-W 602.16}

(a) Families that have received FANF due to having been previously granted a hardship extension pursuant to He-W 602.08 shall have the right to request additional extensions.

(b) The criteria, duration, verification, and request process described in He-W 602.08 through He-W 602.10 and the required NHEP work program participation and extension review process described in He-W 602.14 and He-W 602.15 shall apply to each request for an extension for the same or new hardship reason.

(c) When an AG has had an extension granted pursuant to He-W 602.08(c)(2)b that is documented as long term, and the individual is requesting a subsequent hardship extension for the same reason, the individual shall have also applied for the aid to the permanently and totally disabled program, Supplemental Security Income (SSI), Social Security Disability Income (SSDI), and all other potential disability benefits pursuant to He-W 652.07 prior to the granting of an additional extension request.

(d) When an individual has had an extension granted pursuant to He-W 602.08(c)(2)c, and the individual is requesting a subsequent hardship extension for the same reason, prior to the granting of an additional extension the department shall determine:

(1) If a permanent exemption as described in He-W 637.04(e) exists; and

(2) If the family wishes to transfer to the family assistance program as described in He-W 601.04(d).

(e) Once an AG’s hardship extension has been terminated 2 times due to non-compliance with NHEP work program requirements without good cause, the AG shall not be eligible for additional extensions.

History

#7470, eff 4-1-01; amd by #7918, eff 8-1-03; ss by #9433, eff 4-1-09; amd by #9775, eff 9-1-10; ss by #12182, eff 5-23-17

N.H. Code Admin. R. Ann. He-W 602.17 Two-Parent Families {#sec-he-w-602.17 omnilex-key=us-nh-regs-official--agency-he-w--He-W 602.17}

Whenever a 2-parent AG is requesting a hardship extension to the 60-month lifetime limit on receipt of FANF financial assistance pursuant to He-W 602.08, the following shall apply:

(a) If both parents in the AG have received FANF financial assistance for 54 or more months on the day the AG signs the request for an extension, both parents shall meet one or more of the hardship criteria in He-W 602.08(c);

(b) If one parent has received FANF financial assistance for 54 or more months and the other parent has received FANF financial assistance for less than 54 months on the day the AG signs the request for an extension, only the parent who has received FANF financial assistance for 54 or more months shall meet a hardship criterion;

(c) If the other parent described in (b) above exceeds 54 months of receipt of FANF financial assistance during a 6-month extension period, the AG shall continue to receive FANF financial assistance for the entire 6-month extension period based on one parent meeting one or more hardship criteria; and

(d) When the 6-month extension period in (c) above ends, each parent shall be required to meet one or more hardship criteria as described in (a) above if the AG requests an additional extension pursuant to He-W 602.16.

History

#7470, eff 4-1-01; amd by #7918, eff 8-1-03; ss by #9433, eff 4-1-09; ss by #12182, eff 5-23-17

Part He-W 603 Individual Rights and Responsibilities

N.H. Code Admin. R. Ann. He-W 603.01 Authorized Representative {#sec-he-w-603.01 omnilex-key=us-nh-regs-official--agency-he-w--He-W 603.01}

(a) An individual who chooses an authorized representative (AR), as defined in He-W 601.01, to help with some or all the responsibilities of applying for or receiving financial assistance for needy families or adult category financial assistance shall provide all of the following information in writing:

(1) The name, address, and telephone number of the AR;

(2) The duties that the AR will carry out, as specified in (c) below;

(3) The individual's relationship to the AR;

(4) A statement signed and dated by the individual acknowledging:

a. The individual’s responsibility for any errors, omissions, or failures to report information to the department of health and human services (department), or inaccurate information reported to the department by the AR;

b. That if the AR uses the individual’s benefits without permission, these benefits will not be replaced by the department;

c. That the person the individual names as the AR will continue to act for the individual until the individual or the AR tells the department of a change; and

d. Comprehension of the individual’s choice of AR and the duties assigned to that AR; and

(5) A statement signed and dated by the AR:

a. Agreeing to accept the responsibilities designated by the individual;

b. Acknowledging that the AR understands that:

Proof of the AR’s identity is required;
If disqualified for a program violation, the person identified as the AR can no longer act as an AR unless there is no one else suitable to represent the individual as described in He-W 603.01(b); and
The AR will continue to act as an AR for the individual until the AR or the individual tells the department of a change.

(b) To qualify as an AR, an individual shall be an adult who has:

(1) Expressed concern for the individual's wellbeing;

(2) Sufficient knowledge about the individual's circumstances to assist the individual in applying for or receiving assistance; and

(3) The capability to obtain information about the individual's circumstances.

(1) Obtaining department applications and other forms or department paperwork, and completing these for the individual;

(2) Attending eligibility interviews for the individual;

(3) Providing the department with verification of the individual's income, resources, and other case circumstances;

(4) Reporting and verifying changes in the individual's case circumstances to the department;

(5) Receiving the individual's assistance payment, electronic benefits transfer card, and other department mail;

(6) Asking for, attending, and representing the individual at administrative appeals for the individual; and

(7) Any other duties regarding eligibility for financial assistance an individual chooses to designate to an AR.

(d) If designated pursuant to (a)(2) above, ARs shall:

(1) Sign department forms completed on behalf of the individual; and

(2) Co-sign department forms they assist the individual in completing.

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91, EXPIRED: 6-26-97
amd (g)(5) by #6825, eff 8-3-98; ss by #7182, eff 12-24-99, EXPIRED: 12-24-07
#9063, eff 1-5-08; ss by #11042, eff 2-24-16; ss by #14380, eff 9-20-25, EXPIRES 9-20-35

N.H. Code Admin. R. Ann. He-W 603.02 Individual Responsibility to Supply Accurate Information {#sec-he-w-603.02 omnilex-key=us-nh-regs-official--agency-he-w--He-W 603.02}

Individuals shall supply complete and truthful answers to all written and verbal questions to establish eligibility or fulfill an eligibility requirement, pursuant to RSA 167:17-b.

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #5769, eff 1-3-94; ss by #6614, eff 10-24-97; ss by #7182, eff 12-24-99, EXPIRED: 12-24-07
#9063, eff 1-5-08; ss by #11042, eff 2-24-16; ss by #14380, eff 9-20-25, EXPIRES 9-20-35

N.H. Code Admin. R. Ann. He-W 603.03 Individual Responsibility to Report Changes {#sec-he-w-603.03 omnilex-key=us-nh-regs-official--agency-he-w--He-W 603.03}

Failure to report changes no later than 10 calendar days after the change takes place, pursuant to RSA 167:17, shall result in the recoupment of any resultant overpayments or a corrective payment for any resultant underpayments.

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #6531, INTERIM, eff 6-27-97, EXPIRES: 10-25-97; ss by #6614, eff 10-24-97; ss by #7182, eff 12-24-99, EXPIRED: 12-24-07
#9063, eff 1-5-08; ss by #11042, eff 2-24-16; ss by #14380, eff 9-20-25, EXPIRES 9-20-35

Part He-W 604 Case Decisions

N.H. Code Admin. R. Ann. He-W 604.01 Case Decisions {#sec-he-w-604.01 omnilex-key=us-nh-regs-official--agency-he-w--He-W 604.01}

Except where otherwise noted or specifically prohibited, an assistance group shall be eligible for financial assistance when all general, categorical, technical, and financial requirements for the category and type of assistance requested are met and verified.

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #6531, INTERIM, eff 6-27-97, EXPIRES: 10-25-97; ss by #6614, eff 10-24-97; amd by #8452, eff 10-22-05; paragraph (b) in #6614 EXPIRED 10-24-05; ss by #10471, eff 11-26-13; ss by #13765, eff 10-5-23

N.H. Code Admin. R. Ann. He-W 604.02 Notice of Decision {#sec-he-w-604.02 omnilex-key=us-nh-regs-official--agency-he-w--He-W 604.02}

(a) Except where otherwise specified, increases in benefits shall take effect for the next available payment period after the change is processed, as determined by computer processing cut-off dates.

(b) When an increase or decrease in the amount of assistance, level of eligibility, or other changes occur or are reported simultaneously, the changes shall be processed together and the combined effect of the changes shall determine the advance notice period requirements as described in He-W 604.03.

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #6531, INTERIM, eff 6-27-97, EXPIRES: 10-25-97; ss by #6614, eff 10-24-97; ss by #8452, eff 10-22-05; ss by #10471, eff 11-26-13; ss by #13765, eff 10-5-23

N.H. Code Admin. R. Ann. He-W 604.03 Advance Notice Period {#sec-he-w-604.03 omnilex-key=us-nh-regs-official--agency-he-w--He-W 604.03}

(a) The advance notice period (ANP) shall be one of the following:

(1) Five calendar days when terminating or reducing benefits due to fraud;

(2) Ten calendar days before the date of action to discontinue, terminate, suspend, or reduce assistance; or

(3) Thirty calendar days when the action is the result of information obtained from a United States internal revenue service crossmatch report.

(b) Changes in assistance group (AG) circumstances that occur or are reported during an ANP shall not be processed until the ANP has expired.

(1) Factual information confirms the death of a recipient or of the financial assistance to needy families (FANF) payee and there is no relative available to serve as payee;

(2) A recipient provides a written, dated, and signed request to terminate assistance or gives written information which will result in the termination or decrease in the level of eligibility or amount of assistance;

(3) A recipient has been admitted or committed to an institution and is no longer eligible for assistance;

(4) A recipient’s location is unknown and the department’s mail is returned by the postal service indicating no forwarding address is on file;

(5) The recipient has been accepted for assistance in another state;

(6) A recipient is placed in a nursing facility or requires long term hospitalization;

(7) All recipients in the AG have died;

(8) A recipient has been receiving a positive grant adjustment and the adjustment period is complete;

(9) A recipient requests in writing to voluntarily initiate, change, or remove a vendor payee, or to change the amount of the vendor payment;

(10) A recipient or AG is closed in one case and opened in another, and the eligibility level and benefit amount remain the same; and

(11) A child is removed from the home as a result of a judicial determination or is voluntarily placed in foster care by the child’s legal guardian.

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #6531, INTERIM, eff 6-27-97, EXPIRES: 10-25-97; ss by #6614, eff 10-24-97; amd by #8452, eff 10-22-05; ss by #10471, eff 11-26-13; ss by #13765, eff 10-5-23

N.H. Code Admin. R. Ann. He-W 604.04 Electronic Notification {#sec-he-w-604.04 omnilex-key=us-nh-regs-official--agency-he-w--He-W 604.04}

(a) Notices of decision (NOD), as defined in He-W 601.05, may be accessed electronically by the casehead, as defined in He-W 601.02, if the casehead:

(1) Chooses to access NODs electronically;

(2) Has an email account able to receive notifications from the department;

(3) Provides the department with an email address; and

(4) Activates a user account through the department’s eligibility web portal.

(b) If the casehead chooses to only access NODs electronically, no paper NODs shall be sent to the casehead via the United States Postal Service (USPS).

(c) If the casehead chooses to only access NODs electronically, the casehead shall be responsible for the security and validity of the email account information provided to the department.

(d) All information included in paper NODs, as defined in He-W 601.05, shall also be included in electronic NODs .

(e) If the casehead prefers to reestablish paper NODs sent via the USPS and chooses not to use the department’s eligibility web portal to make this change, the casehead shall submit a written request to the department and include the following information:

(1) The casehead’s printed name;

(2) The request to reestablish paper NODs sent via the USPS;

(3) The case number or recipient identification number, if known, assigned to the casehead; and

(4) The casehead’s signature.

(f) The date the department receives the completed request described in (e) above shall be the casehead’s filing date for the request to reestablish paper NODs.

(g) Paper NODs sent via the USPS shall be mailed to the casehead’s mailing address within 10 days of the casehead’s filing date described in (f) above.

History

#9815, eff 11-19-10; ss by #10729, eff 11-25-14; ss by #13930, eff 4-24-24

N.H. Code Admin. R. Ann. He-W 604.05 Electronic Account Access {#sec-he-w-604.05 omnilex-key=us-nh-regs-official--agency-he-w--He-W 604.05}

(a) Electronic accounts that contain the casehead’s electronic notices of decision (NOD), as defined in He-W 601.05, and other confidential case information shall be activated through the department’s eligibility web portal by:

(1) The casehead;

(2) The casehead’s guardian, conservator, or protective payee;

(3) An authorized representative (AR) or power of attorney chosen by the casehead; or

(4) An organization acting as the casehead’s guardian, conservator, protective payee, AR, or power of attorney.

(b) If an organization acting as the casehead’s guardian, conservator, protective payee, AR, or power of attorney chooses to access a casehead’s electronic account, the organization shall:

(1) Obtain the casehead’s permission to access the electronic account; and

(2) Register with the department by providing the following information:

a. The organization’s name, phone number, both physical and mailing addresses, and email address;

b. The name of a designated administrator for the organization who is responsible for maintaining confidentiality for the entire organization;

c. A 4-digit pin, chosen by the administrator, for security purposes; and

d. The administrator’s dated signature signifying an agreement to abide by confidentiality and safeguarding information policies, pursuant to RSA 167:31, RSA 167:32, and 45 CFR 205.50.

(c) A casehead shall not have access to an electronic account through the department’s eligibility web portal once the casehead has given permission to an organization to access the casehead’s electronic account.

(d) If the organization chooses to only access NODs electronically, with no paper NOD sent via the United States Postal Service (USPS), the organization shall be responsible for the security and validity of the email account information provided to the department.

(e) All information included in a paper NODs, as defined in He-W 601.05, shall also be included in electronic NODs. .

(f) If the organization prefers to reestablish paper NODs sent via the USPS and chooses not to use the department’s eligibility web portal to make this change, the organization shall submit a written request to the department and include the following information:

(1) The casehead’s printed name;

(2) The request to reestablish paper NODs sent via the USPS;

(3) The case number or recipient identification number, if known, assigned to the casehead;

(4) The organization’s name, phone number, both physical and mailing addresses, and email address; and

(5) The printed name and dated signature of the representative for the organization.

History

#10729, eff 11-25-14; ss by #13930, eff 4-24-24

Part He-W 606 Verification

N.H. Code Admin. R. Ann. He-W 606.01 General Verification Requirements - All Categories of Financial Assistance {#sec-he-w-606.01 omnilex-key=us-nh-regs-official--agency-he-w--He-W 606.01}

(a) All general, categorical, technical, and financial factors related to the determination of eligibility and level of benefit for all categories of financial assistance, shall be verified:

(1) At initial determinations;

(2) At redeterminations of eligibility;

(3) Whenever a change occurs; or

(4) When questionable, as defined in He-W 601.06.

(b) Providing acceptable verification shall be the sole responsibility of the individual, except where otherwise noted.

(c) Failure to verify any factor required for the determination of eligibility or level of benefit shall result in denial or termination of assistance for the entire assistance group, except where otherwise noted.

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #6531, INTERIM, eff 6-27-97, EXPIRES: 10-25-97; ss by #6614, eff 10-24-97; ss by #8452, eff 10-22-05; ss by #10471, eff 11-26-13; ss by #13875, eff 2-21-24

N.H. Code Admin. R. Ann. He-W 606.02 Citizenship or Non-citizen Status {#sec-he-w-606.02 omnilex-key=us-nh-regs-official--agency-he-w--He-W 606.02}

(a) Citizenship or non-citizen status shall be verified at each financial assistance group (AG) member's initial determination of eligibility.

(b) If electronic verification, described in (h) below, fails to verify citizenship, the documents described in 42 CFR 435.407(a), (b), and (d) shall be considered acceptable verification of an individual’s United States (US) citizenship.

(c) Acceptable verification of immigrant status shall be documentation issued by the US citizenship and immigration services stating that:

(1) The individual’s deportation has been withheld under 8 USC 1253;

(2) The non-citizen has been admitted as a refugee under 8 USC 1157;

(3) The non-citizen has been admitted as an asylee under 8 USC 1158; or

(4) The individual has been granted status as a lawful temporary or permanent resident under 8 USC 1255.

(d) An individual’s refusal or failure to verify citizenship, non-citizen status, or sponsor status shall result in the denial or termination of financial assistance for the entire AG.

(e) If the non-citizen's sponsor no longer functions as a sponsor, either because the sponsoring organization no longer exists or the sponsor is unable to meet the non-citizen’s total financial needs, the non-citizen shall provide to the department, within 10 days of the date of application, one of the following:

(1) If the non-citizen claims that the sponsoring organization no longer exists, a signed and dated written statement which includes the name of the sponsoring organization or agency and its former address, and the reason that the sponsoring organization or agency no longer exists, if known; or

(2) If the sponsor is contributing no money, or the sponsor’s monetary contribution, combined with the non-citizen’s income makes the non-citizen financially eligible for a financial grant, a signed and dated affidavit on which the sponsoring organization or agency has provided:

a. The non-citizen’s name;

b. The non-citizen’s date of entry into the US;

c. The sponsor’s name and address;

d. The amount of money the sponsor contributed to the non-citizen;

e. The reason the sponsor is no longer able to meet the non-citizen’s financial needs; and

f. A statement that the sponsor agrees to a financial audit, if needed, to substantiate conflicting information.

(f) Documentation provided by a state vital statistics agency in accordance with 42 CFR 435.407(b)(2) shall be considered acceptable verification of a birth record.

(g) Reasonable opportunity to present satisfactory documentary evidence of citizenship, pursuant to 42 CFR 435.956(b)(2), shall be 95 days from the date on the notice of decision as defined in He-W 601.05.

(h) Documentation provided by the Social Security Administration, in accordance with 42 USC. 1396a(ee), shall be considered acceptable verification of (b) above.

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #6531, INTERIM, eff 6-27-97, EXPIRES: 10-25-97; ss by #6614, eff 10-24-97; ss by #8452, eff 10-22-05; amd by #8865, eff 4-13-07; ss by #9274, eff 9-20-08; ss by #9848, eff 1-12-11; ss by #10698, eff 10-21-14; ss by #14017, eff 6-29-24

N.H. Code Admin. R. Ann. He-W 606.03 Financial Assistance and Eligibility for Medical Care {#sec-he-w-606.03 omnilex-key=us-nh-regs-official--agency-he-w--He-W 606.03}

He-W 606.09 - RESERVED

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91

N.H. Code Admin. R. Ann. He-W 606.10 Residency {#sec-he-w-606.10 omnilex-key=us-nh-regs-official--agency-he-w--He-W 606.10}

(a) For the adult categories of financial assistance, the individual's written statement of current physical address shall be accepted as verification of NH residence, unless conflicting evidence is present.

(b) If conflicting evidence is present, the department shall request additional evidence of residence, including, but not limited to:

(1) Mail addressed to the individual at the stated address;

(2) Utility or other bills addressed to the individual at the stated address; or

(3) Receipts from a landlord or mortgage company showing the stated address.

(c) Failure to supply the additional evidence or failure of the additional evidence to verify residence shall result in denial or termination of benefits as described in He-W 606.01(c).

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #6531, INTERIM, eff 6-27-97, EXPIRES: 10-25-97; ss by #6614, eff 10-24-97; ss by #8452, eff 10-22-05; ss by #10471, eff 11-26-13; ss by #13875, eff 2-21-24

N.H. Code Admin. R. Ann. He-W 606.11 Temporary Absence From New Hampshire {#sec-he-w-606.11 omnilex-key=us-nh-regs-official--agency-he-w--He-W 606.11}

(a) Verification of temporary absence from New Hampshire (NH) shall be required whenever an individual notifies the department of an ongoing or intended absence.

(b) A verbal or written statement from the individual regarding the intent to retain NH residency shall be considered sufficient documentation, unless conflicting evidence is present.

(c) Questionable cases, including cases in which the individual has not notified the department and the absence is longer than 30 days, shall be evaluated to determine whether the individual has abandoned residency or is possibly maintaining residency in both NH and another state.

(d) If residency is still questionable after the evaluation described in (c) above, the individual shall submit verification of residency to the department no later than 10 calendar days from the date on the notice requesting the required verification.

(e) Continuation of assistance shall be contingent upon the individual's ability to verify NH residency.

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #6531, INTERIM, eff 6-27-97, EXPIRES: 10-25-97; ss by #6614, eff 10-24-97; amd by #8452, eff 10-22-05; ss by #8452, eff 10-22-05; ss by #10471, eff 11-26-13; amd by #11120, eff 6-22-16; ss by #13875, eff 2-21-24

N.H. Code Admin. R. Ann. He-W 606.12 Financial Assistance and Eligibility for Medical Care {#sec-he-w-606.12 omnilex-key=us-nh-regs-official--agency-he-w--He-W 606.12}

He-W 606.17 - RESERVED

History

(See Revision Note at Chapter Heading He-W 600) #5171, eff 6-26-91

N.H. Code Admin. R. Ann. He-W 606.18 Institutional Residence {#sec-he-w-606.18 omnilex-key=us-nh-regs-official--agency-he-w--He-W 606.18}

(a) The department of health and human services (DHHS) shall verify institutional residence and the individual's status within the institution by written or verbal contact with the institution.

(b) Individuals who received financial assistance but whose assistance was terminated at the time of admission to New Hampshire Hospital (NHH) shall have financial assistance redetermined pursuant to He-W 684.01 without a personal interview, as defined in He-W 601.06(l), if the individual meets the criteria in (c) below.

(1) Is discharged within 60 days from the date of admission;

(2) Provides to DHHS all of the following information in writing:

a. Individual’s name, case number, discharge address, and indication of whether the individual received financial assistance prior to admission to NHH;

b. Date of admission to and discharge from NHH;

c. Shelter costs for the non-adult categories of financial assistance;

d. Assistance group composition of all the people that will reside at the discharge address with the individual, and their relationship to the individual;

e. Current income of the individual and all household members;

f. Current resources, pursuant to He-W 601.07(f), of the individual and all household members;

g. Amount and type of any third-party medical coverage held by the individual and all household members;

h. Any other changes in or information about case circumstances that would impact eligibility; and

i. Individual’s or representative’s dated signature acknowledging:

That the individual has reported all changes that have occurred since the individual’s last eligibility determination and that the information provided to DHHS is true and complete to the best of his or her knowledge;
That the individual must provide proof of all statements and information provided to DHHS, and that the individual’s or representative’s signature gives permission to DHHS to contact other persons or organizations to get additional proofs of the individual’s eligibility;
That any person who intentionally makes a false statement or misrepresents his or her circumstances or intentionally fails to disclose the receipt of property, wages, income, or resources, or any change in circumstances that would affect his or her initial or continued eligibility for assistance may be found guilty of violating state law;
That the individual must report any changes in circumstances within 10 calendar days of when the change occurs, or as instructed by DHHS, pursuant to RSA 167:17; and
That if the individual is not satisfied with any decision made by DHHS, the individual may request an appeal within 30 calendar days from the date of the notice; and

(3) Provides to DHHS documentation of changes in address, shelter costs for the non-adult categories of financial assistance, assistance group composition, income, resources, and medical coverage that have occurred since the last eligibility determination within 10 calendar days of the date of the request.

(d) A personal interview shall be required to redetermine financial assistance for individuals released from an institution when:

(1) An eligibility redetermination was due or overdue when the individual was admitted to New Hampshire Hospital;

(2) An eligibility redetermination is due during the month the individual is discharged from New Hampshire Hospital;

(3) DHHS determines that the individual failed or refused to cooperate without good cause pursuant to He-W 601.04(i) with the medical review process pursuant to He-W 685.01; or

(4) The individual does not meet the criteria described in (c) above.

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #6531, INTERIM, eff 6-27-97, EXPIRES: 10-25-97; ss by #6614, eff 10-24-97; amd by #8452, eff 10-22-05; former paragraphs (b)(2)-(3) in #6614 EXPIRED: 10-24-05; ss by #9083, eff 1-30-08; ss by #11042, eff 2-24-16

N.H. Code Admin. R. Ann. He-W 606.19 Presence of a Dependent Child {#sec-he-w-606.19 omnilex-key=us-nh-regs-official--agency-he-w--He-W 606.19}

Refusal or failure of the parent or caretaker relative to verify the presence of a dependent child shall result in the denial or termination of financial assistance to needy families financial assistance for:

(a) Each child whose presence is not verified; and

(b) The parent or caretaker relative, if it cannot be verified that any dependent children are present.

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #6531, INTERIM, eff 6-27-97, EXPIRES: 10-25-97; ss by #6614, eff 10-24-97; ss by #8452, eff 10-22-05; ss by #10471, eff 11-26-13; ss by #11042, eff 2-24-16

N.H. Code Admin. R. Ann. He-W 606.20 Deprivation Due to Death {#sec-he-w-606.20 omnilex-key=us-nh-regs-official--agency-he-w--He-W 606.20}

(a) The individual shall provide verification of the parent's death whenever death is the cause of deprivation.

(b) The following documentation shall be acceptable for verifying death, provided the deceased is named on the document:

(1) Death certificate;

(2) Medical records or signed statement from the physician of the deceased parent;

(3) Statement or bills from the undertaker or funeral home;

(4) Legal documents that refer to the parent's death;

(5) Documents issued by other agencies, such as Social Security Administration, Veterans Affairs, or insurance companies, which refer to the death of the parent; or

(6) Written statements from 2 individuals who have direct knowledge of the death of the parent.

(c) Refusal or failure to verify the parent's death shall result in the denial of financial assistance to needy families financial assistance for each child for whom deprivation is not verified.

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #6531, INTERIM, eff 6-27-97, EXPIRES: 10-25-97; ss by #6614, eff 10-24-97; ss by #8452, eff 10-22-05; ss by #10471, eff 11-26-13; ss by #13875, eff 2-21-24

N.H. Code Admin. R. Ann. He-W 606.21 Deprivation Due to Continued Absence {#sec-he-w-606.21 omnilex-key=us-nh-regs-official--agency-he-w--He-W 606.21}

(a) Refusal or failure to provide verification of continued absence shall result in the denial or termination of financial assistance to needy families financial assistance for each child for whom deprivation is not verified.

(b) The individual shall verify that continued absence of a parent currently exists, pursuant to He-W 628.01(e).

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #6531, INTERIM, eff 6-27-97, EXPIRES: 10-25-97; ss by #6614, eff 10-24-97; ss by #8452, eff 10-22-05; ss by #10471, eff 11-26-13; ss by #13875, eff 2-21-24

N.H. Code Admin. R. Ann. He-W 606.22 Financial Assistance and Eligibility for Medical Care {#sec-he-w-606.22 omnilex-key=us-nh-regs-official--agency-he-w--He-W 606.22}

RESERVED – Moved to He-W 806.22

History

(See Revision Note #2 at part heading for He-W 806)

N.H. Code Admin. R. Ann. He-W 606.23 Living with a Specified Relative {#sec-he-w-606.23 omnilex-key=us-nh-regs-official--agency-he-w--He-W 606.23}

(a) The relationship to a specified relative shall be verified:

(1) At the initial determination of eligibility;

(2) When a child is added to the assistance group;

(3) When the specified relative changes; or

(4) Whenever the relationship is questionable.

(b) The following shall be considered acceptable verification of the relationship between the specified relative and the child:

(1) Birth, court, school, hospital, or medical records;

(2) Marriage certificate;

(3) Insurance policies; or

(4) Written statements from 2 or more individuals who have direct knowledge of the family relationship.

(c) Refusal or failure to adequately verify the relationship between the child and the specified relative shall result in the denial or termination of financial assistance for each child for whom the relationship is not verified.

(d) The living arrangement of the child and specified relative shall be verified through individual statements obtained during the personal interview.

(e) If the living arrangement of the child is questionable, the following shall be considered acceptable verification:

(1) School, medical, legal, or child care center records;

(2) Other records which indicate where and with whom the child lives; or

(3) A written statement from 2 or more individuals who have direct knowledge of the living arrangement of the child.

(f) Refusal or failure to adequately verify that a child is living with a specified relative shall result in the denial or termination of financial assistance for each child for whom such verification is not provided.

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #6531, INTERIM, eff 6-27-97, EXPIRES: 10-25-97; ss by #6614, eff 10-24-97; ss by #8452, eff 10-22-05; ss by #10471, eff 11-26-13; ss by #13875, eff 2-21-24

N.H. Code Admin. R. Ann. He-W 606.24 Age {#sec-he-w-606.24 omnilex-key=us-nh-regs-official--agency-he-w--He-W 606.24}

(a) The age of each child in a financial assistance to needy families (FANF) financial assistance group shall be verified at that child's initial determination of eligibility and whenever additional evidence indicates incorrect age.

(b) Refusal or failure to verify age shall result in the denial or termination of FANF financial assistance for each child for whom age is not verified.

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #6531, INTERIM, eff 6-27-97, EXPIRES: 10-25-97; ss by #6614, eff 10-24-97; ss by #8452, eff 10-22-05; ss by #10471, eff 11-26-13; ss by #13875, eff 2-21-24

N.H. Code Admin. R. Ann. He-W 606.25 Financial Assistance and Eligibility for Medical Care {#sec-he-w-606.25 omnilex-key=us-nh-regs-official--agency-he-w--He-W 606.25}

RESERVED

History

(See Revision Note at Chapter Heading He-W 600) #5171, eff 6-26-91

N.H. Code Admin. R. Ann. He-W 606.26 Strikers {#sec-he-w-606.26 omnilex-key=us-nh-regs-official--agency-he-w--He-W 606.26}

(a) The individual's statement regarding circumstances related to the strike shall be acceptable verification, unless questionable.

(b) If the individual’s statement is questionable as in (a) above, the individual shall provide verification of the following circumstances:

(1) Employees have been locked out of the workplace;

(2) Employees are prevented from working due to other striking employees; or

(3) Crossing the picket line is a threat to physical safety.

(c) If the individual refuses or fails to provide required documentation in (b) above to substantiate non-participation in a strike, the individual shall be considered to be on strike.

(d) Participation in a strike shall be treated in accordance with He-W 634.01.

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #6531, INTERIM, eff 6-27-97, EXPIRES: 10-25-97; ss by #6614, eff 10-24-97; ss by #8452, eff 10-22-05; ss by #10471, eff 11-26-13; ss by #13875, eff 2-21-24

N.H. Code Admin. R. Ann. He-W 606.27 Financial Assistance and Eligibility for Medical Care {#sec-he-w-606.27 omnilex-key=us-nh-regs-official--agency-he-w--He-W 606.27}

RESERVED

History

(See Revision Note at Chapter Heading He-W 600) #5171, eff 6-26-91

N.H. Code Admin. R. Ann. He-W 606.28 Proof of Identity {#sec-he-w-606.28 omnilex-key=us-nh-regs-official--agency-he-w--He-W 606.28}

(a) The identity for each financial assistance group (AG) member shall be verified at the initial eligibility determination.

(b) If electronic verification described in (e) below fails to verify identity, documents described in 42 CFR 435.407(a), (c) or (d) shall be considered acceptable verification of an individual’s identity.

(c) Refusal or failure to verify identity shall result in the denial or termination of financial assistance for the entire AG.

(d) Reasonable opportunity to present satisfactory documentary evidence of identity, pursuant to 42 CFR 435.956(b)(2), shall be 95 days from the date on the notice of decision as defined in He-W 601.05.

(e) Documentation provided by the Social Security Administration, in accordance with 42 USC 1396a(ee), shall be considered acceptable verification of an individual’s identity.

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #6531, INTERIM, eff 6-27-97, EXPIRES: 10-25-97; ss by #6614, eff 10-24-97; amd by #7666, eff 4-1-02; amd by #8452, eff 10-22-05; ss by #9274, eff 9-20-08; ss by #9848, eff 1-12-11; ss by #10698, eff 10-21-14; ss by #14017, eff 6-29-24

N.H. Code Admin. R. Ann. He-W 606.29 Financial Assistance and Eligibility for Medical Care {#sec-he-w-606.29 omnilex-key=us-nh-regs-official--agency-he-w--He-W 606.29}

RESERVED

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91

N.H. Code Admin. R. Ann. He-W 606.30 NHEP Exemption {#sec-he-w-606.30 omnilex-key=us-nh-regs-official--agency-he-w--He-W 606.30}

(a) For an exemption due to temporary illness or injury, and pursuant to RSA 167:82, II, the NHEP participant shall provide a signed statement from a licensed physician, licensed physician assistant (PA), licensed advanced practice registered nurse (APRN), board-certified psychologist, master licensed alcohol and drug counselor (MLADC), licensed pastoral psychotherapist (LPP), licensed independent clinical social worker (LICSW), licensed clinical mental health counselor (LCMHC), or licensed marriage and family therapist (LMFT) explaining:

(1) Why the individual is unable to participate in a NHEP activity;

(2) The type of illness or injury; and

(3) The length of time the illness or injury is expected to continue.

(b) For an exemption due to incapacity or disability, the individual shall provide a signed statement from a licensed physician, licensed PA, licensed APRN, board-certified psychologist, MLADC, LPP, LICSW, LCMHC, or LMFT, that explains:

(1) Why the individual is unable to participate in a NHEP activity;

(2) The type of incapacity; and

(3) The permanent nature of the incapacity, unless the individual is eligible for FANF financial assistance on the basis of an incapacity or disability already documented.

(c) For an exemption due to school attendance, the individual shall provide a statement or other document from the school indicating full-time enrollment and attendance at an elementary, secondary, vocational, or technical school.

(d) For an exemption due to the illness or incapacity of another member of the assistance group, the individual shall provide a signed statement from a licensed physician, licensed PA, licensed APRN, board-certified psychologist, MLADC, LPP, LICSW, LCMHC, or LMFT, which includes:

(1) An explanation of why the individual's presence is required in the home;

(2) A description of the illness or incapacity of the assistance group member being cared for;

(3) The expected date of recovery; and

(4) Confirmation that no other member of the household is available or appropriate to provide the needed care.

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #6531, INTERIM, eff 6-27-97, EXPIRES: 10-25-97; ss by #6614, eff 10-24-97; ss by #8452, eff 10-22-05; paragraph (a) intro. amd by #8740, INTERIM, eff 10-13-06, EXPIRED: 4-11-07; paragraph (a) intro. amd by #8869, eff 4-19-07; ss by #10471, eff 11-26-13; ss by #12718, eff 1-26-19

N.H. Code Admin. R. Ann. He-W 606.31 Good Cause Reasons for Non-Cooperation with Child Support Requirement {#sec-he-w-606.31 omnilex-key=us-nh-regs-official--agency-he-w--He-W 606.31}

(a) To claim a good cause waiver for non-cooperation with the child support requirements described in RSA 167:79, III(c)(1)-(2) & (c)(4), for any of the reasons specified in RSA 167:82, III(b), the individual shall provide verification pursuant to 45 CFR 232.42(b) - 45 CFR 232.43, except as specified in this section.

(b) If a claim for good cause for non-cooperation with child support requirements is due to the claimant being or having been battered or subjected to extreme cruelty pursuant to 42 USC 602(a)(7), but verification pursuant to He-W 602.10(a)(1)(b.)(1.) is not submitted to support the claim, the department of health and human services (DHHS) shall accept a signed, written statement from the individual, under penalty of unsworn falsification pursuant to RSA 641:3, that:

(1) States the reason for the claim of the battering or extreme cruelty; and

(2) Indicates that cooperation with a child support requirement in RSA 167:79, III(c)(1)-(2) or (c)(4) would, pursuant to 45 CFR 260.52(c):

a. Make it more difficult for the family to escape the situation of battering or extreme cruelty;

b. Unfairly penalize the family who is or has been victimized by the situation of battering or extreme cruelty; or

c. Put the family at further risk of the situation of battering or extreme cruelty.

(c) False information provided on a signed, written statement pursuant to (b) above shall result in the loss of the good cause waiver for non-cooperation with the child support requirement due to being battered or subjected to extreme cruelty, pursuant to 42 USC 602(a)(7)(B), and be considered a violation of RSA 167:17-b and RSA 641:3.

History

(See Revision Note #1 at Chapter Heading He-W 600) rsvd by #5171, eff 6-26-91; ss by #7192, eff 2-1-00; ss by #9104, eff 3-15-08; ss by #11063, eff 3-25-16

N.H. Code Admin. R. Ann. He-W 606.32 NHEP Medical Exemption Review Process {#sec-he-w-606.32 omnilex-key=us-nh-regs-official--agency-he-w--He-W 606.32}

(a) Required documentation for exemption from NHEP program participation due to medical conditions identified in He-W 606.30(a), (b) and (d) shall be subject to an exemption review process.

(b) The department or an agency, business, or organization designated by the department, herein-after referred to as a designee, shall conduct an exemption review process in order to assess an individual’s:

(1) Physical or mental inability to engage in any of the NHEP activities pursuant to He-W 637 for any period of time; or

(2) Inability to engage in any of the NHEP activities pursuant to He-W 637 for any period of time due to being required in the home to care for an ill or incapacitated household member.

(1) Have staff trained in the reviewing of medical information in order to perform the review process;

(2) Have staff trained in the eligibility requirements of other financial assistance programs including but not limited to:

a. Supplemental security income and social security disability income;

b. APTD;

c. Workers’ Compensation;

d. ANB; and

e. Other related financial assistance programs;

(3) Review all supporting documentation provided by the individual and make a determination as to whether the documentation supports an exemption, pursuant to He-W 606.30; and

(4) Determine the individual’s capacity for participation in an NHEP activity when an exemption is not granted.

(d) To obtain a temporary exemption from NHEP employment-related activities pursuant to RSA 167:82,II, pregnant women shall provide documentation from a licensed physician, an advanced registered nurse practitioner, a certified nurse midwife or certified medical practitioner which specifies the nature of the problem and the limitations or restrictions it imposes on NHEP participation.

(e) In order to obtain clarification of the documentation provided by the individual, the department or its designee shall contact any treatment providers indicated by the individual.

(f) The department or its designee shall require an interview with the individual requesting the exemption or request additional documentation when the department or its designee determines the documentation is insufficient to support the exemption, pursuant to He-W 606.30.

(g) Failure or refusal by the individual to document the exemption request or attend an interview with the department or its designee making the determination of exemption, without good cause pursuant to He-W 637.07, shall result in the denial of the exemption request.

(h) Individuals exempted from NHEP participation shall provide additional documentation whenever their conditions change or are expected to change as specified by their treatment providers.

(i) Individuals exempted under this section shall provide written releases from their treatment providers in order to participate in NHEP once their exemptions have ended.

(j) Individuals who have been participating in an NHEP activity as specified in (c) (2) above shall provide written releases from their treatment providers in order to change or expand their participation in NHEP.

(k) Failure to provide the written release required pursuant to (i) and (j) above, without good cause pursuant to He-W 637.07, shall result in a sanction pursuant to He-W 637.08.

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91, EXPIRED: 6-26-97
#8176, eff 10-1-04; paragraph (d) amd by #8740, INTERIM, eff 10-13-06, EXPIRED: 4-11-06; paragraph (d) amd by #8869, eff 4-19-07

N.H. Code Admin. R. Ann. He-W 606.33 Financial Assistance and Eligibility for Medical Care {#sec-he-w-606.33 omnilex-key=us-nh-regs-official--agency-he-w--He-W 606.33}

He-W 606.35 - RESERVED

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91, EXPIRED: 6-26-97

(a) Acceptable documentation of a Social Security Number (SSN) shall be data cross matched with the Social Security Administration (SSA) pursuant to 45 CFR 205.52.

(b) Acceptable documentation of an SSN shall be proof issued from the SSA that:

(1) For newborns, an SSN has been applied for on behalf of the newborn; or

(2) For all individuals except newborns, the individual has applied for an SSN.

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #6531, INTERIM, eff 6-27-97, EXPIRES: 10-25-97; ss by #6614, eff 10-24-97; ss by #6836, eff 8-26-98; ss by #8684, eff 7-21-06; ss by #10743, eff 12-12-14; ss by #14017, eff 6-29-24

In accordance with He-W 652.07(b) the applicant or recipient pursuing Social Security benefits under 42 USC 401-434 or USC 1381-1383f shall provide to the department of health and human services:

(a) All pages of any Social Security denials received within the previous 12 months; and

(b) Documentation from Social Security indicating:

(1) An appeal is currently pending; or

(2) That the current application is pending by providing all pages of the application summary from Social Security.

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #5749, INTERIM, eff 12-1-93, EXPIRED: 3-31-94; ss by #5806, eff 3-30-94; ss by #7135, eff 11-23-99; ss by#9030, eff 11-17-07; ss by #11026, eff 1-23-16; ss by #14219, eff -3-26-25

N.H. Code Admin. R. Ann. He-W 606.38 Financial Assistance and Eligibility for Medical Care {#sec-he-w-606.38 omnilex-key=us-nh-regs-official--agency-he-w--He-W 606.38}

He-W 606.40 - RESERVED

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; rpld by #5819, eff 4-29-94

N.H. Code Admin. R. Ann. He-W 606.41 Financial Assistance and Eligibility for Medical Care {#sec-he-w-606.41 omnilex-key=us-nh-regs-official--agency-he-w--He-W 606.41}

RESERVED

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #6531, INTERIM, eff 6-27-97, EXPIRES: 10-25-97; ss by #6614, eff 10-24-97; ss by #8452, eff 10-22-05; ss by #10471, eff 11-26-13; rpld by #13875, eff 2-21-24

N.H. Code Admin. R. Ann. He-W 606.42 Old Age Assistance Age Requirements {#sec-he-w-606.42 omnilex-key=us-nh-regs-official--agency-he-w--He-W 606.42}

(a) Age shall be verified at the initial determination of eligibility and whenever conflicting evidence indicates an incorrect age.

(b) Refusal or failure to verify age shall result in the denial or termination of old age assistance financial assistance for the individual whose age is not verified.

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #6531, INTERIM, eff 6-27-97, EXPIRES: 10-25-97; ss by #6614, eff 10-24-97; ss by #8452, eff 10-22-05; ss by #10471, eff 11-26-13; ss by #13875, eff 2-21-24

N.H. Code Admin. R. Ann. He-W 606.43 Financial Assistance and Eligibility for Medical Care {#sec-he-w-606.43 omnilex-key=us-nh-regs-official--agency-he-w--He-W 606.43}

He-W 606.54 - RESERVED

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91

N.H. Code Admin. R. Ann. He-W 606.55 Deemed Income {#sec-he-w-606.55 omnilex-key=us-nh-regs-official--agency-he-w--He-W 606.55}

Income deemed from a parent or legal guardian to a minor casehead, when the casehead lives with the parent or legal guardian, shall be verified in the same manner as income of a FANF or adult category assistance group member, unless otherwise designated.

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #6531, INTERIM, eff 6-27-97, EXPIRES: 10-25-97; ss by #6614, eff 10-24-97; ss by #8452, eff 10-22-05; ss by #10108, eff 4-4-12

N.H. Code Admin. R. Ann. He-W 606.56 Financial Assistance and Eligibility for Medical Care {#sec-he-w-606.56 omnilex-key=us-nh-regs-official--agency-he-w--He-W 606.56}

and He-W 606.57 - RESERVED

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91

N.H. Code Admin. R. Ann. He-W 606.58 Lump Sum Income {#sec-he-w-606.58 omnilex-key=us-nh-regs-official--agency-he-w--He-W 606.58}

(a) Failure or refusal to verify the lump sum income amount shall result in the termination or denial of financial assistance to needy families financial assistance.

(b) Failure or refusal to verify directly related expenses or amounts spent on life threatening circumstances shall result in these expenses not being subtracted when eligibility and the period of ineligibility is first calculated.

(c) Failure or refusal to verify changes, such as new shelter costs, life threatening circumstances, or incurred medical expenses during the period of ineligibility, shall result in the period of ineligibility not being recalculated.

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #6531, INTERIM, eff 6-27-97, EXPIRES: 10-25-97; ss by #6614, eff 10-24-97; ss by #8452, eff 10-22-05; ss by #10471, eff 11-26-13; ss by #13875, eff 2-21-24

N.H. Code Admin. R. Ann. He-W 606.59 Treatment of Specific Types of Income {#sec-he-w-606.59 omnilex-key=us-nh-regs-official--agency-he-w--He-W 606.59}

If the individual’s name and benefit amount are on the documents listed in (1) through (5) below, acceptable verification of Social Security Administration (SSA) or Supplemental Security Income (SSI) benefits shall be at least one of the following:

(a) Current SSA or SSI check;

(b) Current SSA or SSI check stub;

(d) For SSA benefits only, the current SSA Beneficiary and Earnings Data Exchange computer cross-match listing supplied to the department from SSA; or

(e) For SSI benefits only, the current SSI State Data Exchange computer cross-match listing supplied to the department from SSA.

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #6531, INTERIM, eff 6-27-97, EXPIRES: 10-25-97; ss by #6614, eff 10-24-97; amd by #8452, eff 10-22-05; paragraph (a)(5) in #6614 EXPIRED: 10-24-05; ss by #10471, eff 11-26-13; ss by #13875, eff 2-21-24

N.H. Code Admin. R. Ann. He-W 606.60 Verification of Educational Income - Adult Categories {#sec-he-w-606.60 omnilex-key=us-nh-regs-official--agency-he-w--He-W 606.60}

Acceptable verification of specific types of educational income shall be provided to the department as follows:

(a) For United States(US) Secretary of Education scholarships and grants:

(1) Written or verbal contact with the financial aid officer at the individual's school; or

(2) A letter of award;

(b) For Federal Work-Study (FWS) income:

(1) Written or verbal contact with the financial aid officer at the individual's school;

(2) Written or verbal contact with the individual’s employer to obtain earnings information; or

(3) Pay stubs;

(1) Written or verbal contact with the financial aid officer at the individual's school; or

(2) A letter of award;

(d) For veterans' educational assistance benefits:

(1) A written or verbal statement from the US Department of Veterans Affairs;

(2) A letter of award indicating the amount of assistance and that benefits are contingent upon regular school attendance; or

(3) A check or check stub to verify the amount; and

(e) For student loans:

(1) Written or verbal contact with the financial aid officer at the individual's school; or

(2) A loan agreement or other loan document.

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #6531, INTERIM, eff 6-27-97, EXPIRES: 10-25-97; ss by #6614, eff 10-24-97; amd by #6672, eff 1-26-98, EXPIRED: 1-26-06
#8744, eff 10-24-06; ss by #10699, eff 10-24-14; ss by #14017, eff 6-29-24

N.H. Code Admin. R. Ann. He-W 606.61 Financial Assistance and Eligibility for Medical Care {#sec-he-w-606.61 omnilex-key=us-nh-regs-official--agency-he-w--He-W 606.61}

RESERVED

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #6531, INTERIM, eff 6-27-97, EXPIRES: 10-25-97; ss by #6614, eff 10-24-97; amd by #6672, eff 1-26-98, EXPIRED: 1-26-06

N.H. Code Admin. R. Ann. He-W 606.62 Financial Assistance and Eligibility for Medical Care {#sec-he-w-606.62 omnilex-key=us-nh-regs-official--agency-he-w--He-W 606.62}

He-W 606.64 - RESERVED

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #6531, INTERIM, eff 6-27-97, EXPIRES: 10-25-97; rpld by #6614, eff 10-24-97

N.H. Code Admin. R. Ann. He-W 606.65 Plan to Achieve Self Support (PASS) Income and Resources {#sec-he-w-606.65 omnilex-key=us-nh-regs-official--agency-he-w--He-W 606.65}

(a) Acceptable verification of income and resources set aside under a plan to achieve self support (PASS), as defined in He-W 601.06, shall be written documentation from the Social Security Administration that indicates:

(1) The individual is participating in the PASS;

(2) The amount of income and resources to be excluded; and

(3) The begin and end dates of the plan.

(b) Money set aside under a verified PASS, pursuant to (a) above, shall be treated as follows for all categories of financial assistance:

(1) Funds set aside under a PASS are excluded as resources; and

(2) Supplemental Security Income allocated into a PASS is excluded as income.

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #5248, eff 10-16-91; ss by #6614, eff 10-24-97; ss by #8452, eff 10-22-05; ss by #10471, eff 11-26-13; ss by #13875, eff 2-21-24

N.H. Code Admin. R. Ann. He-W 606.66 Financial Assistance and Eligibility for Medical Care {#sec-he-w-606.66 omnilex-key=us-nh-regs-official--agency-he-w--He-W 606.66}

and He-W 606.67 - RESERVED

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91

N.H. Code Admin. R. Ann. He-W 606.68 Adult OAA and APTD Employment Expense Disregard {#sec-he-w-606.68 omnilex-key=us-nh-regs-official--agency-he-w--He-W 606.68}

(a) Verification of employment expenses shall not be required for adult category old age assistance (OAA) and aid to the permanently and totally disabled (APTD) financial assistance if the individual's claimed monthly employment expenses are $18.00 or less.

(b) Acceptable verification of the amount of employment expenses for adult category OAA and APTD financial assistance shall be:

(1) For payroll deductions:

a. For social security taxes:

Pay stubs; or
A letter or other written information from the employer which specifies the amount of social security taxes withheld from earnings;

b. For railroad retirement taxes:

Pay stubs; or
A letter or other written information from the employer which specifies the amount of railroad retirement taxes withheld from earnings;

c. For federal withholding:

Pay stubs;
A letter or other written information from the employer which specifies the amount of federal taxes withheld from earnings; or
For self-employed individuals, federal tax forms or other documents which indicate the amount of federal withholding taxes being paid; and

d. For all other mandatory payroll deductions, a letter or other written information from the employer which specifies the minimum amount the individual must contribute, and that the deduction is not elective;

(2) For transportation costs:

a. A statement signed by the individual indicating whether reimbursement is received and the amount and source of the reimbursement;

b. If child care related transportation costs are claimed, a statement signed by the child care provider attesting to the fact that it is necessary for the individual to provide the child's transportation;

c. If the individual's own vehicle is used, a signed statement indicating the number of miles claimed and that such mileage is the shortest necessary to travel to and from work;

d. If the individual rides in another person's privately owned vehicle, the documentation in c. above, and a statement signed by the driver which indicates the amount and frequency of the charge for transportation; or

e. If the individual uses public transportation, a statement signed by the provider of the transportation which indicates the amount normally charged to the public and whether the charge is for one-way or round-trip.

(3) For special clothing, paid receipts for purchased clothing which substantiate that the costs are recurring.; and

(4) For child care costs:

a. If the individual is being reimbursed for child care costs through the New Hampshire child care scholarship program, the amount, if any, of the child care fee which the individual shall pay as shown on the Department invoice; or

b. If there is no New Hampshire child care scholarship program involvement with child care costs, acceptable documentation shall be:

A statement signed by the individual indicating whether reimbursement is received and the amount and source of the reimbursement;
A written statement signed by the child care provider indicating the amount and frequency of the child care cost; or
department verbal contact with the child care provider indicating the amount and frequency of the child care cost.

(c) If the individual fails or refuses to provide verification of a claimed expense, the amount of the unverified expense shall not be an allowable employment expense.

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #5750, eff 12-1-93; ss by #7135, eff 11-23-99; ss by #9030, eff 11-17-07; ss by #11026, eff 1-23-16; ss by #14355, eff 8-26-25, EXPIRES: 8-26-35

(a) When claiming impairment related work expenses (IRWE) during the substantial gainful activity eligibility process pursuant to RSA 167:6, VI, aid to the permanently and totally disabled (APTD) applicants shall furnish the department of health and human services (department) with documentation of the need for and the unreimbursed cost of one or more IRWE as described in 20 CFR 416.976.

(b) Acceptable documentation of the need for an IRWE shall be a signed statement from a physician, psychologist, vocational rehabilitation counselor, or other medical health professional which:

(1) Indicates that the expense is related to the applicant’s impairment and is necessary for employment; and

(2) Is dated within 30 days of the date documentation is provided to the department.

(c) Acceptable documentation of the unreimbursed cost of the expense shall be a paid receipt, canceled check, or other documentation that demonstrates that the applicant has paid for the item or service out of the applicant’s own funds, and has not nor will not, be reimbursed for the expense.

(d) For an applicant wishing to claim mileage expenses for their specially equipped vehicle, the applicant shall provide documentation of:

(1) The ownership, make, and model of the vehicle;

(2) The specific modifications that were made to the vehicle; and

(3) The number of miles traveled to and from work.

(e) Refusal or failure to provide verification of an IRWE shall result in the expense not being allowed as a deduction from earned income.

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #5750, eff 12-1-93; ss by #7135, eff 11-23-99; ss by #9030, eff 11-17-07; ss by #11026, eff 1-23-16; ss by #14355, eff 8-26-25, EXPIRES: 8-26-35

N.H. Code Admin. R. Ann. He-W 606.70 Financial Assistance and Eligibility for Medical Care {#sec-he-w-606.70 omnilex-key=us-nh-regs-official--agency-he-w--He-W 606.70}

He-W 606.72 - RESERVED

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91

N.H. Code Admin. R. Ann. He-W 606.73 Child Care Costs for All Categories {#sec-he-w-606.73 omnilex-key=us-nh-regs-official--agency-he-w--He-W 606.73}

If the individual refuses or fails to verify child care costs, the unverified amount shall not be:

(a) An allowable employment expense; or

(b) Subtracted from household income when determining financial eligibility.

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #6531, INTERIM, eff 6-27-97, EXPIRES: 10-25-97; ss by #6614, eff 10-24-97; ss by #8452, eff 10-22-05; ss by #10471, eff 11-26-13; ss by #10471, eff 11-26-13; ss by #13875, eff 2-21-24

N.H. Code Admin. R. Ann. He-W 606.74 Allowable Deductions {#sec-he-w-606.74 omnilex-key=us-nh-regs-official--agency-he-w--He-W 606.74}

(a) Acceptable verification of allowable deduction amounts for adult categories of financial assistance shall include:

(1) For court-ordered child support, a copy of the most current court order;

(2) For court-ordered spousal support, a copy of the most current court order;

(3) For garnishments, a letter from the employer;

(4) For training expenses:

a. The same documentary evidence required under He-W 606.68 for transportation costs, special clothing, child care costs, and other allowable expenses; and

b. A letter from an official of the training program which states that the expense is required and a receipt or other verification showing the amount which is required to be paid for the expense; and

(5) For allocated income, acceptable verifications as specified in He-W 606.75.

(b) Acceptable verification of allowable deduction amounts for financial assistance to needy families shall include:

(1) For court-ordered child support, a copy of the most current court order and proof of the actual amount paid;

(2) For court-ordered spousal support, a copy of the most current court order and proof of the actual amount paid;

(3) For garnishments, a letter from the employer;

(4) For training expenses:

a. The same documentary evidence required under He-W 606.68 for transportation costs, special clothing, child care costs, and other allowable expenses; and

b. A letter from an official of the training program which states that the expense is required and a receipt or other verification showing the amount which is required to be paid for the expense.

(c) If the individual refuses or fails to provide verification of a claimed expense, the amount of the unverified expense shall not be considered an allowable deduction.

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #5565, eff 2-8-93; ss by #6955, eff 3-3-99; ss by #8783, INTERIM, eff 12-30-06, EXPIRES: 6-28-07; ss by #8903, eff 6-28-07; ss by #10895, eff 7-22-15; ss by #14098, eff 10-18-24

N.H. Code Admin. R. Ann. He-W 606.75 Allocated Income {#sec-he-w-606.75 omnilex-key=us-nh-regs-official--agency-he-w--He-W 606.75}

(a) If the individual refuses or fails to verify a claimed allocation, the unverified amount shall not be an allowable deduction.

(b) An institutionalized individual, as defined in He-W 601.05, who has a spouse living in the community, shall provide verification of the following:

(1) The need for institutionalization of at least 30 days;

(2) The income and shelter expenses of the spouse who resides in the community, if applicable;

(3) Marital status;

(4) Incurred medical expenses of the institutionalized individual, if applicable;

(5) Legal dependent status and income of individuals claimed as dependents, if applicable;

(6) Identity of the dependent and relationship of the dependent to the institutionalized individual or spouse who supports the dependent, if applicable; and

(7) Court ordered support against the institutionalized individual, if applicable.

(1) A signed and dated statement from the admitting physician, caseworker, hospital social worker, bureau of elderly and adult services social worker, or representative of the institution, which indicates that based on available medical data, the institutionalized individual requires a minimum of 30 days of institutionalization;

(2) Documentation that substantiates the amount and frequency of income as specified in He-W 606.59;

(3) A marriage certificate, a record of marriage from the town clerk's office, or other document that provides proof of marriage;

(4) Documentation which is no more than 2 months old and which substantiates the community spouse's shelter expenses, such as:

a. Rent receipts which indicate the amount and frequency of payment;

b. A bill or receipt for the mortgage payment;

c. Property taxes;

d. Homeowner insurance premiums;

e. Manufactured housing lot rent;

f. Utility expenses; or

g. Condominium fees;

(5) Bills or receipts that substantiate that the institutionalized spouse has incurred non-reimbursable medical expenses and the frequency of such expenses;

(6) A copy of the most recent filed internal revenue service income tax return or other documentation that substantiates legal dependency status;

(7) A driver's license, military record, voter registration card, school or hospital record, or any other document that establishes the identity of the dependent;

(8) A birth certificate, baptismal record, marriage certificate, or other documentation which establishes the relationship between the dependent and the spouse who provides support; and

(9) A copy of the court order or other documentation that substantiates that the institutionalized spouse has been ordered to pay support and which indicates the amount and frequency of such support payments.

(d) The allocation from the institutionalized individual's income to the community spouse shall take effect in the month that the institutionalized individual provides documentation of the items cited in (b) above.

(e) If documentation described in (d) above is provided within 10 calendar days of the department request, the allocation shall take effect the month in which the request was made.

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #6531, INTERIM, eff 6-27-97, EXPIRES: 10-25-97; ss by #6614, eff 10-24-97; ss by #8452, eff 10-22-05; ss by #10471, eff 11-26-13; ss by #13875, eff 2-21-24

N.H. Code Admin. R. Ann. He-W 606.76 Resources - Basic Principles {#sec-he-w-606.76 omnilex-key=us-nh-regs-official--agency-he-w--He-W 606.76}

If excluded resources have been commingled with countable resources, the individual shall provide proof of the portion that is excluded.

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #6531, INTERIM, eff 6-27-97, EXPIRES: 10-25-97; ss by #6614, eff 10-24-97; ss by #8452, eff 10-22-05; ss by #10471, eff 11-26-13; ss by #13875, eff 2-21-24

N.H. Code Admin. R. Ann. He-W 606.77 Financial Assistance and Eligibility for Medical Care {#sec-he-w-606.77 omnilex-key=us-nh-regs-official--agency-he-w--He-W 606.77}

RESERVED

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91

N.H. Code Admin. R. Ann. He-W 606.78 Personal Property Resources {#sec-he-w-606.78 omnilex-key=us-nh-regs-official--agency-he-w--He-W 606.78}

(a) For all categories of financial assistance:

(1) The following documents shall be used to verify that a resource is legally unavailable to the applicant or recipient, pursuant to RSA 167:81, IV(e):

a. For irrevocable trust funds, the trust instrument or agreement;

b. For irrevocable burial funds, the bank account, agreement, trust instrument, or similar document which clearly states that the burial funds are not legally available to the individual; and

c. For property in probate, written or verbal contact with the register of probate in the appropriate county indicating that the property is currently in probate and legally unavailable to the applicant or recipient or a letter from the attorney handling the property indicating the property is legally unavailable to the applicant or recipient;

(2) Acceptable verification of income tax refunds or lump sum earned income tax credit payments shall be a copy of the tax refund check or the applicant’s or recipient’s submitted tax return;

(3) Acceptable verification of the value of IRA and non-contractual Keogh accounts and penalty for early withdrawal shall be a written statement from the financial institution where the account was issued indicating the current balance in the account and penalty for withdrawal of the entire amount in the account;

(4) Acceptable verification of the type of Keogh account, such as contractual or non-contractual, shall be a written statement from the individual's employer or the financial institution where the account was issued indicating whether it involves a contractual relationship with other individuals and if money can be withdrawn without affecting the other individuals involved;

(5) Acceptable verification of the face value of life insurance shall be:

a. The actual policy itself; or

b. Written or verbal contact with the insurance company when the face value cannot be determined using the actual policy;

(6) Acceptable verification of the equity value of life insurance shall be determined by written or verbal contact with the insurance company;

a. Using the cash value or non-forfeiture of benefits table, if there is no loan on the policy; or

b. Written or verbal contact with the insurance company, if there is a loan on the policy;

(7) Acceptable verification of lump sum death benefits shall be a letter of award, written contact with the agency providing the benefit or with the funeral director arranging for payment of the benefit, or if written documentation cannot be furnished, department of health and human services (DHHS) verbal contact with the agency or funeral director;

(8) Acceptable verification of resources resulting from an accumulation of types of income which are excluded by federal mandate shall be letters of award, written statements from the source providing benefits, or, if written documentation cannot be furnished, DHHS verbal contact with the source providing the benefits;

(9) Acceptable verification of stocks and bonds shall be the market value of the stock or bond in the financial section of a current newspaper or, if written documentation cannot be located, DHHS verbal contact with a stock broker; and

(10) Good faith effort to sell a personal property asset that cannot be readily converted to cash shall be newspaper clippings or evidence of other means of advertising showing that the asset is for sale at a price commensurate with the property’s fair market value.

(b) For verification of resources for the FANF category of financial assistance the following shall apply:

(1) For equity value of a vehicle:

a. The fair market value of an automobile or truck shall be verified by using the “trade-in value” in the most recent edition of the NADA Official Used Car Guide, also known as the “Blue Book”;

b. The fair market value shall not be increased because of special equipment for the handicapped, low mileage, or optional equipment;

c. If the applicant or recipient states that the fair market value in the Blue Book does not apply to the vehicle because of body damage or other factors, the individual shall present verification of the true fair market value of the vehicle from an auto dealer or an individual who is engaged in a vehicle sales or service business; and

d. If a vehicle is custom made, too old, or too new to be included in the Blue Book, the applicant or recipient shall verify its fair market value by:

Obtaining an appraisal from an automobile dealer or an individual who is engaged in a vehicle sales or service business;
Submitting a tax assessment on the vehicle indicating its value; or
Submitting a newspaper advertisement which indicates the amount for which like vehicles are being sold;

(2) The applicant’s or recipient’s written statement shall be acceptable verification of the fact that a vehicle is a junk vehicle, provided the statement gives an accurate and complete description of the vehicle's condition; and

(3) Acceptable verification of the fact that farm machinery and vehicles are necessary for subsistence, maintenance, or employment shall be a written statement from the applicant or recipient.

(c) Acceptable verification of incurred unpaid medical expenses for adult category financial assistance shall be bills which substantiate the amount of unpaid medical expenses that the applicant or spouse have incurred and that the applicant or spouse is still liable for the unpaid medical expenses.

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #5392, eff 5-11-92, EXPIRED: 5-11-98
#6779, INTERIM, eff 6-27-98, EXPIRED: 10-25-98; ss by #6817, eff 7-25-98; amd by #7295, eff 6-1-00; amd by #8684, eff 7-21-06; ss by #9174, eff 6-7-08; amd by #10259, eff 1-24-13; ss by #11141, eff 7-22-16

N.H. Code Admin. R. Ann. He-W 606.79 Financial Assistance and Eligibility for Medical Care {#sec-he-w-606.79 omnilex-key=us-nh-regs-official--agency-he-w--He-W 606.79}

He-W 606.82 - RESERVED

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91

N.H. Code Admin. R. Ann. He-W 606.83 Verification of Shelter and Living Arrangement {#sec-he-w-606.83 omnilex-key=us-nh-regs-official--agency-he-w--He-W 606.83}

(a) The minimum verification information for a rental situation shall consist of the:

(1) Date tenancy began;

(2) Rent amount;

(3) Payment period;

(4) Home address;

(5) Housing or rent subsidy type;

(6) Gross family contribution for tenants receiving deep subsidy rental assistance;

(7) Basic rent for tenants in unsubsidized housing and urban development 236 housing; and

(8) Number of people living in the unit.

(b) If the individual is unable to provide the documentation required in (a) above, the department shall request the required information directly from the landlord, property manager, or housing authority with a requested return date 10 calendar days later.

(c) If the landlord, property manager, or housing authority does not respond within the timeframe specified in (b) above, a written statement from the individual shall be acceptable verification.

(d) Acceptable verification of home ownership shall be:

(1) A copy of the mortgage or deed;

(2) A written statement on the letterhead of the bank or lending institution that specifies the terms of the mortgage payment; or

(3) Bills or receipts for the mortgage payment, property taxes, homeowners insurance premiums, manufactured housing lot rental, or other expenses attributable to owning the home, such as condominium association fees.

(e) Acceptable verification of rooming, boarding, shared, or provided shelter arrangements, shall be a signed and dated statement from the individual providing or sharing the shelter, which contains:

(1) An explanation of the exact nature of the shelter arrangement; and

(2) The cost(s) to the individual being provided with shelter.

(f) In situations where the liability for the mortgage payment is shared with an individual who is not an assistance group member, acceptable verification of home ownership shall be:

(1) A signed statement from the individual who shares the liability but is not an assistance group member; or

(2) A letter from an attorney, certified public accountant, or lending institution, certifying the extent of liability of the individual in the assistance group.

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #6531, INTERIM, eff 6-27-97, EXPIRES: 10-25-97; ss by #6614, eff 10-24-97; ss by #8452, eff 10-22-05; ss by #10471, eff 11-26-13; ss by #13875, eff 2-21-24

N.H. Code Admin. R. Ann. He-W 606.84 Adult Category Verification of Shelter and Living Arrangement {#sec-he-w-606.84 omnilex-key=us-nh-regs-official--agency-he-w--He-W 606.84}

(a) Acceptable verification of living arrangement and assistance group size shall be the individual’s statement.

(b) If questionable, the individual shall verify the living arrangement pursuant to He-W 606.83.

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #6531, INTERIM, eff 6-27-97, EXPIRES: 10-25-97; ss by #6614, eff 10-24-97; ss by #8452, eff 10-22-05; ss by #10471, eff 11-26-13; ss by #13875, eff 2-21-24

N.H. Code Admin. R. Ann. He-W 606.85 Financial Assistance and Eligibility for Medical Care {#sec-he-w-606.85 omnilex-key=us-nh-regs-official--agency-he-w--He-W 606.85}

He-W 606.88 - RESERVED

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91

N.H. Code Admin. R. Ann. He-W 606.89 Financial Assistance and Eligibility for Medical Care {#sec-he-w-606.89 omnilex-key=us-nh-regs-official--agency-he-w--He-W 606.89}

– RESERVED

History

(See Revision Note at Part Heading for He-W 806)

N.H. Code Admin. R. Ann. He-W 606.90 Financial Assistance and Eligibility for Medical Care {#sec-he-w-606.90 omnilex-key=us-nh-regs-official--agency-he-w--He-W 606.90}

– RESERVED

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #6531, INTERIM, eff 6-27-97, EXPIRES: 10-25-97; ss by #6614, eff 10-24-97; ss by #8452, eff 10-22-05; ss by #10471, eff 11-26-13; rpld by #13875, eff 2-21-24

N.H. Code Admin. R. Ann. He-W 606.91 Financial Assistance and Eligibility for Medical Care {#sec-he-w-606.91 omnilex-key=us-nh-regs-official--agency-he-w--He-W 606.91}

– RESERVED

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91

N.H. Code Admin. R. Ann. He-W 606.92 Telephone Redetermination {#sec-he-w-606.92 omnilex-key=us-nh-regs-official--agency-he-w--He-W 606.92}

(a) Current recipients of any program of financial assistance who reapply for assistance via the telephone, shall be considered to have requested a redetermination as described in He-W 684.01(a).

(b) The telephone redetermination process pursuant to (a) above shall only be available as funding and resources within the current state fiscal year are available.

(c) All general, categorical, technical, and financial requirements that apply when eligibility for assistance is redetermined whether based on federal or state law, federal regulation, or published department rules, shall apply when an individual requests a redetermination pursuant to (a) above.

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #5440, eff 7-24-92; ss by #6817, eff 7-25-98; rpld by #8018, eff 12-20-03; ss by #9787, eff 10-1-10; ss by #12714, eff 1-23-19 (formerly He-W 606.101)

N.H. Code Admin. R. Ann. He-W 606.93 Financial Assistance and Eligibility for Medical Care {#sec-he-w-606.93 omnilex-key=us-nh-regs-official--agency-he-w--He-W 606.93}

He-W 606.97 - RESERVED

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91

N.H. Code Admin. R. Ann. He-W 606.98 Financial Assistance and Eligibility for Medical Care {#sec-he-w-606.98 omnilex-key=us-nh-regs-official--agency-he-w--He-W 606.98}

RESERVED

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #6531, INTERIM, eff 6-27-97, EXPIRES: 10-25-97; ss by #6614, eff 10-24-97; ss by #8452, eff 10-22-05; ss by #10471, eff 11-26-13; rpld by #13875, eff 2-21-24

N.H. Code Admin. R. Ann. He-W 606.99 Financial Assistance and Eligibility for Medical Care {#sec-he-w-606.99 omnilex-key=us-nh-regs-official--agency-he-w--He-W 606.99}

RESERVED

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91

N.H. Code Admin. R. Ann. He-W 606.100 Redetermination of Eligibility {#sec-he-w-606.100 omnilex-key=us-nh-regs-official--agency-he-w--He-W 606.100}

(a) For a desk review, as defined in He-W 601.03, the individual shall provide the required verification of the change in case circumstances no later than 10 calendar days from the date on the notice requesting the required verification.

(b) For a full redetermination, the individual shall provide the required verification no later than 10 calendar days:

(1) After the personal interview; or

(2) From the date on the notice requesting the required verification, if a personal interview is not required.

(c) When verification has been requested from a third party, such as an employer or landlord, and the verification has not been received within the time frames above, 10 additional calendar days shall be allowed after the department sends a follow-up letter to the third party and the individual.

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #6531, INTERIM, eff 6-27-97, EXPIRES: 10-25-97; ss by #6614, eff 10-24-97; ss by #8452, eff 10-22-05; ss by #10471, eff 11-26-13; ss by #13875, eff 2-21-24

N.H. Code Admin. R. Ann. He-W 606.101 Financial Assistance and Eligibility for Medical Care {#sec-he-w-606.101 omnilex-key=us-nh-regs-official--agency-he-w--He-W 606.101}

RESERVED

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #5440, eff 7-24-92; ss by #6817, eff 7-25-98; rpld by #8018, eff 12-20-03; ss by #9787, eff 10-1-10; (moved by #12714 to He-W 606.92)

N.H. Code Admin. R. Ann. He-W 606.102 Financial Assistance and Eligibility for Medical Care {#sec-he-w-606.102 omnilex-key=us-nh-regs-official--agency-he-w--He-W 606.102}

and He-W 606.103 - RESERVED

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91

N.H. Code Admin. R. Ann. He-W 606.104 Verification Requirements for Emergency Assistance {#sec-he-w-606.104 omnilex-key=us-nh-regs-official--agency-he-w--He-W 606.104}

(a) The following verification requirements shall apply to any individual requesting emergency assistance as described in He-W 699.05:

(1) Individuals shall provide the documentation in (b) below of their emergency situation within 10 calendar days of their request for emergency assistance. Failure to provide the required verification shall result in denial of the emergency assistance request;

(2) Individuals shall provide documentation indicating the amount of assistance necessary to cure the emergency situation;

(3) Individuals shall provide documentation of the personal property resources owned by all members of the assistance group, as described in He-W 699.05 ;

(4) For utility deposits, utility arrearages, and deliveries of home heating fuel, the individual shall provide documentation indicating that energy assistance funds are not available to meet the emergency need;

(5) For deliveries of home heating fuel, the individual shall provide documentation from the fuel delivery company indicating that a payment for the current delivery or a payment for the amount of arrearage from either the individual’s current or past residence will allow a current fuel delivery; and

(6) Individuals shall provide additional documentation indicating that the payment authorized by the department shall cure the emergency situation. If the amount of the emergency need exceeds the maximum emergency assistance provided by the department, as specified in He-W 699.05.

(b) Acceptable documentation shall be:

(1) A bill, rental agreement, or other document signed and dated by the landlord indicating the amount of the security deposit;

(2) A bill, or signed and dated statement provided by a representative of the utility company indicating the amount of the utility deposit;

(3) One of the following, if the amount of the security deposit, utility deposit, or home heating fuel delivery, is greater than the maximum allowed by the department, as described in He-W 699.05, plus the individual's personal property resources, as described in He-W 699.05:

a. A signed and dated statement from an outside source indicating that it shall provide the remainder of the deposit or home heating fuel cost;

b. A signed and dated statement from the landlord, utility company, home heating fuel company, or provider stating that the payment authorized by the department shall secure the housing, utility, or home heating fuel; or

c. Documentation that a payment plan has been arranged for the remainder of the deposit or home heating fuel cost;

(4) A termination notice, a bill, or a statement from the utility company indicating the amount of the utility arrearage;

(5) One of the following, if the amount of the back rent, mortgage principal and interest, or utility arrearage exceeds 2 months:

a. A signed and dated statement from the landlord, mortgagee, or utility company indicating that payment of a 2-month portion of the arrearage shall respectively prevent eviction, foreclosure, or termination of utility service;

b. A signed and dated statement from an outside source indicting that it shall provide payment for the remainder of the back rent, mortgage principal and interest, or utility bill; or

c. A signed and dated statement from the landlord, mortgagee, or utility company indicating that a payment plan has been arranged for the balance of the arrearage;

(6) An eviction notice, court order, notice to quit, or a signed and dated written demand for rent for an actual or pending eviction, indicating the name of the landlord and the amount of the back rent;

(7) A notice of foreclosure, court order, or a signed and dated written demand for mortgage principal and interest initiating foreclosure proceedings, indicating the name of the mortgagee and the amount of the back mortgage principal and interest;

(8) A current dated bank statement, or a signed and dated statement from a representative of the financial institution for personal property resources;

(9) Fuel assistance termination letter, or a signed and dated statement from a representative of the organization administering federal fuel assistance payments specifying the reason that fuel assistance is not available to meet the emergency need;

(10) One of the following, if verifying incapacity:

a. A check, letter, or other document from the social security administration indicating receipt of social security disability benefits or supplemental security income benefits; or

b. A physician's statement indicating that the individual is disabled and unable to work for a period of at least 30 days from the date of application for emergency assistance; or

(11) One of the following, if there are unsafe or unhealthy living conditions:

a. Documentation of the unsafe or unhealthy living conditions from a third party, including but not limited to a school nurse, school counselor, social worker, case manager, therapist, housing and support services, town welfare, primary medical provider, or pastoral support; or

b. The individual’s written self-attestation of the unsafe or unhealthy living conditions.

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #5370, eff 4-13-92; amd by #6672, eff 1-26-98; ss by #6754, eff 5-20-98; ss by #8596, eff 3-30-06; ss by #10563, eff 3-30-14; ss by #10860, eff 6-30-15; amd by #12697, eff 12-31-18; ss by #14299, eff 7-1-25, EXPIRES: 7-1-35

Part He-W 608 Use of Money Payments

N.H. Code Admin. R. Ann. He-W 608.01 Use of Money Payments {#sec-he-w-608.01 omnilex-key=us-nh-regs-official--agency-he-w--He-W 608.01}

(a) The individual shall be responsible for the satisfaction of the individual’s creditors to the same extent as any other citizen.

(b) The department shall not intervene in disputes involving the individual and a provider in matters relating to financial obligations.

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #6531, INTERIM, eff 6-27-97, EXPIRES: 10-25-97; ss by #6614, eff 10-24-97; ss by #8452, eff 10-22-05; ss by #10495, eff 1-1-14; ss by #13760, eff 9-28-23

N.H. Code Admin. R. Ann. He-W 608.02 Prohibited Use of Money Payments {#sec-he-w-608.02 omnilex-key=us-nh-regs-official--agency-he-w--He-W 608.02}

(a) A violation of RSA 167:7-b,I shall have occurred if the electronic benefit transfer (EBT) card assigned to the individual designated as the EBT cardholder, or cash obtained with the EBT card, was used at a business described in RSA 167:7-b,II, as determined by the EBT record of transaction indicating usage of the EBT card at a point-of-sale (POS) device or ATM machine that is located within the walls of the place of business.

(b) A finding of a violation pursuant to (a) above shall result in the application of the suspension provisions at RSA 167:7-b,I, pursuant to (c) below, subject to the administrative appeals process described in He-C 200.

(c) For the purposes of applying suspension provisions in accordance with RSA 167:7-b,I, the following shall apply if the individual designated as the EBT cardholder is a member of the assistance group (AG):

(1) Subject to opportunity for a hearing through the administrative appeals process described in He-C 200, the suspension of cash assistance benefits shall be applied beginning the first semi-monthly payment period following the date that a violation of RSA 167:7-b has been discovered, pursuant to (a) above; and

(2) Financial assistance benefits for the AG during the suspension period shall be determined by:

a. Recalculating eligibility based on removing the person who has been designated as the EBT card holder as an eligible individual from the AG, while counting that individual’s income, resources, and expenses for the AG in order to determine the sanction amount;

b. Deducting any other sanctions currently being applied to the AG from the amount derived in (2)a. above;

c. Dividing the amount obtained in (2)b. above by 2, to determine the 2 semi-monthly payments pursuant to He-W 670.04; and

d. Removing the sanction amount as determined in (2)c. above from the AG’s EBT card for the number of payment periods required by RSA 167:7-b,I.

(d) If the person who has been designated as the EBT card holder is not a member of the AG and a violation of RSA 167:7-b,I has occurred pursuant to (a) above, then the following shall apply, subject to a hearing which may be requested through the administrative appeals process described in He-C 200:

(1) The person who has been designated as the EBT card holder shall reimburse the state for the funds used at the restricted location within 15 days of the notice of the violation or under such repayment terms as is agreeable to both the department and the person, pursuant to (h) below; and

(2) The members of the AG shall designate a new EBT card holder within 15 days of the notice of the violation.

(e) Failure to reimburse the state within the timeframes pursuant to (d)(1) above shall result in a fraud referral to the department of justice, office of the attorney general.

(f) Failure to designate a new EBT cardholder within the timeframes pursuant to (d)(2) above shall result in termination of financial assistance for the entire AG.

(g) For the purpose of this section:

(1) The phrase “gaming establishment” referenced in RSA 167:7-b,II(c), shall:

a. Include commercial and charitable bingo halls, card halls, or race tracks, even if the gaming provided is through video, rather than live, events; and

b. Not include establishments such as, but not limited to, grocery stores or convenience stores, whose only gaming activity is in the sale of lottery tickets or lucky 7 tickets and the sale of these tickets is secondary to the establishment’s sales of other goods unrelated to gaming;

(2) The phrase “retail establishments which provide adult-oriented entertainment” referenced in RSA 167:7-b,II(d) shall include:

a. Establishments in which greater than 50% of visible inventory being sold or rented, is material, as defined in RSA 650:1,III, in which performers disrobe or perform in an unclothed state for entertainment; and

b. Establishments which provide on or off-site adult-oriented entertainment for such venues commonly referred to as, but not limited to, bachelor parties or peep shows, in which performers disrobe or perform in an unclothed state for entertainment; and

(3) The phrase “off-premises retail licensees that exclusively or primarily sell beer, wine, or other alcoholic beverages” referenced in RSA 167:7-b, II(b) shall:

a. Include any establishments in which greater than 50% of visible inventory is beer, wine, or other alcoholic beverages; and

b. Not include establishments that have been certified as a food stamp retailer, pursuant to 7 CFR 278.1.

(h) For purposes of (d)(1) above, repayment terms shall be considered agreeable to both the department and the person when the individual designated as the EBT cardholder has:

(1) Contacted the special investigations unit (SIU) to discuss a repayment plan within the time period described in (d)(1) above;

(2) Provided the following information on the repayment plan:

a. Date of birth;

b. Mailing address; and

c. Case number, if the individual is a member in another AG; and

(3) Within 15 days of the date of the repayment plan agreement, returned the repayment plan agreement with his or her dated signature attesting to the amount, frequency, and dates of the partial payments that he or she shall make until the amount used at the restricted location is paid in full.

PARTS He-W 609 – He-W 615 - RESERVED

History

#10495, eff 1-1-14; amd by #11043, eff 2-24-16
(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91

Part He-W 616 Citizenship/Alien Status

N.H. Code Admin. R. Ann. He-W 616.01 Sponsored Aliens Who Apply for Financial Assistance to Needy Families (FANF). {#sec-he-w-616.01 omnilex-key=us-nh-regs-official--agency-he-w--He-W 616.01}

For an alien who has been sponsored by an agency or an organization to be eligible for financial assistance to needy families (FANF) financial assistance, the following conditions shall be met:

(a) The alien shall provide a signed and dated affidavit, on which the sponsoring agency or organization has provided the following:

(1) The name of the alien;

(2) The alien's date of entry into the United States;

(3) The name and address of the sponsor;

(4) The amount of money the sponsor contributed to the alien, if any;

(5) The reason the sponsor cannot meet the alien's total needs; and

(6) A statement that the sponsor agrees to a financial audit when needed to substantiate conflicting information;

(b) The sponsor shall be considered to not be meeting the alien's total needs, if:

(1) The sponsor is contributing no money to the alien; or

(2) The amount contributed is not enough to render the case ineligible for FANF financial assistance due to excess income; and

(1) A written, signed, and dated statement indicating the name and former address of the sponsor;

(2) A statement that the sponsor no longer exists; and

(3) The reason the sponsor no longer exists, if known.

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #6531, INTERIM, eff 6-27-97, EXPIRES: 10-25-97; ss by #6614, eff 10-24-97; ss by #8452, eff 10-22-05; ss by #10471, eff 11-26-13; ss by #13857, eff 1-23-24

N.H. Code Admin. R. Ann. He-W 616.02 Eligibility of Qualified Aliens {#sec-he-w-616.02 omnilex-key=us-nh-regs-official--agency-he-w--He-W 616.02}

(a) As long as all other eligibility requirements are met, financial and medical assistance shall be provided to qualified aliens as defined in 8 USC 1641(b), under the following conditions:

(1) The qualified alien entered the United States with a status within the meaning of the term “qualified alien” before August 22, 1996; or

(2) For qualified aliens who enter the United States on or after August 22, 1996, a period of 5 years has elapsed since the date of the alien’s entry into the United States with a status within the meaning of the term “qualified alien.”

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #6446, eff 2-1-97; ss by #8271, eff 2-1-05, EXPIRED: 2-1-13
#10275, eff 2-21-13

Part He-W 618 - Residency

N.H. Code Admin. R. Ann. He-W 618.01 Financial Assistance and Eligibility for Medical Care {#sec-he-w-618.01 omnilex-key=us-nh-regs-official--agency-he-w--He-W 618.01}

RESERVED

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #6595, eff 10-1-97; amd by #7192, eff 2-1-00; paras. (a)-(d) EXPIRED: 10-1-05; paras. (e)-(h) EXPIRED: 2-1-08

N.H. Code Admin. R. Ann. He-W 618.02 Temporary Absence from New Hampshire {#sec-he-w-618.02 omnilex-key=us-nh-regs-official--agency-he-w--He-W 618.02}

(a) For adult category financial assistance, "temporary absence" shall be defined in accordance with He-W 601.08.

(b) Acceptable reasons for a temporary absence shall include the following:

(1) Visiting;

(2) Vacationing;

(3) Temporary hospitalization;

(4) Convalescent care; or

(5) School attendance.

(d) When a recipient who is absent from New Hampshire fails to notify the department of that absence, and the department becomes aware of the absence, the absence shall be considered temporary for at least 30 days and assistance shall continue for that period of time.

(e) When unreported absences last longer than 30 days, continuation of assistance shall be contingent on the recipient’s verification of New Hampshire residency.

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #6531, INTERIM, eff 6-27-97, EXPIRES: 10-25-97; ss by #6614, eff 10-24-97; ss by #8452, eff 10-22-05; ss by #10471, eff 11-26-13; ss by #13589, eff 3-24-23

Part He-W 619 Presumptive Eligibility for Home and Community-Based Care for the Elderly and Chronically Ill (hcbc-Eci)

N.H. Code Admin. R. Ann. He-W 619.01 Definitions {#sec-he-w-619.01 omnilex-key=us-nh-regs-official--agency-he-w--He-W 619.01}

As used in this section, the following terms shall have the meanings indicated:

(a) “Expedited disability determination” means any of the following determination processes implemented by the Social Security Administration:

(1) Quick disability determination pursuant to 20 CFR 404.1602;

(2) Terminal illness determination pursuant to the Social Security Administration (SSA) Programs Operations Manual System (POMS) section DI 23020.045; or

(3) Presumptive disability determination pursuant to 20 CFR 416.931 through 416.934.

(b) “Presumptive eligibility (PE)” means a period of medical coverage, excluding home or environmental modification coverage, extended to qualifying individuals pending the final processing of a Title XIX medicaid application.

(1) Begins on the date the department determines that the applicant likely meets the eligibility criteria; and

(2) Ends on the date a final determination of eligibility is made or the applicant is determined to be ineligible.

(d) “Qualified provider” means an individual or enrolled provider identified at He-W 619.03 and trained to refer an individual for presumptive eligibility based on a standardized assessment process as specified in He-W 619.04.

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; EXPIRED: 6-26-99
#9155, eff 5-10-08, EXPIRED: 5-10-16
#11104, INTERIM, eff 5-25-16, EXPIRES: 11-21-16

N.H. Code Admin. R. Ann. He-W 619.02 Presumptive Eligibility For HCBC-ECI {#sec-he-w-619.02 omnilex-key=us-nh-regs-official--agency-he-w--He-W 619.02}

(a) Presumptive eligibility for medicaid services shall be available to the applicant:

(1) Who applies for HCBC-ECI;

(2) Who requests a presumptive eligibility determination, either directly or through a qualified provider;

(3) Who submits a completed medicaid application and all related, necessary verifications as contemplated at He-W 606, within 10 days;

(4) Who undergoes a face-to-face clinical assessment by a registered nurse designated by the department’s bureau of elderly and adult services (BEAS);

(5) Who the department or qualified provider determines in accordance with He-W 619.02(b) is likely to be at risk of institutionalization without HCBC-ECI services;

(6) Who the department determines is likely to be medicaid-eligible in accordance with He-W 619.02(c);

(7) Who has not previously applied for or received PE coverage in the previous 12 months; and

(8) Who acknowledges in writing his or her understanding and agreement that if the application is denied for any reason, the applicant shall be responsible for:

a. The cost of services rendered after a determination of ineligibility; and

b. The cost of services rendered during the presumptive eligibility period, if the department finds the application was filed with fraudulent intent.

(b) Individuals shall be determined by the department or qualified provider to be at risk of institutionalization if:

(1) Adult protective services has made a finding of abuse, neglect or exploitation and recommends home and community based care services because of a risk of institutionalization;

(2) The individual is in a hospital, nursing facility or other medical facility, ready to be discharged, and the discharge planning team determines that the individual cannot be discharged home without supports in addition to those already available to him or her.

(3) The individual has lost the assistance of a family or other caregiver, permanently or temporarily, whom the individual has depended on to meet his or her needs and no other alternatives are available; or

(4) The individual does not have access to sufficient paid and/or unpaid supports that would enable the individual to safely maintain him or herself in the current home or community-based setting pending the routine eligibility determination process.

(c) An individual who requests a presumptive eligibility determination shall be considered likely eligible for medicaid if the individual requires a nursing facility level of care and meets one of the following:

(1) The individual is a medicaid recipient;

(2) The individual was previously eligible for HCBC-ECI services but:

a. The department closed the case due to an institutional stay of more than 30 days;

b. There is no change in financial circumstances; and

c. The individual is ready to return to the community;

(3) The individual was previously eligible for HCB-ECI services but:

a. The department closed the case due to a lump sum payment or other change in circumstances; and

b. Such cause is no longer an impediment to eligibility;

(4) The individual is a medicaid applicant who is age 65 or older, whose completed application indicates general and financial eligibility, and who does not benefit from a trust or annuity and has not transferred assets within the applicable lookback period as contemplated in He-W 620; or

(5) The individual is a medicaid applicant aged 18 through 64 who is determined by the department to meet the standards for an expedited disability determination, presents a completed application that indicates general and financial eligibility, and who does not benefit from a trust or annuity and has not transferred assets within the applicable lookback period as contemplated in He-W 620.

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; EXPIRED: 6-26-99
#9155, eff 5-10-08, EXPIRED: 5-10-16
#11104, INTERIM, eff 5-25-16, EXPIRES: 11-21-16

N.H. Code Admin. R. Ann. He-W 619.03 Qualified Providers {#sec-he-w-619.03 omnilex-key=us-nh-regs-official--agency-he-w--He-W 619.03}

Qualified providers shall include the following:

(a) ServiceLink, the department’s information and referral resource centers;

(b) Hospital, rehabilitation, and nursing facility discharge planners; and

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; EXPIRED: 6-26-99
#9155, eff 5-10-08, EXPIRED: 5-10-16
#11104, INTERIM, eff 5-25-16, EXPIRES: 11-21-16

N.H. Code Admin. R. Ann. He-W 619.04 Presumptive Eligibility Determination Process {#sec-he-w-619.04 omnilex-key=us-nh-regs-official--agency-he-w--He-W 619.04}

(a) A written referral for presumptive eligibility shall be initiated by the individual or qualified provider and transmitted to the department with a completed medicaid application and medical eligibility determination (MED) application, unless these forms had been filed within the prior 60 days.

(b) An individual referred for presumptive eligibility shall undergo a face-to-face clinical assessment and the department shall review the medicaid application to verify presumptive eligibility.

(c) The clinical assessment shall take place before or after the review of the completed application by the department, but no later than 20 business days after the referral for presumptive eligibility is received from the qualified provider or individual. The clinical assessment shall include the development of an initial support plan, if the individual is found to be clinically eligible.

(d) The department shall review the medicaid application for categorical and financial eligibility, prior to or after the clinical assessment, but no later than 5 business days after the clinical assessment is completed.

(e) An applicant shall not be eligible for a presumptive eligibility authorization if his or her financial eligibility is contingent upon a legal review of a trust instrument or annuity or investigation of any known complex issues such as asset transfers that could preclude eligibility.

(f) Medicaid service coverage shall begin immediately upon:

(1) A finding of presumptive eligibility;

(2) Completion of a support plan; and

(3) The applicant’s written acknowledgement of the responsibility described in He-W 619.02(a)(8).

(g) Presumptive eligibility shall continue until a final determination of eligibility or ineligibility.

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; EXPIRED: 6-26-99
#9155, eff 5-10-08, EXPIRED: 5-10-16
#11104, INTERIM, eff 5-25-16, EXPIRES: 11-21-16

N.H. Code Admin. R. Ann. He-W 619.05 Termination of Presumptive Eligibility Period {#sec-he-w-619.05 omnilex-key=us-nh-regs-official--agency-he-w--He-W 619.05}

(a) If the department verifies that the individual is eligible for medicaid, the individual shall be notified in writing and coverage of care shall continue without interruption.

(b) If the department determines that the individual is ineligible for medicaid, or HCBC-ECI, the individual shall receive written notification of the determination. Coverage of care for which the individual is not eligible shall cease immediately upon notification of ineligibility. Coverage of care for which the individual is eligible shall continue without interruption.

(c) If the individual’s application for PE or for medicaid is denied and the department finds that the individual filed the application with fraudulent intent, coverage for the individual’s care shall cease and the case shall be referred to the department’s office of special investigations for recoupment action.

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; EXPIRED: 6-26-99
#9155, eff 5-10-08, EXPIRED: 5-10-16
#11104, INTERIM, eff 5-25-16, EXPIRES: 11-21-16

Part He-W 620 Asset Transfers

N.H. Code Admin. R. Ann. He-W 620.01 Asset Transfers {#sec-he-w-620.01 omnilex-key=us-nh-regs-official--agency-he-w--He-W 620.01}

(a) Pursuant to RSA 167:4, I(b), a transfer of assets shall be considered to have been made when:

(1) Action is taken that reduces or eliminates an individual's ownership or control of such assets;

(2) Another person has been given access to the asset through joint ownership and any action is taken, either by the individual or by any other person, that reduces or eliminates such individual's ownership;

(3) An instrument to transfer title at some future date has been completed by the individual who is applying for or receiving assistance and delivered to the individual who is to receive title;

(4) An individual who is applying for or receiving financial assistance has transferred or transfers title or ownership of an otherwise excluded home to another individual or entity, including a home, which has become income producing;

(5) An individual places assets into an irrevocable trust or similar legal device, including an annuity;

(6) An individual applying for or receiving financial assistance obtains a reverse mortgage, a home equity conversion mortgage, or similar loan on an otherwise excluded home or other real property and transfers the proceeds to another individual;

(7) An individual applying for or receiving financial assistance converts a countable asset; or

(8) An individual is entitled to an asset but does not receive the asset because of action:

a. By the individual or the individual's spouse;

b. By a person, including a court or administrative body, with legal authority to act in place of or on behalf of the individual or such individual's spouse; or

c. By any person, including any court or administrative body, acting at the direction or upon the request of the individual or such individual's spouse.

(b) Actions which would cause income or resources not to be received shall include but not be limited to:

(1) Irrevocably waiving pension income or any other form of income;

(2) Waiving an inheritance;

(3) Not accepting or accessing injury settlements, judgments, or court awards;

(4) Tort settlements which are diverted by the defendant into a trust or similar device to be held for the benefit of the plaintiff; or

(5) Refusal to take legal action to obtain a court ordered payment that is not being paid, such as child support or alimony, unless the individual is being, has been, or is at risk of being battered or subjected to extreme cruelty as described in 42 USC 608(a)(7)(c) and is corroborated by the documentation described in He-W 602.10(a)(1)b.1.

(c) For individuals applying for or receiving financial assistance, the department of health and human services (DHHS) shall evaluate asset transfers to determine if the individual derived fair market value, as defined in He-W 601.04(b), from the transfer.

(d) DHHS shall evaluate the transfer to determine if the individual derived fair market value, as defined in He-W 601.04(b), whenever an individual applying for or receiving financial assistance has transferred, assigned, or disposed of title or ownership of an otherwise excluded home to another individual or entity.

(e) Asset transfers in which the individual receives fair market value shall require no further evaluation for asset transfer.

(f) For an asset to be considered transferred for fair market value or to be considered to be transferred for valuable consideration, the compensation received for the asset shall be in a tangible or otherwise assessable form with intrinsic value. A transfer of assets for love and consideration, or similar reasons, shall not be considered to be a transfer for fair market value.

(g) Although relatives may legitimately be paid for providing care, a transfer of assets to a relative for care provided in the past shall not be a transfer for fair market value. It shall be assumed that services provided for free in the past were intended to be provided without compensation unless it can be rebutted with tangible evidence that a compensation arrangement had been agreed to in writing at the time services were provided.

(h) When determining whether an individual has received fair market value for a transfer when a life estate has been established, the division shall:

(1) Determine what the fair market value of the asset was at the time of transfer;

(2) Take into account the individual’s age at the time of the transfer; and

(3) Calculate the value of the life estate using the life estate tables found in the Supplemental Security Income (SSI) Program Operations Manual System (POMS), section SI 01140.120 as follows:

a. The life estate value shall be established by multiplying the market value of the asset by the life estate factor that corresponds to the individual’s age at the time of the transfer;

b. The value of the life estate shall be subtracted from the value of the asset transferred; and

c. The difference between the value of the life estate and the amount the individual was reimbursed for the remainder interest shall be the portion of the asset transferred for less than fair market value.

(i) When determining whether an individual or spouse has received fair market value for a transfer of assets into an annuity, DHHS shall:

(1) Determine the fair market value of the asset at the time of transfer into the annuity;

(2) Determine if the expected return on the annuity is commensurate with a reasonable estimate of the life expectancy of the beneficiary in order to determine whether the annuity is actuarially sound;

(3) Use the life expectancy tables published by the office of the chief actuary of the social security administration;

(4) Determine that the individual has received fair market value for the annuity if the average number of years of expected life remaining for the individual coincides or exceeds the life of the annuity; and

(5) Determine that the individual did not receive fair market value for the annuity if the average number of years of expected life remaining for the individual is less than the life of the annuity.

(j) The background information of the asset transfer shall be evaluated further to determine if assets might have been transferred for purposes of qualifying for financial assistance, if DHHS determines that the individual did not receive fair market value from the transfer.

(k) Factors to be evaluated in assessing asset transfers shall include:

(1) Timeframes between the transfer of assets and the date of application;

(2) The individual's health at the time of the transfer; and

(3) The individual's economic situation at the time of the transfer.

(l) The transfer shall be considered questionable if the evaluation of background information of the transfer suggests that the individual transferred assets for purposes of qualifying for financial assistance or results in qualifying earlier than otherwise would have been possible if the individual had retained all of the asset(s).

(m) The individual shall provide additional information and documentation to demonstrate that assets were not transferred for purposes of qualifying for assistance, if the transfer is considered questionable.

(n) Reasons for transferring assets for purposes other than qualifying for assistance shall include:

(1) The individual transferred the asset to prevent foreclosure or sale of the asset by the lien holder, thus preventing total loss of the asset;

(2) The individual transferred the asset for self-support because the individual's income and resources were insufficient to meet basic needs or to maintain upkeep of the asset, such as taxes and repairs, and the individual's basic needs were provided for in return for the transfer, or the individual lived off the proceeds of the asset;

(3) The individual transferred the asset to meet the terms of a written agreement, including debts arising from such agreement;

(4) The individual transferred the asset to meet the terms of an oral agreement, including debts arising from such agreement; or

(5) The individual is not able to afford to take the necessary action to obtain the asset or the cost of obtaining the asset is greater than the asset is worth, resulting in a case of failure to cause assets to be received.

(6) The individual is being, has been or is at risk of being, battered or subjected to extreme cruelty as described in 42 USC 608(a)(7)(c) and as corroborated by the documentation described in He-W 602.10(a)(1)b.1.

(o) The burden of proof for substantiating the fact that assets were not transferred for purposes of qualifying for assistance shall rest with the individual.

(p) If the individual refuses or fails to prove that assets were not transferred for purposes of qualifying for financial assistance, DHHS shall determine that assets were transferred for the purposes of qualifying for assistance and shall deny financial assistance:

(1) For 60 months from the date of the transfer to an irrevocable trust when the principal is not available to the individual; and

(2) For 36 months from the date of all other transfers.

(q) A penalty shall not be assessed for transfers of assets for less than fair market value under any of the following circumstances:

(1) The individual intended and attempted to dispose of the asset either at fair market value, or for other valuable consideration, and circumstances caused the individual to transfer the asset for less than fair market value;

(2) The individual transferred the assets for a purpose other than to qualify for financial assistance; or

(3) All of the assets transferred for less than fair market value have been returned to the individual.

(r) Individuals claiming that circumstances caused the asset to be transferred for less than fair market value pursuant to (q)(1) above, shall provide documentation of:

(1) The individual’s attempt to dispose of the asset at fair market value, or for other valuable consideration; and

(2) The value at which the asset was disposed.

(s) Individuals claiming that assets were transferred for a purpose other than to qualify for financial assistance pursuant to (q)(2) above, shall provide documentation of:

(1) The specific purpose for which the asset was transferred; and

(2) The reason it was necessary to transfer the asset for less than fair market value.

(t) If a penalty was assessed for transferring an asset for less than fair market value and the asset was returned to the individual, then DHHS shall generate a retroactive adjustment back to the beginning of the penalty period if the individual met all other eligibility criteria.

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #6111, eff 11-1-95; ss by #7978, eff 10-22-03; amd by #8865, eff 4-13-07; ss by # 9136, eff 4-22-08; amd by #10078, eff 1-25-12; amd by #11058, INTERIM, eff 3-24-16, EXPIRES: 9-20-16; ss by #11187, eff 9-20-16

Part He-W 621 Reserved

N.H. Code Admin. R. Ann. He-W 621.01 Financial Assistance and Eligibility for Medical Care {#sec-he-w-621.01 omnilex-key=us-nh-regs-official--agency-he-w--He-W 621.01}

– He-W 621.03

History

(See Revision Note at Part heading for He-W 821)

Part He-W 622 Liability of Relatives to Support

N.H. Code Admin. R. Ann. He-W 622.01 Liability of Relatives to Support {#sec-he-w-622.01 omnilex-key=us-nh-regs-official--agency-he-w--He-W 622.01}

(a) When a married couple lives together in an independent living arrangement, income belonging to either spouse shall be considered available in accordance with He-W 652.03 in determining eligibility for all categories of financial assistance.

(b) For financial assistance to needy families, in accordance with RSA 167:3, parents shall be liable for their minor children as defined under RSA 167:78, XV.

(c) For the adult categories of financial assistance, the ability of a liable relative in accordance with RSA 167:3 to contribute to an individual’s support shall be determined as follows:

(1) The amount of the expected contribution shall be based on the gross annual income of the liable relative;

(2) The income considered shall be all money or monies that are defined as income in the individual's category of assistance;

(3) Money or monies defined as resources in the individual's category of assistance shall not be considered in determining the ability of the relative to contribute;

(4) The gross annual income of the liable relative or a legal dependent shall be reduced by the amount of the following unreimbursed and unreimbursable expenses:

a. Medical care costs;

b. Educational expenses;

c. Any court-ordered payments, including, but not limited to, child support, alimony, or guardianship fees;

d. Repayments, including garnishments, or prior indebtedness excluding shelter costs; or

e. Life-threatening circumstances as described in He-W 654.03(h);

(5) The legally liable relative's income, less expenses noted in (c)(4) above, shall be compared to 200% of the federal poverty income guidelines, as described in 42 USC 9902(2) and annually updated by the department pursuant to (8) below, for the appropriate number of persons dependent on the legally liable relative's income noted in (6) below;

(6) The number of persons dependent on the income shall include the liable relative and any persons legally claimed as dependents for federal income tax purposes by that relative except for the recipient;

(7) In the case of self-employed persons, the gross income shall be the income remaining after deducting business expenses allowed by the Internal Revenue Service for federal income tax purposes;

(8) The income limit of 200% of the federal poverty income guidelines shall be effective no later than the first of the month following the first complete month after the federal poverty income guidelines have been published in the federal register; and

(9) If the income is:

a. Less than or equal to 200% of the federal poverty income guidelines for the number of persons dependent on the legally liable relative’s income, no contribution shall be expected from the liable relative; or

b. Greater than 200% of the federal poverty income guidelines for the number of persons dependent on the legally liable relative's income, a contribution equal to 10% of that portion of income over 200% of the federal poverty income guidelines for the number of persons dependent on the legally liable relative's income shall be expected to be made by the liable relative towards the individual's support.

(d) If contributions are actually made by a legally liable relative on a regular, recurring basis to an individual, the monthly contribution amount shall be treated as unearned income in determining the individual's eligibility and benefit level.

(e) Refusal of the liable relative to supply adequate information regarding their ability to contribute shall have no impact on the individual's eligibility.

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #5855, eff 7-15-94; ss by #7257, eff 5-1-00; amd by #7665, eff 4-1-02; ss by #9137, eff 4-22-08; ss by #10551, eff 3-25-14; ss by #13931, eff 4-24-24; ss by #14239, eff 4-22-25, EXPIRES: 4-22-35

Part He-W 624 Institutional Residence

N.H. Code Admin. R. Ann. He-W 624.01 Institutional Residence {#sec-he-w-624.01 omnilex-key=us-nh-regs-official--agency-he-w--He-W 624.01}

(a) The following individuals shall not be considered inmates of public institutions or private institutions primarily engaged in treating mental or emotional disorders or tuberculosis:

(1) Individuals who are admitted to the New Hampshire Hospital for purposes of evaluation only, for a period not to exceed 3 months;

(2) Individuals who, while remaining under the general supervision of a public institution as an official inmate of that institution, physically reside outside the institution;

(3) Individuals under age 22 or age 65 or older who are certified for care at a designated receiving facility as defined in He-M 405.02(f);

(4) Patients at the psychiatric unit of the Dartmouth - Hitchcock Medical Center;

(5) Children in placement in foster homes or other approved child caring institutions;

(6) Children who participate in the special education program at the Sununu Youth Services Center;

(7) Adults in residential care facilities and community living residences; and

(8) Inmates committed by a court order to a NH correctional facility, who require inpatient care at a medical institution as defined in 42 CFR 435.1010.

(b) Individuals who are patients at the Glencliff nursing facility unit of the New Hampshire Hospital shall be considered as residing in a nursing facility.

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #6531, INTERIM, eff 6-27-97, EXPIRES: 10-25-97; ss by #6614, eff 10-24-97; ss by #7005, eff 5-26-99, EXPIRED: 5-26-07
#8897, eff 6-7-07; ss by #9083, eff 1-30-08; ss by #11042, eff 2-24-16

(a) Financial assistance applicants or recipients who do not have a social security number (SSN), or are unable to furnish their SSN, shall apply for an original SSN or replacement card.

(b) The individual shall provide verification of an SSN or application for an SSN as specified in He-W 606.36.

(c) The department shall grant good cause for failure to furnish an SSN or to apply for an SSN card when the individual is unable to furnish or apply for an SSN card or submit the required verification, despite good faith efforts to do so.

(d) Good cause for failure to furnish or apply for an SSN card shall include, but not be limited to, the following:

(1) Delays in obtaining required verification because another agency, such as the town clerk's office, is not able to process the individual’s request for documents in a timely manner; or

(2) The agency is not able to provide documents because its records have been destroyed.

(e) The individual shall complete the SSN application requirements for a newborn child by the second month following the month in which the child's mother is discharged from the hospital, for newborn children who receive financial assistance.

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #6531, INTERIM, eff 6-27-97, EXPIRES: 10-25-97; ss by #6614, eff 10-24-97; amd by #6836, eff 8-26-98; amd by #8452, eff 10-22-05; amd by #8684, eff 7-21-06; ss by #10471, eff 11-26-13; ss by #13713, eff 8-3-23

Part He-W 626 TECHNICAL REQUIREMENTS FOR THE Family PLANNING ExPANSION CaTEGORY (FPEC) OF MEDICAL ASSISTANCE

N.H. Code Admin. R. Ann. He-W 626.01 Purpose {#sec-he-w-626.01 omnilex-key=us-nh-regs-official--agency-he-w--He-W 626.01}

The purpose of the Family Planning Expansion Category (FPEC) of medical assistance is to offer family planning and family planning-related services and supplies, pursuant to He-W 509, to needy individuals who meet the eligibility requirements set forth in this part.

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91, EXPIRED: 6-26-97
#10357, eff 7-1-13

N.H. Code Admin. R. Ann. He-W 626.02 Family Planning Expansion Category (FPEC) {#sec-he-w-626.02 omnilex-key=us-nh-regs-official--agency-he-w--He-W 626.02}

(a) All general, categorical, technical, and financial factors related to the determination of categorically needy medical assistance shall apply to applicants and recipients of FPEC, except as specified otherwise in He-W 626.

(b) Individuals shall be eligible for FPEC medical assistance, pursuant to 42 USC 1396a(a)(10)(A)(ii)(XXI), as amended, when the individual:

(1) Applies for medical assistance, as defined in He-W 601.17;

(2) Is not pregnant; and

(3) Has net income that does not exceed the income limit described in He-W 641.06(b).

(d) Redeterminations of eligibility for FPEC shall be scheduled pursuant to He-W 684.02(c).

(e) When determining eligibility for FPEC:

(1) Only the income of the FPEC applicant or recipient shall be counted, pursuant to 42 USC 1396a(ii)(3); and

(2) The income level against which countable income shall be considered shall be for a group size of 2.

(f) When applying the criteria described in (e)(1) above, the department shall:

(1) Not deem income from spouse to spouse or parent to child; and

(2) Allow the following verified deductions or disregards to be subtracted from the budgetary unit’s gross income when determining financial eligibility for FPEC:

a. A $90 employment expense deduction, pursuant to He-W 641.02(b)(2); and

b. Other allowable deductions, pursuant to He-W 654.14, He-W 654.19, and He-W 654.20.

(g) Eligible individuals who choose not to receive FPEC, or the eligible individual’s authorized representative, shall notify the department of this decision by providing the department with the following written information terminating FPEC services:

(1) The casehead’s name;

(2) The name of the person for whom the casehead is requesting the termination of FPEC assistance; and

(3) The casehead’s signature.

(h) The date the department receives the completed information described in (g) above, shall be the individual’s FPEC eligibility end date.

History

#10357, eff 7-1-13

N.H. Code Admin. R. Ann. He-W 626.03 Presumptive Eligibility Determinations {#sec-he-w-626.03 omnilex-key=us-nh-regs-official--agency-he-w--He-W 626.03}

(a) A qualified entity as defined in He-W 520.01(g) shall determine presumptive eligibility for FPEC services pursuant to 42 USC 1396r-1c.

(b) Within 5 business days of making the FPEC PE determination, the qualified entity shall provide the department with the following information:

(1) The complete name, address, and date of birth of the individual for whom the FPEC PE determination was made; and

(2) The date the PE determination was made.

History

#10357, eff 7-1-13

Part He-W 627 Technical Requirements for Idp and Fwoc Categories of Financial and Medical Assistance

N.H. Code Admin. R. Ann. He-W 627.01 Technical Requirements for the Interim Disabled Parent (IDP) Category of Financial Assistance {#sec-he-w-627.01 omnilex-key=us-nh-regs-official--agency-he-w--He-W 627.01}

(a) As a condition of eligibility for IDP financial assistance, applicants shall be determined:

(1) Incapacitated pursuant to He-W 628.02;

(2) To be recipients of aid to the permanently and totally disabled (APTD) or aid to the needy blind (ANB); or

(3) Temporarily exempt from the New Hampshire employment program (NHEP) work program pursuant to He-W 606.32.

(b) Applicants and recipients shall not be eligible for IDP when all adults in the assistance group are receiving:

(1) Supplemental security income (SSI); or

(2) Social security disability income (SSDI).

(d) When funding and resources within the current state fiscal year are available and identified by the department as maintenance of effort funding pursuant to 45 CFR 263.2, applicants shall receive IDP financial assistance when the individual:

(1) Has requested an exemption from the NHEP work program pursuant to He-W 606.30(a), (b), or (d); and

(2) Is awaiting a determination of the exemption pursuant to He-W 606.32.

History

#9123, eff 4-3-08; ss by #9275, eff 9-20-08; ss by #9682, eff 3-20-10; ss by #12528, eff 5-22-18

N.H. Code Admin. R. Ann. He-W 627.02 Financial Assistance and Eligibility for Medical Care {#sec-he-w-627.02 omnilex-key=us-nh-regs-official--agency-he-w--He-W 627.02}

RESERVED

History

#9123, eff 4-3-08

N.H. Code Admin. R. Ann. He-W 627.03 Technical Requirements for Families With Older Children (FWOC) Category of Financial and Medical Assistance {#sec-he-w-627.03 omnilex-key=us-nh-regs-official--agency-he-w--He-W 627.03}

(a) To be eligible for FWOC, an assistance group shall include at least one dependent child who is:

(1) At least age 19 up to age 20; and

(2) Enrolled full-time in a secondary school or the equivalent level of vocational or technical training.

(b) Applicants and recipients of FWOC shall include all dependent children described in He-W 601.03(e)(1) when they are counted in the assistance group.

(c) Assistance groups receiving FWOC, which no longer include a dependent child as defined in He-W 601.03(e)(3), shall have eligibility determined for FANF assistance, pursuant to He-W 600.

(d) Recipients of FANF assistance shall have eligibility automatically determined for FWOC when the oldest child in the assistance group turns 19, pursuant to He-W 600.

History

#9123, eff 4-3-08; ss by #9275, eff 9-20-08; ss by #10163, eff 7-26-12

N.H. Code Admin. R. Ann. He-W 627.04 General Requirements for IDP and FWOC Financial Assistance {#sec-he-w-627.04 omnilex-key=us-nh-regs-official--agency-he-w--He-W 627.04}

(a) Applicants and recipients of IDP, as defined in He-W 601.05(i), and FWOC, as defined in He-W 601.04(e), categories of financial assistance shall not be required to assign their rights to financial child support to the department as a condition of eligibility.

(b) Applicants and recipients of IDP and FWOC financial assistance shall not be subject to child support sanctions described in RSA 167:82, V(a).

History

#9123, eff 4-3-08; ss by #9275, eff 9-20-08; ss by #11186, eff 9-20-16

N.H. Code Admin. R. Ann. He-W 627.05 Financial Assistance and Eligibility for Medical Care {#sec-he-w-627.05 omnilex-key=us-nh-regs-official--agency-he-w--He-W 627.05}

RESERVED

History

#9123, eff 4-3-08; ss by #9275, eff 9-20-08; rpld by #11186, eff 9-20-16

Part He-W 628 Deprivation of Parental Support or Care for Financial Assistance to Needy Families Financial Assistance

N.H. Code Admin. R. Ann. He-W 628.01 Deprivation Due to Continued Absence {#sec-he-w-628.01 omnilex-key=us-nh-regs-official--agency-he-w--He-W 628.01}

(a) For a child to be considered deprived of parental support or care due to continued absence, one or both parents shall be physically absent from the child for at least 30 continuous days, beginning with and including the day of separation, in conjunction with any one of the circumstances listed below:

(1) The parents are not married to each other;

(2) The parents are divorced or legally separated;

(3) A parent has filed for a divorce, legal separation, or annulment and such application has been pending in the court for at least 30 days;

(4) The court has issued an injunction or restraining order forbidding a parent to visit the spouse or child for at least 30 days, or if for an indefinite period of time, with a reasonable expectation that the order will be in effect for 30 days or more;

(5) The parent(s) is not legally able to return to the home because of confinement in a correctional institution or mental hospital which will continue or is reasonably expected to continue for at least 30 days; or

(6) The parent(s) has deserted the child or there is mutual separation, and the absence of one or both parents has been continuous for at least 30 days.

(b) The 30-day continuous absence period shall be applied as follows:

(1) If the 30 days have not elapsed at the time of the initial eligibility determination interview, but the absence is expected to last for 30 days or more, financial assistance shall be initiated prior to the end of the 30-day continuous absence period if all other eligibility factors are met;

(2) The individual shall not be entitled to an assistance payment until 30 days of continuous absence have actually elapsed, and the individual has verified the absence as described in (d) and (e) below;

(3) The 30-day continuous absence period shall not be interrupted if:

a. The absent parent returns home to visit the child; or

b. The parents have attempted reuniting the family within the 30 days or within the temporary adjustment period as defined in He-W 601.08, but this attempt has failed; and

(4) Counting for the 30-day continuous absence period shall begin again if:

a. Reunited parents separate following the termination of the temporary adjustment period; or

b. Deprivation is being determined for a different absent parent.

(c) During the temporary adjustment period, financial assistance shall be provided automatically for the month in which the parent returns home and for one full calendar month thereafter unless the individual requests an earlier termination of assistance.

(d) The individual shall verify continued absence:

(1) At the initial eligibility determination;

(2) Whenever a new child is being added to the assistance group;

(3) Whenever the individual, absent parent, or third party reports to the department that the absent parent has returned to the home; and

(4) At each subsequent redetermination.

(e) To verify continued absence pursuant to (d)(1) - (d)(3) above, the individual shall complete and submit Form 773 “Certification of Continued Absence” (October 2024), including signing and dating the form, certifying the following:

(1) “I understand that the deprivation of parental support and care is a condition of eligibility of Financial Assistance to Needy Families (FANF) cash assistance. I agree to notify the district office immediately if any responsible parent returns to my home”; and

(2) Either:

a. “I certify that the parent(s) named below currently has/have been absent from the home for 30 or more continuous days and the absence is expected to continue”; or

b. “I certify that the parent(s) named below currently has/have been absent from the home for less than 30 continuous days but is/are expected to be absent for 30 or more continuous days”.

(f) Pursuant to (d)(4) above, if continued absence pursuant to (e) above was verified at initial certification, and there have been no subsequent changes, the individual shall verify the continued absence of all responsible parents associated with the financial assistance to needy families (FANF) case by:

(1) Attesting to the continued absence of all responsible parents associated with the FANF case; and

(2) Agreeing to immediately notify the department if any responsible parent returns to the home.

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; EXPIRED 6-26-97
#7084, eff 8-26-99; ss by #8970, eff 8-25-07; ss by #10861, eff 8-25-15; ss by #14107, eff 11-2-24

N.H. Code Admin. R. Ann. He-W 628.02 Deprivation Due to Incapacity {#sec-he-w-628.02 omnilex-key=us-nh-regs-official--agency-he-w--He-W 628.02}

(a) The child or children shall be considered to be deprived of support or care due to the parent’s physical or mental incapacity when the incapacity is expected to last for at least 30 days, and the individual:

(1) Is eligible for or receiving supplemental security income (SSI) or social security disability income (SSDI) disability benefits;

(2) Provides currently dated documentation from a licensed physician, licensed physician assistant (PA), licensed advanced practice registered nurse (APRN), board-certified psychologist, master licensed alcohol and drug counselor (MLADC), licensed pastoral psychotherapist (LPP), licensed independent clinical social worker (LICSW), licensed clinical mental health counselor (LCMHC), or licensed marriage and family therapist (LMFT) certifying an incapacity of at least 30 continuous days;

(3) Has been determined by the office of medicaid and business policy (OMBP) as permanently disabled or blind;

(4) Reapplies for assistance within 90 days of being terminated from a case in which incapacity had been established, provided termination was not related to incapacity or earnings from employment;

(5) Is convalescing after being treated in an institution for the mentally ill, or was discharged within 90 days prior to applying for assistance; or

(6) Is needy and intellectually disabled, has resided in a state-operated intermediate care facility for individuals with intellectual disabilities (ICF/IID), and was officially discharged within 90 days of applying for assistance.

(b) The individual shall verify physical or mental incapacity:

(1) At the initial eligibility determination;

(2) At each subsequent redetermination; and

(3) Whenever a change in the incapacity occurs.

(c) To verify incapacity pursuant to (a)(2) above, the individual shall provide currently dated documentation which includes all of the following:

(1) The individual’s name; and

(2) A statement by a licensed physician, licensed PA, licensed APRN, board-certified psychologist, MLADC, LPP, LICSW, LCMHC, or LMFT which indicates:

a. That the current incapacity has existed, or is expected to exist, for at least 30 days;

b. The date when the incapacity began, ended, or is expected to end;

c. The diagnosis, examination date, and current and recommended medical treatment; and

d. The name, address, phone number, profession, and dated signature of the licensed physician, licensed PA, licensed APRN, board-certified psychologist, MLADC, LPP, LICSW, LCMHC, or LMFT.

(d) When incapacity no longer exists, FANF financial assistance shall be provided for the month in which the incapacity ended and for the next full calendar month, unless the individual requests an earlier termination of assistance.

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; EXPIRED 6-26-97
#7084, eff 8-26-99; ss by #8970, eff 8-25-07; ss by #10318, eff 4-25-13; ss by #12718, eff 1-26-19

N.H. Code Admin. R. Ann. He-W 628.03 Financial Assistance and Eligibility for Medical Care {#sec-he-w-628.03 omnilex-key=us-nh-regs-official--agency-he-w--He-W 628.03}

RESERVED

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #6531, INTERIM, eff 6-27-97, EXPIRES: 10-25-97; ss by #6614, eff 10-24-97; amd by #6825, eff 8-3-98; ss by #7084, eff 8-26-99; ss by #8970, eff 8-25-07; ss by #10163, eff 7-26-12; rpld by #13629, eff 5-10-23

Part He-W 630 Living with a Specified Relative

N.H. Code Admin. R. Ann. He-W 630.01 Living with a Specified Relative {#sec-he-w-630.01 omnilex-key=us-nh-regs-official--agency-he-w--He-W 630.01}

(a) For purposes of determining the assistance group for FANF financial and medical assistance, "dwelling" means:

(1) An individual's principal residence or place of abode;

(2) The family setting maintained or in the process of being established as a home, as evidenced by assumption, continuation, and exercise of responsibility for day-to-day care and control of the child by the relative with whom the child is living; and

(3) A living unit as defined in (1) and (2) above with no more than one postal address.

(b) If the dwelling has a separate living unit attached to it with a separate postal address, this living unit shall not be considered part of the same dwelling.

(c) The department shall consider a child to be living with a specified relative as defined in RSA 167:78,XXIII when the child lives in the same dwelling as defined in (a) above as the specified relative unless the conditions in (e) apply.

(d) The department shall consider the specified relative in (c) above to be the casehead for the assistance group.

(e) If a child lives in the same dwelling as both the child's parent and a non-parent specified relative, the department shall consider the child to be living with the parent.

(f) The department shall consider the parent in (e) above to be the casehead in the assistance group unless the conditions in (g) below apply.

(g) If the non-parent specified relative in (e) above is the legal guardian of the child pursuant to RSA 169-C:3,XIV, the department shall:

(1) Consider the non-parent specified relative to be the casehead in the assistance group; and

(2) Consider the parent to be a member of the assistance group pursuant to RSA 167:79,II and He-W 601.01(u).

(h) A child who is not living with a specified relative for a period of 45 consecutive days shall be ineligible for FANF financial assistance if good cause does not exist.

(i) For purposes of paragraph (h), good cause shall exist, pursuant to 42 USC 608(a)(10), when:

(1) The specified relative retains care and control of the child;

(2) The child's return to the home is expected; and

(3) For a child who is absent from the home to attend school, the child returns home during vacation periods and semester breaks or returns home at the end of the school year and has not established another dwelling.

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #6446, eff 2-1-97; amd by #6614, eff 10-24-97; ss by #8050, eff 3-1-04; ss by #10077, eff 3-1-12

Part He-W 631 Unwed Minor Parents

N.H. Code Admin. R. Ann. He-W 631.01 Unwed Minor Parent Requirements {#sec-he-w-631.01 omnilex-key=us-nh-regs-official--agency-he-w--He-W 631.01}

(a) An unwed minor parent shall meet the living arrangement or exemption criteria described in 45 CFR 233.107, or the good cause criteria specified in (b) below as a condition of eligibility for FANF financial assistance.

(b) The department shall determine good cause for failure to meet the living arrangement or exemption criteria described in 45 CFR 233.107 for any of the following reasons:

(1) The parents or legal guardian of the unwed minor parent are unable to accommodate the unwed minor parent and child or children due to insufficient space or lease or rental restrictions or prohibitions;

(2) The unwed minor parent and child or children are living in a court-approved living arrangement; or

(3) The unwed minor parent has:

a. Attempted but was unable to obtain verification for an exemption on his or her own; and

b. Requested district office assistance to obtain verification, and the district office was also unable to obtain such verification.

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #6032, eff 4-29-95; ss by #7834, eff 2-24-03; ss by #9845, eff 2-24-11; ss by #12773, eff 5-7-19

Part He-W 632 Age

N.H. Code Admin. R. Ann. He-W 632.01 Financial Assistance to Needy Families (FANF) Age Requirements {#sec-he-w-632.01 omnilex-key=us-nh-regs-official--agency-he-w--He-W 632.01}

(a) For initial determinations of eligibility for FANF financial assistance, the dependent child shall be younger than the maximum allowable age, as defined in He-W 601.05, on the first day of eligibility and on the day the first financial assistance payment is issued.

(b) Terminations of FANF financial assistance due to a dependent child attaining the maximum age limit shall be effective as of the first day of the month following the child's birth month.

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; amd by #6195, eff 2-24-96; ss by #6531, INTERIM, eff 6-27-97, EXPIRES: 10-25-97; ss by #6614, eff 10-24-97; amd by #6825, eff 8-3-98; amd by #8452, eff 10-22-05; amd by #8684, eff 7-21-06; ss by #10471, eff 11-26-13; ss by #13767, eff 10-7-23

Part He-W 634 Strikers

N.H. Code Admin. R. Ann. He-W 634.01 Strikers and Eligibility for Financial Assistance to Needy Families (FANF) {#sec-he-w-634.01 omnilex-key=us-nh-regs-official--agency-he-w--He-W 634.01}

(a) If an individual is participating in a strike, as defined in He-W 601.07, the individual shall be denied FANF financial assistance, regardless of whether the individual:

(1) Voted for or against the strike; or

(2) Is exempt from New Hampshire employment program (NHEP) work participation requirements.

(b) The following individuals shall not be considered strikers:

(1) Individuals whose work place is closed due to a lockout by an employer to resist demands of employees;

(2) Individuals unable to work as a result of other employees on strike; or

(3) Individuals not wanting to cross a picket line due to fear of personal injury or death.

(c) Individuals who quit their jobs or are fired while on strike shall be treated like any other applicant or recipient for FANF financial assistance who has quit or been fired from employment.

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #6531, INTERIM, eff 6-27-97, EXPIRES: 10-25-97; ss by #6614, eff 10-24-97; ss by #8452, eff 10-22-05; ss by #10471, eff 11-26-13; ss by #13615, eff 4-26-23

Part He-W 636 Technical Requirements for New Hampshire Employment Program (nhep) and Family Assistance Program (fap) Financial Assistance

N.H. Code Admin. R. Ann. He-W 636.01 Personal Interview {#sec-he-w-636.01 omnilex-key=us-nh-regs-official--agency-he-w--He-W 636.01}

(a) A personal interview at each regularly scheduled redetermination of eligibility shall not be required when members of the financial assistance for needy families (FANF) financial assistance group (AG) do not receive benefits from the supplemental nutrition assistance program (SNAP) and when:

(1) A caretaker relative, as defined in He-W 601.02, is a member of the AG; or

(2) The parent is not included as a member of the AG.

(b) A personal interview between the FANF individual or the individual’s authorized representative (AR), as defined in He-W 601.01, and the department’s representative shall be required:

(1) At initial determination of eligibility;

(2) At least once in a 12-month period for a regularly scheduled redetermination; and

(3) As a result of reported changes or discovery of conflicting information regarding eligibility.

(1) Within 30 days from the date of application, for an initial determination of eligibility, then assistance shall be denied; or

(2) Within the redetermination month for a redetermination of eligibility, then assistance shall be terminated at the end of the advance notice period, as described in He-W 604.03.

(d) The individual or the individual’s AR shall review the summary of the information provided to the department’s representative during the interview, make any necessary corrections, and return it to the

department within 10 calendar days if corrections have been made.

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #6531, INTERIM, eff 6-27-97, EXPIRES: 10-25-97; ss by #6614, eff 10-24-97; amd by #6745, (HB 32), eff 5-1-98, EXPIRED: 12-31-98; amd by #6826, eff 8-3-98; amd by #6896, eff 12-1-98; amd by #6925, eff 1-1-99; amd by #7666, eff 4-1-02; amd by #7766, eff 10-1-02; amd by #8325, eff 5-1-05; amd by #8452, eff 10-22-05; amd by #8783, INTERIM, eff 12-30-06, EXPIRES: 6-28-07; amd by #8903, eff 6-28-07; ss by #10163, eff 7-26-12; ss by #13438, eff 8-20-22; ss by #13801, eff 10-21-23

N.H. Code Admin. R. Ann. He-W 636.02 Verification of Identity {#sec-he-w-636.02 omnilex-key=us-nh-regs-official--agency-he-w--He-W 636.02}

All financial assistance to needy families (FANF) applicants, including parents, caretaker relatives, and children, shall verify their identity, pursuant to He-W 606.28, as a condition of eligibility.

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #6531, INTERIM, eff 6-27-97, EXPIRES: 10-25-97; ss by #6614, eff 10-24-97; ss by #8452, eff 10-22-05; ss by #10471, eff 11-26-13; ss by #13663, eff 6-21-23

N.H. Code Admin. R. Ann. He-W 636.03 School Attendance {#sec-he-w-636.03 omnilex-key=us-nh-regs-official--agency-he-w--He-W 636.03}

(a) To be classified as a student, the individual shall:

(1) Be listed as a current student by the school, educational institute, or training program;

(2) Be present in person or online for the class or program; and

(3) Be considered to be in regular attendance when verification is provided that proves:

a. Full-time attendance, as defined by the school, the educational institute or training program, or the curriculum of study or training leading to a certificate, diploma, or degree;

b. At least half-time attendance, as defined by the school, the educational institute or training program, or the curriculum of study or training leading to a certificate, diploma, or degree, while also regularly employed in, or available for and actively seeking, part-time employment; or

c. At least half-time attendance, as defined by the school, the educational institute or training program, or the curriculum of study or training leading to a certificate, diploma or degree, and precluded from full-time attendance or part-time employment because of a verified disability.

(b) The conditions for classification as a student as described in (a) above shall not be considered to have been met when the individual:

(1) Enrolls in, but does not regularly attend, classes; or

(2) Takes correspondence courses.

(c) Individuals shall be considered students during months in which they are not attending a school, an educational institute, or a training program when the absence is due to:

(1) Official school, educational institute, or training program semester breaks or vacations; or

(2) Illness, convalescence, or family emergency, as long as the individual plans on returning to the school, educational institute, or training program when the reason for the absence has ended.

(d) An individual who has already received a certificate, degree, or diploma, but is repeating the course or program to obtain better grades or skills in an effort to improve employment opportunities, shall be classified as a student if all other criteria are met.

(e) An individual shall be considered a student through the end of the month in which the individual completes or discontinues attending the school, the educational institute, or the training program.

(f) Once student status is verified, the individual shall be considered a student until the next redetermination, unless the department is notified otherwise by the individual, the school, the educational institute, or the training program.

(g) If student status is not verified, the individual shall not be considered a student.

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; amd by #6195, eff 2-24-96; ss by #6531, INTERIM, eff 6-27-97, EXPIRES: 10-25-97; ss by #6614, eff 10-24-97; ss by #8452, eff 10-22-05; ss by #10471, eff 11-26-13; ss by #13663, eff 6-21-23

N.H. Code Admin. R. Ann. He-W 636.04 Financial Assistance and Eligibility for Medical Care {#sec-he-w-636.04 omnilex-key=us-nh-regs-official--agency-he-w--He-W 636.04}

He-W 636.07 - RESERVED

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #5447, eff 10-1-92; ss by #5528, eff 12-14-92; amd by #5856, eff 7-1-94; amd by #5901, eff 10-1-94; amd by #6238, eff 5-1-96; amd by #6241, eff 5-4-96; amd by #6242, eff 5-4-96; rpld by #6446, eff 2-1-97

N.H. Code Admin. R. Ann. He-W 636.08 Disclosure of Paternity Information {#sec-he-w-636.08 omnilex-key=us-nh-regs-official--agency-he-w--He-W 636.08}

(a) All FANF applicants and recipients shall identify the father of a child for whom assistance is being sought as specified in RSA 167:79, III (c), unless good cause pursuant to RSA 167:82, III (b) exists.

(b) Individuals who do not identify the father at the personal interview shall:

(1) Be referred to the bureau of child support services (BCSS);

(2) Be contacted and interviewed by a BCSS child support worker for the purpose of understanding the importance of child support and establishing paternity; and

(3) Participate in an interview with the BCSS child support worker within 10 days from the contact.

(c) Individuals who do not participate in the interview with child support within 10 days from the date of the BCSS contact shall be denied financial assistance.

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #5447, eff 10-1-92; ss by #5528, eff 12-14-92; amd by #5856, eff 7-1-94; amd by #5901, eff 10-1-94; amd by #6238, eff 5-1-96; amd by #6241, eff 5-4-96; amd by #6242, eff 5-4-96; rpld by #6446, eff 2-1-97
#8869, eff 4-19-07; ss by #10163, eff 7-26-12; ss by #13438, eff 8-20-22

N.H. Code Admin. R. Ann. He-W 636.09 Good Cause for Failure to Cooperate {#sec-he-w-636.09 omnilex-key=us-nh-regs-official--agency-he-w--He-W 636.09}

(a) Good cause reasons for failure to cooperate with child support requirements shall be one of the following:

(1) The effort to establish paternity or secure child support is against the best interests of the child and could result in:

a. Physical or emotional harm to the child; or

b. Physical or emotional harm to the parent or caretaker relative;

(2) The child was conceived as a result of incest or rape;

(3) Proceedings for adoption of the child are pending in a court; or

(4) A public or private social service agency is helping the parent or caretaker relative decide whether to relinquish the child for adoption.

(b) No child support action shall be taken while a good cause claim is being verified by the department.

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #6531, INTERIM, eff 6-27-97, EXPIRES: 10-25-97; ss by #6614, eff 10-24-97; amd by #8452, eff 10-22-05; paragraphs (a) and (b) in #6614 EXPIRED: 10-24-05; ss by #10471, eff 11-26-13; ss by #13663, eff 6-21-23

N.H. Code Admin. R. Ann. He-W 636.10 Sanction for Failure to Cooperate {#sec-he-w-636.10 omnilex-key=us-nh-regs-official--agency-he-w--He-W 636.10}

A sanction of 25% of the assistance group’s payment standard as defined in He-W 658.02 shall be implemented, in accordance with 42 U.S.C. 608(a)(2), for any individual receiving family assistance program or New Hampshire employment program financial assistance who fails to cooperate with child support requirements without good cause as described in RSA 167:82, III(b).

History

(See Revision Note #1 at Chapter Heading He-W 600) #6446, eff 2-1-97; ss by #8271, eff 2-1-05; ss by #8740, INTERIM, eff 10-13-06, EXPIRED: 4-11-07
#8869, eff 4-19-07; ss by #10803, eff 3-26-15; ss by #14130, eff 11-26-24, EXPIRES: 11-26-34

Part He-W 637 The New Hampshire Employment Program (nhep)

N.H. Code Admin. R. Ann. He-W 637.01 Financial Assistance and Eligibility for Medical Care {#sec-he-w-637.01 omnilex-key=us-nh-regs-official--agency-he-w--He-W 637.01}

Definitions.

(a) “Assessment” means an evaluation of a New Hampshire employment program (NHEP) participant, conducted by a NHEP representative, in order to develop or update an employability plan and identify the need for support services.

(b) “Case management” means a process of planning, locating, coordinating, and monitoring services jointly with a NHEP participant in order to achieve the goals of the employability plan.

(c) “Employability plan” means an individualized plan designed to direct the NHEP participant toward long-term economic mobility. The term includes “employment contract”.

(d) “Employed” means, for the purposes of participation requirements under NHEP, NHEP participants who are engaged in unsubsidized employment for wages.

(e) “Exempt individual” means a financial assistance to needy families (FANF) recipient who is not required to participate in the employment, training, or other employment-related activity under the NHEP work program.

(f) “NHEP participant” means an individual who is enrolled in the NHEP work program and is receiving FANF financial assistance.

(g) “NHEP representative” means any agency staff providing services to NHEP participants.

(h) “Provider” means a business, agency, or organization that is responsible for the supervision of an NHEP participant in a federally approved temporary assistance to needy families (TANF) activity.

(i) “Satisfactory progress” means meeting the minimum standards set by an organization or agency, the educational or training facility, employer or provider, which measures the NHEP participant's:

(1) Proficiency level in an activity; and

(2) Ability to complete the activity in a timely manner.

(j) “Serious and substantial personal barrier” means the NHEP participant is experiencing a debilitating situation such as homelessness, substance abuse addiction, domestic violence, physical or mental disability, emotional or mental instability, or any other situation which needs to be addressed.

(k) “Single training course or course of study” means a class or training as described in He-W 637.15(a).

(l) “Vocational education and training” means a program of study beyond high school or its equivalent to include an associate’s degree, a bachelor’s or a master’s degree, credential certificate, or a licensure attainment. This term includes “vocational educational training”.

History

(See Revision Note #1 at Chapter Heading He-W 600) #6446, eff 2-1-97; amd by #6818, eff 7-25-98; amd by #6997, eff 5-20-99; amd by #7372, eff 12-1-00; amd by #8161, eff 10-1-04; amd by #8268, eff 2-1-05; amd by #8269, eff 2-1-05; ss by #8740, INTERIM, eff 10-13-06, EXPIRED: 4-11-07
#8869, eff 4-19-07; ss by #10163, eff 7-26-12; ss by #13549, eff 2-1-23

N.H. Code Admin. R. Ann. He-W 637.02 NHEP Orientation {#sec-he-w-637.02 omnilex-key=us-nh-regs-official--agency-he-w--He-W 637.02}

(a) Pursuant to RSA 167:79, III(a), during the eligibility application interview, applicants for FANF financial assistance shall be scheduled for an NHEP orientation session within 10 days from the date of application.

(b) The NHEP orientation session shall be offered by telephone, virtually, or in-person.

(1) Is an applicant for financial assistance program (FAP) financial assistance;

(2) Is an adult claiming incapacity in a family applying for FANF financial assistance; or

(3) Is an applicant for FANF financial assistance who are experiencing a serious medical condition that prevents the ability to attend.

(d) Individuals described in (a) above shall be rescheduled for another NHEP orientation session within 10 days of the individual’s contact with department staff, when:

(1) The individual is unable to attend the first scheduled NHEP orientation session; and

(2) The individual contacts the department to reschedule the session prior to the denial of financial assistance as described in (e) below.

(e) Individuals described in (a) above who do not contact the department to reschedule the NHEP orientation session shall be denied financial assistance on the 21st day following the eligibility application interview.

(f) Attendance at the NHEP orientation session shall be a condition of financial eligibility pursuant to RSA 167:79, III(a) and shall be considered fulfilled when the department or NHEP representative confirms that the individual in (a) above has attended.

History

(See Revision Note #1 at Chapter Heading He-W 600) #6446, eff 2-1-97; amd by #6595, eff 10-1-97; amd by #6818, eff 7-25-98; amd by #6997, eff 5-20-99; amd by #7206, eff 3-1-00; amd by #8268, eff 2-1-05; ss by #8452, eff 10-22-05; ss by #8740, INTERIM, eff 10-13-06, EXPIRED: 4-11-07
#8869, eff 4-19-07; ss by #10163, eff 7-26-12; ss by #13549, eff 2-1-23

N.H. Code Admin. R. Ann. He-W 637.03 NHEP Employment Activities Participation Requirements {#sec-he-w-637.03 omnilex-key=us-nh-regs-official--agency-he-w--He-W 637.03}

(a) Unless specifically exempted under one or more of the criteria described in RSA 167:82, II, NHEP participants shall attend all required appointments and participate in NHEP employment-related activities as specified in the employability plan pursuant to He-W 637.12, as funding and resources allow.

(b) NHEP activities, pursuant to RSA 167:85, shall be a single activity or a combination of activities to equal the requirements in (c) or (d) below and as specified in the employability plan.

(c) NHEP participants with a child 6 years of age or older shall participate in NHEP employment-related activities for a minimum period as specified in 42 U.S.C. 607, up to a maximum of 40 hours a week as specified in the employability plan.

(d) NHEP participants with a child 13 weeks of age and up to the child’s 6th birthday, shall participate in NHEP employment-related activities for a minimum of 20 hours a week pursuant to RSA 167:85, VI.

(e) When an NHEP participant is meeting the requirements stated in (d) above, the NHEP representative shall have the option to amend the employability plan as agreed upon with the participant to require the participant to participate in additional weekly hours above the 20 hour minimum up to a maximum of 40 hours to aid in improving the participant’s economic status over the course of the participant’s lifetime.

(f) Participants described in (d) above who are in unsubsidized employment or in a work experience or community service program as described in He-W 637.21 and participating for a minimum of 20 hours a week, shall participate in other approved federal temporary assistance to needy families (TANF) activities up to a combined maximum of 40 hours a week as specified in the employability plan.

(g) Acceptable verification of NHEP weekly participation hours in approved activities pursuant to RSA 167:85, IV shall include, but not be limited to a signed statement or verified electronic confirmation as outlined in the employability plan from the NHEP participant containing all of the following information:

(1) The NHEP participant’s name, recipient identification number, and week begin and end dates; and

(2) The date each approved activity took place, the time spent in each activity described in 15 minute increments, and the miles driven to participate in each activity, if applicable.

(h) Self-employed participants who are unable to verify NHEP participation hours using the documentation described in (g) above, shall verify NHEP participation hours by providing documentation establishing a participant’s compliance which includes, but is not limited to:

(1) That the self-employment work is currently being performed for income;

(2) A brief description of the self-employment responsibilities;

(3) The amount of the expected income; and

(4) That the income will be paid and received within 30 days from the date of verification.

(i) Failure to meet the requirements indicated in (h) above shall result in the application of the sanction provisions pursuant to RSA 167:82,V.

(j) The NHEP participant shall contact the NHEP representative a minimum of once every 4 weeks, unless the employability plan indicates otherwise.

(k) Participation in educational or training programs shall meet hourly work program participation requirements, provided:

(1) The NHEP participant is making satisfactory progress in the programs; and

(2) The need for the educational or training program meets the requirements described in RSA 167:85 and in He-W 637.22.

(l) Individuals who volunteer to participate in NHEP shall be subject to the same requirements of the program activities as mandatory NHEP participants, but shall not be sanctioned for failure to participate as specified in He-W 637.06.

History

(See Revision Note #1 at Chapter Heading He-W 600) #6446, eff 2-1-97; amd by #6595, eff 10-1-97; amd by #6789, eff 7-1-98; amd by #6818, eff 7-25-98; amd by #7206, eff 3-1-00; ss by #7523, eff 7-1-01; amd by #8161, eff 10-1-04; amd by #8175, eff 10-1-04; amd by #8268, eff 2-1-05; amd by #8269, eff 2-1-05; paragraph (d) EXPIRED: 7-1-06; paragraph (h) EXPIRED: 7-25-06; ss by #8740, INTERIM, eff 10-13-06, EXPIRED: 4-11-07
#8869, eff 4-19-07; ss by #10163, eff 7-26-12; ss by #13549, eff 2-1-23

N.H. Code Admin. R. Ann. He-W 637.04 Exemptions {#sec-he-w-637.04 omnilex-key=us-nh-regs-official--agency-he-w--He-W 637.04}

(a) Exemptions from work requirements shall be either temporary or permanent, and decisions regarding exemptions shall be subject to the administrative appeals process described in He-C 200.

(b) A parent under age 20 without a high school diploma or its equivalent shall, pursuant to 42 U.S.C 608(a)(4), participate in basic education activities described in He-W 637.17 when the child reaches age 12 weeks, for the number of hours specified in He-W 637.03.

(1) The next redetermination of eligibility;

(2) The individual notifies the department that the condition qualifying for the exemption no longer exists;

(3) The department discovers that the individual no longer qualifies for the exemption; or

(4) The individual enters his or her 40th month of receipt of FANF assistance.

(d) Individuals who lose exemption status due to (c)(4) above shall participate in the New Hampshire employment program (NHEP) work program except for:

(1) Individuals who have been temporarily deferred pursuant to (b) above, who shall not be required to participate until their youngest child reaches 12 weeks old; and

(2) Individuals who have medical exemptions pursuant to He-W 606.30.

(e) A permanent exemption shall exist when:

(1) A parent or included caretaker relative does not meet the definition of able-bodied as defined in RSA 167:78, I and receives one or more of the following benefits:

a. Supplemental security income (SSI);

b. Social security disability insurance (SSDI);

c. Veteran’s disability rating of 80% or more; or

d. State supplemental assistance, such as aid to the permanently and totally disabled (APTD), aid to the needy blind (ANB), or old age assistance (OAA);

(2) A dependent child who is 16 or older and is not a full time student has a documented permanent and total disability as verified by a licensed physician, licensed physician assistant (PA), licensed advanced practice registered nurse (APRN), board certified psychologist, master licensed alcohol and drug counselor (MLADC), licensed pastoral psychotherapist (LLP), licensed independent clinical social worker (LICSW), licensed clinical mental health counselor (LCMHC), or licensed marriage and family therapist (LMFT); or

(3) A determination has been made by the NHEP representative that a parent or included caretaker relative has long term obstacles to employment resulting in an inability to participate in employment or activities leading to employment subject to the following:

a. The individual has participated in and complied with all NHEP requirements or has been unable to comply with good cause;

b. The NHEP representative has completed case management activities with the individual for at least one year;

c. During the one year specified in b. above, all reasonable efforts to assist the individual in becoming employable by providing case management services and access to all NHEP employment related activities for which the individual might qualify have been made; and

d. The individual agrees with the NHEP representative’s decision; and

(4) A recommendation has been made by the hardship extension review committee that the family includes an adult caring for a household member with a disability per RSA 167:82, II(g) subject to the following:

a. The individual has received at least one hardship extension for this reason; and

b. The individual agrees with the committee’s recommendation.

(f) Permanent exemptions shall not be re-evaluated:

(1) As long as the benefits specified in (e)(1) above, are being received by the individual; or

(2) Until the individual notifies the department that his or her circumstances as described in (e)(2), (3), and (4) above, have changed, or the department discovers that circumstances have changed, whichever occurs first.

History

(See Revision Note #1 at Chapter Heading He-W 600) #6446, eff 2-1-97; amd by #6595, eff 10-1-97; amd by #6789, eff 7-1-98; amd by #7372, eff 12-1-00; amd by #7523, eff 7-1-01; amd by #7918, eff 8-1-03; amd by #8269, eff 2-1-05; paragraph (b) amd by #8740, INTERIM, eff10-13-06, EXPIRED: 4-11-07; paragraph (b) amd by #8869, eff 4-19-07; ss by #9534, eff 9-1-09; ss by #12402, eff 10-20-17; ss by #12718, eff 1-26-19

N.H. Code Admin. R. Ann. He-W 637.05 Compliance {#sec-he-w-637.05 omnilex-key=us-nh-regs-official--agency-he-w--He-W 637.05}

(a) In accordance with RSA 167:82, 167:85, 167:88, and 167:90-92, the NHEP participant shall:

(1) Develop and maintain a written, current contingency plan, with the assistance and approval of the NHEP representative, identifying child care and transportation arrangements as needed to participate in all NHEP appointments and scheduled activities;

(2) Contact an NHEP representative prior to being unable to attend orientations, assessments, NHEP activities, or other scheduled appointments;

(3) Attend an NHEP orientation as a condition of eligibility for NHEP financial assistance or financial assistance for unemployed parents;

(4) Keep all scheduled appointments and attend scheduled NHEP activities;

(5) Cooperate in the completion of the assessment interview as described in He-W 637.09 and in the development of the employability plan as described in He-W 637.12;

(6) Participate in a single activity or in a combination of NHEP employment-related activities as specified in the employability plan within the timeframes indicated on the employability plan;

(7) Make a good faith effort, as described in (b) below, in meeting and complying with all of the steps in the NHEP participant’s employability plan; and

(8) Accept and maintain suitable employment, pursuant to RSA 167:92.

(b) A good faith effort on the part of the NHEP participant shall include all of the following:

(1) Keeping scheduled appointments;

(2) Providing required verification or information whenever requested by department staff;

(3) Attending classes, meetings, orientations, workshops, and appointments as scheduled;

(4) Going to job and work experience interviews as instructed;

(5) For individuals who remain eligible for FANF financial assistance, continuing employment, and other NHEP activities; and

(6) Participating in the number of hours specified in the employability plan for any required activity.

History

(See Revision Note #1 at Chapter Heading He-W 600) #6446, eff 2-1-97; amd by #8161, eff 10-1-04; ss by #8269, eff 2-1-05; ss by #8740, INTERIM, eff 10-13-06, EXPIRED: 4-11-07
#8869, eff 4-19-07; ss by #10163, eff 7-26-12; ss by #13549, eff 2-1-23

N.H. Code Admin. R. Ann. He-W 637.06 Failure to Comply {#sec-he-w-637.06 omnilex-key=us-nh-regs-official--agency-he-w--He-W 637.06}

(a) Pursuant to RSA 167:83, III, a New Hampshire employment program (NHEP) participant who has not complied with an NHEP requirement shall be advised in writing of the following:

(1) The specific act of non-compliance by the NHEP participant which constitutes grounds for sanction;

(2) The specific action required by the NHEP participant to remove the sanction;

(3) The opportunity to claim good cause as described in He-W 637.07; and

(4) The right to request an administrative appeal pursuant to He-C 200.

(b) To avoid being sanctioned, pursuant to RSA 167:82, V, the NHEP participant shall:

(1) Contact the NHEP representative to explain the reason for the act of non-compliance; and

(2) Provide verification:

a. Showing that the NHEP participant did comply; or

b. Substantiating a good cause claim, as described in He-W 637.07.

(c) The NHEP participant shall have 7 business days from the date of the notification of non-compliance to meet the requirements described in (b) above.

(d) Failure to meet the requirements described in (b) above within the time period described in (c) above shall result in the individual being sanctioned, pursuant to RSA 167:82, V, no later than 10 business days from the date of the notification of non-compliance.

(e) No sanction shall be applied for an NHEP participant who participates in NHEP voluntarily.

(f) Pursuant to RSA 167:82, III(c) and (d), NHEP participants who voluntarily quit unsubsidized positions without good cause, as described in He-W 637.07, shall be subject to sanctions as specified in RSA 167:82, V.

History

(See Revision Note #1 at Chapter Heading He-W 600) #6446, eff 2-1-97; amd by #7933, eff 9-1-03; amd by #8161, eff 10-1-04; amd by #8269, eff 2-1-05; ss by #8740, INTERIM, eff 10-13-06, EXPIRED: 4-11-07
#8869, eff 4-19-07; ss by #10803, eff 3-26-15; ss by #14131, eff 11-26-24, EXPIRES: 11-26-34

N.H. Code Admin. R. Ann. He-W 637.07 Good Cause {#sec-he-w-637.07 omnilex-key=us-nh-regs-official--agency-he-w--He-W 637.07}

(a) Good cause shall exist, pursuant to RSA 167:82, III(c), when:

(1) A family experiences a net loss of income or loss of shelter, pursuant to (f) and (g) below; or

(2) A family includes an individual who has been a victim of domestic violence as defined in 42 U.S.C. 602(a)(7)(B), pursuant to (h) below.

(b) Good cause for lack of adequate child care pursuant to RSA 167:82, III(c)(8) shall:

(1) Apply for children:

a. Under age 13; or

b. Over age 13 but under age 18 provided the child’s physical or mental condition is such that the child would cause harm to themselves or to others without supervision;

(2) Not include instances where providers refuse to provide child care due to intentional non-payment of child care bills by the individual; and

(3) Be considered to exist when the individual provides in writing the claim and the specific reason(s) why the quality of care from a provider is not adequate as described in (d)(4) below.

(c) When the individual claims inadequate child care as identified in (b)(3) above, the individual shall explore other child care providers and options for obtaining adequate child care.

(d) Adequate child care, as referenced in (b) above, shall be considered available from providers who:

(1) Have openings and to whom the individual has a means of transporting the children;

(2) Are licensed or license-exempt;

(3) Meet all the qualifications and requirements for providers, contract agencies, or both specified in He-C 6914.04 and meet the definitions at RSA 170-E:2, IV or RSA 170-E:3;

(4) Provide care that is representative of the quality of child care provided to other children in

the community; and

(5) Meet the household's basic requirements for child care, such as providing care during the required hours, or providing special treatment for a child with a disability if necessary.

(e) Acceptable verification for a good cause reason for non-participation with New Hampshire employment program (NHEP) work requirements shall include, but not be limited to:

(1) Written verification from a third party pertaining to the individual’s medical visits, mandated appointments or other circumstances beyond the individual’s control;

(2) A signed and dated written statement from the individual, under penalty of unsworn falsification pursuant to RSA 641:3, indicating the individual’s past efforts to contact local agencies to resolve the reason for non-participation; or

(3) A signed and dated written statement from the individual, under penalty of unsworn falsification pursuant to RSA 641:3, indicating the individual’s continued efforts to resolve the reason for non-participation.

(f) The good cause provision due to net loss of income as identified in (a)(1) above, shall be met when the net income available to a family at the time the offer of employment was made is less than the financial assistance grant the family received under financial assistance to needy families.

(g) Net loss of income shall be calculated as the family’s gross income, which shall include, but not be limited to, earnings, unearned income, and cash assistance less the total of necessary work-related expenses, such as child care, transportation, and any other mandatory work related expense required by the employer.

(h) Individuals who make a good cause claim due to (a)(2) above shall be required to provide the following corroborative evidence to verify the claim:

(1) Court, medical, criminal, child protective services, psychological, or law enforcement records, or a statement from a social service provider;

(2) A signed and dated written statement from a social worker from a public or private social service agency; or

(3) A signed and dated written statement from an individual not included in the assistance group with knowledge of the circumstances.

(i) Pursuant to 45 CFR 260.52(c), if the individual is not able to provide corroborative evidence as described in (h) above, the individual shall submit a signed and dated written statement, under penalty of unsworn falsification, pursuant to RSA 641:3, that indicates:

(1) The existence of the situation in (a)(2) above and that compliance with the work program participation requirements would make it more difficult for the assistance group to escape the situation;

(2) That the work participation requirements would unfairly penalize the assistance group which is or has been victimized; or

(3) That the work participation requirements would put the assistance group at further risk.

(j) Good cause for loss of shelter shall be deemed to temporarily exist for failure to comply with voluntary quit and work-related activities when the individual:

(1) Is in immediate threat of eviction;

(2) Is living in an abandoned building, place of business, car or other vehicle, or in a place not designed to be, or not ordinarily used as, a regular sleeping accommodation for human beings; or

(3) Has provided documentation establishing the existence of an unstable living arrangement that impedes the individual’s ability to meet work participation requirements.

(k) An individual may make the claim for good cause for non-participation with NHEP work requirements when they indicate that they are, or have previously been, a victim of domestic violence as defined in 42 U.S.C. 602(a)(7)(B), where compliance with normal work program requirements would:

(1) Make it more difficult to escape the situation;

(2) Unfairly penalize those who are or have been victimized; or

(3) Put them at further risk.

(l) All good cause decisions shall be made by the department of health and human services considering all available facts and circumstances, including information submitted by:

(1) The individual;

(2) The employer;

(3) Other agencies providing an NHEP service or activity; and

(4) Any other individual with firsthand knowledge of the facts, circumstances, or both, of the situation.

(m) Good cause decisions shall be subject to the administrative appeal process established by He-C 200.

History

(See Revision Note #1 at Chapter Heading He-W 600) #6446, eff 2-1-97; amd by #7192, eff 2-1-00, amd by #8175, eff 10-1-04; amd by #8269, eff 2-1-05; intro. and paragraphs (d) & (g)-(i) amd by #8740, INTERIM, eff 10-13-06, EXPIRED: 4-11-07; intro. and paragraphs (d) & (g)-(i) amd by #8869, eff 4-19-07; ss by #9104, eff 3-15-08; ss by #11063, eff 3-25-16; ss by #14354, eff 8-26-25, EXPIRES: 8-26-35

N.H. Code Admin. R. Ann. He-W 637.08 Sanctions {#sec-he-w-637.08 omnilex-key=us-nh-regs-official--agency-he-w--He-W 637.08}

(a) Sanctions, as defined in He-W 601.07, shall be implemented for a parent or caretaker relative in accordance with RSA 167:82, III – V.

(b) Financial assistance shall be restored retroactively to the pre-sanction level if the department applies a sanction and later grants good cause to remove the sanction for the sanctionable action.

(c) Individuals who have identified themselves as homeless on their application shall not be sanctioned for failure to comply with mailed instructions unless the department is informed by the participant or other outside sources that the mailing was received.

History

(See Revision Note #1 at Chapter Heading He-W 600) #6446, eff 2-1-97; amd by #7933, eff 9-1-03; amd by #7991, eff 12-1-03; amd by #8161, eff 10-1-04; amd by #8269, eff 2-1-05; paragraphs (a)-(d) amd by #8740, INTERIM, eff 10-13-06, EXPIRED: 4-11-07; paragraphs (a)-(d) amd by #8869, 4-19-07; ss by #10163, eff 7-26-12; ss by #13549, eff 2-1-23

N.H. Code Admin. R. Ann. He-W 637.09 Initial Assessment {#sec-he-w-637.09 omnilex-key=us-nh-regs-official--agency-he-w--He-W 637.09}

(a) An individual shall participate in an initial assessment interview with department staff.

(b) Participation in an initial assessment interview shall be required for all NHEP participants pursuant to 45 CFR 261.11.

(c) The NHEP participant shall provide information, pursuant to 45 CFR 261.13 to the NHEP representative resulting in the development of the employability plan as outlined in He-W 637.12.

(d) An initial assessment shall be completed by an NHEP representative within 90 days of the date an individual becomes eligible for financial assistance.

History

(See Revision Note #1 at Chapter Heading He-W 600) #6446, eff 2-1-97; paragraphs (a)-(c) EXPIRED: 2-1-05; paragraphs (d)-(f) amd by #8269, eff 2-1-05; paragraphs (a)-(c) amd by #8740, INTERIM, eff 10-13-06, EXPIRED: 4-11-07; paragraphs (a)-(c) & (f)-(k) amd by #8869, eff 4-19-07; ss by #10163, eff 7-26-12; ss by #13549, eff 2-1-23

N.H. Code Admin. R. Ann. He-W 637.10 Financial Assistance and Eligibility for Medical Care {#sec-he-w-637.10 omnilex-key=us-nh-regs-official--agency-he-w--He-W 637.10}

RESERVED

History

(See Revision Note #1 at Chapter Heading He-W 600) #6446, eff 2-1-97; amd by #7206, eff 3-1-00; amd by #8268, eff 2-1-05; amd by #8269, eff 2-1-05, rpld by #8740, INTERIM, eff 10-13-06

N.H. Code Admin. R. Ann. He-W 637.11 Financial Assistance and Eligibility for Medical Care {#sec-he-w-637.11 omnilex-key=us-nh-regs-official--agency-he-w--He-W 637.11}

RESERVED

History

(See Revision Note #1 at Chapter Heading He-W 600) #6446, eff 2-1-97; amd by #6818, eff 7-25-98, EXPIRED: 7-25-06

N.H. Code Admin. R. Ann. He-W 637.12 Employability Plan {#sec-he-w-637.12 omnilex-key=us-nh-regs-official--agency-he-w--He-W 637.12}

(a) Information collected during the initial assessment pursuant to RSA 167:88 and He-W 637.09 shall be used to develop the employability plan.

(b) For purposes of establishing the employability plan as defined in He-W 637.01(c), the New Hampshire employment program (NHEP) representative shall take into account the following:

(1) Available program activities and support services as funding and resources permit;

(2) The extent of support services needed by and available to the participant and the participant's family;

(3) The participant's skills;

(4) Employment opportunities that meet the needs of the participant; and

(5) Employment goals for achieving long-term economic independence to aid in improving the participant’s economic status over the participant’s lifetime including goals for employment in the labor market.

(1) Be developed jointly with the participant and, if applicable, the authorized representative (AR), as defined in He-W 601.01(w), and the NHEP representative;

(2) Indicate employment goals for achieving long-term economic independence including goals for employment in the local labor market;

(3) Outline a planned series of action steps and the related time frames necessary to support employment goals;

(4) Describe the NHEP activities to establish participant obligations;

(5) Address the support services needed for the participant and their family; and

(6) Indicate the type and frequency of the contact between the NHEP participant and NHEP representative.

(d) Participants may request a review of the employability plan at any time.

(e) The NHEP representative shall have the final authority for approval of the employability plan.

(f) Failure to make satisfactory progress as required in RSA 167:85 IV(e) and as defined in He-W 637.01(i) in an activity shall result in a review of the employability plan and the participant’s participation in that activity.

History

(See Revision Note #1 at Chapter Heading He-W 600) #6446, eff 2-1-97; ss by #8269, eff 2-1-05; paragraph (a) amd by #8740, INTERIM, eff 10-13-06, EXPIRED: 4-11-07; paragraphs (a) & (b) amd by #8869, eff 4-19-07; ss by #10275, eff 2-21-13; ss by #13603, eff 3-28-23

N.H. Code Admin. R. Ann. He-W 637.13 Financial Assistance and Eligibility for Medical Care {#sec-he-w-637.13 omnilex-key=us-nh-regs-official--agency-he-w--He-W 637.13}

RESERVED

History

(See Revision Note #1 at Chapter Heading He-W 600) #6446, eff 2-1-97; amd by #6818, eff 7-25-98; rpld by #8268, eff 2-1-05

N.H. Code Admin. R. Ann. He-W 637.14 Financial Assistance and Eligibility for Medical Care {#sec-he-w-637.14 omnilex-key=us-nh-regs-official--agency-he-w--He-W 637.14}

RESERVED

History

(See Revision Note #1 at Chapter Heading He-W 600) #6446, eff 2-1-97; amd by #6595, eff 10-1-97; amd by #6818, eff 7-25-98; amd by #8269, eff 2-1-05; amd by #8452, eff 10-22-05; paragraphs (a), (d)-(g) EXPIRED: 7-25-06; rpld by #8740, INTERIM, eff 10-13-06

N.H. Code Admin. R. Ann. He-W 637.15 Single Course Authorization {#sec-he-w-637.15 omnilex-key=us-nh-regs-official--agency-he-w--He-W 637.15}

(a) An NHEP participant shall be authorized to participate in a single employment-related training course or course of study when:

(1) The participant has completed an initial assessment pursuant to He-W 637.09 and an employability plan with the NHEP representative pursuant to He-W 637.12;

(2) The single training course or course of study is supported by the employment goals as indicated on the employability plan;

(3) The single training course or course of study improves the participant’s immediate employment prospects; and

(4) The single training course or course of study is specific to the participant’s occupational career pathway.

(b) Single course authorization shall meet the additional conditions specified in He-W 655.

History

(See Revision Note #1 at Chapter Heading He-W 600) #6446, eff 2-1-97; ss by #8269, eff 2-1-05; paragraph (a) amd by #8740, INTERIM, eff 10-13-06, EXPIRED: 4-11-07; paragraph (a) amd by #8869, eff 4-19-07; ss by #10275, eff 2-21-13; ss by #13603, eff 3-28-23

N.H. Code Admin. R. Ann. He-W 637.16 Financial Assistance and Eligibility for Medical Care {#sec-he-w-637.16 omnilex-key=us-nh-regs-official--agency-he-w--He-W 637.16}

RESERVED

History

(See Revision Note #1 at Chapter Heading He-W 600) #6446, eff 2-1-97; amd by #7372, eff 12-1-00; amd by #8268, eff 2-1-05; amd by #8269, eff 2-1-05; rpld by #8740, INTERIM, eff 10-13-06

N.H. Code Admin. R. Ann. He-W 637.17 High School Diploma or Equivalent {#sec-he-w-637.17 omnilex-key=us-nh-regs-official--agency-he-w--He-W 637.17}

Dependent children ages 16 and 17 who do not have a high school diploma or equivalent and who are mandatory NHEP participants shall participate full-time in an educational program that leads to a high school diploma or equivalency, as defined by the institution that provides the activity, to satisfy participation requirements pursuant to He-W 637.03.

History

(See Revision Note #1 at Chapter Heading He-W 600) #6446, eff 2-1-97; amd by #7206, eff 3-1-00; ss by #8269, eff 2-1-05; ss by #8740, INTERIM, eff 10-13-06, EXPIRED: 4-11-07
#8869, eff 4-19-07; ss by 10163, eff 7-26-12; ss by #13549, eff 2-1-23

N.H. Code Admin. R. Ann. He-W 637.18 Interim Activities {#sec-he-w-637.18 omnilex-key=us-nh-regs-official--agency-he-w--He-W 637.18}

New Hampshire employment program (NHEP) participants shall be required to participate in the specific interim activities, including the allowable federal activities pursuant to 45 CFR 261.30, identified in the NHEP participant’s employability plan as defined in He-W 637.01.

History

(See Revision Note #1 at Chapter Heading He-W 600) #6446, eff 2-1-97; amd by #7192, eff 2-1-00; amd by #8269, eff 2-1-05; ss by #8740, INTERIM, eff 10-13-06, EXPIRED: 4-11-07
#8869, eff 4-19-07; ss by #10803, eff 3-26-15; ss by #14131, eff 11-26-24, EXPIRES: 11-26-34

N.H. Code Admin. R. Ann. He-W 637.19 Financial Assistance and Eligibility for Medical Care {#sec-he-w-637.19 omnilex-key=us-nh-regs-official--agency-he-w--He-W 637.19}

RESERVED

History

(See Revision Note #1 at Chapter Heading He-W 600) #6446, eff 2-1-97; amd by #8161, eff 10-1-04; amd by #8268, eff 2-1-05; amd by #8269, eff 2-1-05; rpld by #8740, INTERIM, eff 10-13-06

N.H. Code Admin. R. Ann. He-W 637.20 On-the-Job Training (OJT) {#sec-he-w-637.20 omnilex-key=us-nh-regs-official--agency-he-w--He-W 637.20}

(a) Placement into OJT as defined in RSA 167:78, XVIII, shall require the following pursuant to RSA 167:88 IV:

(1) A written contract between the employer providing the OJT placement and the department, including the verification that the participant will be an employee of the business from the on-set of the OJT contract; and

(2) An approved employability plan which includes the placement information.

(b) The contract described in (a)(1) above shall include the provisions that the employer:

(1) Provide training and supervision to the participant as part of the contract; and

(2) Submit a monthly progress report which substantiates how training and supervision in (1) above has been provided to support the financial reimbursement made to the employer as described in (c) below and includes the employer’s evaluation of the NHEP participant.

(c) The department shall reimburse the business placement up to an amount no less than 30% of the wages paid to the participant, as agreed to by the parties and specified in the contract.

(d) An OJT placement shall be terminated prior to the end of the contract period if the employer or participant fails or neglects to comply with the requirements of the contract.

(e) The department shall notify the employer in writing at least 7 calendar days prior to termination that the contract shall be terminated and state the reason(s) for the termination.

(f) The employer or the participant shall have the 7 calendar days’ notice period, referenced in (e) above, to remedy the violation or complaint prior to the contract termination.

History

(See Revision Note #1 at Chapter Heading He-W 600) #6446, eff 2-1-97; amd by #8269, eff 2-1-05, EXPIRED: 2-1-13
#10275, eff 2-21-13; ss by #13603, eff 3-28-23

N.H. Code Admin. R. Ann. He-W 637.21 Work Experience and Community Service Program (WECSP) {#sec-he-w-637.21 omnilex-key=us-nh-regs-official--agency-he-w--He-W 637.21}

(a) A work experience and community service program (WECSP) placement shall provide the following:

(1) Work experience;

(2) Community service; or

(3) Work experience and community service.

(b) A WECSP shall require the following:

(1) A written agreement between the placement and the NHEP participant, specifying the tasks to be performed by the NHEP participant, hours of the work placement, and the duration of the agreement; and

(2) An approved employability plan which includes the placement information.

(c) Individuals who receive a reduction in FANF financial assistance pursuant to RSA 167:82, III, shall have required participation hours in a WECSP work placement calculated against the full, available pre-sanctioned financial assistance amount.

(d) Individuals participating in a WECSP work placement shall not be required to participate for more hours than the individual would be compensated for if the individual were paid at minimum wage, equal to the full, available pre-sanctioned financial assistance benefit amount, plus the family’s supplemental nutrition assistance program (SNAP) benefit amount.

History

(See Revision Note #1 at Chapter Heading He-W 600) #6446, eff 2-1-97; amd by #6699, eff 2-28-98; amd by #8269, eff 2-1-05; paragraphs (j) & (k) EXPIRED: 2-28-06; ss by #8740, INTERIM, eff 10-13-06, EXPIRED: 4-11-07
#8869, eff 4-19-07; ss by #10163, eff 7-26-12; ss by #13549, eff 2-1-23

N.H. Code Admin. R. Ann. He-W 637.22 Vocational Educational and Training {#sec-he-w-637.22 omnilex-key=us-nh-regs-official--agency-he-w--He-W 637.22}

(a) When determining the NHEP participant's need for vocational education and training, as described in RSA 167:85 and RSA 167:91, the NHEP representative shall perform an assessment of the following:

(1) The participant’s marketability of current skills, experience, training, and education;

(2) The participant’s ability to achieve long-term economic independence without a vocational education and training program;

(3) The marketability of the specific vocational education and training program;

(4) The participant’s ability to successfully complete a vocational education and training program; and

(5) The participant’s access to support services, such as transportation and child care, while engaged in a vocational education and training program.

(b) Vocational education and training programs shall meet all of the following criteria:

(1) The training shall be designed to provide participants with the knowledge and skills to prepare for an industry specific occupation;

(2) The vocationally specific training shall be in an occupation or career pathway, which is consistent with the participant’s employability plan;

(3) The training program shall have an expectation to result in a participant’s ability to obtain employment in a specific occupation or career pathway; and

(4) The training provider shall provide documentation of satisfactory progress as indicated in He-W 637.20 (b)(2).

(c) The vocational education and training program shall be approved, pursuant to RSA 167:91, for a period of time not to exceed the federal lifetime limit of 12 months of participation.

(d) In the event a participant’s lifetime limit has been exceeded, the following shall occur:

(1) The participant’s activity shall remain on the employment plan to support completion of the activity and employment plan; and

(2) The department shall not provide funds to the participant.

(e) For participants with a previous certificate, diploma, or completed training program, retraining shall be appropriate if one of the following conditions is met:

(1) Significant labor market changes have occurred which effect the occupation in which training has been previously received; or

(2) The participant no longer possesses the necessary skills to perform the job functions due to documented circumstances.

History

(See Revision Note #1 at Chapter Heading He-W 600) #6446, eff 2-1-97; amd by #6818, eff 7-25-98; ss by #8269, eff 2-1-05; paragraphs (a)-(f) amd by #8740, INTERIM, eff 10-13-06, EXPIRED: 4-11-07; paragraphs (a)-(f) amd by #8869, eff 4-19-07; ss by #10275, eff 2-21-13; ss by #13603, eff 3-28-23

N.H. Code Admin. R. Ann. He-W 637.23 Post Secondary Education {#sec-he-w-637.23 omnilex-key=us-nh-regs-official--agency-he-w--He-W 637.23}

(a) When determining the NHEP participant's need for a post secondary educational program, as described in RSA 167:85 and 167:91, the NHEP representative shall perform an assessment of the following:

(1) The marketability of the participant’s current skills, experience, training, and education;

(2) The participant’s ability to achieve self-sufficiency without a post secondary educational program;

(3) The specific post secondary educational program’s direct marketability in the local labor market;

(4) The participant’s ability to successfully complete a post secondary educational program;

(5) The participant’s ability to access support services needed to engage in a post secondary educational program, such as transportation and child care; and

(6) The participant’s prior enrollment and progress made in previous education and training experiences.

(b) A post secondary educational program shall meet the following criteria:

(1) Be consistent with the participant’s employability plan; and

(2) Have a reasonable expectation that the degree or certificate will result in the participant obtaining employment.

(c) To maintain approval for the post secondary educational program, the participant shall provide verification of satisfactory progress in the program, as defined in He-W 637.01(j).

(d) The post secondary educational program shall be approved for a period of time not to exceed a lifetime limit of 12 months, whether or not consecutive months, including in the sum total of 12 months any months spent in vocational educational training activities as described in He-W 637.22.

(e) The time limit identified in (d) above shall:

(1) Be extended for an additional 3 months beyond the 12 month lifetime limit when additional time is needed for the participant to complete and graduate from a program in which the participant is making satisfactory progress; and

(2) Not apply to a participant with a documented learning disability who provides verification of the disability and the need and length of time for extended participation in the post secondary educational program from either:

a. A state certified education professional licensed to diagnose learning disabilities; or

b. A licensed psychologist.

(f) When determining the NHEP participant’s need for additional postsecondary educational programs when the participant already has at least one prior post secondary degree, the NHEP representative shall consider the following:

(1) Whether labor market changes have affected the occupation associated with the participant’s prior post secondary degree;

(2) Whether, due to a documented disability, the participant no longer possesses the needed abilities to perform the job functions associated with the prior post secondary degree;

(3) Whether the participant’s prior post secondary educational program was interrupted due to a personal emergency, and if that situation is now resolved; and

(4) Whether the participant was previously unsuccessful in completing a post secondary educational program, and the reasons for the prior failure.

History

(See Revision Note #1 at Chapter Heading He-W 600) #6446, eff 2-1-97; amd by #6818, eff 7-25-98; amd by #7206, eff 3-1-00; amd by #8269, eff 2-1-05; paragraphs (a) intro. & (c)-(g) amd by #8740, INTERIM, eff 10-13-06, EXPIRED: 4-11-07; paragraphs (a) intro. & (c)-(g) amd by #8869, eff 4-19-07; ss by #9275, eff 9-20-08; ss by #11186, eff 9-20-16

N.H. Code Admin. R. Ann. He-W 637.24 Financial Assistance and Eligibility for Medical Care {#sec-he-w-637.24 omnilex-key=us-nh-regs-official--agency-he-w--He-W 637.24}

RESERVED

History

(See Revision Note #1 at Chapter Heading He-W 600) #6446, eff 2-1-97; amd by #6818, eff 7-25-98; amd by #8269, eff 2-1-05; paragraphs (a)(5) & (b) EXPIRED: 7-25-06; rpld by #8740, INTERIM, eff 10-13-06

N.H. Code Admin. R. Ann. He-W 637.25 Financial Assistance and Eligibility for Medical Care {#sec-he-w-637.25 omnilex-key=us-nh-regs-official--agency-he-w--He-W 637.25}

RESERVED

History

(See Revision Note #1 at Chapter Heading He-W 600) #6446, eff 2-1-97; ss by #6595, eff 10-1-97; amd by #6818, eff 7-25-98; amd by #7206, eff 3-1-00; amd by #8452, eff 10-22-05; rpld by #8740, INTERIM, eff 10-13-06

N.H. Code Admin. R. Ann. He-W 637.26 Financial Assistance and Eligibility for Medical Care {#sec-he-w-637.26 omnilex-key=us-nh-regs-official--agency-he-w--He-W 637.26}

RESERVED

History

(See Revision Note #1 at Chapter Heading He-W 600) #6446, eff 2-1-97; amd by #6818, eff 7-25-98; amd by #8269, eff 2-1-05; paragraphs (b) & (c) EXPIRED: 7-25-06; paragraphs (a)-(c) & (g) amd by #8740, INTERIM, eff 10-13-06, EXPIRED: 4-11-07; paragraphs (a)-(c) & (g) amd by #8869, eff 4-19-07; rpld by #10163, eff 7-26-12

N.H. Code Admin. R. Ann. He-W 637.27 Financial Assistance and Eligibility for Medical Care {#sec-he-w-637.27 omnilex-key=us-nh-regs-official--agency-he-w--He-W 637.27}

RESERVED

History

(See Revision Note #1 at Chapter Heading He-W 600) #6446, eff 2-1-97; ss by #8269, eff 2-1-05; rpld by #10163, eff 7-26-12

N.H. Code Admin. R. Ann. He-W 637.28 Financial Assistance and Eligibility for Medical Care {#sec-he-w-637.28 omnilex-key=us-nh-regs-official--agency-he-w--He-W 637.28}

RESERVED

History

#8268, eff 2-1-05; rpld by #8740, INTERIM, eff 10-13-06

Part He-W 638 Homecare Works

N.H. Code Admin. R. Ann. He-W 638.01 Financial Assistance and Eligibility for Medical Care {#sec-he-w-638.01 omnilex-key=us-nh-regs-official--agency-he-w--He-W 638.01}

RESERVED

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; rpld by #5819, eff 4-29-94
#8418, eff 8-22-05; ss by #10275, eff 2-21-13; rpld by #13539, eff 1-26-23

N.H. Code Admin. R. Ann. He-W 638.02 Financial Assistance and Eligibility for Medical Care {#sec-he-w-638.02 omnilex-key=us-nh-regs-official--agency-he-w--He-W 638.02}

RESERVED

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; rpld by #5819, eff 4-29-94
#8418, eff 8-22-05; ss by #10275, eff 2-21-13; rpld by #13539, eff 1-26-23

Part He-W 639 Granite Workforce

N.H. Code Admin. R. Ann. He-W 639.01 Purpose {#sec-he-w-639.01 omnilex-key=us-nh-regs-official--agency-he-w--He-W 639.01}

The purpose of this part is to implement the granite workforce pilot program (GWPP) established in Laws 2018, 342:3-9.

History

#12713, INTERIM, eff 1-22-19, EXPIRES: 7-22-19

N.H. Code Admin. R. Ann. He-W 639.02 Subject To Available Funding {#sec-he-w-639.02 omnilex-key=us-nh-regs-official--agency-he-w--He-W 639.02}

The services provided under this part are subject to the continuing availability of Temporary Assistance for Needy Families (TANF) funds as described in Chapter Law 342:9, 2018.

History

#12713, INTERIM, eff 1-22-19, EXPIRES: 7-22-19

N.H. Code Admin. R. Ann. He-W 639.03 Definitions {#sec-he-w-639.03 omnilex-key=us-nh-regs-official--agency-he-w--He-W 639.03}

(a) “Beneficiary” means an individual determined eligible and currently receiving Medicaid.

(b) “Department” means the New Hampshire department of health and human services.

(d) “Granite advantage health care program (granite advantage)” means the granite advantage health care program established under RSA 126-AA.

(e) “Granite workforce representative” means an employee of the New Hampshire department of employment security or the department.

(f) “Participant” means a beneficiary enrolled in the granite advantage and receiving GWPP services under this part.

(g) “Month” means the total wages paid by the employer during the prior four weeks.

(h) “New Hampshire employment security (NHES)” means New Hampshire employment security.

History

#12713, INTERIM, eff 1-22-19, EXPIRES: 7-22-19

N.H. Code Admin. R. Ann. He-W 639.04 Participant Eligibility {#sec-he-w-639.04 omnilex-key=us-nh-regs-official--agency-he-w--He-W 639.04}

(a) To be eligible to receive GWPP services, a beneficiary shall be:

(1) In a household with a household income up to 138 percent of the federal poverty level;

(2) Enrolled in granite advantage;

(3) Mandatorily required to meet the community engagement requirement in He-W 837.03 unless exempted under He-W 837.04 and He-W 837.05; and

(4) One of the following:

a. A parent who is more than 19 years old and less than 65 years old and has a child who is less than 18 years old in the household;

b. A noncustodial parent who is more than 19 years old and less than 65 years old and has a child who is less than 18 years old; or

c. A childless adult who is more than 19 years old and less than 25 years old.

(b) A participant whose earned income increases and causes the household income to exceed 138 percent of the federal poverty level shall continue to receive GWPP services provided the household income does not exceed 250 percent of the federal poverty level, subject to (c) below.

(c) Participants in subsidized employment whose household income exceeds 138 percent of the federal poverty level and is below 250 percent of the federal poverty level shall be terminated from receiving GWPP services once the employer is paid the second subsidy payment, pursuant to He-W 639.08 below.

(d) NHES shall verify the beneficiary is enrolled in granite advantage and determine the beneficiary’s eligibility for GWPP services as described in (a) above.

(e) Any participant whose household income exceeds 250 percent of the federal poverty level shall be terminated from participation in GWPP.

(f) A beneficiary, who is otherwise exempted from the community engagement requirement under He-W 837.04 and He-W 837.05, and voluntarily participates in the community engagement requirement may request to participate voluntarily in the GWPP if they meet the requirements in (a) above.

History

#12713, INTERIM, eff 1-22-19, EXPIRES: 7-22-19

N.H. Code Admin. R. Ann. He-W 639.05 Initial Assessment {#sec-he-w-639.05 omnilex-key=us-nh-regs-official--agency-he-w--He-W 639.05}

(a) A beneficiary shall participate in an initial interview when the beneficiary volunteers to participate in GWPP and the interview shall include an assessment of job skills, experience, and vocational interests using the occupational information network interest profiler or another assessment tool that measures vocational interests, job skills, experience, aptitude, and educational needs.

History

#12713, INTERIM, eff 1-22-19, EXPIRES: 7-22-19

N.H. Code Admin. R. Ann. He-W 639.06 Activities and Services {#sec-he-w-639.06 omnilex-key=us-nh-regs-official--agency-he-w--He-W 639.06}

(a) NHES shall offer the following activities and services to participants:

(1) Case management, vocational assessment, career planning, and job readiness services including referral for employment support services pursuant to He-W 639.07;

(2) Referral to community agencies including but not limited to those under contract with the department to provide services to mitigate barriers to employment;

(3) Referral to education and training providers including:

a. The New Hampshire community college system for training and apprenticeship opportunities;

b. The department of business and economic affairs for available training funds and support services;

c. The department of education for education and employment programs for youth; and

d. Other available post-secondary educational programs, training programs, and apprenticeship programs;

(4) Referral for education, training, apprenticeships, and direct job placement;

(5) Direct placement into subsidized employment for industry specific skills for jobs in high need areas, as determined by the NHES based upon workforce shortages; and

(6) Referral to services to assist meeting the work and community engagement requirements in He-W 837.03.

(b) Payment for services described in (a)(2) above shall be limited to four months.

History

#12713, INTERIM, eff 1-22-19, EXPIRES: 7-22-19

N.H. Code Admin. R. Ann. He-W 639.07 Employment Support Services {#sec-he-w-639.07 omnilex-key=us-nh-regs-official--agency-he-w--He-W 639.07}

(a) Employment support services shall be available for participants who have met the requirement of He-W 639.04 and He-W 639.05 above, as funding and budgets permit.

(b) Participants shall receive the employment support services listed below:

(1) Mileage reimbursement shall be provided for transportation to and from approved activities listed in He-W 639.06 subject to the following:

a. Mileage reimbursement shall not exceed $160 per month;

b. Participants shall not receive mileage reimbursement for more than 4 months out of the state fiscal year;

c. Participants shall provide the following information to the department for mileage reimbursement:

Mileage to and from the approved GWPP activity; or
Verification of the actual cost of transportation to and from the approved activity;

d. Mileage reimbursement shall be paid as follows:

The actual cost of transportation to and from the approved GWPP activity; or
The number miles traveled multiplied by $0.30; and

e. Reimbursement shall be provided for rides verified by receipt and purchased from a public for hire transportation agency under contract with the New Hampshire department of transportation, the United States department of transportation, or a registered common carrier under RSA 376 and RSA 376-A directly for transportation services.

(2) Tuition assistance shall be provided for allowable education and training activities pursuant to He-W 837.08(a)(5), (6), and (8) as follows:

a. Payment shall be made to the education or training provider, including books, fees, and supplies up to $5,000 per participant in a lifetime; and

b. Payment shall be approved by the granite workforce representative if the participant provides the following information:

Name of the institution the participant attends;
Verification of the courses the participant is taking; and
Verification of the cost of any necessary tuition, books, fees, and supplies;

(3) Financial support shall be provided for allowable education and training activities in the case of a beneficiary who has not received a high school diploma or a certificate of a high school equivalency pursuant to He-W 837.08(a)(9) and (10) as follows:

a. Payment shall be made to the education or training provider, including books, fees, and supplies up to $450 per participant in a lifetime; and

b. Payment shall be approved by the granite workforce representative if the participant provides the following information:

Name of the institution the participant attends;
Verification of the courses the participant is taking; and
Verification of the cost of any necessary tuition, books, fees, and supplies;

(4) Emergency housing support shall be paid subject to the following:

a. Payment shall not be greater than $650 per household in a lifetime to assist in securing or retaining permanent housing;

b. Payment shall be made to a landlord, management company, or bank; and

c. Participants shall:

Provide verification from a landlord, management company, or mortgagee that the participant is experiencing or threatened with homelessness or unsafe or unhealthy living conditions pursuant to He-W 606.104;
Indicate in writing whether the request is for a rental or mortgage payment, the amount needed to secure or retain permanent housing or a safe and healthy living situation, and the third party to be paid;
Provide a signed and dated third party verification when the housing costs exceed $650 indicating that the third party shall provide the remainder of the deposit, rent, or mortgage obligation to prevent the housing crisis or ensure permanent housing; and
Submit the signed and dated writing that includes the required information in 1. and 2. above, and the verification required in 3. above to the granite workforce representative for review; and

(5) Payment for child care registration fees shall be paid subject to the following:

a. Payment shall not be greater than $100 per child in a lifetime and shall be paid to the child care provider;

b. Payment shall only be made for registration and shall not include other fees associated with the pre-payment of child care services or the holding or securing of child care slots; and

c. Participants shall:

Provide verification from the child care provider indicating the child’s name and the required child care registration fees;
Indicate the amount required to secure child care and the child care provider’s information necessary for payment; and
Submit a signed and dated writing including the required information and verification to the granite workforce representative for review.

(d) Participants shall submit invoices for employment support services within 90 days of the granite workforce representative’s approval of the costs of the services.

(e) The granite workforce representative shall review the submitted invoices as required in (d) to confirm that they are consistent with the beneficiary’s employment plan and the assessment results.

History

#12713, INTERIM, eff 1-22-19, EXPIRES: 7-22-19

N.H. Code Admin. R. Ann. He-W 639.08 Employer Subsidies {#sec-he-w-639.08 omnilex-key=us-nh-regs-official--agency-he-w--He-W 639.08}

Subsidies for employers shall be provided by the department as follows:

(a) Employers who hire and retain participants shall receive a wage subsidy:

(1) After 3 months of continued employment from the hire date; and

(2) After 9 months of continued employment from the hire date;

(b) Each wage subsidy payment shall equal 50 percent of the documented and confirmed gross wages paid by the employer to the participant for the prior month, not to exceed $2,000 per payment;

(c) Employers shall invoice the department within 90 days after the 3 months of continued employment and within 90 days after the 9 months of continued employment;

(d) The department shall pay the employer subsidy within 90 days of receipt of invoice;

(e) The employer shall notify NHES of any improper payment within 30 days of the date the employer is aware of the overpayment; and

(f) The employer shall reimburse the department within 90 days of the notification of an improper payment in (e) above.

History

#12713, INTERIM, eff 1-22-19, EXPIRES: 7-22-19

N.H. Code Admin. R. Ann. He-W 639.09 Termination of GWPP {#sec-he-w-639.09 omnilex-key=us-nh-regs-official--agency-he-w--He-W 639.09}

(a) GWPP shall terminate pursuant to Laws 2018, 342:9 within 20 business days when:

(1) The department determines that the available federal TANF funds have fallen below $40,000,000;

(2) The program receives no additional federal TANF funds; or

(3) The federal or state authority to operate granite advantage ends as stipulated in RSA 126-AA.

(b) Any outstanding contractual or other obligations of GWPP shall be terminated as soon as practicable and in accordance with the following schedule:

(1) Participants receiving case management services from NHES shall continue to receive case management services for up to 90 days from the program termination date;

(2) Participants receiving barrier reduction services from community providers under contract with the department shall continue to receive barrier reduction services for up to 30 days from the program termination date;

(3) Employers shall be paid qualifying wage subsidies following the 3rd and 9th month of continued employment for participants hired by the employer prior to the program termination date; and

(4) Participants receiving education, training, or apprenticeship services from education and training facilities shall continue to receive education or training services when this service has been approved or paid for prior to the program termination date.

(c) Payment for outstanding program obligations following after program termination shall be allowed as funding and budgets permit as follows:

(1) Community providers, under contract with the department for barrier reduction services for participants enrolled in barrier reduction services, shall be allowed to submit invoices the department for 90 days following the closure of all participants from the barrier reduction services;

(2) Employers shall be allowed to submit invoices for 90 days following the 3rd and 9th month of a participant’s continued employment;

(3) Providers of education and training for participants enrolled in services prior to the termination date shall be allowed to submit invoices for 90 days following program termination date; and

(4) Personnel related costs for the department and NHES for staffing deemed necessary to carry out program responsibilities shall not extend beyond 12 months from the program termination date.

History

#12713, INTERIM, eff 1-22-19, EXPIRES: 7-22-19

Part He-W 641 Special Medical Assistance Only Coverage Groups

N.H. Code Admin. R. Ann. He-W 641.01 Financial Assistance and Eligibility for Medical Care {#sec-he-w-641.01 omnilex-key=us-nh-regs-official--agency-he-w--He-W 641.01}

RESERVED

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; amd by #5915, eff 11-1-94; amd by #5992, eff 2-25-95; ss by #6531, INTERIM, eff 6-27-97, EXPIRES: 10-25-97; ss by #6614, eff 10-24-97; ss by #8452, eff 10-22-05; ss by #10471, eff 11-26-13; rpld by #13781, eff 10-21-23

N.H. Code Admin. R. Ann. He-W 641.02 Qualified Pregnant Women/60 Day Extended MA {#sec-he-w-641.02 omnilex-key=us-nh-regs-official--agency-he-w--He-W 641.02}

(a) In accordance with 42 USC 1396a(a) and 42 USC 1396d(n) relative to medical assistance for qualified pregnant women, all general, technical and financial eligibility requirements for FANF medical assistance specified in He-W 600 shall apply, in addition to the requirements below.

(b) If a pregnant woman is a minor casehead, as defined by He-W 601.05(r), a portion of her parents' income shall be deemed available to her as follows:

(1) The amount of each parent's countable gross earned income, as defined in He-W 601.04(m) and He-W 601.04(n), if any, shall be determined;

(2) Net earned income, as defined in He-W 601.05(u), shall be determined by deducting $90 from each parent’s countable gross earned income;

(3) Countable unearned income, as defined in He-W 601.08(k), shall be added to net earned income;

(4) The shelter payment allowance for unsubsidized housing, as defined in He-W 658.02(e)(2), for the appropriate assistance group size shall be subtracted from the total amount of countable unearned and net earned income; and

(5) The assistance group size shall be determined by including the parents of the pregnant woman, any other individuals living in the home who are legal dependents of the pregnant woman's parents and any individuals outside the home who could be claimed as legal dependents by the pregnant woman’s parents.

(c) If a pregnant woman is a minor casehead, as defined in He-W 601.05(r), the total amount of her parents' countable resources, as defined in He-W 601.04(v), shall be deemed available to her when determining her resource eligibility.

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #5992, eff 2-25-95; ss by #7835, eff 2-24-03; amd by #8063, eff 3-20-04; ss by #9845, eff 2-24-11

N.H. Code Admin. R. Ann. He-W 641.03 Medicaid for Employed Adults with Disabilities (MEAD) {#sec-he-w-641.03 omnilex-key=us-nh-regs-official--agency-he-w--He-W 641.03}

(a) In accordance with RSA 167:3-i, RSA 167:3-c, XII, RSA 167:6, IX, and 42 USC 1396a(a)(10)(A)(ii)(XV) relative to medical assistance for employed adults with disabilities, medical assistance shall be provided to any applicant who:

(1) Meets the general and technical requirements for APTD or ANB as specified in He-W 600;

(2) Is age 18 through 64, inclusive;

(3) Meets the medical criteria for MEAD pursuant to He-W 504.02;

(4) Is employed for pay pursuant to He-W 641.03(b), or self-employed for pay pursuant to He-W 641.03(c), on the date of application, during the time of MEAD eligibility determination, and during the retroactive period, should the individual request this medical coverage period;

(5) Has net income determined by applying the APTD or ANB treatment and disregards to his or her gross income, and if applicable, to the spouse’s gross income pursuant to He-W 654, that when combined with spousal net income does not exceed 450% of the federal poverty guidelines, as published annually in the Federal Register and effective no later than the first of the month following the first complete month after the federal poverty income guidelines have been published in the federal register;

(6) Has countable resources that do not exceed the 2002 limit of $20,000 for an individual or $30,000 for a married couple, the amounts of which shall be updated annually in accordance with (a)(5) above by the percentage that applies pursuant to the Consumer Price Index; and

(7) Pays the monthly premium, established pursuant to He-C 5003.

(b) To be considered employed for pay, an individual shall:

(1) Receive remuneration and contribute to the Federal Insurance Contributions Act (FICA); and

(2) Not be paid for participation in a program designed to enhance an individual’s ability to obtain paid employment.

(1) Meet the requirements of (b)(2) above; and

(2) Provide documentation that he or she makes regular payments based on earnings as required pursuant to FICA.

(d) The items listed below shall not be counted as a resource when determining MEAD eligibility:

(1) Retirement plans;

(2) Medical savings accounts established pursuant to 26 USC 220; and

(3) MEAD employability accounts specifically designated and set aside by the individual for the purpose of purchasing certain goods or services that:

a. Will enhance an applicant’s employability; and

b. Are not:

Covered by the medicaid program;
Otherwise reimbursable;
Specifically excluded pursuant to He-W 656; or
Already allowed as a deduction pursuant to He-W 654.

(e) Goods or services for which MEAD employability accounts may be designated and set aside pursuant to (d)(3) above shall include, but not be limited to:

(1) Equipment, supplies, operating capital, and inventory required to establish a business;

(2) Any cost associated with an educational or occupational training facility, including, but not limited to, tutoring, or counseling;

(3) Work-related attendant care services to enable the individual to prepare for work, including, but not limited to, bathing and dressing, or services provided in the workplace;

(4) Medical devices, which enable the applicant to work, including, but not limited to:

a. Wheelchairs;

b. Prosthetics;

c. Pacemakers; and

d. Respirators;

(5) Equipment or tools either specific to an applicant's condition or designed for general use;

(6) Uniforms, specialized clothing, and safety equipment;

(7) Least costly transportation cost(s) to and from work, such as weekly or monthly bus passes;

(8) Purchase of a private vehicle;

(9) Operational or accessibility modifications to buildings or vehicles to accommodate disability;

(10) Routine drugs or medical services to ameliorate disability that are not covered by medicaid;

(11) Diagnostic procedures related to evaluation, control, or treatment of a disabling condition;

(12) Prescribed non-medical appliances and devices essential for controlling the disabling condition at home or work such as air filtering equipment;

(13) Expendable medical supplies; and

(14) Guide dogs, dog food, licenses, and veterinary services.

(f) If an applicant uses funds in a MEAD employability account for items other than those described in He-W 641.03(d)(3), the remaining funds in the account shall be counted as a resource.

(g) Applicants who have been determined eligible for medical assistance pursuant to He-W 641.03(a) and who subsequently become unemployed but who intend to return to work shall remain eligible for MEAD for a 6-month extension period beginning with the date the individual becomes unemployed, if:

(1) The recipient was involuntarily terminated from employment, or seasonal work ended, and is currently seeking new employment; or

(2) The recipient voluntarily terminated employment with good cause in accordance with (i) below.

(h) A recipient who has completed the 6-month extension may obtain one additional 6-month extension if the recipient provides either:

(1) A doctor’s written statement regarding the individual’s medical condition as it relates to their inability to work; or

(2) Written documentation of proven job search through contacts made to employers, and/or employment agencies such as One-Stops, Vocational Rehabilitation, or Employment Networks.

(i) The division of family assistance shall determine that good cause for leaving employment exists, in accordance with RSA 167:82, III(c)(1), (2), (4), (6), (7), and (8).

(j) A recipient shall be terminated from MEAD when 3 consecutive occurrences of employment by a recipient indicate that the date of hire occurred during the last month of each of the 6-month periods.

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #5895, eff 9-15-94; rpld by #6446, eff 2-1-97
#7644, eff 2-8-02; ss by #8292, eff 2-24-05; ss by #9402, eff 3-5-09

N.H. Code Admin. R. Ann. He-W 641.04 Financial Assistance and Eligibility for Medical Care {#sec-he-w-641.04 omnilex-key=us-nh-regs-official--agency-he-w--He-W 641.04}

RESERVED

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; amd by #5992, eff 2-25-95; ss by #6531, INTERIM, eff 6-27-97, EXPIRES: 10-25-97; ss by #6614, eff 10-24-97; amd by #7354, eff 9-1-00; amd by #8452, eff 10-22-05; ss by #10471, eff 11-26-13; rpld by #13781, eff 10-21-23

N.H. Code Admin. R. Ann. He-W 641.05 Presumptive Eligibility Determinations {#sec-he-w-641.05 omnilex-key=us-nh-regs-official--agency-he-w--He-W 641.05}

(a) Once an individual has been determined presumptively eligible for medical assistance pursuant to Sections 1920 and 1920A of the Social Security Act, that individual shall only be allowed to have another presumptive eligibility determination if the individual:

(1) Was determined eligible for medical assistance by the department and received such assistance after the presumptive eligibility period ended; and

(2) Subsequently became ineligible for medical assistance.

History

(See Revision Note #1 at Chapter Heading He-W 600) rsvd by #5171, eff 6-26-91; ss by #7003, eff 6-1-99, EXPIRED: 6-1-07
#8897, eff 6-7-07, EXPIRED: 6-7-15

N.H. Code Admin. R. Ann. He-W 641.06 Medical Coverage for Pregnant Women {#sec-he-w-641.06 omnilex-key=us-nh-regs-official--agency-he-w--He-W 641.06}

For purposes of Section 1902(l) of the Social Security Act relative to medical assistance for pregnant women, the following shall apply:

(a) Pregnant women, who apply for or receive medical coverage for pregnant women (MCPW) as defined in He-W 601.05(q), shall not be subject to the maximum resource limits for medical assistance; and

(b) The income of pregnant women shall be compared to a percentage of the federal poverty income guidelines, as required under section 1902 (1)(2)(A)(i) of the Social Security Act, for the appropriate budgetary unit size. In order for a pregnant woman to be income eligible for medical coverage, monthly income of the budgetary unit, as defined in He-W 601.02(e), shall not exceed the current percentage of the poverty income guidelines established under the Social Security Act or RSA 167:68, whichever is higher, for the appropriate budgetary unit size.

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #5417, INTERIM, eff 7-1-92, EXPIRED: 10-29-92
#5499, eff 11-6-92; amd by #5915, eff 11-1-94; ss by #6865, eff 10-3-98; ss by #7004, eff 5-26-99, EXPIRED: 5-26-07
8897, eff 6-7-07, EXPIRED: 6-7-15

N.H. Code Admin. R. Ann. He-W 641.07 Medical Assistance for Low Income Children {#sec-he-w-641.07 omnilex-key=us-nh-regs-official--agency-he-w--He-W 641.07}

(a) “Low income children” means children under the age of 19 whose family income is less than or equal to 300% of the federal poverty income guidelines as published annually in the Federal Register by the Secretary of the U.S. Department of Health and Human Services.

(b) Resources shall not be counted when eligibility is determined for low income children.

(c) For children to be income eligible for medical assistance as a low income child, monthly family income shall not exceed 300% of the federal poverty income guidelines;

(d) For purposes of determining income eligibility for medical assistance for a low income child, changes in the poverty level guidelines shall become effective the first day of the second month following publication of the poverty income guidelines in the Federal Register.

(e) A qualified entity as defined in He-W 520.01(h) shall be allowed to make presumptive eligibility determinations as defined in He-W 520.01(f) for initial eligibility for medical coverage for low income children whose eligibility is based on a percentage of the federal poverty income guidelines.

(f) For purposes of this section, all requirements for FANF medical assistance specified in He-W 600 shall apply except that:

(1) A verbal declaration stating the monthly amount received in child support shall fulfill general verification requirements specified in He-W 606;

(2) A verbal declaration stating the monthly amount paid for child care expenses shall fulfill child care cost verification requirements specified in He-W 606.73; and

(3) A verbal declaration stating the amount of monthly wage garnishments shall fulfill garnishment verification requirements specified in He-W 606.74(a)(4).

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #5215, eff 8-30-91; ss by #5417, INTERIM, eff 7-1-92, EXPIRED: 10-29-92
#5499, eff 11-6-923; amd by #5915, eff 11-1-94; amd by #5992, eff 2-25-95; amd by #6745, (HB 32), eff 5-1-98, EXPIRED: 12-31-98; ss by #6925, eff 1-1-99; amd by #7666, eff 4-1-02; amd by #8783, INTERIM, eff 12-30-06, para. (c) EXPIRED: 6-28-07; amd by #8903, eff 6-28-07; ss by #9664, eff 4-1-10; ss by #10139, eff 7-1-12

N.H. Code Admin. R. Ann. He-W 641.08 Financial Assistance and Eligibility for Medical Care {#sec-he-w-641.08 omnilex-key=us-nh-regs-official--agency-he-w--He-W 641.08}

RESERVED

History

#6925, eff 1-1-99; rpld by #7666, eff 4-1-02

N.H. Code Admin. R. Ann. He-W 641.09 Breast and Cervical Cancer Program {#sec-he-w-641.09 omnilex-key=us-nh-regs-official--agency-he-w--He-W 641.09}

(a) “Course of treatment” means the period of time a woman requires treatment for breast or cervical cancer as specified in writing by the woman’s attending physician.

(b) Medical assistance shall be provided to any woman who:

(1) Meets the requirements specified in 42 USC 1396a(aa) pursuant to 42 USC 96a(a)(10)(A)(ii)(XVIII);

(2) Is a resident of the State of New Hampshire as defined in He-W 601.07(e); and

(3) Is a citizen of the United States or a qualified alien as described in He-W 616.02.

(c) Medical assistance made available to a woman described in (b) above shall be limited to the woman’s course of treatment.

(d) Medical assistance made available to a woman described in (b) above shall be terminated when:

(1) The woman no longer meets the requirements specified in 42 USC 1396a(aa);

(2) The woman’s attending physician states in writing that the woman has completed her course of treatment; or

(3) The woman no longer resides in the State of New Hampshire.

History

#7459, EMERGENCY, eff 3-13-01 EXPIRED: 9-9-01; ss by #7546, eff 9-1-01; ss by #9532, eff 9-1-09

Part He-W 642 Categorical Requirements - Adult Financial Assistance

N.H. Code Admin. R. Ann. He-W 642.01 Financial Assistance and Eligibility for Medical Care {#sec-he-w-642.01 omnilex-key=us-nh-regs-official--agency-he-w--He-W 642.01}

RESERVED

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91

N.H. Code Admin. R. Ann. He-W 642.02 Old Age Assistance Categorical Requirements {#sec-he-w-642.02 omnilex-key=us-nh-regs-official--agency-he-w--He-W 642.02}

(a) If an individual applies for financial assistance in the category of old age assistance (OAA) in the month in which the individual turns 65 years of age, the individual shall meet the age requirement as of the day the individual turns 65 years of age.

(b) If a recipient is transferred to OAA financial assistance from another category of financial assistance, the recipient shall receive assistance under OAA commencing in the month following the month in which the recipient turns 65.

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #6531, INTERIM, eff 6-27-97, EXPIRES: 10-25-97; ss by #6614, eff 10-24-97; ss by #8452, eff 10-22-05; ss by #10471, eff 11-26-13; ss by #13893, eff 2-27-24

N.H. Code Admin. R. Ann. He-W 642.03 Aid to the Permanently and Totally Disabled Categorical Requirements {#sec-he-w-642.03 omnilex-key=us-nh-regs-official--agency-he-w--He-W 642.03}

(a) Applicants and recipients of aid to the permanently and totally disabled (APTD) financial assistance shall meet all aspects of the APTD disability requirement in RSA 167:6 VI for initial and continuing eligibility.

(b) Recipients of APTD financial assistant shall be transferred to OAA financial assistance the month following the month in which the recipient turns 65.

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #6531, INTERIM, eff 6-27-97, EXPIRES: 10-25-97; ss by #6614, eff 10-24-97; ss by #8452, eff 10-22-05; ss by #10471, eff 11-26-13; ss by #13893, eff 2-27-24

Applicants and recipients of aid to the needy blind (ANB) financial assistance shall meet all aspects of the ANB blindness requirement in He-W 502.02 for initial and continuing eligibility.

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #6531, INTERIM, eff 6-27-97, EXPIRES: 10-25-97; ss by #6614, eff 10-24-97; ss by #8452, eff 10-22-05; ss by #10471, eff 11-26-13; ss by #13893, eff 2-27-24

Part He-W 644 Technical Requirements for Adult Financial and Medical Assistance

N.H. Code Admin. R. Ann. He-W 644.01 Personal Interview {#sec-he-w-644.01 omnilex-key=us-nh-regs-official--agency-he-w--He-W 644.01}

(a) A personal interview between the individual or the individual’s authorized representative (AR) and a department representative shall be required for:

(1) Each initial determination of eligibility for adult category financial assistance; and

(2) Each regularly scheduled redetermination of eligibility for all adult category clients except for individuals residing in independent living arrangements and not receiving supplemental nutrition assistance program (SNAP) benefits.

(b) A personal interview shall be conducted for all adult category cases, including those exempted above in (a)(2), as a result of reported changes or the discovery of conflicting information related to eligibility.

(c) A personal interview shall be required once during a 12-month period for any adult category case on a more frequent redetermination of assistance schedule pursuant to He-W 684.02(d).

(d) If the individual or the individual’s AR fails to appear for a personal interview:

(1) Within 30 days from the date of application for an initial determination of eligibility, then assistance shall be denied; or

(2) Within the redetermination month for a redetermination of eligibility, then assistance shall be terminated at the end of the advance notice period, as described in He-W 604.03.

(e) The individual or the individual’s AR shall review the summary of the information provided to the department’s representative during the interview, make any necessary corrections, and return it to the department within 10 calendar days if corrections have been made.

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #6531, INTERIM, eff 6-27-97, EXPIRES: 10-25-97; ss by #6614, eff 10-24-97; amd by #7766, eff 10-1-02; amd by #8325, eff 5-1-05; amd by #8452, eff 10-22-05; ss by #9788, eff 10-1-10; ss by#12714, eff 1-23-19; ss by #13801, eff 10-21-23

Part He-W 648 Residential Care Facilities and Community Residences

N.H. Code Admin. R. Ann. He-W 648.01 Financial Assistance and Eligibility for Medical Care {#sec-he-w-648.01 omnilex-key=us-nh-regs-official--agency-he-w--He-W 648.01}

Reserved

History

(See Revision Note at Chapter Heading He-W 600) #5171, eff 6-26-91

N.H. Code Admin. R. Ann. He-W 648.02 Residential Care Facilities {#sec-he-w-648.02 omnilex-key=us-nh-regs-official--agency-he-w--He-W 648.02}

(a) Individuals living in residential care facilities, as described in RSA 151:2, I(e), shall meet all general, technical, categorical, and financial requirements for adult category financial assistance, in addition to the requirements below.

(b) Individuals living in residential care facilities shall be entitled to a different standard of need than individuals residing in independent living arrangements when the residential care facility is licensed by the department as meeting the standards for the care of residential care facility residents.

(c) Financial eligibility for individuals in residential care facilities shall be determined as an assistance group size of one.

(d) If an individual is determined eligible, financial assistance shall be provided directly to the individual, not to the operator of the residential care facility.

(e) The standard of need for an individual in a residential care facility shall be adjusted annually as specified in He-W 648.04.

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #5418, INTERIM, eff 7-1-92, EXPIRED: 10-29-92
#5500, eff 11-6-92; amd by #5966, eff 1-27-95; ss by #6865, eff 10-3-98; amd by #6969, eff 4-1-99; amd by #7451, eff 2-17-01; amd by #7622, INTERIM, eff 1-9-02 EXPIRED: 7-8-02; amd by #7693, eff 5-25-02; amd by #7803, INTERIM, eff 1-1-03, EXPIRED: 6-30-03; amd by #7876, eff 4-23-03; amd by #8015, eff 1-1-04, EXPIRED: 6-29-04; amd by #8092, eff 5-28-04; amd by #8252, eff 1-8-05; amd by #8684, eff 7-21-06; ss by #9364, eff 2-1-09; ss by #12179, eff 5-23-17

N.H. Code Admin. R. Ann. He-W 648.03 Community Residences {#sec-he-w-648.03 omnilex-key=us-nh-regs-official--agency-he-w--He-W 648.03}

(a) Individuals living in community residences, as defined in He-M 1001.02(k), shall meet all general, technical, categorical, and financial requirements for adult category financial assistance, in addition to the requirements below.

(b) Individuals living in community residences shall be entitled to a different standard of need than individuals residing in independent living arrangements when:

(1) The community residence is certified or licensed by the department;

(2) The individual has been determined appropriate for community residence care by a division of developmental services area agency case manager; and

(3) The individual has been placed in a community residence.

(c) Financial eligibility for individuals in community residences shall be determined as an assistance group size of one.

(d) If an individual is determined eligible, financial assistance shall be provided directly to the individual, not to the operator of the community residence.

(e) The standard of need shall be adjusted annually, as specified in He-W 648.04, for individuals living in:

(1) Community residences, as defined in He-M 1001.02(k); and

(2) Family residences, as defined in He-M 1001.02(k) and He-M 1001.02(p).

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #5418, INTERIM, eff 7-1-92, EXPIRED: 10-29-92
#5500, eff 11-6-92; amd by #5966, eff 1-27-95; ss by #6865, eff 10-3-98; amd by #6969, eff 4-1-99; amd by #7451, eff 2-17-01; amd by #7622, INTERIM, eff 1-9-02 EXPIRED: 7-8-02; amd by #7693, eff 5-25-02; amd by #7803, INTERIM, eff 1-1-03, EXPIRED: 6-30-03; amd by #7876, eff 4-23-03; amd by #8015, eff 1-1-04, EXPIRED: 6-29-04; amd by #8092, eff 5-28-04; amd by #8252, eff 1-8-05; amd by #8684, eff 7-21-06; ss by #9364, eff 2-1-09; ss by #12179, eff 5-23-17

N.H. Code Admin. R. Ann. He-W 648.04 Cost-of-Living Adjustments for Supplemental Security Income {#sec-he-w-648.04 omnilex-key=us-nh-regs-official--agency-he-w--He-W 648.04}

(a) In accordance with 42 USC 1382g and pursuant to RSA 167:27-c, the department shall maintain the minimum supplemental payment levels for individuals living in:

(1) Residential care facilities, as defined in RSA 151:2, I(e);

(2) Community residences, as defined in He-W 601.02(r) or He-M 1001.02(k); and

(3) Family residences, as defined in He-M 1001.02(p).

(b) The standard of need for individuals living in residences specified in (a) above, shall be determined by:

(1) Subtracting the adult standard disregard as specified in He-W 654.16, from the current maximum supplemental security income (SSI) payment level; and

(2) Adding the figure in (b)(1) above to the appropriate minimum state supplemental payment level in accordance with 20 CFR 416.2098.

PARTS He-W 649 - He-W 651 – RESERVED

History

#8252, eff 1-8-05; ss by #10257, eff 1-24-13; ss by #13537, eff 1-26-23, EXPIRES: 1-26-33
(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91

Part He-W 652 Income - Basic Principles

N.H. Code Admin. R. Ann. He-W 652.01 Financial Assistance and Eligibility for Medical Care {#sec-he-w-652.01 omnilex-key=us-nh-regs-official--agency-he-w--He-W 652.01}

RESERVED

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91

N.H. Code Admin. R. Ann. He-W 652.02 Available Income {#sec-he-w-652.02 omnilex-key=us-nh-regs-official--agency-he-w--He-W 652.02}

(a) Available income for adult category financial assistance shall be verified in the same manner as financial assistance to needy families, as described in He-W 606.

(b) Income received which represents contributions or compensation for a period of more than one month, or which varies steadily from month-to-month, shall be averaged to obtain a monthly figure.

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #6531, INTERIM, eff 6-27-97, EXPIRES: 10-25-97; ss by #6614, eff 10-24-97; ss by #8452, eff 10-22-05; ss by #10471, eff 11-26-13; ss by #13856, eff 1-23-24

N.H. Code Admin. R. Ann. He-W 652.03 Deemed Income For Financial and Medical Assistance {#sec-he-w-652.03 omnilex-key=us-nh-regs-official--agency-he-w--He-W 652.03}

(a) The income of a caretaker relative who is not a parent and is not included in the assistance group (AG), shall not be considered available to the children in the assistance group.

(b) If all family members living together apply for assistance as one group, deeming of the parents’ or legal guardians' income shall not apply.

(c) The minor casehead’s income and resources, and the income and resources of the minor casehead’s parent(s) or legal guardian(s), shall not be counted when determining eligibility for the FANF AG when the minor casehead is:

(1) Not a parent; and

(2) Not included in the AG.

(d) When determining eligibility for FANF financial and medical assistance, the parent’s income shall be deemed to the minor casehead in the following manner:

(1) The countable gross earned income, if any, for each employed parent shall be determined pursuant to He-W 654;

(2) The employment expense disregard as specified in He-W 654.13 shall be deducted from the gross earned income for each employed parent resulting in the net earned income for each;

(3) Countable unearned income shall be added to net earned income, as described in (2) above, which shall result in available income;

(4) The following shall be subtracted from available income, as described in (3) above, resulting in the amount of deemed income:

a. The FANF standard of need, as described in He-W 658.01, for the appropriate group size, for a group with the following members:

Parents living in the home;
Any other individuals living in the home who are legal dependents of the parents; and
Any individuals outside the home whom the parent claims as dependents for federal income tax purposes; and

b. The amount of child support or alimony paid by the parents to individuals outside the home;

(5) The amount of deemed income above shall be treated as unearned income when determining income eligibility for the FANF case;

(6) The amount of income that is deemed available to the FANF case shall remain constant until the next redetermination, unless a change is reported or discovered by the department; and

(7) The parent’s income, resources, and expenses shall be verified pursuant to He-W 606.

(e) For the adult categories of assistance, the following shall apply:

(1) Treatment of income and resources shall be pursuant to He-W 654;

(2) The standard of need for a group size of 2 shall be compared to the available income to determine the amount of deemed income, when an adult category applicant or recipient lives with an applicant or non-applicant spouse, or a needy essential person; and

(3) The standard of need for a group size of 3 shall be compared to the available income to determine the amount of deemed income when an adult category applicant or recipient lives with an applicant or non-applicant spouse and a needy essential person.

(f) When determining eligibility and benefit amount for an aid to the needy blind (ANB) financial assistance applicant or recipient under the age of 18, the available income (AI) to be deemed from the ANB applicant’s or recipient’s parent or parents, as defined by He-W 601.06(b), to the ANB child shall be determined as follows:

(1) Deduct from the parent or parents’ combined countable unearned income, as defined in He-W 601.08(k):

a. An allocation for each ineligible child in the house, pursuant to 20 CFR 416.1165(b); and

b. A general income exclusion, pursuant to 20 CFR 416.1165(d)(1);

(2) Deduct from the parent or parents’ combined earned income, as defined in He-W 601.03(k):

a. Verified expenses as described in He-W 606.74 and He-W 654.21; and

b. The earned income disregards described in 20 CFR 416.1165(d)(2); and

(3) Add together the remaining unearned income from (1) above and the remaining earned income from (2) above and deduct a parental living allowance for each parent residing with the ANB applicant or recipient child, pursuant to 20 CFR 416.1165(d)(3).

(g) The AI, as determined by (f)(3) above, shall be deemed from the parent or parents to the ANB applicant or recipient under the age of 18 as unearned income pursuant to 20 CFR 416.1165(e)(1)–(2).

(h) To be eligible for the allocation described in (f)(1)a. above, the ineligible child shall be:

(1) Under the age of 18, or under the age of 20 if a full-time student in a secondary school or the equivalent level of vocational or technical training;

(2) Unmarried and not applying for or receiving ANB financial assistance; and

(3) Residing in the home of the ANB financial assistance applicant or recipient who is under the age of 18.

(i) When determining eligibility for an ANB financial assistance applicant or recipient under the age of 18, the available resources (AR) to be deemed from the parent or parents, as defined in He-W 601.06(b), to the ANB child shall be the parent or parents’ countable resources that exceed the resource limits described in 20 CFR 416.1205(c).

(j) For an ANB financial assistance applicant or recipient under the age of 18 to be considered eligible for ANB financial assistance, the sum of the following shall not exceed the ANB financial assistance resource limit described in He-W 656.06(c):

(1) The AR from (i) above; and

(2) The ANB child’s countable resources, as defined by He-W 601.02(v).

(k) The AI and AR deemed available to the ANB financial assistance case pursuant to (g) and (i) above shall remain constant until the next redetermination, unless a change is reported or discovered by the department.

(l) The parent or parents’ income and resources shall be verified pursuant to He-W 606, unless otherwise designated.

(m) A verbal declaration shall suffice as proof of the parent or parents’ name, date of birth, and marital status.

(n) The parent or parents of the ANB applicant or recipient shall provide all of the following verifications to receive the deduction described in (f)(1)a. above:

(1) A copy of the birth certificate for each sibling for which a deduction is requested;

(2) A signed statement from the parent or parents living in the home certifying, under penalty of perjury, that the sibling or siblings are unmarried and live in the home with the ANB applicant or recipient under the age of 18; and

(3) For siblings 18 and older but under the age of 20, proof of full-time student enrollment in a secondary school or the equivalent level of vocational or technical training, including but not limited to a current student identification card, a school report card, or a letter of enrollment from the school on school letterhead.

(o) Failure or refusal to fulfill the criteria described in (l)-(m) above shall result in the denial or termination of ANB financial assistance for the ANB applicant or recipient under the age of 18.

(p) Failure or refusal to fulfill the criteria described in (n) above shall result in no deduction being allowed for each sibling for which the criteria was not fulfilled.

(q) Parental deeming to an ANB applicant or recipient child shall end as of the month following the month in which the child turns 18, pursuant to 20 CFR 416.1165(g)(7).

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; amd by #6446, eff 2-1-97; ss by #6531, INTERIM, eff 6-27-97, EXPIRES: 10-25-97; ss by #6614, eff 10-24-97; amd by #6952, eff 3-1-99; amd by #8063, eff 3-20-04; amd by #8452, eff 10-22-05; ss by #10108, eff 4-4-12

N.H. Code Admin. R. Ann. He-W 652.04 Income of Disqualified Individuals {#sec-he-w-652.04 omnilex-key=us-nh-regs-official--agency-he-w--He-W 652.04}

(a) The income of individuals disqualified from receiving financial assistance to needy families (FANF), pursuant to 42 USC 608(a)(9), and of individuals disqualified from receiving adult categories of financial assistance, pursuant to RSA 167:6 X, shall be deemed to remaining eligible household members.

(b) The full amount of income, minus the allowable deductions specified in He-W 654.20, of disqualified individuals shall be considered in the determination of eligibility and benefit amount for FANF and adult categories of financial assistance.

(c) For individuals disqualified from receiving FANF, the earned income disregard, employment expense disregard, and child and dependent care disregard shall not be allowable deductions pursuant to (b) above.

History

#13831, eff 12-23-23

N.H. Code Admin. R. Ann. He-W 652.05 Conversion to Monthly Amounts {#sec-he-w-652.05 omnilex-key=us-nh-regs-official--agency-he-w--He-W 652.05}

(a) Income received weekly, bi-weekly, or semi-monthly, shall be converted to a monthly amount by multiplying by the following factors:

(1) For weekly amounts, multiply by 4.33;

(2) For bi-weekly amounts, multiply by 2.17; and

(3) For semi- monthly amounts, multiply by 2.

(b) The result shall be carried out to 2 decimal places and not be rounded up or down.

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #6531, INTERIM, eff 6-27-97, EXPIRES: 10-25-97; ss by #6614, eff 10-24-97; ss by #8452, eff 10-22-05; ss by #10471, eff 11-26-13; ss by #13856, eff 1-23-24

N.H. Code Admin. R. Ann. He-W 652.06 Fluctuating Income {#sec-he-w-652.06 omnilex-key=us-nh-regs-official--agency-he-w--He-W 652.06}

(a) "Best estimate" means an expectation of income to be received by an individual determined by evaluating past, present, and anticipated significant and non-significant income changes.

(b) "Fluctuating income" means:

(1) Earned income that varies from month to month such as when an individual works varying hours, overtime, or on a piece work basis; or

(2) Unearned income that varies from month to month due to changes in frequency or amount.

(c) "Non-significant changes" means any temporary or short-term variations in the amount of earned or unearned income caused by a situation which is not ongoing.

(d) "Significant changes" means changes in sources or amounts of earned or unearned income which are:

(1) Expected to continue into the future; or

(2) Short-term because is it caused by a situation which is not ongoing.

(e) The department of health and human services (DHHS) shall convert fluctuating income to a monthly amount pursuant to He-W 652.05 by averaging income for the most recent consecutive 4 weeks when such income represents a best estimate of future income pursuant to (a) above as verified by pay stubs or a statement from the employer.

(f) Income received during weeks with non-significant income changes pursuant to (c) above shall not be used to determine the average monthly amount.

(g) When the average monthly amount determined in (e) above does not represent a best estimate of future income pursuant to (a) above, the average monthly amount shall be determined as follows:

(1) Only data for weeks that accurately represent past earnings, up to a maximum of 8 weeks’ data, shall be included;

(2) The average weekly income shall be determined using the data from the weeks identified in (g)(1) above; and

(3) The appropriate multiplier under He-W 652.05 shall be used to convert average weekly income to a monthly amount.

(h) When income has been received for less than 4 consecutive weeks, the best estimate of future income pursuant to (a) above, shall be determined by computing a monthly average based on the actual number of weeks the income was received.

(i) The following shall apply to self-employment income:

(1) If self-employment income is the only income received from employment in a 12-month period, it will be averaged over a 12-month period;

(2) If self-employment income is the only income received from employment in a period of fewer than 12 months, it will be averaged over the number of months it was received; and

(3) If self-employment income is not the only income received from employment, it will be treated as income in the months received and will not be averaged.

(j) The estimated average monthly gross earned income as defined in He-W 601.04(m), shall be used until the next redetermination of eligibility.

(k) The estimated average monthly gross earned self-employment income as defined in He-W 601.04(n), shall be used for one year.

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #6531, INTERIM, eff 6-27-97, EXPIRES: 10-25-97; ss by #6614, eff 10-24-97; ss by #6826, eff 8-3-98; amd by #7722, eff 7-1-02; amd by #8684, eff 7-21-06; ss by #9738, eff 7-1-10; ss by #12616, eff 8-30-18

N.H. Code Admin. R. Ann. He-W 652.07 Developing Potential Sources of Income {#sec-he-w-652.07 omnilex-key=us-nh-regs-official--agency-he-w--He-W 652.07}

(a) “Finding of clinical ineligibility” means any denial or termination of federal cash benefits:

(1) Due to not meeting the medical disability criteria; and

(2) In response to an application, reapplication, or appeal filed for federal cash benefits.

(b) To be eligible for FANF or adult category financial assistance an individual shall have applied for all potential sources of income or benefits including, but not limited to:

(1) Benefits described under Title XVI of the Social Security Act;

(2) Benefits described under Title II of the Social Security Act;

(3) Veteran's benefits, including the veteran's affairs aid and attendance allowance;

(4) Retirement benefits or pensions;

(5) Disability benefits or pensions;

(6) Unemployment or worker's compensation;

(7) Contributions from any liable third-party; and

(8) Third-party medical coverage.

(1) Prior to the department initiating a determination of eligibility for the adult category financial assistance program; or

(2) If applying for FANF, no later than 30 days after the referral for those benefits were made.

(d) If the individual is incapable of applying for the aid and attendance allowance pursuant to (b)(3) above, does not have an authorized representative to apply on the individual's behalf, and the nursing facility will not apply on the individual's behalf, the eligibility worker shall initiate the application for the aid and attendance allowance on the individual's behalf.

(e) When applying for the benefits described in (b) above, applicants and recipients of FANF or adult category financial assistance shall:

(1) Provide all required information and verification and complete all forms as required in the application process for the other benefit;

(2) Cooperate in taking all necessary steps to obtain the other income or benefit;

(3) Accept the other income or benefit if eligible; and

(4) Pursue all appeal options within the timeframes set by the eligibility-determining agencies or individuals responsible for the other benefits described in (b) above, up to, but not including, court action, if found ineligible for the benefit due to medical reasons.

(f) Financial assistance for the entire assistance group shall be terminated or denied if an individual is ineligible for the other benefits described in (b) above, due to refusal or failure to:

(1) Complete the application process for the other benefit;

(2) Provide information or verification to obtain the benefits described in (b) above;

(3) Cooperate with the eligibility-determining agencies or individuals responsible for the other benefits described in (b) above;

(4) Meet the application timeframes described in (c) above or set by the eligibility-determining agencies or individuals responsible for the other benefits described in (b) above;

(5) Pursue all appeal options in accordance with (f)(2) above; or

(6) Accept the benefit if eligible.

(g) To be eligible for APTD financial assistance and pursuant to RSA 167:6,VI, APTD financial assistance applicants and recipients who have received a finding of clinical ineligibility shall provide the department with the following:

(1) Written notification from the federal agency which indicates the date and reason the individual was denied federal cash benefits within:

a. Thirty calendar days from the date of application for adult category financial assistance for any finding of clinical ineligibility received prior to the APTD financial assistance application, provided the finding of clinical ineligibility was made not more than 12 months prior to the date of application; and

b. Ten calendar days from the date on the notice of any finding of clinical ineligibility after the date of APTD financial application; and

(2) Written notification from the federal agency that denied the benefits which verifies that the APTD applicant or recipient is appealing the denial or has reapplied for federal benefits within 30 calendar days of having received a finding of clinical ineligibility for federal benefits.

(h) To be eligible for APTD financial assistance once APTD financial assistance has been terminated or denied due to a finding of clinical ineligibility, the individual shall:

(1) File a new application;

(2) Meet all APTD program eligibility requirements; and

(3) Meet all the requirements in (i) below.

(i) If APTD financial benefits were terminated or denied:

(1) Due to being denied federal cash benefits due to a finding of clinical ineligibility, the individual shall provide proof that the individual is now approved for federal cash benefits; or

(2) Due to failure to provide notification of clinical ineligibility decision or appeal of clinical ineligibility decision pursuant to (g) above, the individual shall:

a. Provide all the required proof; and

b. Demonstrate via the proof provided that the federal financial cash benefits denials and subsequent appeals of the denials, were not due to a finding of clinical ineligibility.

(j) If an individual is eligible for APTD financial assistance pursuant to (h) above, APTD financial assistance shall begin the next semi-monthly payment period following the date all the requirements in (i) are met.

(k) To be eligible for continued receipt of APTD financial assistance pending the decision on the administrative appeal after an individual’s APTD financial assistance is terminated due to a finding of clinical ineligibility the individual shall:

(1) Appeal the decision within 10 days from the date on the notice of decision; and

(2) Provide documentation:

a. Dated and signed by a physician, physician’s assistant (PA), advanced practice registered nurse (APRN), or psychologist which includes:

The printed name of the health professional signing the documentation;
The specialty of the health professional; and
The address and phone number of the health professional; and

b. That states the individual’s medical condition and that the medical condition:

Has increased in severity within the last 12 months; or
That was used when applying for or appealing the federal benefits is unrelated to the medical condition for which the individual applied for APTD financial assistance.

(l) Applicants denied cash assistance due to a finding of clinical ineligibility that have not started receiving cash benefits are not eligible for continued receipt of benefits pending appeal pursuant to (k) above.

(m) If the department’s termination of APTD financial assistance is overturned at the appeals hearing due to the circumstances described in (k) above, the individual shall provide the department with written notification from the federal agency that the individual has:

(1) Appealed the federal denial received if the individual appealed the department’s decision based on (k)(2)b.1. above; or

(2) Reapplied for federal benefits for the same medical condition for which the individual applied for APTD financial assistance if the individual appealed the department’s decision based on (k)(2)b.2. above.

(n) The amount of all APTD financial assistance provided to the individual during the pendency of the appeal is subject to recoupment, in accordance with He-W 692, if the administrative appeal does not find in favor of the individual.

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; amd by #5749, INTERIM, eff 12-1-93, EXPIRED: 3-31-94; amd by #5806, eff 3-30-94; ss by #6531, INTERIM, eff 6-27-97, EXPIRES: 10-25-97; ss by #6614, eff 10-24-97; ss by #7913, eff 6-26-03; ss by #9893, eff 6-26-11; amd by #10374, eff 7-12-13 paras. (a)-(i) EXPIRED: 6-26-19; ss by #12829, INTERIM, eff 7-20-19, EXPIRED: 1-16-20
#13121, eff 10-21-20

Part He-W 654 Evaluation and Treatment of Income

N.H. Code Admin. R. Ann. He-W 654.01 Evaluation and Treatment of Income. {#sec-he-w-654.01 omnilex-key=us-nh-regs-official--agency-he-w--He-W 654.01}

(a) Except where otherwise specified or specifically prohibited, income for all adult categories of financial assistance shall be evaluated and treated in the same manner as in the financial assistance to needy families (FANF) program.

(b) For self-employed individuals, if the cost of doing business exceeds gross self-employment income, the self-employment income amount shall be zero.

(c) Costs of doing business which exceed gross self-employment income shall not be an allowable deduction, nor subtracted from any other income that the individual may have.

(d) Income shall be considered to belong to the individual on whose behalf it is paid.

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #6531, INTERIM, eff 6-27-97, EXPIRES: 10-25-97; ss by #6614, eff 10-24-97; ss by #8452, eff 10-22-05; ss by #10471, eff 11-26-13; ss by #13715, eff 8-8-23

N.H. Code Admin. R. Ann. He-W 654.02 Income Computation {#sec-he-w-654.02 omnilex-key=us-nh-regs-official--agency-he-w--He-W 654.02}

(a) In computing eligibility and benefits, if any subtraction results in a negative amount, the result shall be considered to be zero instead of the negative amount.

(b) Except where otherwise specified or specifically prohibited, eligibility and the level of benefits for FANF financial assistance shall be determined for the assistance group (AG), rather than an individual basis, as follows:

(1) The amount of each AG member's countable gross earned income shall be determined;

(2) For each individual, the earned income disregard (EID), as specified in He-W 654.13, shall be computed and subtracted from gross earned income;

(3) From the remaining amount in (2) above, the child/dependent care disregard, as specified in He-W 654.14, shall be subtracted, to obtain the individual’s net earned income;

(4) Each individual’s net earned income amount shall be added together to obtain the AG’s net earned income amount;

(5) The countable gross unearned income of all AG members shall be added to the AG’s net earned income described in (4) above;

(6) From the total amount in (5) above, allowable deductions as specified in He-W 654.20 and He-W 654.21 shall be subtracted;

(7) The result of the computation in (6) above shall be the AG’s net income;

(8) The AG’s net income shall be compared to the AG’s payment standard in He-W 658.02; and

(9) The difference between the AG’s payment standard and the AG’s net income shall equal the AG’s monthly benefit amount.

(c) For an individual not living in a nursing facility who is applying for or receiving adult category financial assistance, and, if applicable, his or her applicant spouse, as defined in He-W 601.01(o), net income, as defined in He-W 601.05(v), shall be computed as follows:

(1) The amount of the individual’s and the individual’s applicant spouse’s countable gross earned income, as defined in He-W 601.04(m)-(n), shall be determined;

(2) For each individual, the earned income disregard (EID) for the adult category under which each individual is applying or receiving assistance, as specified in He-W 654.15, shall be computed and subtracted from each individual’s countable gross earned income to obtain each individual’s net earned income, as defined in He-W 601.05(u);

(3) Each individual’s net earned income amount shall be added together to obtain the AG’s net earned income amount;

(4) The countable gross unearned income, as defined in He-W 601.08(k), of each individual shall be added to the AG’s net earned income, described in (3) above;

(5) From the total in (4) above, the adult standard disregard, as specified in He-W 654.16, and allowable deductions, as specified in He-W 654.20 and He-W 654.21, shall be subtracted; and

(6) The result shall be the AG’s net income.

(d) For an individual not living in a nursing facility who is applying for or receiving APTD or OAA financial assistance, and who lives with his or her nonapplicant spouse, as defined in He-W 601.05(x), net income, as defined in He-W 601.05(v) shall be computed as follows:

(1) The coun gross earned incomes of the applicant and nonapplicant spouse shall be combined;

(2) The EID, as specified in He-W 654.15(h), shall be subtracted from the combined gross earned income determined in (1) above to obtain the AG’s net earned income;

(3) The countable gross unearned income, as defined in He-W 601.08(k), of all AG members shall be added to the AG’s net earned income amount determined in (2) above;

(4) From the total in (3) above, the adult standard disregard, as specified in He-W 654.16, and allowable deductions, as specified in He-W 654.20 and He-W 654.21, shall be subtracted; and

(5) The result shall be the AG’s net income.

(e) For an individual not living in a nursing facility who is applying for or receiving ANB financial assistance who lives with his or her nonapplicant spouse as defined in He-W 601.05(x), net income, as defined in He-W 601.05(v), shall be computed as follows:

(1) The countable gross earned incomes of the applicant and nonapplicant spouse shall be combined;

(2) The EID, as specified in He-W 654.15(c), including additional employment-related amounts as described in He-W 654.15(d), if applicable, shall be subtracted from the combined gross earned income determined in (1) above, to obtain the AG’s net earned income;

(3) The countable gross unearned income, as defined in He-W 601.08(k), of all AG members shall be added to the AG’s net earned income amount determined in (2) above;

(4) From the total in (3) above, the adult standard disregard, as specified in He-W 654.16, and allowable deductions, as specified in He-W 654.20 and He-W 654.21, shall be subtracted; and

(5) The result shall be the AG’s net income.

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #5750, eff 12-1-93; amd by #6446, eff 2-1-97; ss by #7135, eff 11-23-99; ss by #7342, eff 10-1-00; ss by #9276, eff 10-1-08; ss by #12015, eff 10-25-16

N.H. Code Admin. R. Ann. He-W 654.03 Lump Sum Income – Financial Assistance to Needy Families (FANF) {#sec-he-w-654.03 omnilex-key=us-nh-regs-official--agency-he-w--He-W 654.03}

(a) For FANF financial assistance, lump sum income shall include, but not be limited to, non-recurring countable earned or unearned lump sum payments such as the following:

(1) Retroactive earned income;

(2) Retroactive lump sum social security benefits;

(3) Retroactive lump sum railroad retirement benefits;

(4) Unemployment compensation lump sum payments;

(5) Insurance settlements;

(6) Lump sum retirement benefits; and

(7) Windfalls such as inheritances, lotteries, and other financial prizes.

(b) Lump sum income shall not include retroactive Social Security Income (SSI) payments or refunds of the individual's own money, such as a returned security or utility deposit.

(c) A lump sum earned income amount shall be reduced by the employment expense disregard (EED), as specified in He-W 654.13(f), if the individual has not already received the EED.

(d) Lump sum income amounts received in the month of application shall be reduced in the manner described below:

(1) If assistance begins on the first day of the month of application, no additional reduction of the lump sum amount shall be allowed;

(2) If assistance begins on the 16th day of the month of application, the lump sum amount shall be reduced by an amount equal to one-half of the FANF standard of need as defined in He-W 601.07 for the assistance group (AG) size as defined in He-W 601.01; and

(3) If assistance begins on the first day of the month after the month of application, the lump sum amount shall be reduced by an amount equal to the full FANF standard of need for the AG size.

(e) When determining the period a case will be ineligible due to receipt of lump sum income:

(1) One month shall be equal to 2 payroll periods; and

(2) The period of ineligibility shall begin the month following the month of receipt of the lump sum.

(f) The period of ineligibility shall be recalculated at the individual’s request under one or more of the following circumstances:

(1) There are changes in the FANF standard of need;

(2) Shelter costs have increased;

(3) The lump sum is or was spent on life-threatening circumstances described in (g) below, under the following conditions:

a. The individual has no other income or resources available; and

b. The lump sum is or was being used to meet essential needs prior to being used for the life-threatening circumstances; or

(4) An AG member incurred, paid, and verified approved medical expenses described in (i) below.

(g) Life-threatening circumstances shall be circumstances which cannot be reasonably predicted and result in loss or unavailability of the lump sum.

(h) Life-threatening circumstances referred to in (g) above shall include, but not be limited to, the following:

(1) Natural disasters such as floods, fires, earthquakes, and hurricanes;

(2) Man-made occurrences which cause harm to the AG, such as theft of clothing, food, or money, arson, eviction, or loss of an owned residence;

(3) Medical emergencies or a serious illness of a member of the AG or of persons for whom a member of the AG, under state law, is liable to support;

(4) Use of the lump sum or a portion of it to obtain or prevent discontinuance of utilities or heat; and

(5) Use of the lump sum or a portion of it to prevent a situation, as defined by state law that would imperil the physical or mental well-being of a child or children.

(i) Approved medical expenses shall include, but not be limited to:

(1) Any expense that medicaid would pay for if the AG were eligible for medicaid, regardless of service limits;

(2) Health care insurance premiums;

(3) Prescription drugs; and

(4) Medical services, supplies, or equipment that are not covered by medicaid but which are prescribed by a licensed medical professional.

(j) An increase in the AG size shall not be considered an increase in the FANF standard of need.

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; amd by #6446, eff 2-1-97; ss by #6531, INTERIM, eff 6-27-97, EXPIRES: 10-25-97; ss by #6614, eff 10-24-97; ss by #8452, eff 10-22-05; ss by #10471, eff 11-26-13; ss by #13715, eff 8-8-23

N.H. Code Admin. R. Ann. He-W 654.04 Treatment {#sec-he-w-654.04 omnilex-key=us-nh-regs-official--agency-he-w--He-W 654.04}

of Specific Types of Income.

(a) The following types of income shall be excluded for purposes of eligibility:

(1) Adoption subsidy payments;

(2) Pension or insurance benefits specifically designated for use as payment for hospitalization or medical services;

(3) Assistance in the form of vendor payments directly to a provider;

(4) Assistance that must be reimbursed, such as a loan from an individual or a financial institution, for personal or business reasons;

(5) The earned income of dependent children, as defined in He-W 601.03, in a financial assistance to needy families (FANF) assistance group (AG) who are students;

(6) Foster care income payments made to an individual by a public or private agency for taking care of a foster child or children; or

(7) For FANF only, combat pay that a household receives from a military member who is currently absent from the household due to the military member’s deployment to or service in an area designated as a combat zone.

(b) The following types of income shall be treated as specified below:

(1) A child support payment paid on behalf of more than one child shall be prorated to obtain an amount for each child;

(2) A yearly wage amount which, by contract, is paid during a specific work period of less than 12 months, such as income received by a teacher, shall be treated as available to the individual for the whole year covered by the contract and the yearly wage amount divided by 12;

(3) Child care income, which is payment an individual receives for taking care of children in the individual’s own home, shall be treated as self-employment income;

(4) Direct relief, which is assistance from other agencies and organizations, shall be counted in determining eligibility and the amount of assistance;

(5) Dividends that are automatically reinvested to purchase additional stock, and interest that is automatically added to a cash account, shall be treated as a part of the resource to which they were added, rather than counted as income;

(6) Lump sum earned income, which is payment for work performed over a period of more than one month, shall be subject to the employment-related disregards and calculated in the following manner:

a. The lump sum shall be divided by the number of months during which work was performed to arrive at a monthly amount;

b. If the lump sum earned income is income from self-employment, the monthly cost of doing business shall be subtracted from the monthly income amount; and

c. The monthly income amount shall be counted as income for a period equal to the number of months that work was performed following the payment of the lump sum;

(7) Rental income, which is payment to an AG member by someone in a rental housing situation, shall be treated as described below:

a. Rental income shall be reduced by the cost of doing business as described in b. below, and the remainder shall be considered net rental income;

b. The cost of doing business shall be the higher of the following monthly figures:

$50 per tenant; or
The actual documented expense of providing shelter to the tenants, excluding the following expenses which shall not be business expenses:

(i) Depreciation;

(ii) Personal business and entertainment;

(iii) Personal transportation;

(iv) Payments on the principals of business loans;

(v) Purchase prices of capital assets;

(vi) Payments on the principals of the purchase prices of capital assets; and

(vii) Personal taxes, such as income taxes;

c. If rental income is the result of services performed by an AG member, the net rental income shall be treated as earned income;

d. If a rental property is managed by a rental agency or by someone other than the AG member who receives the income, the net rental income shall be treated as unearned income; and

e. If the rental income is derived from a rooming arrangement, the net rental income shall be treated as unearned income;

(8) Boarder income, which is payment by an individual who lives in and is provided meals in someone else's home, shall be treated as unearned income and be reduced by the cost of doing business of which is the higher of the following:

a. The supplemental nutrition assistance program maximum monthly allotment level pursuant to 7 CFR 273.10(e)(4), for a household size equivalent to the total number of boarders; or

b. The actual documented expense of providing room and meals to the boarder or boarders;

(9) Payments from a trust or similar legal device, or payments from the corpus of a trust or a similar legal device, made to, for the benefit of, or on behalf of the individual, shall be considered income to the individual; and

(10) For FANF only, military pay that is not considered combat pay pursuant to (a)(7) above and is made available to a household while a military member is absent from the household shall be treated as unearned income.

(c) Pursuant to RSA 167:80, IV(h), Supplemental Security Income (SSI) shall be counted as unearned income for FANF and the adult categories of financial assistance, when computing income pursuant to He-W 652.02 and He-W 654.02.

(d) With respect to (c) above, SSI shall be excluded for the FANF categories of financial assistance when the recipient of the SSI benefit is a dependent child, as defined in He-W 601.03.

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; amd by #6111, eff 11-1-95; ss by #6531, INTERIM, eff 6-27-97, EXPIRES: 10-25-97; ss by #6614, eff 10-24-97; amd by #6740, eff 4-25-98; amd by #6826, eff 8-3-98; amd by #8452, eff 10-22-05; amd by #8616, INTERIM, eff 4-25-06, EXPIRED: 10-22-06; amd by #8729, eff 9-26-06; ss by #10358, eff 6-12-13; para. (d) amd by #11174, EMERGENCY RULE, eff 9-1-16, EXPIRES: 2-28-17; para (d) amd by #12116, eff 2-28-17; amd by #12561, eff 6-29-18; ss by #13927, eff 4-23-24

N.H. Code Admin. R. Ann. He-W 654.05 Educational Income - Adult Categories of Financial Assistance {#sec-he-w-654.05 omnilex-key=us-nh-regs-official--agency-he-w--He-W 654.05}

(a) Income from scholarships and grants that are not otherwise excluded by federal law or regulation, shall be:

(1) Counted only to the extent that the income exceeds actual verified educational expenses during the period it is intended to cover; and

(2) Divided by the number of months the income is intended to cover to calculate a monthly amount.

(b) Income from student loans, regardless of the source or the purpose to which it is used, shall not be counted when determining eligibility or the amount of assistance.

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #6531, INTERIM, eff 6-27-97, EXPIRES: 10-25-97; ss by #6614, eff 10-24-97; amd by #6672, eff 1-26-98; ss by #8452, eff 10-22-05; ss by #10471, eff 11-26-13; ss by #13715, eff 8-8-23

N.H. Code Admin. R. Ann. He-W 654.06 Educational Expenses - Adult Categories {#sec-he-w-654.06 omnilex-key=us-nh-regs-official--agency-he-w--He-W 654.06}

(a) Repayment of a student loan shall not be an allowable deduction from educational income.

(b) Other educational expenses with the exclusion of (a) above shall be an allowable deduction from educational income if all of the following conditions are met:

(1) The expense is directly related to and necessary for school attendance;

(2) The student is responsible for the payment of the expense; and

(3) The expense has not been or will not be reimbursed from another source;

(c) If the educational expense has been or will be partially reimbursed, the remaining amount shall be allowed as a deduction from educational income; and

(d) Transportation costs to and from school shall be computed and verified in the same manner as for the employment expense disregard, specified in He-W 654.18.

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #6531, INTERIM, eff 6-27-97, EXPIRES: 10-25-97; ss by #6614, eff 10-24-97; amd by #6672, eff 1-26-98; ss by #8452, eff 10-22-05; ss by #10471, eff 11-26-13; ss by #13715, eff 8-8-23

N.H. Code Admin. R. Ann. He-W 654.07 Income-In-Kind {#sec-he-w-654.07 omnilex-key=us-nh-regs-official--agency-he-w--He-W 654.07}

(a) For all adult categories of financial assistance, earned income-in-kind received on a regular basis shall be assigned a dollar value and shall be treated as countable earned income as follows:

(1) The dollar value shall be determined by a statement from the employer indicating the frequency and dollar value of earned income-in-kind, or, if unable to obtain such a statement, by multiplying the number of hours worked times the hourly wage as provided by the employer;

(2) If the employer is unable to provide an approximate hourly wage, or the client is self-employed, the current minimum hourly wage shall be used; and

(3) From the dollar value amount determined as referenced in (1) or (2) above, any monetary payment received as a supplement for the same job shall be subtracted, resulting in gross earned income-in-kind.

(b) With the exception of payments made from trusts or similar legal devices, for adult category financial assistance, unearned income-in-kind shall represent a component of the adult category standard of need and shall not be counted as income.

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; amd by #6111, eff 11-1-95; ss by #6531, INTERIM, eff 6-27-97, EXPIRES: 10-25-97
#6740, eff 4-25-98; ss by #8596, eff 3-30-06; ss by #10563, eff 3-30-14; ss by #13929, eff 4-24-24

N.H. Code Admin. R. Ann. He-W 654.08 Provided Shelter {#sec-he-w-654.08 omnilex-key=us-nh-regs-official--agency-he-w--He-W 654.08}

Shelter that is either provided at no charge to the AG or is paid by an individual, agency, organization, or governmental unit outside of the AG, shall not be assigned a dollar value or be counted as income.

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #6531, INTERIM, eff 6-27-97, EXPIRES: 10-25-97; ss by #6614, eff 10-24-97; ss by #8452, eff 10-22-05; ss by #10471, eff 11-26-13; ss by #13715, eff 8-8-23

N.H. Code Admin. R. Ann. He-W 654.09 Treatment of Assigned Support {#sec-he-w-654.09 omnilex-key=us-nh-regs-official--agency-he-w--He-W 654.09}

(a) Child and spousal support shall be considered the unearned income of the individual on whose behalf it is paid.

(b) Child and spousal support shall be treated as follows in determining eligibility for the remainder of the assistance group, as defined in He-W 601.01(u):

(1) Support paid on behalf of an individual who is ineligible for financial assistance to needy families (FANF) financial assistance shall not be counted; and

(2) Unless otherwise stipulated by court order or administrative order, child support payments paid on behalf of more than one child shall be prorated by the number of children on whose behalf it is paid and the prorated amount shall be considered the unearned income of each child.

(c) If an individual in a FANF financial assistance case for whom support is assigned receives a direct support payment from or on behalf of the responsible parent, and the individual does not remit the direct support payment to the department, the full amount of the support payment shall be treated as unearned income in determining eligibility and the level of benefits.

(d) If an individual in a FANF financial assistance case for whom support is assigned receives a direct support payment from or on behalf of the responsible parent and the individual remits the direct support payment to the department, the full amount of the support payment shall be treated as unearned income in determining eligibility only.

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; amd by #6446, eff 2-1-97; amd by #6531, INTERIM, eff 6-27-97, EXPIRES: 10-25-97; amd by #6614, eff 10-24-97; amd by #8271, eff 2-1-05; amd by #8452, eff 10-22-05; ss by #10275, eff 2-21-13; ss by #13540, eff 1-28-23

(a) In accordance with 8 USC 1631, a portion of a sponsor’s income shall be deemed to the sponsored non-citizen and treated as unearned income when determining eligibility and the amount of financial assistance to needy families (FANF). The amount deemed shall be determined as follows:

(1) Subtract 20% from the monthly gross earned income of the sponsor and of the sponsor’s spouse, if applicable, and total the resulting individual net earned income amounts to determine the net earned income;

(2) Add the net earned income and all unearned income of the sponsor and the sponsor’s spouse; and

(3) Subtract all of the following:

a. The standard of need, in accordance with He-W 658.01, for the sponsor, sponsor’s spouse, and all individuals living in the sponsor’s home who could be claimed as legal dependents for tax filing purposes;

b. Any amounts actually paid by the sponsor or the sponsor’s spouse to individuals who are not in the home and could be claimed as legal dependents for tax filing purposes; and

c. Any amount actually paid by the sponsor or the sponsor’s spouse for child or spousal support.

(b) The available deemed income, as determined in (a) above, shall be added to the assistance group’s other income and eligibility shall be determined in accordance with He-W 654.02.

(c) Income shall not be deemed from a sponsor receiving FANF, an adult category of financial assistance, or supplemental security income.

(d) In accordance with 45 CFR 233.52, good cause for not providing sponsor information to the department shall exist when the sponsor provided accurate information to the non-citizen and the non-citizen misinterpreted or misrepresented the information when applying for financial assistance.

(e) Income shall be deemed to a non-citizen from the sponsor and sponsor’s spouse until one of the following circumstances occur:

(1) The sponsor or the non-citizen dies;

(2) The non-citizen becomes a United States citizen;

(3) The non-citizen has earned, or can be credited with, 40 qualifying quarters of work, as defined by the Social Security Administration;

(4) The non-citizen ceases to hold the status of lawful permanent resident and leaves the United States; or

(5) The non-citizen is subject to removal, but applies for and obtains in removal proceedings, a new grant of adjustment of status.

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #5530, eff 12-16-92; ss by #6865, eff 10-3-98; ss by #8684, eff 7-21-06; ss by #10743, eff 12-12-14; ss by #14053, eff 8-17-24, EXPIRES: 8-17-34

N.H. Code Admin. R. Ann. He-W 654.11 Federally Mandated Excluded Income {#sec-he-w-654.11 omnilex-key=us-nh-regs-official--agency-he-w--He-W 654.11}

Except where otherwise specified, income that is considered excluded for FANF shall also be excluded for the adult categories of financial assistance.

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #6531, INTERIM, eff 6-27-97, EXPIRES: 10-25-97; ss by #6614, eff 10-24-97; ss by #8452, eff 10-22-05; ss by #10471, eff 11-26-13; ss by #13715, eff 8-8-23

N.H. Code Admin. R. Ann. He-W 654.12 Other Excluded Income {#sec-he-w-654.12 omnilex-key=us-nh-regs-official--agency-he-w--He-W 654.12}

(a) Loans for personal or business reasons shall be excluded income and disregarded when determining eligibility and the amount of assistance for all categories of financial assistance.

(b) All earned and unearned income received by a dependent child from the summer youth employment and training program shall be disregarded for the FANF program.

(c) For individuals receiving home and community based care services (HCBC), the aid and attendance allowance shall be applied to the cost of care.

(d) The value of a FANF AG's share of a governmental housing subsidy shall be excluded income.

(e) Income set aside under a social security administration approved plan to achieve self support , shall be excluded for the duration of the plan.

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #5248, eff 10-16-98; ss by #6614, eff 10-24-97; amd by #8452, eff 10-22-05; paragraphs (c) and (f) in #6614 EXPIRED: 10-24-05; ss by #10471, eff 11-26-13; ss by #13715, eff 8-8-23

N.H. Code Admin. R. Ann. He-W 654.13 Earned Income Disregard (EID) and Employment Expense Disregard (EED) for Financial Assistance to Needy Families (FANF) {#sec-he-w-654.13 omnilex-key=us-nh-regs-official--agency-he-w--He-W 654.13}

(a) An earned income disregard (EID), as defined in He-W 601.03(l), shall be subtracted from gross earned income for each applicant or recipient whose needs and income are considered when determining eligibility for FANF financial assistance.

(b) For applicants who have not received FANF financial assistance in any one of the previous 6 months, the EID shall be 20% of the individual’s monthly gross earned income.

(1) Used to determine eligibility for applicants of FANF financial assistance in (b) above; and

(2) The first subtraction from the monthly gross earned income.

(d) If a financial assistance applicant is determined eligible after applying the 20% EID as described in (c) above, then the benefit amount shall be determined using a 50% EID as described in (e) below.

(e) The 50% EID shall be used to determine:

(1) The eligibility and the benefit amount for current FANF financial assistance recipients;

(2) The eligibility and the benefit amount for applicants who have received FANF financial assistance in any one of the previous 6 months; and

(3) The benefit amount for applicants who are determined eligible as described in (d) above.

(f) For FANF deeming and lump sum calculations, the employment expense disregard (EED), as defined in He-W 601.03(o), shall be 20% of the individual’s gross earned income.

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #6446, eff 2-1-97; ss by #7354, eff 9-1-00; ss by #9252, eff 9-1-08’ ss by #11186, eff 9-20-16

N.H. Code Admin. R. Ann. He-W 654.14 Child and Dependent Care Disregard for Financial Assistance {#sec-he-w-654.14 omnilex-key=us-nh-regs-official--agency-he-w--He-W 654.14}

(a) For purposes of this rule, an individual shall be considered a full-time employee if the individual is earning $377.00 or more per month in gross earned income and shall be considered a part-time employee if the individual is earning less than $377.00 in gross earned income per month.

(b) The maximum disregard for child and dependent care costs for full-time employees shall be:

(1) For each child age 6 or older, $175.00 per month;

(2) For each incapacitated parent, $175.00 per month; and

(3) For each child under age 6, $200.00 per month.

(1) For each child age 6 or older, $87.50 per month;

(2) For each incapacitated parent, $87.50 per month; and

(3) For each child under age 6, $100.00 per month.

(d) In order for the employed person to be eligible for the child/dependent care disregard, the child or incapacitated parent receiving the care shall:

(1) Live in the employed individual's home; and

(2) Be receiving or applying for assistance in:

a. The same financial assistance to needy families (FANF) financial or medical assistance case;

b. A related FANF financial or separate medical assistance case, unless the child or incapacitated parent is in a separate medical assistance case due to failure to meet a financial assistance eligibility requirement;

c. An aid to the permanently and totally disabled (APTD) or aid to the needy blind (ANB) financial or medical assistance case; or

d. An old age assistance (OAA) financial or medical assistance case, only if the OAA parent or spouse is determined by the disability determination unit (DDU) to meet the APTD or ANB incapacity criteria specified in He-W 500.

(e) Because the cost for a child or incapacitated parent cannot be prorated when there is more than one employed person in an assistance group, all child and dependent care costs claimed by each employed person shall be for different individuals in the assistance group.

(f) Good cause for terminating employment, failure to accept a job, and reduced earnings, as it relates to suspension of the employment-related disregards, shall be determined to exist if non-compliance was precipitated by circumstances beyond the individual's control, including but not limited to:

(1) Illness of the individual;

(2) Illness of another family member requiring the presence of the parent;

(3) Family emergency or unanticipated emergencies; or

(4) Breakdown of transportation.

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; amd by #6446, eff 2-1-97; amd by #6531, INTERIM, eff 6-27-97, EXPIRES: 10-25-97; amd by #6614, eff 10-24-97; amd by #8271, eff 2-1-05; amd by #8452, eff 10-22-05; ss by #10275, eff 2-21-13; ss by #13665, eff 6-21-23

N.H. Code Admin. R. Ann. He-W 654.15 Adult Category Earned Income Disregard {#sec-he-w-654.15 omnilex-key=us-nh-regs-official--agency-he-w--He-W 654.15}

(a) The earned income disregard shall be the first subtraction from earned income when computing net income for the adult categories of financial assistance.

(b) For aid to the needy blind (ANB) financial assistance applicants and recipients and for their applicant spouses who are also applying for ANB, the earned income disregard for each individual shall be the first $85.00 of each individual's monthly gross earned income plus one half of the remaining amount.

(c) ANB financial assistance applicants and recipients shall have additional employment-related amounts added to the earned income disregard if:

(1) There is an individualized plan for employment for a specified period of time which has been approved by the New Hampshire department of education and meets the requirements cited in 29 USC 720 et. seq.; and

(2) The plan described in (1) above requires the use of additional disregards.

(d) For ANB financial assistance applicants and recipients with applicant spouses who are applying for aid to the permanently and totally disabled (APTD) or old age assistance (OAA), the computation method for determining the amount of the earned income disregard for the spouse shall be the method to determine the APTD or OAA earned income disregard in (f) below for financial assistance.

(e) For APTD or OAA financial assistance applicants and recipients with applicant spouses who are applying for ANB, the computation method for determining the amount of the earned income disregard for the spouse shall be the method to determine the ANB earned income disregard in (b) and (c) above.

(f) For APTD or OAA financial assistance applicants and recipients and their spouses or a needy essential person, as defined in He-W 601.05(t), the earned income disregard for each individual shall be:

(1) The first $20.00 of each individual's monthly gross earned income;

(2) Plus one half of the remaining amount up to $30;

(3) For a sum total of (f)(1) and (f)(2) not to exceed $50; and

(4) Less an employment expense disregard pursuant to He-W 654.18(b)-(c).

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #5750, eff 12-1-93; ss by #7135, eff 11-23-99; ss by #7342, eff 10-1-00; ss by #9276, eff 10-1-08; ss by #10253, eff 1-19-13; ss by #13525, eff 1-24-23

N.H. Code Admin. R. Ann. He-W 654.16 Adult Standard Disregard {#sec-he-w-654.16 omnilex-key=us-nh-regs-official--agency-he-w--He-W 654.16}

(a) For adult category financial assistance applicants or recipients, a standard disregard shall be subtracted from income as described in He-W 654.02(c)(5).

(b) The amount of the disregard shall depend on the number of individuals whose needs are considered when determining eligibility, as follows:

(1) The standard disregard for one individual shall be $13.00;

(2) The standard disregard shall be $20.00 for an individual and applicant or nonapplicant spouse, or an individual and a needy essential person; and

(3) The standard disregard shall be $25.00 for an individual and applicant or nonapplicant spouse and a needy essential person.

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #6531, INTERIM, eff 6-27-97, EXPIRES: 10-25-97; ss by #6614, eff 10-24-97; ss by #7342, eff 10-1-00; ss by #9276, eff 10-1-08; ss by #11042, eff 2-24-16; ss by #14304, eff 7-1-25, EXPIRES: 7-1-35

N.H. Code Admin. R. Ann. He-W 654.17 Post-Eligibility Computation of Cost of Care for Nursing Facility Care {#sec-he-w-654.17 omnilex-key=us-nh-regs-official--agency-he-w--He-W 654.17}

– (Moved to He-W 854.17)

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #6531, INTERIM, eff 6-27-97, EXPIRES: 10-25-97; ss by #6614, eff 10-24-97; ss by #7118, eff 10-16-99; ss by #7342, eff 10-1-00; amd by #8408, eff 9-1-05; amd by #8451, eff 11-1-05; ss by #9276, eff 10-1-08; amd by #9789, eff 10-1-10

N.H. Code Admin. R. Ann. He-W 654.18 Adult Employment Expense Disregard {#sec-he-w-654.18 omnilex-key=us-nh-regs-official--agency-he-w--He-W 654.18}

(a) An employment expense disregard (EED) which is reasonably attributable to the earning of income shall be subtracted from the earned income of an applicant or recipient of OAA or APTD financial assistance when determining eligibility and benefit amount.

(b) The amount of the employment expense disregard shall be a minimum flat rate of $18 per month, or actual verified expenses if higher than $18 per month.

(c) The following expenses, if actually incurred and verified, shall be considered reasonably attributable to the earning of income:

(1) Social security taxes, at the rate set by SSA;

(2) Railroad retirement taxes;

(3) Federal withholding taxes, corresponding to the number of exemptions which the individual is legally entitled to claim;

(4) Mandatory retirement payments;

(5) Mandatory union dues;

(6) Other mandatory deductions from wages provided that the individual can document that the payroll deduction is not elective;

(7) Costs for transportation to and from work or to and from child care when child care is necessary for employment, subject to the following conditions:

a. To qualify as an allowable employment expense, transportation shall be the least expensive reasonable means available to the individual;

b. The amount of allowable transportation costs shall be computed by multiplying the average number of days per month an individual is employed, without deducting temporary absences of short duration, by the transportation cost for one day;

c. If the individual has been or will be reimbursed for transportation costs in any manner, the amount of the reimbursement shall be subtracted from the amount that would otherwise be allowed;

d. For travel incurred by an individual using his or her own vehicle, the allowable transportation cost shall be $0.21 per mile multiplied by the number of miles anticipated to be traveled in a month;

e. For travel provided in another person's privately owned vehicle, the allowable transportation cost shall be as charged up to the amount that would be allowed if the individual used his or her own vehicle; and

f. For travel provided by public transportation, such as by taxi or bus, the allowable transportation cost shall be the amount charged the public for such travel;

(8) Costs for uniforms and other unique clothing which are required for employment and are not worn outside the work environment, subject to the following conditions:

a. Cleaning of uniforms shall not be an allowable employment expense unless the individual can document that a standard of cleanliness requires professional cleaning as a condition of employment;

b. The allowable expense shall be the amount actually paid by the individual for the special clothing;

c. If the amount varies monthly, an average shall be computed and applied until the next regularly scheduled redetermination; and

d. If the individual has been or will be reimbursed in any manner for a claimed special clothing expense, the reimbursed amount shall be subtracted from the amount which would otherwise be allowed; and

(9) Other mandatory employment related expenses claimed and verified by the individual.

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #5750, eff 12-1-93; ss by #7135, eff 11-23-99; ss by #7342, eff 10-1-00; ss by #9276, eff 10-1-08; ss by #12015, eff 10-25-16

N.H. Code Admin. R. Ann. He-W 654.19 Child Care Costs {#sec-he-w-654.19 omnilex-key=us-nh-regs-official--agency-he-w--He-W 654.19}

(a) For all categories of financial assistance, child care costs incurred as the result of employment shall be an allowable deduction only when the individual taking care of the child or children is a licensed provider or does not require licensing under state law.

(b) Only that part of the child care expense which is not being reimbursed from another source, such as child care development funds, shall be an allowable expense.

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #6531, INTERIM, eff 6-27-97, EXPIRES: 10-25-97; ss by #6614, eff 10-24-97; ss by #8452, eff 10-22-05; ss by #10471, eff 11-26-13; ss by #13715, eff 8-8-23

N.H. Code Admin. R. Ann. He-W 654.20 Allowable Deductions {#sec-he-w-654.20 omnilex-key=us-nh-regs-official--agency-he-w--He-W 654.20}

(a) When determining eligibility and the amount of assistance for all adult categories of financial assistance, an allowable deduction, as defined in He-W 601.01(l), from the income available to the assistance group shall be made in an amount which has been or must be paid by an individual for non-employment-related types of expenses, including the following:

(1) With the exception of restitution, any court-ordered payments, regardless of the amount the individual may be paying, including but not limited to:

a. Child support;

b. Alimony; and

c. Guardianship fees;

(2) Garnishments from an individual’s earnings to repay a legal debt;

(3) Training expenses when all the following circumstances are met:

a. The individual is enrolled in and regularly attending a program on at least a half-time basis, as defined by the program, which must have an organized curriculum with the specific objective of training individuals for gainful employment;

b. The training program is sponsored by public education, the federal government, or is offered by private schools for a particular trade;

c. The individual has not received reimbursement for the training expense from any other source, or if partial reimbursement has been made, the remaining expense shall be an allowable deduction;

d. The training expense is not part of an employment expense disregard, either because the individual has no earned income, or because the training is totally unrelated to the individual's employment; and

e. The expense occurs on at least a monthly basis; and

(4) Allocated income, as specified in He-W 606.75.

(b) When determining eligibility and the amount of assistance for financial assistance to needy families (FANF), an allowable deduction from the income available to the assistance group shall be made, in an amount which has been paid by an individual for non-employment-related types of expenses, including the following:

(1) The actual payment amount of court-ordered child support payments;

(2) The actual payment amount of court-ordered spousal support payments;

(3) Garnishments from an individual’s earnings to repay a legal debt;

(4) Training expenses when all the following circumstances are met:

b. The training program is sponsored by public education or the federal government, or is offered by private schools for a particular trade;

c. The individual has not received reimbursement for the training expense from any other source, or if partial reimbursement has been made, the remaining expense shall be an allowable deduction;

e. The expense occurs on at least a monthly basis.

(1) Any individual whose needs are included in the assistance group; and

(2) Any individual whose income is counted even if the individual’s needs are not included in the assistance group.

(d) The amount of the deduction shall be the amount of:

(1) The verified expense for adult categories of financial assistance; and

(2) The actual payment amount for FANF.

(e) Allowable deductions shall be applied as follows:

(1) For FANF, and for adult category financial assistance cases in which there is a non-applicant spouse, the allowable deductions shall be subtracted from the amount which represents the monthly combined earned income, less all applicable disregards to earned income as described in He-W 654.14 and He-W 654.15, plus all unearned income; and

(2) For adult category financial assistance cases in which there is an applicant spouse, the allowable deductions shall be subtracted from the amounts which represent the individual monthly net incomes of the applicant and the applicant spouse.

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #6531, INTERIM, eff 6-27-97, EXPIRES: 10-25-97; ss by #6614, eff 10-24-97; ss by #7342, eff 10-1-00; ss by #9276, eff 10-1-08; ss by #11042, eff 2-24-16; ss by #13540, eff 1-28-23

N.H. Code Admin. R. Ann. He-W 654.21 Allocated Income {#sec-he-w-654.21 omnilex-key=us-nh-regs-official--agency-he-w--He-W 654.21}

(a) Income of applicants and recipients of financial or medical assistance shall be allocated to provide for the unmet needs of a dependent, as described below, upon request of the client.

(b) For adult categories of financial and medical assistance other than medical assistance for institutionalized individuals who have a community spouse, an individual shall be considered a dependent, for purposes of allocating income, when the individual is:

(1) Financially dependent upon the individual from whom the income shall be allocated;

(2) Ineligible for any category of financial or medical assistance; and

(3) Either:

a. A parent;

b. A spouse who is separated due to institutionalization;

c. A child under the age of 18; or

d. A child age 18 or older who is unable to work due to a physical or mental disability.

(c) An individual shall be considered a dependent for purposes of allocation of income for the FANF category of assistance, when the individual is:

(1) Financially dependent upon the person from whom the income shall be allocated;

(2) Someone whom the FANF client is claiming or could claim for personal income tax purposes; or

(3) An individual whom the FANF client is legally obligated to support.

(d) Individuals who allocate income shall be:

(1) Age 18 or older; and

(2) The casehead, as defined in He-W 601.02(j).

(e) The amount of allocated income for a dependent who resides outside the FANF household shall be the amount the FANF client actually pays to support that dependent.

(f) The amount of allocated income for dependents residing in the FANF household and other dependents of a non-institutionalized individual shall be the difference between:

(1) The FANF standard of need for a group size equal to the number of legal dependents; and

(2) Any other gross income available to the dependents.

(g) When an individual in an adult category case with no spouse who lives in the community, enters or leaves a nursing facility, a portion of his or her income shall be allocated, at his or her request, for maintenance of the home in order to meet expenses incurred or to be incurred outside of the institution for that part of the month spent in the institution, as follows:

(1) If the stay of an institutionalized individual is to be 3 months or less, as certified by a physician, a portion of the client's income which represents the FANF shelter allowance shall be allocated, at the client's request, to the maintenance of the home to which the client is expected to return; or

(2) If the stay of an institutionalized individual is to be in excess of 3 months, the amount allowed as allocated income for maintenance of the home shall be the amount of the verified outside expenses for the first month of institutionalization and for the month the individual leaves the institution to return to the home.

(h) The department shall determine if the income of the community spouse as defined in 42 USC 1396r–5(d) is sufficient to have a maintenance needs allowance equal to the minimum percentage of the federal poverty income guidelines required under 42 USC 1396r–5.

(i) If the department determines that the income of the community spouse is insufficient to meet the minimum maintenance needs allowance in (h) above, the department shall determine an income allowance for the community spouse, pursuant to 42 USC 1396r–5(d).

(j) If either the institutionalized spouse or the community spouse is dissatisfied with the community spouse income allowance determination in (i) above, he/she shall be entitled to an administrative appeal pursuant to He-C 200 and with respect to such determination pursuant to the requirements specified in 42 USC 1396r–5(e).

(k) If either spouse verifies at the administrative appeal that the community spouse needs a higher income allowance than determined in (h) or (i) above due to exceptional circumstances resulting in significant financial duress, there shall be substituted for the minimum percentage an amount adequate to provide for such additional need.

(l) Exceptional circumstances resulting in significant financial duress shall be one or more of the following:

(1) Costs of medical, remedial, or other support services, including medical insurance, necessary for community spouses to maintain themselves in the community;

(2) Cost of repairs necessary to maintain the home in a livable condition;

(3) Cost of repairs to appliances within the home;

(4) Cost of repairs or maintenance of one vehicle, including insurance and registration;

(5) Costs associated with unforeseen circumstances such as fire or flood which result in loss of housing, clothing, household goods or other necessities; and

(6) Costs for items or services which have been certified in writing by a physician as being medically necessary to maintain the community spouse in the community.

(m) Acceptable documentation of the costs cited in (1) shall be a currently dated bill or written estimate from the provider which indicates the amount of the expense.

(n) When the administrative appeals unit determines that significant financial duress exists as a result of the costs described in (1) above, the community spouse's income allowance shall be adjusted as follows:

(1) If the cost is a one time expense and the institutionalized individual has sufficient monthly income to allocate to the community spouse to cover the cost, the allowance shall be adjusted only in the month that the expense is approved;

(2) If the cost is a one time expense and the institutionalized individual has insufficient monthly income to allocate to the community spouse to cover the cost, the cost shall be prorated and allowance shall be adjusted for the specific number of months required to accommodate the expense; and

(3) If the cost is an ongoing expense, the allowance shall be adjusted for the specific number of months for which the ongoing expense exists, if known, or until a change is reported or at the next regularly scheduled redetermination in accordance with He-W 684.02, whichever occurs first.

(o) The amount of allocated income for each legal dependent of the spouse who lives in the community or the institutionalized individual shall be one third of the difference between the dependent's gross income and the maintenance allowance, pursuant to 42 USC 1396r–5(d).

(p) For purposes of allocating income, individuals applying for or receiving home and community based care services pursuant to He-W 658.06 shall not be considered to be institutionalized individuals.

(q) There shall be no allocation of income to a legal dependent who would be categorically eligible for assistance but refuses to apply or cooperate in the application process.

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #6531, INTERIM, eff 6-27-97, EXPIRES: 10-25-97; ss by #6614, eff 10-24-97; amd by #7086, eff 10-1-99; amd by #8452, eff 10-22-05; ss by #9980, eff 8-20-11; ss by #12851, INTERIM, eff 8-20-19, EXPIRES: 2-17-20

Part He-W 655 Purchased Services for Employment Support Services

N.H. Code Admin. R. Ann. He-W 655.01 Definitions {#sec-he-w-655.01 omnilex-key=us-nh-regs-official--agency-he-w--He-W 655.01}

(a) “Employment support services” means services, such as transportation assistance, child care, tuition assistance, and fees and supplies, which enable an NHEP participant to seek or maintain employment.

(b) “Fees and supplies” means books, mandatory fees, supplies, tools of the trade, and required uniforms or specialized clothing when necessary for an NHEP participant's employment or education/training preparatory to employment.

(c) “Provider” means any individual or public or private organization supplying employment support services to the NHEP participant.

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #5440, eff 7-24-92; ss by #5712, eff 10-4-93; amd by #5858, eff 7-1-94; amd by #6396, eff 12-16-96; amd by #6446, eff 2-1-97; ss by #7243, eff 5-1-00; ss by #9137, eff 4-22-08; ss by #11092, eff 5-7-16

N.H. Code Admin. R. Ann. He-W 655.02 Availability of Funds {#sec-he-w-655.02 omnilex-key=us-nh-regs-official--agency-he-w--He-W 655.02}

(a) New Hampshire employment program (NHEP) activities as described in He-W 637 shall only be required as budgeted funding and resources within the current state fiscal year are available for a particular employment and training support service.

(b) NHEP participants, as defined in He-W 637.01, shall be the only individuals eligible for assistance for fees, supplies, and tuition as described in He-W 655.06 and He-W 655.08, respectively.

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91
#7243, eff 5-1-00; amd by #8268, eff 2-1-05; ss by #8740, INTERIM, eff 10-13-06, EXPIRED: 4-11-07
#8869, eff 4-19-07; ss by #10163, eff 7-26-12; ss by #13439, eff 8-20-22; ss by #14299, eff 7-1-25, EXPIRES: 7-1-34

N.H. Code Admin. R. Ann. He-W 655.03 Authorization of Payments {#sec-he-w-655.03 omnilex-key=us-nh-regs-official--agency-he-w--He-W 655.03}

(a) The department shall operate an assistance program for employment and training support (ETS) services pursuant to RSA 167:7, V and RSA 167:86 to provide payments to remove obstacles to employment.

(b) ETS services shall include, but not be limited to:

(1) Fees and supplies that include:

a. Child care registration fees;

b. Education and training fees;

c. Books and supplies;

d. Uniforms; and

e. Tools of the trade;

(2) Automobile repairs including inspection fees;

(3) Transportation assistance;

(4) Automobile insurance and registration fees;

(5) Driver’s license fees or replacement fees;

(6) Tuition assistance for post-secondary education or vocational training;

(7) Work clothing expenses, not including uniforms, needed for job interviews or to begin employment;

(8) Personal care items or services including but not limited to haircuts, deodorant, shampoo, toothpaste, toothbrush, and razors; and

(9) Adult cosmetic dental care for services not covered by medicaid.

(c) Recipients of financial assistance to needy families who are participating in the New Hampshire employment program (NHEP) work activities pursuant to He-W 637, shall be authorized to receive payments as funding allows for resolution of employment-related obstacles which are essential and directly related to the NHEP participant obtaining or keeping employment, or to resolve employment-related obstacles in direct relationship to the NHEP participant’s ability to participate or remain in an approved NHEP activity, as specified on the employability plan (EP), when:

(1) The NHEP representative as defined in He-W 637.01 and the NHEP participant have agreed upon an educational or vocational goal;

(2) The NHEP participant has participated in an assessment interview(s) and has developed an EP that has been approved by the NHEP representative;

(3) Removal of the employment obstacle has been:

a. Documented as necessary by the NHEP participant’s employer or potential employer; or

b. Determined as necessary by the NHEP representative after assessing the NHEP participant’s need to resolve employment-related barriers in direct relationship to the NHEP participant’s ability to participate or remain in an approved NHEP activity as specified on the EP, pursuant to He-W 637.12;

(4) ETS services are necessary to remedy the existing sanction for NHEP participants who are currently under sanction pursuant to He-W 637.08;

(5) The NHEP participant is enrolled in an approved activity and is:

a. Complying with the EP or making a good faith effort to participate;

b. Meeting the requirements pursuant to He-W 637.03; and

c. Complying with NHEP program requirements in order to remove a sanction; and

(6) ETS services shall be restored retroactively to the pre-sanction level if the department applies a sanction and later grants good cause to remove the sanction for the sanctionable act.

History

#14299, eff 7-1-25, EXPIRES: 7-1-35 (formerly He-W 655.05)

N.H. Code Admin. R. Ann. He-W 655.04 Methods of Payment {#sec-he-w-655.04 omnilex-key=us-nh-regs-official--agency-he-w--He-W 655.04}

(a) Employment and training support (ETS) services shall be paid either to the eligible New Hampshire employment program (NHEP) participant or to the provider as defined in He-W 655.01, depending on the kind of services received.

(b) When payment is made to the NHEP participant for ETS services, the following shall apply:

(1) The NHEP participant shall pay the provider of the service, and the department shall incur no financial liability to the provider;

(2) The NHEP participant shall provide a signed and dated receipt or a written statement from the service provider, indicating that the payment received was actually spent on the authorized services; and

(3) When the NHEP participant receives direct payment for services and does not provide verification that the payment received was actually spent on the authorized services as specified in (2) above, the NHEP representative shall:

a. Request that the department put a recoupment for the amount of the service on the NHEP participant’s support service check for the amount of payment owed; or

b. Make a referral to the department’s special investigations unit when fraud is suspected.

(1) There shall be no payment of fees and supplies assistance prior to a cost for the services being incurred or a service being purchased; and

(2) Fees and supplies assistance shall be paid directly to the service provider upon receipt by the department, within 90 days of the date of purchase, of an itemized bill and receipt for the service(s).

(d) Pursuant to He-W 655.07, transportation assistance payments shall be made by the department as listed below:

(1) The department shall pay transportation assistance either directly to providers of transportation services that are enrolled with the department or by reimbursing the NHEP participant pursuant to He-W 655.07(d);

(2) Before the department issues a mileage reimbursement or a public for hire transportation reimbursement payment to an NHEP participant, the following conditions shall be met:

a. The NHEP participant shall have requested and been determined eligible for transportation assistance ;

b. The service shall have been provided;

c. The NHEP participant shall have completed a weekly service reimbursement invoice which shall include the following:

The NHEP participant's name and address, the department recipient identification number (RID), ETS request number, and ETS resource number;
The dates, destination(s), and number of miles traveled per day;
The actual cost of each day’s transportation;
The NHEP participant's dated signature; and
If the NHEP participant is not employed, the dated signature and telephone number of one of the following individuals:

(i) A school official;

(ii) An NHEP representative;

(iii) An activity provider; or

(iv) A training site coordinator;

d. The NHEP participant shall submit the invoice to the department’s data management unit no later than 90 days following the last date of service on the invoice; and

e. The NHEP participant shall correct and resubmit any incorrect, incomplete, or illegible invoices; and

(3) Payments for mileage reimbursement already provided shall be made directly to the NHEP participant listed on the service reimbursement invoice.

(e) Pursuant to He-W 655.08, tuition assistance payments shall be made by the department as listed below:

(1) The department shall not pay tuition assistance directly to the NHEP participant; and

(2) Tuition assistance shall be paid directly to the service provider upon receipt by the department, within 90 days of the last day of the tuition coverage period, of an itemized bill and receipt for the service(s).

(f) Payments for auto repairs shall be paid by the department to a provider who operates an automobile repair business as described in He-W 655.09 as listed below:

(1) A provider shall complete a reimbursement invoice, subsequent to approved repairs being completed, which includes the following:

a. The NHEP participant’s name, address, and RID number;

b. The provider’s name, address, and telephone number;

c. An itemized receipt or bill indicating the total amount charged for automobile repairs;

d. A statement of road worthiness with completions of repairs;

e. The date the service was provided;

f. The provider’s federal identification number used for Internal Revenue Service purposes;

g. The dated signature of the provider who performed the repairs; and

h. To whom payment shall be made;

(2) A legible, complete, and correct reimbursement invoice shall be submitted to the department’s data management unit no later than 90 days from the date services were provided; and

(3) The department shall not pay for any balance due on automobile repairs after payment is made on behalf of an NHEP participant.

(g) Payments for other ETS related services shall be made either to a provider or the NHEP participant, as described in He-W 655.10.

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #5440, eff 7-24-92; ss by #5528, eff 12-14-92; ss by #5610, eff 5-3-93; ss by #5712, eff 10-4-93; amd by #5858, eff 7-1-94; amd by #5967, eff 1-27-95; amd by #6014, eff 4-1-95; amd by #6396, eff 12-16-96; amd by #6446, eff 2-1-97; amd by #6593, eff 10-1-97; amd by #6706, eff 3-3-98; amd by #6746, eff 5-19-98; ss by #7243, eff 5-1-00; ss by #9137, eff 4-22-08; ss by #11123, eff 6-22-16; ss by #14299, eff 7-1-25, EXPIRES: 7-1-35

N.H. Code Admin. R. Ann. He-W 655.05 Eligibility for Child Care. {#sec-he-w-655.05 omnilex-key=us-nh-regs-official--agency-he-w--He-W 655.05}

Eligibility for child care assistance shall be determined pursuant to He-C 6910.

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #6009, eff 4-1-95; ss by #6009, eff 4-1-95; amd by #6361, eff 11-1-96; ss by #6446, eff 2-1-97; ss by #7243, eff 5-1-00, ss by #8740, INTERIM, eff 10-13-06, EXPIRED: 4-11-07
#8869, eff 4-19-07; ss by #10803, eff 3-26-15; ss by #14299, eff 7-1-25, EXPIRES: 7-1-35 (formerly He-W 655.03)

N.H. Code Admin. R. Ann. He-W 655.06 Fees and Supplies. {#sec-he-w-655.06 omnilex-key=us-nh-regs-official--agency-he-w--He-W 655.06}

(a) Fees and supplies assistance shall be authorized for New Hampshire employment program (NHEP) participants who meet the conditions of He-W 655.02(b).

(b) Fees and supplies assistance that has been authorized for an NHEP participant in on-the-job training shall continue for the duration of the training contract, even if the NHEP participant becomes ineligible for financial assistance to needy families due to increased earnings.

(c) Fees and supplies assistance shall be authorized only after all available NHEP participant resources have been applied against educational expenses, such as the NHEP participant's own financial resources, veterans' educational benefits, insurance, scholarships, grants, and work study income.

(d) To verify participation in education or training preparatory to employment, the NHEP participant shall provide the NHEP representative with acceptable verification as described in He-W 637.03(g).

(e) The cost of fees and supplies shall be authorized for payment or reimbursement as follows:

(1) Books shall be authorized when the expense is documented by itemized receipts from the vendor;

(2) Supplies including but not limited to paper, notebooks, and writing instruments shall be authorized when the supplies are necessary to accomplish the required course objectives of the NHEP participant, and when the expense is documented by itemized receipts from the vendor;

(3) Tools of the trade shall be authorized only when the tools are necessary for participation in training or employment when the NHEP participant is engaged, as identified and approved in the employability plan, and when the expense is documented by itemized receipts from the vendor;

(4) Uniforms or specialized clothing including but not limited to steel-toed shoes, hard hats, coats for laboratory assistants, and medical technician uniforms shall be authorized when required for participation in employment, training, or a course of study, and when the expense is documented by itemized receipts from the vendor;

(5) Mandatory fees shall be authorized only when associated with applying for or attending school, or participating in training or education programs, and when the expense is documented by itemized receipts from the vendor; and

(6) Parents participating in approved NHEP activities who are approved to receive child care assistance while participating in that activity, shall be eligible for a one-time payment, per family, per provider, per state fiscal year, for child care registration fees assessed by the provider.

(f) The NHEP representative shall deny fees and supplies assistance as follows:

(1) If the NHEP participant's participation in training is harmful to the family's stability and the emotional or physical well-being of any of its members;

(2) If the NHEP participant fails to provide the verification of participation;

(3) If the NHEP participant is not making satisfactory progress as defined in He-W 637.01; or

(4) When the NHEP participant's occupational goal is not in line with local employment opportunities based on current labor market trends.

(g) The combined total expense for all fees and supplies assistance shall be limited to $500 per NHEP participant in any 12-month period ending June 30 of each year.

(h) Provisions under this section shall be subject to the restrictions described at He-W 655.02.

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #5440, eff 7-24-92; ss by #5712, eff 10-4-93; amd by #6361, eff 11-1-96; amd by #6593, eff 10-1-97; amd by #6818, eff 7-25-98; ss by #7243, eff 5-1-00; paragraphs (a)-(d) amd by #8740, INTERIM, eff 10-13-06, EXPIRED: 4-11-07; paragraphs (a)-(d) amd by #8869, eff 4-19-07; ss by #7243, eff 5-1-00; ss by #9137, eff 4-22-08; ss by #11092, eff 5-7-16; ss by #14299, eff 7-1-25, EXPIRES: 7-1-35 (formerly He-W 655.05)

N.H. Code Admin. R. Ann. He-W 655.07 Transportation Assistance. {#sec-he-w-655.07 omnilex-key=us-nh-regs-official--agency-he-w--He-W 655.07}

(a) Transportation assistance shall be provided to New Hampshire employment program (NHEP) participants for the purpose of obtaining transportation which enables them to prepare for, secure, or maintain employment and training as follows:

(1) Mileage reimbursement pursuant to (d)(1)-(d)(3) below; and

(2) Public for hire transportation, or reimbursement for public for hire transportation pursuant to (d)(4) below.

(b) Transportation assistance shall be authorized for payment or reimbursement for NHEP participants who meet the conditions of He-W 655.02(b).

(c) Transportation assistance that has been authorized for an NHEP participant in on-the-job training (OJT) shall continue for the duration of the OJT contract, even if the NHEP participant becomes ineligible for financial assistance to needy families due to increased earnings.

(d) Payment for transportation assistance shall be made by the department as listed below:

(1) Transportation assistance shall be allowed for round trip travel starting at the NHEP participant's home, proceeding to the location of the child care provider if applicable, and ending at the location of the NHEP participant's approved NHEP activity;

(2) The department shall pay for the actual cost of travel reimbursement, or an amount equal to $0.30 multiplied by the number of miles traveled, which shall not exceed 520 miles per month, or $160 per month, including monthly or a multiple ride transportation pass, as authorized by an NHEP representative;

(3) Transportation assistance shall not be paid for travel expenses that are reimbursed from another source; and

(4) The department shall directly pay the following as approved vendors for transportation services for NHEP participants who are participating in the following approved activities:

a. Public for hire transportation agencies under contract with the New Hampshire department of transportation;

b. United States Department of Transportation, registered common carriers pursuant to RSA 376; and

c. Transportation network companies pursuant to RSA 376-A.

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #6446, eff 2-1-97; ss by #7243, eff 5-1-00; paragraphs (a)-(e)(2)a. amd by #8740, INTERIM, eff 10-13-06, EXPIRED: 4-11-07; paragraphs (a)-(e)(2)a. amd by #8869, eff 4-19-07; ss by #9137, eff 4-22-08; ss by #11123, eff 6-22-16; ss by #14299, eff 7-1-25, EXPIRES: 7-1-35 (formerly He-W 655.06)

N.H. Code Admin. R. Ann. He-W 655.08 Tuition Assistance {#sec-he-w-655.08 omnilex-key=us-nh-regs-official--agency-he-w--He-W 655.08}

(a) Tuition assistance shall be authorized for payment or reimbursement for New Hampshire employment program (NHEP) participants who meet the conditions of He-W 655.02(b).

(b) NHEP participants shall be eligible for tuition assistance when:

(1) The NHEP participant is engaged in approved NHEP activities; and

(2) The program requiring tuition assistance is identified on the NHEP participant’s employability plan (EP).

(1) Educational programs leading to a high school diploma or equivalent, or to basic literacy;

(2) Vocational education and training programs; or

(3) A course of study preparatory to employment.

(d) Tuition assistance shall be provided only when there are no other sources of tuition funding available to the NHEP participant and the NHEP participant has exhausted all other tuition funding sources;

(e) The training program or course of study to be pursued shall be consistent with the NHEP participant’s EP;

(f) NHEP participants shall be eligible for tuition assistance if the vocational educational training program or course of study:

(1) Prepares the NHEP participant for participation in either a certificate program, degree, or employment;

(2) Leads to employment advancement, a certificate, or degree in an area of specialization; or

(3) Is a single training course or course of study which:

a. Is vocationally specific;

b. Is supported by the employment goals as indicated on the approved EP; and

c. Improves the NHEP participant’s immediate employment prospects.

(g) Tuition assistance shall be authorized only after all available NHEP participant resources have been applied against education expenses, such as the NHEP participant's own financial resources, veterans' educational benefits, insurance, scholarships, grants, and work study income.

(h) The NHEP participant shall verify participation in education or training preparatory to employment pursuant to He-W 637.03(e).

(i) Tuition assistance shall not exceed $1,575 for any NHEP participant in any 12-month period ending June 30 of each year.

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #6446, eff 2-1-97; ss by #7243, eff 5-1-00; ss by #8740, INTERIM, eff 10-13-06, EXPIRED: 4-11-07
#8869, eff 4-19-07; ss by #10803, eff 3-26-15; ss by #14299, eff 7-1-25, EXPIRES: 7-1-35 (formerly He-W 655.07)

N.H. Code Admin. R. Ann. He-W 655.09 Automobile Repairs {#sec-he-w-655.09 omnilex-key=us-nh-regs-official--agency-he-w--He-W 655.09}

(a) Automobile repairs shall be provided to New Hampshire employment program (NHEP) participants for the purpose of maintaining reliable transportation which enables the NHEP participant to prepare for, secure, or maintain employment.

(b) The department shall pay for the actual cost of approved automobile repairs up to $500 per state fiscal year, per NHEP participant, and subject to the following:

(1) An automobile for which an NHEP participant is requesting automobile repairs shall be:

a. Determined by an NHEP representative as necessary for the NHEP participant to participate in an approved NHEP activity or employment; and

b. Registered to:

The NHEP participant;
Either parent in a 2-parent family, as long as the parent indicates in writing that the parent will consistently transport the NHEP participant to the NHEP participant’s NHEP activity; or
The NHEP participant’s dependent child who resides in the same household, as long as the NHEP participant is the parent of the dependent child, and the dependent child indicates in writing that they will consistently transport the NHEP participant to the NHEP participant’s NHEP activity;

(2) The NHEP participant requesting the automobile repair assistance shall:

a. Have a valid operator or commercial license in effect at the time the request for automobile repair reimbursement is made or, if the NHEP participant lacks a valid driver’s license, the other parent in the 2-parent family, or the dependent child who resides in the same household, has a valid driver’s license and the other parent in the 2-parent family or the dependent child indicates in writing that the other parent in the 2-parent family or the dependent child will consistently transport the NHEP participant to the NHEP participant’s NHEP activity; and

b. Obtain one written estimate of the cost of automobile repairs from a provider who operates an automobile repair business, which contains:

The name, address, and telephone number of the provider;
A description of the types of repairs in the form of an itemized list of parts, labor, and associated costs which are auto-body and mechanical repairs necessary to make the automobile functional;
A statement indicating that in the provider’s professional judgment the automobile repair is reasonable based on the roadworthiness and reliability of the car; and
The dated signature of the provider;

(3) The written estimate as described in (2)b. above shall be submitted to an NHEP representative for prior approval for the automobile repair assistance;

(4) The NHEP representative shall review the written estimate for completeness and ensure that it meets the requirements prior to approving the repair;

(5) Automobile repair assistance shall be approved by an NHEP representative in advance of the actual service(s) to be provided, except in an emergency in which the vehicle required towing and repairs are needed to make it functional; and

(6) Repairs shall be performed by a New Hampshire registered automotive provider of the NHEP participant’s choice.

History

#14299, eff 7-1-25, EXPIRES: 7-1-35

(a) Employment and training support (ETS) services shall be provided to New Hampshire employment program (NHEP) participants for the purposes of enabling NHEP participants to obtain or keep employment, or to resolve employment-related obstacles in direct relationship to the NHEP participant’s ability to remain in an approved NHEP activity, as specified in the employability plan.

(b) ETS services for employment-related obstacles shall include, but not be limited to:

(1) Auto insurance costs, up to $750 per state fiscal year;

(2) Auto registration fees, up to a maximum of $350 per state fiscal year;

(3) Driver’s license fees or replacement fees up to a maximum of $90 per state fiscal year;

(4) Work clothing expenses, not including uniforms, needed for job interviews or to begin employment, up to a maximum of $200 per state fiscal year;

(5) Personal care items or services, including but not limited to, haircuts, deodorant, shampoo, toothpaste, toothbrush, and razors, up to a maximum of $25 per state fiscal year; and

(6) Adult cosmetic dental care for services not covered by Medicaid, up to a maximum of $1500.

(c) The department shall pay auto insurance costs to a provider, as described in (b)(1) above, either quarterly or monthly subject to the following:

(1) The auto insurance policy shall provide a minimum of 12-months of coverage;

(2) Auto insurance may be billed prior to the actual service being provided; and

(3) The NHEP participant shall provide a statement of coverages and charges from the insurance provider.

(d) The auto insurance expenses referenced in (c) above shall be payable at the usual and customary rates excluding higher rates due to accidents, violations, or other causes.

(e) The total of all payments for ETS services described in (b)(1) through (b)(5) above, to aid in removing obstacles to employment shall not exceed $750 per individual, per state fiscal year.

(f) The maximum limit for adult cosmetic dental care identified in (b)(6) above shall be considered a separate payment limit from the limit for items cited in (b)(1) through (b)(5) above and assistance for this service shall be available regardless of any other payments received in (b)(1) through (b)(5).

(g) Before approving payment, the NHEP representative shall ensure that any and all other available third-party resources have been exhausted.

(h) If the employment-related obstacle request exceeds the payment limits specified in He-W 655.06 through He-W 655.09, before the maximum assistance payment is authorized for other employment supports pursuant to, He-W 655.10, the NHEP participant shall demonstrate:

(1) That the payment authorized by the department is sufficient to remove the employment-related obstacle; and

(2) How the remainder of the request shall be secured or that a payment plan has been arranged for the remainder of the bill.

(i) The following shall apply to authorizations of other ETS related services to aid in removing obstacles to employment:

(1) There shall be no limit to the number of times assistance for employment-related support services can be approved per state fiscal year so long as the maximum payment limits specified in (b) above are not exceeded; and

(2) Authorization and requests for ETS services to remove employment-related obstacles shall be limited to the maximum dollar limits, described above, per state fiscal year.

(j) ETS service payments shall be denied when funds for the programs are no longer available.

History

#14299, eff 7-1-25, EXPIRES: 7-1-35

Part He-W 656 Resources

N.H. Code Admin. R. Ann. He-W 656.01 Resources-Basic Principles {#sec-he-w-656.01 omnilex-key=us-nh-regs-official--agency-he-w--He-W 656.01}

Except where otherwise specified or specifically prohibited, resources shall be evaluated and treated in the same manner for the adult categories of financial assistance as in the financial assistance to needy families categories of financial assistance.

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; amd by #6111, eff 11-1-95; ss by #6531, INTERIM, eff 6-27-97, EXPIRES: 10-25-97; ss by #6614, eff 10-24-97; amd by #6740, eff 4-25-98; ss by #7086, eff 10-1-99; ss by #8993, eff 10-1-07; ss by #10924, eff 10-1-15; ss by #14083, eff 9-26-24, EXPIRES: 9-26-34

N.H. Code Admin. R. Ann. He-W 656.02 Treatment of Specific Types of Resources {#sec-he-w-656.02 omnilex-key=us-nh-regs-official--agency-he-w--He-W 656.02}

Funds from an individual development account used for unqualified purposes, pursuant to 42 USC 604(h), shall be treated as:

(a) Lump sum income in accordance with He-W 654.03, for all categories of FANF financial assistance; or

(b) Lump sum payment in accordance with He-W 656.04(b)(10), for the adult categories of financial assistance.

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91, EXPIRED: 6-26-97
#7603, eff 12-1-01; ss by #9604, eff 12-1-09; ss by #12481, eff 2-21-18

N.H. Code Admin. R. Ann. He-W 656.03 Jointly Owned Resources {#sec-he-w-656.03 omnilex-key=us-nh-regs-official--agency-he-w--He-W 656.03}

(a) Personal property resources established prior to November 1, 1995, which an individual owns together with an individual who is not an applicant or recipient, shall be considered to be shared equally among the owners, unless the individual verifies ownership of more or less than an equal share. If the individual verifies ownership of more or less than an equal share through documentary evidence, only the amount of the share actually owned by the individual shall count as a resource.

(b) Personal property resources established on or after November 1, 1995, which an individual owns together with an individual who is not an applicant or recipient, shall be considered to belong to the individual who is applying for or receiving assistance. If there is more than one individual who is applying for or receiving assistance that jointly owns the resource, it shall be assumed that each individual owns an equal share.

(c) If an individual wishes to rebut the ownership presumption, the individual shall submit a written statement and verification of the statement to the department including the following information:

(1) A corroborating statement from each additional account holder;

(2) If the only additional account holder is incompetent or a minor, the individual shall submit a corroborating statement from a competent adult aware of the circumstances surrounding establishment of the account;

(3) Account records showing deposits, withdrawals, and interest in the months in which ownership is an issue;

(4) If the individual does not own any of the funds, evidence showing that the individual can no longer withdraw funds from the account; and

(5) If the individual owns only a portion of the funds, evidence showing removal from the account of such funds, or removal of the funds owned by the other account holder(s), and redesignation of the account.

(d) If the evidence establishes that a resource is owned by the other account holder(s), as determined by the department, and that the individual can no longer withdraw funds from the account, then that resource shall not be considered to belong to the individual. However, such resources shall be deemed available to the individual if the account holder to whom they belong is someone whose resources would be used in determining the individual's eligibility.

(e) Jointly owned real property resources shall be excluded if the terms of ownership of the property prevent the individual from unilaterally liquidating the property and the other owner or owners refuse to agree to the sale. The addition of a joint owner shall be evaluated as an asset transfer in accordance with He-W 620.01.

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #6111, eff 11-1-95; ss by #6531, INTERIM, eff 6-27-97, EXPIRES: 10-25-97; ss by #6614, eff 10-24-97; ss by #6740, eff 4-25-98; ss by #8596, eff 3-30-06; ss by #10563, eff 3-30-14; amd by #10982, eff 11-24-15 (paras (a) & (b)); ss by #13888, eff 2-24-24

N.H. Code Admin. R. Ann. He-W 656.04 Personal Property Resources {#sec-he-w-656.04 omnilex-key=us-nh-regs-official--agency-he-w--He-W 656.04}

(a) For all categories of financial assistance, personal property resources shall be treated as follows:

(1) At application and redetermination, the assistance group shall report and verify all resources;

(2) The value of accumulated interest, the equity value of life insurance policies and the value of stocks and bonds, when verified at application or redetermination, shall be considered unchanged until the next redetermination;

(3) Changes to the value of the resources identified in He-W 656.03(a) shall be reported between redeterminations;

(4) Individuals shall report the acquisition of new resources and the selling of existing resources, pursuant to RSA 167:17;

(5) The following resources shall not be counted when determining eligibility:

a. Borrowed money, except for when the individual transfers the proceeds or a portion of the proceeds of the loan to another individual pursuant to He-W 620.01(a)(6);

b. All household items;

c. Inaccessible personal property resources whose value is legally unobtainable by the individual, except as specified in (7) below;

d. Group, term and fraternal life insurance policies which have no equity value and are only payable upon the death of the insured;

e. Lump sum death payments to cover funeral and burial expenses;

f. Resources resulting from an accumulation of types of income that are excluded by federal mandate;

g. Federal, state, and local income tax refunds; and

h. Keogh accounts which involve a contractual relationship with a non-assistance group member, provided the contract prevents the individual from withdrawing money from the account without affecting the employer or other employees;

(6) All Individual Retirement Accounts (IRA), one person Keogh accounts, and non-contractual Keogh accounts shall be counted towards the resource limit as follows:

a. The balance in the account minus the penalty for early withdrawal for the entire account shall be counted; and

b. The balance amount and the amount of the penalty for early withdrawal shall be as specified on the date on which they are initially verified and these amounts shall remain in effect until the next redetermination;

(7) Trusts and similar legal devices shall be treated as follows:

a. Trusts and similar legal devices, including annuities, established after August 10, 1993 and trusts and legal devices that were established prior to August 11, 1993 but have been added to or otherwise augmented or amended after August 10, 1993 shall be treated as follows:

For purposes of determining an individual's eligibility for, or amount of, benefits, the rules established in this subparagraph shall apply to a trust established by such individual;
An individual shall be considered to have established a trust if assets of the individual were used to form all or part of the corpus of the trust and if any of the following individuals established such trust other than by will:

(i) The individual;

(ii) The individual's spouse;

(iii) A person, including a court or administrative body, with legal authority to act in place of or on behalf of the individual or the individual's spouse; or

(iv) A person, including any court or administrative body, acting at the direction or upon the request of the individual or the individual's spouse;

In the case of a trust, the corpus of which includes assets of an individual as determined under He-W 656.04(a)(7)a.2. and assets of any other person or persons, the provisions of this subparagraph shall apply to the portion of the trust attributable to the assets of the individual;
Subject to He-W 656.04(a)(7)a.7., this subparagraph shall apply without regard to:

(i) The purposes for which a trust is established;

(ii) Whether the trustees have or exercise any discretion under the trust;

(iii) Any restrictions on when or whether distributions may be made from the trust; or

(iv) Any restrictions on the use of distributions from the trust;

In the case of a revocable trust:

(i) The corpus of the trust shall be considered resources available to the individual;

(ii) Payments from the trust to or for the benefit of the individual shall be considered income of the individual; and

(iii) Any other payments from the trust shall be considered assets disposed of by the individual;

In the case of an irrevocable trust:

(i) If there are any circumstances under which payment from the trust could be made to or for the benefit of the individual, the portion of the corpus from which, or the income on the corpus from which, payment to the individual could be made shall be considered resources available to the individual, and payments from that portion of the corpus or income:

i. To or for the benefit of the individual, shall be considered income of the individual; and

ii. For any other purpose, shall be considered a transfer of assets by the individual; and

(ii) Any portion of the trust from which, or any income on the corpus from which, no payment could under any circumstances be made to the individual shall be considered, as of the date of establishment of the trust or, if later, the date on which payment to the individual was foreclosed, to be assets disposed by the individual, and the value of the trust shall be determined by including the amount of any payments made from such portion of the trust after such date;

This subparagraph shall not apply to any of the following conforming trusts:

(i) A trust containing the assets of an individual under age 65 who is disabled and which is established for the benefit of such individual by the individual, a parent, grandparent, legal guardian of the individual, or a court if the state will receive all amounts remaining in the trust upon the death of such individual up to an amount equal to the total medical assistance paid on behalf of the individual under a state plan;

(ii) A trust containing the assets of an individual who is disabled as defined in 42 USC 1382c(a)(3)that meets the following conditions:

i. The trust is established and managed by a non-profit association;

ii. A separate account is maintained for each beneficiary of the trust, but, for purposes of investment and management of funds, the trust pools these accounts; and

iii. Accounts in the trust are established solely for the benefit of individuals who are disabled as defined in 42 USC 1382c(a)(3) by the parent, grandparent, or legal guardian of such individuals, by such individuals, or by a court;

b. No clause or requirement in the trust, no matter how specifically it applies to state or federal programs shall preclude a trust from being considered in accordance with He-W 656.04(a)(7)a.1.-6.;

c. Any payments from revocable trusts, which are not made to, or on behalf of, the individual shall be considered assets disposed of for less than fair market value pursuant to He-W 620;

d. Payments of income or payments from the corpus of irrevocable trusts that are not made to or for the benefit of the individual, shall be treated as a transfer of assets for less than fair market value pursuant to He-W 620;

e. Irrevocable trusts where payments from some portions or all of the trust cannot under any circumstances be made to, or for the benefit of, the individual shall be treated as follows:

The portion of the corpus or income on the corpus which cannot be paid to the individual shall be treated as a transfer of assets and shall be treated in accordance with He-W 620;
In treating portions of the corpus or income which cannot be paid to the individual as a transfer of assets, the date of the transfer shall be the date the trust was established or, if later, the date on which payment to the individual was restricted or eliminated;
In determining the value of the portion of the trust which cannot be paid to the individual for transfer purposes, any payments made, for whatever purpose, after the date the trust was established or, if later, the date payment to the individual was foreclosed, shall not be subtracted from the value of the trust;
If funds were added to that portion of the trust after these dates, those funds shall be considered to be a new transfer of assets, effective on the date the funds are added to the trust; and
The value of the transferred amount shall be no less than its value on the date of establishment or the date that access to the principal of the trust was restricted or eliminated;

f. When some portion of the corpus or income on the corpus of a trust is or can be paid to the individual, such portion or income shall be treated in accordance with the standards set forth in He-W 656.04(a)(7)a.5.(i) or (ii), as applicable;

g. Payments shall be considered to be made to the individual when any amount from the trust, including an amount from the corpus, or income produced by the corpus, is paid directly to the individual, or to someone acting on the individual's behalf; and

h. Payments made for the benefit of the individual shall be payments of any sort, including an amount from the corpus, or income produced by the corpus, paid to another entity such that the individual derives some benefit from the payment;

(8) An irrevocable burial trust established by an individual for the purpose of paying, at some point in the future, for the various expenses associated with the individual's funeral and burial shall be an exempt trust if the individual has a signed contract with a funeral home and the corpus of the trust does not exceed the contracted amount;

(9) Annuities shall be excluded from the resource computation when the expected return on the annuity is commensurate with the life expectancy of the beneficiary in accordance with He-W 620.01(i)(2);

(10) Annuities excluded from the resource computation pursuant to (9) above shall be treated as follows:

a. When an individual cannot access the principal of an annuity, the annuity shall be treated as an irrevocable trust;

b. If an annuity provides for payments to be made to the individual, those payments shall be considered unearned income to the individual;

c. Any portion of the principal of the annuity that is paid to or on behalf of the individual shall be considered unearned income to the individual; and

d. Portions of the annuity that cannot be paid to or for the benefit of the individual shall be treated as transfers of assets and shall be evaluated in accordance with He-W 620; and

(11) Where application of the trust provisions discussed in He-W 656.04(a)(7)a.7.(i) and (iii) would cause an undue hardship as specified in He-W 602.08(c), those provisions shall not apply.

(b) For the adult categories of financial assistance, personal property resources shall be treated as follows:

(1) The following resources shall not be counted when determining eligibility for the adult categories of financial assistance:

a. All vehicles such as but not limited to cars, trucks, boats, motorcycles, and snowmobiles; and

b. Farm machinery, livestock, tools, and equipment;

(2) The equity value of the following resources shall be counted when determining eligibility for all adult categories of financial assistance:

a. Bank accounts, including checking accounts;

b. Stocks and bonds; and

c. Pre-paid debit cards, such as direct express cards.

(3) Accessible burial funds shall be treated in the following manner:

a. Up to $1500 of the burial funds shall not be counted when determining eligibility for the adult categories of financial assistance when the value of the burial funds, added to the individual’s other countable resources, exceeds the resource limits as specified in He-W 656.06;

b. The amount of the burial fund exclusion shall be reduced by:

The combined face value of any life insurance policies; and
Any irrevocable trusts or irrevocable funds identified as available to meet burial expenses;

c. Interest earned on excluded burial funds and appreciation on the value of excluded burial arrangements shall be excluded as a resource, if left to accumulate as part of the separately identified burial fund;

d. Interest earned on any portion of the burial fund not excluded as a resource shall be excluded only if inaccessible to the individual; and

e. Accumulated interest which is accessible to the individual shall be counted as a resource at each eligibility determination;

(4) Resources set aside under a Social Security Administration (SSA) approved plan for self-support (PASS) shall be excluded for the duration of the plan;

(5) Life insurance policies shall be:

a. A countable resource when the combined equity value of all an individual’s policies exceeds $1,500; or

b. An excluded resource when:

The total combined equity value of all the individual’s policies is equal to or less than $1,500; or
The combined equity value of the individual’s policies exceeds $1,500, but the state of New Hampshire has been made the beneficiary to the policies pursuant to RSA 167:4, IV(c);

(6) Applicants whose life insurance policies have a combined face value exceeding $1,500 shall be allowed to offset the excess equity value of life insurance for 3 months if:

a. The equity value of life insurance exceeds resource limits in He-W 656.06, but other countable resources do not exceed the resource limits; and

b. The applicant or the applicant's legal spouse who is living with the applicant has incurred and is liable for unpaid medical expenses;

(7) The excess value of life insurance shall be offset as follows:

a. Unpaid medical bills which were incurred before the period for which eligibility is requested shall be deducted from the equity value of the life insurance policies;

b. If there are not enough prior unpaid medical bills to offset the equity value of life insurance, unpaid medical bills incurred within the period of which eligibility is requested shall be deducted from the equity value of the life insurance policies in chronological sequence, starting with the earliest unpaid bill; and

c. No incurred unpaid medical bill shall be offset more than once;

(8) The period of offsetting incurred medical expenses shall begin on the date that the applicant provides verification to the department of health and human services (DHHS) of resources and incurred medical expenses, and shall end 3 months thereafter;

(9) At the end of the 3 month period, the equity value of life insurance shall be counted in full without any offset for medical expenses; and

(10) Lump sum payments, with the exception of lump sum earned income and excludable lump sum payments paid to cover funeral expenses and portions of third party medical and other expenses directly associated with receipt of the lump sum, shall be counted as a resource when determining eligibility for the adult categories of financial assistance.

(c) For the financial assistance for needy families (FANF) categories of financial assistance, personal property resources shall be treated as follows:

(1) Liquid resources such as bank accounts, stocks, bonds, and savings certificates, owned by an alien's sponsor or sponsor's spouse, shall be deemed to be available to the alien when determining an alien's eligibility for FANF financial assistance;

(2) Liquid resources such as vehicles which are owned by an alien's sponsor or sponsor's spouse shall not be deemed to be available to the alien;

(3) Junk vehicles used only to supply parts for the individual's main vehicle, are in such dilapidated condition that they cannot be reasonably repaired for sale or use, or which can only be sold for scrap or parts, and vehicles which are jointly owned with a non-assistance group member, shall be excluded as a resource when determining eligibility for FANF financial assistance;

(4) Lump sum payments derived from converting a non-liquid resource to cash shall be counted as a lump sum resource when determining eligibility for FANF financial assistance;

(5) The remaining balance of the working checking account or pre-paid debit card on the day it is reviewed, reduced by the amount that represents the FANF payment standard for an assistance group of comparable size with no income, shall be counted as a resource for FANF financial assistance;

(6) The following special provisions shall apply to FANF recipients whose countable resources exceed the allowable limit because their sole resources consist of personal property assets which cannot be readily converted to cash, or which consist of such assets and real property as follows:

a. Recipients shall reduce excess resources to within allowable limits no later than the month following the month in which resources first exceed the limit;

b. The recipient shall verify that the recipient is making a good faith effort to sell the personal property resource which caused the resource limit to be exceeded; and

c. Financial assistance shall terminate if the recipient fails to reduce resources within the above time frames;

(7) The equity value of each individual’s life insurance policies shall be counted as a resource when determining eligibility for FANF financial assistance, when the total combined value of the policies is greater than $1,500;

(8) For the purposes of the FANF vehicle exclusion specified in RSA 167:81,IV(b), the total number of vehicles excluded as a resource, regardless of ownership or value, shall not exceed the number of parents or caretaker relatives of the assistance group; and

(9) The equity value of all life insurance policies shall be excluded as a resource when determining eligibility for FANF financial assistance, when:

a. The combined value of each individual's policies is $1,500 or less; or

b. The total combined value of each individual's policies exceeds $1,500, but the state of New Hampshire has been made the beneficiary to the policies pursuant to RSA 167:4,IV(c).

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #5248, eff 10-16-91; ss by #5392, eff 5-11-92; amd by #6111, eff 11-1-95; amd by #6446, eff 2-1-97; amd by #6740, eff 4-25-98; amd by #6754, eff 5-20-98; amd by #6779, INTERIM, eff 6-27-98, EXPIRED: 10-25-98; amd by #6817, eff 7-25-98; amd by #7644, eff 2-8-02; amd by #8022, eff 2-1-04; amd by #8635, eff 5-26-06; amd by #8684, eff 7-21-06; amd by #8865, eff 4-13-07; ss by #10069, eff 2-12-12; ss by #13395, eff 6-18-22

N.H. Code Admin. R. Ann. He-W 656.05 Real Property Resources {#sec-he-w-656.05 omnilex-key=us-nh-regs-official--agency-he-w--He-W 656.05}

(a) For the adult categories of financial assistance, real property resources, as defined in He-W 601.07, shall be treated as follows when determining eligibility:

(1) The home occupied by the individual shall not be counted;

(2) An unoccupied home shall not be counted during periods of temporary absence such as short-term hospitalization or institutionalization;

(3) Income-producing property shall not be counted;

(4) Any real property not otherwise excluded shall not be counted if it is necessary as the residence for the individual’s spouse, minor child, or disabled child;

(5) One burial plot per assistance group (AG) member shall not be counted; and

(6) The equity value of real property which is not specifically excluded above shall be counted as a resource.

(b) For adult categories of financial assistance, the AG shall take action to dispose of the property within 6 months of being notified by the department of health and human services (department) that the property must be liquidated, and:

(1) The equity value of the property shall not be counted during the disposal period; and

(2) The disposal period shall be extended as long as:

a. The individual verifies that action has been taken to sell the property and that there are valid reasons for inability to sell the property; or

b. The individual’s hospitalization or institutionalization, although long term, is not expected to be permanent and it is likely that the individual will return to the home.

(c) If disposal does not occur within the disposal period, as specified in (b) above, financial assistance shall be denied or terminated.

(d) For financial assistance to needy families (FANF), disposal of real property shall be treated as follows:

(1) The AG shall take action to dispose of the property within 6 months of being notified by the department that the property must be liquidated;

(2) Individuals shall have an additional 3 months to dispose of excess unoccupied real property, when the individual verifies that a good faith effort has been made to sell the property;

(3) The equity value of the property shall not be counted during the disposal period described in (1) and (2) above; and

(4) When the property is sold, the net proceeds from the sale of the property shall count as a lump sum resource, in accordance with He-W 654.03.

(e) For FANF, real property resources of a sponsor or sponsor’s spouse shall not be deemed available to a non-citizen.

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #6531, INTERIM, eff 6-27-97; ss by #6614, eff 10-24-97; ss by #8452, eff 10-22-05; amd by #8865, eff 4-13-07; ss by #9136, eff 4-22-08; ss by #11058, INTERIM, eff 3-24-16; ss by #11187, eff 9-20-16; ss by #14053, eff 8-17-24, EXPIRES: 8-17-34

N.H. Code Admin. R. Ann. He-W 656.06 Resource Limits {#sec-he-w-656.06 omnilex-key=us-nh-regs-official--agency-he-w--He-W 656.06}

(a) When determining eligibility for Financial Assistance to Needy Families (FANF):

(1) Applicant households that have received financial assistance under FANF in any one of the previous 6 months shall be considered a recipient household in determining the resource limit to be used; and

(2) The resource limits shall be:

a. For applicant households, $1,000; and

b. For recipient households, $5,000.

(b) The resource limit for adult category financial assistance shall be $1,500.

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #6531, INTERIM, eff 6-27-97, EXPIRES: 10-25-97; ss by #6614, eff 10-24-97; amd by #6672, eff 1-26-98; ss by #7354, eff 9-1-00; amd by #7644, eff 2-8-02; amd by #8865, eff 4-13-07; ss by #9252, eff 9-1-08; ss by #11186, eff 9-20-16; ss by #13647, eff 5-24-23

N.H. Code Admin. R. Ann. He-W 656.07 Resources of Disqualified Individuals {#sec-he-w-656.07 omnilex-key=us-nh-regs-official--agency-he-w--He-W 656.07}

(a) The resources of individuals disqualified from receiving financial assistance to needy families (FANF), pursuant to 42 USC 608(a)(9), and of individuals disqualified from receiving adult categories of financial assistance, pursuant to RSA 167:6 X., shall be deemed to remaining eligible household members.

(b) The full value of countable resources belonging to disqualified individuals shall be considered in the determination of eligibility for FANF and adult categories of financial assistance.

History

#13831, eff 12-23-23

Part He-W 658 Standard of Need

N.H. Code Admin. R. Ann. He-W 658.01 Financial Assistance to Needy Families (FANF) Standard of Need {#sec-he-w-658.01 omnilex-key=us-nh-regs-official--agency-he-w--He-W 658.01}

(a) The standard of need for FANF shall:

(1) Be based upon the size of the assistance group (AG), as defined in He-W 601.01; and

(2) Consist of 2 components:

a. The basic maintenance needs allowance (BMNA); and

b. Shelter costs, if incurred, up to a maximum of $342 as derived by reviewing weighted average shelter expenses for FANF recipients in subsidized and unsubsidized housing.

(b) The original minimum monthly BMNA amounts as effective in July 2012 shall be listed in Table 600-9, BMNA, below as determined in 2012 using reliable market data based on the Department of Labor’s annual update and using the living wage calculator in 2012 from the Pennsylvania State University.

Table 600-9, BMNA

Assistance Group Size

BMNA

$1,313

$2,564

$3,431

$4,194

$4,898

$5,200

$5,502

$5,804

$6,106

$6,408

$6,710

$7,012

(c) Table 600-9 above shall act as the starting figures and $302 shall be added to the monthly BMNA amount which was derived by using reliable market data described in (b) above, to determine the average increase in cost for basic living for a household size of 5 or larger.

(d) When the "Consumer Price Index" (CPI) for updating the standard of need is referred to, the "Percent Change From the Previous Year's Annual Average" of the "Consumer Price Index for All Urban Consumers" (CPI-U), as published by the United States Department of Labor, Bureau of Labor Statistics found at https://www.bls.gov/cpi/, shall be used.

(e) Pursuant to RSA 167:7, II, the BMNA shall be equal to the minimum amount in Table 600-9 and updated for July 1 of each year by:

(1) Multiplying the prior year’s BMNA by the current CPI average percent change in accordance with (d) above;

(2) Adding the product derived in (e)(1) to the prior year’s BMNA; and

(3) Rounding down the BMNA derived in (e)(2) to the nearest whole dollar.

(f) If the CPI average percent change for the most current year is negative or zero, there shall be no change to the BMNA.

(g) When a FANF AG is charged less than $342 for any shelter related costs, the standard of need for the group shall consist only of the BMNA for the appropriate group size.

(h) Any portion of the shelter related costs that is paid by an individual, agency, organization, or governmental unit outside of the AG shall not be considered a shelter charge to the FANF AG.

(i) When a FANF AG changes its shelter arrangement, the standard of need shall be based on the new shelter expenses regardless of arrearages owed for the previous shelter.

(j) Utility costs, such as electricity, heat, water, or sewage that are incurred separately from shelter costs shall not be allowable shelter expenses.

(k) For privately owned homes, shelter expenses shall be costs attributable to owning the home, including, but not limited to:

(1) Property taxes;

(2) Mortgage principal and interest;

(3) Fire insurance premiums;

(4) If living in a mobile home, lot rent; and

(5) If living in a condominium, mandatory condominium fees.

(l) Shelter expenses shall not include upkeep costs.

(m) For a boarding arrangement as defined by He-W 601.02, shelter expenses shall be the higher of the following figures:

(1) The AG’s payment for board decreased by the supplemental nutrition assistance program (SNAP) maximum "Thrifty Food Plan, 2021. FNS-916", as determined and published annually in the Federal Register by the United States Department of Agriculture in accordance with 7 CFR 273.10(e)(4) for a household size equivalent to the total number of individuals with boarding arrangements; or

(2) The AG’s payment for board decreased by actual expenses for food.

(n) The shelter expense amount calculated for a boarding arrangement shall be used until the next redetermination of eligibility, regardless of increases in the thrifty food plan amount, unless the assistance group reports a change in household size, boarding arrangement payments, or shelter costs.

(o) For FANF children who live with a caretaker relative who is not included in the FANF AG, shelter expenses shall be the verified amount, if any, the caretaker relative actually charges the child for housing.

(p) If a FANF casehead is prohibited from receiving FANF financial assistance due to the receipt of SSI or adult category financial assistance, shelter costs of the AG including the casehead shall be allowed.

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #5530, eff 12-16-92; ss by #5713, eff 10-1-93; ss by #5773, eff 1-14-94; ss by #5857, eff 7-1-94; amd by #6156, eff 12-29-95; amd by #6394, eff 1-1-97; amd by #6534, eff 7-1-97; amd by #6952, eff 3-1-99; ss by #7019, eff 7-1-99; amd by #7310, eff 7-1-00; amd by #7509, eff 7-1-01; amd by #8063, eff 3-20-04; amd by #8106, eff 7-1-04; amd by #8380, eff 6-21-05; amd by #8668, eff 6-21-06; amd by #8897, eff 6-7-07; amd by #8905, eff 7-1-07; ss by #9194, eff 7-1-08; ss by #9485, eff 7-1-09; ss by #9735, eff 7-1-10; amd by #9943, eff 7-1-11; ss by #10152, eff 7-1-12; ss by #13564, eff 2-22-23

N.H. Code Admin. R. Ann. He-W 658.02 Financial Assistance To Needy Families Payment Standard {#sec-he-w-658.02 omnilex-key=us-nh-regs-official--agency-he-w--He-W 658.02}

The payment standard for financial assistance to needy families financial assistance shall be based upon the size of the assistance group (AG) and be equal to 60% of the federal poverty guideline for the AG size.

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #5530, eff 12-16-92; ss by #5713, eff 10-1-93; ss by #5773, eff 1-14-94; ss by #7055, eff 8-1-99; ss by #7226, eff 4-1-00; amd by #8063, eff 3-20-04; ss by #9111, INTERIM, eff 3-24-08, EXPIRES: 9-20-08; ss by #9208, eff 7-19-08; ss by #11121, eff 7-19-16; ss by #13761, eff 9-28-23

N.H. Code Admin. R. Ann. He-W 658.03 Adult Category Standard of Need {#sec-he-w-658.03 omnilex-key=us-nh-regs-official--agency-he-w--He-W 658.03}

(a) The standard of need for adult categories of financial assistance for individuals in independent living arrangements, as defined in He-W 601.05, shall be a fixed amount based on AG size.

(b) Adult category individuals shall be treated as an AG size of one when determining eligibility, except when an adult category individual lives with:

(1) A spouse or a needy essential person, as defined in He-W 601.05, in an independent living arrangement, eligibility shall be determined as an AG of 2; or

(2) A spouse and a needy essential person in an independent living arrangement, eligibility shall be determined as an AG of 3.

(c) For each AG size, the standard of need for adult category individuals in independent living arrangements shall maintain the minimum payment level as specified by 42 USC 1382g.

(d) When supplemental security income (SSI) benefits change due to an SSI flat rate increase, the standard of need for adult category individuals in independent living arrangements shall not increase, as a portion of the SSI flat rate benefit increase is excluded in order to maintain the minimum payment level as described in (c) above.

(e) When SSI benefits change due to a cost of living increase, the following method shall be used to determine the standard of need for each AG size for adult category individuals in independent living arrangements:

(1) Amounts from SSI flat rate benefit increases which are excluded shall be subtracted from the SSI maximum benefit amount for AG sizes of one, 2, or 3 individuals;

(2) The adult standard disregard, as specified in He-W 654.16, shall be subtracted from the minimum payment level;

(3) The amount determined in (e)(1) above shall be added to the amount determined in (e)(2) above; and

(4) The sum, by AG size, shall be the standard of need for adult category individuals who reside in independent living arrangements.

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #6531, INTERIM, eff 6-27-97, EXPIRES: 10-25-97; ss by #6614, eff 10-24-97; ss by #8452, eff 10-22-05; ss by #10471, eff 11-26-13; ss by #13761, eff 9-28-23

N.H. Code Admin. R. Ann. He-W 658.04 Financial Assistance and Eligibility for Medical Care {#sec-he-w-658.04 omnilex-key=us-nh-regs-official--agency-he-w--He-W 658.04}

RESERVED

History

(See Revision Note #1 at Part heading for He-W 858)

N.H. Code Admin. R. Ann. He-W 658.05 Financial Assistance and Eligibility for Medical Care {#sec-he-w-658.05 omnilex-key=us-nh-regs-official--agency-he-w--He-W 658.05}

RESERVED

History

(See Revision Note #2 at Part heading for He-W 858)

N.H. Code Admin. R. Ann. He-W 658.06 Financial Assistance and Eligibility for Medical Care {#sec-he-w-658.06 omnilex-key=us-nh-regs-official--agency-he-w--He-W 658.06}

RESERVED

History

(See Revision Note #2 at Part heading for He-W 858)

N.H. Code Admin. R. Ann. He-W 658.07 Financial Assistance and Eligibility for Medical Care {#sec-he-w-658.07 omnilex-key=us-nh-regs-official--agency-he-w--He-W 658.07}

RESERVED

PARTS He-W 659 - He-W 661 - RESERVED

History

#9499, EMERGENCY RULE, eff 6-30-09; rpld by REPEAL OF EMERGENCY RULE, #9524, eff 7-31-09
(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91

Part He-W 664 Separate Medical Assistance Group

N.H. Code Admin. R. Ann. He-W 664.01 Financial Assistance and Eligibility for Medical Care {#sec-he-w-664.01 omnilex-key=us-nh-regs-official--agency-he-w--He-W 664.01}

RESERVED

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #6531, INTERIM, eff 6-27-97, EXPIRES: 10-25-97; ss by #6614, eff 10-24-97; ss by #6826, eff 8-3-98; ss by #8684, eff 7-21-06; rpld by #10743, eff 12-12-14

N.H. Code Admin. R. Ann. He-W 664.02 FANF Medical Assistance Only Case {#sec-he-w-664.02 omnilex-key=us-nh-regs-official--agency-he-w--He-W 664.02}

-MOVED TO HE-W 864.02

PARTS He-W 665 - He-W 669 - RESERVED

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #5992, eff 2-25-95; amd by #6952, eff 3-1-99; ss by #9845, eff 2-24-11; moved by #12773 (see He-W 864.02)
(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91

Part He-W 670 Determination of Financial Eligibility and the Amount of Assistance

N.H. Code Admin. R. Ann. He-W 670.01 Financial Assistance and Eligibility for Medical Care {#sec-he-w-670.01 omnilex-key=us-nh-regs-official--agency-he-w--He-W 670.01}

He-W 670.02 - RESERVED

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91

N.H. Code Admin. R. Ann. He-W 670.03 Determination of the Grant {#sec-he-w-670.03 omnilex-key=us-nh-regs-official--agency-he-w--He-W 670.03}

(a) For adult category financial assistance, the amount of the grant shall be determined as follows:

(1) If the net income amount is less than the adult category standard of need amount, the difference between the 2 amounts shall equal the grant;

(2) The grant shall be a monthly dollar amount;

(3) If the grant amount ends in:

a. $0.49 or less, it shall be rounded down to the nearest dollar; or

b. $0.50 or more, it shall be rounded up to the nearest dollar; and

(4) The minimum authorized grant amount shall be $2.00 per month, after rounding.

(b) For Financial Assistance to Needy Families (FANF), the amount of the grant shall be in accordance with 45 CFR 233.20(a)(2)(iv), and be determined by the following:

(1) If the assistance group is found eligible and the net income amount is less than the payment standard, the difference between the 2 amounts shall equal the FANF grant amount;

(2) The grant shall be a monthly dollar amount;

(3) If the grant amount ends in:

a. $0.01-$.99, it shall be rounded down to the nearest dollar; or

b. Ends in zero cents, the result shall be the actual monthly grant;

(4) The minimum authorized monthly FANF grant amount before any adjustments shall be equal to $10 or more;

(5) No payment shall be made if the amount of the FANF grant before any adjustments is less than $10 in accordance with 45 CFR 233.20 (a)(3)(viii)(C); and

(6) If the monthly FANF grant prior to adjustments is equal to $10 or more, and the monthly FANF grant amount after adjustments is greater than $2.00 then the FANF grant amount shall be issued to the recipient.

(c) The adult category grant pursuant to (a) above shall be reduced by one-third when the individual who is requesting, receiving, or will be receiving the grant:

(1) Resides with others in an independent living arrangement, as defined in He-W 601.05(d), and:

a. Does not have any food expenses;

b. Does not have any residence expenses associated with their independent living arrangement; and

c. Does not receive Supplemental Nutritional Assistance Program (SNAP) benefits, as described in 7 CFR 273.10; or

(2) Fails or refuses to provide the documentation described in (d) or (e) below, pursuant to He-W 606.01.

(d) An individual who has food expenses pursuant to (c)(1)a. above, shall provide written documentation that includes the following:

(1) The individual’s printed name and address; and

(2) A signed statement from the individual certifying that the individual pays toward the food the individual eats.

(e) Residence expenses pursuant to (c)(1)b. above shall mean any of the following expenses incurred as a result of the individual’s independent living arrangement:

(1) Rental costs to live in the independent living arrangement;

(2) Utility costs to live in the independent living arrangement;

(3) Mortgage payments to live in the independent living arrangement; or

(4) Property taxes or property insurance associated with living in the independent living arrangement.

(f) An individual who has residence expenses pursuant to (e) above, shall provide one of the following:

(1) A lease or rent receipt for the residence in the individual’s name;

(2) A copy of a utility bill for the residence in the individual’s name;

(3) A copy of a mortgage payment or statement for the residence in the individual’s name;

(4) A copy of property taxes or property insurance for the residence in the individual’s name; or

(5) A statement signed by the individual with whom the adult category applicant or recipient resides, certifying that the individual pays toward rent, a utility listed in (g) below, mortgage, property taxes, or property insurance for the residence.

(g) Only the following shall be considered a utility residence expense, pursuant to (e)(2) above:

(1) Electricity;

(2) Cooking fuel;

(3) Heating fuel;

(4) Water or sewage; or

(5) Trash removal.

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #6531, INTERIM, eff 6-27-97, EXPIRES: 10-25-97; ss by #6614, eff 10-24-97; amd by #6826, eff 8-3-98; amd by #8452, eff 10-22-05; amd by #8684, eff 7-21-06; ss by #10075, eff 1-25-12; ss by #13308, eff 12-17-21

N.H. Code Admin. R. Ann. He-W 670.04 Determination of the Assistance Payment {#sec-he-w-670.04 omnilex-key=us-nh-regs-official--agency-he-w--He-W 670.04}

(a) The financial assistance grant amount shall be issued in the form of a semi-monthly assistance payment.

(b) The amount of the assistance payment shall be determined by the monthly grant and adjustments, if any, to the grant, as follows:

(1) If there are no adjustments, the assistance payment shall be equal to one-half the monthly grant; and

(2) If there are adjustments to the grant, the assistance payment shall be equal to one-half the monthly grant plus or minus one-half of the adjustments.

(c) The first semi-monthly payment shall be issued on the 15th of the month for the period covering the 1st through the 15th of that month.

(d) The second semi-monthly payment shall be issued on the 30th of the month, or the last day of the month in February, for the period covering the 16th through the last day of that month.

(e) If the 15th or the 30th of the month, or the last day of February, falls on a weekend, or falls on a Friday or a Monday holiday, EFT payments, described in He-W 671.02, or checks shall be issued on the preceding state business day.

(f) An adult category grant which has been reduced by one-third pursuant to He-W 670.03, shall have the one-third reduction removed effective the next semi-monthly payment period following:

(1) The date the individual provides proof that he or she:

a. No longer resides in an independent living arrangement, as defined in He-W 601.05(d); or

b. Now lives alone in an independent living arrangement;

(2) The date the individual provides proof of residence expenses or food expenses, pursuant to He-W 670.03(d)-(g); or

(3) The date the individual begins to receive food stamp benefits pursuant to 7 CFR 273.10.

(g) An individual whose independent living arrangement has changed pursuant to (f)(1)a. above shall provide a statement from the residential care facility, community residence, or licensed and certified nursing facility on the facility’s letterhead confirming the individual’s residence in the facility.

(h) An individual whose independent living arrangement has changed pursuant to (f)(1)b. above, shall provide a signed and dated statement from:

(1) The individual or individuals with whom the adult category applicant or recipient formerly resided indicating that they no longer live with the adult category applicant or recipient; and

(2) The adult category applicant or recipient indicating that he or she now lives alone.

(i) The semi-monthly payment, as described in (c) and (d) above, shall not be issued unless:

(1) The assistance group was eligible for financial assistance for the entire semi-monthly period; or

(2) The sanctioned individual was eligible for financial assistance for the entire semi-monthly period.

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #6531, INTERIM, eff 6-27-97, EXPIRES: 10-25-97; ss by #6614, eff 10-24-97; amd by #6825, eff 8-3-98; ss by #6826, eff 8-3-98; ss by #6896, eff 12-1-98; ss by #8684, eff 7-21-06; ss by #10075, eff 1-25-12; amd by #10511, eff 1-24-14; ss by #13827, eff 12-22-23

Part He-W 671 Issuance of Assistance Payments

N.H. Code Admin. R. Ann. He-W 671.01 Electronic Benefit Transfer (EBT) {#sec-he-w-671.01 omnilex-key=us-nh-regs-official--agency-he-w--He-W 671.01}

(a) Financial assistance payments shall be issued through the electronic benefit transfer (EBT) system when the individual or authorized representative has elected not to receive these benefits via electronic funds transfer (EFT) as described in He-W 671.02.

(b) An individual receiving financial assistance payments through the EBT system shall:

(1) Obtain an EBT card through:

a The district office; or

b. The mail;

(2) Activate the EBT card by selecting a personal identification number (PIN):

a. At the district office; or

b. Through an automated method made available through the department’s EBT contractor;

(3) Access the EBT cash account with the EBT card using the PIN; and

(4) Be responsible for the security of the EBT card and PIN.

(c) An individual or authorized representative obtaining an EBT card at the district office shall present proof of identity before being given the EBT card.

(d) Cash benefits which have not been accessed by the individual for a period of 90 calendar days after the date the benefits were issued shall be considered no longer available to the individual and permanently removed from the EBT account.

(e) EBT cash benefits shall not be replaced by the department.

(f) An individual shall request a replacement EBT card through:

(1) The department’s EBT contractor, whose phone number shall be provided by the department; or

(2) The district office.

(g) Fees charged by the EBT contractor for individual use of the EBT cash account shall be automatically deducted from the individual’s EBT cash account.

(h) The department shall provide the individual with notification of the fees described in (g) above, upon request.

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #6825, eff 8-3-98; ss by #6897, eff 12-1-98; amd by #7977, eff 11-1-03; ss by #8071, eff 4-23-04; ss by #9816, eff 11-19-10, EXPIRED: 11-19-18
#13122, INTERIM, eff 10-21-20, EXPIRED: 4-19-
#13190, eff 4-20-21

N.H. Code Admin. R. Ann. He-W 671.02 Electronic Funds Transfer (EFT) {#sec-he-w-671.02 omnilex-key=us-nh-regs-official--agency-he-w--He-W 671.02}

(a) Financial assistance payments shall be issued by method of direct deposit into the individual’s bank account through the electronic funds transfer (EFT) system when the individual or authorized representative has elected to receive these benefits in this manner.

(b) The portion of the assistance payment authorized as a vendor payment made to a vendor payee, pursuant to He-W 686.01, shall be made as an EFT deposit to the account of the vendor.

(d) To process an EFT, the individual, authorized representative, protective payee or vendor payee shall:

(1) Have an open checking or savings account; and

(2) Provide the department with the bank account information necessary to make a direct deposit.

(e) If an individual provides access or joint ownership to the account into which the EFT deposits are made, the department shall not replace EFT benefits used by the joint owner.

(f) EFT deposits shall not be split between separate accounts, unless the household has authorized an amount to be deposited into the account of a vendor payee as described in He-W 686.01.

(g) EFT deposits shall be posted to the individual’s personal bank account in accordance with He-W 670.04.

(h) Financial assistance payments shall be issued via EBT, pursuant to He-W 671.01, when:

(1) EFT is chosen for benefit issuance, but the individual does not have an open checking or savings account, pursuant to (d)(1) above;

(2) EFT is chosen for benefit issuance, but the individual does not provide the department with bk account information necessary to make a direct deposit, pursuant to (d)(2) above;

(3) The individual does not choose EFT for benefit issuance, pursuant to (a) above; or

(4) The individual provides information for EFT benefit issuance, but the information provided results in the bank rejecting the EFT deposit, pursuant to He-W 671.01(a).

History

(See Revision Note at Chapter Heading He-W 600); #6825, eff 8-3-98; ss by #6897, eff 12-1-98; ss by #8071, eff 4-23-04; ss by #10178, eff 8-24-12; ss by #13190, eff 4-20-21

N.H. Code Admin. R. Ann. He-W 671.03 Adjustment to an Electronic Benefit Transfer (EBT) Account {#sec-he-w-671.03 omnilex-key=us-nh-regs-official--agency-he-w--He-W 671.03}

(a) An EBT transaction error shall be deemed to have occurred when a cash assistance recipient uses an EBT card at an authorized point-of-sale or ATM machine, and due to a systems error or malfunction:

(1) The authorized retailer is not credited with some or all of the transfer of funds; or

(2) The cash assistance recipient does not receive some or all of the benefits requested although the recipient’s EBT account is debited.

(b) The department shall adjust a cash assistance EBT account within 45 business days of being notified of an EBT transaction error described in (a) above.

(c) Within 5 business days of making the adjustment described in (b) above, the department shall notify the recipient of the following:

(1) The total amount of the adjustment required to reconcile the account;

(2) The date the transaction occurred at the point-of-sale or ATM machine;

(3) The name of the merchant and location where the transaction occurred;

(4) That the recipient has 90 days to request an administrative appeal; and

(5) That if the recipient requests an administrative appeal within 10 calendar days from the date of notification from the department:

a. The amount of the adjustment will be credited to the recipient’s EBT account pending the outcome of the administrative appeal, if the individual requests; and

b. The amount of the adjustment credited to the recipient’s EBT cash account is subject to recoupment, in accordance with He-W 692, if the administrative appeal does not find in favor of the recipient.

(d) For EBT transaction errors described in (a)(1) above, the department shall additionally notify the recipient of the following:

(1) That the amount described in (c)(1) above has been placed on hold status and is unavailable for the recipient’s use as of the date of the notification; and

(2) If the EBT account has insufficient funds to cover the total adjustment described in (c)(1) above, the department will place a hold against the following month’s cash assistance benefits for the remaining amount of the adjustment.

(e) If the recipient does not request an administrative appeal within 10 calendar days from the date of notification from the department, the amount of the adjustment in (d)(1) above shall be removed from hold status and credited to the merchant, pursuant to (d)(2) above.

(f) If the recipient requests an administrative appeal after 10 calendar days but within 90 calendar days from notification of the adjustment from the department, the department shall make a provisional credit to the recipient equal to the amount described in (c)(1) above, if:

(1) The individual requests a provisional credit due to hardship pursuant to (g) below; or

(2) The administrative appeal finds in favor of the recipient, but:

a. The merchant refuses to credit the recipient’s EBT account for the adjustment error; or

b. The merchant is no longer an EBT provider.

(g) Hardship shall be deemed to exist when 80% of the benefit was not received by the recipient and the recipient provides a written statement indicating that the individual or household is experiencing or threatened by at least one of the following:

(1) Homelessness or eviction;

(2) Termination of a utility or dependent care; or

(3) Lack of medicine, food, heat, hot water, or cooking fuel.

(h) Provisional credits to the recipient in accordance with (f)(1) above shall be subject to recoupment, in accordance with He-W 692, if the administrative appeal does not find in favor of the recipient.

(i) The amount withheld from the current and following month’s EBT accounts in accordance with (d)(2) above, shall constitute the total adjustment amount, even if the actual amount needed to reconcile the EBT transaction error exceeds this amount.

History

#7977, eff 11-1-03; ss by #9987, eff 11-1-11, EXPIRED: 11-1-19
#13122, INTERIM, eff 10-21-20, EXPIRED: 4-19-21
#13190, eff 4-20-21

N.H. Code Admin. R. Ann. He-W 671.04 Paper Checks {#sec-he-w-671.04 omnilex-key=us-nh-regs-official--agency-he-w--He-W 671.04}

Financial assistance payments shall be issued by method of paper check only when a nursing facility client chooses to receive PNA payments in this manner.

History

#8071, eff 4-23-04; ss by #10178, eff 8-24-12; ss by #13190, eff 4-20-21

Part He-W 672 Initiation of Financial Assistance

N.H. Code Admin. R. Ann. He-W 672.01 Initiation of FANF Category Financial Assistance {#sec-he-w-672.01 omnilex-key=us-nh-regs-official--agency-he-w--He-W 672.01}

(a) FANF financial assistance shall begin effective with the first of the month following the month of application, or effective with the payroll period in which eligibility is determined, whichever occurs first, provided that the family is eligible on the date payment is made.

(b) A FANF applicant, who is required to comply with He-W 628.01, shall receive the first assistance payment pursuant to (a), above, or the following, whichever is later:

(1) The day following compliance with He-W 628.01(b)(2), if EBT is the method of benefit issuance; or

(2) The second day following compliance with He-W 628.01(b)(2), if EFT is the method of benefit issuance.

(c) A FANF applicant who is required to comply with RSA 167:79,III(b), shall receive the first assistance payment pursuant to (a) above, or effective with the payroll period in which the condition described in RSA 167:79,III(b) is met, whichever is later.

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #6531, INTERIM, eff 6-27-97, EXPIRES: 10-25-97; ss by #6614, eff 10-24-97; ss by #6825, eff 8-3-98; ss by #8684, eff 7-21-06; amd by #8869, eff 4-19-07; ss by #10163, eff 7-26-12

N.H. Code Admin. R. Ann. He-W 672.02 Initiation of Adult Category Financial Assistance {#sec-he-w-672.02 omnilex-key=us-nh-regs-official--agency-he-w--He-W 672.02}

(a) Adult category financial assistance shall begin effective with the payment period in which eligibility is determined, provided that the case is eligible on the date payment is issued.

(b) When eligibility for ANB or APTD is denied solely due to a disability determination unit (DDU) decision and the DDU decision is subsequently reversed, financial assistance shall be determined beginning on the first day of the month of that denial decision, provided:

(1) All general, technical and categorical eligibility requirements are met; and

(2) Either of the following apply:

a. The DDU reversal is based on review of medical information prior to an administrative appeal; or

b. The DDU decision is reversed as a result of an administrative appeal.

(c) When an eligibility determination is made after the 45-day or 90-day application processing periods, pursuant to 42 CFR 435.911(a), financial assistance shall begin effective with the payment period of the month in which:

(1) The 45th day fell, for OAA and ANB applicants; or

(2) The 90th day fell, for APTD applicants.

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; amd by #5749, INTERIM, eff 12-1-93, EXPIRED: 3-31-94; amd by #5806, eff 3-30-94; amd by #6195, eff 2-24-96; ss by #6531, INTERIM, eff 6-27-97, EXPIRES: 10-25-97; ss by #6614, eff 10-24-97; ss by #8452, eff 10-22-05; ss by #10511, eff 1-24-14; amd by #10923, eff 9-1-15

Part He-W 674 Termination of Financial Assistance

N.H. Code Admin. R. Ann. He-W 674.01 Termination of Financial Assistance {#sec-he-w-674.01 omnilex-key=us-nh-regs-official--agency-he-w--He-W 674.01}

(a) Financial assistance shall terminate as of the end of the required advance notice period.

(b) If the individual is potentially eligible for financial assistance under another category, assistance shall be determined without a separate application.

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #6531, INTERIM, eff 6-27-97, EXPIRES: 10-25-97; ss by #6614, eff 10-24-97; ss by #8452, eff 10-22-05; ss by #10471, eff 11-26-13; ss by #13648, eff 5-24-23

Part He-W 682 Termination of Medical Assistance

N.H. Code Admin. R. Ann. He-W 682.01 Termination of Medical Assistance {#sec-he-w-682.01 omnilex-key=us-nh-regs-official--agency-he-w--He-W 682.01}

(a) Except where otherwise specified, medical assistance shall cease as of the last day of the advance notice period, as defined in He-W 601.01(e).

(b) If the former medical assistance recipient is potentially eligible for medical assistance under another category or for in and out medically needy medical assistance under the same or another category, the individual shall reapply for this other assistance.

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; amd by #6195, eff 2-24-96; ss by #6531, INTERIM, eff 6-27-97, EXPIRES: 10-25-97; ss by #6614, eff 10-24-97; amd by #6745, (HB 32), eff 5-1-98, EXPIRED: 12-31-98; ss by #6925, eff 1-1-99; ss by #8783, INTERIM, eff 12-30-06, EXPIRES: 6-28-07; ss by #8903, eff 6-28-07; ss by #10139, eff 7-1-12

N.H. Code Admin. R. Ann. He-W 682.02 Financial Assistance and Eligibility for Medical Care {#sec-he-w-682.02 omnilex-key=us-nh-regs-official--agency-he-w--He-W 682.02}

He-W 682.03 - RESERVED

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91

N.H. Code Admin. R. Ann. He-W 682.04 Financial Assistance and Eligibility for Medical Care {#sec-he-w-682.04 omnilex-key=us-nh-regs-official--agency-he-w--He-W 682.04}

RESERVED

History

(See Revision Note at Part heading for He-W 882)

N.H. Code Admin. R. Ann. He-W 682.05 Financial Assistance and Eligibility for Medical Care {#sec-he-w-682.05 omnilex-key=us-nh-regs-official--agency-he-w--He-W 682.05}

RESERVED

History

(See Revision Note at Part heading for He-W 882)

Part He-W 684 Redetermination of Eligibility

N.H. Code Admin. R. Ann. He-W 684.01 Redeterminations - General {#sec-he-w-684.01 omnilex-key=us-nh-regs-official--agency-he-w--He-W 684.01}

(a) A redetermination of eligibility shall be required under the following conditions:

(1) At regularly scheduled intervals as prescribed by federal regulations;

(2) When requested by the individual;

(3) When the department of health and human services (DHHS) discovers conflicting information regarding eligibility factors; or

(4) When a change in case circumstances affects other eligibility factors.

(b) Except for individuals who meet the requirements of He-W 636.01(a) or He-W 644.01(a)(2), an individual shall participate in a personal interview with an eligibility worker as follows:

(1) For all financial assistance to needy families (FANF) financial cases; and

(2) For adult category financial cases when the individual resides in a residential care facility, community residence, or an independent living arrangement and receives supplemental nutritional assistance.

(c) The personal interview for adult category individuals shall be conducted with the individual, an authorized representative, or a nursing facility representative.

(d) For all redeterminations requiring a personal interview, the date of the redetermination shall be the day on which the interview is conducted.

(e) When a personal interview is not required, the date of the redetermination shall be the return date for the required verification.

(f) Refusal or failure, without good cause as defined in He-W 601.04(i), to schedule or appear for a redetermination interview and provide required verification shall result in the termination of financial assistance for the entire assistance group.

(g) A desk review, as defined in He-W 601.03(g), shall be required when a reported or anticipated change does not affect more than one eligibility factor or case circumstance.

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #6531, INTERIM, eff 6-27-97, EXPIRES: 10-25-97; ss by #6614, eff 10-24-97; amd by #6745, (HB 32), eff 5-1-98, EXPIRED: 12-31-98; ss by #6925, eff 1-1-99; amd by #7766, eff 10-1-02; amd by #8783, INTERIM, eff 12-30-06, EXPIRES: 6-28-07; amd by #8903, eff 6-28-07; ss by #9277, eff 10-1-08; ss by #10139, eff 7-1-12; ss by #13524, eff 1-24-23, EXPIRES: 1-24-33

N.H. Code Admin. R. Ann. He-W 684.02 Regularly Scheduled Redeterminations {#sec-he-w-684.02 omnilex-key=us-nh-regs-official--agency-he-w--He-W 684.02}

(a) For FANF financial assistance, redeterminations shall be scheduled at least every 6 months from the application month, with the month of application or redetermination always being zero, except as described in He-W 684.02(b).

(b) Redeterminations shall be scheduled by counting no more than 12 months from the application month, with the application month being zero, for the following assistance groups:

(1) FANF financial assistance groups in which no assistance group member receives supplemental nutritional assistance and:

a. The parent is not included in the assistance group; or

b. A caretaker relative is a member of the assistance group; and

(2) FANF medical assistance only groups in which no assistance group member receives supplemental nutritional assistance.

(1) The first redetermination date shall be determined by counting 12 months from the month of application with the month of application always being zero; and

(2) Subsequent redetermination dates shall be no more than 12 months following the most recent redetermination.

(d) For any case containing multiple assistance groups receiving assistance under different categories of assistance, a redetermination shall be conducted for all assistance groups in the case whenever the assistance group with the most frequent redetermination schedule is required to conduct a redetermination.

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; amd by #5819, eff 4-29-94; ss by #5967, eff 1-27-95; amd by #6826, eff 8-3-98; amd by #6896, eff 12-1-98; amd by #6925, eff 1-1-99; amd by #7282, eff 6-1-00; amd by #7510, eff 7-1-01; ss by #7560, eff 10-1-01; amd by #7666, eff 4-1-02; amd by #7835, eff 2-24-03; amd by #8325, eff 5-1-05; ss by #9277, eff 10-1-08; ss by #10139, eff 7-1-12; ss by #13524, eff 1-24-23, EXPIRES: 1-24-33

Part He-W 685 Additional Eligibility Requirements

N.H. Code Admin. R. Ann. He-W 685.01 Special Reviews of Eligibility {#sec-he-w-685.01 omnilex-key=us-nh-regs-official--agency-he-w--He-W 685.01}

(a) Applicants for or recipients of FANF or adult category financial or medical assistance shall cooperate with special reviews of eligibility and provide any requested verification.

(b) Special reviews shall be required of applicants or recipients, based upon quality control data or the results of other formal or informal studies, in order to assist the department in the efficient administration of its programs.

(d) The department shall not impose any new or changed condition(s) of eligibility during these reviews.

(e) Applicants and recipients who are subject to a special review shall be entitled to all rights that are usually provided, including the following:

(1) Advance notice of action to deny, terminate, or reduce benefits;

(2) The right to appeal; and

(3) The right to request continued benefits pending the outcome of a hearing.

(f) A client’s failure or refusal to cooperate with a quality control review pursuant to (a) through (c) above, shall result in the the assistance group being determined ineligible for the program under review.

(g) If the program selected for review in (f) above is Medicaid, the client’s failure or refusal to cooperate shall also result in the assistance group’s ineligibility for financial assistance.

(h) The period of ineligibility described in (f) above shall continue until the earlier of:

(1) The client’s compliance with the quality control review requirements; or

(2) The end of the federal reporting period during which the quality control review was conducted.

(i) When the period specified in (h) above has expired, the client shall be required to reapply for assistance.

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #6531, INTERIM, eff 6-27-97, EXPIRES: 10-25-97; ss by #6614, eff 10-24-97; amd by #6826, eff 8-3-98; amd by #6896, eff 12-1-98; amd by #8452, eff 10-22-05; amd by #8684, eff 7-21-06; ss by #10471, eff 11-26-13

Part He-W 686 Protective and Vendor Payments

N.H. Code Admin. R. Ann. He-W 686.01 Protective and Vendor Payments {#sec-he-w-686.01 omnilex-key=us-nh-regs-official--agency-he-w--He-W 686.01}

(a) Protective and vendor payments shall be made under the same circumstances and in the same manner for adult category financial assistance and for financial assistance to needy families (FANF) financial assistance, unless otherwise specified.

(b) Pursuant to RSA 167:26, protective payments shall be authorized when required by federal regulations and due to mismanagement of funds as described in (d) below.

(c) The entire assistance payment, notices of decision, and medical assistance benefit cards shall be sent to the person designated as protective payee.

(d) Mismanagement of funds shall include, but not be limited to:

(1) Recurring inability to plan for and meet the monthly living expenses of the individual;

(2) Recurring failure to meet obligations for rent and groceries;

(3) Repeated evictions or incurrence of debts with attachments against current non-assistance income; or

(4) Recurring incidents of children not being properly fed or clothed, and their health and safety being threatened as a result.

(e) Physical or mental incapacities by themselves shall not be valid reasons for assigning a protective payee.

(f) The protective payee shall be selected from the following:

(1) A relative, friend, neighbor, or clergyperson;

(2) An individual who works with voluntary social agencies, or is on the staff of a public agency which provides homemaker and housekeeping aid services, practical nursing, rehabilitation, or housing; or

(3) For adult category cases, the superintendent, or a designated representative of a public institution for the mentally ill or intellectually disabled, provided that there are staff available to assist the superintendent in carrying out the protective payee function.

(g) The protective payee shall not be a staff member of the department.

(h) The responsibilities of the protective payee shall be as follows:

(1) To receive the individual's entire assistance payment, and pay the bills according to a budget planned with the individual;

(2) Encourage the individual to actively participate in the management of the individual’s income, resources, and expenses;

(3) Cooperate with the social worker and the department staff member in helping the individual learn how to manage household budgeting;

(4) Maintain an accurate accounting of the individual's assistance payments; and

(5) Comply with applicable federal laws and regulations and state statutes regarding confidentiality.

(i) For adult category cases, protective payments for mismanagement shall be continued indefinitely if the mismanagement situation is not resolved.

(j) When voluntarily requested in writing by the individual, pursuant to (k)-(l) below, a portion or all of the assistance payment shall be made payable to a vendor payee, as defined in He-W 601.08.

(k) To initiate vendor payments, the individual shall:

(1) Specify the vendor's name, address, and the amount of the payment; and

(2) Notify the department in writing when a vendor payment is to be changed or when a vendor payment is to be terminated.

(l) Vendor payments shall not be made if:

(1) A creditor is coercing the individual; or

(2) The department has knowledge that a creditor will not provide the individual with the same quality and quantity of goods that would be provided to the general public.

(m) Voluntary vendor payments shall not be authorized for individuals who have a:

(1) Protective payee due to mismanagement of funds or non-compliance with Title IV-D requirements, as defined in He-W 601.08, even if the assistance payment is directed to the casehead; or

(2) Foster parent, guardian, or conservator.

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #6531, INTERIM, eff 6-27-97, EXPIRES: 10-25-97; ss by #6614, eff 10-24-97; amd by #6825, eff 8-3-98; amd by #6826, eff 8-3-98; amd by #6896, eff 12-1-98; amd by #8452, eff 10-22-05; amd by #8684, eff 7-21-06; ss by #10471, eff 11-26-13; ss by #13662, eff 6-21-23

Part He-W 688 Corrective Payments

N.H. Code Admin. R. Ann. He-W 688.01 Corrective Payments {#sec-he-w-688.01 omnilex-key=us-nh-regs-official--agency-he-w--He-W 688.01}

(a) For adult category financial assistance, corrective payments, as described in He-W 601.02, shall be made under the same circumstances and in the same manner as in the financial assistance to needy families (FANF) category of assistance.

(b) The individual shall not receive a corrective payment for the following:

(1) Differences between independent living and community residence standards of need, when the department is not notified of the community residence living arrangement; or

(2) Differences in benefit amounts or eligibility that result from using current information for a prior period.

(c) Pursuant to 45 CFR 233.20(u)(12)(ii)(c), corrective payments shall only be made for underpayments totaling $5.00 or more.

(d) The underpayment period shall begin with the first payroll period that was affected, using the actual or maximum time frames for client reporting, department action, and the advance notice period, when applicable.

(e) The underpayment period shall end:

(1) When a correct payment has been issued, if information is still current; or

(2) With the first payroll period after applying the actual or maximum time frames for client reporting, department action, and advance notice period, if information is no longer current.

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #6531, INTERIM, eff 6-27-97, EXPIRES: 10-25-97; ss by #6614, eff 10-24-97; ss by #8452, eff 10-22-05; ss by #10471, eff 11-26-13; ss by #13646, eff 5-24-23

Part He-W 690 Reimbursement

N.H. Code Admin. R. Ann. He-W 690.01 Reimbursement {#sec-he-w-690.01 omnilex-key=us-nh-regs-official--agency-he-w--He-W 690.01}

(a) Pursuant to RSA 167:28, each applicant for old age assistance (OAA), aid to the needy blind (ANB), or aid to the permanently and totally disabled (APTD) financial assistance, as well as the spouse of the applicant if residing with the applicant, shall complete an agreement to reimburse the federal government, the state, and the county for all assistance granted.

(b) The agreement required in (a) above shall include:

(1) The printed name of the applicant;

(2) The printed name of the applicant’s spouse, if applicable;

(3) The applicant’s street address;

(4) The county where the applicant resides;

(5) The physical location where the agreement is being signed;

(6) The dated signature of the applicant, and spouse if applicable;

(7) The dated signature of a notary public or justice of the peace;

(8) The date the commission of the notary public or justice of the peace expires;

(9) The raised seal if witnessed by a notary public; and

(10) Acknowledgement that the department has advised the applicant of the requirements of RSA 167:16-a, if applicable.

(c) If an applicant or spouse fails to complete and sign the agreement, eligibility for OAA, ANB, or APTD financial assistance shall be denied.

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #6531, INTERIM, eff 6-27-97, EXPIRES: 10-25-97; ss by #6614, eff 10-24-97; ss by #8452, eff 10-22-05; ss by #10471, eff 11-26-13; ss by #13759, eff 9-28-23

Part He-W 692 Recoupment

N.H. Code Admin. R. Ann. He-W 692.01 Financial Assistance and Eligibility for Medical Care {#sec-he-w-692.01 omnilex-key=us-nh-regs-official--agency-he-w--He-W 692.01}

RESERVED

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91

N.H. Code Admin. R. Ann. He-W 692.02 Erroneously Paid Financial Assistance {#sec-he-w-692.02 omnilex-key=us-nh-regs-official--agency-he-w--He-W 692.02}

(a) For adult category and financial assistance to needy families (FANF) financial assistance, the rate and method of recoupment of overpayments, as defined in He-W 601.06, shall be the same, except where otherwise specified.

(b) Differences in benefit amounts or eligibility that result from using current information for a prior period shall not be considered an overpayment.

(c) For overpaid residential care facility or community residence cases, the method and amount of recoupment shall be determined in consultation with the department’s division of long term supports and services.

(d) When a FANF financial assistance recipient receives direct child support or spousal support, no overpayment shall occur as long as the support income is used in the calculation of eligibility.

(e) The overpayment period shall begin with the first payroll period that was affected, using the actual or maximum time frames for individual reporting, department action, and advance notice period, when applicable.

(f) When both an overpayment and an underpayment exist for the same case, one shall be offset by the other to arrive at a reduced recoupment or corrective payment amount.

(g) All overpayments shall be recovered at the same rate, except where otherwise noted.

(h) The rate of recovery shall be computed in the following manner:

(1) Pursuant to (n) below, determine a rate of:

a. Ten percent of the assistance group's payment standard; or

b. The nearest whole dollar to 10% of the assistance group’s payment standard to equalize issuance of semi-monthly payments, pursuant to He-W 670.04, when 10% does not allow equal semi-monthly payments;

(2) The result of (1) above shall be the maximum monthly amount recouped from the assistance group;

(3) The amount shall be rounded as described in He-W 670.03(a)(3) in order to equalize payments for the period; and

(4) Changes in the payment standard shall require:

a. A recalculation of the recoupment rate and the repayment period; and

b. Notice to the recipient.

(i) The recoupment amount shall not reduce the amount of the assistance payment to less than $0.00.

(j) A written repayment agreement shall be completed by the individual whenever the individual chooses to repay an overpayment by direct payment in lieu of, or in addition to, a grant reduction.

(k) The repayment agreement shall be considered complete when the following is provided:

(1) The individual’s name;

(2) The period of overpayment;

(3) The amount of the overpayment;

(4) An indication of full or partial repayment;

(5) The amount and frequency of payments;

(6) The individual’s signature; and

(7) The date the individual signed the agreement.

(l) The terms of a direct repayment shall be renegotiated at any time by completion of a new repayment agreement.

(m) Changes to an existing recoupment agreement shall require an advance notice period when the change results in a new overpayment added to the original overpayment.

(n) If the FANF casehead, as defined in He-W 601.02, has been disqualified due to an intentional program violation pursuant to He-W 693.02, the rate described in (h)(1) above shall be $10 per month until the disqualification ends.

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #6531, INTERIM, eff 6-27-97, EXPIRES: 10-25-97; ss by #6614, eff 10-24-97; amd by #6826, eff 8-3-98; amd by #6896, eff 12-1-98; amd by #8452, eff 10-22-05; amd by #8684, eff 7-21-06; ss by #10471, eff 11-26-13; ss by #13756, eff 9-27-23

N.H. Code Admin. R. Ann. He-W 692.03 Erroneously Paid Medical Assistance {#sec-he-w-692.03 omnilex-key=us-nh-regs-official--agency-he-w--He-W 692.03}

Medical assistance which is erroneously paid on behalf of a client shall be subject to recovery if the erroneous payment is due to client error, withholding of information, or failure to comply with eligibility requirements.

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #6531, INTERIM, eff 6-27-97, EXPIRES: 10-25-97; ss by #6614, eff 10-24-97; ss by #8417, eff 9-1-05; ss by #10384, eff 9-1-13; ss by #13756, eff 9-27-23

Part He-W 693 Fanf Intentional Program Violations

N.H. Code Admin. R. Ann. He-W 693.01 Applicability {#sec-he-w-693.01 omnilex-key=us-nh-regs-official--agency-he-w--He-W 693.01}

These rules shall apply to any individual who obtains, attempts to obtain, or aids or abets any individual in obtaining financial assistance to needy families (FANF) benefits to which the individual is not entitled.

History

(See Revision Note #1 at Chapter Heading He-W 600) #6008, eff 3-24-95; ss by #7834, eff 2-24-03, ss by #9871, INTERIM, eff 2-24-11, EXPIRES: 8-23-11; ss by #9983, eff 8-23-11; ss by #12901, eff 10-22-19

N.H. Code Admin. R. Ann. He-W 693.02 Intentional Program Violation {#sec-he-w-693.02 omnilex-key=us-nh-regs-official--agency-he-w--He-W 693.02}

(a) “Intentional program violation (IPV)” means a fraudulent act for which an individual intentionally provides false or misleading statements or information to the department. This term includes an individual’s intentional failure to disclose changes in resources or circumstances that would affect the receipt of or eligibility for receipt of financial assistance to needy families (FANF) benefits.

(b) An individual shall be found to have committed an IPV if the individual has:

(1) Pled guilty or nolo contendere to, or otherwise been found guilty of, an IPV in state or federal court;

(2) Been determined to have committed an IPV by a hearing officer following an administrative disqualification hearing on the alleged violation pursuant to He-W 693.03;

(3) Executed a waiver of his or her right to an administrative disqualification hearing pursuant to He-W 693.04; or

(4) Signed a consent agreement pursuant to He-W 693.05.

History

(See Revision Note #1 at Chapter Heading He-W 600) #6008, eff 3-24-95; ss by #7834, eff 2-24-03, ss by #9871, INTERIM, eff 2-24-11, EXPIRES: 8-23-11; ss by #9983, eff 8-23-11; ss by #12901, eff 10-22-19

N.H. Code Admin. R. Ann. He-W 693.03 Administrative Disqualification Hearing Procedures {#sec-he-w-693.03 omnilex-key=us-nh-regs-official--agency-he-w--He-W 693.03}

(a) The department’s administrative appeals unit (AAU) shall conduct an administrative disqualification hearing (ADH) for an individual accused of an IPV in accordance with He-C 200 and these rules unless an individual executes a waiver of the ADH in accordance with He-W 693.04.

(b) The AAU shall consolidate an individual’s ADH with a pending administrative appeal hearing to be conducted in accordance with He-C 200 when they are based on the same or related circumstances provided that the individual receives prior notice of the consolidation.

(c) The department shall send written notice of the ADH to the accused individual at least 30 days in advance of the date of the scheduled ADH.

(d) The hearing officer shall postpone a scheduled hearing at the individual’s or the department’s request in accordance with He-C 205.09.

(e) If the individual requests a review of the eligibility file, the review shall be scheduled at least 10 days following the request for the review, unless the department can accommodate an earlier review.

(f) The hearing officer shall determine an individual committed an IPV if the evidence demonstrates by clear and convincing evidence, as defined in He-C 203.14(a)(3), that the individual intentionally obtained, attempted to obtain, aided, or abetted in the receipt of benefits to which the individual was not otherwise entitled.

(g) The AAU shall issue decisions in accordance with He-C 203.22 and RSA 541-A:35.

History

(See Revision Note #1 at Chapter Heading He-W 600) #6008, eff 3-24-95; ss by #7834, eff 2-24-03; ss by #9871, INTERIM, eff 2-24-11, EXPIRES: 8-23-11; ss by #9983, eff 8-23-11; ss by #12901, eff 10-22-19

N.H. Code Admin. R. Ann. He-W 693.04 Waiver of the Administrative Disqualification Hearing {#sec-he-w-693.04 omnilex-key=us-nh-regs-official--agency-he-w--He-W 693.04}

(a) An individual accused of an IPV may waive his or her right to the ADH.

(b) An individual who chooses to waive his or her right to an ADH shall do so in writing by submitting the waiver form provided by the department entitled “Administrative FANF Disqualification Hearing Waiver” Form 402 (May 1996).

(c) If an individual waives his or her right to an ADH, the department shall impose the disqualification penalty and provide notice of the disqualification penalty pursuant to He-W 693.06.

History

(See Revision Note #1 at Chapter Heading He-W 600) #6008, eff 3-24-95; ss by #7834, eff 2-24-03; ss by #9871, INTERIM, eff 2-24-11, EXPIRES: 8-23-11; ss by #9983, eff 8-23-11 (from He-W 693.05); ss by #12901, eff 10-22-19

(a) An individual accused of an IPV may sign an agreement, otherwise known as a consent agreement, pursuant to the approval by the prosecuting authority in which he or she admits to committing an IPV or at least agreeing to the finding and the resulting disqualification penalties.

(b) The consent agreement shall include the following information:

(1) A statement for the accused individual to sign which demonstrates that he or she understands the consequences of signing the agreement; and

(2) A statement that informs the individual that signing the agreement will result in disqualification and might result in a reduction in payments to the household for the designated period of time as described in He-W 693.06.

History

(See Revision Note #1 at Chapter Heading He-W 600) #6008, eff 3-24-95; ss by #7834, eff 2-24-03; ss by #9871, INTERIM, eff 2-24-11, EXPIRES: 8-23-11; ss by #9983, eff 8-23-11 (from He-W 693.06); ss by #12901, eff 10-22-19

N.H. Code Admin. R. Ann. He-W 693.06 Disqualification Penalties {#sec-he-w-693.06 omnilex-key=us-nh-regs-official--agency-he-w--He-W 693.06}

(a) A disqualification penalty shall not be imposed until the individual has been found to have committed an IPV in accordance with He-W 693.02(b).

(b) An individual found to have committed an IPV shall be disqualified from receiving FANF benefits for the following period of time:

(1) Six months for the first violation;

(2) Twelve months for the second violation; or

(3) Permanently for the third violation.

(1) Count the income and resources for those individuals in the household found to have committed an IPV as 100% available deemed resources and deemed income to the FANF household; and

(2) Calculate the disqualified individual’s earned income without applying the earned income disregard.

(d) A disqualification penalty imposed on an individual by the FANF state agency in another state shall be used in determining the disqualification penalty for that same individual in New Hampshire by adding the total number of IPVs committed by that individual in the other state and in New Hampshire.

(e) Recoupment of the FANF overpayment shall be conducted by the department in accordance with He-W 692.02, except that the department shall limit the recoupment amount during the time the individual is disqualified to the lesser of the percentage specified in He-W 692.02(h) or $10 per month from the FANF payments made to the household of the disqualified individual.

History

(See Revision Note #1 at Chapter Heading He-W 600) #6008, eff 3-24-95; ss by #7834, eff 2-24-03; ss by #9871, INTERIM, eff 2-24-11, EXPIRES: 8-23-11; ss by #9983, eff 8-23-11 (from He-W 693.02); ss by #12901, eff 10-22-19

Part He-W 694 Funeral and Burial Expenses

N.H. Code Admin. R. Ann. He-W 694.01 Funeral and Burial Expenses {#sec-he-w-694.01 omnilex-key=us-nh-regs-official--agency-he-w--He-W 694.01}

(a) The department shall pay up to $750 toward the funeral and burial expenses when a recipient of financial assistance dies, provided that:

(1) The recipient does not have a prepaid burial contract;

(2) The total cost of the funeral and burial does not exceed $1500;

(3) The cost of the funeral and burial is not covered by:

a. An insurance policy in which the presiding funeral director is the beneficiary; or

b. Other burial funds as defined in 20 CFR 416.1231; and

(4) The funeral director does not receive a death benefit or payments from friends or relatives which cover the entire cost of the deceased recipient's funeral and burial.

(b) If at the time of death the recipient owned any personal property resources as defined in He-W 601.06(n), these resources shall be applied toward the cost of the funeral and burial before the department shall consider making any payment up to the $750 limit described in (a) above.

(c) If an insurance policy or burial funds, as described in (a)(3) above, or other death benefits or payments from friends or relatives, as described in (a)(4) above, do not cover the entire cost of the funeral, then the department shall pay the difference between the total of all payments and the cost of the funeral, subject to the $750 and $1500 limits noted in (a) above.

(d) To request reimbursement for funeral and burial expenses of a deceased financial assistance recipient, the funeral director shall submit an itemized bill to the department and list:

(1) The incurred expenses; and

(2) Payments made, if any, with the name and address of the source providing the payment.

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #6531, INTERIM, eff 6-27-97, EXPIRES: 10-25-97; ss by #6614, eff 10-24-97; ss by #8452, eff 10-22-05

Part He-W 696 Nutritional Supplement for Working Families (nswf)

N.H. Code Admin. R. Ann. He-W 696.01 Purpose {#sec-he-w-696.01 omnilex-key=us-nh-regs-official--agency-he-w--He-W 696.01}

The purpose of Nutritional Supplement for Working Families (NSWF) is to offer working recipients of Supplemental Nutrition Assistance Program (SNAP) benefits a supplemental monthly assistance pursuant to 45 CFR 260.31(a)(1) to be used only to augment their families’ nutritional needs and help offset their other financial obligations. Recipients of NSWF shall be counted in the department’s work participation rate pursuant to RSA 167:77-a,I(e).

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #6531, INTERIM, eff 6-27-97, EXPIRES: 10-25-97; ss by #6614, eff 10-24-97, EXPIRED: 10-24-05
#10052, eff 12-20-11; ss by #13294, eff 11-24-21

N.H. Code Admin. R. Ann. He-W 696.02 Nutritional Supplement for Working Families (NSWF) {#sec-he-w-696.02 omnilex-key=us-nh-regs-official--agency-he-w--He-W 696.02}

(a) Nutritional Supplement for Working Families (NSWF) shall be provided, as funding and resources allow, to single parents residing with at least one dependent child, as defined by RSA 161-B:2, IV, who:

(1) Are employed for at least 35 hours per week;

(2) Are receiving SNAP benefits pursuant to 7 CFR 273.10; and

(3) Do not receive:

a. Any category of financial assistance offered by the department;

b. Extended SNAP benefits pursuant to He-W 756.06; or

c. SNAP benefits described in 7 CFR 273.10(e)(3).

(b) The child who resides with the parent pursuant to (a) above, shall:

(1) Be under age 18; and

(2) Not have another biological or adopted parent living in the home.

(c) The self-employed SNAP recipient shall be considered to have met the NSWF employment eligibility requirements in (a)(1) above when:

(1) His or her net monthly self-employment profit is divided by the federal minimum wage;

(2) The result of the calculation in (c)(1) above is divided by 4.33 to obtain average hours worked per week; and

(3) The result of the calculation in (c)(2) above shall meet or exceed the figure described in (a)(1) above.

(d) NSWF shall:

(1) Begin the next payroll period in which the criteria in He-W 696.02 are met, provided that the NSWF assistance group (AG) meets the criteria on the date payment is made;

(2) Be issued pursuant to He-W 671.01 and He-W 670.04(a) and (c)-(e);

(3) Be calculated by dividing the total amount of NSWF funding within the current fiscal year by the total number of currently eligible NSWF households and rounding the resulting figure down to the nearest dollar; and

(4) Be used only to purchase SNAP-eligible items pursuant to 7 CFR 271.2.

(e) If the number of eligible NSWF households has increased to such a number that it would cause the depletion of NSWF funds before the end of the respective fiscal year, the standard monthly NSWF amount calculated pursuant to (d)(3) above shall be reduced to an amount that prevents the depletion of the NSWF funds before the end of that fiscal year.

(f) NSWF shall terminate:

(1) For the entire AG when any of the eligibility requirements described in He-W 696.02 are not met;

(2) For the entire AG when a NSWF recipient applies for any category of financial assistance pursuant to He-W 601.01(p); or

(3) For all recipients when funding and resources within the current state fiscal year are no longer available to offer NSWF.

(g) If the NSWF recipient requests an administrative appeal pursuant to He-C 203.03 to review the department’s decision to terminate NSWF, the NSWF recipient:

(1) Shall not continue to receive NSWF during the appeal process; and

(2) Shall be denied an administrative appeal if the termination was due to reasons described in (f)(3) above, pursuant to He-C 203.03(g).

(h) The following provisions shall not apply to AGs receiving NSWF:

(1) Receipt of payments under the emergency assistance program described in He-W 699.05(a)(2);

(2) Exemption from the child care waitlist pursuant to He-C 6910.10(c);

(3) The time limits on receipt of financial assistance described in He-W 602.05(a);

(4) Receipt of employment support services pursuant to He-W 655;

(5) The title IV-D requirements as defined in He-W 601.08(e); or

(6) Receipt of NSWF for retroactive periods of time, as described in He-W 601.07(h).

(i) The department shall consider recipients of NSWF to have met all the requirements of He-W 637.03 by being employed for at least the minimum hours per week described in (a)(1) above.

(j) NSWF shall not be provided:

(1) When an individual has applied for any category of financial assistance; or

(2) While eligibility for any category of financial assistance is being determined.

(k) NSWF shall be deducted from the SNAP recipient’s EBT account and will no longer be available for use, if the benefit:

(1) Was issued by the department in error;

(2) Was issued by the department while the individual was ineligible for NSWF; or

(3) Is not used for a period of 90 days pursuant to He-W 671.01(d).

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #6531, INTERIM, eff 6-27-97, EXPIRES: 10-25-97; ss by #6614, eff 10-24-97, EXPIRED: 10-24-05
#10052, eff 12-20-11; ss by #13294, eff 11-24-21

Part He-W 698 Buy in of Medicare Part B

N.H. Code Admin. R. Ann. He-W 698.01 Financial Assistance and Eligibility for Medical Care {#sec-he-w-698.01 omnilex-key=us-nh-regs-official--agency-he-w--He-W 698.01}

RESERVED

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #6531, INTERIM, eff 6-27-97, EXPIRES: 10-25-97; ss by #6614, eff 10-24-97; ss by #8452, eff 10-22-05; ss by #10471, eff 11-26-13; rpld by #13906, eff 3-19-24

Part He-W 699 Special Payment Situations

N.H. Code Admin. R. Ann. He-W 699.01 Financial Assistance and Eligibility for Medical Care {#sec-he-w-699.01 omnilex-key=us-nh-regs-official--agency-he-w--He-W 699.01}

RESERVED

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91

N.H. Code Admin. R. Ann. He-W 699.02 Financial Assistance and Eligibility for Medical Care {#sec-he-w-699.02 omnilex-key=us-nh-regs-official--agency-he-w--He-W 699.02}

RESERVED

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #6531, INTERIM, eff 6-27-97, EXPIRES: 10-25-97; ss by #6614, eff 10-24-97; ss by #6825, eff 8-3-98; ss by #8684, eff 7-21-06; ss by #10743, eff 12-12-14

N.H. Code Admin. R. Ann. He-W 699.03 Financial Assistance and Eligibility for Medical Care {#sec-he-w-699.03 omnilex-key=us-nh-regs-official--agency-he-w--He-W 699.03}

RESERVED

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #6531, INTERIM, eff 6-27-97, EXPIRES: 10-25-97; ss by #6614, eff 10-24-97; ss by #6825, eff 8-3-98, EXPIRED: 8-3-06

N.H. Code Admin. R. Ann. He-W 699.04 Deceased Recipients {#sec-he-w-699.04 omnilex-key=us-nh-regs-official--agency-he-w--He-W 699.04}

(a) Assistance payments shall be returned to the department by any person having possession of such payments when the payments:

(1) Are received after the death of the recipient;

(2) Are uncashed at the time of the recipient's death;

(3) Cannot be delivered; or

(4) Are the unused portion of previous benefits remaining in the electronic benefit transfer account.

(b) Amounts deposited through electronic funds transfer into the account of a deceased recipient which have not yet been spent to cover the deceased recipient’s expenses described in (c), below, shall be returned to the department by:

(1) The administrator of the deceased recipient’s estate;

(2) The joint owner of the account; or

(3) Any person with access to the deceased recipient’s account.

(1) For expenses included in the recipient’s grant that:

a. Were incurred prior to the death of the recipient; and

b. Would have been covered by the returned payment; and

(2) Only for expenses which were incurred during the month of the recipient’s death.

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #6531, INTERIM, eff 6-27-97, EXPIRES: 10-25-97; ss by #6614, eff 10-24-97; ss by #6825, eff 8-3-98; ss by #8684, eff 7-21-06; ss by #10743, eff 12-12-14, EXPIRED: 12-12-24
#13950, eff 4-30-24

N.H. Code Admin. R. Ann. He-W 699.05 Emergency Assistance {#sec-he-w-699.05 omnilex-key=us-nh-regs-official--agency-he-w--He-W 699.05}

(a) The department shall operate an emergency assistance program pursuant to RSA 167:7, V to assist families to secure or retain permanent housing.

(b) To be financially eligible to receive emergency assistance to secure or retain permanent housing, the family shall meet one of the following:

(1) Be eligible for and receiving financial assistance to needy families (FANF);

(2) Be categorically and financially eligible for FANF according to the requirements described throughout He-W 600 but not be receiving it; or

(3) Meet all the categorical and financial requirements to receive FANF, as described throughout He-W 600 except that the caretaker relative shall not be required to meet the definition of a specified relative, as defined in He-W 601.07, provided that the children did live with a specified relative, as so defined, within 6 months prior to the month in which the emergency assistance is requested.

(c) When determining financial eligibility for emergency assistance to secure or retain permanent housing, the income and resources of all eligible children, and a specified relative as defined in He-W 601.07 and the specified relative’s spouse, shall be combined and compared to the FANF payment standard for the appropriate assistance group (AG) size as described in He-W 658.02, and FANF resource limits, as described in He-W 656.06, whether the family is receiving FANF or not.

(d) Non-financial eligibility requirements for emergency assistance to secure or retain permanent housing shall be as follows:

(1) The applicant shall submit a written request for assistance to the department as indicated in (e) below;

(2) The applicant shall verify that the AG is experiencing or is threatened with homelessness or unsafe or unhealthy living conditions pursuant to He-W 606.104(b);

(3) The applicant:

a. Has complied with all verification requirements of He-W 606.104; and

b. Is not under sanction pursuant to RSA 167:79, VI(b)-(d) or RSA 167:82, III(c)-(g) at the time of application or at any time during the eligibility determination process for emergency assistance, or if an individual in sanction has a plan to cure and is actively engaging in curing the sanction with the New Hampshire employment program (NHEP), then the individual shall be eligible to apply for emergency assistance;

(4) The applicant's residence shall be currently occupied and:

a. Owned or rented by any of the individuals whose needs, income, and resources are used to determine eligibility for emergency assistance;

b. Jointly owned with:

An individual whose needs, income, and resources are used to determine eligibility for emergency assistance; or
The individual's spouse or adult child who resides on the property; or

c. Be owned on a future date by any of the individuals cited in (4)a and (4)b above, pursuant to a court order which awards the property to the individuals(s) and specifies that the property will be transferred; and

(5) The applicant’s need for emergency assistance is not due to:

a. Voluntarily quitting a job of at least 20 hours a week within 60 days of applying for emergency assistance unless the reason for voluntarily quitting meets the good cause criteria pursuant to RSA 167:82, III(c)-(d); or

b. Any of the reasons described in RSA 167:79, VI(b)-(d), and RSA 167:82, III(c)-(g).

(e) The applicant shall submit a signed and dated written request for emergency assistance to secure or retain permanent housing to the department which contains the following information:

(1) The type of emergency situation, including time periods, if the request is for a rental, mortgage principal or interest, or utility or fuel delivery arrearages;

(2) The specific type of assistance required; and

(3) The amount of assistance requested.

(f) The following types of expenses shall be the only expenses authorized under the emergency assistance to secure or retain permanent housing program:

(1) Rental security deposits or first month’s rent, or both, required to obtain housing, provided that the monthly rental expense does not exceed 100% of the AG’s total monthly income;

(2) The minimum amount of back rent required to retain current housing, provided that:

a. The period the back rent is intended to cover has expired; and

b. If the monthly rent obligation exceeds 100% of the AG’s total monthly income, the AG provides a signed and dated statement from any person or entity indicating the intent to assist in maintaining the AG’s monthly rent obligation;

(3) The minimum amount of back mortgage principal and interest required to retain current housing, provided that:

a. The period the back mortgage principal and interest is intended to cover has expired; and

b. If the monthly mortgage obligation exceeds the AG’s total monthly income, the AG provides a signed and dated statement from any person or entity indicating the intent to assist in maintaining the AG’s monthly mortgage obligation;

(4) Utility deposits required to obtain heat, electricity, water, sewer, and gas service;

(5) Utility arrearages to prevent termination of heat, electricity, water, sewer, and gas service; and

(6) Deliveries of home heating fuel, including:

a. A current fuel delivery; or

b. Payment of the cost of the most recent fuel delivery arrearage which will allow for a current fuel delivery.

(g) The AG shall meet the following conditions for the permanent housing expense requested:

(1) The applicant shall provide verification of the emergency situation specified in (e) and (f) above pursuant to He-W 606.104;

(2) If the rental or utility security deposit request exceeds the maximum allowed by the department, the AG shall verify one of the following pursuant to He-W 606.104(b):

a. That the remainder of the deposit will be secured;

b. A payment plan has been arranged for the balance of the deposit; or

c. The payment authorized by the department will secure the housing;

(3) If the amount of the back rent, mortgage principal and interest, or utility arrearage exceeds a 2-month period, the AG shall verify the following pursuant to He-W 606.104(b):

a. The remainder of the back rent, mortgage principal and interest, or the utility arrearage will be secured;

b. Payment of a 2-month portion will prevent eviction, foreclosure, or termination of utilities; or

c. A payment plan has been arranged for the remainder of the bill;

(4) For utility deposits, utility arrearages, and deliveries of home heating fuel requests, the applicant shall verify the following pursuant to He-W 606.104(b):

a. That all sources of energy assistance have been exhausted;

b. That the AG is ineligible for energy assistance; or

c. That energy assistance cannot be provided in time to meet the emergency need; and

(5) If the amount requested for home heating fuel exceeds the maximum allowed by the department, the AG shall verify one of the following pursuant to He-W 606.104(b):

a. That the remainder of the cost will be secured;

b. A payment plan has been arranged with the home heating fuel company for the remainder of the cost; or

c. The payment authorized by the department will secure a current home heating fuel delivery.

(h) The maximum amount of emergency assistance to secure or retain permanent housing shall be authorized as follows:

(1) For rental security deposits or first month’s rent, $650;

(2) For rental security deposits and first month’s rent, $650 combined;

(3) For utility deposits, the amount charged by the utility provider;

(4) For deliveries of home heating fuel, $700; and

(5) For rent, mortgage principal and interest, or utility arrearages, the amount charged for a 2-month period.

(i) The following shall apply to authorizations of emergency assistance to secure or retain permanent housing:

(1) An emergency assistance request for the same item shall only be approved by the department more than once in a 12-month consecutive period in the following circumstances:

a. Until the maximum amount specified in (h)(3) above is reached, home heating fuel can be authorized up to 6 times in the 12 consecutive months; and

b. A rental security deposit that would enable the applicant to change residences can be authorized more than once in a 12-month consecutive period, provided the landlord has returned or will return the previously authorized deposit to the department;

(2) The department shall authorize payment for either a rental security deposit or a back rent or mortgage principal and interest arrearage, but not both, in the same 30-day period;

(3) The AG shall be:

a. Allowed to retain a total of $250 of the following cash resources, or resources readily converted to cash, which belong to the applicant and the applicant’s spouse if residing with the applicant:

Personal property resources, as defined in He-W 601.06;
Resources resulting from accumulation of types of income excluded by federal mandate; and
Accumulation of federal, state, and local income tax refunds; and

b. Required to apply any remaining amounts of these resources toward the emergency situation before emergency assistance for permanent housing services can be authorized;

(4) The department shall send a written notice of decision (NOD) to the applicant within 15 working days of the date the application for emergency assistance is received by the department;

(5) The NOD described in (4) above shall include the following:

a. The eligibility decision;

b. The reason for the decision, if the emergency assistance request is denied; and

c. The resource computation, if the full amount of the request was reduced by the applicant's personal property resources; and

(6) Emergency assistance payments to secure or retain permanent housing shall be paid to the provider of the service and shall not be paid to the applicant.

(j) Emergency assistance payments shall be denied when funds for the programs are no longer available.

History

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #5370, eff 4-13-92; amd by #6672, eff 1-26-98; ss by #6754, eff 5-20-98; amd by #7206, eff 3-1-00; amd by #7415, EMERGENCY, eff 12-15-00, EXPIRED: 6-13-01; ss by #7497, eff 6-14-01; amd by #7714, eff 7-1-02; paragraphs (j)-(k) amd by #8740, INTERIM, eff 10-13-06, EXPIRED: 4-11-07; paragraphs (j)-(k) amd by #8869, eff 4-19-07; paragraph (h) amd by #9300, EMERGENCY RULE, eff 10-21-08, EXPIRES: 4-19-09; ss by #9434, eff 4-1-09; amd by #9642, eff 2-1-10; ss by #10860, eff 6-30-15; amd by #12697, eff 12-31-18; ss by #14299, eff 7-1-25, EXPIRES: 7-1-35

N.H. Code Admin. R. Ann. He-W 699.06 Financial Assistance and Eligibility for Medical Care {#sec-he-w-699.06 omnilex-key=us-nh-regs-official--agency-he-w--He-W 699.06}

RESERVED.

APPENDIX

Rule

Specific State or Federal Statute or Regulations the Rule Implements

He-W 601.01

RSA 161:2,I; RSA 161-B:2, XIII & XIV; RSA 161-C:22; RSA 167:3-c,I & XII; RSA 167:4,I,IV(b) & (e), RSA 167:6,I,IV,V,VI,VIII & IX; RSA 167:7,IV; RSA 167:8,I; RSA 167:14-a; RSA 170-B:2,I & XII; RSA 167:78,II; RSA 167:79,II & III(g); RSA 167:80; RSA 167:81; RSA 167:83,II(b) & III(b);8 CFR 215.1(a); 38 CFR 3.352; 42 CFR 435.4; 42 CFR 435.908; 45 CFR 206.10(a)(1)(iii), (a)(4),(b)(1)-(2) & (b)(5); 45 CFR 234.11; 45 CFR 233.20(a); 45 CFR 260.31; Section 407 of PRWORA (PL 104-193); Section 419 of PRWORA (PL 104-193); 8 USC 1158; 42 U.S.C 619(1); 42 USC 608(b); 42 USC 601; 42 USC 608(a)(3); 42 USC 659(i)(3); 42 USC 1206; 42 USC 1320b-7(d); 42 USC 1355; 42 USC 1382b(c); 42 USC 1382c(b); 42 USC 1396p(c)

He-W 601.02

RSA 126-A:19; RSA 126-A:20; RSA 161:2,I; RSA 161-B:2, I & XIII; RSA 167:3-c,I & II; RSA 167:4,I; RSA 167:7,II-III; RSA 167:82,VII; RSA 167:78,III & VI; RSA 167:79,II; RSA 167:82,VII;42 CFR 435.406; 42 CFR 435.407; 45 CFR 260.30; 45 CFR 206.10(a)(1)(vii),(a)(8) & (b)(5); 45 CFR 233.20(a)(2)-(3)(i),(a)(12); 42 USC 619(2); 42 USC 1320b-7; 42 USC 1382a(a)(2)(g); 42 USC 1382b;42 USC 1396u

He-W 601.03

RSA 161-B:2,II & IV; RSA 161:2,I; RSA 167:3-c,I & & IX; RSA 167:4,I; RSA 167:6,V; RSA 167:7,IV; RSA 167:13; RSA 167:14-14-a; RSA 167:28; RSA 167:78,VI-VIII XV, & XXIII; RSA 167:79,I & III(a); RSA 167:80; RSA 167:81; RSA 167:82; RSA 167:83,II(c),(l)& (o); RSA 167:84,I; 24 CFR 5.100; 45 CFR 206.10(a)(9)(iii)-(iv) & (b)(3); 45 CFR 233.20(a)(2)-(a)(3)& (a)(6)-(a)(11); 45 CFR 233.39; 45 CFR 260.30; 45 CFR 261.10; 45 CFR 263.2(b)(2); 42 USC 619(2); 42 USC 1437f; Section 404(g) of PRWORA (P.L. 104-193); 42 USC 1382b

He-W 601.04

RSA 161-B:2,XIII; RSA 167:4,I(b); RSA 161:4-a,V & IX; RSA 167:77-a,I; RSA 167:77-e; RSA 167:78,VI & X; RSA 167:83,II(l); RSA 167:84; 24 CFR 5.100; 42 CFR 435.4; 42 USC 608(a)(1); 45 CFR 233.20(a)(2)-(3), (a)(6) & (a)(15)(i); 45 CFR 260.30; 45 CFR 263.2(b)(2); 42 USC 608(a)(1); 42 USC 602;42 USC 1382b; 42 USC 1396p(d)(2)(A); 42 USC 1396t

He-W 601.05

RSA 151; RSA 161-B:1- B:2,XI & XIII-XIV; RSA 167:3; RSA 167:3-a; RSA 167:3-b; RSA 167:3-c,I; RSA 161:4-a,IX; RSA 167:6,V & VII; RSA 167:7,I-a(a); RSA 167:8,I; RSA 167:68; RSA 167:77-a,I(a); RSA 167:78, II,VI, XI, XVI & XVII; RSA 167:79; RSA 167:80; RSA 167:82; RSA 167:83,II(b),(l)&(o): RSA 167:85; 8 CFR 1.2; 8 CFR 101.1; 8 CFR 215.1(a), 42 CFR 435.121(e)(4); 42 CFR 435.301(a)(1)(ii); 42 CFR 435.602; 42 CFR 435.1009; 45 CFR 206.10(a)(4);45 CFR 233.20(a)(2)-(3); 45 CFR 233.107;42 USC 604(f); 42 USC 608(a)(1); 42 USC 608; 42 USC 1382(e)42 USC 1382b; 42 USC 1320b-7; 42 USC 1396a(a)(10); 42 USC 1396d(a); 42 USC 1396p(d)-(e); 42 USC 1396r(a); 42 USC 1396u(d); 42 USC 1397d(a)(5); 42 USC 1397jj

He-W 601.06

RSA 161-B:2,XIII-XIV; RSA 161:2,I; RSA 167:3; RSA 167:3-c,I-II; RSA 167:4,I(b),III-a & IV; RSA 167:6,V & VI; RSA 167:7,II & III; RSA 167:8,I; RSA 167:26; RSA 167:28; RSA 167:77-e; RSA 167:79,III(e)-(f) & III(j) & IV(b); RSA 167:81; RSA 167:82,VI; RSA 167:83,II(c),(e)-(f),(h)& (i); RSA 170-B:2,XII; 20 CFR 416.1180-.1182; 45 CFR 206.10; 45 CFR 233.20(a)(3) & (a)(12)(i); 45 CFR 234.60(a)(7)(i); 42 USC 1385; 42 USC 1382(e); 42 USC 1382a(a)(2)(G); 42 USC 1382b; 42 USC 1382c(a)(3); 42 USC 1396a; 42 USC 1396p(d); 42 USC 1396u-1

He-W 601.07

RSA 21:6;RSA 161-B:2,XIV; RSA 167:3; RSA 167:3-c,I; RSA 167:4,I; RSA 167:6,V; RSA 167:7,I-III; RSA 167:14-a; RSA 167:78,XXIII; RSA 167:79,II-IV(a),VI; RSA 167:81; RSA 167:82,III-V, VII; RSA 167:83,II(i); RSA 170-B:2,XII; 42 CFR 435.403(d); 42 USC 607(e); 45 CFR 206.10(a)(1)(vii)(A); 45 CFR 233.10(b)(2); 45 CFR 233.20(a); 42 USC 409(a)(4); 42 USC 1396a(a)(34);42 USC 1382b; 42 USC 1396p

He-W 601.08

RSA 161-B:1, RSA 161-C:22; RSA 161:2,XVI; RSA 167:3-c,I; RSA 167:7,IV; RSA 167:14-a,V; RSA 167-77-e; RSA 167:78; RSA 167:79,III(c); RSA 167:80; RSA 167:81; RSA 167:83,II; 45 CFR 303.0 et. Seq; 42 USC 422; 42 USC 404(a)(1);42 USC 607(d)(8); 42 USC 608(a)(2)-(3); 42 USC 1382a(a)(2); 42 USC 1396p(c)-(d); 42 USC 1397

He-W 602

Section 408(a)(7) of the SSA Act as amended by the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) of 1996

He-W 602.01

Section 1902(a)(10)(A) of the Social Security Act (SSA); [42 USC 1396a] Section 1931 of the SSA [42 USC 1396u-1]; 42 CFR 435.21042 CFR 435.601(b); RSA 167:3-c, I

He-W 602.02

42 USC 607; 45 CFR 205-206; 45 CFR 232-235; 45 CFR 250; RSA 167:3-c, I RSA 167:77

He-W 602.03

RSA 161:4-a, IX; RSA 167:3-c, I; RSA 167:4; RSA 167:8; 45CFR 206.10(a)(1); 45 CFR 206.10(b)(2)

He-W 602.04 Reserved

He-W 602.04(b)(8)-(10)

Section 1902(a)(10)(A)(ii)(XIV) of the Social Security Act [42 U.S.C 1396a] Section 1905(u)(2) of the Social Security Act [42 U.S.C. 1396d]

RSA 167:3-c, VIII; RSA 167:3-e; RSA 167:3-f; RSA 167:6, VII

RSA 167:68, I; 42CFR 435.210; 42 CFR 435.222; 42 CFR 435:225

He-W 602.05

Section 408(a)(7) of the SSA [42 USC 608(a)(7)]; RSA 167:3-c, I; RSA 167:77

He-W 602.05(a)

Section 408(a)(7) of the Social Security Act (SSA) [42 USC 608(a)(7)]

He-W 602.06

RSA 167:3-c, I; RSA 167:82; RSA 167:85; 42 USC 602(a)(1)(A)(iii)

He-W 602.08

RSA 167:3-c, I; RSA 167:7, III; RSA 167:82; 42 USC 608(a)(7)(C)

He-W 602.09

RSA 167:3-c, I; RSA 167:7, III; 42 USC 608(a)(7)

He-W 602.10

RSA 167:3-c, I; RSA 167:7, III; RSA 167:17-b, II; RSA 167:17-c; RSA 167:82; 42 USC 608(a)(7)(C); 45 CFR 260.55

He-W 602.14

RSA 167:3-c, l; RSA 167:7, III; 42 USC 608(a)(7)

He-W 602.15

RSA 167:3-c, I; RSA 167:7, III; 42 USC 608(a)(7)(C); 45 CFR 205.10

He-W 602.16

RSA 167:3-c, I; RSA 167:7, III; 42 USC 608(a)(7)(C)

He-W 602.17

RSA 167:3-c, I; RSA 167:7, III; 42 USC 608(a)(7)(C); 45 CFR 233.100-101

He-W 603.01

RSA 167:83, III(b); 45 CFR 206.10(a)(1)(iii); 42 CFR 435.923(c)

He-W 603.02

RSA 167:17-b; RSA 167:83, II(c); RSA 641:3; 45 CFR 206.10(a)(2)(ii)

He-W 603.03

RSA 167:17; 45 CFR 206.10(a)(2)(ii)

He-W 604.01

RSA 167:3-c, I; RSA 167:4, I; RSA 167:10

He-W 604.02

RSA 167:10; RSA 167:83, II(b) & (f), & III(c); 45 CFR 206.10(a)(4)

He-W 604.03

RSA 167:83, II(b) & III(c); 45 CFR 205.10(a)(4); 45 CFR 206.10(a)(7)

He-W 604.04

RSA 167:3-c, I; RSA 167:83, II(b); 45 CFR 206.10(a)(4)

He-W 604.05

RSA 167:3-c, I; RSA 167:31; RSA 167:32; RSA 167:83, II(b);

45 CFR 206.10(a)(4); 45 CFR 206.10(a)(1)(iii); 45 CFR 205.36; 45 CFR 205.50

He-W 606.01

RSA 167:4-a; RSA 167:4-c; 42 CFR 435.913; 42 CFR 435.916; 45 CFR 205.55; 45 CFR 206.10(a)(8); Section 1935 of the SSA [42 USC 1396u-5]

He-W 606.02

RSA 167:3-c; RSA 167:4; RSA 167:4-c; RSA 167:79, IV(c); RSA 167:79, V(a)(1); RSA 167:82; RSA 167:83, II(c); RSA 167:84; RSA 167:84, II; 42 CFR 435.406; 42 CFR:435.407; 42 CFR 435.956(b)(2); 45 CFR 233.50; 8 USC 1157; 8 USC 1158; 8 USC 1253; 8 USC 1255; 43 USC 1320b-7; 42 USC 1396.a(ee); 42 USC 1396b.

He-W 606.02(b)

P.L. 109-171 section 6036 amends Section 1903 of the Social Security Act

[42 USC 1396b]; 42 CFR 435.407

He-W 606.10

RSA 167:6, I, IV, & VI; 42 CFR 435.403; 42 CFR 435.913

He-W 606.11

RSA 167:78, XXIV; RSA 167:79, II & IV

He-W 606.11(d)

RSA 167:78, XXIV; RSA 167:79, II & IV(a); 45 CFR 206.10(a)(9)(ii)

He-W 606.18

RSA 167:79, IV(b)

He-W 606.19

RSA 167:6, V; RSA 167:79; RSA 167:83, I(a) & II(c); 45 CFR 206.10(a)(1)(vii); 45 CFR 233.90(c)(1)

He-W 606.20

RSA 167:6, V; RSA 167:79, I(a); RSA 167:83, II(c); RSA 167:84, I(a); 45 CFR 233.90(a)(1) & (c)(1)(i)-(ii)

He-W 606.21

RSA 167:6, V; RSA 167:79, I(a); RSA 167:83, II(c); RSA 167:84, I(a);

45 CFR 233.90(a)(1) & (c)(1)(i) & (iii)

He-W 606.22

45 CFR 233.100-101; RSA 167:6, V; RSA 167:83, II(c)

He-W 606.23

RSA 167:6, V; RSA 167:78, III & XXIII; RSA 167:79, I(a) & III(i);

RSA 167:83, II(c); RSA 167:84, I(b); 45 CFR 206.10(a)(1)(vii);

45 CFR 233.90(c)(1)(v)

He-W 606.24

RSA 167:6, V; RSA 167:78, VI & XV; RSA 167:83, II(c); 45 CFR 233.39

He-W 606.26

RSA 167:79, III(l); RSA 167:83, II(c); 45 CFR 233.106

He-W 606.28

RSA 167:3-c; 167:4-c; 167:79, III(i); RSA 167:79, IV(c); RSA 167:83, II(c); RSA 167:84; 42 CFR 435.407(c); 42 CFR 435.407(d)(I). 42 CFR 435.956(b)(2); USC 1396a(ee)

He-W 606.30

RSA 167:4, I(c); RSA 167:78, I; RSA 167:82, II; RSA 167:83, II(c)

He-W 606.31

RSA 167:79, III(c); RSA 167:82, III(b); 45 CFR 232.40, & .42-.43;

45 CFR 260, Subpart B; 42 USC 602(a)(7)

He-W 606.32

RSA 167:82,II

He-W 606.36

RSA 167:79, III(h); RSA 167:4-c; 45 CFR 205.52; 42 USC 1320b-7

He-W 606.37

RSA 167:3-c, l; 45 CFR 233.20(a)(3)(ix); Title II of the SSA [42 USC 401 et seq]; Title XVI of the SSA [42 USC 1381 et seq.]

He-W 606.41

Reserved

He-W 606.42

RSA 167:6, I; 42 CFR 435.913; 45 CFR 233.39; 42 USC 306(a)

He-W 606.55

RSA 167:3-b; RSA 167:3-c,I; RSA 167:79,V(b); RSA 167:80;

RSA 167:83,II(m); 20 CFR 416.1165; 20 CFR 416.1202; 20 CFR 416.1205

Section 1902(a)(17)(d) of the Social Security Act [42 USC 1396a(a)(17)(d)]

He-W 606.58

RSA 167:80, V

He-W 606.59

RSA 167:79, III(e); RSA 167:80, I & III; RSA 167:83, II(c); 42 CFR 435.913; 45 CFR 233.20

He-W 606.60

RSA 161:4-a, II; RSA 167:3-c,I; RSA 167:7,IV; RSA 167:17,III; RSA167:17-b,I(a); RSA 167:17-b,I(d)

He-W 606.65

RSA 167:6, VI; RSA 167:80, IV(i); RSA 167:81, IV(g); RSA 167:83, II(c); 20 CFR 416.1180-.1182; 42 CFR 435.913

He-W 606.68

RSA 167:4, I(a)

He-W 606.69

RSA 167:6, VI; 20 CFR 416.905; 20 CFR 416.976; 20 CFR 416.1112(c)(6); 42 USC 1382c

He-W 606.73

RSA 167:80, I; RSA 167:82, VII(a)(4) & (b); RSA 167:83, II(c); 42 CFR 435.913

He-W 606.74

RSA 167:4, I(a)

He-W 606.75

RSA 167:80, I; RSA 167:83, II(c); 42 CFR 435.913; 45 CFR 233.20

He-W 606.76

RSA 167:4, I(a); RSA 167:79, III(f); RSA 167:81; RSA 167:83, II(c);

He-W 606.78

RSA 167:4; RSA 167:7, IV; RSA 167:81, I; 45 CFR 233.20(a)(1)(v) & (a)(3)

He-W 606.78(a)(6)

RSA 167:4; RSA 167:7, IV; RSA 167:81, I; 42 CFR 435.845

45 CFR 233.20(a)(1)(v) & (a)(3)

He-W 606.83

RSA 167:79, IV; RSA 167:83, II(c) & (e); 42 CFR 435.913

He-W 606.84

42 CFR 435.913

He-W 606.89

42 CFR 435.4; 42 CFR 435.831; RSA 161:4-a,IX

He-W 606.90

Reserved

He-W 606.92

RSA 161:4-a, IX; RSA 167:3-c, I; RSA 167:4; 45 CFR 206.10(a)(2)(iii); 45 CFR 206.10(a)(9); 45 CFR 206.10(b)(4)

He-W 606.98

Reserved

He-W 606.100

42 CFR 435.913; 42 CFR 435.916

He-W 606.104

RSA 167:3-c, II-a; RSA 167:7, V;

RSA 167:83, I(c) & II(c)

He-W 608.01

RSA 161:2, I; RSA 167:3-c, I

He-W 608.02

RSA 161:2,I; RSA 167:3-c,I; RSA 167:7-b; 42 USC 602(a)(1)(A)(vii); 42 USC 608(a)(12); 42 USC 609(a)(16)

He-W 616.01

RSA 167:3-c, I; 45 CFR 233.51

He-W 616.02

RSA 167:3-c, I; 8 USC 1641(b); 42 USC 602(a)(1)(B)(ii); 45 CFR 233.50

He-W 618.01

RSA 167:79, IV & V; Section 408(a)(7)(c)(iii) of the Social Security Act

He-W 618.02

42 CFR 435.403

He-W 619.01

RSA 151-E:18, IV, VII

He-W 619.02

RSA 151-E:18

He-W 619.03

RSA 151-E:18, II

He-W 619.04

RSA 151-E:18, VII

He-W 619.05

RSA 151-E:18

He-W 620.01

RSA 161:4-a, II; RSA 167:3-c, I; RSA 167:4, I(b)

He-W 621 Reserved

He-W 622.01

RSA 167:2; RSA 167:3; RSA 167:3-c, I; RSA 167:78, XV; 42 USC 9902(2)

He-W 624.01

RSA 167:79, IV(b)

He-W 625.01

RSA 167:4-c; RSA 167:79,III(h); 45 CFR 205.52; 42 USC 1320b-7

He-W 625.01(a) and (b)

RSA 167:79,III(e); 45 CFR 205.52; 42 CFR 435.910; Section 1137 of the Social Security Act; [42 USC 1320b-7]

He-W 625.01(c)-(e)

RSA 167:79 45; CFR 205.52; Section 1137(a)(1) of the Social Security Act [42 USC 1320b-7]

He-W 626.01 – 626.03

Section 1902(a)(10)(A)(ii) of the Social Security Act [42 U.S.C. 1396a(a)(10)(A)(ii)]; 42 USC 1396r-1c; 42 U.S.C. 1396a(ii)(3), RSA 126-A:4-c

He-W 627

45 CFR 260.31; RSA 167:77-a,I(a); RSA 167:77-a,I(b); RSA 167:78, VI

He-W 627.01

RSA 167:77-a; RSA 167:77-e; RSA 167:79; 45 CFR 260.31

He-W 627.03

45 CFR 260.31; RSA 167:77-a, I(a); RSA 167:78, VI

He-W 627.04

RSA 167:77-a, I(a); RSA 167:77-e, II

He-W 627.05 Reserved

He-W 628.01

RSA 167:6, V; RSA 167:79, I(a); RSA 167:84, I; 45 CFR 233.90(a)(1) & (c)(1)(i)-(iv)

He-W 628.02

RSA 167:3-c,I; RSA 167:6,V; RSA 167:79,I(a); RSA 167:83,II(c)

RSA 167:84,I; 45 CFR 233:90(b)(6) & (c)(1)(iv)

He-W 628.03 Reserved

He-W 630.01

Section 408(a)(7) of the SSA Act as amended by PRWORA; RSA 167:6; RSA 1690C:3,XIV; RSA 167:6; RSA 167:78; RSA 167:79,II and V(b); RSA 167:83,II

He-W 632.01

RSA 167:6,V; RSA 167:78,VI & XV; RSA 167:79,I; RSA 167:83,II(c); 42 CFR 435.522(c); 45 CFR 233.39; 45 CFR 260.30; 42 USC 619(2)

He-W 632.01(a)

RSA 167:78,VI; 45 CFR 233.39; 45 CFR 260.30; 42 USC 619(2)

He-W 632.01(b)-(c)

RSA 167:79 45, CFR 233.39

He-W 634.01

RSA 167:79,III(l); 45 CFR 233.106

He-W 636.01

RSA 161:4-a, IX; RSA 167:8; RSA 167:79, III(j); RSA 167:83, II(d) and (c);45 CFR 206.10(a)

He-W 636.01

RSA 161:4-a, IX; RSA 167:8; RSA 167:79, III(j); RSA 167:83, II(d) and (c);

45 CFR 206.10(a)

He-W 636.02

RSA 167:79,III(i); 42 CFR 435.407; 42 CFR 435.913

He-W 636.03

RSA 167:6,V; RSA 167:78,XIV; RSA 167:80,IV(b); RSA 167:82,II(b)

He-W 636.08

RSA 167:79,III (c), RSA 167:82, III (b)

He-W 636.09

RSA 161:4-a,V; RSA 167:79,III(c) & VI(a); RSA 167:82,III(b) & V; RSA 167:83,II(c) & (l)

He-W 636.09(c)-(e)

RSA 167:82, III(b); RSA 167:82, V

He-W 636.10

RSA 167:79,VI(a); RSA 167:82 III(b); 42 USC 608(a)(2)

He-W 637.01

45 CFR 261.2; RSA 167:77, IV; RSA 167:78.

He-W 637.02

RSA 167:77; RSA 167:78; RSA 167:79, III(a).

He-W 637.03

P.L. 104-193, section 407(d) of the SSA [42 USC 607(d)]; 45 CFR 261.2(i)-(k)

He-W 637.04

RSA 167:3-c, I; RSA 167:78, I; RSA 167:82, II; RSA 167:83, II(o) RSA 167:85, V; 42 USC 608(a)(4)

He-W 637.04(e)(4)

Section 408(a)(7) of the SSA Act as amended by the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) of 1996

He-W 637.05

RSA 167:79, III(a) & VI(c)-(e); RSA 167:82; RSA 167:85; RSA 167:88; RSA 167:90-92

He-W 637.06

RSA 167:82,III – V; RSA 167:83,II(o) & III(h); RSA 167:85; 42 USC 607(e)

He-W 637.07

RSA 167:82, III(c)-IV; 45 CFR 260, Subpart B; 42 USC 602(a)(7)

He-W 637.08

P.L. 104-193, section 407(e) [42 USC 607(e)]; RSA 167:79, III(b); RSA 167:82, III-V; RSA 167:84, II.

He-W 637.09

RSA 167:77, IV-V; RSA 167:79, III(a); RSA 167:85; RSA 167:88;45 CFR 261.11; 45 CFR 261.13

He-W 637.10

RSA 167:78,XIII

He-W 637.12

RSA 167:77, IV-V; RSA 167:84, II; RSA 167:85, IV(e);

RSA 167:88; 45 CFR 261.12; 45 CFR 261.11

He-W 637.13(a) & (b)

RSA 161:4-a, IX

He-W 637.14

RSA 167:88

He-W 637.15

RSA 167:85; RSA 167:88; RSA 167:91, III-a

He-W 637.16

RSA 167:85

He-W 637.17

45 CFR 261.2(k)-(l); 45 CFR 261.33; RSA 167:85; RSA 167:91

He-W 637.18

RSA 167:78, XII-a; RSA 167:82, V; RSA 167:85, IV(n); RSA 167:88, IV(a)-(e); RSA 167:91; 42 USC 608(a)(7)(C)(iii); 45 CFR 260.55; 45 CFR 261.30

He-W 637.19

RSA 167:78,XIII

He-W 637.20

RSA 167:78, XVIII; RSA 167:83, II(o); RSA 167:85, IV(e); 45 CFR 261.2(f)

He-W 637.21

42 USC 607(b) and (i); RSA 167:82, III; RSA 167:85; RSA 167:91

He-W 637.22

He-W 637.23

RSA 167:85, IV(i); RSA 167:88; RSA 167:91, III-a; 45 CFR 260.20(b); 45 CFR 261.2(i); 45 CFR 261.30

He-W 637.24

P.L. 109-171, Section 7102

He-W 637.25

RSA 167:3-c,I; RSA 167:85,IV

He-W 637.26

RSA 167:77-e; RSA 167:79

He-W 637.27

RSA 167:77-e; RSA 167:79

He-W 637.28

P.L. 109-171, Section 7102; RSA 161:4-a, IX; RSA 167:85, I(k)

He-W 638

RSA 161:4-a, IX; Section 408(a)(7) of the SSA as amended by PRWORA

He-W 638.01

Reserved

He-W 638.02

Reserved

He-W 639.01

RSA 126-AA; 2018 NH Chapter Law 342:2-9

He-W 639.02

RSA 126-AA; 2018 NH Chapter Law 342:2-9

He-W 639.03

RSA 126-AA; 2018 NH Chapter Law 342:2-9

He-W 639.04

RSA 126-AA; 2018 NH Chapter Law 342:2-9

He-W 639.05

RSA 126-AA; 2018 NH Chapter Law 342:2-9

He-W 639.06

RSA 126-AA; 2018 NH Chapter Law 342:2-9

He-W 639.07

RSA 126-AA

He-W 639.08

RSA 126-AA; 2018 NH Chapter Law 342:2-9

He-W 639.09

RSA 126-AA; 2018 NH Chapter Law 342:2-9

He-W 641.01

He-W 641.02

Sections 1902(a) and 1905(n) of the SSA [42 U.S.C 1396a(a)] and

[42 U.S.C1396d(n)]; RSA 167:3-I; RSA 167:6,IX

He-W 641.02(b)(4)

SSA Act Section 1902(a)(17)(D)

He-W 641.03

RSA 167:3-I; RSA 167:3-c,XII;RSA 167:6,IX; 42 USC 1396a(a)(10)(A)(ii)(XV) [Section 1902(a)(10)(A)(ii)(XV) of the Social Security Act]

He-W 641.04 Reserved

He-W 641.05

42 USC 1396r-1; 42 USC 1396r-1a; RSA 167:68

He-W 641.06

42 USC 1396a (l)(1)(2)(A)(i); RSA 167:68

He-W 641.07

Section 1902(l) of the SSA [42 U.S.C. 1396a]; Section 2101 of the SSA

[42 U.S.C. 1397aa]; 42 USC 9902(2); 42 CFR 435.902; RSA 126-A:3,VIII as amended by Chapter 224:43, Laws of NH 2011; RSA 167:68,I; RSA 167:83,I(c)

He-W 641.09

42 USC 1396a(a)(10)(A)(ii)(XVIII) [Section 1902(a)(10)(A)(ii)(XVIII) of the Social Security Act]; 42 USC 1396a(aa) [Section 1902(aa)of the

Social Security Act]

He-W 642.02

RSA 167:6; 42 CFR 435.4; 45 CFR 233.10(b)(2); 45 CFR 233.39

He-W 642.03

RSA 167:6; 42 CFR 435.4; 45 CFR 233.10(b)(2); 45 CFR 233.39

He-W 642.04

RSA 167:6; RSA 161:4-a,II; 42 CFR 435.4; 45 CFR 233.10(b)(2);

45 CFR 233.39

He-W 644.01

45 CFR 206.10(a)(9); RSA 161:4-a, IX; RSA 167:3-c, I

He-W 644.02

RSA 167:79,II

He-W 648.02

RSA 167:3-c, II-b; RSA 167:7, I-a; RSA 167:27-c; 42 USC 1382g

He-W 648.03

RSA 167:3-c, II-b; RSA 167:7, I-a; RSA 167:27-c; 42 USC 1382g

He-W 648.04

RSA 151:2, I(e); RSA 167:3-c,II-b; RSA 167:27-c

Section 1618 of the Social Security Act [42 U.S.C. 1382g]; 20 CFR 416.2098

He-W 652.02

RSA 167:3-c,I; RSA 167:7,IV; 42 CFR 435.913

He-W 652.04

RSA 167:6 X.; RSA 167:83, II.(m); 42 USC 608(a)(9)

He-W 654.01

RSA 167:3-c,I; RSA 167:4,I(a)

He-W 654.02

RSA 167:3-c, I & IX; RSA 167:4, I(a); RSA 167:78, XVII; RSA 167:80, I & IV(i); RSA 167:82, VII; RSA 167:83, II(e); 45 CFR 233.20(a)(2)(iv), (a)(3)(ii)(B), and (a)(6)

He-W 654.03

RSA 167:80,V; RSA 167:81,V; RSA 167:82,VII(b); RSA 167:83,II(c) & (e); 45 CFR 233.20(a)(3)(ii)(F)

He-W 654.04

RSA 167:3-c, I, RSA 167:4, I(a); RSA 167:79, II; RSA 167:80, IV;

7 CFR 273.10(e)(4); 45 CFR 233.20(a)(3); Section 1612(a) of the Social Security Act (SSA) [42 USC 1382a(a)]; Section 1902(f) & (r)(2) of the SSA

[42 USC 1396a(f) & (r)(2)]; Section 1917(d) of the SSA [42 USC 1396p(d)]

He-W 654.05

RSA 167:3-c,I; RSA 167:4,I(a); RSA 167:7,IV; RSA 167:17,III; 42 CFR 435.601(b);

He-W 654.06

RSA 167:3-c,I; RSA 167:4,I(a); RSA 167:7,IV; RSA 167:17,III; 42 CFR 435.601(b);

He-W 654.07

RSA 167:4,I(a); 42 USC 1382a(a)(2)(A)

He-W 654.01

RSA 167:3-c,I; RSA 167:4,I(a)

He-W 654.02

RSA 167:3-c, I & IX; RSA 167:4, I(a); RSA 167:78, XVII; RSA 167:80, I & IV(i); RSA 167:82, VII; RSA 167:83, II(e); 45 CFR 233.20(a)(2)(iv), (a)(3)(ii)(B), and (a)(6)

He-W 654.03

RSA 167:80,V; RSA 167:81,V; RSA 167:82,VII(b); RSA 167:83,II(c) & (e); 45 CFR 233.20(a)(3)(ii)(F)

He-W 654.04

RSA 167:3-c, I; RSA 167:4, I(a); RSA 167:79, II; RSA 167:80, IV;

7 CFR 273.10(e)(4); 45 CFR 233.20(a)(3); 42 USC 1382a(a)

He-W 654.04 (a) intro., (a)(7), (b) intro., (b)(11)

RSA 167:3-c, I; RSA 167:4, I(a); 7 USC 2014(d)(19); 7 CFR 273.9(c)(20)

He-W 654.04(a)(1), (3)-(6), (b)(1)-(2), (4)-(9)

RSA 167:4, I(a); 45 CFR 233.20 Section 1902(f) & (r)(2) of the Social Security Act; [42 USC 1396a]; 7 CFR 273.10(e)(4)

He-W 654.04 (b) (10)

RSA 167:3-c, I; RSA 167:4, I (a); RSA 167:80; 45 CFR 233.20(a)(3)

Section 1612 (a)(2)(G) of the Social Security Act [42 USC 1382a]

Section 1917 (d) of the Social Security Act [42 USC 1396p]

He-W 654.04(d)

RSA 167:3-c, I, RSA 167:4, I(a); RSA 167:79, II; RSA 167:80, IV(h)

He-W 654.05

RSA 167:3-c,I; RSA 167:4,I(a); RSA 167:7,IV; RSA 167:17,III; 42 CFR 435.601(b); Section 1902(r)(2) of the SSA [42 USC 1396a]

He-W 654.06

RSA 167:3-c,I; RSA 167:4,I(a); RSA 167:7,IV; RSA 167:17,III; 42 CFR 435.601(b); Section 1902(r)(2) of the SSA [42 USC 1396a]

He-W 654.07

RSA 167:3-c, I; RSA 167:4,I(a); 42 USC 1382a(a)(2)(A)

He-W 652.07(j)-(x)

RSA 167:3-c,I; RSA 167:4;RSA 167:6,VI;42 CFR 435.608;

45 CFR 233.20(a)(3)(ix)

He-W 654.08

RSA 167:3-c,I; RSA 167:4,I(a); RSA 167:7,IV; RSA 167:80,IV(i)

He-W 654.09

RSA 161-C:22; RSA 167:3-c, I; 42 USC 608(a)(3); 45 CFR 233.20(a)(3)(v)

He-W 654.09(a)-(b)

RSA 161:4-a, IX; RSA 167:3-c, I, 45; CFR 233.20 Section 1902(f) of the Social Security Act [42 USC 1396a]

He-W 654.10

RSA 167:83, II(l) & (m); 45 CFR 233.51; 45 CFR 233.52; 8 USC 1631; 42 USC 608(f)(1)

He-W 654.11

RSA 167:3-c,I; RSA 167:4,I(a); RSA 167:80

He-W 654.12

RSA 161:4-a; RSA 167:3-c,I; RSA 167:80,IV(i); 20 CFR 416.1180-1182; ; 45 CFR 233.20;

He-W 654.12(a)-(b), (d)-(e), (g)

RSA 161:4-a, RSA 167:3-c, I; 45 CFR 233.20, 42 CFR 435.735,

20 CFR 628.700

He-W 654.13

RSA 167:4, I(a); RSA 167:80, IV(i) and V; RSA 167:82, VII(b);

45 CFR 233.20(a)(6), (a)(11)

He-W 654.14

RSA 167:3-c, I; RSA 167:82, VII(a)(4); RSA 167:82, VII(b)

45 CFR 233.20(a)(2)(v)(B)

He-W 654.15

RSA 167:3-c, IX; RSA 167:4, I(a)

Section 1902(a)(17) of the Social Security Act [42 USC 1396a(a)(17)]

20 CFR 416.1112; 20 CFR 416.1166; 29 USC 720

He-W 654.16

RSA 167:4, I(a)

He-W 654.17

RSA 167:3-c,I; RSA 167:27-a; 167:27-b; 42 CFR 435.733(c)

42 CFR 435.832(c)(4)(ii); 38 USC 5503 Section 1611(e)(1)(E) & (G) of the SSA [42 USC 1382(e)(1)(E) & (G)]

He-W 654.17(b)

RSA 167:3-c,I; RSA 167:27-a; RSA 167:27-b; 42 CFR 435.733(c)(1)(iii)

42 CFR 435.832(c)(4)(ii); 38 USC 5503 Section 1611(e)(1)(E) & (G) of the SSA [42 USC 1382(e)(1)(E) & (G)]

He-W 654.17(c)

RSA 167:27-a; 167:27-b; 42 CFR 435.733(c)(1)(iii)

He-W 654.18

RSA 167:3-c, I & IX, RSA 167:4, I(a)

He-W 654.19

RSA 167:82,VII(a)(4) & (b)

He-W 654.20

RSA 167:4, I(a)

He-W 654.21

RSA 161:4-a, III & X(a); RSA 167:3-c, I; 42 USC 1396r-5

He-W 655.01

RSA 167:83, II(o); RSA 167:86

He-W 655.02

RSA 167:79; RSA 167:85; RSA 167:86; RSA 167:88

He-W 655.03

RSA 167:3-c; RSA 167:7, V; RSA 167:83; RSA 167:86

He-W 655.04

RSA 167:3-c; RSA 167:7, V; RSA 167:83; RSA 167:86

He-W 655.05

RSA 167:3-c; RSA 167:7, V; RSA 167:83; RSA 167:86

He-W 655.05(a)-(d)

P.L. 109-171, section 7102; 45 CFR 261.2(f); RSA 167:78,XVIII

RSA 167:79,III; RSA 167:86; RSA 167:91,IV

He-W 655.06

RSA 167:3-c; RSA 167:7, V; RSA 167:78; RSA 167:79, III; RSA 167:83; RSA 167:86; RSA 167:91, IV; 45 CFR 261.2; P.L. 109-171, section 7102

He-W 655.06(a)-(e)(2)a.

P.L. 109-171, section 7102; 45 CFR 261.2(f); RSA 167:78,XVIII

RSA 167:79,III; RSA 167:86; RSA 167:91,IV

He-W 655.07

RSA 167:3-c; RSA 167:7, V; RSA 167:78, XVIII; RSA 167:79, III; RSA 167:83; RSA 167:86; RSA 167:88; RSA 167:91, IV; RSA 376; RSA 376-A; 45 CFR 261.2(f); 42 USC 607(d); P.L. 109-171, section 7102

He-W 655.08

RSA 167:3-c; RSA 167:7, V; RSA 167:85, IV; RSA 167:86; RSA 167:91, IV; 45 CFR 261.2(i) & (k); 42 USC 607(d)

He-W 655.09

RSA 167:3-c; RSA 167:7, V; RSA 167:83; RSA 167:86

He-W 655.10

RSA 167:3-c; RSA 167:7, V; RSA 167:83; RSA 167:86

He-W 656.01

RSA 167:4, RSA 167:81

He-W 656.02

RSA 161:4-a, III; 42 USC 604(h); 45 CFR 263.20-23; 45 CFR 260.31(b)(5)

He-W 656.03

RSA 167:3-c, I; RSA 167:4-a; RSA 167:7, IV; 42 USC 1382b(c)(1)(D); 20 CFR 416.1208; 42 USC 1396p(c)(3)

He-W 656.03(a)-(b)

RSA 167:3-c,I; RSA 167:4-a; RSA 167:7,IV; 42 USC 1382b(c)(1)(D); 20 CFR 416.1208

He-W 656.04

RSA 167:3-c,I; RSA 167:4; RSA 167:17; RSA 167:81 45 CFR 233.20(a)(3); Section 1612(a)(2)(G) of the Social Security Act (SSA)[42 USC 1382a(a)(2)(G)]; Section 1613(a) of the SSA [42 USC 1382b(a)]

He-W 656.04(a)

Section 1917(d) of the Social Security Act; HB 758, which amends RSA 167:4 and RSA 167:3-c, I

He-W 656.04(b)

Social Security Act Section 1902(a)(10)(A)(ii)(XV); RSA 167:6, IX

He-W 656.04(b)(1) – (b)(4) and (b)(6) – (b)(10)

Section 1613(a) of the Social Security Act [42 USC 1382b]; RSA 67:4,I(a)

He-W 656.04(b)(5)

RSA 167:4,I(a); RSA 167:3-c,I; RSA 167:4,IV(c) as amended by HB691

He-W 656.04 (b)(6) – (b)(10)

Section 1613(a) of the Social Security Act [42 USC 1382b];RSA 167:4,I(a)

He-W 656.04(b)(10)

RSA 167:3-c, I; RSA 167:4, I(a); RSA 167:80; 45 CFR 233.20(a)(3)

Section 1612(a)(2)(G) of the Social Security Act (42 USC 1382a)

Section 1917(d) of the Social Security Act (42 USC 1396p)

He-W 656.04(b)(11)

P.L 109-171 section 6015 amends section 1917(c)(1)(H)-(I) of the Social Security Act [42 USC 1396p(c)(1)(H)-(I)]

He-W 656.04(c)

RSA 167:4,I(a); RSA 167:3-c,I; RSA 167:4,IV(c) as amended by HB691

RSA 167:81

He-W 656.05

RSA 161:4-a, II; RSA 167:3-c, I; RSA 167:81; 45 CFR 233.20(a)(3)(i)(B)(5)

He-W 656.07

RSA 167:6 X.; RSA 167:83, II.(m); 42 USC 608(a)(9)

He-W 656.06

RSA 167:81, II

He-W 658.01

RSA 167:3-c, II; RSA 167:7, II-III; 45 CFR 233.20(a)(2); 7 CFR 273.10

He-W 658.02

RSA 167:3-c, II; RSA 167:7, II and III; 45 CFR 233.20(a)(2)(i); RSA 167:77-g

He-W 658.03

RSA 167:7,I & I-a; 42 USC 1382g

He-W 658.04 Reserved

He-W 658.05 Reserved

He-W 658.06 Reserved

He-W 664.01 Reserved

He-W 664.02

RSA 167:79, II

He-W 670.03

RSA 167:3-c,I; RSA 167:7; RSA 167:83,I(a); 20 CFR 416.1131; 45 CFR 233.20(a)(2)(iv);45 CFR 233.20(a)(3)(viii)(C); 45 CFR 233.31

He-W 670.04

RSA 161:2,l; RSA 167:83,II(f); 45 CFR 233.23

He-W 671.01

RSA 161:2, I

He-W 671.02

RSA 167:3-c,I; RSA 161:2, I

He-W 671.03

RSA 161:4-a,IX; 15 USC 1693b

He-W 670.04

RSA 161:2,l ; RSA 167:83,II(f); 45 CFR 233.23

He-W 672.01

45 CFR 206.10(a)(6)(i); RSA 167:79,III(b); RSA 167:83,II(f)

He-W 672.01(c)

45 CFR 206.10(a)(6)(i); RSA 167:83, II

He-W 672.02

RSA 167:3-c,I; RSA 167:10; 42 CFR 435.911(a); 45 CFR 206.10(a)(3)(i)

He-W 672.02(a)

RSA 167:3-c,I; RSA 167:10

He-W 674.01

RSA 161:2,I; RSA 167:3-c,I; 45 CFR 206.10

He-W 676.01 - Reserved

He-W 680.01

Section 2102 of the SSA [42 USC 1397bb] ; 42 CFR 435.914

RSA 126-A:3,VIII as amended by Chapter 224:43, Laws of NH 2011

RSA 167:3-c, VIII

He-W 680.01(a)– (c)

RSA 167:3-c, VIII; Section 2102 of the Social Security Act [42 U.S.C. 1397bb] 42 CFR 435.914

He-W 680.01(d)

RSA 167:3-c, VIII; Section 2102 of the Social Security Act [42 USC 1397bb]

He-W 680.01 (e)

42 CFR 435.914

He-W 680.02

42 CFR 435.914(a); RSA 126-A:3,VIII as amended by Chapter 224:43, Laws of NH 2011; RSA 167:3-c,I; RSA 167:10

He-W 682.01

Section 2102 of the SSA [42 U.S.C. 1397bb]; 42 CFR 435.919;

RSA 126-A:3,VIII as amended by Chapter 224:43, Laws of NH 2011

RSA 167:3-c,VIII

He-W 682.04 Reserved

He-W 682.05 Reserved

He-W 684.01

45 CFR 206.10(a)(9)

He-W 684.02

45 CFR 206.10(a)(9); RSA 161:4-a, IX; RSA 167:83,II(d)

He-W 684.02(b)(1)

RSA 167:83, II(d); 161:4-a, IX; 45 CFR 206.10(a)(9)

He-W 685.01

RSA 167:3-c,I; RSA 167:79,IV(d); RSA 167:83,II(c) & (j); 42 CFR 431.800; 42 CFR 435.916; 45 CFR 206.10(a)(9); 45 CFR 233.10(a)(1)

He-W 686.01(a)-(b), (d)-(g), (h)(2)-(i), (k)-(m)

RSA 167:26, RSA 167:3-c, I

He-W 686.01(c), (h)(1), & (j)

RSA 167:5,II; RSA 167:26; RSA 167:83,II(h); 45 CFR 234.60(a)(7)(i)

45 CFR 234.70

He-W 686.01

RSA 167:3-c,I; RSA 167:5; RSA 167:26; RSA 167:83,II(g) & (h); RSA 170-B:2,IX; RSA 463:2,IV; RSA 463-A:1,IV; RSA 464-A:2,III; RSA 464-A:2,VIII, IX, & XIV-b; 45 CFR 234.60; 45 CFR 234.70

He-W 688.01

RSA 167:3-c,I; RSA 167:10; RSA 167:83,II(i); 45 CFR 233.20(u)(12)-(13)

He-W 690.01

RSA 167:13; RSA 167:14; RSA 167:14-a; RSA 167:16; RSA 167:16-a;

He-W 692.02

RSA 167:17-a; RSA 167:83,II(i); 45 CFR 233.20(a)(12)-(13); 42 CFR 433.36(i)

He-W 692.02(i)

RSA 167:17-a; RSA 167:83,ll(i)

He-W 692.03

RSA 161:4-a,X(l); RSA 167:3-c,I; RSA 167:14-a; RSA 167:17-a;

RSA 167:17-b; RSA 167:59; RSA 167:61-a; RSA 167:83,II(i);

Section 208 of the Social Security Act (SSA) [42 USC 408];

Section 1632 of the SSA [42 USC 1383a]

He-W 693.01

RSA 161:2, XV; RSA 167:83, II (k); 45 CFR 235.110

He-W 693.02

RSA 161:2, XV; RSA 167:83, II (k); 45 CFR 235.110

He-W 693.03

RSA 161:2, XV; RSA 167:83, II (k); 45 CFR 235.110

He-W 693.04

RSA 161:2, XV; RSA 167:83, II (k); 45 CFR 235.110

He-W 693.05

RSA 161:2, XV; RSA 167:83, II (k); 45 CFR 235.110

He-W 693.06

RSA 161:2, XV; RSA 167:83, II (k); 45 CFR 235.110

He-W 694.01

RSA 167:11

He-W 695 - Reserved

He-W 696.01

RSA 167:3-c,I; RSA 167:77-a,I(e); 42 USC 607(a)(1); 45 CFR 260.31(a)(1); 45 CFR 261.21

He-W 696.02

RSA 161-B:2,IV; 7 CFR 271.2; 7 CFR 273.10; 7 CFR 273.10(e)(3)

45 CFR 261.21

He-W 698 - Reserved

He-W 699.02 - Reserved

He-W 699.04

RSA 167:3-c, I

He-W 699.05

RSA 167:3-c, II-a; RSA 167:7, V; RSA 167:79, VI;

RSA 167:82, III; RSA 167:83, I(c); RSA 167:86;

RSA 167:88

He-W 699.06

RSA 161:4-a, IX

History

#7455, EMERGENCY, eff 2-23-01, EXPIRED: 8-22-01

Chapter He-W 700 He-W 700 SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM (SNAP)

Part He-W 701 Definitions

N.H. Code Admin. R. Ann. He-W 701.01 Definitions A- E {#sec-he-w-701.01 omnilex-key=us-nh-regs-official--agency-he-w--He-W 701.01}

(a) "Able-bodied adult without dependents (ABAWD)" means a recipient who is at least age 18 but younger than age 55 who does not have dependents and is subject to special work requirements in order to receive supplemental nutrition assistance program (SNAP) benefits.

(b) “Agency error” means an action or lack of action by the department resulting in the underpayment or an overpayment of an applicant or recipient’s level of benefit or resulting in an incorrect determination of eligibility or ineligibility. This term includes “administrative error (AE)”.

(d) “Application” means a formal request for assistance or services pursuant to RSA 167:8, which is signed and dated by an individual or authorized representative.

(e) “Assistance group (AG)” means individuals living together whose needs, income, and resources are considered and combined together when determining eligibility or the amount of benefits.

(f) “Authorized representative (AR)” means an individual acting on behalf of the casehead in some or all of the aspects of initial and continuing eligibility.

(g) “Best estimate” means an expectation of income to be received by an individual determined by evaluating past, present, and anticipated significant and non-significant income changes.

(h) “Casehead” means the individual under whose name the case is listed.

(i) “Department” means the New Hampshire (NH) department of health and human services (DHHS).

(j) “Educational income” means financial assistance, payments, loans, reimbursements, or allowances paid to or on behalf of post-secondary education students.

(k) “Electronic benefit transfer” (EBT) means the method of issuing SNAP benefits to an account, which is accessed by a recipient with a debit card.

History

(See Revision Note at chapter heading for He-W 700) #5133, eff 5-2-91; ss by #6507, INTERIM, eff 5-1-97, EXPIRES: 8-29-97; ss by #6549, eff 8-1-97; ss by #7327, eff 8-1-00; ss by #9207, eff 7-19-08; ss by #11121, eff 7-19-16; ss by #13699, eff 7-25-23; ss by #14082, eff 10-1-24

N.H. Code Admin. R. Ann. He-W 701.02 Definitions F – O {#sec-he-w-701.02 omnilex-key=us-nh-regs-official--agency-he-w--He-W 701.02}

(a) “Fleeing felon” means an individual who is fleeing to avoid prosecution or custody for a crime, or an attempt to commit a crime, that would be classified as a felony, or in the state of New Jersey, a high misdemeanor.

(b) “Fluctuating income” means:

(1) Earned income that varies from month-to-month such as when an individual works varying hours, overtime, or on a piece-work basis; or

(2) Unearned income that varies from month-to-month due to changes in frequency or amount.

(c) “Non-significant changes” means any temporary or short-term variations in the amount of earned or unearned income caused by a situation which is not ongoing.

(d) “Notice of decision (NOD)” means a computer-generated or manually prepared form which advises applicants and recipients of the results of eligibility determinations, increases or decreases in changes to the amount of assistance or level of eligibility, or other changes.

History

(See Revision Note at chapter heading for He-W 700) #5133, eff 5-2-91; ss by #6507, INTERIM, eff 5-1-97, EXPIRES: 8-29-97; ss by #6549, eff 8-1-97; ss by #6672, eff 1-26-98; ss by #6825, eff 8-3-98, EXPIRED: 8-3-06
#13699, eff 7-25-23; ss by #14082, eff 10-1-24

N.H. Code Admin. R. Ann. He-W 701.03 Definitions P – Z {#sec-he-w-701.03 omnilex-key=us-nh-regs-official--agency-he-w--He-W 701.03}

(a) “Personal identification number (PIN)” means the 4-digit number used by an individual to activate and control the use of the EBT card.

(b) “Probation and parole violators” means individuals who are violating a condition of probation or parole under federal or state law.

(c) "Questionable" means any written or oral statement by an applicant or recipient, which is inconsistent with other statements made by the same individual, inconsistent with information provided on current or past applications for assistance, or inconsistent with information received by the department from other sources.

(d) “Recipient identification number (RID)” means a number assigned to an individual who is currently receiving benefits or was previously receiving benefits.

(e) “Significant changes” means changes in sources or amounts of earned or unearned income which are:

(1) Expected to continue into the future; or

(2) Short-term, but will last long enough to affect at least one issuance of SNAP benefits.

(f) “Supplemental nutrition assistance program (SNAP) account” means the EBT account established by the department into which SNAP benefits are deposited for the purpose of purchasing SNAP eligible items, as determined by the United States Department of Agriculture (USDA) Food and Nutrition Service.

(g) “Standard utility allowance (SUA)” means standard utility amounts that are used in place of actual costs in determining household excess shelter deductions.

(h) "Verification" means the use of third party documentation or third party information to establish the accuracy of statements by an individual to the department.

History

(See Revision Note at chapter heading for He-W 700) #5133, eff 5-2-91; ss by #6507, INTERIM, eff 5-1-97, EXPIRES: 8-29-97; ss by #6549, eff 8-1-97; ss by #6672, eff 1-26-98; ss by #8546, eff 1-24-06; ss by #10514, eff 1-24-14; ss by #13699, eff 7-25-23; ss by #14082, eff 10-1-24

N.H. Code Admin. R. Ann. He-W 701.04 Supplemental Nutrition Assistance Program (snap) {#sec-he-w-701.04 omnilex-key=us-nh-regs-official--agency-he-w--He-W 701.04}

RESERVED

History

#6549, eff 8-1-97; ss by #6672, eff 1-26-98; ss by #6825, eff 8-3-98; ss by #8715, INTERIM, eff 9-5-06, EXPIRES: 3-4-07; ss by #8822, eff 2-17-07; ss by #10767, eff 1-22-15; rpld by #13699, eff 7-25-23

N.H. Code Admin. R. Ann. He-W 701.05 Supplemental Nutrition Assistance Program (snap) {#sec-he-w-701.05 omnilex-key=us-nh-regs-official--agency-he-w--He-W 701.05}

RESERVED

History

#6549, eff 8-1-97; ss by #6672, eff 1-26-98; ss by #6825, eff 8-3-98; ss by #8715, INTERIM, eff 9-5-06, EXPIRES: 3-4-07; rpld by #13699, eff 7-25-23

N.H. Code Admin. R. Ann. He-W 701.06 Supplemental Nutrition Assistance Program (snap) {#sec-he-w-701.06 omnilex-key=us-nh-regs-official--agency-he-w--He-W 701.06}

RESERVED

History

#6825, eff 8-3-98; ss by #8715, INTERIM, eff 9-5-06, EXPIRES: 3-4-07; ss by #8822, eff 2-17-07; ss by #10767, eff 1-22-15; rpld by #13699, eff 7-25-23

N.H. Code Admin. R. Ann. He-W 701.07 Supplemental Nutrition Assistance Program (snap) {#sec-he-w-701.07 omnilex-key=us-nh-regs-official--agency-he-w--He-W 701.07}

RESERVED

History

#6825, eff 8-3-98; ss by #8715, INTERIM, eff 9-5-06, EXPIRES: 3-4-07; ss by #8822, eff 2-17-07; ss by #10767, eff 1-22-15; rpld by #13699, eff 7-25-23

N.H. Code Admin. R. Ann. He-W 701.08 Supplemental Nutrition Assistance Program (snap) {#sec-he-w-701.08 omnilex-key=us-nh-regs-official--agency-he-w--He-W 701.08}

RESERVED

History

#6825, eff 8-3-98; ss by #6954, eff 3-3-99, EXPIRED: 3-3-07

N.H. Code Admin. R. Ann. He-W 701.09 Supplemental Nutrition Assistance Program (snap) {#sec-he-w-701.09 omnilex-key=us-nh-regs-official--agency-he-w--He-W 701.09}

RESERVED

History

#6825, eff 8-3-98; ss by #8715, INTERIM, eff 9-5-06, EXPIRED: 3-4-07

N.H. Code Admin. R. Ann. He-W 701.10 Supplemental Nutrition Assistance Program (snap) {#sec-he-w-701.10 omnilex-key=us-nh-regs-official--agency-he-w--He-W 701.10}

RESERVED

History

#6825, eff 8-3-98; ss by #8715, INTERIM, eff 9-5-06, EXPIRES: 3-4-07; ss by #8822, eff 2-17-07; ss by #10767, eff 1-22-15; rpld by #13699, eff 7-25-23

Part He-W 702 Supplemental Nutrition Assistance Program (snap) Benefit Issuance

N.H. Code Admin. R. Ann. He-W 702.01 Method of Issuance {#sec-he-w-702.01 omnilex-key=us-nh-regs-official--agency-he-w--He-W 702.01}

(a) Supplemental nutrition assistance program (SNAP) benefits shall be issued to eligible individuals through the electronic benefit transfer (EBT) system, pursuant to 7 CFR 274.1(b)(1).

(b) An individual who is determined eligible to receive SNAP benefits shall:

(1) Obtain an EBT card through:

a. The district office; or

b. The mail, from the department;

(2) Select a Personal Identification Number (PIN) for the EBT Card:

a. At the district office; or

b. Using an automated method made available through the department’s EBT contractor;

(3) Access the EBT account with the EBT card using the PIN; and

(4) Be responsible for the security of the EBT card and PIN.

(d) An individual or authorized representative (AR) obtaining an EBT card at the district office shall present proof of identity, pursuant to the examples of acceptable documentary evidence described at 7 CFR 273.2(f)(1)(vii), before being given the EBT card.

(e) An individual described in (b), above, shall be allowed to designate an AR, pursuant to He-W 603.01, to:

(1) Receive an EBT card on behalf of the individual and select a PIN for the card chosen by the AR;

(2) Obtain the card on the individual’s behalf for subsequent selection of a PIN by the individual using the automated method made available through the EBT contractor; or

(3) Perform the PIN selection at the district office for the individual with the PIN provided by the individual to the AR.

(f) An individual may obtain the AR’s EBT card on behalf of the AR when the individual has authorized the AR to receive the EBT card pursuant to (d) above.

(g) SNAP benefits which have not been accessed by the individual for a period of 274 days after the date the benefits were issued shall be considered no longer available to the individual and permanently removed from the EBT account, pursuant to 7 CFR 274.2(i)(1)(i).

(h) EBT benefits shall be replaced by the department pursuant to 7 CFR 274.6.

(i) An individual shall request a replacement EBT card through the department’s EBT contractor or the district office.

History

(See Revision Note at chapter heading for He-W 700) #5133, eff 5-2-91; ss by #6507, INTERIM, eff 5-1-97, EXPIRES: 8-29-97; ss by #6549, eff 8-1-97; ss by #6825, eff 8-3-98; ss by #6897, eff 12-1-98; ss by #8730, eff 9-26-06; ss by #9327, eff 11-21-08; ss by #12074, eff 12-23-16; ss by #12787, eff 7-1-19; ss by #13196, eff 4-24-21

N.H. Code Admin. R. Ann. He-W 702.02 Supplemental Nutrition Assistance Program (snap) {#sec-he-w-702.02 omnilex-key=us-nh-regs-official--agency-he-w--He-W 702.02}

RESERVED

History

(See Revision Note at chapter heading for He-W 700) #5133, eff 5-2-91; ss by #6507, INTERIM, eff 5-1-97, EXPIRES: 8-29-97; ss by #6549, eff 8-1-97, EXPIRED: 8-1-05

N.H. Code Admin. R. Ann. He-W 702.03 Telephone Application {#sec-he-w-702.03 omnilex-key=us-nh-regs-official--agency-he-w--He-W 702.03}

(a) Applicants for food stamp benefits who request assistance via the telephone, shall be considered to have submitted an application as described in 7 CFR 273.2.

(b) The telephone application process pursuant to (a) above shall only be available as funding and resources within the current state fiscal year are available.

(c) All general, categorical, technical, and financial requirements that apply when an individual submits a written application, whether based on federal or state law, federal regulation, or published department rules, shall apply when an individual requests assistance via (a) above.

History

(See Revision Note at chapter heading for He-W 700) #5133, eff 5-2-91; ss by #6507, INTERIM, eff 5-1-97, EXPIRES: 8-29-97; ss by #6549, eff 8-1-97, EXPIRED: 8-1-05
#9697, eff 4-23-10; ss by #12552, eff 6-20-18

Part He-W 704 Case Decisions

N.H. Code Admin. R. Ann. He-W 704.01 Supplemental Nutrition Assistance Program (snap) {#sec-he-w-704.01 omnilex-key=us-nh-regs-official--agency-he-w--He-W 704.01}

– He-W 704.03 - RESERVED

History

(See Revision Note at chapter heading for He-W 700) #5133, eff 5-2-91

N.H. Code Admin. R. Ann. He-W 704.04 Electronic Notification {#sec-he-w-704.04 omnilex-key=us-nh-regs-official--agency-he-w--He-W 704.04}

(a) Notices, as defined in 7 CFR 273.13, may be accessed electronically by the head of household, as defined in 7 CFR 273.1(d)(1), if the head of household:

(1) Chooses to access notices electronically;

(2) Has an email account able to receive notifications from the department;

(3) Provides the department with his or her email account address; and

(4) Activates an account through the department’s eligibility web portal.

(b) If the head of household chooses to access notices only electronically, no paper notices shall be sent to the head of household via the mail.

(c) If the head of household chooses to access notices only electronically, the head of household shall be responsible for the security and validity of the email account information provided to the department.

(d) All requirements that apply when the head of household receives a paper notice shall apply when the head of household chooses to access notices only electronically.

(e) If the head of household prefers to reestablish generation of paper notices sent via the mail and chooses not to use the department’s eligibility web portal to make this change, he or she shall submit a request to the department in writing and include the following information:

(1) The head of household’s printed name;

(2) The request to reestablish generation of paper notices;

(3) The case number or recipient identification number (RID) assigned to the head of household’s case; and

(4) The head of household’s signature.

(f) The date the department receives the completed request described in (e) above shall be the household’s filing date for the request to reestablish paper notices.

(g) Paper generation of notices shall be generated to the household’s mailing address within 10 days of the individual’s filing date described in (f) above.

History

#9815, eff 11-19-10

N.H. Code Admin. R. Ann. He-W 704.05 Electronic Account Access {#sec-he-w-704.05 omnilex-key=us-nh-regs-official--agency-he-w--He-W 704.05}

(a) Electronic accounts that contain the casehead’s electronic notices of decisions (NODs), as defined in He-W 701.02, and other confidential case information, shall be activated through the department’s eligibility web portal by:

(1) The case head;

(2) The casehead’s guardian, conservator, or protective payee;

(3) An authorized representative (AR) or power of attorney chosen by the casehead; or

(4) An organization acting as the caseheads’s guardian, conservator, protective payee, AR, or power of attorney.

(b) If an organization acting as the casehead’s guardian, conservator, protective payee, AR, or power of attorney chooses to access a casehead’s electronic account, the organization shall:

(1) Obtain the casehead’s permission to access the electronic account; and

(2) Register with the department by providing the following information:

a. The organization’s name, phone number, both physical and mailing addresses, and email address;

b. The name of a designated administrator for the organization who is responsible for maintaining confidentiality for the entire organization;

c. A 4-digit pin, chosen by the administrator, for security purposes; and

d. The administrator’s dated signature signifying an agreement to abide by confidentiality and disclosure policies, pursuant to RSA 167:31, RSA 167:32, and 7 CFR 272.1(c).

(e) All information included in paper NODs shall also be included in electronic NODs.

(f) If the organization prefers to reestablish paper NODs sent via the USPS, and chooses not to use the department’s eligibility web portal to make this change, the organization shall submit a written request to the department and include the following information:

(1) The casehead’s printed name;

(2) The request to reestablish paper NODs sent via the USPS;

(3) The case number or recipient identification number, if known, assigned to the casehead;

(4) The organization’s name, phone number, both physical and mailing addresses, and email address; and

(5) The printed name and dated signature of the AR for the organization.

PARTS He-W 705 through He-W 707 - RESERVED

History

#10729, eff 11-25-14; ss by #13976, eff 5-23-24
(See Revision Note at chapter heading for He-W 700) #5133, eff 5-2-91

Part He-W 708 Claims Against Households

N.H. Code Admin. R. Ann. He-W 708.01 Collection Action on Claims {#sec-he-w-708.01 omnilex-key=us-nh-regs-official--agency-he-w--He-W 708.01}

(a) In accordance with 7 CFR 273.18(e)(2)(i), the department shall not pursue payment of a claim, as follows:

(1) An agency error (AE) claim, as described in 7 CFR 273.18(b)(3), when the gross AE claim is less than $450; and

(2) Inadvertent household error (IHE) claim, as described in 7 CFR 273.18(b)(2), when the gross IHE claim is less than $300.

(b) Collection on court adjudicated claims shall be conducted as follows:

(1) When criminal or civil proceedings are brought against an individual suspected of intentional program violation (IPV) as defined in 7 CFR 273.16(c), the following shall apply:

a. If the court orders the individual to make restitution to the department, the court's directive on the method and schedule of repayment shall be followed; or

b. If the individual is fined, imprisoned, or both and no repayment is ordered by the court, collection action shall be pursued; and

(2) If criminal proceedings are brought against the individual and a verdict of not guilty is rendered, the department shall pursue collection action in the instance when a court's verdict does not relate to:

a. Whether an overpayment has occurred; or

b. Whether repayment to the department is required.

(c) The department shall postpone a collection action on an IHE claim, as described in 7 CFR 273.18(b)(2), when it is determined that a collection action will prejudice legal action on the case being referred for:

(1) Possible prosecution; or

(2) Administrative disqualification in accordance with 7 CFR 273.16.

(d) In accordance with 7 CFR 273.18(e)(7)(i), the department shall reduce the gross amount of an AE claim, if the AE claim cannot be repaid by the household within 3 years of the AE claim.

(e) Pursuant to (d) above, households that are current recipients at the time the AE claim is established shall have the net AE claim amount calculated by multiplying 10 percent of the household’s current monthly allotment or $10, whichever is greater, by 36 months.

(f) If the household’s net AE claim amount calculated in (e) above is:

(1) Equal to or greater than the gross AE claim amount, the AE claim amount shall not be reduced; or

(2) Less than the gross AE claim amount:

a. The net AE claim amount calculated in (e) above shall become the AE claim amount that shall be collected; and

b. The difference between the gross AE amount and the net AE amount calculated in (e) above shall be the compromised amount, pursuant to 7 CFR 273.18(e)(7)(i).

(g) If overpayment on a claim occurs, the household shall be repaid within 10 calendar days of the date the overpayment is received and processed, pursuant to 7 CFR 273.18(h)(1).

History

(See Revision Note at chapter heading for He-W 700) #5133, eff 5-2-91; ss by #6507, INTERIM, eff 5-1-97, EXPIRES: 8-29-97; ss by #6549, eff 8-1-97; amd by #8388, eff 7-8-05; paragraphs (d)-(f) EXPIRED: 8-1-05; ss by #10368, eff 7-8-13; ss by #13762, eff 9-28-23

Part He-W 709 Administrative Disqualification Hearings on Intentional Program Violation

N.H. Code Admin. R. Ann. He-W 709.01 Supplemental Nutrition Assistance Program (snap) {#sec-he-w-709.01 omnilex-key=us-nh-regs-official--agency-he-w--He-W 709.01}

RESERVED

History

(See Revision Note at chapter heading for He-W 700) #5133, eff 5-2-91; ss by #6507, INTERIM, eff 5-1-97, EXPIRES: 8-29-97; ss by #6549, eff 8-1-97; EXPIRED: 8-1-05

N.H. Code Admin. R. Ann. He-W 709.02 Waived Hearings {#sec-he-w-709.02 omnilex-key=us-nh-regs-official--agency-he-w--He-W 709.02}

An individual accused of an intentional program violation may waive the individual’s right to an administrative disqualification hearing in accordance with 7 CFR 273.16(f).

History

(See Revision Note at chapter heading for He-W 700) #5133, eff 5-2-91; ss by #6507, INTERIM, eff 5-1-97, EXPIRES: 8-29-97; ss by #6549, eff 8-1-97; ss by #8388, eff 7-8-05; ss by #10368, eff 7-8-13; ss by #13527, eff 1-24-23

N.H. Code Admin. R. Ann. He-W 709.03 Timeframe for Signing Waivers {#sec-he-w-709.03 omnilex-key=us-nh-regs-official--agency-he-w--He-W 709.03}

In accordance with 7 CFR 273.16(f)(1)(ii)(A), the household shall have 10 days from the postmark date of the waiver to sign and return the waiver to avoid an administrative disqualification hearing being scheduled.

PARTS He-W 710 through He-W 721 - RESERVED

History

(See Revision Note at chapter heading for He-W 700) #5133, eff 5-2-91; ss by #6507, INTERIM, eff 5-1-97, EXPIRES: 8-29-97; ss by #6549, eff 8-1-97; ss by #8388, eff 7-8-05; ss by #10368, eff 7-8-13; ss by #13527, eff 1-24-23
(See Revision Note at chapter heading for He-W 700) #5133, eff 5-2-91; ss by #6507, INTERIM, eff 5-1-97, EXPIRES: 8-29-97; rpld by #6549, eff 8-1-97

Part He-W 722 Interviewing Households

N.H. Code Admin. R. Ann. He-W 722.01 Interview Requirements {#sec-he-w-722.01 omnilex-key=us-nh-regs-official--agency-he-w--He-W 722.01}

(a) In accordance with 7 CFR 273.2(e)(2), all households shall have the option to participate in a telephone interview in lieu of a face-to-face interview.

(b) The casehead, as defined in He-W 701.01, or authorized representative shall review the summary of the information provided during the interview with the department’s representative who conducted the interview, and make any corrections to the information, if needed.

History

(See Revision Note at chapter heading for He-W 700) #5133, eff 5-2-91; ss by #6507, INTERIM, eff 5-1-97, EXPIRES: 8-29-97; ss by #6549, eff 8-1-97; amd by #6826, eff 8-3-98; amd by #6896, eff 12-1-98; amd by #8388, eff 7-8-05; paragraph (a) EXPIRED: 8-1-05; amd by #8730, eff 9-26-06; ss by #10368, eff 7-8-13; ss by #13695, eff 7-22-23

Part He-W 724 Verification Requirements

N.H. Code Admin. R. Ann. He-W 724.01 Required Verification {#sec-he-w-724.01 omnilex-key=us-nh-regs-official--agency-he-w--He-W 724.01}

(a) When a newly arrived resident of the state applies for food stamps at the department of health and human services (DHHS), DHHS shall contact the state in which the household previously resided to determine whether the household already received food stamps for the month of application, subject to 7 CFR 273.3(a).

(b) The applicant or recipient shall provide to DHHS within 10 calendar days of the date of the request verification regarding excluded income as follows:

(1) For loan income, the applicant or recipient shall provide to DHHS a statement signed by the lender and the lendee indicating that the payment is a loan and must be repaid;

(2) If a household receives payments on a recurrent and regular basis from the same source, but claims the payments are loans, the applicant or recipient shall sign an affidavit which states:

a. That repayments are being made or shall be made; and

b. The repayment schedule.

(c) The applicant or recipient shall provide to DHHS within 10 calendar days of the date of the request proof of work registration exemptions as follows:

(1) For an exemption due to the age of a child pursuant to 7 CFR 273.7(b)(1)(iv), the applicant or recipient shall:

a. Be the child's parent, foster parent, stepparent, adoptive parent, guardian, adult with legal custody, or when no parent resides in the household, a member of the household exercising parental control; and

b. Provide documentation, such as a birth certificate, which substantiates the child's date of birth;

(2) For an exemption due to employment of 30 hours per week, the applicant or recipient shall provide documentation or information that establishes the accuracy of statements regarding the number of hours worked;

(3) For an exemption due to self-employment, the applicant or recipient shall provide documentation or information that establishes the accuracy of statements regarding the number of hours worked; and

(4) For an exemption due to self-employment, the applicant or recipient who has been self-employed for 18 consecutive calendar months or more shall show that this has resulted in weekly net income equal to at least 30 hours multiplied by the current federal minimum wage for 6 of the most recent 12 calendar months.

(d) For an exemption due to:

(1) Being physically or mentally unfit for employment pursuant to 7 CFR 273.7(b)(1)(ii), the applicant or recipient shall provide to DHHS within 10 calendar days of the date of the request:

a. Documentation which indicates that a household member is receiving temporary or permanent disability benefits issued by governmental or private sources; or

b. A statement from a licensed physician or licensed or certified psychologist;

(2) Receipt of earnings above the minimum specified by 7 CFR 273.5(b)(5), the self-employed student shall provide to DHHS within 10 calendar days of the date of the request documentation or information which indicates that weekly earnings are 20 times the federal minimum hourly wage;

(3) Lack of adequate child care, the applicant or recipient shall provide to DHHS within 10 calendar days of the date of the request a written statement that adequate child care is not available for a child age 6 through 11 years;

(4) Continuous enrollment in an institution of higher education, the student shall provide to DHHS within 10 calendar days of the date of the request a written statement regarding his or her intent to return or register for the next normal school term;

(5) Being younger than 16 years of age or older than 60 years of age, pursuant to 7 CFR 273.7(b)(1)(i), the applicant or recipient shall provide documentation, such as a birth certificate, which substantiates the individual’s date of birth within 10 calendar days of the date of the request; and

(6) Participation in a drug addiction or alcoholic treatment and rehabilitation program, the applicant shall provide documentation from the program demonstrating his or her current enrollment, if federal law provides for such an exemption.

(e) Pursuant to 7 CFR 273.2(f)(1)(v), the applicant shall verify to DHHS within 10 calendar days of the date of the request his or her Social Security Account Number (SSN) or application for an SSN card either:

(1) By providing a SSN card issued to the individual by the Social Security Administration (SSA); or

(2) By submitting proof issued from the SSA that:

a. The individual has applied for an SSN; or

b. If a newborn infant, that an SSN has been applied for on behalf of the newborn.

PARTS He-W 725 through He-W 731 - RESERVED

History

(See Revision Note at chapter heading for He-W 700) #5133, eff 5-2-91; ss by #6507, INTERIM, eff 5-1-97, EXPIRES: 8-29-97; amd and moved by #6549, eff 8-1-97 (formerly He-W 724.03, originally #6446, eff 2-1-97); amd by #6726, eff 4-1-98; amd by #6744, eff 5-1-98; amd by #6836, eff 8-26-98; amd by #6954, eff 3-3-99; amd by #7391, eff 12-1-00; amd by #7962, eff 10-1-03; amd by #8388, eff7-8-05; amd by #8715, INTERIM, eff 9-5-06, EXPIRES: 3-4-07; paragraphs (b), (c)(3), (d), (e), (j)(1)-(10) & (k) EXPIRED: 8-1-05
#9174, eff 6-7-08; amd by #9763, eff 7-30-10; ss by #11141, eff 7-22-16
(See Revision Note at chapter heading for He-W 700) #5133, eff 5-2-91

Part He-W 734 Disqualifications

N.H. Code Admin. R. Ann. He-W 734.01 Disqualifications for Voluntary Quit {#sec-he-w-734.01 omnilex-key=us-nh-regs-official--agency-he-w--He-W 734.01}

(a) Pursuant to 7 CFR 273.7(j)(1)-(2), an individual shall be temporarily disqualified for food stamp benefits for the period specified in (b) below if the individual has voluntarily quit employment or voluntarily reduced his or her work effort without good cause, as described in 7 CFR 273.7(i), within 30 days prior to application or at any time while receiving benefits.

(b) If an otherwise eligible individual has been disqualified from receipt of food stamp benefits due to (a) above, the minimum mandatory sanction, pursuant to 7 CFR 273.7(f)(2) and (j)(3)(vi), shall be applied as follows:

(1) One month for the first violation;

(2) Three months for the second violation; and

(3) Six months for the third and subsequent violations.

History

(See Revision Note at chapter heading for He-W 700) #5133, eff 5-2-91; ss by #6507, INTERIM, eff 5-1-97, EXPIRES: 8-29-97; ss by #6549, eff 8-1-97; ss by #8388, eff 7-8-05; rpld by #9763, eff 7-30-10
#11122, eff 7-1-16

N.H. Code Admin. R. Ann. He-W 734.02 Disqualification for Fleeing Felon and Probation or Parole Violators {#sec-he-w-734.02 omnilex-key=us-nh-regs-official--agency-he-w--He-W 734.02}

(a) An individual determined to be a fleeing felon, as defined in He-W 701.02(a), shall be an ineligible household member. Pursuant to 7 CFR 273.11(n)(1)(i), the department shall establish an individual as a fleeing felon through a four-part test:

(1) There is an outstanding felony warrant for the individual by a federal, state, or local law enforcement agency, and the underlying cause for the warrant is for committing or attempting to commit a crime that is a felony under the law of the place from which the individual is fleeing or a high misdemeanor under the law of New Jersey;

(2) The individual is aware of, or should reasonably have been able to expect that, the felony warrant has already or would have been issued;

(3) The individual has taken some action to avoid being arrested or jailed; and

(4) The federal, state, or local law enforcement agency is actively seeking the individual pursuant to 7 CFR 273.11(n)(3).

(b) An individual determined to be a probation or parole violator shall be an ineligible household member. To be considered a probation or parole violator, an impartial party, as designated by the department, must determine that the individual violated a condition of probation or parole imposed under federal or state law and that federal, state, or local law enforcement authorities are actively seeking the individual to enforce the conditions of the probation or parole, pursuant to 7 CFR 273.11(n)(3).

History

#6549, eff 8-1-97; rpld by #7510, eff 7-1-01
#13645, eff 5-24-23

N.H. Code Admin. R. Ann. He-W 734.03 Child Support {#sec-he-w-734.03 omnilex-key=us-nh-regs-official--agency-he-w--He-W 734.03}

Arrearage in court-ordered child support shall not be cause for disqualification.

History

#6549, eff 8-1-97; ss by #8388, eff 7-8-05; ss by #10368, eff 7-8-13; ss by #13543, eff 1-28-23

N.H. Code Admin. R. Ann. He-W 734.04 Work Requirements {#sec-he-w-734.04 omnilex-key=us-nh-regs-official--agency-he-w--He-W 734.04}

The household shall not be disqualified because the head of household is disqualified under work requirements, pursuant to 7 CFR 273.7(f)(5).

PARTS He-W 735 through He-W 739 - RESERVED

History

#6549, eff 8-1-97; ss by #8388, eff 7-8-05; ss by #10368, eff 7-8-13; ss by #13543, eff 1-28-23
(See Revision Note at chapter heading for He-W 700) #5133, eff 5-2-91; ss by #6507, INTERIM, eff 5-1-97, EXPIRES: 8-29-97; rpld and rsvd by #6549, eff 8-1-97

Part He-W 740 Income

N.H. Code Admin. R. Ann. He-W 740.01 Excluded Income {#sec-he-w-740.01 omnilex-key=us-nh-regs-official--agency-he-w--He-W 740.01}

(a) Pursuant to 7 CFR 273.9(c)(3), all educational income, as defined in He-W 701.03, shall be excluded regardless of its source or how it is spent.

(b) To qualify for the exclusion in (a) above, an individual shall be attending the institution at least half-time as determined by the institution of post-secondary education.

(d) The exclusion of payments made to individuals from AmeriCorps Volunteers in Service to America (VISTA) shall not be altered by a temporary interruption in receipt of SNAP benefits when determining income eligibility pursuant to 7 CFR 273.9(c)(10)(iii), if the temporary interruption is not more than 60 days and is:

(1) Due to the individual’s failure to recertify timely for SNAP eligibility pursuant to He-W 766.01; or

(2) Caused by the individual’s reassignment to a VISTA location in another state that necessitates the individual’s reapplication for SNAP benefits in that state.

History

(See Revision Note at chapter heading for He-W 700) #5133, eff 5-2-91; ss by #6507, INTERIM, eff 5-1-97, EXPIRES: 8-29-97; rpld and rsvd by #6549, eff 8-1-97
#6672, eff 1-26-98; amd by #7767, eff 10-1-02; amd by #8546, eff 1-24-06; ss by #9788, eff 10-1-10; amd by #10289, eff 3-20-13; ss by #12714, eff 1-23-19

Part He-W 741 Resources

N.H. Code Admin. R. Ann. He-W 741.01 Excluded Resources {#sec-he-w-741.01 omnilex-key=us-nh-regs-official--agency-he-w--He-W 741.01}

(a) When determining resource eligibility for SNAP benefits, household vehicles shall be excluded pursuant to 7 CFR 273.8(e)(3).

(b) A vehicle not excluded by (a) above shall be excluded when the vehicle is:

(1) Leased;

(2) Jointly owned with a non-household member; or

(3) Unregistered and:

a. Used only to supply parts for the household’s main vehicle;

b. Is in such dilapidated condition that it cannot be reasonably repaired for sale or use; or

c. Can only be sold for scrap or parts.

(c) In addition to household vehicles as described in (a) and (b) above, one additional vehicle per adult AG member shall be excluded as a resource, regardless of value or ownership, so long as the total number of vehicles excluded does not exceed the number of adult household members.

(d) Vehicles excluded in (c) above shall include vehicles belonging to minors in the household so long as the total number of vehicles excluded does not exceed the number of adult household members.

(e) If the equity value of countable real property alone or in combination with other countable resources exceeds the resource limit when determining resource eligibility for SNAP benefits, the household shall take action to dispose of the property within 6 months of being notified by the department of health and human services (DHHS) that the property is required to be liquidated and:

(1) The equity value of the property shall not be counted during the disposal period;

(2) The disposal period shall be extended in 3 month increments as long as the individual verifies that action has been taken to sell the property and that there are valid reasons for an inability to sell the property;

(3) If disposal does not occur within the disposal period, SNAP benefits shall be denied or terminated; and

(4) When the property is sold, the net proceeds from the sale of the property shall be counted as a lump sum resource pursuant to 7 CFR 273.8.

History

#7510, eff 7-1-01; amd by #7767, eff 10-1-02; ss by #9534, eff 9-1-09; ss #12402, eff 10-20-17

Part He-W 742 Allowable Income Deductions

N.H. Code Admin. R. Ann. He-W 742.01 Mileage for Medical Travel {#sec-he-w-742.01 omnilex-key=us-nh-regs-official--agency-he-w--He-W 742.01}

A member of a household qualifying as elderly or disabled as defined in 7 CFR 271.2, using a vehicle owned by the individual for travel related to medical needs shall be allowed to claim unreimbursed cost of travel as a deduction. The medical travel expense deduction shall be determined by multiplying the number of miles traveled related to medical needs by the federal mileage rate for medical travel, as determined annually by the Internal Revenue Service.

History

(See Revision Note at chapter heading for He-W 700) #5133, eff 5-2-91; ss by #6507, INTERIM, eff 5-1-97, EXPIRES: 8-29-97; ss by #6549, eff 8-1-97; ss by #8388, eff 7-8-05; ss by #10368, eff 7-8-13; ss by #13565, eff 2-22-23

N.H. Code Admin. R. Ann. He-W 742.02 Utility Expenses Incurred Separately {#sec-he-w-742.02 omnilex-key=us-nh-regs-official--agency-he-w--He-W 742.02}

(a) In accordance with 7 CFR 273.9(d)(6)(iii), standard utility allowances (SUA) shall be used to represent how much a household, as defined in 7 CFR 273.1(a), pays for one of the following shelter costs separate and apart from the household’s monthly rent or mortgage payments:

(1) Heating or cooling;

(2) Utilities only;

(3) Electric only;

(4) Telephone only; or

(5) Internet only.

(b) The standard monthly SUA amounts shall be as listed in Table 700-1, SUA, below and the amounts are established per (l) below;

Table 700-1, SUA

SUA

Monthly Dollar Allowance

Heating or Cooling SUA

$965

Utilities only SUA

$353

Electric only SUA

$206

Telephone only SUA

$37

Internet only SUA

$50

(c) The heating or cooling SUA amount in (a)(1) above shall be a monthly allowance used to calculate shelter costs for households that incur a heating or cooling expense, including central or room air conditioner, separate and apart from the household’s rent or mortgage payments, pursuant to 7 CFR 273.9(d)(6)(iii).

(d) The utilities only SUA described in (a)(2) above shall:

(1) Be a monthly utility allowance used to calculate shelter costs for households that incur a minimum of 2 utility expenses and do not incur heating or cooling expenses separate and apart from the household’s rent or mortgage payments; and

(2) Represent monthly household expenses incurred for cooking fuel, water, sewage, trash removal, electricity not used to heat or cool the household, internet service, and the basic service fee for one telephone or cell phone.

(e) The electric only SUA described in (a)(3) above shall be used to calculate shelter costs for any household in which the only expense incurred by the household separate and apart from rent or mortgage payments are for electric costs not used to heat or cool the household.

(f) The internet only SUA described in (a)(5) above shall be used to calculate shelter costs for any household in which the only expense incurred separate and apart from rent or mortgage payments is for internet service, even if actual internet services costs are higher or lower than the standard.

(g) The telephone only SUA described in (a)(4) above shall be used to calculate shelter costs for any household in which:

(1) The only costs incurred by a household separate and apart from rent or mortgage payments are for regular household telephone or cell phone services, even if actual household telephone or cell phone expenses are higher or lower than the standard amounts in Table 700-1, SUA above; or

(2) The household does not have regular household telephone or cell phone service but incurs costs separate and apart from rent or mortgage payments for phone expenses, even if actual household phone expenses are higher or lower than the telephone only SUA amount.

(h) The telephone only SUA amount described in (g) above shall not include the costs incurred by a household to purchase a cellular phone.

(i) Households that share utility costs and are entitled to a utility allowance shall be granted the appropriate standard utility allowance, as described in (a) above, regardless of whether all households receive SNAP.

(j) For the purposes of meeting the 2 utility criteria in (d) above, ownership and use of a well or septic system by the household shall be considered a verified utility expense for the household and shall count as a utility cost.

(k) When the "Consumer Price Index" (CPI) for updating the SUAs is referred to, the New England Consumer Price Index Card for all urban consumers (CPI-U) for the Northeast region, not seasonally adjusted, as published by the United States Department of Labor, Bureau of Labor Statistics shall be used.

(l) Pursuant to 7 CFR 273.9(d)(6)(iii)(B), the SUAs shall be equal to the standard amounts in Table 700-1, SUA, and every SUA except for the internet only SUA shall be updated for October 1 of each year, as cited in Appendix B, by:

(1) Multiplying the current SUA amount by the average CPI percent of change in the cost of fuel and utilities from the previous year to the current year, using the most recent 12-month period available, in accordance with (k) above;

(2) Adding the product derived in (l)(1) above to the current SUA amount; and

(3) Rounding the SUA amount derived in (l)(2) above to the nearest whole dollar, if necessary.

(m) If the most recent CPI average percent change described in (l)(1) is zero, there shall be no change to the SUA amounts.

History

(See Revision Note at chapter heading for He-W 700) #5133, eff 5-2-91; ss by #6507, INTERIM, eff 5-1-97, EXPIRES: 8-29-97; ss by #6549, eff 8-1-97; amd by #7136, eff 11-23-99; ss by #7510, eff 7-1-01; amd by #7767, eff 10-1-02; amd by #8378 eff 7-1-05; ss by #9534, eff 9-1-09; ss by #10713, eff 11-5-14; ss by #11041, eff 2-24-16; amd by #11057, INTERIM, eff 3-24-16, EXPIRES: 9-20-16; amd by #11188, eff 9-20-16; amd by #12369, eff 8-25-17; amd by #12703, eff 1-3-19; amd by #12927, eff 11-26-19; ss by #13565, eff 2-22-23

Part He-W 744 Determination of Monthly Food Stamp Income and Deductions and Household Eligibility

N.H. Code Admin. R. Ann. He-W 744.01 Converting Income {#sec-he-w-744.01 omnilex-key=us-nh-regs-official--agency-he-w--He-W 744.01}

Pursuant to 7 CFR 273.10(c)(2)(i), income received on a weekly, biweekly, or semi-monthly basis shall be converted to a monthly amount using the department’s public assistance conversion standards as follows:

(a) The income amount shall be multiplied by a factor of 4.33 for weekly amounts, 2.17 for biweekly amounts, and 2 for semi-monthly amounts; and

(b) The result shall be carried out to 2 decimal places and shall not be rounded up or down.

History

(See Revision Note at chapter heading for He-W 700) #5133, eff 5-2-91; ss by #6507, INTERIM, eff 5-1-97, EXPIRES: 8-29-97; ss by #6549, eff 8-1-97; ss by #8388, eff 7-8-05; ss by #10368, eff 7-8-13; ss by #13616, eff 4-26-23

N.H. Code Admin. R. Ann. He-W 744.02 Ineligible Alien Income and Financial Resources {#sec-he-w-744.02 omnilex-key=us-nh-regs-official--agency-he-w--He-W 744.02}

The eligibility and allotment amount of a household that includes an ineligible alien member shall be determined by:

(a) Counting the alien's income, minus a pro-rated share; and

(b) Counting the alien’s resources as 100% available, pursuant to 7 CFR 273.11(c)(3)(i).

History

(See Revision Note at chapter heading for He-W 700) #5133, eff 5-2-91; ss by #6507, INTERIM, eff 5-1-97, EXPIRES: 8-29-97; ss by #6549, eff 8-1-97; amd by #8388, eff 7-8-05; paragraph (b) EXPIRED: 8-1-05; ss by #10368, eff 7-8-13; ss by #13616, eff 4-26-23

N.H. Code Admin. R. Ann. He-W 744.03 Fluctuating Income {#sec-he-w-744.03 omnilex-key=us-nh-regs-official--agency-he-w--He-W 744.03}

(a) The department shall convert fluctuating income, as defined in He-W 701.02, to a monthly amount pursuant to He-W 744.01 by averaging income for the most recent consecutive 4 weeks when such income represents a best estimate of future income as defined in He-W 701.01 and verified by third party documentation as defined in He-W 701.03.

(b) Income received during weeks with non-significant income changes, as defined in He-W 701.02, shall not be used to determine the average monthly amount.

(c) When the average monthly amount determined in (a) above does not represent a best estimate of future income, the average monthly amount shall be determined as follows:

(1) Only data for weeks that accurately represent past earnings, up to a maximum of 8 weeks of data, shall be included;

(2) The average weekly income shall be determined using the data from the weeks identified in (1) above; and

(3) The appropriate multiplier under He-W 744.01 shall be used to convert average weekly income to a monthly amount.

(d) When income has been received for less than 4 consecutive weeks, the best estimate of future income, shall be determined by computing a monthly average based on the actual number of weeks the income was received.

(e) The following shall apply to self-employment income:

(1) If self-employment income is the only income received from employment in a 12-month period, it will be averaged over a 12-month period;

(2) If self-employment income is the only income received from employment in a period of fewer than 12 months, it will be averaged over the number of months it was received; and

(3) If self-employment income is not the only income received from employment, it will be treated as income in the months received and will not be averaged.

(f) The estimated average monthly gross earned income, pursuant to 7 CFR 273.10(c)(3), shall be used until the next recertification of eligibility.

(g) The estimated average monthly gross earned self-employment income, pursuant to 7 CFR 273.10(c)(3) and 7 CFR 273.11(a), shall be used for one year.

History

#6826, eff 8-3-98; amd by #7722, eff 7-1-02; amd by #8715, INTERIM, eff 9-5-06, EXPIRES: 3-4-07; ss by #8822, eff 2-17-07; ss by #10767, eff 1-22-15; ss by #14082, eff 10-1-24

Part He-W 746 Actions on Eligible Households

N.H. Code Admin. R. Ann. He-W 746.01 Determination {#sec-he-w-746.01 omnilex-key=us-nh-regs-official--agency-he-w--He-W 746.01}

of the Monthly Allotment.

(a) Applicant and recipient households that are eligible for zero benefits shall be denied or closed.

(b) When an otherwise eligible individual has been disqualified due to voluntarily quitting employment within the 30 days prior to application or at any time during participation in the program, and the disqualification period has ended, the needs of the individual shall be included effective with the first allotment issued following the end of the disqualification.

(c) When a household applies and is eligible for expedited SNAP after the 15th day of the month, the household’s initial allotment shall be equal to the allotment amount to which the household is entitled for the initial month and shall not be combined with the allotment for the next calendar month.

History

(See Revision Note at chapter heading for He-W 700) #5133, eff 5-2-91; ss by #6507, INTERIM, eff 5-1-97, EXPIRES: 8-29-97; ss by #6549, eff 8-1-97; amd by #6875, eff 10-24-98; amd by #8388, eff 7-8-05; amd by #8730, eff 9-26-06; ss by #10368, eff 7-8-13; ss by #13700, eff 7-25-23

N.H. Code Admin. R. Ann. He-W 746.02 Establishing Certification Periods {#sec-he-w-746.02 omnilex-key=us-nh-regs-official--agency-he-w--He-W 746.02}

(a) In accordance with 7 CFR 273.10(f) and He-W 684.02(d), up to 12 months certification shall be allowed for households where:

(1) Income and circumstances are very stable as described in 7 CFR 273.10(f), and all individuals are disabled or elderly; or

(2) The only source of income is from self-employment.

(b) In accordance with 7 CFR 273.10(f) and He-W 684.02(d), up to 6 months certification shall be allowed for households where:

(1) There is little likelihood of changes in income and household circumstances;

(2) A household that had been certified for 12 months provided information which resulted in incorrect benefits;

(3) The household receives or is eligible for assistance payments and the household expenses do not exceed its income;

(4) A household receives earned income or unemployment compensation;

(5) The household’s income is from self-employment and includes one or more individuals with unstable circumstances as described in 7 CFR 273.10(f)(3); or

(6) After the initial 4-month certification period, the household meets one or more criteria specified in (b)(1)-(5) above.

(c) In accordance with 7 CFR 273.10(f) and He-W 684.02(d), up to 4 months certification shall be allowed for households where:

(1) Expenses exceed household income;

(2) A member is a potential wage earner;

(3) The household’s situation is unstable as described in 7 CFR 273.10(f)(3); or

(4) At least one member is an able bodied adult without dependents as defined in He-W 701.01.

(d) One month certification shall be allowed for households where imminent changes are expected pursuant to 7 CFR 273.10(f)(3)(iii).

(e) For a household where one or more members are subject to lockout or are on strike, the following certification periods shall apply:

(1) One month certification for a household that applies before the 15th of the month; and

(2) Two months certification for a household that applies after the 15th of the month.

History

(See Revision Note at chapter heading for He-W 700) #5133, eff 5-2-91; ss by #6507, INTERIM, eff 5-1-97, EXPIRES: 8-29-97; ss by #6549, eff 8-1-97; ss by #7282, eff 6-1-00; amd by #7510, eff 7-1-01; ss by #9174, eff 6-7-08; ss by #11141, eff 7-22-16

N.H. Code Admin. R. Ann. He-W 746.03 Withdrawal of Fair Hearing Requests {#sec-he-w-746.03 omnilex-key=us-nh-regs-official--agency-he-w--He-W 746.03}

Households withdrawing fair hearing requests shall do so in writing or verbally.

History

(See Revision Note at chapter heading for He-W 700) #5133, eff 5-2-91; ss by #6507, INTERIM, eff 5-1-97, EXPIRES: 8-29-97; ss by #6549, eff 8-1-97; ss by #8388, eff 7-8-05; ss by #10368, eff 7-8-13; ss by #13700, eff 7-25-23

Part He-W 748 Employment and Training Requirements

N.H. Code Admin. R. Ann. He-W 748.01 Reimbursement for Mileage {#sec-he-w-748.01 omnilex-key=us-nh-regs-official--agency-he-w--He-W 748.01}

(a) Individuals participating in any component of the supplemental nutrition assistance program employment and training (SNAP E&T) program, pursuant to 7 USC 2015(d)(4)(B)(i), shall be provided mileage reimbursement as described in (c) below as funding and resources for SNAP E&T within the current federal fiscal year allow.

(b) Pursuant to 7 USC 2015(d)(4)(I)(i)(I), mileage reimbursement shall be paid as determined pursuant to (c) below.

(1) Be calculated by multiplying the actual number of miles traveled by the SNAP E&T participant in a personal vehicle by the current mileage reimbursement rate, as described in He-W 655.06(e)(2)a.;

(2) Be actual costs for public transportation including but not limited to taxi rides, bus passes, and ride sharing; and

(3) Not exceed $100 per month.

(d) SNAP E&T participants, pursuant to 7 USC 2015(d)(4)(B)(i), shall be eligible to receive mileage reimbursement when the following conditions are met:

(1) The documented costs of mileage is for SNAP E&T activities;

(2) Mileage reimbursement documentation includes:

a. The date the mileage costs were incurred;

b. The physical location and mailing address of the SNAP E&T related activity;

c. The specific actions taken during the SNAP E&T related activity;

d. Contact name and phone number for the SNAP E&T activity;

e. The total amount of miles traveled;

f. The participant’s printed name and dated signature attesting under the penalty of unsworn falsification, pursuant to RSA 641:3, that the information provided is true and accurate; and

g. The participant’s recipient identification (RID) number; and

(3) Documentation is received by the department no later than 90 days from the date of travel.

(e) To remain eligible for mileage reimbursement, participants in the SNAP E&T program who have received mileage reimbursement for 12 or more months over the participant’s lifetime receipt of SNAP benefits shall participate in a reassessment every 6 months to determine the SNAP E&T participant’s abilities, skills, and barriers to employment while continuing to search for employment.

(f) Mileage reimbursement shall be issued:

(1) As a cash deposit into the participant’s bank account through the electronic funds transfer (EFT) system, as defined in He-W 601.03(n);

(2) As a cash deposit onto the participant’s electronic benefit transfer (EBT) card, or another electronic payment card provided by the department if the participant does not have a bank account or the participant’s bank does not accept direct deposit; or

(3) By paper check.

(g) Participants shall be provided mileage reimbursement in the order that the participant’s documentation in (d)(2) is received by the department.

History

#6549, eff 8-1-97; ss by #7767, eff 10-1-02; ss by #8004, eff 12-13-03; ss by #9763, eff 7-30-10; ss by #10989, eff 1-1-16; ss by #13592, eff 3-24-23

N.H. Code Admin. R. Ann. He-W 748.02 Supplemental Nutrition Assistance Program (snap) {#sec-he-w-748.02 omnilex-key=us-nh-regs-official--agency-he-w--He-W 748.02}

RESERVED

History

#6549, eff 8-1-97, EXPIRED: 8-1-05
#8715, INTERIM, eff 9-5-06, EXPIRES: 3-4-07; ss by 8822, eff 2-17-07; rpld by #9763, eff 7-30-10

N.H. Code Admin. R. Ann. He-W 748.03 Supplemental Nutrition Assistance Program (snap) {#sec-he-w-748.03 omnilex-key=us-nh-regs-official--agency-he-w--He-W 748.03}

RESERVED

History

#7391, eff 12-1-00; ss by #9327, eff 11-21-08; rpld by #9763, eff 7-30-10

Part He-W 750 Actions Because of Delayed Eligibility Determinations

N.H. Code Admin. R. Ann. He-W 750.01 Actions Because of Delayed Eligibility Determinations {#sec-he-w-750.01 omnilex-key=us-nh-regs-official--agency-he-w--He-W 750.01}

Pursuant to 7 CFR 273.2(h)(3)(i), if the department has not taken all required actions to determine eligibility within the first 30 days from date of application and the household has not provided all required verification, the household shall be allowed an additional 30 days from the initial request for the verification to provide the verification that is missing.

History

(See Revision Note at chapter heading for He-W 700) #5133, eff 5-2-91; ss by #6507, INTERIM, eff 5-1-97, EXPIRES: 8-29-97; ss by #6549, eff 8-1-97; ss by #8388, eff 7-8-05; ss by #10368, eff 7-8-13; ss by #13591, eff 4-24-23

Part He-W 751 Reporting Requirements

N.H. Code Admin. R. Ann. He-W 751.01 Change Reporting Requirements {#sec-he-w-751.01 omnilex-key=us-nh-regs-official--agency-he-w--He-W 751.01}

(a) Pursuant to 7 CFR 273.12(a)(5), households certified for 4, 5, and 6 months shall be required to report changes that cause the household's gross monthly income to exceed 130% of the federal poverty income level for the household size.

(b) All households except for those described in (a) above, shall be required to report:

(1) Changes in gross monthly earned income if the amount changes by more than $100 in any one month during the certification period; and

(2) Changes in gross monthly unearned income from sources other than federal or federally aided public assistance programs, if the amount changes by more than $100 in any one month during the certification period.

(c) Households shall not be required to report any change in unearned income pursuant to (b) above, when the household's income has been averaged over the certification period in accordance with 7 CFR 273.10(c)(3).

History

(See Revision Note at chapter heading for He-W 700) #5133, eff 5-2-91; ss by #6446, eff 2-1-97; ss by #7767, eff 10-1-02; ss by #8004, eff 12-13-03; ss by #9987, eff 11-1-11

Part He-W 752 Notices to Clients

N.H. Code Admin. R. Ann. He-W 752.01 Change Reporting {#sec-he-w-752.01 omnilex-key=us-nh-regs-official--agency-he-w--He-W 752.01}

(a) To determine if a change is reported timely in accordance with 7 CFR 273.12, the department shall use the date the report of the change was received as the reported date of the change.

(b) In accordance with 7 CFR 273.12(c)(1)(iii), the recipient shall provide verification, as defined in He-W 7 CFR 273.2(f) of any reported changes which would result in an increase in the household's benefits before the department shall act on the changes.

PARTS He-W 753 through He-W 755 - RESERVED

History

(See Revision Note at chapter heading for He-W 700) #5133, eff 5-2-91; ss by #6507, INTERIM, eff 5-1-97, EXPIRES: 8-29-97; amd and moved by #6549, eff 8-1-97 (formerly He-W 752.05, originally #6446, eff 2-1-97); amd by #8270, eff 2-1-05; amd by #8388, eff 7-8-05; paragraphs (a) & (b) EXPIRED: 8-1-05; ss by #10275, eff 2-21-13; ss by #13594, eff 3-24-23
(See Revision Note at chapter heading for He-W 700) #5133, eff 5-2-91

Part He-W 756 Determination of Eligibility for Special Situation Households

N.H. Code Admin. R. Ann. He-W 756.01 Households with Shared Custody of Children {#sec-he-w-756.01 omnilex-key=us-nh-regs-official--agency-he-w--He-W 756.01}

(a) When a casehead, as defined in He-W 701.01, in supplemental nutrition assistance program (SNAP) household, hereinafter known as household x claims a child as a member of their SNAP household, but the child is currently included as a member of another SNAP household, hereinafter known as household y, the casehead of SNAP household x shall provide to the department one of the following documents:

(1) If the child is under the age of 18, a signed statement from the casehead of SNAP household y which states the child resides in SNAP household x; or

(2) If the child is at least age 18 but under the age of 22, a signed statement from the child stating the child resides in SNAP household x.

(b) When the documentation described in (a) above is received by the department, the child shall be removed from the assistance group (AG) of SNAP household y and placed in the AG of SNAP household x within the following timeframes:

(1) Thirty days of the application filing date, pursuant to 7 CFR 273.2(g)(1), if the child was reported on a new application; or

(2) Ten days of receiving report of the change, pursuant to 7 CFR 273.12(c)(1)(iii), if SNAP household x is currently participating and is requesting to add the child.

(c) If the documentation described in (a) above cannot be provided, the casehead of SNAP household x shall provide to the department the following types of documentation, including, but not limited to:

(1) Court order in which the dates and information in the order indicate that SNAP household x legally has physical custody of the child more than 50% of the time;

(2) Current school records which indicate that the child currently resides in SNAP household x;

(3) Current medical records which indicate that the child currently resides in SNAP household x; or

(4) Current child care records which indicate that the child currently resides in SNAP household x.

(d) The department shall review the documentation described in (c) above to determine if the documentation verifies that the child resides in household x more than 50% of the time. If the department reaches this determination, then the department shall remove the child from the AG of SNAP household y and place the child in the AG of SNAP household x within the timeframes specified in (b) above.

(e) The child shall remain in household y in accordance with 7 CFR 273.3(a) when:

(1) Household x fails to provide the documentation described in (a) or (c) above within 10 calendar days of the request to add the child to household x; or

(2) The documentation described in (c) above does not prove that the child resides in household x more than 50% of the time.

(f) If a court order and all other documentation described in (c) above indicates the child resides in SNAP household x exactly 50% of the time, the casehead of SNAP household x shall provide to the department the parenting plan of the court order indicating the number of meal time hours the child has resided in SNAP household x for the previous 6 months.

(g) Meal time hours as described in (f) above shall be defined as breakfast, lunch, and dinner, as follows:

(1) Breakfast time hours shall be the hours between 12:00 a.m. and 10:00 a.m.;

(2) Lunch time hours shall be the hours between 10:01 a.m. and 3:00 p.m.; and

(3) Dinner time hours shall be the hours between 3:01 p.m. and 11:59 p.m..

(h) The child shall be removed from SNAP household y and placed in SNAP household x, within the timeframes specified in (b) above, when the documentation described in (f) indicates the child resided in SNAP household x more than 50% of meal time hours for the previous 6 months.

(i) The child shall remain in household y in accordance with 7 CFR 273.3(a) when:

(1) Household x fails to provide the documentation described in (f) above within 10 calendar days of the request to add the child to household x; or

(2) The documentation described in (f) above does not prove that the child resided in household x more than 50% of meal time hours for the previous 6 months.

History

(See Revision Note at chapter heading for He-W 700) #5133, eff 5-2-91; ss by #6507, INTERIM, eff 5-1-97, EXPIRES: 8-29-97; ss by #6549, eff 8-1-97, EXPIRED: 8-1-05
#10404, eff 9-3-13; ss by #13624, eff 4-27-23

N.H. Code Admin. R. Ann. He-W 756.02 Supplemental Nutrition Assistance Program (snap) {#sec-he-w-756.02 omnilex-key=us-nh-regs-official--agency-he-w--He-W 756.02}

RESERVED

History

(See Revision Note at chapter heading for He-W 700) #5133, eff 5-2-91; ss by #6507, INTERIM, eff 5-1-97, EXPIRES: 8-29-97; ss by #6549, eff 8-1-97; ss by #8388, eff 7-8-05; ss by #10368, eff 7-8-13; rpld by #13624, eff 4-27-23

N.H. Code Admin. R. Ann. He-W 756.03 Households {#sec-he-w-756.03 omnilex-key=us-nh-regs-official--agency-he-w--He-W 756.03}

in Group Living Arrangements.

(a) Individuals meeting the following criteria shall be treated as a household of one:

(1) Developmentally disabled individuals covered under home and community-based care, as defined in He-W 820.02(c), for the developmentally disabled; and

(2) Individuals living independently in a certified community residence, as defined in He-W 601.02(r) or He-M 1001.02(k), whose financial and medical eligibility is determined in accordance with the residence policy as outlined in He-W 648.03 and He-W 848.03.

(b) Individuals living in group living arrangements, as defined in 7 CFR 271.2, including arrangements under (a) above, shall have shelter expenses determined as follows:

(1) If the individual is charged for room and board as separately identifiable charges, the room portion only shall be allowed as a shelter expense;

(2) If the individual is charged a flat rate for combined room and board, the maximum supplemental nutrition assistance program allotment for the household size shall be subtracted from the amount charged and the remainder allowed as a shelter expense; and

(3) If the individual is charged for telephone expenses, the individual shall be eligible for the telephone-only standard utility allowance, as defined in He-W 742.02(f).

History

(See Revision Note at chapter heading for He-W 700) #5133, eff 5-2-91; ss by #6507, INTERIM, eff 5-1-97, EXPIRES: 8-29-97; ss by #6549, eff 8-1-97; ss by #8388, eff 7-8-05; ss by #10368, eff 7-8-13; ss by #13702, eff 7-27-23

N.H. Code Admin. R. Ann. He-W 756.04 Self-employment {#sec-he-w-756.04 omnilex-key=us-nh-regs-official--agency-he-w--He-W 756.04}

(a) Except for income from boarders, gross income from self-employment shall be the income remaining after deducting business expenses pursuant to 7 CFR 273.11(b).

(b) Gross income from boarders shall be the income remaining after deducting the greater of the maximum monthly SNAP allotment for the number of boarders, or actual expenses, if claimed and verified.

History

(See Revision Note at chapter heading for He-W 700) #5133, eff 5-2-91; ss by #6507, INTERIM, eff 5-1-97, EXPIRES: 8-29-97; ss by #6549, eff 8-1-97; ss by #7510, eff 7-1-01; ss by #9534, eff 9-1-09; ss by #12402, eff 10-20-17

N.H. Code Admin. R. Ann. He-W 756.05 Adopted Children Age 18 up to Age 22 Residing with a Birthparent Who Has Relinquished Parental Rights {#sec-he-w-756.05 omnilex-key=us-nh-regs-official--agency-he-w--He-W 756.05}

An adopted child who resides with a birthparent shall be in a separate supplemental nutrition assistance program household when:

(a) The birthparent has not reestablished parental rights over the adopted child;

(b) The adopted child is age 18 or older and does not live with an adoptive parent; and

(c) Within the application processing timeframes described in 7 CFR 273.2(g), the adopted child provides a signed statement, under penalty of unsworn falsification, pursuant to RSA 641:3 that the adopted child purchases food and prepares meals separately from the adopted child’s birthparent.

History

(See Revision Note at chapter heading for He-W 700) #5133, eff 5-2-91; ss by #6507, INTERIM, eff 5-1-97, EXPIRES: 8-29-97; ss by #6549, eff 8-1-97, EXPIRED: 8-1-05
#10730, eff 11-25-14; ss by #13933, eff 4-24-24

N.H. Code Admin. R. Ann. He-W 756.06 Public Assistance Households {#sec-he-w-756.06 omnilex-key=us-nh-regs-official--agency-he-w--He-W 756.06}

(a) Pursuant to 7 CFR 273.26, eligible households in which at least one member of the household is receiving financial assistance to needy families (FANF), shall be provided with up to 5 months of extended food stamp (EFS) benefits after the household’s FANF financial assistance ends.

(b) When determining eligibility for and during the period of time when the household is receiving EFS benefits, changes in household circumstances that are used to determine eligibility and benefit amount for other state or federal means-tested assistance programs in which the household participates, shall not be used to adjust the EFS benefit amount.

(c) Pursuant to 7 CFR 273.27(c), the food stamp certification period for households eligible for the EFS benefits described in (a) above shall be adjusted to end in the month that the household’s 5-month extended benefit period ends.

(d) Pursuant to 7 CFR 273.31(b), at the end of the EFS certification period described in (c) above, the household shall be required to recertify pursuant to 7 CFR 273.14.

History

(See Revision Note at chapter heading for He-W 700) #5133, eff 5-2-91; ss by #6507, INTERIM, eff 5-1-97, EXPIRES: 8-29-97; ss by #6549, eff 8-1-97; amd by #8379, eff 6-21-05; paragraphs (a) & (b) EXPIRED: 8-1-05; ss by #9327, eff 11-21-08; ss by #12074, eff 12-23-16

N.H. Code Admin. R. Ann. He-W 756.07 Households with an Individual Development Account {#sec-he-w-756.07 omnilex-key=us-nh-regs-official--agency-he-w--He-W 756.07}

Funds from an individual development account used for unqualified purposes, pursuant to 42 USC 604(h), shall be treated as nonrecurring lump sum income in accordance with 7 CFR 273.9(c)(8).

History

(See Revision Note at chapter heading for He-W 700) #5133, eff 5-2-91; ss by #6507, INTERIM, eff 5-1-97, EXPIRES: 8-29-97; ss and moved by #6549, eff 8-1-97 (from He-W 756.08); rpld by #7510, eff 7-1-01
#7603, eff 12-1-01, ss by #9604, eff 12-1-09; ss by #12481, eff 2-21-18

N.H. Code Admin. R. Ann. He-W 756.08 Determining Eligibility for Able-Bodied Adults Without Dependents {#sec-he-w-756.08 omnilex-key=us-nh-regs-official--agency-he-w--He-W 756.08}

(a) Pursuant to 7 CFR 273.24(d)(1)(iv), an able-bodied adult without dependents (ABAWD), who has received three countable months of supplemental nutrition assistance program benefits, may regain eligibility if they verify that within 30 days subsequent to application they will:

(1) Work 80 or more hours;

(2) Participate in and comply with the requirements of a work program for 80 or more hours;

(3) Perform any combination of work and participation in a work program for 80 or more hours; or

(4) Become exempt from ABAWD work requirements, pursuant to 7 CFR 273.24(c).

(b) Pursuant to 7 CFR 273.24(d)(2)(i), an ABAWD who is regaining eligibility by working, participating in a work program, or a combination of both for 80 hours, shall have benefits prorated from the date of application.

History

#13832, eff 12-23-23

Part He-W 758 Target Population - Elderly and Disabled Individuals

N.H. Code Admin. R. Ann. He-W 758.01 Medical Expenses of Target Population Members {#sec-he-w-758.01 omnilex-key=us-nh-regs-official--agency-he-w--He-W 758.01}

For purposes of determining allowable medical expenses of target population individuals, in accordance with 7 CFR 273.9, the following shall apply:

(a) If a household is reimbursed for attendant care costs by United States Department of Veteran Affairs Aid and Attendance Allowance payments, pursuant to 38 CFR 3.3(a)(3), the reimbursement shall be subtracted from the total attendant care cost to determine the actual cost to the client; and

(b) Changes in attendant care meal deductions allowed by 7 CFR 273.9 shall be applied at the next scheduled recertification, or earlier at the client's request.

PARTS He-W 759 through He-W 765 - RESERVED

History

(See Revision Note at chapter heading for He-W 700) #5133, eff 5-2-91; ss by #6507, INTERIM, eff 5-1-97, EXPIRES: 8-29-97; ss by #6549, eff 8-1-97; ss by #8388, eff 7-8-05; ss by #10368, eff 7-8-13
(See Revision Note at chapter heading for He-W 700) #5133, eff 5-2-91

Part He-W 766 Recertification of Eligibility

N.H. Code Admin. R. Ann. He-W 766.01 Recertification of Eligibility {#sec-he-w-766.01 omnilex-key=us-nh-regs-official--agency-he-w--He-W 766.01}

A supplemental nutritional assistance program (SNAP) household that has filed a timely application for recertification as defined in 7 CFR 273.14 shall provide all required verification, as specified in He-W 724.01 and 7 CFR 273.2(f)(8)(i), by the later of the following:

(a) The end of the current certification period; or

(b) Within 30 days after the date of application.

History

(See Revision Note at chapter heading for He-W 700) #5133, eff 5-2-91; ss by #6507, INTERIM, eff 5-1-97, EXPIRES: 8-29-97; ss by #6549, eff 8-1-97; amd by #8388, eff 7-8-05; paragraph (a) EXPIRED: 8-1-05; ss by #10368, eff 7-8-13; ss by #13596, eff 3-24-23, EXPIRES: 3-24-33

N.H. Code Admin. R. Ann. He-W 766.02 Telephone Redetermination {#sec-he-w-766.02 omnilex-key=us-nh-regs-official--agency-he-w--He-W 766.02}

(a) A SNAP household who reapplies for assistance via the telephone, shall be considered to have requested a recertification pursuant to 7 CFR 273.14.

(b) The telephone recertification process pursuant to (a) above shall only be available as funding and resources within the current state fiscal year are available.

(c) All general, categorical, technical, and financial requirements that apply when eligibility for assistance is redetermined, whether based on federal or state law, federal regulation, or published department rules, shall apply when a household requests a recertification pursuant to (a) above.

PARTS He-W 767 through He-W 774 - RESERVED

History

#9787, eff 10-1-10; ss by#12714, eff 1-23-19
(See Revision Note at chapter heading for He-W 700) #5133, eff 5-2-91

Chapter He-W 800 Eligibility for Medical Assistance

Part He-W 801 - Definitions

N.H. Code Admin. R. Ann. He-W 801.01 Definitions A {#sec-he-w-801.01 omnilex-key=us-nh-regs-official--agency-he-w--He-W 801.01}

(b) “Adult” means any individual age 18 or older, except as modified by various program policies.

(c) “Adult category” means the medical assistance program under old age assistance (OAA), medical assistance for employed adults with disabilities (MEAD), medical assistance for employed older adults with disabilities (MOAD), aid to the needy blind (ANB), and aid to the permanently and totally disabled (APTD).

(d) “Advance notice” means a written decision which is generated by the department and provided to a casehead prior to a negative change in benefits.

(f) “Aid and attendance” means a veterans affairs allowance.

(g) “Aid to the needy blind (ANB)” means the medical assistance program as described in RSA 167:6, IV.

(h) “Aid to the permanently and totally disabled (APTD)” means the medical assistance program as described in RSA 167:6, VI.

(i) “Alimony” means payments for maintenance and care made to and on behalf of a former or estranged spouse.

(j) “Allowable deduction” means an amount subtracted from case income which represents an expense that is or was paid by an assistance group (AG) member or other person whose income is counted in the determination of eligibility.

(k) “Annuity” means any monetary source of fixed or periodic payments, either for life or for a term of years.

(l) “Applicant” means a person on whose behalf an application for assistance is being made for any of the NH department of health and human services (department) programs.

(m) “Applicant spouse” means the spouse of an OAA, ANB, MEAD, MOAD, or APTD individual who lives with the OAA, ANB, MEAD, MOAD, or APTD individual in an independent living arrangement and is also applying for or receiving OAA, ANB, MEAD, MOAD, or APTD medical assistance.

(n) “Application” means a formal request for assistance or services pursuant to RSA 167:8, which is signed and dated by an individual or authorized representative (AR).

(o) “Assets” means all income and resources of a medical assistance applicant or recipient and the applicant or recipient’s spouse.

(p) “Assistance group (AG)” means the individuals living together with or without benefit of a dwelling pursuant to He-W 830.01(a), whose needs, income, and resources are considered and combined together when determining eligibility or the level of benefits for medical assistance.

(q) “Asylee” means a non-citizen that has been granted political asylum by the U.S. Attorney General.

(r) “Authorized representative (AR)” means an individual acting on behalf of the casehead in some or all of the aspects of initial and continuing eligibility.

(s) “Available income” means all income which is regular and recurring and income which is treated as available for use regardless of actual receipt.

History

#13836, eff 12-28-23

N.H. Code Admin. R. Ann. He-W 801.02 Definitions B–C {#sec-he-w-801.02 omnilex-key=us-nh-regs-official--agency-he-w--He-W 801.02}

(a) “Beneficiary” means any individual or individuals, designated in a trust instrument as benefiting in some way from the trust.

(b) “Budgetary unit” means a group of individuals:

(1) Who reside in the same housing unit; and

(2) Whose needs are taken into account in identifying the income and resource levels against which countable income and resources are measured to determine eligibility for medical assistance.

(c) “Burial plot” means a conventional gravesite, crypt, mausoleum, urn, or other repository which is customarily and traditionally used for the remains of a deceased person.

(d) “Cap” means the gross income eligibility ceiling for the categorically needy level of eligibility for adult categories of assistance.

(e) “Caretaker relative” means an individual who is not the biological parent, but is legally related to, and providing care for, a child in an AG.

(g) “Casehead” means the individual under whose name the case is listed.

(h) “Case income” means the combined countable income of all AG members.

(i) “Category of assistance” means the types of medical assistance offered by the department, such as children’s medicaid, parent or other caretaker relative, pregnant women medical, OAA, ANB, MEAD, MOAD, or APTD.

(j) “Certified” as it relates to nursing facilities, means approval by the division of public health services as meeting federal financial participation requirements for medicare and medicaid.

(k) “Child” means a biological, adoptive, or step-dependent.

(l) “Citizen” means an individual born in the U.S. or born overseas to a parent born in the U.S., or someone who becomes a citizen through the naturalization process.

(m) “Community residence” means a:

(1) Residential facility which:

a. Provides housing on a 24-hour basis to individuals with a mental illness or developmental impairment; and

b. Receives funds or applies to receive funds from the department, community mental health programs, or area agencies; or

(n) “Continuing care retirement communities (CCRC)” means, for the purpose of medical assistance eligibility, a community that offers a lifetime contract to its residents allowing a resident to age in place, guaranteeing services such as meals, housekeeping, maintenance, medical care, and nursing care, if needed, for the payment of specified fees. CCRC’s offer multiple levels of care, such as independent living, assisted living, and nursing home care, allowing a resident to age in place.

(o) “Countable income” means available income less excluded income and adjustments for determining the gross amount.

(p) “Countable resources” means real or personal property that is considered in determining eligibility.

History

#13836, eff 12-28-23

N.H. Code Admin. R. Ann. He-W 801.03 Definitions D–E {#sec-he-w-801.03 omnilex-key=us-nh-regs-official--agency-he-w--He-W 801.03}

(a) “Date of application” means the date on which a signed application for assistance is received by the department.

(b) “Deemed income” means income which is considered available for use regardless of actual receipt.

(c) “Deemed resources” means that real and personal property that is considered to be available to the AG whether or not the property is owned by a member of the AG.

(d) “Department” means New Hampshire department of health and human services (DHHS).

(e) “Dependent child” means a child as described in RSA 167:6, V.

(f) “Deprivation” means the interruption or termination of one or both parent's function as a provider of maintenance, physical care, and guidance for the child due to death, continued absence, unemployment, or physical or mental incapacity.

(g) “Desk review” means verification of a reported or discovered change in an eligibility factor or case circumstance and the resultant adjustments to case eligibility or benefits, if any.

(h) “Disregard” means an amount subtracted from an individual or total combined AG income and is not counted in the determination of eligibility or the amount of assistance.

(i) “Documentary evidence” means written supportive information which authenticates and confirms that certain conditions or circumstances upon which good cause is predicated do, in fact, exist.

(j) “Earned income” means a monetary source or in-kind benefits received as payment for work performed either as an employee, through the receipt of wages, salaries, tips, or commissions, or as a self-employed individual.

(k) “Earned income disregard (EID)” means an amount which is computed and subtracted from earned income.

(l) “Earned income-in-kind” means compensation received for work performed in place of or as a supplement to wages, salary, commissions, profit or payment in cash, or otherwise received as the result of work performed, either employed by another or self-employed.

(m) “Effective income level” means effective income level as defined in 42 CFR 435.4.

(n) “Electronic account” means electronic account as defined in 42 CFR 435.4.

(o) “Eligibility determination” means an eligibility determination as defined in 42 CFR 435.4.

(p) “Employment expense disregard (EED)” means an amount subtracted from earned income, which represents a flat monthly amount or actual expenses, which are reasonably attributable to the earning of income.

(q) “Employment-related disregards” means the EED, the child or dependent care disregard, and the EID.

(r) “Equity value” means the current redemption rate or fair market value of a resource, less any financial claims against the resource.

(s) “Excluded income” means specific types of income which are not counted in the determination of eligibility or the level of eligibility.

(t) “Excluded resources” means real or personal property which is not counted in determining eligibility.

History

#13836, eff 12-28-23

N.H. Code Admin. R. Ann. He-W 801.04 Definitions: F–H {#sec-he-w-801.04 omnilex-key=us-nh-regs-official--agency-he-w--He-W 801.04}

(a) “Face value” means the death benefit of a life insurance policy exclusive of dividend additions or additional amounts payable because of accidental death or under other special provisions.

(b) “Fair market value” means, for purposes of this chapter:

(1) For all assets other than automobiles and trucks, the price at which a willing seller and a willing buyer will trade; or

(1) One or more adults and children, if any, related by blood, marriage, or adoption, who reside in the same home;

(2) Separate groups of related adults, other than spouses, or unrelated adults residing together;

(3) Minor siblings living with non-legally responsible relatives; or

(4) Minor siblings living under the care of unrelated persons.

(d) “Family member” means any individual who can be included in an AG, such as a parent or caretaker relative, child, or spouse.

(e) “Federal poverty level (FPL)” means the federal poverty level updated periodically in the federal register by the secretary of health and human services under the authority of 42 USC 9902(2), as in effect for the applicable budget period used to determine an individual’s eligibility.

(f) “Former foster care” means former foster care as described in 42 USC 1396a(a)(10)(A)(i)(IX).

(g) “Four month extended medical assistance” means medical assistance provided regardless of financial eligibility when certain specific factors are met by the AG.

(h) “Good cause” means a substantiated reason which justifies the parent or caretaker relative's refusal to cooperate and still retain eligibility for medical assistance.

(i) “Good faith effort to sell real property” means that the applicant or recipient is making a genuine attempt to sell the property and can provide evidence to the department that the property has been put up for sale, is currently for sale, and that no reasonable offer for the property has been refused.

(j) “Gross earned income for an individual employed by another” means the total amount, prior to payroll deductions.

(k) “Gross earned income for self-employed individuals” means the total monetary value or the dollar value of in-kind benefits received by a self-employed individual as compensation for work performed minus the cost of doing business.

(l) “Gross income” means the total amount of countable earned and unearned income or in-kind benefits received by AG members prior to any disregards or deductions.

(m) “Home and community-based services (HCBS)” means community services that individuals might need in order to prevent institutionalization.

History

#13836, eff 12-28-23

N.H. Code Admin. R. Ann. He-W 801.05 Definitions: I–N {#sec-he-w-801.05 omnilex-key=us-nh-regs-official--agency-he-w--He-W 801.05}

(a) “Immigrant” means an individual lawfully admitted for permanent residence in the U.S. who entered the country with the express purpose of maintaining permanent residence.

(b) “In-and-out medical assistance” means medical assistance in any category to which is granted for a period of one to 6 months to eligible AGs.

(d) "Income-in-kind" means goods, commodities, or services which are provided as compensation or contribution in lieu of cash and is considered either earned or unearned.

(e) “Independent living arrangement” means the form of housing for OAA, ANB, and APTD individuals who do not reside in a residential care facility, a community residence, or a licensed and certified nursing facility.

(f) “Inmate” means an individual living in a public institution as described in RSA 167:78, XI, with the exception of those who are described in He-W 824.01.

(g) “Inpatient” means a patient who has been admitted to a medical institution as an inpatient on recommendation of a physician or dentist and who:

(1) Receives room, board, and professional services in the institution for a 24 hour period or longer; or

(2) Is expected by the institution to receive room, board, and professional services in the institution for a 24 hour period or longer even if it later develops that the patient dies, is discharged, or is transferred to another facility and does not actually stay in the institution for 24 hours.

(h) “Institutionalized individual” means, for purposes of asset transfers, an individual who is an inpatient in a medical institution, as described in 42 CFR 435.1009, and with respect to whom payment is based on a level of care provided in a nursing facility, or who is a home and community-based services applicant or recipient.

(i) “Insured” means an individual or organization whose life, health, or property is covered by an insurance policy.

(j) “Investigation” means an inquiry made by the department regarding the circumstances upon which a good cause claim is based when documentary evidence is not sufficient.

(k) “Interim disabled parent (IDP)” means the medically needy category of medical assistance for single or 2-parent families in which one or both of the parents are temporarily incapacitated.

(l) “Irrevocable trust” means a trust that cannot in any way be revoked by the grantor.

(m) “Level of eligibility” means the following types of assistance for which an individual might be eligible:

(1) “Categorically needy” medical assistance as defined in 42 CFR 435.4;

(2) “Medically needy” medical assistance as defined in 42 CFR 435.4; and

(3) “Medicare Savings Program” as defined in He-W 801.05 below.

(n) “Liable relative” means an individual who by law or regulation might be required to contribute to the support of an applicant or recipient of medical assistance.

(o) “Licensed” means approved by the department as meeting federal or state standards.

(p) “Medicaid for employed adults with disabilities (MEAD)” means the medicaid eligibility category defined in 42 USC 1396a(a)(10)(A)(ii)(XV) and established by RSA 167:3-i.

(q) “Medicaid” means the Title XIX and Title XXI programs administered by the department that makes medical assistance available to eligible individuals.

(r) “Medicaid expansion group” means individuals defined in 42 USC 1396a(a)(10)(A)(i)(VIII).

(s) “Medicaid for employed older adults with disabilities (MOAD)” means a category of eligibility that allows certain individuals age 65 or older, who are working to either retain or obtain medicaid eligibility.

(t) “Medicare Savings Program (MSP)” means the 4 medical assistance eligibility groups that serve certain low-income medicare beneficiaries. These groups include the Qualified Medicare Beneficiary (QMB), Specified Low-Income Medicare Beneficiary (SLMB), Qualifying Individual (QI), and Qualified Disabled, and Working Individual (QDWI), each separately codified in 42 CFR 435.123 through 42 CFR 435.126.

(u) “Modified adjusted gross income (MAGI)” means MAGI based income defined in 42 CFR 435.603(e).

(v) “Net earned income” means an individual's monthly gross earned income minus all allowable employment-related disregards.

(w) “Net income” means gross income minus all allowable disregards and deductions.

(x) “Non-applicant” means an individual who is not seeking an eligibility determination for the individual’s own self and is instead included in an applicant’s or beneficiary’s household to determine eligibility for such applicant or beneficiary.

(y) “Non-applicant spouse” means the spouse of an OAA, ANB, MEAD, MOAD, or APTD individual who lives with the individual in an independent living arrangement and who is:

(1) Not applying for and not receiving OAA, ANB, MEAD, MOAD, or APTD medical assistance; or

(2) Applying for or currently receiving medical assistance offered by the department other than OAA, ANB, MEAD, MOAD, or APTD.

(z) “Non-citizen” means any individual who is not a citizen of the United States (U.S.).

(aa) “Notice of decision (NOD)” means a computer-generated or manually-prepared form which advises applicants and recipients of the results of eligibility determinations, increase or decrease in the amount of assistance, level of eligibility, or other change.

(ab) “Nursing facility" means a licensed or certified medical facility which provides health-related care and services on a daily inpatient basis in accordance with He-E 802.

History

#13836, eff 12-28-23

N.H. Code Admin. R. Ann. He-W 801.06 Definitions: O–Q {#sec-he-w-801.06 omnilex-key=us-nh-regs-official--agency-he-w--He-W 801.06}

(a) “Outpatient” means a patient of an organized medical facility, or distinct part of that facility, who is expected by the facility to receive, and who does receive, professional services for less than a 24-hour period regardless of the hour of admission, and whether or not a bed is used or whether or not the patient remains in the facility past midnight.

(b) “Overpayment” means medical assistance received by an AG that is in excess of what the AG is actually entitled to receive.

(d) “Parental support or care” means financial support, guidance, physical care, or supervision of a dependent child.

(e) “Patient” means an individual who is receiving needed professional services that are directed by a licensed practitioner of the healing arts toward maintenance, improvement, or protection of health, or lessening of illness, disability, or pain.

(f) “Payment from a trust” means any disbursal from the corpus of a trust, or from income generated by a trust, which benefits the party receiving it, regardless of whether the benefit is monetary, or nonmonetary, or property disbursements, such as the right to use and occupy real property.

(g) “Penalty period” means the length of time during which payment for services is denied.

(h) “Period of ineligibility” means the length of time an individual is ineligible for assistance due to excess resources or receipt of a lump sum.

(i) “Permanently and totally disabled” means permanent physical or mental impairment, disease, or combination thereof, which substantially precludes an individual from engaging in useful occupations within their competence, as determined by the department, in accordance with RSA 167:6, VI.

(j) “Personal interview” means a conference between the applicant, recipient, or AR and the department staff member, in order to:

(1) Discuss all circumstances which have a bearing on eligibility;

(2) Advise the applicant, recipient, or AR of the eligibility requirements and their rights and responsibilities; and

(3) Afford applicants, recipients, and ARs an opportunity to ask any questions about the department's programs.

(k) “Personal property” for purposes of reimbursement means “personal property resources" and personal effects such as furnishings, tools, and equipment.

(l) “Personal property resources” means a form of cash or an item which can readily be converted to cash, including such items as bank accounts, stocks, or bonds.

(m) “Plan to achieve self-support (PASS)” means a time limited arrangement or accomplishing financial independence, which is approved by the Social Security Administration and allows a recipient who is visually impaired, disabled, or elderly to set aside income and resources for a work goal.

(n) “Pregnant women (PW)” means medical coverage provided by the department to pregnant women whose income meets eligibility requirements for categorically needy medical assistance, pursuant to RSA 167:68.

(o) “Primary wage earner (PWE)” means the parent or caretaker relative in a 2-parent household who earned the highest income in the 24 months prior to the application for medical assistance, for eligibility of parent and other caretaker relative medical assistance.

(p) “Private institution” means a facility that provides shelter, custody, or care to 2 or more persons and is managed entirely or partially by private funds.

(q) “Protected income level (PIL)” means the amount, based on AG size, against which net income is compared in determining eligibility as medically needy for medical assistance when the AG has applied for medical assistance as medically needy only or is found to be financially ineligible for financial assistance.

(r) “Public institution” means a facility, other than a child care or medical institution, which affords shelter, custody, or care to 2 or more persons and is managed entirely or partially by or through any public instrumentality, official, or employee acting in an official capacity.

(s) “Questionable” means, with regard to verifying factors of eligibility, any verbal or written statement made by an AG member which is inconsistent with:

(1) Other statements made by the same AG member or another AG member;

(2) Information provided on current or past applications for assistance; or

(3) Any information received by the department from any other source.

History

#13836, eff 12-28-23

N.H. Code Admin. R. Ann. He-W 801.07 Definitions R–S {#sec-he-w-801.07 omnilex-key=us-nh-regs-official--agency-he-w--He-W 801.07}

(a) “Real property resources” means resources that are in the form of real estate, including land and buildings.

(b) “Recipient” means any individual who has been determined eligible and is currently receiving medical assistance.

(c) “Recoupment” means the collection or recovery by the department for the value of assistance erroneously paid to an individual regardless of the cause.

(d) “Resident” means an individual who lives in the state voluntarily, pursuant to RSA 21:6.

(e) “Resources” means property owned by an individual, and includes both personal and real property resources.

(f) “Responsible parent” means a biological parent, adoptive parent, stepparent, or grandparent who, by state law, is liable for the support of a child who receives medical assistance.

(g) “Retroactive month” means any one of the 3 months directly preceding the application beginning the day prior to the application date back to the same date in each of the preceding 3 months.

(h) “Revocable trust” means a trust that can be revoked by the grantor, including trusts that are called irrevocable but which will terminate if some action is taken by the grantor.

(i) “Similar legal device” means any instrument, device, or arrangement which cannot be called a trust under state law, but which exhibits the general characteristics of a trust as defined in He-W 801.08(d), such as escrow accounts, investment accounts, pension funds, annuities, and other similar instruments managed by an individual or entity with fiduciary responsibilities.

(j) “Specified relative” means father, mother, grandfather, grandmother, brother, sister, stepfather, stepmother, stepbrother, stepsister, uncle, aunt, first cousin, nephew, or niece, including relatives of half-blood, relatives of preceding generations as denoted by the prefixes of grand, great, or great-great, adoptive parents and their relatives to the same degree as blood relatives, and spouses of the above relatives even after the marriage is terminated by death or divorce, who provides care and parental control to a dependent child.

(k) “Standard disregard” for adult category assistance means a flat amount which is subtracted from unearned income.

(l) “Standard of need” means the amount of income necessary for recipients to have a reasonable level of subsistence for categorically needy medical assistance.

(m) “Stepparent” means an individual who is currently legally married to a child's biological or adoptive parent but has no biological or adoptive parental relationship to the child.

(n) “Student” means an individual who is officially enrolled in, and regularly attending, an elementary or secondary school, college, university, or a technical or vocational training program which has the main objective of training individuals for gainful employment.

(o) “Sworn statement” means a statement made under oath or affirmation reciting facts which are personally known by the signer, and which are sworn to and notarized by either a notary public or justice of the peace.

History

#13836, eff 12-28-23

N.H. Code Admin. R. Ann. He-W 801.08 Definitions: T–V {#sec-he-w-801.08 omnilex-key=us-nh-regs-official--agency-he-w--He-W 801.08}

(b) “Termination” means the discontinuance of assistance or benefits received by an individual or AG when the conditions of eligibility for receipt of such assistance are no longer met.

(c) “Title IV-D requirements (IV-D)” means the assignment of rights to medical support and cooperation in establishing paternity and obtaining support as a condition of eligibility for medical assistance, as established under 42 USC 608.

(d) “Trust” means any arrangement in which a grantor transfers property to a trustee(s) with the intention that it be held, managed, or administered by the trustee(s) for the benefit of the grantor or certain designated beneficiaries, which is valid under state law and manifested by a valid trust instrument or agreement, and where the trustee(s) hold a fiduciary responsibility to manage the trust's corpus and income for the benefit of the beneficiaries.

(e) “Trustee” means any individual, individuals, or entity, such as an insurance company or bank, who manage a trust, or similar device, and who has fiduciary responsibilities.

(f) “Uncompensated value” means the difference between the fair market value at the time of transfer, less any outstanding loans, mortgages, or other financial claims against the asset, and the amount received for the asset.

(g) “Unearned income” means all contributions, payments, pensions, benefits, loans, awards, or other income which are not received as compensation for work performed.

(h) "Unearned income-in-kind" means a contribution which does not represent compensation for a job performed.

History

#13836, eff 12-28-23

Part He-W 802 Program Coverages and Limitations

N.H. Code Admin. R. Ann. He-W 802.03 Telephone Application {#sec-he-w-802.03 omnilex-key=us-nh-regs-official--agency-he-w--He-W 802.03}

(a) Applicants for any program of medical assistance except for medi12cal assistance as described in He-W 858.05 and He-W 858.06, who request assistance via the telephone, shall be considered to have submitted an application as described in He-W 601.01(p).

(b) The telephone application process pursuant to (a) above shall only be available as funding and resources within the current state fiscal year are available.

(c) All the application requirements that apply when an individual submits a written application shall apply when an individual requests assistance via (a) above, including:

(1) Verification requirements described in He-W 806;

(2) Interview requirements described in He-W 636.01 and He-W 644.01; and

(3) All program requirements as described in He-W 800.

History

#12552, eff 6-20-18

N.H. Code Admin. R. Ann. He-W 802.04 Categorically Needy and Medically Needy Medical Assistance {#sec-he-w-802.04 omnilex-key=us-nh-regs-official--agency-he-w--He-W 802.04}

(a) The department shall provide medical assistance under the provisions of 42 USC 1396a (a)(10)(A)(i).

(b) Categorically needy medical assistance shall be provided to the following coverage groups pursuant to 42 USC 1396a(a)(10)(A)(ii):

(1) Individuals who would be eligible for, but are not receiving, financial assistance under one of the department's financial assistance programs, in accordance with 42 CFR 435.210;

(2) Individuals who would be eligible for, but are not receiving, financial assistance under one of the department's financial assistance programs due to their medical institutional status, in accordance with 42 CFR 435.211;

(3) Children for whom public agencies are assuming full or partial financial responsibility or who are in a foster home or private institution, as defined in He-W 801.06;

(4) Children whose adoption is being subsidized in full or part by a public agency;

(5) Individuals receiving adult category financial assistance;

(6) Individuals in institutions who are eligible under a special income level, in accordance with 42 CFR 435.236;

(7) Individuals who would be eligible for medical assistance if they were in a medical institution, but are instead receiving home and community based services in accordance with 42 CFR 435.217;

(8) Children with severe disabilities who meet the requirements, in accordance with RSA 167:3-e, RSA 167:3-f, RSA 167:3-g and 42 CFR 435.225; or

(9) Deemed newborn children as described in 42 CFR 435.117.

(c) Medically needy medical assistance shall be provided to any individual who meets the general, categorical, and technical requirements for categorically needy medical assistance, provided the individuals meet the financial requirements for medically needy medical assistance and not the financial requirements for categorically needy medical assistance.

(d) Medical assistance shall be provided to individuals age 65 or older who are patients in institutions for mental diseases, in accordance with 42 CFR 441.101.

History

#13833, eff 12-23-23

Part He-W 803 Individual Rights and Responsibilities

N.H. Code Admin. R. Ann. He-W 803.01 Authorized Representative {#sec-he-w-803.01 omnilex-key=us-nh-regs-official--agency-he-w--He-W 803.01}

(a) A individual who chooses an authorized representative (AR), as defined in He-W 601.01(w), to help with some or all the responsibilities of applying for or receiving medical assistance shall provide all of the following information in writing:

(1) The name, address, and telephone number of the AR;

(2) The duties that the AR will carry out, as specified in (c) below;

(3) The individual's relationship to the AR;

(4) A statement signed and dated by the individual acknowledging:

a. His or her responsibility for any errors, omissions, failures to report information to DHHS, or inaccurate information reported to DHHS by the AR;

b. That if the AR uses the individual’s benefits without permission, these benefits will not be replaced by DHHS;

c. That the person the individual names as the AR will continue to act for the individual until the individual or the AR tells DHHS of a change; and

d. Comprehension of the individual’s choice of AR and the duties assigned to that AR; and

(5) A statement signed and dated by the AR:

a. Agreeing to accept the responsibilities designated by the individual;

b. Acknowledging that the AR understands that:

Proof of the AR’s identity is required;
If disqualified for a program violation, the person identified as the AR can no longer act as an AR unless there is no one else suitable to represent the individual; and
The AR will continue to act as an AR for the individual until the AR or the individual tells DHHS of a change.

(b) To qualify as an AR, an individual shall be an adult who has:

(1) Expressed concern for the individual's wellbeing;

(2) Sufficient knowledge about the individual's circumstances to assist the individual in applying for or receiving assistance; and

(3) The capability to obtain information about the individual's circumstances.

(1) Obtaining DHHS applications and other forms or DHHS paperwork, and completing these for the individual;

(2) Attending eligibility interviews for the individual;

(3) Providing DHHS with verification of the individual's income, resources and other case circumstances;

(4) Reporting and verifying changes in the individual's case circumstances to DHHS;

(5) Receiving the individual's medical assistance identification card and other DHHS mail;

(6) Asking for, attending, and representing the individual at administrative appeals for the individual;

(7) Communicating with the individual’s managed care organization or qualified health plan; and

(8) Any other duties regarding eligibility for medical assistance an individual chooses to designate to an AR.

(d) If designated pursuant to (a)(2) above, ARs shall:

(1) Sign DHHS forms completed on behalf of the individual; and

(2) Co-sign DHHS forms they assist the individual in completing.

History

#11042, eff 2-24-16

N.H. Code Admin. R. Ann. He-W 803.02 Individual Responsibility to Supply Accurate Information {#sec-he-w-803.02 omnilex-key=us-nh-regs-official--agency-he-w--He-W 803.02}

Individuals shall supply complete and truthful answers to all written and verbal questions to establish eligibility or fulfill an eligibility requirement, pursuant to RSA 167:17-b.

History

#11042, eff 2-24-16

N.H. Code Admin. R. Ann. He-W 803.03 Individual Responsibility to Report Changes {#sec-he-w-803.03 omnilex-key=us-nh-regs-official--agency-he-w--He-W 803.03}

History

#11042, eff 2-24-16

Part He-W 804 Case Decisions

N.H. Code Admin. R. Ann. He-W 804.01 Case Decisions {#sec-he-w-804.01 omnilex-key=us-nh-regs-official--agency-he-w--He-W 804.01}

Except where otherwise noted or specifically prohibited, an assistance group shall be eligible for medical assistance only when all general, categorical, technical, and financial requirements for the category and type of assistance requested are met and verified.

History

#13765, eff 10-5-23

N.H. Code Admin. R. Ann. He-W 804.02 Notice of Decision {#sec-he-w-804.02 omnilex-key=us-nh-regs-official--agency-he-w--He-W 804.02}

(a) Except where otherwise specified, increases in the level of eligibility shall take effect on the first of the following month after the change is processed, as determined by computer processing cut-off dates.

(b) When positive and negative changes occur or are reported simultaneously, the changes shall be processed together and the combined effect of the changes shall determine the advance notice period requirements as described in He-W 804.03.

History

#13765, eff 10-5-23

N.H. Code Admin. R. Ann. He-W 804.03 Advance Notice Period {#sec-he-w-804.03 omnilex-key=us-nh-regs-official--agency-he-w--He-W 804.03}

(a) The advance notice period (ANP) shall be one of the following:

(1) Five calendar days when terminating or reducing benefits due to fraud;

(2) Ten calendar days before the date of action to discontinue, terminate, suspend, or reduce assistance; or

(3) No advance notice period shall be provided in accordance with 42 CFR 431.213, as described in (d) below or when the situations described in (e) below apply.

(b) For 12-month extended medical assistance (EMA), a 10-calendar day advance notice shall be provided when a client is moving out of state.

(c) Changes in assistance group (AG) circumstances that occur or are reported during an ANP shall not be processed until the ANP has expired.

(d) The department shall not provide an ANP when federal regulations allow the option of dispensing with the ANP when:

(1) Factual information confirms the death of a recipient;

(3) A recipient has been admitted or committed to an institution and is no longer eligible for assistance;

(4) A recipient’s location is unknown and the department’s mail is returned by the postal service indicating no forwarding address is on file; and

(5) The recipient has been accepted for assistance in another state.

(e) The department shall not provide an ANP when no action is taken or it would be impossible to provide an ANP to the AG, including, but not limited to, in the following situations:

(1) A recipient is placed in a nursing facility or requires long term hospitalization;

(2) All recipients in the AG have died;

(3) A recipient or AG is closed in one case and opened in another, and the eligibility level and benefit amount remain the same; and

(4) A child is removed from the home as a result of a judicial determination or is voluntarily placed in foster care by the child’s legal guardian.

(f) For 12-month EMA, advance notice shall not be provided for the following situations:

(1) There is no longer a dependent child in the 12-month EMA AG;

(2) The individual does not meet the employment requirements;

(3) The individual requests termination of benefits; or

(4) If the result of gross earned income, minus child care costs, for all AG members exceeds the EMA income limit.

History

#13765, eff 10-5-23

N.H. Code Admin. R. Ann. He-W 804.04 Electronic Notification {#sec-he-w-804.04 omnilex-key=us-nh-regs-official--agency-he-w--He-W 804.04}

(a) Notices of decision (NOD), as defined in He-W 801.05, may be accessed electronically by the casehead, as defined in He-W 801.02, if the casehead:

(1) Chooses to access NODs electronically;

(2) Has an email account able to receive notifications from the department;

(3) Provides the department with an email address; and

(4) Activates a user account through the department’s eligibility web portal.

(b) If the casehead chooses to only access NODs electronically, no paper NODs shall be sent to the casehead via the United States Postal Service (USPS).

(c) If the casehead chooses to only access NODs electronically, the casehead shall be responsible for the security and validity of the email account information provided to the department.

(d) All information included in paper NODs shall also be included in electronic NODs.

(e) If the casehead prefers to reestablish generation of paper NODs sent via the USPS and chooses not to use the department’s eligibility web portal to make this change, the casehead shall submit a request to the department in writing and include the following information:

(1) The casehead’s printed name;

(2) The request to reestablish generation of paper NODs;

(3) The case number or recipient identification number assigned to the casehead’s case; and

(4) The casehead’s signature.

(f) The date the department receives the completed request described in (e) above shall be the casehead’s filing date for the request to reestablish paper NODs.

(g) Paper NODs shall be mailed to the casehead’s mailing address within 10 days of the casehead’s filing date described in (f) above.

History

#10729, eff 11-25-14; ss by #14220, eff 3-26-25

N.H. Code Admin. R. Ann. He-W 804.05 Electronic Account Access {#sec-he-w-804.05 omnilex-key=us-nh-regs-official--agency-he-w--He-W 804.05}

(a) Electronic accounts that contain the casehead’s electronic notices of decision (NOD) and other confidential case information shall be activated through the department’s eligibility web portal by: