N.H. Code Admin. R. Ann. He-M — Former Division of Mental Health and Developmental Services

Chapter He-M 200 Practice and Procedure

Part He-M 201 Administrative Review of Complaint Investigation Findings

N.H. Code Admin. R. Ann. He-M 201.01 Purpose. {#sec-he-m-201.01 omnilex-key=us-nh-regs-official--agency-he-m--He-M 201.01}

The purpose of these rules is to provide any person employed by a state institution an opportunity to challenge any finding that she or he has abused, neglected or exploited a client.

History

#4924, eff 8-24-90, EXPIRED 8-24-96
#6981, eff 4-22-99; ss by #8847, INTERIM, eff 4-16-07, EXPIRED: 10-13-07
#9058, eff 1-3-08, EXPIRED: 1-3-16

N.H. Code Admin. R. Ann. He-M 201.02 Definitions {#sec-he-m-201.02 omnilex-key=us-nh-regs-official--agency-he-m--He-M 201.02}

The words and phrases used in these rules shall mean the following:

(a) “Abuse” means an act or omission by an employee, consultant or volunteer of an institution that:

(1) Is not accidental;

(2) Harms or threatens to harm a client's physical, mental or emotional health or safety; and

(3) Includes emotional abuse, physical abuse, and sexual abuse.

(b) “Client” means a person receiving services at a state institution.

(d) “Complaint investigator” means an employee of a state institution who is designated by the commissioner and is responsible for conducting investigations of complaints of alleged rights violations, including investigations of abuse, neglect, or exploitation in accordance with RSA 161-F:46, II and 49, I and II and other rights violations.

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

(f) “Emotional abuse” means:

(1) The misuse of power, authority or both;

(2) Verbal harassment; or

(3) Unreasonable confinement that results or could result in mental anguish or emotional distress of a client.

(g) “Employee” means an employee of a state institution.

(h) “Exploitation” means:

(1) The use of a client's person or property for another's profit or advantage; or

(2) Breach of a fiduciary relationship through improper use of a client's person or property including situations where a person obtains money, property, or services from a client through undue influence, harassment, duress, deception, or fraud.

(i) “Finding” means a decision made by a complaint investigator pursuant to He-M 201.03 (c) that an allegation of abuse, neglect, or exploitation of a client by an employee has been substantiated.

(j) “Incapacitated” means “incapacitated” as defined in RSA 161-F:43, VII.

(k) “Institution” means New Hampshire hospital or Glencliff home for the elderly.

(l) “Neglect” means an act of omission that results or could result in the deprivation of essential services necessary to maintain the minimum mental, emotional, or physical health of a client.

(m) “Physical abuse” means the use of physical force that results or could result in physical injury to a client.

(n) “Sexual abuse” means contact or interaction of a sexual nature involving a client and an employee of, or a consultant or volunteer for, an institution.

History

#4924, eff 8-24-90, EXPIRED 8-24-96
#6981, eff 4-22-99; ss by #8847, INTERIM, eff 4-16-07, EXPIRED: 10-13-07
#9058, eff 1-3-08, EXPIRED: 1-3-16

N.H. Code Admin. R. Ann. He-M 201.03 Investigation Process {#sec-he-m-201.03 omnilex-key=us-nh-regs-official--agency-he-m--He-M 201.03}

(a) As designee of the commissioner, the complaint investigator of each state institution shall investigate any allegation of abuse, neglect, or exploitation of clients of the institution.

(b) When a complaint investigator has reason to believe that a client might have been abused, neglected, or exploited by an employee, the complaint investigator shall, at a minimum:

(1) Determine whether the allegations are required to be referred to law enforcement for investigation as mandated by RSA 161-F:51, II for cases involving serious bodily injury to an incapacitated adult;

(2) Insure that the guardian, if any, is notified of the allegations, as follows:

a. The guardian of the person of the client shall be notified unless the allegations involve financial exploitation; and

b. If the allegations involve financial exploitation, the guardian of the estate of the client shall be notified;

(3) Interview the complainant, client, and employee and all witnesses regarding the allegations;

(4) Personally inspect the location of the alleged incident(s); and

(5) Review all records, documents and other data that have a bearing on the allegations.

(1) Evaluate all of the evidence collected;

(2) Determine if the allegation is substantiated by such evidence;

(3) Prepare a report of the investigation that includes:

a. A summary of the allegation;

b. A description of the investigation process;

c. The complaint investigator's findings; and

d. The evidence supporting those findings; and

(4) Determine whether the evidence and findings require that a referral be made to law enforcement for possible prosecution as mandated by RSA 161-F:51, II, for cases of abuse, neglect or exploitation of an incapacitated adult.

(d) Any employee against whom an allegation of abuse, neglect or exploitation has been made shall be notified of the outcome of the investigation. Such notification shall be hand delivered to the employee or sent by registered or certified mail, return receipt requested, to the employee at his or her last known address.

(e) If the complaint investigator concludes that the allegation is substantiated, the notification shall include:

(1) The date of the initial report;

(2) The identity of the alleged victim;

(3) A brief description of the incident, including the type of abuse, neglect, or exploitation that has occurred;

(4) The reasons for substantiating the finding;

(5) Notice of the employee's right to a reconsideration meeting pursuant to He-M 201.04;

(6) Notice of the employee's right to a review hearing pursuant to He-M 201.05 in lieu of or following the reconsideration meeting; and

(7) Notice of the employee's right to be represented by an attorney or other representative during the reconsideration meeting or review hearing, at the employee's own expense.

(f) If the complaint investigator concludes that the allegation is not substantiated, the notice shall inform the employee that the allegation has not been substantiated.

(g) The report of an investigation conducted pursuant to He-M 201.03(b) shall be forwarded to the client regarding whom the investigation was made, or to such client's guardian, and to the department’s office of client and legal services.

History

#4924, eff 8-24-90, EXPIRED 8-24-96
#6981, eff 4-22-99; ss by #8847, INTERIM, eff 4-16-07, EXPIRED: 10-13-07
#9058, eff 1-3-08, EXPIRED: 1-3-16

N.H. Code Admin. R. Ann. He-M 201.04 Reconsideration Process {#sec-he-m-201.04 omnilex-key=us-nh-regs-official--agency-he-m--He-M 201.04}

(a) An employee against whom a finding is made may request a reconsideration of that finding. To exercise such right, an employee shall request, in writing, a reconsideration of the decision from the complaint investigator within 10 working days of receipt of notice that an allegation is substantiated.

(b) Within 5 working days of receipt of a reconsideration request, the complaint investigator and his or her supervisor shall meet with the employee and his or her representative, if any, to discuss any additional information the employee might have that has a bearing on the finding and to discuss whether information obtained during the investigation supports the finding. Following this meeting, the supervisor shall determine if there is reason to uphold, reverse, or modify the finding made by the complaint investigator.

(c) Within 2 working days of the reconsideration meeting held pursuant to (b) above, the complaint investigator's supervisor shall inform the employee in writing of whether the finding has been modified, reversed, or upheld in light of the issues discussed at the reconsideration meeting. In such reconsideration determination, the supervisor shall notify the employee of his or her right to review the complaint investigator's report if he or she requests a review hearing pursuant to He-M 201.05(a). This notification shall be hand delivered to the employee or sent by registered or certified mail, return receipt requested, to the employee at his or her last known address.

(d) A copy of the reconsideration determination shall be forwarded to the client regarding whom the investigation was made, or to such client's guardian, and to the department.

(e) Following the reconsideration determination, or in lieu of the reconsideration meeting, the employee may request a review hearing to appeal the finding made by the complaint investigator or the reconsideration determination.

History

#4924, eff 8-24-90, EXPIRED 8-24-96
#6981, eff 4-22-99; ss by #8847, INTERIM, eff 4-16-07, EXPIRED: 10-13-07
#9058, eff 1-3-08, EXPIRED: 1-3-16

N.H. Code Admin. R. Ann. He-M 201.05 Hearing Process {#sec-he-m-201.05 omnilex-key=us-nh-regs-official--agency-he-m--He-M 201.05}

(a) An employee may request a review hearing to appeal a finding pursuant to He-M 201.03(c) or a reconsideration determination pursuant to He-M 201.04(c).

(b) The purpose of a review hearing shall be to determine if the finding of abuse, neglect or exploitation is supported by the evidence collected during the investigation.

History

#4924, eff 8-24-90, EXPIRED 8-24-96
#6981, eff 4-22-99; ss by #8847, INTERIM, eff 4-16-07, EXPIRED: 10-13-07
#9058, eff 1-3-08, EXPIRED: 1-3-16

Part He-M 202 Rights Protection Procedures for Developmental Services

N.H. Code Admin. R. Ann. He-M 202.01 Purpose {#sec-he-m-202.01 omnilex-key=us-nh-regs-official--agency-he-m--He-M 202.01}

The purpose of these rules is to define the procedures for protection of the rights of persons applying for, eligible for, or receiving services from area agencies or developmental services or acquired brain disorder programs funded through the bureau of developmental services.

History

(See Revision Note at part heading for He-M 202) #5830, eff 5-24-94, EXPIRED: 5-24-00
#7730, eff 7-24-02; ss by #9754, INTERIM, eff 7-24-10, EXPIRED: 1-20-11
#9962, eff 8-15-11; ss by #12940, eff 12-10-19

N.H. Code Admin. R. Ann. He-M 202.02 Definitions {#sec-he-m-202.02 omnilex-key=us-nh-regs-official--agency-he-m--He-M 202.02}

(a) “Abuse” means an act or omission by an employee of, or a contractor, consultant, or volunteer for an area agency or program which is not accidental and harms or is likely to harm an individual’s physical, mental, or emotional health or safety and includes emotional abuse, physical abuse, and sexual abuse.

(b) “Acquired brain disorder” means a disruption in brain functioning that:

(1) Is not congenital or caused by birth trauma;

(2) Presents a severe and life-long disabling condition which significantly impairs a person’s ability to function in society;

(3) Occurs prior to age 60;

(4) Is attributable to one or more of the following reasons:

a. External trauma to the brain as a result of:

A motor vehicle incident;
A fall;
An assault; or
Another related traumatic incident or occurrence;

b. Anoxic or hypoxic injury to the brain such as from:

Cardiopulmonary arrest;
Carbon monoxide poisoning;
Airway obstruction;
Hemorrhage; or
Near drowning;

c. Infectious diseases such as encephalitis and meningitis;

d. Brain tumor;

e. Intracranial surgery;

f. Cerebrovascular disruption such as a stroke;

g. Toxic exposure; or

h. Other neurological disorders, such as Huntington’s disease or multiple sclerosis, which predominantly affect the central nervous system; and

(5) Is manifested by:

a. Significant decline in cognitive functioning and ability; or

b. Deterioration in:

Personality;
Impulse control;
Judgment;
Modulation of mood; or
Awareness of deficits.

(c) “Area agency” means “area agency” as defined in RSA 171-A:2, I-b, namely, “an entity established as a nonprofit corporation in the state of New Hampshire which is established by rules adopted by the commissioner to provide services to developmentally disabled persons in the area.”

(d) “Bureau” means the bureau of developmental services of the department of health and human services.

(e) “Bureau administrator” means the chief administrator of the bureau of developmental services.

(f) “Commissioner” means the commissioner of the department of health and human services or his or her designee.

(g) “Complaint” means:

(1) Any allegation or assertion that a right of an individual as set forth in He-M 310, rights of persons receiving developmental services or acquired brain disorder services in the community has been violated;

(2) Any allegation or indication that an individual has been abused, neglected, or exploited by an employee of, or a contractor, consultant, or volunteer for an area agency or program; or

(3) Any allegation or assertion that the department or an area agency or program has acted in an illegal or unjust manner with respect to an individual or category of individuals.

(h) “Complaint investigator” means a person who is designated by the office of client and legal services to investigate and take other appropriate action on complaints.

(i) “Department” means the department of health and human services.

(j) “Developmental disability” means “developmental disability” as defined in RSA 171-A:2, V, namely, “a disability:

a. Which is attributable to an intellectual disability, cerebral palsy, epilepsy, autism, or a specific learning disability, or any other condition of an individual found to be closely related to an intellectual disability as it refers to general intellectual functioning or impairment in adaptive behavior or requires treatment similar to that required for persons with an intellectual disability; and

b. Which originates before such individual attains age 22, has continued or can be expected to continue indefinitely, and constitutes a severe disability to such individual's ability to function normally in society.”

(k) “Emotional abuse” means any of the following when the act results, or is likely to result, in the mental anguish or emotional distress of an individual:

(1) The misuse of power, authority, or both;

(2) Verbal harassment; or

(3) Unreasonable confinement.

(l) “Exploitation” means the use of an individual's person or property for another's profit or advantage, or breach of a fiduciary relationship through improper use of an individual's person, property, or money including situations where a person obtains property or services from an individual through undue influence, harassment, duress, deception, or fraud.

(m) “Founded” means that the facts indicate that a right of an individual under He-M 310 was violated.

(n) “Guardian” means a person appointed pursuant to RSA 464-A or the parent of an individual under the age of 18 whose parental rights have not been terminated or limited by law.

(o) “Incident report” means a document used to inform management, supervisory staff, or any other appropriate staff of a program or facility of a serious injury, or other event threatening the health or safety of individuals or staff.

(p) “Individual” means a person with a developmental disability or acquired brain disorder who is applying for, eligible for, or receiving services from an area agency or program.

(q) “Neglect” means an act or omission which results, or could result, in the deprivation of essential services necessary to maintain the minimum mental, emotional, or physical health of an individual.

(r) “Office of client and legal services (OCLS)” means the client and legal services section of the department established by RSA 171-A:19 to, in part, assist the commissioner in responding to complaints by or on behalf of persons with developmental disabilities.

(s) “Physical abuse” means the use of physical force which results, or could result, in physical injury to an individual.

(t) “Program” means any service that is licensed, certified, funded, monitored, or regulated by the department, and supports persons with an acquired brain disorder or a developmental disability.

(u) “Respondent” means the person, area agency, or program against whom a complaint is made.

(v) “Rights violation” means a violation of a right enumerated in He-M 310.

(w) “Sexual abuse” means contact or interaction of a sexual nature between an individual and an employee of, or a contractor, consultant, or volunteer for, an area agency or program.

(x) “Systemic factors” means internal and external policies and processes that influence the department’s or an area agency’s or program’s operations and effectiveness, including:

(1) Practices regarding hiring, training, and managing employees;

(2) Practices to assure quality of service and consumer satisfaction;

(3) Practices to assure accurate fiscal management; and

(4) Governmental regulations regarding licensing, funding, and service provision.

(y) “Unfounded” means that the facts do not indicate that a right of an individual was violated.

(z) “Unreasonable confinement” means any confinement that is neither medically necessary nor necessary for the protection of a person or to prevent harmful behavior, or confinement used with punitive intent.

History

(See Revision Note at part heading for He-M 202) #5830, eff 5-24-94, EXPIRED: 5-24-00
#7730, eff 7-24-02; ss by #9754, INTERIM, eff 7-24-10, EXPIRED: 1-20-11
#9962, eff 8-15-11; ss by #12940, eff 12-10-19

N.H. Code Admin. R. Ann. He-M 202.03 Complaints {#sec-he-m-202.03 omnilex-key=us-nh-regs-official--agency-he-m--He-M 202.03}

(a) A complaint may be made by any person including, but not limited to:

(1) An individual;

(2) An individual’s guardian or family member;

(3) An applicant for services; or

(4) An employee of, or a contractor, consultant, or volunteer for the department, an area agency, or a program.

(b) A person wishing to make a complaint may make the complaint orally or in writing to the OCLS or any employee of an area agency, a program, or the bureau. Any person receiving a complaint shall promptly forward the complaint to the OCLS.

(1) Encourage the complainant to submit the complaint in writing; and

(2) Put the complaint in writing if the complainant cannot or will not do so.

(d) Neither the OCLS nor any area agency or program shall require a complaint to be submitted on a specified form or in a specified format.

(e) A complaint may be made anonymously. If so, the identity of the complainant shall be kept confidential throughout the complaint investigation process. The complainant may be referenced by name as a witness or in another role in the course of the investigation or in the complaint report, but the fact that he or she acted as the complainant shall not be disclosed without consent.

(f) No individual shall be subject to any form of harassment or retaliation by any area agency, program, or department employee, contractor, consultant, or volunteer as a result of filing a complaint.

(g) Except when necessary to protect an individual’s health or safety, an area agency or program shall not discontinue, amend, or otherwise disrupt services provided to an individual as a result of that individual, or a person acting on the individual’s behalf, filing a complaint.

(h) No employee of, or contractor, consultant, or volunteer for the department or an area agency or program shall be subject to any form of discipline, harassment, or retaliation as a result of filing a complaint.

History

(See Revision Note at part heading for He-M 202) #5830, eff 5-24-94, EXPIRED: 5-24-00
#7730, eff 7-24-02; ss by #9754, INTERIM, eff 7-24-10, EXPIRED: 1-20-11
#9962, eff 8-15-11 (from He-M 202.04); ss by #12940, eff 12-10-19

N.H. Code Admin. R. Ann. He-M 202.04 Responsibility to Complain {#sec-he-m-202.04 omnilex-key=us-nh-regs-official--agency-he-m--He-M 202.04}

(a) Employees of the department or an area agency or program shall promptly make a complaint on behalf of an individual whenever they have reason to suspect that an individual has been subjected to abuse, neglect, exploitation, or a rights violation by an employee of, or a contractor, consultant, or volunteer for an area agency or program.

(b) Persons making a complaint or filing a complaint on behalf of another shall forward the complaint to the OCLS.

(c) As soon as possible but not later than one business day following receipt, OCLS shall submit the complaint to a complaint investigator, and inform the executive director of the appropriate area agency that a complaint was filed.

(d) Employees of the department or an area agency or program shall assist persons who wish to file a complaint to contact the OCLS.

(e) Employees described in (d) above shall inform persons making complaints of the availability of advocacy services from an advocacy agency such as the Disability Rights Center - NH or New Hampshire Legal Assistance.

(f) A complaint investigator shall report a complaint of abuse, neglect, or exploitation of an individual or other person to the bureau of elderly and adult services (BEAS) or division for children, youth and families (DCYF), as appropriate.

(g) When an employee of the department or an area agency or program has reason to suspect that an individual has been subject to abuse, neglect, exploitation, or a rights violation by a person who is not an employee of, or a contractor, consultant, or volunteer for, that area agency or program, the employee shall take all practicable steps to protect the individual, and immediately report the violation to OCLS.

(h) Upon receipt of a report pursuant to (g) above, OCLS shall:

(1) Assess the issues presented and actions taken;

(2) Take whatever further action is necessary to safeguard the individual; and

(3) Report an instance of abuse, neglect, or exploitation to BEAS or DCYF, as appropriate.

(i) Employees of an area agency or program shall file an incident report with the area agency regarding any circumstance that the policy of the area agency or program identifies as an incident including, at a minimum, a serious injury or other event threatening the health or safety of individuals or staff.

(j) In the event of the death of an individual, where there are or were allegations of abuse, neglect, or exploitation, the area agency or program shall report the allegations to OCLS for investigation.

History

(See Revision Note at part heading for He-M 202) #5830, eff 5-24-94, EXPIRED: 5-24-00
#7730, eff 7-24-02; ss by #9754, INTERIM, eff 7-24-10, EXPIRED: 1-20-11
#9962, eff 8-15-11 (from He-M 202.06); ss by #12940, eff 12-10-19

N.H. Code Admin. R. Ann. He-M 202.05 Informal Resolution {#sec-he-m-202.05 omnilex-key=us-nh-regs-official--agency-he-m--He-M 202.05}

(a) At the individual’s option or, if the individual has a guardian, at the option of the guardian, and except in cases of reported abuse, neglect, or exploitation, complaints may be addressed informally pursuant to (e) below by convening a meeting with the appropriate parties or by administrative action by the area agency or program.

(b) At any time during informal resolution, the individual or, if the individual has a guardian, his or her guardian may request a formal investigation.

(c) The complaint investigator shall promptly advise the individual on whose behalf a complaint is filed and his or her guardian and service coordinator of:

(1) All the available rights protection procedures including informal resolution pursuant to (e) below and complaint investigation pursuant to He-M 202.07;

(2) The individual’s right at any time to pursue a formal investigation if informal resolution efforts do not address the issue in a manner deemed satisfactory by the individual or guardian; and

(3) The individual’s right, at his or her expense, to have the assistance of an advocate such as the Disability Rights Center – NH or New Hampshire Legal Assistance.

(d) The individual or, if the individual has a guardian, his or her guardian shall provide to the complaint investigator, within 2 business days, an indication of whether he or she prefers informal resolution or an investigation. The complaint investigator shall investigate the complaint pursuant to He-M 202.07 if he or she is not contacted by the individual or guardian.

(e) When an individual or, if the individual has a guardian, his or her guardian chooses the informal resolution option:

(1) The complaint investigator shall notify the appropriate area agency of the choice;

(2) The area agency shall designate a person to facilitate the resolution within 2 business days;

(3) The area agency designee shall:

a. Attempt to resolve the complaint within 15 business days; and

b. Notify the complaint investigator, in writing, of the status of the complaint upon resolution or at the end of the 15 business days, whichever is earlier;

(4) Upon notice pursuant to (3) b. above, the complaint investigator shall contact the individual or his or her guardian to determine the individual’s satisfaction with the outcome;

(5) If the complaint has been resolved, no further action shall be required; and

(6) If the complaint has not been resolved, the complaint investigator shall conduct a formal investigation.

(f) A guardian shall be involved in a complaint only if he or she has authority over the particular matter which is the subject of the complaint, as identified in the letter of guardianship issued pursuant to RSA 464-A:11.

(g) Within the limitations of (f) above, a guardian shall:

(1) Have authority to do the following on behalf of his or her ward:

a. Make a complaint;

b. Pursue informal resolution;

c. Withdraw a complaint made by the guardian or ward ; or

d. Pursue an appeal pursuant to He-M 202.08; and

(2) Consider the preferences of the ward to the extent that the guardian deems appropriate.

History

(See Revision Note at part heading for He-M 202) #5830, eff 5-24-94, EXPIRED: 5-24-00
#7730, eff 7-24-02; ss by #9754, INTERIM, eff 7-24-10, EXPIRED: 1-20-11
#9962, eff 8-15-11; ss by #12940, eff 12-10-19

N.H. Code Admin. R. Ann. He-M 202.06 Emergency Action {#sec-he-m-202.06 omnilex-key=us-nh-regs-official--agency-he-m--He-M 202.06}

(a) Area agencies and programs shall take emergency action on all complaints when there exists an act or circumstance that, if not promptly corrected or resolved, will likely result in serious harm to the individual, other persons, or property.

(b) An area agency or program shall immediately take steps to protect the safety of the individuals involved.

History

(See Revision Note at part heading for He-M 202) #5830, eff 5-24-94, EXPIRED: 5-24-00
#7730, eff 7-24-02; ss by #9754, INTERIM, eff 7-24-10, EXPIRED: 1-20-11
#9962, eff 8-15-11 (from He-M 202.09); ss by #12940, eff 12-10-19

N.H. Code Admin. R. Ann. He-M 202.07 Complaint Investigation {#sec-he-m-202.07 omnilex-key=us-nh-regs-official--agency-he-m--He-M 202.07}

(a) The OCLS shall at all times have at least 3 persons designated as complaint investigators to carry out all the duties of the complaint investigator within the timelines required by He-M 202.

(b) Complaint investigators shall not serve as employees of, or contractors, consultants, or volunteers for an area agency or program. This requirement shall not restrict complaint investigators from providing, by short-term contract, training on rights under He-M 310, the complaint process, or related subjects to the staff of programs or area agencies.

(c) Following receipt from the department, each area agency shall annually forward to programs and family groups the procedures and contact information for filing a complaint.

(d) Area agencies and programs shall post the information identified in (c) above within area agency and program offices and on websites, as applicable.

(e) At each individual’s annual service planning meeting, the service coordinator shall provide, in writing, to the individual, guardian, and family the procedures and contact information for filing a complaint.

(f) OCLS shall submit all complaints to a complaint investigator as soon as possible, but not later than one business day following receipt.

(g) Complaints involving abuse, neglect, or exploitation shall be investigated prior to any other complaints. Such other complaints shall be investigated in the order received.

(h) The complaint investigator shall investigate and attempt to resolve the complaint to the satisfaction of the individual or his or her guardian within 15 business days.

(i) The complaint investigator shall conduct an impartial and thorough investigation that includes, at a minimum:

(1) Interviewing:

a. The complainant;

b. The individual;

c. The guardian, if any;

d. The respondent; and

e. Any witnesses to any incident on which the complaint is based;

(2) As deemed relevant by the complaint investigator, consulting with professionals or other persons who have knowledge of the individuals involved;

(3) Reviewing information in the individual's record, program policies and procedures, and any other documents that have been determined by the investigator to be relevant;

(4) Reviewing relevant systemic factors; and

(5) Reviewing any physical evidence.

(j) Area agencies and programs shall allow complaint investigators:

(1) Unfettered access to program premises, staff, training records, files of individuals who are the subjects of complaints; and

(2) Access to any other program documents or information determined relevant by the complaint investigator, unless otherwise restricted by law.

(k) During the complaint process, the complaint investigator shall keep the area agency executive director or his or her designee informed of the progress of the investigation.

(l) The respondent may be represented by counsel during the interview conducted by the complaint investigator. However, the complaint investigator shall not share an individual’s confidential information with the respondent or the respondent’s attorney without the permission of the individual or his or her guardian.

(m) Regardless of the number of individuals affected, 2 or more complaints involving the same act or incident shall be consolidated and treated as one complaint, provided that:

(1) Separate notices and copies of resolutions shall be sent to each individual or his or her guardian; and

(2) Each individual, or his or her guardian, shall be given the opportunity to accept or appeal such resolution.

(n) The complaint investigator shall prepare a report for OCLS review that includes:

(1) A summary of the issues presented, including any issues that arose during the investigation;

(2) The names of persons interviewed during the investigation;

(3) A list of all documents and other evidence reviewed;

(4) The dates of any reports made to BEAS or DCYF, if applicable;

(5) Investigatory findings of fact;

(6) A discussion of the investigatory findings of fact, a proposed determination of whether the allegations are founded or unfounded, and an explanation of why such determination was made;

(7) A discussion of systemic factors that caused, contributed to, or exacerbated the violation; and

(8) The proposed resolution and, as applicable, the proposed corrective action by the area agency, program, or bureau.

(o) Following OCLS review to determine that the elements in (n) (1)-(8) above have been addressed and within 15 business days of the filing of the complaint, the complaint investigator shall forward the full report to the individual or his or her guardian, the area agency executive director, and the program involved, if any.

(p) To protect the confidentiality of individuals, witnesses, and accused parties, an area agency or program shall limit access to complaint reports to its management staff and officers of its board of directors, and shall not release reports to outside entities. Reports shall not be made part of an individual’s record.

(q) The timeframe in (o) above shall be extended for 10 business days if any of the following factors makes it impossible to issue a report as required:

(1) The number of allegations to be investigated;

(2) The number or availability of witnesses to be contacted;

(3) The availability of evidence; or

(4) Other similar complicating circumstances.

(r) The individual or his or her guardian, the area agency executive director, and the program involved, if any, shall have 10 business days from the receipt of the report to respond in writing, indicating approval or disapproval of the determination and the proposed resolution in the complaint investigation report. Failure to respond within the time allowed shall constitute acceptance of the report’s determination and proposed resolution, and the report shall be considered final.

(s) The timeframe to respond in (r) above shall be extended by 10 business days upon written request of the individual, guardian, area agency executive director, or program to the complaint investigator. Failure to respond within the extended time allowed shall constitute acceptance of the report’s determination and proposed resolution, and the report shall be considered final.

(t) If the individual or his or her guardian, the area agency executive director, or the program involved, if any, does not accept the proposed determination or proposed resolution, such party shall, within 10 business days, request further investigation by the complaint investigator or further review by the bureau administrator by stating, in writing, and submitting to the bureau the specific reasons for the disagreement.

(u) If further investigation is requested pursuant to (t) above, the requesting party shall specify, in writing, the areas of concern, and the complaint investigator shall review all relevant materials and amend the report as needed, which shall be considered the final report.

(v) If further review by the bureau administrator is requested pursuant to (t) above, the requesting party shall specify, in writing, the areas of concern, and the bureau administrator shall review all relevant materials prior to issuing a decision pursuant to (w) below.

(w) The bureau administrator shall issue a final written decision to the individual or his or her guardian, the area agency executive director, and the program involved, if any, within 10 business days of a request pursuant to (t) above and notify the parties of the right to appeal to the commissioner pursuant to He-C 200.

(x) Once a complaint report is final pursuant to (r), (s), (u), or (w) above, if the report includes recommendations for resolution that require area agency or program action, the area agency or program shall send written documentation of implementation of such actions to the complaint investigator within 20 business days of the date of the final report, unless a shorter timeline is specified. If implementation of the action will take longer than 20 business days, the area agency or program shall send documentation to the complaint investigator of the planned action within 20 business days from the date of the report, and shall send written documentation demonstrating implementation of the action to the complaint investigator upon completion. .

(y) An area agency or a program may conduct its own investigation of a complaint. Such an investigation shall not commence until an OCLS complaint report is final.

History

(See Revision Note at part heading for He-M 202) #5830, eff 5-24-94, EXPIRED: 5-24-00
#7730, eff 7-24-02; ss by #9754, INTERIM, eff 7-24-10, EXPIRED: 1-20-11
#9962, eff 8-15-11; ss by #12940, eff 12-10-19

N.H. Code Admin. R. Ann. He-M 202.08 Appeal {#sec-he-m-202.08 omnilex-key=us-nh-regs-official--agency-he-m--He-M 202.08}

(a) Within 30 days of receipt of a final determination pursuant to He-M 202.07 (w), or determinations concerning eligibility termination or suspension of services pursuant to He-M 503 or He-M 522, an individual, applicant, or guardian may appeal in accordance with He-C 200.

(b) Appeals shall be forwarded, in writing, to the OCLS. The OCLS shall immediately forward each appeal to the department’s administrative appeals unit which shall assign a presiding officer to conduct a hearing, as provided in He-C 200.

(c) The presiding officer conducting the hearing or review for the administrative appeals unit shall issue final decisions on behalf of the commissioner.

(d) Nothing in He-M 202.08 shall limit an individual’s right to appeal decisions under He-M 503 or other department rules.

(e) The burden of proof in appeals shall be determined in accordance with He-C 203.14.

(f) In appeals of decisions under He-M 202.07 (w), the presiding officer shall forward the decision to the bureau administrator, who shall issue orders related to corrective action as is necessary to bring the area agency or program into compliance with department rules.

(g) Parties regarding whom corrective action is ordered pursuant to (f) above shall take such action within 20 days of the order unless a shorter timeframe is specified by the bureau administrator.

(h) Except as provided in He-M 310, an award of money damages shall not be made.

History

(See Revision Note at part heading for He-M 202) #5830, eff 5-24-94, EXPIRED: 5-24-00
#7730, eff 7-24-02; amd by #8186, eff 10-2-04; ss by #9754, INTERIM, eff 7-24-10, EXPIRED: 1-20-11
#9962, eff 8-15-11; ss by #12940, eff 12-10-19

N.H. Code Admin. R. Ann. He-M 202.09 Complaint Investigator Training and Data Collection {#sec-he-m-202.09 omnilex-key=us-nh-regs-official--agency-he-m--He-M 202.09}

(a) A complaint investigator shall have, at a minimum:

(1) A bachelor’s degree from an accredited college in social work, sociology, psychology, human services, related behavioral services, or criminal justice, and experience in performing complaint investigations totaling 2 years or more; or

(2) Experience in developmental disabilities in New Hampshire totaling 3 years or more in an area such as:

a. Service coordination;

b. Program management; or

c. Quality assurance.

(b) Each complaint investigator shall participate in in-service training offered by the department. The OCLS shall train each newly hired complaint investigator and schedule annual training to occur for all complaint investigators.

(1) Reviewing investigatory procedures and methods;

(2) Investigation report writing;

(3) Rights;

(4) Options for complaint resolution;

(5) Advocacy resources; and

(6) Related topics.

(d) Participants shall sign in at the time of training as verification of attendance.

(e) The OCLS shall maintain a list of those who have completed complaint investigator in-service training.

(f) A newly hired complaint investigator without experience in investigating cases of abuse, neglect, and exploitation or rights violations shall:

(1) First observe an experienced complaint investigator over the course of 2 investigations;

(2) Then be observed by an experienced complaint investigator while performing 2 investigations; and

(3) Be determined, as judged by the experienced investigator, to be capable of performing independently.

(g) A complaint investigator shall investigate an allegation of abuse, neglect, exploitation, or a rights violation only after the investigator has received training identified in (b) and (f) above.

(h) Complaint investigators shall meet quarterly with OCLS to review cases and discuss issues, concerns, and possible resolutions.

(i) On a semi-annual basis, the OCLS shall compile data collected from complaint investigators into a report that contains:

(1) The number of complaints filed;

(2) The types of complaints, such as abuse, neglect, exploitation, service availability, or quality of care;

(3) Identification of the complaints as founded or unfounded; and

(4) Any trends or systemic factors identified in the process of complaint investigation.

(j) OCLS shall send the report prepared pursuant to (i) above to:

(1) The bureau administrator;

(2) The area agency executive directors;

(3) The human rights committees established pursuant to RSA 171-A:17, I; and

(4) The developmental services quality council established pursuant to RSA 171-A:33.

(k) The OCLS shall solicit feedback on the report from the developmental services quality council and use this information to improve complaint investigator training, the investigatory process, and quality of services.

History

(See Revision Note at part heading for He-M 202) #5830, eff 5-24-94, EXPIRED: 5-24-00
#7730, eff 7-24-02; ss by #9754, INTERIM, eff 7-24-10, EXPIRED: 1-20-11
#9962, eff 8-15-11; ss by #12940, eff 12-10-19

N.H. Code Admin. R. Ann. He-M 202.10 Waivers {#sec-he-m-202.10 omnilex-key=us-nh-regs-official--agency-he-m--He-M 202.10}

(a) A area agency or program may request a waiver of specific procedures outlined in He-M 202 using the form titled “NH Bureau of Developmental Services Waiver Request.”

(b) The entity requesting a waiver shall:

(1) Complete the form entitled “NH Bureau of Developmental Services Waiver Request” (September 2013 edition); and

(2) Include a signature from the individual(s) or legal guardian(s) indicating agreement with the request and the area agency’s executive director or designee recommending approval of the waiver.

(d) No provision or procedure prescribed by statute shall be waived.

(e) The request for a waiver shall be granted by the commissioner or his or her designee within 30 days if the alternative proposed by the requesting entity meets the objective or intent of the rule and it:

(1) Does not negatively impact the health or safety of the individual(s);

(2) Does not affect the quality of services to individuals; and

(3) Does not interfere with the procedural or substantive rights afforded an individual under He-M 202, He-M 310, and RSA 171-A:14, 15, and 29.

(f) The determination on the request for a waiver shall be made within 30 days of the receipt of the request.

(g) Upon receipt of approval of a waiver request, the program’s or area agency’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.

(h) Waivers shall be granted in writing for a specific duration not to exceed 5 years except as in (i) below.

(i) Any waiver shall end with the closure of the related program or service.

(j) An area agency or program may request a renewal of a waiver from the bureau. Such request shall be made at least 90 days prior to the expiration of a current waiver.

(k) A request for renewal of a waiver shall be approved in accordance with the criteria specified in(e) above.

History

(See Revision Note at part heading for He-M 202) #5830, eff 5-24-94, EXPIRED: 5-24-00
#7730, eff 7-24-02; ss by #9754, INTERIM, eff 7-24-10, EXPIRED: 1-20-11
#9962, eff 8-15-11

Part He-M 203 Complaint Resolution Procedures for Family-Centered Early Supports and Services

N.H. Code Admin. R. Ann. He-M 203.01 Purpose {#sec-he-m-203.01 omnilex-key=us-nh-regs-official--agency-he-m--He-M 203.01}

The purpose of these rules is to define the procedures for the lead agency for Part C of IDEIA for the resolution of complaints asserting a violation of the rights of families, including infants and toddlers with disabilities, applying for or receiving family-centered early supports and services pursuant to He-M 510.

History

#5744, eff 12-1-93; ss by #6727, eff 4-1-98; ss by #7233, eff 4-22-00; ss by #9135, INTERIM, eff 4-22-08, EXPIRED: 10-19-08
#9593, eff 11-11-09; ss by #10324, eff 4-26-13

N.H. Code Admin. R. Ann. He-M 203.02 Definitions {#sec-he-m-203.02 omnilex-key=us-nh-regs-official--agency-he-m--He-M 203.02}

The words and phrases used in these rules shall have the following meanings:

(a) “Applicant” means any person under the age of 3 whose parent requests services pursuant to He-M 510.06;

(b) “Area agency” means “area agency” as defined in RSA 171-A:2, I-b, namely, “an entity established as a nonprofit corporation in the state of New Hampshire which is established by rules adopted by the commissioner to provide or coordinate services to developmentally disabled persons in the area in accordance with 42 CFR 441.301.”;

(d) “Bureau administrator” means the chief administrator of the bureau;

(e) “Child” means an infant or toddler with a disability who is under 3 years of age and:

(1) Is at risk for, or has a developmental delay;

(2) Exhibits atypical behavior; or

(3) Has an established condition

(f) “Commissioner” means the commissioner of the NH department of health and human services or their designee;

(g) “Complainant” means a parent, family, individual or organization that makes a complaint in accordance with He-M 203.04 or He-M 203.11;

(h) “Department” means the New Hampshire department of health and human services;

(i) “Established condition” means that a child has a diagnosed physical or mental condition that has a high probability of resulting in a developmental delay, even if no delay exists at the time of referral, as documented by the family and personnel listed in He-M 510.11 (b)(1), including, at a minimum, conditions such as:

(1) Chromosomal anomaly or genetic disorder;

(2) Inborn errors of metabolism;

(3) A congenital malformation;

(4) A severe infectious disease;

(5) A neurological disorder;

(6) A sensory impairment;

(7) A severe attachment disorder;

(8) Fetal alcohol spectrum disorder;

(9) Lead poisoning; or

(10) Toxic exposure;

(j) “Family-centered early supports and services (FCESS)” means a wide range of activities and assistance, based on peer reviewed research to the extent practicable, that develops and maximizes the family’s and other caregivers’ ability to care for the child and to meet his or her needs in a flexible manner;

(k) “Family-centered early supports and services (FCESS) program” means a program under contract with the department to provide FCESS as defined by He-M 510;

(l) “Foster parent” means a person with whom a child lives and who is licensed pursuant to He-C 6446 and certified pursuant to He-C 6347;

(m) “Impartial person” means someone who:

(1) Is not an employee of any agency or other entity that:

a. Is involved in the provision of early supports and services;

b. Provides care for children; or

c. Provides care for applicants;

(2) Does not have a personal or professional interest that would conflict with his or her objectivity in hearing a complaint brought under these rules; and

(3) Is not considered to have a conflict solely because the person is paid by the department to implement the He-M 203 complaint resolution process;

(n) “Informed decision” means “informed decision” as defined in RSA 171-A:2, XI, namely, “a choice made by a client or potential client or, where appropriate, his legal guardian that is reasonably certain to have been made subsequent to a rational consideration on his part of the advantages and disadvantages of each course of action open to him.”;

(o) “Mediator” means an impartial person who:

(1) Is qualified through completion of a mediation training course from an organization that provides such training or who has at least 5 years’ experience as a mediator;

(2) Is knowledgeable in the laws and regulations relating to the provision of early supports and services;

(3) Is not an employee of the department or any agency or other entity involved in the dispute to be mediated; and

(4) Is selected on a random, rotational, or other impartial basis;

(p) “Parent” means:

(1) A biological or adoptive parent of a child; or

(2) As identified in a judicial decree or when the biological or adoptive parent does not have legal authority to make educational or FCESS decisions on behalf of the child:

a. A guardian authorized to act as the child’s parent, or authorized to make early intervention, educational, health, or developmental decisions for the child, but not the state if the child is in the custody of the New Hampshire division for children, youth, and families;

b. A foster parent as defined in (l) above;

c. An individual acting in the place of a biological or adoptive parent, including a grandparent, stepparent, or other relative with whom the child lives;

d. A surrogate parent as defined in He-M 510.02 (am); or

e. Any other individual who is legally responsible for the child’s welfare;

(q) “Part C of the IDEIA” means Part C of Public Law 108-446, Individuals with Disabilities Education Improvement Act of 2004, 20 U.S.C. 1400 et seq; and

(r) “Provider” means a person receiving any form of remuneration for the provision of services to a child or applicant.

History

#5744, eff 12-1-93; ss by #6727, eff 4-1-98; ss by #7233, eff 4-22-00; ss by #9135, INTERIM, eff 4-22-08, EXPIRED: 10-19-08
#9593, eff 11-11-09; ss by #10324, eff 4-26-13; ss by #13751, eff 9-23-23

N.H. Code Admin. R. Ann. He-M 203.03 Informal Resolutions {#sec-he-m-203.03 omnilex-key=us-nh-regs-official--agency-he-m--He-M 203.03}

At the option of the parent, concerns regarding FCESS may be addressed informally. However, at any time during informal resolution the family may make a complaint under He-M 203 or any other applicable administrative rule, state statute, or federal regulation.

History

#5744, eff 12-1-93; ss by #6727, eff 4-1-98; ss by #7233, eff 4-22-00; ss by #9135, INTERIM, eff 4-22-08, EXPIRED: 10-19-08
#9593, eff 11-11-09 (from He-M 203.09); ss by #10324, eff 4-26-13

N.H. Code Admin. R. Ann. He-M 203.04 Resolution of Individual Child Complaints – Mediation {#sec-he-m-203.04 omnilex-key=us-nh-regs-official--agency-he-m--He-M 203.04}

(a) A parent may request mediation, in writing, involving any matter under He-M 510 or He-M 203.

(b) If a parent is unable to make a request in writing, an agency or department employee receiving a complaint shall document the complaint in writing and seek to have the complaint signed by the complainant.

(d) Mediation shall be voluntary and not be used to deny or delay a parent’s right to an impartial due process hearing under He-M 203.05, Part C of IDEIA, or He-M 510.

(e) Within 10 days of a request for mediation, the mediator shall convene a session with the family and an area agency representative, at a location that is convenient to the family, to which each party may bring 3 participants.

(f) An agreement shall be to the satisfaction of all parties to the dispute and not in conflict with state or federal law, rule, or policy.

(g) The mediator shall record in writing any agreement reached during a mediation session and include:

(1) A description of the resolution; and

(2) A statement describing the requirements of (j) below.

(h) All parties shall sign the written agreement.

(i) The mediator shall provide all parties with a copy of the written agreement.

(j) Discussions that occur during the mediation process shall be held confidential and not be used as evidence in any subsequent impartial due process hearings or civil proceedings.

(k) If resolution is reached during mediation, the written agreement shall be legally binding and enforceable in a state court of competent jurisdiction or in a U.S. district court.

(l) Parents may simultaneously file a written request for mediation and for an impartial due process hearing. If an agreement is reached in mediation, the due process hearing shall be cancelled.

(m) Mediation shall be completed within 30 days of the receipt of a request for mediation.

(n) The implementation of all procedural safeguards, including mediation, shall be carried out at the expense of the bureau.

History

#5744, eff 12-1-93; ss by #6727, eff 4-1-98; ss by #7233, eff 4-22-00; ss by #9135, INTERIM, eff 4-22-08 EXPIRED: 10-19-08
#9593, eff 11-11-09 (from He-M 203.10); ss by #10324, eff 4-26-13

N.H. Code Admin. R. Ann. He-M 203.05 Resolution of Individual Child Complaints – Requesting an Impartial Due Process Hearing {#sec-he-m-203.05 omnilex-key=us-nh-regs-official--agency-he-m--He-M 203.05}

(a) A parent may request an impartial due process hearing to address a complaint related to the identification, evaluation, or provision of appropriate early supports and services for his or her child.

(b) The complaint described in (a) above shall allege a violation that occurred not more than one year prior to the date that the complaint is received.

(c) Mediation, pursuant to He-M 203.04, shall be made available to the parent whenever an impartial due process hearing is requested.

(d) Parents shall submit requests for an impartial due process hearing to address a complaint, in writing, to the bureau and send a copy to the FCESS program and area agency.

(e) If a parent is unable to make a request in writing, the agency or department employee receiving a complaint shall document the complaint in writing and seek to have the complaint signed by the complainant.

(f) The written request in (d)-(e) above shall include:

(1) The child’s name and home address;

(2) The name of the provider or FCESS program serving the child;

(3) A statement identifying the points of disagreement related to the identification, evaluation, or provision of appropriate FCESS to the child or the family;

(4) A proposed resolution to the disagreement;

(5) The signature and contact information of the person submitting the complaint; and

(6) The date of the complaint.

History

#5744, eff 12-1-93; ss by #6727, eff 4-1-98; ss by #7233, eff 4-22-00; ss by #9135, INTERIM, eff 4-22-08, EXPIRED: 10-19-08
#9593, eff 11-11-09 (from He-M 202.03); ss by #10324, eff 4-26-13; ss by 13751, eff 9-23-23

N.H. Code Admin. R. Ann. He-M 203.06 Status of a Child During Proceedings {#sec-he-m-203.06 omnilex-key=us-nh-regs-official--agency-he-m--He-M 203.06}

(a) During the pendency of any proceeding involving a complaint under He-M 203 the child shall continue to receive the FCESS currently being provided unless the area agency and the parents of the child otherwise agree.

(b) If the complaint involves an initial application for FCESS, the child shall receive those services that are not in dispute.

History

#5744, eff 12-1-93; ss by #6727, eff 4-1-98; ss by #7233, eff 4-22-00; ss by #9135, INTERIM, eff 4-22-08, EXPIRED: 10-19-08
#9593, eff 11-11-09 (from He-M 203.08); ss by #10324, eff 4-26-13

N.H. Code Admin. R. Ann. He-M 203.07 Appointment of Impartial Person {#sec-he-m-203.07 omnilex-key=us-nh-regs-official--agency-he-m--He-M 203.07}

(a) An impartial person shall be appointed by the commissioner to hear matters brought under He-M 203.05.

(b) That impartial person shall:

(1) Have knowledge of the provisions of Part C of the IDEIA;

(2) Have knowledge of the needs of, and services available for, children and their families as set out in He-M 510 and of their other rights as set out in He-M 203 and pursuant to state law and federal regulation; and

(3) Include, but not be limited to, presiding officers as defined in RSA 541-A:1, XIV and mediators as defined in He-M 203.02 (o).

(1) Listen to the presentation of relevant viewpoints about the complaint;

(2) Examine all information relevant to the issues;

(3) Reach and issue a written decision on the complaint within 30 days of the date of the complaint; and

(4) Provide for a verbatim tape recorded or written record of the proceedings.

(d) In the written decision, the impartial person shall require the area agency to implement the resolution of the complaint consistent with the contract between the department and the area agency, He-M 203, other administrative rules, state statute, and Part C of the IDEIA, as applicable.

History

#5744, eff 12-1-93; ss by #6727, eff 4-1-98; ss by #7233, eff 4-22-00; ss by #9135, INTERIM, eff 4-22-08, EXPIRED: 10-19-08
#9593, eff 11-11-09 (from He-M 203.04); ss by #10324, eff 4-26-13

N.H. Code Admin. R. Ann. He-M 203.08 Parent’s Rights in Due Process Hearings for Resolving Individual Child Complaints {#sec-he-m-203.08 omnilex-key=us-nh-regs-official--agency-he-m--He-M 203.08}

Any parent involved in a due process hearing under He-M 203.05 may:

(a) Be accompanied and advised by counsel and by individuals with special knowledge or training with respect to family-centered early supports and services for children, at his or her own expense;

(b) Compel the attendance of witnesses;

(d) Prohibit the introduction of any evidence at the proceedings that has not been disclosed to the parent at least 5 days before the hearings;

(e) Obtain a written or electronic verbatim transcription of the hearings at no cost to the parent; and

(f) Receive written findings of fact and decisions from the impartial person within 30 days of the date of the complaint, at no cost to the parent.

History

#5744, eff 12-1-93; ss by #6727, eff 4-1-98; ss by #7233, eff 4-22-00; ss by #9135, INTERIM, eff 4-22-08, EXPIRED: 10-19-08
#9593, eff 11-11-09 (from He-M 203.05); ss by #10324, eff 4-26-13

N.H. Code Admin. R. Ann. He-M 203.09 Due Process Hearing Scheduling and Timelines {#sec-he-m-203.09 omnilex-key=us-nh-regs-official--agency-he-m--He-M 203.09}

(a) Any due process hearings brought pursuant to He-M 203 shall be held at a time and place convenient to the parent.

(b) The impartial person shall, no later than 30 days after the initial receipt of a parent’s complaint under He-M 203.05, complete the due process hearing and issue and mail a written decision to each of the parties.

(c) The impartial person may grant specific extensions of time beyond the period set out in (b) above at the request of either party.

History

#5744, eff 12-1-93; ss by #6727, eff 4-1-98; ss by #7233, eff 4-22-00; ss by #9135, INTERIM, eff 4-22-08, EXPIRED: 10-19-08
#9593, eff 11-11-09; ss by #10324, eff 4-26-13

N.H. Code Admin. R. Ann. He-M 203.10 Civil Action {#sec-he-m-203.10 omnilex-key=us-nh-regs-official--agency-he-m--He-M 203.10}

Any party aggrieved by the findings and decisions of the appointed impartial person in the due process proceedings as set out in He-M 203.03 through He-M 203.08 may immediately bring a civil action in state or federal court under § 639 (a) (1) of the IDEIA.

History

#5744, eff 12-1-93; ss by #6727, eff 4-1-98; ss by #7233, eff 4-22-00; ss by #9135, INTERIM, eff 4-22-08, EXPIRED: 10-19-08
#9593, eff 11-11-09 (from He-M 203.07); ss by #10324, eff 4-26-13

N.H. Code Admin. R. Ann. He-M 203.11 State Administrative {#sec-he-m-203.11 omnilex-key=us-nh-regs-official--agency-he-m--He-M 203.11}

Complaints.

(a) A parent, family, individual, or organization may forward a signed, written complaint that the department, an area agency, FCESS program, or provider is violating or has violated Part C of IDEIA requirements to the bureau and the FCESS provider agency.

(b) A written, signed complaint shall include:

(1) A statement that the department, area agency, FCESS program, or provider has violated Part C of IDEIA requirements;

(2) The facts on which the complaint is based;

(3) The contact information for the complainant; and

(4) If alleging violations with respect to a specific child:

a. The name and address of the child;

b. The name of the area agency, FCESS program, or provider serving the child;

c. A description of the nature of the problem, including facts relating to the problem; and

d. A proposed resolution of the problem, to the extent known and available to the party at the time the complaint was filed.

(c) The alleged violation shall have occurred not more than one year before the date that the complaint is received by the bureau administrator unless:

(1) The alleged violation continues for that child or other children; or

(2) The complainant is requesting reimbursement or corrective action for a violation that occurred not more than 3 years before the date on which the complaint is received by the bureau administrator.

(d) Within 60 days of receipt of the complaint, the bureau administrator or his or her designee shall:

(1) Carry out an independent on-site investigation;

(2) Give the complainant the opportunity to submit additional information, either orally or in writing, about the allegations in the complaint;

(3) Provide the area agency, FCESS program, or provider with an opportunity to respond to the complaint including a proposal to resolve the complaint;

(4) Review all relevant information and make an independent determination as to whether the area agency, FCESS program, or provider is violating a requirement of Part C of the IDEIA;

(5) Provide the opportunity for a parent who has filed a complaint and the area agency, FCESS program, or provider to voluntarily engage in mediation consistent with He-M 203.04; and

(6) Issue a written decision to the complainant that addresses each allegation in the complaint and contains:

a. Findings of fact and conclusions;

b. The reasons for the department's final decision; and

c. Procedures for effective implementation of the final decision, if needed, including technical assistance activities, negotiations, and corrective actions to achieve compliance.

(e) A 60 day extension of the time limit under (d) above shall be authorized by the bureau administrator or his or her designee, pursuant to Part C of the IDEIA, if:

(1) The case involves complex issues such that the investigation cannot be completed within the 60 days allowed under (d) above; or

(2) The parties involved agree to extend the time to engage in mediation under He-M 203.04.

(f) If a written complaint is received that is also the subject of a due process hearing, or contains multiple issues, of which one or more are part of that hearing, the department shall set aside any part of the complaint that is being addressed in the due process hearing until the conclusion of the hearing. However, any issue in the complaint that is not a part of the due process action shall be solved within the 60-calendar-day timeline using the complaint procedures described above.

(g) If an issue is raised in a complaint that has been previously decided in a due process hearing involving the same parties:

(1) The due process hearing decision shall be binding on that issue; and

(2) The department shall inform the complainant to that effect.

(h) A complaint alleging an area agency’s, FCESS program’s, or provider’s failure to implement a due process decision shall be resolved by the department.

History

#6727, eff 4-1-98; ss by #7233, eff 4-22-00; ss by #9135, INTERIM, eff 4-22-08, EXPIRED 10-19-08
#9593, eff 11-11-09; ss by #10324, eff 4-26-13

N.H. Code Admin. R. Ann. He-M 203.12 Notice of Procedural Safeguards {#sec-he-m-203.12 omnilex-key=us-nh-regs-official--agency-he-m--He-M 203.12}

(a) Parents and other interested individuals and organizations to include surrogate parents, area agencies, local programs, advocate programs, or anyone who may be associated with the child and family, shall be informed by the department about the complaint procedures described in He-M 203 at a minimum by making available on the department’s website at https://www.dhhs.nh.gov/programs-services/disability-care/developmental-services/birth-3-family-centered-early-supports-1 the “Know Your Rights” handbook, as approved by the United States Office of Special Education Programs, pursuant to Part C of the IDEIA.

(b) Hard copies shall be made available upon request to:

(1) Area agencies;

(2) FCESS programs and providers;

(3) Parents;

(4) The Parent Information Center;

(5) The Disabilities Rights Center, Inc.; and

(6) Other interested parties.

History

#10324, eff 4-26-13; ss by #13751, eff 9-23-23

Part He-M 204 Rights Protection Procedures for Mental Health Services

N.H. Code Admin. R. Ann. He-M 204.01 Purpose {#sec-he-m-204.01 omnilex-key=us-nh-regs-official--agency-he-m--He-M 204.01}

The purpose of these rules is to define the procedures for protection of the rights of persons applying for, eligible for, or receiving mental health services which are funded, monitored or regulated by the department, and state mental health facilities, community mental health programs, community mental health providers or their subcontracted service providers.

History

(See Revision Note at part heading for He-M 204) #5868, eff 7-15-94, EXPIRED 7-15-00
#9850, eff 1-20-11, EXPIRED: 1-20-19
#12731, INTERIM RULE, eff 2-22-19, EXPIRED: 8-21-19
#12878, eff 9-25-19

N.H. Code Admin. R. Ann. He-M 204.02 Definitions {#sec-he-m-204.02 omnilex-key=us-nh-regs-official--agency-he-m--He-M 204.02}

(a) “Abuse” means an act or omission by an employee, subcontracted service provider, consultant, student, intern, or volunteer of a program which is not accidental and harms or threatens to harm an individual’s physical, mental, or emotional health or safety and includes emotional abuse, physical abuse, and sexual abuse.

(b) “Administrator” means the chief administrator for the bureau of mental health services of the department of health and human services.

(c) “Agency” means a facility, community mental health program, community mental health provider, or any of their subcontracted service providers.

(d) “Agency director” means the person responsible for the overall administration or operation of a CMHP, community mental health provider, peer support agency, emergency shelter, or facility or the agency director’s designee.

(e) “Bureau of mental health services (BMHS)” means the bureau of mental health services of the department of health and human services.

(f) “Coercion” means an act by an employee, subcontracted service provider, student, intern, or volunteer, which is designed to compel an individual to act in clear opposition to the preference of the individual excluding involuntary admissions, revocations of conditional discharge, the imposition of emergency treatment, and as otherwise prescribed by law or rule.

(g) “Commissioner” means the commissioner of the department of health and human services or the commissioner’s designee.

(h) “Community mental health program (CMHP)” means “community mental health program” as defined in RSA 135-C:2, IV.

(i) “Community mental health provider” means a medicaid provider of community mental health services that has been approved by the commissioner to provide specific mental health services pursuant to He-M 426.

(j) “Complaint” means:

(1) Any allegation or assertion that a right of an individual as set forth in He-M 309, rights of persons receiving mental health services in the community, or He-M 311, rights of persons in state mental health facilities, have been violated; or

(2) Any allegation or assertion that the department or an agency has acted in an illegal or unjust manner with respect to an individual or category of individuals.

(k) “Complaint investigator” means the person who is designated by office of client and legal services or a facility to investigate, resolve, or take other appropriate action on complaints.

(l) “Complaint manager” means a person designated by the community mental health program or the community mental health provider who is responsible for receiving, managing, and resolving complaints in accordance with these rules.

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

(n) “Emotional abuse” means any of the following when the act results, or is likely to result in the mental anguish or emotional distress of an individual:

(1) The misuse of power, authority, or both;

(2) Harassment, such as:

a. Intimidation;

b. Humiliation; or

c. Degradation; or

(3) Unreasonable confinement.

(o) “Exploitation” means the use of an individual’s person or property for another’s profit or advantage, or breach of a fiduciary relationship through improper use of an individual’s person or property, including situations where a person obtains property or services from an individual through undue influence, harassment, deception, fraud, or duress.

(p) “Facility” means New Hampshire hospital, Glencliff home, Hampstead hospital and residential treatment facility, or any other treatment program designated under RSA 135-C:26.

(q) “Facility administrator” means the chief executive officer at New Hampshire hospital or Hampstead hospital and residential treatment facility, or administrator at Glencliff home, or any other treatment program designated under RSA 135-C:26.

(r) “Founded” means that the facts indicate that the rights of an individual under He-M 309 or He-M 311 were violated.

(s) “Guardian” means a person appointed by the court pursuant to RSA 464-A:9 to have care and custody of an individual, or the parent or legal custodian of a minor child.

(t) “Individual” means a consumer as defined by He-M 401.02 or an individual as defined in He-M 311.02, who has applied for, has been found eligible for, or is receiving state-funded services from an agency, or peer support agency, or a guardian acting on the individual’s behalf.

(u) “Neglect” means “neglect” as defined in RSA 135-C:2, XI namely, “an act or omission which results or could result in the deprivation of essential services or supports necessary to maintain the minimum mental, emotional, or physical health and safety of an incapacitated adult”. This term also applies to an individual.

(v) “Office of client and legal services (OCLS)” means the client and legal services section of the department established by RSA 171-A:19 to, in part, assist the commissioner in responding to complaints by or on behalf of individuals with mental illness.

(w) “Physical abuse” means the use of physical force which results or is likely to result in physical injury to an individual.

(x) “Restraint” means:

(1) Any drug or medication when it:

a. Is used as a restriction to manage an individual’s behavior or restrict the individual’s freedom of movement; and

b. Is not a standard treatment or dosage for the individual’s condition, in that its overall effect reduces an individual’s ability to effectively or appropriately interact;

(2) Any manual method, physical or mechanical device, material, or equipment that immobilizes an individual or reduces the ability of an individual to move their arms, legs, head, or other body parts freely but does not include devices, such as orthopedically prescribed devices, surgical dressings or bandages, protective helmets, or other methods that involve the physical holding of an individual, if necessary, for the purpose of:

a. Conducting routine physical examinations or tests;

b. Protecting the individual from falling out of bed; or

c. Permitting the individual to participate in activities without the risk of physical harm; or

(3) “Restraint” as defined in RSA 126-U:1, IV when the individual is a child as defined in RSA 126-U:1, I.

(y) “Seclusion” means:

(1) The involuntary confinement of an individual who:

a. Is placed alone in a room or area from which the individual is physically prevented, by lock or person, from leaving; and

b. Cannot or will not make an informed decision to agree to such confinement; or

(2) “Seclusion” as defined in RSA 126-U:1, V-a when the individual is a child as defined in RSA 126-U:1, I.

(z) “Sexual abuse” means contact or interaction of a sexual nature between an individual and an employee of, a consultant, or a volunteer for a program.

(aa) “Unfounded” means that the facts do not indicate that the rights of an individual under He-M 309 or He-M 311 were violated.

(ab) “Unreasonable confinement” means any confinement which is neither medically necessary nor necessary for the protection of a person or to prevent harmful behavior, or confinement used with punitive intent.

History

(See Revision Note at part heading for He-M 204) #5868, eff 7-15-94, EXPIRED 7-15-00
#9850, eff 1-20-11, EXPIRED: 1-20-19
#12731, INTERIM RULE, eff 2-22-19, EXPIRED: 8-21-19
#12878, eff 9-25-19; ss by #14033-A, eff 7-30-24

N.H. Code Admin. R. Ann. He-M 204.03 Responsibility for Rights Protection {#sec-he-m-204.03 omnilex-key=us-nh-regs-official--agency-he-m--He-M 204.03}

(a) Each agency shall have the responsibility for rights protection in accordance with these rules both in the services it operates and in the services it provides by contract with third parties.

(b) Agencies that are operated directly by the department shall have the responsibility for rights protection in accordance with these rules.

(d) A peer support agency shall have complaint procedures that comply with He-M 315.10.

(e) Each agency shall have one or more staff persons designated as complaint managers to receive complaints in accordance with these rules at all times.

(f) Each peer support agency shall have one or more staff persons designated as complaint investigators to receive complaints in accordance with these rules at all times.

History

(See Revision Note at part heading for He-M 204) #5868, eff 7-15-94, EXPIRED 7-15-00
#9850, eff 1-20-11, EXPIRED: 1-20-19
#12731, INTERIM RULE, eff 2-22-19, EXPIRED: 8-21-19
#12878, eff 9-25-19

N.H. Code Admin. R. Ann. He-M 204.04 Allegations of Abuse, Neglect, and Exploitation {#sec-he-m-204.04 omnilex-key=us-nh-regs-official--agency-he-m--He-M 204.04}

(a) Any person who suspects or believes in good faith that an individual has been subject to abuse, neglect, or exploitation, as defined in RSA 161-F, RSA 169-C, or these rules shall:

(1) Take all practicable steps to protect the individual; and

(2) Report the instance, including the issues presented and the actions taken, of abuse, neglect or exploitation to the Bureau of Elderly and Adult Services (BEAS) or division of children youth and families (DCYF), as appropriate, OCLS and the agency director.

(b) BEAS shall investigate allegations of abuse, neglect, and exploitation in accordance with RSA 161-F.

(d) Upon completion of the investigations that occurred in accordance with (b) and (c) above, BEAS or DCYF, respectively, shall report the findings to OCLS and the appropriate agency.

(e) In the event of the death of an individual the agency shall report on the circumstances surrounding the death to the department, in compliance with department’s quality assurance measures under RSA 126-A:4, IV.

History

(See Revision Note at part heading for He-M 204) #5868, eff 7-15-94, EXPIRED 7-15-00
#9850, eff 1-20-11, EXPIRED: 1-20-19
#12731, INTERIM RULE, eff 2-22-19, EXPIRED: 8-21-19
#12878, eff 9-25-19

N.H. Code Admin. R. Ann. He-M 204.05 Complaints {#sec-he-m-204.05 omnilex-key=us-nh-regs-official--agency-he-m--He-M 204.05}

(a) A complaint as defined in He-M 204.02 (j) may be made by any person, including but not limited to:

(1) An individual;

(2) An individual’s guardian;

(3) An applicant for services; or

(4) An employee of:

a. The department; or

b. An agency.

(b) A complaint may be made orally or in writing to any employee of an agency.

(c) Complaints alleging coercion, restraint, seclusion, or retaliation may be made to the complaint manager or to OCLS orally or in writing.

(d) Agency staff shall put the complaint in writing and seek to have it signed by the complainant.

(e) Agencies shall designate a staff person to receive and respond to complaints as described in (g) through (k) below.

(f) All complaints shall be submitted to the complaint manager except for as described in He-M 204.11.

(g) At any point in the complaint process, the individual shall have the right to:

(1) Have a person advocate on his or her behalf, including but not limited to:

a. A peer support advocate;

b. An advocate from the Disability Rights Center-NH; or

c. A person designated by the individual to function in that capacity;

(2) Decide whether the complaint is resolved formally or informally; and

(3) Elect a formal resolution if informal resolution efforts do not address the issue in a manner deemed satisfactory by the individual.

(h) The expense of advocacy, if any, shall be borne by the individual.

(i) The complaint manager shall:

(1) Explain to the individual the processes for resolution:

a. Informal resolution through the agency in accordance with He-M 204.07; or

b. Formal resolution through the department in accordance with He-M 204.08;

(2) Notify the individual of his or her rights described in (g) above; and

(3) Ensure that the safety of the individual is protected.

(j) If the individual has a guardian, the agency staff person shall notify the guardian of the complaint.

(k) Except as described in He-M 204.11, if the individual chooses to resolve the complaint formally:

(1) The complaint manager shall immediately forward the complaint to OCLS; and

(2) Within 3 business days, OCLS shall designate a complaint investigator for initiation of the formal resolution process in accordance with He-M 204.08.

(l) A designated complaint investigator shall not be an employee of the CMHP nor shall an employee of one CMHP be designated to investigate a complaint at another CMHP.

(m) Employees of the department or agency shall assist persons to file complaints.

(n) Employees of the department or agency shall provide information to obtain advocacy services.

(o) A complainant may request to keep his or her identity confidential throughout the complaint process.

(p) If the confidentiality of the complainant interferes with the investigation and/or the resolution of the complaint, the complaint investigator or complaint manager shall:

(1) Notify the complainant if his or her request for confidentiality in (o) above interferes with the investigation and resolution of the complaint; and

(2) Work collaboratively with the complainant to determine whether or not his or her identity will be revealed.

(q) Except for as described in He-M 204.11, agencies shall maintain a record of complaints filed which contain the following information:

(1) The nature of the complaint with reference to the section(s) of He-M 309 that coincide with the alleged violation;

(2) The outcome of the informal resolution;

(3) The length of time to resolve the complaint from the time of the filing of the complaint through resolution; and

(4) Whether or not the complaint was forwarded for formal resolution.

(r) For any complaints involving allegations of seclusion or restraint of a child, the agency shall comply with the notice and reporting requirements of RSA 126-U:7 and 10.

History

(See Revision Note at part heading for He-M 204) #5868, eff 7-15-94, EXPIRED 7-15-00
#9850, eff 1-20-11, EXPIRED: 1-20-19
#12731, INTERIM RULE, eff 2-22-19, EXPIRED: 8-21-19
#12878, eff 9-25-19

N.H. Code Admin. R. Ann. He-M 204.06 Protection from Retaliation {#sec-he-m-204.06 omnilex-key=us-nh-regs-official--agency-he-m--He-M 204.06}

(a) No individual or applicant for services shall be subject to any form of harassment or retaliation by any person under the jurisdiction of the department as a result of filing a complaint.

(b) No employee of the department or an agency shall be subject to any form of discipline as a result of filing a complaint when such complaint is made in good faith.

(c) Except when necessary to protect the health and safety of the individual and others, an agency shall not discontinue, amend, or otherwise disrupt services provided to the individual as a result of that individual or a person acting on the individual’s behalf filing a complaint.

History

(See Revision Note at part heading for He-M 204) #5868, eff 7-15-94, EXPIRED 7-15-00
#9850, eff 1-20-11, EXPIRED: 1-20-19
#12731, INTERIM RULE, eff 2-22-19, EXPIRED: 8-21-19
#12878, eff 9-25-19

N.H. Code Admin. R. Ann. He-M 204.07 Informal Resolution {#sec-he-m-204.07 omnilex-key=us-nh-regs-official--agency-he-m--He-M 204.07}

(a) The individual may choose to resolve the complaint through the informal resolution process.

(b) The objective of informal resolution shall be to empower, engage, and assist the individual to resolve the problem through techniques such as negotiation and mediation.

(c) Informal resolution shall be completed within 30 days of submission of the complaint, unless the complainant authorizes an extension of time.

(d) If resolution cannot be achieved, the matter shall be subject to formal resolution as described in He-M 204.08.

(e) The individual may request the initiation of the formal resolution process at any time during the informal resolution process.

(f) Discussions that occur during the informal resolution process shall be held confidential and not used as evidence in subsequent formal resolution proceedings and administrative hearings in this part.

(g) No complaint alleging retaliation, coercion, restraint, seclusion, abuse, neglect or exploitation shall be resolved utilizing the process outlined in this section.

(h) Matters referred to OCLS may be resolved informally with the consent of the individual.

History

(See Revision Note at part heading for He-M 204) #5868, eff 7-15-94, EXPIRED 7-15-00
#9850, eff 1-20-11, EXPIRED: 1-20-19
#12731, INTERIM RULE, eff 2-22-19, EXPIRED: 8-21-19
#12878, eff 9-25-19

N.H. Code Admin. R. Ann. He-M 204.08 Formal Resolution {#sec-he-m-204.08 omnilex-key=us-nh-regs-official--agency-he-m--He-M 204.08}

(a) The complaint investigator shall investigate and attempt to resolve the complaint to the satisfaction of the individual within 20 business days of receipt of a complaint or after the individual requests initiation of the formal resolution process unless the complainant authorizes an extension.

(b) The complaint investigator, if necessary to develop relevant facts, shall:

(1) Interview:

a. The complainant;

b. The individual;

c. The guardian, if any;

d. The respondent;

e. Any witnesses to any incident on which the complaint is based; and

f. Any clinical consultant whom the investigator utilizes to assist with the investigation; and

(2) Review information in the individual’s record, policies and procedures, any physical and forensic evidence, and any other documents.

(c) Agencies shall allow designated complaint investigators unfettered access to the agency premises, staff, training records, and files of individuals who are the subjects of complaints, and any other agency documents or information relevant to the complaint investigation unless otherwise restricted by law.

(d) Two or more complaints involving the same act or incident shall be consolidated and treated as one complaint provided that:

(1) Separate notices and copies of resolutions shall be sent to each individual; and

(2) Each individual shall be given the opportunity to accept or appeal such resolution.

(e) The respondent may be represented by counsel during the interview conducted by the complaint investigator. However, the complaint investigator shall not share confidential information about the individual with the respondent or the respondent’s attorney without the permission of the individual.

(f) The complaint investigator shall prepare and submit a report to the bureau administrator which includes:

(1) The nature of the allegations;

(2) A summary of the issues presented, including those that arose during the investigation;

(3) The names of persons interviewed during the formal resolution process;

(4) The investigatory findings of fact;

(5) The dates of any reports made to BEAS or DCYF; and

(6) A list of all documents reviewed.

(g) Based upon a review of the report submitted in accordance with (f) above, the bureau administrator shall determine whether or not the complaint is founded or unfounded within 10 business days of receiving the report.

(h) The bureau administrator shall issue a decision that includes:

(1) Whether or not the complaint is founded;

(2) The basis for the determination;

(3) The corrective action that will be implemented; and

(4) The appeal procedure.

(i) The bureau administrator shall forward to the individual and the agency:

(1) The complaint investigator’s report; and

(2) The written final decision.

(j) CMHPs or community mental health providers shall implement corrective actions included in (h) above within 20 business days of the date of the decision.

(k) The CMHP or community mental health provider shall provide documentation of implementation of corrective actions in accordance with (h) above to the bureau administrator no later than 20 days from the date of the decision.

History

(See Revision Note at part heading for He-M 204) #5868, eff 7-15-94, EXPIRED 7-15-00
#9850, eff 1-20-11, EXPIRED: 1-20-19
#12731, INTERIM RULE, eff 2-22-19, EXPIRED: 8-21-19
#12878, eff 9-25-19

N.H. Code Admin. R. Ann. He-M 204.09 Emergency Action {#sec-he-m-204.09 omnilex-key=us-nh-regs-official--agency-he-m--He-M 204.09}

(a) Agencies and peer support agencies shall take emergency action on all complaints when there exists an act or circumstance that, if not promptly corrected or resolved, will likely result in serious harm to the individual, other persons, or property.

(b) An agency or peer support agency shall immediately take steps to protect the safety of the individuals involved.

History

(See Revision Note at part heading for He-M 204) #5868, eff 7-15-94, EXPIRED 7-15-00
#9850, eff 1-20-11, EXPIRED: 1-20-19
#12731, INTERIM RULE, eff 2-22-19, EXPIRED: 8-21-19
#12878, eff 9-25-19

N.H. Code Admin. R. Ann. He-M 204.10 Role and Responsibilities of Complaint Managers and Complaint Investigators {#sec-he-m-204.10 omnilex-key=us-nh-regs-official--agency-he-m--He-M 204.10}

(a) Each complaint manager and complaint investigator shall complete an in-service training offered by the department, annually and within 3 months of being hired.

(b) The in-service training shall include:

(1) A review of investigatory procedures;

(2) Rights and advocacy resources; and

(3) Informal resolution methods.

(c) Participants shall sign in at the time of training as verification of attendance, and OCLS shall maintain a list of those who have completed this training requirement.

(d) Each agency and peer support agency shall prominently post the names of the complaint managers or complaint investigator, as applicable and contact information for OCLS.

History

(See Revision Note at part heading for He-M 204) #5868, eff 7-15-94, EXPIRED 7-15-00
#9850, eff 1-20-11, EXPIRED: 1-20-19
#12731, INTERIM RULE, eff 2-22-19, EXPIRED: 8-21-19
#12878, eff 9-25-19

N.H. Code Admin. R. Ann. He-M 204.11 Special Requirements for Facilities {#sec-he-m-204.11 omnilex-key=us-nh-regs-official--agency-he-m--He-M 204.11}

The following requirements shall apply to complaints relative to facilities:

(a) All complaints shall be submitted to the designated facility complaint investigator for resolution in accordance with He-M 204.05 and 204.06;

(b) Formal resolutions shall be completed in accordance with He-M 204.08, including investigating and attempting to resolve the complaint to the satisfaction of the individual, within 20 business days of receipt of a complaint or after the individual requests initiation of the formal resolution process unless the individual authorizes an extension of time;

(c) Designated facility complaint investigators shall submit reports containing the required elements described in He-M 204.08 (f) to the facility administrator;

(d) Based on the report, the facility administrator shall determine whether or not the complaint is founded and issue orders for corrective action, in the event that the complaint is founded, within 10 business days of receiving the report;

(e) Designated facility complaint investigators shall not have responsibility for:

(1) Direct provision of services to a individual on whose behalf a complaint is forwarded for investigation; and

(2) The risk management activities of the facility;

(f) The facility administrator shall forward the decision to the individual immediately;

(g) Facilities shall record the following information:

(1) The nature of the complaint;

(2) The method of the resolution, whether formal or informal;

(3) The outcome of the formal resolution, whether founded or unfounded; and

(4) The length of time to resolve the complaint from the filing of the complaint to the resolution;

(h) Facilities shall report the information recorded in (g) above to OCLS annually; and

(i) For any complaints involving allegations of seclusion or restraint of children in schools and treatment facilities, the facility shall comply with the notice and reporting requirements of RSA 126-U:7 and 10.

History

(See Revision Note at part heading for He-M 204) #5868, eff 7-15-94, EXPIRED 7-15-00
#9850, eff 1-20-11, EXPIRED: 1-20-19
#12731, INTERIM RULE, eff 2-22-19, EXPIRED: 8-21-19
#12878, eff 9-25-19

N.H. Code Admin. R. Ann. He-M 204.12 Appeals {#sec-he-m-204.12 omnilex-key=us-nh-regs-official--agency-he-m--He-M 204.12}

(a) An individual may appeal in accordance with He-C 200 within 30 calendar days of the date of the decision pursuant to He-M 204.08 (h).

(b) Appeals shall be forwarded to the administrator, in writing, in care of the department’s OCLS.

(c) The OCLS shall immediately forward the appeal to the department’s administrative appeals unit which shall assign a presiding officer to conduct a hearing , as provided in He-C 200.

(d) The burden of proof in appeals shall be determined in accordance with He-C 203.14.

(e) The presiding officer shall issue a decision with orders for corrective action.

(f) An award of money damages shall not be made except as reimbursement for the loss of any money held in safekeeping by the community residence or a facility in accordance with He-M 309 and He-M 311.

History

#9850, eff 1-20-11, EXPIRED: 1-20-19
#12731, INTERIM RULE, eff 2-22-19, EXPIRED: 8-21-19
#12878, eff 9-25-19

Part He-M 205 Public Hearings for Rulemaking - Expired

N.H. Code Admin. R. Ann. He-M 205.01 Practice and Procedures {#sec-he-m-205.01 omnilex-key=us-nh-regs-official--agency-he-m--He-M 205.01}

205.06 - EXPIRED

APPENDIX

Rule

Specific State or Federal Statutes or Regulations which the Rule Implements

He-M 201.01 - 201.05

RSA 161-F:51; RSA 135-C:56

He-M 201.03

RSA 161-F:46

He-M 202.01 - 202.10

RSA 171-A:13; 14; 19, III

He-M 202.09 (g)-(h)

RSA 171-A:33

He-M 203 - All sections

RSA 171-A:14, V (Specific provisions implementing

He-M 203.01

34 CFR Part 303.400, IDEIA Part C

He-M 203.02

RSA 171-A:2, I-b; RSA 171-A:14, V, 34 CFR Part 303.27, 34 CFR Part 303.431, 34 CFR Part 303.435, and IDEIA Part C

He-M 203.03 - 203.04

34 CFR Part 303.421, IDEIA Part C

He-M 203.05

34 CFR Part 303.443, 303.403, and IDEIA Part C

He-M 203.06

34 CFR Part 303.430 , IDEIA Part C

He-M 203.07

34 CFR Part 303.435, IDEIA Part C

He-M 203.08

34 CFR Part 303.436 , IDEIA Part C

He-M 203.09

34 CFR Part 303.437, IDEIA Part C

He-M 203.10

34 CFR Part 303.438 , IDEIA Part C

He-M 203.11

34 CFR Part 303.433-303.434, IDEIA Part C

He-M 203.12

34 CFR Part 303.404 and 303.421, and IDEIA Part C

He-M 204.01

RSA 135-C:56-57, RSA 171-C:19

He-M 204.02

RSA 135-C:56-57, RSA 171-C:19

He-M 204.03

RSA 135-C:56-57, RSA 171-C:19

He-M 204.04

RSA 135-C:56-57, RSA 171-C:19

He-M 204.05

RSA 135-C:56-57, RSA 171-C:19

He-M 204.06

RSA 135-C:56-57, RSA 171-C:19

He-M 204.07

RSA 135-C:56-57, RSA 171-C:19

He-M 204.08

RSA 135-C:56-57, RSA 171-C:19

He-M 204.09

RSA 135-C:56-57, RSA 171-C:19

He-M 204.10

RSA 135-C:56-57, RSA 171-C:19

He-M 204.11

RSA 135-C:56-57, RSA 171-C:19

He-M 204.12

RSA 135-C:56-57, RSA 171-C:19

History

#6001, eff 4-1-95, EXPIRED: 4-1-03

Chapter He-M 300 Rights

Part He-M 305 Personal Safety Emergencies

N.H. Code Admin. R. Ann. He-M 305.01 Purpose {#sec-he-m-305.01 omnilex-key=us-nh-regs-official--agency-he-m--He-M 305.01}

The purpose of these rules is to define the circumstances in which, and mechanisms by which, involuntary emergency treatment, seclusion, or restraint can be provided in facilities serving adults and children with mental illness. These emergency interventions are designed to be effective, safe, and time-limited and utilized only after all less restrictive options have been exhausted.

History

#3095, eff 8-19-85; EXPIRED: 8-19-93
#5204, eff 8-22-91, EXPIRED: 8-22-97
#7183, eff 12-24-99, EXPIRED: 12-24-07
#9120, eff 4-3-08, EXPIRED: 4-3-16
#11102, INTERIM, eff 5-25-16, EXPIRED: 11-21-16
#12077, eff 12-28-16

N.H. Code Admin. R. Ann. He-M 305.02 Definitions {#sec-he-m-305.02 omnilex-key=us-nh-regs-official--agency-he-m--He-M 305.02}

(a) “Advance practice registered nurse (APRN)” means “advanced practice registered nurse” as defined in RSA 135-C:2, II-a, namely, “an advanced practice registered nurse licensed by the board of nursing who is certified as a psychiatric mental health nurse practitioner by a board-recognized national certifying body.”

(b) “CMS regional office” means the office of the U.S. Department of Health and Human Services, Branch Chief, Survey and Enforcement Branch, Centers for Medicare & Medicaid Services, Room 2275, John F. Kennedy Federal Building, Boston, Massachusetts 02203.

(d) “Department” means the department of health and human services.

(e) “Facility” means New Hampshire hospital, Glencliff home for the elderly, Hampstead hospital and residential treatment facility, or any other treatment program designated under RSA 135-C:26

(f) “Individual” means a person receiving services from a facility.

(g) “Informed decision” means “informed decision” as defined in RSA 135-C: IX namely, “ a choice made by a client or person seeking to be admitted who has the ability to make such a choice and who makes it voluntarily after all relevant information necessary to making the decision has been provided, and who understands that he is free to choose or refuse any available alternative, and who clearly indicates or expresses his choice. The choice shall be free from all coercion”. The term also includes such decision of an individual, as defined in He-M 311.02(l), and the individual’s legal guardian, where appropriate, based on the same factors as an informed decision by an individual or person seeking to be admitted.

(h) “Nursing staff” means a registered or licensed practical nurse or other care provider working under the direct supervision of a registered nurse.

(i) “Personal safety emergency” means a physical status or a mental status and an act or pattern of behavior of an individual which, if not treated immediately, will result in serious physical harm to the individual or others.

(j) “Physician” means “physician” as defined in RSA 135-C:2, XII namely, “a medical doctor licensed to practice in New Hampshire”.

(k) “Restraint” means:

(1) Any drug or medication when it:

a. Is used as a restriction to manage an individual’s behavior or restrict the individual’s freedom of movement; and

b. Is not a standard treatment or dosage for the individual’s condition, in that its overall effect reduces an individual’s ability to effectively or appropriately interact;

(2) Any manual method, physical or mechanical device, material, or equipment that immobilizes an individual or reduces the ability of an individual to move their arms, legs,

head, or other body parts freely but does not include devices, such as orthopedically prescribed devices, surgical dressings or bandages, protective helmets, or other methods that involve the physical holding of an individual, if necessary, for the purpose of:

a. Conducting routine physical examinations or tests;

b. Protecting the individual from falling out of bed; or

c. Permitting the individual to participate in activities without the risk of physical harm; or

(3) The term restraint means “restraint” as defined in RSA 126-U:1, IV as applied to a person who has not reached 18 years of age, or who is otherwise a child as defined by RSA 126-U:1, I.

(l) “Seclusion” means the involuntary confinement of an individual who:

(1) With regard to a person who is 18 or older:

a. Is placed alone in a room or area from which the individual is physically prevented, by lock or person, from leaving; and

b. Cannot or will not make an informed decision to agree to such confinement; or

(2) The term “seclusion” as defined in RSA 126-U:1, V-a as applied to a person who has not reached 18 years of age, or who is otherwise a child as defined by RSA 126-U:1, I.

(m) “Training” means provision of education to staff, based on the specific needs of the individual population, resulting in demonstrated knowledge and documented competency.

(n) “Treatment” means medical or psychiatric care, excluding seclusion or restraint, provided by a physician, or a person acting under the direction of a physician, in accordance with generally accepted clinical and professional standards.

History

#3095, eff 8-19-85; EXPIRED: 8-19-93
#5204, eff 8-22-91, EXPIRED: 8-22-97
#7183, eff 12-24-99, EXPIRED: 12-24-07
#9120, eff 4-3-08, EXPIRED: 4-3-16
#11102, INTERIM, eff 5-25-16, EXPIRED: 11-21-16
#12077, eff 12-28-16; ss by #14033-B, eff 7-30-24

N.H. Code Admin. R. Ann. He-M 305.03 Emergency Response {#sec-he-m-305.03 omnilex-key=us-nh-regs-official--agency-he-m--He-M 305.03}

(a) As soon as possible after an admission, the treatment staff of the facility and the individual shall develop a crisis plan to:

(1) Identify the individual’s preferred response to a psychiatric emergency situation in order to avoid more restrictive interventions;

(2) Identify the individual’s history of physical, sexual, or emotional trauma, if any;

(3) Minimize the possibility of involuntary emergency measures; and

(4) If the individual is a child, the plan shall meet the requirements of RSA 126-U:3.

(b) Involuntary emergency treatment, seclusion, or restraint in a facility shall not be implemented unless a physician determines that a personal safety emergency exists.

(c) A physician shall authorize involuntary emergency treatment, seclusion, or restraint without consent of the individual or his or her guardian only following personal examination or observation, except as provided in He-M 305.04 or He-M 305.05 (b).

(d) No involuntary emergency treatment shall be administered pursuant to He-M 305 unless it is to take effect within 24 hours and is expected to alleviate or ameliorate the status or condition which has caused the emergency.

(e) The emergency response that is administered pursuant to He-M 305 shall be an intervention that:

(1) Is expected to be effective;

(2) Considers whether any of the following factors regarding the individual’s condition would require special accommodation to ensure necessary communication and the individual’s safety:

a. Medical factors;

b. Psychological factors; and

c. Physical factors, including:

Blindness or other limitations of sight;
Deafness or other limitations of hearing; and
Any other physical limitation that would require special accommodation;

(3) Is the least restrictive of the individual’s freedom of movement; and

(4) Gives consideration to the individual’s preferred response to a psychiatric emergency situation.

(f) Involuntary emergency treatment, seclusion, or restraint ordered following a personal safety emergency shall be authorized for no more than is necessary, but in no case for more than 24 hours in accordance with He-M 305.04(k).

(g) If the individual is a child, and the emergency response and involuntary emergency treatment set forth in (c) through (e) above includes the use of restraint or seclusion, that use shall be made in accordance with RSA 126-U:5, RSA 126 U:5-a, and RSA 126 U:5-b and shall not include techniques listed in RSA 126-U:4.

(h) If the individual is a child, notification of the use of restraint or seclusion as part of an emergency response in (a)–(g) above shall be made to the child’s parent or guardian pursuant to RSA 126-U:7.

History

#3095, eff 8-19-85; EXPIRED: 8-19-93
#5204, eff 8-22-91, EXPIRED: 8-22-97
#7183, eff 12-24-99, EXPIRED: 12-24-07
#9120, eff 4-3-08, EXPIRED: 4-3-16
#11102, INTERIM, eff 5-25-16, EXPIRED: 11-21-16
#12077, eff 12-28-16

N.H. Code Admin. R. Ann. He-M 305.04 Seclusion or Restraint {#sec-he-m-305.04 omnilex-key=us-nh-regs-official--agency-he-m--He-M 305.04}

(a) An emergency response may include use of restraint or seclusion.

(b) Restraint or seclusion shall:

(1) Not be imposed longer than is necessary to resolve a personal safety emergency regardless of the length of the time identified in the order;

(2) Not exceed 15 minutes unless there is documented authorization by a physician; and

(3) Only be used with a child according to the requirements of RSA 126-U:5, and RSA 126-U:5-a, 5-b and shall not include techniques listed in RSA 126-U:4.

(c) Before seclusion or restraint is employed, an individual who can make an informed decision to be voluntarily placed in an unlocked room shall be offered that alternative, if feasible.

(d) Restraint or seclusion shall be used only as a last resort when no other intervention in an emergency situation is feasible to protect the immediate safety of the individual or others.

(e) Seclusion or restraint shall never be used explicitly or implicitly as punishment for the behavior of the individual.

(f) Individuals in seclusion or restraint shall be afforded privacy through practices including:

(1) The use of a single room;

(2) Minimizing external stimuli such as noise, nearby movement, and approaches by other individuals;

(3) Continuous staff observation to assure the conditions in (2) above are met; and

(4) If the individual in seclusion or restraint is a child, the conditions of seclusion shall be pursuant to RSA 126-U:5-a, RSA126-U:5-b, and RSA 126-U:11, and shall not include the techniques listed in RSA 126-U:4.

(g) Authorization for the use of seclusion or restraint shall be as follows:

(1) A physician may write an order for the use of seclusion or restraint; or

(2) A physician may authorize the use of seclusion or restraint via telephone when the order:

a. Follows deliberate and comprehensive consultation between the physician and a trained advanced practice registered nurse (APRN) or registered nurse (RN) who has personally evaluated the individual by reviewing:

The assessments of the individual that have been performed;
The safety issues involved; and
The potential antecedents to the seclusion or restraint;

b. Is for a period not to exceed one hour; and

c. Is countersigned by the ordering physician within 24 hours of the time such treatment was ordered and;

(3) If authorization is for the use of seclusion or restraint with a child, the authorization shall be given pursuant to a written policy consistent with RSA 126-U:2 and authorization and monitoring pursuant to RSA 126-U:11.

(h) A physician may authorize in writing, on the physician order sheet, or verbally, by telephone, the extension of an order of seclusion or restraint if he or she, or a trained APRN or RN, has personally examined, observed, and assessed the individual for whom the seclusion or restraint is ordered.

(i) Following an examination and assessment as required by (g) above, a physician may issue an order to extend seclusion or restraint if the order is for:

(1) Not more than 4 hours if the individual is at least 18 years old;

(2) Not more than 2 hours if the individual is at least 9 but not more than 17 years old; or

(3) Not more than one hour if the individual is less than 9 years old.

(j) If the individual is a child, then any order to extend seclusion or restraint in (i) above shall be subject to the limitations of RSA 126-U:11, III and IV.

(k) A physician who authorizes seclusion or restraint shall, in collaboration with the attending registered nurse, establish release criteria for the termination of the seclusion or restraint.

(l) If the condition of the individual does not improve to meet the criteria for termination, the physician may renew the order as specified in (h) above for up to the time limits established in (i) above, provided that no individual shall remain in seclusion or restraint for more than 24 hours from the time such procedure was initiated unless a physician personally examines, observes and assesses the individual and renews the order in writing.

(m) Nursing staff trained pursuant to He-M 305.07 shall continually monitor the individual during periods of seclusion or restraint to ensure that:

(1) In the judgment of the nursing staff, all reasonable measures are in place to ensure that the individual’s health and safety is protected during the period of seclusion or restraint;

(2) The individual receives meals and regular opportunities to move and to utilize the bathroom;

(3) All other basic physiological needs are identified and met; and

(4) The seclusion or restraint is discontinued as soon as the emergency is resolved, regardless of the length of time identified in the order.

(n) Individuals in seclusion or restraint shall have the right to:

(1) Wear their own clothes, unless clinically contraindicated; and

(2) Meet with an attorney.

(o) No procedure or device for seclusion or restraint shall be utilized without the authorization of the clinical managers of the facility.

History

#3095, eff 8-19-85; EXPIRED: 8-19-93
#5204, eff 8-22-91, EXPIRED: 8-22-97
#7183, eff 12-24-99, EXPIRED: 12-24-07
#9120, eff 4-3-08, EXPIRED: 4-3-16
#11102, INTERIM, eff 5-25-16, EXPIRED: 11-21-16
#12077, eff 12-28-16

N.H. Code Admin. R. Ann. He-M 305.05 Emergency Medication and Other Emergency Treatment {#sec-he-m-305.05 omnilex-key=us-nh-regs-official--agency-he-m--He-M 305.05}

(a) A physician or APRN in a facility shall prescribe medication as a form of emergency treatment, to be administered without the individual’s consent, only after personally examining or observing the individual for whom the medication is ordered, except as provided in (b) below.

(b) A physician or APRN may authorize involuntary administration of a previously prescribed medication by telephone order at the time a personal safety emergency is declared. Such authorization shall be countersigned by the ordering physician or APRN within 24 hours of the order for involuntary administration of the medication.

(c) When emergency medication is ordered, the individual shall be offered, whenever feasible, a choice of taking the medication orally or by injection.

(d) Psychosurgery, electroconvulsive therapy, sterilization, or experimental treatment of any kind shall not be used as involuntary emergency treatment.

(e) If a physician or APRN prescribes medication for a child as stated in He-M 305.02(k)(1)a. and b., the administration shall be considered a “medication restraint” as defined in RSA 126-U:1, IV(a), and shall be administered pursuant to the requirements of RSA 126-U.

History

#3095, eff 8-19-85; EXPIRED: 8-19-93
#5204, eff 8-22-91, EXPIRED: 8-22-97
#7183, eff 12-24-99, EXPIRED: 12-24-07
#9120, eff 4-3-08, EXPIRED: 4-3-16
#11102, INTERIM, eff 5-25-16, EXPIRED: 11-21-16
#12077, eff 12-28-16; ss by #12929, eff 11-26-19

N.H. Code Admin. R. Ann. He-M 305.06 Review and Documentation of Emergency Response {#sec-he-m-305.06 omnilex-key=us-nh-regs-official--agency-he-m--He-M 305.06}

(a) At the time that any emergency treatment, seclusion, or restraint is administered in a facility pursuant to He-M 305, the physician administering or directing such treatment, or a person acting under his or her direction, shall promptly record the circumstances pertaining to the personal safety emergency.

(b) The person completing a record pursuant to (a) above shall include the following:

(1) The individual’s name;

(2) The date and time when the report is completed;

(3) The physician’s name;

(4) A description of the individual’s physical or mental status and the act or pattern of behavior which constitutes the emergency;

(5) The names of any witnesses other than the individual;

(6) A description of any alternatives attempted or considered prior to declaring a personal safety emergency;

(7) Any treatment limitations;

(8) A description of the specific emergency treatment, seclusion, or restraint ordered; and

(9) The physician’s signature.

(c) As soon as possible following an involuntary emergency treatment, seclusion, or restraint, facility medical or nursing staff, or both shall advise the individual’s treating physician regarding the emergency intervention if such intervention was not ordered by the treating physician.

(d) As soon as possible following the resolution of the emergency situation, nursing staff shall:

(1) Address any physical injuries or trauma that might have occurred as a result of the episode;

(2) Hold and document a discussion with the individual to:

a. Review the circumstances that led up to the emergency with the individual involved;

b. Ascertain the individual’s willingness or desire to involve family or other caregivers in a debriefing to discuss and clarify their perceptions about the episode and to identify additional alternatives or treatment plan modifications;

c. Hear and document the individual’s perspective on the episode;

d. Discuss and clarify any possible misperceptions the individual or staff might have concerning the incident;

e. Identify with the individual any environmental changes or alternative interventions to reduce the potential for additional episodes; and

f. Ascertain whether the individual’s rights and physical well-being were addressed during the episode and advise the individual of the process to address perceived rights grievances; and

(3) Support the individual’s re-entry into the treatment setting.

(e) Within one business day, nursing staff shall, after discussion with the individual, modify the treatment plan as needed through a treatment team review including areas noted in (d)(1)-(3) above and seek an informed decision on that plan by the individual.

(f) An executive review of the clinical appropriateness of the use of seclusion or restraint shall be conducted:

(1) As authorized by the facility’s chief executive officer;

(2) On the next business day following a personal safety emergency;

(3) To assess compliance with the requirements of He-M 305;

(4) To consider and take any action needed to prevent the recurrence of the same or similar personal safety emergencies; and

(5) To include:

a. A member of the individual’s treatment team;

b. A member of nursing management; and

c. The medical director or designee.

(g) If the individual subject to seclusion or restraint is a child, information shall be collected and notification made pursuant to RSA 126-U:7 and 126-U:10.

History

#3095, eff 8-19-85; EXPIRED: 8-19-93
#5204, eff 8-22-91, EXPIRED: 8-22-97
#7183, eff 12-24-99, EXPIRED: 12-24-07
#9120, eff 4-3-08, EXPIRED: 4-3-16
#11102, INTERIM, eff 5-25-16, EXPIRED: 11-21-16
#12077, eff 12-28-16

N.H. Code Admin. R. Ann. He-M 305.07 Training {#sec-he-m-305.07 omnilex-key=us-nh-regs-official--agency-he-m--He-M 305.07}

(a) Facilities shall provide training for leadership in strategies toward the elimination of seclusion and restraint.

(b) At a minimum, facilities shall provide training at the following intervals to all staff who will be involved in the use of any type of restraint or seclusion:

(1) During initial orientation; and

(2) During annual competency evaluation.

(c) Staff shall not perform any action relative to restraint or seclusion without having been trained in the use of such methods, in accordance with (d) below.

(d) Training in the use of restraint or seclusion shall address at least the following:

(1) Techniques to identify behaviors, events, and environmental factors regarding individuals and staff that might trigger circumstances that require restraint or seclusion;

(2) Use of non-physical interventions;

(3) How to identify and choose positive behavioral supports and the least restrictive intervention based on an individualized assessment of the individual’s medical or behavioral status or condition;

(4) How to ensure that the individual and staff are able to communicate effectively;

(5) Safe application and use of all types of restraint or seclusion, including mitigating positional risks that can result in asphyxia or airway obstruction, in accordance with individual needs;

(6) How to monitor the physical and psychological well-being of the individual who is restrained or secluded;

(7) How to recognize and respond to signs of physical and psychological distress;

(8) How to identify clinical changes that indicate that restraint or seclusion is no longer necessary;

(9) How to monitor respiratory and circulatory status, skin integrity, and vital signs during restraint; and

(10) Training in first aid techniques and certification in cardiopulmonary resuscitation (CPR), including CPR recertification every two years.

(e) Training shall be given by a person who:

(1) As defined in writing by the facility, possesses the requisite qualifications based upon education, training, experience, and certification to teach the assessment of, and response to, an individual’s medical or behavioral status or condition;

(2) Is certified by a nationally recognized program, such as the American Heart Association, as an instructor in CPR; and

(3) Is trained in crisis prevention utilizing a nationally recognized program or comparable curriculum.

History

#9120, eff 4-3-08, EXPIRED: 4-3-16
#11102, INTERIM, eff 5-25-16, EXPIRED: 11-21-16
#12077, eff 12-28-16

N.H. Code Admin. R. Ann. He-M 305.08 Notice and Right of Appeal {#sec-he-m-305.08 omnilex-key=us-nh-regs-official--agency-he-m--He-M 305.08}

(a) On the business day following administration of emergency treatment, seclusion, or restraint under He-M 305, the individual’s case manager or another staff member designated by the program or facility shall forward the following to the individual or his or her guardian:

(1) A copy of the record completed pursuant to He-M 305.06(a);

(2) The specific rules that support, or the federal or state law that requires, the action;

(3) Notice of the individual’s right to complain against and appeal the administration of emergency treatment as a client rights violation in accordance with the emergency procedures contained in He-M 204 and He-C 200, rules of practice and procedure;

(4) Notice of the right to have representation in an appeal by:

a. Legal counsel;

b. A relative;

c. A friend; or

d. Another spokesperson;

(5) Notice that neither the facility nor the bureau is responsible for the cost of representation; and

(6) Notice of organizations with their addresses and phone numbers that might be available to provide legal assistance and advocacy, including the Disabilities Rights Center and pro bono or reduced fee assistance.

(b) Appeals of the final decision under He-M 204 shall be forwarded, in writing, to the director of the bureau of behavioral health in care of the department’s office of client and legal services. An exception shall be that appeals may be filed verbally if the individual is unable to convey the appeal in writing.

(c) The director shall immediately forward the appeal to the department’s administrative appeals unit for action in accordance with He-C 200. The burden shall be as provided by He-C 203.14. A proposed decision shall be issued in accordance with He-M 204.

History

#9120, eff 4-3-08, EXPIRED: 4-3-16
#11102, INTERIM, eff 5-25-16, EXPIRED: 11-21-16
#12077, eff 12-28-16

N.H. Code Admin. R. Ann. He-M 305.09 Reporting of Death {#sec-he-m-305.09 omnilex-key=us-nh-regs-official--agency-he-m--He-M 305.09}

(a) In accordance with Patient Rights 42 CFR 482.13(g)(1)i and the Protection and Advocacy for Mentally Ill Individuals Act (PAIMI Act), 42 U.S.C. § 10801-10851, facility staff shall make a telephone report to the CMS regional office, no later than the close of the next business day and to the state protection and advocacy agency within 7 days following knowledge of an individual’s death that:

(1) Occurs while an individual is in restraint or in seclusion at the facility;

(2) Occurs within 24 hours after the individual has been removed from restraint or seclusion; and

(3) Occurs within one week after restraint or seclusion where it is reasonable to assume that the use of restraint or placement in seclusion contributed directly or indirectly to the individual’s death including, at a minimum:

a. Death related to restrictions of movement for prolonged periods of time; and

b. Death related to chest compression, restriction of breathing, or asphyxiation.

(b) Staff shall document in the individual’s medical record the date and time the death was reported.

(c) If the individual subject to seclusion or restraint as part of emergency treatment suffers injury or death, and the individual is a child as defined in RSA 126-U:1, I, the facility staff shall provide notification pursuant to RSA 126-U:7 and RSA 126-U:10.

History

#9120, eff 4-3-08, EXPIRED: 4-3-16
#11102, INTERIM, eff 5-25-16, EXPIRED: 11-21-16
#12077, eff 12-28-16

Part He-M 306 Medical and Psychiatric Emergencies

N.H. Code Admin. R. Ann. He-M 306.01 Purpose {#sec-he-m-306.01 omnilex-key=us-nh-regs-official--agency-he-m--He-M 306.01}

The purpose of these rules is to establish procedures by which an individual involuntarily admitted to New Hampshire hospital has emergency treatment authorized when he or she has been determined to lack the capacity to make an informed treatment decision.

History

#3096, eff 8-19-85; EXPIRED: 8-19-91
#4708, eff 12-1-89, EXPIRED: 12-1-95
#7133, eff 11-23-99; ss by #7559, eff 9-25-01; ss by #9520, eff 8-4-09, EXPIRED: 89-4-18
#13035, EMERGENCY, eff 4-14-20, EXPIRES: 10-11-20; ss by #13108, eff 9-22-20

N.H. Code Admin. R. Ann. He-M 306.02 Definitions {#sec-he-m-306.02 omnilex-key=us-nh-regs-official--agency-he-m--He-M 306.02}

(a) "Administrator" means the chief executive officer of New Hampshire hospital or, in the absence of the administrator, the executive person in charge of the facility.

(b) “Advance practice registered nurse (APRN)” means “advanced practice registered nurse” as defined in RSA 135-C:2, II-a, namely “an advanced practice registered nurse licensed by the board of nursing who is certified as a psychiatric mental health nurse practitioner by a board-recognized national certifying body.”

(d) "Lack of capacity" means the inability of a person, after efforts have been made to explain the nature, effects, and risks of the proposed treatment and alternatives to the proposed treatment, to engage in a rational decision-making process regarding the proposed treatment as evidenced by his or her inability to weigh the nature, purpose, risks, and benefits of the proposed treatment and any available alternatives and the likely consequences of refusing treatment.

(e) "Medical emergency" means a physical condition of a patient which, if not treated, will result in an immediate, substantial, and progressive deterioration of a serious physical illness.

(f) “Patient” means a person involuntarily admitted to New Hampshire hospital by order of a probate court pursuant to RSA 135-C:34-54.

(g) “Presiding officer” means an individual who has been delegated authority by the commissioner of the department of health and human services, in accordance with RSA 126-A:5, III, to render decisions on appeals under RSA 126-A:5, VIII.

(h) "Psychiatric emergency" means a mental condition of a patient, resulting from mental illness, which, if not treated promptly, likely will result in either:

(1) Imminent danger of harm to the patient or others as evidenced by:

a. Symptoms that in the past have immediately preceded acts of harm to self or others; or

b. A recent overt act including, but not limited to, an assault, or self-injurious behavior when the likelihood of preventing such harm would be substantially diminished if treatment is delayed;

(2) Deterioration of the patient's mental status from his or her usual mental status as manifested by exacerbation of psychiatric symptoms that potentially endanger self or others, or lead to severe self-neglect, or lead to a failure to function in a less restrictive environment when the likelihood of stabilizing and reversing such deterioration would be substantially diminished if treatment is delayed; or

(3) Continued decompensation of the patient’s mental status from his or her usual mental status as manifested by persistent psychiatric symptoms that potentially endanger self or others, or lead to severe self-neglect, or lead to a failure to function in a less restrictive environment when there is a reasonable likelihood that such symptoms could be alleviated if treatment could be administered to the patient.

(i) "Treatment" means a form of medical or psychiatric care that:

(1) Is provided by a physician, or a person acting under the direction of a physician;

(2) Is provided in accordance with generally accepted clinical and professional standards; and

(3) Does not include:

a. Psychosurgery;

b. Electroconvulsive therapy;

c. Sterilization; or

d. Experimental treatment of any kind.

History

#3096, eff 8-19-85; EXPIRED: 8-19-91
#4708, eff 12-1-89, EXPIRED: 12-1-95
#7133, eff 11-23-99; ss by #7559, eff 9-25-01; ss by #9520, eff 8-4-09; amd by #10641, eff 7-18-14 paras (a), and (c) – (i) EXPIRED: 8-4-18
#13035, EMERGENCY, eff 4-14-20, EXPIRES: 10-11-20; ss by #13108, eff 9-22-20

N.H. Code Admin. R. Ann. He-M 306.03 Emergency Treatment Authorized {#sec-he-m-306.03 omnilex-key=us-nh-regs-official--agency-he-m--He-M 306.03}

A physician, or a person acting under the direction of a physician, shall administer treatment to a patient, without the consent of the patient, when authorization is granted by the presiding officer pursuant to the provisions set forth below.

History

#3096, eff 8-19-85; EXPIRED: 8-19-91
#4708, eff 12-1-89, EXPIRED: 12-1-95
#7133, eff 11-23-99; ss by #7559, eff 9-25-01; ss by #9520, eff 8-4-09, EXPIRED: 8-4-18
#13035, EMERGENCY, eff 4-14-20, EXPIRES: 10-11-20; ss by #13108, eff 9-22-20

N.H. Code Admin. R. Ann. He-M 306.04 Criteria for Emergency Treatment {#sec-he-m-306.04 omnilex-key=us-nh-regs-official--agency-he-m--He-M 306.04}

(a) A treating physician or APRN shall submit a written request for treatment authorization to the department’s administrative appeals unit, the administrator, and the patient if he or she determines that:

(1) The involuntarily admitted patient cannot make a decision regarding his or her treatment due to lack of capacity;

(2) A medical or psychiatric emergency exists;

(3) The patient does not have a guardian authorized to make medical decisions; and

(4) A reasonable person would consent to the administration of emergency treatment.

(b) A physician’s or APRN’s request for treatment authorization submitted pursuant to (a) above shall contain the following information:

(1) A description of the efforts that have been made to inform the patient of the nature, effects, and risks of the proposed treatment, and facts demonstrating that, despite this effort, the patient lacks the capacity to make an informed decision with respect to the medical or psychiatric treatment offered;

(2) A statement of facts which indicate that a medical or psychiatric emergency exists;

(3) A description of the proposed treatment, including:

a. Its anticipated therapeutic benefit;

b. Its potentially significant risks; and

c. The nature and severity of possible side effects;

(4) A statement indicating the supports or treatment, if any, that the patient has agreed to accept and why provision of such treatment would not ameliorate the medical or psychiatric emergency; and

(5) The reasons why a delay in treatment would:

a. In the case of a medical emergency, likely result in an immediate, substantial, and progressive deterioration of a serious physical illness; or

b. In the case of a psychiatric emergency:

Substantially diminish the likelihood of preventing imminent harm to the patient or others;
Substantially diminish the likelihood of stabilizing or reversing the patient's deteriorating mental status; or
Result in continued decompensation of the patient’s mental status from his or her usual mental status as manifested by persistent psychiatric symptoms when there is a reasonable likelihood that such symptoms could be alleviated if treatment could be administered to the patient.

History

#3096, eff 8-19-85; EXPIRED: 8-19-91
#4708, eff 12-1-89, EXPIRED: 12-1-95
#7133, eff 11-23-99; ss by #7559, eff 9-25-01; ss by #9520, eff 8-4-09; ss by #10641, eff 7-18-14

N.H. Code Admin. R. Ann. He-M 306.05 Hearing {#sec-he-m-306.05 omnilex-key=us-nh-regs-official--agency-he-m--He-M 306.05}

Upon receipt of the physician’s or APRN’s written request for treatment authorization, the presiding officer shall:

(a) Schedule a hearing to be held as soon as reasonably possible and, in any event, within 3 working days of the date of receipt of the written request for treatment authorization;

(b) Notify the legal staff of New Hampshire hospital of the patient’s need for legal counsel; and

History

#3096, eff 8-19-85; EXPIRED: 8-19-91
#4708, eff 12-1-89, EXPIRED: 12-1-95
#7133, eff 11-23-99; ss by #7559, eff 9-25-01; ss by #9520, eff 8-4-09; ss by #10641, eff 7-18-14

N.H. Code Admin. R. Ann. He-M 306.06 Decision {#sec-he-m-306.06 omnilex-key=us-nh-regs-official--agency-he-m--He-M 306.06}

(a) Within 2 working days of the hearing, the presiding officer shall issue a written decision.

(b) The presiding officer shall authorize the proposed treatment if the presiding officer determines that the state has demonstrated, by clear and convincing evidence, that each of the following criteria is met:

(l) The patient lacks the capacity to make an informed decision with respect to the proposed treatment;

(2) A medical or psychiatric emergency exists that would:

a. In the case of a medical emergency, likely result in an immediate, substantial, and progressive deterioration of a serious physical illness; or

b. In the case of a psychiatric emergency:

Substantially diminish the likelihood of preventing imminent harm to the patient or others;
Substantially diminish the likelihood of stabilizing or reversing the patient's deteriorating mental status; or
Result in continued decompensation of the patient’s mental status from his or her usual mental status as manifested by persistent psychiatric symptoms when there is a reasonable likelihood that such symptoms could be alleviated if treatment could be administered to the patient;

(3) The proposed treatment is the least restrictive appropriate alternative available;

(4) The patient does not have a guardian authorized to make treatment decisions; and

(5) A reasonable person would consent to the administration of emergency treatment.

History

#3096, eff 8-19-85; EXPIRED: 8-19-91
#4708, eff 12-1-89, EXPIRED: 12-1-95
#7133, eff 11-23-99; ss by #7559, eff 9-25-01; ss by #9520, eff 8-4-09, EXPIRED: 8-4-18
#13035, EMERGENCY, eff 4-14-20, EXPIRES: 10-11-20; ss by #13108, eff 9-22-20

N.H. Code Admin. R. Ann. He-M 306.07 Guardianship {#sec-he-m-306.07 omnilex-key=us-nh-regs-official--agency-he-m--He-M 306.07}

During the course of the authorized treatment period, New Hampshire hospital staff shall assess the patient's need for the appointment of a guardian and take actions consistent with RSA 135-C:60.

History

#3096, eff 8-19-85; EXPIRED: 8-19-91
#4708, eff 12-1-89, EXPIRED: 12-1-95
#7133, eff 11-23-99; ss by #7559, eff 9-25-01; ss by #9520, eff 8-4-09, EXPIRED: 8-4-18
#13035, EMERGENCY, eff 4-14-20, EXPIRES: 10-11-20; ss by #13108, eff 9-22-20

N.H. Code Admin. R. Ann. He-M 306.08 Treatment Limitations {#sec-he-m-306.08 omnilex-key=us-nh-regs-official--agency-he-m--He-M 306.08}

(a) No involuntary treatment shall be imposed pursuant to a request for authority to administer emergency treatment prior to a decision being rendered by the presiding officer in accordance with He-M 306.06 except in accordance with He-M 305, personal safety emergencies.

(b) Treatment shall not be administered to a voluntarily admitted individual who refuses to accept it.

(c) The chief medical officer of New Hampshire hospital shall monitor treatment provided pursuant to He-M 306.03 at least every 7 days through review with the attending physician or APRN and order discontinuation of the treatment authorization upon determination that the criteria for treatment authorization no longer exist. The chief medical officer may delegate these functions to the associate medical director or to another New Hampshire hospital psychiatrist who is a board-certified physician and not the attending physician for the patient.

(d) No more than 2 authorizations for emergency treatment shall be granted during each single involuntary admission.

(e) Authorizations shall not exceed 4 during the total period of the involuntary admission order.

(f) “Single involuntary admission” means:

(1) The period of initial involuntary admission following the order of the probate court pursuant to RSA 135 C-34-54; or

(2) Any subsequent period of involuntary admission following an absolute revocation of conditional discharge.

(g) The authorization to provide emergency treatment to the patient shall immediately expire if a guardian over the person of the patient with authority to make treatment decisions is appointed during the period of emergency treatment authorized by the presiding officer.

History

#3096, eff 8-19-85; EXPIRED: 8-19-91
#4708, eff 12-1-89, EXPIRED: 12-1-95
#7133, eff 11-23-99; ss by #7559, eff 9-25-01; ss by #9520, eff 8-4-09; amd by #10641, eff 7-18-14; paras (a), (b), and (d)-(g) expired: 8-4-18,
#13035, EMERGENCY, eff 4-14-20, EXPIRES: 10-11-20; ss by #13108, eff 9-22-20

Part He-M 309 Rights of Persons Receiving Mental Health Services in the Community

N.H. Code Admin. R. Ann. He-M 309.01 Purpose {#sec-he-m-309.01 omnilex-key=us-nh-regs-official--agency-he-m--He-M 309.01}

The purpose of these rules is to define the rights of individuals applying for services or individuals who have been found eligible for services under RSA 135-C:12 and who are receiving services in the community. Individuals might have additional rights under RSA 151:21, patients' bill of rights, for residents of health care facilities.

History

#4412, eff 4-27-88; ss by #5093, eff 3-15-91, EXPIRED: 3-15-97
#6757, eff 5-27-98; ss by #8639, INTERIM, eff 5-27-06, EXPIRES: 11-23-06, ss by #8757, eff 11-17-06; ss by #10706, INTERIM, eff 11-15-14, EXPIRES: 5-14-15; ss by #10819, eff 4-23-15, EXPIRED: 4-23-25
#14352, INTERIM, eff 8-26-25, EXPIRES: 2-22-26

N.H. Code Admin. R. Ann. He-M 309.02 Definitions {#sec-he-m-309.02 omnilex-key=us-nh-regs-official--agency-he-m--He-M 309.02}

(a) “Abuse” means an act or omission by an employee, consultant or volunteer of a program which is not accidental and harms or threatens to harm an individual’s physical, mental, or emotional health, or safety and includes emotional abuse, physical abuse, and sexual abuse.

(b) “Attorney” means a member of the New Hampshire Bar Association who is retained, employed, or appointed by a court to represent an individual.

(d) “Client” means “individual” as defined in (l) below.

(e) “Community” means a non-facility or non-institutional service setting that is integrated as much as possible into the service network available to all citizens in the geographic area served by the program.

(f) “Community residence” means a residence, exclusive of any independent living arrangement, that:

(1) Provides residential services in accordance with He-M 426 for at least one individual with a mental illness;

(2) Provides services based on the needs identified in a resident’s individual service plan (ISP);

(3) Is operated:

a. Directly by a community mental health center (CMHC);

b. By contract or agreement between a CMHC and another entity, or

c. Directly by an entity under contract with the department;

(4) Serves individuals whose services are funded by the department; and

(5) Is certified pursuant to He-M 1002.

(g) “Department” means the department of health and human services.

(h) “Direct care” means services provided to individuals including, but not limited to: assistance with medication, accompanying an individual to a treatment team or other clinical meeting, and providing ongoing direct and active support.

(i) “Emotional abuse” means the misuse of power, authority, or both, verbal harassment, or unreasonable confinement which results or could result in mental anguish or emotional distress of an individual.

(j) “Exploitation” means the use of an individual’s person or property for another's profit or advantage or breach of a fiduciary relationship through improper use of an individual’s person or property including situations where a person obtains money, property, or services from an individual through undue influence, harassment, deception, or fraud.

(k) “Guardian” means a person, appointed under RSA 463 or RSA 464-A, or the parent of an individual under the age of 18 whose parental rights have not been terminated or limited by law in such a way as to remove the person’s right to make health care decisions on behalf of the individual.

(l) “Individual” means ..A person who is receiving or applying for a service from a program or community residence. The term includes “client.”

(m) “Informed decision” means “informed decision” as defined in RSA 135-C:2, IX, namely, “a choice made by a client or person seeking to be admitted who has the ability to make such a choice and who makes it voluntarily after all relevant information necessary to making the decision has been provided, and who understands that he or she is free to choose or refuse any available alternative, and who clearly indicates or expresses his or her choice. The choice shall be free from all coercion.” The term includes such decision of an individual, as defined in He-M 309.02(l) above, and the individual’s legal guardian, where appropriate, based on the same factors as an informed decision made by a client or person seeking to be admitted.

(n) “Intellectual disability” means “intellectual disability” as defined in RSA 171-A:2, XI-a, namely, “significantly subaverage general intellectual functioning existing concurrently with deficits in adaptive behavior, and manifested during the developmental period. A person with an intellectual disability may be considered mentally ill provided that no person with an intellectual disability shall be considered mentally ill solely by virtue of his or her intellectual disability.”

(o) “Mental illness” means “mental illness” as defined in RSA 135-C:2 X, namely, "a substantial impairment of emotional processes, or of the ability to exercise conscious control of one's actions, or of the ability to perceive reality or to reason, when the impairment is manifested by instances of extremely abnormal behavior or extremely faulty perceptions. It does not include impairment primarily caused by: (a) epilepsy; (b) intellectual disability; (c) continuous or noncontinuous periods of intoxication caused by substances such as alcohol or drugs; or (d) dependence upon or addiction to any substance such as alcohol or drugs."

(p) “Neglect” means an act or omission which results or could result in the deprivation of essential services or supports necessary to maintain the minimum mental, emotional, or physical health of an incapacitated adult. The term includes neglect toward an individual.

(q) “Program” means any public or private corporation, person or organization which provides services to individuals with a mental illness or intellectual disability when such services are funded in whole or in part or are operated, monitored or regulated by the bureau.

(r) “Physical abuse” means the use of physical force which results or could result in physical injury to an individual.

(s) “Service” means any evaluation, training, counseling, therapy, habilitation, case management, or other type of assistance, medical care, or treatment provided by a program.

(t) “Service delivery system” means those facilities and programs funded, in whole or in part, operated, monitored, or regulated by the bureau.

(u) “Sexual abuse” means contact or interaction of a sexual nature between an individual and an employee of or a consultant or volunteer for a program.

(v) “Treatment” means “treatment” as defined in RSA 135-C:2, XVI, namely, “examination, diagnosis, training, rehabilitation therapy, pharmaceuticals, and other services provided to clients in the mental health services system. Treatment shall not include examination or diagnosis for the purpose of determining the need for involuntary emergency admissions pursuant to RSA 135-C:27-33 or involuntary admissions pursuant to RSA 135-C:34-54.” The term includes treatment provided to individuals in the mental health services system.

History

#4412, eff 4-27-88; ss by #5093, eff 3-15-91, EXPIRED: 3-15-97
#6757, eff 5-27-98; ss by #8639, INTERIM, eff 5-27-06, EXPIRES: 11-23-06; ss by #8757, eff 11-17-06; ss by #10706, INTERIM, eff 11-15-14, EXPIRES: 5-14-15; ss by #10819, eff 4-23-15, EXPIRED: 4-23-25
#14352, INTERIM, eff 8-26-25, EXPIRES: 2-22-26

N.H. Code Admin. R. Ann. He-M 309.03 Notice of Individual and Applicant Rights {#sec-he-m-309.03 omnilex-key=us-nh-regs-official--agency-he-m--He-M 309.03}

(a) Programs shall inform individuals or their guardians of the individual’s rights under RSA 135-C and these rules in clearly understandable language and form, both verbally and in writing.

(b) The notification of rights required under (a) above shall include, at a minimum, the following measures:

(1) Individuals applying for services shall be informed of the rights in (a) above relating to evaluations and access to treatment;

(2) Programs shall provide meaningful and understandable information about individual rights described in (a) above to individuals who are minors or who have been adjudicated incapacitated as well as to their parents, guardians, or attorneys;

(3) Individuals shall be advised of their rights upon initial participation in any program, and at least once a year after initial participation;

(4) Every program within the service delivery system shall post notice of the rights set forth in these rules, as follows:

a. The notice shall be posted continuously and conspicuously; and

b. The notice shall be presented in clearly understandable language and form; and

(5) Each program and community residence shall have on the premises complete copies of He-M 309 available for individual and staff review.

(d) Any person shall have the right to complain or bring a grievance on behalf of an individual or a group of individuals pursuant to He-M 204.

History

#4412, eff 4-27-88; ss by #5093, eff 3-15-91, EXPIRED: 3-15-97
#6757, eff 5-27-98; ss by #8639, INTERIM, eff 5-27-06, EXPIRES: 11-23-06, ss by #8757, eff 11-17-06; ss by #10706, INTERIM, eff 11-15-14, EXPIRES: 5-14-15; ss by #10819, eff 4-23-15, EXPIRED: 4-23-25
#14352, INTERIM, eff 8-26-25, EXPIRES: 2-22-26

N.H. Code Admin. R. Ann. He-M 309.04 Fundamental Rights {#sec-he-m-309.04 omnilex-key=us-nh-regs-official--agency-he-m--He-M 309.04}

(a) Any individual receiving treatment for mental illness shall be entitled to any legal right to which all citizens are entitled regardless of that individual's admission to the mental health services system.

(b) The legal rights protected shall include, at a minimum:

(1) The right to freedom of religious preference and practice, the right to be free from engaging in any religious activity, and the right to receive reasonable assistance in attending places of worship;

(2) The right to register to vote, if eligible, in public elections and to receive assistance in registering to vote and in voting;

(3) The following civil rights, unless a court has determined that an individual is legally incapacitated pursuant to RSA 464-A, and a guardian has been appointed to make certain decisions, or an emergency exists under He-M 305, personal safety emergencies:

a. The right to manage affairs;

b. The right to contract;

c. The right to hold professional, occupational, or motor vehicle driver's licenses;

d. The right to marry or to obtain a divorce;

e. The right to make a will; and

f. The right to exercise any other civil right;

(4) The right to not be discriminated against in any manner because of race, color, sex, religion, national origin, age, marital status, disability, sexual orientation, or degree of disability as provided in state and federal laws, title VII of the civil rights act of 1964, section 504 of the rehabilitation act of 1973, the age discrimination act of 1975, the Americans with Disabilities Act of 1990, and the provisions of certain block grants, including:

a. Access to auxiliary aids needed by persons with disabilities;

b. Services which are accessible to persons of limited English proficiency; and

c. Service locations that are physically accessible; and

(5) The right to legal remedies, including the right to petition for and receive the benefits of a writ of habeas corpus, and to seek any other remedy provided by law.

History

#4412, eff 4-27-88; ss by #5093, eff 3-15-91, EXPIRED: 3-15-97
#6757, eff 5-27-98; ss by #8639, INTERIM, eff 5-27-06, EXPIRES: 11-23-06; ss by #8757, eff 11-17-06; ss by #10706, INTERIM, eff 11-15-14, EXPIRES: 5-14-15 ss by #10819, eff 4-23-15, EXPIRED: 4-23-25
#14352, INTERIM, eff 8-26-25, EXPIRES: 2-22-26

N.H. Code Admin. R. Ann. He-M 309.05 Personal Rights {#sec-he-m-309.05 omnilex-key=us-nh-regs-official--agency-he-m--He-M 309.05}

(a) Individuals who are applying for services or individuals in the service delivery system shall be treated with dignity and respect at all times.

(b) Individuals shall be free from abuse, neglect, and exploitation including, at a minimum, the following:

(1) Freedom from any emotional, physical, or sexual abuse or neglect;

(2) Freedom from the intentional use of physical force, except the minimum force necessary to prevent harm to the individual or others, to prevent substantial damage to real property, or to impose emergency treatment under He-M 305, personal safety emergencies or RSA 135:21-b; and

(3) Freedom from personal or financial exploitation.

(d) Individuals who are applying for services, or who are currently, or were previously in the service delivery system shall have the right to confidentiality of all information and records.

(e) At a minimum, programs shall adhere to the following confidentiality requirements:

(1) Material safeguarded shall include any information with respect to an individual or through which an individual can be identified such as:

a. Names;

b. Addresses;

c. Diagnoses and evaluative data;

d. Medical and clinical records;

e. Individual service plans; and

f. Whether an individual is using or has used a program’s services;

(2) The individual or his or her guardian shall be informed that clinical information may be released to the third party payor to the extent necessary to substantiate charges for care and treatment;

(3) If the individual or his or her guardian wishes to bear the cost of services privately rather than allow the release of information to third party payors, the individual or his or her guardian shall be personally responsible for the full cost of care and treatment;

(4) All program staff shall be informed so as to know and understand confidentiality and comply with confidentiality statutes and rules;

(5) Separate, individual records shall be maintained when group treatment methods are employed and joint records of treatment activity shall not be maintained;

(6) No program shall photograph, fingerprint, or record any individual by audio or visual equipment unless the individual or his or her guardian has consented following an informed decision, nor allow any third party to photograph, fingerprint, or record any individual by audio or visual equipment unless the individual or his or her guardian has consented following an informed decision;

(7) These rules shall not affect the obligation of programs to release information as required by:

a. RSA 161-F:42-57, protective services to adults;

b. RSA 169-C:29, report of child abuse;

c. RSA 631:6, report of injury caused by criminal act; or

d. Other law; and

(8) In accordance with RSA 329:26, RSA 330-A:32, RSA 329-B:26 and RSA 326-B:35, statements made by individuals to physicians licensed pursuant to RSA 329, psychologists licensed pursuant to RSA 329-B, persons licensed pursuant to RSA 330-A, advanced practice registered nurses licensed pursuant to RSA 326-B, or to those who work under their supervision, may be disclosed for the purpose of commitment hearings conducted pursuant to RSA 135-C:27-54 or RSA 464-A.

(f) Access to an individual’s records shall be as follows:

(1) Information pertaining to an individual shall be released to the individual or his or her guardian upon request including all information provided by third parties except that information which was provided by someone other than a health care provider under an agreement that the information would not be disclosed and disclosure would be reasonably likely to reveal the source of the information. When information is not released, the individual or his or her guardian shall be provided with a written denial stating the basis for the denial, a description of how a complaint may be filed, the name, title and address of the contact person to receive the complaint; and the process for filing a complaint pursuant to 45 C.F.R. 160.306;

(2) A clinical staff member shall be present at a record review if:

a. There is a reasonable concern that an individual will experience a harmful effect as a result of reviewing his or her record, or reasonable concern that the security of the record is at risk; and

b. The determination that (2)a. above applies has been made on a case by case basis, and the reasons for the determination have been documented in writing;

(3) Information shall be released to any person or organization that has obtained the written consent of the individual or his or her guardian;

(4) Information shall be released to the department and funding, licensing, and accrediting agencies by programs within the service delivery system as necessary for:

a. Determining eligibility for funding;

b. Assisting in accrediting or licensing decisions;

c. Monitoring and evaluating service delivery;

d. Assuring the delivery of appropriate services to individuals; and

e. Planning future service delivery;

(5) Programs shall not include or release confidential information in an individual’s record which pertains to other individuals;

(6) Programs shall include within the records of an individual any supplemental information provided by the individual or his or her guardian either clarifying or rebutting information deemed by the individual to be inaccurate;

(7) An attorney appointed by a court to represent an individual shall have access to all records and information pertaining to that individual;

(8) Legal counsel for the department shall have access to all relevant records and information pertaining to an individual when such records and information are necessary because the individual:

a. Is the subject of an involuntary commitment hearing;

b. Is the subject of a guardianship proceeding; or

c. Has instituted legal action against the state in regard to care and treatment provided by the mental health service delivery system;

(9) In cases where an individual, his or her guardian, an attorney or other advocate representing the individual, after review of the record, requests copies of the record, such copies in paper format, shall be made available free of charge for the first 25 pages and not more than 25 cents per page thereafter; or, if available, copies of records electronically stored and produced, shall be made available free of charge for the first 25 pages and at actual cost per page thereafter. The individual, his or her guardian, attorney or other advocate representing the individual may choose whether to receive the record in paper form, or if available in electronic form;

(10) Information regarding the medical treatment of an individual shall be released to law enforcement officials or health facility personnel if necessary to address an emergency situation involving danger to the individual's health or safety, but only specific information necessary to the relief of the emergency may be released without the individual or his or her guardian’s consent;

(11) In accordance with RSA 329:31, RSA 330-A:35, RSA 329-B:29, and RSA 326-B:33, any of the following persons licensed in New Hampshire shall make reasonable efforts to disclose to a third party or law enforcement when an individual has made a serious threat of physical violence against a clearly identified or reasonably identifiable victim or victims, or a serious threat of substantial damage to real property:

a. A physician;

b. A psychologist;

c. An advance practice registered nurse;

d. Any person licensed pursuant to RSA 330-A; or

e. Any person who works under the supervision of any of the above;

(12) In accordance with RSA 135-C:19-a, I, a community mental health center may disclose to a family member or other person, if such family member or other person lives with the individual or provides direct care to the individual information regarding:

a. Diagnosis;

b. Admission to or discharge from a treatment facility;

c. Functional assessment;

d. The name of the medicine prescribed;

e. The side effects of any medication prescribed;

f. Behavioral or physical manifestations which would result from failure of the individual to take such prescribed medication;

g. Treatment plans and goals; and

h. Behavioral management strategies;

(13) Information shall not be released pursuant to (12) above unless the program first:

a. Provides written notice to the individual or his or her guardian specifying the information requested, the reason for the request, and the person making the request;

b. Requests the individual or his or her guardian’s consent to release the information; and

c. If consent cannot be obtained, the individual shall be notified in writing prior to the disclosure of:

The reason for the intended disclosure;
The name of the person(s) to whom the information will be released; and
The specific information intended to be released;

(14) A community mental health center shall receive or accept communications from family members, friends, or other persons with information pertaining to the health and safety of the individual, and shall document such communications in the individual’s record;

(15) In accordance with RSA 135-C:19-a, II, when the medical director or designee determines that obtaining information is essential to the care or treatment of an individual admitted pursuant to RSA 135-C:27-54, a designated receiving facility may request, and any health care provider which previously provided services to any individual involuntarily admitted to the facility may provide, information about such individual limited to medications prescribed, known medication allergies or other information essential to the medical or psychiatric care of the individual admitted;

(16) Information shall not be released pursuant to (15) above unless the program first:

a. Provides written notice to the individual or his or her guardian specifying the information requested, the reason for the request, and the person making the request;

b. Requests, the individual or his or her guardian's consent to release the information; and

c. If consent cannot be obtained, the facility shall notify the individual in writing prior to the disclosure of:

The name of the care provider who have been asked to provide information;
The reason for the disclosure;
The name of the person(s) to whom the information will be released; and
The specific information which will be released;

(17) In accordance with RSA 135-C:19-a, II-a, when the medical director, or designee, determines that obtaining information is essential to the care and treatment of an individual admitted pursuant to RSA 135-C: 27-54 and the consent of the individual or his or her guardian admitted cannot be obtained, the designated receiving facility may request and any community mental health program which has previously provided services to such individual shall immediately provide information about the individual including medications prescribed, known medication allergies, services provided and other information essential to the medical and psychiatric care of the individual admitted. The facility may disclose information necessary to identify the individual and the facility which is requesting the information; and

(18) In accordance with RSA 135-C:19-a, III, a community mental health program or state facility may disclose to an interdisciplinary committee designated by the governor to review child fatalities, information which is relevant to a case of suicide or traumatic fatal injury under review by such committee. Information to be disclosed to such committee shall be limited to the diagnosis and course of treatment of the child or the person who caused the fatality. Information disclosed pursuant to this subparagraph shall remain confidential and shall not be subject to discovery, subpoena, or admission into evidence in any judicial or administrative proceeding.

(g) Individuals or their guardians shall have the right to complain about any alleged violation of a right afforded by these rules or by any state or federal law or rule or any other matter.

History

#4412, eff 4-27-88; ss by #5093, eff 3-15-91, EXPIRED: 3-15-97
#6757, eff 5-27-98; ss by #8639, INTERIM, eff 5-27-06, EXPIRES: 11-23-06, ss by #8757, eff 11-17-06; ss by #10706, INTERIM, eff 11-15-14, EXPIRES: 5-14-15; ss by #10819, eff 4-23-15, EXPIRED: 4-23-25
#14352, INTERIM, eff 8-26-25, EXPIRES: 2-22-26

N.H. Code Admin. R. Ann. He-M 309.06 Treatment Rights {#sec-he-m-309.06 omnilex-key=us-nh-regs-official--agency-he-m--He-M 309.06}

(a) Individuals shall have the right to adequate and humane treatment, including:

(1) The right of access to treatment including:

a. For those individuals applying for services the right to evaluation to determine the individual’s need for services and to determine which programs are most suited to provide the services needed;

b. The right to receive necessary services when those services are available, subject to the admission and eligibility policies and standards of each program; and

c. The right to receive services without regard to race, color, age, religion, sex, marital status, national origin, severity of disability, sexual orientation or inability to pay except in accordance with He-M 401.14;

(2) The right to quality treatment including:

a. Treatment and services provided in accordance with licensing requirements and applicable rules adopted by the department in He-M 200-1300 and applicable rules of other state agencies; and

b. Services provided in keeping with generally accepted clinical and professional standards applicable to the persons and programs providing the treatment and to the conditions for which the individual is being treated;

(3) The right to receive services in such a manner as to promote the individual's full participation in his or her community;

(4) The right to receive all services or treatment in accordance with the time frame set forth in the individual service plan;

(5) The right to an individual service plan developed, reviewed, and revised in accordance with He-M 401 which addresses the individual’s own goals;

(6) The right to receive treatment and services contained in individual service plans designed to provide opportunities for the individual to participate in meaningful activities in the communities in which they live and work;

(7) The right to service and treatment in the least restrictive alternative or environment necessary to achieve the intended purposes of treatment including programs which least restrict freedom of movement, informed decision-making, and participation in the community while providing the level of security and support needed by the individual;

(8) The right to be served, whenever possible, in generic, integrated settings rather than specialized programs for persons with mental illness, except that programs may restrict access by individuals to various areas to:

a. Ensure the privacy or safety of the individuals;

b. Achieve other necessary objectives contained in the individual service plan; or

c. Comply with provisions of law or orders of court;

(9) The right for the individual or his or her guardian to be informed of all significant risks, benefits, side effects and alternative treatment and services and to give consent to any treatment, placement, or referral following an informed decision except actions taken under He-M 305 or where otherwise provided by law, such that:

a. Whenever possible, the consent shall be given in writing; and

b. In all other cases, evidence of consent shall be documented by the program and be witnessed by at least one person;

(10) The right to refuse to participate in any form of experimental treatment or research;

(11) The right to be fully informed of one's own diagnosis and prognosis;

(12) The right to voluntary placement unless RSA 135-C:27-33, 135-C:34-48, or 135-C:51 apply, including the right to:

a. Seek changes in placement, services, or treatment at any time; and

b. Withdraw from any form of voluntary treatment or from the service delivery system;

(13) The right to services which promote independence including services which shall be directed toward:

a. Eliminating, or reducing as much as possible, the individual’s needs for continued services and treatment; and

b. Promoting the ability of the individuals to function at their highest capacity and as independently as possible;

(14) The right to refuse medication and treatment except emergency treatment provided under the terms and conditions of RSA 135:21-b;

(15) The right to referral for medical care and treatment including:

a. Assistance in finding such care and treatment in a prompt and timely manner; and

b. Access to such medical services as is required in accordance with He-M 401;

(16) The right to consultation and second opinion including:

a. At the individual's own expense, the consultative services of:

Private physicians;
Psychologists;
Dentists; and
Other health practitioners;

b. Granting to such health practitioners reasonable access to the individual in programs; and

c. Allowing such health practitioners to make recommendations to programs regarding the services and treatment provided by the programs;

(17) The right, upon request, to have one or more of the following present at any treatment meeting requiring the individual’s participation and informed decision-making:

a. Guardian;

b. Representative;

c. Attorney;

d. Family member;

e. Friend;

f. Advocate;

g. Consultant; or

h. Peer;

(18) The right to freedom from restraint including the right to be free from seclusion and physical, mechanical or pharmacological restraint; and

(19) If the individual meets the definition of a “child” in RSA 126-U:1, the right to freedom from restraint and seclusion, as defined in RSA 126-U:1, IV and V-a, respectively, except as allowed by RSA 126-U.

(b) These rules shall not require any behavioral health care professional to administer treatment contrary to such professional's clinical judgment.

(d) For individuals who have a guardian, the following provisions shall apply:

(1) The program shall ensure that, the guardian and all persons involved in the provision of service are made aware of the individual’s needs, views, preferences and aspirations;

(2) The program shall comply with the decisions made by the guardian within the legitimate scope of his or her authority;

(3) A guardian is only allowed to make decisions that are within the scope of his or her powers pursuant to RSA 464-A:25, RSA 463 and as modified by the court, or as otherwise allowed by law;

(4) The program shall request a copy of the guardianship order from the guardian and keep the order in the individual’s record at the program;

(5) If any issues arise relative to the provision of services and supports which are outside the scope of the guardian’s decision-making authority as set forth in the guardianship order, the individual’s choice and preference relative to those issues shall prevail unless the guardian’s authority is expanded by the court to include those issues;

(6) A program shall take such steps as are necessary to prevent a guardian from exceeding the decision-making authority granted by the court or acting in a manner that does not further the best interests of the individual, including:

a. Reviewing with the guardian the limits on his or her decision-making authority; and

b. If necessary, bringing the matter to the attention of the court that appointed the guardian; and

(7) In the event that there is a dispute between the program and the guardian, the program shall inform the guardian of his or her right to take either or both of the following actions:

a. Appeal the matter pursuant to He-M 204 and He-C 200; or

b. Bring the dispute to the attention of the probate court that appointed the guardian.

History

#4412, eff 4-27-88; ss by #5093, eff 3-15-91, EXPIRED: 3-15-97
#6757, eff 5-27-98; ss by #8639, INTERIM, eff 5-27-06, EXPIRES: 11-23-06; ss by #8757, eff 11-17-06; ss by #10706, INTERIM, eff 11-15-14, EXPIRES: 5-14-15; ss by #10819, eff 4-23-15, EXPIRED: 4-23-25
#14352, INTERIM, eff 8-26-25, EXPIRES: 2-22-26

N.H. Code Admin. R. Ann. He-M 309.07 Termination of Services {#sec-he-m-309.07 omnilex-key=us-nh-regs-official--agency-he-m--He-M 309.07}

Termination of services shall be done only pursuant to He-M 401.14.

History

#4412, eff 4-27-88; ss by #5093, eff 3-15-91, EXPIRED: 3-15-97
#6757, eff 5-27-98; ss by #8639, INTERIM, eff5-27-06, EXPIRES: 11-23-06; ss by #8757, eff 11-17-06; ss by #10706, INTERIM, eff 11-15-14, EXPIRES: 5-14-15; ss by #10819, eff 4-23-15, EXPIRED: 4-23-25
#14352, INTERIM, eff 8-26-25, EXPIRES: 2-22-26

N.H. Code Admin. R. Ann. He-M 309.08 Suspension of Services {#sec-he-m-309.08 omnilex-key=us-nh-regs-official--agency-he-m--He-M 309.08}

Suspension of services shall be done only pursuant to He-M 401.14.

History

#4412, eff 4-27-88; ss by #5093, eff 3-15-91, EXPIRED: 3-15-97
#6757, eff 5-27-98; ss by #8639, INTERIM, eff 5-27-06, EXPIRES: 11-23-06; ss by #8757, eff 11-17-06; ss by #10706, INTERIM, eff 11-15-14, EXPIRES: 5-14-15; ss by #10819, eff 4-23-15, EXPIRED: 4-23-25
#14352, INTERIM, eff 8-26-25, EXPIRES: 2-22-26

N.H. Code Admin. R. Ann. He-M 309.09 Individual Rights in Community Residences {#sec-he-m-309.09 omnilex-key=us-nh-regs-official--agency-he-m--He-M 309.09}

(a) In addition to the foregoing rights, individuals in community residences shall also have the following rights:

(1) The right to a safe, sanitary and humane living environment;

(2) The right to freely and privately communicate with others, including:

a. The right to send and receive unopened and uncensored written and electronic correspondence;

b. The right to have reasonable access to telephones and to be allowed to make and to receive reasonable numbers of telephone calls except that community residences may require an individual to reimburse them for the cost of any long distance calls made by the individual;

c. The right to receive and to refuse to receive visitors except that community residences may impose reasonable restrictions on the number and time of visits in order to ensure effective provision of services; and

d. The right to engage in social, recreational, and religious activities including the provision of regular opportunities for individuals to engage in such activities;

(3) The right to privacy, including the following:

a. The right to courtesies such as knocking on closed doors before entering and ensuring privacy for telephone calls, electronic communications, and visits;

b. The right to opportunities for personal interaction in a private setting except that any conduct or activity which is illegal shall be prohibited; and

c. The right to be free from searches of their persons and possessions except in accordance with applicable constitutional and legal standards;

(4) The right to personal choice, including the following:

a. The right to keep and wear their own clothes;

b. The right to reasonable space for personal possessions;

c. The right to keep and to read materials of his or her own choosing;

d. The right to keep and spend their own money; and

e. The right to be compensated for any work performed and the right not to work, except that:

Individuals may be required to perform personal housekeeping tasks within the individual's own immediate living area and equitably shared housekeeping tasks within the common areas of the community residence, without compensation; and
Individuals may perform vocational learning tasks or work required for the operation or maintenance of a community residence, if the work is consistent with their individual service plans and the individual is compensated for work performed according to laws, rules, and regulations set by the state and federal governments; and

(5) The right to be reimbursed for the loss of any money held in safekeeping by the community residence.

(b) Nothing in He-M 309.09 shall require a community residence to have policies governing the behavior of the residents.

(c) Individuals and guardians shall have the right to be informed of any house policies prior to admission to the community residence.

(d) Residents shall have the right to participate in the development and modification of any house policies. Residents shall formally review the house policies at least annually.

(e) House policies shall be posted by community residences.

(f) House policies shall be in conformity with He-M 309.

(g) House policies shall be periodically reviewed for compliance with He-M 309 in connection with community mental health program and department site visits.

History

#4412, eff 4-27-88; ss by #5093, eff 3-15-91, EXPIRED: 3-15-97
#6757, eff 5-27-98; ss by #8639, INTERIM, eff 5-27-06, EXPIRES: 11-23-06; ss by #8757, eff 11-17-06; ss by #10706, INTERIM, eff 11-15-14, EXPIRES: 5-14-15; ss by #10819, eff 4-23-15, EXPIRED: 4-23-25
#14352, INTERIM, eff 8-26-25, EXPIRES: 2-22-26

Part He-M 310 Rights of Persons Receiving Developmental Services or Acquired Brain Disorder Services in the Community

N.H. Code Admin. R. Ann. He-M 310.01 Purpose {#sec-he-m-310.01 omnilex-key=us-nh-regs-official--agency-he-m--He-M 310.01}

The purpose of these rules is to define the rights of applicants for service or persons who have been found eligible for services under He-M 503.03 or He-M 522.03 and who are being served in the community or in a state-operated designated receiving facility. Individuals might have additional rights under RSA 151:21, patients' bill of rights for residents of health care facilities.

History

#4413, eff 4-27-88; ss by #5094, eff 3-15-91; ss by #6212, INTERIM, eff 3-30-96, EXPIRES: 12-31-98; ss by #6758, eff 5-27-98; ss by #8640, INTERIM, eff 5-27-06, EXPIRES: 11-23-06; ss by #8701, eff 8-4-06; ss by #10821, eff 4-25-15; ss by #13676, eff 6-24-23

N.H. Code Admin. R. Ann. He-M 310.02 Definitions {#sec-he-m-310.02 omnilex-key=us-nh-regs-official--agency-he-m--He-M 310.02}

The words and phrases used in this part shall have the following meanings:

(a) “Abuse” means an act or omission by an employee, consultant, or volunteer of a provider agency which is not accidental and harms or threatens to harm an individual's physical, mental or emotional health, or safety and includes emotional abuse, physical abuse, and sexual abuse;

(b) “Acquired brain disorder” means a disruption in brain functioning that:

(1) Is not congenital or caused by birth trauma;

(2) Presents a severe and life-long disabling condition which significantly impairs a person's ability to function in society;

(3) Occurs prior to age 60;

(4) Is attributable to one or more of the following reasons:

a. External trauma to the brain as a result of:

A motor vehicle incident;
A fall;
An assault; or
Another related traumatic incident or occurrence;

b. Anoxic or hypoxic injury to the brain such as from:

Cardiopulmonary arrest;
Carbon monoxide poisoning;
Airway obstruction;
Hemorrhage; or
Near drowning;

c. Infectious diseases such as encephalitis and meningitis;

d. Brain tumor;

e. Intracranial surgery;

f. Cerebrovascular disruption such as a stroke;

g. Toxic exposure; or

h. Other neurological disorders such as Huntington's disease or multiple sclerosis which predominantly affect the central nervous system; and

(5) Is manifested by one or more of the following:

a. Significant decline in cognitive functioning and ability; or

b. Deterioration in:

Personality;
Impulse control;
Judgment;
Modulation of mood; or
Awareness of deficits;

(d) “Area agency” means “area agency” as defined in RSA 171-A:2, I-b;

(e) “Attorney” means a member of the New Hampshire bar association retained, employed, or appointed by a court to represent an individual;

(f) “Coercion” means an act by an employee, contractor, consultant, or volunteer of a provider agency which is designed to compel an individual to act in clear opposition to the preference of the individual, excluding requirements otherwise prescribed by law or rule;

(g) “Community residence” means either an agency residence as defined in He-M 1001.02 (b) or family residence as defined in He-M 1001.02 (p) exclusive of any independent living arrangement that:

(1) Provides residential services for at least one person with a developmental disability, in accordance with He-M 503, or acquired brain disorder in accordance with He-M 522;

(2) Provides services and supervision for an individual on a daily and ongoing basis, both in the home and in the community, unless the individual’s service agreement states that the individual may be without supervision for specified periods of time;

(3) Serves individuals whose services are funded by the department; and

(4) Is certified pursuant to He-M 1001;

(h) “Designated receiving facility (DRF)” means a residential treatment program designated by the commissioner pursuant to RSA 171-A:20 and He-M 526 to provide care, custody, and treatment to persons involuntarily admitted to the state developmental services system;

(i) “Developmental disability” means “developmental disability” as defined in RSA 171-A:2, V, namely, “a disability:

b Which originates before such individual attains age 22, has continued or can be expected to continue indefinitely, and constitutes a severe disability to such individual's ability to function normally in society.";

(j) “Emotional abuse” means:

(1) The misuse of power, authority or both;

(2) Verbal harassment; or

(3) Unreasonable confinement which results or could result in the mental anguish or emotional distress of an individual;

(k) “Exploitation” means the use of an individual’s person or property for another’s profit or advantage or breach of a fiduciary relationship through improper use of an individual's person or property including situations where a person obtains money, property, or services from an individual through undue influence, harassment, deception, or fraud;

(l) “Guardian” means a person appointed under RSA 463 or RSA 464-A or who is a parent of an individual under the age of 18 whose parental rights have not been terminated or limited by law in such a way as to remove the person’s right to make decisions pursuant to RSA 171-A on behalf of the individual;

(m) “Habilitation” means “habilitation” as defined in RSA 171-A:2, IX, namely, “the process by which program personnel assist clients to acquire and maintain those life skills which enable them to cope more effectively with the demands of their own persons and of their environment, to be economically self-sufficient and to raise the level of their physical, mental and social efficiency. Habilitation includes but is not limited to programs of formal, structured education and treatment.”;

(n) “Individual” means a person who has a developmental disability as defined in (i) above or an acquired brain disorder as defined in (b) above;

(o) “Individual treatment plan” means, for an individual receiving treatment pursuant to RSA 171-B:12, a plan developed by the individual's treatment team to address the individual’s clinical needs and the behavior or condition which creates a potential danger for others;

(p) “Informed decision” means a choice made voluntarily by an individual receiving services or an applicant for services or, where appropriate, such person's legal guardian or representative, after all relevant information necessary to making the choice has been provided, when:

(1) The person understands that he or she is free to choose or refuse any available alternative;

(2) The person clearly indicates or expresses his or her choice; and

(3) The choice is free from all coercion;

(q) “Intellectual disability” means “intellectual disability” as defined in RSA 171-A:2, XI-a, namely, “significantly subaverage general intellectual functioning existing concurrently with deficits in adaptive behavior, and manifested during the developmental period. A person with an intellectual disability may be considered mentally ill provided that no person with an intellectual disability shall be considered mentally ill solely by virtue of his or her intellectual disability.”;

(r) “Neglect" means an act or omission which results or could result in the deprivation of essential services necessary to maintain the minimum mental, emotional, or physical health of an individual;

(s) “Parent” means the father or mother of an individual under the age of 18 whose parental rights have not been terminated or limited by law;

(t) “Physical abuse” means the use of physical force which results or could result in physical injury to an individual;

(u) “Prescribing practitioner” means a licensed professional with prescriptive authority, including the following:

(1) Physician;

(2) Advance practice registered nurse (APRN);

(3) Dentist;

(4) Physician's assistant;

(5) Optometrist; and

(6) Podiatrist;

(v) “Provider agency” means an entity that is providing services to individuals;

(w) “Resident” means an individual who lives in a community residence;

(x) “Restraint” means:

(1) Any manual method, physical or mechanical device, material, or equipment that immobilizes an individual or reduces the ability of an individual to move his or her arms, legs, head, or other body parts freely but does not include devices, such as orthopedically prescribed devices, or other methods that involve the physical holding of an individual, if necessary, for the purpose of:

a. Protecting the individual from falling out of bed; or

b. Permitting the individual to participate in activities without the risk of physical harm; or

(2) Any drug or medication when it:

a. Is used as a restriction to manage an individual’s behavior or restrict the individual’s freedom of movement; and

b. Is not a standard treatment or dosage for the individual’s diagnosis, in that its overall effect reduces an individual’s ability to effectively or appropriately interact; or

(3) “Restraint” as defined in RSA 126-U:1, IV as applied to a person who has not reached 18 years of age, or who is otherwise a child as defined by RSA 126-U:1, I;

(y) “Representative” means:

(1) The parent or guardian of an individual under the age of 18;

(2) The legal guardian of an individual 18 or over; or

(3) A person who has power of attorney for the individual;

(z) “Seclusion” means

(1) For an individual who is 18 or older:

a. Is placed alone in a room or area from which the individual is physically prevented, by lock or person, from leaving; and

b. Cannot or will not make an informed decision to agree to such confinement; or

(2) “Seclusion” as defined in RSA 126-U:1, V-a as applied to a person who has not reached 18 years of age, or who is otherwise a child as defined by RSA 126-U:1, I;

(aa) “Service” means any evaluation, training, counseling, therapy, habilitation, service coordination, or other type of assistance provided by a provider agency;

(ab) “Sexual abuse” means contact or interaction of a sexual nature between an individual and an employee of or a consultant or volunteer for a provider agency;

(ac) “Service agreement” means a written agreement between the individual, guardian, or representative and provider(s) that is prepared as a result of the person-centered planning process and describes the services that an individual will receive and constitutes an individual service agreement as defined in RSA 171-A:2, X; and

(ad) “Treatment” means medical care provided by a prescribing practitioner.

History

#4413, eff 4-27-88; ss by #5094, eff 3-15-91; ss by #6212, INTERIM, eff 3-30-96, EXPIRES: 12-31-98; ss by #6758, eff 5-27-98; ss by #8640, INTERIM, eff 5-27-06, EXPIRES: 11-23-06; ss by #8701, eff 8-4-06; ss by #10821, eff 4-25-15; ss by #13676, eff 6-24-23

N.H. Code Admin. R. Ann. He-M 310.03 Notice of Rights of Individuals and Applicants {#sec-he-m-310.03 omnilex-key=us-nh-regs-official--agency-he-m--He-M 310.03}

(a) Provider agencies shall inform individuals and applicants of their rights under these rules in clearly understandable language and form, both verbally and in writing, on an annual basis.

(b) The notification of rights required pursuant to (a) above shall include, at a minimum, the following measures:

(1) Provider agencies shall inform applicants for services of their rights to evaluations and access to treatment and other services;

(2) Provider agencies shall provide meaningful and understandable information about rights to individuals who are minors or who have been adjudicated incapacitated as well as to their parents, guardians, representatives, or attorneys;

(3) Provider agencies shall provide information outlining the process of how to file a complaint pursuant to He-M 202;

(4) Provider agencies shall advise individuals and their guardians or representatives of individuals’ rights upon initial participation in any service, upon any change in provider agency or community residence, and at least once a year after initial participation;

(5) Every provider agency shall post a notice of the rights set forth in these rules, as follows:

a. The notice shall be posted continuously and conspicuously; and

b. The notice shall be presented in clearly understandable language and form; and

(6) Each provider agency and community residence shall have on the premises complete copies of rules pertaining to rights of individuals which are available for individuals, guardians, representatives, and staff to review.

(c) Each provider agency shall document, as indicated by signature of the individual or his or her parent, guardian, or representative, notifications of rights in individuals’ records.

History

#4413, eff 4-27-88; ss by #5094, eff 3-15-91; ss by #6212, INTERIM, eff 3-30-96, EXPIRES: 12-31-98; ss by #6758, eff 5-27-98; ss by #8640, INTERIM, eff 5-27-06, EXPIRES: 11-23-06; ss by #8701, eff 8-4-06; ss by #10821, eff 4-25-15; ss by #13676, eff 6-24-23

N.H. Code Admin. R. Ann. He-M 310.04 Fundamental Rights {#sec-he-m-310.04 omnilex-key=us-nh-regs-official--agency-he-m--He-M 310.04}

(a) Any person receiving services for a developmental disability or acquired brain disorder shall be entitled to any legal right to which all citizens are entitled regardless of that person's admission to the developmental services system, except as provided by RSA 171-B.

(b) The legal rights protected shall include, at a minimum:

(2) The right to register to vote, if eligible, in public elections and, as provided in 42 U.S.C. § 1973aa-6, the right to receive assistance from the person of his or her choice in registering to vote and in voting;

(3) The following civil rights, unless a court has determined that an individual is legally incapacitated pursuant to RSA 464-A and a guardian or representative has been appointed to make certain decisions or a behavior change program, as described in He-M 310.11, exists that limits an individual’s rights and is approved by a human rights committee pursuant to RSA 171-A:17, II(c):

a. The right to manage affairs;

b. The right to contract;

c. The right to hold professional, occupational, or motor vehicle driver’s licenses;

d. The right to marry or to obtain a divorce;

e. The right to make a will; and

f. The right to exercise any other civil right;

(4) The right to not be discriminated against in any manner because of race, color, sex, religion, national origin, age, disability, marital status, sexual orientation or degree of disability as provided in state and federal laws, title VII of the civil rights act of 1964, section 504 of the rehabilitation act of 1973, the age discrimination act of 1975, the Americans with Disabilities Act of 1990, and the provisions of certain block grants, including:

a. Access to auxiliary aids needed by the individual;

b. Services which are accessible to individuals of limited English proficiency; and

c. Service locations that are accessible and meet the individuals physical, sensory, intellectual, or emotional needs; and

(5) The right to legal remedies including the right to petition for and receive the benefits of a writ of habeas corpus and to seek any other remedy provided by law.

(c) The legal rights of a person involuntarily admitted in accordance with RSA 171-B may be limited to the extent necessary to prevent harm to the individual or others, unless the individual is committed to the secure psychiatric unit of the New Hampshire state prison.

History

#4413, eff 4-27-88; ss by #5094, eff 3-15-91; ss by #6212, INTERIM, eff 3-30-96, EXPIRES: 12-31-98; ss by #6758, eff 5-27-98; ss by #8640, INTERIM, eff 5-27-06, EXPIRES: 11-23-06; ss by #8701, eff 8-4-06; ss by #10821, eff 4-25-15; ss by #13676, eff 6-24-23

N.H. Code Admin. R. Ann. He-M 310.05 Personal Rights {#sec-he-m-310.05 omnilex-key=us-nh-regs-official--agency-he-m--He-M 310.05}

(a) Persons who are applicants for services or individuals who are receiving services from provider agencies shall be treated with dignity and respect at all times.

(b) Individuals shall be free from abuse, neglect, and exploitation including, at a minimum, the following:

(1) Freedom from any emotional, physical, or sexual abuse or neglect;

(2) Freedom from the intentional use of physical force except the minimum force necessary to prevent harm to the individual or others or substantial damage to property or when a behavior change program exists that limits an individual’s rights and is approved by a human rights committee pursuant to RSA 171-A:17, II(c); and

(3) Freedom from personal or financial exploitation.

(d) Individuals shall have the right to be free from coercion.

(e) Any individual who uses or has used provider agency services shall have the right to confidentiality of all information and records.

(f) At a minimum, provider agencies shall adhere to the following confidentiality requirements:

(1) Material safeguarded shall include any information with respect to an individual or through which an individual can be identified such as:

a. Names;

b. Photographic and video images;

c. Addresses;

d. Diagnoses and evaluative data;

e. Medical and clinical records;

f. Service agreements; and

g. Whether a person is using or has used a provider agency’s services;

(2) Provider agency staff may disclose to the chief of police in the community in which the individual resides, or any law enforcement officer, as safety and security of the individual and others require, or the individual’s legal counsel that an individual is served by a provider agency if that individual is a victim of a crime, has been charged with a misdemeanor or felony, or is involuntarily admitted in accordance with RSA 171-B;

(3) The individual and guardian or representative shall be informed that clinical information shall be released to the third party payor to the extent necessary to substantiate charges for services;

(4) If the individual, guardian, or representative wishes to bear the cost of services privately rather than allow the release of information to third party payors, the individual shall be personally responsible for the full cost of such services;

(5) All employees, consultants, and volunteers of provider agencies shall be informed so as to know and understand confidentiality and comply with confidentiality statutes and rules;

(6) Separate, individual records shall be maintained when group treatment methods are employed and joint records of treatment activity that identify participants shall not be maintained;

(7) No provider agency shall photograph, fingerprint, or record any individual by audio or visual equipment unless the individual, guardian, or representative has consented following an informed decision, nor allow any third party to photograph, fingerprint, or record any individual by audio or visual equipment unless the individual, guardian, or representative has consented following an informed decision, except if such monitoring or recording is part of a treatment program for a person committed in accordance with RSA 171-B;

(8) These rules shall not affect the obligation of provider agencies to release information as required by:

a. RSA 161-F:56, protective services to adults;

b. RSA 169-C:29, report of child abuse;

c. RSA 631:6, report of injury caused by criminal act;

d. He-M 202.07 (j); or

e. Other law; and

(9) Statements made by individuals to physicians licensed pursuant to RSA 329, psychologists licensed pursuant to RSA 329-B, or persons licensed pursuant to RSA 330-A or to those who work under their supervision, may be disclosed for the purpose of commitment hearings.

(g) Access to records shall be as follows:

(1) Information pertaining to an individual shall be released to the individual and guardian or representative upon request including all information provided by third parties except that which was provided prior to May 1982, under an agreement that the information would not be disclosed;

(2) A provider agency service coordinator or nurse shall be present at a record review if:

a. There is a reasonable concern that an individual will experience a harmful effect as a result of reviewing his or her record, or reasonable concern that the security of the record is at risk; and

b. The determination that a. above applies has been made on an individual, case-by-case basis and the reasons for the determination have been documented in writing;

(3) Information shall be released to any person or organization that has obtained the written consent of the individual, guardian, or representative;

(4) Information shall be released to the department and funding, licensing, and accrediting agencies by provider agencies under RSA 171-A as necessary for:

a. Determining eligibility for funding;

b. Assisting in accrediting or licensing decisions;

c. Delivering appropriate services to individuals;

d. Monitoring and evaluating service delivery; and

e. Planning future service delivery;

(5) Provider agencies shall not include or release confidential information in an individual's record which pertains to other individuals;

(6) Provider agencies shall include within the records of an individual any supplemental information provided by the individual, guardian, or representative either clarifying or rebutting information deemed by the individual to be inaccurate;

(7) An attorney appointed by a court to represent an individual shall have access to all records and information pertaining to that individual;

(8) Legal counsel for the department shall have access to all relevant records and information pertaining to an individual when such records and information are necessary because the individual:

a. Is the subject of an involuntary commitment hearing;

b. Is the subject of a guardianship proceeding; or

c. Has instituted legal action against the state in regard to services provided by the developmental services system;

(9) In cases where an individual, or an attorney or other advocate who represents the individual, after review of the record, requests copies of the record, such copies shall be made available free of charge for the first 25 pages and for not more than 25 cents per page thereafter;

(11) In accordance with RSA 329:31, RSA 329-B:29, and RSA 330-A:35, when an individual has made a serious threat of physical violence against a clearly identified or reasonably identifiable victim or victims, or a serious threat of substantial damage to real property, the following shall be obligated to make reasonable efforts to disclose the threat to the third party or law enforcement officials:

a. Physicians licensed pursuant to RSA 329;

b. Psychologists licensed pursuant to RSA 329-B; and

c. Persons licensed pursuant to RSA 330-A and those who work under their supervision.

(h) Individuals and guardians or representatives shall have the right to complain about any alleged violation of a right afforded by these rules or by any state or federal law or rule or the unreasonable restriction of a legal, personal, or treatment right of a person involuntarily admitted in accordance with RSA 171-B, or any other matter.

(i) Any person shall have the right to complain or bring a grievance on behalf of an individual or a group of individuals. The rules governing procedures for protection of rights of individuals, He-M 202, shall apply to such complaints and grievances.

(j) An individual shall have the right to a hearing pursuant to RSA 171-A and He-C 200 when a recommendation is made to provide service for that individual in any residential setting that restricts in any way the liberty or informed decisions of the individual. The individual shall have a right to representation by legal counsel, except that persons involuntarily admitted pursuant to RSA 171-B may only challenge that admission in accordance with procedures set forth in RSA 171-B.

(k) The personal rights of a person involuntarily admitted in accordance with RSA 171-B shall be restricted where safety or security requires such limitation.

History

#4413, eff 4-27-88; ss by #5094, eff 3-15-91; ss by 6212, INTERIM, eff 3-30-96, EXPIRES: 12-31-98; ss by #6758, eff 5-27-98; ss by #8640, INTERIM, eff 5-27-06, EXPIRES: 11-23-06; ss by #8701, eff 8-4-06; ss by #10821, eff 4-25-15; ss by #13676, eff 6-24-23

N.H. Code Admin. R. Ann. He-M 310.06 Service Rights {#sec-he-m-310.06 omnilex-key=us-nh-regs-official--agency-he-m--He-M 310.06}

(a) Individuals shall have the right to adequate and humane service and treatment, including:

(1) The right of access to services including:

a. The right to evaluation to determine the type of services needed and which provider agencies are most suited to provide those services;

b. The right to receive necessary services when those services are available, subject to the admission and eligibility policies and standards of each provider agency; and

c. The right to receive services without regard to race, color, age, religion, sex, marital status, national origin, severity of disability, sexual orientation, or inability to pay;

(2) The right to quality services including services provided in accordance with licensing requirements and rules adopted by the department in He-M 200-1300 and other applicable rules of state agencies and services provided in keeping with generally accepted clinical and professional standards applicable to the individuals’ disabilities and services;

(3) The right to receive services in his or her community:

a. To the same degree of access as persons not receiving services;

b. That will promote the individual’s full community participation; and

c. Except as limited by individual treatment plans for individuals involuntarily admitted in accordance with RSA 171-B;

(4) The right to a person-centered planning process that:

a. Is directed by the individual or representative, if applicable;

b. Is intended to identify the strengths, capacities, preferences, needs, and desired outcomes of the individual;

c. Includes participants freely chosen by the individual as important contributors;

d. Provides information and support to assist the individual to direct the process and to make informed choices and decisions;

e. Reflects cultural considerations of the individual and is conducted in clearly understandable language and form;

f. Occurs at times and location of convenience to the individual;

g. Includes strategies for solving conflict or disagreement within the process;

h. Offers informed choices to the individual or representative, if applicable, regarding services and supports;

i. Involves the family or other participants in enabling and assisting the individual to identify and access a personalized mix of paid and non-paid services and supports that will assist him or her to achieve personally defined outcomes in the most integrated setting appropriate to the needs of the individual;

j. Includes identification of the individual’s planning goals to achieve personal outcomes in collaboration with those whom the individual has identified;

k. Results in a service agreement that identifies personally defined outcomes and training supports, therapies, treatments, and other services the individual is to receive to achieve those outcomes;

l. Includes a method for the individual to request amendments to the agreement; and

m. Records the alternative home and community based settings that were considered by the individual;

(5) The right to a service agreement developed, reviewed, and revised in accordance with He-M 503;

(6) The right to services in accordance with the time frame set in the service agreement;

(7) The right to services in a setting that is:

a. Based on the individual’s needs and preferences;

b. Chosen by the individual or his or her representative from among options that are identified in the service agreement and include non-disability specific settings; and

c. Integrated in, and supportive of full access of individuals to, the greater community, including opportunities to:

Seek employment and work in competitive integrated settings;
Engage in community life;
Control schedules and activities;
Control personal resources;
Receive services in the community to the same degree of access as the general population; and
Live in a private unit in a residential setting, based on the resources available for room and board;

(8) The right to be informed of all significant risks, benefits, side effects, and alternative treatment and services and to give consent to any treatment, behavior change program, service, or referral following an informed decision, except when action is necessary to prevent harm to the individual or others or prevent substantial damage to property or where otherwise provided by law, such that:

a. Whenever it is possible, the consent shall be given in writing; and

b. In all other cases, evidence of consent shall be documented by the provider agency and shall be witnessed by at least one person;

(9) The right to refuse to participate in any form of experimental treatment or in any research or have one’s representative refuse on the individual’s behalf;

(10) The right to be fully informed of one's own diagnosis and prognosis;

(11) The right to voluntary participation in services, as decided by the individual or his or her representative, including the right to seek changes in services or provider agency at any time or to withdraw from any form of service or from a provider agency, unless the person is involuntarily admitted in accordance with RSA 171-B;

(12) The right to services which promote independence including services which shall be directed toward:

a. Eliminating or reducing the individual's need for continued services; and

b. Promoting the ability of the individuals to function at their highest capacity and as independently as possible;

(13) The right to receive medical care and treatment, including ensuring medications are refilled in a timely manner and avoid expiration;

(14) The right to refuse medications and treatment, except emergency treatment that is:

a. Necessary to prevent harm to the individual or others or prevent substantial damage to property; or

b. In accordance with a behavior change program that limits an individual’s rights and is approved by a human rights committee;

(15) The right to consultation and second opinion, including;

a. At the individual's own expense, the consultative services of:

Private physicians;
Psychologists;
Dentists; and
Other health practitioners;

b. Granting such health practitioners reasonable access to the individual by provider agencies; and

c. Allowing such health practitioners to make recommendations to provider agencies regarding the services and treatment provided;

(16) The right to choose, or have one’s representative choose, one or more of the following persons to be present at any person-centered planning meeting or other service planning meeting requiring the individual’s participation and informed decision-making:

a. Guardian;

b. Representative;

c. Attorney;

d. Family member;

e. Friend;

f. Direct support staff;

g. Advocate;

h. Consultant; or

i. Other person the individual requests;

(17) The right to freedom from restraint including:

a. For individuals under the age of 18, the right to limitations on the use of restraint and seclusion pursuant to RSA 126-U; and

b. The right to be free from seclusion and physical, mechanical, or pharmacological restraint except that in cases of emergency such as the occurrence or serious threat of extreme violence, personal injury, or attempted suicide where no less restrictive alternative would be effective:

Such means of restraint as are authorized by a prescribing practitioner and approved by a human rights committee pursuant to RSA 171-A:17, II(c), may be used as part of a treatment plan to which the individual or individual’s guardian or representative, if any, has consented, having made an informed decision to do so; and
The minimum necessary degree of restraint may also be used:

(i) In an emergency to prevent harm to the individual or others or prevent substantial damage to property;

(ii) As part of a behavior change program that limits an individual’s rights and is approved by a human rights committee pursuant to RSA 171-A:17, II, (c); or

(iii) When the person is involuntarily admitted in accordance with RSA 171-B; and

(18) The right to choose with whom to interact.

(b) Applicants shall have the right to evaluation to determine an applicant’s eligibility for services and the type of services needed and to determine which provider agencies are most suited to provide the services needed.

(d) Whenever possible, individuals shall be served in generic, integrated settings rather than specialized programs for persons with developmental disabilities or acquired brain disorders.

(e) Provider agencies may restrict access by individuals to various locations to:

(1) Ensure the privacy or safety of the individuals;

(2) Achieve other necessary objectives contained in the service agreement; or

(3) Comply with provisions of law and orders of court.

(f) These rules shall not require any licensed professional to administer treatment contrary to such professional's clinical judgment.

(g) The service rights of a person involuntarily admitted in accordance with RSA 171-B may be restricted where safety or security requires such limitation.

(h) For individuals who have a guardian or representative, the following provisions shall apply:

(1) The provider agency shall ensure that the guardian or representative and all persons involved in the provision of services are made aware of the individual’s needs, views, preferences, and aspirations;

(2) The provider agency shall comply with decisions made by the guardian or representative within the legitimate scope of his or her authority;

(3) A guardian or representative is only allowed to make decisions that are within the scope of his or her powers pursuant to RSA 464-A:25, RSA 463:12, or RSA 137-J:5 and as modified by the court, or as otherwise allowed by law;

(4) The area agency and provider agencies shall obtain a copy of the guardianship order or power of attorney from the guardian or representative and keep the order in the individual’s record;

(5) If any issues arise relative to the provision of services and supports which are outside the scope of the guardian’s or representative’s decision-making authority as set forth in the guardianship order or power of attorney, the individual’s choice and preference relative to those issues shall prevail unless the guardian’s or representative’s authority is expanded by the court to include those issues;

(6) A provider agency shall take such steps as are necessary to prevent a guardian or representative from exceeding the decision-making authority granted by the court or acting in a manner that does not further the best interests of the individual, including:

a. Reviewing with the guardian or representative the limits on his or her decision-making authority; and

b. If necessary, bringing the matter to the attention of the court that appointed the guardian; and

(7) In the event that there is a dispute between the provider agency and the guardian or representative, the provider agency shall inform the guardian or representative of his or her right to take either or both of the following actions:

a. Appeal the matter pursuant to He-M 202 and He-C 200; or

b. Bring the dispute to the attention of the probate court that appointed the guardian.

History

#4413, eff 4-27-88; ss by #5094, eff 3-15-91; ss by 6212, INTERIM, eff 3-30-96, EXPIRES: 12-31-98; ss by #6758, eff 5-27-98; ss by #8640, INTERIM, eff 5-27-06, EXPIRES: 11-23-06; ss by #8701, eff 8-4-06; ss by #10821, eff 4-25-15; ss by #13676, eff 6-24-23

N.H. Code Admin. R. Ann. He-M 310.07 Termination of Services {#sec-he-m-310.07 omnilex-key=us-nh-regs-official--agency-he-m--He-M 310.07}

(a) Except as provided in (g) below, an individual’s services shall not be terminated unless:

(1) Such termination is deemed in the best interest of the individual;

(2) The individual can function independently without such service;

(3) The individual has received optimal benefit from the service;

(4) The individual or representative refuses to pay for the services that he or she is receiving despite having the financial resources to do so; or

(5) The individual or representative refuses to apply for benefits that could cover the cost of the services that he or she is receiving despite the fact that the individual is or might be eligible for such benefits.

(b) Provider agencies shall only terminate services to individuals in accordance with RSA 171-A:8.

(d) The notice shall:

(1) Be in writing;

(2) Contain the reasons for the termination;

(3) Contain the effective date of the termination; and

(4) Explain that the individual, guardian, or representative has the right to appeal the termination in accordance with He-M 202 and He-C 200.

(e) Services shall be continued while an administrative appeal under He-M 202 or He-C 200 is pending.

(f) In every instance of termination, the area agency shall recommend appropriate services or be responsible for contacting the individual in accordance with RSA 171-A:8, II.

(g) Services to persons involuntarily admitted in accordance with RSA 171-B shall not be terminated except as provided in RSA 171-A:8, V.

History

#4413, eff 4-27-88; ss by #5094, eff 3-15-91; ss by #6212, INTERIM, eff 3-30-96, EXPIRES: 12-31-98; ss by #6758, eff 5-27-98; ss by #8640, INTERIM, eff 5-27-06, EXPIRES: 11-23-06; ss by #8701, eff 8-4-06; ss by #10821, eff 4-25-15; ss by #13676, eff 6-24-23

N.H. Code Admin. R. Ann. He-M 310.08 Suspension of Services {#sec-he-m-310.08 omnilex-key=us-nh-regs-official--agency-he-m--He-M 310.08}

(a) A provider agency shall not suspend services to an individual unless the individual and guardian or representative have prior written notice of the specific behaviors and conduct for which suspension is imposed.

(b) Prior written notice shall be given through the service agreement process or through written provider agency policies which are explained to the individual and guardian or representative upon admission.

(c) Upon suspension, the provider agency shall give the individual and guardian or representative written notice containing the following:

(1) The reason for the suspension;

(2) The length of the suspension; and

(3) An explanation of the right to appeal in accordance with He-M 202 and He-C 200.

(d) The maximum length of a suspension shall be 5 service days. However, should an individual, guardian, or representative choose to exercise the right to appeal, the individual shall be suspended for no longer than one service day pending resolution of the appeal.

(e) Services to persons involuntarily admitted under RSA 171-B shall not be suspended.

History

#4413, eff 4-27-88; ss by #5094, eff 3-15-91; ss by 6212, INTERIM, eff 3-30-96, EXPIRES: 12-31-98; ss by #6758, eff 5-27-98; ss by #8640, INTERIM, eff 5-27-06, EXPIRES: 11-23-06; ss by #8701, eff 8-4-06; ss by #10821, eff 4-25-15; ss by #13676, eff 6-24-23

N.H. Code Admin. R. Ann. He-M 310.09 Rights of Individuals in Community Residences {#sec-he-m-310.09 omnilex-key=us-nh-regs-official--agency-he-m--He-M 310.09}

(a) In addition to the foregoing rights, individuals living in community residences shall also have the following rights:

(1) The right to a safe, sanitary, and humane living environment;

(2) The right to settings that are physically accessible to the individual;

(3) The right to freely and privately communicate with others, including:

a. The right to send and receive unopened and uncensored written and electronic correspondence;

b. The right to have access to telephones and to be allowed to make and to receive reasonable numbers of telephone calls;

c. The right to receive and to refuse to receive visitors; and

d. The right to engage in social, recreational, and religious activities including the provision of regular opportunities for individuals to engage in such activities;

(4) The right to privacy in the individual's sleeping or living unit, including the following:

a. The right to courtesies such as knocking on closed doors before entering and ensuring privacy for telephone calls, electronic communications, and visits;

b. The right to entrance doors lockable by the individual with only appropriate staff having keys to doors;

c. The right to receive visitors of one’s choosing at any time;

d. The right to opportunities for personal interaction in a private setting;

e. The right to receive personal care in private; and

f. The right to be free from searches of their persons and possessions except in accordance with applicable constitutional and legal standards;

(5) The right to individual choice, including the following:

a. The right to keep and wear their own clothes;

b. The right to reasonable space for personal possessions;

c. The right to keep and to read materials of their own choosing;

d. The right to keep and spend their own money;

e. The right to be compensated for any work performed and the right not to work, except that:

Individuals may be required to perform personal housekeeping tasks within the individual's own immediate living area and equitably shared housekeeping tasks within the common areas of the community residence, without compensation; and
Individuals may perform vocational learning tasks or work required for the operation or maintenance of a community residence, if the work is consistent with their service agreements and the individual is compensated for work performed according to laws, rules, and regulations set by the state and federal governments;

f. The right to choose one’s roommate when bedrooms are shared;

g. The right to furnish and decorate one’s sleeping or living unit within the limits of the lease or other agreement; and

h. The freedom and support to control one’s own activities and schedules, and to access food at any time;

(6) The right to a residency agreement in accordance with He-M 310.10; and

(7) The right to be reimbursed for the loss of any money held in safekeeping by the community residence.

(b) In community residences serving persons involuntarily admitted in accordance with RSA 171-B, restrictions on a person’s communication, privacy, and personal choice may be imposed if necessary for the person’s treatment if consistent with the individual treatment plan.

(d) Individuals and guardians or representatives shall have the right to be informed in writing of any house policies prior to admission to the community residence.

(e) Residents shall have the right to participate in the development and modification of any house policies. Residents shall formally review the house policies at least annually.

(f) House policies shall be in conformity with He-M 310.

(g) House policies shall be periodically reviewed for compliance with He-M 310 in connection with provider and department site visits.

(h) Any modification to (a)(4), (5), or (6) above shall be supported by a specific, assessed need and documentation described in (i) below, and be reviewed and approved by the human rights committee of the individual’s provider agency.

(i) A provider agency shall only make modifications pursuant to (h) above by documenting in the service agreement, developed pursuant to He-M 503.10 or He-M 522.11, the following:

(1) The specific and individualized assessed need and a description of the condition that is directly proportionate to the need;

(2) Positive interventions and supports used prior to any modification to the service agreement;

(3) Less intrusive methods of meeting the need that have been tried unsuccessfully;

(4) A method for the regular collection and review of data to measure the ongoing effectiveness of the modification, and established timelines for periodic reviews to determine whether the modification is still necessary or can be terminated;

(5) Informed consent of the individual, guardian, or representative; and

(6) An assurance that the interventions and supports will not cause harm to the individual.

History

#4413, eff 4-27-88; ss by #5094, eff 3-15-91; ss by 6212, INTERIM, eff 3-30-96, EXPIRES: 12-31-98; ss by #6758, eff 5-27-98; ss by #8640, INTERIM, eff 5-27-06, EXPIRES: 11-23-06; ss by #8701, eff 8-4-06; ss by #10821, eff 4-25-15; ss by #13676, eff 6-24-23; ss by #14099, eff 10-18-24, EXPIRES: 10-18-34

N.H. Code Admin. R. Ann. He-M 310.10 Residency Agreement {#sec-he-m-310.10 omnilex-key=us-nh-regs-official--agency-he-m--He-M 310.10}

(a) Individuals living in community residences shall enter into a residency agreement with the provider in accordance with (b)-(d) below.

(b) The individual or resident, legal guardian, if applicable, and provider shall complete the “New Hampshire Residency Agreement” (April 2023) outlining the following:

(1) The resident’s right to:

a. Privacy in his or her sleeping and living unit;

b. Lockable doors to his or her sleeping or living unit with only appropriate staff having keys;

c. The ability to have visitors of his or her choosing at any time;

d. The choice of furnishings and decorations in his or her sleeping or living unit;

e. The choice of roommate, if bedrooms are shared;

f. Have access to food at any time;

g. An inventory of personal property valued at $25.00 or greater, as well as any item of sentimental value to the resident, that will occur on the day of move-in and will be updated quarterly to ensure accuracy; and

h. Modifications of his or her rights in a. through g. above, pursuant to He-M 310.09(h) and (i);

(2) The responsibilities as a resident to include:

a. Maintaining cleanliness of his or her sleeping or living unit and shared living spaces; and

b. Reviewing and signing a complete inventory of personal property valued at $25.00 or greater, as well as any item of sentimental value to the resident on the day of move-in, quarterly to ensure accuracy, and on the day of departure of the residence;

(3) The responsibilities as a provider to include:

a. Maintaining a safe residential environment;

b. Always treating the resident with dignity and respect;

c. Implementing the resident’s approved individual service agreement and approved behavior support plan;

d. Providing services in accordance with all applicable state regulations, and the contract with the provider agency; and

e. Assisting, as necessary, the resident to develop and maintain an inventory of personal property, valued at $25.00 or more, as well as any item of sentimental value to the resident and ensuring that upon termination of the residency agreement, the resident receives all personal property listed on the most recent inventory.

(1) The provider shall notify the resident, legal guardian, if applicable, and service coordinator in writing of the intended termination of the residency agreement, and the reason(s) therefor, at least 90 calendar days before the proposed termination date of the residency agreement, and in an agency residence, inform the resident that this notice is not an order requiring them to vacate the residence, and include the rights of the resident to appeal the provider’s decision to terminate the residency agreement, in accordance with He-M 310.12 below;

(2) The resident or legal guardian, if applicable, shall have the right to request a team meeting to discuss whether the provider would reconsider the notice;

(3) Upon receipt of the notice required in (c)(1) above, the service coordinator shall convene a team meeting within 10 calendar days to develop a transition plan for the resident in order to ensure an appropriate transition to an alternative residence;

(4) In cases where the behavior of the resident poses a serious threat of bodily harm to the provider or others living in the residence, or substantial damage to the residence or property, the provider shall notify the resident, legal guardian, if applicable, and the service coordinator of the situation and provide 72 hours’ notice before the proposed termination date, and in an agency residence, inform the resident that this notice is not an order requiring them to vacate the residence, and include the rights of the resident to appeal the provider’s decision to terminate the residency agreement, in accordance with He-M 310.12 below;

(5) Upon receipt of notification in (4) above, the service coordinator, or designee, shall immediately convene a team meeting within 24 hours to determine and take the appropriate course of action to ensure the resident’s health and safety, and ensure that the resident has access to an alternative safe residence;

(6) In an agency residence, if the resident fails to vacate the residence by the proposed termination date, the provider shall issue a notice to the resident or legal guardian if applicable, for the resident to vacate the residence within 3 days, and include the rights of the resident to appeal the notice in accordance with He-M 310.12 below, and remain in the residence in accordance with He-M 310.12(d); and

(7) In the absence of the conditions for termination provided in (4) above, an agency residence shall only terminate the residency agreement for the following reasons:

a. If the termination is necessary for the resident’s welfare and the resident’s needs can no longer be met at the agency residence;

b. The agency resident ceases to operate; or

c. Other good cause, which need not be based on the action or inaction of the resident including, but not limited to any legitimate business or economic reasons.

(d) If the resident chooses to end the residency agreement:

(1) The resident or legal guardian if applicable, shall notify the provider and service coordinator in writing of the intended termination of residency agreement 90 calendar days prior to the proposed termination date;

(2) In cases where the behavior of the provider poses a serious threat of bodily harm to the resident or others living in the residence, or substantial damage to the residence or property, the resident or legal guardian, if applicable, shall notify the service coordinator of the situation and the resident, legal guardian, or service coordinator shall provide 72 hours’ notice before the proposed termination date; and

(3) Upon receipt of notification in (2) above, the service coordinator, or designee, shall immediately convene a team meeting, in accordance with the requirements of He-M 503, within 24 hours to determine the appropriate course of action to ensure the residents health and safety, and that the resident has access to an alternative safe residence and ensure that the complaint procedure in He-M 202 is initiated.

(e) The residency agreement shall be renewed on an annual basis, at the time of the annual service agreement.

(f) The resident or provider may request a team meeting at any time to discuss the terms of the residency agreement.

(g) Upon termination of the residency agreement, the resident shall be entitled to all personal property as reflected on the most current inventory of the resident’s property.

History

#13676, eff 6-24-23

N.H. Code Admin. R. Ann. He-M 310.11 Behavior Change Program {#sec-he-m-310.11 omnilex-key=us-nh-regs-official--agency-he-m--He-M 310.11}

(a) Unless an individual is subject to a commitment order pursuant to RSA 171-B, and unless otherwise specified in this rule, an individual’s rights shall not be restricted and no interventions designed to address challenging behavior unless the requirements of (b) through (e) below are met.

(b) A behavior change program shall be a written plan, protocol, or procedure that outlines strategies including:

(1) Physical environment modifications;

(2) Restrictive strategies;

(3) Use of monitoring devices; or

(4) Other strategies for altering behavior.

(d) A behavior change program approved by the individual, guardian, or representative shall also be approved by an area agency human rights committee pursuant to RSA 171-A:17, II(c) prior to implementation.

(e) A behavior change program shall be reviewed at least annually at the service agreement planning meeting.

History

#13676, eff 6-24-23

N.H. Code Admin. R. Ann. He-M 310.12 Rights of Individuals in Agency Residence to Appeal Termination {#sec-he-m-310.12 omnilex-key=us-nh-regs-official--agency-he-m--He-M 310.12}

(a) A notice to vacate the residence provided in accordance with He-M 310.10 (c)(6) shall include the following:

(1) The specific reason(s) for the termination in accordance with He-M 310.10 (c)(4) or (c)(7)a. or c.;

(2) Notice of the resident’s right to appeal pursuant to He-C 200 within 5 business days, and the process for filing an appeal, including the contact information to initiate the appeal with the Administrative Appeals Unit;

(3) Notice of the resident’s right to remain in their residence pending appeal, when applicable, pursuant to (d) below;

(4) Notice of the right to have legal representation of the resident’s choosing at an appeal;

(5) Notice that the resident is responsible for the costs of legal representation; and

(6) Notice of organizations with their addresses and phone numbers that might be available to provide pro bono or reduced fee legal assistance and advocacy, including Disability Rights Center – NH.

(b) Appeals shall be forwarded to the department’s administrative appeals unit, which shall assign a presiding officer to conduct a hearing in accordance with He-C 200, within 10 calendar days of receipt of the appeal.

(c) The burden of proof shall be on the provider to prove by a preponderance of the evidence that the termination was in accordance with He-M 310.10 (c)(4) or (c)(7).

(d) If a hearing is requested, the provider shall continue to provide residential services to the individual at their current residence until a decision is rendered by the administrative appeals unit, unless the reason for termination is the behavior of the resident posing a serious threat of bodily harm to the provider or others living in the residence, or substantial damage to the residence or property in accordance with He-M 310.10(c)(4).

(e) If a resident fails to appeal a notice within 5 business days of receipt of the notice required in (a) above, the resident loses their appeal rights and shall vacate the premises immediately.

(f) The hearings officer shall render a decision within 3 business days of the hearing.

(g) If the hearings officer finds that the provider met the burden of proof, the resident shall vacate the premises within 3 business days of the decision, unless the resident files a notice of intent to file a motion to reconsider with the administrative appeals unit within 3 business days of the hearings officer’s decision.

(h) If a resident files a motion to reconsider, the resident shall not be required to vacate the premises until a decision has been issued on a motion to reconsider. Additionally, if a resident does not prevail on a motion to reconsider and within 3 business days after receipt of the decision on the motion to reconsider files with the administrative appeals unit a notice of intent to appeal to the supreme court, the resident shall not be required to vacate the premises until a decision is rendered by the supreme court.

(i) In the event a resident does not file either a motion to reconsider or an appeal with the supreme court after filing an intent to do so, the resident shall vacate the premises within 3 business days of the expiration of the time period for filing such reconsideration or appeal.

History

#13676, eff 6-24-23

Part He-M 311 Rights of Persons in State Mental Health Facilities

N.H. Code Admin. R. Ann. He-M 311.01 Purpose {#sec-he-m-311.01 omnilex-key=us-nh-regs-official--agency-he-m--He-M 311.01}

The purpose of these rules is to define the rights of individuals receiving services in state mental health facilities which include New Hampshire hospital, Glencliff home, Hampstead hospital and residential treatment facility, and any receiving facility so designated by the commissioner pursuant to RSA 135-C:26.

History

#4414, eff 4-27-88; ss by #5095, eff 3-15-91, EXPIRED: 3-15-97
#6759, eff 5-27-98; ss by #8641, INTERIM, eff 5-27-06, EXPIRES: 11-23-06; ss by #8758, eff 11-17-06; ss by #10707, INTERIM, eff 11-15-14, EXPIRES: 5-14-15; ss by #10820, eff 4-23-15; ss by #14033-B, eff 7-30-24

N.H. Code Admin. R. Ann. He-M 311.02 Definitions {#sec-he-m-311.02 omnilex-key=us-nh-regs-official--agency-he-m--He-M 311.02}

(a) “Abuse” means an act or omission by an employee, consultant, or volunteer of a mental health facility or designated receiving facility which is not accidental and harms or threatens to harm an individual’s physical, mental, or emotional health or safety and includes emotional abuse, physical abuse, and sexual abuse.

(b) “Attorney” means a member of the New Hampshire Bar Association who is retained, employed, or appointed by a court to represent an individual.

(d) “Client” means “individual” as defined in (l) below.

(e) “Community residence” means a residence, exclusive of any independent living arrangement, that:

(1) Provides residential services in accordance with He-M 426 for at least one individual with a mental illness;

(2) Provides services based on the needs identified in a resident’s individual service plan (ISP);

(3) Is operated directly by a facility or by contract or agreement between a facility and another entity;

(4) Serves individuals whose services are funded by the department; and

(5) Is certified pursuant to He-M 1002.

(f) “Department” means the department of health and human services.

(g) “Direct care” means services provided to individuals including, but not limited to, assistance with medication, accompanying an individual to a treatment team or other clinical meeting, or providing ongoing direct and active support.

(h) “Emotional abuse” means the misuse of power, authority, or both, verbal harassment, or unreasonable confinement which results or could result in mental anguish or emotional distress of an individual.

(i) "Exploitation" means the use of an individual’s person or property for another's profit or advantage or breach of a fiduciary relationship through improper use of an individual’s person or property including situations where a person obtains money, property, or services from an individual through undue influence, harassment, deception, or fraud.

(j) "Facility" means New Hampshire hospital, Glencliff home, Hampstead hospital and residential treatment facility, and any receiving facility so designated by the commissioner pursuant to RSA 135-C:26.

(k) "Guardian" means a person appointed under RSA 463, or RSA 464-A, or who is a parent of an individual under the age of 18 whose parental rights have not been terminated or limited by law in such a way as to remove the person’s right to make health care decisions on behalf of the individual.

(l) "Individual" means a person who is receiving or applying for a service from a facility. The term includes “client.”

(m) "Informed decision" means “informed decision” as defined in RSA 135-C:2, IX namely, “a choice made by a client or person seeking to be admitted who has the ability to make such a choice and who makes it voluntarily after all relevant information necessary to making the decision has been provided, and who understands that he is free to choose or refuse any available alternative, and who clearly indicates or expresses his choice. The choice shall be free from all coercion.” The term also includes such decision of an individual, as defined in He-M 311.02(l) above, and the individual’s legal guardian, where appropriate, based on the same factors as an informed decision by an individual or person seeking to be admitted.

(n) "Mental illness" means “mental illness” as defined in RSA 135-C:2 X, namely, "a substantial impairment of emotional processes, or of the ability to exercise conscious control of one's actions, or of the ability to perceive reality or to reason, when the impairment is manifested by instances of extremely abnormal behavior or extremely faulty perceptions. It does not include impairment primarily caused by: (a) epilepsy; (b) intellectual disability; (c) continuous or noncontinuous periods of intoxication caused by substances such as alcohol or drugs; or (d) dependence upon or addiction to any substance such as alcohol or drugs."

(o) "Neglect" means “neglect” as defined in RSA 135-C:2, XI namely, “an act or omission which results or could result in the deprivation of essential services or supports necessary to maintain the minimum mental, emotional, or physical health and safety of an incapacitated adult”. The term also includes neglect toward an individual.

(p) “Physical abuse” means the use of physical force which results or could result in physical injury to an individual.

(q) "Program" means any public or private corporation, person, or organization which provides services to individuals with a mental illness or intellectual disability when such services are funded in whole or in part or are operated, monitored, or regulated by the bureau.

(r) "Service" means any evaluation, training, counseling, therapy, habilitation, case management, or other type of assistance, medical care, or treatment provided by a facility.

(s) "Service delivery system" means those facilities and programs funded, in whole or in part, operated, monitored, or regulated by the bureau.

(t) “Sexual abuse” means contact or interaction of a sexual nature between an individual and an employee of or a consultant or volunteer for a facility.

(u) “Treatment" means “treatment” as defined in RSA 135-C:2, XVI, namely, "examination, diagnosis, training, rehabilitation therapy, pharmaceuticals, and other services provided to clients in the mental health services system. Treatment shall not include examination or diagnosis for the purpose of determining the need for involuntary emergency admissions pursuant to RSA 135-C:27-33 or involuntary admissions pursuant to RSA 135-C:34-54.” The term includes treatment provided to individuals in the mental health system.

History

#4414, eff 4-27-88; ss by #5095, eff 3-15-91, EXPIRED: 3-15-97
#6759, eff 5-27-98; ss by #8641, INTERIM, eff 5-27-06, EXPIRES: 11-23-06; ss by #8758, eff 11-17-06; ss by #10707, INTERIM, eff 11-15-14, EXPIRES: 5-14-15; ss by #10820, eff 4-23-15; ss by #14033-B, eff 7-30-24

N.H. Code Admin. R. Ann. He-M 311.03 Notice of Individual and Applicant Rights {#sec-he-m-311.03 omnilex-key=us-nh-regs-official--agency-he-m--He-M 311.03}

(a) Facilities shall inform individuals or guardians of the individual’s rights under RSA 135-C and these rules in clearly understandable language and form, both verbally and in writing.

(b) The notification of rights required pursuant to (a) above shall include, at a minimum, the following measures:

(1) Individuals applying for services shall be informed of the rights in (a) above relating to evaluations and access to treatment;

(2) Facilities shall provide meaningful and understandable information about the rights described in (a) above to individuals who are minors or who have been adjudicated incapacitated as well as to their parents, guardians, or attorneys;

(3) Individuals shall be advised of their rights upon entry into any facility, upon change from one facility to another, and at least once a year after entry;

(4) Every facility within the service delivery system shall post a notice of the rights set forth in these rules, as follows:

a. The notice shall be posted continuously and conspicuously; and

b. The notice shall be presented in clearly understandable language and form;

(5) Each facility and community residence shall have on the premises complete copies of He-M 311 available for individual and staff review; and

(6) Individuals admitted to a receiving facility pursuant to RSA 135-C:27-33 shall be given immediate notice by the facility administrator or his/her designee in simple language he/she understands, and written notice within 12 hours, of the following rights:

a. To be represented by legal counsel;

b. To have legal counsel appointed for him or her if he or she is indigent;

c. To apply for admission on a voluntary basis;

d. To consult with legal counsel prior to a change in admission status;

e. That involuntary emergency admission shall not exceed a period of 10 days unless the period is extended pursuant to RSA 135-C:32; and

f. That no treatment shall be administered during involuntary emergency admission unless the individual makes an informed decision to consent to treatment, or unless a medical or psychiatric emergency exists in accordance with He-M 305.

(d) Any person shall have the right to complain or bring a grievance on behalf of an individual or a group of individuals pursuant to He-M 204.

History

#4414, eff 4-27-88; ss by #5095, eff 3-15-91, EXPIRED: 3-15-97
#6759, eff 5-27-98; ss by #8641, INTERIM, eff 5-27-06, EXPIRES: 11-23-06; ss by #8758, eff 11-17-06; ss by #10707, INTERIM, eff 11-15-14, EXPIRES: 5-14-15; ss by #10820, eff 4-23-15

N.H. Code Admin. R. Ann. He-M 311.04 Fundamental Rights {#sec-he-m-311.04 omnilex-key=us-nh-regs-official--agency-he-m--He-M 311.04}

(a) Any individual receiving treatment for mental illness shall be entitled to any legal right to which all citizens are entitled regardless of that person's admission to the mental health services system.

(b) The legal rights protected shall include, at a minimum:

(2) The right to register to vote, if eligible, in public elections and to receive assistance in registering to vote and in voting;

a. The right to manage affairs;

b. The right to contract;

c. The right to hold professional, occupational, or motor vehicle driver's licenses;

d. The right to marry or to obtain a divorce;

e. The right to make a will; and

f. The right to exercise any other civil right;

(4) The right to not be discriminated against in any manner because of race, color, sex, religion, national origin, age, marital status, disability, sexual orientation or degree of disability as provided in state and federal laws, title VII of the civil rights act of 1964, 42 U.S.C. 2000e et. seq.; section 504 of the rehabilitation act of 1973, 29 U.S.C. 791 et. seq.; the age discrimination act of 1975, 29 U.S.C. 621; the Americans with Disabilities Act of 1990, 42 U.S.C. 12101; and the provisions of certain block grants, including:

a. Access to auxiliary aids needed by persons with disabilities;

b. Services which are accessible to persons of limited English proficiency; and

c. Service locations that are physically accessible; and

(5) The right to legal remedies, including the right to petition for and receive the benefits of a writ of habeas corpus, and to seek any other remedy provided by law.

History

#4414, eff 4-27-88; ss by #5095, eff 3-15-91, EXPIRED: 3-15-97
#6759, eff 5-27-98; ss by #8641, INTERIM, eff 5-27-06, EXPIRES: 11-23-06; ss by #8758, eff 11-17-06; ss by #10707, INTERIM, eff 11-15-14, EXPIRES: 5-14-15; ss by #10820, eff 4-23-15

N.H. Code Admin. R. Ann. He-M 311.05 Personal Rights {#sec-he-m-311.05 omnilex-key=us-nh-regs-official--agency-he-m--He-M 311.05}

(a) Individuals in the service delivery system shall be treated with dignity and respect at all times.

(b) Individuals shall be free from abuse, neglect, and exploitation including, at a minimum, the following:

(1) Freedom from any emotional, sexual, or physical abuse or neglect;

(2) Freedom from the intentional use of physical force, except the minimum force necessary to prevent harm to the individual or others, or to impose emergency treatment under He-M 305, personal safety emergencies; and

(3) Freedom from personal or financial exploitation.

(d) Individuals applying for services, or who are currently, or were previously in the service delivery system shall have the right to confidentiality of all information and records.

(e) At a minimum, facilities shall adhere to the following confidentiality requirements:

(1) Material safeguarded shall include any information with respect to an individual or through which an individual can be identified such as:

a. Names;

b. Addresses;

c. Diagnoses and evaluative data;

d. Medical and clinical records;

e. Individual service plans; and

f. Whether an individual is using or has used a facility’s services;

(2) Clinical information shall be released by the facility to a third-party payor in order to substantiate both need for and charges for care and treatment rendered to the individual by the facility;

(3) All staff shall be trained so as to know and understand confidentiality and shall comply with confidentiality statutes and rules;

(4) Separate, individual records shall be maintained when group treatment methods are employed and joint records of treatment activity shall not be maintained;

(5) These rules shall not affect the obligation of facilities to release information as required by:

a. RSA 161-F:42-57, protective services to adults;

b. RSA 169-C:29, report of child abuse;

c. RSA 631:6, report of injury caused by criminal act; or

d. Other law; and

(6) In accordance with RSA 329:26, RSA 330-A:32, RSA 329-B:26, and RSA 326-B:35, statements made by individuals to physicians licensed pursuant to RSA 329, psychologists licensed pursuant to RSA 329-B, persons licensed pursuant to RSA 330-A, advanced practice registered nurses licensed pursuant RSA 326-B, or to those who work under their supervision, may be disclosed for the purpose of commitment hearings.

(f) Audio or video recording shall only occur in areas where there is no expectation of privacy, such as entrances and exits, public areas, exterior areas, or common areas, which include but are not limited to corridors, stairways, elevators, day rooms, visiting rooms, dining rooms, classrooms, activity rooms, seclusion or restraint rooms, libraries, or gymnasiums.

(g) A facility recording pursuant to (f) above, shall:

(1) Post a notice of the use of audio or video surveillance, or both, at any public entrance to the facility; and

(2) Develop and follow a policy for audio or video monitoring and recording, or both, designed to maintain safety and provide for appropriate patient privacy in compliance with (f) above.

(h) A facility may photograph individuals upon admission and for the purpose of conducting investigations.

(i) New Hampshire hospital’s high security unit may record individuals via audio or video equipment, or both, as necessary to maintain safety for patients, staff, and visitors. The high security unit shall post a notice of the use of audio or video surveillance, or both, at all entrances to the unit.

(j) Access to records shall be as follows:

(1) Information pertaining to an individual shall be released to the individual or their guardian upon request including all information provided by third parties except that information which was provided by someone other than a health care provider under an agreement that the information would not be disclosed and disclosure would be reasonably likely to reveal the source of the information. When information is not released, the individual or their guardian shall be provided with a written denial stating the basis for the denial, a description of how a complaint may be filed, the name, title, and address of the contact person to receive the complaint, and the process for filing a complaint pursuant to 45 CFR 160.306;

(2) A clinical staff member shall be present at a record review if:

a. There is a reasonable concern that an individual will experience a harmful effect as a result of reviewing their record, or reasonable concern that the security of the record is at risk; and

b. The determination that (2)a. above applies has been made on a case by case basis and the reasons for the determination have been documented in writing;

(3) Information shall be released to any person or organization that has obtained the written consent of the individual or their guardian;

(4) Information shall be released to the department and funding, licensing, and accrediting agencies by facilities within the service delivery system as necessary for:

a. Determining eligibility for funding;

b. Assisting in accrediting or licensing decisions;

c. Monitoring and evaluating service delivery;

d. Assuring the delivery of appropriate services to individuals; and

e. Planning future service delivery;

(5) Facilities shall not include or release confidential information in an individual's record which pertains to other individuals;

(6) Facilities shall include within the records of an individual any supplemental information provided by the individual either clarifying or rebutting information deemed by the individual or their guardian to be inaccurate;

(7) An attorney appointed by a court to represent an individual shall have access to all records and information pertaining to that individual;

(8) Legal counsel for the department shall have access to all relevant records and information pertaining to an individual when such records and information are necessary because the individual:

a. Is the subject of an involuntary commitment hearing;

b. Is the subject of a guardianship proceeding; or

c. Has instituted legal action against the state in regard to care and treatment provided by the mental health service delivery system;

(9) In cases where an individual, their guardian, attorney, or other advocate who represents the individual requests copies of the record, the cost for electronic copies shall be charged at a reasonable rate not to exceed $50.00. The cost for paper copies shall not exceed $5 for the first page, $.41 per page for pages 2 through 50, and $.30 per page for pages 51 and higher. The individual, their guardian, attorney, or other advocate who represents the individual may choose whether to receive the record in paper form, or if available, in electronic form;

(10) Information regarding the medical treatment of an individual shall be released to law enforcement officials or health facility personnel if necessary to address an emergency situation involving danger to the individual's health or safety, but only specific information necessary to the relief of the emergency shall be released without the individual's consent;

(11) These rules shall not affect the obligation of providers such as physicians, psychologists, APRNs, and individuals supervised by such providers to make reasonable efforts to disclose to a third party or law enforcement when an individual has made a serious threat of physical violence against a clearly identified victim(s), or a serious threat of substantial damage to real property, pursuant to RSA 329:31, RSA 330-A:35, RSA 329-B:29, and RSA 326-B:33;

(12) In accordance with RSA 135-C:19-a, I, a facility shall disclose to a family member or other person, if such family member or other person lives with the individual or provides direct care to the individual, information regarding:

a. Diagnosis;

b. Admission to or discharge from a treatment facility;

c. Functional assessment;

d. The name of the medicine prescribed;

e. The side effects of any medication prescribed;

f. Behavioral or physical manifestations which would result from failure of the individual to take such prescribed medication;

g. Treatment plans and goals; and

h. Behavioral management strategies;

(13) Information shall not be released pursuant to (12) above unless the facility first:

a. Provides written notice to the individual or their guardian specifying the information requested, the reason for the request, and the person making the request;

b. Requests the individual or their guardian's consent to release the information; and

c. If consent cannot be obtained, the facility shall notify the individual in writing prior to the disclosure of:

The reason for the disclosure;
The name of the person(s) to whom the information will be released; and
The specific information which will be released;

(14) The facility shall receive or accept communications from family members, friends, or other persons with information pertaining to the health and safety of the individual, and shall document such communications in the individual’s record;

(15) In accordance with RSA 135-C:19-a, II, when the medical director or designee determines that obtaining information is essential to the care or treatment of an individual admitted pursuant to RSA 135-C:27-54, a designated receiving facility may request, and any health care provider which previously provided services to any individual involuntarily admitted to the facility shall provide, information about such individual limited to medications prescribed, known medication allergies or other information essential to the medical or psychiatric care of the individual admitted;

(16) Information shall not be released pursuant to (15) above unless the program first:

a. Provides written notice to the individual or their guardian specifying the information requested, the reason for the request, and the person making the request;

b. Requests the individual or their guardian's consent to release the information; and

c. If consent cannot be obtained, the individual shall be notified prior to disclosure in writing of:

The reason for the disclosure;
The name of the person(s) to whom the information will be released; and
The specific information which will be released;

(17) In accordance with RSA 135-C:19-a, II-a, when the medical director, or designee, determines that obtaining information is essential to the care and treatment of a individual admitted pursuant to RSA 135-C: 27-54 and the consent of the individual admitted cannot be obtained, the designated receiving facility may request and any community mental health program which has previously provided services to such individual shall immediately provide information about the individual including medications prescribed, known medication allergies, services provided and other information essential to the medical and psychiatric care of the individual admitted. The facility shall only disclose information necessary to identify the individual and the facility which is requesting the information; and

(18) In accordance with RSA 135-C:19-a, III, a community mental health program or state facility may disclose to an interdisciplinary committee designated by the governor to review child fatalities, information which is relevant to a case of suicide or traumatic fatal injury under review by such committee. Information to be disclosed pursuant to this subparagraph shall be limited to the diagnosis and course of treatment of the child or the person who caused the fatality. Information disclosed pursuant to this paragraph shall remain confidential and shall not be subject to discovery, subpoena, or admission into evidence in any judicial or administrative proceeding.

(k) Individuals shall have the right to complain about any alleged violation of a right afforded by these rules or by any state or federal law or rule or any other matter.

(l) Individuals shall have the right to freely and privately communicate with others, including:

(1) The right to send and receive unopened and uncensored written correspondence except that if there are reasonable grounds to believe that incoming mail contains items or substances which might be harmful to the individual or others, the facility shall direct reasonable examination of the mail in the presence of the individual or, wherever possible, permit the individual to open the mail in the presence of a staff person provided that the facility shall not read the mail but may regulate the disposition of the items or substances;

(2) The right to stationery, writing implements, and postage in reasonable amounts upon request and as determined by the facility;

(3) The right to have reasonable access to telephones, as determined by the facility, and to make and to receive reasonable numbers of telephone calls, as determined by the facility, except that facilities shall require an individual to reimburse them for the cost of any long distance calls made by the individual if the individual has the financial ability to do so;

(4) The right to receive and to refuse to receive visitors except that:

a. Facilities shall impose reasonable restrictions, as determined by the facility, on the number and time of visits as necessary to ensure effective provision of services; and

b. A parent, guardian, individual representative, or court-appointed attorney may visit without the consent of the individual except as provided in (5) below;

(5) The right to receive visits from any person unless the facility has documented that a visit with that particular person or visits in general present a serious likelihood of physical harm to the individual or other individuals in the facility;

(6) The right to opportunities for personal interaction in a private setting except that any conduct or activity which is illegal shall be prohibited; and

(7) The right to engage in social, recreational, and religious activities including the provision of regular opportunities for individuals to engage in such activities;

(m) Facilities may consider circumstances such as staffing, acuity of the milieu, and the particular patients’ situation when determining the number of visitors or number of telephone calls a patient makes or receives, as outlined in (l)(3) and (4) above.

(n) Individuals shall have the right to be free from searches of their persons and possessions except where reasonably necessary for the protection of the safety of the individual or others, to prevent the introduction of contraband, and as in (p) below.

(o) Facilities shall conduct searches of individuals or visitors according to the following:

(1) Searches conducted without the consent of the individual and without a warrant shall be performed only under the following circumstances:

a. A physician shall order that a search of an individual's person or possessions be made upon determination that a search is necessary to protect the safety of the individual or others based on reliable information that the individual possesses contraband;

b. The individual, nurse coordinator, and one other staff member shall be present during the search, except that, in an emergency, the individual need not be present;

c. A written inventory of the property searched shall be made and a copy of the inventory shall be documented in the individual's record;

d. At the time of the search the staff members conducting the search shall sign the inventory and the individual shall be asked to sign the inventory; and

e. The facility coordinator shall, within 24 hours of the search, forward a report of the search, together with the rationale for the search, to the unit director and superintendent;

(2) Facilities shall require a visitor, upon notice, to submit to a search prior to a visit or restrict visitors to a secure area, or both, when the facility reasonably believes, based upon reliable information, that the visitor may be introducing contraband such as drugs, weapons, toxic substances, explosives, and instruments of escape; and

(3) Facilities which have individuals committed through the criminal justice system shall subject visitors to a search by electronic means as necessary to prevent the introduction of contraband such as weapons, toxic substances, explosives, and instruments of escape into the facility provided that the facility has the means to conduct electronic searches.

(p) Individuals shall have the right to individual choice including, at a minimum, the following:

(1) The right to keep and wear their own clothes except:

a. Where necessary to prevent the individual from causing harm to themselves; and

b. Where the need for such restriction is documented in the individual's record;

(2) The right to keep personal possessions not otherwise prohibited by law or facility policy in accordance with He-M 311.05(o) and the right to reasonable space for personal possessions, as determined by the facility based on facility space and design;

(3) The right to keep and to read materials of their own choosing; and

(4) The right to keep and spend their own money unless a medical determination of incapacity to handle funds has been approved by the state or federal agency which administers those funds except that reasonable limits shall be imposed on the amount of money kept by individuals on their persons or in their rooms in order to prevent the individuals from causing harm to themselves or to prevent theft.

(q) Individuals shall have the right not to work and to be compensated for any work performed, except that:

(1) Individuals shall be required to perform personal housekeeping tasks within the individuals’ own immediate living areas and equitably shared housekeeping tasks within the common areas of the community residence, without compensation, unless the facility determines that it would be clinically or medically contraindicated or inappropriate to require an individual to perform such tasks; and

(2) Individuals may have the option to perform pre-vocational or vocational learning tasks or work required for the operation or maintenance of a community residence if:

a. The work is consistent with their individual service plans; and

b. The individuals are compensated for work performed according to laws, rules, and regulations set by the state and federal governments.

History

#4414, eff 4-27-88; ss by #5095, eff 3-15-91; amd by #6220, eff 4-13-96, EXPIRES: 12-31-98; ss by #6759, eff 5-27-98; ss by #8641, INTERIM, eff 5-27-06, EXPIRES: 11-23-06; ss by #8758, eff 11-17-06; ss by #10707, INTERIM, eff 11-15-14, EXPIRES: 5-14-15; ss by #10820, eff 4-23-15; ss by #14229, eff 4-2-25

N.H. Code Admin. R. Ann. He-M 311.06 Treatment Rights {#sec-he-m-311.06 omnilex-key=us-nh-regs-official--agency-he-m--He-M 311.06}

(a) Individuals shall have the right to adequate and humane treatment, including:

(1) The right to access to treatment including:

a. For those applying for services the right to evaluation to determine the individual ’s need for services and to determine which programs are most suited to provide the services needed;

b. The right to receive necessary services subject to the admission and eligibility policies and standards of each facility; and

c. The right to receive services without regard to race, color, age, religion, sex, national origin, type or severity of disability, sexual orientation or inability to pay except in accordance with He-M 311.07;

(2) The right to quality treatment including:

a. Treatment and services provided in accordance with licensing requirements and applicable rules adopted by the department in He-M 200-1300 and applicable rules of other state agencies; and

b. Services provided in keeping with generally accepted clinical and professional standards applicable to the persons and facilities providing the treatment and to the conditions for which the individual is being treated;

(3) The right to receive all services or treatment in accordance with the time frame set forth in the individual’s individual service plan;

(4) The right to quality treatment such that where state rules adopted pursuant to RSA 541-A do not set a different requirement, the quality of services and treatment at New Hampshire Hospital shall be in accordance with “The Joint Commission Comprehensive Accreditation Manual for Hospitals” (January 2015) published by Joint Commission Resources, Inc. One Renaissance Boulevard, Oakbrook Terrace, Illinois 60181;

(5) The right to an individual service plan developed, reviewed and revised in accordance with RSA 135-C:19 and “The Joint Commission Comprehensive Accreditation Manual for Hospitals” (January 2015) published by Joint Commission Resources, Inc. One Renaissance Boulevard, Oakbrook Terrace, Illinois 60181;

(6) The right to receive service and treatment in the least restrictive alternative or environment necessary to achieve the intended purpose of treatment including services and treatment which least restrict freedom of movement, informed decision-making, and participation in the community while providing the level of security and support needed by the individual;

(7) The right to be served in the least restrictive program or facility and also the least restrictive setting within a program or facility, except that a facility may restrict access by individuals to various areas as necessary to:

a. Ensure the privacy or safety of the individuals;

b. Achieve other necessary objectives contained in the individual service plan; or

c. Comply with provisions of law and orders of court;

(8) The right to be informed of all significant risks, benefits, side effects, and alternative treatments and services and to give consent to any treatment, placement, or referral following an informed decision, except actions taken under He-M 305 or otherwise permitted by law, such that:

a. Whenever it is possible, the consent shall be given in writing; and

b. In all other cases, evidence of consent shall be documented by the facility and be witnessed by at least one person;

(9) The right to refuse to participate in any form of experimental treatment or in any research;

(10) The right to be fully informed of one's own diagnosis and prognosis;

(11) The right to voluntary placements and to seek changes in placement, services, or treatment except that:

a. Placements shall not be voluntary if RSA 135-C:27-48 or 135-C:51 apply; and

b. Withdrawal shall be restricted as provided in RSA 135-C:17;

(12) The right to services which promote independence including services which shall be directed toward:

a. Eliminating, or reducing as much as possible, the individuals' needs for continued services and treatment; and

b. Promoting the ability of the individuals to function at their highest capacity and as independently as possible;

(13) The right to prompt medical care and treatment as the person's condition requires;

(14) The right to consultation and second opinion including:

a. At the individual's own expense, the consultative services of:

Private physicians;
Psychologists;
Dentists; and
Other health practitioners; and

b. Granting to such health practitioners of reasonable access to their individuals in facilities; and

c. Allowing such health practitioners to make recommendations to facilities regarding the services and treatment provided by the facilities;

(15) The right, upon request, to have one or more of the following present at any treatment meeting requiring the individual’s participation and informed decision-making:

a. Guardian;

b. Representative;

c. Attorney;

d. Family member;

e. Friend;

f. Advocate;

g. Consultant; or

h. Peer;

(16) The right to refuse medication and treatment except emergency treatment under the terms and conditions provided in He-M 305, He-M 306 and RSA 135:21-b;

(17) The right to freedom from restraint including the right to be free from seclusion and physical, mechanical or pharmacological restraint except that:

a. Such means of seclusion and restraint may be used as part of a service plan to which the individual or individual’s guardian, if any, has consented having made an informed decision to do so; and

b. Physical restraint may also be used as a form of emergency treatment following the requirements of He-M 305, personal safety emergencies;

(18) If the individual meets the definition of a “child” in RSA 126-U:1, I, the right to freedom from restraint and seclusion, as defined in RSA 126-U:1, IV and V-a, respectively, except as allowed by RSA 126 U; and

(19) The right to a safe, sanitary and humane living environment.

(b) These rules shall not require any medical or behavioral health care professional to administer treatment contrary to such professional's clinical judgment.

(d) The following provisions shall apply to individuals for whom a guardian has been appointed by a court of competent jurisdiction:

(1) The facility shall ensure that the guardian and all persons involved in the provision of services are made aware of the individual’s needs, views, preferences and aspirations;

(2) The facility shall comply with decisions made by the guardian or representative within the legitimate scope of his or her authority;

(3) The facility shall request a copy of the guardianship order from the guardian and keep the order in the individual’s record at the facility;

(4) If any issues arise relative to the provision of services and supports which are outside the scope of the guardian’s decision-making authority as set forth in the guardianship order, the individual’s choice and preference relative to those issues shall prevail unless the guardian’s authority is expanded by the court to include those issues;

(5) A facility shall take such steps as are necessary to prevent a guardian from exceeding the decision-making authority granted by the court or acting in a manner that does not further the best interests of the individual, including:

a. Reviewing with the guardian the limits on his or her decision-making authority; and

b. If necessary, bringing the matter to the attention of the court that appointed the guardian; and

(6) In the event that there is a dispute between the facility and the guardian, the facility shall inform the guardian of his or her right to take either or both of the following actions:

a. Appeal the matter pursuant to He-M 204 and He-C 200; or

b. Bring the dispute to the attention of the probate court that appointed the guardian.

History

#4414, eff 4-27-88; ss by #5095, eff 3-15-91, EXPIRED: 3-15-97
#6759, eff 5-27-98; ss by #8641, INTERIM, eff 5-27-06, EXPIRES: 11-23-06; ss by #8758, eff 11-17-06; ss by #10707, INTERIM, eff 11-15-14, EXPIRES: 5-14-15; ss by #10820, eff 4-23-15

N.H. Code Admin. R. Ann. He-M 311.07 Termination of Services {#sec-he-m-311.07 omnilex-key=us-nh-regs-official--agency-he-m--He-M 311.07}

(a) All individuals shall be provided with reasonable notice before services are terminated.

(b) A termination notice shall:

(1) Be in writing;

(2) Contain the reasons for, and the effective date of, the termination; and

(3) Explain that the individual has the right to appeal the termination in accordance with He-M 204.

(d) Services shall be terminated:

(1) When termination is in the best interests of the individual;

(2) When the individual cannot benefit from the service;

(3) If the individual endangers or threatens to endanger other individuals s or staff;

(4) If the individual or his or her guardian refuses to pay for the services that he or she is receiving despite having the financial resources to do so; or

(5) If the individual or his or her guardian refuses to apply for benefits that could cover the cost of the services that he or she is receiving despite the fact that the individual is or might be eligible for such benefits.

(e) A facility shall offer, when feasible, alternative, appropriate treatment or services before terminating an individual.

PARTS He-M 312 – He-M 313 - RESERVED

History

#4414, eff 4-27-88; ss by #5095, eff 3-15-91, EXPIRED: 3-15-97
#6759, eff 5-27-98; ss by #8641, INTERIM, eff 5-27-06, EXPIRES: 11-23-06; ss by #8758, eff 11-17-06; ss by #10707, INTERIM, eff 11-15-14, EXPIRES: 5-14-15; ss by #10820, eff 4-23-15

Part He-M 314 Rights of Persons Using Emergency Shelters

N.H. Code Admin. R. Ann. He-M 314.01 Purpose {#sec-he-m-314.01 omnilex-key=us-nh-regs-official--agency-he-m--He-M 314.01}

The purpose of these rules is to define the rights of persons requesting or receiving emergency shelter or shelter services from shelter providers that receive funding from the State of New Hampshire and to establish the responsibilities of shelter providers relative to such rights.

History

#7405, eff 11-21-00; ss by #9328, eff 11-22-08; ss by #12056, INTERIM, eff 11-22-16, EXPIRED: 5-21-17

N.H. Code Admin. R. Ann. He-M 314.02 Definitions {#sec-he-m-314.02 omnilex-key=us-nh-regs-official--agency-he-m--He-M 314.02}

The words and phrases used in this chapter shall have the following meanings:

(a) “Emergency shelter” means any facility, the primary purpose of which is to provide temporary shelter for homeless individuals or families. The term “emergency shelter” does not include transitional housing designed to provide housing as well as educational or rehabilitative programs and services for a person or family for at least 6 consecutive months.

(b) “Guest” means a homeless person who is receiving shelter services from an emergency shelter.

(1) An individual or family who lacks a fixed, regular, and adequate nighttime residence; or

(2) An individual or family who has a primary nighttime residence that is:

a. A supervised publicly or privately operated shelter designed to provide temporary living accommodations, including:

Welfare hotels; and
Congregate shelters;

b. An institution other than a penal facility that provides temporary residence for individuals intended to be institutionalized; or

c. A public or private place not designed for, or ordinarily used as, a regular sleeping accommodation for human beings.

(d) “Shelter services” means:

(1) Provision of the following:

a. Adequate bedding and mattress;

b. Basic food at no cost to the guest;

c. Soap and hot water for personal hygiene; and

d. First aid; and

(2) Additional services the shelter elects to provide, including:

a. Assistance in obtaining permanent housing;

b. Medical and psychological counseling and supervision;

c. Employment counseling;

d. Nutritional counseling;

e. Substance abuse intervention, treatment and counseling;

f. Assistance in obtaining other federal, state, and local assistance; and

g. Other services related to obtaining self-sufficiency such as:

Child care;
Transportation;
Job placement; and
Job training.

(e) “Specialized facility” means an emergency shelter designed solely to serve the needs of homeless members of an identifiable group including:

(1) Victims of domestic violence;

(2) Persons with mental illness;

(3) Families with children;

(4) Persons with substance abuse problems; and

(5) Other groups of homeless people with similar therapeutic, rehabilitative, or programmatic needs.

History

#7405, eff 11-21-00; ss by #9328, eff 11-22-08; ss by #12056, INTERIM, eff 11-22-16, EXPIRED: 5-21-17

N.H. Code Admin. R. Ann. He-M 314.03 Notice of Rights {#sec-he-m-314.03 omnilex-key=us-nh-regs-official--agency-he-m--He-M 314.03}

(a) In clearly understandable language, each emergency shelter shall provide persons entering the shelter with a verbal summary of their rights and responsibilities pursuant to He-M 314, notification of how to access the shelter’s grievance procedures, and, upon request, a written copy of the grievance procedures.

(b) A notice of rights and any house rules shall be permanently posted in a public area of the shelter and be presented in clearly understandable language and form.

(c) Each emergency shelter shall have on the premises complete copies of rules pertaining to guest rights that are available for guest review including, at a minimum, He-M 204, He-M 314, and He-C 200.

History

#7405, eff 11-21-00; ss by #9328, eff 11-22-08; ss by #12056, INTERIM, eff 11-22-16, EXPIRED: 5-21-17

N.H. Code Admin. R. Ann. He-M 314.04 Fundamental Rights {#sec-he-m-314.04 omnilex-key=us-nh-regs-official--agency-he-m--He-M 314.04}

(a) No emergency shelter shall deprive a guest receiving emergency shelter services in New Hampshire of any legal right to which all citizens of the state and the United States are entitled.

(b) The legal rights protected shall include, at a minimum:

(1) The right of freedom of religion and religious preference, including the right to be free from engaging in any religious activity or practice; and

(2) The right to not be discriminated against in any manner because of race, color, sex, sexual orientation, religion, national origin, age, or physical or mental disability, as provided in RSA 354-A:17, title VII of the civil rights act of 1964, 42 U.S.C. 2000e et. seq.; section 504 of the rehabilitation act of 1973, 29 U.S.C. 791 et. seq.; the age discrimination act of 1975, 29 U.S.C. 621; the Americans with Disabilities Act of 1990, 42 U.S.C. 12101, and the Fair Housing Act, 42 U.S.C. Sec. 3601.

History

#7405, eff 11-21-00; ss by #9328, eff 11-22-08; ss by #12056, INTERIM, eff 11-22-16, EXPIRED: 5-21-17

N.H. Code Admin. R. Ann. He-M 314.05 Personal Rights {#sec-he-m-314.05 omnilex-key=us-nh-regs-official--agency-he-m--He-M 314.05}

(a) Persons who are requesting or receiving emergency shelter services shall be treated by emergency shelter staff and volunteers with dignity and respect regardless of the circumstances which brought them to the shelter.

(b) Staff and volunteers of an emergency shelter shall not abuse, neglect or exploit guests.

(c) Guests shall have the right to have information in their records treated as confidential and disclosed by staff to third parties only as permitted by the guest, required by law, or allowed in accordance with (e) below.

(d) Any provisions of He-M 314 that conflict with RSA 173-C:1 shall not apply.

(e) A shelter employee may disclose:

(1) To law enforcement personnel that information necessary to report a crime committed at the shelter; and

(2) To an employee of another shelter:

a. The fact that a guest committed a violent act or threats of violence within the last 30 days while on shelter premises; and

b. The circumstances of such acts or threats.

(f) Guests shall have the right to privacy including the following:

(1) The right to courtesies such as knocking on closed doors before entering;

(2) The right to send and receive unopened and uncensored correspondence;

(3) The right to have reasonable access to a telephone with such privacy as shelter arrangements allow, provided that:

a. Guests may be required to pay for long distance calls; and

b. Calls shall only be made for the following reasons:

Searching for a job;
Making medical appointments;
Searching for housing; or
Other similar matters related to the affairs of the resident; and

(4) The right to be free from searches of their persons and possessions, except that:

a. Searches shall be conducted only in accordance with applicable constitutional and legal standards;

b. Guests may be subjected to routine screening or scanning for detection of concealed weapons upon entering the shelter; and

c. The policies and practices regarding such searches shall be uniformly applied to all guests.

(g) No emergency shelter shall exclude guests for any part of the day, from October 1 through April 30, unless reasonable arrangements are made for guests to use an alternative indoor site which is available for guests’ use while the shelter is closed. From May 1 through September 30, guests shall not be excluded during severe weather without an adequate indoor alternative.

History

#7405, eff 11-21-001; ss by #9328, eff 11-22-08; ss by #12056, INTERIM, eff 11-22-16, EXPIRED: 5-21-17

N.H. Code Admin. R. Ann. He-M 314.06 Admission {#sec-he-m-314.06 omnilex-key=us-nh-regs-official--agency-he-m--He-M 314.06}

(a) No person, regardless of previous place of residence, shall be denied admission to an emergency shelter if beds or rooms are available, except as detailed in He-M 314.07 below.

(b) No person shall be denied emergency shelter because he or she does not have a valid state driver’s license, non-driver ID, or other form of government-issued identification.

(c) An emergency shelter shall have the ability to approve admission of persons at least 18 hours per day and 7 days per week. A shelter may defer entry to the facility until the facility opens for the night except as provided in He-M 314.05(g).

(d) A shelter shall, at a minimum, admit a person to an available bed during the shelter’s posted evening hours. A shelter shall admit a person at other hours if staff resources permit.

(e) No person seeking admission to an emergency shelter shall be denied access for lack of funds to pay for shelter nor be required to receive approval of a third party payor or intermediary.

(f) Shelters may establish a sliding fee scale for admission to the shelter, provided that the fee scale includes the provision of shelter services at no cost to guests who are currently unemployed and lack other means of financial support.

(g) At the time of admission, shelters shall advise guests of the daily fee, if any, the guest will be charged.

(h) Shelter fees paid by guests shall:

(1) Be structured so as not to inhibit transition into permanent housing; and

(2) Not exceed 30% of a guest’s net income.

History

#7405, eff 11-21-00; ss by #9328, eff 11-22-08; ss by #12056, INTERIM, eff 11-22-16, EXPIRED: 5-21-17

N.H. Code Admin. R. Ann. He-M 314.07 Denial of Admission and Termination of Service {#sec-he-m-314.07 omnilex-key=us-nh-regs-official--agency-he-m--He-M 314.07}

(a) A request for admission to a shelter shall be denied if the person requesting services poses a direct threat to the health or safety of others in the shelter and the shelter is unable to provide a reasonable accommodation which would eliminate the risk of direct threat. When a person is denied admission on this basis, the shelter may contact the local police department.

(b) A request for admission to a shelter shall be denied if the shelter lacks space to house the person.

(c) A request for admission to a shelter may be denied if the shelter is a specialized facility and the person seeking shelter is not a member of the special population for which the shelter is designed.

(d) For any person who is denied admission to a shelter, the shelter shall:

(1) Inform the person of the reasons for the denial;

(2) Make every effort to locate alternate emergency shelter; and

(3) Inform the person of the shelter’s grievance procedures if the denial is for any reason other than lack of space or failure to meet the shelter’s admission criteria.

(e) An emergency shelter may require a guest to leave the shelter under the following circumstances:

(1) The guest engages in behavior which poses a direct threat to the health or safety of others in the shelter;

(2) The guest engages in behavior which poses a direct threat to his or her own health or safety;

(3) The guest steals or destroys the property of the shelter or other guests, provided that if the guest denies such allegations he or she shall not be required to leave unless:

a. The guest is arrested by the police; or

b. Following an investigation by a shelter staff member, pursuant to (h) below, the staff member conducting the investigation finds the allegation to be true; or

(4) The shelter director or person in charge of the shelter at the time of the incident has reason to believe that the guest, while on the premises, is engaging in behavior that substantially interferes with the use and enjoyment of the premises by other guests.

(f) A shelter shall maintain a log of all guests required to leave the shelter and the reasons therefor. The information contained in the log shall be forwarded to the bureau of homeless and housing services upon request.

(g) Whenever a guest is required to leave a shelter pursuant to (e) above, the shelter shall:

(1) Provide the guest written documentation of the reason for being required to leave the shelter and the time frame during which the guest cannot return to the shelter; and

(2) No later than 24 hours after the guest is excluded, create a written record which contains the following information:

a. A full description of the guest’s behavior that resulted in his or her being required to leave the shelter;

b. The names of the persons who were adversely affected by the behavior; and

c. The signature of the staff member who witnessed the behavior or conducted the investigation.

(h) If the circumstances that result in a guest being required to leave a shelter are not witnessed by a staff member, the incident shall be investigated by a staff member. Shelter staff shall document in the written record required in (g) above that the matter was investigated by a staff member and identify who performed the investigation.

(i) No guest shall be required to leave a shelter based upon the application of a limit on the length of time that a guest is allowed to remain in residence.

History

#7405, eff 11-21-00; ss by #9328, eff 11-22-08; ss by #12056, INTERIM, eff 11-22-16, EXPIRED: 5-21-17

N.H. Code Admin. R. Ann. He-M 314.08 House Rules {#sec-he-m-314.08 omnilex-key=us-nh-regs-official--agency-he-m--He-M 314.08}

(a) Emergency shelters shall adopt house rules determined by the shelter to be necessary for the safe and effective operation of the shelter provided that such rules do not conflict with He-M 314 or state or federal law. Whenever house rules are developed or revised, representative guests and former guests shall be asked for input. A shelter may develop sanctions for rules violations, except that sanctions shall not include withholding food or medical attention.

(b) House rules shall clearly state those rule infractions that could result in a guest being required to leave the shelter and the corresponding time frames during which a guest cannot return to a shelter. These rules shall be based on the categories described in He-M 314.07(e).

(1) Posted in a public area; and

(2) Reviewed by staff with each guest upon admission. A copy of the rules shall be signed by a staff person and the guest to indicate that they were reviewed and be kept in each guest’s file.

(d) Any house rules or revisions of house rules, including any sanctions, shall be forwarded to the bureau of homeless and housing services for review and approval prior to implementation. House rules that the bureau of homeless and housing services determines to be in conflict with He-M 314.08(a) and (b) shall not be implemented.

History

#7405, eff 11-21-00; ss by #9328, eff 11-22-08; ss by #12056, INTERIM, eff 11-22-16, EXPIRED: 5-21-17

N.H. Code Admin. R. Ann. He-M 314.09 Grievance Procedures {#sec-he-m-314.09 omnilex-key=us-nh-regs-official--agency-he-m--He-M 314.09}

(a) Each shelter shall establish written grievance procedures by which a guest’s complaints are addressed.

(b) A shelter shall provide a guest who files a grievance the opportunity to have someone assist him or her in filing the grievance. If the guest cannot obtain assistance, the shelter staff, upon the guest’s request, shall attempt to obtain assistance for such guest from New Hampshire Legal Assistance or the Legal Advice and Referral Center (LARC).

(c) Each shelter shall establish written investigation procedures for allegations that a guest’s rights as stated in He-M 314.04 through 314.06 have been violated by shelter staff or volunteers.

(d) The investigation of a guest’s grievance shall not be conducted by any person who participated in the action or decision that is the subject of the grievance.

(e) Following completion of the investigation, the shelter shall:

(1) Issue a written decision to the complainant setting forth the disposition of the grievance;

(2) Include information on how the guest can appeal the decision in accordance with He-M 204; and

(3) Forward a copy of the decision to the bureau of homeless and housing services.

(f) A guest may appeal the finding and proposed resolution to his or her grievance to the department in accordance with He-M 204, rights protection procedures, and He-C 200, rules of practice and procedure.

(g) Each shelter shall forward its grievance procedures and any proposed revisions to its grievance procedures to the bureau of homeless and housing services for review and approval, prior to implementation. Grievance procedures that the bureau of homeless and housing services determines to be in conflict with He-M 314.09 shall not be implemented.

History

#7405, eff 11-21-00; ss by #9328, eff 11-22-08; ss by #12056, INTERIM, eff 11-22-16, EXPIRED: 5-21-17

Part He-M 315 Rights of Persons Receiving Peer Support Services

N.H. Code Admin. R. Ann. He-M 315.01 Purpose {#sec-he-m-315.01 omnilex-key=us-nh-regs-official--agency-he-m--He-M 315.01}

The purpose of this part is to define the rights of members and participants who are receiving peer support services from providers that receive funding from the State of New Hampshire and to establish the responsibilities of peer support agencies (PSA) relative to such rights.

History

#8445, eff 10-6-05, EXPIRED: 10-6-13
#12191, eff 5-26-17

N.H. Code Admin. R. Ann. He-M 315.02 Applicability {#sec-he-m-315.02 omnilex-key=us-nh-regs-official--agency-he-m--He-M 315.02}

Nothing in this part shall affect issues between members or participants of a PSA that do not arise out of the operations of the PSA.

History

#8445, eff 10-6-05, EXPIRED: 10-6-13
#12191, eff 5-26-17

N.H. Code Admin. R. Ann. He-M 315.03 Definitions {#sec-he-m-315.03 omnilex-key=us-nh-regs-official--agency-he-m--He-M 315.03}

(a) “Abuse” means an act or omission by an employee, consultant, or volunteer of a PSA which is not accidental and harms or threatens to harm a member’s or participant’s physical, mental or emotional health or safety and includes emotional abuse, physical abuse, and sexual abuse.

(b) “Culturally competent” means having attained the knowledge, skills, and attitudes necessary to provide effective supports, services, education, and technical assistance to populations in the geographic area served by the agency.

(d) “Discrimination” means an action or a failure to act that has the effect of excluding a consumer from participation, subjecting a member to unequal treatment, or harassing a member because of and on the basis of:

(1) Race;

(2) Color;

(3) Sex;

(4) Sexual orientation;

(5) Marital status;

(6) Religion;

(7) National origin;

(8) Age;

(9) Disability;

(10) Socio-economic class;

(11) Political ideology;

(12) Veterans status; or

(13) Gender identity.

(e) “Emotional abuse” means:

(1) The misuse of power, authority, or both;

(2) Verbal harassment; or

(3) Unreasonable confinement that results or could result in mental anguish or emotional distress of a member.

(f) “Exploitation” means the use of a member’s or participant’s person or property for another’s profit or advantage or breach of a fiduciary relationship through improper use of a member’s person or property including situations where a person obtains money, property. or services from a member or participant through undue influence, harassment, deception, or fraud.

(g) “Guest” means any person who is invited to visit the PSA by a member, a participant, or the PSA.

(h) “Member” means any peer, who has made an informed decision to join, and agrees to support the goals, objectives, rights, and responsibilities of, the PSA.

(i) “Neglect” means an act or omission which results or could result in the deprivation of essential services necessary to maintain the minimum mental, emotional, or physical health of a member or participant.

(j) “Participant” means a peer, whether or not he or she is a member, who participates in any aspect of the PSA.

(k) “Peer” means any individual, 18 years of age or older, who self identifies as having lived experience as a former recipient, or as at significant risk of becoming a recipient of publicly funded mental health services.

(l) “Peer support agency (PSA)” means an organization whose primary purpose is to provide culturally competent peer support to peers 18 years of age or older.

(m) “Physical abuse” means the use of physical force which results or could result in physical injury to a member or participant.

History

#8445, eff 10-6-05, EXPIRED: 10-6-13
#12191, eff 5-26-17

N.H. Code Admin. R. Ann. He-M 315.04 Membership {#sec-he-m-315.04 omnilex-key=us-nh-regs-official--agency-he-m--He-M 315.04}

(a) All peers shall be granted access to services provided by a PSA except as provided in He-M 315.08.

(b) All peers seeking membership in a PSA shall be granted membership at no charge.

(c) Membership meetings shall be convened for the purpose of seeking membership input and feedback into planning and delivery of services.

(d) Board of director meetings shall be open to members except upon majority vote to enter an executive session limited to board members.

History

#8445, eff 10-6-05, EXPIRED: 10-6-13
#12191, eff 5-26-17

N.H. Code Admin. R. Ann. He-M 315.05 Notice of Rights {#sec-he-m-315.05 omnilex-key=us-nh-regs-official--agency-he-m--He-M 315.05}

(a) Each PSA shall provide members and participants with a verbal and written summary, in clearly understandable language and form, of their rights and responsibilities pursuant to He-M 315 and notification of the complaint procedures.

(b) A notice including member and participant personal and fundamental rights, membership rules, and reasons for suspension of membership or participation, pursuant to He-M 315 shall be permanently posted in a public area and be presented in clearly understandable language and form.

(1) Member and participant rights;

(2) Member and participant rules;

(3) Complaint procedures; and

(4) Appeal procedures.

History

#8445, eff 10-6-05, EXPIRED: 10-6-13
#12191, eff 5-26-17

N.H. Code Admin. R. Ann. He-M 315.06 Fundamental Rights {#sec-he-m-315.06 omnilex-key=us-nh-regs-official--agency-he-m--He-M 315.06}

(a) No PSA shall deprive a member or participant of any legal right to which all citizens of New Hampshire and the United States are entitled.

(b) The legal rights protected shall include:

(1) The right of freedom of religion and religious preference, including the right to be free from engaging in any religious activity or practice; and

(2) The right not to be discriminated against in any manner as defined 315.03 (c)

History

#8445, eff 10-6-05, EXPIRED: 10-6-13
#12191, eff 5-26-17

N.H. Code Admin. R. Ann. He-M 315.07 Personal Rights {#sec-he-m-315.07 omnilex-key=us-nh-regs-official--agency-he-m--He-M 315.07}

(a) Persons receiving services from a PSA shall have the right to be treated by PSA staff, volunteers, and consultants with dignity and respect at all times.

(b) Staff, volunteers, and consultants of a PSA shall not abuse, neglect, or exploit agency members or participants.

(d) A PSA shall maintain the confidentiality of membership records except as in (e) below.

(e) A PSA may disclose to law enforcement personnel that information necessary to report a crime committed at the agency.

(f) The PSA shall disclose the information specified in (e) above:

(1) To the department of health and human services;

(2) When required to report abuse or neglect of a child pursuant to RSA 169-C;

(3) When required to report abuse, neglect or exploitation of an adult pursuant to RSA 161-F; and

(4) As otherwise required by law.

(g) Members and participants of a PSA shall have the right to privacy including the following:

(1) The right to courtesies such as knocking on closed doors before entering; and

(2) The right to have reasonable access to a telephone and a computer, if one is available for use, with such privacy as agency facilities allow, provided that members and participants may be required to pay for long distance calls.

History

#8445, eff 10-6-05, EXPIRED: 10-6-13
#12191, eff 5-26-17

N.H. Code Admin. R. Ann. He-M 315.08 Suspension of Membership or Participation {#sec-he-m-315.08 omnilex-key=us-nh-regs-official--agency-he-m--He-M 315.08}

(a) A PSA shall suspend a member or participant for the day and require him or her to immediately leave the agency premises under the following circumstances:

(1) The member or participant engages in behavior that poses an imminent risk of harm to the health and safety of others in the agency;

(2) The member or participant engages in behavior which poses an imminent risk of harm to his or her own health or safety; or

(3) The member or participant is verbally abusive of others in the agency.

(b) A PSA may suspend a member or participant for up to 12 months under the following circumstances:

(1) The member or participant steals or destroys the property of the PSA or any person while on the premises of the PSA;

(2) The member or participant engages in behavior that substantially interferes with the use and enjoyment of the premises by others; or

(3) The member or participant violates a rule of the PSA for which the rules of the PSA impose such a suspension.

(c) If the member or participant denies allegations made pursuant to a suspension and files a complaint pursuant to He-M 315.10, a proposed suspension under He-M 315 shall not be effective unless:

(1) The member or participant is arrested by the police; or

(2) The allegation is founded following a review pursuant to the PSA’s internal complaint procedures.

(d) Whenever a member or participant is directed to leave a PSA pursuant to He-M 315, the agency shall, no later than 24 hours after the person is excluded, create a written record which contains the following information:

(1) A full description of the member’s or participant’s behavior that resulted in him or her being directed to leave the PSA; and

(2) The PSA shall make good faith effort to obtain the signature(s) of the individual(s) who witnessed the behavior.

(e) Any member or participant suspended from services available on-site at a PSA shall be eligible for off-site services offered by the PSA, such as warm-line services, provided that he or she agrees to comply with all rules of the PSA.

(f) Any member or participant suspended from services available off-site shall be eligible for on-site services offered by the PSA, provided that he or she agrees to comply with all rules of the PSA.

(g) Providers shall ensure that all guests follow the same rules as members and participants, and shall ask guests to leave the premises of the PSA if they refuse to comply.

(h) Any member or participant suspended pursuant to He-M 315 for a period of more than 5 days shall be reinstated following the suspension period at such time as a reentry plan developed by the member or participant which addresses the circumstances that led to the suspension is accepted by the PSA director or his or her designee.

(i) Any member or participant subject to suspension may exercise his or her rights as provided in He-M 315.

History

#8445, eff 10-6-05, EXPIRED: 10-6-13
#12191, eff 5-26-17

N.H. Code Admin. R. Ann. He-M 315.09 Member and Participant Rules {#sec-he-m-315.09 omnilex-key=us-nh-regs-official--agency-he-m--He-M 315.09}

(a) A PSA shall adopt rules for members and participants as determined by the board of directors to be necessary for the safe and effective operation of the PSA provided that such rules do not conflict with state or federal law or rule.

(b) When PSA rules are developed or revised, staff shall solicit comments from members.

(c) A PSA shall grant members the right to vote on PSA business at member meetings and vote at annual meetings to elect a board of directors.

(d) A PSA may develop sanctions for rules violation. Sanctions shall not include permanent expulsion.

(e) Each PSA shall have rules that address:

(1) Use of telephone, fax, computers and other PSA resources available for use by members and participants;

(2) Substance use on agency property by members and participants;

(3) Code of conduct of members and participants;

(4) Suspension and reentry procedures;

(5) Privacy and confidentiality; and

(6) Criminal activity.

(f) PSA rules shall be posted in a public area and reviewed by staff with each member at the time the member joins.

(g) Any PSA rules or revisions of those rules, including any sanctions, shall be forwarded to the department for review 30 days prior to adoption by the board. PSA rules that conflict with state or federal law or rule, shall not be adopted.

History

#8445, eff 10-6-05, EXPIRED: 10-6-13
#12191, eff 5-26-17

N.H. Code Admin. R. Ann. He-M 315.10 Complaint Procedures {#sec-he-m-315.10 omnilex-key=us-nh-regs-official--agency-he-m--He-M 315.10}

(a) Every member, participant, and applicant for membership shall have the right to file a complaint, which may be made either orally or in writing. A complainant may request to keep his or her identity confidential throughout the complaint process. If the complainant requests to have his or her identity kept confidential, he or she shall be notified that it may interfere with the investigation, the resolution of the complaint, or both.

(b) Each PSA shall establish complaint procedures that include:

(1) Informal means by which a member’s or participant’s complaints can be addressed;

(2) A formal process to investigate allegations that a member’s or participant’s rights have been violated by agency staff, volunteers, consultants, or peers; and

(3) An immediate review by the PSA director or his or her designee when a member or participant is suspended.

(d) A PSA shall provide a member or participant who files a complaint the opportunity to have someone assist him or her in presenting the complaint. If the member or participant cannot obtain assistance, the agency staff, upon the member’s or participant’s request, shall attempt to obtain assistance for such person from available advocacy services.

(e) The investigation of a member’s or participant’s complaint shall not be conducted by any person who participated in the action or decision that is the subject of the grievance.

(f) Following completion of a formal investigation, the board of directors of the PSA shall issue a written decision to the member or participant within 20 business days setting forth the disposition of the complaint. The PSA shall immediately forward a copy of the decision to the office of client and legal services (OCLS).

(g) A member or participant may appeal the finding and proposed resolution to his or her complaint in accordance with He-M 202, rights protection procedures, and He-C 200, rules of practice and procedure.

(h) He-M 315, He-M 402, He-M 202, and He-C 200 shall be available at every PSA in a public location for review.

(i) Each PSA shall forward its complaint procedure and any proposed revisions to the complaint procedure to the OCLS for review and consultation 30 days prior to implementation. PSA procedures that conflict with He-M 315, as determined by the OLCS shall not be implemented.

History

#8445, eff 10-6-05, EXPIRED: 10-6-13
#12191, eff 5-26-17

Part He-M 316 Committee for the Protection of Human Subjects

N.H. Code Admin. R. Ann. He-M 316.01 Purpose {#sec-he-m-316.01 omnilex-key=us-nh-regs-official--agency-he-m--He-M 316.01}

The purpose of this rule is to establish fees in order to offset departmental costs of providing assistance to the committee for the protection of human subjects (CPHS).

History

#9588, eff 11-4-09; ss by #12408, INTERIM, eff 10-24-17, EXPIRES: 4-22-18

N.H. Code Admin. R. Ann. He-M 316.02 Definitions {#sec-he-m-316.02 omnilex-key=us-nh-regs-official--agency-he-m--He-M 316.02}

(a) “Committee for the protection of human subjects (CPHS, committee)” means a department-sponsored institutional review board (IRB) charged with overseeing all research projects involving human subjects that are conducted in institutions and community programs funded in whole or in part by the bureau of behavioral health (BBH), the bureau of developmental services (BDS), or the bureau of drug and alcohol services (BDAS) of the New Hampshire department of health and human services.

(b) “Continuing review” means an annual review of the progress of the research.

(d) “Expedited review” means a review carried out by the CPHS chairperson or by one of more experienced reviewers designated by the chairperson from among the members of the CPHS.

(e) “Full committee review” means a review of the research submission at a meeting at which a quorum is convened by the committee established pursuant to RSA 171-A:19-a, II.

(f) “Principal investigator (PI)” means the individual with primary responsibility for the design, conduct, and funding of a research project.

(g) “Quorum” means a majority of the members of the CPHS are present, including at least one member whose primary expertise is scientific and one member whose primary expertise is nonscientific.

(h) “Research” means a systematic investigation, including research development, testing and evaluation, designed to develop or contribute to generalizable knowledge, and for the purposes of this rule does not include:

(1) Activities that are solely for the purpose of clinical intervention;

(2) The collection of information for quality improvement activities; or

(3) Client satisfaction surveys.

History

#9588, eff 11-4-09; ss by #12408, INTERIM, eff 10-24-17, EXPIRES: 4-22-18

N.H. Code Admin. R. Ann. He-M 316.03 Fees {#sec-he-m-316.03 omnilex-key=us-nh-regs-official--agency-he-m--He-M 316.03}

(a) The fee for the review of each research submission shall be as follows:

(1) $2000 for full committee review; and

(2) $750 for expedited review.

(b) The fees in (a) above shall include the continuing review.

(1) Unfunded research studies;

(2) Studies that utilize department funds; and

(3) Request for review to determine exemption from CPHS oversight per 45 CFR 46.101(b).

APPENDIX A: Incorporation by Reference Information

Rule

Title

Publisher; How to Obtain; and Cost

He-M 311.06(a)(4)-(5)

“The Joint Commission Comprehensive Accreditation Manual for Hospitals” (January 2015)

Joint Commission Resources, Inc. One Renaissance Boulevard, Oakbrook Terrace, Illinois 60181; or at http://www.jcrinc.com. Cost: $374.

APPENDIX B

RULE

SPECIFIC STATE OR FEDERAL STATUTE OR REGULATIONS THE RULE IMPLEMENTS

He-M 305.01

RSA 135-C:57, IV; RSA 126-U:1

He-M 305.02

RSA 135-C:57, IV; RSA 126-U:1

He-M 305.03(a)

RSA 135:21-b; RSA 126-U:3

He-M 305.03(b)

42 CFR 482.13(e)(3)(ii); (f)(3)(ii)

He-M 305.03(b)-(d)

RSA 135-C:57, IV

He-M 305.03(d)

42 CFR 482.13(e)(2), (3)(ii)(A); (f)(2), (3)(ii)(A)

He-M 305.03(e)(2)

42 CFR 482.13(e)(3)(iv); (f)(3)(iv)

He-M 305.03(e)-(f)

RSA 135:21-b

He-M 305.03(e)-(h)

RSA 135:21-b

He-M 305.04(a)

RSA 135-C:57, V; RSA 126-U:4, 5, 5-a, 5-b, and 11

He-M 305.04(b)(1)

42 CFR 482.13(e)(1)(9)

He-M 305.04(b)-(d)

RSA 135:21-b

He-M 305.04(c), (d)

42 CFR 482.13(e)(3)(i); (f)(3)(i), RSA 126-U:4, 5, 5-a, and 5-b

He-M 305.04(e)-(i)

RSA 135-C:57, IV; RSA 126-U:4, 5, 5-a, and 5-b

He-M 305.04(f)

42 CFR 482.13(c)(1), RSA 126:5 and 5-a

He-M 305.04(g)

42 CFR 482.13(e)(5), RSA 126-U:2 and 11

He-M 305.04(h)

42 CFR 482.13(e)(8)

He-M 305.04(i), (k)

42 CFR 482.13(e)(1)

He-M 305.04(j)

RSA 135-C:61, I

He-M 305.04(k)-(l)

RSA 135-C:57, IV

He-M 305.04(l)

42 CFR 482.13(e)(1)

He-M 305.04(l)(4)

42 CFR 482.13(e)(1)

He-M 305.04(m)-(o)

RSA 135:21-b

He-M 305.05(a)-(b)

RSA 135-C:57, IV; 42 CFR 482.13(e)(1)(B); RSA 126-U:1

He-M 305.05(c)-(e)

RSA 135:21-b

He-M 305.06(a)-(b)

RSA 135-C:57, I, RSA 126-U:7 and 10

He-M 305.06(c)

RSA 135-C:61, XI; 42 CFR 482.13(e)(3)(ii)(B);

RSA 126-U:7 and 10

He-M 305.06(d)-(f)

RSA 135-C:61, XII, RSA 126-U:7 and 10

He-M 305.06(d)-(g)

RSA 135-C:61, XII, RSA 126-U:7 and 10

He-M 305.07

RSA 135-C:5, I(b)

He-M 305.07(a)

42 CFR 482.13(e);

He-M 305.08

RSA 135-C:61, XII

He-M 305.09

42 CFR 482.13(g)(1)(iii), RSA 126-U:7 and 10

He-M 306.01 - 306.06

RSA 135-C:57, III, V

He-M 306.07

RSA 135-C:60

He-M 306.08

RSA 135-C:57, III, V

He-M 309.01

RSA 135-C:13, 18, 56, 57, and 59

He-M 309.02

RSA 135-C:13, 18, 56, 57, and 59

He-M 309.03

RSA 135-C:59

He-M 309.04

RSA 135-C:56

He-M 309.05

RSA 135-C:56 and 57; RSA 135-C:19-a; RSA 329; RSA 330-A; RSA 329-B; RSA 326-B

He-M 309.06

RSA 135-C:57

He-M 309.07

RSA 135-C:18

He-M 309.08

RSA 135-C:18

He-M 309.09

RSA 135-C:58

He M 310.01

RSA 171-A:8; 11, 12, 13, 14, 15 and 29; RSA 137-K-3, IV

He M 310.02

RSA 171-A:8; 11, 12, 13; 14; 15 and 29

He M 310.03

RSA 171-A:15; RSA 137-K:3, IV

He M 310.04

RSA 171-A:14, I; RSA 137-K:3, IV

He M 310.05

RSA 171-A:14 and 29; RSA 137-K:3, IV

He M 310.06

RSA 171-A:11, 12, and 13; RSA 137-K-3, IV; 42 CFR 441.301(c)(1)

He M 310.07

RSA 171-A:8; RSA 137-K-3, IV

He M 310.08

RSA 171-A:8; RSA 137-K-3, IV

He M 310.09

RSA 171-A:14, II, III, IV; RSA 171-A:29; RSA 137-K:3, IV;

42 CFR 441.301(c)(4)(vi)(F)

He M 310.10

42 CFR 441.301(c)(4)(vi)(A)

He-M 310.11

RSA 171-A:17

He-M 310.12

42 CFR 441.301(c)(4)(vi)(A)

He M 311.01

RSA 135-C:2, 8, 11, 12, 13, 14, 15, and 29

He M 311.02

RSA 135-C:8, 11, 12, 13, 14, 15, and 29

He M 311.03

RSA 135-C:59

He M 311.04

RSA 135-C:13 and RSA 135-C:56

He M 311.05

RSA 135-C:5, I(b); RSA 135-C:13; RSA 135-C:56; RSA 135-C:58; RSA 135-C:59; RSA 135-C: 61, V, VI, and XI; RSA 135-C:63-a, II; RSA 135-C:19-a;

He M 311.06

RSA 135-C:57

He M 311.07

RSA 135-C:18

He-M 314.01 - 314.09

RSA 126-A:26

He-M 315

RSA 126-N:3; RSA 135-C:1

He-M 316.01 - 316.02

RSA 171-A:19-a

He-M 316.03

RSA 171-A:19-a, IX

History

#9588, eff 11-4-09; ss by #12408, INTERIM, eff 10-24-17, EXPIRES: 4-22-18

Chapter He-M 400 Community Mental Health

Part He-M 401 Eligibility Determination and Individual Service Planning

N.H. Code Admin. R. Ann. He-M 401.01 Purpose {#sec-he-m-401.01 omnilex-key=us-nh-regs-official--agency-he-m--He-M 401.01}

The purpose of these rules is to establish the requirements and procedures for determining eligibility for state-funded community mental health services and for developing and monitoring the individual service plan.

History

(See Revision Note at part heading for He-M 401) #4194, eff 1-1-87; ss by #4197 Emergency, eff 12-31-86; ss by #4237, eff 2-27-87, EXPIRED: 2-27-93
#6644, eff 12-2-97; ss by #8155, eff 9-2-04, EXPIRED: 9-2-12
#10256, INTERIM, eff 1-24-13, EXPIRES: 7-23-13; ss by #10383, eff 7-23-13

N.H. Code Admin. R. Ann. He-M 401.02 Definitions {#sec-he-m-401.02 omnilex-key=us-nh-regs-official--agency-he-m--He-M 401.02}

The words and phrases in these rules shall mean the following:

(a) “Adult” means a person 18 years of age or older.

(b) “Applicant” means any person who requests state-funded services from a CMHP.

(c) “Area of origin” means the city or town in which a consumer resides or, if the consumer is in a state institution, the city or town in which the consumer resided immediately prior to entering the institution.

(d) “Bureau” means the bureau of behavioral health.

(e) “Case manager” means a person designated by a CMHP to monitor, advocate for, and facilitate the delivery of services to consumers.

(f) “Child” means a person who is less than 18 years of age.

(g) “Child and family service plan” means a written document developed for a child that specifies the services and supports that are needed for the family and child to attain their identified goals.

(h) “Clinician” means a person who has been authorized by a CMHP to render consumer services and who is qualified to provide such services pursuant to He-M 426.05 (e)-(j).

(i) “Community mental health program (CMHP)” means a community mental health program operated by the state or a city, town, county, or nonprofit corporation and approved pursuant to He-M 403 for the purposes of planning, establishing, and administering an array of mental health services.

(j) “Conference” means a meeting or series of meetings held to develop or revise an individual or family service plan pursuant to He-M 401.10 or He-M 401.11.

(k) “Consumer” means any person receiving state-funded services from a CMHP.

(l) “Crisis plan” means a written agreement between a consumer and a CMHP that:

(1) Outlines the interventions to be utilized and/or considered during an impending or acute psychiatric crisis;

(2) Promotes illness self-management;

(3) Emphasizes a preventive approach through the identification of early warning signs of acute psychiatric episodes and specific treatment approaches to be used in the event of a psychiatric crisis;

(4) Reflects a team effort among the consumer, CMHP staff, and others invited by the consumer; and

(5) May include the use of peer supports.

(m) “Eligibility” means the determination that a person meets the criteria for one or more of the eligibility categories in He-M 401.05 through He-M 401.09.

(n) “Employment or education plan” means a written plan that is based on the consumer’s own job and career goal(s) and includes the following:

(1) Identification of the skills, supports, and resources necessary to help the consumer achieve and maintain his or her job and educational goal; and

(2) Determination of whether or not assistance in job acquisition or placement is needed and, if so, a plan describing such.

(o) “Guardian” means a guardian, or a temporary guardian, of the person appointed pursuant to RSA 464-A or the parent of a consumer under the age of l8 whose parental rights have not been terminated or limited by law.

(p) “Individual service plan (ISP)” means a written document that specifies the services and supports that a consumer, aged 18 or older, needs to attain his or her personal goals.

(q) “Interagency involvement” means the services provided to a child who:

(1) Meets the criteria specified in He-M 401.09 (a) and has been identified by a school administrative unit as being educationally handicapped; or

(2) Is referred to a CMHP and is under the legal jurisdiction of the division for children, youth and families (DCYF).

(r) “Master's level clinician” means a person who graduated from an accredited college or university program with a graduate degree in psychology or counseling and who is working under the supervision of a psychiatrist or psychologist as specified in He-M 401.04.

(s) “Mental illness” means the following psychiatric disorders classified in the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition, Text Revision) (DSM-IV-TR, 2000), available as noted in Appendix A:

(1) Schizophrenia and other psychotic disorders;

(2) Mood disorders;

(3) Borderline personality disorder;

(4) Post traumatic stress disorder;

(5) Obsessive compulsive disorder;

(6) Eating disorders;

(7) Dementia, where the psychiatric symptoms cause the functional impairments and one or more of the following co-morbid symptoms exist:

a. Anxiety;

b. Depression;

c. Delusions;

d. Hallucinations; or

e. Paranoia; or

(8) Panic disorder.

(t) “Region” means a geographic area identified in He-M 425.03 for the purpose of assigning primary responsibility for providing mental health services to the residents of certain communities.

(u) “Serious emotional disturbance” means severe mental disability in persons under the age of 18, and includes psychiatric disorders classified as axis I disorders or an axis II borderline personality disorder in the DSM-IV-TR with the exception of substance abuse disorders and V codes, which are conditions not attributable to a mental disorder.

(v) “Serious psychosocial dysfunction” means a significant disruption in functioning, due to a mental illness, in the areas of role performance, thinking, behavior toward self or others, and/or moods or emotions.

(w) “Severely functionally-impaired” means that as a result of a person's mental illness he or she requires intensive supervision or is in acute psychiatric crisis and cannot function in an autonomous or semi-autonomous fashion.

(x) “Severely mentally disabled” means “severely mentally disabled” as defined in RSA 135-C:2, XV, namely, “having a mental illness which is either so acute or of such duration as to cause a substantial impairment of a person’s ability to care for himself or herself or to function normally in society in accordance with rules authorized by RSA 135-C: 61.”

(y) “Suspension” means a time limited, specific withholding of any available service(s) from a consumer for well-defined and documented reasons and pursuant to He-M 401.14 (a)-(c).

(z) “Support” means informal assistance or resources provided by friends, family members, neighbors, or others to enable an individual to participate in community life.

(aa) “Termination” means the cessation for an indefinite period of all services to a consumer.

History

(See Revision Note at part heading for He-M 401) #4194, eff 1-1-87; ss by #4197 Emergency, eff 12-31-86; ss by #4237, eff 2-27-87, EXPIRED: 2-27-93
#6644, eff 12-2-97; ss by #8155, eff 9-2-04, EXPIRED: 9-2-12
#10256, INTERIM, eff 1-24-13, EXPIRES: 7-23-13; ss by #10383, eff 7-23-13

N.H. Code Admin. R. Ann. He-M 401.03 Intake Process {#sec-he-m-401.03 omnilex-key=us-nh-regs-official--agency-he-m--He-M 401.03}

(a) Intake application shall be made as follows:

(1) All persons seeking community mental health services shall make application to the CMHP by providing to the CMHP such information as required by He-M 408.04 (b)(1); or

(2) For those persons who have been determined eligible for state-funded services and who are returning to the community from New Hampshire hospital or a designated receiving facility, the discharge plan, when developed in conjunction with the CMHP, shall constitute application for admission into the state-funded service delivery system.

(b) The provisions of He-M 401.03 (a)(2) above shall not preclude any individual from applying directly to a CMHP for services.

(c) The CMHP shall be responsible for the inclusion of all components listed in He-M 408.04 (b)(1) in intake applications.

(d) In the event that a psychiatric emergency regarding an applicant exists pursuant to He-M 401.03 (e) below, the CMHP shall refer the applicant to emergency services pursuant to He-M 426.09.

(e) A CMHP shall determine that a psychiatric emergency regarding an applicant or consumer exists if, due to the applicant's or consumer's mental illness:

(1) There is the potential of a serious increase in psychiatric symptoms likely to result in impaired functioning;

(2) The person is in danger of psychiatric hospitalization; or

(3) There is likelihood of danger to the person or to others if CMHP services are not provided.

(f) For all persons applying, the CMHP shall identify the services it anticipates providing. This listing shall function as the individual service plan until the full service planning process can be completed.

History

(See Revision Note at part heading for He-M 401) #4194, eff 1-1-87; ss by #4197 Emergency, eff 12-31-86; ss by #4237, eff 2-27-87, EXPIRED: 2-27-93
#6644, eff 12-2-97; ss by #8155, eff 9-2-04, EXPIRED: 9-2-12
#10256, INTERIM, eff 1-24-13, EXPIRES: 7-23-13; ss by #10383, eff 7-23-13

N.H. Code Admin. R. Ann. He-M 401.04 Eligibility Determination {#sec-he-m-401.04 omnilex-key=us-nh-regs-official--agency-he-m--He-M 401.04}

(a) The CMHP shall be responsible for conducting an eligibility determination pursuant to He-M 401 for each applicant.

(b) An eligibility determination shall be conducted by:

(1) A psychiatrist who meets the definition in RSA 135-C:2, XIII;

(2) A psychologist who is licensed in accordance with RSA 330-A:16, I;

(3) A pastoral psychotherapist who is certified in accordance with RSA 330-A:17;

(4) A clinical social worker who is licensed in accordance with RSA 330-A:18;

(5) A nurse who is registered as required by RSA 326-B and has a master’s degree in psychiatric nursing or is certified as an advanced practice registered nurse with a psychiatric mental health specialty in accordance with RSA 326-B:10;

(6) A clinical mental health counselor licensed in accordance with RSA 330-A:19;

(7) A registered nurse (RN-C) certified in psychiatric nursing by the American Nurses Association;

(8) A marriage and family therapist licensed in accordance with RSA 330-A:21; or

(9) Any of the following, provided that the eligibility determination is reviewed and cosigned by a professional identified in He-M 401.04 (b) (1) through (7):

a. A case manager, including staff members who possess a bachelors’ degree and staff who meet the criteria to provide individual resiliency and recovery oriented services (IROS) under He-M 426; or

b. A master’s level clinician.

(c) An eligibility determination shall be effective on the date that the determination is signed by the professional(s) making the determination.

(d) A redetermination shall be conducted and signed no later than 30 days after the expiration date of the previous determination. The person shall be deemed eligible during that 30 day period.

(e) A CMHP shall notify an applicant of the services for which he or she is eligible within 15 days of the effective date of eligibility determination.

(f) Once an applicant’s eligibility for state-funded services is determined, the CMHP shall do one of the following:

(1) If the applicant, including an applicant returning to the community from New Hampshire hospital or a designated receiving facility who does not have a current individual service plan, is determined eligible for state-funded services, an individual service plan shall be developed; or

(2) If the applicant does not meet the eligibility criteria specified under He-M 401, that applicant shall be referred to non-state-funded services and the CMHP shall document the referral.

(g) The eligibility determination shall be documented in the consumer’s clinical record.

History

(See Revision Note at part heading for He-M 401) #4194, eff 1-1-87; ss by #4197 Emergency, eff 12-31-86; ss by #4237, eff 2-27-87, EXPIRED: 2-27-93
#6644, eff 12-2-97; ss by #8155, eff 9-2-04, EXPIRED: 9-2-12
#10256, INTERIM, eff 1-24-13, EXPIRES: 7-23-13; ss by #10383, eff 7-23-13

N.H. Code Admin. R. Ann. He-M 401.05 Eligibility Criteria for Adults with Severe and Persistent Mental Illness {#sec-he-m-401.05 omnilex-key=us-nh-regs-official--agency-he-m--He-M 401.05}

(a) An adult shall be eligible for community mental health services if he or she has a severe and persistent mental illness (SPMI) pursuant to (b) below.

(b) An adult shall be determined by a CMHP to have a severe and persistent mental illness (SPMI) if he or she meets each of the following criteria:

(1) The adult has a diagnosed mental illness;

(2) The adult has a severe functional impairment as a result of his or her mental illness as determined through assessment of the person’s ability to function in the following functional domains:

a. Activities of daily living;

b. Interpersonal functioning;

c. Adaptation to change; and

d. Concentration and task performance or pace; or

e. Equivalent domains as defined in an outcome measurement tool approved by the commissioner;

(3) For adults age 18-59, the assessment of functional impairment required by (2) above demonstrates:

a. Moderate impairment causing chronic or durable problems in each of the four functional domains such that the person requires regular support and a variety of services;

b. Marked impairment causing ongoing symptoms in two or more of the functional domains such that the person requires intensive and frequent supportive interventions;

c. Extreme impairment causing risk of death in at least one functional domain such that the person requires a constant level of services; or

d. Equivalent impairment ratings based on an outcome measurement tool approved by the commissioner;

(4) For adults age 60 and older, the assessment of functional impairment required by (2) above demonstrates, without regard to the older adult’s score on the General Assessment of Functioning (GAF) scale:

a. Moderate impairment causing chronic or durable problems in three or more of the functional domains such that the person requires regular support and a variety of services; or

b. Marked impairment causing ongoing symptoms in one or more of the functional domains such that the person that requires intensive and frequent supportive interventions; and

(5) The adult has had the severe functional impairment for one year or more.

(c) An adult shall be eligible for community mental health services as a result of having SPMI if he or she meets the criteria specified in (b)(1) and (5) above but does not meet the criteria currently as a result of the use of clozaril or clozapine or as a result of close supervision such as that provided in a community residence as defined in He-M 1002.02.

(d) Redetermination of eligibility in this category shall occur every 2 years.

History

(See Revision Note at part heading for He-M 401) #4194, eff 1-1-87; ss by #4197 Emergency, eff 12-31-86; ss by #4237, eff 2-27-87, EXPIRED: 2-27-93
#6644, eff 12-2-97; ss by #8155, eff 9-2-04, EXPIRED: 9-2-12
#10256, INTERIM, eff 1-24-13, EXPIRES: 7-23-13; ss by #10383, eff 7-23-13

N.H. Code Admin. R. Ann. He-M 401.06 Eligibility Criteria for Adults with Severe Mental Illness {#sec-he-m-401.06 omnilex-key=us-nh-regs-official--agency-he-m--He-M 401.06}

(a) An adult shall be eligible for community mental health services if he or she has a severe mental illness (SMI) pursuant to (b) below.

(b) An adult shall be determined by a CMHP to have a severe mental illness (SMI) if he or she meets each of the following criteria:

(1) The adult has one of the following:

a. A diagnosis of mental illness; or

b. A provisional diagnosis of mental illness, if the person has not previously applied for community mental health services;

(2) The adult has a severe functional impairment as a result of his or her mental illness as determined through assessment of the person's abilities in the following functional domains:

a. Activities of daily living;

b. Interpersonal functioning;

c. Adaptation to change; and

d. Concentration and task performance or pace; or

e. Equivalent domains as defined in an outcome measurement tool approved by the commissioner;

(3) For adults age 18-59, the assessment of functional impairment required by (2) above demonstrates:

a. Moderate impairment causing chronic or durable problems in each of the four functional domains such that the person requires regular support and a variety of services;

b. Marked impairment causing ongoing symptoms in two or more of the functional domains such that the person requires intensive and frequent supportive interventions;

c. Extreme impairment causing risk of death in at least one functional domain such that the person requires a constant level of services; or

d. Equivalent impairment ratings based on an outcome measurement tool approved by the commissioner; and

(4) The assessment of functional impairment of adults age 60 and older demonstrates, without regard to the older adult’s score on the General Assessment of Functioning (GAF) scale:

a. Moderate impairment causing chronic or durable problems in three or more of the functional domains; or

b. Marked impairment causing ongoing symptoms that require intensive and frequent supportive interventions in one or more of the functional domains; and

(5) The adult has had the severe functional impairment for less than one year.

History

(See Revision Note at part heading for He-M 401) #4194, eff 1-1-87; ss by #4197 EMERGENCY, eff 12-31-86; ss by #4237, eff 2-27-87, EXPIRED: 2-27-93
#6644, eff 12-2-97; ss by #8155, eff 9-2-04, EXPIRED: 9-2-12
#10256, INTERIM, eff 1-24-13, EXPIRES: 7-23-13; ss by #10383, eff 7-23-13

N.H. Code Admin. R. Ann. He-M 401.07 Eligibility Criteria for Adults with Severe or Severe and Persistent Mental Illness with Low Service Utilization {#sec-he-m-401.07 omnilex-key=us-nh-regs-official--agency-he-m--He-M 401.07}

(a) An adult shall be eligible for community mental health services if he or she has SMI or SPMI with low service utilization pursuant to He-M 401.07 (b) below.

(b) A CMHP shall determine that an adult has SMI or SPMI with low service utilization if he or she:

(1) Has a mental illness but no longer meets all the criteria for SPMI or SMI and receives services that are designed to prevent relapse;

(2) Has functional impairments that are due to a developmental disability or receives services primarily through another agency such as a provider for persons with developmental disabilities or New Hampshire hospital; or

(3) Meets criteria for SPMI or SMI but has refused recommended services and for whom the CMHP is providing outreach.

(c) Attempts by the CMHP to engage the adult with SMI or SPMI with low service utilization in further services shall be made in accordance with his or her clinical needs and be documented in the person's record.

(d) Redetermination of eligibility in this category shall occur every 2 years.

History

(See Revision Note at part heading for He-M 401) #4194, eff 1-1-87; ss by #4197 Emergency, eff 12-31-86; ss by #4237, eff 2-27-87, EXPIRED: 2-27-93
#6644, eff 12-2-97; ss by #8155, eff 9-2-04, EXPIRED: 9-2-12
#10256, INTERIM, eff 1-24-13, EXPIRES: 7-23-13; ss by #10383, eff 7-23-13

N.H. Code Admin. R. Ann. He-M 401.08 Eligibility Criteria for Children with Serious Emotional Disturbance {#sec-he-m-401.08 omnilex-key=us-nh-regs-official--agency-he-m--He-M 401.08}

(a) To be eligible for community mental health services as a result of having a serious emotional disturbance, a child shall:

(1) Have a serious emotional disturbance;

(2) Have a serious psychosocial impairment as determined through an assessment of the following domains:

a. The child’s:

School or work role performance;
Home role performance;
Community role performance;
Behavior towards others;
Mood and emotions;
Behavior towards self;
Substance use; and
Thinking; and

b. The child’s caregiver’s ability to provide physical and emotional support to the extent necessary to promote the child’s emotional health; and

(3) Have the assessment of psychosocial impairment required by (2) above demonstrate:

a. At least mild impairment in three or more of the child centered domains causing periodic difficulty or distress;

b. At least moderate impairment in one or more child centered domains causing chronic or durable problems; or

c. At least mild impairment in the caregiver’s ability to provide physical and emotional support to the extent necessary to promote the child’s emotional health.

(b) Redetermination of eligibility in this category shall occur annually.

History

(See Revision Note at part heading for He-M 401) #4194, eff 1-1-87; ss by #4197 Emergency, eff 12-31-86; ss by #4237, eff 2-27-87, EXPIRED: 2-27-93
#6644, eff 12-2-97; ss by #8155, eff 9-2-04, EXPIRED: 9-2-12
#10256, INTERIM, eff 1-24-13, EXPIRES: 7-23-13; ss by #10383, eff 7-23-13

N.H. Code Admin. R. Ann. He-M 401.09 Eligibility Criteria for Children with Serious Emotional Disturbance and Having Current Interagency Involvement {#sec-he-m-401.09 omnilex-key=us-nh-regs-official--agency-he-m--He-M 401.09}

(a) To be eligible for community mental health services as a result of having a serious emotional disturbance and interagency involvement, a child shall:

(1) Have a diagnosed serious emotional disturbance;

(2) Have a serious psychosocial impairment as determined through an assessment of the following domains:

a. The child’s:

School or work role performance;
Home role performance;
Community role performance;
Behavior towards others;
Moods or emotions;
Behavior towards self;
Substance use; and
Thinking; and

b. The child’s caregiver’s ability to provide physical and emotional support to the extent necessary to promote the child’s emotional health;

(3) Have the assessment of psychosocial impairment required by (2) above demonstrate:

a. At least mild impairment in three or more of the child centered domains causing periodic difficulty or distress;

b. At least moderate impairment in one or more child centered domains causing chronic or durable problems; or

c. At least mild impairment in the caregiver’s ability to provide physical and emotional support to the extent necessary to promote the child’s emotional health; and

(4) Have current interagency involvement.

(b) Redetermination of eligibility in this category shall occur annually.

History

(See Revision Note at part heading for He-M 401) #4194, eff 1-1-87; ss by #4197 Emergency, eff 12-31-86; ss by #4237, eff 2-27-87, EXPIRED: 2-27-93
#6644, eff 12-2-97; ss by #8155, eff 9-2-04, EXPIRED: 9-2-12
#10256, INTERIM, eff 1-24-13, EXPIRES: 7-23-13; ss by #10383, eff 7-23-13

N.H. Code Admin. R. Ann. He-M 401.10 Adult Service Planning Process {#sec-he-m-401.10 omnilex-key=us-nh-regs-official--agency-he-m--He-M 401.10}

(a) A CMHP shall complete a written individual service plan within 90 calendar days after the determination that the person is eligible for services.

(b) Development of the ISP shall be a collaborative effort between the consumer and the CMHP. If the consumer has a guardian, the guardian shall play an active role in the process.

(1) The purpose of the Individual Service Planning process as specified in 401.10(h), and

(2) The components of the ISP, including goals, measurable objectives, services, timelines, referrals, quarterly reviews, a crisis plan and employment or education plan, as appropriate.

(d) The case manager or primary clinician shall fully explain to the consumer or guardian, verbally and in writing that the consumer or guardian has the power to choose either of the following methods by which his or her ISP is developed:

(1) Through a formal client centered conference that is a meeting at a mutually convenient time and place with the psychiatrist and other involved persons as approved by the consumer, such as family members, CMHP staff, representatives of other agencies providing services to the consumer such as vocational rehabilitation, friends, an attorney, legal representative, a peer advocate and/or others with relevant knowledge or expertise; or

(2) Through a less formal method that shall include one or more one-on-one or small group meetings with the psychiatrist and/or others listed in 401.10 (d)(1) by phone, in person and/or through other effective means of communication such as electronic mail.

(e) The consumer or guardian shall be advised that he or she may consult with family, friends, therapists, advocates and others before making the decision regarding the method to develop the ISP.

(f) The consumer or guardian shall have 10 days to make a decision after receiving the written explanation regarding the methods to develop the ISP, which the consumer or guardian shall indicate by his or her signature.

(g) The decision of the consumer or guardian, indicating that the choices were explained, shall be documented in the clinical record.

(h) The outcome of the process described in (b)-(g) above shall be the development of an ISP that:

(1) Focuses on recovery;

(2) Focuses on strengths;

(3) Promotes community integration and participation;

(4) Enhances natural community supports and relationships, with particular emphasis on maintaining and improving family relationships;

(5) Fosters employment, self sufficiency, and other similar, socially valued roles;

(6) Identifies functional impairments which are a result of mental illness;

(7) Identifies treatment interventions;

(8) Promotes access to generic services and resources;

(9) Establishes time specific, sequentially stated objectives for improved personal functioning;

(10) Establishes a crisis plan as defined in He-M 401.02; and

(11) Establishes an employment or educational plan, as appropriate.

(i) Consumers determined eligible in a low utilizer category pursuant to He-M 401.07 shall have a service planning process which shall at a minimum:

(1) On a biennial basis:

a. Redetermine eligibility pursuant to He-M 401.07;

b. Assess the level of need for continued mental health services;

c. Assess the need for referral to other services;

d. Result in the development or continuation of goals and objectives; and

e. If the consumer is receiving only medication-related services, result in medication related objectives, as appropriate, developed by the psychiatrist and the consumer to serve as the individual service plan; and

(2) Follow the comprehensive service planning process pursuant to He-M 401.10 if there is any increased need for more extensive utilization of mental health services.

(j) A case manager, if needed, or primary clinician, shall be assigned to each consumer who has been determined to have a severe and persistent mental illness.

(k) A case manager, if needed, or primary clinician, shall be assigned to each consumer who has been determined to have a severe mental illness.

(l) A CMHP shall not deny available, appropriate services to any eligible consumer who lives within the CMHP's region. Upon inquiry, a CMHP shall provide information about available services.

(m) The individual service plan shall include the signature of the consumer/guardian as indication of approval of the plan. If it is necessary to notify the consumer/guardian by mail, the consumer/guardian shall have 15 days from the date notice was sent to respond in writing, indicating approval or disapproval of the ISP. Failure to respond within the time allowed shall constitute approval of the ISP.

(n) If the consumer or guardian refuses to sign the individual service plan, the dispute shall be resolved:

(1) Through informal discussions with the CMHP;

(2) By convening or reconvening a service planning meeting; or

(3) By the individual or guardian filing an appeal with the bureau pursuant to He-M 204.

(o) The individual service plan shall be signed by a psychiatrist as indication of CMHP approval of the plan and as indication that the services to be provided that are covered by medicaid are medically necessary.

(p) The consumer shall receive a copy of the final version of the individual service plan.

(q) If necessary services are not available, such service shall be documented through individual service plans.

(r) When services have been documented to be necessary but unavailable, each agency responsible for provision of such services shall notify the department of the need for these services by submitting an annual report due July 1 and submitted no later than July 15 of each year.

(s) The department shall utilize such information as is provided pursuant to (q)-(r) above for budgetary planning purposes.

History

(See Revision Note at part heading for He-M 401) #4194, eff 1-1-87; ss by #4197 Emergency, eff 12-31-86; ss by #4237, eff 2-27-87, EXPIRED: 2-27-93
#6644, eff 12-2-97; ss and moved by #8155, eff 9-2-04 (from He-M 401.12), EXPIRED: 9-2-12
#10256, INTERIM, eff 1-24-13, EXPIRES: 7-23-13; ss by #10383, eff 7-23-13

N.H. Code Admin. R. Ann. He-M 401.11 Child, Adolescent and Family Service Planning Process {#sec-he-m-401.11 omnilex-key=us-nh-regs-official--agency-he-m--He-M 401.11}

(a) For children determined eligible due to a severe emotional disturbance pursuant to He-M 401.08 or He-M 401.09, the service planning process shall include a child and family service plan written within 90 calendar days from the date of eligibility determination and annually thereafter.

(b) The purpose of the service planning process shall be to assure the development of an individualized plan based on the family’s and child’s expressed goals and objectives. The service planning process may include a conference if the parent(s) or guardian so desire. The case manager or primary clinician shall notify the parent(s) or guardian of the right to a conference and document the notification in the clinical record. The record shall contain a signed acknowledgement that such notification was provided.

(1) Focus on strengths;

(2) Promote community integration and participation;

(3) Enhance natural community supports and relationships;

(4) Identify functional impairments which are a result of mental illness;

(5) Identify treatment interventions; and

(6) Promote access to generic services and resources.

(d) If the parent(s) or guardian requests a conference, those invited to participate may include:

(1) The child's parent(s) or legal guardian;

(2) The child's case manager and/or primary therapist;

(3) Staff from agencies with which the child has involvement such as DCYF, the local school system, or the juvenile justice system;

(4) The child's psychiatrist;

(5) Other involved CMHP staff; and

(6) The child, if his or her attendance is determined by CMHP staff to be clinically appropriate.

(e) The child and family service plan shall include the signature of the consumer or guardian as indication of approval of the plan. If it is necessary to notify the consumer/guardian by mail, the consumer or guardian shall have 15 days from the date notice was sent to respond, in writing, indicating approval or disapproval of the child and family service plan. Failure to respond within the time allowed shall constitute approval of the child and family service plan.

(f) If the consumer or guardian refuses to sign the child and family service plan, the dispute shall be resolved:

(1) Through informal discussions with the CMHP;

(2) By convening or reconvening a service planning meeting; or

(3) By the individual, parent, or guardian filing an appeal with the bureau pursuant to He-M 204.

(g) The child and family service plan shall be signed by a psychiatrist as indication of CMHP approval of the plan.

(h) The psychiatrist may order, based on legitimate treatment considerations, the continuation of services by the child and adolescent program for a person who has turned age 18, up to the age of 21.

(i) The child and family shall receive a copy of the final version of the child and family service plan.

(j) If necessary services are not available, such service shall be documented through child and family service plans.

(k) When services have been documented to be necessary but unavailable, each agency responsible for provision of such services shall notify the department of the need for these services by submitting an annual report due July 1 and submitted no later than July 15 of each year.

(l) The department shall utilize such information as is provided pursuant to (k) above for budgetary planning purposes.

History

(See Revision Note at part heading for He-M 401) #4194, eff 1-1-87; ss by #4197 Emergency, eff 12-31-86; ss by #4237, eff 2-27-87, EXPIRED: 2-27-93
#6644, eff 12-2-97; ss and moved by #8155, eff 9-2-04 (from He-M 401.13), EXPIRED: 9-2-12
#10256, INTERIM, eff 1-24-13, EXPIRES: 7-23-13; ss by #10383, eff 7-23-13

N.H. Code Admin. R. Ann. He-M 401.12 Review of the Individual Service Plan {#sec-he-m-401.12 omnilex-key=us-nh-regs-official--agency-he-m--He-M 401.12}

(a) Consumers determined eligible in a low utilizer category pursuant to He-M 401.07 shall have a service plan review process as follows:

(1) Each contact with a consumer shall be documented;

(2) Such documentation, if services are provided at least quarterly, shall serve as the periodic review;

(3) If no service has been provided in the last quarter, a review regarding the continued need for services shall occur and be documented; and

(4) The annual review and modification of the objectives by the primary service provider(s) and the consumer shall serve as the annual consumer conference.

(b) All eligible consumers other than those referenced in He-M 401.12 (a) shall have their individual service plans reviewed on a quarterly basis and revised as necessary.

(1) A review of the consumer's progress toward the goals in the individual service plan;

(2) Documentation that all needed services are being provided;

(3) Revision of the individual service plan, as appropriate;

(4) Determination of continued need for services;

(5) A review of any residential, vocational, social, or other changes in the consumer's life; and

(6) A review of psychiatric hospitalizations.

(d) The CMHP shall document the results of a quarterly review in a quarterly review note pursuant to He-M 408.11.

(e) The CMHP shall indicate on the quarterly review note as to whether or not the information was reviewed with the consumer. Whenever possible, the consumer shall be asked to sign his or her quarterly review note to indicate participation in, and agreement with, the results of the review.

(f) An annual plan review shall meet the requirements of He-M 401.10 and He-M 401.12(c) and shall constitute the fourth quarter review.

(g) Following an annual plan review, an annual individual service plan shall be written, or reviewed and revised as necessary.

History

(See Revision Note at part heading for He-M 401) #4194, eff 1-1-87; ss by #4197 Emergency, eff 12-31-86; ss by #4237, eff 2-27-87, EXPIRED: 2-27-93
#6644, eff 12-2-97; ss and moved by #8155, eff 9-2-04 (from He-M 401.14), EXPIRED: 9-2-12
#10256, INTERIM, eff 1-24-13, EXPIRES: 7-23-13; ss by #10383, eff 7-23-13

N.H. Code Admin. R. Ann. He-M 401.13 Review of the Child and Family Service Plan {#sec-he-m-401.13 omnilex-key=us-nh-regs-official--agency-he-m--He-M 401.13}

(a) All eligible children and adolescents shall have their child and family service plan reviewed and revised as necessary on a quarterly basis.

(b) The quarterly review shall include the following:

(1) A review of the child’s progress toward the goals in the child and family service plan;

(2) Assessment that all needed services are being provided;

(3) Revision of the child and family service plan, as appropriate;

(4) Determination of continued need for services;

(5) A review of any residential, educational, social, or other changes in the child’s life; and

(6) A review of psychiatric hospitalizations.

(d) CMHP staff shall indicate on the quarterly review note as to whether or not the information was reviewed with the consumer. Whenever possible, the consumer shall be asked to sign his or her quarterly review note to indicate participation in, and agreement with, the results of the review.

(e) An annual plan review shall meet the requirements of He-M 401.11 and He-M 401.13(b) and shall constitute the fourth quarter review.

(f) Following an annual plan review, the CMHP staff shall write an annual child and family service plan or review and revise the existing plan, as necessary.

History

#6644, eff 12-2-97; ss and moved by #8155, eff 9-2-04 (from He-M 401.15), EXPIRED: 9-2-12
#10256, INTERIM, eff 1-24-13, EXPIRES: 7-23-13; ss by #10383, eff 7-23-13

N.H. Code Admin. R. Ann. He-M 401.14 Suspension and Termination of Services {#sec-he-m-401.14 omnilex-key=us-nh-regs-official--agency-he-m--He-M 401.14}

(a) A consumer shall be suspended from a CMHP's service(s) if:

(1) The consumer:

a. Endangers or threatens to endanger other consumers or staff and the clinical circumstances would not result in an involuntary emergency admission pursuant to RSA 135-C:27-33;

b. Is no longer benefiting from service(s) he or she is receiving; or

c. Meets suspension provisions as part of the treatment program as specified in the consumer's individual service plan or as specified in the CMHP's policies and procedures;

(2) The suspension has been approved by the CMHP's chief executive officer or designee as meeting the criteria specified herein; and

(3) The consumer and his or her guardian, if any, have received written and verbal notice prior to the suspension which shall:

a. Specify the effective date of the suspension;

b. Specify the length of time the suspension is to last;

c. List the clinical or management reasons for the suspension; and

d. Explain the rights to appeal and the appeal process pursuant to He-M 204.

(b) Suspension of a consumer shall not exceed 5 program days except as required by He-M 401.14 (h);

(1) The consumer has been notified of the suspension; and

(2) The suspension has been approved by the CMHP's chief executive officer or designee.

(d) A consumer shall be terminated from a CMHP's service(s), with the exception of emergency services, if:

(1) The consumer:

a. Endangers or threatens to endanger, other consumers or staff requiring intervention of law enforcement, or engages in illegal activity on the property of the CMHP; and

b. The clinical circumstances would not appropriately result in an involuntary emergency admission pursuant to RSA 135-C:27-33;

(2) The consumer is no longer benefiting from the service(s) he or she is receiving;

(3) The consumer refuses to pay for the services that he or she is receiving despite having the financial resources to do so; or

(4) The consumer refuses to apply for benefits that could cover the cost of the services that he or she is receiving despite the fact that the consumer is or may be eligible for such benefits.

(e) A termination from CMHP services shall not occur unless:

(1) It has been approved by the CMHP's chief executive officer or designee as meeting the criteria specified herein; and

(2) The CMHP has given a written and verbal notice to the consumer and consumer's guardian, if any, at least 30 days prior to the termination which shall:

a. Give the effective date of termination;

b. List the clinical or management reasons for termination; and

c. Explain the rights to appeal and the appeal process pursuant to He-M 204.

(f) A CMHP shall document in the record of a consumer who has been discharged that:

(1) The consumer has been notified of the termination; and

(2) The termination has been approved by the CMHP's program director.

(g) A CMHP shall notify the bureau of all terminations of service.

(h) If a consumer is endangering or threatens to endanger other consumers or staff, or engages in illegal activity on the property of the CMHP and 30 days' notice would place at risk those threatened, the CMHP shall suspend the consumer from the services and then start the termination process.

History

#6644, eff 12-2-97; ss and moved by #8155, eff 9-2-04 (from He-M 401.16), EXPIRED: 9-2-12
#10256, INTERIM, eff 1-24-13, EXPIRES: 7-23-13; ss by #10383, eff 7-23-13

N.H. Code Admin. R. Ann. He-M 401.15 Waivers {#sec-he-m-401.15 omnilex-key=us-nh-regs-official--agency-he-m--He-M 401.15}

(a) A CMHP or consumer may request a waiver of specific procedures outlined in this chapter, in writing, from the department.

(b) A request for waiver shall include:

(1) A specific reference to the section of the rule for which a waiver is being sought;

(2) A full explanation of why a waiver is necessary; and

(3) A full explanation of alternative provisions or procedures proposed by the CMHP or consumer.

(d) A request for waiver shall be granted after the commissioner determines that the alternative proposed by the CMHP or consumer meets the objective or intent of the rule and:

(1) Does not negatively impact the health or safety of the consumer(s); or

(2) Is administrative in nature, and does not affect the quality of consumer care.

(e) Upon receipt of approval of a waiver request, the CMHP’s or consumer'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.

(f) Waivers shall be granted in writing for a specific duration not to exceed 5 years except as in (g) below.

(g) Those waivers which relate to the following shall be effective for the CMHP’s current certification period only:

(1) Fire safety; or

(2) Other issues relative to consumer health, safety or welfare that require periodic reassessment.

(h) A CMHP or consumer may request a renewal of a waiver from the department. Such request shall be made at least 90 days prior to the expiration of a current waiver.

History

#6644, eff 12-2-97; ss and moved by #8155, eff 9-2-04 (from He-M 401.17), EXPIRED: 9-2-12
#10256, INTERIM, eff 1-24-13, EXPIRES: 7-23-13; ss by #10383, eff 7-23-13

Part He-M 402 Peer Support

N.H. Code Admin. R. Ann. He-M 402.01 Purpose {#sec-he-m-402.01 omnilex-key=us-nh-regs-official--agency-he-m--He-M 402.01}

(a) The purpose of this part is to define the criteria and procedures for the operation of Peer Support Agencies (PSAs).

(b) The purpose of a PSA is to provide peer supports, peer education and peer programming approved by the state mental health authority that:

(1) Foster wellness in participants by supporting peers in identifying, and achieving an evolving and hopeful vision for their future;

(2) Foster self-advocacy skills, autonomy, and independence;

(3) Foster the ability to enhance a quality of life for participants including:

a. Connection with their families;

b. Connection with communities of their choice; and

c. Personally meaningful occupation;

(4) Emphasize mutuality as demonstrated by:

a. Shared decision making;

b. Strong conflict resolution;

c. Non-medical approaches to support; and

d. Non-static roles, such as, staff who are members and participants, and members and participants who are educators;

(5) Offer alternative views on wellness and the effects of trauma and abuse;

(6) Encourage informed decision-making about all aspects of participant’s lives;

(7) Support peers in understanding how they came to know what they know, by challenging perceived self-limitations, while encouraging the development of beliefs that enhance personal and relational growth and moving towards the life the peer desires; and

(8) Emphasize a holistic approach to health that includes a vision of the “whole” person.

History

#2038, eff 7-1-82; ss by #2711, eff 5-16-84; ss by #5130, eff 5-1-91, EXPIRED: 5-1-97
#8445, eff 10-6-05, EXPIRED: 10-6-13
#12193, eff 5-26-17

N.H. Code Admin. R. Ann. He-M 402.02 Definitions {#sec-he-m-402.02 omnilex-key=us-nh-regs-official--agency-he-m--He-M 402.02}

(a) “Board of directors” means the governing body of a nongovernmental PSA.

(b) “Culturally competent” means having attained the knowledge, skills and attitudes necessary to provide effective supports, services, education and technical assistance to populations in the geographic area served by the agency.

(d) “Guest” means any person who is invited to visit the PSA by a member, a participant, or the PSA.

(e) “Member” means any peer, who has made an informed decision to join, and agrees to support the goals and objectives of the PSA.

(f) “Participant” means a consumer, whether or not he or she is a member, who participates in any aspect of the peer support agency.

(g) “Peer” means any individual, 18 years of age or older, who self identifies as having lived experience as a former recipient, or as at significant risk of becoming a recipient of publicly funded mental health services.

(h) “Peer support agency (PSA)” means an organization whose primary purpose is to provide culturally competent peer support to peers 18 years of age or older.

(i) “Peer support services” means services that:

(1) Are provided for peers and by peers;

(2) Are designed to assist peers in their recovery;

(3) Include an educational environment in which people have the opportunity to learn wellness strategies while developing mutually beneficial relationships; and

(4) Include other educational, vocational or housing opportunities, as determined by the PSA.

(j) “Recovery” means, development of personal and social skills, beliefs and characteristics that:

(1) Support choice;

(2) Increase quality of life;

(3) Decrease dependence on the most restrictive services.

History

#2038, eff 7-1-82; ss by #2711, eff 5-16-84; ss by #5130, eff 5-1-91, EXPIRED: 5-1-97
#8445, eff 10-6-05, EXPIRED: 10-6-13
#12193, eff 5-26-17

N.H. Code Admin. R. Ann. He-M 402.03 Composition and Responsibilities of a PSA {#sec-he-m-402.03 omnilex-key=us-nh-regs-official--agency-he-m--He-M 402.03}

(a) A PSA shall be incorporated and shall have an established plan for governance.

(b) The plan for governance shall comply with the following:

(1) A PSA’s board of directors shall:

a. Have responsibility for the programmatic, fiduciary and policy oversight of the corporation; and

b. Have the powers usually vested in the board of directors of a nonprofit corporation, except as regulated in He-M 402;

(2) The responsibility and powers described in (1) above shall be stated in a set of bylaws maintained by the PSA board;

(3) A PSA’s board of directors shall not allow more than 20% of the board members to serve for more than 6 consecutive years;

(4) A PSA’s board of directors shall specify in its bylaws a procedure by which inactive PSA members are removed from the PSA board;

(5) The size and composition of the board of directors of a PSA shall be as follows:

a. The number of persons serving as board members shall be no fewer than 9;

b. Consumers shall comprise a minimum of 51% of the membership of the PSA board;

c. No more than 20% of board members shall be related by blood, marriage or cohabitation to other board members;

d. Board membership shall not be open to the following individuals:

Employees of a PSA, the spouses or significant others of employees, or anyone living in the same household as an employee, except that the executive director shall be eligible as an ex officio member;
Employees of the New Hampshire department of health and human services or their spouses; and
Individuals or the spouses of individuals who are under contract with a PSA;

(6) By-laws shall include term limits for board of director officers; and

(7) By-laws shall include a nominating process that actively recruits diverse individuals whose skills and life experiences will serve the needs of the agency.

(c) The PSA’s board of directors shall establish policies for the governance and administration of the PSA and all services provided through contract with the PSA.

(d) Policies shall be developed to ensure efficient and effective operation of the PSA and adherence to requirements of federal funding sources and rules and contracts established by the department.

(e) The PSA shall be responsible and accountable for all PSA services whether administrated directly by a PSA or provided under contracts with other organizations.

(f) Upon dissolution of the PSA or upon the event that the PSA no longer contracts with the department, ownership and possession of all assets and property obtained with funds granted by the department shall revert to the department.

History

#2038, eff 7-1-82; ss by #2711, eff 5-16-84; ss by #5130, eff 5-1-91, EXPIRED: 5-1-97
#8445, eff 10-6-05, EXPIRED: 10-6-13
#12193, eff 5-26-17

N.H. Code Admin. R. Ann. He-M 402.04 Fiscal Management {#sec-he-m-402.04 omnilex-key=us-nh-regs-official--agency-he-m--He-M 402.04}

(a) A PSA shall utilize federal, third party, and other public and private sources of funds that are available for the agency to carry out the purposes of the PSA.

(b) The board of directors shall establish and document an orientation process for educating new board members regarding:

(1) Fiduciary responsibilities of board membership; and

(2) Trainings for treasurer and all board members regarding reviewing and analyzing financial statements and general financial oversight.

(c) The department shall conduct announced or unannounced reviews of PSAs and audit PSAs including all or part of any services, finances, or operations of the PSAs, whether operated directly by the PSA or for services contracted through or with another organization.

(d) A PSA shall submit annually to the department an independent audit of the PSA and an independent audit of any subcontractor of the PSA that provides peer support services. The independent audits shall be performed by a certified public accountant and be submitted together with a management letter, if issued, by October 31 for the previous fiscal year ending June 30.

History

#2038, eff 7-1-82; ss by #2711, eff 5-16-84; ss by #5130, eff 5-1-91, EXPIRED: 5-1-97
#8445, eff 10-6-05, EXPIRED: 10-6-13
#12193, eff 5-26-17

N.H. Code Admin. R. Ann. He-M 402.05 Staff Training, Staff Development and Orientation {#sec-he-m-402.05 omnilex-key=us-nh-regs-official--agency-he-m--He-M 402.05}

(a) A PSA shall provide a training orientation for all new staff providing peer support that includes at a minimum:

(1) The statewide peer support system;

(2) All department rules applicable to peer support;

(3) Protection of member and participant rights pursuant to He-M 315;

(4) Agency policies and procedures;

(5) PSA grievance procedures;

(6) Procedures regarding harassment, discrimination, and diversity;

(7) Documentation such as incident reports, attendance records, and telephone logs; and

(8) Procedures regarding confidentiality.

(b) The executive director shall arrange for peer support agency employees to receive training to have the necessary skills to perform their job functions.

(c) A PSA shall establish and implement written staff development policies applicable to all staff that specifically address the following:

(1) Job descriptions;

(2) Staffing pattern;

(3) Conditions of employment;

(4) Grievance procedures;

(4) Performance reviews; and

(6) Individual staff development plans.

(d) Prior to employment, each staff member shall demonstrate evidence of, or willingness to verify:

(1) Citizenship or authorization to work;

(2) Motor vehicles record check to ensure that the potential employee has a valid driver's license, if such employee will be transporting members or participants;

(3) Criminal records check;

(4) Previous employment; and

(5) References.

(e) Prior to employment each staff member shall be screened for tuberculosis (TB) as follows:

(1) All newly employed employees, including those with a history of bacille calmette guerin (BCG) vaccination, who will have direct contact with members and participants and the potential for occupational exposure to Mantoux TB through shared air space with persons with infectious TB shall have a TB symptom screen, consisting of a Mantoux tuberculin skin test or QuantiFERON-TB test, performed upon employment;

(2) Baseline 2-step testing, if performed in association with Mantoux testing, shall be conducted in accordance with the “Guidelines for Environmental Infection Control in Health-Care Facilities” (2003) published by the Centers for Disease Control and Prevention (CDC) as updated (August 1, 2014), available as listed in Appendix A;

(3) Employees with a documented history of TB, documented history of a positive Mantoux test, or documented completion of treatment for TB disease or latent TB infection may substitute that documentation for the baseline two-step test;

(4) All positive TB test results shall be reported to the department's bureau of disease control, at 271-4469, in accordance with RSA 141-C:7, He-P 301.02 and He-P 301.03;

(5) All employees with a diagnosis of suspect active pulmonary or laryngeal TB shall be excluded from the PSA until a diagnosis of TB is excluded or until the employee is on TB treatment and a determination has been made that the employee is noninfectious;

(6) All employees with a newly positive tuberculin skin test shall be excluded from the PSA until a diagnosis of TB disease is ruled out;

(7) Repeat TB testing shall be conducted in accordance with the Guidelines for Environmental Infection Control in Health-Care Facilities” (2003) published by the Centers for Disease Control and Prevention (CDC) as updated (August 1, 2014), available as listed in Appendix A; and

(8) Those employees with a history of previous positive results shall have a symptom screen and, if symptomatic for TB disease, be referred for a medical evaluation.

(f) Each staff person employed by a PSA shall have an annual performance review based upon that staff person's job description and conducted by his or her supervisor.

(g) An individual staff development plan shall be prepared annually with each staff person by his or her supervisor. Such a plan shall be based upon an annual performance review and shall identify objectives and methods for improving the staff person's work-related skills and knowledge.

(h) A PSA shall conduct, or refer staff to, training activities that address objectives for improving staff competencies. Each staff member shall participate in such training activities as specified in that person's individual staff development plan and, in addition, receive ongoing training in protection of member and participant rights.

History

#2038, eff 7-1-82; ss by #2711, eff 5-16-84; ss by #5130, eff 5-1-91, EXPIRED: 5-1-97
#8445, eff 10-6-05, EXPIRED: 10-6-13
#12193, eff 5-26-17

N.H. Code Admin. R. Ann. He-M 402.06 Peer Support Services {#sec-he-m-402.06 omnilex-key=us-nh-regs-official--agency-he-m--He-M 402.06}

(a) PSAs shall provide the following supports and services:

(1) Peer support, consisting of supportive interactions among members, participants, staff and volunteers, are based on shared experience which are:

a. Face-to-face or by telephone;

b. Intended to assist people to understand their potential and ability to move towards wellness; and

c. Based on acceptance, trust, respect, and mutual support;

(2) Outreach, consisting of any community-based activity, face-to-face or by telephone, that:

a. Is designed to contact peers; and

b. Includes, at a minimum, the following:

Providing support to members and participants and other peers who are unable to attend activities of the peer support agency;
Visiting peers, at their request, who are psychiatrically hospitalized; and
Reaching out to people who meet membership criteria and are homeless;

(3) Telephone peer support, consisting of peer support provided to members and participants of a PSA or to others who contact the agency during business hours;

(4) A monthly newsletter published and distributed by the PSA that describes:

a. Agency services and activities;

b. Social and recreational opportunities;

c. Other community services that might be of interest to members and participants; and

d. Other relevant topics;

(5) Wellness training, consisting of training provided by or sponsored by a PSA intended to enhance members’ and participants’ ability to attain and maintain their wellness;

(6) Monthly educational events, which over the course of a year shall include:

a. Rights protection;

b. Peer advocacy;

c. Wellness management; and

d. Community resources; and

(7) Individual peer assistance provided to peers to:

a. Locate, obtain and maintain services and supports through referral, consumer education and self-empowerment;

b. Provide support for individuals who are identifying problems to be addressed or resolving grievances; and

c. Promote self-advocacy.

(b) PSAs may provide additional services not identified in (a) above including the following:

(1) Peer respite, which shall:

a. Consist of a 24-hour, short-term, non-medical program designed as an alternative to hospitalization; and

b. Be operated by PSA staff trained in methods designed to address the needs of peers experiencing psychiatric crises;

(2) Residential services, which shall consist of support and assistance provided by a PSA to a member or participant;

(3) Vocational support, which shall consist of the provision of peer support intended to promote a member’s or participant’s competitive employment;

(4) Warmline, which shall:

a. Be a separate program within the PSA;

b. Offer on-call telephone peer support services;

c. Be available to members, participants, and others who want or need support;

d. Have staff trained to provide warmline services; and

e. Be provided in the specific scheduled hours during which the PSA is closed; and

(5) Transportation.

(c) A PSA shall conduct community education activities, including the provision of education and consultation to members of the community at large, with the goal of increasing the acceptance of persons recovering from mental illness. Activities shall include working with the media, public speaking, and information dissemination.

(d) A PSA shall collaborate with other local human service providers that serve consumers in order to:

(1) Facilitate referrals; and

(2) Share information about services and other local resources.

(e) A PSA shall offer training and technical assistance to help peers advocate on their own behalf regarding health care.

(f) A PSA shall ensure through the monthly newsletter that peers are informed and provided with the opportunity for involvement in local and system-wide service planning, program evaluation, education, wellness, and training activities as described in (a) above.

(g) Guests may be invited to participate in peer support activities.

History

#2038, eff 7-1-82; ss by #2711, eff 5-16-84; ss by #5130, eff 5-1-91, EXPIRED: 5-1-97
#8445, eff 10-6-05, EXPIRED: 10-6-13
#12193, eff 5-26-17

N.H. Code Admin. R. Ann. He-M 402.07 Executive Director Selection and Evaluation {#sec-he-m-402.07 omnilex-key=us-nh-regs-official--agency-he-m--He-M 402.07}

(a) Each PSA shall employ an executive director who is a peer and has, at a minimum the following qualifications:

(1) Demonstrated knowledge of the values and philosophy of peer support as determined by the board of directors of the PSA;

(2) One year of supervisory or management experience; and

(3) An associate’s degree or higher in administration, business management, education, health, or human services; or

(4) Each year of experience in the peer support field may be substituted for one year of academic experience.

(b) An executive director of a PSA shall be appointed and evaluated as follows:

(1) Each board of directors shall appoint an executive director of the PSA;

(2) The executive director shall be selected, employed, and supervised by the PSA board of directors in accordance with a published job description and a competitive application process; and

(3) The executive director shall be evaluated annually by the PSA board of directors to ensure that programming is provided in accordance with:

a. The performance expectations approved by the board;

b. The department's rules;

c. Contract provisions; and

d. Quality improvement reviews.

History

#2038, eff 7-1-82; ss by #2711, eff 5-16-84; ss by #5130, eff 5-1-91, EXPIRED: 5-1-97
#8445, eff 10-6-05, EXPIRED: 10-6-13
#12193, eff 5-26-17

N.H. Code Admin. R. Ann. He-M 402.08 Quality Improvement {#sec-he-m-402.08 omnilex-key=us-nh-regs-official--agency-he-m--He-M 402.08}

(a) The department shall conduct announced or unannounced quality assurance reviews of PSAs to assure that such services and programs are operated in accordance with the department's rules and contract provisions.

(b) A PSA shall perform active monitoring and comprehensive quality assurance activities including, at a minimum:

(1) Participation in quality improvement reviews conducted by the department;

(2) Member satisfaction surveys;

(3) Review of personnel files for completeness; and

(4) Review of the complaint process.

History

#2038, eff 7-1-82; ss by #2711, eff 5-16-84; ss by #5130, eff 5-1-91, EXPIRED: 5-1-97
#8445, eff 10-6-05, EXPIRED: 10-6-13
#12193, eff 5-26-17

N.H. Code Admin. R. Ann. He-M 402.09 Life Safety {#sec-he-m-402.09 omnilex-key=us-nh-regs-official--agency-he-m--He-M 402.09}

(a) A PSA shall be located in a building that is in compliance with local health, building, and fire safety codes.

(b) Each PSA shall be maintained in good repair and be free of hazard.

(1) At least one indoor bathroom which includes a sink and toilet;

(2) At least one telephone for incoming and outgoing calls;

(3) A functioning septic or other sewage disposal system; and

(4) A source of potable water for drinking and food preparation, as follows:

a. If drinking water is supplied by a non-public water system, the water shall be tested and found to be in accordance with and as often as required by Env-Dw 700; and

b. If the water is not approved for drinking, an alternative method for providing safe drinking water shall be implemented.

History

#2038, eff 7-1-82; ss by #2711, eff 5-16-84; ss by #5130, eff 5-1-91, EXPIRED: 5-1-97
#8445, eff 10-6-05, EXPIRED: 10-6-13
#12193, eff 5-26-17

N.H. Code Admin. R. Ann. He-M 402.10 Waivers {#sec-he-m-402.10 omnilex-key=us-nh-regs-official--agency-he-m--He-M 402.10}

(a) A PSA or peer may request a waiver of specific procedures outlined in this part, in writing, from the department.

(b) A request for a waiver shall include:

(1) A specific reference to the section of the rule for which a waiver is being sought;

(2) A full description of why a waiver is necessary; and

(3) A full explanation of alternative provisions or procedures proposed by the PSA or peer.

(d) A request for a waiver shall be granted after the commissioner or his or her designee determines that the alternative proposed by the PSA or peer:

(1) Meets the objective or intent of the rule;

(2) Does not negatively impact the health or safety of the people who participate in peer support activities; and

(3) Does not affect the quality of peer support activities.

(e) Upon receipt of approval of a waiver request, the PSA’s or peer’s subsequent compliance with the alternative provisions or procedures approved in the waiver shall be considered compliance with the rule for which the waiver was sought.

(f) Waivers shall be granted in writing for a specific duration not to exceed 5 years except as in (h) below.

(g) Those waivers which relate to the following shall be effective for the PSA’s current certification period only:

(1) Fire safety; or

(2) Other issues relative to peer health, safety or welfare that require periodic reassessment.

(h) A PSA or peer may request a renewal of a waiver from the department. Such request shall be made at least 90 days prior to the expiration of a current waiver.

History

#2038, eff 7-1-82; ss by #2711, eff 5-16-84; ss by #5130, eff 5-1-91, EXPIRED: 5-1-97
#8445, eff 10-6-05, EXPIRED: 10-6-13
#12193, eff 5-26-17

Part He-M 403 Approval and Operation of Community Mental Health Programs

N.H. Code Admin. R. Ann. He-M 403.01 Purpose {#sec-he-m-403.01 omnilex-key=us-nh-regs-official--agency-he-m--He-M 403.01}

The purpose of these rules is to define the criteria and procedures for approval and operation of community mental health programs.

History

#4195, eff 1-1-87, EXPIRED: 1-1-93
#6816, eff 7-25-98, EXPIRED: 7-25-06
#8716, INTERIM, eff 9-6-06, EXPIRED: 3-5-07
#9533, eff 9-1-09, EXPIRED: 9-1-17
#12388, INTERIM, eff 9-23-17, EXPIRED: 3-22-18
#12522, eff 4-3-18

N.H. Code Admin. R. Ann. He-M 403.02 Definitions {#sec-he-m-403.02 omnilex-key=us-nh-regs-official--agency-he-m--He-M 403.02}

(a) “Advisory board” means the governing body of a governmental community mental health program (CMHP).

(b) “Applicant” means a city, town, county, or nonprofit corporation that has submitted the required materials to the bureau for consideration for approval as a CMHP.

(c) “Approval” means a written decision by the administrator that an applicant has been determined to be in compliance with the eligibility requirements set forth in He-M 403 and has been approved as a CMHP for the region.

(d) “Area agency” means “area agency” as defined in RSA 171-A:2, I-b.

(e) “Board of directors” means the governing body of a nongovernmental CMHP. The term includes board.

(f) “Bureau” means the bureau of mental health services of the department of health and human services.

(g) “Commissioner” means the commissioner of the department of health and human services.

(h) “Community mental health program (CMHP)” means a program operated by the state, city, town, or county, or a community based New Hampshire nonprofit corporation for the purpose of planning, establishing, and administering an array of community-based, mental health services pursuant to He-M 403 and as defined in RSA 135-C:2, IV.

(i) “Conditional reapproval” means a written ruling by the administrator that a CMHP has partially complied with the reapproval criteria listed in He-M 403.09 and that continued approval is contingent upon fulfilling certain requirements determined by the administrator.

(j) “Developmental disability” means “developmental disability” as defined in RSA 171-A:2, V, namely, “a disability:

(1) Which is attributable to intellectual disability, cerebral palsy, epilepsy, autism, or a specific learning disability, or any other condition of an individual found to be closely related to an intellectual disability as it refers to general intellectual functioning or impairment in adaptive behavior or requires treatment similar to that required for persons with an intellectual disability; and

(2) Which originates before such individual attains age 22, has continued or can be expected to continue indefinitely, and constitutes a severe handicap to such individual's ability to function normally in society.”

(k) “Director” means the director of the bureau of mental health services and the director of the bureau of children’s mental health.

(l) “Disaster” means any event that causes major upheaval or turmoil in a community, such as floods, fires, and earthquakes, transportation accidents, violent acts, or other events causing mass casualties, with one result being that many citizens require related support, comfort, and assistance.

(m) “Facility” means New Hampshire hospital or a receiving facility designated pursuant to RSA 135-C:26 and He-M 405, any psychiatric hospital, Glencliff Home, or an acute psychiatric residential treatment program.

(n) “Generic services” means services available to the general population that are not specifically designed for persons with mental illness.

(o) “Governmental CMHP” means a program operated by the state, city, town, or county, for the purpose of planning, establishing, and administering an array of community-based mental health services pursuant to He-M 403.

(p) “Individual” means any person receiving or applying for services from a CMHP or community residence. The term includes client.

(q) “Intake” means the process used to determine eligibility for CMHP services pursuant to He-M 401.03.

(r) “Integrated activity” means personal interaction between persons with and without mental illness which occurs within community settings.

(s) “Least restrictive environment” means the program or service which least inhibits a client's freedom of movement, informed decisions, and participation in the community, while achieving the purposes of habilitation and treatment.

(t) “Mental illness” means a condition of a person who is determined severely mentally disabled in accordance with He-M 401.05 through He-M 401.07 and who has at least one of the following psychiatric disorders classified in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as listed in Appendix A:

(1) Schizophrenia spectrum and other psychotic disorders except for the following:

a. Schizotypal personality disorder;

b. Substance or medication induced psychotic disorder; and

c. Psychotic disorder due to another medical condition;

(2) Bipolar and related disorders except for the following:

a. Substance or medication induced bipolar and related disorder; and

b. Bipolar disorder and related disorder due to another medical condition;

(3) Depressive disorders except for the following:

a. Disruptive mood dysregulation disorder;

b. Premenstrual dysphoric disorder;

c. Substance or medication induced depressive disorder; and

d. Depressive disorder due to another medical condition;

(4) Borderline personality disorder;

(5) Panic disorder;

(6) Obsessive compulsive disorder;

(7) Post traumatic stress disorder;

(8) Bulimia nervosa;

(9) Anorexia nervosa;

(10) Other specific feeding or eating disorders;

(11) Unspecified feeding or eating disorders; and

(12) Major neurocognitive disorders where psychiatric symptom clusters cause significant functional impairment and one or more of the following symptom categories are the focus of psychiatric treatment:

a. Anxiety;

b. Depression;

c. Delusions;

d. Hallucinations; and

e. Paranoia.

(u) “Natural environments” means integrated community settings where persons with and without mental illness live, work and pursue leisure activity.

(v) “Nongovernmental CMHP” means an incorporated nonprofit program operated for the purpose of planning, establishing and administering an array of community-based mental health services pursuant to He-M 403.

(w) “Office of Inspector General's List of Excluded Individuals/Entities” means a database maintained by the Office of Inspector General of the U.S. Department of Health and Human Services that provides information to the health care industry and the public regarding persons and entities currently excluded from participation in Medicare, Medicaid and all other Federal health care programs due to a conviction related to the Medicare or Medicaid program, a conviction related to patient abuse, or an action taken by a state licensing authority.

(x) “Person with mental illness” means an adult with a severe mental illness or a child or adolescent with a severe emotional disturbance who has been determined eligible pursuant to He-M 401.

(y) “Preadmission screening and resident review (PASRR)” means procedures by which the department, in conformance with section 1919(b)(3)(F)(i) and (ii) of the Social Security Act, determines whether persons with mental illness who are applying for placement, or currently residing in, nursing facilities are in need of nursing facility level of service and, if so, whether they are in need of specialized services pursuant to He-M 1302.07.

(z) “Recovery” for a person with a mental illness means development of personal and social skills that minimize susceptibility to symptoms of illness and minimize dependence on professional supports.

(aa) “Region” means a geographic area defined and designated in He-M 425 for the purpose of assigning primary responsibility for providing mental health services to the residents of certain communities.

(ab) “Serious emotional disturbance” means severe mental disability in persons from birth to age 18 who currently, or at any time within the past year, have had a diagnosable mental, behavioral, or emotional disorder of sufficient duration to meet diagnostic criteria specified with the DSM 5, that resulted in functional impairment, which substantially interfered with or limited the child’s role or functioning in the family, school, or community activities. This definition excludes substance abuse disorders and conditions due to another medical condition or substance and medication induced disorders.

(ac) “Transitional housing services program” means a residential program for persons with a severe mental illness, or severe and persistent mental illness which has contracted with the department.

History

#4195, eff 1-1-87, EXPIRED: 1-1-93
#6816, eff 7-25-98, EXPIRED: 7-25-06
#8716, INTERIM, eff 9-6-06, EXPIRED: 3-5-07
#9533, eff 9-1-09, EXPIRED: 9-1-17
#12388, INTERIM, eff 9-23-17, EXPIRED: 3-22-18
#12522, eff 4-3-18

N.H. Code Admin. R. Ann. He-M 403.03 Composition of a Nongovernmental CMHP {#sec-he-m-403.03 omnilex-key=us-nh-regs-official--agency-he-m--He-M 403.03}

(a) A nongovernmental CMHP shall be incorporated and shall have an established plan for governance.

(b) The plan for governance shall comply with the following:

(1) A CMHP board of directors shall have responsibility for the entire management and control of the property and affairs of the corporation and shall have the powers usually vested in the board of directors of a nonprofit corporation, except as regulated herein, and such responsibility and powers shall be stated in a set of bylaws maintained by the CMHP board;

(2) A CMHP board of directors shall ensure that no more than 50% of the board members shall have served for more than 6 consecutive years;

(3) A CMHP board of directors shall specify in its bylaws a procedure by which inactive CMHP board members are removed from the CMHP board; and

(4) The size and composition of the board of directors of a CMHP shall be as follows:

a. The number of persons serving as members shall be no fewer than 9 and no more than 25;

b. Members shall be generally representative of the geographic area served by the CMHP and shall include representation by individuals and family members of individuals;

c. Membership shall be open to all persons who reside in the region except for persons excluded as follows:

Persons or the spouses of persons who are under contract with a CMHP;
Employees or the spouses of employees of agencies or programs which are under contract with a CMHP;
Employees or the spouses of employees of a CMHP, except that the executive director shall be eligible as an ex officio member; and
Employees of the New Hampshire department of health and human services or their spouses; and

d. Board members or the spouses of board members of agencies or programs under contract with a CMHP shall be eligible for membership on the CMHP board but shall comprise no more than one third of the board.

History

#4195, eff 1-1-87, EXPIRED: 1-1-93
#6816, eff 7-25-98, EXPIRED: 7-25-06
#8716, INTERIM, eff 9-6-06, EXPIRED: 3-5-07
#9533, eff 9-1-09, EXPIRED: 9-1-17
#12388, INTERIM, eff 9-23-17, EXPIRED: 3-22-18
#12522, eff 4-3-18

N.H. Code Admin. R. Ann. He-M 403.04 Composition of a Governmental CMHP {#sec-he-m-403.04 omnilex-key=us-nh-regs-official--agency-he-m--He-M 403.04}

(a) A governmental CMHP shall have an advisory board and an established plan for governance.

(b) A CMHP advisory board shall:

(1) Have the authority to review, monitor, and advise the governmental entity responsible for the CMHP regarding the entire management of the CMHP;

(2) Include in its bylaws a statement that, in the event of dissolution of the CMHP or in the event that the agency is no longer approved as a CMHP, ownership and possession of all assets and property obtained with funds granted by the department and in which the department has a security interest shall revert to the department; and

(3) Comply with the requirements of He-M 403.03 (b) (2)-(4) regarding board membership.

History

#4195, eff 1-1-87, EXPIRED: 1-1-93
#6816, eff 7-25-98, EXPIRED: 7-25-06
#8716, INTERIM, eff 9-6-06, EXPIRED: 3-5-07
#9533, eff 9-1-09, EXPIRED: 9-1-17
#12388, INTERIM, eff 9-23-17, EXPIRED: 3-22-18
#12522, eff 4-3-18

N.H. Code Admin. R. Ann. He-M 403.05 Role and Responsibilities of Governmental and Nongovernmental CMHPs {#sec-he-m-403.05 omnilex-key=us-nh-regs-official--agency-he-m--He-M 403.05}

(a) A CMHP shall plan, establish, and maintain a comprehensive and coordinated array of programs and services for persons with mental illness who are residing in the region or are moving to the region from a facility, or a transitional housing program pursuant to He-M 426.

(b) A CMHP shall use funds provided by the department for use in planning, establishing, operating, and administering programs and services and coordinating the service delivery system with existing generic services on behalf of persons with mental illness in the region. A CMHP may receive funds from sources other than the department to assist it in carrying out its responsibilities.

(c) A CMHP shall utilize federal, third party, and other public and private sources of funds that are available for mental health services to carry out the purposes of the CMHP.

(d) A CMHP shall ensure that all programs and services it administers:

(1) Foster integrated activity for persons with mental illness;

(2) Build upon the individual’s strengths and mitigate, as much as possible, the disabling effects of mental illness;

(3) Enhance the capacity of individuals to manage the symptoms of their mental illness and to foster the process of recovery to the greatest extent possible; and

(4) Enhance the capacity of families and other community members to support persons with mental illness.

(e) A CMHP board of directors shall establish policies for the governance and administration of the CMHP and all services through contracts with the CMHP. Policies shall be developed to ensure efficient and effective operation of the CMHP-administered service delivery system and adherence to requirements of federal funding sources and rules and contracts established by the department.

(f) Each board of directors/advisory board shall establish and document an orientation process for educating new board members regarding:

(1) The regional and state mental health system;

(2) The principles of recovery and family support; and

(3) The fiduciary responsibilities of board membership.

(g) Each program shall employ a senior executive officer who has at a minimum:

(1) The following:

a. Five years of full-time employment experience in programs for persons with long-term mental illness;

b. Two years of supervisory, management, or administrative experience; and

c. A master’s degree in public administration, business management, or human services; or

(2) An equivalent combination of education and experience, such that one additional year of education in a human services field may be substituted for one year of professional experience, up to a maximum of 2 years.

(h) A senior executive officer, as described in (g) above, of a CMHP shall be appointed as follows:

(1) Each board of directors/advisory board shall appoint a senior executive officer of the CMHP who shall serve at the pleasure of the board and as a full-time employee of the agency;

(2) The senior executive officer shall be selected, employed, and supervised by the CMHP board of directors/advisory board in accordance with a published job description and a competitive application process; and

(3) The senior executive officer shall be evaluated annually by the CMHP board of directors/advisory board to ensure that services are provided in accordance with the performance expectations approved by the board, based on the department’s rules and contract provisions.

(i) Each program shall employ a medical director who shall:

(1) Possess a valid license to practice medicine in the United States; and

(2) Be board eligible or board certified in psychiatry according to the regulations of the American Board of Psychiatry and Neurology, Inc., or its successor organization at the time of hiring; and

(3) Maintain board eligibility or certification throughout hisor her tenure as medical director.

(j) Each program shall employ a children's services coordinator who shall work with the department in service system planning for children and adolescents and all inpatient admissions and discharges.

(k) Each program shall employ a service coordinator who oversees program development, training, and interagency collaboration, supporting persons age 60 and older, and who participates in regional and state-wide planning activities with other agencies serving older adults.

History

#4195, eff 1-1-87, EXPIRED: 1-1-93
#6816, eff 7-25-98, EXPIRED: 7-25-06
#8716, INTERIM, eff 9-6-06, EXPIRED: 3-5-07
#9533, eff 9-1-09, EXPIRED: 9-1-17
#12388, INTERIM, eff 9-23-17, EXPIRED: 3-22-18
#12522, eff 4-3-18

N.H. Code Admin. R. Ann. He-M 403.06 CMHP Services and Programs {#sec-he-m-403.06 omnilex-key=us-nh-regs-official--agency-he-m--He-M 403.06}

(a) A CMHP shall provide the following, either directly or through a contractual relationship:

(1) Supports and services pursuant to He-M 426 and He-M 401;

(2) Protection of consumers’ rights pursuant to He-M 204 and He-M 309;

(3) Planning, coordination, and implementation of a regional mental health disaster response plan which shall specify responsibilities and procedures for:

a. Coordination with other local and regional agencies that provide emergency management services including relief from a disaster;

b. Identification of members of the community at large who are vulnerable to behavioral health crises during times of disaster;

c. Provision of on site crisis assessment and diagnostic and counseling services; and

d. Addressing the acute psychiatric treatment needs of community members and assuring the availability of community support and treatment services to consumers of the state mental health system who are vulnerable during times of disaster due to the nature of their mental illness;

(4) Outreach to persons with mental illness who are homeless for the purpose of engaging such persons in the service system and providing non-office-based diagnostic and treatment services;

(5) Services to emergency shelters and providers of services to homeless persons, including:

a. Liaison services to ensure service coordination and problem solving;

b. Education and training of staff in topics regarding mental illness, psychiatric medications, available treatments and services, and other relevant topics through inclusion in related and appropriate CMHP staff development activities; and

c. Consultation regarding specific individuals with mental illness;

(6) Collaboration with state and local housing agencies and providers to promote access to existing housing and the development of housing for persons with mental illness, including home ownership and rental options;

(7) Consultation, as requested, and support to peer-run programs promoting the development of self-help or, peer support for the individual;

(8) NHH census management services, including a staff liaison who has NHH privileges and participates in NHH treatment and discharge planning meetings on a regular basis; and

(9) Specialized treatment services to eligible persons with mental illness and a concomitant alcohol and/or substance use disorder, including assessment of alcohol/substance use disorders, as part of the clinical evaluation process and provision of treatment for both the substance use disorder and the mental illness, as necessary.

(b) In addition to those services identified above, a CMHP shall provide developmentally appropriate services to children who are eligible for services pursuant to He-M 401 and elderly persons residing in community settings who are eligible for services pursuant to He-M 401 and shall give priority to children connected to the division for children, youth and families when there is an inability to serve all applicants at a given time.

(d) Services provided to children shall include the following:

(1) Family support and education, including designation of a family liaison;

(2) Psychiatric diagnostic and medication services;

(3) Case management, including appropriate interagency involvement;

(4) Individual, family, and group therapy;

(5) Intake and assessment;

(6) Crisis intervention;

(7) Outreach support to children and their families, both in their homes and in community settings;

(8) Functional support services;

(9) Sexual offender assessments and treatment; and

(10) Specialty services for the treatment of attachment disorder.

(e) Services provided to elderly persons residing in community settings shall include:

(1) Intake and assessment;

(2) Psychiatric diagnosis and treatment;

(3) Case management;

(4) Consultation and education to families, community agencies, and the general public;

(5) Outreach support to elders and their families, both in their homes and in community settings;

(6) PASRR evaluations, coordinated with nursing homes, hospitals, and the bureau, as needed; and

(7) Referral Education Assistance and Prevention Program.

(f) A CMHP shall make services available to persons who have both a mental illness pursuant to

He-M 401 and a developmental disability pursuant to He-M 503.

(g) A CMHP shall participate in regular interagency team meetings with representatives of the other agencies serving mutual clients.

(h) A CMHP shall conduct community education activities, including the provision of education and consultation to members of the community at large, with the goal of increasing the acceptance of persons with mental illness. Activities shall include working with the media, public speaking and information dissemination.

(i) A CMHP shall perform active monitoring of services through a comprehensive quality assurance program that:

(1) Is based on a written quality assurance plan which includes outcome indicators and incorporates input from individuals and family members;

(2) Includes the following activities:

a. Utilization review;

b. Peer review;

c. Evaluation of clinical services;

d. Consumer satisfaction surveys;

e. Validation of staff credentials to practice;

f. Complaints review; and

g. Reporting and assessment of serious incidents; and

(3) Results in an annual report.

(j) A CMHP shall strive to provide all services within the least restrictive environment in each consumer's own community, and in a manner which promotes the personal self-sufficiency, dignity, and maximum community participation of each individual.

(k) A CMHP shall provide services that are responsive to the particular needs of members of minority communities within the region.

(l) The services and programs for which a CMHP is responsible may be administered directly by the CMHP, or the CMHP may enter into agreement(s) with individuals and organizations for the provision of designated services or programs.

(m) A CMHP shall be responsible and accountable for all CMHP services and programs, whether administered directly by the CMHP or provided under contracts with individuals or organizations.

(n) A CMHP shall ensure that services and programs shall be operated in compliance with rules and contract requirements.

(o) In order to ensure the best possible coordination and continuity of services for clients and their families, a CMHP shall establish working relationships with other human service agencies in the region who serve consumers, including but not limited to:

(1) Independent peer support programs, which shall include coordination with and referral to individual operated peer support programs such as telephone support lines where available;

(2) Homeless shelters;

(3) The division of vocational rehabilitation of the department of education;

(4) Area agencies;

(5) Criminal justice agencies;

(6) The division for children, youth, and families; and

(7) Local interagency family assistance teams that are made up of:

a. The division for children youth, and families;

b. Local school districts; and

c. Other child-serving agencies.

History

#4195, eff 1-1-87, EXPIRED: 1-1-93
#6816, eff 7-25-98, EXPIRED: 7-25-06
#8716, INTERIM, eff 9-6-06, EXPIRED: 3-5-07
#9533, eff 9-1-09, EXPIRED: 9-1-17
#12388, INTERIM, eff 9-23-17, EXPIRED: 3-22-18
#12522, eff 4-3-18

N.H. Code Admin. R. Ann. He-M 403.07 Staff Training and Development {#sec-he-m-403.07 omnilex-key=us-nh-regs-official--agency-he-m--He-M 403.07}

(a) A CMHP shall establish and implement an effective employee recruitment, retention, and development program applicable to all staff, and which shall addresses the following:

(1) Job descriptions;

(2) Staffing patterns;

(3) Conditions of employment;

(4) Staff grievance procedures;

(5) Staff performance reviews; and

(6) Individual staff development plans.

(b) A CMHP shall conduct criminal background checks, bureau of elderly and adult services at the department (BEAS) registry checks, and a review of the Office of Inspector General’s List of Excluded Individuals/Entities for each newly hired and re-hired staff member. In addition, motor vehicle record checks shall be conducted for staff who will be transporting individuals pursuant to employment.

(c) Each staff person employed by a CMHP shall have an annual performance review based upon that staff person's job description and conducted by his or her supervisor, which shall include an individual staff development plan.

(d) A CMHP shall conduct or refer staff to training activities which address objectives for improving staff competencies. Each staff member shall participate in such training activities as specified in that person's individual staff development plan and in addition shall receive ongoing training in protection of client rights pursuant to He-M 204 and He-M 309.

(e) A CMHP shall provide an orientation for all new staff providing services to persons with mental illness, which, at a minimum, includes:

(1) The service delivery system at the state and local level, including family support and consumer self-help programs for individuals;

(2) Mental illness, including the effects of mental illness on persons having such illness and current practices in treatment and rehabilitation;

(3) All department rules applicable to community mental health services provided by the staff member;

(4) Accessing generic services, so that such staff are familiarized with social, medical, and other services available in the local community; and

(5) Protection of client rights pursuant to He-M 204 and He-M 309.

History

#4195, eff 1-1-87, EXPIRED: 1-1-93
#6816, eff 7-25-98, EXPIRED: 7-25-06
#8716, INTERIM, eff 9-6-06, EXPIRED: 3-5-07
#9533, eff 9-1-09, EXPIRED: 9-1-17
#12388, INTERIM, eff 9-23-17, EXPIRED: 3-22-18
#12522, eff 4-3-18

N.H. Code Admin. R. Ann. He-M 403.08 CMHP Application Procedures and Criteria {#sec-he-m-403.08 omnilex-key=us-nh-regs-official--agency-he-m--He-M 403.08}

(a) In regions where there is a CMHP that has been approved by the administrator, the CMHP shall retain its approved status until it is reapproved pursuant to He-M 403.11, or He-M 403.12, or until reapproval is denied pursuant to He-M 403.13.

(b) Not less than 90 days before the end of the designation period, the department shall initiate the CMHP approval process by publishing a notice on its website http://www.dhhs.nh.gov and in one or more newspapers of regional distribution to convey information about the role and responsibilities of a CMHP, and the CMHP application and approval process, including the closing date for submission of application materials required by (c) below.

(c) Cities, towns, or counties, or boards of community based New Hampshire private, non-profit agencies, may apply for approval as a CMHP provided that the applicable requirements under He-M 403.03 (c), He-M 403.04 (b) (1)-(3), and (d) below have been met.

(d) An applicant shall submit application materials to the department as follows:

(1) The applicant shall submit to the department written assurances of adherence to, and capacity to provide services pursuant to, rules adopted by the department relating to the delivery of mental health services and the protection of client rights;

(2) The applicant shall demonstrate that there is a documented need for services to individuals meeting certification or eligibility criteria pursuant to He-M 401 and shall describe the unmet service needs of individuals and how the applicant proposes to meet those service needs;

(3) The applicant shall submit a written proposal which shall include a line item budget and a description of all programs and services to be provided; and

(4) If the applicant is the board of a currently operating CMHP, the application materials shall also include the following:

a. A description of all current programs and services operated by the applicant;

b. A description of staffing patterns and current staff qualifications, including psychiatric staff; and

c. A copy of the current operating budget and most recent external audit.

History

#4195, eff 1-1-87, EXPIRED: 1-1-93
#6816, eff 7-25-98, EXPIRED: 7-25-06
#8716, INTERIM, eff 9-6-06, EXPIRED: 3-5-07
#9533, eff 9-1-09, EXPIRED: 9-1-17 (from He-M 403.10)
#12388, INTERIM, eff 9-23-17, EXPIRED: 3-22-18
#12522, eff 4-3-18

N.H. Code Admin. R. Ann. He-M 403.09 CMHP Approval {#sec-he-m-403.09 omnilex-key=us-nh-regs-official--agency-he-m--He-M 403.09}

(a) The administrator shall solicit and consider comments from individuals and groups in the region as to the ability of each applicant to carry out its responsibilities as stated in He-M 403.05 and He-M 403.06.

(b) The administrator shall review the completed applications and shall assign staff to conduct a site visit for any applicant that appears to meet the requirements of He-M 403. Such site visit and review shall be completed within 90 days of the date of referral for site visit and shall result in a determination of the compliance or non-compliance of the CMHP with He-M 403 and all other applicable department rules.

(c) Within 15 days of the date of the site reviews, the administrator shall approve an applicant that has been determined to be in compliance with He-M 403 and all other applicable rules.

(d) Approval of a CMHP shall be for a 5-year term, unless suspended or revoked pursuant to He-M 403.10.

(e) The administrator shall notify each applicant that does not receive approval and shall explain the reason why the applicant was not approved.

(f) If there is no applicant selected for approval in the region, the administrator shall notify each applicant and request a second submission of application materials.

(g) If no applicant in the region receives approval following the second submission of CMHP application materials, or if no operating CMHP applies for reapproval pursuant to He-M 403.11, the administrator shall:

(1) Initiate or re-initiate the application procedure for approval of a CMHP; and

(2) Appoint as an interim CMHP a nonprofit agency that the administrator determines has the capacity to operate in the region; or

(3) If an interim CMHP that has the capacity to operate programs and services in accordance with department rules cannot be identified, designate department staff to temporarily operate CMHP services and programs until a new CMHP can be approved.

(h) An applicant denied approval by the administrator may appeal pursuant to He-C 200.

History

#4195, eff 1-1-87, EXPIRED: 1-1-93
#6816, eff 7-25-98, EXPIRED: 7-25-06
#8716, INTERIM, eff 9-6-06, EXPIRED: 3-5-07
#9533, eff 9-1-09, EXPIRED: 9-1-17 (from He-M 403.11)
#12388, INTERIM, eff 9-23-17, EXPIRED: 3-22-18
#12522, eff 4-3-18

N.H. Code Admin. R. Ann. He-M 403.10 Suspension and Revocation of Approval {#sec-he-m-403.10 omnilex-key=us-nh-regs-official--agency-he-m--He-M 403.10}

(a) If the administrator finds at any time that the health, safety, or welfare of individuals or the public is endangered by the continued operation of services by a CMHP, the administrator shall immediately suspend that CMHP's approval and shall issue the CMHP and board written notice of suspension, which shall specify the reason(s) therefor, and the process for a hearing pursuant to He-M 403.15.

(b) In the event that the administrator determines that a CMHP is not providing services and programs in accordance with the department’s rules or contract, the administrator shall send a written notice to the CMHP and board specifying the nature of the deficiencies and/or the remedial action which is required. Such notice shall contain time limitations stating when the remedial action shall be completed. Said time limitations shall not exceed 180 days.

(c) If a CMHP has not complied with the remedial action required pursuant to (b) above, the administrator shall issue the CMHP and board written notice of revocation, which shall specify the reason(s) therefor.

(d) If the administrator determines that changes to federal or state laws necessitate restructuring of the state's community mental health service delivery system through revocation of a CMHP's approval, the administrator shall issue the CMHP and board written notice of revocation, which shall specify the reason(s) therefor.

(e) A notice of revocation of approval shall specify the reasons for the revocation and the effective date. The effective date of the revocation shall be at least 90 days from the date of the notice, except that revocation of a suspended approval shall be effective immediately upon notice.

(f) Upon issuance of an order to revoke a CMHP's approval, the administrator shall initiate the process to approve a successor CMHP pursuant to He-M 403.08. Final approval of a successor CMHP shall not be made unless and until a revocation order is issued and any appeals to the administrator have been decided upon.

History

#4195, eff 1-1-87, EXPIRED: 1-1-93
#6816, eff 7-25-98, EXPIRED: 7-25-06
#8716, INTERIM, eff 9-6-06, EXPIRED: 3-5-07
#9533, eff 9-1-09, EXPIRED: 9-1-17 (from He-M 403.12)
#12388, INTERIM, eff 9-23-17, EXPIRED: 3-22-18
#12522, eff 4-3-18

N.H. Code Admin. R. Ann. He-M 403.11 Reapproval {#sec-he-m-403.11 omnilex-key=us-nh-regs-official--agency-he-m--He-M 403.11}

(a) CMHPs shall apply to the administrator for reapproval no later than 180 days prior to the expiration of their current approval.

(b) A CMHP that is in operation shall retain its approved status until the application for reapproval is acted upon by the administrator pursuant to these rules.

(1) A comprehensive self-assessment of the CMHP’s current abilities and past performance;

(2) A comprehensive listing of critical unmet service needs within the region;

(3) Assurances of compliance with applicable federal and state laws and rules; and

(4) A copy of the mission statement of the organization.

(d) The administrator shall review application materials and written comments from the CMHP, department personnel, provider agencies, individuals, family members, and the general public regarding the CMHP’s past performance and current ability to provide services.

(e) The administrator shall consider the following during review of the application:

(1) Materials collected as part of the reapproval process, which shall include, at a minimum, the following:

a. Written comments and other documentary evidence, solicited from area citizens, CMHP subcontractors, and community groups through means which shall include publication of public notice of the CMHP's application for reapproval in a newspaper or newspapers of regional distribution, demonstrating the CMHP's ability to offer satisfactory services and provide leadership in addressing the needs of its clientele;

b. Comments of individuals and family members of individuals of the CMHP illustrating responsiveness and overall quality within the service system; and

c. Any complaints that have been filed by or on behalf of individuals regarding service provision and have been resolved by the CMHP; and

(2) Other available documents which shall demonstrate:

a. CMHP compliance with all contract requirements, including adherence to the annual budget;

b. CMHP compliance with federal and state rules;

c. Corrective action taken by the CMHP in response to the department's quality assurance reviews, when such reviews have determined that a CMHP is not in compliance with department rules;

d. The CMHP's internal quality assurance activities; and

e. The CMHP's ability to articulate its legal mandates, including the setting of annual goals and agency priorities.

(f) If the administrator determines, after considering the information gathered pursuant to (e) (1) and (2) above, that a CMHP is providing services that comply with all applicable state and federal rules and laws, the administrator shall reapprove the CMHP for a period of 5 years.

History

#4195, eff 1-1-87, EXPIRED: 1-1-93
#6816, eff 7-25-98, EXPIRED: 7-25-06
#8716, INTERIM, eff 9-6-06, EXPIRED: 3-5-07
#9533, eff 9-1-09, EXPIRED: 9-1-17 (from He-M 403.13)
#12388, INTERIM, eff 9-23-17, EXPIRED: 3-22-18
#12522, eff 4-3-18

N.H. Code Admin. R. Ann. He-M 403.12 Conditional Reapproval {#sec-he-m-403.12 omnilex-key=us-nh-regs-official--agency-he-m--He-M 403.12}

(a) The administrator shall reapprove a CMHP on a conditional basis for a period of 180 days if he or she determines, after considering the information gathered pursuant to He-M 403.11 (e) (1) and (2), that the CMHP:

(1) Is not currently providing services that comply with applicable state and federal rules and laws; or

(2) Is projected to lack the capacity to provide services in accordance with state and federal rules and laws beyond the next 6 months for reasons such as, but not limited to:

a. Lack of adequate operating funds, as determined by an independent audit performed by a certified public accountant and submitted with a management letter;

b. Failure to hire or retain staff sufficient to comply with He-M 403.05 through He-M 403.07;

c. Matters related to illegal activities, such as fraud, abuse, neglect, exploitation, sexual misconduct, or other illegal activity; or

d. Other similar matters that prohibit the CMHP from providing services.

(b) The administrator shall specify, in writing, conditions and time frames that shall be met by the CMHP in order to be eligible for reapproval.

(c) At least 30 days prior to the expiration date of the conditional approval, department staff designated by the administrator shall review, and issue a written report regarding, a CMHP's compliance with the conditions and time frames identified in (b) above.

(d) Except as allowed in (e) below, at least 15 days prior to the expiration of the conditional reapproval, the administrator shall:

(1) Reapprove the CMHP, effective as of the date of conditional reapproval, if all conditions have been met; or

(2) Deny the reapproval if all conditions have not been met.

(e) A CMHP may request a 180-day extension of the conditional reapproval by filing a written request for the extension with the bureau at least 30 days prior to the expiration date of the conditional approval.

(f) The director shall approve a request for an extension upon receipt except in cases where the health or safety of consumers is at risk.

History

#4195, eff 1-1-87, EXPIRED: 1-1-93
#6816, eff 7-25-98, EXPIRED: 7-25-06
#8716, INTERIM, eff 9-6-06, EXPIRED: 3-5-07
#9533, eff 9-1-09, EXPIRED: 9-1-17 (from He-M 403.14)
#12388, INTERIM, eff 9-23-17, EXPIRED: 3-22-18
#12522, eff 4-3-18

N.H. Code Admin. R. Ann. He-M 403.13 Denial of Reapproval {#sec-he-m-403.13 omnilex-key=us-nh-regs-official--agency-he-m--He-M 403.13}

(a) If the administrator denies an application for reapproval, the administrator shall notify the CMHP in writing of the decision. Such a notice shall specify the reasons for the decision and its effective date. The effective date of the decision shall be at least 90 days from the date of said notice. The CMHP shall have 20 days following the date of the notice to request reconsideration of the denial and submit additional information to the administrator.

(b) The administrator shall review the submission of any additional information by the CMHP. Following this review, the administrator shall issue his/her final decision. In the event that that decision denies reapproval, the CMHP may request a hearing pursuant to He-M 403.15.

(c) Upon issuance of a decision to deny reapproval, the administrator shall initiate the process to approve a successor CMHP as outlined in He-M 403.08. Final approval of a successor CMHP shall not be made until any appeal to the commissioner has been decided.

History

#4195, eff 1-1-87, EXPIRED: 1-1-93
#6816, eff 7-25-98, EXPIRED: 7-25-06
#8716, INTERIM, eff 9-6-06, EXPIRED: 3-5-07
#9533, eff 9-1-09, EXPIRED: 9-1-17 (from He-M 403.15)
#12388, INTERIM, eff 9-23-17, EXPIRED: 3-22-18
#12522, eff 4-3-18

N.H. Code Admin. R. Ann. He-M 403.14 Relinquishment of Approval by a CMHP {#sec-he-m-403.14 omnilex-key=us-nh-regs-official--agency-he-m--He-M 403.14}

(a) In the event that the board of directors of a CMHP decides, after the conclusion of negotiations, not to enter into a contract with the department of health and human services for provision of community behavioral health services, the board shall provide 180 days advance notice to the department of its intent to relinquish its approval as a CMHP.

(b) During the 180-day notice period, the CMHP shall continue to provide services to individuals and shall continue to be compensated for those services, in accordance with the last contract in effect.

History

#4195, eff 1-1-87, EXPIRED: 1-1-93
#6816, eff 7-25-98, EXPIRED: 7-25-06
#8716, INTERIM, eff 9-6-06, EXPIRED: 3-5-07
#9533, eff 9-1-09, EXPIRED: 9-1-17
#12388, INTERIM, eff 9-23-17, EXPIRED: 3-22-18
#12522, eff 4-3-18

N.H. Code Admin. R. Ann. He-M 403.15 Hearings {#sec-he-m-403.15 omnilex-key=us-nh-regs-official--agency-he-m--He-M 403.15}

(a) A CMHP may request a hearing regarding a denial of approval or reapproval or suspension or revocation of approval.

(b) A request for hearing shall be submitted to the commissioner in writing within 20 days following the date of the notification of denial or suspension or revocation.

(c) The commissioner or his or her designee shall conduct a hearing in accordance with the procedures set forth in He-C 200 within 30 days of receipt of a request. The presiding officer shall submit a written proposed decision to the commissioner in accordance with RSA 126-A:5, VIII(d), and He-C 203.22(d).

(d) Within 10 days of the hearing, the commissioner shall issue a proposed decision in accordance with RSA 126-A:5, VIII(e), and He-C 203.22(e).

(e) The CMHP may appeal the commissioner’s decision to a court of competent jurisdiction.

History

#4195, eff 1-1-87, EXPIRED: 1-1-93
#6816, eff 7-25-98, EXPIRED: 7-25-06
#8716, INTERIM, eff 9-6-06, EXPIRED: 3-5-07
#9533, eff 9-1-09, EXPIRED: 9-1-17
#12388, INTERIM, eff 9-23-17, EXPIRED: 3-22-18
#12522, eff 4-3-18

N.H. Code Admin. R. Ann. He-M 403.16 Waivers {#sec-he-m-403.16 omnilex-key=us-nh-regs-official--agency-he-m--He-M 403.16}

(a) A CMHP may request a waiver of specific requirements outlined in this part, in writing, from the department.

(b) A request for a waiver shall include:

(1) A specific reference to the section of the rule for which a waiver is being sought;

(2) A full description of why a waiver is necessary; and

(3) A full explanation of alternative provisions or procedures proposed by the CMHP or community mental health provider.

(d) A request for a waiver shall be granted after the commissioner or his or her designee determines that the alternative proposed by the CMHP meets the objective or intent of the rule, and:

(1) Does not negatively impact the health or safety of recipients; and

(2) Does not affect the quality of CMHP services.

(e) Upon receipt of approval of a waiver request, the CMHP’s subsequent compliance with the alternative provisions or procedures approved in the waiver shall be considered compliance with the rule for which the waiver was sought.

(f) Waivers shall be granted in writing for a specific duration not to exceed 5 years except as in (g) below.

(g) Those waivers which relate to the following shall be effective for the CMHP’s current certification period only:

(1) Fire safety; or

(2) Other issues relative to consumer health, safety or welfare that require periodic reassessment.

(h) A CMHP 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.

History

#4195, eff 1-1-87, EXPIRED: 1-1-93
#6816, eff 7-25-98, EXPIRED: 7-25-06
#8716, INTERIM, eff 9-6-06, EXPIRED: 3-5-07
#9533, eff 9-1-09, EXPIRED: 9-1-17
#12388, INTERIM, eff 9-23-17, EXPIRED: 3-22-18
#12522, eff 4-3-18

Part He-M 405 Designation of Receiving Facilities

N.H. Code Admin. R. Ann. He-M 405.01 Purpose {#sec-he-m-405.01 omnilex-key=us-nh-regs-official--agency-he-m--He-M 405.01}

The purpose of these rules is to outline standards and procedures for the designation and operation of designated receiving facilities (DRFs) for involuntary treatment of minors and adults with mental illness.

History

#1806, eff 9-7-81; ss by #2579, Emergency, eff 1-10-84, EXPIRED, 5-11-90
#2712, eff 5-16-84, EXPIRED, 5-16-90
#5323, eff 1-31-92; ss by #5432, eff 7-1-92; ss by #5581, eff 2-12-93, EXPIRED, 2-12-99
#7051, eff 6-29-99, EXPIRED: 6-29-07
#10389, INTERIM, eff 8-1-13, EXPIRES: 1-28-14; ss by #10516, eff 1-28-14; ss by #13299, eff 12-2-21

N.H. Code Admin. R. Ann. He-M 405.02 Definitions {#sec-he-m-405.02 omnilex-key=us-nh-regs-official--agency-he-m--He-M 405.02}

(a) “Adult” means a person 18 years of age or older.

(b) “Applicant” means that legal entity that requests designation as a designated receiving facility.

(d) “Commissioner” means the commissioner of the department of health and human services, or his or her designee.

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

(f) “Designated receiving facility (DRF)” means a hospital-based psychiatric unit or a non-hospital-based residential treatment program designated by the commissioner to provide care, custody, and treatment to persons involuntarily admitted to the state mental health services system.

(g) “Designation” means a decision by the commissioner that a facility that has not been operating as a DRF immediately prior to its application is approved to operate as a DRF pursuant to He-M 405.

(h) “Minor” means a person less than 18 years of age.

(i) “Redesignation” means a decision by the commissioner that a DRF whose designation is effective has been approved to continue to operate as a DRF pursuant to He-M 405.15.

(j) “Region” means a geographic area designated pursuant to He-M 425.03 for the purpose of assigning primary responsibility for providing mental health services to the residents of certain communities.

History

#1806, eff 9-7-81; ss by #2579, Emergency, eff 1-10-84, EXPIRED, 5-11-84
#2712, eff 5-16-84, EXPIRED, 5-16-90
#5323, eff 1-31-92; ss by #5432, eff 7-1-92; ss by #5581, eff 2-12-93, EXPIRED, 2-12-99
#7051, eff 6-29-99, EXPIRED: 6-29-07
#10389, INTERIM, eff 8-1-13, EXPIRES: 1-28-14; ss by #10516, eff 1-28-14; ss by #13299, eff 12-2-21

N.H. Code Admin. R. Ann. He-M 405.03 Designation Requirements {#sec-he-m-405.03 omnilex-key=us-nh-regs-official--agency-he-m--He-M 405.03}

(a) A DRF may be designated to receive clients for any of the following purposes:

(1) Involuntary emergency admission (IEA) pursuant to RSA 135-C:27-33 beginning with initial custody and continuing through the day following the probable cause hearing;

(2) Involuntary emergency admission pursuant to RSA 135-C:27-33 for the period of such admission following the probable cause hearing; or

(3) Non-emergency involuntary admission (IA) pursuant to RSA 135-C:34-54.

(b) A DRF shall establish written procedures by which each client’s ability to pay for services is determined and shall provide services to clients in the same manner and of the same quality whether or not they have been determined to be unable to pay.

(d) A DRF shall have comprehensive general liability insurance against all claims of bodily injury, death, or property damage in amounts of not less than $250,000 per claim and $2,000,000 per occurrence.

(e) A DRF shall maintain the inpatient capacity applied for, and approved by the department, at all times, except as provided in He-M 405.14(c).

(f) A DRF shall adopt policies and procedures which limit the use of seclusion and restraint and which shall be consistent with He-M 305 and RSA 126-U.

History

#1806, eff 9-7-81; amd by #2358, eff 5-2-83; ss by #2579, Emergency, eff 1-10-84, EXPIRED, 5-11-84
#2712, eff 5-16-84, EXPIRED, 5-16-90
#5323, eff 1-31-92; ss by #5432, eff 7-1-92; ss by #5581, eff 2-12-93, EXPIRED, 2-12-99
#7051, eff 6-29-99, EXPIRED: 6-29-07
#10389, INTERIM, eff 8-1-13, EXPIRES: 1-28-14; ss by #10516, eff 1-28-14; amd by #13212, EMERGENCY RULE, eff 5-28-21, EXPIRED: 11-24-21 (in para (e)); ss by #13299, eff 12-2-21

N.H. Code Admin. R. Ann. He-M 405.04 Application Procedure and Designation/Redesignation Criteria {#sec-he-m-405.04 omnilex-key=us-nh-regs-official--agency-he-m--He-M 405.04}

(a) An application for designation or redesignation as a DRF shall be made in writing to the commissioner, and shall include a description of all programs and services operated by the applicant, including services to be available through the proposed DRF, as required by (c) below.

(b) An application for redesignation shall be submitted by a DRF to request redesignation or to alter the service capacity or type of services a facility is designated to provide. An application for redesignation shall be submitted to the commissioner at least 6 months prior to the expiration date of the DRF’s designation. Submission of such application shall cause the DRF’s current designation to be effective until the commissioner issues a decision pursuant to (g) below.

(1) The name and address of the applicant;

(2) A description of the physical location of the DRF, including whether the facility is hospital-based or non-hospital-based;

(3) A statement of intent to provide services pursuant to He-M 405.03(a)(1), He-M 405.03(a)(2), and/or He-M 405.03(a)(3);

(4) A statement describing the capacity of the DRF to provide services pursuant to He-M 405.11 and He-M 405.12;

(5) A description of staffing patterns and staff qualifications, including psychiatric staff, that demonstrates compliance with He-M 405.11; and

(6) Documentation which demonstrates that the DRF meets the requirements set forth in He-M 405.03(c)-(f).

(d) A hospital-based DRF which submits an application for designation or redesignation shall include a certification of compliance with the Conditions of Participation for hospital-based psychiatric services as set forth by the federal Centers for Medicare and Medicaid Services (CMS) in accordance with 42 CFR Part 482. Such certification of compliance shall be obtained from either the department on behalf of the Centers for Medicare and Medicaid Services or a national accrediting organization that has been deemed by CMS as having standards and a survey process that meets the Medicare conditions of participation and federal survey requirements.

(e) A non-hospital-based DRF which submits an application for designation or redesignation shall include documentation demonstrating that the DRF is licensed by the department in accordance with RSA 151 and He-P 830 and/or certified as a community residence pursuant to He-M 1002.

(f) The commissioner shall assign staff to review the application materials and conduct a site visit of any DRF applying for designation or redesignation. Such review and site visit shall result in a determination of the compliance or non-compliance of the DRF with He-M 405 and all other applicable department rules.

(g) Upon completion of a review and site visit, the commissioner shall:

(1) Designate or redesignate as a DRF those facilities which have been determined, pursuant to (f) above, to be in compliance with He-M 405 and all other applicable rules;

(2) Conditionally designate or redesignate as a DRF for a period of up to 180 days, those facilities which have been determined, after considering the information gathered pursuant to (f) above, to be substantially in compliance with He-M 405 and all other applicable rules, provided that there is no indication the health or safety of clients is at risk; or

(3) Deny designation or redesignation as a DRF to those facilities which have been determined, pursuant to (f) above, not to comply with He-M 405 and all other applicable rules.

(h) A conditional designation or redesignation pursuant to (g)(2) above may be renewed only if the DRF has engaged with the department in good faith efforts to address any areas of non-compliance leading to the initial conditional designation or redesignation.

(i) The commissioner shall notify an applicant in writing upon approval or denial of application for designation or redesignation. Designation or redesignation shall be effective for 5 years from the date of notification. A DRF shall be designated or redesignated to provide only those services described by the applicant pursuant to (a) above and those required pursuant to He-M 405.12.

(j) Notification of a decision to deny designation or redesignation shall specify the reasons for the decision and its effective date. The effective date of the decision denying a redesignation shall be at least 90 days from the date of the denial notice. The DRF may appeal a decision pursuant to He-C 200.

(k) Following designation or redesignation, a DRF shall undergo a bi-annual review by the department that evaluates:

(1) Any policies that have changed since the designation, re-designation, or bi-annual review; and

(2) The applicable medical record specified below:

a. One record shall be for an individual affiliated with a community mental health program; and

b. One record shall be for an individual who is not affiliated with a community mental health program.

History

#1806, eff 9-7-81; ss by #2579, eff 1-10-84, EXPIRED, 5-11-84
#2712, eff 5-16-84, EXPIRED, 5-16-90
#5323, eff 1-31-92; ss by #5432, eff 7-1-92; ss by #5581, eff 2-12-93, EXPIRED: 2-12-99
#7051, eff 6-29-99, EXPIRED: 6-29-07
#10389, INTERIM, eff 8-1-13, EXPIRES: 1-28-14; ss by #10516, eff 1-28-14; amd by #13212, EMERGENCY RULE, eff 5-28-21, EXPIRED: 11-24-21 (in para (g)); ss by #13299, eff 12-2-21

N.H. Code Admin. R. Ann. He-M 405.05 Collaboration with Community Mental Health Programs {#sec-he-m-405.05 omnilex-key=us-nh-regs-official--agency-he-m--He-M 405.05}

(a) For individuals engaged with a community mental health program (CMHP), at the time of admission, and the client has signed all necessary release documents, the DRF shall:

(1) Jointly develop with the CMHP all treatment plans, discharge plans, and referrals for clients whom they both serve as evidenced by care coordination notes within the clients chart;

(2) Maintain consistent contact with the CMHP to ensure the CMHP is informed of the individual’s progress while in the DRF;

(3) If the client is agreeable, schedule an appointment for the individual with the CMHP to occur within 7 days after discharge at a date and time that is agreeable for the client or if the DRF is unable to schedule an appointment, document the attempts made to schedule an appointment and identify the reasons why the appointment could not be scheduled;

(4) Give notice to the CMHP of the individual’s discharge prior to, or within no more than one hour after discharge; and

(5) If an individual was previously receiving Assertive Community Treatment (ACT) services at a CMHP at the time of admission and the client is willing, a DRF shall ensure that an appointment with the CMHP is scheduled to occur within 2 calendar days after discharge or if the client is not willing to schedule an appointment with the CMHP, document the client’s unwillingness for the appointment and identify the reasons why the client did not want the appointment.

(b) If an individual was not engaged with a CMHP at the time of admission, but is agreeable to engagement and has signed all the necessary release documents, a DRF shall inform the appropriate regional CMHP and facilitate the scheduling of an intake appointment to occur within 7 days after discharge.

(c) If an individual is engaged with non-CMHP providers at the time of admission and has signed all necessary release documents, a DRF shall:

(1) Jointly develop with the non-CMHP providers all treatment plans, discharge plans, and referrals for the individual they both serve as evidenced by care coordination notes within the clients chart;

(2) Maintain consistent contact with the non-CMHP providers to ensure the providers are informed of the individual’s progress while in the DRF;

(3) If the client is agreeable, schedule appointments with the non-CMHP providers to occur within 7 days after discharge at a date and time that is agreeable for the client or if the DRF is unable to schedule an appointment, document the attempts made to schedule an appointment and identify the reasons why the appointment could not be scheduled.

History

#1806, eff 9-7-81; ss by #2579, Emergency, eff 1-10-84, EXPIRED, 5-11-84
#2712, eff 5-16-84, EXPIRED, 5-16-90
#5323, eff 1-31-92; ss by #5432, eff 7-1-92; ss by #5581, eff 2-12-93, EXPIRED, 2-12-99
#7051, eff 6-29-99, EXPIRED: 6-29-07
#10389, INTERIM, eff 8-1-13, EXPIRES: 1-28-14; ss by #10516, eff 1-28-14; ss by #13212, EMERGENCY RULE, eff 5-28-21, EXPIRED: 11-24-21; ss by #13299, eff 12-2-21

N.H. Code Admin. R. Ann. He-M 405.06 Admission Procedures {#sec-he-m-405.06 omnilex-key=us-nh-regs-official--agency-he-m--He-M 405.06}

(a) Involuntary admissions shall be made according to the procedures for IEAs under RSA 135-C:27-54.

(b) A DRF shall not refuse admission of a person sent to such facility pursuant to RSA 135-C:28 or 135-C:36-45, unless there are no beds available at the time of admission.

(c) A DRF shall have admission policies which require that involuntary emergency admissions be given priority over non-emergency and voluntary admissions and clearly outline the circumstances of when prioritization of IEAs cannot be fulfilled.

History

#1806, eff 9-7-81; ss by #2579, eff 1-10-84, EXPIRED, 5-11-84
#2712, eff 5-16-84, EXPIRED, 5-16-90
#5323, eff 1-31-92; ss by #5432, eff 7-1-92; ss by #5581, eff 2-12-93, EXPIRED, 2-12-99
#7051, eff 6-29-99, EXPIRED: 6-29-07
#10389, INTERIM, eff 8-1-13, EXPIRES: 1-28-14; ss by #10516, eff 1-28-14 (from He-M 405.05); amd by #13212, EMERGENCY RULE, eff 5-28-21, EXPIRED: 11-24-21 (in para (c)); ss by #13299, eff 12-2-21

N.H. Code Admin. R. Ann. He-M 405.07 Criteria and Procedures for Medical Transfer {#sec-he-m-405.07 omnilex-key=us-nh-regs-official--agency-he-m--He-M 405.07}

(a) Non-medically related transfer from a DRF to another facility shall be conducted in accordance with He-M 612.

(b) An involuntarily admitted client shall be transferred to an acute care hospital only if the following conditions apply:

(1) The client has acute, non-psychiatric, medical needs requiring treatment which cannot be provided at the DRF;

(2) The acute care hospital to which the client is to be transferred can provide the treatment that the client requires; and

(3) The transfer has been approved by the client, the client’s legal guardian if the guardian has been granted decision-making authority regarding medical care, or the division for children, youth and families if that division has custody of a client who is a minor.

(c) A medical transfer may occur without the approval in (b)(3) above if a physician has determined that a personal safety emergency exists pursuant to He-M 305.03.

(d) The order for IEA shall remain in effect for a person who is transferred from a DRF for medical treatment.

(e) If a client is being transferred under (a) and (b) above, and the client, the client’s legal guardian, or the division for children, youth and families, if that division has custody of a client who is a minor, objects to the transfer, the challenge shall be treated as a client complaint in accordance with He-M 204. Except as provided in (c) above, such a transfer shall not occur until the complaint has been resolved.

History

#1806, eff 9-7-81; amd by #2104, eff 8-1-82; ss by #2579, Emergency, eff 1-10-84, EXPIRED, 5-11-84
#2712, eff 5-16-84, EXPIRED, 5-16-90
#5323, eff 1-31-92; ss by #5432, eff 7-1-92; ss by #5581, eff 2-12-93, EXPIRED, 2-12-99
#7051, eff 6-29-99, EXPIRED: 6-29-07
#10389, INTERIM, eff 8-1-13, EXPIRES: 1-28-14; ss by #10516, eff 1-28-14 (from He-M 405.06); ss by #13299, eff 12-2-21

N.H. Code Admin. R. Ann. He-M 405.08 Discharge Pursuant to Voluntary Admission {#sec-he-m-405.08 omnilex-key=us-nh-regs-official--agency-he-m--He-M 405.08}

(a) If a client is at a DRF on a voluntary basis, he or she or, if the client is under age 18, his or her parent(s) or legal guardian may request withdrawal from the facility whether or not such withdrawal is made against medical advice.

(b) A client or the parent(s) or legal guardian of a client who wishes to withdraw shall state such intent in writing to staff of the DRF.

(c) The time and date of receipt of a notice of intent to withdraw shall be indicated on the notice, if applicable, and in the client’s medical record.

(d) A client who has requested withdrawal or whose parent(s) or legal guardian has requested withdrawal shall be discharged by a DRF within 24 hours of receipt of such request, excluding weekends and holidays, except as provided in (f) below.

(e) If the division for children, youth and families has custody of a client who is a minor, that division shall have such rights and responsibilities as are assigned to the parent(s) or legal guardian of a client pursuant to this section.

(f) At any time prior to discharge of a client admitted for inpatient care on a voluntary basis, any person, pursuant to RSA 135-C:28, may petition for an involuntary emergency admission of the client. If a physician certifies that the criteria for involuntary emergency admission in RSA 135-C:27 are met, the admission of the client shall be continued on an involuntary basis in accordance with RSA 135-C:30-33.

(g) A client’s discharge plan shall include information about community supports such as peer support agencies, the availability of family support and education, and other supportive services such as emergency services, housing supports, and financial services.

History

#1806, eff 9-7-81; ss by #2579, Emergency, eff 1-10-84, EXPIRED, 5-11-84
#2712, eff 5-16-84, EXPIRED, 5-16-90
#5323, eff 1-31-92; ss by #5432, eff 7-1-92; ss by #5581, eff 2-12-93, EXPIRED, 2-12-99
#7051, eff 6-29-99, EXPIRED: 6-29-07
#10389, INTERIM, eff 8-1-13, EXPIRES: 1-28-14; ss by #10516, eff 1-28-14 (from He-M 405.07); amd by #13212, EMERGENCY RULE, eff 5-28-21, EXPIRED: 11-24-21 (in para (g)); ss by #13299, eff 12-2-21

N.H. Code Admin. R. Ann. He-M 405.09 Discharge Pursuant to Involuntary Emergency Admission {#sec-he-m-405.09 omnilex-key=us-nh-regs-official--agency-he-m--He-M 405.09}

(a) Pursuant to RSA 135-C:32, if a person is a client at a DRF subsequent to an involuntary emergency admission, such involuntary confinement shall be limited to a 10-day period unless a petition for involuntary emergency admission is filed pursuant to RSA 135-C:28 or unless a petition is filed in the probate court within the 10 day period requesting a judicial hearing on the issue of involuntary admission. Subsequent to the filing of such petition, confinement shall continue only until issuance of the probate court order or until such time as is specified in that order.

(b) Pursuant to RSA 135-C:33, any person involuntarily admitted to a DRF on an emergency basis shall be granted discharge by the administrator or his/her designee if the administrator determines that the person no longer meets the criteria for admission identified in RSA 135-C:27.

(1) The DRF shall give notice of the discharge to the community mental health program in the region from which the person was admitted and the region to which the person was discharged;

(2) The DRF shall issue written notice to the person discharged and that person’s legal guardian, if applicable, or the division for children, youth and families if that division has custody of the person, that notification pursuant to (c)(1) above was made; and

(3) The DRF shall, with the consent of the person admitted, return such person to the place where the person resided at the time the petition and certificate were completed and signed. If the person admitted does not consent to be returned to his or her place of residence, the DRF may agree to provide transportation to another location such as the home of a relative or friend, a peer support agency, or a CMHP.

(d) A client’s discharge plan shall include information about community supports such as peer support agencies, the availability of family support and education, and other supportive services such as emergency services, housing supports, and financial services.

History

#1806, eff 9-7-81; ss by #2579, Emergency, eff 1-10-84, EXPIRED, 5-11-84
#2712, eff 5-16-84, EXPIRED, 5-16-90
#5323, eff 1-31-92; ss by #5432, eff 7-1-92; ss by #5581, eff 2-12-93, EXPIRED, 2-12-99
#7051, eff 6-29-99, EXPIRED: 6-29-07
#10389, INTERIM, eff 8-1-13, EXPIRES: 1-28-14; ss by #10516, eff 1-28-14 (from He-M 405.08); amd by #13212, EMERGENCY RULE, eff 5-28-21, EXPIRED: 11-24-21 (in para (d)); ss by #13299, eff 12-2-21

N.H. Code Admin. R. Ann. He-M 405.10 Discharge Pursuant to Non-emergency Involuntary Admission {#sec-he-m-405.10 omnilex-key=us-nh-regs-official--agency-he-m--He-M 405.10}

(a) Pursuant to RSA 135-C:39, if a person is a client at a DRF subsequent to an involuntary admission, such involuntary confinement shall not continue beyond the time allowed by the probate court order unless a petition requesting a judicial hearing on the issue of involuntary admission is filed within the period of involuntary admission. Subsequent to the filing of such petition, confinement shall only continue until issuance of the probate court order or until such time as is specified in that order.

(b) Discharge of any person involuntarily admitted to a DRF on a non-emergency basis shall be made in accordance with RSA 135-C:49-54.

(c) Upon discharge from a DRF of any person admitted on a non-emergency, involuntary basis, the administrator shall immediately, and in writing, notify the person’s parent(s) or legal guardian, the division for children, youth and families, if that division has custody of the person who is a minor, and the probate court entering the original order of commitment that a discharge has been granted to the person.

(d) Any person who has been involuntarily admitted to a DRF on a non-emergency basis may be conditionally discharged under the conditions specified in He-M 609.

(e) A client’s discharge plan shall include information about community supports such as peer support agencies, the availability of family support and education, and other supportive services such as emergency services, housing supports, and financial services.

History

#1806, eff 9-7-81; ss by #2579, Emergency, eff 1-10-84, EXPIRED, 5-11-84
#2712, eff 5-16-84, EXPIRED, 5-16-90
#5323, eff 1-31-92; ss by #5432, eff 7-1-92; ss by #5581, eff 2-12-93, EXPIRED, 2-12-99
#7051, eff 6-29-99, EXPIRED: 6-29-07
#10389, INTERIM, eff 8-1-13, EXPIRES: 1-28-14; ss by #10516, eff 1-28-14 (from He-M 405.09); ); amd by #13212, EMERGENCY RULE, eff 5-28-21, EXPIRED: 11-24-21 (in para (e)); ss by #13299, eff 12-2-21

N.H. Code Admin. R. Ann. He-M 405.11 Staffing {#sec-he-m-405.11 omnilex-key=us-nh-regs-official--agency-he-m--He-M 405.11}

(a) Hospital-based DRFs shall be staffed in accordance with the Centers for Medicare and Medicaid Services conditions of participation in 42 CFR 482.62.

(b) Non-hospital-based DRFs shall be staffed by a multidisciplinary team which includes:

(1) A psychiatrist who shall either be present in the facility or on call at all times;

(2) A registered nurse who shall be present in the facility at all times; and

(3) Additional staff such that:

a. At least 2 staff shall be on duty in the facility at all times, to include:

The registered nurse in (2) above; and
A person who has been determined by the DRF to have received specific training in providing treatment to persons with mental illness; and

b. A ratio of at least one staff person to 6 clients shall be maintained.

(c) In addition to the requirements of (a) and (b) above, DRFs that provide services to minors shall employ the following staff on a full-time, part-time, or consultant basis:

(1) A child psychiatrist;

(2) A medical doctor specializing in pediatrics;

(3) A psychologist; and

(4) A social worker.

(d) In addition to the requirements of (a) through (c) above, staff of DRFs that provide services to minors whose length of stay exceeds 30 days shall include:

(1) A rehabilitation counselor; and

(2) A teacher certified as a general special education teacher by the department of education in accordance with Ed 507.39.

(e) Professional staff and consultants of a non-hospital-based DRF who provide psychotherapy shall meet the requirements of He-M 426.04.

History

#5323, eff 1-31-92; ss by #5432, eff 7-1-92; ss by #5581, eff 2-12-93, EXPIRED, 2-12-99
#7051, eff 6-29-99, EXPIRED: 6-29-07
#10389, INTERIM, eff 8-1-13, EXPIRES: 1-28-14; ss by #10516, eff 1-28-14 (from He-M 405.11); ss by #13299, eff 12-2-21

N.H. Code Admin. R. Ann. He-M 405.12 Services to Be Provided {#sec-he-m-405.12 omnilex-key=us-nh-regs-official--agency-he-m--He-M 405.12}

(a) The following shall be basic services provided to all clients of DRFs:

(1) Psychiatric evaluation, including mental status and alcohol/substance abuse evaluations, as determined necessary by the treating psychiatrist;

(2) Administration of psychotropic medication, where appropriate;

(3) Medical monitoring, as ordered by the treating psychiatrist;

(4) Clinical supervision of clients by DRF staff, including monitoring signs and symptoms of mental illness, monitoring responses to medication and other treatment, and monitoring implementation of treatment plans;

(5) Individual and group therapeutic activity directed toward short-term stabilization of psychiatric crisis;

(6) Family support, including family education, consultation, and, when clinically indicated, therapy;

(7) For minors, family support services unless clinically contraindicated; and

(8) Case coordination, including coordination of client evaluation, treatment planning, discharge, and linkage with appropriate community services, as follows:

a. Clients who are not currently assigned to a CMHC case manager shall receive case coordination services from either CMHC or DRF staff upon admission to a DRF and continuing through discharge; and

b. Clients who are currently assigned to a CMHC case manager shall continue to receive such services, which shall include those services outlined in He-M 405.12(a)(8).

(b) In addition to the services identified in (a) above, a DRF shall provide the following rehabilitative services to clients whose lengths of admission exceed 30 days:

(1) For adults:

a. A functional assessment of each client’s independent living skills; and

b. Instruction in independent living skills to prepare each client for discharge, as specified in a client treatment plan; and

(2) For minor clients:

a. A therapeutic milieu which provides behavioral management and structured activities;

b. Educational screening;

c. Educational programming which meets board of education standards; and

d. Treatment and discharge planning which shall include participation of family members, guardians, teachers, and representatives of other agencies which provide services to the clients.

(c) Services shall be age and developmentally appropriate such that discrete, physically separate residential quarters and programmatically separate program areas shall be provided for minors and adults. Services shall be provided such that language barriers are overcome.

History

#5323, eff 1-31-92; ss by #5432, eff 7-1-92; ss by #5581, eff 2-12-93, EXPIRED, 2-12-99
#7051, eff 6-29-99, EXPIRED: 6-29-07
#10389, INTERIM, eff 8-1-13, EXPIRES: 1-28-14; ss by #10516, eff 1-28-14 (from He-M 405.11); ss by #13299, eff 12-2-21

N.H. Code Admin. R. Ann. He-M 405.13 Safety Procedures {#sec-he-m-405.13 omnilex-key=us-nh-regs-official--agency-he-m--He-M 405.13}

A DRF shall maintain written policies on safety procedures in accordance with the Centers for Medicare and Medicaid Services conditions of participation in 42 CFR 482, He-P 830, or He-M 1002, as applicable, and He-M 305 and RSA 126-U.

History

#5323, eff 1-31-92; ss by #5432, eff 7-1-92; ss by #5581, eff 2-12-93, EXPIRED, 2-12-99
#7051, eff 6-29-99, EXPIRED: 6-29-07
#10389, INTERIM, eff 8-1-13, EXPIRES: 1-28-14; ss by #10516, eff 1-28-14 (from He-M 405.12); ss by #13299, eff 12-2-21

N.H. Code Admin. R. Ann. He-M 405.14 Annual Reporting {#sec-he-m-405.14 omnilex-key=us-nh-regs-official--agency-he-m--He-M 405.14}

(a) A DRF shall submit monthly client-level reporting to the department’s bureau of mental health services, on or before the 15th day of the following month that includes the following client-level data:

(1) Demographic information;

(2) Insurance information;

(3) Admission and discharge data;

(4) Whether an individual was involuntary during any part of the admission period;

(5) The number of seclusions and restraints that occurred during the reporting period; and

(6) Discharge disposition.

(b) A DRF shall submit monthly reports to the department’s bureau of mental health services, on or before the 15th day of the following month that summarizes:

(1) Total number of completed referrals received by the DRF;

(2) Total number of referrals that were declined; and

(3) Reasons for declined referrals.

(c) If a DRF is unable to maintain its designated inpatient capacity, the DRF shall inform the department why the capacity cannot be met and shall notify the department when it returns to its designated capacity as required by He-M 405.03(e).

History

#5323, eff 1-31-92; ss by #5432, eff 7-1-92; ss by #5581, eff 2-12-93, EXPIRED, 2-12-99
#7051, eff 6-29-99, EXPIRED: 6-29-07
#10389, INTERIM, eff 8-1-13, EXPIRES: 1-28-14; ss by #10516, eff 1-28-14 (from He-M 405.13); ss by #13212, EMERGENCY RULE, eff 5-28-21, EXPIRED: 11-24-21; ss by #13299, eff 12-2-21

N.H. Code Admin. R. Ann. He-M 405.15 Denial and Revocation of Designation {#sec-he-m-405.15 omnilex-key=us-nh-regs-official--agency-he-m--He-M 405.15}

(a) An application for designation shall be denied or designation shall be revoked, following written notice pursuant to (b)(2) below and opportunity for appeal pursuant to He-C 200, due to:

(1) Failure of the DRF to comply with this part or any other applicable rule adopted by the department;

(2) The DRF administrator or applicant failing to provide information required by the department or knowingly giving false or misleading information to the department;

(3) Refusal by personnel at the DRF to admit any employee of the department authorized to monitor or inspect the DRF;

(4) Any reported abuse, neglect, or exploitation of clients by DRF personnel or persons living in the DRF, if:

a. Such personnel have not been prevented from having contact with clients; and

b. Such abuse, neglect, or exploitation is founded based on a protective investigation performed by the department in accordance with He-E 700 and an administrative hearing held pursuant to He-C 200, if such a hearing is requested;

(5) Revocation of licensure or denial of an application for licensure pursuant to RSA 151; or

(6) Revocation of certification or denial of an application for certification pursuant to He-M 1001.

(b) Revocation of designation or denial of application for designation shall be in accordance with the following:

(1) Upon determination that a DRF meets any of the criteria for revocation or denial of application listed in (a)(1)-(6) above, the commissioner shall issue a notice of intent to revoke or deny the designation of the DRF;

(2) Revocation or denial of application shall only occur following:

a. The provision of 30 days’ written notice by the commissioner to the DRF stating the specific rule(s) with which the DRF does not comply; and

b. Opportunity for an adjudicative proceeding pursuant to He-C 200, if requested by the DRF;

(3) The commissioner shall withdraw a notice of revocation or denial if, within the notice period, the DRF complies with the specified rule(s); and

(4) Pending compliance with all requirements for designation specified in the written notice made pursuant to (b)(2) above, a DRF shall not accept additional clients if a notice of revocation has been issued concerning a violation which presents potential danger to the health or safety of the clients being served.

History

#5323, eff 1-31-92; ss by #5432, eff 7-1-92; ss by #5581, eff 2-12-93, EXPIRED, 2-12-99
#7051, eff 6-29-99, EXPIRED: 6-29-07
#10389, INTERIM, eff 8-1-13, EXPIRES: 1-28-14; ss by #10516, eff 1-28-14 (from He-M 405.14); ss by #13299, eff 12-2-21

N.H. Code Admin. R. Ann. He-M 405.16 Suspension of Designation {#sec-he-m-405.16 omnilex-key=us-nh-regs-official--agency-he-m--He-M 405.16}

(a) The department shall order the immediate suspension of a DRF, the cessation of operations, and the transfer of care of clients when it finds that the health, safety, or welfare of clients is in jeopardy and requires emergency action in accordance with RSA 541-A:30, III.

(b) If an immediate suspension is upheld, the DRF shall not resume operating until the department determines through a site visit that compliance with He-M 405 is achieved.

History

#5323, eff 1-31-92; ss by #5432, eff 7-1-92; ss by #5581, eff 2-12-93, EXPIRED, 2-12-99
#7051, eff 6-29-99, EXPIRED: 6-29-07
#10389, INTERIM, eff 8-1-13, EXPIRES: 1-28-14; ss by #10516, eff 1-28-14 (from He-M 405.15); ss by #13299, eff 12-2-21

N.H. Code Admin. R. Ann. He-M 405.17 Waivers {#sec-he-m-405.17 omnilex-key=us-nh-regs-official--agency-he-m--He-M 405.17}

(a) A DRF may request a waiver of specific procedures outlined in this part, in writing, from the department.

(b) A request for a waiver shall include:

(1) A specific reference to the section of the rule for which a waiver is being sought;

(2) A full description of why a waiver is necessary; and

(3) A full explanation of alternative provisions or procedures proposed by the DRF.

(d) A request for a waiver shall be granted after the commissioner or his or her designee determines that the alternative proposed by the DRF meets the objective or intent of the rule and:

(1) Does not negatively impact the health or safety of clients; and

(2) Does not affect the quality of DRF services.

(e) Upon receipt of approval of a waiver request, the DRF’s subsequent compliance with the alternative provisions or procedures approved in the waiver shall be considered compliance with the rule for which the waiver was sought.

(f) Waivers shall be granted in writing for a specific duration not to exceed 5 years except as in (g) below.

(g) Those waivers which relate to the following shall be effective for the DRF’s current designation period only:

(1) Fire safety; or

(2) Other issues relative to consumer health, safety or welfare that require periodic reassessment.

(h) A DRF 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.

History

#10516, eff 1-28-14 (from He-M 405.16); ss by #13299, eff 12-2-21

Part He-M 406 Housing Bridge Subsidy Program

N.H. Code Admin. R. Ann. He-M 406.01 Purpose {#sec-he-m-406.01 omnilex-key=us-nh-regs-official--agency-he-m--He-M 406.01}

The housing bridge subsidy program provides supported housing to people who have serious mental illness. The purpose of supported housing is to reduce institutionalization by combining mental health outreach services with a subsidy to help pay rent. The rental subsidy terminates when the individual receives a Section 8 Housing Choice Voucher. Accordingly, in order for a person to be eligible for the housing bridge subsidy program, the person must apply for the Section 8 Housing Choice Voucher. The purpose of this rule is to describe the eligibility criteria, the application process, the services offered, the wait list and the appeal procedures for the housing bridge subsidy program.

History

#2745, eff 6-14-84; rpld by #4215, eff 1-22-87, EXPIRED: 1-22-93
#11191, eff 9-27-16

N.H. Code Admin. R. Ann. He-M 406.02 Definitions {#sec-he-m-406.02 omnilex-key=us-nh-regs-official--agency-he-m--He-M 406.02}

(a) “Applicant” means a person or guardian who is applying for acceptance into the housing bridge subsidy program.

(b) “Assertive Community Treatment” (ACT) means a team-based approach to delivering comprehensive and flexible treatment, support, and services.

(d) “Community mental health program (CMHP)” means “community mental health program” as defined in RSA 135-C: 2, IV.

(e) “Controlled drug(s)” means controlled drugs as defined in RSA 318-B:1, VI.

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

(g) “Facility” means New Hampshire hospital or a receiving facility designated pursuant to RSA 135-C:26 and He-M 405, Glencliff Home, or an acute psychiatric residential treatment program.

(h) “Individual” means any person who is an applicant for or recipient of services from the housing bridge subsidy program.

(i) “Household” means the people who will occupy a housing unit under the HBSP including related family members, and all the unrelated people, if any, such as lodgers, foster children, wards, or employees. A person living alone in a housing unit, or a group of unrelated people sharing a housing unit such as partners or roomers, is also a household.

(j) “Permanent” means community-based housing with a designated length of stay.

(k) “Program” means the housing bridge subsidy program (HBSP) administered by the department either directly or through a contract for the provision of services under this rule.

(l) “Severe mental illness” means a condition of a person who is determined severely mentally disabled in accordance with He-M 401.05 or He-M 401.07.

(m) “Severe and persistent mental illness” means a condition of a person who is determined severely mentally disabled in accordance with He-M 401.06 or He-M 401.07.

(n) “State fiscal year” means the period of time extending from July 1 of one year through June 30 of the following year.

(o) “Transitional housing services program” means the residential program for persons with a severe mental illness or severe and persistent mental illness operated on the grounds of New Hampshire Hospital.

(p) “Violent criminal offense” means any conviction that has as one of its elements the use, attempted use, or threatened use of physical force substantial enough to cause, or be reasonably likely to cause, serious bodily injury or property damage including but not limited to murder, manslaughter, assault, rape, robbery, burglary, arson, and kidnapping. This term does not include simple assault by itself.

(q) “Wait list” means a list of individuals who have been determined eligible for the housing bridge subsidy program but for whom funding is not available.

History

#11191, eff 9-27-16

N.H. Code Admin. R. Ann. He-M 406.03 Eligibility Criteria {#sec-he-m-406.03 omnilex-key=us-nh-regs-official--agency-he-m--He-M 406.03}

(a) In order to be eligible for HBSP a person shall meet the following eligibility criteria:

(1) The person shall have a severe mental illness or a severe and persistent mental illness;

(2) The person shall be 18 years or older;

(3) The person shall be eligible for services from a CMHP, facility, or the transitional housing services program;

(4) The person and any member of the person’s household who is 18 years or older, shall have applied for or be listed on the person’s application for the Section 8 Housing Choice Voucher Program; and

(5) The person shall lack safe and permanent housing options in the community, and meet one of the following criteria:

a. Be ready for discharge from a facility;

b. Be ready for discharge from the transitional housing services program or a community residence as defined in He-M 1002;

c. Be on an Assertive Community Treatment Team (ACT);

d. Be incarcerated as a result of mental illness and ready for release;

e. Have a minimum of two admissions to New Hampshire Hospital within the last two years;

f. Have used crisis, or emergency services as defined in He-M 426.09, for psychiatric reasons within the last two years; or

g. Be unable to access needed community mental health services within the last two years.

(b) Eligibility for the HBSP shall not be conditioned on an individual participating in treatment or complying with mandatory programmatic criteria.

(1) Individuals who have been convicted of:

a. A violent criminal offense within the past 15 years; or

b. The illegal manufacture, sale, or distribution of a controlled drug, or the possession of a controlled drug with intent to manufacture, sell, or distribute within the past 7 years;

(2) Individuals who are current required to register for any sexual offense as defined in 651-B, “Registration of Criminal Offenders;”

(3) Individuals with a household member who meets the criteria in (1) or (2) above; and

(4) Individuals with a house hold income in excess of the “Area Income Limits” for the area in which housing is sought, as listed by the New Hampshire Housing Finance Authority, (May 1,2015), and available on–line under “Publications” at http://www.nhhfa.org/rental-housing-choice-vouchers.cfm.

(d) Individuals meeting the criteria in He-M 406.03(a) and in paragraphs (c) (1) or (2) above, may request an eligibility accommodation whereby the individual demonstrates to the department:

(1) That there is a link between the mental illness and the behavior; and

(2) That the behavior is controlled through on-going treatment, a completed rehabilitation program, or the terms of a conditional discharge.

(e) The department shall grant the eligibility accommodation if it determines, that based on the information provided in (d) above good cause exists to believe that the individual will not otherwise possess a threat to the health, safety, or wellbeing of another tenant, so long as the conditions of (d)(2) are followed.

History

#11191, eff 9-27-16

N.H. Code Admin. R. Ann. He-M 406.04 Notice and Income Verification {#sec-he-m-406.04 omnilex-key=us-nh-regs-official--agency-he-m--He-M 406.04}

(a) An individual shall inform the program within 30 days if:

(1) The individual or a household member is convicted of any offense in He-M 406.03(b);

(2) The household income increases by more than 20%; or

(3) Any other event occurs that causes the individual to become ineligible for services under the program.

(b) The applicable income level shall be verified by the program annually.

History

#11191, eff 9-27-16

N.H. Code Admin. R. Ann. He-M 406.05 Application For Services {#sec-he-m-406.05 omnilex-key=us-nh-regs-official--agency-he-m--He-M 406.05}

(a) Applicants shall apply for services under this program by completing and submitting the “Housing Bridge Subsidy Program Application,” (October 2015), which shall be:

(1) Prepared by the applicant with the assistance of the CMHP, facility, or the transitional housing services program;

(2) Signed and dated by the applicant; and

(3) Submitted by a CMHP, a facility, or the transitional housing services program.

(b) In addition to the application in (a) above, applicants shall provide:

(1) A signed and dated authorization for a New Hampshire criminal background check of the applicant as prepared by the NH Department of Safety;

(2) A signed and dated authorization for a New Hampshire criminal background check of any other member of the household 18 years of age or older;

(3) For applicants or other members of the household 18 years of age or older who have lived outside of New Hampshire within the last 5 years, a signed and dated authorization for a state criminal background check from the appropriate agency in the state(s) where the applicant lived; and

(4) A signed and dated certification stating, “I certify, under penalty of unsworn falsification, that all of the information in this application is true and complete to the best of my knowledge and belief. False information will result in denial of application or dismissal from this program.”

(c) Any applicant shall participate in a face-to face interview with the program, if necessary for the program to clarify any information provided in or with the application.

(d) Individuals may request a reasonable modification pursuant to 28 CFR 35.130(b)(7) at any time, and will be provided with information and assistance by the HBSP about their fair housing rights.

(e) Within 45 days of its receipt of an application, which includes all requirements in (a)-(c) above, the department shall determine whether the applicant is eligible for the program.

(f) An application shall be denied if the individual does not meet the eligibility requirements in He-M 406.03 above.

(g) The department shall notify the applicant, in writing, if the application has been accepted or denied, and:

(1) If accepted, the notice shall include a statement as to whether the individual has been placed on the wait list in accordance with He-M 406.07; and

(2) If denied, the notice shall state the basis for denial and provide notice of appeal rights in accordance with RSA 126-A:5, VIII and He-C 200, along with information on obtaining legal assistance.

(h) Individuals who do not meet (a)(1) and (3) above and would like to apply to the HBSP shall complete and submit the “Housing Bridge Subsidy Program Intake Form” (February 2016) directly to the department.

(i) When an individual has been accepted into the HBSP, the program shall make every reasonable effort to obtain housing. However, the HBSP cannot guarantee that housing will be found.

History

#11191, eff 9-27-16

N.H. Code Admin. R. Ann. He-M 406.06 Services to be Provided {#sec-he-m-406.06 omnilex-key=us-nh-regs-official--agency-he-m--He-M 406.06}

(a) The program shall assist the individual in identifying safe and affordable housing in the community chosen by the individual.

(b) The program shall provide case management services if the individual does not otherwise have a case manager.

(c) The program shall provide support services that are flexible and available as needed and desired, and that enable individuals to attain and maintain integrated housing.

(d) The program shall assist the individual with obtaining, but not paying for, the following:

(1) A security deposit;

(2) Utility services; and

(3) Furniture.

(e) The program shall provide a monthly subsidy toward rent in an amount to be determined based on the amount of rent, the individual’s household income, and cost projections of available program funding.

(f) The individual shall be responsible to pay up to 30% of the household income toward the rent.

History

#11191, eff 9-27-16

N.H. Code Admin. R. Ann. He-M 406.07 Wait List {#sec-he-m-406.07 omnilex-key=us-nh-regs-official--agency-he-m--He-M 406.07}

(a) When annual departmental cost projections reflect that available funds will be over-expended for the current state fiscal year, a wait list shall be established.

(b) The wait list shall include any individual that has applied and been deemed eligible for the HBSP and for whom a subsidy is not available.

(c) The individual shall be determined eligible in accordance with He-M 406.03 above before being placed on the wait list.

(d) The wait list shall be prioritized as follows:

(1) Individuals ready for discharge from a facility, but who lack safe and permanent housing options in the community will be given the first priority;

(2) Individuals who are on an ACT team, but who lack safe and permanent options in the community, will be given the second priority;

(3) Individuals ready for discharge from the transitional housing services program, but who lack safe and permanent options in the community, will be given third priority; and

(4) Any other individual who has been found eligible in accordance with He-M 406.03.

(e) Individuals shall be added to the wait list according to the date that eligibility is determined;

(f) The program shall confirm the individual’s continued eligibility as of the date the individual is removed from the wait list to receive the subsidy.

History

#11191, eff 9-27-16

N.H. Code Admin. R. Ann. He-M 406.08 Termination from the Program {#sec-he-m-406.08 omnilex-key=us-nh-regs-official--agency-he-m--He-M 406.08}

(a) An individual shall be terminated from the program if the individual:

(1) Is convicted of any offense described in section He-M 406.03(c)(1) or (2) above;

(2) Has a household member who meets the criteria in (c)(1) or (2) above;

(3) Has an increase in household income above the allowable amount listed in He-M 406.03(c) above;

(4) Is no longer eligible on the date his or her name is removed from the wait list to receive the subsidy;

(5) Fails to pay their portion of rent for at least three consecutive months;

(6) Has received two or more eviction notices based on the individual’s conduct; or

(7) Commits an act of bodily harm, or makes threats of bodily harm toward department or program staff that requires intervention of law enforcement.

(b) The department shall provide 30 days advance notice of the termination in writing. If a person is being terminated pursuant to He-M 406.08 (a)(7) and there is risk to those threatened or endangered if the bridge subsidy is not immediately suspended, the 30 day notice shall be waived.

(c) An individual shall not be terminated from the program if he or she is eligible for services under He-M 401, but chooses not to receive mental health or housing support services.

History

#11191, eff 9-27-16

N.H. Code Admin. R. Ann. He-M 406.09 Appeals {#sec-he-m-406.09 omnilex-key=us-nh-regs-official--agency-he-m--He-M 406.09}

(a) Persons may request a hearing regarding termination, denial of an eligibility accommodation, or to contest the amount of the subsidy as calculated pursuant to He-M 406.06(e) above.

(b) Appeals shall be submitted, in writing, to the department in care of the office of client and legal services within 30 days following the date of the notification of denial or termination of services, or amount of subsidy as calculated.

(c) The office of client and legal services shall immediately forward the appeal to the department’s administrative appeals unit (AAU) which shall assign a presiding officer to conduct a hearing or independent review, as provided in He-C 200.

(d) If a hearing is requested, the following actions shall occur:

(1) Services and payment shall be continued until the decision is made; and

(2) An expedited hearing shall be scheduled as provided in He-C 200.

History

#11191, eff 9-27-16

N.H. Code Admin. R. Ann. He-M 406.10 Waivers {#sec-he-m-406.10 omnilex-key=us-nh-regs-official--agency-he-m--He-M 406.10}

(a) An applicant, community mental health program, facility, or the transitional housing services program, may request a waiver of specific rules in this part, in writing, from the department.

(b) A request for waiver shall include:

(1) A specific reference to the section of the rule for which a waiver is being sought;

(2) A full explanation of why a waiver is necessary; and

(3) A full explanation of alternative provisions or procedures proposed.

(d) A request for waiver shall be granted if the commissioner determines that the alternatives proposed meet the objective or intent of the rule and either:

(1) Do not negatively impact the health or safety of the individual; or

(2) Are administrative in nature, and do not affect the quality of individual care.

History

#11191, eff 9-27-16

Part He-M 408 Clinical Records

N.H. Code Admin. R. Ann. He-M 408.01 Purpose {#sec-he-m-408.01 omnilex-key=us-nh-regs-official--agency-he-m--He-M 408.01}

These rules establish the required components of the clinical records maintained by community mental health programs and their subcontracted service providers for persons eligible to receive state-funded services pursuant to RSA 135-C:13 and He-M 401 and identify the contents of those components.

History

#2039, eff 7-1-82; ss by #2423, eff 7-13-83; rpld by #2468, eff 9-6-83
#3051, eff 7-8-85, EXPIRED: 7-8-91
#7281, eff 5-23-00, EXPIRED: 5-23-08
#9512 eff 7-9-09; ss by #12409, eff 10-24-17

N.H. Code Admin. R. Ann. He-M 408.02 Definitions {#sec-he-m-408.02 omnilex-key=us-nh-regs-official--agency-he-m--He-M 408.02}

(a) “Case manager” means the person employed by the community mental health program who provides targeted case management services in accordance with He-M 426.

(b) “Clinical record” means the cumulative documents, collected and preserved, containing information relative to the care and treatment of each individual.

(d) “Community mental health program (CMHP)” means a program operated by the state, city, town, or county, or a community-based New Hampshire nonprofit corporation for the purpose of planning, establishing, and administering an array of community-based, mental health services pursuant to He-M 403 and as defined in RSA 135-C:2, IV.

(e) “Credentials” means the abbreviation of one’s academic degree and title as it pertains to the person’s role in providing services to an individual.

(f) “Department” means the department of health and human services.

(g) “Electronic clinical record” means the cumulative documents collected and preserved by the CMHP and containing information relative to the health record of an individual’s care and treatment in digital format.

(h) “Electronic prescribing” means a prescriber’s ability to electronically send an accurate, error-free, and understandable prescription directly to a pharmacy from the point-of-care.

(i) “Electronic signature” means a computer data compilation of any symbol or series of symbols executed, adopted, or authorized by an individual to be the legally binding equivalent of the individual’s handwritten signature.

(j) “Facility” means New Hampshire hospital or a community receiving facility designated pursuant to RSA 135-C:26 and He-M 405, or an acute psychiatric residential treatment program.

(k) “Family member” means the parent, foster parent, legal guardian, child, brother, sister, spouse, significant other, grandparent, grandchild, stepparent, aunt, uncle, or first cousin of the individual.

(l) “Goals” means long-term, observable, desired accomplishments or changes to be achieved by an individual.

(m) “Guardian” means a person appointed pursuant to RSA 463 or RSA 464-A or the parent of an individual under the age of l8 whose parental rights have not been terminated or limited by law.

(n) “Individual” means a person who is receiving or applying for a service from a program or community residence.

(o) “Individual service plan (ISP)” means a written document that:

(1) Is developed annually as the result of a service planning process pursuant to He-M 401; and

(2) Includes the identification of the individual’s:

a. Goals and objectives;

b. Treatments and services; and

c. Criteria for achieving the stated goals.

(p) “Licensed practitioner of the healing arts” means a person who meets the qualifications and provides psychotherapy or other services identified pursuant to He-M 426.

(q) “Medical necessity” means that the services and supports provided to an individual are:

(1) Consistent with the generally accepted clinical practice for diagnosis and treatment of the symptoms of mental illness or serious emotional disturbance;

(2) The most efficient and economical that can be safely provided, as prescribed by a physician; and

(3) Not solely for the convenience of the individual or the providers.

(r) “Mental illness” means a condition of a person who is determined severely mentally disabled in accordance with He-M 401 and who has at least one of the following psychiatric disorders classified in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), available as listed in Appendix A:

(1) Schizophrenia spectrum and other psychotic disorders except for the following:

a. Schizotypal personality disorder:

b. Substance or medication induced psychotic disorder; and

c. Psychotic disorder due to another medical condition:

(2) Bipolar and related disorders except for the following:

a. Substance or medication induced bipolar and related disorder; and

b. Bipolar disorder and related disorder due to another medical condition;

(3) Depressive disorders except for the following:

a. Disruptive mood dysregulation disorder;

b. Premenstrual dysphoric disorder;

c. Substance or medication induced depressive disorder; and

d. Depressive disorder due to another medical condition;

(4) Borderline personality disorder;

(5) Panic disorder;

(6) Obsessive compulsive disorder;

(7) Post-traumatic stress disorder;

(8) Bulimia nervosa;

(9) Anorexia nervosa;

(10) Other specific feeding or eating disorders;

(11) Unspecified feeding or eating disorders; and

a. Anxiety;

b. Depression;

c. Delusions; and

d. Hallucinations.

(s) “Objectives” means short-term, desired accomplishments designed to assist the individual in achieving the long-term goals identified on the individual service plan.

(t) “Person-centered” means that individuals receiving mental health services are the center of the system of care, and their needs and direction drive the care and services provided.

(u) “Rehabilitation” means the reinstatement of a former level of functioning or achieving a higher level of functioning than existed on admission to a program or residence through the provision of therapy, education, and activities as specified in the individual service plan.

(v) “Residential program” means a non-facility based residence for the care and treatment of people with a mental illness.

(w) “Serious emotional disturbance” means severe mental disability in persons from birth to age 18 who currently, or at any time within the past year, have had a diagnosable mental, behavioral, or emotional disorder of sufficient duration to meet diagnostic criteria specified with the DSM-5, that resulted in functional impairment, which substantially interfered with or limited the child’s role or functioning in the family, school, or community activities. This definition excludes substance abuse disorders and conditions due to another medical condition or substance ormedication induced disorders.

(x) “Service planning process” means the annual review conducted in accordance to He-M 401 to develop or revise an individual service plan.

(y) “Suspension” means a time limited, specific withholding of any available service(s) from an individual for well-defined and documented reasons and pursuant to He-M 401.

(z) “Termination” means the cessation for an indefinite period of all services to an individual in accordance with He-M 401.

(aa) “Treatment” means the examination, assessment, diagnosis, training, rehabilitation therapy, pharmaceuticals and other services provided to individuals within the mental health service system, excluding examination or diagnosis for the purpose of determining the need for involuntary emergency admissions pursuant to RSA 135-C:27-33 or involuntary admissions pursuant to RSA 135-C:34-54.

History

#2039, eff 7-1-82; ss by #2423, eff 7-13-83; rpld by #2468, eff 9-6-83
#3051, eff 7-8-85, EXPIRED: 7-8-91
#7281, eff 5-23-00, EXPIRED: 5-23-08
#9512 eff 7-9-09; ss by #12409, eff 10-24-17

N.H. Code Admin. R. Ann. He-M 408.03 Establishment of the Clinical Record {#sec-he-m-408.03 omnilex-key=us-nh-regs-official--agency-he-m--He-M 408.03}

(a) Each community mental health and residential program shall have a written clinical records policy that:

(1) Outlines the content, maintenance, and monitoring requirements for its clinical records in both paper and electronic formats;

(2) Addresses the completeness, accuracy, and timeliness of documentation;

(3) Addresses confidentiality;

(4) Stipulates how and when individuals may access their own records;

(5) Addresses electronic signatures; and

(6) Addresses electronic prescribing procedures.

(b) Every individual shall have a clinical record that meets the requirements of He-M 408 and the program’s policy.

(1) Accessible to staff providing services;

(2) Accessible to the individual or the parent or guardian if the individual is a minor or legally incompetent, unless otherwise prohibited by law; and

(3) Available for supervisory and quality assurance activities conducted by the CMHP or the department of health and human services’ bureau of mental health services.

(d) If an individual, his or her guardian, an attorney or other advocate representing the individual, after review of the record, requests copies of the record, such copies in paper format, shall be made available free of charge for the first 25 pages and not more than 25 cents per page thereafter. If available, copies of records electronically stored and produced, shall be made available free of charge for the first 25 pages and at actual cost per page thereafter. The individual, his or her guardian, attorney or other advocate representing the individual may choose whether to receive the record in paper form or, if available, in electronic form.

(e) Each documentation in the clinical record of a CMHP service shall include:

(1) The signature of the service provider;

(2) The service provider’s credentials;

(3) The legible name of the service provider including a typed name, name stamp, or printed name within proximity of the credentials and signature of the service provider;

(4) The date of service; and

(5) The date of documentation.

(f) Documentation shall not be altered or changed by erasure or masking, such as through the use of liquid correction fluid. Corrections shall be made by drawing a line through the mistake. All corrections shall be signed and dated by the person making the change. Corrections to entries made in the electronic medical record shall clearly show the correction that was made, and the date, time, and name of the person making the correction.

(g) Service documentation shall be completed prior to the service being billed.

(h) The individual or guardian shall document informed consent for all planned services except as otherwise prohibited by law or where emergency treatment is indicated pursuant to RSA 135:21-b.

(i) Clinical records shall be retained by a program or facility for 7 years after closure of a record for an adult and for 7 years beyond the age of 18 for a child.

(j) Subcontracted service providers shall comply with all the provisions of He-M 408.

History

#2039, eff 7-1-82; ss by #2423, eff 7-13-83; rpld by #2468, eff 9-6-83
#3051, eff 7-8-85, EXPIRED: 7-8-91
#7281, eff 5-23-00, EXPIRED: 5-23-08
#9512 eff 7-9-09; ss by #12409, eff 10-24-17

N.H. Code Admin. R. Ann. He-M 408.04 Clinical Record Components {#sec-he-m-408.04 omnilex-key=us-nh-regs-official--agency-he-m--He-M 408.04}

(a) The clinical record shall be designed to:

(1) Document the medical necessity for services provided;

(2) Document the response to and effectiveness of services;

(3) Document the extent of coordination of care by system-wide providers and, when appropriate, with providers outside the mental health system; and

(4) Provide documentation substantiating the delivery and appropriateness of services as required by He-M 401 and He-M 426.

(b) The clinical record shall include, at a minimum, the following components:

(1) Intake and assessment information in accordance with He-M 408.06;

(2) Demographic data in accordance with He-M 408.05;

(3) Annual notification of an individual’s rights in accordance with He-M 309;

(4) Documentation of eligibility determination in accordance with He-M 401;

(5) Individual service planning documentation pursuant to He-M 401;

(6) Individual service plan;

(7) Documentation of service delivery and outcomes;

(8) Suspension, transfer, and discharge notes, if applicable;

(9) Documentation of ISP reviews;

(10) Medication orders, laboratory results, and general health information;

(11) Pertinent legal data;

(12) Admission and discharge reports from mental health facilities and from other providers, when applicable; and

(13) Targeted case management assessment and care plan pursuant to He-M 426, which shall include documentation of the following, when applicable:

a. Identification of the individual’s targeted case management needs;

b. The referral and monitoring activities to be provided; and

c. An individual’s refusal to receive specific services in the care plan.

History

#2039, eff 7-1-82; ss by #2423, eff 7-13-83; rpld by #2468, eff 9-6-83
#3051, eff 7-8-85, EXPIRED: 7-8-91
#7281, eff 5-23-00, EXPIRED: 5-23-08
#9512 eff 7-9-09; ss by #12409, eff 10-24-17

N.H. Code Admin. R. Ann. He-M 408.05 Application and Demographic Data {#sec-he-m-408.05 omnilex-key=us-nh-regs-official--agency-he-m--He-M 408.05}

(a) Pursuant to He-M 401, an application for services shall be completed and signed by the individual or guardian at or before the intake interview.

(b) The following demographic data shall be collected and documented:

(1) Name, address, and telephone number of the individual or applicant;

(2) Date of application for services;

(3) Date of birth of the individual or applicant;

(4) Name, address, and telephone number of guardian, if applicable;

(5) Financial information including:

a. Insurance;

b. Private resources; and

c. Eligibility determinations for financial assistance from programs such as Supplemental Security Income, Aid to the Permanently and Totally Disabled, Medicare, Medicaid, and food stamps;

(6) Emergency contact information;

(7) Educational history;

(8) Marital or civil union status;

(9) Living situation;

(10) Employment status and history;

(11) Race, ethnicity, and primary language;

(12) Gender;

(13) Gender identification; and

(14) Current legal involvement, such as:

a. Probation or parole;

b. Conditional discharge;

c. Guardianship; and

d. Any other court ordered involvement.

(c) Data collected in (b) above shall be reviewed and a hard copy signed by the individual at least annually and updated as needed.

History

#2039, eff 7-1-82; ss by #2423, eff 7-13-83; rpld by #2468, eff 9-6-83
#3051, eff 7-8-85, EXPIRED: 7-8-91
#7281, eff 5-23-00, EXPIRED: 5-23-08
#9512 eff 7-9-09; ss by #12409, eff 10-24-17

N.H. Code Admin. R. Ann. He-M 408.06 Intake Assessment {#sec-he-m-408.06 omnilex-key=us-nh-regs-official--agency-he-m--He-M 408.06}

(a) The CMHP shall complete and document an intake assessment for each individual.

(b) The intake assessment shall:

(1) Include medical, psychiatric, and social information;

(2) Include historical and current information and assessments; and

(3) Serve as a basis for ISP development.

(1) Medical information including:

a. A statement of the individual’s general physical health status;

b. Medical history, including current weight, height, blood pressure, pulse, and smoking status;

c. When applicable, medical diagnoses, and the results of any medical or neurological screenings, examinations, or tests; and

d. The name and contact information for the individual’s primary care physician;

(2) Psychiatric information including:

a. History of mental illness or serious emotional disturbance, including onset and severity;

b. Previous services and treatments, including medications and hospitalizations;

c. Individual’s strengths;

d. Illness self-management skills;

e. Precipitating events for current psychiatric symptoms, as applicable;

f. Documentation of the medical necessity for services;

g. Current diagnosis;

h. Medication orders;

i. Current medications;

j. Results of formalized psychiatric and/or psychological tests, if applicable;

k. Mental status examination results; and

l. Diagnostic formulation by a psychiatrist or other licensed practitioner of the healing arts under the auspices of a psychiatrist licensed to practice in the state of New Hampshire; and

(3) Social information including:

a. Developmental history;

b. Educational history and current status, if applicable;

c. Family history and current family status;

d. History of childhood abuse and neglect;

e. History of trauma, including domestic violence;

f. Results of a substance use screening tool;

g. Employment history including work skills and types, and lengths of employment;

h. Military history and veterans status, if applicable;

i. Current living situation including type of environment and nature of relationship with any room/house mates or family;

j. Social and leisure time activities and skills;

k. Ability to develop and maintain friendships;

l. Involvement with or history of involvement with other social service agencies or the criminal justice system;

m. Guardianship, if applicable; and

n. Other legal documents.

(d) Intake assessments that are completed to function as the initial ISP shall include the initial services to be provided and a physician’s signature.

(e) The intake assessment and updates shall be signed and dated by the person completing the assessment.

History

#7281, eff 5-23-00, EXPIRED: 5-23-08
#9512 eff 7-9-09; ss by #12409, eff 10-24-17

N.H. Code Admin. R. Ann. He-M 408.07 Medication Orders {#sec-he-m-408.07 omnilex-key=us-nh-regs-official--agency-he-m--He-M 408.07}

(a) A complete list of all prescribed medications, laboratory testing, and, when applicable, dietary and other specific orders shall be maintained in the clinical record on the medication order sheet, and shall be visible and available within the electronic medical record.

(b) Medication order sheets or progress notes shall specify, at a minimum:

(1) Date ordered;

(2) Name, credentials, and signature of prescriber;

(3) Medication name;

(4) Medication dosage;

(5) Amount dispensed;

(6) An individual’s allergies;

(7) Route of medication administration;

(8) Medication frequency;

(9) Medication start and stop dates;

(10) Date medication expired or was discontinued;

(11) Special instructions, if any;

(12) Reason for pro re nata medication; and

(13) Whether or not the individual has the cognitive ability to self-administer or control access to their medications, or both.

(c) At a minimum, a copy of each medication prescription shall be maintained in the clinical record for individuals who self-administer and control access to the individual’s own medications.

(d) Each time a medication is added or deleted or when a dosage is adjusted, the prescriber shall document the change, the reason for the change, and the individual’s ability to understand and follow the new orders.

History

#7281, eff 5-23-00, EXPIRED: 5-23-08
#9512 eff 7-9-09; ss by #12409, eff 10-24-17

N.H. Code Admin. R. Ann. He-M 408.08 Individual Service Plan {#sec-he-m-408.08 omnilex-key=us-nh-regs-official--agency-he-m--He-M 408.08}

(a) The ISP shall be developed in accordance with He-M 401 and documented and maintained within the clinical record.

(b) The ISP shall be a comprehensive document which identifies:

(1) Individual’s strengths, problems, and functional impairments due to the mental illness;

(2) The treatment and rehabilitative goals and objectives; and

(3) The services to be provided.

(c) The ISP shall be person-centered and written in a style and language that is understandable to the individual and other non-professionals.

(d) The ISP shall include:

(1) The effective date of the plan;

(2) The individual strengths;

(3) Family strengths, as applicable;

(4) The level and nature of family involvement;

(5) Numbered goals and objectives;

(6) Specific completion criteria for each objective;

(7) The specific rehabilitative services and modalities to be used to achieve the desired goals and objectives;

(8) The start and anticipated completion dates for each objective;

(9) The specific services for each objective;

(10) The frequency, duration, and purpose of each service;

(11) The discipline of personnel that will provide each service;

(12) A list of names of participants including their titles and/or relationship to the individual;

(13) A crisis plan as defined in He-M 401; and

(14) A projected schedule for completing reevaluations of the individual’s condition and updating the ISP.

(e) For those individuals whose ISPs indicate residential or supported housing services, plans shall include specific, measurable objectives to be achieved through the provision of these services.

(f) For those individuals whose ISPs indicate employment, an employment goal shall be indicated.

(g) For those individuals whose ISPs indicate wellness management, wellness goals and objectives shall be indicated.

(h) Prior to the implementation of the plan, a psychiatrist’s signature shall be required to indicate the medical necessity of the services to be provided.

(i) For individuals whose ISPs indicate “medication monitoring only” services, the physician shall enter in the ISP, at least quarterly, a comprehensive statement, indicating:

(1) The continued medical necessity of “medication monitoring only” services; or

(2) The need for additional services, and the initiation of the ISP planning processes as outlined in He-M 401.

(j) The clinical record shall include documentation indicating that the choices regarding the development of the ISP were explained to the individual or guardian pursuant to He-M 401.

(k) The clinical record shall include documentation of the decision of the individual or guardian regarding the method of ISP development pursuant to He-M 401.

(l) The clinical record shall include the signature of the individual or guardian indicating:

(1) Involvement in the ISP development;

(2) The receipt of a written copy of the ISP;

(3) The explanation of the rights of the individual in accordance with He-M 309; and

(4) The receipt of a written copy of the individual’s rights.

(m) Documentation of any amendments to the ISP shall include the signature of the individual and the physician.

(n) Documentation of the addition of new services to the ISP shall include the signature of a physician prior to the services being provided or billed.

History

#7281, eff 5-23-00, EXPIRED: 5-23-08
#9512 eff 7-9-09; ss by #12409, eff 10-24-17

N.H. Code Admin. R. Ann. He-M 408.09 Documentation of Service Delivery {#sec-he-m-408.09 omnilex-key=us-nh-regs-official--agency-he-m--He-M 408.09}

(a) Progress notes shall be written for each:

(1) Therapeutic face-to-face encounter;

(2) Contact related to a crisis or change in health status; and

(3) Activity related to assessment, monitoring, or referral.

(b) Progress notes shall document:

(1) The therapeutic services provided;

(2) The objective(s) in the ISP for which the service was provided;

(3) The individual’s response to the service including progress towards objectives;

(4) The date the service was provided;

(5) The start and stop time of the service provided;

(6) The setting where the service was provided; and

(7) The signature, credentials, and title of the person providing services.

History

#7281, eff 5-23-00, EXPIRED: 5-23-08
#9512 eff 7-9-09; ss by #12409, eff 10-24-17

N.H. Code Admin. R. Ann. He-M 408.10 ISP Reviews {#sec-he-m-408.10 omnilex-key=us-nh-regs-official--agency-he-m--He-M 408.10}

(a) Timeframes identified in this section shall not replace any more frequent timeframes for reviews required by insurers or other agency or federal regulations.

(b) For each individual, the CMHP shall conduct and document a quarterly ISP review at least every 90 days from the effective date of the ISP.

(c) The quarterly review shall be based on the individual’s current status and progress, or lack thereof, in achieving the goals and objectives identified in the ISP, as documented in the progress notes for the reporting quarter.

(d) Documentation of the quarterly review shall include:

(1) The time period covered by the review;

(2) Description of the individual’s current functional impairments due to mental illness;

(3) Any other clinically relevant information regarding changes in status during the reporting quarter;

(4) Services received during the reporting quarter;

(5) The individual’s progress toward achieving ISP goals and objectives during the reporting quarter and the reasons for failure, if any, to meet the goals or objectives;

(6) Changes in the ISP during the reporting quarter;

(7) A statement and a dated, physician’s signature indicating participation in the quarterly review and the medical necessity of services to be provided;

(8) The date the documentation was completed and the signature and title of the person documenting the review; and

(9) Indication of individual/family/guardian participation in the review including signatures and dates whenever possible.

(e) All signatures required in (d) above, shall be obtained within 90 days of the date of the completion of the quarterly review.

(f) The CMHP shall conduct and document the annual ISP as the fourth quarterly review in accordance with the requirements in He-M 408.08 and (d) above.

History

#7281, eff 5-23-00, EXPIRED: 5-23-08
#9512 eff 7-9-09; ss by #12409, eff 10-24-17

N.H. Code Admin. R. Ann. He-M 408.11 Service Suspension and Termination Notes {#sec-he-m-408.11 omnilex-key=us-nh-regs-official--agency-he-m--He-M 408.11}

(a) All suspensions and terminations shall comply with the procedures identified in He-M 401.

(b) Whenever an individual has been suspended or terminated from a program or service, a note shall be entered into the clinical record and include:

(1) If a suspension of services, the effective date and length of the suspension of services;

(2) If a termination of services, the effective date of the termination of services;

(3) The reason(s) for the suspension or termination;

(4) The approval of the appropriate CMHP personnel; and

(5) Documentation that notification of the suspension or termination has been provided to the individual.

History

#7281, eff 5-23-00, EXPIRED: 5-23-08
#9512 eff 7-9-09; ss by #12409, eff 10-24-17

N.H. Code Admin. R. Ann. He-M 408.12 Discharge and Transfer Notes {#sec-he-m-408.12 omnilex-key=us-nh-regs-official--agency-he-m--He-M 408.12}

(a) For the purposes of this rule, “transfer” means when an individual moves from one treatment team to another within the same CMHP.

(b) For the purposes of this rule, “discharge” means when an individual discontinues treatment at a CMHP.

(1) Within 15 days after an individual’s discharge or transfer from a program; or

(2) No later than the date of the next scheduled quarterly review.

(d) The discharge or transfer note shall consist of a summary which includes, at a minimum:

(1) The reasons for admission;

(2) Progress made by the individual while in the program;

(3) The individual’s diagnosis;

(4) The individual’s physical and mental status at time of discharge or transfer;

(5) A brief service history and medication history;

(6) A listing of the individual’s current medication(s);

(7) The treating clinicians’ recommendations for further services and treatment including referrals, if indicated;

(8) The reason(s) for discharge or transfer;

(9) A statement that notification of the discharge or transfer was given to the individual; and

(10) The prognosis.

(e) Discharge and transfer notes shall be available to other service providers with the permission of the individual.

(f) The discharge due to the death of an individual shall be documented and include:

(1) The cause of death, when known;

(2) The date and time of death; and

(3) Results of an autopsy, when available.

History

#7281, eff 5-23-00, EXPIRED: 5-23-08
#9512 eff 7-9-09; ss by #12409, eff 10-24-17

N.H. Code Admin. R. Ann. He-M 408.13 Confidentiality {#sec-he-m-408.13 omnilex-key=us-nh-regs-official--agency-he-m--He-M 408.13}

(a) Each agency and facility, other than state facilities, shall develop and implement a policy regarding the confidentiality, storage, and disposal of clinical records and the circumstances under which information may be released.

(b) Confidentiality policies shall conform with He-M 309.

History

#7281, eff 5-23-00, EXPIRED: 5-23-08
#9512 eff 7-9-09; ss by #12409, eff 10-24-17

N.H. Code Admin. R. Ann. He-M 408.14 Waivers {#sec-he-m-408.14 omnilex-key=us-nh-regs-official--agency-he-m--He-M 408.14}

(a) A CMHP may request a waiver of specific procedures outlined in this part, in writing, from the department.

(b) A request for a waiver shall include:

(1) A specific reference to the section of the rule for which a waiver is being sought;

(2) A full description of why a waiver is necessary; and

(3) A full explanation of alternative provisions or procedures proposed by the CMHP.

(d) A request for a waiver shall be granted after the commissioner or his or her designee determines that the alternative proposed by the CMHP meets the objective or intent of the rule and:

(1) Does not negatively impact the health or safety of recipients; and

(2) Does not affect the quality of CMHP services.

(f) Waivers shall be granted in writing for a specific duration not to exceed 5 years except as in (g) below.

(g) Those waivers which relate to the following shall be effective for the CMHP’s current certification period only:

(1) Fire safety; or

(2) Other issues relative to health, safety or welfare of the individual that require periodic reassessment.

(h) A CMHP 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.

History

#7281, eff 5-23-00, EXPIRED: 5-23-08
#9512 eff 7-9-09; ss by #12409, eff 10-24-17

Part He-M 425 Community Mental Health Regions

N.H. Code Admin. R. Ann. He-M 425.01 Purpose {#sec-he-m-425.01 omnilex-key=us-nh-regs-official--agency-he-m--He-M 425.01}

The purpose of these rules is to designate the community mental health regions.

History

#4117, eff 8-22-86, EXPIRED 8-22-92
#5582, eff 2-12-93, EXPIRED 2-12-99
#6951, eff 2-27-99; ss by #8821, eff 2-17-07, EXPIRED: 2-17-14
#12523, eff 4-20-18

N.H. Code Admin. R. Ann. He-M 425.02 Definitions {#sec-he-m-425.02 omnilex-key=us-nh-regs-official--agency-he-m--He-M 425.02}

The words and phrases in this rule shall mean the following:

(a) "Commissioner" means the commissioner of the department of health and human services.

(b) "Community mental health program (CMHP)” means a program operated by the state, city, town, or county, or a community based New Hampshire nonprofit corporation for the purpose of planning, establishing, and administering an array of community-based, mental health services pursuant to He-M 403 and as defined in RSA 135-C:2, IV.

(c) "Region" means a geographic area designated in He-M 425.03 for the purpose of assigning primary responsibility for providing mental health services to the residents of certain communities.

History

#4117, eff 8-22-86, EXPIRED 8-22-92
#5582, eff 2-12-93, EXPIRED 2-12-99
#6951, eff 2-27-99; ss by #8821, eff 2-17-07, EXPIRED: 2-17-14
#12523, eff 4-20-18

N.H. Code Admin. R. Ann. He-M 425.03 Designation of Community Mental Health Regions {#sec-he-m-425.03 omnilex-key=us-nh-regs-official--agency-he-m--He-M 425.03}

(a) Regions designated for the purpose of providing community mental health services shall be the 10 community mental health regions specified in table 425-1, which sets forth the numerical designation of the regions and lists towns and cities by region:

Table 425-1, TOWNS AND CITIES BY REGION

REGION 1

Albany

Dummer

Lisbon

Shelburne

Bartlett

Easton

Littleton

Stark

Bath

Eaton

Livermore

Stewartstown

Benton

Effingham

Lyman

Stratford

Berlin

Errol

Madison

Sugar Hill

Bethlehem

Franconia

Milan

Tamworth

Brookfield

Freedom

Monroe

Tuftonboro

Carrol

Gorham

Moultonboro

Wakefield

Chatham

Hart's Location

Northumberland

Warren

Clarksville

Haverhill

Ossipee

Waterville

Colebrook

Jackson

Piermont

Wentworth Location

Columbia

Jefferson

Pittsburg

Whitefield

Conway

Lancaster

Randolph

Wolfeboro

Dalton

Landaff

Sandwich

Woodstock

Dixville

Lincoln

REGION 2

Acworth

Dorchester

Langdon

Orford

Canaan

Enfield

Lebanon

Plainfield

Charlestown

Goshen

Lempster

Springfield

Claremont

Grafton

Lyme

Sunapee

Cornish

Grantham

Newport

Unity

Croydon

Hanover

Orange

Washington

REGION 3

Alexandria

Bristol

Groton

Plymouth

Alton

Campton

Hebron

Rumney

Ashland

Center Harbor

Holderness

Sanbornton

Barnstead

Ellsworth

Laconia

Thornton

Belmont

Gilford

Meredith

Tilton

Bridgewater

Gilmanton

New Hampton

Wentworth

REGION 4

Allenstown

Danbury

Hopkinton

Salisbury

Andover

Deering

Loudon

Sutton

Boscawen

Dunbarton

Newbury

Warner

Bow

Epsom

New Loudon

Weare

Bradford

Franklin

Northfield

Webster

Canterbury

Henniker

Pembroke

Wilmot

Chichester

Hill

Pittsfield

Windsor

Concord

Hillsboro

REGION 5

Alstead

Greenville

Nelson

Surry

Antrim

Hancock

New Ipswich

Swanzey

Bennington

Harrisville

Peterborough

Temple

Chesterfield

Hinsdale

Richmond

Troy

Dublin

Jaffrey

Rindge

Walpole

Fitzwilliam

Keene

Roxbury

Westmoreland

Francestown

Lyndeborough

Sharon

Wilton

Gilsum

Marlborough

Stoddard

Winchester

Greenfield

Marlow

Sullivan

REGION 6

Amherst

Hudson

Merrimack

Mont Vernon

Brookline

Litchfield

Milford

Nashua

Hollis

Mason

REGION 7

Auburn

Candia

Hooksett

Manchester

Bedford

Goffstown

Londonderry

New Boston

REGION 8

Brentwood

Greenland

Newfields

Portsmouth

Deerfield

Hampton

Newington

Raymond

East Kingston

Hampton Falls

Newmarket

Rye

Epping

Kensington

North Hampton

Seabrook

Exeter

Kingston

Northwood

South Hampton

Fremont

New Castle

Nottingham

Stratham

REGION 9

Barrington

Lee

Milton

Rolinsford

Dover

Madbury

New Durham

Somersworth

Durham

Middleton

Rochester

Strafford

Farmington

REGION 10

Atkinson

Derry

Pelham

Sandown

Chester

Hampstead

Plaistow

Windham

Danville

Newton

Salem

(b) The community mental health program approved for each region pursuant to He-M 403.11 shall be responsible for providing mental health services to the residents of the region.

History

#4117, eff 8-22-86, EXPIRED 8-22-92
#5582, eff 2-12-93, EXPIRED 2-12-99
#6951, eff 2-27-99; ss by #8821, eff 2-17-07, EXPIRED: 2-17-14
#12523, eff 4-20-18

Part He-M 426 Community Mental Health Services

N.H. Code Admin. R. Ann. He-M 426.01 Purpose {#sec-he-m-426.01 omnilex-key=us-nh-regs-official--agency-he-m--He-M 426.01}

The purpose of these rules is to describe the services provided by CMHPs and community mental health providers that are offered to persons eligible for services pursuant to He-M 401 and are reimbursable under the medicaid program.

History

(See Revision Note at part heading for He-M 426) #5433, eff 7-2-92, EXPIRED: 7-2-98
#7088, eff 8-31-99; ss by #8867, eff 4-13-07; ss by #9285, eff 9-30-08; ss by #11182, INTERIM, eff 9-29-16, EXPIRES: 3-28-17; ss by #12154, eff 3-28-17

N.H. Code Admin. R. Ann. He-M 426.02 Definitions {#sec-he-m-426.02 omnilex-key=us-nh-regs-official--agency-he-m--He-M 426.02}

The words and phrases in this rule shall mean the following:

(a) “Assertive Community Treatment (ACT)” means the evidence-based practice of delivering comprehensive and effective services to individuals by a multidisciplinary team primarily in their homes, communities, and other natural environments.

(b) “Acute episode” means a sudden, generally unexpected, debilitating, and precipitous event in a psychiatric disorder.

(c) “Advanced practice registered nurse (APRN)” means a registered nurse who is licensed as having specialized clinical qualifications as provided in RSA 326-B:18 and is certified in psychiatric mental health.

(d) “Affiliated agency” means an agency that provides mental health or related services to individuals served by a community mental health program and that coordinates services and service planning with the community mental health program.

(e) “Commissioner” means the commissioner of the department of health and human services.

(f) “Community mental health program (CMHP)” means a program operated by the state, city, town, or county, or a community based New Hampshire nonprofit corporation for the purpose of planning, establishing, and administering an array of community-based, mental health services pursuant to He-M 403 and as defined in RSA 135-C:2, IV.

(g) “Community mental health provider” means a medicaid provider of community mental health services that has been previously approved by the commissioner to provide specific mental health services pursuant to He-M 426.

(h) “Competitive employment” means community-based employment at prevailing wage jobs, which reflect consumer preferences, strengths, and goals. The term includes positions in mainstream settings that are part or full time for any number of hours and result in payment of the Federal Insurance Contributions ACT (FICA) tax. The term refers to employment in which an individual earns the same pay and benefits as everyone else who holds the same position. The term includes self-employment that results in, or has the potential to result in, payment of the Self-Employment Contributions Act Tax (SECA). The term does not include employment that is set aside for mental health consumers or work that is controlled by a service agency.

(i) “Continuous treatment team” means a team of licensed practitioners of the healing arts and other mental health clinicians whose caseload is 12 or fewer individuals per direct service staff and who provide intensive treatment through an array of services to individuals who have mental illness and may have a history of substance abuse.

(j) “Covered services” means rehabilitative, treatment, and other community mental health services that are funded by the department and are available through CMHPs, community mental health providers, or agencies affiliated with such programs or providers.

(k) “Current Procedural Terminology” means a listing of descriptive terms and identifying codes for reporting and billing medical services and procedures, developed by the American Medical Association (AMA) in 2007 CPT available as listed in Appendix A.

(l) “Department” means the New Hampshire Department of Health and Human Services.

(m) “Evidence-based practices” means mental health practices that have consistently demonstrated their ability to help consumers achieve desired outcomes in mental health service research trials, where such trials have been conducted by multiple researchers with similar outcomes.

(n) “Evidence-based supported employment (EBSE)” means the provision of vocational supports to individuals following the Supported Employment Evidence Based Practice Kit (2010), available as listed in Appendix A, to ensure successful competitive employment in the community.

(o) “Facility” means New Hampshire hospital or a receiving facility designated pursuant to RSA 135-C:26 and He-M 405, Glencliff Home, or an acute psychiatric residential treatment program.

(p) “Functional support services” means medically necessary individual and group interventions that support optimal functioning and enhance resiliency, recovery, and integration in the community.

(q) “Family member” means the parent, foster parent, legal guardian, child, stepchild, brother, sister, spouse, significant other, grandparent, grandchild, stepparent, aunt, uncle, or first cousin of the individual.

(r) “Illness management and recovery (IMR)” means a specific set of services aimed at promoting recovery that are based on the Illness Management and Recovery Evidence Based Practice Kit (2010), available as listed in Appendix A.

(s) “Individual” means any person receiving or applying for services from a program or community residence. The term includes client.

(t) “Individual service plan (ISP)” means a written proposal that:

(1) Is developed annually as the result of a service planning process pursuant to He-M 401; and

(2) Includes the identification of an individual’s:

a. Goals and objectives;

b. Treatments and services;

c. Timelines for achieving the stated goals; and

d. Referrals to other specialized health services when appropriate.

(u) “Individualized resiliency and recovery oriented services (IROS)” means the following set of services:

(1) Illness management and recovery (IMR);

(2) Supported employment (SE);

(3) Crisis intervention;

(4) Therapeutic behavioral services;

(5) Family support; and

(6) Medication support.

(v) “Institution for mental diseases (IMD)” means a hospital, nursing facility, or other institution of more than 16 beds that is primarily engaged in providing diagnosis, treatment, or care of persons with mental diseases, including medical attention, nursing care, and related services. Further, an institution is an IMD if its overall character is that of a facility established and maintained primarily for the care and treatment of individuals with mental diseases.

(w) “Intensive partial hospitalization services” means clinically oriented programs designed to promote stabilization and rapid amelioration of the symptoms of any combination of acute or severe psychiatric disturbances.

(x) “Licensed practitioner of the healing arts” means a person who provides psychotherapy or other services identified pursuant to He-M 426 and meets the qualifications of He-M 426.08(h).

(y) “Long-term care” means services covered by Medicaid for Medicaid recipients who have been determined eligible pursuant to the criteria outlined in He-M 401.

(z) “Mental illness” means a condition of a person who is determined severely mentally disabled in accordance with He-M 401.05 through He-M 401.07 and who has at least one of the following psychiatric disorders classified in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as listed in Appendix A:

(1) Schizophrenia spectrum and other psychotic disorders except for the following:

a. Schizotypal personality disorder;

b. Substance or medication induced psychotic disorder; and

c. Psychotic disorder due to another medical condition;

(2) Bipolar and related disorders except for the following:

a. Substance or medication induced bipolar and related disorder; and

b. Bipolar disorder and related disorder due to another medical condition;

(3) Depressive disorders except for the following:

a. Disruptive mood dysregulation disorder;

b. Premenstrual dysphoric disorder;

c. Substance or medication induced depressive disorder; and

d. Depressive disorder due to another medical condition;

(4) Borderline personality disorder;

(5) Panic disorder;

(6) Obsessive compulsive disorder;

(7) Post traumatic stress disorder;

(8) Bulimia nervosa;

(9) Anorexia nervosa;

(10) Other specific feeding or eating disorders;

(11) Unspecified feeding or eating disorders; and

a. Anxiety;

b. Depression;

c. Delusions;

d. Hallucinations; and

e. Paranoia.

(aa) “Natural support” means a reference to people in a variety of roles who are engaged in supportive relationships with people in recovery outside of behavioral health settings. Examples of natural supports include family, friends, and other loved ones, landlords, employers, neighbors, or any other person who plays a positive, but non-professional, role in someone’s recovery.

(ab) “Not otherwise classified” means a category of covered CMHP services consisting of treatment or services rendered which do not meet the requirements of the procedures identified in He-M 426.07 - He-M 426.14 but meet the requirements identified pursuant to He-M 426.14(b).

(ac) “Nursing facility” means an institution as defined pursuant to He-E 802.01(s).

(ad) “Pre-admission screening and resident review (PASRR)” means procedures by which the department, in conformance with section 1919(b)(3)(F)(i) and (ii) of the Social Security Act, determines whether persons with mental illness who are applying for placement or currently residing in nursing facilities are in need of nursing facility level of service and, if so, whether they are in need of specialized services pursuant to He-M 1302.07.

(ae) “Peer support specialist” means CMHP staff who self-identify as having experience with a mental health or substance use condition and who chooses to become a service practitioner in the health care system.

(af) “Psychotherapy” means face to face clinical intervention or assessment and monitoring necessary to determine the course and progress of therapy that:

(1) Is based on psychological treatment principles;

(2) Has as its purpose the improvement of interpersonal and self-care skills, psychological understanding, or a change in behavior(s), or any combination of these;

(3) Is provided by a professional qualified pursuant to He-M 426.08(h)-(l);

(4) Is monitored through the clinical record; and

(5) Is based on an ISP.

(ag) “Recipient” means an individual who is eligible for reimbursement of CMHP and community mental health provider services under the state medicaid program.

(ah) “Restorative partial hospitalization services” means evidenced informed services that address integrated health care goals and objectives and are intended to impact the person’s whole health status, improve physical and overall health status indicators, as these factors have an important impact the individual’s mental health, maximize a recipient’s strengths, increase his or her ability to function in his or her living environments, and lead to integration of the recipient into the community.

(ai) “Serious emotional disturbance (SED)” means severe mental disability in persons under the age of 18, and includes all psychiatric disorders in the Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 with the exception of developmental disabilities, intellectual disabilities, neurocognitive disorders, anti-social personality disorders, and and conditions “due to another medical condition.”

(aj) “State fiscal year” means the period of time extending from July 1 of one year through June 30 of the following year.

(ak) “Subcontractor” means an person or organization that enters into an agreement with a CMHP to receive payments from the CMHP for the delivery of medicaid funded mental health services described in an ISP.

(al) “Transitional employment” means time-limited employment for the purpose of vocational assessment or training.

(am) “Unit” means a period of time during which services are rendered. Where units refer to a specific length of time, units are reimbursed in whole units and time of service is rounded to the nearest whole unit.

(an) “Visit” means all services provided to a recipient per appointment or encounter with a provider.

(ao) “Work preparation” means interventions that assist in obtaining or maintaining competitive employment, and may include cues for social norms and activities of daily living (ADL).

History

(See Revision Note at part heading for He-M 426) #5433, eff 7-2-92; amd by #5971, eff 2-1-95; amd by #6568, eff 8-22-97; ss by #7088, eff 8-31-99; ss by #8867, eff 4-13-07; ss by #9285, eff 9-30-08; ss by #9581, eff 10-24-09; amd by #12079, eff 12-29-16; ss by #12154, eff 3-28-17

N.H. Code Admin. R. Ann. He-M 426.03 Recipient Eligibility {#sec-he-m-426.03 omnilex-key=us-nh-regs-official--agency-he-m--He-M 426.03}

All medicaid recipients who are not residents of an IMD shall be eligible to receive the services of CMHPs and community mental health providers when services are delivered in accordance with an ISP.

History

(See Revision Note at part heading for He-M 426) #5433, eff 7-2-92; ss by #6568, eff 8-22-97; ss by #7088, eff 8-31-99; ss by #8867, eff 4-13-07; ss by #9285, eff 9-30-08; ss by #11182, INTERIM, eff 9-29-16, EXPIRES: 3-28-17; ss by #12154, eff 3-28-17

N.H. Code Admin. R. Ann. He-M 426.04 Community Mental Health Providers {#sec-he-m-426.04 omnilex-key=us-nh-regs-official--agency-he-m--He-M 426.04}

(a) Community mental health providers approved prior to August 22, 1997 shall be authorized to continue to provide medicaid funded mental health services until the date of expiration of provider status as long as the provider:

(1) Is in compliance with applicable rules;

(2) The provider shall have a plan which describes:

a. Methods for collaborative service planning and service delivery with the regional CMHP, including joint development and approval of an ISP for each individual;

b. Service planning which includes the individual’s family members and other persons significant to the individual, to the extent that the individual wishes such persons to be involved;

c. Service linkages so there is continuity of care between the community mental health provider and CMHP with minimal resource duplication; and

d. Provision of 24 hour emergency services, which:

Are contracted or provided directly by the community mental health provider or CMHP; and
Include contingency plans for each individual; and

(3) Maintains a quality assurance plan which shall:

a. Include quality assurance indicators to identify problems that impact directly or indirectly on individuals or on areas which influence individual care;

b. Provide for the development and monitoring of corrective action plans to correct identified problems or deficiencies, where such plans specify time frames and persons responsible for corrective action;

c. Specify how quality assurance findings are utilized in staff development and annual staff evaluations; and

d. Allow the department to conduct announced or unannounced quality assurance reviews of the community mental health providers to assure that such services and programs are operated in accordance with the department’s rules, contract provisions, and the federally approved state plan mandated by Public Law 106-310.

(b) Only CMHPs or their subcontractors shall be authorized to provide the medicaid funded community mental health services described in these rules.

History

(See Revision Note at part heading for He-M 426) #5433, eff 7-2-92; amd by #5971, eff 2-1-95; ss by #6568, eff 8-22-97; ss by #7088, eff 8-31-99; ss by #8867, eff 4-13-07; ss by #9285, eff 9-30-08; ss by #11182, INTERIM, eff 9-29-16, EXPIRES: 3-28-17; ss by #12154, eff 3-28-17

N.H. Code Admin. R. Ann. He-M 426.05 Provider Participation {#sec-he-m-426.05 omnilex-key=us-nh-regs-official--agency-he-m--He-M 426.05}

(a) Providers of services shall provide sufficient privacy to maintain confidentiality of communication between recipient and staff members.

(b) CMHPs shall be staffed by a multidisciplinary team consisting of licensed practitioners of the healing arts in:

(1) Psychiatry;

(2) Psychology;

(3) Psychiatric social work;

(4) Psychiatric nursing; and

(5) Mental health counseling.

(c) CMHPs shall have as a medical director a psychiatrist who is either board certified or eligible for application for certification according to the most recent regulations of the American Board of Psychiatry and Neurology, Inc., or its successor organization, to assume medical responsibility for all clinical diagnoses and treatment programs. The medical director shall be at the CMHP a minimum of 20 hours per week.

(d) Services offered by CMHPs shall be overseen by a psychiatrist responsible for the individual’s care as documented in the ISP.

(e) An M.D. or APRN enrolled in a residency training program in psychiatry from a college or university accredited by an accrediting agency recognized by the U.S. Department of Education shall deliver services in accordance with his or her specific board of licensure.

(f) Providers of community mental health services shall have multidisciplinary staff conferences pursuant to He-M 401.12 to review the progress of current cases. Each CMHP shall have a quality assurance program including utilization and peer review to evaluate the effectiveness of covered services as contained in He-M 426.04.

History

(See Revision Note at part heading for He-M 426) #5433, eff 7-2-92; ss by #6568, eff 8-22-97; ss by #7088, eff 8-31-99; ss by #8867, eff 4-13-07; ss by #9285, eff 9-30-08; ss by #11182, INTERIM, eff 9-29-16, EXPIRES: 3-28-17; ss by #12154, eff 3-28-17

N.H. Code Admin. R. Ann. He-M 426.06 Provider Limitations {#sec-he-m-426.06 omnilex-key=us-nh-regs-official--agency-he-m--He-M 426.06}

(a) The services listed in He-M 426.07 - He-M 426.17 shall be covered services, available under the medicaid program to all eligible medicaid recipients when provided by, or recommended by, a licensed practitioner of the healing arts pursuant to these rules. Services identified in He-M 426.07 - He-M 426.17 may be provided by CMHPs. Community mental health providers shall only provide those services identified in He-M 426.07 - He-M 426.17 for which they have received approval pursuant to He-M 426.04.

(b) Services provided in an inpatient hospital setting shall only be reimbursable through medicaid if provided by a legally qualified psychiatrist. Services provided in an IMD shall not be reimbursable.

(c) Services recommended by a licensed practitioner of the healing arts shall be provided in accordance with department rules and state law.

History

(See Revision Note at part heading for He-M 426) #5433, eff 7-2-92, EXPIRED: 7-2-98
#7088, eff 8-31-99; ss by #8867, eff 4-13-07; ss by #9285, eff 9-30-08; ss by #11182, INTERIM, eff 9-29-16, EXPIRES: 3-28-17; ss by #12154, eff 3-28-17

(a) Administration of medication by injection shall:

(1) Be a covered CMHP service;

(2) Be performed by a physician, physician assistant, registered nurse, or licensed practical nurse licensed to practice in New Hampshire; and

(3) Include administering intramuscular medication required for the treatment of a recipient’s mental illness.

(b) The service outlined in (a) above shall not include administration of oral medication, or medical analysis and review performed pursuant to a medication check. Administration of medication by injection and medication check may be billed, using the respective billing codes, as part of the same visit.

(c) Nursing assessment and evaluation for the purpose of reviewing medication compliance, education and symptomatology shall be a covered service when provided by a registered nurse or licensed practical nurse. There shall be no more than one procedure billed per recipient per day.

(d) Brief office visit shall be a covered service when conducted for the sole purpose of monitoring or changing drug prescriptions used in the treatment of mental, psychoneurotic or personality disorders by physicians, physician assistants or APRNs within the purview of their respective professions. This service shall be billed in accordance with current procedural terminology.

(e) Pharmacological management, including prescription, use, and review of medication with no more than minimal medical psychotherapy conducted by physicians, physician assistants, or APRNs within the purview of their respective professions shall be a covered service.

(f) Brief office visits, nursing assessment and evaluation, or pharmacologic management shall not be billed for recipients on days during which the recipient is in attendance at a partial hospitalization program. A nurse assessment and evaluation shall not be billable on the same day as a medication check.

(g) Comprehensive medication service for clozapine or clozaril management shall be a covered service provided by a physician, physician assistant, APRN, registered nurse, or licensed practical nurse within the purview of their respective profession to prescribe, monitor the effects of, review, or adjust prescribed clozapine or clozaril. Treatment may be provided up to a maximum of once per day, when a documented drop in the individual’s white blood cell count (WBC) occurs.

(h) Comprehensive medication service for clozapine or clozaril management shall include the following:

(1) Ensuring that the required blood sample is drawn;

(2) Ensuring that the WBC is within established limits;

(3) Recording the WBC;

(4) Sending the results of the WBC to the prescribed clozapine or clozaril monitoring system;

(5) Writing the prescription for clozapine or clozaril as appropriate;

(6) Ensuring that the individual is provided with a supply of clozapine or clozaril as appropriate; and

(7) Signature by a physician, physician assistant, or APRN.

(i) Medication services described in (c) through (f) above shall be limited to one service per day and shall not be billed on the same day as any other service described in (c) through (f) above.

History

(See Revision Note at part heading for He-M 426) #5433, eff 7-2-92; amd by #5971, eff 2-1-95; ss by #7088, eff 8-31-99; ss by #8867, eff 4-13-07; ss by #9285, eff 9-30-08; ss by #11182, INTERIM, eff 9-29-16, EXPIRES: 3-28-17; ss by #12154, eff 3-28-17

N.H. Code Admin. R. Ann. He-M 426.08 Psychotherapeutic Services {#sec-he-m-426.08 omnilex-key=us-nh-regs-official--agency-he-m--He-M 426.08}

(a) Individual psychotherapy shall:

(1) Be a covered CMHP service;

(2) Include therapy, crisis intervention, or assessment and monitoring necessary to determine the course and progress of therapy or to stabilize an individual experiencing an acute psychiatric episode; and

(3) Be verbal, with the therapist in direct, personal, involvement with the recipient to the exclusion of other recipients, individuals, and duties.

(b) Individual psychotherapy shall be billed in accordance with current procedural terminology. Individual therapy with medication management shall be billed as one procedure when delivered during the same visit.

(1) Be a covered CMHP service; and

(2) Be therapy, or assessment and monitoring necessary to determine the course and progress of therapy, that is performed in a direct, personal, involvement with the recipient in a setting with other recipients or individuals.

(d) Group psychotherapy shall be billed in accordance with current procedural terminology.

(e) Group psychotherapy shall meet the following criteria:

(1) A minimum of 2 unrelated recipients and a maximum of 10 recipients shall be in attendance to constitute a group;

(2) Sessions shall be scheduled often enough to provide effective treatment consistent with the ISP;

(3) The group focus shall be face-to-face dialogue of a verbal rather than performance nature; and

(4) Individual progress notes for each session shall be recorded in each recipient’s record with specific attention directed toward goal achievement as stated in the recipient’s ISP.

(f) Family therapy shall be:

(1) A covered service; and

(2) Psychotherapy with:

a. The primary identified recipient and that recipient’s natural or surrogate family member(s); or

b. The natural or surrogate family member(s) without the recipient present.

(g) Billing for family therapy shall be as follows:

(1) Only one family member’s medicaid identification number shall be billed regardless of the eligibility of other members or their inclusion in the problem;

(2) If a child who has been determined eligible for services pursuant to He-M 401 is the primary reason for the family to be receiving therapy, then that child’s medicaid identification number shall be used when billing for services;

(3) If the primary recipient is not present but continues to be the focus of the therapy, that recipient’s medicaid identification number shall be used when billing for services and the reason why the recipient was not present shall be documented; and

(4) This procedure shall be billed in accordance with current procedural terminology.

(h) For the purpose of providing psychotherapy without supervision, clinical staff of CMHPs or providers shall meet the applicable following minimum qualifications:

(1) Psychiatrists shall meet the requirements of RSA 135-C:2, XIII;

(2) Psychologists shall be licensed in accordance with RSA 329-B;

(3) Pastoral psychotherapists shall be licensed in accordance with RSA 330-A:17;

(4) Marriage and family therapists shall be licensed in accordance with RSA 330-A:21;

(5) Clinical mental health counselors shall be licensed in accordance with RSA 330-A:19;

(6) Clinical social workers shall be licensed in accordance with RSA 330-A:18; and

(7) Nurses shall be registered as required by RSA 326-B:6 and have a master’s degree in psychiatric nursing or be licensed as an advanced registered nurse practitioner (APRN) with a psychiatric mental health specialty in accordance with RSA 326-B:11.

(i) Except as provided pursuant to (k) and (m) below, anyone providing psychotherapy services who does not meet the established standards as indicated in (h) above shall:

(1) Have completed at least one year of work in the field of psychiatric or mental health services under the supervision of a psychiatrist, doctoral level psychologist or a licensed mental health professional or person authorized pursuant to RSA 329-B:28, I(e); and

(2) Have at least a master’s degree in marriage and family therapy, psychology, social work, rehabilitation counseling, or education/counseling from a college or university accredited by an accrediting agency recognized by the U.S. Department of Education; or

(3) Be a registered nurse with a certificate in mental health nursing from the American Nurses’s Association.

(j) Persons who qualify to provide psychotherapy pursuant to (i) above shall have ongoing supervision of at least 2 hours per month. There shall be direct individual or group supervision of at least one hour per month by a licensed practitioner of the healing arts. The second hour may be peer review or case review, such as client centered conferences. Direct supervision shall occur when the supervisor meets with the clinician to review his or her clinical practice in order to evaluate his or her performance.

(k) Persons who are enrolled in formal internships in a professional field of study of mental health services and provide psychotherapy services shall:

(1) Be enrolled in at least a master’s degree program in psychology, social work, rehabilitation counseling, education/counseling, or nursing at a college or university accredited by an accrediting agency recognized by the U.S. Department of Education; or

(2) Be enrolled in a doctoral or post-doctoral program at a college or university accredited in psychology by an accrediting agency recognized by the U.S. Department of Education.

(l) Persons providing psychotherapy pursuant to (k) above shall receive direct supervision of at least one hour per week from a licensed practitioner of the healing arts, appropriate to the intern’s field of study. The medicaid program shall reimburse CMHPs and community mental health providers only when supervision occurs and is documented. Direct supervision shall occur when the supervisor meets with the intern to review his or her clinical practice in order to evaluate his or her performance. 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 a monthly note summarizing his or her evaluation.

(m) Pursuant to RSA 135-C:3, persons providing medicaid reimbursed psychotherapy services in approved CMHPs prior to July 1, 1987, the initial effective date of He-M 426, shall be considered to have met the standards for other providers of psychotherapy set forth in (i) above and shall be supervised in accordance with the applicable requirements in (j) above.

History

(See Revision Note at part heading for He-M 426) #5433, eff 7-2-92; amd by #5971, eff 2-1-95; ss by #7088, eff 8-31-99; ss by #8867, eff 4-13-07; ss by #9285, eff 9-30-08; ss by #11182, INTERIM, eff 9-29-16, EXPIRES: 3-28-17; ss by #12154, eff 3-28-17

N.H. Code Admin. R. Ann. He-M 426.09 Emergency Services {#sec-he-m-426.09 omnilex-key=us-nh-regs-official--agency-he-m--He-M 426.09}

(a) Emergency services shall be:

(1) Covered CMHP services;

(2) Face to face interventions for the purposes of:

a. Reducing a recipient’s acute psychiatric symptoms;

b. Reducing the likelihood of the recipient harming self or others; or

c. Assisting the recipient to return to his or her pre-crisis level of functioning; and

(3) Conducted with the therapist in direct, personal, involvement with the recipient and at the recipient’s request, natural and surrogate family members.

(b) Emergency services shall be available 24 hours a day, 7 days per week and be accessible to individuals anywhere in the region served by the CMHP.

(c) As follow-up to the initial emergency response, an individual shall be eligible to receive a maximum of 5 emergency service sessions, consisting of not more than 6 15-minute units per session, for the purpose of stabilization of the emergency situation prior to intake or referral to another service or agency.

(d) Emergency services shall be billed in 15-minute units, and shall be limited to 6 units per recipient per day to a maximum of 6 sessions per period of acute psychiatric crisis.

(e) Emergency services shall be provided by staff of discrete emergency services programs or other staff serving as part of a formalized emergency services rotation.

(f) Emergency assessment shall be provided for the purpose of emergency evaluation for hospital placement, crisis respite care, revocation of conditional discharge, or other out-of-home placement.

(g) The providers of emergency assessment shall meet the qualifications established in He-M 426.08(h)-(m).

History

(See Revision Note at part heading for He-M 426) #5433, eff 7-2-92, EXPIRED: 7-2-98
#7088, eff 8-31-99; ss by #8867, eff 4-13-07; ss by #9285, eff 9-30-08 (from He-M 426.08); ss by #11182, INTERIM, eff 9-29-16, EXPIRES: 3-28-17; ss by #12154, eff 3-28-17

N.H. Code Admin. R. Ann. He-M 426.10 Evaluations and Testing {#sec-he-m-426.10 omnilex-key=us-nh-regs-official--agency-he-m--He-M 426.10}

(a) Psychiatric diagnostic interview exam shall include:

(1) History of present illness;

(2) Mental status examination; and

(3) Disposition.

(b) Psychiatric diagnostic interview exam shall:

(1) Be a covered CMHP service when conducted by staff meeting qualifications as outlined in He-M 426.08(h)-(k);

(2) Be billed for the initial intake service;

(3) Be billed as one event;

(4) Be billed in accordance with current procedural terminology; and

(5) Be co-signed by a licensed supervisor when completed by CMHC staff qualified pursuant to He-M 426.08 (i)-(l).

(1) History of present illness;

(2) Examination; and

(3) Medical decision-making.

(d) Evaluation and management shall:

(1) Be a covered CMHP service;

(2) Be billed as one event; and

(3) Be billed in accordance with current procedural terminology.

(e) Psychological testing shall be a covered CMHP service and consist of psychometric or projective tests, or both, with a written report. This procedure shall be billed per hour and be limited to 6 hours per recipient per 6 month period.

(f) Neuropsychological tests shall be evaluations that are:

(1) Designed to determine the functional consequences of known or suspected brain injury through testing of the neurocognitive domains responsible for language, including:

a. Perception;

b. Memory;

c. Language;

d. Problem solving;

e. Adaptation; and

f. Constructional praxis; and

(2) Carried out on persons who have suffered neurocognitive effects of medical disorders that impinge directly or indirectly on the brain.

(g) Neuropsychological tests shall be billed per hour and be limited to 6 hours per recipient per 6 month period. Persons licensed by state statute to provide psychological services shall provide this service.

(h) Neuropsychological testing may be performed by persons enrolled in formal internship in a professional field of study of psychology or neuropsychological testing if they are enrolled in a doctoral or postdoctoral program at a college or university accredited in psychology by an accrediting agency recognized by the U.S. Department of Education.

(i) Persons providing neuropsychological testing pursuant to (h) above shall receive direct supervision of at least one hour per week from a person licensed by state statute to provide psychological services:

(1) Direct supervision shall occur when the supervisor meets with the intern to review his or her neurological testing practice in order to evaluate his or her performance;

(2) 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;

(3) The supervisor shall write and sign a monthly note summarizing his or her evaluation; and

(4) The person shall meet the supervision requirements relative to meeting his or her internship requirements, if applicable.

(j) The medicaid program shall reimburse CMHPs and community mental health providers only when supervision occurs and is documented.

(k) PASRR evaluations shall be covered CMHP services and include psychiatric evaluations and related services to determine appropriateness for nursing home placement.

History

(See Revision Note at part heading for He-M 426) #5433, eff 7-2-92; amd by #5971, eff 2-1-95; ss by #7088, eff 8-31-99; ss by #8867, eff 4-13-07; ss by #9285, eff 9-30-08 (from He-M 426.09);ss by #11182, INTERIM, eff 9-29-16, EXPIRES: 3-28-17; ss by #12154, eff 3-28-17

N.H. Code Admin. R. Ann. He-M 426.11 Partial Hospitalization Services {#sec-he-m-426.11 omnilex-key=us-nh-regs-official--agency-he-m--He-M 426.11}

(a) Partial hospitalization shall be a covered service and shall consist of intensive partial hospitalization services and restorative partial hospitalization services as described in (e) and (f) below.

(b) Only individuals certified to receive long-term care services pursuant to He-M 426.19 shall be eligible for partial hospitalization services.

(c) Programs shall operate a minimum of 6 hours per day on weekdays and 4 hours per day on holidays and weekends for each day for which services are billed.

(d) Billing for partial hospitalization services shall be in half day or full day units, as follows:

(1) One half day of partial hospitalization shall be attendance at staff directed programs for at least 2 and less than 3 hours; and

(2) A full day of partial hospitalization shall be attendance at staff directed programs for 3 or more hours.

(e) Intensive partial hospitalization services shall be provided as follows:

(1) Placement into intensive partial hospitalization shall be made only with a written order from a psychiatrist, and be based on symptoms affecting the recipient’s ability to function adequately in a community setting;

(2) Intensive partial hospitalization shall be offered no fewer than 5 days per week and be designed to provide short-term, structured, and active treatments which are problem-solving in nature and which are directed toward full or partial recovery from the prevailing crisis and the return of the recipient to a pre-crisis level of functioning;

(3) The provision of intensive partial hospitalization services shall be based on identified recipient needs as documented in the recipient’s ISP;

(4) Intensive partial hospitalization services shall include:

a. Individual or group psychotherapy;

b. Psychological evaluations and testing;

c. Medication monitoring, evaluation, administration, and education;

d. Clinical assessments to assist in individual service planning;

e. Family or significant other psychotherapy; and

f. Psychologically supportive individual or group activities.

(5) The daily services and activities of an intensive partial hospitalization program shall consist of:

a. A minimum of 2 hours per day of any combination of activities contained in (e)(4)a. - e. above; and

b. The remainder of the day may consist of activities contained in (e)(4)f. above;

(6) Participation in this program shall not exceed 20 treatment days per acute episode without a written order from a psychiatrist and a documented service plan review; and

(7) There shall be no reimbursement from medicaid for any treatment exceeding 30 days per episode, or 90 days per state fiscal year.

(f) Restorative partial hospitalization shall be provided as follows:

(1) Services shall encourage the development of those skills necessary for transfer to a variety of community living environments, including employment settings, and, as much as possible, reduce a recipient’s dependency on state or federally funded programs while enabling the recipient to become a productive member of society, earn a wage, and live as independently as possible;

(2) Placement and participation in restorative partial hospitalization services shall be based on the needs of the recipient as documented in the ISP and functional deficits identified in the eligibility determination process pursuant to He-M 401;

(3) Restorative treatment shall:

a. Promote emotional, behavioral, physical health, and psychological change;

b. Minimize the effects of mental disorders;

c. Promote health maintenance through clinical activities which foster the reduction of psychological stress;

d. Promote independent living;

e. Help maintain the individual in a community setting;

f. Teach skills necessary for an individual to function in the environments in which he or she lives and works; and

g. Utilize accepted principles of psychosocial rehabilitation;

(4) Restorative partial hospitalization services shall consist of the following components:

a. A comprehensive identification of the recipient’s skills, strengths, and deficits in relation to the skill demands and supports required in the particular environment in which the recipient wants or needs to function, as such environment is consistent with the goals listed in the individual’s ISP;

b. Active recipient involvement which requires that assessment and intervention procedures be explained to and understood by the recipient;

c. Teaching of skills necessary for the recipient to succeed in his or her chosen environments;

d. A crisis management plan which shall serve to avert crises or mobilize resources rapidly to respond to crises and be implemented by intensive partial hospitalization services staff, emergency services staff, or other appropriate staff within the CMHP; and

e. Case management to assure linkage with all necessary services and people involved in the recipients’ care, coordinated service planning, and monitoring of progress toward goals;

(5) Restorative partial hospitalization services shall include the following services:

a. Individual or group counseling and psychotherapy;

b. Medication monitoring, evaluation, administration, and education;

c. Family or significant other services, counseling, and psychotherapy;

d. Teaching daily living skills, community living skills, and self-care skills;

e. Nutritional services;

f. Basic education;

g. Recreational services;

h. Psychological evaluations and testing; and

i. Psychologically supportive individual or group activities;

(6) Recreational activities such as bowling, swimming, and field trips shall be billable only when they are adjunct to, but not the only component of, the restorative partial hospitalization service; and

(7) Medicaid reimbursement for restorative partial hospitalization services shall not be made for a recipient for any day in which the recipient receives fewer than 2 hours of service, exclusive of recreational activities, unless in a given week the average per day participation in non-recreational activities exceeds 2 hours per day of service to the recipient.

(g) In addition to requirements listed in (e) and (f) above, reimbursement criteria for intensive and restorative partial hospitalization services shall include the following:

(1) Out-of-facility activities shall be covered under the following circumstances:

a. The activities shall be directed by the partial hospitalization staff as part of a program based in the CMHP; and

b. Stipends shall not be paid to recipients of partial hospitalization services in connection with the activities;

(2) The medicaid rate for partial hospitalization shall be all inclusive;

(3) On a day that a recipient receives partial hospitalization services, no reimbursement for other covered services shall be made except as allowed in (4) below;

(4) The following services shall be reimbursable on any day that a recipient receives partial hospitalization services:

a. Case management services when provided under an approved case management option of the medicaid program;

b. Emergency visits if they occur outside of the normal operating hours of the partial hospitalization program;

c. Services provided by an assertive community treatment team;

d. Individualized resiliency and recovery oriented services;

e. Medication checks for clozaril and clozapine management;

f. Psychiatric evaluation for medicaid eligibility; and

g. Services provided by a mobile crisis team, which is a multidisciplinary team that provides crisis stabilization and case management services as an alternative to hospitalization.

(5) Services provided on a day the recipient did not attend partial hospitalization shall be billed in the normal manner for the service; and

(6) Reimbursement for partial hospitalization services shall be limited to services for outpatients.

(h) Staff who provide partial hospitalization services shall meet the following criteria:

(1) A partial hospitalization program shall employ a partial hospitalization supervisor who performs the following duties:

a. Supervises all staff of the partial hospitalization program;

b. Provides program administration; and

c. Ensures partial hospitalization services are coordinated with other services to assure continuity of recipient service; and

(2) The supervisor of partial hospitalization services shall minimally have:

a. Full time employment equaling 3 years’ experience in programs for persons with long term mental illness;

b. One year of supervisory, management, or administrative experience; and

c. A baccalaureate degree in social work, rehabilitation, psychology, education, or a related human services field.

(i) Each staff person providing partial hospitalization services shall at a minimum have:

(1) Either:

a. A baccalaureate degree in social work, rehabilitation, psychology, education, or a related human services field; or

b. An associate’s degree in social work, rehabilitation, psychology, education, or a related human services field and the following experience:

Two years of experience working with persons who have severe mental disability; or
Two years of experience that provides an person with an understanding of mental illness and that was acquired as an adult in the provision of significant supports to persons with mental illness, including the experience acquired by family members of persons with mental illness or by other persons who have personal knowledge of mental illness; and

(2) Completed the training curriculum based on the Illness Management and Recovery Evidence Based Practice Kit (2010), available as listed in Appendix A, if the staff will be providing IMR services.

History

(See Revision Note at part heading for He-M 426) #5433, eff 7-2-92; amd by #5971, eff 2-1-95; ss by #7088, eff 8-31-99; ss by #8867, eff 4-13-07; ss by #9285, eff 9-30-08 (from He-M 426.10); ss by #11182, INTERIM, eff 9-29-16, EXPIRES: 3-28-17; ss by #12154, eff 3-28-17

N.H. Code Admin. R. Ann. He-M 426.12 Individualized Resiliency and Recovery Oriented Services (IROS) {#sec-he-m-426.12 omnilex-key=us-nh-regs-official--agency-he-m--He-M 426.12}

(a) IROS shall be a covered service and consist of:

(1) Evidence-based practices delivered in accordance with the Illness Management and Recovery Evidence Based Practice Kit (2010), available as listed in Appendix A, which describes the following services:

a. Illness management and recovery (IMR), group;

b. Illness management and recovery, individual; and

c. Evidence-based supported employment (EBSE); and

(2) Functional support services including the following:

a. Crisis intervention;

b. Group therapeutic behavioral services;

c. Individual therapeutic behavioral services;

d. Family support; and

e. Medication support.

(b) IROS shall be provided in the individual’s current living, employment or educational situation. or other community setting taking into account the individual’s preferences.

(c) IROS provided in any office setting shall not exceed 1 hour per month, or 12 hours per state fiscal year with the exception of computer-based EBSE, IMR, crisis intervention, and medication support.

(d) IROS shall not be eligible for reimbursement if provided in an office setting with the exception of (c) above, with the exception of computer-based EBSE, IMR, crisis intervention and medication support.

(e) Only individuals eligible to receive long-term services pursuant to He-M 426.19 shall be eligible to receive IROS.

(f) Quality assurance reviews shall be as follows:

(1) A sample of clinical records for recipients of IROS services shall be reviewed as part of a quality assurance review;

(2) The purpose of this review shall be to determine whether documentation in the clinical record conforms with all requirements outlined in He-M 408 and He-M 426.12; and

(3) Fidelity review process utilizing the Illness Management and Recovery Evidence Based Practice Kit (2010), available as listed in Appendix A.

(g) IROS shall be face-to-face individual and group interventions that include the elements and objectives in (h)-(j) below. IROS shall be billed as a group intervention when 2 or more unrelated recipients are in attendance, not to exceed 10 participants.

(h) Illness management and recovery (IMR), delivered on an individual and group basis, shall:

(1) Be based on the Illness Management and Recovery Evidence Based Practice Kit (2010), available as listed in Appendix A, and ensure fidelity to that model;

(2) Have as its objective teaching individuals with a mental illness, strategies for:

a. Collaborating actively in their treatment with professionals;

b. Reducing their risk of relapses and rehospitalizations;

c. Reducing the severity and distress related to symptoms; and

d. Improving their social support;

(3) Include the following specific components, at a minimum:

a. Psychoeducation about the nature of mental illness and its treatment;

b. Behavioral tailoring to help individuals incorporate the taking of medications into their daily routines;

c. Relapse prevention planning;

d. Teaching coping strategies to manage distressing, persistent symptoms;

e. Cognitive behavior therapy strategies for psychosis, depression, and bipolar disorder; and

f. Social skills training;

(4) Incorporate the following:

a. An assessment, identification, and documentation of the target symptom(s) or problem(s);

b. The specification of the goals or desired outcomes; and

c. The specific interventions that will be used to achieve the desired outcomes;

(5) Be of a duration that allows the time necessary to complete the IMR curriculum; and

(6) Be individual or group interventions that support recipients’ optimal functioning and enhance resiliency, recovery, and integration in the community.

(i) Evidence-based supported employment (EBSE) shall:

(1) Be based on the Supported Employment Evidence Based Practice Kit (2010) as, available as listed in Appendix A, and fidelity to that model;

(2) Have as its objective the participation in competitive employment for individuals eligible under He-M 401;

(3) Utilize a team approach inclusive of an employment specialist for treatment;

(4) Include medicaid and non-medicaid funded services, funded in part by New Hampshire Vocational Rehabilitation;

(5) Include the following specific components and criteria:

a. Support of an individual’s entry into or return to competitive employment on a permanent status, where potential applicants include persons in the general population;

b. Full integration of SE staff with other CMHP staff;

c. Eligibility based primarily on consumer choice, where eligibility criteria such as the following shall be irrelevant:

Job readiness;
Lack of substance abuse;
No history of violent behavior;
Minimal intellectual functioning; and
Mild symptoms;

d. Supports for individuals that are:

Provided on an ongoing basis;
Not time limited; and
Based on the individual’s continued need for services, as documented in the ISP;

e. Vocational assessment which shall gather information about psychiatric history, symptoms, functional limitations, coping skills and strengths and how these affect the consumer’s employment history and daily functioning as it is relates to employment, and excludes competency testing, screening for exclusionary criterion, work readiness evaluations, vocational testing, interest inventories, situational assessments, and transitional employment;

f. Job search support which shall assist an individual in managing symptoms so that they may develop a plan for approaching employers, identify personal preferences, identify and develop supports around work preparation, have individual outreach to employers, obtain support related to interviews, and include other interventions around meeting with other providers regarding benefits, work incentives, and other vocational supports; and

g. Follow-along supports which shall include interventions, strategies, and prompts to assist individuals in managing their psychiatric symptoms as they affect employment and address the following:

Managing social conflicts or challenges in the workplace;
Managing symptoms that impact getting to and from employment;
Managing work related income;
Coordinating benefits and entitlement as impacted by work; and
Improving ability to communicate on and off the job;

(6) Be direct, active, face-to-face clinical interventions necessary for the individual to achieve the goals and objectives identified on the ISP;

(7) Be individual interventions; and

(8) Be delivered as a clinical service if they are directly related to an individual’s symptoms due to a mental illness which inhibits the individual from participating in or obtaining competitive employment.

(j) The individual’s treatment planning team shall include an EBSE specialist to assure services effectively address symptoms and challenges that prevent the individual from successfully achieving their employment goals.

(k) The EBSE components in(j)(5)e.-g. above shall not be a medicaid billable service when they, either:

(1) Do not include the individual; or

(2) Do not address symptoms related to an individual’s mental illness.

(l) Documentation of interventions for EBSE shall comply with He-M 408.09.

(m) Functional support services (FSS) shall be medically necessary individual or group interventions that shall:

(1) Be direct, active, face-to-face clinical interventions necessary for the individual to achieve the goals and objectives identified on the ISP;

(2) Actively engage the individual in planned and unplanned, therapeutic activities;

(3) Be billed as an individual service when provided on a one-to-one basis;

(4) Be billed as a group service when provided with 2 or more recipients present;

(5) Exclude activities that are social and recreational in nature without active clinical intervention;

(6) Enhance resiliency, recovery, and integration in the community;

(7) Support the restoration of an individual to the best possible functional level; and

(8) Include interventions consisting of:

a. Crisis intervention services, delivered on an individual basis, that:

Are designed for individuals who are experiencing acute exacerbation of symptoms that increase the likelihood that the individual will harm himself, herself or others, or that imminently jeopardize the individual’s ability to remain in the community;
Include continuous assessment and monitoring of safety and symptoms;
Include family, friends, or significant others when appropriate; and
Are delivered based on a direct benefit to the service recipient with each crisis intervention service specifically documented in the clinical record;

b. Therapeutic behavioral services, delivered on an individual and group basis, that are specific and individualized interventions whose primary objective is to develop, reinforce and apply skills and strategies to ameliorate or reduce symptoms and behaviors that impede an individual’s ability to function in an age and developmentally appropriate manner and return the individual to an optimal level of functioning;

c. Family support, delivered on an individual basis, that:

Consists of face-to-face, specific interventions provided to family members, caregivers, or significant others;
Supports and maintains the management of the eligible recipient’s mental illness or serious emotional disturbance, and maintains the individual’s tenure in the community;
Has as its primary objective the enhancement and promotion of the recipient’s resiliency and recovery;
Includes assistance to the family member or caregiver, in delivering specific interventions to the individual to promote the goals and objectives identified in the individual service plan as required by He-M 401; and
Is provided in accordance with the following:

(i) The ISP shall specify who shall be present during the delivery of this service; and

(ii) Family support services shall be delivered based on a direct benefit to the service recipient, and documented as such; and

d. Medication support, delivered on an individual basis, that:

Is a specific and individualized intervention that is designed to support the individual in maintaining his or her medication regimen, as prescribed in the clinical record, as a strategy to promote effective management of his or her mental illness;
Is modeled on the concept of “behavioral tailoring” which includes developing strategies for incorporating medication into the individual’s daily routine, as outlined in the Illness Management and Recovery Evidence Based Practice Kit (2010), available as listed in Appendix A;
Is not billed when these interventions are delivered during the course of a routine or comprehensive medication check as outlined in He-M 426.07; and
Includes the following as described in the Illness Management and Recovery Evidence Based Practice Kit (2010):

(i) Providing accurate information about medications for mental illness, including both their advantages and disadvantages;

(ii) Providing an opportunity for recipients to talk openly about their beliefs about medication and their experience with taking various medications;

(iii) Helping recipients weigh the advantages and disadvantages of taking medications; and

(iv) Helping recipients who have decided to take medications to develop strategies for taking medication regularly, including behavioral tailoring and simplifying the medication regimen.

(n) The following IROS services shall be billed separately from one another, with one claim submitted per day for each category below:

(1) Illness management and recovery, group;

(2) Illness management and recovery, individual;

(3) Evidence-based supported employment;

(4) Crisis intervention;

(5) Group therapeutic behavioral services; and

(6) Individual therapeutic behavioral services, family support services, and medication support services.

(o) The CMHP shall separately aggregate the minutes for each category listed in (n) above that are provided in a single day into a single claim before determining the number of billable 15 minute units for each category.

(p) Billing for functional support services provided to each individual, except for crisis intervention services, those who are served on an ACT team, and all functional support services provided to individuals eligible to receive children’s program services under He-M 401, shall be limited as follows:

(1) Individual therapeutic behavioral services, family support services, and medication support services shall be limited to a combined total of 10 units per day; and

(2) Group therapeutic behavioral services shall be limited to 10 units per day.

(q) A CMHP or community mental health provider may request a waiver of the 10 unit daily limit by submitting the request in writing to the department in accordance with He-M426.24.

(r) In addition to the requirements in He-M 426.24, the waiver request shall include the following:

(1) Supporting documentation that the provision of functional support services beyond the 2.5 hours per day is necessary to allow the individual to achieve the desired outcome;

(2) A statement by the clinician most familiar with the needs of the individual that there are no other treatment modalities available, such as peer support, community support, or other natural supports, that will enable the individual to achieve the desired outcome;

(3) A copy of the current and previous ISP, signed by the psychiatrist, which specifies the frequency, duration and purpose of the requested functional support services in excess of 10 units per day;

(4) A copy of the current eligibility determination form; and

(5) The date range for the waiver, which shall not exceed the date range specified on the ISP.

(s) A waiver request shall be granted by the commissioner, or designee, in accordance with He-M 426.24 and the following:

(1) The commissioner, or designee, determines that there are extenuating circumstances unique to the individual that would make a denial of the waiver request clinically contraindicated; or

(2) The commissioner, or designee, determines that approval of the waiver can reasonably be expected to prevent the need for more costly services within the following 12 months, including prevention of hospitalization or institutionalization.

(t) A recipient whose waiver request to exceed 10 units per day is not granted by the commissioner or his or her designee may appeal pursuant to He-C 200.

(u) IROS shall be reimbursed at a per diem rate if services are provided in:

(1) A non-hospital receiving facility designated pursuant to He-M 405 or He-M 1005; or

(2) A facility licensed by the department or certified as a community residence by the department, if such facilities meet the following criteria:

a. A psychiatrist shall be available 24 hours per day for consultation or treatment, as appropriate, to address medical, medication, and other issues under the domain of a psychiatrist;

b. Supervision shall be provided by program staff who meet the criteria of (a) above;

c. Supervision shall be sufficient to ensure the individual’s safety and implementation of ISPs;

d. Supervision of individuals shall be provided whenever individuals are present in the facility unless an individual’s ISP requires that that individual be left alone;

e. All service components shall be available within the program and may be provided on site or off; and

f. There shall be regular communication between residential staff and each resident’s case manager to ensure that services are provided in accordance with an ISP and that there is no duplication of service.

(v) Reimbursement for IROS pursuant to (u) above shall preclude the possibility of billing for IROS in 15-minute units within the community residence with the exception of IMR provided by non-residential staff. For any day on which an individual receives per diem services, residential staff of the same program shall not also bill for IROS in 15-minute units for that individual.

(w) Reimbursement for services provided on a per diem basis in an acute psychiatric residential treatment program designated pursuant to He-M 1005.04 shall preclude the possibility of billing for any other service described in He-M 426.07 through He-M 426.12 except case management services, emergency services, psychological testing, and intake psychiatric diagnostic interview.

(x) Documentation for IROS services shall include:

(1) The start and duration of each event; or

(2) The start and stop time for each event.

History

(See Revision Note at part heading for He-M 426) #5433, eff 7-2-92, EXPIRED: 7-2-98
#7088, eff 8-31-99; ss by #8867, eff 4-13-07; ss by #9285, eff 9-30-08; ss by #9581, eff 10-24-09; ss by #12154, eff 3-28-17

N.H. Code Admin. R. Ann. He-M 426.13 IROS Staff Qualifications {#sec-he-m-426.13 omnilex-key=us-nh-regs-official--agency-he-m--He-M 426.13}

(a) All staff providing IROS shall be supervised by a supervisor who:

(1) Provides program administration and coordinates such services with other service providers to assure continuity of recipient service;

(2) Has at least 3 years of full-time employment experience in programs for persons with long term mental illness or SED;

(3) Has at least one year of supervisory, management, or administrative experience;

(4) Has a baccalaureate degree or higher in social work, rehabilitation, psychology, education, or a related human services field; and

(5) Has received training in the Illness Management and Recovery Evidence Based Practice Kit (2010), available as listed in Appendix A, if the staff will be providing IMR.

(b) Each staff person providing IROS shall at a minimum have:

(1) Either:

a. A baccalaureate degree in social work, rehabilitation, psychology, education, or a related human services field; or

b. An associate’s degree in social work, rehabilitation, psychology, education, or a related human services field and the following experience:

Two years of experience working with persons who have severe mental disability or SED; or
Two years of experience that provides a person with an understanding of mental illness and that was acquired as an adult in the provision of significant supports to persons with mental illness, including the experience acquired by family members of persons with mental illness or by other persons who have personal knowledge of mental illness; and

(2) Received training in the evidence-based practice in Illness Management and Recovery Evidence Based Practice Kit (2010), available as listed in Appendix A, developed by Dartmouth, if those staff will be providing those services.

(d) Any staff person who does not meet the criteria of (b) above shall be eligible to provide IROS services if:

(1) Such staff person was providing mental illness management services under former He-M 426.11 for at least 2 years prior to the 4/13/2007 effective date of former He-M 426.11; and

(2) The following criteria are met:

a. The staff person shall receive individual or group supervision of at least one hour per week provided by a supervisor meeting the qualifications of (a) above;

b. A supervisor meeting the criteria of (a) above shall be available at all times to provide back-up support or consultation; and

c. A record of the following shall be maintained in the staff person’s personnel file:

The staff person’s educational background; and
Supervision provided, including:

(i) The professional title and level of education of the supervisor;

(ii) The supervisory schedule; and

(iii) The staff development and training needs and how they have been addressed; and

(3) In instances when the staff will provide IMR services, the staff person has received training in the Illness Management and Recovery Evidence Based Practice Kit (2010), available as listed in Appendix A.

(4) Such person is a peer support specialist;

a. Peer support specialists shall:

Enter into a mutually supportive, non-authoritative relationship that support wellness and recovery as defined by the individual being serviced;
Participate in trainings as required by the employer and the department;
Function as a member of the individual’s treatment team;
Function as an advocate for the individuals served;
Provide services pursuant to the individual service plan;
Participate in and attend treatment team meetings;
Be supervised by a supervisor as defined in He-M 426.13(a);
Meet quarterly with a peer trained in intentional peer support (IPS) for a peer review to evaluate effectiveness of IPS and to review the principles of IPS;
Be certified in wellness action recovery plans, intentional peer support, whole health action management or equivalents authorized by the department within 12 months of employment at the CMHC; and
Receive annually:

(i) One evidence based practice training;

(ii) Client rights training; and

(iii) One suicide prevention training.

History

(See Revision Note at part heading for He-M 426) #5971, eff 2-1-95; ss by #7088, eff 8-31-99; amd by #8282, eff 2-8-05; ss and moved by #8867, eff 4-13-07 (from He-M 426.12); ss by #9285, eff 9-30-08; ss by #9581, eff 10-24-09; ss by #12154, eff 3-28-17

N.H. Code Admin. R. Ann. He-M 426.14 Services to Determine Medicaid Eligibility {#sec-he-m-426.14 omnilex-key=us-nh-regs-official--agency-he-m--He-M 426.14}

(a) Copying a portion of a recipient’s record to be used for medicaid eligibility determination shall:

(1) Be a covered CMHP service; and

(2) Be limited to one unit per 6 month period.

(b) Psychiatric evaluation for medicaid eligibility shall:

(1) Be a covered CMHP service;

(2) Refer to one evaluation session of any duration; and

(3) Be limited to one session per recipient per 6-month period.

(1) History of present illness;

(2) Family and social history;

(3) Current mental status examination;

(4) Psychiatric diagnosis;

(5) Associated medical problems; and

(6) An assessment of disability including a suggested individual treatment plan and further diagnostic evaluation studies, with a written report to the office of family services.

History

(See Revision Note at part heading for He-M 426) #5433, eff 7-2-92; ss by #5589, eff 2-25-93; ss by #7088, eff 8-31-99; ss and moved by #8867, eff 4-13-07 (from He-M 426.13); ss by #9118, EMERGENCY RULE, eff 4-1-08, EXPIRES: 9-28-08; ss by #9285, eff 9-30-08 (from He-M 426.13); ss by #11182, INTERIM, eff 9-29-16, EXPIRES: 3-28-17; ss by #12154, eff 3-28-17

N.H. Code Admin. R. Ann. He-M 426.15 Targeted Case Management Services {#sec-he-m-426.15 omnilex-key=us-nh-regs-official--agency-he-m--He-M 426.15}

(a) Case management shall:

(1) Assist individuals eligible under the state plan in gaining access to needed medical, social, educational, and other services, on a one to one basis only;

(2) Be a covered CMHP service;

(3) Consist of at least one direct contact, either face-to-face or by telephone, with the individual or guardian within every 90 days;

(4) Be documented in the clinical record, including:

a. Whether the goals specified in the care plan have been achieved;

b. Whether the individual has declined services in the care plan;

c. Timelines for providing services and reassessment; and

d. The need for, and occurrences of, coordination with case managers of other programs.

(5) For each event, the documentation shall include:

a. The name of the individual;

b. The dates of case management service;

c. The name of the provider agency;

d. The nature, content, and units of case management service received, including, for units:

The start time and duration of each event; or
The start and stop time for each event; and

e. The signature of the person who provided the service.

(6) Be billed only by the agency that is the primary service provider for individuals who receive services from both the behavioral health and developmental services systems.

(b) The primary service provider shall be:

(1) The agency that provides the greater dollar value of services to the individual; or

(2) The agency chosen by the consumer to provide case management subject to the following:

a. Persons who are conditionally discharged from a designated receiving facility in accordance with He-M 609 shall be considered eligible for a case manager from the behavioral health system in addition to a case manager from the developmental services system in cases where the developmental services system is the primary service provider;

b. Pursuant to He-M 426.24, providers may, with the consent of the consumer, request a waiver from He-M 426.16(a)(6) to enable consumers to receive case management by both systems; and

c. The commissioner shall grant a waiver if a review of the person’s clinical condition establishes that the person has symptoms that are acute or severe and that require multiple services from the secondary service provider.

(1) Assessment and periodic reassessment of an eligible individual to determine service needs, including the following activities:

a. Taking the individual’s history;

b. Gathering information from other sources such as family members, medical providers, social workers and educators, if necessary, to form a complete assessment of the eligible individual;

c. Assessing the individual’s strengths; and

d. Determining the individual’s preferences;

(2) The assessment shall determine the need for the following services:

a. Medical services including, but not limited to, primary care, dental care, home health care, and assistance with activities of daily living (ADL);

b. Educational services including, but not limited to, obtaining high school or advanced degrees, skill-building classes, parenting education, and other support groups;

c. Social services including, but not limited to, employment, housing, and transportation; and

d. Other services, including but not limited to, opportunities for personal development, maintenance and support of social and familial relationships and the pursuit of hobbies and interests such as spiritual development;

(3) Development and periodic revision of a specific and comprehensive care plan based on the information collected through an assessment or reassessment that specifies the goals and actions to address the medical, social, educational, and other services needed by the eligible individual. An individual may decline to receive services in the care plan;

(4) Referral and related activities to help an individual obtain needed services, such as scheduling appointments, but not including transportation, escort, and childcare services; and

(5) Monitoring and follow-up activities, including activities and contacts that are necessary to ensure that the care plan is effectively implemented and adequately addresses the needs of the eligible individual. Monitoring shall occur no less frequently than annually.

(d) An individual shall be eligible to receive case management services when:

(1) Services are delivered in accordance with an ISP; and

(2) The individual is:

a. A severely mentally disabled person who is eligible to receive department-funded services pursuant to He-M 401; or

b. A family member of a person who is eligible for long-term care as defined in He-M 401 and is under age 21.

(e) Case management services for an individual who has been admitted to a hospital or nursing facility shall include:

(1) Providing ongoing case management services on behalf of the individual in order to ensure that services and supports are established and maintained within the community and within the community mental health system;

(2) Establishing and maintaining contact with community agencies and individuals to develop community resources, to foster access to services other than those offered through the state mental health system, and to encourage community support to the individual when he or she returns to the community;

(3) Arranging, in collaboration with the hospital or nursing facility, community supports appropriate to the individual’s need;

(4) Participating in the service planning process, from initial treatment planning through discharge planning, and supporting the participation of the individual, the family, and the guardian in the treatment planning process and, with the individual’s or guardian’s consent, involving significant others;

(5) Providing information necessary for individual service planning, with the consent of the individual, pursuant to He-M 408;

(6) Participating in making discharge plans and in securing access to available community resources of choice in order to foster a smooth transition to the community; and

(7) After an individual involuntary commitment and conditional discharge pursuant to He-M 609, advising the administrators of the CMHP or provider and the hospital concerning the individual’s progress with, and suggesting revisions in, the discharge conditions.

(f) Transitional case management shall:

(1) Be provided to individuals, under the age of 22 and over the age of 64, who are transitioning from a hospital or nursing facility to the community;

(2) Be a covered service during the last 180 consecutive days of a medicaid eligible person’s institutional stay if provided for the purpose of community transition; and

(3) Be billed if the following conditions are met:

a. The individual has been discharged from the hospital or nursing facility;

b. The individual is enrolled with the community case management provider; and

c. The individual is receiving medically necessary services in a community setting.

(g) Case managers shall not exercise the state agency’s authority to authorize or deny the provision of other services under the state plan.

(h) All staff providing case management services shall be supervised in accordance with the requirements contained in He-M 426.13(a) relative to supervision of staff providing functional support services.

(i) Each staff person providing case management services shall meet the requirements contained in He-M 426.13(b) and (d) relative to requirements for staff providing functional support services.

History

(See Revision Note at part heading for He-M 426) #5433, eff 7-2-92; amd by #5703, eff 9-17-93; ss by #7088, eff 8-31-99; ss and moved by #8867, eff 4-13-07; ss by #9285, eff 9-30-08 (from He-M 426.14); ss by #11182, INTERIM, eff 9-29-16, EXPIRES: 3-28-17; ss by #12154, eff 3-28-17

N.H. Code Admin. R. Ann. He-M 426.16 Assertive Community Treatment (ACT) {#sec-he-m-426.16 omnilex-key=us-nh-regs-official--agency-he-m--He-M 426.16}

(a) Assertive community treatment (ACT) services shall be:

(1) Based on “The Assertive Community Treatment Implementation Resource Kit” (Evaluation Edition 2003) available as noted in Appendix A;

(2) Provided with fidelity to the Dartmouth Assertive Community Treatment Scale (DACTS) found in “The Assertive Community Treatment Implementation Resource Kit” (Evaluation Edition 2003);

(3) Customized to the individual’s needs, and shall vary over time as the individual’s needs change; and

(4) Provided to allow the individual a reasonable opportunity to live independently in the community.

(b) ACT teams shall be available:

(1) To the individual 24 hours per day, 7 days per week.

(2) From midnight to 8:00 a.m. services shall be provided on an on-call basis;

(3) In the event of a crisis and consistent with safety concerns, to conduct a face to face meeting within 3 hours, to de-escalate the crisis.

(c) Every individual eligible for services under He-M 401 shall be assessed for ACT services at the time of intake, at quarterly service reviews, upon request, and in the event of discharge from a facility, the Glencliff Home, or from emergency department admission.

(d) The decision to provide ACT services shall be made on an individualized basis with careful consideration for the individual’s clinical needs and shall utilize the following criteria:

(1) The individual shall have a severe mental illness or a severe and persistent mental illness;

(2) The individual shall have a primary diagnosis of psychotic or major mood disorder, with or without a co-occurring substance use disorder;

(3) An individual diagnosed with a personality disorder shall not be excluded from ACT services solely due to diagnosis;

(4) The individual shall be 18 years or older; and

(5) The individual shall meet at least one of the following criteria:

a. Has had lengthy or multiple uses of acute psychiatric hospitalization in past 12 months;

b. Has used multiple emergency services or crisis services within the past 12 months due to symptoms of a mental illness;

c. Has consistently demonstrated the inability to engage in and benefit from other community based mental health services as a result of symptoms of mental illness for the past 12 months;

d. Had involvement with the legal system as a result of symptoms of mental illness that have resulted in arrest, incarceration, probation, or parole within the past 12 months;

e. Is currently in-patient at a facility and could move to a less restrictive environment if the individual were to receive ACT services; or

f. Is currently residing in a community residence as identified in He-M 1002 and could move to a less restrictive environment if the individual were to receive ACT services.

(e) The decision to transfer individuals to a less intensive level of care shall be made on an individualized basis with careful consideration of the individual’s clinical needs and shall utilize the following criteria:

(1) The individual has maintained stable housing in the community for more than 12 months;

(2) The individual has utilized an emergency room due to psychiatric symptoms no more than twice in the past 12 months;

(3) The individual has consistently demonstrated the ability to engage in and benefit from community based mental health services;

(4) The individual has not been arrested or incarcerated during the past 12 months due to psychiatric symptoms;

(5) The individual has mutually agreed with ACT team members that he or she is ready to transition to a less intensive level of care; and

(6) The individual has required no more than 2 ACT team contacts for the month in a 6 month period.

(f) Once the individual has satisfied criteria in He-M 426.16(e), the ACT team shall take steps below to commence transition planning. Once these steps have been accomplished, the individual shall be transitioned from ACT to lower intensity services:

(1) The ACT team meets with the individual to identify and discuss individual transition planning goals and objectives;

(2) The ACT team and the individual have identified and met with appropriate non-ACT service providers in order to coordinate continuity of care;

(3) The individualized service plan is updated to reflect transition planning goals and identified service needs; and

(4) The crisis plan has been updated and developed with the assistance of identified non-ACT service providers.

(g) No ACT team shall terminate services provided to an individual because that individual has withdrawn consent or cannot be located unless the ACT team can document at least 3 months of persistent, caring attempts to engage that individual.

(h) The requirement in (g) above shall not limit the individual’s right to decline ACT services in accordance with RSA 135-C:16 and RSA 135-C:57, III.

(i) The community mental health program (CMHP) providing ACT services shall make available written information provided by the department to individuals that describes ACT services, the right to file a complaint, and contact information for legal assistance.

(j) The written information in (i) shall be given directly to any individual who has specifically requested ACT service but for whom the treatment team has determined that ACT services are not clinically appropriate.

(k) Commencing in 2017, the department shall conduct an ACT fidelity assessment of each CMHP every other year. The CMHP shall conduct a self-assessment fidelity review in the year(s) the department does not conduct the review.

History

#12079, eff 12-29-16

N.H. Code Admin. R. Ann. He-M 426.17 Services Not Otherwise Classified {#sec-he-m-426.17 omnilex-key=us-nh-regs-official--agency-he-m--He-M 426.17}

(a) The invoice for services not otherwise classified in this rule shall be accompanied by a statement describing the service including the following:

(1) The name of the recipient receiving the service(s);

(2) The type, frequency, and duration of the service(s);

(3) The name, title, and professional qualifications of the person(s) providing the service(s); and

(4) The reason(s) why the service(s) was provided, which shall include reference to the recipient’s ISP.

(b) Services not otherwise classified shall be:

(1) Designed to meet a specific need identified in a recipient’s ISP; and

(2) Allowed by federal requirements.

History

(See Revision Note at part heading for He-M 426) #5433, eff 7-2-92; amd by #5589, eff 2-25-93; ss by #5703, eff 9-17-93; amd by #5971, eff 2-1-95; amd by #6568, eff 8-22-97; ss by #7088, eff 8-31-99; ss by #8282, eff 2-8-05; ss and moved by #8867, eff 4-13-07 (from He-M 426.15); ss by #9285, eff 9-30-08 (from He-M 426.15); ss by #11182, INTERIM, eff 9-29-16, EXPIRES: 3-28-17; renumbered by #12079 (from He-M 426.16); ss by #12154, eff 3-28-17

N.H. Code Admin. R. Ann. He-M 426.18 Documentation {#sec-he-m-426.18 omnilex-key=us-nh-regs-official--agency-he-m--He-M 426.18}

Clinical information and documentation of services as required byHe-M 408 shall be maintained by the CMHP or community mental health provider.

History

(See Revision Note at part heading for He-M 426) #5433, eff 7-2-92; ss by #6568, eff 8-22-97; ss by #7088, eff 8-31-99; ss and moved by #8867, eff 4-13-07 (from He-M 426.16); ss by #9285, eff 9-30-08 (from He-M 426.16); ss by #11182, INTERIM, eff 9-29-16, EXPIRES: 3-28-17; renumbered by #12079 (from He-M 426.17); ss by #12154, eff 3-28-17

N.H. Code Admin. R. Ann. He-M 426.19 Medicaid Payment for Long-Term Care Certification {#sec-he-m-426.19 omnilex-key=us-nh-regs-official--agency-he-m--He-M 426.19}

(a) Except for those medicaid recipients eligible to receive early and periodic screening, diagnosis and treatment (EPSDT) pursuant to He-W 546 or eligible to receive long-term care services in accordance with (b) below, the medicaid payment limit per fiscal year for all community mental health services shall be the limit established by the commissioner with approval of the US Department of Health and Human Services Centers for Medicare and Medicaid Services as an amendment to the Title XIX State Plan in accordance with He-W 520.02 and Section 1902(a) of the Social Security Act. The fiscal year runs from July 1 to June 30. Individual service limits shall still apply.

(b) An individual shall qualify for services in excess of the annual medicaid payment limit if that individual has been certified for long-term care services by:

(1) Determination by the CMHP that the individual is eligible to receive department funded services pursuant to He-M 401; or

(2) Determination by a CMHP that a child through age 17 is eligible for services pursuant to He-M 401 unless the psychiatrist has approved the child to remain until age 21in a children’s program pursuant to He-M 401.

(c) The department shall recover any medicaid payments in excess of the medicaid payment limit per state fiscal year for a recipient under each of the following circumstances:

(1) The recipient’s record lacks a properly completed eligibility statement which covers long-term care services billed for the period under review;

(2) The eligibility period has expired and the redetermination of eligibility has not been completed;

(3) Documentation in the clinical record fails to substantiate that the recipient meets the criteria for certification for long-term care; and

(4) The recipient’s diagnosis does not meet the criteria in He-M 401.

(d) Certifications made pursuant to (b)(1) above and dated later than the service period being billed for shall be invalid.

(e) For individuals eligible as adults with severe or severe and persistent mental illness with low service utilization pursuant to He-M 401.07, the commissioner shall establish a limit on the payment for services per state fiscal year. The limit shall be subject to approval by the US Department of Health and Human Services Centers for Medicare and Medicaid Services as an amendment to the Title XIX State Plan in accordance with He-W 520.02 and Section 1902(a) of the Social Security Act. The annual limit shall be waived if the standards established by He-M 426.24 are met.

(f) Mental health assessment by a non-physician for the purpose of determining long-term care eligibility shall be a covered service when performed by individuals meeting the qualifications in He-M 401.04(b).

(g) Comprehensive geriatric assessment and treatment planning performed by assessment team for the purpose of determining long-term care eligibility shall be a covered service when performed by individuals meeting the qualifications in He-M 401.04(b).

History

(See Revision Note at part heading for He-M 426) #5433, eff 7-2-92; amd by #6568, eff 8-22-97; ss by #7088, eff 8-31-99; ss and moved by #8867, eff 4-13-07 (from He-M 426.17); ss by #9285, eff 9-30-08 (from He-M 426.17); ss by #11182, INTERIM, eff 9-29-16, EXPIRES: 3-28-18); renumbered by #12079 (from He-M 426.18); ss by #12154, eff 3-28-17

N.H. Code Admin. R. Ann. He-M 426.20 Fair Hearings {#sec-he-m-426.20 omnilex-key=us-nh-regs-official--agency-he-m--He-M 426.20}

Any medicaid recipient who has been found ineligible for long-term care services by the CMHP or community mental health provider may appeal the adverse decision by requesting a fair hearing in accordance with He-C 200. Complaints regarding provision of services may be filed in accordance with He-M 309, and He-M 204

History

(See Revision Note at part heading for He-M 426) #5433, eff 7-2-92; ss and moved by #6568, eff 8-22-97 (from He-M 426.20); ss by #7088, eff 8-31-99; ss and moved by #8867, eff 4-13-07 (from He-M 426.18); ss by #9285, eff 9-30-08 (from He-M 426.18); ss by #11182, INTERIM, eff 9-29-16, EXPIRES: 3-28-17l; renumbered by #12079 (from He-M 426.19); ss by #12154, eff 3-28-17

N.H. Code Admin. R. Ann. He-M 426.21 Revocation of Approval as a Community Mental Health Provider {#sec-he-m-426.21 omnilex-key=us-nh-regs-official--agency-he-m--He-M 426.21}

(a) Approval as a community mental health provider shall be revoked, following written notice pursuant to (b)(2) below and opportunity for a hearing pursuant to He-C 200, due to:

(1) Failure of the provider to comply with this rule or any other applicable rule promulgated by the department;

(2) The provider failing to provide information requested by the department and required pursuant to chapter He-M 400 or knowingly giving false or misleading information to the department;

(3) Refusal by the provider to admit any employee of the department authorized to monitor or inspect the provider’s services and programs;

(4) Any reported abuse, neglect, or exploitation of individuals by a provider’s staff if:

a. Such personnel have not been prevented from having contact with individuals as of the reporting date of the alleged violation; and

(5) Revocation of licensure or denial of application for licensure pursuant to RSA 151; or

(6) Revocation of certification pursuant to He-M 1002.

(b) Revocation of approval shall be in accordance with the following:

(1) Upon determination that a provider meets any of the criteria for revocation listed in (a) above, the commissioner shall revoke the approval of the provider;

(2) Revocation shall only occur following:

a. The provision of 30 days’ written notice by the commissioner to the provider stating the reason(s) for the revocation and, if applicable, the specific rule(s) with which the provider is alleged to not comply; and

b. Opportunity for a hearing on the decision pursuant to He-C 200, if requested by the provider;

(3) The commissioner shall withdraw a notice of revocation if, within the notice period, the provider takes corrective action resulting in the elimination of the reason(s) for revocation; and

(4) Pending corrective action by the provider eliminating the reason(s) for revocation, a provider shall not accept additional individuals if a notice of revocation has been issued concerning a violation which presents potential danger to the health or safety of the individuals being served.

History

(See Revision Note at part heading for He-M 426) #5433, eff 7-2-92; ss and moved by #6568, eff 8-22-97 (from He-M 426.21); ss by #7088, eff 8-31-99; ss and moved by #8867, eff 4-13-07 (from He-M 426.19); ss by #9285, eff 9-30-08 (from He-M 426.19); ss by #11182, INTERIM, eff 9-29-16, EXPIRES: 3-28-17; renumbered by #12079 (from He-M 426.20); ss by #12154, eff 3-28-17

N.H. Code Admin. R. Ann. He-M 426.22 Suspension of Approval {#sec-he-m-426.22 omnilex-key=us-nh-regs-official--agency-he-m--He-M 426.22}

(a) In the event that a violation poses an immediate and serious threat to the health or safety of the individuals, the commissioner shall suspend a provider’s approval immediately upon issuance of written notice specifying the reasons for the action.

(b) In the event that the commissioner suspends the approval of a provider, the suspension shall be effective from the date that the violation occurred until such time as the commissioner determines that the provider is in compliance with all applicable rules adopted by the commissioner and no longer poses an immediate and serious threat to the health or safety of the individuals served by the provider.

(c) At the time that the commissioner suspends the approval of a provider, the commissioner or his or her designee shall schedule a hearing to be held within 10 working days, in accordance with He-C 204.

(d) A hearing held pursuant to (c) above shall:

(1) Have as its purpose determination of whether the provider in fact posed an immediate and serious threat to the health and safety of its individuals at the time its approval was suspended; and

(2) Afford the provider an opportunity to show that:

a. Since the time that its approval was suspended it has come into compliance with all applicable rules promulgated by the department and no longer poses an immediate and serious threat to the health or safety of its individuals; or

b. It had never been out of compliance or had never posed an immediate and serious threat to the health or safety of its individuals.

History

(See Revision Note at part heading for He-M 426) #5433, eff 7-2-92, EXPIRED: 7-2-98
#7088, eff 8-31-99; ss and moved by #8867, eff 4-13-07 (from He-M 426.20); ss by #9285, eff 9-30-08 (from He-M 426.20); ss by #11182, INTERIM, eff 9-29-16, EXPIRES: 3-28-17; renumbered by #12079 (from He-M 426.21); ss by #12154, eff 3-28-17

N.H. Code Admin. R. Ann. He-M 426.23 Payment {#sec-he-m-426.23 omnilex-key=us-nh-regs-official--agency-he-m--He-M 426.23}

(a) Medicaid payments shall be made for CMHP services rendered to recipients with both psychiatric and intellectual disability diagnoses for services related to the psychiatric diagnosis. Medical and billing records shall support this classification. The claim shall indicate the primary diagnosis related to the service rendered.

(b) Community mental health services shall be paid at rates set by the department based on the audited costs of covered services as determined by units of services provided by all community mental health providers divided by the sum of costs for the individual’s transportation, staff and staff related costs to provide such services incurred by all community mental health providers.

(c) Claims for medicare-eligible medicaid recipients shall be submitted to medicare for all medicare covered services prior to submitting claims to medicaid.

(d) Except for claims for people not eligible for medicaid, claims for service shall be submitted to the fiscal agent designated by the department.

(e) Claims for services necessary to determine the appropriateness of nursing home referral, PASRR, for people who are not eligible for medicaid shall be submitted to:

NH Department of Health and Human Services

Behavioral Health

PASRR Office

105 Pleasant Street

Concord, NH 03301

History

#8867, eff 4-13-07 (from He-M 426.21); ss by #9285, eff 9-30-08 (from He-M 426.21); ss by #11182, INTERIM, eff 9-29-16, EXPIRES: 3-28-17; renumbered by #12079 (from He-M 426.22); ss by #12154, eff 3-28-17

N.H. Code Admin. R. Ann. He-M 426.24 Waivers {#sec-he-m-426.24 omnilex-key=us-nh-regs-official--agency-he-m--He-M 426.24}

(a) A CMHP or community mental health provider may request a waiver of specific procedures outlined in this part, in writing, from the department.

(b) A request for a waiver shall include:

(1) A specific reference to the section of the rule for which a waiver is being sought;

(2) A full description of why a waiver is necessary; and

(3) A full explanation of alternative provisions or procedures proposed by the CMHP or community mental health provider.

(d) A request for a waiver shall be granted after the commissioner or his or her designee determines that the alternative proposed by the CMHP or community mental health provider meets the objective or intent of the rule and:

(1) Does not negatively impact the health or safety of recipients; and

(2) Does not affect the quality of CMHP or community mental health provider services.

(e) Upon receipt of approval of a waiver request, the CMHP’s or community mental health provider’s subsequent compliance with the alternative provisions or procedures approved in the waiver shall be considered compliance with the rule for which the waiver was sought.

(f) Waivers shall be granted in writing for a specific duration not to exceed 5 years except as in (g) below.

(g) Those waivers which relate to the following shall be effective for the CMHP’s or community mental health provider’s current certification period only:

(1) Fire safety; or

(2) Other issues relative to consumer health, safety or welfare that require periodic reassessment.

(h) A CMHP or community mental health 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.

APPENDIX A: INCORPORATION BY REFERENCE INFORMATION

Rule

Title

Publisher; How to Obtain; and Cost

He-M 401.02(s)

Diagnostic and Statistical Manual of Mental Disorders, (Fourth Edition, Text Revision) (DSM-IV-TR, 2000)

Available from the publisher, American Psychiatric Publishing (http://www.appi.org/Home), a division of the American Psychiatric Association (APA) (www.psychiatry.org).

Cost is $121.00.

He-M 402.05(e)(2)

“Guidelines for Environmental Infection Control in Health-Care Facilities” (2003) as updated on August 1, 2014 and published by the Centers for Disease Control and Prevention (CDC)

The document can be obtained at free of charge in pdf format at https://www.cdc.gov/hicpac/pdf/guidelines/eic_in_HCF_03.pdf.

He-M 402.05(e)(7)

“Guidelines for Environmental Infection Control in Health-Care Facilities” (2003) as updated on August 1, 2014 and published by the Centers for Disease Control and Prevention (CDC)

The document can be obtained at free of charge in pdf format at https://www.cdc.gov/hicpac/pdf/guidelines/eic_in_HCF_03.pdf.

He-M 403.02(t) and He-M 403.02(ab)

Diagnostic and Statistical Manual of Mental Disorders

(DSM-5)

He-M 408.02(r)

Diagnostic and Statistical Manual of Mental Disorders, (Fifth Edition, Text Revision)

(DSM-5)

Available from the publisher, American Psychiatric Publishing (http://www.appi.org/Home), a division of the American Psychiatric Association (APA) (www.psychiatry.org).

Cost is $155.00.

He-M 426.02(k)

American Medical Association 2017 CPT

https://commerce.ama-assn.org/store/catalog/productDetail.jsp?product_id=prod2730008&navAction=push; or for a full text at a Cost: $89.95, published by the American Medical Association, PO Box 930876 Atlanta GA 31193-0876.

He-M 426.02(n), and He-M 426.12(i)

Supported Employment Evidence Based Practice Kit (2010)

Available on line free of charge at: http://store.samhsa.gov/product/Supported-Employment-Evidence -Based-Practices-EBP-KIT/SMA08-4365.

He-M 426.02(r), He-M 426.11(i)(2), He-M 426.12(a)(i), (f)(3), (h)(1), (m)(8)d.2., (m)(8)d.4, He-M 426.13(a)(5), (b)(2) and (d)(3)

Illness Management and Recovery Evidence Based Practice Kit (2010)

Available on line free of charge at:

http://store.samhsa.gov/product/Illness-Management-and-Recovery-Evidence-Based-Practices-EBP-KIT /SMA09-4463.

He-M 426.02(z), and (ai),

Diagnostic and Statistical Manual of Mental Disorders, (Fifth Edition, Text Revision) (DSM-5)

Available from the publisher, American Psychiatric Publishing (http://www.appi.org/Home), a division of the American Psychiatric Association (APA) (www.psychiatry.org).

Cost is $155.00.

He-M 426.16 (a)(1)

“The Assertive Community Treatment Implementation Resource Kit” (Evaluation Edition 2003)

Available free of charge as pdf athttp://store.samhsa.gov/product/Assertive-Community-Treatment-ACT-Evidence-Based-Practices-EBP-KIT/SMA08-4345

APPENDIX B: – STATUTES IMPLEMENTED

RULE

STATE OR FEDERAL STATUES THE RULE IMPLEMENTS

He-M 401.01

RSA 135-C:3

He-M 401.02

RSA 135-C:3

He-M 401.03

RSA 135-C:12

He-M 401.04 – He-M 401.09

RSA 135-C:13; RSA 135-C:61, II

He-M 401.10 – He-M 401.13

RSA 135-C:19; RSA 135-C:61, VII

He-M 401.14

RSA 135-C:18; RSA 135-C:61, VI

He-M 401.15

RSA 135-C:3; RSA 135-C:61, XII

He-M 402

RSA 126-N:3

He-M 403.01-He-M 403.02

RSA 135-C:10

He-M 403.03

RSA 135-C:7, RSA 135-C:10

He-M 403.04

RSA 135-C:7, 8, 10

He-M 403.05 - He-M 403.16

RSA 135-C:10

He-M 405.01

RSA 135-C:26, III

He-M 405.02

RSA 135-C:26, III

He-M 405.03

RSA 135-C:26, III; RSA 135-C:26, II; and RSA 126-U

He-M 405.04

RSA 135-C:26, III

He-M 405.05

RSA 135-C:26, III

He-M 405.06

RSA 135-C:31, V; RSA 135-C:48

He-M 405.07

RSA 135-C:33

He-M 405.08

RSA 135-C:17

He-M 405.09

RSA 135-C:49-54

He-M 405.10

RSA 135-C:26, III

He-M 405.11

RSA 135-C:26, III

He-M 405.12

RSA 135-C:26, III

He-M 405.13

RSA 135-C:26, III

He-M 405.14

RSA 135-C:26, III

He-M 405.15

RSA 135-C:26, III

He-M 405.16

RSA 135-C:26, III

He-M 405.17

RSA 541-A:22, IV

He-M 406

RSA 135-C:5, I

He-M 408.01 – He-M 408.14

RSA 135-C:5, I(e), RSA 135-C:61, III

He-M 425.01 – He-M 425.03

RSA 135-C:3

He-M 426.01, He-M 426.02 intro., (a)-(c), (e)-(s), (u)-(ap), 426.03–426.15 and

426.17-426.24

RSA 135-C:1; 57

He-M 426.01, He-M 426.03-426.11, He-M 426.14-23

RSA 135-C:1; RSA 135-C:57

He-M 426.02 – He-M 426.12 -426.13

RSA 135-C:1; 57

He-M 426.02(d) and (t)

RSA 135-C:1; RSA 135-C:57

He-M 426.16

RSA 135-C:5

History

#9285, eff 9-30-08 (from He-M 426.22); ss by #11182, INTERIM, eff 9-29-16, EXPIRES: 3-28-17; renumbered by #12079 (from He-M 426.23); ss by #12154, eff 3-28-17

Chapter He-M 500 Developmental Services

Part He-M 502 Records Standards for Individuals Served - Developmental Services

N.H. Code Admin. R. Ann. He-M 502.01 Developmental Services {#sec-he-m-502.01 omnilex-key=us-nh-regs-official--agency-he-m--He-M 502.01}

– He-M 502.09 - EXPIRED

History

(See Revision Note at part heading for He-M 502) #5046, eff 1-18-91, EXPIRED: 1-18-97
#6646, eff 12-2-97, EXPIRED: 12-2-05

Part He-M 503 Eligibility and the Process of Providing Services

N.H. Code Admin. R. Ann. He-M 503.01 Purpose {#sec-he-m-503.01 omnilex-key=us-nh-regs-official--agency-he-m--He-M 503.01}

The purpose of these rules is to establish standards and procedures for the determination of eligibility, the development of service agreements, and the provision and monitoring of services which maximize the ability and informed decision-making authority of individuals with developmental disabilities and which promote the individual’s personal development, independence, and quality of life in a manner that is determined by the individual.

History

#1969, eff 2-25-82; ss by #2615, eff 2-6-84; ss by #2962, eff 1-22-85; ss by #5211, eff 8-28-91; EXPIRED: 8-28-97
#6581, INTERIM, eff 9-19-97, EXPIRED: 1-17-98
#6932, eff 1-27-99; ss by #8805, eff 1-27-07; ss by #10774, INTERIM, eff 1-27-15, EXPIRES: 7-27-15; ss by #10900, eff 7-25-15; ss by #13841, eff 12-29-23

N.H. Code Admin. R. Ann. He-M 503.02 Definitions {#sec-he-m-503.02 omnilex-key=us-nh-regs-official--agency-he-m--He-M 503.02}

(a) “Amendment” means any change to the personal profile, provider agency, or provision of services, including the amount, scope, type, frequency, or duration, within a service agreement.

(b) “Applicant” means any person who requests services under RSA l71-A.

(c) “Area” means “area” as defined in RSA 171-A:2, I-a, namely, “a geographic region established by rules adopted by the commissioner for the purpose of providing services to developmentally disabled persons.” This term includes “region”.

(d) “Area agency” means “area agency” as defined in RSA 171-A:2, I-b.

(e) “Area agency director” means that person who is appointed as executive director or acting executive director of an area agency by the area agency’s board of directors.

(f) “Assistive technology” means technology designed to be utilized in an “assistive technology device” as defined in 29 U.S.C. section 3002(4) or “assistive technology service” as defined in 29 U.S.C. section 3002(5).

(g) “Autism,” also called “autism spectrum disorder” means a developmental disorder of brain function that presents with:

(1) Persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following, currently or by history:

a. Deficits in social-emotional reciprocity;

b. Deficits in nonverbal communicative behaviors used for social interaction; and

c. Deficits in developing, maintaining, and understanding relationships;

(2) Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least 2 of the following, currently or by history:

a. Stereotyped or repetitive motor movements, use of objects, or speech;

b. Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior;

c. Highly restricted, fixated interests that are abnormal in intensity or focus; or

d. Hyper- or hyporeactivity to sensory input or unusual interests in sensory aspects of the environment;

(3) Symptoms that are present in the early developmental period, but might not become fully manifested until social demands exceed limited capacities, or might be masked by learned strategies in later life;

(4) Symptoms that cause clinically significant impairment in social, occupational, or other important areas of current functioning; and

(5) Disturbances that are not better explained by intellectual disability or global developmental delay.

(h) “Bureau” means the bureau of developmental services of the department of health and human services.

(i) “Bureau administrator” means the chief administrator of the bureau of developmental services.

(j) “Cerebral palsy” means a condition resulting from brain damage occurring in utero or during infancy or childhood and characterized by permanent motor impairment that constitutes a severe disability to such individual’s ability to function normally in society.

(k) “Commissioner” means the commissioner of the department of health and human services or their designee.

(l) “Comprehensive risk assessment” means an evaluation administered pursuant to He-M 503.09(m)(11) using evidence-based tools to evaluate an individual’s behaviors and determine the potential risks to the individual or others posed by said behaviors.

(m) “Conditional eligibility” means a category of eligibility where a person under the age of 22 is determined to have a developmental disability only provisionally because either the diagnostic information is inconclusive or it cannot yet be determined whether the disability will continue indefinitely.

(n) “Days” means calendar days unless otherwise specified.

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

(p) “Developmental disability” means “developmental disability” as defined in RSA 171-A:2, V, namely, “a disability:

(1) Which is attributable to an intellectual disability, cerebral palsy, epilepsy, autism, or a specific learning disability, or any other condition of an individual found to be closely related to an intellectual disability as it refers to general intellectual functioning or impairment in adaptive behavior or requires treatment similar to that required for persons with an intellectual disability; and

(2) Which originates before such individual attains age 22, has continued or can be expected to continue indefinitely, and constitutes a severe disability to such individual’s ability to function normally in society.”

(q) “Epilepsy” means a neurological condition characterized by recurrent seizures which might be accompanied by loss of consciousness, convulsive movements, or disturbances of feeling, thought, or behavior and constitutes a severe disability to such individual’s ability to function normally in society.

(r) “Guardian” means a person appointed pursuant to RSA 463 or RSA 464-A or the parent of an individual under the age of 18 whose parental rights have not been terminated or limited by law.

(s) “Health Risk Screening Tool (HRST)” means the 2015 edition of the Health Risk Screening Tool, available as noted in Appendix A, which is a web-based rating instrument used for performing health risk screenings on individuals in order to:

(1) Determine an individual’s vulnerability regarding potential health risks; and

(2) Enable the early identification of health issues and monitoring of health needs.

(t) “Home and community-based waiver services (“waiver services”) ” means the services defined and funded pursuant to New Hampshire’s agreement with the federal government, known as the Developmental Disabilities Waiver, pursuant to the authority of section 1915(c) of the Social Security Act which allows the federal funding of long-term care services in non-institutional settings for persons who are developmentally disabled.

(u) “Individual” means a person who has a developmental disability.

(v) “Informed consent” means a decision made voluntarily by an individual or applicant for services or, where appropriate, such person's legal guardian or representative, after all relevant information necessary to making the choice has been provided, when the person understands that they are free to choose or refuse any available alternative, when the person clearly indicates or expresses their choice, and when the choice is free from all coercion.

(w) “Intellectual disability” means “intellectual disability” as defined in RSA 171-A:2, XI-a, namely, “significantly subaverage general intellectual functioning existing concurrently with deficits in adaptive behavior, and manifested during the developmental period. A person with an intellectual disability may be considered mentally ill provided that no person with an intellectual disability shall be considered mentally ill solely by virtue of his or her intellectual disability.”

(x) “Local education agency (LEA)” means “local education agency” as defined in 34 CFR 300.28. This term includes “school district” as defined in Ed 1102.03(n).

(y) “Participant directed and managed services” means a method of service delivery provided pursuant to He-M 525.

(z) “Person-centered service planning” is an individual-directed, positive approach to the planning and coordination of a person’s services and other supports based on the individual’s aspirations, needs, preferences, and goals.

(aa) “Personal profile” means a narrative description that includes a personal statement from the individual and those who know them best that summarizes the individual’s strengths and capacities, communication and learning style, challenges, needs, interests, and any health concerns, as well as the individual’s hopes and dreams.

(ab) “Provider” means a person receiving any form of remuneration for the provision of services to an individual.

(ac) “Provider agency” means an agency or an independent provider that is established to provide services to individuals and meets the criteria in He-M 504.

(ad) “Representative” means:

(1) The parent or guardian of an individual under the age of 18;

(2) The guardian of an individual 18 or over; or

(3) A person who has power of attorney for the individual.

(ae) “Service” means any paid assistance to an individual in meeting their own needs provided through the developmental services system.

(af) “Service agreement” means a written agreement between the individual, guardian, or representative and provider agencies that is prepared as a result of the person-centered service planning process and that describes the services that an individual will receive and constitutes an individual service agreement as defined in RSA 171-A:2, X and developed pursuant to He-M 503.10.

(ag) “Service coordination agency” means a provider agency providing service coordination services to individuals, that meets the criteria in He-M 504.

(ah) “Service coordinator” means a provider who meets the criteria in He-M 503.08 (b) and(c) and is chosen by an individual and their guardian or representative to organize, facilitate and document service planning and to negotiate and monitor the provision of the individual’s services.

(ai) “Service planning meeting” means a gathering of 2 or more people, one of whom is the individual who receives services unless they choose not to attend, called to develop, review, add to, delete from, or otherwise change a service agreement.

(aj) “Specific learning disability” means a chronic condition of presumed neurological origin that selectively interferes with the development, integration, or demonstration of verbal or non-verbal abilities, and constitutes a severe disability to such individual’s ability to function normally in society. The term includes such conditions as perceptual handicaps, brain injury, dyslexia, and developmental aphasia. The term does not include individuals who have learning problems which are primarily the result of visual, hearing, or motor handicaps, intellectual disability, emotional disturbance, or environmental, cultural, or economic disadvantage.

(ak) “State of residence” means state of residence as defined in 42 CFR 435.403.

(al) “Supported decision-making” means “supported-decision making” as defined in RSA 464-D: 4, VI.

(am) “Supports Intensity Scale-Adult Version ® (SIS-A ®)” means the 2023 edition of the Supports Intensity Scale, available as noted in Appendix A, which is an assessment tool intended to assist in service planning by measuring the individual’s support needs in the areas of home living, community living, lifelong learning, employment, health and safety, social activities, and protection and advocacy. The tool uses a formal rating scale to identify the type of supports needed, frequency of supports needed, and daily support time.

(an) “Termination” means the cessation of a service by an area agency director with or without the informed consent of the individual or their guardian or representative.

(ao) “Withdrawal” means the choice of an individual or their guardian to discontinue that individual’s participation in a service.

History

#1969, eff 2-25-82; ss by #2615, eff 2-6-84; ss by #2962, eff 1-22-85; ss by #5211, eff 8-28-91; EXPIRED: 8-28-97
#6581, INTERIM, eff 9-19-97, EXPIRED: 1-17-98
#6932, eff 1-27-99; ss by #8805, eff 1-27-07; ss by #10774, INTERIM, eff 1-27-15, EXPIRES: 7-27-15; ss by #10900, eff 7-25-15; ss by #13841, eff 12-29-23

N.H. Code Admin. R. Ann. He-M 503.03 Eligibility for Services {#sec-he-m-503.03 omnilex-key=us-nh-regs-official--agency-he-m--He-M 503.03}

(a) Pursuant to RSA 171-A, and as referenced in He-M 503.02 (ak) and (o), any person whose state of residence is New Hampshire and who has a developmental disability shall be eligible for services as described in (b) through (h) below.

(b) Individuals who meet the requirements of (a) above, shall be eligible under He-M 503 to receive the following services:

(1) Service coordination;

(2) Family support services pursuant to He-M 519;

(3) Respite services pursuant to He-M 513; and

(4) Other applicable services available pursuant to He-M 500 that are needed as determined in accordance with He-M 503.05, except those that are the legal responsibility of the local education agency (LEA) pursuant to the Interagency Agreement in accordance with RSA 186-C:7-a, the department’s division for children, youth and families (DCYF), or another state agency to provide.

(c) Individuals described in (a) above shall also be eligible for home and community-based waiver services if they meet the requirements of He-M 517.03.

(d) Individuals described in (a), from birth through 21 who have not graduated or exited the school system and who live at home shall be eligible for in-home support services if the requirements of He-M 524.03 are met.

(e) Individuals described in (a) above who are under age 3 shall also be eligible for family-centered early supports and services if the requirements of He-M 510.06 are met.

(f) An applicant under the age of 18 who has a developmental disability cited in He-M 503.02 (o) at the time of application shall be found conditionally eligible for services if either the diagnostic information is inconclusive or it cannot be determined whether the disability will continue indefinitely.

(g) When the eligibility of an individual has been determined to be conditional, the eligibility for services shall be periodically reviewed pursuant to He-M 503.06 so that the area agency can reach a conclusive decision before the individual turns age 18.

History

#1969, eff 2-25-82; ss by #2615, eff 2-6-84; ss by #2962, eff 1-22-85; ss by #5211, eff 8-28-91; EXPIRED: 8-28-97
#6581, INTERIM, eff 9-19-97, EXPIRED: 1-17-98
#6932, eff 1-27-99; ss by #8805, eff 1-27-07; ss by #10774, INTERIM, eff 1-27-15, EXPIRES: 7-27-15; ss by #10900, eff 7-25-15; ss by #13841, eff 12-29-23

N.H. Code Admin. R. Ann. He-M 503.04 Application for Services {#sec-he-m-503.04 omnilex-key=us-nh-regs-official--agency-he-m--He-M 503.04}

(a) Application for services shall be made by:

(1) The applicant;

(2) A guardian of an applicant under the age of 18;

(3) A guardian of an applicant age 18 or over if a guardian of the person has been appointed by the probate court per RSA 464-A; or

(4) A representative of the applicant authorized to make such application.

(b) An application for services shall be made in writing to the area agency in the applicant’s region of residence.

(c) An area agency shall explain the eligibility process and offer assistance to the applicant, guardian, or representative in making application for services.

(d) The area agency shall inform the applicant, guardian, or representative of its roles and responsibilities and provide information about:

(1) The types of evaluations, assessments, and screenings needed to assist in development of the service agreement;

(2) Eligibility determination;

(3) Service coordination;

(4) Service agreement development and review;

(5) Services provided by the area agency and the assistance available to identify the services that are needed;

(6) Service provision;

(7) Service monitoring; and

(8) Advocacy supports.

(e ) To aid in the provision of comprehensive, efficient, and coordinated services, the area agency shall undertake a review of the public and private benefits and resources that are available to the applicant and inform the applicant of all such benefits and resources.

(f) To receive services beyond age 3, the eligibility of a child served in family-centered early supports and services shall be determined by the area agency pursuant to He-M 503.03 and He-M 503.05 prior to the date the child turns age 3, without the need of the family reapplying for services. The eligibility determination process shall be initiated by the area agency at least 90 days prior to the child’s third birthday.

(g) An area agency shall request each applicant to authorize the release of information to permit the area agency to access relevant current and historical records and information for determination of eligibility pursuant to He-M 503.03 regarding the applicant’s:

(1) Developmental disabilities;

(2) Personal, family, social, educational, psychological, and medical status; and

(3) Functional abilities, interests, and aptitudes.

(h) Authorization to release information shall specify:

(1) The name of the applicant and the information to be released;

(2) The name of the person or organization being authorized to release the information;

(3) The name of the person or organization to whom the information is to be released; and

(4) The time period for which the authorization is given, which shall not exceed one year.

History

#1969, eff 2-25-82; ss by #2615, eff 2-6-84; ss by #2962, eff 1-22-85; ss by #5211, eff 8-28-91; EXPIRED: 8-28-97
#6581, INTERIM, eff 9-19-97, EXPIRED: 1-17-98
#6932, eff 1-27-99; ss by #8805, eff 1-27-07; ss by #10774, INTERIM, eff 1-27-15, EXPIRES: 7-27-15; ss by #10900, eff 7-25-15; ss by #13841, eff 12-29-23

N.H. Code Admin. R. Ann. He-M 503.05 Determination of Eligibility {#sec-he-m-503.05 omnilex-key=us-nh-regs-official--agency-he-m--He-M 503.05}

(a) To determine the existence of an applicant’s developmental disability, the area agency shall perform a comprehensive screening evaluation consisting of:

(1) Reviewing available information, including, but not limited to:

a. Birth, developmental, and educational histories;

b. Current physical, intellectual, cognitive, and behavioral evaluations;

c. An age-appropriate standardized functional assessment; and

d. As applicable, additional specialty medical, health, or clinical evaluations, such as communication, functional behavior, psychological, or psychopharmacological assessments, assistive technology, and personal safety or comprehensive risk assessments; and

(2) Gathering additional information and performing the additional evaluations among those listed in (1) above that are necessary to complete the determination, if the information available is not adequate to make a determination of eligibility.

(b) The results of the comprehensive screening evaluation pursuant to (a) above and any other information concerning the applicant’s disability shall be the basis for determination of eligibility pursuant to He-M 503.03 and assist in the identification of needs and provision of services.

(c) To the extent possible, the area agency shall utilize generic resources to pay for an applicant’s comprehensive screening evaluation. Such resources shall, with the applicant’s consent, include private and public insurance.

(d) An area agency shall review the information it has received regarding an applicant and, within 15 business days after the receipt of the completed application, make and communicate one of the following decisions on the eligibility of the applicant in accordance with He-M 503.03 to the applicant, guardian, or representative:

(1) Eligible;

(2) Conditionally eligible pursuant to He-M 503.02(l); or

(3) Ineligible.

(e) If an area agency determines additional information is necessary in order to make a determination in accordance with (d) above, a communication detailing the additional information necessary shall be provided to the applicant, guardian, or representative, and the application shall not be determined complete until all necessary information has been received by the area agency.

(f) In cases where the information on eligibility is inconclusive, the area agency may consult with the bureau regarding determination of eligibility prior to making a decision in accordance with (d) above.

(g) Decisions by the bureau in (f) above shall be made within 5 business days.

(h) In instances where consultations in (f) above would cause the area agency’s decision pursuant to (d) above to exceed 15 business days, an additional 7 business days shall be allowed to make such decision.

(i) A written denial of eligibility pursuant to (d)(3) above, shall describe the specific legal and factual basis for the denial, including specific citation of the applicable law or department rule, and advise the applicant of the appeal rights under He-M 503.16.

(j) Following denial of eligibility, the applicant, guardian, or representative, as applicable, may reapply for services if new information regarding the diagnosis, age of onset, or severity of the disability becomes available.

(k) Communication of approval or conditional eligibility in accordance with (d)(1) or (2) above shall include a contact person at the area agency.

(l) Preliminary planning to determine the services needed shall occur with the individual and guardian, or representative at the time of intake or during subsequent discussions. Preliminary evaluations shall be completed and preliminary recommendations for services shall be made within 21 days of a completed application for service.

(m) Within 3 days of the determination of an applicant’s eligibility under He-M 503.05 (d)(1) or (2), an area agency shall review 1915(c) of the Social Security Act, home and community-based waiver services with the individual, guardian, or representative in order to make a decision.

(n) If the individual, guardian, or representative is interested in pursuing home and community-based waiver services within the next 12 months, within 5 business days of the individual’s decision pursuant to (m) above, the area agency shall submit an application for waiver level of care eligibility pursuant to He-M 517.03 to the bureau.

(o) The bureau shall review an application submitted pursuant to (n) above and make a decision within 15 business days of receipt of the application.

(p) Within 3 days of the decision, the bureau shall communicate the decision to the area agency and the individual, guardian, or representative in writing.

(q) If the bureau determines the individual is not eligible for services in He-M 517, the notice shall include the specific legal and factual basis for the determination, including a specific citation to the applicable law or department rule, and the bureau shall advise the individual, guardian, or representative in writing of the appeal rights under He-M 517.09.

(r) If there is not sufficient information to determine the individual’s level of care, a request for additional information shall be sent by the bureau to the submitting entity to allow an additional 10 days to provide information sufficient to determine level of care.

(s) If information to determine is not provided, the bureau shall deny the level of care application, however, if new information becomes available after such denial, a new application may be submitted.

(t) Pursuant to RSA 171-A:6, IV, in an emergency situation, temporary service arrangements may be made prior to the completion of the evaluation in (a) above if the bureau administrator, or designee, first determines that the individual meets one of the following:

(1) Is a victim of abuse or neglect pursuant to He-E 700;

(2) Is abandoned and homeless;

(3) Is without a caregiver due to death or incapacitation;

(4) Is at significant risk of physical or psychological harm due to decline in their medical or behavioral status; or

(5) Is presenting a significant risk to community safety.

(u) The determination of eligibility by one area agency, pursuant to He-M 503.05(d), shall be accepted by every other area agency in the state.

History

#1969, eff 2-25-82; ss by #2615, eff 2-6-84; ss by #2962, eff 1-22-85; ss by #5211, eff 8-28-91; EXPIRED: 8-28-97; ss by #10774, INTERIM, eff 1-29-15, EXPIRES: 7-27-15
#6581, INTERIM, eff 9-19-97, EXPIRED: 1-17-98
#6932, eff 1-27-99; ss by #8805, eff 1-27-07; ss by #10774, INTERIM, eff 1-27-15, EXPIRES: 7-27-15; ss by #10900, eff 7-25-15; ss by #13841, eff 12-29-23

N.H. Code Admin. R. Ann. He-M 503.06 Periodic Review of Conditional Eligibility {#sec-he-m-503.06 omnilex-key=us-nh-regs-official--agency-he-m--He-M 503.06}

(a) Subsequent to finding an individual to be conditionally eligible for services pursuant to He-M 503.03 (f), the area agency shall render a definitive decision on eligibility before the individual reaches the age of 18.

(b) To determine whether the applicant is eligible, the area agency shall, at minimum, arrange for reevaluations:

(1) Anytime during the ages of 7 through 9;

(2) Anytime during the ages of 12 through 14; and

(3) Not later than the individual’s 18th birthday.

(c) If any of the reevaluations pursuant to (b) above, or any other information obtained subsequent to finding an applicant conditionally eligible, demonstrates to the area agency that a person is eligible for services pursuant to He-M 503.03 (a), any subsequent required reevaluations to determine eligibility shall not be performed.

(d) If the results of any of the reevaluations, or any other information obtained subsequent to finding an applicant conditionally eligible, demonstrate to the area agency that the applicant’s disability will continue indefinitely or the diagnosis is conclusive as defined in He-M 503.02 (o), the area agency shall determine them eligible for services and so inform the applicant, guardian, or representative in writing.

(e) If the results of any of the reevaluations demonstrate that the applicant does not meet the criteria as defined in He-M 503.02 (o), the area agency shall inform the applicant, guardian, or representative in writing no more than 3 business days from the determination of ineligibility and phase out services over the 12 months following the date of notice. The phase plan shall be outlined through a service agreement.

(f) In each instance where the reevaluation leads to a denial of eligibility, the area agency shall, in writing:

(1) Inform the applicant, guardian, or representative of the determination;

(2) Describe the specific legal and factual basis for the denial, including specific citation of the applicable law or department rule; and

(3) Advise the applicant of the appeal rights under He-M 503.16.

(g) An applicant, guardian, or representative may appeal a denial of eligibility based on the reevaluation pursuant to He-M 503.16 and He-C 200.

History

#1969, eff 2-25-82; ss by #2615, eff 2-6-84; ss by #2962, eff 1-22-85; ss by #5211, eff 8-28-91; EXPIRED: 8-28-97
#6581, INTERIM, eff 9-19-97, EXPIRED: 1-17-98
#6932, eff 1-27-99; ss by #8805, eff 1-27-07; ss by #10774, INTERIM, eff 1-27-15, EXPIRES: 7-27-15; ss by #10900, eff 7-25-15; ss by #13841, eff 12-29-23

N.H. Code Admin. R. Ann. He-M 503.07 Service Guarantees {#sec-he-m-503.07 omnilex-key=us-nh-regs-official--agency-he-m--He-M 503.07}

(a) Except as provided by RSA 171-B, all services shall:

(1) Be voluntary;

(2) Be provided only after the informed consent of the individual, guardian, or representative;

(3) Comply with the rights of the individual established under RSA 171-A:13-14, He-M 310, and federal laws and rules; and

(4) Maximize as much as possible the individual’s ability to determine and direct the services they will receive, in accordance with federal and state laws and rules.

(b) All services shall be designed to:

(1) Promote the individual’s personal development and quality of life in a manner that is determined by the individual;

(2) Meet the individual’s needs in life skills to promote independent living:

a. Including educational activities with the purpose of assisting the individual in attaining or enhancing community living skills, or adaptive skill development to assist the individual in residing in the most appropriate setting for their needs; and

b. Not including post-secondary education, regardless of whether it leads to a degree, or private tutoring;

(3) Promote the individual’s health and safety within the bounds of reasonable risk;

(4) Protect the individual’s right to freedom from abuse, neglect, and exploitation;

(5) Increase the individual’s participation in a variety of integrated activities and settings;

(6) Provide opportunities for the individual to exercise personal choice, independence, and autonomy within the bounds of reasonable risks;

(7) Enhance the individual’s ability to perform personally meaningful or functional activities;

(8) Assist the individual to acquire and maintain life skills, such as, managing a personal budget, participating in meal preparation, or traveling safely in the community, including accessing community transportation;

(9) Be provided in such a way that the individual is seen as a valued, contributing member of their community; and

(10) Meet the individual’s needs in accordance with He-M 503.09(m).

(c) The environment or setting in which an individual receives services shall be the least restrictive, most integrated setting that promotes that individual’s:

(1) Freedom of movement;

(2) Ability to make informed decisions;

(3) Self-determination;

(4) Participation in the community in accordance with 42 CFR 441.301; and

(5) Rights in accordance with He-M 310.

(d) An individual, guardian, or representative may select any available provider that is qualified pursuant to He-M 504, to deliver one or more of the services identified in the individual’s service agreement. All provider agencies and providers shall comply with the administrative rules and terms of the waiver when applicable, pertaining to the service(s) offered and meet the provisions specified within the individual’s service agreement.

(e) The area agency shall notify each individual, annually, that they have a right to choose their service coordinator who meets the requirements in He-M 503.08(a).

(f) No one shall be denied an opportunity for services on the basis of the severity of their developmental disability.

(g) An area agency shall monitor timeliness of the completion of annual service agreements by the service coordinator for all individuals, with the exception of those individuals or families who request only information and referral.

(h) Area agencies and provider agencies shall inform individuals and applicants of their rights under these rules in clearly understandable language and form.

(i) For individuals who require a positive behavior plan, emergency physical restraint shall only be approved for safely responding to situations in which the individual presents with imminent credible risk of significant harm to self or others by providers who are trained and certified in recognized intervention modalities.

History

#1969, eff 2-25-82; ss by #2615, eff 2-6-84; ss by #2962, eff 1-22-85; ss by #5211, eff 8-28-91; EXPIRED: 8-28-97
#6581, INTERIM, eff 9-19-97, EXPIRED: 1-17-98
#6932, eff 1-27-99; ss by #8805, eff 1-27-07; ss by #10774, INTERIM, eff 1-27-15, EXPIRES: 7-27-15; ss by #10900, eff 7-25-15 (from He-M 503.08); ss by #13841, eff 12-29-23

N.H. Code Admin. R. Ann. He-M 503.08 Service Coordination {#sec-he-m-503.08 omnilex-key=us-nh-regs-official--agency-he-m--He-M 503.08}

(a) The service coordinator shall be a person chosen by the individual, guardian, or representative who meets the criteria in He-M 504, He-M 506, and He-M 503.08 (b)-(c) below.

(b) The service coordinator shall:

(1) Advocate on behalf of individuals for services to be provided in accordance with the service guarantees in He-M 503.07 (b);

(2) Coordinate the service planning process in accordance with He-M 503.07, He-M 503.09, and He-M 503.10;

(3) Describe to the individual, guardian, or representative service delivery options including participant directed and managed services;

(4) Monitor and document services provided to the individual in accordance with He-M 503.10 below and He-M 517 for home and community-based waiver services;

(5) Ensure continuity and quality of services provided in the amount, scope, frequency, and duration as outlined in the service agreement;

(6) Monitor and document quality of services provided in accordance with He-M 503.10 below and He-M 517 for home and community-based waiver services;

(7) Provide crisis and critical incident coordination and planning;

(8) Ensure that service documentation is maintained pursuant to He-M 503.10 (c) and (l)(2)-(3) and He-M 517 for home and community-based waiver services;

(9) Determine and implement necessary action and document resolution when goals are not being addressed, support services are not being provided in accordance with the service agreement, or when health or safety issues have arisen;

(10) Convene person-centered service planning meetings at least annually and whenever:

a. The individual, guardian, or representative is not satisfied with the services received;

b. There is no progress on the goals after follow-up interventions;

c. The individual’s needs change;

d. There is a need for a new provider agency; or

e. The individual, guardian, or representative requests a meeting;

(11) Document service coordination visits and contacts pursuant to He-M 503.09 (u) and He-M 503.10 (l) (2)-(4);

(12) No less than 45 days in advance of the annual person-centered service planning meeting:

a. Ensure that all needed evaluations, screenings, or assessments, such as the SIS-A ®, HRST, assistive technology evaluation, comprehensive risk assessments, positive behavior plans, and other clinical or health evaluations are updated and, if necessary, performed and that information from said evaluations, screenings, and assessments is discussed and shared with the individual, guardian, or representative;

b. Identify risk factors and plans to minimize them;

c. Assess the individual’s interest in, or satisfaction with, employment; and

d. Discuss and assess the individual’s progress on goals and preparing for the development of new goals to be included in the new service agreement;

(13) Assist the individual, guardian, or representative to maintain the individual’s public benefits; and

(14) Participate in risk management activities by:

a. Making referrals to the applicable area agency’s local risk management committee for individual’s exhibiting behaviors including but not limited to violent aggression, problematic sexual behaviors, or fire-setting behaviors for evaluations or planning activities initially and ongoing;

b. Participating in and presenting to committees and other groups related to risk management including, but not limited to, local human rights committees, statewide and local risk management committees, and community of practice to determine application of assessment recommendations received;

c. Attending risk management training activities; and

d. Attending clinically specialized trainings, based on assessed needs of the individuals supported, that enable successful completion of and participation in risk management activities.

(1) Be a guardian or representative of the individual whose services they are coordinating; or

(2) Have a conflict of interest concerning the individual, such as providing, or being employed by the provider agency that also provides other direct services to the individual, except in accordance with He-M 503.08(d) and (e) below.

(d) A provider agency that provides direct services to the individual and seeks to also provide service coordination, shall be determined the only willing and qualified service coordination agency and permitted to provide service coordination and direct services if the following criteria are met:

(1) There is a lack of another qualified service coordination agency willing to provide services to the individual as outlined in their service agreement;

(2) The individual, guardian, or representative agrees that the same agency shall provide both service coordination and direct services;

(3) The agency ensures that service coordination and direct services are located in different departments and different physical locations within the organization, and report to separate and equal organizational leadership; and

(4) The direct services department shall not develop or have any influence on developing the individual’s service agreement.

(e) A provider agency requesting determination to serve as the only willing and qualified service coordination agency in accordance with (d) above shall complete and submit the form entitled “NH Bureau of Developmental Services Exemption Request” (December 2023) along with the following documentation:

(1) Documentation that the criteria outlined in He-M 503.08(d)(1) through (4) above has been met;

(2) Such agency’s plan to develop or recruit service coordination agencies;

(3) Documentation of service coordinator orientation and training that outlines the role of the service coordinator as a neutral facilitator and how to offer choice to individuals;

(4) Documentation of how such agency ensures all individuals, guardians, and representatives have accurate and accessible information relative to service providers; and

(5) Documentation to demonstrate how such agency monitors that choice is given to individuals, guardians, and representatives.

(f) Upon review of the form submitted pursuant to (e) above, the bureau shall approve such a request if all the requirements are met.

(g) The approval of being the only willing and qualified service coordination agency shall be for one year.

(h) After approval of an initial exemption request, the agency in (e) above shall resubmit to the department a “NH Bureau of Developmental Services Exemption Request” form (December 2023) annually.

(i) The documentation required in (e)(1)-(4) shall only be required with the initial request.

(j) Subsequent requests shall not require the described documentation provided that the only willing and qualified service coordination agency certifies that there have been no changes to the original documentation submitted.

(k) Once an only willing and qualified service coordination agency request has been approved in accordance with (f) or (j) above, the bureau shall conduct ongoing quarterly monitoring regarding the criteria in (d)(1) above.

History

#1969, eff 2-25-82; ss by #2615, eff 2-6-84; ss by #2962, eff 1-22-85; ss by #5211, eff 8-28-91; EXPIRED: 8-28-97
#6581, INTERIM, eff 9-19-97, EXPIRED: 1-17-98
#6932, eff 1-27-99; ss by #8805, eff 1-27-07; ss by #10774, INTERIM, eff 1-27-15, EXPIRES: 7-27-15; ss by #10900, eff 7-25-15 (from He-M 503.09); ss by #13841, eff 12-29-23

N.H. Code Admin. R. Ann. He-M 503.09 Service Planning {#sec-he-m-503.09 omnilex-key=us-nh-regs-official--agency-he-m--He-M 503.09}

(a) Preliminary planning for services shall be done in accordance with He-M 503.05(l).

(b) Within 15 days of an individual’s eligibility or conditional eligibility pursuant to He-M 503.05(d) or level of care approval pursuant to He-M 503.05(o), for those for whom an application for home and community-based waiver services has been submitted pursuant to He-M 503.05(n), the area agency shall assist the individual, guardian, or representative with resources to select a service coordinator.

(c) In instances when an individual has been determined eligible pursuant to He-M 503.05(d), and declines services available pursuant to He-M 503.05(l) and (m), the area agency shall assign a service coordinator within 30 days.

(d) In instances when a service coordinator has been assigned pursuant to (c) above, the service coordinator shall, at minimum, contact the individual annually to discuss ongoing needs and determine if service planning is desired.

(e) The service coordinator shall hold an initial person-centered service planning meeting to determine the individual’s goals and service needs in meeting those goals with the individual, the individual’s guardian or representative, and any other person chosen by the individual within 15 business days of the selection of and acceptance by, a service coordination agency.

(f) The service coordinator shall document that they have maximized the extent to which an individual participates in and directs their person-centered service planning process by:

(1) Explaining to the individual the person-centered service planning process and providing the information and support necessary to ensure that the individual directs the process to the maximum extent possible;

(2) Explaining to the individual their rights and responsibilities pursuant to He-M 310;

(3) Eliciting information from the individual regarding their goals, personal preferences, and service needs, including any health concerns, that shall be a focus of person-centered service planning meetings;

(4) Determining with the individual issues to be discussed during all person-centered service planning meetings; and

(5) Explaining to the individual the limits of the decision-making authority of the guardian, if applicable, and the individual’s right to make all other decisions related to services.

(g) The person-centered service planning process shall include a discussion regarding whether or not there is a need for a limited or full guardianship, conservatorship, representative payee for social security benefits, durable power of attorney, durable power of attorney for healthcare, supported-decision making, or other less restrictive alternatives to guardianship. The discussion and any recommendations from the team shall be incorporated into the service agreement.

(h) Service coordinators shall facilitate service planning to develop service agreements in accordance with He-M 503.10. Service agreements shall be prepared initially according to the timeframe specified in He-M 503.10 (c) and annually thereafter, as required by He-M 503.08 (b)(10).

(i) The individual, guardian, or representative may determine the following elements of the person-centered service planning process:

(1) The number and length of meetings;

(2) The location, date, and time of meetings;

(3) The meeting participants; and

(4) Topics to be discussed.

(j) Copies of relevant evaluations and reports shall be sent to the individual and guardian at least 5 business days before person-centered service planning meetings.

(k) If people who provide services to the individual are not selected by the individual to participate in a person-centered service planning meeting, and the individual determines that the provider would have information beneficial to service planning, the service coordinator shall contact such persons prior to the meeting so that their input can be considered.

(l) The service coordinator shall contact all persons who have been identified to provide a service to the individual and confirm arrangements for providing such services.

(m) All service planning shall occur through a person-centered service planning process that:

(1) Maximizes the decision-making of the individual;

(2) Is directed by the individual or the individual’s guardian or representative, if applicable;

(3) Facilitates personal choice by providing information and support to assist the individual to direct the process, including information describing:

a. The array of services and provider agencies available; and

b. Options regarding self-direction of services;

(4) Includes participants freely chosen by the individual;

(5) Reflects cultural considerations of the individual and is conducted in clearly understandable language and form;

(6) Occurs at times and a location of convenience to the individual, guardian, or representative;

(7) Includes strategies for solving conflict or disagreement within the process, including clear conflict of interest guidelines for all planning participants;

(8) Is consistent with an individual’s rights to privacy, dignity, respect, and freedom from coercion and restraint;

(9) Includes the process for the individual, guardian, or representative to request amendments to the service agreement;

(10) Records the alternative home- and community-based settings that were considered by the individual, guardian, or representative;

(11) Includes information related to risk by:

a. Incorporating information obtained through a comprehensive risk assessment, which shall be administered:

Initially, at the beginning of service planning, or as needed to each individual with a history of, or exhibiting signs of, behaviors that pose a potentially serious likelihood of danger to self or others, or a serious threat of substantial damage to real property, such as, but not limited to, the following:

(i) Problematic sexual behavior;

(ii) Violent aggression;

(iii) Fire-setting behaviors; or

(iv) Other similar violent or dangerous behaviors or events;

Prior to any significant change in the level of the individual’s treatment or supervision;
At any time an individual who previously has not had a comprehensive risk assessment begins to engage in behaviors referenced in 1. above; and
By an evaluator with specialized experience, training, and expertise in the treatment of the types of behaviors referenced in 1. above;

b. Ensuring that plans created pursuant to He-M 505 are reviewed with evaluators to consider ongoing appropriateness and opportunities for modification of restrictions following initiation of risk management related strategies. Such considerations may be made through reassessment or through a consultative review of other documentation and updated data related to the individual’s progress;

c. Ensuring documentation of activities and progress in treatment relative to management of risk for an individual to help inform development of person-centered service plans;

d. Making referrals for individuals associated with high-risk incidents to participate in evaluations or planning activities initially and ongoing;

e. Processing and analyzing incidents related to violent aggression, problematic sexual behavior, or fire-setting behaviors; and

f. Making referrals for individuals associated with high-risk incidents to evaluations or planning activities initially and ongoing;

(12) Includes information from specialty medical and health assessments and clinical assessments as needed, including, at a minimum, communication, assistive technology, and functional behavior assessments, as applicable;

(13) Includes strategies to address co-occurring severe mental illness or behavioral challenges which are interfering with the person’s functioning, including positive behavior plans or other strategies based on functional behavior or other evaluations or referrals to behavioral health services;

(14) Provides the individual with information regarding the services and provider agencies available to enable the individual to make informed decisions as to whom they would like to provide services;

(15) Includes individualized backup plans and strategies;

(16) Includes strategies for solving disagreements;

(17) Uses a strengths-based approach to identify the positive attributes of the individual;

(18) Includes the provision of auxiliary aids and services when needed for effective communication, including low literacy materials and interpreters;

(19) Addresses the individual’s concerns about current or contemplated guardianship or other legal assignment of rights;

(20) Explores housing and employment in integrated settings, and develops plans consistent with the individual’s goals and preferences;

(21) Includes a review of the past year that:

a. Includes the individual’s:

Personal achievements;
Relationships;
Degree of community involvement;
Challenging issues or behavior;
Health status and any changes in health; and
Safety considerations during the year;

b. Addresses the previous year’s goals with level of success and, if applicable, identifies any obstacles encountered;

c. Identifies the individual’s personal goals and the supports that will aid in achieving their goals;

d. Identifies the type and amount of services the individual receives and the support services provided under each service category;

e. Identifies the individual’s health needs;

f. Identifies the individual’s safety needs;

g. Identifies any follow-up action needed on concerns and the persons responsible for the follow-up; and

h. Includes a statement of the individual’s and guardian’s satisfaction with services;

(22) Includes the individual’s paid employment and volunteer positions, as applicable;

(23) Considers historical information about the individual’s experiences; and

(24) Includes a discussion of the need for assistive technology that could be utilized to support all services and activities identified in the proposed service agreement without regard to the individual’s current use of assistive technology.

(n) The information outlined in (m)(1)-(24) above shall be entered into the service agreement outlined in He-M 503.10 when the individual, guardian, or planning team determine that such information is necessary for successful participation in the services and supports outlined in the service agreement.

(o) All planning for home and community-based waiver services shall include information from the following assessments:

(1) The American Association on Intellectual and Developmental Disabilities’, “SIS-A ®”, (2023 edition), available as noted in Appendix A, for individuals aged 16 or older, which shall be administered:

a. Initially, within 60 days of the determination of eligibility for waiver services pursuant to He-M 503.05(o) for each individual;

b. For individual’s receiving In Home Supports home and community-based waiver services within 60 days of when the individual reaches age 16;

c. Upon a significant change as defined under SIS-A ® protocols;

d. Five years following each prior administration; and

e. To individuals who have moved to New Hampshire and are requesting home and community-based waiver services in the next 12 months. If the individual has previously had a SIS-A ® completed in another state within the last 5 years, however, then they may provide the out-of-state SIS-A ® results in place of taking a new SIS-A ®; and

(2) Information obtained through the HRST (2015 edition), available as noted in Appendix A, which shall be administered:

a. Initially, upon determination of eligibility for waiver services pursuant to He-M 503.05(o) or He-M 524 for each individual; and

b. Annually or upon significant change in an individual’s status; and

(3) For residential services, includes information from personal safety assessments pursuant to He-M 1001.

(p) In order to develop or revise a service agreement to the satisfaction of the individual, guardian, or representative, the person-centered service planning process shall consist of periodic and ongoing discussions regarding elements identified in He-M 503.07(b) that:

(1) Include the individual and other persons involved in their life;

(2) Are facilitated by a service coordinator; and

(3) Are focused on the individual’s abilities, health, interests, and achievements.

(q) Service agreements shall be reviewed by the service coordinator with the individual, guardian, or representative at least once during the first 6 months of service and as needed. The annual review required by He-M 503.08 (b)(10) shall include a service planning meeting.

(r) Pursuant to RSA 171-A:11, the reviews required in (q) above shall include, at a minimum, the following:

(1) A thorough clinical examination including an annual health assessment;

(2) An assessment of the individual’s capacity to make informed decisions; and

(3) Consideration of less restrictive alternatives for service.

(s) The individual, guardian, or representative may request, in writing, a delay in an initial or annual service agreement planning meeting. The area agency and provider agencies shall honor this request.

(t) In the event an individual, guardian, or representative requests an extension of the service agreement meeting, the extension shall be documented and not exceed 60 days after the expiration of the current service agreement.

(u) The service coordinator shall be responsible for monitoring services identified in the service agreement pursuant to He-M 503.10(l) and for assessing individual, family, or guardian satisfaction at least annually for non-waiver services and quarterly for waiver services.

(v) If an individual has a residency agreement and there is notification of intended termination, the service coordinator shall convene a person-centered service planning meeting as follows:

(1) Within 10 days of receipt of notification of the intended termination; or

(2) Within 24 hours of receipt of the notification if the intended termination is within 72 hours due to the threat of serious bodily injury by or to the resident.

(w) An area agency, service coordinator, provider agency, provider, individual, guardian, or representative shall have the authority to request a person-centered service planning meeting at any time.

(x) Service agreement amendments may be proposed at any time.

(y) If the individual, guardian, or provider agency disapproves of the service agreement, or a service agreement amendment, the dispute shall be resolved:

(1) Through informal discussions between the individual, guardian, or representative and service coordinator;

(2) By reconvening a person-centered service planning meeting; or

(3) By the individual, guardian, or representative filing an appeal to the bureau pursuant to He-C 200.

History

#1969, eff 2-25-82; ss by #2615, eff 2-6-84; ss by #2962, eff 1-22-85; ss by #5211, eff 8-28-91; EXPIRED: 8-28-97
#6581, INTERIM, eff 9-19-97, EXPIRED: 1-17-98
#6932, eff 1-27-99; ss by #8805, eff 1-27-07; ss by #10774, INTERIM, eff 1-27-15, EXPIRES: 7-27-15; ss by #10900, eff 7-25-15 (from He-M 503.10); ss by #13841, eff 12-29-23

N.H. Code Admin. R. Ann. He-M 503.10 Service Agreements {#sec-he-m-503.10 omnilex-key=us-nh-regs-official--agency-he-m--He-M 503.10}

(a) The service coordinator shall create service agreements for all individuals in accordance with (b)-(f) below.

(b) All service agreements shall:

(1) Be understandable to the individual, guardian, or representative and all provider agencies and providers responsible for service provision;

(2) At a minimum, be written in plain language and in a manner accessible to individuals with disabilities and persons who have limited proficiency in English;

(3) Be finalized and agreed to in writing by the individual, guardian, or representative and signed by all provider agencies responsible for the implementation of the service agreement;

(4) Be entered into the electronic platform, IntellectAbility at https://nhbds.hrstapp.com/ , and then NH Easy at https://nheasy.nh.gov/#/ , when IntellectAbility sunsets; and

(5) Be distributed to the individual, guardian or representative, area agency, and all provider agencies and providers who are responsible for the implementation or monitoring of the service agreement.

(c) Within 14 days of the initial person-centered service planning meeting pursuant to He-M 503.09 (e), the service coordinator shall develop a service agreement that includes, but is not limited to, the following:

(1) A statement of the nature of the specific strengths, interests, capacities, disabilities, and specific needs of the individual;

(2) A description of intermediate and long-range habilitation and treatment goals chosen by the individual and their guardian with a projected timetable for their attainment;

(3) A statement of specific services to be provided and the amount, scope, frequency, and duration of each service;

(4) Specification of the provider agencies to furnish each service identified in the service agreement;

(5) Criteria for transfer to less restrictive settings for habilitation, including criteria for termination of service, and a projected date for termination of service;

(6) Demographic information;

(7) A personal profile;

(8) The specific services to be furnished based on the support needs identified in (1) above and how the services selected will support the individual’s goals;

(9) Guardianship, supported decision-making, and representative payee information;

(10) Service documentation requirements sufficient to track outcomes;

(11) Identification of the persons and entities responsible for monitoring the services in the service agreement;

(12) Documentation that all settings where the individual receives services meet the criteria of 42 CFR 441.301, are chosen by the individual or representative, and support full access to the greater community, including opportunities to seek employment and work in competitive integrated settings, engage in community life, control personal resources, and receive services in the community to the same degree of access as people not receiving services;

(13) Documentation that the setting is selected by the individual from among setting options, including non-disability specific settings and an option for a private unit in a residential setting, and that the settings options are identified and based on the individual’s needs, and preferences;

(14) Documentation that any restriction on the right of an individual is justified by:

a. An identified specific and individualized need that the modification is based on;

b. The positive interventions and supports used prior to any modifications to the individual’s rights;

c. The less intrusive methods of meeting the need that were tried but did not work;

d. A clear description of the condition that is directly proportionate to the specific assessed need;

e. The regular collection and review of data to measure the ongoing effectiveness of the modification;

f. Established time limits for periodic reviews of the necessity of the modification;

g. The informed consent of the individual, guardian, or representative; and

h. An assurance that the modification will not cause harm to the individual;

(15) Services needed but not currently available; and

(16) If applicable, risk factors and the measures required to be in place to minimize them, including backup plans and strategies.

(d) For individuals receiving waiver services, the information provided below shall be added to the service agreement:

(1) The specific waiver services to be provided including the amount, scope, frequency, and duration;

(2) The results of the SIS-A ® and the HRST;

(3) Service documentation requirements sufficient to describe progress on goals and the services received; and

(4) If applicable, reporting mechanisms under self-directed services regarding budget updates and individual and guardian satisfaction with services.

(e) For individuals who reside in a provider owned or controlled residential setting, the service agreement shall document any modifications of the individual’s rights in said setting to:

(1) Privacy in their sleeping or living unit, including doors lockable by the individual with only appropriate providers having keys to doors as needed;

(2) Freedom and support to control their own schedule and activities;

(3) Access to food at any time;

(4) Having visitors of their choosing at any time; and

(5) Freedom to furnish and decorate sleeping or living units.

(f) A provider agency shall only make modifications pursuant to (e) above by documenting in the service agreement the following:

(1) An identified specific and individualized assessed need that the modifications are based on;

(2) The positive interventions and supports used prior to any modifications to the service agreement;

(3) The less intrusive methods of meeting the need that have been tried but did not work;

(4) A clear description of the condition that is directly proportionate to the specific assessed need;

(5) The regular collection and review of data to measure the ongoing effectiveness of the modification;

(6) Established time limits for periodic reviews to determine if the modification is still necessary or can be terminated;

(7) The informed consent of the individual or representative; and

(8) An assurance that the interventions and support will not cause harm to the individual.

(g) Within 5 business days of completion of a service agreement, or service agreement amendment, the service coordinator shall provide the individual and guardian, or representative the following:

(1) The service agreement, signed by the service coordinator, and all provider agencies identified in the service agreement;

(2) The name, address, email, and phone number of all provider agencies; and

(3) A description of the procedures for challenging the proposed service agreement pursuant to He-M 503.16 for those situations where the individual, guardian, or representative disapproves of the service agreement.

(h) The individual, guardian, or representative shall have 10 business days from the date of receipt of the service agreement, or the service agreement amendment, to respond in writing, indicating approval or disapproval of the service agreement or amendment. Unless otherwise arranged between the individual, guardian, or representative and the service coordinator, failure to respond within the time allowed shall constitute approval of the service agreement or amendment.

(i) When a service agreement has been approved by the individual, guardian, or representative and service coordinator, the services shall be implemented and monitored as follows:

(1) A person responsible for implementing any part of a service agreement, shall collect and record information about services provided and how they have impacted progress on the individual’s goals, in a timeframe outlined in the service agreement or, at a minimum, monthly;

(2) On at least a monthly basis, the service coordinator shall visit or have verbal or written contact, as determined by the individual or persons responsible for implementing a service agreement, and document these contacts;

(3) The service coordinator shall visit the individual and contact the guardian, if any, at least quarterly, or more frequently if so specified in the individual’s service agreement, to determine and document:

a. Whether services match the interests and needs of the individual;

b. Individual and guardian satisfaction with services; and

c. Progress on the goals in the expanded service agreement; and

(4) If the individual receives services under He-M 1001, or residential services under He-M 521, He-M 524, or He-M 525, all of the service coordinator’s quarterly visits with the individual shall be in the home where the individual resides.

History

#1969, eff 2-25-82; ss by #2615, eff 2-6-84; ss by #2962, eff 1-22-85; ss by #5211, eff 8-28-91; EXPIRED: 8-28-97
#6581, INTERIM, eff 9-19-97, EXPIRED: 1-17-98
#6932, eff 1-27-99; ss by #8805, eff 1-27-07; ss by #10774, INTERIM, eff 1-27-15, EXPIRES: 7-27-15; ss by #10900, eff 7-25-15 (from He-M 503.11); ss by #13841, eff 12-29-23

N.H. Code Admin. R. Ann. He-M 503.11 Record Requirements for Area Agencies and Provider Agencies {#sec-he-m-503.11 omnilex-key=us-nh-regs-official--agency-he-m--He-M 503.11}

(a) Area agencies, service coordinators, and other provider agencies, or their designees shall maintain a separate record for each individual who receives services and ensure the confidentiality of information pertaining to the individual, including:

(1) Maintaining the confidentiality of any personal data in the records;

(2) Storing and disposing of records in a manner that preserves confidentiality; and

(3) Obtaining a release of information pursuant to He-M 503.04 (h) prior to release of any part of a record to a third party.

(b) An individual’s record shall include, as applicable:

(1) Personal and identifying information including the individual’s:

a. Name;

b. Address;

c. Date of birth; and

d. Telephone number;

(2) All information used to determine eligibility for services pursuant to He-M 503.05 and He-M 503.06;

(3) Information about the individual that would be essential in case of an emergency, including:

a. Name, address, and telephone number of legal guardian, representative, or next of kin or other person to be notified;

b. Name, address, and telephone number of current providers; and

c. Medical information as applicable, including:

Diagnosis(es);
Health history;
Allergies;
Do not resuscitate (DNR) orders, as appropriate;
Advance directives, as determined by the individual;
Current medications; and
Any correspondence related to medical information relevant to the individual;

(4) A copy of the individual’s current service agreement;

(5) Copies of all service agreement amendments;

(6) Progress notes on goals and support services provided as identified in the service agreement;

(7) All service coordination contact notes and quarterly assessments pursuant to He-M 503.10(i)(2)-(4);

(8) Copies of evaluations and reviews by providers and professionals;

(9) Copies of correspondence within the past year with the individual and guardian, area agency, provider agencies, providers, physicians, attorneys, state and federal agencies, family members, and others in the individual’s life;

(10) Other correspondence or memoranda concerning any significant events in the individual’s life;

(11) Information about transfer or termination of services, as appropriate; and

(12) Proof that the individual was given choice of provider agencies.

(c) All entries made into an individual record shall be legible and dated and have the author identified by name and position.

(d) In addition to the documentation requirements identified in He-M 503, each area agency, service coordinator, provider agency, and provider shall comply with all applicable documentation requirements of other department rules.

(e) Each billing entity shall:

(1) Retain records supporting each Medicaid bill for a period of not less than 6 years; and

(2) Retain an individual’s social history, medical history, evaluations, and any court-related documentation for a period of not less than 6 years after termination of services.

History

#1969, eff 2-25-82; ss by #2615, eff 2-6-84; ss by #2962, eff 1-22-85; ss by #5211, eff 8-28-91; EXPIRED: 8-28-97
#6581, INTERIM, eff 9-19-97, EXPIRED: 1-17-98
#6932, eff 1-27-99; ss by #8805, eff 1-27-07; ss by #10774, INTERIM, eff 1-27-15, EXPIRES: 7-27-15; ss by #10900, eff 7-25-15 (from He-M 503.12); ss by #13841, eff 12-29-23

N.H. Code Admin. R. Ann. He-M 503.12 Service Funding {#sec-he-m-503.12 omnilex-key=us-nh-regs-official--agency-he-m--He-M 503.12}

(a) Pursuant to RSA 171-A:1-a, I, services shall be funded in such a manner that:

(1) For individuals in school and already eligible for services from the area agencies, funds shall be allocated to them 90 days prior to their graduating or exiting the school system or earlier so that any new or modified services needed are available and provided upon such school graduation or exit;

(2) For newly found eligible adults, the period between the time of completion of a service agreement and the allocation by the department of the funds needed to carry out the services required by the service agreement shall not exceed 90 days; and

(3) For individuals already receiving services who experience significant life changes, such as a significant change in their medical conditions, the period of time for initiation of new services shall not exceed 90 days from the amendment of the service agreement except by mutual agreement between the area agency and the individual specifying a time limited extension.

(b) Service funding needs for (a)(1)-(2) shall be documented by the area agency into NH Easy at https://nheasy.nh.gov/#/.

(c) Service funding needs for (a)(3) shall be documented by the service coordinator into NH Easy at https://nheasy.nh.gov/#/.

(d) The bureau shall make the final determination on the cost effectiveness of proposed services for all funding requests.

History

#1969, eff 2-25-82; ss by #2615, eff 2-6-84; ss by #2962, eff 1-22-85; ss by #5211, eff 8-28-91; EXPIRED: 8-28-97
#6581, INTERIM, eff 9-19-97, EXPIRED: 1-17-98
#6932, eff 1-27-99; ss by #8805, eff 1-27-07; ss by #10774, INTERIM, eff 1-27-15, EXPIRES: 7-27-15; ss by #10900, eff 7-25-15 (from He-M 503.14); amd by #12948, eff 12-20-19; ss by #13841, eff 12-29-23

N.H. Code Admin. R. Ann. He-M 503.13 Transfers Across Regions {#sec-he-m-503.13 omnilex-key=us-nh-regs-official--agency-he-m--He-M 503.13}

(a) If an individual, guardian, or representative plans to relocate where the individual lives and wishes to transfer the individual’s area agency affiliation to that region, the individual, guardian, or representative shall notify, in writing, the area agency in the current region and the area agency in the proposed region that the individual is moving and wishes to transfer services to that region.

(b) The current area agency shall send to the proposed area agency all information contained within the individual’s file as outlined in He-M 503.11.

(c) Service coordinators shall assist with the coordination when an individual transfers so that benefits obtained from third party resources such as Medicaid, community mental health center services, and the division of vocational rehabilitation services shall not be lost or delayed during the transition from one region to another.

History

#1969, eff 2-25-82; ss by #2615, eff 2-6-84; ss by #2962, eff 1-22-85; ss by #5211, eff 8-28-91; EXPIRED: 8-28-97
#6581, INTERIM, eff 9-19-97, EXPIRED: 1-17-98
#6932, eff 1-27-99; ss by #8805, eff 1-27-07; ss by #10372, eff 7-1-13; ss by #10900, eff 7-25-15 (from He-M 503.15); ss by #13841, eff 12-29-23 (formerly He-M 503.14)

N.H. Code Admin. R. Ann. He-M 503.14 Termination of Services {#sec-he-m-503.14 omnilex-key=us-nh-regs-official--agency-he-m--He-M 503.14}

(a) If termination of services is being considered by the area agency, service coordinator, individual, guardian, representative, or provider agency, then the service coordinator shall meet with either the individual or their guardian or representative, or both to discuss the reasons for the recommended termination.

(b) Any recommendation for termination shall be made in writing to the area agency director and be based on one or both of the following:

(1) The individual can function without such service; or

(2) Services are no longer necessary because they have been replaced by other supports or services.

(c) Within 10 business days of receipt of a recommendation for termination of services, an area agency director shall call a meeting with the service coordinator, either the individual or their guardian or representative, if applicable, and the provider agencies to be convened to review the request. The purpose of the meeting shall be to determine if the criteria listed in (b) above applies to the individual.

(d) Based on the information presented and determinations made at the meeting, the service coordinator shall prepare a written report for the area agency director which sets forth one of the following:

(1) A statement of concurrence with the recommendation for termination;

(2) A recommendation for continuance; or

(3) Changes to the individual’s service agreement.

(e) The area agency director shall make the final decision regarding termination based on the criteria listed in (b) above.

(f) If a decision is made to terminate services pursuant to (b) above, the area agency director shall send a termination notice to the individual, guardian, or representative at least 30 days prior to the proposed termination date. Services may be terminated sooner than 30 days with the consent of the individual, guardian, or representative. The individual, guardian, or representative may appeal the termination decision in accordance with He-C 200.

(g) In each termination notice the area agency shall provide information on the reason for termination, the right to appeal, and the process for appealing the decision, including the names, addresses, and phone numbers of the office of client and legal services of the bureau and advocacy organizations, such as the Disability Rights Center-NH, which the individual, guardian, or representative may contact for assistance in appealing the decision.

(h) An individual whose services have been terminated may request resumption of services if they believe that the reasons for the termination of services no longer apply. Such a request shall be made by the individual, guardian, or representative, in writing, to the area agency director.

(i) Upon request of the individual, guardian, or representative, the area agency director shall resume services to the individual if the criteria in (b) above no longer apply and if funding is available.

History

#1969, eff 2-25-82; ss by #2615, eff 2-6-84; ss by #2962, eff 1-22-85; ss by #5211, eff 8-28-91; EXPIRED: 8-28-97
#6581, INTERIM, eff 9-19-97, EXPIRED: 1-17-98
#6932, eff 1-27-99; ss by #8805, eff 1-27-07; ss by #10774, INTERIM, eff 1-27-15, EXPIRES: 7-27-15; ss by #10900, eff 7-25-15 (from He-M 503.16); ss by #13841, eff 12-29-23 (formerly He-M 503.15)

N.H. Code Admin. R. Ann. He-M 503.15 Voluntary Withdrawal from Services {#sec-he-m-503.15 omnilex-key=us-nh-regs-official--agency-he-m--He-M 503.15}

(a) An individual, guardian, or representative may withdraw voluntarily from any service(s) at any time, except as provided by RSA 171-B.

(b) The administrator of the service from which withdrawal is made shall notify the area agency in writing of the withdrawal and so indicate in the individual’s record.

(c) If any provider determines that withdrawal from a service might constitute abuse, neglect, or exploitation on the part of a guardian or representative, the provider or service coordinator shall report such abuse, neglect, or exploitation as required by law.

(d) If an individual does not have a guardian or representative and their service coordinator or any other person believes that the individual is not making an informed decision to withdraw from services and might suffer harm as a result of abuse, neglect, or exploitation, the area agency shall pursue the least restrictive protective means including, as appropriate, guardianship to address the situation.

(e) An individual who has withdrawn from services may request resumption of services at any time. Such a request shall be made by the individual, guardian, or representative, in writing, to the area agency director.

(f) Upon request of the individual, guardian, or representative, the area agency director shall resume services to the individual if funding is available.

History

#1969, eff 2-25-82; ss by #2615, eff 2-6-84; ss by #2962, eff 1-22-85; ss by #5211, eff 8-28-91; EXPIRED: 8-28-97
#6581, INTERIM, eff 9-19-97, EXPIRED: 1-17-98
#6932, eff 1-27-99; ss by #8805, eff 1-27-07 (from He-M 503.13); ss by #10774, INTERIM, eff 1-27-15, EXPIRES: 7-27-15; ss by #10900, eff 7-25-15 (from He-M 503.17); ss by #13841, eff 12-29-23 (formerly He-M 503.16)

N.H. Code Admin. R. Ann. He-M 503.16 Challenges and Appeals {#sec-he-m-503.16 omnilex-key=us-nh-regs-official--agency-he-m--He-M 503.16}

(a) Any determination, action, or inaction by the bureau, a service coordination agency, provider agency, or area agency may be appealed by an individual, guardian, or representative.

(b) An individual, guardian, or representative may choose to pursue formal or informal resolution to resolve any disagreement with the bureau, a service coordination agency, provider agency, or an area agency. If informal resolution is sought, at any time during the process or within 30 business days of the bureau, service coordination agency, provider agency, or area agency decision, the individual may choose to file a formal appeal pursuant to (e)-(g) below. All formal appeals shall be filed within 30 days of the bureau, area agency, provider agency, or service coordination agency determination, action, or inaction.

(1) Adverse eligibility actions under He-M 503.05(i) and (q) and He-M 503.06(e) and (f);

(2) Proposed service agreements or service agreement amendments if the individual, guardian, or representative disapproves pursuant to He-M 503.10(h); and

(3) A determination to terminate services under He-M 503.14(f).

(d) The bureau, area agency, provider agency, or service coordination agency, as applicable, shall provide written notice to the applicant, individual, and guardian or representative of the actions specified in (c) above, including:

(1) The specific rules that support, or the federal or state law that requires, the action;

(2) Notice of the individual’s right to appeal in accordance with He-C 200 within 30 business days and the process for filing an appeal, including the contact information to initiate the appeal with the bureau’s administrator;

(3) Notice of the individual’s continued right to services pending appeal, when applicable, pursuant to (g) below;

(4) Notice of the right to have representation with an appeal by:

a. Legal counsel;

b. A relative;

c. A friend; or

d. Another spokesperson;

(5) Notice that neither the area agency, provider agency, service coordination agency, nor the bureau is responsible for the cost of representation; and

(6) Notice of organizations with their addresses and phone numbers that might be available to provide pro bono or reduced fee legal assistance and advocacy, including the Disability Rights Center-NH.

(e) Appeals shall be forwarded, in writing, to the bureau administrator in care of the department’s office of client and legal services. An exception shall be that appeals may be filed verbally if the individual is unable to convey the appeal in writing.

(f) The bureau administrator shall immediately forward the appeal to the department’s administrative appeals unit which shall assign a presiding officer to conduct a hearing, as provided in He-C 200. The burden shall be as provided by He-C 204.12.

(g) If a hearing is requested, the following actions shall occur:

(1) For current recipients, services and payments shall be continued as a consequence of an appeal for a hearing until a decision has been made; and

(2) If the bureau, service coordination agency, provider agency, or area agency decision is upheld:

a. Benefits shall cease 60 days from the date of the denial letter or 30 days from the hearing decision, whichever is later; or

b. In the instance of termination of services, services shall cease one year after the initial decision to terminate services or 30 days from the hearing decision, whichever is later.

History

#8805, eff 1-27-07 (from He-M 503.14); ss by #10774, INTERIM, eff 1-27-15, EXPIRES: 7-27-15; ss by #10900, eff 7-25-15 (from He-M 503.18); ss by #13841, eff 12-29-23 (formerly He-M 503.17)

N.H. Code Admin. R. Ann. He-M 503.17 Waivers {#sec-he-m-503.17 omnilex-key=us-nh-regs-official--agency-he-m--He-M 503.17}

(a) An applicant, area agency, service coordination agency, provider agency, individual, guardian, representative, or provider may request a waiver of specific procedures outlined in He-M 503 by completing and submitting the form titled “NH Bureau of Developmental Services Waiver Request” (October 2023). The request shall be sent in writing to the bureau administrator.

(b) A completed waiver request form shall be signed by:

(1) The individual, guardian, or representative indicating agreement with the request; and

(2) If applicable, the area agency, service coordination agency, or provider agency’s executive director or designee recommending approval of the waiver.

(1) Email at bds@dhhs.nh.gov; or

(2) By mail to:

Bureau of Developmental Services

Hugh J. Gallen State Office Park

105 Pleasant Street, Main Building

Concord, NH 03301

(d) No provision or procedure prescribed by statute shall be waived.

(e) The request for a waiver shall be granted by the commissioner or their designee within 30 days if the alternative proposed by the requesting entity meets the objective or intent of the rule and it:

(1) Does not negatively impact the health or safety of the individual(s); and

(2) Does not affect the quality of services to individuals.

(f) Upon receipt of approval of a waiver request, the requesting entity’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 granted in writing for the minimum period necessary to accommodate the waiver request, with a specific duration not to exceed 5 years except as in (h)-(i) below.

(h) Any waiver shall end with the closure of the related program or service.

(i) A requesting entity may request a renewal of a waiver from the bureau. Such request shall be made at least 30 days prior to the expiration of a current waiver.

History

#8805, eff 1-27-07 (from He-M 503.15); ss by #10774, INTERIM, eff 1-27-15, EXPIRES: 7-27-15; ss by #10900, eff 7-25-15 (formerly He-M 503.19); ss by #13841, eff 12-29-23(formerly He-M 503.18)

Part He-M 504 Provider and Provider Agency Operations

N.H. Code Admin. R. Ann. He-M 504.01 Purpose {#sec-he-m-504.01 omnilex-key=us-nh-regs-official--agency-he-m--He-M 504.01}

The purpose of these rules is to define the expectations for all providers and provider agencies seeking payment from the department for the provision of authorized services to eligible individuals with developmental disabilities and acquired brain disorders.

History

#13679, EMERGENCY RULE, eff 6-28-23; ss by #13807, eff 11-17-23

N.H. Code Admin. R. Ann. He-M 504.02 Definitions {#sec-he-m-504.02 omnilex-key=us-nh-regs-official--agency-he-m--He-M 504.02}

The words and phrases used in these rules shall mean the following, except where a different meaning is clearly intended from the context:

(a) “Acquired brain disorder” means a disruption in brain functioning that:

(1) Is not congenital or caused by birth trauma;

(2) Presents a severe and life-long disabling condition which significantly impairs a person’s ability to function in society;

(3) Occurs prior to age 60;

(4) Is attributable to one or more of the following reasons:

a. External trauma to the brain as a result of:

A motor vehicle incident;
A fall;
An assault; or
Another related traumatic incident or occurrence;

b. Anoxic or hypoxic injury to the brain such as from:

Cardiopulmonary arrest;
Carbon monoxide poisoning;
Airway obstruction;
Hemorrhage; or
Near drowning;

c. Infectious diseases such as encephalitis and meningitis;

d. Brain tumor;

e. Intracranial surgery;

f. Cerebrovascular disruption such as a stroke;

g. Toxic exposure; or

h. Other neurological disorders such as Huntington’s disease or multiple sclerosis which predominantly affect the central nervous system resulting in diminished cognitive functioning and ability; and

(5) Is manifested by one or more of the following:

a. Significant decline in cognitive functioning and ability; or

b. Deterioration in:

Personality;
Impulse control;
Judgment;
Modulation of mood; or
Awareness of deficits;

(b) "Area agency" means “area agency” as defined in RSA 171-A:2, I-b.

(d) “Commissioner” means the commissioner of the department of health and human services or designee;

(e) “Cost of care” means the amount of income that eligible individuals receiving home and community based waiver services are liable to contribute toward the cost of their services as specified in He-M 517;

(f) “Critical incident” means an alleged, suspected, or actual occurrence of:

(1) Abuse including physical, sexual, verbal, and psychological abuse;

(2) Neglect;

(3) Exploitation;

(4) Serious injury;

(5) Death other than by natural causes; and

(6) Other events that threaten the health or safety of an individual such as hospitalizations, administration of the wrong medication, failure to administer medication, or use of restraints or behavioral interventions that are not included in an approved behavior change program;

(g) “Days” means calendar days unless otherwise specified;

(h) “Department” means the New Hampshire department of health and human services;

(i) "Developmental disability" means “developmental disability” as defined in RSA 171-A:2, V, namely, "a disability:

(2) Which originates before such individual attains age 22, has continued or can be expected to continue indefinitely, and constitutes a severe disability to such individual's ability to function normally in society.";

(j) “Enrolled provider” means a provider agency or independent provider that the department has determined is eligible to provide Home and Community Based 1915 (c) waiver services and receive payment therefore;

(k) “Guardian” means a person appointed pursuant to RSA 463 or RSA 464-A or the parent of an individual under the age of 18 whose parental rights have not been terminated or limited by law;

(l) “Home and community based waiver services” means the services defined and funded pursuant to New Hampshire’s agreement with the federal government, known as the Developmental Disabilities Waiver, In-Home Supports Waiver, and the Acquired Brain Disorder Waiver, pursuant to the authority section of 1915(c) of the Social Security Act which allows the federal funding of long-term care services in non-institutional settings for persons who are developmentally disabled or who have an acquired brain disorder;

(m) “Individual” means a person who has a developmental disability or acquired brain disorder;

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

(o) “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;

(p) “Organized health care delivery system (OHCDS)” means an area agency, designated pursuant to He-M 505, that directly provides at least one home and community based waiver service;

(q) “Pass-through billing” means an arrangement, pursuant to 42 CFR 447.10(g)(3), whereby the OHCDS is the enrolled provider of home and community based waiver services for the purposes of billing and subcontracting for the service provision and has authorization from the department to do so;

(r) “Person-centered service planning” is an individual-directed, positive approach to the planning and coordination of a person’s services and other supports based on the individual’s aspirations, needs, preferences, and goals;

(s) “Problematic sexual behavior” means non-consensual touching or attempting to touch another person’s body in a sexualized manner, unsolicited sexualized statements, public exposure, and illegal sexual conduct whether in person or online.

(t) “Provider” means a person receiving any form of remuneration for the provision of services to an individual;

(u) “Provider agency” means an agency or an independent provider that is established to provide services to individuals;

(v) “Provider applicant” means a provider agency who is undergoing the enrollment or re-enrollment process to become a New Hampshire Medicaid provider;

(w) “Provider enrollment ID” means a unique identification number assigned to provider agencies who are enrolled in the state’s Medicaid program and authorized to provide services to Medicaid beneficiaries;

(x) “Room and board” means shelter type expenses, including all property-related costs such as rental or purchase of real estate and furnishings, maintenance, utilities, and related administrative services, and 3 meals a day or any other full nutritional regimen;

(y) “Sentinel event” means an unexpected occurrence involving death or serious physical or psychological injury, or risk thereof. Serious injury specifically includes loss of limb or function. Categories of reportable sentinel events are individual-centered events, in which the individual is either a victim or perpetrator, including, but are not limited to:

(1) Any sudden, unanticipated, or accidental death, not including homicide or suicide, and not related to the natural course of an individual’s illness or underlying condition;

(2) Permanent loss of function, not related to the natural course of an individual’s illness or underlying condition, resulting from such causes including but not limited to:

a. A medication error;

b. An unauthorized departure or abduction from a facility providing care; or

c. A delay or failure to provide requested or medically necessary services due to waitlists, availability, insurance coverage, or resource limits;

(3) Homicide;

(4) Suicide;

(5) Suicide attempt, such as self-injurious behavior with a non-fatal outcome, with explicit or implicit evidence that the person intended to die and medical intervention was needed;

(6) Rape or any other sexual assault;

(7) Serious physical injury;

(8) Serious psychological injury that jeopardizes the person’s health that is associated with the planning and delivery of care; or

(9) Injuries due to physical or mechanical restraints;

(10) High profile or high risk event, such as:

a. Media coverage; or

b. Police involvement leading to an arrest;

(z) “Service” means any paid assistance to an individual in meeting their own needs provided through the developmental services system;

(aa) “Service coordinator” means a provider who meets the criteria in He-M 503 or He-M 522 and is chosen by an individual and their guardian or representative to organize, facilitate, and document service planning and to negotiate and monitor the provision of the individual’s services;

(ab) “Service coordination agency” means a provider agency providing service coordination services to individuals and licensed pursuant to He-P 819;

(ac) “Staff” means a person employed by a provider agency, subcontract agency, or other employer; and

(ad) “Utilization review and control” means the monitoring of medicaid program services pursuant to 42 CFR 455 and 42 CFR 456.

History

#13679, EMERGENCY RULE, eff 6-28-23; ss by #13807, eff 11-17-23

N.H. Code Admin. R. Ann. He-M 504.03 Roles and Responsibilities of Providers and Provider Agencies {#sec-he-m-504.03 omnilex-key=us-nh-regs-official--agency-he-m--He-M 504.03}

(a) All provider agencies shall obtain and maintain certifications for community residences, enhanced family care shared living residential habilitation services, and adult day community participation services in accordance with He-M 507 or He-M 1001, as applicable.

(b) All providers and provider agencies shall be responsible for the following:

(1) Participating in person-centered service planning in accordance with He-M 503, He-M 522, and He-M 524;

(2) Ensuring service delivery is led by the individual and family, if chosen by the individual, and promotes community involvement, relationship development, independence, societal contribution, enhancement of individual communications, and aligns with an individual’s service agreement and in accordance with RSA 171-A;

(3) Reviewing the service agreement to ensure:

a. That all provider agencies review and sign the service agreement in accordance with He-M 503, He-M 522, and He-M 524, as applicable, to indicate that they agree to provide services in the amount, scope, frequency and duration, as outlined; and

b. That all providers review the service agreement relative to the service that they will be providing prior to service provision;

(4) Ensuring that all services and supports are provided in accordance with He-M 310, He-M 503, He-M 517, He-M 522, He-M 524, and He-M 1201, as applicable;

(5) Creating and maintaining documentation in accordance with He-M 503, He-M 517, He-M 522, He-M 524, and He-M 1201, as applicable;

(6) Providing documentation of service planning, monitoring, and billing related to the service being provided, within 30 days of the request from the following entities, unless otherwise stated in rule, as follows:

a. To the department;

b. To area agencies, regarding information that is necessary for area agencies to complete their responsibilities pursuant to He-M 505; and

c. To service coordinators, regarding information that is necessary for the service coordination provider agency and service coordinator to complete their responsibilities pursuant to He-M 500;

(7) Providing documentation in (6) above within 3 business days in circumstances when the information is needed to support crisis planning;

(8) Participating in activities with the area agency that are necessary to complete its responsibilities pursuant to He-M 505;

(9) Participating in crisis mitigation and management which includes, but is not limited to, identifying alternative placement options, sharing information with other provider agencies and providers, and participating in crisis management meetings;

(10) Documenting and submitting to service coordination agencies and notifying guardians, if applicable, incident reports regarding critical incidents;

(11) Documenting and submitting to area agencies incident reports regarding critical incidents when the service coordination agency is the reporting entity; and

(12) Managing responses to areas of risk, in accordance with He-M 503, He-M 522, and He-M 524 and by:

a. Reviewing and analyzing incidents related to violent aggression, problematic sexual behaviors, or fire-setting behaviors as they pertain to service planning and provision;

b. Notifying service coordinators of the presentation of incidents in accordance with (a) above;

c. Presenting to committees and other groups related to risk management, when invited by the service coordinator, including, but not limited to, local human rights committees, statewide and local risk management committees, and community of practice to determine application of assessment recommendations received, when the provider agency participated in the plan development;

d. Ensuring documentation of activities and progress in treatment relative to management of risk for an individual to help inform the person-centered development of plans;

e. Ensuring that agency personnel and contractors receive clinically specialized trainings, based on assessed needs of the individuals supported, that enable these personnel to successfully complete risk management activities;

f. Ensuring participation in risk management training activities; and

g. Ensuring that plans are reviewed regularly with individuals and their treatment team to consider ongoing appropriateness and, in the event that potential changes are indicated, seeking additional consultation with providers qualified to conduct and author assessments, whether they created the initial plans or are new, to discuss opportunities for modification of restrictions by sharing data regarding the individual’s updated progress in treatment.

(c) In addition to the requirements in He-M 504.03(b)(9) for response to management of risk, service coordination provider agencies and service coordination providers shall:

(1) Make referrals, as applicable, to the appropriate area agency’s local risk management committee for individuals exhibiting violent aggression, problematic sexual behaviors, or fire-setting behaviors for evaluations or planning activities initially and ongoing;

(2) Arrange for assessments or evaluations resulting from local human rights committee recommendations; and

(3) Participate in and present to committees and other groups related to risk management including, but not limited to, local human rights committees, statewide and local risk management committees and communities of practice to determine application of assessment recommendations received.

(d) All service coordination agencies shall document sentinel events and submit reports to the applicable area agency for finalization in accordance with RSA 126-A:4.

(e) All provider agencies shall be able to be contacted during their published hours of business, as indicated in the medicaid provider enrollment process.

(f) In addition to (e) above, all home and community based waiver community residence and enhanced family care shared living residential habilitation provider agencies and service coordination provider agencies shall be accessible 24/7 and have an on-call system for emergency access outside of regular business hours to ensure response within 30 minutes by a representative with decision-making authority.

(g) Each provider agency must complete a New Hampshire criminal records check no more than 30 days prior to hire and prior to working with any individual, and every other year thereafter, for all of its providers, staff, contractors, and volunteers who will have direct contact with individuals or families and:

(1) If the applicable provider, staff, contractor or volunteer’s primary residence is out of state, a criminal records check for their state of residence shall be completed prior to working with any individual, and every other year thereafter; or

(2) If the applicable provider, staff, contractor or volunteer has resided in New Hampshire for less than one year, a criminal records check for their previous state(s) of residence shall be completed prior to working with any individual.

(h) Each provider agency shall complete a check of the division of children, youth and families (DCYF) state registry, pursuant to RSA 169-C:35 for all of its providers, staff, contractors, and volunteers who will have direct contact with individuals or families, prior to working with any individual and every other year thereafter.

(i) Each provider agency shall complete a check of the registry of founded reports of abuse, neglect, and exploitation pursuant to RSA 161-F:49 for all of its providers, staff, contractors, and volunteers who will have direct contact with individuals and families prior to working with any individual and every other year thereafter.

(j) Each provider agency shall obtain an attestation from all of its providers, staff, contractors, and volunteers who will have direct contact with individuals or families in the year in between the checks required pursuant to (g)-(i) above that they have not:

(1) Been convicted of a felony or misdemeanor in this or any other state; and

(2) Had a finding by the department or any administrative agency in this or any other state for assault, fraud, abuse, neglect, or exploitation of any person.

(k) Except as allowed in (l) and (m) below, a provider agency shall not hire a person, or permit them to volunteer:

(1) Who has a:

a. Felony conviction; or

b. Any misdemeanor conviction involving:

Physical or sexual assault;
Violence;
Exploitation;
Child pornography;
Threatening or reckless conduct;
Theft;
Driving under the influence of drugs or alcohol; or
Any other conduct that represents evidence of behavior that could endanger the well-being of an individual; or

(2) Whose name is on either of the state registries of founded abuse, neglect, and exploitation as established by RSA 161-F:49 and RSA 169-C:35.

(l) A provider agency may hire a person, or permit the person to volunteer, with a criminal record listed in (k)(1) a. or b. above for a single offense that occurred 10 or more years ago in accordance with (m) and (n) below. In such instances, the individual, their guardian if applicable, and the provider agency shall review the person’s history prior to approving the person’s employment.

(m) Employment of a person pursuant to (l) above shall only occur if such employment:

(1) Is approved by the individual, their guardian, if applicable, and the provider agency;

(2) Does not negatively impact the health or safety of the individual; and

(3) Does not affect the quality of services to the individual.

(n) Upon hiring or permitting a person to volunteer pursuant to (l) and (m) above, the provider agency shall document and retain the following information in the individual’s record:

(1) The date(s) of the approvals in (l) above;

(2) The name of the individual for whom the person will provide services;

(3) The name of the person hired or permitted to volunteer;

(4) Description of the person’s criminal offense;

(5) The type of service the person is hired or volunteering to provide;

(6) The provider agency’s name and address;

(7) A full explanation of why the provider agency is hiring or allowing the person to volunteer despite the person’s criminal record;

(8) Signature of the individual, or of the legal guardian(s) if applicable, indicating

agreement with the employment and date signed;

(9) Signature of the provider agency staff person who obtained the individual or guardian’s signature and date signed;

(10) Signature of the provider agency’s executive director or designee approving the

employment; and

(11) The signature and phone number of the person being hired or permitted to volunteer.

(o) In instances when obtaining the checks required in (g)-(h) would delay a provider agency’s ability to have a provider, staff, contractor, or volunteer provide services, the provider agency shall obtain a self-attestation from the prospective provider, staff, contractor, or volunteer to attest that they have not:

(1) Committed a felony or misdemeanor in this or any other state; and

(2) Had a finding by the department or any administrative agency in this or any other state for assault, fraud, abuse, neglect, or exploitation of any person.

(p) Self-attestations obtained in accordance with (o) above shall be accepted while the provider agency is awaiting the results of the checks required in (g)-(h) above, but shall not be valid for more than 90 days once signed. Individual and guardian approval shall be obtained if a provider, staff, contractor or volunteer will work directly with an individual and not under the supervision of a provider, staff, contractor or volunteer with completed checks pursuant to (g)-(h) above.

(q) Each provider agency shall check the office of the inspector general exclusion list prior to hire and monthly thereafter with regard to checking names of prospective or current providers, staff, and contractors.

(r) Each provider agency shall ensure all providers, staff, contractors, and volunteers who drive individuals, in their own vehicle or agency vehicle, have a valid driver’s license.

(s) Each provider agency, provider, staff, contractor, and volunteer is a mandated reporter and shall report to the appropriate department authority any individual who is suspected of being abused, neglected, exploited, or self-neglecting, in accordance with, RSA 161-F:46 and RSA 169-C:35, and pursuant to He-M 202, any individual who is suspected of being abused, neglected, exploited, or having had their service rights violated, in accordance with He-M 310.

(t) Each provider agency shall report instances of restraint and seclusion to each individual’s area agency not less than quarterly.

(u) Provider agencies shall collect any applicable room and board payments.

(v) Provider agencies shall collect any applicable cost of care payments.

History

#13679, EMERGENCY RULE, eff 6-28-23; ss by #13807, eff 11-17-23

N.H. Code Admin. R. Ann. He-M 504.04 Provider and Provider Agency Participation {#sec-he-m-504.04 omnilex-key=us-nh-regs-official--agency-he-m--He-M 504.04}

(a) Each provider agency who seeks to be enrolled to provide and receive reimbursement for home and community based waiver services shall:

(1) Complete an application for enrollment via the MMIS portal at: https://nhmmis.nh.gov/portals/wps/portal/ProviderLogin in order to apply to be and operate as a New Hampshire Medicaid enrolled provider in accordance with 42 CFR 455.410 and He-W 520.06, unless they choose to contract with an OHCDS for pass-through billing, pursuant to He-M 504.06;

(2) Contact the bureau to request a screening in accordance with (b) below:

a. Following initiation of an application in accordance with (1) above; or

b. Not less than 120 days prior to expiration of the current enrollment period when the provider agency intends to submit an application for re-enrollment;

(3) Meet the applicable licensing, certification, or other requirements of the specific service they provide, such as but not limited to, criteria required in New Hampshire RSA 151, RSA 171-A, 42 CFR 441.301, or a contract with the bureau or OHCDS; and

(4) Have an executed Medicaid provider participation agreement with the department in order to obtain Medicaid agency identification numbers from the department for the specific services for which the provider agency is enrolling.

(b) Each provider applicant shall participate in a department screening upon enrollment and re-enrollment to review the following:

(1) Mission and vision statements, as applicable;

(2) Training practices, such as but not limited to, requirements per specific position, purchased training platforms, and continuing education hours requirements;

(3) Service-specific competencies, as related to developmental services defined in chapter He-M 500;

(4) Three references that illustrate the provider applicant’s ability to meet their service obligations in accordance with their mission and vision statement;

(5) Financial indicators of fiscal integrity, including but not limited to;

a. Financial statements identifying current portion of long-term debt payments including principal and interest; and

b. A measure of total current assets available to cover the cost of current liabilities;

(6) Liability protections;

(7) Policies and practices regarding restraint and seclusion;

(8) Attestation that criminal background and appropriate registry checks were completed pursuant to He-M 504.03(g)-(h); and

(9) Attestation that office of inspector general checks were completed in accordance with He-M 504.03(n).

(c) The screening in (b) above shall occur within 90 days of application for enrollment and within 120 days for reenrollment.

(d) A provider applicant shall not be enrolled pursuant to (a)(4) above until the department has completed the screening in (b) above and has communicated this to the department’s program integrity office.

(e) In addition to the reasons set forth in He-W 520.06, the department shall deny an application for provider agency enrollment or re-enrollment, as applicable, due to any of the following reasons:

(1) Failure to complete the screening required in (b) above;

(2) Any reported abuse, neglect, or exploitation of an individual by an applicant, provider, provider agency, or contractor, if such abuse, neglect, or exploitation is reported on the state registry of abuse, neglect, and exploitation in accordance with RSA 161-F:49 or RSA 169-C:35 and the provider agency failed to take appropriate action;

(3) A provider agency fails to ensure that its providers, staff, and contractors meet the training requirements in chapter He-M 500, He-M 1001, He-M 1201, or Nur 404;

(4) A provider agency, provider, staff, or contractor has an illness or behavior that, as evidenced by documentation obtained or the observations made by the department, would endanger the well-being of the individuals or impair the ability of the provider agency to comply with department rules and the provider agency failed to take appropriate action to address and respond;

(5) A provider agency, or any of its providers, staff, contractors, or any representative thereof, knowingly provides materially false or misleading information to the department;

(6) A provider agency, or any of its providers, staff, contractors, or any representative thereof, fails to permit or interferes with any inspection or investigation by the department;

(7) A provider agency, or any of its providers, staff, contractors, or representatives thereof, fails to provide required documents to the department or entities acting on its behalf;

(8) Federal or state laws, regulations, or guidelines are modified in such a way that either providing the services under the medicaid provider participation agreement is prohibited or the department is prohibited from paying for such services from the planned funding source; or

(9) The provider agency, provider, or contractor no longer holds a required license, certification, or other credential to qualify as a provider of services.

(f) Enrollment or re-enrollment shall be denied upon the written notice by the department to the provider agency stating the specific rule(s) with which the provider agency does not comply.

(g) A provider agency may request an appeal, in accordance with He-C 200, regarding a proposed denial of enrollment or re-enrollment within 30 business days of the decision.

(h) The provider agency’s enrollment status shall be suspended until the appeal determination is adjudicated.

(i) The denial shall not become final until the period for requesting an appeal has expired, or, if the provider agency requests an appeal, until such time as the administrative appeals unit issues a decision upholding the department’s decision.

(j) If the department’s decision is not upheld, the denial would be ineffective, and the provider shall continue to provide services.

(k) Appeals shall be submitted in writing, to the bureau administrator in care of the department’s office of client and legal services.

(l) Each enrolled provider shall:

(1) Submit claims for payment in accordance with He-M 504.05; and

(2) Be subject to monitoring by the department or entities acting on its behalf, in accordance with the requirements of He-M 504.09, He-M 500, and He-M 1201.

(m) An enrolled provider or applicant shall update MMIS and notify the department, in writing to the bureau chief, or designee, of any material change in any status or condition of any element on their application within 30 days of the change occurring for changes such as, but not limited to:

(1) Business affiliation;

(2) Ownership and control information;

(3) Federal tax identification number;

(4) Criminal convictions;

(5) Addition to the bureau of elderly and adult services (BEAS) or DCYF state registries; and

(6) The types of services that are offered.

(n) An enrolled provider shall notify any applicable service coordination agency if any change results in a change to the provider agency’s ability to deliver services to an individual as outlined in that individual’s service agreement within 2 business days.

(o) An enrolled provider or provider applicant shall notify any applicable area agency or service coordination agency if any change impacts their status as a provider agency within 2 business days.

(p) An enrolled provider shall immediately notify, in writing, the department, any applicable area agencies, any applicable service coordination agencies, and any individuals receiving services from the provider agency, in accordance with He-M 504.13 of their decision to terminate their status as an enrolled provider and update the MMIS at least 90 days prior to the termination date.

(q) Enrolled providers terminating in accordance with (n) above shall ensure each individual’s full service file and any other pertinent documentation is transferred to their respective service coordination agency within 2 business days of the notification.

(r) Documentation of services provided between the date of notice and the last date of service provision shall be transferred to the respective service coordination entity no more than 2 business days after the end of service provision.

(s) Claims submitted by, or payments made to, enrolled provider agencies who have not timely furnished the notification of changes or have not submitted any of the items that are required due to a change, in accordance with (n)-(q) above, shall be denied payment or be subject to recovery.

N.H. Code Admin. R. Ann. He-M 504.05 Payment for Services {#sec-he-m-504.05 omnilex-key=us-nh-regs-official--agency-he-m--He-M 504.05}

(a) Provider agencies shall submit all initial claims to the MMIS, so that the claims are received within 90 days after the date of service on the claim.

(b) If a provider agency has submitted a claim in compliance with (a) above and it is denied, the provider agency shall resubmit the claim within 15 months from the earliest date of service if the provider agency still wishes to receive reimbursement.

(1) The service was delivered in compliance with all applicable federal and state rules and requirements in effect on the date the service(s) was provided, including but not limited to, the home and community based waiver services, chapter He-M 500, He-W 520, He-W 521, and CFR 455.410;

(2) The provider agency has created and maintained all records necessary in accordance with He-M 503, He-M 517, He-M 522, and He-M 524;

(3) The provider agency is prepared to share records with the department or the department’s designee, including area agencies, within 30 days as requested; and

(4) The information included within the claim is accurate and complete.

(d) Provider agencies shall not bill the individual for medicaid covered services, even if medicaid denies the claim, when the individual is eligible for medicaid and approved for the service provided.

(e) Claims submitted by, or payments made to, provider agencies who have not timely billed pursuant to this part shall be subject to denied payment or recovery.

History

#13679, EMERGENCY RULE, eff 6-28-23; ss by #13807, eff 11-17-23

N.H. Code Admin. R. Ann. He-M 504.06 Pass-Through Billing {#sec-he-m-504.06 omnilex-key=us-nh-regs-official--agency-he-m--He-M 504.06}

(a) Pass-through billing shall be permissible for the following home and community based waiver services:

(1) Assistive technology;

(2) Environmental and vehicle modification services;

(3) Individual goods and services;

(4) Non-medical transportation;

(5) Personal emergency response system;

(6) Community integration services;

(7) Respite;

(8) Wellness coaching; and

(9) Specialty services for assessments, consultations, and evaluations.

(b) An OHCDS that provides pass-through billing shall:

(1) Establish itself as the enrolled provider for the home and community based waiver

service(s) in (a) above for which pass-through billing will be done;

(2) Hold a contract or other agreement with a provider or provider agency for service provision, except that provision of goods, other than environmental or vehicle modifications, shall not require a contract or agreement;

(3) Ensure that the providers and provider agencies with whom it contracts, or has agreements with, meet:

a. The service and provider qualification standards under the applicable home and community based services waiver, He-M 504 and He-M 506 to provide the services pursuant to (1) above;

b. Medicaid requirements and are free from sanctions or exclusions or are otherwise not excluded from receiving medicaid reimbursement;

c. Medicaid office of inspector general screening requirements prior to service delivery and monthly thereafter;

d. All federal and state rules and requirements; and

e. All applicable regulatory and industry standards and maintains good standing as a provider agency;

(4) Submit claims to MMIS for rendered services and goods and ensure that records are maintained to verify that such services and goods were provided in the amount, scope, and frequency that was claimed;

(5) Reimburse subcontractors;

(6) Submit to the bureau within 30 days of the close of the state fiscal year, in addition to all other required reports and statements, an aggregate annual summary delineating OHCDS activities, including subcontractor names, amounts paid per subcontractor, nature of services, and number of individuals served by each subcontractor;

(7) Ensure that it maintains detailed records, available for the department, its designee, or respective individual, at request for review at any time, to verify the purchase of services and goods outlined in (a) above; and

(8) Ensure that policies and practices do not:

a. Restrict any home and community-based waiver services provider agency or provider to participate only through an OHCDS and that such arrangements are voluntary; and

b. Restrict individuals into securing services exclusively through an OHCDS.

History

#13679, EMERGENCY RULE, eff 6-28-23; ss by #13807, eff 11-17-23

N.H. Code Admin. R. Ann. He-M 504.07 Third Party Liability {#sec-he-m-504.07 omnilex-key=us-nh-regs-official--agency-he-m--He-M 504.07}

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

History

#13679, EMERGENCY RULE, eff 6-28-23; ss by #13807, eff 11-17-23

N.H. Code Admin. R. Ann. He-M 504.08 Monitoring and Determination of Cost Effectiveness {#sec-he-m-504.08 omnilex-key=us-nh-regs-official--agency-he-m--He-M 504.08}

(a) Each provider agency shall submit to the department annually, cost reporting information, which includes, but is not limited to, the following:

(1) A signed statement certifying that the information provided is true, accurate, and complete and acknowledging that penalties for any false statement or misrepresentation of material fact include fine or imprisonment;

(2) Financial statements and schedules for the reporting period;

(3) Expenses, including all personnel related expenses; and

(4) Information reflective of the most recent desk audit or field audit adjustments made to the previous cost report, if applicable, with the exception of items still under appeal that have not been resolved.

(b) Complete cost information shall be submitted:

(1) No later than 120 days after the end of the state fiscal year, unless an extension has been granted by the department, pursuant to (g)-(h) below; or

(2) By the former owner of the organization within 90 days of the sale of the entity when a change in ownership occurs.

(c) The department shall consider annual cost information reported to be incomplete if it is not provided in accordance with (a) above.

(d) The department shall audit the cost information reported not less than every 3 years.

(e) Any provider agency that submits incomplete cost reporting information shall be subject to penalties described in (i) below, unless an extension has been granted pursuant to (g)-(h) below.

(f) The department shall notify the provider agency of incomplete cost reporting information within 30 days of receipt of information and the timeframe for submitting complete cost reporting information as described in (b)(1)-(2) shall not change due to an incomplete report submitted by a provider agency.

(g) Requests for extensions for submitting cost reporting beyond the prescribed deadline shall:

(1) Be in writing;

(2) Be submitted to the department at least 10 business days prior to the due date, unless one of the circumstances identified in (h)(1)-(4) below occurs during the 10 business day prior to the due date, in which case the request shall be made by telephone within 10 business days of the occurrence;

(3) Clearly explain the necessity for the extension; and

(4) Specify the date on which the report shall be submitted.

(h) Approval of extensions shall be made only if it is determined that the delay is caused by circumstances beyond the provider agency’s control, such as, but not limited to:

(1) Natural or manmade disasters;

(2) Strikes by employees;

(3) The death of an owner or senior management; or

(4) Any other instances where the agency can demonstrate a critical impact to operations.

(i) Failure to submit the required cost information shall result in delayed or reduced payments effective on the first day of the month following the due date for filing of cost information, and for each successive month of delinquency in filing the completed cost information.

History

#13679, EMERGENCY RULE, eff 6-28-23; ss by #13807, eff 11-17-23

N.H. Code Admin. R. Ann. He-M 504.09 Utilization Review and Control {#sec-he-m-504.09 omnilex-key=us-nh-regs-official--agency-he-m--He-M 504.09}

The department’s program integrity unit shall monitor utilization of home and community-based waiver 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

#13679, EMERGENCY RULE, eff 6-28-23; ss by #13807, eff 11-17-23

N.H. Code Admin. R. Ann. He-M 504.10 Fraud Detection and Investigation {#sec-he-m-504.10 omnilex-key=us-nh-regs-official--agency-he-m--He-M 504.10}

(a) In accordance with 42 CFR 455.14, the department’s program integrity unit shall address complaints of medicaid fraud, waste, or abuse from any source or the identification of any questionable practices after analysis of paid claim history by conducting 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.

(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 agency’s failure to maintain supporting records in accordance He-W 520 and He-M 504.

History

#13679, EMERGENCY RULE, eff 6-28-23; ss by #13807, eff 11-17-23

N.H. Code Admin. R. Ann. He-M 504.11 Provider and Provider Agency Staff Requirements {#sec-he-m-504.11 omnilex-key=us-nh-regs-official--agency-he-m--He-M 504.11}

(a) All providers shall meet the applicable provider training requirements in He-M 506.

(b) All provider agency staff, providers, and contractors who have direct contact with individuals and families shall participate in a person-centered thinking program and demonstrate competencies by March of 2025 and every 5 years thereafter.

(c) All provider agency staff, providers, and contractors who have direct contact with individuals and families shall participate in at least one person-centered thinking course per year.

(d) Person-centered trainings and programs for (b)-(c) above shall consist of nationally recognized models and best practices as identified by the National Center on Advancing Person-Centered Practices and Systems (NCAPPS) or the National Alliance for Direct Support Professionals NADSP.

(e) Providers of the following services shall not be subject to the requirements in (b)-(c) above:

(1) Assistive technology;

(2) Environmental and vehicle modification services;

(3) Individual goods and services;

(4) Non-medical transportation;

(5) Personal emergency response services;

(6) Community integration services;

(7) Respite;

(8) Wellness coaching; and

(9) Specialty services for assessments, consultations, and evaluations.

(f) Providers who offer services listed in (e) above and any additional services shall be subject to the requirements of (b)-(c) above.

(g) Providers who are also family members shall be subject to (b)-(c) at the discretion of the individual and guardian.

History

#13679, EMERGENCY RULE, eff 6-28-23; ss by #13807, eff 11-17-23

N.H. Code Admin. R. Ann. He-M 504.12 Suspension and Revocation of Provider Enrollment {#sec-he-m-504.12 omnilex-key=us-nh-regs-official--agency-he-m--He-M 504.12}

(a) If the department finds at any time that an enrolled provider repeatedly fails to meet their participation, information sharing and billing obligations, or that their continued operations endanger the health, safety, or welfare of individuals, or the public, the department shall order the suspension or revocation of the enrolled provider.

(b) Suspension shall include receiving notice from the department of its intent to suspend payment of any claims submitted or the provider enrollment ID for the specific service location associated with the violation or, if the violation is specific to all sites, the provider enrollment ID’s for that provider agency.

(c) Revocation shall include receiving notice from the department of its intent to revoke the provider enrollment ID for the specific service location associated with the violation or, if the violation is specific to all sites, the provider enrollment ID’s for that provider agency.

(d) When a claim or provider enrollment suspension is issued, pursuant to (b) above, a plan of correction shall be issued by the department which shall outline the conditions necessary for reinstatement including if the provider agency shall be permitted to continue to provide services during a claim suspension period.

(e) If the provider agency is permitted to continue providing services during the suspension period, the processing and payment of claims shall be suspended until the provider has met the requirements of the corrective action plan.

(f) If a provider agency is not permitted to continue providing services during the suspension period, the department shall deny claims for payment or other reimbursement requests for dates of service during the suspension period.

(g) Provider agencies shall remain under suspension until specified conditions for reinstatement as outlined in a corrective action plan issued pursuant to (d) above, are met and approved by the department.

(h) If the provider agency does not meet the conditions for reinstatement, as outlined in a corrective action plan, a recommendation shall be made for enrollment termination to the department’s program integrity unit.

(i) A provider agency may request an appeal, in accordance with He-C 200, regarding a proposed suspension or revocation of enrollment within 30 business days of the decision.

(j) The provider’s enrollment status shall be suspended until the appeal determination is adjudicated.

(k) The revocation shall not become final until the period for requesting an appeal has expired, or, if the provider agency requests an appeal, until such time as the administrative appeals unit issues a decision upholding the department’s decision.

(l) If the department’s decision is not upheld, the denial would be ineffective, and the provider shall continue to provide services.

(m) Appeals shall be submitted in writing, to the bureau administrator in care of the department’s office of client and legal services.

History

#13679, EMERGENCY RULE, eff 6-28-23; ss by #13807, eff 11-17-23

N.H. Code Admin. R. Ann. He-M 504.13 Discontinuation of Services by Provider or Provider Agency {#sec-he-m-504.13 omnilex-key=us-nh-regs-official--agency-he-m--He-M 504.13}

(a) A provider agency that is not delivering services in conjunction with a residency agreement, in accordance with He-M 310.10(c), shall immediately provide the individual, guardian, and service coordinator, with a written 90-day notice that clearly describes the basis for the provider agency’s decision to discontinue service provision and all reasonable efforts made by the provider agency to work with the participant and guardian to maintain such service provision.

(b) When written notice is issued in accordance with (a), services shall not end before the 90-day notice period except by mutual agreement of the individual, guardian, and provider agency.

(c) A provider agency that is delivering services in conjunction with a residency agreement, in accordance with He-M 310.10(c), shall follow the procedures for notification outlined in He-M 310.

(d) If a notice to discontinue services is issued in accordance with (a) above, the following actions shall occur:

(1) The provider agency shall transfer a copy of the individual’s full service file to their service coordination agency within 2 business days;

(2) The service coordinator shall conduct service planning for any necessary transitions, in accordance with He-M 503, He-M 522, or He-M 524 within 5 business days; and

(3) The provider and provider agency shall participate in service planning and provision based on developments resulting from (2) above during the notice period outlined in (a) above or the transition period to a new provider agency.

(e) If a notice is issued in accordance with (b) above, the following shall occur:

(1) The provider agency shall transfer a copy of the individual’s full service file to their service coordination agency within 2 business days;

(2) The service coordinator shall conduct service planning for any necessary transitions in accordance with He-M 310.10; and

(3) The provider agency shall provide the service coordinator with alternative residential options, if applicable, or demonstrate a good faith effort to provide this information.

(f) An individual or guardian may request an appeal of a notice provided in accordance with (a) above, unless the reason for discontinuation of services is due to the provider agency’s cessation of services.

(g) Appeals shall be filed, in writing, to the bureau administrator in care of the department’s office of client and legal services within 30 days following the date of notification of service discontinuation, in accordance with (a) above and He-C 200.

(h) If an appeal is requested, the following actions shall occur:

(1) Services and payments shall be continued as a consequence of an appeal for a hearing until a decision has been made; and

(2) If the provider agency’s decision is upheld, services shall cease 60 days from the date of the denial letter or 30 days from the hearing decision, whichever is later.

History

#13679, EMERGENCY RULE, eff 6-28-23; ss by #13807, eff 11-17-23

N.H. Code Admin. R. Ann. He-M 504.14 Waivers {#sec-he-m-504.14 omnilex-key=us-nh-regs-official--agency-he-m--He-M 504.14}

(a) A provider applicant, area agency, provider agency, individual, guardian, or provider may request a waiver of specific procedures outlined in He-M 504 by completing and submitting the form titled “NH Bureau of Developmental Services Waiver Request” (October 2023 edition) in accordance with (b) and (c) below.

(b) A completed waiver request form shall be signed by the provider agency’s executive director or designee recommending approval of the waiver.

(1) Email at bds@dhhs.nh.gov; or

(2) By mail to:

Bureau of Developmental Services

Hugh J. Gallen State Office Park

105 Pleasant Street, Main Building

Concord, NH 03301

(d) No provision of procedure prescribed by statue shall be waived.

(e) The request for a waiver shall be granted by the commissioner or designee within 30 days if the alternative proposed by the requesting entity meets the objective or intent of the rule and it:

(1) Does not negatively impact the health or safety of the individual(s); and

(2) Does not affect the quality of services to individuals.

(g) Waivers shall be granted in writing for the minimum period necessary to accommodate the waiver request, with a specific duration not to exceed 5 years except as in (h)-(i) below.

(h) Any waiver shall end with the closure, termination, revocation, or suspension of the related program or service.

(i) A requesting entity may request a renewal of a waiver from the bureau. Such request shall be made at least 30 days prior to the expiration of a current waiver.

History

#13679, EMERGENCY RULE, eff 6-28-23; ss by #13807, eff 11-17-23; (see also Revision Note at part heading for He-M 504)

Part He-M 505 Establishment and Operation of Area Agencies

N.H. Code Admin. R. Ann. He-M 505.01 Purpose {#sec-he-m-505.01 omnilex-key=us-nh-regs-official--agency-he-m--He-M 505.01}

The purpose of these rules is to define the procedures and criteria for the establishment, designation, and redesignation of area agencies, and to define their role and responsibilities.

History

#1647, eff 10-14-80; ss by #2020, eff 5-11-82; ss by #2678, eff 4-18-84; ss by #4667, eff 8-25-89; ss by #4729, eff 1-15-90, EXPIRED: 1-15-96
#6871, eff 10-21-98; ss by #8728, INTERIM, eff 10-21-06, EXPIRED: 4-19-07
#8928, eff 6-30-07; ss by #10916, eff 8-26-15; ss by #13842, eff 12-29-23

N.H. Code Admin. R. Ann. He-M 505.02 Definitions {#sec-he-m-505.02 omnilex-key=us-nh-regs-official--agency-he-m--He-M 505.02}

The words and phrases used in these rules shall mean the following, except where a different meaning is clearly intended from the context:

(a) “Acquired brain disorder” means a disruption in brain functioning that:

(1) Is not congenital or caused by birth trauma;

(2) Presents a severe and life-long disabling condition which significantly impairs a person’s ability to function in society;

(3) Occurs prior to age 60;

(4) Is attributable to one or more of the following reasons:

a. External trauma to the brain as a result of:

A motor vehicle incident;
A fall;
An assault; or
Another related traumatic incident or occurrence;

b. Anoxic or hypoxic injury to the brain such as from:

Cardiopulmonary arrest;
Carbon monoxide poisoning;
Airway obstruction;
Hemorrhage; or
Near drowning;

c. Infectious diseases such as encephalitis and meningitis;

d. Brain tumor;

e. Intracranial surgery;

f. Cerebrovascular disruption such as a stroke;

g. Toxic exposure; or

h. Other neurological disorders such as Huntington’s disease or multiple sclerosis which predominantly affect the central nervous system; and

(5) Is manifested by one or more of the following:

a. Significant decline in cognitive functioning and ability; or

b. Deterioration in:

Personality;
Impulse control;
Judgment;
Modulation of mood; or
Awareness of deficits;

(b) “Applicant group” means a group of area citizens that has submitted the required materials to the bureau for consideration for designation as an area agency;

(c) “Area” means “area” as defined in RSA 171-A:2, I-a, namely “a geographic region established by rules adopted by the commissioner for the purpose of providing services to developmentally disabled persons.”;

(d) “Area agency” means “area agency” as defined in RSA 171-A:2, I-b;

(e) “Area board” means “area board” as defined in RSA 171-A:2, I-c, namely “the governing body or board of directors of an area agency.”;

(f) “Area plan” means a document prepared by the area agency that outlines that agency’s goals, objectives, and activities pursuant to He-M 505.04(p) and RSA 171-A:18;

(g) “Bureau” means the bureau of developmental services of the department of health and human services;

(h) "Bureau administrator" means the chief administrator of the bureau of developmental services;

(i) “Commissioner” means the commissioner of the department of health and human services, or their designee;

(j) “Conditional redesignation” means a written ruling by the commissioner pursuant to He-M 505.10 that an area agency has partially complied with the redesignation criteria listed in He-M 505.09 and that continued designation is contingent upon fulfilling the requirements established by He-M 505;

(k) “Critical incident” means an alleged, suspected, or actual occurrence of:

(1) Abuse, including physical, sexual, verbal, and psychological abuse;

(2) Neglect;

(3) Exploitation;

(4) Serious injury;

(5) Death other than by natural causes; and

(l) “Designation” means a written ruling by the commissioner that an applicant group has been determined to be in compliance with the eligibility requirements set forth in He-M 505.06 and has been approved as the area agency for the area;

(m) “Developmental disability” means “developmental disability” as defined in RSA 171-A:2, V, namely, “a disability:

(a) Which is attributable to an intellectual disability, cerebral palsy, epilepsy, autism, or a specific learning disability, or any other condition of an individual found to be closely related to intellectual disability as it refers to general intellectual functioning or impairment in adaptive behavior or requires treatment similar to that required for persons with an intellectual disability; and

(b) Which originates before such individual attains age 22, has continued or can be expected to continue indefinitely, and constitutes a severe disability to such individual's ability to function normally in society.”;

(n) “Financial management services” means fiscal intermediary services available to individuals who elect to direct and manage their services, pursuant to He-M 524 and He-M 525;

(o) “Generic services” means services available to the general population that are not specifically designed for individuals;

(p) “Governance review” means an announced review to monitor annual compliance of area agency operations including, but not limited to, services, programs, functions, and finances, whether operated directly by the area agency or through contracts with persons or organizations;

(q) “Guardian” means a person appointed pursuant to RSA 463 or RSA 464-A or the parent of an individual under the age of 18 whose parental rights have not been terminated or limited by law;

(r) “Individual” means a person who has a developmental disability or acquired brain disorder;

(s) “Integrated activity” means personal interaction between persons with and without developmental disabilities or acquired brain disorders that occurs within community settings;

(t) “Integrated setting” means a setting where the majority of persons are without developmental disabilities and the primary activity is neither bureau-funded nor designed primarily for individuals;

(u) “Interim designation” means a written ruling by the commissioner pursuant to He-M 505.06 (e)(8) that an applicant group or other organization has been approved as the interim area agency until a final designation is made by the commissioner;

(v) “Mission” means the stated goals of the service system as established by the bureau or area agencies;

(w) “Problematic sexual behavior” means non-consensual touching or attempting to touch another person’s body in a sexualized manner, unsolicited sexualized statements, public exposure, and illegal sexual conduct whether in person or online;

(x) “Provider” means a person receiving any form of remuneration for the provision of services to an individual;

(y) “Provider agency” means an agency or an independent provider that is established to provide services to individuals;

(z) “Region” means, when followed by a Roman numeral, the area agency in the area corresponding to the identified numeral;

(aa) “Registry” means the list maintained in the department’s electronic database which itemizes identified service needs for individuals in the following 5 years;

(ab) “Sentinel event” means an unexpected occurrence involving death or serious physical or psychological injury, or risk thereof. Serious injury specifically includes loss of limb or function. Categories of reportable sentinel events are individual-centered events, in which the individual is either a victim or perpetrator, including, but are not limited to:

(1) Any sudden, unanticipated, or accidental death, not including homicide or suicide, and not related to the natural course of an individual’s illness or underlying condition;

(2) Permanent loss of function, not related to the natural course of an individual’s illness or underlying condition, resulting from such causes including but not limited to:

a. A medication error;

b. An unauthorized departure or abduction from a facility providing care; or

c. A delay or failure to provide requested or medically necessary services due to waitlists, availability, insurance coverage, or resource limits;

(3) Homicide;

(4) Suicide;

(5) Suicide attempt, such as self-injurious behavior with a non-fatal outcome, with explicit or implicit evidence that the person intended to die and medical intervention was needed;

(6) Rape or any other sexual assault;

(7) Serious physical injury;

(8) Serious psychological injury that jeopardizes the person’s health that is associated with the planning and delivery of care;

(9) Injuries due to physical or mechanical restraints; and

(10) High profile or high risk event, such as:

a. Media coverage; and

b. Police involvement leading to an arrest;

(ac) “Service coordination agency” means a provider agency providing service coordination services to individuals that meets the criteria in He-M 504; and

(ad) “Service coordinator” means a provider who meets the criteria in He-M 503 or He-M 522 and is chosen by an individual and their guardian or representative to organize, facilitate, and document service planning and to negotiate and monitor the provision of the individual’s services.

History

#1647, eff 10-14-80; ss by #2020, eff 5-11-82; ss by #2678, eff 4-18-84; ss by #4667, eff 8-25-89; ss by #4729, eff 1-15-90, EXPIRED: 1-15-96
#6871, eff 10-21-98; ss by #8728, INTERIM, eff 10-21-06, EXPIRED: 4-19-07
#8928, eff 6-30-07; ss by #10916, eff 8-26-15; ss by #13842, eff 12-29-23

N.H. Code Admin. R. Ann. He-M 505.03 Role and Responsibilities of the Area Agency {#sec-he-m-505.03 omnilex-key=us-nh-regs-official--agency-he-m--He-M 505.03}

(a) The primary responsibility of an area agency, designated in accordance with He-M 505, shall be to plan, establish, or maintain comprehensive service access and delivery for all individuals who are residing in the area, in accordance with RSA 171-A and the rules promulgated thereunder, by:

(1) Maintaining a current contract with the department to serve as an area agency;

(2) Managing and providing family support services in accordance with He-M 519;

(3) Managing and providing family centered early supports and services in accordance with He-M 510;

(4) Providing or supporting the arrangement of financial management services for individuals who choose to direct and manage their waiver services;

(5) Managing and completing intake and eligibility activities for individuals in order to determine access to the developmental services system in accordance with He-M 503 and He-M 522 and to facilitate and assist individuals in applying for and maintaining Medicaid benefits;

(6) Developing and managing initial service planning and access to supports for individuals found to be eligible for services pursuant He-M 503, He-M 522, or He-M 524;

(7) Providing oversight and management of the provider network by:

a. Coordinating and monitoring the provider network to support the needs of the catchment region as outlined in the agency’s area plan, developed pursuant to He-M 505.04 (p);

b. Communicating relevant service delivery system updates to provider agencies and provide training as needed;

c. Monitoring current service capacity using data from the bureau to identify risk and solutions;

d. Reporting to the bureau quarterly, the results from monitoring in c. above and follow up on actions taken pursuant to f. below, to support provider network management;

e. Promoting the establishment of new provider agencies to increase service capacity as determined by the bureau based on the data provided in d. above; and

f. Providing follow-up to the bureau on actions taken in accordance with e. above;

(8) Providing information, education, and referrals to the service delivery system, as defined in RSA 171-A:2, XVI, by:

a. Providing objective information and assistance that empowers people to make informed decisions about their services and supports; and

b. Networking and partnering with community organizations with the goal of supporting inclusive community life, leveraging natural resources, services, and supports, and in improving the community’s understanding of the service delivery system;

(9) Managing registry documentation by:

a. Assisting individuals in the determination of and documentation of need for services to be provided, pursuant to He-M 503, within 5 years from the date of initial eligibility; and

b. Reviewing and updating the registry as early as practicable anytime a need for services in the next 5 years is identified;

(10) Submitting level of care submissions to the bureau in accordance with He-M 517 and He-M 524 for initial level of care determinations as well as level of care determinations for transfers between home and community based services waivers;

(11) Initiating waiver services in accordance with He-M 503, He-M 522, and He-M 524 including:

a. Facilitating the scheduling of an individual’s initial supports intensity scale assessment for individuals who do not have a service coordinator;

b. Providing resources to an individual regarding service coordination agencies so the individual can select a service coordination provider; and

c. Following bureau approval of level of care in accordance with He-M 503.05, submission of the individual’s selection in accordance with b. above to NH Easy for provider review and acceptance;

(12) Maintaining and updating records in the electronic database NH Easy at https://nheasy.nh.gov/#/ ;

(13) Completing service utilization and quality oversight by:

a. Managing service agreement development through monthly monitoring of annual service agreement renewals;

b. Reviewing service agreements quarterly and communicating any identified needs to applicable service provider agencies;

c. Managing and overseeing submission of out-of-state service provision requests to the bureau;

d. Monitoring provision of services as prescribed in the service agreement by:

Completing annual service and post-payment audits using a tool provided by the bureau within 60 days of request by the bureau; and
Providing results of the audits completed in accordance with (1) above to include raw data, aggregated data, and analysis of findings;

e. Assessing annual satisfaction with quality of services, and reviewing and continuously improving quality of services by:

Soliciting feedback from individuals and families within the agency’s geographic region; and
Providing results of the feedback received in accordance with (1) above to include raw data, aggregated data, and analysis of findings;

f. Completing inquiry and review at the request of the bureau related to service concerns, complaints, or grievances;

g. Ensuring training and education dissemination related to identified trends of sentinel events, restraint and seclusion, and mortality. Area agencies shall ensure that at least one training per state fiscal year quarter is offered and provided to those who register;

h. Collaborating with the community mental health center that serves the region to support coordinated service planning and delivery for individuals accessing or wishing to access services from both service systems; and

i. Collaborating with the regional public health network that serves the region to support emergency planning processes in order to develop and execute response and recovery plans;

(14) Increasing access to employment by:

a. Acting on employment trends, as identified by the bureau; and

b. Participating in the employment leadership committee pursuant to He-M 518;

(15) Providing critical incident management by:

a. Collecting restraint and seclusion data and providing such data to the bureau quarterly with analysis of findings on a tool approved by the bureau;

b. Finalizing mortality notifications and reviews received from provider agencies and submitting these reviews to the bureau;

c. Finalizing sentinel event reports and submitting these reports to the bureau;

d. Reviewing reports of incidents to determine if a sentinel event report is needed;

e. Monitoring follow-up related to findings from formal complaint investigations conducted pursuant to He-M 202;

f. Providing coordination, logistical support, and subject matter expertise to service coordinators regarding crisis mitigation situations;

g. Providing crisis data to the bureau quarterly with analysis of any observed findings on a tool approved by the bureau;

h. Ensuring area agency availability 24/7 in order to provide critical incident coordination, logistical support, and subject matter expertise;

i. Completing expedited intake and eligibility supports to individuals who are experiencing a critical incident but have not sought eligibility for services through the developmental services system; and

j. Facilitating strategy development and coordination meetings in collaboration with the bureau;

(16) Monitoring, maintaining, safeguarding, and promoting human rights by:

a. Maintaining and facilitating a human rights committee, whose duties pursuant to RSA 171-A:17 for all individuals working with the committee, shall be;

Monitoring and approving all positive behavior change programs created pursuant to He-M 310.11;
Ensuring emergency physical restraint shall only be approved for safely responding to situations in which the individual presents with an imminent credible risk of significant harm to self or others by staff who are trained and certified in recognized intervention modalities;
Evaluating the treatment and habilitation provided to individuals;
Regularly monitoring the implementation of individual service agreements;
Monitoring the use of restrictive or intrusive interventions designed to address challenging behavior pursuant to He-M 310.11; and
Promoting advocacy programs on behalf of individuals;

b. Offering and providing to those who register, 2 trainings per year on advocacy and individual rights;

c. Maintaining and distributing a list of current advocacy groups within the catchment area; and

d. Completing informal investigations pursuant to He-M 202.05;

(17) Managing catchment region risk by:

a. Coordinating and facilitating a local risk management committee whose duties shall be:

Reviewing and analyzing referrals from service coordinators related to violent aggression, problematic sexual behavior, or fire-setting behaviors;
Making assessment or evaluation referral recommendations to service coordinators for individuals exhibiting behaviors including but not limited to violent aggression, problematic sexual behaviors, or fire-setting behaviors;
Reviewing assessment and evaluation results completed for individuals for whom a referral was submitted in accordance with 2. above to determine whether a need is identified for a plan to manage risk;
Providing consultation to service coordinators in identifying providers to create plans to manage risk who have expertise in the areas identified in 1. above;
Reviewing plans to manage risk created when a recommendation for such a plan was made pursuant to 4 above to ensure it appropriately applies assessment or evaluation recommendations received pursuant to 3. above;
Participating in committees and other groups related to risk management including, but not limited to, statewide risk management committees, and communities of practice to determine application of assessment or evaluation recommendations received pursuant to 2. above;
Reviewing documentation from service coordinators and provider agencies on an ongoing basis to determine the impact of such data relative to management of risk for an individual and related plans;
Ensuring that plans to manage risk created when a recommendation for such a plan was made pursuant to 4 above are reviewed regularly with individuals and their treatment team to consider ongoing appropriateness and, in the event that potential changes are indicated, seeking additional consultation with providers qualified to conduct and author assessments, whether they created the initial plans or are new, to discuss opportunities for modification of restrictions by sharing data regarding the individual’s progress in treatment. Such considerations shall be made through reassessment or through a consultative review of other documentation and updated data related to the individual’s progress;
Offering recommendations to the area agency for training for the service system;
Offering recommendations, as applicable, to service coordinators for individual-specific training needs;
Conducting training related to risk management activities, as requested by the area agency;
Ensuring that provider agencies and providers are trained in risk management plans;
Ensuring that relevant area agency personnel, provider agencies, and providers receive recommendations for clinically specialized trainings, based on assessed needs of the individuals supported, that enable these personnel to successfully complete risk management activities; and
Ensuring monthly representation in the statewide risk management committees; and

b. Collaborate with all area agencies to co-facilitate and convene a statewide risk management committee;

(18) Managing Health Risk Screening Tool (HRST) IntellectAbility accounts and data at https://nhbds.hrstapp.com/ by:

a. Providing administrative support for HRST account management; and

b. Completing a clinical review for individuals with a score greater than or equal to 3;

(19) Managing New Hampshire Easy (NH Easy) accounts and data by:

a. Ensuring that appropriate staff receive and maintain access to NH Easy in order to carry out duties;

b. Ensuring that the area agency’s NH Easy account remains in good standing; and

c. Notifying NH Easy support of any noted system issues;

(20) Completing the request for the funding of a public guardian if the individual does not have a service coordinator;

(21) Participating in medication administration planning by:

a. Attending the state medication committee meeting as defined in He-M 1201.11;

b. Reviewing the 6-month medication error reports described in He-M 1201.11(c)-(e); and

c. Offering and providing to those who register, training to provider agencies and providers about medication administration trends as determined by the state medication committee and confirmed by the bureau;

(22) Completing information gathering via survey by:

a. Disseminating and coordinating the annual national core indicator satisfaction surveys;

b. Reviewing survey results to identify areas of quality improvement; and

c. In partnership with the bureau, distributing and reviewing survey results to ensure continuous quality improvement of the service delivery system;

(23) Maintaining records pursuant to He-M 503, He-M 510, He-M 517, He-M 519, and He-M 522, as applicable; and

(24) Managing transitions between regions.

(b) Failure of a provider agency to comply with the requirements in He-M 504 with respect to providing an area agency with necessary information or participating in activities in order for an area agency to carry out its responsibilities in (a) above shall not be considered noncompliance by an area agency.

(c) In instances of a provider agency failure as reflected in (b) above, the area agency shall notify the bureau within 15 days.

(d) For items (a)(4)–(24), Medicaid administrative reimbursement may be claimed by the designated and contracted area agency for activities completed each month on behalf of individuals in the area who are eligible for or seeking eligibility for Medicaid.

(e) Pursuant to RSA 171-A:18, I, the area agency shall be the primary recipient of these funds provided by the bureau for use in establishing, operating, and administering supports and services and coordinating these with existing generic services on behalf of individuals in the area. The area agency may receive funds from sources other than the bureau to assist it in carrying out its responsibilities.

(f) In order to collect Medicaid administrative reimbursement, pursuant to (d) above, the area agency shall:

(1) Ensure that records are maintained to support that the services in (a)(4)-(24) above were provided in the manner that was claimed;

(2) Ensure that records pursuant to (1) above are made available to the bureau or any state or federal auditing entity; and

(3) Provide information regarding services, supports, and costs, as requested by the department not less than every 5 years.

(g) When possible, the area agency shall utilize community based, integrated services, rather than establish separate services for people with developmental disabilities or acquired brain disorders.

History

#1647, eff 10-14-80; ss by #2020, eff 5-11-82; ss by #2678, eff 4-18-84; ss by #4667, eff 8-25-89; ss by #4729, eff 1-15-90, EXPIRED: 1-15-96
#6871, eff 10-21-98; amd by #8443, eff 1-1-06; amd by #8728, INTERIM, eff 10-21-06, EXPIRED: 4-19-07
#8928, eff 6-30-07; ss by #10916, eff 8-26-15; ss by #13842, eff 12-29-23

N.H. Code Admin. R. Ann. He-M 505.04 Governance and Composition of the Area Agency Board {#sec-he-m-505.04 omnilex-key=us-nh-regs-official--agency-he-m--He-M 505.04}

(a) Each area agency board shall establish policies and procedures for the governance and administration of the area agency and those policies and procedures shall:

(1) Be developed to ensure efficient and effective operation of the local service delivery system;

(2) Be developed to adhere to the requirements of state and federal funding sources, the area plans, and the rules and contracts established by the department; and

(3) Be developed to ensure that the area agency avoids any conflict of interest and any appearance of conflict of interest in its business relationships.

(b) The department shall assist area agencies in the establishment and provision of services through contract establishment, contract monitoring, consultation, technical assistance, guidance regarding service reviews, staff and board training, coordination with other service systems, and other means.

(c) The area agency shall be incorporated and have an established plan for governance in accordance with He-M 505.04 (d)-(p) below.

(d) The area agency board shall have responsibility for the entire management and control of the property and affairs of the corporation and have the powers usually vested in the board of directors of a not-for-profit corporation, except as regulated herein. This shall be stated in a set of bylaws maintained and updated by the area board.

(e) The area board shall include in its articles of incorporation and its bylaws a statement that, in the event of dissolution of the area agency or in the event that the agency is no longer designated as an area agency, disposal of all debts and obligations shall be provided for.

(f) Each area agency board shall include in its bylaws:

(1) A provision requiring rotation of area board membership so that 1/4 of the members’ terms expire each year. Said rotation shall not result in all terms of individuals, guardians, or family members expiring in the same year;

(2) A provision that the maximum consecutive period during which a board member may serve as an officer of the board shall not exceed 6 years; and

(3) A procedure by which inactive members are removed from the area board.

(g) The size and composition of the area agency board shall be as follows:

(1) In all cases, the board of directors shall be composed of an uneven number of persons;

(2) The number of persons serving as members shall be no fewer than 9 and no more than 25;

(3) Individuals, guardians, and family members shall comprise at least 1/3 of the membership of the area agency board;

(4) Members shall be representative of the agency’s individuals supported, their family members, and the entire area; and

(5) Membership shall be open to persons who reside in the area except for those excluded as follows:

a. Persons or the spouses of persons who are under financial contract with the area agency or any organization that is a subsidiary or affiliate of the area agency shall not be eligible for membership on the area board;

b. Employees or the spouses of employees of agencies that are under financial contract with the area agency shall not be eligible for membership on the area board;

c. Employees or the spouses of employees of the area agency shall not be eligible for membership on the area board;

d. Employees of the New Hampshire department of health and human services or their spouses shall not be eligible for membership on the area board; and

e. Volunteer board members or the spouses of volunteer board members of agencies or programs under contract with the area agency shall be eligible for membership on the area board but shall comprise no more than 1/3 of the board.

(h) All area agency board members shall participate in at least one nationally recognized person-centered thinking training when they begin their first term of board membership and every 5 years thereafter.

(i) The area board shall fill vacancies by soliciting interested persons to submit applications to the area board. Such solicitation shall be by conducting public meetings, placing public announcements in local media, and by any other means.

(j) Pursuant to RSA 171-A:18, III, the area board shall appoint an executive director of the area agency. The executive director shall serve at the pleasure of the area board and as a full-time employee of the agency.

(k) The executive director shall be selected, employed, and supervised by the area board in accordance with a published job description and a competitive application procedure pursuant to the area agency’s personnel policies.

(l) The executive director shall have the following experience qualifications, at a minimum:

(1) Five years of administrative experience in human services; and

(2) Four years of experience in developmental services programs, which may be done all or in part in the above administrative capacity.

(m) The executive director shall demonstrate extensive knowledge of all aspects of the fields of developmental disabilities and acquired brain disorders, including knowledge of:

(1) Administration;

(2) Planning;

(3) Community networking;

(4) Business management; and

(5) Financial and social resources.

(n) The executive director’s performance shall be evaluated annually by the area board to ensure that services are provided in accordance with the agency mission, area plan, contract provisions, and mission as well as federal and state laws and rules.

(o) Pursuant to RSA 171-A:18, V, the area agency board shall prepare and submit to the department an area plan for the provision of programs and services to individuals in the area for a 5-year period that coincides with the redesignation cycle identified in Table 505-2.

(p) The area plan shall:

(1) Clearly identify the extent to which the area agency has involved its individuals and families, the area family support council established pursuant to RSA 126-G:4, the general public residing in the area, and generic service agencies in the planning and provision of services for individuals;

(2) Demonstrate that services and supports for which the agency is responsible, as outlined in He-M 505.03(a), are intended to establish and maintain a comprehensive service delivery system that is:

a. Based on the nature and extent of the service needs of individuals and their care-giving families;

b. Consistent with RSA 171-A and the agency’s and bureau’s mission statements and priorities;

c. Responsive to the priorities of the individuals and families in the area agency’s catchment region; and

d. Free from conflict in accordance with 42 CFR 441.301;

(3) Be submitted to the bureau administrator for approval pursuant to (q) below; and

(4) Be reviewed by the area board every 2 years and may be amended by the area board at any time, with such amendments submitted to the bureau administrator for approval if:

a. The area board proposes to change, discontinue, or expand services to individuals and their care-giving families; or

b. Amendment is necessary to reflect changes in area-wide individual and family needs, legislation, or area demographics, vendors, or funding.

(q) The bureau administrator, commissioner, or the commissioner’s designee shall review area plans and amendments to area plans submitted for approval pursuant to (p)(3) and (4) above and approve those plans or amendments that are determined to comply with the agency mission and department rules and other applicable state and federal laws, regulations, and rules.

(r) The area agency shall utilize all applicable federal, third party, and other public and private sources of funds to carry out its mission and responsibilities.

(s) The area agency shall not enter any merger, sale, affiliation, or other substantial change in its corporate identity without the prior approval of the bureau administrator, with notice being provided to the bureau no less than 6 months before the change.

(t) The bureau administrator shall review any proposed merger, sale, affiliation, or other substantial change in the corporate identity of an area agency.

(u) The bureau administrator shall assess the potential impact on the developmental services system stability and approve such proposed changes if they determine that the developmental services system stability can be maintained adequately by the resulting organization’s compliance with department rules and other applicable state and federal laws, regulations, and rules, and that such changes are in the best interest of individuals residing in the area.

(v) The services, programs, and functions for which the area agency is responsible to oversee may be provided directly by the area agency or the area agency may, pursuant to RSA 171-A:18, II, enter into agreements with persons and organizations for the provision of designated services. The area agency shall not delegate its financial management responsibility to any person or organization.

(w) An area agency planning to enter into agreements pursuant to He-M 505.04 (v) shall:

(1) Obtain written permission from the commissioner pursuant to RSA 171-A:18; and

(2) Include in said notice a description of services to be provided, payment schedules, and reporting requirements, and assurances that the participants in the agreements agree to comply with all pertinent state and federal requirements.

(x) The area agency shall be responsible and accountable for all area agency services, programs, and functions whether administered directly by the area agency or provided under contracts with persons or organizations.

(y) Monitoring and evaluation of all area agency services, whether administered directly or by contract, shall be conducted by the area agency with its findings and any remedial action taken reported to the area agency board.

(z) Area agency services, programs, and functions shall be operated in compliance with applicable state and federal laws and rules and contract requirements established by the department and comply with the goals and priorities of the approved area plan.

(aa) The department shall conduct annual governance reviews, announced or unannounced reviews of area agencies, and audit area agencies at least every 5 years, including all or part of any services, programs, functions, finances, operations, or contract requirements of the area agency, whether operated directly by the area agency or through contracts with persons or organizations.

(ab) The results of the review conducted in accordance with He-M 505.04(aa) above, and any resulting trends in performance, shall be considered during the redesignation process.

History

#1647, eff 10-14-80; ss by #2020, eff 5-11-82; ss by #2678, eff 4-18-84; ss by #4667, eff 8-25-89; ss by #4729, eff 1-15-90, EXPIRED: 1-15-96
#6871, eff 10-21-98; ss by #8443, eff 1-1-06; ss by #8928, eff 6-30-07; ss by #10916, eff 8-26-15; ss by #13842, eff 12-29-23

N.H. Code Admin. R. Ann. He-M 505.05 Designation of Area Boundaries {#sec-he-m-505.05 omnilex-key=us-nh-regs-official--agency-he-m--He-M 505.05}

Areas designated for the purpose of providing services to individuals shall be the developmental services areas specified in table 505-1, which sets forth the numerical designation of the areas and lists towns by area:

Table 505-1, INCORPORATED TOWNS AND CITIES BY AREA

Area I

Albany

Easton

Lisbon

Stark

Bartlett

Eaton

Littleton

Stewartstown

Benton

Effingham

Lyman

Stratford

Berlin

Errol

Madison

Sugar Hill

Bethlehem

Franconia

Milan

Tamworth

Brookfield

Freedom

Monroe

Tuftonboro

Carroll

Gorham

Moultonborough

Wakefield

Chatham

Hart's Location

Northumberland

Warren

Clarksville

Haverhill

Ossipee

Waterville Valley

Colebrook

Jackson

Piermont

Whitefield

Columbia

Jefferson

Pittsburg

Wolfeboro

Conway

Lancaster

Randolph

Woodstock

Dalton

Landaff

Sandwich

Dummer

Lincoln

Shelburne

Area II

Acworth

Dorchester

Langdon

Orford

Canaan

Enfield

Lebanon

Plainfield

Charlestown

Goshen

Lempster

Springfield

Claremont

Grafton

Lyme

Sunapee

Cornish

Grantham

Newport

Unity

Croydon

Hanover

Orange

Washington

Area III

Alexandria

Bristol

Groton

Plymouth

Alton

Campton

Hebron

Rumney

Ashland

Center Harbor

Holderness

Sanbornton

Barnstead

Ellsworth

Laconia

Thornton

Belmont

Gilford

Meredith

Tilton

Bridgewater

Gilmanton

New Hampton

Wentworth

Area IV

Allenstown

Danbury

Hopkinton

Sutton

Andover

Deering

Loudon

Warner

Boscawen

Dunbarton

Newbury

Weare

Bow

Epsom

New London

Webster

Bradford

Franklin

Northfield

Wilmot

Canterbury

Henniker

Pembroke

Windsor

Chichester

Hill

Pittsfield

Concord

Hillsborough

Salisbury

Area V

Alstead

Greenville

Nelson

Surry

Antrim

Hancock

New Ipswich

Swanzey

Bennington

Harrisville

Peterborough

Temple

Chesterfield

Hinsdale

Richmond

Troy

Dublin

Jaffrey

Rindge

Walpole

Fitzwilliam

Keene

Roxbury

Westmoreland

Francestown

Lyndeborough

Sharon

Winchester

Gilsum

Marlborough

Stoddard

Greenfield

Marlow

Sullivan

Area VI

Amherst

Hudson

Merrimack

Nashua

Brookline

Litchfield

Milford

Wilton

Hollis

Mason

Mont Vernon

Area VII

Auburn

Candia

Hooksett

Manchester

Bedford

Goffstown

Londonderry

New Boston

Area VIII

Brentwood

Greenland

Newfields

Portsmouth

Deerfield

Hampton

Newington

Raymond

East Kingston

Hampton Falls

Newmarket

Rye

Epping

Kensington

North Hampton

Seabrook

Exeter

Kingston

Northwood

South Hampton

Fremont

New Castle

Nottingham

Stratham

Area IX

Barrington

Lee

New Durham

Strafford

Dover

Madbury

Rochester

Durham

Middleton

Rollinsford

Farmington

Milton

Somersworth

Area X

Atkinson

Derry

Pelham

Sandown

Chester

Hampstead

Plaistow

Windham

Danville

Newton

Salem

History

#1647, eff 10-14-80; ss by #2020, eff 5-11-82; ss by #2678, eff 4-18-84; ss by #4667, eff 8-25-89; ss by #4729, eff 1-15-90, EXPIRED: 1-15-96
#6871, eff 10-21-98; ss by #8443, eff 1-1-06; ss by #8928, eff 6-30-07; ss by #10916, eff 8-26-15; ss by #13842, eff 12-29-23

N.H. Code Admin. R. Ann. He-M 505.06 Area Agency Designation Procedures and Criteria {#sec-he-m-505.06 omnilex-key=us-nh-regs-official--agency-he-m--He-M 505.06}

(a) The bureau shall initiate the area agency designation process by publishing a notice in a newspaper or newspapers of area-wide distribution to convey information about:

(1) The role and responsibilities of the area agency;

(2) Membership on the area board; and

(3) The area agency application and designation process, including the closing date for submission of application materials required by (c) below.

(b) Existing boards of private, non-profit agencies, including community mental health programs approved pursuant to RSA 135-C:10, may apply for designation as an area agency provided that the requirements under RSA 171-A:18, He-M 505.04(g), and (d) below have been met.

(1) The name of the applicant group’s contact person;

(2) Written assurances of adherence to these rules and applicable federal and state laws and rules;

(3) A personal data summary for each member of the applicant group, which shall:

a. Contain information documenting the person's experience and knowledge as required by (d) below; and

b. Demonstrate that the person is not excluded from board membership pursuant to He-M 505.04(g)(5);

(4) A description of the unmet service needs of individuals and how the applicant group proposes to meet those service needs; and

(5) A written proposal which shall include a line item budget and a description of all services to be provided.

(d) The members of the applicant group shall collectively demonstrate, through the submission of personal data summaries as required in (c)(3) above, experience in development and provision of services as well as knowledge of the fiscal, legal, and management issues of services and of the needs and abilities of individuals. The members of the applicant group shall have a demonstrated commitment to community-based, individual -directed services and have the capacity to meet the needs of individuals and families.

(e) The designation process shall be as follows:

(1) The commissioner shall solicit and consider comments from individuals, their families, and other stakeholders, such as local human services, educational, or advocacy organizations, in the area as to the ability of the applicant group(s) to carry out its responsibilities as stated in He-M 505.03 and He-M 505.04;

(2) The commissioner shall review the materials submitted by each applicant group as specified in (c) above and such information as is obtained from comments as provided in (e) (1) above;

(3) The commissioner shall select for site review the applicant group(s) that appear to be able to comply with all applicable state and federal laws and rules;

(4) The applicant group that is determined to be able to best comply with applicable deferral and state laws and rules shall receive designation as the area agency within 75 days following the date of the application deadline by the commissioner;

(5) Designation shall be for a 5-year term, unless revoked or suspended pursuant to He-M 505.07 or He-M 505.08 or unless an agency applies for redesignation in accordance with He-M 505.09;

(6) The commissioner shall notify each applicant group that does not receive designation of the reason why the applicant group was not designated;

(7) If there is no applicant group selected for designation in the area, the commissioner shall notify each applicant group and request that a second submission of application materials occur within 30 days following notification by the commissioner;

(8) If no applicant group in the area receives designation following the second submission of area agency application materials, the commissioner shall reinitiate the application procedure for designation of an area agency and either appoint an interim area agency to operate in the area or designate department staff to temporarily operate area agency services until a new area agency can be designated; and

(9) An applicant group denied designation by the commissioner shall have the right to appeal pursuant to He-M 505.12.

(f) An agency that has had its status as an area agency revoked in accordance with He-M 505.07, shall not be eligible to apply for designation as a successor area agency for 5 years following the date of the revocation.

(g) In cases where 2 or more areas are consolidated as a result of amendment of He-M 505.05, the commissioner shall select one area agency as the designated area agency for the new consolidated area using the criteria identified in He-M 505.09 (f)-(g). The area agency selected shall be one of the area agencies previously designated to serve the areas being consolidated.

History

#1647, eff 10-14-80; ss by #2020, eff 5-11-82; ss by #2678, eff 4-18-84; ss by #4667, eff 8-25-89; ss by #4729, eff 1-15-90, EXPIRED: 1-15-96
#6871, eff 10-21-98; ss by #8728, INTERIM, eff 10-21-06, EXPIRED: 4-19-07
#8928, eff 6-30-07; ss by #10916, eff 8-26-15; ss by #13842, eff 12-29-23 (formerly He-M 505.05)

N.H. Code Admin. R. Ann. He-M 505.07 Revocation of Designation {#sec-he-m-505.07 omnilex-key=us-nh-regs-official--agency-he-m--He-M 505.07}

(a) The bureau administrator shall monitor:

(1) The contract requirements, services, programs, and functions provided by the area agency to assure that area agency services are operated in accordance with the department rules and other applicable statutes, and federal laws, regulations, and rules, contract provisions, and mission statement, and the area plan in accordance with 505.04 (o)-(p); and

(2) The fiscal integrity, in accordance with contract requirements, of the area agencies.

(b) In the event that the bureau administrator determines that the area agency is not providing such services programs, supports, and functions in accordance with said laws, rules, contract, plan, mission, or that the area agency has not maintained fiscal integrity pursuant to contract requirements, the bureau administrator shall send a written notice to the area agency and area board specifying the nature of the deficiencies and the remedial action that is requested.

(d) In the event that the commissioner determines that the area agency has not complied with the remedial action requested pursuant to (b) above, the commissioner shall revoke the area agency’s designation.

(e) The commissioner shall issue written notice of revocation that specifies the reasons for the decision and its effective date. The effective date of the decision shall be at least 90 days from the date of said revocation notice.

(f) An area agency may request a revocation hearing in accordance with He-M 505.12.

(g) In the event that the decision to revoke designation is upheld following a revocation hearing, the commissioner shall initiate the process to select a successor area agency according to He-M 505.06.

History

#1647, eff 10-14-80; ss by #2020, eff 5-11-82; ss by #2678, eff 4-18-84; ss by #4667, eff 8-25-89; ss by #4729, eff 1-15-90, EXPIRED: 1-15-96
#6871, eff 10-21-98; ss by #8728, INTERIM, eff 10-21-06, EXPIRED: 4-19-07
#8928, eff 6-30-07; ss by #10916, eff 8-26-15; ss by #13842, eff 12-29-23 (formerly He-M 505.06)

N.H. Code Admin. R. Ann. He-M 505.08 Suspension {#sec-he-m-505.08 omnilex-key=us-nh-regs-official--agency-he-m--He-M 505.08}

(a) If the commissioner finds at any time that the health, safety, or welfare of individuals or the public is endangered by the continued operation of services by an area agency, the commissioner shall order the immediate suspension of the area agency’s designation.

(b) The commissioner or their designee shall conduct a hearing on the suspension within 10 days of its issue. Such a hearing shall be conducted pursuant to RSA 541-A:31-36 and He-C 200, except as provided in (f) below.

(c) The department shall send a notice to the area agency specifying the reasons for the suspension and the time and place of the hearing scheduled pursuant to (b) above.

(d) Within 10 days of the hearing, the commissioner shall either revoke or reinstate the area agency’s designation.

(e) The area agency may appeal the commissioner’s decision to a court of competent jurisdiction.

(f) In the event that the area agency waives its right to a hearing on a decision to suspend designation, or that such decision is upheld following a hearing, the commissioner shall initiate the process to designate a successor area agency pursuant to He-M 505.06.

History

#1647, eff 10-14-80; ss by #2020, eff 5-11-82; ss by #2678, eff 4-18-84; ss by #4667, eff 8-25-89; ss by #4729, eff 1-15-90, EXPIRED: 1-15-96
#6871, eff 10-21-98; amd by #8443, eff 1-1-06; ss by #8728, INTERIM, eff 10-21-06, EXPIRED: 4-19-07
#8928, eff 6-30-07; ss by #10916, eff 8-26-15; ss by #13842, eff 12-29-23 (formerly He-M 505.07)

N.H. Code Admin. R. Ann. He-M 505.09 Redesignation {#sec-he-m-505.09 omnilex-key=us-nh-regs-official--agency-he-m--He-M 505.09}

(a) Each area agency shall notify the bureau administrator of its intent to be redesignated every 5 years, in accordance with Table 505-2.

(b) Submission of notification of the area agency’s intention to be redesignated shall cause the area agency’s current designation to be effective until the bureau administrator issues a decision pursuant to (i) below.

(c) If an area agency’s current designation is due to expire earlier than the scheduled redesignation in Table 505-2, the current designation shall be extended to remain effective until the scheduled redesignation review is completed.

(d) Area agencies shall submit a comprehensive self-assessment with the notification of intent to be redesignated, to outline the area agency’s performance, within 180 days, but not less than 150 days, prior to the expiration of its current redesignation according to Table 505-2 below:

Table 505-2, Redesignation Schedule

2024 and 2029

2025 and 2030

2026 and 2031

2027 and 2032

2028 and 2033

Region II

Region III

Region VII

Region IV

Region I

Region V

Region VI

Region X

Region IX

Region VIII

(e) The bureau administrator shall review the agency’s self-assessment, department materials, and feedback from provider agencies, providers, individuals, family members, area citizens, advocacy and self-advocacy groups, and community groups regarding the area agency’s past performance and current ability to coordinate access to a comprehensive service delivery system.

(f) The bureau administrator shall consider the area agency’s past and current performance in providing services, programs, and functions to individuals and their families, including reviewing results and trends identified from the annual governance reviews conducted pursuant to He-M 505.04(aa).

(g) An area agency shall be considered successful and operating efficiently when it annually:

(1) Demonstrates, through its services, programs, and functions, a commitment to a mission that embraces and emphasizes active community membership and inclusion for persons with disabilities;

(2) Demonstrates, through multiple means, its commitment to individual rights, health promotion, and safety;

(3) Provides individuals and families with information and supports to design and direct their services in accordance with their needs, preferences, and capacities and to decide who will provide them;

(4) Involves those who use its services in area planning, system design, and development;

(5) Assesses and continuously improves the quality of its services, and ensures that the recipients of services are satisfied with the services that they receive;

(6) Demonstrates, through its board of directors and management team, effective governance, administration, and oversight of the area agency staff, provider agencies, and, if applicable, subcontract agencies;

(7) Is fiscally sound, manages resources effectively to support its mission, and utilizes generic community resources and proactive supports in assisting people;

(8) Complies, along with its subcontractors, if applicable, with all contract requirements and state and federal requirements; and

(9) Achieves the goals identified in its area plan and implements the recommendations made in its previous redesignation report from the department, if applicable.

(h) Approval of an area agency’s request for redesignation shall be granted if, based on the following information, the area agency is found to be in compliance with (f)(1)-(9) above:

(1) Materials collected as part of the redesignation process, which shall include, at a minimum, the following:

a. Comments solicited from individuals, family members, area citizens, provider agencies, providers, advocacy and self-advocacy groups, and community groups demonstrating the area agency’s ability to coordinate access to comprehensive services and provide leadership in addressing the needs of individuals within its catchment region; and

b. Information to demonstrate that the area agency has complied with the requirements of He-M 202 with respect to implementation of recommendations; and

(2) Other available documents which shall demonstrate:

a. Compliance with all department rules and other applicable statutes and federal laws, regulations, and rules, and contract requirements;

b. The results of the annual governance reviews and any other announced or unannounced reviews;

c. Compliance with performing and documenting Medicaid administration functions and claiming in accordance with 505.03; and

d. Corrective action taken in response to any department’s quality assurance review.

(i) The bureau administrator shall issue a report redesignating or conditionally redesignating an area agency.

(j) An area agency shall respond to any corrective action request included in a letter of redesignation.

History

#1647, eff 10-14-80; ss by #2020, eff 5-11-82; ss by #2678, eff 4-18-84; ss by #4667, eff 8-25-89; ss by #4729, eff 1-15-90, EXPIRED: 1-15-96
#6871, eff 10-21-98; ss by #8728, INTERIM, eff 10-21-06, EXPIRED: 4-19-07
#8928, eff 6-30-07; ss by #10916, eff 8-26-15; ss by #13842, eff 12-29-23 (formerly He-M 505.08)

N.H. Code Admin. R. Ann. He-M 505.10 Conditional Redesignation {#sec-he-m-505.10 omnilex-key=us-nh-regs-official--agency-he-m--He-M 505.10}

(a) If the area agency fails to meet the redesignation criteria specified in He-M 505.09, the commissioner shall redesignate the area agency on a conditional basis for a period of time not to exceed l80 days.

(b) The commissioner shall specify, in writing, conditions and time frames that shall be met by the area agency in order to be eligible for redesignation.

(c) Department staff designated by the bureau administrator shall review and issue a report regarding the area agency’s progress toward compliance with the conditions identified pursuant to He-M 505.10 (b).

(d) At least 2 weeks prior to the expiration of the conditional redesignation, the commissioner shall:

(l) Approve the application for redesignation, effective as of the date of conditional redesignation, if all conditions have been met within the required time frame; or

(2) Deny the application for redesignation if all conditions have not been met within the required time frame.

(e) Any corrective action not fully completed at the time an application for redesignation is approved in accordance with (d)(1) above shall be incorporated in the next area plan developed by the area agency after the redesignation review.

History

#1647, eff 10-14-80; ss by #2020, eff 5-11-82; ss by #2678, eff 4-18-84; ss by #4667, eff 8-25-89; ss by #4729, eff 1-15-90, EXPIRED: 1-15-96
#6871, eff 10-21-98; ss by #8728, INTERIM, eff 10-21-06, EXPIRED: 4-19-07
#8928, eff 6-30-07; ss by #10916, eff 8-26-15; ss by #13842, eff 12-29-23 (formerly He-M 505.09)

N.H. Code Admin. R. Ann. He-M 505.11 Denial of Redesignation {#sec-he-m-505.11 omnilex-key=us-nh-regs-official--agency-he-m--He-M 505.11}

(a) In those cases where the commissioner denies an application for redesignation, the commissioner shall notify the area agency in writing of the decision.

(b) Such a notice described in (a) above, shall specify the reasons for the decision and its effective date.

(d) The area agency shall have 20 days following the date of the notice to request a hearing on the denial in accordance with He-M 505.12.

(e) In the event that a hearing request is not made or the denial is upheld following a hearing, the commissioner shall initiate the process to designate a successor area agency as outlined in He-M 505.06.

History

#1647, eff 10-14-80; ss by #2020, eff 5-11-82; ss by #2678, eff 4-18-84; ss by #4667, eff 8-25-89; ss by #4729, eff 1-15-90, EXPIRED: 1-15-96
#6871, eff 10-21-98; ss by #8728, INTERIM, eff 10-21-06, EXPIRED: 4-19-07
#8928, eff 6-30-07; ss by #10916, eff 8-26-15; ss by #13842, eff 12-29-23 (formerly He-M 505.10)

N.H. Code Admin. R. Ann. He-M 505.12 Hearings {#sec-he-m-505.12 omnilex-key=us-nh-regs-official--agency-he-m--He-M 505.12}

(a) An area agency may request a hearing regarding a denial of designation or redesignation or revocation of designation.

(b) A request for hearing shall be submitted to the commissioner in writing within 20 days following the date of the notification of denial or revocation.

(c) The commissioner or their designee shall conduct a hearing in accordance with the procedures set forth in He-C 200 within 30 days of receipt of a request.

(d) Within 10 days of the hearing, the commissioner shall grant or deny an application for designation or redesignation or revoke or reinstate an area agency’s designation.

(e) The area agency may appeal the commissioner’s decision to a court of competent jurisdiction.

History

#1647, eff 10-14-80; ss by #2020, eff 5-11-82; ss by #2678, eff 4-18-84; ss by #4667, eff 8-25-89; ss by #4729, eff 1-15-90, EXPIRED: 1-15-96
#6871, eff 10-21-98; ss by #8728, INTERIM, eff 10-21-06, EXPIRED: 4-19-07
#8928, eff 6-30-07; ss by #10916, eff 8-26-15; ss by #13842, eff 12-29-23 (formerly He-M 505.11)

N.H. Code Admin. R. Ann. He-M 505.13 Designation of Successor Area Agency {#sec-he-m-505.13 omnilex-key=us-nh-regs-official--agency-he-m--He-M 505.13}

(a) If the commissioner or designee upholds the denial of designation or redesignation, suspension of designation, or revocation, the commissioner shall initiate the process described in He-M 505.06 to designate a successor area agency.

(b) Pursuant to RSA 171-A:18, VII, the department shall assume all or any part of the responsibilities of the area agency at any time during which an area agency is not designated.

(c) Following the revocation of an area agency’s designation, the department shall operate the services directly, enter a contract with the agency for provision of certain services, or enter into contracts with other area agencies to ensure the needs of individuals are met by service providers that have the capacity to provide high quality services pending the selection of a successor area agency.

History

#6871, eff 10-21-98; ss by #8728, INTERIM, eff 10-21-06, EXPIRED: 4-19-07
#8928, eff 6-30-07; ss by #10916, eff 8-26-15; ss by #13842, eff 12-29-23 (formerly He-M 505.12)

N.H. Code Admin. R. Ann. He-M 505.14 Waivers {#sec-he-m-505.14 omnilex-key=us-nh-regs-official--agency-he-m--He-M 505.14}

(a) An applicant, area agency, provider agency, individual, guardian, or provider may request a waiver of specific procedures outlined in He-M 505 by completing and submitting the form titled “NH Bureau of Developmental Services Waiver Request” (October 2023) in accordance with (b) and (c) below.

(b) A completed waiver request form shall be signed by the individual or guardian, if applicable, and the area agency’s executive director or designee recommending approval of the waiver.

(1) Email at bds@dhhs.nh.gov; or

(2) By mail to:

Bureau of Developmental Services

Hugh J. Gallen State Office Park

105 Pleasant Street, Main Building

Concord, NH 03301

(d) No provision or procedure prescribed by statute shall be waived.

(1) Does not negatively impact the health or safety of the individual(s); and

(2) Does not affect the quality of services to individuals.

(g) Waivers shall be granted in writing for the minimum period necessary to accommodate the waiver request, with a specific duration not to exceed 5 years except as in (h) and (j) below.

(h) Those waivers which relate to other issues relative to the health, safety, or welfare of individuals that require periodic reassessment shall be effective for the current designation period only.

(i) Any waiver shall end with the closure of the related program or service.

(j) A requesting entity may request a renewal of a waiver from the bureau. Such request shall be made at least 90 days prior to the expiration of a current waiver.

History

#6871, eff 10-21-98; ss by #8728, INTERIM, eff 10-21-06, EXPIRED: 4-19-07
#8928, eff 6-30-07; ss by #10916, eff 8-26-15; ss by #13842, eff 12-29-23; ss by #13842, eff 12-29-23 (formerly He-M 505.13)

Part He-M 506 Provider, Staff, and Contractor Qualifications and Development Requirements for Developmental Service Agencies

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

The purpose of these rules is to outline the minimum qualifications and training requirements of providers and staff.

History

#2033, eff 6-7-82; ss by #2679, eff 4-18-84; ss by #5047, eff 1-18-91, EXPIRED: 1-18-97
#6645, eff 12-2-97, EXPIRED: 12-2-05
#8604, eff 4-11-06; ss by #10528, eff 3-1-14; ss by #14039, eff 8-1-24

N.H. Code Admin. R. Ann. He-M 506.02 Definitions {#sec-he-m-506.02 omnilex-key=us-nh-regs-official--agency-he-m--He-M 506.02}

(a) “Acquired brain disorder” means a disruption in brain functioning that:

(1) Is not congenital or caused by birth trauma;

(2) Presents a severe and life-long disabling condition which significantly impairs a person's ability to function in society;

(3) Occurs prior to age 60;

(4) Is attributable to one or more of the following reasons:

a. External trauma to the brain as a result of:

A motor vehicle incident;
A fall;
An assault; or
Another related traumatic incident or occurrence;

b. Anoxic or hypoxic injury to the brain such as from:

Cardiopulmonary arrest;
Carbon monoxide poisoning;
Airway obstruction;
Hemorrhage; or
Near drowning;

c. Infectious diseases such as encephalitis and meningitis;

d. Brain tumor;

e. Intracranial surgery;

f. Cerebrovascular disruption such as a stroke;

g. Toxic exposure; or

h. Other neurological disorders such as Huntington's disease or multiple sclerosis which predominantly affect the central nervous system resulting in diminished cognitive functioning and ability; and

(5) Is manifested by one or more of the following:

a. Significant decline in cognitive functioning and ability; or

b. Deterioration in:

Personality;
Impulse control;
Judgment;
Modulation of mood; or
Awareness of deficits.

(b) “Area agency” means “area agency” as defined under RSA 171-A:2, I-b.

(d) “Days” means calendar days unless otherwise specified.

(e) “Developmental disability” means “developmental disability” as defined in RSA 171‑A:2, V, namely, “a disability:

(a) Which is attributable to an intellectual disability, cerebral palsy, epilepsy, autism or a specific learning disability or any other condition of an individual found to be closely related to an intellectual disability as it refers to general intellectual functioning or impairment in adaptive behavior or requires treatment similar to that required for persons with an intellectual disability; and

(f) “Family” means a group of 2 or more persons that:

(1) Are related by ancestry, marriage, or other legal arrangement;

(2) Are living in the same household; and

(3) Have at least one member who is an individual as defined in (i) below.

(g) “Health Risk Screening Tool (HRST)” means the 2015 edition of the Health Risk Screening Tool, available as noted in Appendix A, which is a web-based rating instrument used for performing health risk screenings on individuals in order to:

(1) Determine an individual’s vulnerability regarding potential health risks; and

(2) Enable the early identification of health issues and monitoring of health needs.

(h) “Home and community based waiver services (HCBS waiver services)” means the services defined and funded pursuant to New Hampshire’s agreement with the federal government, known as the “Disabilities Waiver” and the “Acquired Brain Disorder Waiver", pursuant to the authority section of 1915(c) of the Social Security Act which allows the federal funding of long-term care services in non-institutional settings for persons who are developmentally disabled or who have an acquired brain disorder.

(i) “Individual” means any person with a developmental disability or acquired brain disorder.

(j) “Provider” means a person receiving any form of remuneration for the provision of services to an individual.

(k) “Provider agency” means an agency or an independent provider that is established to provide services to individuals and who meets the criteria in He-M 504.

(l) “Staff” means a person employed by a provider agency, subcontract agency, or other employer.

(m) “Supports Intensity Scale-Adult Version ® (SIS-A ®)” means the 2023 edition of the Supports Intensity Scale, available as noted in Appendix A, which is an assessment tool intended to assist in service planning by measuring the individual’s support needs in the areas of home living, community living, lifelong learning, employment, health and safety, social activities, and protection and advocacy. The tool uses a formal rating scale to identify the type of supports needed, frequency of supports needed, and daily support time.

History

#2033, eff 6-7-82; ss by #2679, eff 4-18-84; ss by #5047, eff 1-18-91, EXPIRED: 1-18-97
#6645, eff 12-2-97, EXPIRED: 12-2-05
#8604, eff 4-11-06; ss by #10528, eff 3-1-14; ss by #14039, eff 8-1-24

N.H. Code Admin. R. Ann. He-M 506.03 Minimum Provider, Staff, and Contractor Qualifications {#sec-he-m-506.03 omnilex-key=us-nh-regs-official--agency-he-m--He-M 506.03}

(a) Providers, staff, and contractors shall meet the qualifications and requirements for providing HCBS waiver services identified in He-M 503, He-M 504, He-M 507, He-M 510, He-M 513, He-M 518, He-M 521, He-M 524, He-M 1001, and He-M 1201.

(b) All providers, staff, and contractors shall be at least 18 years of age, except as permitted in He-M 524.22 and He-M 525.12.

(c) Prior to a person working directly with individuals, the provider agency, with the consent of the person, shall complete the necessary registry, criminal background, and office of the inspector general exclusion list checks in accordance with He-M 504.03.

(d) Records, including information relating to providers, staff, and contractors shall be maintained by the provider agency for a period of 6 years after that provider, staff, or contractor no longer provides HCBS waiver services to individuals or is no longer employed by the provider agency.

History

#2033, eff 6-7-82; ss by #2679, eff 4-18-84; ss by #5047, eff 1-18-91, EXPIRED: 1-18-97
#6645, eff 12-2-97, EXPIRED: 12-2-05
#8604, eff 4-11-06; ss by #10528, eff 3-1-14; ss by #14039, eff 8-1-24

N.H. Code Admin. R. Ann. He-M 506.04 Policy and Procedure Requirements {#sec-he-m-506.04 omnilex-key=us-nh-regs-official--agency-he-m--He-M 506.04}

Each provider agency shall establish and implement written policies which shall specifically address the following:

(a) Non-discrimination on the basis of:

(1) Race;

(2) Color;

(3) Sex;

(4) Creed;

(5) National origin;

(6) Age;

(7) Marital status;

(8) Familial status;

(9) Sexual orientation; or

(10) Physical or mental disability; and

(b) Knowledge, skills, and abilities relative to providing HCBS waiver services.

History

#2033, eff 6-7-82; ss by #2679, eff 4-18-84; ss by #5047, eff 1-18-91; amd by #5322, eff 1-31-92; ss by #6645, eff 12-2-97; EXPIRE: 12-2-05
#8604, eff 4-11-06; ss by #10528, eff 3-1-14; ss by #14039, eff 8-1-24

N.H. Code Admin. R. Ann. He-M 506.05 Provider, Staff, and Contractor Development Requirements {#sec-he-m-506.05 omnilex-key=us-nh-regs-official--agency-he-m--He-M 506.05}

(a) Within the first month of providing HCBS waiver services, a provider agency shall train each provider, staff, and contractor in:

(1) An overview of the rights of persons who receive services, as described in He-M 202 and He-M 310; and

(2) Developing an understanding of the stigmas, negative labels, and common life experiences of people with disabilities including how individuals utilize behavior as communication.

(b) All provider agency providers, staff, and contractors who have direct contact with individuals and families shall meet the applicable requirements in He-M 504.11.

(c) All provider agency providers, staff, and contractors who have direct contact with individuals or are hired after March 31,2025 shall participate in a person-centered thinking program and demonstrate competencies within the first 3 months of providing HCBS waiver services and every 5 years thereafter.

(d) Person-centered programs for (c) above shall consist of nationally recognized models and best practices as identified by the National Center on Advancing Person-Centered Practices and Systems (NCAPPS) or the National Alliance for Direct Support Professionals (NADSP).

(e) Prior to working directly with an individual, providers, staff, and contractors shall be trained in the following information regarding the individual:

(1) Personal profile;

(2) Goals;

(3) Specific health-related requirements, including:

a. All current medical conditions, medical history, and routine and emergency protocols;

b. Any special nutrition, hydration, elimination, personal hygiene, oral health, or ambulation needs; and

c. Any special, cognitive, mental health, or behavioral needs;

(4) Information the family, and guardian if applicable, believe would be helpful to the service provision process;

(5) Emergency contact information;

(6) Safety plan;

(7) Behavior or risk management plan;

(8) HRST information pertinent to supporting the individual;

(9) SIS information pertinent to supporting the individual;

(10) Any other information needed to ensure the individual’s health and safety needs are understood; and

(11) Any information in the service agreement not specified in (1)-(10) above.

(f) Staff with no prior experience providing services directly to individuals shall be assigned to work with an experienced staff member, for not less than 16 hours during their orientation.

(g) Prior to staff working directly with an individual and annually thereafter, supervisors shall ask each staff to demonstrate, through examples, their understanding of the information presented pursuant to (e) above.

(h) At least monthly, supervisors or their designees shall conduct unannounced visits to staff at community locations while they are providing services for individuals. The purpose of the visits shall be to assure that services are provided in accordance with each individual's service agreement.

(i) Providers, staff, and contractors shall be re-trained annually in an overview of the rights of individuals, as described in He-M 202 and He-M 310. Provider agencies shall re-train providers, staff, and contractors and the re-training shall include examples of rights violations.

(j) A provider agency shall train providers, staff, and contractors in the following areas within the first 6 months of providing HCBS waiver services:

(1) An overview of developmental disabilities and acquired brain disorders, which shall include:

a. An overview of the different types of developmental disabilities and acquired brain disorders and their causes;

b. An overview of the local and state service delivery system; and

c. An overview of professional services and technologies including therapies, assistive technologies, and environmental modifications necessary to achieve individuals' goals at home, in the community, in the workplace and in recreation or leisure activities;

(2) An overview of conditions promoting or detracting from the quality of life that individuals enjoy, which shall provide providers, staff, and contractors the competencies necessary to:

a. Support individuals to obtain and maintain valued social roles;

b. Support individuals to build relationships with their families, neighbors, co-workers, and other community members;

c. Create and enhance opportunities for individuals to:

Increase their presence in the life of their local communities; and
Increase the ways in which they contribute to their communities;

d. Support individuals to have as much control as possible over their own lives;

e. Build individuals’ skills, strengths, and interests that are functional and meaningful in natural community environments;

f. Create supports that enable individuals to explore and participate in a wide variety of community activities and experiences in settings that are available to the general public; and

g. Support individuals to gain as much independence as possible;

(3) Methods to assist individuals with challenging behaviors utilizing positive behavioral supports as described in He-M 1001.07 (d);

(4) Understanding, and assisting individuals to manage behavior that derives from neurological compromises or limitations;

(5) Techniques to:

a. Facilitate social relationships;

b. Enhance skills that improve everyday living and promote independence; and

c. Teach, coach, and mentor individuals to learn skills that maximize independence;

(6) Basic health and safety practices related to:

a. Personal wellness;

b. Success in living, working, and recreating in the community; and

c. An understanding of the importance of common signs and symptoms of illness;

(7) Training relative to supporting individuals in employment pursuant to He-M 518, as appropriate;

(8) Skills necessary to support individuals and their families to:

a. Make their own decisions;

b. Advocate for themselves; and

c. Create their own social networks;

(9) Any trainings specified in an individual’s service agreement; and

(10) Training in orienting individuals to fire safety and emergency evacuation procedures.

History

#2033, eff 6-7-82; ss by #2679, eff 4-18-84; ss by #5047, eff 1-18-91, EXPIRED: 1-18-97
#6645, eff 12-2-97, EXPIRED: 12-2-05
#8604, eff 4-11-06; ss by #10528, eff 3-1-14; ss by #14039, eff 8-1-24

N.H. Code Admin. R. Ann. He-M 506.06 Waivers {#sec-he-m-506.06 omnilex-key=us-nh-regs-official--agency-he-m--He-M 506.06}

(a) A provider agency, individual, guardian, or provider may request a waiver of specific procedures outlined in He-M 506 using the form titled “NH Bureau of Developmental Services Waiver Request” (October 2023 edition).

(b) A completed waiver request form shall be signed by:

(1) The individual or guardian indicating agreement with the request, if applicable; and

(2) The provider agency’s executive director or designee recommending approval of the waiver.

(1) Email at bds@dhhs.nh.gov; or

(2) By mail to:

Department of Health and Human Services

Bureau of Developmental Services

Hugh J. Gallen State Office Park

105 Pleasant Street, Main Building

Concord, NH 03301

(d) No provision or procedure prescribed by statute shall be waived.

(1) Does not negatively impact the health or safety of the individual(s); and

(2) Does not affect the quality of services to individuals.

(g) Waivers shall be granted in writing for the minimum period necessary to accommodate the waiver request, with a specific duration not to exceed 5 years except as in (h) and (i) below.

(h) Any waiver shall end with the closure of the related program or service.

(i) A requesting entity may request a renewal of a waiver from the bureau. Such request shall be made at least 90 days prior to the expiration of a current waiver.

History

#6645, eff 12-2-97, EXPIRED: 12-2-05
#8604, eff 4-11-06; ss by #10528, eff 3-1-14; ss by #14039, eff 8-1-24

Part He-M 507 Community Participation Services

N.H. Code Admin. R. Ann. He-M 507.01 Purpose {#sec-he-m-507.01 omnilex-key=us-nh-regs-official--agency-he-m--He-M 507.01}

The purpose of these rules is to establish standards for certified community participation services as part of a comprehensive array of community-based services for persons with developmental disabilities or acquired brain disorders that:

(a) Assist the individual to attain, improve, and maintain a variety of life skills, including vocational skills;

(b) Emphasize, maintain and broaden the individual’s opportunities for community participation and relationships;

(d) Promote personal choice and control in all aspects of the individual’s life and services, including the involvement of the individual, to the extent he or she is able, in the selection, hiring, training, and ongoing evaluation of his or her primary staff and in determining the quality of services; and

(e) Are provided in accordance with the individual’s service agreement and goals and desired outcomes.

History

#2269, eff 1-10-83; ss by #2963, eff 1-22-85; ss by #4314, eff 9-27-87; ss by #4659, eff 8-4-89; EXPIRED: 8-4-95
#6285, eff 7-12-96, EXPIRED: 7-12-04
#8142, INTERIM, eff 8-21-04, EXPIRED: 2-17-05
#8324, eff 4-16-05, EXPIRED: 4-16-13
#10320, INTERIM, eff 4-25-13, EXPIRES: 10-22-13; ss by #10426, eff 10-1-13

N.H. Code Admin. R. Ann. He-M 507.02 Definitions {#sec-he-m-507.02 omnilex-key=us-nh-regs-official--agency-he-m--He-M 507.02}

The words and phrases used in these rules shall mean the following:

(a) “Acquired brain disorder” means a disruption in brain functioning that:

(1) Is not congenital or caused by birth trauma;

(2) Presents a severe and life-long disabling condition which significantly impairs a person’s ability to function in society;

(3) Occurs prior to age 60;

(4) Is attributable to one or more of the following reasons:

a. External trauma to the brain as a result of:

A motor vehicle incident;
A fall;
An assault; or
Another related traumatic incident or occurrence;

b. Anoxic or hypoxic injury to the brain such as from:

Cardiopulmonary arrest;
Carbon monoxide poisoning;
Airway obstruction;
Hemorrhage; or
Near drowning;

c. Infectious diseases such as encephalitis and meningitis;

d. Brain tumor;

e. Intracranial surgery;

f. Cerebrovascular disruption such as a stroke;

g. Toxic exposure; or

h. Other neurological disorders such as Huntington's disease or multiple sclerosis which predominantly affect the central nervous system; and

(5) Is manifested by one or more of the following:

a. Significant decline in cognitive functioning and ability; and

b. Deterioration in:

Personality;
Impulse control;
Judgment;
Modulation of mood; or
Awareness of deficits.

(b) “Area agency” means “area agency” as defined under RSA 171-A:2, I-b, namely, “an entity established as a nonprofit corporation in the state of New Hampshire which is established by rules adopted by the commissioner to provide services to developmentally disabled persons in the area.”

(c) “Basic living skills” means activities accomplished each day to acquire, improve, or maintain independence in daily life.

(d) “Bureau” means the bureau of developmental services of the department of health and human services.

(e) “Centralized service site” means a location operated by a provider agency where individuals receive community participation services for more than one hour per day.

(f) “Certification” means the written approval by the bureau of health facilities administration for the operation of community participation services in accordance with the requirements set forth in He-M 507.

(g) “Community participation services”, also called “day services” elsewhere in He-M 500 and He-M 1001, means habilitation, assistance, and instruction provided to individuals that:

(1) Improve or maintain their performance of basic living skills;

(2) Offer vocational and community activities, or both;

(3) Enhance their social and personal development;

(4) Include consultation services, in response to individuals’ needs, and as specified in service agreements, to improve or maintain communication, mobility, and physical and psychological health; and

(5) At a minimum, meet the needs and achieve the desired goals and outcomes of each individual as specified in the service agreement.

(h) “Covered services” means community participation services described pursuant to He-M 507.04 as reimbursable under the Medicaid program or through grants from the bureau.

(i) “Department” means the department of health and human services.

(j) “Developmental disability” means “developmental disability” as defined in RSA 171‑A:2, V, namely, “a disability:

(a) Which is attributable to an intellectual disability, cerebral palsy, epilepsy, autism or a specific learning disability, or any other condition of an individual found to be closely related to an intellectual disability as it refers to general intellectual functioning or impairment in adaptive behavior or requires treatment similar to that required for persons with an intellectual disability; and

(b) Which originates before such individual attains age 22, has continued or can be expected to continue indefinitely, and constitutes a severe handicap to such individual's ability to function normally in society.”

(k) “Exploitation” means “exploitation” as defined in RSA 161-F:43, IV.

(l) “Family” means a group of 2 or more persons related by ancestry, marriage, or other legal arrangement.

(m) “Health assessment” means an evaluation of an individual’s health status done by a physician or other licensed practitioner for the purpose of making recommendations regarding strategies for promoting and maintaining optimum health.

(n) “Health Risk Screening Tool (HRST) (2009 edition)”, available as noted in Appendix A, means a web-based rating instrument used for performing health risk screenings on individuals in order to:

(1) Determine an individual’s vulnerability regarding potential health risks; and

(2) Enable the early identification of health issues and monitoring of health needs.

(o) “Home and community‑based care waiver” means the waiver of sections 1902 (a) (10) and 1915 (c) of the Social Security Act which allows the federal Medicaid funding of long‑term services for persons in non‑institutional settings who are elderly, disabled, or chronically ill.

(p) “Individual” means any person with a developmental disability or acquired brain disorder who receives, or has been found eligible to receive, area agency services.

(q) “Personal development” means supporting or increasing an individual's capacity to make choices, to communicate interests and preferences, and to have sufficient opportunities for exploring and meeting those interests.

(r) “Personal profile” means a narrative description prepared pursuant to He-M 503.11 (f)(1) a. 1. that includes:

(1) A personal statement from the individual and those who know him or her best that summarizes the individual’s strengths and capacities, communication and learning style, challenges, needs, interests, and any health concerns, as well as the individual’s hopes and dreams;

(2) A personal history covering significant life events, relationships, living arrangements, health, use of assistive technology, and results of evaluations which contribute to an understanding of the individual’s needs;

(3) A review of the past year that:

a. Summarizes the individual’s:

Personal achievements;
Relationships;
Degree of community involvement;
Challenging issues or behavior;
Health status and any changes in health; and
Safety considerations during the year;

b. Addresses the previous year’s desired goals and outcomes with level of success and, if applicable, identifies any obstacles encountered;

c. Identifies the desired goals and outcomes of the individual for the coming year;

d. Identifies the type and amount of services the individual receives and the support services provided under each service category;

e. Identifies the individual’s health needs;

f. Identifies the individual’s safety needs;

g. Identifies any follow-up action needed on concerns and the persons responsible for the follow-up; and

h. Includes a statement of the individual’s and guardian’s satisfaction with services;

(4) An attached work history of the individual’s paid employment and volunteer positions, as applicable, that includes:

a. Dates of employment;

b. Type of work;

c. Hours worked per week; and

d. Reason for leaving, if applicable; and

(5) A reference to sensitive historical information in other sections of the record when the individual or guardian, as applicable, prefers not to have this included in the profile.

(s) “Primary staff” means staff who are regularly assigned to provide services to specific individuals.

(t) “Provider” means a person receiving any form of remuneration for the provision of services to an individual.

(u) “Provider agency” means an area agency or an entity under contract with an area agency that is responsible for providing community participation services to individuals.

(v) “Risk management plan” means a person-centered document that describes the services, supports, approaches and guidelines to be utilized to meet the individual’s needs and mitigate risks to community safety and which is consistent with the service guarantees and protections articulated in He-M 503.

(w) “Service agreement” means a written agreement between an individual or guardian and the area agency that describes the services that the individual will receive and constitutes an individual service agreement as defined in RSA 171-A:2, X. The term includes a basic service agreement for all individuals who receive services and an expanded service agreement for those who receive more complex services pursuant to He-M 503.11.

(x) “Service coordinator” means a person who is chosen or approved by an individual and his or her guardian and designated by the area agency to organize, facilitate and document service planning and to negotiate and monitor the provision of the individual’s services and who is:

(1) An area agency service coordinator, family support coordinator, or any other area agency or provider agency employee;

(2) A member of the individual’s family;

(3) A friend of the individual; or

(4) Another person chosen to represent the individual.

(y) “Sheltered workshop” means a program that provides a segregated service environment where the contract objectives of the provider agency are the primary focus and goal.

(z) “Supports Intensity Scale (2004 edition)”, available as noted in Appendix A, means an assessment tool intended to assist in service planning by measuring the individual’s support needs in the areas of home living, community living, lifelong learning, employment, health and safety, social activities, and protection and advocacy. The tool uses a formal rating scale to identify the type of supports needed, frequency of supports needed, and daily support time.

(aa) “Systematic, therapeutic, assessment, respite and treatment (START)” means the model of service supports that is intended to optimize independence, treatment, and community living for individuals with developmental disabilities and mental health needs.

History

#2269, eff 1-10-83; ss by #2963, eff 1-22-85; ss by #4314, eff 9-27-87; ss by #4659, eff 8-4-89; EXPIRED: 8-4-95
#6285, eff 7-12-96, EXPIRED: 7-12-04
#8142, INTERIM, eff 8-21-04, EXPIRED: 2-17-05
#8324, eff 4-16-05, EXPIRED: 4-16-13
#10320, INTERIM, eff 4-25-13, EXPIRES: 10-22-13; ss by #10426, eff 10-1-13

N.H. Code Admin. R. Ann. He-M 507.03 Service Principles {#sec-he-m-507.03 omnilex-key=us-nh-regs-official--agency-he-m--He-M 507.03}

(a) All community participation services shall be designed to:

(1) Support the individual’s participation in a variety of integrated community activities and settings;

(2) Assist the individual to be a contributing and valued member of his or her community through vocational and volunteer opportunities;

(3) Meet the individual’s needs, goals, and desired outcomes, as identified in his or her service agreement, related to community opportunities for volunteerism, employment, personal development, socialization, recreation, communication, mobility, and personal care;

(4) Help the individual to achieve more independence in all aspects of his or her life by learning, improving, or maintaining a variety of life skills, such as:

a. Traveling safely in the community;

b. Managing personal funds;

c. Participating in community activities; and

d. Other life skills identified in the service agreement;

(5) Promote the individual’s health and safety;

(6) Protect the individual’s right to freedom from abuse, neglect, and exploitation; and

(7) Provide opportunities for the individual to exercise personal choice and independence within the bounds of reasonable risks.

(b) Community participation services shall be primarily provided in community settings outside of the home where the individual lives.

(c) An individual or guardian may select any person, any provider agency, or another area agency as a provider to deliver the community participation services identified in the individual’s service agreement.

(d) All providers shall:

(1) Comply with the rules pertaining to community participation services;

(2) Enter into a contractual agreement with the area agency; and

(3) Operate within the limits of funding authorized by the agreement.

History

#2269, eff 1-10-83; ss by #2963, eff 1-22-85; ss by #4314, eff 9-27-87; ss by #4659, eff 8-4-89; EXPIRED: 8-4-95
#6285, eff 7-12-96, EXPIRED: 7-12-04
#8142, INTERIM, eff 8-21-04, EXPIRED: 2-17-05
#8324, eff 4-16-05; amd by #8545, eff 1-24-06; paras (a)-(g) and (i)-(q) expired on 4-16-13; ss by #10320, INTERIM, eff 4-25-13, EXPIRES: 10-22-13; ss by #10426, eff 10-1-13

N.H. Code Admin. R. Ann. He-M 507.04 Covered Services {#sec-he-m-507.04 omnilex-key=us-nh-regs-official--agency-he-m--He-M 507.04}

(a) All community participation services shall be designed and provided in accordance with the individual’s specific needs, interests, competencies, and learning style, as described in the individual’s service agreement and personal profile.

(b) The following services shall be covered:

(1) Instruction and assistance to learn, improve, or maintain:

a. Social and safety skills in different community settings;

b. Decision-making regarding choice of and participation in community activities;

c. Life skills as applied to community-based activities, such as purchasing items and managing personal funds;

d. Good nutrition and healthy lifestyle;

e. Self-advocacy and rights and responsibilities as citizens; and

f. Any other skill identified by the individual or guardian during service planning and related to the individual’s participation in, or contribution to, his or her community;

(2) Supports to identify and develop the individual’s interests and capacities related to securing employment opportunities, including internships;

(3) Services related to job development and on-the-job training;

(4) Assistance in finding and maintaining volunteer positions;

(5) Supports related to enabling the individual to explore, and participate in, a wide variety of community activities and experiences in settings that are available to the general public;

(6) Consultation services as specified in the service agreement to improve or maintain the individual’s communication, mobility, and physical and psychological health and well-being; and

(7) Transportation that is:

a. Related to community participation services, including travel from the individual’s residence to locations where the community participation service activities are taking place; or

b. Travel from the individual’s residence to employment or volunteer positions described in He-M 507.05 (a)(3) below.

History

#2269, eff 1-10-83; ss by #2963, eff 1-22-85; ss by #4314, eff 9-27-87; ss by #4659, eff 8-4-89; EXPIRED: 8-4-95
#6285, eff 7-12-96, EXPIRED: 7-12-04
#8142, INTERIM, eff 8-21-04, EXPIRED: 2-17-05
#8324, eff 4-16-05, EXPIRED: 4-16-13
#10320, INTERIM, eff 4-25-13, EXPIRES: 10-22-13; ss by #10426, eff 10-1-13

N.H. Code Admin. R. Ann. He-M 507.05 Non‑Covered Services {#sec-he-m-507.05 omnilex-key=us-nh-regs-official--agency-he-m--He-M 507.05}

(a) The following services shall not be covered by community participation services funding provided by the bureau or the Medicaid home- and community‑based care waiver:

(1) Custodial care programs provided only to maintain an individual’s basic welfare;

(2) Sheltered workshops;

(3) Employment or volunteer positions where the individual is:

a. Being solely supported by persons who are not providers; and

b. Not receiving any services from a provider agency at those locations; and

(4) Educational services or education programs for individuals under 21 years of age for which school districts are responsible.

(b) When the community participation services for an individual are phased out at a volunteer or job site and the individual begins to be supported by non-paid persons exclusively, as described in (a)(3) above, the provider agency may include such an arrangement as a part of its billable community participation service for a maximum of another 120 days. The staffing resources freed up from such an arrangement may be used to support the individual in other activities or need areas identified in the individual’s service agreement.

History

#2269, eff 1-10-83; ss by #2963, eff 1-22-85; ss by #4314, eff 9-27-87; ss by #4659, eff 8-4-89; amd by #5864, eff 7-1-94; EXPIRED: 8-4-95
#6285, eff 7-12-96, EXPIRED: 7-12-04
#8142, INTERIM, eff 8-21-04, EXPIRED: 2-17-05
#8324, eff 4-16-05, EXPIRED: 4-16-13
#10320, INTERIM, eff 4-25-13, EXPIRES: 10-22-13; ss by #10426, eff 10-1-13

N.H. Code Admin. R. Ann. He-M 507.06 Certification {#sec-he-m-507.06 omnilex-key=us-nh-regs-official--agency-he-m--He-M 507.06}

(a) To be eligible for reimbursement by the bureau or by Medicaid for community participation services provided to individuals, community participation services shall be certified by the department.

(b) If a provider agency wishes to furnish community participation services to 3 or more persons who have not been found eligible for area agency services, the provider agency shall be licensed as an adult day program in accordance with RSA 151 and He-P 818.

(c) An entity seeking certification or recertification to provide community participation services shall submit an application to:

Bureau of Health Facilities Administration (BHFA)

Hugh J. Gallen State Office Park

129 Pleasant Street, Brown Building

Concord, NH 03301

(d) Application materials shall include the following:

(1) A completed “Request for Certification of Community Residence and/or Individual Community Participation Services Provider” application (September 2013 edition);

(2) A written description of the proposed staffing pattern necessary to provide services pursuant to He-M 507.04;

(3) The names, titles, qualifications and relevant experience of all staff members, in accordance with He-M 506.03 and He-M 507.10;

(4) Written administrative policies and procedures, which shall comply with He-M 507.08(b); and

(5) If the community participation services are provided in a centralized service site, a copy of a life safety report which shall:

a. Have been completed no more than 90 days prior to submission; and

b. Include:

The name and address of the provider agency;
The date of inspection and certification by the local fire inspector that the centralized service site, if applicable, complies with local fire safety codes;
The maximum number of individuals authorized to receive services; and
The signature, title, and professional affiliation of the local fire inspector.

(e) For a provider agency requesting initial certification, certification shall be granted for 90 days from the date the department receives all required information if the provider agency meets the requirements of, or demonstrates the capacity to meet the requirements of, He-M 507.04, He-M 507.08 (b), and He-M 507.10.

(f) An initial certification review shall be conducted at the provider agency location by BHFA within 90 days of the effective date of the initial certificate for the purposes of determining whether or not the community participation services are in compliance with these rules.

(g) Initial certification shall be granted from the effective date of the initial certificate until the last day of the twelfth month following certification when the provider agency verifies that:

(1) Any necessary corrective action has been taken; and

(2) The services conform with all applicable rules adopted by the commissioner.

(h) For community participation services that are applying for recertification, BHFA shall conduct a certification review prior to the expiration date of the certificate. The current certification shall be effective until recertification has been granted or denied or unless the current certification is revoked.

(i) A community participation service program applying for recertification shall submit a completed application 60 days prior to the expiration of the certificate.

(j) The renewal period for certificates shall be one year from the expiration date of the previous certificate for:

(1) Community participation service programs certified for 51 or more individuals; and

(2) Community participation service programs certified for 50 or fewer individuals with 3 or more deficiencies.

(k) The renewal period for certificates shall be 2 years from the expiration date of the previous certificate for community participation service programs certified for 50 or fewer individuals with 2 or fewer deficiencies.

(l) When a renewal certificate is issued for a period of 2 years, the provider agency holding the certificate shall conduct a quality assurance review one year following the issuance to ensure that the community participation service program remains in compliance with all applicable rules.

(m) When BHFA staff conduct the 2-year certification review:

(1) If the community participation service program has documentation of a review pursuant to (l) above, BHFA staff shall:

a. Review such documentation;

b. Cite any deficiency noted during the agency-conducted quality assurance review that has not been addressed; and

c. Review the community participation service program’s compliance for the previous year; or

(2) If the community participation service program lacks documentation of a review pursuant to (l) above, BHFA staff shall:

a. Cite this as a deficiency; and

b. Hold the entire 2-year period subject to review.

(n) Notwithstanding (m) (1) above, any documentation maintained by a community participation service program during its most recent 2-year certification period shall be open to review by BHFA staff for compliance with applicable department rules.

(o) If deficiencies were cited in the inspection report, within 21 days of the date of issuance of the report the community participation service program shall submit a written plan of correction or submit information demonstrating that the deficiency(ies) did not exist. The department shall evaluate any submitted information on its merits and render a written decision on whether a written plan of correction is necessary.

(p) The department shall, within 45 days:

(1) Accept a plan of correction or other information submitted pursuant to (o) above if:

a. The plan:

Addresses each identified deficiency in a manner which achieves full compliance with rules cited in the inspection report;
Does not create another violation of statute or rule as the result of its implementation;
States a completion date; and
Identifies a plan for how each deficiency will be prevented in the future; or

b. The information submitted proves that the deficiency was cited erroneously; or

(2) Reject a plan of correction or other information submitted pursuant to (o) above that fails to meet the criteria in (1) above.

(q) If the proposed plan of correction is rejected, the department shall notify the provider agency in writing of the reason(s) for rejection.

(r) Within 10 business days of the date of the written notice under (q) above, the provider agency shall submit a revised plan of correction that includes proposed alternatives that address the reason(s) for rejection.

(s) The department shall either accept or reject the revised plan in accordance with (p) above. If the revised plan of correction is rejected, the department shall deny the certification request. The provider agency may appeal the denial pursuant to He-M 507.15.

(t) The department shall renew a certificate if it determines that:

(1) No deficiencies exist; or

(2) The plan of correction complies with (p) (1) a. above.

History

#2269, eff 1-10-83; ss by #2963, eff 1-22-85; ss by #4314, eff 9-27-87; ss by #4659, eff 8-4-89; EXPIRED: 8-4-95
#6285, eff 7-12-96, EXPIRED: 7-12-04
#8142, INTERIM, eff 8-21-04, EXPIRED: 2-17-05
#8324, eff 4-16-05, EXPIRED: 4-16-13
#10320, INTERIM, eff 4-25-13, EXPIRES: 10-22-13; ss by #10426, eff 10-1-13 (from He-M 507.03)

N.H. Code Admin. R. Ann. He-M 507.07 Operating Requirements {#sec-he-m-507.07 omnilex-key=us-nh-regs-official--agency-he-m--He-M 507.07}

(a) Each individual shall have a written service agreement that includes goals and desired outcomes and activities specific to his or her community participation services. Each service agreement shall meet the requirements of He-M 503.11.

(b) For each individual receiving community participation services, the annual service planning meeting shall include a discussion of employment and volunteer opportunities.

(d) Review of each individual’s progress with respect to goals and outcomes shall be conducted and documented as specified in the service agreement, but not less than quarterly.

(e) Participation in all community participation services shall be voluntary.

(f) Any person may make a recommendation for termination of services in accordance with He-M 503.16.

History

#2269, eff 1-10-83; ss by #2963, eff 1-22-85; ss by #4314, eff 9-27-87; ss by #4659, eff 8-4-89; EXPIRED: 8-4-95
#6285, eff 7-12-96, EXPIRED: 7-12-04
#8142, INTERIM, eff 8-21-04, EXPIRED: 2-17-05
#8324, eff 4-16-05; amd by #8545, eff 1-24-06; paras (a)-(d) and (f) expired on 4-16-13; ss by #10320, INTERIM, eff 4-25-13, EXPIRES: 10-22-13; ss by #10426, eff 10-1-13 (from He-M 507.06)

N.H. Code Admin. R. Ann. He-M 507.08 Organization and Administration {#sec-he-m-507.08 omnilex-key=us-nh-regs-official--agency-he-m--He-M 507.08}

(a) The community participation services director shall be responsible for the administration of community participation services and the hiring, training, and supervision of community participation services staff.

(b) Provider agencies shall have written policies and procedures that address the following:

(1) The provision of covered services;

(2) Emergency plans, which shall minimally include:

a. Procedures to follow while at a service site, in a vehicle, or in the community in case of:

Behavioral or medical emergencies of an individual; or
Fire or severe weather; and

b. If individuals gather at a centralized service site to receive services, an emergency evacuation plan including provisions in compliance with the following:

Each individual shall be oriented to evacuation procedures upon starting services;
If the service site has been evacuated in 3 minutes or less during each of 6 consecutive monthly drills, the provider agency shall thereafter conduct a drill at least once quarterly;
If the service site has not been evacuated in 3 minutes or less during each of 6 consecutive monthly drills, the provider agency shall conduct monthly drills;
For each individual unable to evacuate in 3 minutes or less, the provider agency shall implement a specific evacuation plan;
Evacuation drills shall be held at varied times of the day;
A written record of each drill shall be kept on file by the provider agency;
Staff shall be trained in all aspects of evacuation procedures; and
Staff who conduct training pursuant to 7. above shall document such training;

(3) A policy for the administration of medication, which shall comply with the requirements of He-M 1201;

(4) A policy on individual rights in accordance with He-M 202 and He-M 310; and

(5) If individuals gather at a centralized service site to receive services, a policy which ensures compliance with applicable local and state health, zoning, building, and fire codes and requires documentation of compliance with fire codes.

(1) Records shall comply with the requirements of He-M 310, rights of individuals receiving developmental services in the community, and He-M 503.10–503.11, service planning and service agreements;

(2) The provider agency shall maintain a separate record for each individual and records regarding administration of services;

(3) Each individual’s record shall have an administrative and a service component as described in (d) and (e) below; and

(4) Attendance records, either individual or collective, shall be kept at the administrative offices of the provider agency and at the area agency.

(d) The administrative component of each individual’s record shall include, for that individual, at least the following:

(1) Personal and identifying information, including:

a. Name;

b. Address;

c. Phone number;

d. Photo or physical description;

e. Date of birth;

f. Primary language, if other than English, or communication means and level;

g. Emergency contact;

h. Parent or next of kin;

i. Guardian, if applicable;

j. Home provider, if applicable;

k. Service coordinator; and

l. Health insurance, if any; and

(2) A current health assessment.

(e) The service component of each individual’s record shall include at least the following:

(1) A copy of the current service agreement containing:

a. Goals and desired outcomes specific to the individual’s participation in community participation services; and

b. The methods or strategies for achieving the individual’s community participation services’ goals and desired outcomes;

(2) As a guide for planning activities, an individual, week-long, personal schedule or calendar that is created at the time of the annual service planning meeting and, if applicable, identifies:

a. The days, times, and locations of the individual’s:

Paid employment;
Community activities, volunteerism, or internship; and
Other regularly recurring activities, such as therapeutic activities related to communication, mobility, and personal care; and

b. The days and approximate times of unspecified community activities, which shall not exceed 20% of the total community participation service hours the individual receives per week;

(3) A record of daily community participation services activities maintained by the provider agency, including:

a. The name(s) of individual(s) served and names of staff supporting them;

b. The dates on which services were provided; and

c. Activities that took place and the locations of the activities;

(4) Narrative progress notes, and other service documentation as specified in the service agreement, recorded at least monthly, and addressing:

a. The individual’s community participation services goals and actual outcomes; and

b. Other activities related to the individual’s support services, health, interests, achievements, and relationships;

(5) The individual’s medical status, including current medications, known allergies, and other pertinent health care information;

(6) Results of any screenings or evaluations that have been conducted, including:

a. The Supports Intensity Scale (2004 edition), available as noted in Appendix A;

b. Vocational assessments;

c. Results of any assistive technology assessments;

d. The Health Risk Screening Tool (HRST) (2009 edition), available as noted in Appendix A;

e. START in-depth assessments and crisis plans; and

f. Risk management plans; and

(7) For each individual for whom medications are administered during community participation services, medication log documentation pursuant to He-M 1201.07.

(f) Records of service operations shall include the following:

(1) A register of current and prior individuals who received community participation services, including termination dates when applicable;

(2) A daily census;

(3) Documentation of all incident reports as defined in He-M 202.02 (o);

(4) Evacuation drill records, if there is a centralized service site; and

(5) Copies of emergency plans.

(g) Provider agencies shall have personal injury liability insurance for the staff and providers and for vehicles used to transport individuals. Proof of insurance shall be on file at the provider agency premises.

History

#2269, eff 1-10-83; ss by #2963, eff 1-22-85; ss by #4314, eff 9-27-87; ss by #4659, eff 8-4-89; EXPIRED: 8-4-95
#6285, eff 7-12-96, EXPIRED: 7-12-04
#8142, INTERIM, eff 8-21-04, EXPIRED: 2-17-05
#8324, eff 4-16-05, EXPIRED: 4-16-13
#10320, INTERIM, eff 4-25-13, EXPIRES: 10-22-13; ss by #10426, eff 10-1-13; (from He-M 507.07)

N.H. Code Admin. R. Ann. He-M 507.09 Oversight and Quality Improvement {#sec-he-m-507.09 omnilex-key=us-nh-regs-official--agency-he-m--He-M 507.09}

(a) The community participation services director shall:

(1) Be responsible for providing oversight; and

(2) Evaluate, facilitate, and improve the quality of services being delivered and outcomes achieved.

(b) Each individual’s service coordinator shall provide oversight regarding the community participation service arrangement and review and facilitate the effectiveness of the community participation services being provided and outcomes achieved.

(c) In fulfilling the responsibilities cited in (a) and (b) above, the community participation services director and service coordinator shall determine whether the following criteria are being met and, if not, take appropriate action:

(1) Services are customized and meet the interests, goals, and desired outcomes of the individual, as defined in the service agreement;

(2) Goals reflect the individual’s growth and evolving interests and are revised accordingly;

(3) The goals and desired outcomes identified in the service agreement are being achieved;

(4) Staff are knowledgeable of the individual’s service agreement as it pertains to community participation services and are assisting in meeting the desired goals and outcomes;

(5) Services occur in integrated settings;

(6) Methods or strategies for achieving the individual’s community participation services goals and desired outcomes are evident and documented;

(7) An individual week-long personal schedule or calendar is present; and

(8) Individuals, and guardians if applicable, are satisfied with services.

History

#4659, eff 8-4-89; EXPIRED: 8-4-95
#6285, eff 7-12-96, EXPIRED: 7-12-04
#8142, INTERIM, eff 8-21-04, EXPIRED: 2-17-05
#8324, eff 4-16-05 (formerly He-M 507.08), EXPIRED: 4-16-13
#10320, INTERIM, eff 4-25-13, EXPIRES: 10-22-13; ss by #10426, eff 10-1-13 (from He-M 507.08)

N.H. Code Admin. R. Ann. He-M 507.10 Staff and Provider Qualifications {#sec-he-m-507.10 omnilex-key=us-nh-regs-official--agency-he-m--He-M 507.10}

(a) Community participation services staff, contracted providers, and consultants shall collectively possess professional backgrounds and competencies such that the needs of the individuals who receive community participation services can be met.

(b) Community participation services shall be provided, in accordance with each individual’s service agreement, by:

(1) Direct service staff;

(2) Contracted providers;

(3) Consultants;

(4) Professional staff;

(5) Non-professional staff; or

(6) Volunteers.

(c) All personnel identified in (b) above shall be supervised by professional staff or by the director of community participation services or his or her designee.

(d) If clinical consultants are used, they shall be licensed or certified as required by New Hampshire law.

(e) All persons who provide community participation services shall be at least 18 years of age.

(f) Prior to a person providing community participation services to individuals, the provider agency, with the consent of the person, shall:

(1) Obtain at least 2 references for the person;

(2) Complete, at a minimum, a New Hampshire criminal records check;

(3) If a person’s primary residence is out of state, complete a criminal records check for their state of residence;

(4) If a person has resided in New Hampshire for less than one year, complete a criminal records check for their previous state of residence; and

(5) Complete a motor vehicles record check to ensure that the person has a valid driver’s license.

(g) Except as allowed in (h)-(i) below, the provider agency shall not hire a person:

(1) Who has a:

a. Felony conviction; or

b. Any misdemeanor conviction involving:

Physical or sexual assault;
Violence;
Exploitation;
Child pornography;
Threatening or reckless conduct;
Theft;
Driving under the influence of drugs or alcohol; or
Any other conduct that represents evidence of behavior that could endanger the well being of an individual; or

(2) Whose name is on the registry of founded reports of abuse, neglect, and exploitation pursuant to RSA 161-F:49.

(h) A provider agency may hire a person with a criminal record listed in (g)(1)a. or b. above for a single offense that occurred 10 or more years ago in accordance with (i) and (j) below. In such instances, the individual, his or her guardian, and the area agency shall review the person’s history prior to approving the person’s employment.

(i) Employment of a person pursuant to (h) above shall only occur if such employment:

(1) Is approved by the individual, his or her guardian and the area agency;

(2) Does not negatively impact the health or safety of the individual(s); and

(3) Does not affect the quality of services to individuals.

(j) Upon hiring a person pursuant to (h) above, the provider agency shall document and retain the following information in the individual’s record:

(1) Identification of the region, according to He-M 505.04, in which the provider agency is located;

(2) The date(s) of the approvals in (h) above;

(3) The name of the individual or individuals for whom the person will provide services;

(4) The name of the person hired;

(5) Description of the person’s criminal offense;

(6) The type of service the person is hired to provide;

(7) The provider agency’s name and address;

(8) The certification number and expiration date of the certified program, if applicable;

(9) A full explanation of why the provider agency is hiring the person despite the person’s criminal record;

(10) Signature of the individual(s) or legal guardian(s) indicating agreement with the employment and date signed;

(11) Signature of the staff person who obtained the individual’s or guardian’s signature and date signed;

(12) Signature of the area agency’s executive director or designee approving the employment; and

(13) The signature and phone number of the person being hired.

History

#4659, eff 8-4-89; EXPIRED: 8-4-95
#6285, eff 7-12-96, EXPIRED: 7-12-04
#8142, INTERIM, eff 8-21-04, EXPIRED: 2-17-05
#8324, eff 4-16-05 (formerly He-M 507.09), EXPIRED: 4-16-13
#10320, INTERIM, eff 4-25-13, EXPIRES: 10-22-13; ss by #10426, eff 10-1-13

N.H. Code Admin. R. Ann. He-M 507.11 Staff and Provider Training {#sec-he-m-507.11 omnilex-key=us-nh-regs-official--agency-he-m--He-M 507.11}

(a) Prior to delivering community participation services to an individual, the provider agency shall orient staff, contracted providers, and consultants to the needs and interests of the specific individuals they serve, in the following areas:

(1) Rights and safety;

(2) Health-related requirements including those related to:

a. Current medical conditions, medical history, and routine and emergency protocols; and

b. Any special nutrition, dietary, hydration, elimination, or ambulation needs;

(3) Any communication needs;

(4) Any behavioral supports;

(5) The individuals’ service agreements, including all goals and desired outcomes and methods or strategies to achieve the goals and desired outcomes; and

(6) The community participation services’ evacuation procedures, if applicable.

(b) Provider agencies shall:

(1) Assign staff to work with an experienced staff member during their orientation if they have had no prior experience providing services to individuals;

(2) Train staff in accordance with (c) below within the first 6 months of employment; and

(3) Provide staff with training in accordance with their annual individual staff development plans.

(1) An overview of developmental disabilities and acquired brain disorders, which shall include:

a. An overview of the different types of disabilities and their causes;

b. An overview of the local and state service delivery system; and

c. An overview of professional services and technologies including therapies, assistive technologies, and environmental modifications necessary to achieve individuals' goals in the community, in the workplace, in recreation or leisure activities, and at home;

(2) An overview of conditions promoting or detracting from the quality of life that individuals enjoy, which shall:

a. Aid staff to develop an understanding of the stigmas, negative labels and common life experiences of people with disabilities; and

b. Aid staff to gain the competencies necessary to:

Support individuals to obtain and maintain valued social roles;
Support individuals to build relationships with their families, neighbors, co-workers and other community members;
Create and enhance opportunities for individuals to:

(i) Increase their presence in the life of their local communities; and

(ii) Increase the ways in which they contribute to their communities;

Support individuals to have as much control as possible over their own life;
Build individuals’ skills, strengths and interests that are functional and meaningful in natural community environments; and
Create conditions that provide opportunities for individuals to experience and participate in a wide range of community organizations and resources;

(3) Methods to assist individuals with challenging behaviors utilizing positive behavioral supports;

(4) Techniques to:

a. Facilitate social relationships; and

b. Enhance skills that improve everyday living and promote independence;

(5) Basic health and safety practices related to:

a. Personal wellness;

b. Success in living, working, and recreating in the community; and

c. An understanding of the importance of common signs and symptoms of illness; and

(6) Skills necessary to support individuals to:

a. Make their own decisions;

b. Advocate for themselves; and

c. Create their own social networks.

History

#2269, eff 1-10-83; ss by #2963, eff 1-22-85; ss by #4314, eff 9-27-87; ss by #4659, eff 8-4-89; EXPIRED: 8-4-95
#6285, eff 7-12-96, EXPIRED: 7-12-04
#8142, INTERIM, eff 8-21-04, EXPIRED: 2-17-05
#8324, eff 4-16-05 (formerly He-M 507.10), EXPIRED: 4-16-13
#10320, INTERIM, eff 4-25-13, EXPIRES: 10-22-13; ss by #10426, eff 10-1-13 (from He-M 507.09)

N.H. Code Admin. R. Ann. He-M 507.12 Prior Authorization of Community Participation Services {#sec-he-m-507.12 omnilex-key=us-nh-regs-official--agency-he-m--He-M 507.12}

(a) In order to receive community participation services, an individual shall have a developmental disability or acquired brain disorder and a written service agreement that includes one or more goals and desired outcomes for community participation services.

(b) An agency intending to provide community participation services to an individual through the Medicaid program shall request prior authorization using the procedure outlined in He-M 517.08 (b).

History

#4659, eff 8-4-89; EXPIRED: 8-4-95
#6285, eff 7-12-96, EXPIRED: 7-12-04
#8142, INTERIM, eff 8-21-04, EXPIRED: 2-17-05
#8324, eff 4-16-05 (formerly He-M 50711), EXPIRED: 4-16-13
#10320, INTERIM, eff 4-25-13, EXPIRES: 10-22-13; ss by #10426, eff 10-1-13

N.H. Code Admin. R. Ann. He-M 507.13 Denial or Revocation of Certification {#sec-he-m-507.13 omnilex-key=us-nh-regs-official--agency-he-m--He-M 507.13}

(a) The department shall deny an application for certification or issue a notice of intent to revoke certification, following written notice pursuant to (b) below and opportunity for a hearing pursuant to He-C 200, due to any of the following reasons:

(1) Any reported abuse, neglect, or exploitation of an individual by an applicant, provider, provider agency, or community participation services staff, if:

a. Such abuse, neglect, or exploitation is reported on the state registry of abuse, neglect, and exploitation in accordance with RSA 161-F:49;

b. Such person(s) continues to have contact with the individual; and

c. A waiver has not been received pursuant to He-E 720.05;

(2) Except as provided in He-M 507.10(g)-(h), any applicant, provider, provider agency, or community participation services staff for whom He-M 507.10(f)(1) or (2) is true;

(3) A provider agency or area agency fails to conduct criminal records check on all persons who are paid to provide services under He-M 507;

(4) An applicant, provider, provider agency, or community participation services staff has an illness or behavior that, as evidenced by the documentation obtained or the observations made by the department, would endanger the well-being of the individuals or impair the ability of the provider agency to comply with department rules;

(5) An applicant or provider agency, or any representative or employee thereof, knowingly provides materially false or misleading information to the department;

(6) An applicant or provider agency, or any representative or employee thereof, fails to permit or interferes with any inspection or investigation by the department;

(7) An applicant or provider agency, or any representative or employee thereof, fails to provide required documents to the department;

(8) At an inspection the applicant or provider agency is not in compliance with RSA 171-A or He-M 507 or other applicable rules; or

(9) As a result of certification review, the applicant or provider agency or certificate holder is not in compliance with RSA 171-A or He-M 507 or other applicable rules and:

a. The applicant or provider agency failed to fully implement and continue to comply with a plan of correction that has been accepted by the department in accordance with He-M 507.06 (p); or

b. The applicant or provider agency has submitted a revised plan of correction that has been rejected by the department in accordance with He-M 507.06 (s).

(b) Certification shall be denied or revoked upon the written notice by the department to the applicant or provider agency stating the specific rule(s) with which the provider agency does not comply.

(c) Any applicant or provider agency aggrieved by the denial or revocation of certification may request an adjudicative proceeding in accordance with He-M 507.15. The denial or revocation shall not become final until the period for requesting an adjudicative proceeding has expired or, if the applicant or provider agency requests an adjudicative proceeding, until such time as the administrative appeals unit issues a decision upholding the department’s action.

(d) Pending compliance with all requirements for certification specified in the written notice made pursuant to (b) above, a provider agency shall not accept additional individuals if a notice of revocation has been issued concerning a violation which presents potential danger to the health or safety of the individuals being served.

(e) If certification has been revoked, the provider agency shall transfer all individuals to another appropriately certified community participation service program within 10 days of certificate revocation becoming final in accordance with (c) above

History

#6285, eff 7-12-96, EXPIRED: 7-12-04
#8142, INTERIM, eff 8-21-04, EXPIRED: 2-17-05
#8324, eff 4-16-05, EXPIRED: 4-16-13
#10320, INTERIM, eff 4-25-13, EXPIRES: 10-22-13; ss by #10426, eff 10-1-13 (from He-M 507.11)

N.H. Code Admin. R. Ann. He-M 507.14 Immediate Suspension of Certification {#sec-he-m-507.14 omnilex-key=us-nh-regs-official--agency-he-m--He-M 507.14}

(a) Notwithstanding the provision of He-M 507.13(c), in the event that a violation poses an immediate and serious threat to the health or safety of an individual, the department shall, in accordance with RSA 541-A:30, III, suspend a provider agency’s certification immediately upon issuance of written notice specifying the reasons for the action.

(b) The department shall schedule and hold a hearing within 10 working days of the suspension for the purpose of determining whether to revoke or reinstate the provider agency’s certification. The hearing shall provide opportunity for the provider agency whose certification has been suspended to demonstrate that it has been, or is, in compliance with the specified requirements.

History

#6285, eff 7-12-96, EXPIRED: 7-12-04
#8142, INTERIM, eff 8-21-04, EXPIRED: 2-17-05
#8324, eff 4-16-05 (formerly He-M 507.13), EXPIRED: 4-16-13
#10320, INTERIM, eff 4-25-13, EXPIRES: 10-22-13; ss by #10426, eff 10-1-13 (from He-M 507.12)

N.H. Code Admin. R. Ann. He-M 507.15 Appeals {#sec-he-m-507.15 omnilex-key=us-nh-regs-official--agency-he-m--He-M 507.15}

(a) An applicant for certification, provider, provider agency, or area agency may request a hearing regarding a proposed revocation or denial of certification, except as provided in He‑M 507.14 above.

(b) Appeals shall be submitted, in writing, to the bureau administrator in care of the department’s office of client and legal services within 10 days following the date of the notification of denial or revocation of certification.

(c) The bureau administrator or his or her designee shall immediately forward the appeal to the department’s administrative appeals unit which shall assign a presiding officer to conduct a hearing or independent review, as provided in He-C 200. The burden of proof shall be as required in He-C 203.14.

History

#8324, eff 4-16-05 (formerly He-M 507.14), EXPIRED: 4-16-13
#10320, INTERIM, eff 4-25-13, EXPIRES: 10-22-13; ss by #10426, eff 10-1-13 (from He-M 507.13)

N.H. Code Admin. R. Ann. He-M 507.16 Prior Authorization and Payment {#sec-he-m-507.16 omnilex-key=us-nh-regs-official--agency-he-m--He-M 507.16}

(a) In order to receive Medicaid reimbursement for community participation services, area agencies, as the enrolled providers of home and community‑based care services, shall submit claims for payment to:

ACS Xerox

250 Commercial Street, #1

Manchester, NH 03101

(b) Payment for Medicaid waiver services shall only be made if prior authorization has been obtained from the bureau pursuant to He-M 517.08.

Division of Community Based Care Services

Bureau of Developmental Services

State Office Park South

105 Pleasant Street

Concord, NH 03301

History

#10426, eff 10-1-13

N.H. Code Admin. R. Ann. He-M 507.17 Waivers {#sec-he-m-507.17 omnilex-key=us-nh-regs-official--agency-he-m--He-M 507.17}

(a) An applicant, area agency, provider agency, individual, guardian, or provider may request a waiver of specific procedures outlined in He-M 507 using the form titled “NH bureau of developmental services waiver request” (September 2013 edition). The area agency shall submit the request in writing to the bureau administrator.

(b) A completed waiver request form shall be signed by:

(1) The individual or guardian indicating agreement with the request; and

(2) The area agency’s executive director or designee recommending approval of the waiver.

Office of Client and Legal Services

Hugh J. Gallen State Office Park

105 Pleasant Street, Main Building

Concord, NH 03301

(d) No provision or procedure prescribed by statute shall be waived.

(1) Does not negatively impact the health or safety of the individual(s); and

(2) Does not affect the quality of services to individuals.

(g) Waivers shall be granted in writing for a specific duration not to exceed 5 years except as in (h) and (j) below.

(h) Those waivers which relate to other issues relative to the health, safety or welfare of individuals that require periodic reassessment shall be effective for the current certification period only.

(i) Any waiver shall end with the closure of the related program or service.

(j) A requesting entity may request a renewal of a waiver from the bureau. Such request shall be made at least 90 days prior to the expiration of a current waiver.

History

#10426, eff 10-1-13 (from He-M 507.15)

Part He-M 510 Family-Centered Early Supports and Services

N.H. Code Admin. R. Ann. He-M 510.01 Purpose {#sec-he-m-510.01 omnilex-key=us-nh-regs-official--agency-he-m--He-M 510.01}

In its role as designated lead agency for the implementation of federally mandated Part C of Public Law 108-446 Individuals with Disabilities Education Improvement Act (IDEIA) of 2004, 20 U.S.C. 1400 et seq., the department establishes these minimum standards for family-centered early supports and services (FCESS). These services are provided in natural environments as part of a comprehensive array of supports and services for families and their children, as defined in He-M 510.02 (g), residing throughout New Hampshire.

History

(See Revision Note at part heading for He-M 510) #5745, eff 12-1-93, EXPIRED: 12-1-99
#7234, eff 4-22-00; ss by #9135, INTERIM, eff 4-22-08, EXPIRED: 10-19-08
#9594, eff 11-11-09; ss by #10325, eff 4-26-13; ss by #13753, eff 9-27-23

N.H. Code Admin. R. Ann. He-M 510.02 Definitions {#sec-he-m-510.02 omnilex-key=us-nh-regs-official--agency-he-m--He-M 510.02}

The words and phrases used in these rules shall have the following meanings:

(a) “Applicant” means any person under the age of 3 whose parent requests services pursuant to He-M 510.06;

(b) “Area agency” means “area agency” as defined in RSA 171-A:2, I-b, namely, “an entity established as a nonprofit corporation in the state of New Hampshire which is established by rules adopted by the commissioner to provide services to developmentally disabled persons in the area in accordance with 42 CFR 441.301.”;

(c) “Assessment” means the procedures used by personnel, as identified in He-M 510.11 (b)(1), throughout the period of a child’s application and eligibility under this part to identify the child’s unique strengths and needs and the services appropriate to meet those needs, and includes:

(1) A review of the multidisciplinary evaluation described in He-M 510.06 (k);

(2) Personal observations of the child; and

(3) The identification of the child’s needs in each of the following areas:

a. Physical development, including vision, hearing, or both;

b. Cognitive development;

c. Communication development;

d. Social or emotional development; and

e. Adaptive development;

(d) “Assistive technology device” means any item, piece of equipment or product, whether acquired commercially “off the shelf”, modified, or customized, that is used to increase, maintain, or improve the functional capabilities of a child. The term does not include medical devices that are surgically implanted, or the optimization, such as mapping, maintenance, or replacement of such devices.

(e) “At risk for substantial developmental delay” means a child is a substance-exposed newborn, or experiences 3 or more of the following, as reported by the family and documented by personnel listed in He-M 510.11 (b)(1):

(1) Documented conditions, events, or circumstances affecting the child including:

a. Birth weight less than 4 pounds;

b. Respiratory distress syndrome;

c. Gestational age less than 27 weeks or more than 44 weeks;

d. Asphyxia;

e. Infection;

f. History of abuse or neglect;

g. Prenatal drug exposure due to mother’s substance abuse or withdrawal;

h. Prenatal alcohol exposure due to mother’s substance abuse or withdrawal;

i. Nutritional problems that interfere with growth and development;

j. Intracranial hemorrhage grade III or IV; or

k. Homelessness; or

(2) Documented conditions, events, or circumstances affecting a parent, including:

a. Developmental disability;

b. Psychiatric disorder;

c. Family history of lack of stable housing;

d. Education less than 10th grade;

e. Social isolation;

f. Substance misuse or abuse;

g. Age of either parent less than 18 years;

h. Parent and child interactional disturbances; or

i. Founded child abuse or neglect as determined by a district court pursuant to RSA 169-C:21;

(f) “Atypical behavior” means behavior reported by the family and documented by personnel listed in He-M 510.11 (b)(1) that includes one or more of the following:

(1) Extreme fearfulness or other modes of distress that do not respond to comforting by caregivers;

(2) Self-injurious or extremely aggressive behaviors;

(3) Extreme apathy;

(4) Unusual and persistent patterns of inconsolable crying, chronic sleep disturbances, regressions in functioning, absence of pleasurable interest in adults and peers, or inability to communicate emotional needs; or

(5) Persistent failure to initiate or respond to most social situations;

(g) “Child” means an infant or toddler with a disability who is under 3 years of age and:

(1) Is at risk for or has a developmental delay;

(2) Exhibits atypical behavior; or

(3) Has an established condition;

(h) “Commissioner” means the commissioner of the New Hampshire department of health and human services or their designee;

(i) “Consent” means that:

(1) The parent has been fully informed, in the parent’s native language or other mode of communication, of all information relevant to the activity for which approval is sought;

(2) The parent understands and agrees to, in writing, the carrying out of the activity for which the parent’s approval is sought;

(3) The written approval describes the approved activity and lists the records, if any, that will be released and to whom; and

(4) The parent understands that the granting of approval is voluntary on the part of the parent, can be revoked at any time, and that revocation of approval is not retroactive;

(j) “Department” means the New Hampshire department of health and human services;

(k) “Developmental delay” means that a child has a 33% delay in one or more of the following areas as determined through completion of the multidisciplinary evaluation pursuant to He-M 510.06 (k):

(1) Physical development, including vision, hearing, or both;

(2) Cognitive development;

(3) Communication development;

(4) Social or emotional development; or

(5) Adaptive development;

(l) “Division for Children, Youth and Families (DCYF)” means the organizational unit of the department of health and human services that provides services to children and youth referred by courts pursuant to RSA 169-A, RSA 169-B, RSA 169-C, RSA 169-D, and RSA 463;

(m) “Early intervention specialist” means an individual certified by the bureau in accordance with the criteria in He-M 510.11 (k)-(m);

(n) “Established condition” means that a child has a diagnosed physical or mental condition that has a high probability of resulting in a developmental delay, even if no delay exists at the time of referral, as documented by the family and personnel listed in He-M 510.11 (b)(1), including, at a minimum, conditions such as:

(1) Chromosomal anomaly or genetic disorder;

(2) Inborn errors of metabolism;

(3) A congenital malformation;

(4) A severe infectious disease;

(5) A neurological disorder;

(6) A sensory impairment;

(7) A severe attachment disorder;

(8) Fetal alcohol spectrum disorder;

(9) Lead poisoning; or

(10) Toxic exposure;

(o) “Family-centered early supports and services (FCESS)” means a wide range of activities and assistance, based on peer-reviewed research to the extent practicable, that develops and maximizes the family’s and other caregivers’ ability to care for the child and to meet the child’s needs in a flexible manner;

(q) “Family-centered early supports and services (FCESS) program” means a program under contract with the department to provide FCESS as defined in these rules;

(r) “Family support council” means the regional council established pursuant to RSA 126-G:4;

(s) “Foster parent” means a person with whom a child lives and who is licensed pursuant to He-C 6446 and certified pursuant to He-C 6347;

(t) “Frequency and intensity” means the number of days or sessions a service will be provided and whether the service will be provided on an individual or group basis;

(u) “Homeless children” means children under the age of 3 years who meet the definition given the term “homeless children and youths” in section 725 (42 U.S.C. 11434a) of the McKinney-Vento Homeless Assistance Act, as amended, 42 U.S.C. 11431 et seq;

(v) “Individualized family support plan (IFSP)” means a written plan developed in accordance with He-M 510.07 for providing supports and services to an eligible child and family;

(w) “Informed clinical opinion” means the conclusion of a professional identified pursuant to He-M 510.11 (b)(1) based on:

(1) Parent observations of the child as reported to the professional;

(2) Parent reports of the child’s developmental history;

(3) The professional’s multiple and direct observations of the child at home or in other community settings;

(4) The professional’s review of pertinent records related to the child’s current health status and medical history; and

(5) Formal measures of the child’s activities and interactions with others;

(x) “Length” means the period of time the service is provided during each session of that service;

(y) “Local education agency (LEA)” means “local education agency” as defined in Ed 1102.03 (n);

(z) “Medical home” means a model of delivering primary care that is accessible, continuous, comprehensive, family-centered, coordinated, compassionate, and culturally effective;

(aa) “Method” means how a service is provided;

(ab) “Multidisciplinary” means the involvement of 2 or more individuals from separate disciplines or professions;

(ac) “Native language” means:

(1) The language normally used by the parent of the child in the home; or

(2) For a child with deafness or blindness, or for a family with no written language, the mode of communication normally used by the child and family such as sign language, Braille, or oral communication;

(ad) “Natural environment” means places and situations where the child’s age peers without disabilities live, play, and grow;

(ae) “Natural supports” means people including but not limited to family, relatives, friends, neighbors, childcare providers, clergy, and social groups such as religious organizations, co-workers, and social clubs, available to provide assistance as part of everyday living as well as during critical events;

(af) “Notification” means referral of a child to the LEA and the NH department of education;

(ag) “Parent” means:

(1) A biological or adoptive parent of a child; or

(2) As identified in a judicial decree or when the biological or adoptive parent does not have legal authority to make educational or FCESS decisions on behalf of the child:

b. A foster parent as defined in (s) above;

c. An individual acting in the place of a biological or adoptive parent, including a grandparent, stepparent, or other relative with whom the child lives;

d. A surrogate parent as defined in (aq) below; or

e. Any other individual who is legally responsible for the child’s welfare;

(ah) “Personally identifiable information” means:

(1) The name of the parent(s);

(2) The name of the child or other family members;

(3) The address of the child;

(4) A personal identifier such as the parent or child’s social security number; or

(5) A list of personal characteristics, or other information that would make it possible to identify the child or family with reasonable certainty;

(ai) “Potentially eligible” means that an estimation has been made by the IFSP team, as described in He-M 510.07 (c), that a child might be eligible to receive preschool special education services from the child’s LEA;

(aj) “Provider” means a person receiving any form of remuneration for the provision of services to a child or family applying for or receiving FCESS under He-M 510;

(ak) “Record” means, in accordance with the Family Educational Rights and Privacy Act (FERPA) and 34 CFR 99.3, any information recorded in any way including, but not limited to:

(1) Handwriting;

(2) Print;

(3) Computer media;

(4) Video or audio tape;

(5) Email;

(6) Text message; and

(7) Any other electronically stored information;

(al) “Region” means a geographic area designated pursuant to He-M 505.04 for the purpose of providing services to individuals with developmental disabilities and their families;

(am) “Scientifically-based research” means “scientifically-based research” as defined in the Elementary and Secondary Education Act (ESEA), Title IX, Part A, section 9101(37) and 20 U.S.C. 7801(37);

(an) “Service coordinator” means a person who:

(1) Is chosen or approved by the parent of the child;

(2) Is identified in He-M 510.11(b);

(3) Together with the family has the responsibility of planning, accessing, coordinating, and monitoring the delivery of services for an eligible child’s and family; and

(4) Possesses experience relevant to carrying out applicable responsibilities for the child and family’s needs under He-M 510;

(ao) “Setting” means the actual place(s) the services will be provided;

(ap) “Substance-exposed newborn” means “substance-exposed newborn” as defined in RSA 171-A:18-a, namely, “a newborn who was exposed to alcohol, or other drugs in utero, which may have adverse effects, whether or not this exposure is detected at birth through a drug screen or withdrawal symptoms.”; and

(aq) “Surrogate parent” means a person who:

(1) Is appointed by the lead agency;

(2) Is trained by the lead agency regarding FCESS; and

(3) Acts as a child’s advocate in the FCESS decision-making process, including the transition to art B services, in place of the child’s:

a. Biological parents;

b. Adoptive parents; or

c. Guardian.

History

(See Revision Note at part heading for He-M 510) #5745, eff 12-1-93, EXPIRED: 12-1-99
#7234, eff 4-22-00; amd by #7822, eff 2-8-03; ss by #9135, INTERIM, eff 4-22-08, EXPIRED: 10-19-08
#9594, eff 11-11-09; ss by #10325, eff 4-26-13; ss by #13753, eff 9-27-23

N.H. Code Admin. R. Ann. He-M 510.03 Family-Centered Support and Service Categories {#sec-he-m-510.03 omnilex-key=us-nh-regs-official--agency-he-m--He-M 510.03}

(a) Assistive technology services shall directly assist a child in the selection, acquisition, or use of an assistive technology device, including:

(1) The evaluation of the needs of a child, including a functional evaluation of the child in the child’s customary environment;

(2) Purchasing, leasing, or otherwise providing for the acquisition of assistive technology devices by the family;

(3) Selecting, designing, fitting, customizing, adapting, applying, maintaining, repairing, or replacing assistive technology devices;

(4) Coordinating and using other therapies, interventions, supports, or services with assistive technology devices, such as those associated with existing IFSPs;

(5) Training or technical assistance for a child or, if appropriate, that child’s family; and

(6) Training or technical assistance for professionals, including persons providing FCESS and other persons who provide services to, or are otherwise substantially involved in the major life functions of, children.

(b) Audiology services shall include:

(1) Identification of children with auditory impairments, using at risk criteria and appropriate audiologic screening techniques;

(2) Determination of the range, nature, and degree of hearing loss and communication functions, by use of audiological evaluation procedures;

(3) Referral for medical and other services necessary for the habilitation or rehabilitation of children with auditory impairment;

(4) Provision of auditory training, aural rehabilitation, speech reading, and listening device orientation and training, and other services;

(5) Provision of services for prevention of hearing loss; and

(6) Determination of the child’s need for individual amplification, including selecting, fitting, and dispensing appropriate listening and vibrotactile devices, and evaluating the effectiveness of those devices.

(c) Family training, counseling, and home visits shall include assistance to the family in understanding the special needs and building on the interests of the child and enhancing the child’s development.

(d) Health services shall include services necessary to enable a child to benefit from the other FCESS under He-M 510 during the time that the child is eligible to receive other FCESS, including:

(1) Such services as clean intermittent catheterization, tracheotomy care, tube feeding, the changing of dressings or colostomy collection bags, and other health services; and

(2) Consultation by physicians with other FCESS providers concerning the special health care needs of children that will need to be addressed in the course of providing other FCESS.

(e) Health services shall not include:

(1) Services that are surgical in nature, such as cleft palate surgery, surgery for club foot, or the shunting of hydrocephalus;

(2) Services that are purely medical in nature, such as hospitalization for management of congenital heart ailments or the prescribing of medicine or drugs for any purpose;

(3) Services related to the implementation, maintenance, replacement, or optimization, such as mapping, of a medical device that is surgically implanted, including cochlear implants;

(4) Devices such as heart monitors, respirators and oxygen, and gastrointestinal feeding tubes and pumps necessary to control or treat a medical condition; or

(5) Medical-health services, such as immunizations and regular “well baby” care, that are routinely recommended for all children.

(f) Nothing in He-M 510 shall:

(1) Limit the right of a child who has a surgically implanted device, such as a cochlear implant, to receive the early supports and services that are identified in the child’s IFSP as necessary to meet the child’s developmental outcomes; or

(2) Prevent the provider from routinely checking that either the hearing aid or the external components of a surgically implanted device, such as a cochlear implant, of a child are functioning properly.

(g) Medical services shall include services provided by a licensed physician for diagnostic or evaluation purposes to determine a child’s developmental status and need for FCESS.

(h) Nursing services shall include:

(1) The assessment of a child’s health status for the purpose of providing nursing care, including the identification of patterns of human response to actual or potential health problems;

(2) Provision of nursing care to prevent health problems, restore or improve functioning, and promote optimal health and development; and

(3) The administration of medications, treatments, and regimens prescribed by a licensed physician or an advanced practice registered nurse (APRN) in accordance with RSA 326-B:11, III.

(i) Nutrition services shall include:

(1) Conducting individual assessments in:

a. Nutritional history and dietary intake;

b. Anthropometric, biochemical, and clinical variables;

c. Feeding skills and feeding problems; and

d. Food habits and preferences;

(2) Developing and monitoring appropriate plans to address the nutritional needs of children based on the findings in (i)(1) above; and

(3) Making referrals to appropriate community resources to carry out nutrition goals.

(j) Occupational therapy shall be services that:

(1) Address the functional needs of a child related to adaptive development, adaptive behavior and play, and sensory, motor, and postural development;

(2) Are designed to improve the child’s functional ability to perform tasks in home, school, and community settings; and

(3) Include:

a. Identification, assessment, and provision of needed supports and services;

b. Adaptation of the environment and selection, design, and fabrication of assistive and orthotic devices to facilitate development and promote the acquisition of functional skills; and

c. Prevention or minimization of the impact of initial or future impairment, delay in development, or loss of functional ability.

(k) Physical therapy shall be services that:

(1) Address the promotion of sensorimotor function through enhancement of:

a. Musculoskeletal status;

b. Neurobehavioral organization;

c. Perceptual and motor development;

d. Cardiopulmonary status; and

e. Effective environmental adaptation; and

(2) Include:

a. Screening, evaluation, and assessment of children to identify movement dysfunction;

b. Obtaining, interpreting, and integrating information to prevent, alleviate, or compensate for movement dysfunction and related functional problems; and

c. Providing individual and group services to prevent, alleviate, or compensate for movement dysfunction and related functional problems.

(l) Preventative and diagnostic services shall be early and periodic screening, diagnosis, and treatment services as specified in He-W 546.05 (a) and (b).

(m) Psychological services shall include:

(1) Administering psychological and developmental tests and other assessment procedures;

(2) Interpreting assessment results;

(3) Obtaining, integrating, and interpreting information about child behavior and child and family conditions related to learning, mental health, and development; and

(4) Planning and managing a program of psychological services, including:

a. Psychological counseling for children and parents;

b. Family counseling;

c. Consultation on child development;

d. Parent training; and

e. Education programs.

(n) Service coordination shall:

(1) Be services provided by a service coordinator to assist and enable a child and the child’s family to receive the services and rights, including procedural safeguards, required under this part, He-M 203, and He-M 310;

(2) Be an active, ongoing process that involves:

a. Assisting parents of children in gaining access to, and coordinating the provision of, the FCESS required under this part; and

b. Coordinating the other services identified in the IFSP that are needed by, or are being provided to, the child and that child’s family; and

(3) Include:

a. Coordinating all services required under this part across agency lines;

b. Serving as the single point of contact for carrying out the activities described in c. – l. below;

c. Assisting parents of children in obtaining access to needed supports and services and other services identified in the IFSP, including making referrals to providers for needed services and scheduling appointments for children and their families;

d. Coordinating the provision of FCESS and other services, such as educational, social, and medical services that are not provided for diagnostic or evaluative purposes, that the child needs or are being provided;

e. Coordinating evaluations and assessments;

f. Facilitating and participating in the development, review, and evaluation of IFSPs;

g. Conducting referral and other activities to assist families in identifying available providers;

h. Coordinating, facilitating, and monitoring the delivery of services required under this part to ensure that the services are provided in a timely manner;

i. Conducting follow-up activities to determine that appropriate services are being provided;

j. Informing families of their rights and procedural safeguards, as set forth in He-M 203 and He-M 310, and related resources, including organizations with their addresses and telephone numbers that might be available to provide legal assistance and advocacy, such as the Disabilities Rights Center, Inc. and NH Legal Assistance;

k. Coordinating the funding sources for services required under this part; and

l. Facilitating the development of a transition plan to preschool, school, or, if appropriate, to other services.

(o) Use of the term “service coordination” or “service coordination services” by an FCESS program or provider shall not preclude characterization of the services as case management or any other service that is covered by another payor of last resort, such as Title XIX of the Social Security Act—Medicaid, for purposes of claims in compliance with the requirements of 34 CFR 303.501 through 303.521.

(p) Sign language and cued language services shall include:

(1) Teaching sign language, cued language, and auditory and oral language;

(2) Providing oral transliteration services, such as amplification; and

(3) Providing sign and cued language interpretation.

(q) Social work services shall include:

(1) Home visits to evaluate a child’s living conditions and patterns of parent-child interaction;

(2) Preparing a social or emotional developmental assessment of the child within the family context;

(3) Providing individual and family counseling with parents and other family members and appropriate social skill building activities with the child and parents;

(4) Working with the family to resolve problems in the family’s living situation, home, or community that affect the child’s and family’s maximum utilization of FCESS; and

(5) Identifying, mobilizing, and coordinating community resources and services to enable the child and family to receive maximum benefit from FCESS.

(r) Special instruction shall include:

(1) Designing learning environments and activities that promote the child’s acquisition of skills in a variety of developmental areas, including cognitive processes and social interaction;

(2) Curriculum planning, including the planned interaction of personnel, materials, and time and space, that leads to achieving the outcomes in the IFSP;

(3) Providing families with information, skills, and support related to enhancing the skill development of the child; and

(4) Working with the child to enhance the child’s development.

(s) Speech-language pathology services shall include:

(1) Identification of children with communicative or language disorders and delays in development of communication skills, including the diagnosis and appraisal of specific disorders and delays in those skills;

(2) Referral for medical or other professional services necessary for the habilitation or rehabilitation of children with communicative or language disorders and delays in development of communication skills; and

(3) Provision of services for the habilitation, rehabilitation, or prevention of communication or language disorders and delays in development of communication skills.

(t) Transportation services shall include reimbursing the family for the cost of travel such as mileage, or travel by taxi, common carrier, or other means, and other related costs such as tolls and parking expenses, that are necessary to enable an eligible child and the child’s family to receive FCESS.

(u) Vision services shall include:

(1) Evaluation and assessment of visual functioning, including the diagnosis and appraisal of specific visual disorders, delays, and abilities that affect early childhood development;

(2) Referral for medical or other professional services necessary for the habilitation or rehabilitation of visual functioning disorders, or both; and

(3) Communication skills training, orientation and mobility training for all environments, visual training, independent living skills training, and additional training necessary to activate visual motor abilities.

(v) The services and personnel identified and defined in (a)-(u) above shall not comprise exhaustive lists of the types of services that may constitute FCESS or the types of qualified personnel that may provide FCESS. Nothing in this section shall prohibit the identification in the IFSP of another type of service as an FCESS provided that the service meets the criteria in He-M 510.04.

(w) Children and families who qualify for services under He-M 510 may have access to respite services under He-M 513 and He-M 519 as well as other services authorized by the department that meet the intent and purpose and are consistent with evidence-based nationally recognized treatment standards.

History

(See Revision Note at part heading for He-M 510) #5745, eff 12-1-93, EXPIRED: 12-1-99
#7234, eff 4-22-00; amd by #7822, eff 2-8-03; ss by #9135, INTERIM, eff 4-22-08, EXPIRED: 10-19-08
#9594, eff 11-11-09; ss by #10325, eff 4-26-13; ss by #13753, eff 9-27-23

N.H. Code Admin. R. Ann. He-M 510.04 Provision of Supports and Services {#sec-he-m-510.04 omnilex-key=us-nh-regs-official--agency-he-m--He-M 510.04}

(a) FCESS shall:

(1) Be selected in collaboration with parents and provided under public supervision by personnel qualified pursuant to He-M 510.11;

(2) Be provided under the system of payment described in He-M 510.14;

(3) Include those of the services listed in He-M 510.03 (a)-(u), and other services provided by personnel identified in He-M 510.11 (b), that meet the developmental needs of the child and family and enhance the child’s development;

(4) Comply with state laws regulating the professional practice of persons providing services, as well as the requirements of Part C of the IDEIA;

(5) To the maximum extent appropriate, be provided in natural environments; and

(6) Be provided in conformity with an IFSP.

(b) FCESS shall be provided in a variety of natural environments where children and families of the community gather, such as:

(1) The family’s own home;

(2) Neighborhood playgrounds;

(3) Child care settings;

(4) Foster placements;

(5) Relatives’ or friends’ homes;

(6) Libraries;

(7) Recreational programs;

(8) Places of worship;

(9) Grocery stores;

(10) Shopping malls; and

(11) Other similar settings.

(1) Identify and promote the use of natural supports as a principal way of assisting in the development of the child, including supports from:

a. Relatives;

b. Fiends;

c. Neighbors;

d. Co-workers; and

e. Cultural, ethnic, or religious organizations;

(2) Foster the family’s capacity to make decisions and provide care and learning opportunities for their child;

(3) Respect the cultural and ethnic beliefs and traditions, and the personal values and lifestyle of the family;

(4) Respond to the changing needs of the family and to critical transition points in the family’s life; and

(5) Facilitate access to community resources to support families and link them with other families with similar concerns and interests.

(d) FCESS shall include training, support, evaluation, special instruction, and therapeutic services that maximize the family’s and other caregivers’ ability to understand and care for the child’s developmental, functional, medical, and behavioral needs at home as well as in settings described in (b) above.

(e) FCESS to the child and family and other caregivers shall be founded on scientifically-based research to the extent practicable, and include assistance in the following areas as identified in the family’s IFSP:

(1) Understanding the child’s special needs;

(2) Support and counseling for families;

(3) Management and coordination of health and medical issues in collaboration with the primary physician or medical home;

(4) Enhancement of the cognitive, social interactive, and play competencies of the child at home and in community settings;

(5) Enhancement of the ability of the child to develop age-appropriate fine and gross motor skills and overall sensory and physical awareness and development;

(6) Enhancement of the ability of the child to develop functional communication methods and expressive and receptive language skills;

(7) Guidance and management of a child with very active, inappropriate, or life-threatening behaviors;

(8) Consultation regarding appropriate diet and the child’s eating and oral motor skills to insure proper nutrition;

(9) Linkage with assistive technology services that might enhance the child’s growth and development; and

(10) Assessments conducted throughout the period of the child’s eligibility.

(f) FCESS shall promote local and statewide prevention efforts to reduce and, where possible, eliminate the causes of disabling conditions.

History

(See Revision Note at part heading for He-M 510) #5745, eff 12-1-93, EXPIRED: 12-1-99
#7234, eff 4-22-00; ss by #9135, INTERIM, eff 4-22-08, EXPIRED: 10-19-08
#9594, eff 11-11-09; ss by #10325, eff 4-26-13; ss by #13753, eff 9-27-23

N.H. Code Admin. R. Ann. He-M 510.05 Parents’ Right to Written Prior Notice {#sec-he-m-510.05 omnilex-key=us-nh-regs-official--agency-he-m--He-M 510.05}

(a) FCESS programs shall give written notice to families before proposing, refusing to initiate, or changing the eligibility for, evaluation regarding, or provision of FCESS.

(b) The written notice referenced in (a) above shall be provided, at a minimum, prior to:

(1) Eligibility evaluations;

(2) IFSP development;

(3) IFSP reviews;

(4) Changes in IFSP services;

(5) The transition planning conference; and

(6) Notification pursuant to He-M 510.09 (f), (g), and (j).

(1) The proposed date and time of the action;

(2) The action that is being proposed or refused;

(3) The reasons for taking the action;

(4) All procedural safeguards that are available under He-M 510, He-M 203, and He-M 310; and

(5) A summary of the FCESS complaint resolution procedures set forth in He-M 203, including a description of how to file a state administrative complaint and due process complaint and the timelines under these procedures.

(d) The proposed date and time of the action in (c) above shall be timely and convenient to the family.

(e) The notice shall be written in language that is understandable to the general public and in the family’s native language or other mode of communication used by the parent, unless it is clearly not feasible to do so.

(f) If the native language or the other mode of communication of the parent is not a written language, the area agency or FCESS program shall take steps to ensure:

(1) The notice is translated orally, or by other means to the parent in the parent’s native language, or other mode of communication;

(2) The parent understands the notice; and

(3) There is written evidence that the requirements of (1)-(2) above have been met.

History

(See Revision Note at part heading for He-M 510) #5745, eff 12-1-93, EXPIRED: 12-1-99
#7234, eff 4-22-00; amd by #7822, eff 2-8-03; ss by #9135, INTERIM, eff 4-22-08, EXPIRED 10-19-08
#9594, eff 11-11-09; ss by #10325, eff 4-26-13; ss by #13753, eff 9-27-23

N.H. Code Admin. R. Ann. He-M 510.06 Referral and Eligibility Determination {#sec-he-m-510.06 omnilex-key=us-nh-regs-official--agency-he-m--He-M 510.06}

(a) A child as defined in He-M 510.02(g), who is a resident of New Hampshire shall be eligible for FCESS.

(b) Any person may make a referral to FCESS.

(c) When a referral is made by someone other than the parent, the FCESS program shall notify the parent immediately both verbally and in writing.

(d) Participation in FCESS shall be voluntary.

(e) The point of contact for referral to FCESS shall be the area agency.

(f) An area agency shall designate an intake coordinator to make initial contact with families who are referred for FCESS.

(g) The intake coordinator shall:

(1) Have at least 2 years’ experience with children and their families;

(2) Demonstrate the capacity to develop rapport with families;

(3) Have knowledge of resources available in the community; and

(4) Act as an interim service coordinator for families applying for FCESS until eligibility is determined and a service coordinator identified.

(h) The intake coordinator shall:

(1) Document the date the referral was received;

(2) Provide information relative to FCESS and other community services;

(3) Inform the family of the process for the initiation of FCESS, including the family’s rights under He-M 510 and He-M 310 and procedural safeguards under He-M 203;

(4) If the family decides to seek a determination of eligibility for FCESS:

a. Obtain parental consent for the initial evaluation and, if the applicant is eligible, IFSP development;

b. Request a release to obtain the applicant’s medical records and a physician’s referral for evaluation;

c. Request information about the applicant’s insurance, including public and private insurance; and

d. Request consent to utilize private insurance pursuant to He-M 510.14 (b)-(f); and

(5) If the family decides not to seek a determination of eligibility for FCESS, make reasonable efforts to ensure the parent:

a. Is fully aware of the nature of the evaluation, the assessment, and the services that would be available; and

b. Understands that the applicant will not be able to receive the evaluation, the assessment, or other services unless consent is given pursuant to (4)a. above.

(i) If a family decides to seek a determination of eligibility for FCESS, the area agency shall conduct a multidisciplinary evaluation pursuant to (k) below and a family directed assessment.

(j) The purpose of the multidisciplinary evaluation shall be:

(1) To determine if the applicant is eligible for FCESS according to (a) above and He-M 510.02 (g); and

(2) To provide information that will form the basis of the IFSP if the applicant is eligible for FCESS.

(k) The multidisciplinary evaluation shall:

(1) Be based on informed clinical opinion;

(2) Be conducted by an evaluation team composed of the family, other persons requested by the family, and professionals from 2 or more different disciplines identified in He-M 510.11 (b)(1);

(3) Be conducted by professionals whose expertise most closely relates to the needs of the applicant and family;

(4) Be carried out in a setting that is convenient to the family;

(5) Include the completion of the IDA Institute’s “Infant-Toddler Developmental Assessment-2 (IDA-2)”, (Second Edition) or Shine Early Learning’s “Hawaii Early Learning Profile (HELP) Strands 0–3” (1992–2013), available as noted in Appendix A;

(6) Include the components of the assessment as defined in He-M 510.02 (c);

(7) Include the applicant’s medical and developmental history;

(8) Include information from others sources such as family members, other caregivers, medical providers, social workers, and educators, if necessary;

(9) Include a review of the applicant’s medical, educational, or other records;

(10) Include an evaluation of the applicant’s level of functioning in each of the following developmental domains:

a. Physical development, including vision, hearing, or both;

b. Cognitive development;

c. Communication development;

d. Social or emotional development; and

e. Adaptive development;

(11) Determined through the use of an assessment tool and a voluntary family-directed personal interview, include identification of:

a. The family’s resources, priorities, and concerns; and

b. The supports and services necessary to enhance the family’s capacity to meet the developmental needs of the applicant;

(12) Be conducted to:

a. Determine an applicant’s eligibility or a child’s progress;

b. Define or redefine services and expected outcomes; or

c. Plan for future needs;

(13) Be conducted in the applicant’s, child’s, or family’s native language if determined by qualified personnel conducting the evaluation to be developmentally appropriate, given the applicant’s or child’s age and communication skills; and

(14) Be selected and administered so as not to be racially or culturally discriminatory.

(l) An applicant’s medical and other records may be used to establish eligibility prior to conducting a multidisciplinary evaluation if those records contain information regarding the applicant’s level of functioning in the developmental areas identified in (k)(10) above.

(m) Based on the results of the multidisciplinary evaluation pursuant to (k) above or medical records in (l) above, the evaluation team shall determine whether the applicant is a child as defined in He-M 510.02 (g) and is eligible for FCESS pursuant to (a) above.

(n) If the applicant is found eligible for FCESS, the area agency shall, in writing, advise the family of its eligibility status within 3 business days and include the name of, and contact information for, the service coordinator.

(o) If the applicant is found eligible based upon medical records in (l) above, the area agency shall do an assessment of the child and a family assessment as described in (k)(11) above.

(p) If the applicant is found not eligible for FCESS, the area agency shall, in writing, advise the family within 3 business days from date of eligibility determination pursuant to He-M 510.05 of the following:

(1) The findings of the evaluation and recommendations;

(2) Other specific supports and services that meet the needs of the family, including parent-to-parent networks, and an explanation of how to access those supports and services;

(3) The family’s right to file a complaint pursuant to He-M 203; and

(4) The names, addresses, and telephone numbers of advocacy organizations, such as the Disabilities Rights Center, Inc., that the family can contact for assistance in challenging the determination.

(q) In the event of exceptional family circumstances that make it impossible to complete the initial evaluation and develop the IFSP within 45 calendar days of the referral, the FCESS program shall:

(1) Document the specific circumstances of the delay;

(2) Complete the multidisciplinary evaluation as soon as family circumstances allow;

(3) Proceed pursuant to (m)-(p) above; and

(4) Develop and implement an interim IFSP, to the extent appropriate and consistent with He-M 510.07 (a) and (g).

(r) Continued eligibility shall be determined as noted in He-M 510.08 (e) and (f).

History

(See Revision Note at part heading for He-M 510) #5745, eff 12-1-93, EXPIRED: 12-1-99
#7234, eff 4-22-00; amd by #7822, eff 2-8-03; amd by #8065, eff 3-25-04; ss by #9135, INTERIM, eff 4-22-08, EXPIRED 10-19-08
#9594, eff 11-11-09 (from He-M 510.05); ss by #10325, eff 4-26-13; ss by #13753, eff 9-27-23

N.H. Code Admin. R. Ann. He-M 510.07 Initial and Annual IFSP Development {#sec-he-m-510.07 omnilex-key=us-nh-regs-official--agency-he-m--He-M 510.07}

(a) With parental consent, FCESS may begin prior to the completion of the multidisciplinary evaluation if an interim IFSP is in place that contains the name of the service provider responsible for the interim services and a description of the services needed immediately and the elements described in (h) below. Such an interim IFSP shall not preclude the requirement in (b) below of completing the multidisciplinary evaluation and developing a full IFSP within 45 calendar days from the initial date of the referral.

(b) For a child who has been evaluated for the first time and determined to be eligible, a meeting to complete the initial IFSP shall be conducted within 45 calendar days from the initial date of referral received by the IFSP team, described in (c) below.

(1) The parent(s);

(2) The service coordinator;

(3) The person or persons directly involved in conducting the evaluation or assessment;

(4) Providers, as appropriate; and

(5) As requested by the parent:

a. Other family members; and

b. An advocate, or person outside the family.

(d) The initial IFSP meeting shall be held at a time and place mutually agreed upon by the IFSP team and convenient for the family.

(e) At all IFSP team meetings, including reviews required pursuant to He- M 510.08(d), if the person or persons identified in (c)(3) above is unable to attend, the FCESS program shall make arrangements for their involvement through other means including:

(1) Participating in telephone or virtual conference call;

(2) Having a knowledgeable authorized representative attend the meeting; or

(3) Making pertinent records available at the meeting.

(f) All IFSP team meetings shall be conducted in the native language of the family or other mode of communication used by the family, unless it is clearly not feasible to do so.

(g) The IFSP shall be based on the results of the multidisciplinary evaluation.

(h) The IFSP shall include:

(1) Information about the child’s status in the domains noted in He-M 510.06 (k)(10);

(2) To the extent the family agrees, a statement of the family’s concerns, priorities, and resources related to enhancing the family’s capacity to meet the developmental needs of the child;

(3) A statement of the measurable results or measurable outcomes expected to be achieved for the child and family, including pre-literacy and language skills as developmentally appropriate for the child;

(4) The criteria, procedures, and timelines used to determine the degree to which progress toward achieving the outcomes is being made and whether modifications or revisions of the expected results, outcomes, or services are necessary;

(5) A detailed statement of the specific FCESS that are necessary to meet the unique needs of the child and family to achieve the outcomes identified in the IFSP;

(6) The length, frequency, intensity, anticipated duration, method of delivery, location, and payment arrangement, if any, for each support and service;

(7) A statement that each FCESS is provided in the natural environment for that child to the maximum extent appropriate;

(8) Identification of the natural environments in which the FCESS will be provided;

(9) A justification of the extent, if any, as to why a support or service cannot be provided in a natural environment, including:

a. An explanation of why the supports or services cannot be provided satisfactorily for the child in a natural environment;

b. A plan of action that identifies how supports and services can be provided in a natural environment in the future; and

c. A time frame in which this plan will be implemented;

(10) A summary of the documented medical services such as hospitalization, surgery, medication, and other supports that the child needs or is receiving through other sources but that are neither required nor funded under He-M 510;

(11) For services described in (10) above that are not currently being provided, a description of the steps the service coordinator or family can take to assist the child and family in securing and funding those other services;

(12) The name(s) and credentials of the person(s) responsible for implementing the supports and services;

(13) The earliest possible projected start date for each support and service as agreed upon by the IFSP team, including the family;

(14) The name, telephone number, agency, and location of the service coordinator;

(15) The names of the members of the IFSP team participating in the development of the plan;

(16) The steps to be taken to support the transition described in He-M 510.09, including:

a. Discussions with, and training of, parents, as appropriate, regarding future placements and other matters related to the child’s transition;

b. Procedures to prepare the child for changes in service delivery, including steps to help the child adjust to, and function in, a new setting;

c. Confirmation that child find system information, in accordance with 34 CFR 303.115, 303.302, and 303.303, about the child has been transmitted to the LEA or other relevant agency in accordance with He-M 510.09 (f) and (g); and

d. Identification of transition services and other activities that the IFSP team determines are necessary to support the transition of the child; and

(17) Services to be provided to support the smooth transition of the child in accordance with He-M 510.09 to:

a. Preschool special education services to the extent that those services are appropriate; or

b. Other appropriate services.

(i) The steps and services referred to in (h)(16)-(17) above shall be listed in a document called a transition plan as described in He-M 510.09 (a).

(j) Through discussion, all IFSP team members shall consider the advantages and disadvantages of each FCESS suggested during the development of the IFSP.

(k) The FCESS program shall explain the contents of the IFSP to the family prior to the family consenting to the document.

(l) Parents may elect to provide consent with respect to some FCESS and withhold consent for others.

(m) Parents may withdraw consent for some services without jeopardizing other FCESS.

(n) The IFSP shall be considered complete when the family has given consent by signing the IFSP.

(o) The following services shall be provided to each child at public expense at no cost to the parent:

(1) Implementing child find system requirements in accordance with 34 CFR Part 303.115, 303.302, and 303.303;

(2) Evaluation and assessment;

(3) Service coordination;

(4) Development, review, and evaluation of IFSPs; and

(5) Implementation of procedural safeguards available under He-M 203 and Part C of Public Law 102-119, Individuals with Disabilities Education Act, 20 U.S.C. 1400 et seq.

(p) A meeting shall be conducted by the IFSP team, described in (c) above, on at least an annual basis to evaluate and revise, as appropriate, the IFSP for the child and the child’s family, according to the following:

(1) The annual IFSP meeting shall be held at a time and place mutually agreed upon by the IFSP team and convenient for the family; and

(2) The results of any current evaluations or current assessments of the child shall be used in determining the early intervention services that are needed or provided.

History

(See Revision Note at part heading for He-M 510) #5745, eff 12-1-93, EXPIRED: 12-1-99
#7234, eff 4-22-00; amd by #7822, eff 2-8-03; ss by #9135, INTERIM, eff 4-22-08, EXPIRED 10-19-08
#9594, eff 11-11-09; ss by #10325, eff 4-26-13; ss by #13753, eff 9-27-23

N.H. Code Admin. R. Ann. He-M 510.08 Implementation of the IFSP {#sec-he-m-510.08 omnilex-key=us-nh-regs-official--agency-he-m--He-M 510.08}

(a) FCESS shall be delivered as agreed upon in the IFSP.

(b) In addition to arranging direct supports and services for the child and parents or primary caregivers, the service coordinator shall link the child and family with community resources identified in the IFSP.

(c) Each IFSP shall be reviewed periodically at least once every 6 months, or more frequently if a provider proposes adding or discontinuing a support or service or if requested by the family.

(d) Such a review shall:

(1) Include:

a. The parent(s);

b. The service coordinator;

c. If requested, other family members, advocates, and persons outside the family; and

d. Other members of the IFSP team as described in He-M 510.07 (c) and (e) if changes to increase or reduce services in the IFSP are proposed;

(2) Be arranged at a mutually agreed upon time and location; and

(3) Employ a process that is convenient to the family.

(e) The review pursuant to (c)-(d) above shall:

(1) Assess progress toward achieving outcomes;

(2) Determine if the FCESS in the IFSP continue to be appropriate;

(3) Determine whether revisions or additions are needed to the IFSP; and

(4) Discuss continued eligibility for FCESS.

(f) At the review, if the IFSP team is in disagreement regarding the child’s continued eligibility, the FCESS program shall conduct a multidisciplinary evaluation following the process described in He-M 510.06 (k).

(g) At any time, the IFSP team, including the family, may request a multidisciplinary evaluation or an assessment to determine progress review eligibility, redefine services and outcomes, or plan for future needs.

(h) Before implementation of any revision, deletion, or addition to the IFSP, the family shall give consent and sign the revised IFSP. If the family does not give consent, the IFSP shall remain unchanged.

(i) If the family has any concerns with the implementation of the IFSP, the family or the service coordinator may request a meeting. Such a meeting shall be held as soon as possible at a mutually determined time and location that is convenient to the family and include the family, the service coordinator, and others as requested who are involved in providing supports and services to the family and child.

(j) If the family’s concerns are not being addressed to the family’s satisfaction, the procedural safeguards for FCESS identified in He-M 203 shall be made available.

History

(See Revision Note at part heading for He-M 510) #5745, eff 12-1-93, EXPIRED: 12-1-99
#7234, eff 4-22-00; ss by #9135, INTERIM, eff 4-22-08, EXPIRED 10-19-08
#9594, eff 11-11-09 (from He-M 510.07); ss by #10325, eff 4-26-13; ss by #13753, eff 9-27-23

N.H. Code Admin. R. Ann. He-M 510.09 Transition to Special Education Preschool and Other Services {#sec-he-m-510.09 omnilex-key=us-nh-regs-official--agency-he-m--He-M 510.09}

(a) For all children found eligible for FCESS prior to 33 months of age, the service coordinator shall convene the IFSP team when the child is between 27 and 32 months to develop a transition plan for the child to exit the program that:

(1) Reviews the child’s program options for the period from the child’s 3rd birthday through the remainder of the school year;

(2) Identifies steps for the child and the child’s family to exit the FCESS program;

(3) Identifies any transition services needed by the child and family;

(4) Includes, with parental consent, referrals to the area agency and other community resources; and

(5) Determines if the child is potentially eligible for preschool special education.

(b) If the child is determined to not be potentially eligible for preschool special education services, the service coordinator shall convene a transition conference and make reasonable efforts to include providers of other services to discuss appropriate services the child might receive.

(c) If the child is determined to be potentially eligible for preschool special education services, the service coordinator shall provide parents information describing the notification requirement in (f) and (g) below and their right to object, in (d) below, to information about their child being provided to the responsible LEA and the NH department of education.

(d) If a parent informs the FCESS program in writing within 7 calendar days of receiving the information described in (c) above that they object to the notification, the service coordinator shall not provide notification to the responsible LEA and NH department of education.

(e) If the parent objects to notification, the service coordinator shall convene a transition conference and make reasonable efforts to include providers of other services to discuss alternative ways of meeting the child’s needs.

(f) If the parent does not inform the FCESS program within 7 calendar days, as specified in (d) above, that they object, the FCESS program shall refer the child by notifying the responsible LEA and NH department of education as soon as possible but not less than 90 calendar days before the child reaches their 3rd birthday that a child who is potentially eligible for special education is receiving FCESS.

(g) Information provided with the notification and referral described in (f) above shall include:

(1) The child’s name;

(2) The child’s date of birth;

(3) The parents’ names;

(4) The parents’ contact information including addresses and telephone numbers; and

(5) Additional information with parental consent including a copy of the most recent evaluation and assessments of the child and the most recent IFSP.

(h) After the LEA and NH department of education have been notified that a child is potentially eligible for services, the service coordinator shall convene a transition conference that:

(1) Includes the family, other persons requested by the family, the service coordinator, and relevant providers;

(2) Is conducted not less than 90 calendar days but not more than 9 months prior to the child’s 3rd birthday; and

(3) Includes the LEA representative.

(i) The purpose of the transition conference shall be to:

(1) Review the results of the IFSP team meeting held pursuant to (a) above;

(2) Update the transition plan with input from the LEA representative and other providers; and

(3) Discuss the child’s program options for the period from the child’s 3rd birthday through the remainder of the school year, if applicable, including any services the child might be eligible to receive under Part B of IDEIA.

(j) For a child who is determined eligible for FCESS more than 45 calendar days but less than 90 calendar days before the child’s 3rd birthday, the FCESS program, as soon as possible if the parent does not object, shall notify the LEA and NH department of education that the child will reach the age for eligibility for Part B services.

(k) For a child referred fewer than 45 calendar days before the child’s 3rd birthday, the FCESS program, following parental consent, shall refer the child to the NH department of education and LEA as soon as possible. The FCESS program shall not be required to conduct a multidisciplinary evaluation or initial IFSP meeting.

(l) For children exiting the program prior to 27 months of age or found no longer eligible for FCESS, the service coordinator shall develop a transition plan with the family that includes:

(1) Service options for the family to explore based on future needs;

(2) Activities as necessary to prepare the child for exiting the program;

(3) Information about parent training and resources; and

(4) Referrals to other community resources.

History

(See Revision Note at part heading for He-M 510) #5745, eff 12-1-93, EXPIRED: 12-1-99
#7234, eff 4-22-00; ss by #9135, INTERIM, eff 4-22-08, EXPIRED 10-19-08
#9594, eff 11-11-09; ss by #10325, eff 4-26-13; ss by #13753, eff 9-27-23

N.H. Code Admin. R. Ann. He-M 510.10 Administration {#sec-he-m-510.10 omnilex-key=us-nh-regs-official--agency-he-m--He-M 510.10}

(a) Each area agency shall develop an agreement with FCESS programs and the family support council within the region to detail their mutual responsibilities in supporting families who are participating in FCESS.

(b) The agreement in (a) above shall:

(1) Describe the process of referral, eligibility determination, and initiation of supports and services in the area agency system;

(2) Provide for streamlined mechanisms to enable families to easily access family support services from the area agency pursuant to He-M 519;

(3) Provide for ongoing contacts between staff of the area agency and the FCESS program to ensure open communication and effective collaboration; and

(4) Provide for procedures to address issues of common concern in the region.

(1) Practices that will enable FCESS and LEA personnel to collaborate effectively;

(2) When and how information will be shared, including a statement of confidentiality;

(3) A process to facilitate involvement of families, FCESS staff, and LEA staff in transition conference planning activities and meetings; and

(4) Transition activities that will take place such as home and program visits, observations, and evaluations.

(d) Each area agency, in cooperation with its family support council and FCESS programs, shall document evidence of coordination with other local agencies that serve children and their families, such as:

(1) The regional offices of the New Hampshire division of public health services;

(2) Local education agencies;

(3) Visiting nurse associations;

(4) Local hospitals and medical clinics;

(5) Child care providers;

(6) Family resource centers; and

(7) DCYF.

(e) Documentation pursuant to (d) above shall include agreements, minutes of meetings, or memoranda that demonstrate efforts to maximize the use of community resources and prevent duplication of services for families.

(f) Each area agency, in cooperation with the FCESS program, shall document evidence of outreach to local agencies and providers serving children and their families to identify children who might be eligible for FCESS.

(g) Area agencies and FCESS programs shall comply with applicable state and federal rules and regulations.

(h) FCESS programs shall annually conduct and document quality assurance activities, including, at a minimum:

(1) Constituent surveys;

(2) Record reviews;

(3) Performance data measurements;

(4) Participation in lead agency monitoring; and

(5) Development and implementation of a corrective action plan if appropriate based on (1)-(4) above.

(i) Area agencies and FCESS programs shall enter the information identified below into the lead agency’s statewide data system based on the following schedule:

(1) Immediately upon referral of a child, the following information:

a. The child’s name;

b. The child’s date of birth;

c. The child’s gender;

d. Date of referral; and

e. Referral source;

(2) Once contact with the family is established the following information shall be entered:

a. Parent or guardian contact information;

b. The child’s race and ethnicity;

c. Primary language;

d. Date of intake;

e. Diagnosis and reason for referral;

f. Insurance status, as one of the following types:

Public;
Private;
Both public and private; or
None; and

g. FCESS program name;

(3) Upon eligibility determination:

a. Eligibility status; and

b. Eligibility category;

(4) Following preparation of the IFSP:

a. The date of parent or guardian consent;

b. IFSP services to be provided;

c. The delivery method of the services to be provided;

d. The frequency of the services to be provided;

e. The length, in minutes, of the services to be provided;

f. The provider;

g. The environment, including a justification statement if the environment is not a natural environment as defined in He-M 510.02(ad);

h. The projected start date of the services to be provided;

i. Circumstances regarding non-timely services;

j. Actual 6 month review date; and

k. Transition plan activities;

(4) On a monthly basis:

a. Updated insurance status;

b. Services, including evaluations, that have been provided; and

c. The child’s updated diagnosis or eligibility status;

(5) Within 30 calendar days of the child exiting the program:

a. Child outcome data required by 34 CFR 303.702; and

b. The reason for exiting and date of exit; and

(6) As they occur, notifications as required by He-M 510.09 (f), (g), and (k).

(j) Each FCESS program shall have a designated program director who shall be responsible for the overall administration of the supports and services and personnel training and supervision. The director may be involved in the provision of direct supports and services.

(k) FCESS programs shall offer and provide a full array of FCESS to families throughout the calendar year.

(l) FCESS programs shall coordinate personnel schedules so that staff have opportunities to share information and strategies across disciplines on a regular basis.

(m) The area agency shall initiate a referral for a surrogate parent to the NH lead agency in accordance with He-M 510.18 when:

(1) No parent can be identified;

(2) A child is under legal guardianship of the division for children, youth and families; or

(3) A court has issued a written order for a surrogate parent.

History

(See Revision Note at part heading for He-M 510) #5745, eff 12-1-93, EXPIRED: 12-1-99
#7234, eff 4-22-00; ss by #9135, INTERIM, eff 4-22-08, EXPIRED 10-19-08
#9594, eff 11-11-09; ss by #10325, eff 4-26-13 (from He-M 510.11); ; ss by #13753, eff 9-27-23

N.H. Code Admin. R. Ann. He-M 510.11 Personnel {#sec-he-m-510.11 omnilex-key=us-nh-regs-official--agency-he-m--He-M 510.11}

(a) All personnel shall have specific training and experience in child development and knowledge of family support.

(b) Personnel shall be drawn from the following categories:

(1) New Hampshire licensed, department of education certified, or bureau of developmental services certified professionals, including, at a minimum:

a. Advanced practice registered nurse;

b. Audiologist;

c. Clinical mental health counselor;

d. Clinical social worker;

e. Dietitian registered;

f. Early childhood educator;

g. Early childhood special educator;

h. Early intervention specialist;

i. Marriage and family therapist;

j. Occupational therapist;

k. Orientation and mobility specialist;

l. Pastoral psychotherapist;

m. Physician;

n. Physician assistant;

o. Psychologist;

p. Physical therapist;

q. Registered nurse;

r. Speech language pathologist;

s. Speech-language specialist;

t. Special education teacher;

u. Special education teacher in the area of blind and vision disabilities;

v. Special education teacher in the area of deaf and hearing disabilities;

w. Special education teacher in the area of emotional and behavioral disabilities;

x. Special education teacher in the area of intellectual and developmental disabilities;

y. Special education teacher in the area of physical and health disabilities;

z. Special education teacher in area of specific learning disabilities; and

aa. Vision specialist including ophthalmologists and optometrists;

(2) New Hampshire licensed or certified professional assistants, including:

a. Licensed physical therapy assistant;

b. Licensed occupational therapy assistant; and

c. Certified speech and language assistant; and

(3) Unlicensed or uncertified personnel, including personnel who have education, training, or experience relevant to the provision of FCESS.

(c) All personnel shall utilize support strategies, assessment procedures, and treatment techniques considered to be best practice in working with a child and family applying for or receiving FCESS.

(d) All personnel shall ensure the effective provision of FCESS, via a minimum of the following:

(1) Consulting with parents, other providers, and representatives of appropriate community agencies;

(2) Participating in the child’s multidisciplinary evaluation and the development of service outcomes for the IFSP; and

(3) Coaching parents and other persons chosen by the family regarding the provision of the services.

(e) Personnel identified in (b)(1) above shall:

(1) Conduct multidisciplinary evaluations;

(2) Conduct assessments;

(3) Develop or amend IFSPs;

(4) Supervise, when appropriate, licensed assistants and unlicensed personnel; and

(5) Provide service coordination.

(f) Personnel identified in (b)(2) above shall:

(1) Contribute to the multidisciplinary evaluation;

(2) Contribute to assessments;

(3) Contribute to the development or amendment of IFSPs;

(4) Be supervised, as required by their license or certification; and

(5) Provide service coordination.

(g) Personnel identified in (b)(3) above shall:

(1) Contribute to the multidisciplinary evaluation;

(2) Contribute to the assessment;

(3) Contribute to the development or amendment of IFSPs;

(4) Be supervised by one of the providers described in (b)(1) above at least once a month in the setting where FCESS is provided, with additional supervision as needed; and

(5) Provide service coordination.

(h) All FCESS personnel, including program directors and consultants, shall meet New Hampshire requirements for certification, licensing, continuing competence, or other comparable requirements.

(i) An FCESS program director shall:

(1) Be a licensed or certified professional pursuant to (b)(1) above;

(2) Have 3 years of professional experience providing FCESS; and

(3) Have one year of professional experience in a management or administrative role.

(j) A service coordinator shall:

(1) Have completed the orientation program outlined in He-M 510.12 (b); and

(2) Together with the family and other IFSP team member(s), be responsible for accessing, coordinating, and monitoring the delivery of services identified in the child’s IFSP, including transition services and coordination with other agencies and persons.

(k) An individual who wishes to obtain certification as an early intervention specialist shall submit information to the bureau documenting:

(1) Possession of a minimum, in addition to the requirements in (2) below, of a bachelor’s degree in:

a. Human services;

b. Family studies;

c. Psychology;

d. Child development;

e. Communication;

f. Child life;

g. Education;

h. Behavior analysis; or

i. Early intervention;

(2) A minimum of one year experience in an FCESS program for degrees listed in (1) a. - h. above;

(3) A minimum of 6 months’ experience in an FCESS program for the degree listed in (1) i. above;

(4) Possession of a minimum, in addition to the requirements in (5) below, of an associate’s degree or minor of studies in:

a. Physical therapy assistant;

b. Occupational therapy assistant;

c. Speech and language assistant;

d. Child development;

e. Child life;

f. Education; or

g. Early intervention;

(5) A minimum of 2 years’ experience in an FCESS program for degrees listed in (4) a. - g. above;

(6) Completion of the orientation program outlined in He-M 510.12 (b); and

(7) Training and experience in the subject matter in (e)(1)-(3) and (5) above.

(l) Upon completion of (k) above, the bureau shall certify the individual as an early intervention specialist.

(m) To continue to be certified as an early intervention specialist, individuals identified in (k) above shall demonstrate ongoing professional development as described in He-M 510.12 (e).

History

(See Revision Note at part heading for He-M 510) #5745, eff 12-1-93, EXPIRED: 12-1-99
#7234, eff 4-22-00; ss by #9135, INTERIM, eff 4-22-08, EXPIRED 10-19-08
#9594, eff 11-11-09 (from He-M 510.08); ss by #10325,e ff 4-26-13; ss by #10325, eff 4-26-13 (from He-M 510.12); ss by #13753, eff 9-27-23

N.H. Code Admin. R. Ann. He-M 510.12 Personnel Development {#sec-he-m-510.12 omnilex-key=us-nh-regs-official--agency-he-m--He-M 510.12}

(a) All new personnel who provide service coordination or work directly with families, including personnel involved with intake activities, shall participate in an orientation program pursuant to (b) below within 6 months from the date of hire.

(b) The lead agency orientation program shall consist of training and include information about:

(1) The history and philosophy of FCESS;

(2) Provision of service coordination;

(3) Eligibility evaluation and ongoing assessment;

(4) Procedural safeguards pursuant to He-M 203;

(5) Scientifically based research practices in FCESS evaluations, provision of supports, and service delivery;

(6) Funding for FCESS;

(7) IFSP development and implementation; and

(8) Transition from FCESS to community services such as special education.

(c) Each employee involved in the provision of FCESS to families shall have an annual personnel development plan approved by the FCESS program director. The purpose of the personnel development plan shall be to sustain and improve the relevant skills and knowledge of the employees such that the requirements of He-M 510.11 (d) and (h) have been met. Successful achievement of professional development goals shall be included in the criteria for annual review of performance.

(d) Personnel development plans for FCESS program directors shall be developed with, and monitored by, the director’s supervisor.

(e) As a part of their annual personnel development plan an early intervention specialist shall acquire at least 24 hours of continuing education credit in subject matter relevant to their job description, as determined by the program director.

(f) The area agency shall provide all program staff who work directly with families, annual training in procedural safeguards pursuant to He-M 203.

(g) The lead agency shall provide training on child outcome summary and outcome development to all program staff who directly work with families within 6 months of hire.

(h) The lead agency shall provide training on ensuring culturally competent services and adult learning strategies to all program staff who directly work with families within one year of hire.

History

(See Revision Note at part heading for He-M 510) #5745, eff 12-1-93, EXPIRED: 12-1-99
#7234, eff 4-22-00; amd by #7822, eff 2-8-03; ss by #9135, INTERIM, eff 4-22-08, EXPIRED 10-19-08
#9594, eff 11-11-09 (from He-M 510.09); ss by #10325, eff 4-26-13 (from He-M 510.13); ss by #13753, eff 9-27-23

N.H. Code Admin. R. Ann. He-M 510.13 Record keeping {#sec-he-m-510.13 omnilex-key=us-nh-regs-official--agency-he-m--He-M 510.13}

(a) Each program shall maintain individual family records that contain, at a minimum, the following:

(1) Personal information that shall include:

a. Identifying information including:

The child’s name, family name(s), address(es), telephone number(s), and email(s); and
The child’s birth date;

b. The name of the service coordinator;

c. The name, address, and telephone number of the child’s primary health care provider; and

d. Health insurance information;

(2) Medical information that shall include:

a. A record of a physical examination conducted within the past year;

b. Documentation by qualified medical personnel of any established condition(s), as identified in He-M 510.02 (n), including diagnosis;

c. A record of immunizations;

d. A list of any required prescriptions; and

e. Other pertinent medical records;

(3) The current multidisciplinary evaluation of the child and family pursuant to He-M 510.06 (k);

(4) The current IFSP signed by the parent;

(5) Written documentation of each contact with the child and family by the provider, including:

a. A description of the service provided;

b. A description of the child’s and family’s response;

c. The date, location, and duration of the contact; and

d. The name and credentials of the provider;

(6) Reviews of progress once every 6 months or more frequently;

(7) Copies of any letters or notifications written to, or on behalf of, the family;

(8) Information obtained from other agencies or programs that the family believes is important in developing or providing FCESS; and

(9) Releases of information providing consent obtained from the family for evaluation and for the exchange of information among agencies and providers.

(b) Each FCESS program shall have a standard release or exchange of information form, compliant with all state and federal laws, which shall be valid for no longer than one year.

(1) The child’s name and birth date;

(2) The information to be released or obtained;

(3) The purpose of obtaining or releasing the information;

(4) The name of the person or organization being authorized to release the information;

(5) The name of the person or organization to whom the information is to be released; and

(6) The time period for which the authorization is given, if less than one year.

(d) Each FCESS program shall maintain a log of access and disclosures of information that includes:

(1) The information accessed or disclosed;

(2) The date of access or disclosure;

(3) The name of the recipient of the information; and

(4) The purpose for which the party is authorized to use the FCESS records.

(e) Each provider and FCESS program shall maintain the confidentiality of a child’s and family’s records and protect the child’s and family’s personally identifiable information at the collection, storage, disclosure, and destruction stages in accordance with FERPA.

(f) Each FCESS program shall designate a staff member responsible for ensuring the confidentiality of any personally identifiable information, in compliance with federal law.

(g) Each FCESS program shall have policies for the training of all personnel in the collection or use of personally identifiable information and compliance with IDIEA and FERPA.

(h) Parents shall have the following rights with regard to FCESS records for their children:

(1) The right to inspect and review FCESS records at any time;

(2) The right to make requests for explanations and interpretations of the records and to receive a response to these requests within 3 business days;

(3) The right to receive, upon request, copies of records in accordance with (k) and (l) below; and

(4) The right to have a representative of the parent inspect, review, and receive copies of the records.

(i) FCESS programs shall give each family a list of the types and locations of records collected, maintained, or used by FCESS personnel. All parents shall have the right to access such records unless a particular parent does not have this authority under state law.

(j) Information shall be made available only:

(1) To those persons or agencies for whom the parent or guardian has given written consent;

(2) To FCESS personnel;

(3) To the department or other funding, licensing, or accrediting agencies as necessary for determining eligibility for funding or for assisting in accrediting, monitoring, or evaluating supports and services delivery; or

(4) As otherwise required by law.

(k) Each FCESS program shall make copies of records available to parents free of charge for the first 25 pages and not more than 10 cents per page thereafter. The fee shall not effectively prevent the parents from exercising their right to inspect and review those records. A fee shall not be charged for searching for or retrieving information.

(l) Copies of the following documents shall be provided at no cost to the family as soon as possible after each IFSP meeting:

(1) Evaluations;

(2) Assessments of the child and family; and

(3) The IFSP.

(m) FCESS programs shall advise families of their right to request that records be corrected or amended if they believe the information collected, maintained, or used is inaccurate or misleading or violates the privacy or other rights of the child or family.

(n) The FCESS program shall take steps to accommodate any request pursuant to (m) above.

(o) If the FCESS program refuses to amend the information as requested, the program director shall inform the parent of the refusal, why the request to amend the information was refused, and advise the parent of the right to complain pursuant to He-M 203.

(p) If, as a result of a complaint resolution it is decided, pursuant to He-M 203, that the information contained in the records is inaccurate, misleading, or otherwise in violation of privacy or other rights of the child, the FCESS program shall amend the information accordingly and so inform the parent(s) in writing.

(q) If, as a result of a complaint resolution it is decided, pursuant to He-M 203, that the information contained in the records is not inaccurate, misleading, or otherwise in violation of privacy or other rights of the child, the FCESS program shall inform the parent(s) of the right to place in the records a statement commenting on the information or setting forth any reasons for disagreeing with the decision of the FCESS program.

(r) Any explanation placed in the records of the child shall be maintained by the FCESS program as part of the records of the child as long as the record, or the contested portion of a record, is maintained by the program.

(s) If the record, or the contested portion of a record, is disclosed by the FCESS program to any party, the explanation shall be disclosed to the party.

(t) The FCESS program shall inform the parent(s) when personally identifiable information collected, maintained, or used is no longer needed to provide supports and services to the child.

(u) Personally identifiable information that is no longer needed by an FCESS program shall be destroyed at the request of the parent(s).

(v) Notwithstanding (u) above, a permanent record of the following shall be maintained without a time limitation:

(1) The child’s name and date of birth;

(2) The parents’ contact information including address and telephone number;

(3) The name of the service coordinator(s) and early supports and services provider(s); and

(4) Exit data including the year and child’s age and any programs entered into upon exiting.

(w) Records that parents have not requested to be destroyed shall be retained for at least 6 years following termination of service.

(x) All evaluations and assessments, notices of eligibility for services, IFSPs, notices of meetings, information regarding procedural safeguards, progress reports, and consent forms shall be written in language understandable to the general public and provided to the family in their native language or primary mode of communication unless it is unfeasible to do so. If the family’s native language or means of communication is not a written language, the FCESS program shall take steps to ensure that the information is translated orally or by the mode of communication the family typically uses so that the information is meaningful and useful.

History

(See Revision Note at part heading for He-M 510) #5745, eff 12-1-93, EXPIRED: 12-1-99
#7234, eff 4-22-00; ss by #9135, INTERIM, eff 4-22-08, EXPIRED 10-19-08
#9594, eff 11-11-09; ss by #10325, eff 4-26-13 (from He-M 510.14); ss by #13753, eff 9-27-23

N.H. Code Admin. R. Ann. He-M 510.14 Utilization of Public and Private Insurance {#sec-he-m-510.14 omnilex-key=us-nh-regs-official--agency-he-m--He-M 510.14}

(a) When a child is covered by private insurance or enrolled in Medicaid, the FCESS program shall use these benefits to pay for FCESS in accordance with (b) – (k) below.

(b) The FCESS program shall not use the private insurance of a parent or child to pay for FCESS unless the parent provides parental consent. This includes the use of private insurance when such use is a prerequisite for the use of Medicaid.

(c) When an FCESS program uses a child’s private insurance, the program shall not collect costs associated with the use of private insurance from the child’s family, including the cost of deductibles, coinsurance and co-pays.

(d) When private insurance is used to pay for FCESS, the FCESS program shall obtain parental consent at the following times:

(1) When an FCESS program seeks to use the child’s private insurance to pay for the initial provision of an FCESS identified in the IFSP; and

(2) Each time there is an increase in the provision of services and a related change in the child’s IFSP.

(e) When obtaining consent under (d) above or initially using benefits under a private insurance policy, an FCESS program shall provide to the child’s parents:

(1) A copy of the system of payments described in He-M 510.14; and

(2) Notice of the potential costs to the parent when private insurance is used to pay for early intervention services, including premiums or other long-term costs associated with annual or lifetime health insurance coverage caps.

(f) An FCESS program shall not delay or deny the provision of any services in the IFSP when a parent does not provide consent to use private insurance.

(g) If a parent does not provide consent to use private insurance, an FCESS program shall utilize funds available in contract with the department, including federal funds available pursuant to 34 CFR 303.510(a), for the provision of any services in the IFSP.

(h) If funds are utilized pursuant to (g) above, the parent shall not be required to reimburse any such funds.

(i) When Medicaid benefits are used to pay for FCESS, the FCESS program shall provide written notice to the child’s parents that includes:

(1) A statement of the no-cost protection provisions in 34 C.F.R. §303.520(a)(2);

(2) Pursuant to (k) below, a statement that a parent’s refusal to enroll in Medicaid shall not delay or cause to be denied the provision of any services in the child’s IFSP; and

(3) A description of the general categories of costs that the parent would incur as a result of participating in Medicaid, including the required use of private insurance as the primary insurance.

(j) An FCESS program shall not require a parent to sign up for or enroll in Medicaid as a condition of receiving FCESS.

(k) An FCESS program shall not delay or deny the provision of any services in the child’s IFSP if a parent does not enroll in Medicaid.

(l) The FCESS program shall maintain up to date insurance coverage information for each child.

History

#9594, eff 11-11-09 (from He-M 510.11); ss by #10325, eff 4-26-13 (from He-M 510.15); ss by #13753, eff 9-27-23

N.H. Code Admin. R. Ann. He-M 510.15 Interagency Coordinating Council {#sec-he-m-510.15 omnilex-key=us-nh-regs-official--agency-he-m--He-M 510.15}

The purpose of the interagency coordinating council shall be to provide advice to the lead agency regarding the FCESS program. The interagency coordinating council shall be established and operated pursuant to 34 CFR Part 303, Subpart G.

History

#9594, eff 11-11-09; ss by #10325, eff 4-26-13 (from He-M 510.16); ss by #13753, eff 9-27-23

N.H. Code Admin. R. Ann. He-M 510.16 Central Directory {#sec-he-m-510.16 omnilex-key=us-nh-regs-official--agency-he-m--He-M 510.16}

(a) The purpose of the central directory shall be to provide information about:

(1) Public and private early intervention services, resources, and experts available in the state including professionals and other groups that provide assistance to children; and

(2) Research and demonstration projects related to children.

(b) The central directory shall be maintained and operated pursuant to 34 CFR Part 303.117.

History

#9594, eff 11-11-09; ss by #10325, eff 4-26-13 (from He-M 510.17); ss by #13753, eff 9-27-23

N.H. Code Admin. R. Ann. He-M 510.17 Waivers {#sec-he-m-510.17 omnilex-key=us-nh-regs-official--agency-he-m--He-M 510.17}

(a) An area agency, FCESS program, parent, or provider may request a waiver of specific procedures outlined in He-M 510.

(b) The entity requesting a waiver shall:

(1) Complete the form entitled “NH Bureau of Developmental Services Waiver Request” (July 2019 edition); and

(2) Include a signature from the parent(s) or legal guardian(s) indicating agreement with the request and the area agency’s executive director or designee recommending approval of the waiver.

(d) The request for a waiver shall be granted by the commissioner or the commissioner’s designee within 30 calendar days if the alternative proposed by the requesting entity meets the objective or intent of the rule and it:

(1) Does not negatively impact the health or safety of the child; and

(2) Does not affect the quality of services to the child.

(e) The determination on the request for a waiver shall be made within 30 calendar days of the receipt of the request.

(g) Waivers shall be granted in writing for a specific duration not to exceed 5 years except as in (i) below.

(h) Any waiver shall end with the closure of the related program or service.

(i) The requesting entity may request a renewal of a waiver from the department. Such request shall be made at least 90 calendar days prior to the expiration of a current waiver.

History

#9594, eff 11-11-09; ss by #10325, eff 4-26-13 (from He-M 510.18); ss by #13753, eff 9-27-23

N.H. Code Admin. R. Ann. He-M 510.18 Surrogate Parent {#sec-he-m-510.18 omnilex-key=us-nh-regs-official--agency-he-m--He-M 510.18}

(a) A surrogate parent shall be appointed by the lead agency in the following circumstances:

(1) No parent as defined in He-M 510.02(ag) can be identified;

(2) The lead agency, area agency, or FCESS program, after reasonable efforts, including, but not limited to telephone calls and e-mails with documentation of the dates and times of the attempts, cannot locate a parent;

(3) The child is in the custody of DCYF and the court overseeing the case has not appointed a surrogate parent meeting the requirements of (f) below; or

(4) When a court has issued a written order for a surrogate parent.

(b) An application for appointment of a surrogate parent shall be submitted to the lead agency by an area agency or FCESS program if any of the criteria in (a) above are present.

(c) Within 30 days of the receipt of a completed application pursuant to (b) above, the lead agency shall determine whether the child needs a surrogate parent, and if necessary, assign a surrogate parent.

(d) In order to determine whether a child needs a surrogate parent, the lead agency shall obtain information that demonstrates one of the following:

(1) A parent cannot be identified because there is no written record of the existence of such a person available to the area agency, FCESS program, or lead agency;

(2) A parent is not able to be located by the FCESS program or area agency as evidenced through documentation of efforts including but not limited to, telephone calls and emails and the date, time of attempts to contact parent.

(3) The FCESS program or area agency has contacted DCYF for assistance; or

(4) The absence of a court order appointing a surrogate parent for a child in the custody of DCYF.

(e) For children in the custody of DCYF, the lead agency must collaborate with DCYF to obtain necessary information for the appointment of a surrogate parent.

(f) The lead agency shall select individuals to be available to serve as surrogate parents provided such individuals:

(1) Have volunteered to serve as a surrogate parent;

(2) Have satisfactorily completed training to serve as a surrogate parent provided by the lead agency or designee;

(3) Are 21 years of age or over;

(4) Have agreed in writing to serve as a surrogate parent from the date of appointment;

(5) Have no interest that conflicts personally or professionally with the interest of the child they represents;

(6) Are not employees of the lead agency, area agency, or FCESS program responsible for the services, education, care, or any other services to the child or any family member of the child, or the school district of liability related to the transition process; and

(7) Have provided consent to a check of state registries of founded reports of abuse, neglect, exploitation, as established by RSA 161-F:49 and RSA 169-C:35, and their names do not appear on said registries.

(g) A surrogate parent assigned by the lead agency shall have the same rights and responsibilities as a parent defined in He-M 510.02(ag) for purposes of this chapter.

(h) The lead agency shall terminate the appointment of a surrogate parent when:

(1) A parent becomes known, is located, or rescinds their request or consent to have a surrogate parent appointed and will assume educational decision-making;

(2) The child ceases to be under legal custody of DCYF or guardianship of DCYF per RSA 463;

(3) The child is placed within a relative foster placement;

(4) The child is adopted; or

(5) When the assigned surrogate parent provides 30 days’ notice to the lead agency of the desire to end the surrogate parent relationship.

History

#13753, eff 9-27-23

Part He-M 513 Respite Services

N.H. Code Admin. R. Ann. He-M 513.01 Purpose {#sec-he-m-513.01 omnilex-key=us-nh-regs-official--agency-he-m--He-M 513.01}

The purpose of these rules is to establish standards for respite services as part of a system of community based services and supports responsive to the changing needs of individuals with developmental disabilities or acquired brain disorders and their families. These rules also apply to children, birth through age 2, and their families who are eligible for family-centered early supports and services.

History

(See Revision Note at part heading for He-M 513) #4495, eff 9-23-88; EXPIRED: 9-23-94
#6155, eff 12-29-95; ss by #8016, eff 12-29-03; ss by #10030, eff 12-1-11, EXPIRED: 12-1-19
#12944, INTERIM, eff 12-20-19, EXPIRED: 6-17-20
#13263, eff 9-22-21

N.H. Code Admin. R. Ann. He-M 513.02 Definitions {#sec-he-m-513.02 omnilex-key=us-nh-regs-official--agency-he-m--He-M 513.02}

(a) “Acquired brain disorder” means a disruption in brain functioning that:

(1) Is not congenital or caused by birth trauma;

(2) Presents a severe and life-long disabling condition which significantly impairs a person’s ability to function in society;

(3) Occurs prior to age 60;

(4) Is attributable to one or more of the following reasons:

a. External trauma to the brain as a result of:

A motor vehicle incident;
A fall;
An assault; or
Another related traumatic incident or occurrence;

b. Anoxic or hypoxic injury to the brain such as from:

Cardiopulmonary arrest;
Carbon monoxide poisoning;
Airway obstruction;
Hemorrhage; or
Near drowning;

c. Infectious diseases such as encephalitis and meningitis;

d. Brain tumor;

e. Intracranial surgery;

f. Cerebrovascular disruption such as a stroke;

g. Toxic exposure; or

h. Other neurologic disorders, such as Huntington’s disease or multiple sclerosis, which predominantly affect the central nervous system; and

(5) Is manifested by one of the following:

a. Significant decline in cognitive functioning and ability; or

b. Deterioration in:

Personality;
Impulse control;
Judgment;
Modulation of mood; or
Awareness of deficits.

(b) “Area agency” means “area agency” as defined in RSA 171-A:2,I-b.

(d) “Bureau administrator” means the chief administrator of the bureau of developmental services.

(e) “Developmental disability” means “developmental disability” as defined in RSA 171‑A:2, V, namely "a disability:

(1) Which is attributable to an intellectual disability, cerebral palsy, epilepsy, autism, or a specific learning disability, or any other condition of an individual found to be closely related to intellectual disability as it refers to general intellectual functioning or impairment in adaptive behavior or requires treatment similar to that required for persons with an intellectual disability; and

(f) “Family” means a group of 2 or more persons that:

(1) Is related by marriage, ancestry, or other legal arrangement;

(2) Is living in the same household; and

(3) Has at least one member who is an individual as defined in (h) below.

(g) “Home and community‑based care waiver (HCBC-DD)” means that waiver of sections 1902(a)(10) and 1915(c) of the Social Security Act which allows the federal funding of long‑term care services in non-institutional settings for persons who are elderly, disabled, or chronically ill.

(h) “Individual” means a person with a developmental disability or acquired brain disorder or a child, birth through age 2, who is eligible for family-centered early supports and services pursuant to He-M 510.06(a).

(i) “Respite service provider” means a person or agency that delivers respite services to an individual and his or her family who are eligible for area agency services and supports.

(j) “Respite services” means the provision of short‑term care for an individual, in or out of the individual's home, for the temporary relief and support of the family with whom the individual lives.

History

(See Revision Note at part heading for He-M 513) #4495, eff 9-23-88; EXPIRED: 9-23-94
#6155, eff 12-29-95; ss by #8016, eff 12-29-03; ss by #10030, eff 12-1-11, EXPIRED: 12-1-19
#12944, INTERIM, eff 12-20-19, EXPIRED: 6-17-20
#13263, eff 9-22-21

N.H. Code Admin. R. Ann. He-M 513.03 Eligibility and Application for Respite Services {#sec-he-m-513.03 omnilex-key=us-nh-regs-official--agency-he-m--He-M 513.03}

(a) Any family that has a member who is eligible for respite services provided through an area agency in accordance with He‑M 503.03(a)‑(d) or He-M 510.06(a) shall be eligible for respite services.

(b) A family applying for respite services and no other service through the developmental services system shall not be required to go through the complete application process described in He‑M 503.04 and He-M 503.05 or He-M 510.06. The application process shall be as set forth in (c) below.

(1) Documentation to enable the area agency to determine whether the applicant has a developmental disability or acquired brain disorder or is a child as defined in He-M 510.02(f);

(2) An explanation of the needs of the applicant and family; and

(3) A description of the respite services requested.

(d) Agency staff shall:

(1) Describe respite services to the applicant;

(2) Discuss with the applicant the needs of the individual and family;

(3) Determine with the family the respite services required and the amount of respite services to be allocated; and

(4) Assist the family in the selection of area agency or family arranged respite services.

(e) Prior to providing respite services, the area agency shall obtain the following information from families and individuals requesting respite services:

(1) The family's name, address, and telephone number;

(2) The name, age, gender, and disability of the individual;

(3) A description of respite services needs identified by the family, such as location, dates, and times;

(4) Relevant medical information regarding the individual, as applicable, including:

a. Prescribed medication;

b. Allergies;

c. Limitations on activities;

d. Special diets;

e. Assistive technology devices; and

f. Any other specific health or safety needs;

(5) The name and telephone number of at least one person to contact in an emergency; and

(6) The name and telephone number of the individual's family physician or health care provider.

(f) If an emergency circumstance prevents a family from being able to care for an individual, the family may request respite services beyond the amount determined under (d) above. In such cases, the area agency shall approve respite services based on availability of funds.

(g) Providers who operate residences certified under He-M 1001.11, He-M 1001.12, or He-M 1001.13 shall not be eligible for respite services under He-M 513. Such providers may make arrangements for provider time off through the area agency.

History

(See Revision Note at part heading for He-M 513) #4495, eff 9-23-88; EXPIRED: 9-23-94
#6155, eff 12-29-95; ss by #8016, eff 12-29-03; ss by #10030, eff 12-1-11, EXPIRED: 12-1-19
#12944, INTERIM, eff 12-20-19, EXPIRED: 6-17-20
#13263, eff 9-22-21

N.H. Code Admin. R. Ann. He-M 513.04 Agency Arranged Respite Services {#sec-he-m-513.04 omnilex-key=us-nh-regs-official--agency-he-m--He-M 513.04}

(a) When respite services are provided by employees of an area agency or a subcontractor of an area agency, the area agency or the subcontractor shall, at a minimum:

(1) Discuss with the family their current respite services needs;

(2) Encourage the family to use extended family, neighbors, or other people known to the family as respite service providers, whenever possible;

(3) At the request of the family, identify potential respite service providers;

(4) Match respite service providers with eligible individuals and families based on the individuals' and families' needs and preferences and the skills and interests of the respite service providers;

(5) Arrange for a meeting with the individual, the individual's family member or guardian, and the respite service provider prior to the provision of respite services, whenever possible; and

(6) Assist the family to make the final determination regarding respite service providers and where and when respite services are to be provided.

(b) Persons interested in providing respite services arranged by the area agency shall apply to the area agency.

(1) The applicant’s:

a. Name;

b. Address;

c. Telephone number; and

d. Occupation;

(2) A photocopy of the applicant’s driver’s license;

(3) The applicant’s training and experience in the area of developmental disabilities;

(4) The time(s) and duration(s) of availability;

(5) The location(s) where respite services can be provided;

(6) Any specific ability or inability of the applicant to serve an individual with a particular type of disability; and

(7) The names, addresses, and telephone numbers of 2 references unrelated to the applicant.

(d) The area agency shall:

(1) Interview each applicant who submits a completed application pursuant to (c) above;

(2) Request, verify, document, if necessary, and retain 2 written or telephone references; and

(3) With the consent of the applicant:

a. Submit the person’s name for review against the registry of founded reports of abuse, neglect, and exploitation to ensure that the person is not on the registry pursuant to RSA 161-F:49; and

b. Complete a criminal record check in New Hampshire, in the applicant’s state of residence if not New Hampshire, and in the applicants previous state of residence if he or she has lived in New Hampshire for less than one year, ensure that the applicant has no history of fraud, felony, or misdemeanor conviction.

(e) An area agency may hire a person with a criminal record listed in (d)(3)b. above for a single offense that occurred 10 or more years ago in accordance with (h) and (i) below. In such instances, the individual, his or her guardian if applicable, and the area agency shall review the person’s history prior to approving the person’s employment.

(f) Unless a waiver is granted pursuant to (g) below, a provider agency shall not hire a person with a criminal record, other than as specified in (e) above.

(g) The department shall grant a waiver of (f) above if, after reviewing the underlying circumstances, it determines that the person does not pose a threat to the health, safety, or well-being of individuals.

(h) Employment of a person pursuant to (e) above shall only occur if:

(1) Such employment is approved in writing by the individual, or his or her guardian, if applicable;

(2) Such employment is approved in writing by the area agency executive director or designee;

(3) The signature and phone number of the person being hired are obtained;

(4) The employment does not negatively impact the health or safety of the individual(s); and

(5) The employment does not affect the quality of services to individuals.

(i) Upon hiring a person pursuant to (e) above, the provider agency shall document and retain the following information in the individual’s record:

(1) Identification of the region, according to He-M 505.04, in which the provider agency is located;

(2) The date(s) of the approvals in (e) above;

(3) The name of the individual or individuals for whom the person will provide services;

(4) The name of the person hired;

(5) Description of the person’s criminal offense;

(6) The type of service the person is hired to provide;

(7) The provider agency’s name and address; and

(8) A full explanation of why the agency is hiring the person despite the person’s criminal record;

(l) All personnel shall sign a statement annually, which is maintained in the personnel file, stating that since the time of hire they:

(1) Have not been convicted of a felony or misdemeanor in this or any other state, and

(2) Have not had a finding by the department or any administrative agency in this or any other state for assault, fraud, abuse, neglect, or exploitation of any person.

(m) For agency-arranged respite services, an applicant shall be denied employment who:

(1) Is listed on the registry pursuant to RSA 161-F:49; or

(2) Refuses to consent to checks pursuant to (d)(3) above.

(n) If the respite services are to be delivered in the respite service provider’s home, the home shall be visited by a staff member from the area agency prior to the delivery of respite services.

(o) The staff member who visited the respite service provider’s home shall complete a report of the visit that includes a statement of acceptability of the following conditions using criteria established by the area agency:

(1) The general cleanliness;

(2) Any safety hazards;

(3) Any architectural barriers for the individual(s) to be served; and

(4) The adequacy of the following:

a. Lighting;

b. Ventilation;

c. Hot and cold water;

d. Plumbing;

e. Electricity;

f. Heat;

g. Furniture, including beds; and

h. Sleeping arrangements.

(p) The following criteria shall apply to area agency-arranged respite services:

(1) Respite service providers shall be able to meet the day-to-day requirements of the person(s) served, including all of the requirements listed in (v) below;

(2) Respite service providers giving care in their own homes shall serve no more than 2 persons at one time; and

(3) Respite service providers shall contact the area agency in the event that the provider is unable to meet the respite service needs of the individual or comply with these rules.

(q) Within 30 days, an area agency shall notify an applicant to be a respite service provider of the status of the application based on compliance with (c), (o), and (p) above.

(r) Each area agency shall arrange for training of respite service providers in the following areas:

(1) The value and importance of respite services to a family;

(2) The area agency mission statement and the importance of family-centered supports and services as described in He-M 519.04(a);

(3) Basic health and safety practices including emergency first aid;

(4) An overview of developmental disabilities and acquired brain disorders;

(5) Understanding behavior as communication and facilitating positive behaviors; and

(6) Other specialized skills as determined by the area agency in consultation with the family.

(s) If respite is to be provided in a residence certified under He‑M 1001.11, He-M 1001.12, He-M 1001.13, or He‑M 521.09, the respite service provider shall be authorized to administer medication pursuant to He‑M 1201.

(t) The area agency shall maintain a file on each respite service provider that includes:

(1) Items and documentation described under (c)-(o) and (s) above;

(2) Record of any training related to the provision of respite services and provided subsequent to that shown on the application;

(3) Dates and location(s) of service, individuals served, and fees paid; and

(4) Evaluations by the family, described in (v)-(w) below, of each service provided, or cross‑references to individuals’ files where such evaluations are located.

(u) The area agency shall provide or arrange for respite services and provider training such that:

(1) Any special health, behavioral, or communication needs of individuals can be met during the period of respite services;

(2) Respite services to be provided are appropriate to the individual’s needs and family-directed; and

(3) Activities normally engaged in by the individual are included as part of the respite services.

(v) Within one week following provision of area agency arranged respite services by a respite service provider to a new family, area agency staff shall contact the family in person, by telephone, or by questionnaire to review the respite services provided.

(w) The information collected as a result of the family contact shall:

(1) Be documented in writing and maintained at the area agency;

(2) Minimally, address those service requirements listed in (v) above; and

(3) Report the family's satisfaction or dissatisfaction with the respite services provided.

History

(See Revision Note at part heading for He-M 513) #4495, eff 9-23-88; EXPIRED: 9-23-94
#6155, eff 12-29-95; ss by #8016, eff 12-29-03; ss by #10030, eff 12-1-11, EXPIRED: 12-1-19
#12944, INTERIM, eff 12-20-19, EXPIRED: 6-17-20
#13263, eff 9-22-21

N.H. Code Admin. R. Ann. He-M 513.05 Family Arranged Respite Services {#sec-he-m-513.05 omnilex-key=us-nh-regs-official--agency-he-m--He-M 513.05}

(a) Any family approved by the area agency to receive respite services may make its own arrangements for respite services through the use of extended family, neighbors, or other people known to the family.

(b) In circumstances where the family arranges for respite services, all arrangements shall be at the discretion of, and be the responsibility of, the family except as noted in (d) below.

(c) The area agency and family shall discuss the available funds and establish compensation amounts and procedures for family arranged respite services.

(d) If respite services are to be provided in a residence certified under He-M 1001.11, He-M 1001.12, He-M 1001.13, or He-M 521.09, the respite service provider shall be trained in medication administration pursuant to He-M 1201.

(e) The person primarily responsible for an individual’s day-to-day care shall not provide and be reimbursed for respite services for that individual.

History

(See Revision Note at part heading for He-M 513) #4495, eff 9-23-88; EXPIRED: 9-23-94
#6155, eff 12-29-95; ss by #8016, eff 12-29-03; ss by #10030, eff 12-1-11, EXPIRED: 12-1-19
#12944, INTERIM, eff 12-20-19, EXPIRED: 6-17-20
#13263, eff 9-22-21

N.H. Code Admin. R. Ann. He-M 513.06 Role of Regional Family Support Councils {#sec-he-m-513.06 omnilex-key=us-nh-regs-official--agency-he-m--He-M 513.06}

(a) Each area agency shall enter into an agreement with the regional family support council, as described in He-M 519.05(c)(4), which details the regional family support council's role in planning for the provision of respite services within the region.

(b) The regional family support council shall, at a minimum, make recommendations to the area agency regarding the development and implementation of the area plan, pursuant to He-M 505.03 (u), as it pertains to monitoring the quality of, access to, and methods of providing respite services.

History

(See Revision Note at part heading for He-M 513) #4495, eff 9-23-88; EXPIRED: 9-23-94
#6155, eff 12-29-95; ss by #8016, eff 12-29-03; ss by #10030, eff 12-1-11, EXPIRED: 12-1-19
#12944, INTERIM, eff 12-20-19, EXPIRED: 6-17-20
#13263, eff 9-22-21

N.H. Code Admin. R. Ann. He-M 513.07 Payment for Area Agency Arranged and Family Arranged Respite Services {#sec-he-m-513.07 omnilex-key=us-nh-regs-official--agency-he-m--He-M 513.07}

(a) Area agencies may develop and use sliding scale fees to determine the amount of the family’s payment, if any, for respite services.

(b) A sliding fee scale pursuant to (a) above shall:

(1) Be based on family income; and

(2) Only apply to families of individuals who are under the age of 18.

(c) Compensation shall be made by the area agency, the family, or both to respite service providers for each hour or each day that respite services are provided.

(d) Payment for respite services funded under the HCBC‑DD waiver shall be in accordance with He-M 517.10, medicaid covered home and community-based care services for persons with developmental disabilities.

History

(See Revision Note at part heading for He-M 513) #4495, eff 9-23-88; EXPIRED: 9-23-94
#6155, eff 12-29-95; ss by #8016, eff 12-29-03; ss by #10030, eff 12-1-11, EXPIRED: 12-1-19
#12944, INTERIM, eff 12-20-19, EXPIRED: 6-17-20
#13263, eff 9-22-21

N.H. Code Admin. R. Ann. He-M 513.08 Waivers {#sec-he-m-513.08 omnilex-key=us-nh-regs-official--agency-he-m--He-M 513.08}

(a) An area agency, family member, respite service provider, or individual may request a waiver of specific procedures outlined in He-M 513.

(b) The entity requesting a waiver shall:

(1) Complete the form entitled “NH Bureau of Developmental Services Waiver Request” (July 2019 edition); and

(2) Include a signature from the individual(s) or legal guardian(s) indicating agreement with the request and the area agency’s executive director or designee recommending approval of the waiver.

(d) No provision or procedure prescribed by statute shall be waived.

(1) Does not negatively impact the health or safety of the individual(s); and

(2) Does not affect the quality of services to individuals.

(f) The determination on the request for a waiver shall be made within 30 days of the receipt of the request.

(g) Upon receipt of approval of a waiver request, the grantee’s subsequent compliance with the alternative provisions or procedures approved in the waiver shall be considered essential compliance with the rule for which the waiver was sought.

(h) Waivers shall be granted in writing for the minimum period necessary to accomplish the waiver request’s purpose, with the specific duration not to exceed 5 years.

(i) Any waiver shall end with the closure of the related program or service.

(j) An area agency, family member, respite service provider, or individual may request a renewal of a waiver from the bureau. Such request shall be made at least 90 days prior to the expiration of a current waiver.

(k) A request for renewal of a waiver shall be approved in accordance with the criteria specified in (e) above.

History

(See Revision Note at part heading for He-M 513) #4495, eff 9-23-88; EXPIRED: 9-23-94
#6155, eff 12-29-95; ss by #8016, eff 12-29-03; ss by #10030, eff 12-1-11, EXPIRED: 12-1-19
#12944, INTERIM, eff 12-20-19, EXPIRED: 6-17-20
#13263, eff 9-22-21

Part He-M 515 Standards for Individual Skills Training and Payment - Expired

N.H. Code Admin. R. Ann. He-M 515.01 Developmental Services {#sec-he-m-515.01 omnilex-key=us-nh-regs-official--agency-he-m--He-M 515.01}

– He-M 515.10 - EXPIRED

History

(See Revision Note at part heading for He-M 515) #5131, eff 5-1-91, EXPIRED: 5-1-97

Part He-M 517 Medicaid-Covered Home and Community-Based Care Services for Persons with Developmental Disabilities and Acquired Brain Disorders

N.H. Code Admin. R. Ann. He-M 517.01 Purpose {#sec-he-m-517.01 omnilex-key=us-nh-regs-official--agency-he-m--He-M 517.01}

The purpose of these rules is to define the requirements and procedures for medicaid-covered home and community-based care waiver services for persons with developmental disabilities and acquired brain disorders where such services are provided pursuant to He-M 503, He-M 504, He-M 507, He-M 513, He-M 518, He-M 521, He-M 522, He-M 525, and He-M 1001.

History

#4315, eff 9-25-87; EXPIRED: 9-25-93
#6360, eff 10-23-96, EXPIRED: 10-23-04
#8195, INTERIM, eff 10-29-04, EXPIRED: 4-27-05
#8424, eff 9-1-05; ss by #10454, eff 10-31-13; ss by #13988, eff 5-30-24

N.H. Code Admin. R. Ann. He-M 517.02 Definitions {#sec-he-m-517.02 omnilex-key=us-nh-regs-official--agency-he-m--He-M 517.02}

The words and phrases in this chapter shall have the following meanings:

(a) “Acquired brain disorder” means a disruption in brain functioning that:

(1) Is not congenital or caused by birth trauma;

(2) Presents a severe and life-long disabling condition which significantly impairs a person’s ability to function in society;

(3) Occurs prior to age 60;

(4) Is attributable to one or more of the following reasons:

a. External trauma to the brain as a result of:

A motor vehicle incident;
A fall;
An assault; or
Another related traumatic incident or occurrence;

b. Anoxic or hypoxic injury to the brain such as from:

Cardiopulmonary arrest;
Carbon monoxide poisoning;
Airway obstruction;
Hemorrhage; or
Near drowning;

c. Infectious diseases such as encephalitis and meningitis;

d. Brain tumor;

e. Intracranial surgery;

f. Cerebrovascular disruption such as a stroke;

g. Toxic exposure; or

h. Other neurological disorders, such as Huntington’s disease or multiple sclerosis, which predominantly affect the central nervous system resulting in diminished cognitive functioning and ability; and

(5) Is manifested by one or more of the following:

a. Significant decline in cognitive functioning and ability; or

b. Deterioration in:

Personality;
Impulse control;
Judgment;
Modulation of mood; or
Awareness of deficits;

(b) “Agency residence” means a community residence operated by staff of a provider agency;

(d) “Basic living skills” means activities accomplished each day to acquire, improve, or maintain independence in daily life;

(e) “Bureau” means the bureau of developmental services of the department of health and human services;

(f) “Bureau administrator” means the chief administrator of the bureau of developmental services or their designee;

(g) “Centralized service site” means a location operated by a provider agency where individuals receive community participation services for more than one hour per day;

(h) “Commissioner” means the commissioner of the department of health and human services, or their designee;

(i) “Community integration” means:

(1) Participation in a wide variety of experiences in settings that are available to and used by the general public;

(2) Participation in natural relationships with one’s family, friends, neighbors, and co-workers; and

(3) Expansion of one’s personal network of friends to include individuals who do not have disabilities;

(j) “Community residence” means either an agency residence or family residence exclusive of any independent living arrangement that:

(1) Provides residential services for at least one individual with a developmental disability, in accordance with He-M 503, or acquired brain disorder in accordance with He-M 522;

(3) Serves individuals whose services are funded by the department; and

(4) Is certified pursuant to He-M 1001, except as allowed in He-M 517.05(e)(7);

(k) “Cost of care” means the amount that an individual pays to a provider agency because the individual’s net income is above the applicable standard of need established in He-W 658.03;

(l) “Days” means calendar days unless otherwise specified;

(m) “Department” means the New Hampshire department of health and human services;

(n) “Developmental disability” means “developmental disability” as defined in RSA 171‑A:2, V, namely, “a disability:

(a) Which is attributable to an intellectual disability, cerebral palsy, epilepsy, autism, or a specific learning disability, or any other condition of an individual found to be closely related to an intellectual disability as it refers to general intellectual functioning or impairment in adaptive behavior or requires treatment similar to that required for persons with an intellectual disability; and

(b) Which originates before such individual attains age 22, has continued or can be expected to continue indefinitely, and constitutes a severe disability to such individual’s ability to function normally in society.”;

(o) “Family” means a group of 2 or more persons that:

(1) Is related by marriage, ancestry, or other legal arrangement;

(2) Is living in the same household; and

(3) Has at least one member who is an individual as defined in (r) below;

(p) “Family residence” means a community residence that is:

(1) Operated by a person or family residing therein;

(2) Under contract with a provider agency; and

(3) Certified pursuant to He-M 1001;

(q) “Home and community-based waiver services (HCBS waiver services)” means the services defined and funded pursuant to New Hampshire’s agreement with the federal government, known as the “Developmental Disabilities Waiver”, and the “Acquired Brain Disorder Waiver”, pursuant to the authority section of 1915(c) of the Social Security Act which allows the federal funding of long-term care services in non-institutional settings for persons who are developmentally disabled or who have an acquired brain disorder;

(r) “Individual” means a person who has a developmental disability or an acquired brain disorder;

(s) “Natural supports” means people such as family, relatives, friends, neighbors, and clergy, and social groups such as religious organizations, co-workers, and social clubs, available to provide comfort and help as part of everyday living as well as during critical events;

(t) “Organized health care delivery system (OHCDS)” means an area agency, designated pursuant to He-M 505, that directly provides at least one home and community-based waiver service;

(u) “Participant directed and managed services (PDMS)” means services provided pursuant to He-M 525;

(v) “Pass-through billing” means an arrangement, pursuant to 42 CFR 447.10(g)(3), whereby the OHCDS is the enrolled provider of home and community-based waiver services for the purposes of billing and subcontracting for the service provision and has authorization from the department to do so;

(w) “Personal development” means supporting or increasing an individual’s capacity to make choices, to communicate interests and preferences, and to have sufficient opportunities for exploring and meeting those interests;

(x) “Provider” means a person receiving any form of remuneration for the provision of services to an individual;

(y) “Provider agency” means an agency or an independent provider that is established to provide services to individuals pursuant to He-M 517.05 and meets the criteria in He-M 504;

(z) “Representative” means:

(1) The parent or guardian of an individual under the age of 18;

(2) The legal guardian of an individual 18 or over; or

(3) A person who has power of attorney for the individual;

(aa) “Service” means any paid assistance to an individual in meeting their own needs provided through the developmental services system;

(ab) “Service agreement” means a written agreement between the individual, guardian, or representative, and the provider agency that is prepared as a result of the person-centered service planning process and that describes the services that the individual will receive and constitutes an individual service agreement as defined in RSA 171-A:2, X and developed pursuant to He-M 503.10 or He-M 522.11;

(ac) “Service coordinator” means a provider who meets the criteria in He-M 503.08 or He-M 522.09 and is chosen by an individual and their guardian or representative to organize, facilitate, and document service planning and to negotiate and monitor the provision of the individual’s services;

(ad) “Sheltered workshop” means a program that provides a segregated environment where the contract objectives of the provider agency are the primary focus and goal; and

(ae) “Skilled nursing or skilled rehabilitative services” means those services that:

(1) Require the skills of a licensed or certified health professional including, but not limited to:

a. Registered nurse;

b. Licensed practical nurse;

c. Physical therapist;

d. Occupational therapist;

e. Speech pathologist;

f. Audiologist; or

g. Other similar health-related professional; and

(2) Are provided directly by or under the general supervision of such professionals to assure the safety of the individual and to achieve the medically desired result.

History

#4315, eff 9-25-87; EXPIRED: 9-25-93
#6360, eff 10-23-96, EXPIRED: 10-23-04
#8195, INTERIM, eff 10-29-04, EXPIRED: 4-27-05
#8424, eff 9-1-05; ss by #10454, eff 10-31-13; ss by #13988, eff 5-30-24

N.H. Code Admin. R. Ann. He-M 517.03 Eligibility {#sec-he-m-517.03 omnilex-key=us-nh-regs-official--agency-he-m--He-M 517.03}

(a) Based on availability of funds, HCBS waiver services shall be available to any individual who:

(1) Is found to be eligible for services by an area agency pursuant to He-M 503 or He-M 522;

(2) Is found to be eligible for medicaid by the department pursuant to He-W 600 and He-W 800, as applicable;

(3) Meets institutional level of care criteria as demonstrated by one of the following:

a. A developmental disability that requires at least one of the following:

Services on a daily basis for:

(i) Performance of basic living skills;

(ii) Intellectual, physical, or psychological development and well-being;

(iii) Medication administration and instruction in, or supervision of, self-medication by a licensed medical professional; or

(iv) Medical monitoring or nursing care by a licensed professional person;

Services on a less than daily basis as part of a planned transition to more independence; or
Services on a less than daily basis but with continued availability of services to prevent circumstances that could necessitate more intrusive and costly services; or

b. An acquired brain disorder that requires a skilled nursing facility level of care, which means requiring skilled nursing or skilled rehabilitative services on a daily basis; and

(4) Agrees to make the appropriate payment toward the cost of care, as specified in He-M 517.13(c).

(b) To request initial determination of level of care as described in in He-M 517.03(a)(3) above, a “NH bureau of developmental services functional screen for waiver services” electronic form shall be submitted by the area agency via NH Easy, via https://nheasy.nh.gov/#/, within 5 business days of an individual’s decision to seek eligibility for HCBS waiver services.

(d) To request a redetermination of the level of care in He-M 517.03(a)(3) above, a “NH bureau of developmental services functional screen for waiver services” electronic form shall be submitted by the service coordinator via NH Easy, https://nheasy.nh.gov/#/ , not less than 30 days but not more than 45 days prior to expiration of the current level of care determination.

(e) The bureau shall send notification of the level of care determination in accordance with He-M 503.05 or He-M 522.06.

(f) The bureau shall deny services through the home and community-based waiver if it determines that the provision of services will result in the loss of federal financial participation for such services.

History

#4315, eff 9-25-87; EXPIRED: 9-25-93
#6360, eff 10-23-96, EXPIRED: 10-23-04
#8195, INTERIM, eff 10-29-04, EXPIRED: 4-27-05
#8424, eff 9-1-05; ss by #9370, eff 1-24-09; ss by #10454, eff 10-31-13; ss by #13988, eff 5-30-24

N.H. Code Admin. R. Ann. He-M 517.04 Provider and Provider Agency Participation {#sec-he-m-517.04 omnilex-key=us-nh-regs-official--agency-he-m--He-M 517.04}

(a) Every OHCDS and provider agency shall be enrolled with the New Hampshire medicaid program and comply with all requirements set forth in He-M 504 in order to receive reimbursement for the provision of HCBS waiver services.

(b) An OHCDS or provider agency shall allow the department or area agency to examine its service and financial records at any time for the purposes of audit or review in accordance with He-M 504.

History

#4315, eff 9-25-87; EXPIRED: 9-25-93
#6360, eff 10-23-96, EXPIRED: 10-23-04
#8195, INTERIM, eff 10-29-04, EXPIRED: 4-27-05
#8424, eff 9-1-05; ss by #10454, eff 10-31-13; ss by #13988, eff 5-30-24

N.H. Code Admin. R. Ann. He-M 517.05 Covered Services {#sec-he-m-517.05 omnilex-key=us-nh-regs-official--agency-he-m--He-M 517.05}

(a) All HCBS waiver services provided shall be specifically tailored to, and provided in accordance with, the individual’s needs, interests, competencies, and lifestyle as described in the individual’s service agreement.

(b) Services provided pursuant to He-M 517 shall be:

(1) Designed to maintain and enhance each individual’s natural supports;

(2) Responsive to the individual’s changing needs and choices within the limitations of federal and state laws and rules and the HCBS waiver;

(3) Provided only after the informed consent of the individual or their guardian or representative;

(4) Free from conflict in accordance with He-M 503 or He-M 522;

(5) Delivered by any willing and qualified provider agency or provider that is freely chosen by the individual or individual’s guardian or representative and who meets the criteria in He-M 504.03, He-M 504.04, and He-M 504.11; and

(6) Provided in accordance with He-M 310.

(c) The services identified in (d)-(s) below shall be fundable in accordance with the HCBS waiver services if such services are identified within an individual’s service agreement.

(d) Service coordination services shall:

(1) Be provided pursuant to He-M 503 or He-M 522;

(2) Include the following:

a. Coordination and facilitation to assist individuals in gaining access to needed services and resources, as well as needed medical, social, educational, and other services, regardless of funding source, as delineated in the service agreement, including:

System navigation including identifying, providing information about, and assisting families to access available services as well as community resources;
Person-centered service planning including coordination and facilitation of services and the development of a service agreement pursuant to He-M 503.09 and He-M 503.10 or He-M 522.10 and He-M 522.11;
Monitoring and ongoing review of services and individual outcomes, in accordance with He-M 503.10 or He-M 522.11 to include assessing and reassessing service needs, goals and, outcomes;
Monitoring of services for quality in accordance with He-M 503.10 or He-M 522.11;
Monitoring to ensure health and welfare in accordance with He-M 503.10 or He-M 522.11; and
Assistance in identifying available provider agencies and providers;

b. Referral to the bureau for the redetermination of the individual’s continued need for HCBS waiver services pursuant to He-M 503 or He-M 522 and He-M 517.03;

c. Twenty-four hour access, 7 days a week pursuant to He-M 504.03;

d. Monitoring to ensure that documentation is maintained to demonstrate service coordination service provisions;

e. Gathering of documentation from provider agencies to aid in person-centered service planning and in creating an individual’s service agreement in accordance with He-M 503.10 or He-M 522.11;

f. Participating in transition planning; and

g. Providing advocacy education and skill development to the individual, their family, and their representative or guardian; and

(3) Be reimbursed at a monthly rate.

(e) Residential habilitation services shall:

(1) Be provided pursuant to He-M 1001, He-M 525, or He-M 521, as applicable;

(2) Include individually tailored supports to assist with the acquisition, retention, or improvement of community-based living skills including but not limited to:

a. Meal preparation;

b. Eating;

c. Bathing;

d. Dressing;

e. Personal hygiene;

f. Medication management;

g. Community inclusion;

h. Transportation;

i. Social and leisure skills; and

j. Adaptive skill development;

(3) Include assistance to the individual to enable them to reside in the least restrictive setting most appropriate to their needs;

(4) Be provided in the home or outside of the home;

(5) Be reimbursed at a daily rate;

(6) Be certified pursuant to He-M 1001, except as allowed by (7) below.

(7) Be licensed by the bureau of health facilities administration in accordance with RSA 151:2, I, (e) and He-P 814, in addition to being certified pursuant to He-M 1001, if a community residence serves 4 or more people;

(8) Not be required to be certified as a community residence pursuant to He-M 1001 when the residence is funded under the home and community-based care waiver, provides services to persons with acquired brain disorders, and is licensed as a supported residential care facility or a residential treatment and rehabilitation facility under RSA 151:2, I, (e);

(9) Be certified pursuant to He-M 521.09 when residential habilitation services are provided in the family home of an individual who is 18 years of age or older, as described in He-M 521.03; and

(10) Be certified pursuant to He-M 525 for services provided through a participant directed and managed services method of delivery.

(f) Community participation services shall:

(1) Be provided in accordance with He-M 507;

(2) Include the following as outlined in the individual’s service agreement:

a. Instruction and assistance to learn, attain, improve, or maintain:

Social and safety skills in different community settings;
Decision-making regarding choice of and participation in community activities;
Life skills as applied to community-based activities, such as purchasing items and managing personal funds;
Good nutrition and healthy lifestyle;
Self-advocacy and rights and responsibilities as citizens; and
Any other skill identified by the individual or guardian during service planning and related to the individual’s participation in, or contribution to, their community;

b. Supports to identify and develop the individual’s interests and capacities related to securing employment opportunities, including internships;

c. Services related to job development and on-the-job training;

d. Assistance in finding and maintaining volunteer positions;

e. Supports related to enabling the individual to explore, and participate in, a wide variety of community activities and experiences in settings that are available to the general public; and

f. Transportation related to community participation services, including travel from the individual’s residence to locations where the community participation service activities are taking place;

(3) Exclude employment or volunteer positions where the individual is:

a. Being solely supported by persons who are not providers; and

b. Not receiving any services from a provider agency at those locations; and

(4) Be reimbursed at a quarter hour rate.

(g) Supported employment services shall:

(1) Be provided in accordance with He-M 518;

(2) Be available to any individual who:

a. Has a goal or desired outcome related to employment; and

b. Is not authorized and funded by the NH department’ of education’s bureau of vocational rehabilitation for the same supported employment service;

(3) Consist of assistance provided to individuals to:

a. Improve or maintain their skills in employment activities; or

b. Enhance their social and personal development or well-being within the context of vocational goals;

(4) Include referral, evaluation, and consultation for adaptive equipment, environmental modifications, communications technology or other forms of assistive technology, and educational opportunities related to the individual’s employment services and goals;

(5) When combined with another employment service, transportation and training in accessing transportation, as appropriate, to and from work; and

(6) Be reimbursed at a quarter hour rate.

(h) Respite care services shall:

(1) Be provided pursuant to He-M 513;

(2) Consist of the provision of short-term assistance and care for individuals unable to care for themselves because of the absence or need for relief of the family who lives with and normally provides care for the individual;

(3) Be provided in or out of an individual’s home;

(4) Not exceed 20% of an individual’s total funding for services when provided through a participant directed and managed program as outlined in He-M 517.07 below and He-M 525;

(5) Be authorized by the bureau in excess of the limitation in (4) above upon written request which shall include documentation supporting the need and the correlation of the request to the individual’s service agreement; and

(6) Be reimbursed at a quarter hour rate.

(i) Environmental and vehicle modification services shall:

(1) Include modifications or adaptations and maintenance thereof to the individual’s home environment including:

a. Installation of ramps;

b. Installation of grab bars;

c. Widening of doorways to accommodate the participant’s wheelchair or other mobility access equipment; and

d. Other adaptations authorized by the bureau that are necessary to ensure the health and safety of the individual or that are needed to accommodate the medical equipment and supplies that are necessary for the welfare of the individual;

(2) Include modifications or adaptations and maintenance thereof to the vehicle used by the individual in order to enable them to:

a. Travel in greater safety;

b. Access the community; and

c. Carry out activities of daily living;

(3) Comply with applicable state and local building and vehicle codes;

(4) Not exceed $2500 when used for outdoor fencing to support individuals with unsafe wandering or running behaviors; and

(j) Environmental and vehicle modification services shall not cover:

(1) Improvements that are of general utility and do not have direct or medical remedial benefit to the individual;

(2) Adaptations which add to the square footage of the home except when necessary to complete an adaptation;

(3) The purchase or lease of a vehicle;

(4) Regularly scheduled upkeep and maintenance of a vehicle;

(5) Electrical or plumbing work that is beyond what is required to support the authorized adaptation; and

(6) Electrical or plumbing work for which the proposed contractor is unable to state, in writing, that the proposed adaptation can be done within the current electrical or plumbing capacity of the home.

(k) Crisis response services shall:

(1) Consist of direct consultation, clinical evaluation, or support to an individual who is experiencing a behavioral, emotional, or medical crisis in order to reduce the likelihood of harm to the person or others and to assist the individual to return to their pre-crisis status;

(2) Include training and staff development related to the needs of the individual;

(3) Include on-call staff for the direct support of the individual in crisis;

(4) Be authorized for a period of up to 6 months;

(5) Be reimbursed at a quarter hour rate; and

(6) Be authorized by the bureau in excess of the limitation in (4) above upon written request which shall include documentation supporting the need and the correlation of the request to the individual’s service agreement.

(l) Community support services shall:

(1) Be available for an individual who has developed, or is trying to develop, skills to live independently within the community;

(2) Consist of assistance, excluding room and board, provided to an individual to:

a. Improve or maintain their skills in basic daily living and community integration; and

b. Enhance their personal development and well-being;

(3) Not exceed 30 hours per week;

(4) Be provided for up to 24 consecutive months while an individual is residing with their family;

(5) Be authorized by the bureau in excess of the limitation in (3) and (4) above upon written request which shall include documentation supporting the need and the correlation of the request to the individual’s service agreement; and

(6) Be reimbursed at a quarter hour rate.

(m) Assistive technology shall:

(1) Include an item, piece of equipment, certification and training of service animal, or product system, used to increase, maintain, or improve functional capabilities of an individual, including, but not limited to, the following:

a. Devices, controls, or appliances, specified in the individual service agreement that enable the individual to increase their ability to perform activities of daily living, or perceive, control, or communicate with the environment in which they live;;

b. The evaluation of the assistive technology needs of an individual, including a functional evaluation of the impact of the provision of appropriate assistive technology and appropriate services to the individual;

c. Purchasing, leasing, or otherwise providing for the acquisition of assistive technology or devices;

d. Selecting, designing, fitting, customizing, adapting, applying, maintaining, repairing, or replacing assistive technology devices;

e. Coordination and use of necessary therapies, interventions, or services associated with other services in the service agreement;

f. Training or technical assistance for the individual or the individual’s family members, guardians, advocates, or authorized representatives;

g. Training or technical assistance for professional or other individuals who provide services to, employ, or are otherwise substantially involved in the major life functions of an individual; and

h. Training and certification of a service animal, defined in federal regulations implementing the Americans with Disabilities Act, 28 C.F.R. § 36.104 as “service animal means any dog that is individually trained to do work or perform tasks for the benefit of an individual with a disability, including a physical, sensory, psychiatric, intellectual, or other mental disability. Other species of animals, whether wild or domestic, trained or untrained, are not service animals for the purposes of this definition. The work or tasks performed by a service animal must be directly related to the individual's disability.";

(2) Include adaptive equipment which shall be items of durable and non-durable medical equipment necessary to address the individual’s functional limitations;

(3) Not exceed $10,000 over the course of 5 years; and

(4) Be authorized by the bureau in excess of the limitation in (3) above upon written request which shall include documentation supporting the need and the correlation of the request to the individual’s service agreement.

(n) Specialty services shall:

(1) Be available to individuals whose medical, behavioral, therapeutic, health, or personal needs require services that are particularly designed to address the unique conditions and aspects of their developmental disabilities or acquired brain disorders;

(2) Consist of one or more of the following:

a. Assessment;

b. Consultation;

c. Design, development, and provision of services;

d. Training and supervision of staff and providers; and

e. Evaluation of service outcomes; and

(3) Be reimbursed at a quarter hour rate or at cost when for a consultation.

(o) Community integration services shall:

(1) Be services designed to support, enhance, or enable an individual’s level of functioning, independence, and life activities, to promote health and wellness as well as reduce or eliminate the activity limitations and restrictions to participation in life situations caused by a disability shall include, but not be limited to the following:

a. Water safety training;

b. Community based camperships; and

c. A pass or membership for admission to community-based activities only when needed to address assessed needs;

(2) When including community-based activity passes, be purchased as day passes or monthly passes, whichever is the most cost effective;

(3) Not exceed $8,000 annually;

(5) Require a licensed healthcare practitioner’s recommendation when any single community integration service, other than a campership, is over $2,000.

(p) Individual goods and services shall:

(1) Include equipment or supplies that address an identified need in the service agreement, and meet at least one of the following requirements:

a. The good or service decreases the need for other Medicaid services;

b. The good or service promotes inclusion in the community; or

c. The good or service increases the individual's safety in the home environment;

(2) Include payment through the home and community-based services waiver if:

a. The individual does not have the funds to purchase the item or service; or

b. The item or service is not covered through other sources;

(3) Not exceed $1,500 annually;

(5) Have an anticipated finite period of time to be utilized; and

(6) Include a determination on the frequency of purchase of individual goods and services in accordance with the documented continued need of the item and the ability of the item to continue to meet that need.

(q) Non-medical transportation shall:

(1) Be services designed specifically to improve the individual’s and the caregiver's ability to access community activities within their own community in response to needs identified through the individual's service agreement, including, but not limited to:

a. Orientation service using other services or supports for safe movement from one place to another;

b. Travel training such as supporting the individual and family in learning how to access and use informal and public transport for independence and community integration;

c. Transportation service provided by different modalities, including public and community transportation, taxi services, transportation specific to prepaid transportation cards, mileage reimbursement, volunteer transportation, and non-traditional transportation providers; and

d. Prepaid transportation vouchers and cards;

(2) Be limited to:

a. $5,000 annually; or

b. $10,000 annually for individuals who require specialized transportation such as a vehicle that:

Can accommodate a wheelchair or similar;
Has lift capabilities; or
Allows for the individual to not be within reach of the driver;

(3) Be authorized by the bureau in excess of the limitations in (2)(a)-(b) above upon written request which shall include documentation supporting the need and the correlation of the request to the individual’s service agreement;

(4) Be limited to transportation needed:

a. To access a HCBS waiver service that is included in the individual’s service agreement; or

b. To access other activities and resources identified in the individual’s service agreement; and

(5) Not be available to individuals under the age of 16 for public transportation expenses.

(r) Personal emergency response services (PERS) shall:

(1) Consist of smart technology devices that enable individuals to summon help in an emergency including but not limited to:

a. Wearable or portable devices that allow for safe mobility;

b. Response systems that are connected to the individual’s telephone and programmed to signal a response center when activated;

c. Staffed and monitored response systems that operate 24 hours a day, 7 days a week;

d. Any device that informs of elopement; and

e. Monthly expenses that are affiliated with maintenance contracts or agreements to maintain the operations of the device or item;

(2) Include non-smart technology items, such as seatbelt release covers, ID bracelets, and GPS devices;

(3) Not exceed $2,000 annually;

(5) Be authorized as part of a positive behavior plan pursuant to He-M 310 when the device is restrictive.

(s) Wellness coaching shall:

(1) Include planning, directing, coaching, and mentoring individuals with disabilities in community based, inclusive exercise activities in accordance with the recommendations of a licensed recreational therapist or a certified personal trainer;

(2) Include specific goals in the individual’s service agreement which are developed by a wellness coach, including activities that are carried over into the individual’s home and community;

(3) Consist of demonstration by a wellness coach on exercise techniques and form to include observation of individuals and explanation to them of corrective measures necessary to improve their skills;

(4) Include collaboration between a wellness coach and the individual, their family and other caregivers, and with other health and wellness professionals as needed;

(5) Not exceed $5,000 annually; and

(6) Be authorized by the bureau for amount in excess of the limitation in (5) above by written request, which shall include the recommendation of a licensed professional and documentation supporting the need and the correlation of the request to the individual’s service agreement.

(t) Removable prosthodontic services shall:

(1) Assist individuals as a means to prevent functional limitations in order to support community integration and avoid isolation or institutionalization and when, if not otherwise provided:

a. The individual’s health would be compromised through reduced food options and result in restrictive nutritional intake, impacting overall health; or

b. When considerations interfere with supported employment or social development;

(2) Include:

a. Complete dentures, including immediate prosthetic appliances and routine post-delivery care;

b. Partial dentures, including immediate prosthetic appliances and routine post-delivery care;

c. Adjustments to dentures;

d. Repairs to complete and partial dentures;

e. Denture rebase procedures; and

f. Denture reline procedures;

(3) Be included in the individual’s service agreement;

(4) Not exceed $1,500 annually;

(5) Not cover dentures more than once in a 5 year period;

(6) Not be available to individuals under the age of 21 that are not otherwise covered by the Medicaid state plan;

(7) Be authorized by the department in excess of the limitation in (4) and (5) above due to medical necessity through written request, which shall include documentation to support the identified need and how it correlates the individual’s service agreement; and

(8) Be overseen by New Hampshire’s prepaid ambulatory health plan as defined in 42 CFR §438.2.

History

#4315, eff 9-25-87; EXPIRED: 9-25-93
#6360, eff 10-23-96, EXPIRED: 10-23-04
#8195, INTERIM, eff 10-29-04, EXPIRED: 4-27-05
#8424, eff 9-1-05; amd by #9370, eff 1-24-09; ss by #10454, eff 10-31-13; ss by #13988, eff 5-30-24

N.H. Code Admin. R. Ann. He-M 517.06 Acute and Remote Setting Services {#sec-he-m-517.06 omnilex-key=us-nh-regs-official--agency-he-m--He-M 517.06}

(a) Upon request, services in (f) below shall be provided in an acute care hospital when each service is:

(1) Identified in an individual’s service agreement;

(2) Provided to meet needs of the individual that are not met through the provision of hospital services;

(3) Not a substitute for services that the hospital is obligated to provide through its conditions of participation or under federal or state law, or under another applicable requirement; and

(4) Designed to ensure smooth transitions between acute care settings and home and community-based settings, and to preserve the individual’s functional abilities.

(b) If services in (e) are provided pursuant to (c) below, then those services shall be reviewed by the team at the quarterly meeting to ensure this method of service delivery continues to meet the individual’s needs.

(1) This method of service delivery meets the assessed needs of the individual;

(2) The individual, guardian, or representative chose this method of service delivery;

(3) This method of service delivery is reviewed by the team at the quarterly meeting to ensure that it continues to meet the individual’s needs; and

(4) The chosen remote platform for delivery of services is in compliance with the Health Insurance Portability and Accountability Act of 1996, as applicable.

(d) If an individual, guardian, or representative no longer chooses to receive a service in (e) below through a remote method of service delivery, the provider agency shall continue providing services in the same amount, type, scope, frequency, and duration during the time in which services are changed to an in-person method of delivery.

(e) Services that may be provided through a remote method of service delivery pursuant to (c) above shall include:

(1) Community participation services;

(2) Residential habilitation;

(3) Service coordination, except home visits pursuant to He-M 503.10 or He-M 522.11 for residential services;

(4) Supported employment;

(5) Assistive technology;

(6) Community integration services;

(7) Community support services;

(8) Crisis response services;

(9) Individual goods and services;

(10) Specialty services; and

(11) Wellness coaching.

(f) Services that may be provided in an acute care hospital pursuant to (a) above shall include:

(1) Community participation services;

(2) Residential habilitation;

(3) Respite;

(4) Service coordination;

(5) Supported employment;

(6) Assistive technology;

(7) Community support services;

(8) Crisis response services;

(9) Environmental and vehicle modification services;

(10) Individual goods and services;

(11) Personal emergency response services;

(12) Removable prosthodontic services;

(13) Specialty services; and

(14) Wellness coaching.

History

#4315, eff 9-25-87; EXPIRED: 9-25-93
#6360, eff 10-23-96, EXPIRED: 10-23-04
#8195, INTERIM, eff 10-29-04, EXPIRED: 4-27-05
#8424, eff 9-1-05; ss by #10454, eff 10-31-13; ss by #13988, eff 5-30-24

N.H. Code Admin. R. Ann. He-M 517.07 Out of State Service Provision {#sec-he-m-517.07 omnilex-key=us-nh-regs-official--agency-he-m--He-M 517.07}

(a) Services outlined in (c) below shall be provided outside of New Hampshire as follows:

(1) When the only safe and accessible setting is outside of New Hampshire;

(2) Only until a safe and accessible setting is available in New Hampshire or in their community in accordance with (d) below;

(3) The services are approved by the bureau in accordance with (b) below; and

(4) The services are outlined in the individual’s service agreement to reflect the amount, scope, duration, and frequency of the service and the oversight and monitoring of the service agreement.

(b) Out-of-state service provisions shall be requested via written request to the bureau and include:

(1) A transition plan with a timeframe for return to New Hampshire;

(2) Verification that the provider agency meets criteria in accordance with He-M 504, He-M 506, He-M 507, and He-M 518, as applicable;

(3) Demonstration that the provider is in good standing through licensing or certification reports from the previous 5 years, or the maximum number available for providers established within the previous 5 years, from any in-state or out-of-state entity, including deficiency reports and compliance records;

(4) A plan articulated in the service agreement to demonstrate how an individual will access acute care as well as ongoing medical and clinical needs that are not covered by the home and community-based waiver; and

(5) A plan articulated in the service agreement for oversight and monitoring of the service plan in accordance with He-M 503 or He-M 522.

(1) Community participation services;

(2) Residential habilitation;

(3) Supported employment;

(4) Assistive technology;

(5) Community integration services;

(6) Community support services;

(7) Crisis response services;

(8) Environmental and vehicle modification services;

(9) Individual goods and services;

(10) Non-medical transportation;

(11) Personal emergency response services;

(12) Removable prosthodontic services;

(13) Specialty services; and

(14) Wellness coaching.

(d) The provisions outlined in (a)-(b) shall not apply when an individual is requesting services in a town outside of New Hampshire that is not more than a 30 minute drive.

History

#4315, eff 9-25-87; EXPIRED: 9-25-93
#6360, eff 10-23-96, EXPIRED: 10-23-04
#8195, INTERIM, eff 10-29-04, EXPIRED: 4-27-05
#8424, eff 9-1-05; amd by #9370, eff 1-24-09; ss by #10454, eff 10-31-13; ss by #13988, eff 5-30-24

N.H. Code Admin. R. Ann. He-M 517.08 Participant Directed and Managed Services. {#sec-he-m-517.08 omnilex-key=us-nh-regs-official--agency-he-m--He-M 517.08}

(a) Services that are accessed through the participant directed and managed method of service delivery shall:

(1) Be provided pursuant to He-M 525;

(2) Be available for individuals and their families in order to improve or maintain each individual’s health and their experiences and opportunities in work and community life;

(3) Consist of assistance and resources within a flexible process that allows the family and individual to control, to the extent desired, the service provision, including, for each service:

a. The type;

b. The amount;

c. The location;

d. The duration; and

e. The service provider agency and provider;

(4) Be based on an individual service agreement that includes:

a. A description of the services to be provided that also specifies the expenditures to be made;

b. A line-item budget; and

c. A process for measuring the individual’s degree of satisfaction with the services provided;

(5) Not be provided by the spouse of an individual, except as provided in He-M 517.10(g) below, or the parent of an individual where the individual is a minor child;

(6) Be provided by persons qualified pursuant to He-M 504.03, He-M 504.04, He-M 504.11, He-M 525.05, and He-M 525.06, as applicable; and

(7) Be reimbursed in accordance with the process for each service provided as outlined in He-M 517.05.

(b) Participant directed and managed services documentation shall include:

(1) Individual records, including:

a. Information about the individual that would be essential in case of an emergency, including that information specified in He-M 517.09 (b)(1);

b. The portion of the individual’s service agreement pertaining to participant directed and managed services, with any revisions;

c. Monthly progress notes;

d. Monthly notes describing the family’s satisfaction with the services; and

e. Monthly financial statements provided to the individual and family by the service coordinator; and

(2) Detailed description of all services provided, including:

a. The date;

b. The activity or type of service;

c. The location;

d. The duration;

e. The provider agency and provider; and

f. Documentation required for the services provided as outlined in He-M 517.10.

History

#4315, eff 9-25-87; EXPIRED: 9-25-93
#6360, eff 10-23-96, EXPIRED: 10-23-04
#8195, INTERIM, eff 10-29-04, EXPIRED: 4-27-05
#8424, eff 9-1-05; amd by #9370, eff 1-24-09; ss by #10454, eff 10-31-13; ss by #13988, eff 5-30-24

N.H. Code Admin. R. Ann. He-M 517.09 Non-Covered Services {#sec-he-m-517.09 omnilex-key=us-nh-regs-official--agency-he-m--He-M 517.09}

The following services shall not be fundable under home and community-based care waivers:

(a) Educational services or education programs for individuals who are under 22 years of age that are the responsibility of the local education authority;

(b) Post-secondary education, regardless of whether it leads to a degree;

(d) Custodial care programs provided only to maintain an individual’s basic welfare;

(e) Services that are recreational or diversional in nature;

(f) Services which are available under the medicaid state plan; and

(g) Experimental or prohibited treatments.

History

#4315, eff 9-25-87; EXPIRED: 9-25-93
#6360, eff 10-23-96, EXPIRED: 10-23-04
#8195, INTERIM, eff 10-29-04, EXPIRED: 4-27-05
#8424, eff 9-1-05; ss by #10454, eff 10-31-13; ss by #13988, eff 5-30-24 (formerly He-M 517.06)

N.H. Code Admin. R. Ann. He-M 517.10 Documentation {#sec-he-m-517.10 omnilex-key=us-nh-regs-official--agency-he-m--He-M 517.10}

(a) Provider agencies of home and community‑based care for individuals with developmental disabilities or acquired brain disorders shall maintain the documentation described in (b)-(r) below at the sites where services are provided.

(b) Service coordination records shall include:

(1) Information about the individual that would be essential in case of an emergency, including:

a. Name, address, and telephone number of legal guardian, representative, or next of kin; and

b. Medical information, including:

Diagnosis(es);
Health history;
Medications, including dose, frequency, and route;
Allergies;
Do not resuscitate (DNR) status;
Advance directives created in accordance with RSA 137-J; and
Any correspondence related to medical information relevant to the individual;

(2) A copy of each individual’s service agreement;

(3) Copies of all service agreement revisions approved by the individual or their guardian;

(4) Documentation of service agreement monitoring pursuant to He-M 503 or He-M 522 including:

a. Progress notes on goals for which the service coordinator has primary responsibility;

b. Monthly documentation by the service coordinator of service coordination activities, including activities promoting community participation and integration; and

c. At least quarterly documentation of face-to-face visits, inclusive of those that occur in the individual’s home, assessing progress on goals and identifying whether the services:

Match the interests and needs of the individual;
Met with the individual’s and guardian’s satisfaction; and
Meet the terms of the service agreement;

(5) Copies of all evaluations and reviews by providers and professionals;

(6) Copies of correspondence within the past year with the individual or guardian, providers, physicians, attorneys, state and federal agencies, family members, and others in the individual’s life with whom the service coordinator has corresponded; and

(7) Other correspondence or memoranda concerning any significant events in the individual’s life.

(c) For residential habilitation services provided in a community residence pursuant to He-M 1001, services documentation shall include:

(1) Individual records, which shall include:

a. Information about the individual that would be essential in case of an emergency, including that information specified in (b)(1) above;

b. The portion of the service agreement pertaining to residential services, with any revisions; and

c. Monthly progress notes;

(2) Community residence daily service provision records, which shall:

a. Be completed by the provider agency;

b. Include the date;

c. Indicate each individual’s daily presence or absence;

d. If the individual is not present, indicate the date and time of the individual’s departure and return, and include the reason for the absence;

e. For those community residences where supervision is less than 24 hours a day, indicate the days in which services were provided; and

f. Be on file at both the community residence and the provider agency; and

(3) A daily medication log, which shall be completed at the residence pursuant to He-M 1201.07.

(d) For services provided in a family home pursuant to He-M 521, documentation shall include:

(1) Individual records, which shall include:

a. Information about the individual that would be essential in case of an emergency, including that information specified in (b)(1) above;

b. The portion of the service agreement pertaining to residential services with any revisions; and

c. Monthly progress notes; and

(2) Daily service provision records, which shall:

a. Be completed by the provider agency;

b. Include the date; and

c. Indicate days that services were provided.

(e) For community participation services pursuant to He-M 507, individual records shall include:

(1) A copy of the current service agreement containing:

a. Goals and desired outcomes specific to the individual’s participation in community participation services; and

b. The methods or strategies for achieving the individual’s community participation services’ goals and desired outcomes;

(2) As a guide for planning activities, an individual, week-long, personal schedule or calendar that is created at the time of the annual service planning meeting and, if applicable, identifies:

a. The days, times, and locations of the individual’s:

Paid employment;
Community activities, volunteerism, or internship; and
Other regularly recurring activities, such as therapeutic activities related to communication, mobility, and personal care; and

b. The days and approximate times of unspecified community activities, which shall not exceed 20% of the total day service hours the individual receives per week;

(3) A record of daily community participation services activities maintained by the provider agency, which shall include the following:

a. The name(s) of individual(s) served and names of staff supporting them;

b. The dates on which services were provided; and

c. Activities that took place and the locations of the activities;

(4) Narrative progress notes, and other service documentation as specified in the service agreement, recorded at least monthly, and addressing:

a. The individual’s community participation services goals and actual outcomes; and

b. Other activities related to the individual’s support services, health, interests, achievements, and relationships;

(5) The individual’s medical status, including current medications, known allergies, and other pertinent health care information;

(6) Results of any screenings or evaluations including, if applicable:

a. The Supports Intensity Scale, SIS-A ® (2023 edition), available as noted in Appendix A;

b. Vocational assessments;

c. Results of any assistive technology assessments;

d. The Health Risk Screening Tool (HRST) (2015 edition), available as noted in Appendix A;

e. Systematic, therapeutic, assessment, respite and treatment (START) in-depth assessments and crisis plans; and

f. Risk management plans for individuals who are deemed to pose a risk to community safety; and

(7) For each individual for whom medications are administered during community participation services, medication log documentation pursuant to He-M 1201.07.

(f) Individual records for supported employment services shall include:

(1) Information about the individual that would be essential in case of an emergency, including that information specified in (b)(1) above;

(2) The portion of the service agreement pertaining to employment services, with any revisions;

(3) Quarterly progress notes regarding services provided and progress toward goals identified in the service agreement;

(4) Weekly work schedules; and

(5) If there is a provider agency staff person with the individual or individuals at the job site:

a. Service provision records, including documentation of the individual’s attendance at work; and

b. As needed, notation of any employment-related events apart from each individual’s expected work routine.

(g) Respite service records shall include attendance records indicating the dates and duration of the services provided.

(h) Environmental and vehicle modification services documentation shall include:

(1) A specific description of the modifications and estimate(s) of cost, in accordance with He-M 517.08;

(2) A rationale as to why the requested modification is specifically related to the individual’s disability;

(3) The section of the individual’s service agreement that outlines the need for the modifications; and

(4) The date of completion.

(i) Crisis response services documentation shall include:

(1) A brief description of the crisis in the service agreement written by the service coordinator;

(2) A summary of the crisis response services proposed;

(3) Monthly progress notes, including a description of the services provided and the individual’s response to services; and

(4) Service provision records indicating the units of services provided.

(j) Community support services documentation shall include:

(1) Individual records, which shall include:

a. Information about the individual that would be essential in case of an emergency, including that information specified in (b)(1) above;

b. A service agreement with all approved revisions; and

c. Monthly progress notes; and

(2) Service provision records indicating the units of services provided.

(k) Assistive technology documentation shall include:

(1) A brief statement in the service agreement describing:

a. The item or service;

b. The name of the healthcare practitioner recommending the item or service;

c. An evaluation or assessment regarding the appropriateness of the item;

d. A goal related to the use of the item;

e. The anticipated environment in which any item will be used; and

f. Current modifications to the item or product and anticipated future modifications and anticipated cost;

(2) Records indicating the dates and services provided; and

(3) For lease of assistive technology equipment, a written proposal for the cost of the lease.

(l) Specialty services shall include:

(1) Documentation in the service agreement of:

a. The service;

b. An evaluation or assessment regarding the need for the services; and

c. The nature of the service, date, and number of units; and

(2) Records indicating the dates, units and services provided.

(m) Community integration services shall include:

(1) Documentation in the service agreement of:

a. The service;

b. The name of the healthcare practitioner recommending the service when a single service exceeds $2,000 except when such service is a community-based campership;

c. An evaluation or assessment regarding the appropriateness of the services; and

d. The individual’s goal(s) that will be supported through the use of the service; and

(2) Records indicating the dates, costs and services provided.

(n) Individual goods and services documentation shall include:

(1) A summary in the service agreement to include:

a. The service;

b. The duration of any service to include a finite end-date;

c. An evaluation or assessment regarding the appropriateness of the services; and

d. A goal related to the use of the service;

(2) Monthly documentation, pursuant to He-M 503.10, related to the use of the item or service to include:

a. The frequency of purchase; and

b. That the item continues to meet the individual’s identified need; and

(3) Records indicating the dates, costs, and services provided.

(o) Non-medical transportation shall include:

(1) Documentation in the service agreement of:

a. The service; and

b. How the service will be utilized; and

(2) Records indicating the dates and costs of services provided.

(p) Personal emergency response system shall include:

(1) Documentation in the service agreement of:

a. The service; and

b. An evaluation or assessment regarding the need for the services; and

(2) Records indicating the dates, costs, and services provided.

(q) Wellness coaching shall include:

(1) Documentation in the service agreement of:

a. The service;

b. An evaluation or assessment regarding the need for the services; and

c. The desired wellness goals and outcomes for the individual over the coming year; and

(2) Records indicating the dates, costs, and services provided.

(r) Removable prosthodontic services documentation shall include:

(1) Documentation in the service agreement of the need for the service;

(2) Treatment notes;

(3) Radiographic images;

(4) Laboratory prescriptions; and

(5) Laboratory invoices.

(s) Each provider agency shall retain individual records for a period of 6 years following the termination of services to an individual.

History

#4315, eff 9-25-87; EXPIRED: 9-25-93
#6360, eff 10-23-96, EXPIRED: 10-23-04
#8195, INTERIM, eff 10-29-04, EXPIRED: 4-27-05
#8424, eff 9-1-05 (from He-M 517.09) ; ss by #10454, eff 10-31-13; ss by #13988, eff 5-30-24 (formerly He-M 517.07)

N.H. Code Admin. R. Ann. He-M 517.11 Utilization Control {#sec-he-m-517.11 omnilex-key=us-nh-regs-official--agency-he-m--He-M 517.11}

(a) Requests for prior service authorization shall be made to the bureau electronically utilizing NH Easy via https://nheasy.nh.gov/#/, and shall include the service, amount, scope, frequency, and duration.

(b) To request prior service authorization of a change in covered services within a current authorization period, the service coordinator shall complete and submit, via NH Easy at https://nheasy.nh.gov/#/, updated information to reflect the change in the service, amount, scope, frequency, or duration.

(c) The bureau shall approve or deny requests for prior service authorization following determination and approval of the need for services pursuant to He‑M 517.03 and development of a service agreement pursuant to He-M 503.10 or He-M 522.11.

(d) If information submitted pursuant to (b) or (c) above, or similar information obtained at any other time by the bureau, indicates that an individual might no longer meet the criteria for home and community-based care specified in He-M 517.03(a)(3) a. or b., the bureau shall redetermine the individual’s eligibility pursuant to He-M 517.03(a)(3).

(e) Any request for an environmental or vehicle modification shall include:

(1) Two cost estimates when the modification is in excess of $7,500 to include the following, as applicable to the modification:

a. A breakdown of costs between labor and materials;

b. A list of supplies and materials;

c. Blueprints or scaled drawings, if applicable;

d. The name(s) of any subcontractors that will be involved;

e. Written confirmation of whether or not a building permit is required;

f. A written statement if the individual or guardian, if applicable, prefers the more expensive bid over the other, to include an explanation of the preference;

(2) If electrical or plumbing work is required to support the modification, then:

a. A statement signed by the selected plumber or electrician stating that the requested modification can be done within the current electrical or plumbing capacity of the residence; and

b. A copy of the selected electrician or plumber’s license;

(3) A statement signed by the selected provider agency affirming knowledge of all applicable building codes and permitting requirements and affirming that any subcontractors involved in the work are appropriately licensed;

(4) An agreement signed by the selected provider agency stating that reimbursement for the authorized service through the bureau shall be payment in full; and

(5) A notarized written statement from the property owner granting permission to complete the project if the individual is not the owner of the residence.

(f) The bureau shall deny services through the HCBS waiver services if it determines that the provision of services will result in the loss of federal financial participation for such services.

(g) In every case of denial of a request for prior service authorization, the bureau shall notify the service coordinator, individual, guardian, or representative, in writing, of the decision and the reasons for the denial.

(h) Notification pursuant to (g) above shall include:

(1) The specific rules that support, or the federal or state law that requires, the action;

(2) An explanation of the individual’s right to request an appeal and the procedure and timelines set forth in He-M 517.12;

(3) Notice that the individual has the right to have representation with an appeal by:

a. Legal counsel;

b. A relative;

c. A friend; or

d. Another spokesperson;

(4) Notice that neither the area agency, service coordination agency, nor the bureau is responsible for the cost of representation; and

(5) Notice of organizations that might offer assistance or representation to the individual, including pro bono or reduced fee assistance.

History

#8424, eff 9-1-05 (from He-M 517.10); ss by #10454, eff 10-31-13; ss by #13988, eff 5-30-24 (formerly He-M 517.08)

N.H. Code Admin. R. Ann. He-M 517.12 Appeals {#sec-he-m-517.12 omnilex-key=us-nh-regs-official--agency-he-m--He-M 517.12}

(a) Within 30 working days of receipt of a final decision as described in He-M 517.03 or pursuant to He-M 517.11(g), the individual or guardian may appeal in accordance with He-C 200.

(b) Appeals shall be forwarded to the bureau administrator, in writing, in care of the department’s office of client and legal services.

(c) The bureau administrator shall immediately forward the appeal to the department’s administrative appeals unit which shall assign a presiding officer to conduct a hearing or independent review, as provided in He-C 200. The burden shall be as provided by He-C 203.14.

(d) If a hearing is requested, the following actions shall occur:

(1) For current recipients, services and payments shall be continued as a consequence of an appeal for a hearing until a decision has been made; and

(2) If the bureau’s decision is upheld, benefits shall cease 60 days from the date of the denial letter or 30 days from the hearing decision, whichever is later.

History

#4315, eff 9-25-87; EXPIRED: 9-25-93
#6360, eff 10-23-96, EXPIRED: 10-23-04
#8195, INTERIM, eff 10-29-04, EXPIRED: 4-27-05
#8424, eff 9-1-05; ss by #10454, eff 10-31-13; ss by #13988, eff 5-30-24 (formerly He-M 517.09)

N.H. Code Admin. R. Ann. He-M 517.13 Payment {#sec-he-m-517.13 omnilex-key=us-nh-regs-official--agency-he-m--He-M 517.13}

(a) Provider agencies shall submit claims for covered HCBS waiver services pursuant to He-M 504.05:

(b) Payment for HCBS waiver services shall only be made if prior service authorization has been obtained from the bureau pursuant to He-M 517.11.

(c) For those individuals whose net income exceeds the appropriate standard of need, medicaid claims payment shall reflect a reduction in reimbursement equal to the cost of care amount.

(d) Payment for environmental or vehicle modification services shall not be made until the bureau receives the following, as applicable to the modification:

(1) A copy of any required building permit and written confirmation from the building inspector that the work was completed as allowed by the permit;

(2) A signed statement from the individual or guardian, if applicable, stating that the work has been completed according to the approved bid and plans and to the satisfaction of the individual; and

(3) A signed confirmation from the service coordinator stating that the work was completed.

(e) Payment for HCBS waiver services shall not be available to any provider who:

(1) Is the parent of an individual under age 18;

(2) Is a person under age 18, except as permitted in He-M 525; or

(3) Is the spouse of an individual receiving services, except as provided in (g) below.

(f) Payment for provision of residential habilitation services to a person who is receiving services for an acquired brain disorder shall be available to a spouse when:

(1) The individual, or guardian, if applicable, choses the individual's spouse to provide the service;

(2) It is determined that this is in the best interest of the individual;

(3) At least one of the following applies:

The individual’s level of dependency in performing activities of daily living, including the need for assistance with toileting, eating, or mobility, exceeds that of the individual’s peers with an acquired brain disorder;
The individual requires support for a complex medical condition, including airway management, enteral feeding, catheterization, or other similar procedures; or
The individual’s need for behavioral management or cognitive supports exceeds that of the individual’s peers with an acquired brain disorder;

(4) The spouse meets all applicable provider qualifications in accordance with He-M 504.03, He-M 504.04, and He-M 504.11;

(5) The spouse does not provide more than 40 hours per week of residential habilitation services; and

(6) The service coordinator conducts service monitoring in accordance with He-M 522.09.

History

#4315, eff 9-25-87; EXPIRED: 9-25-93
#6360, eff 10-23-96, EXPIRED: 10-23-04
#8195, INTERIM, eff 10-29-04, EXPIRED: 4-27-05
#8424, eff 9-1-05 (from He-M 517.09) ; ss by #10454, eff 10-31-13; ss by #13988, eff 5-30-24 (formerly He-M 517.10)

N.H. Code Admin. R. Ann. He-M 517.14 Waivers {#sec-he-m-517.14 omnilex-key=us-nh-regs-official--agency-he-m--He-M 517.14}

(a) An applicant, area agency, provider agency, individual, guardian, or provider may request a waiver of specific procedures outlined in He-M 517 using the form titled “NH Bureau of Developmental Services Waiver Request” (October 2023).

(b) A completed waiver request form shall be signed by:

(1) The individual or guardian indicating agreement with the request, if applicable; and

(2) The provider agency’s executive director or designee recommending approval of the waiver, when the waiver is requested by a provider agency.

(1) Email to bds@dhhs.nh.gov; or

(2) Mail to:

Department of Health and Human Services

Bureau of Developmental Services

Hugh J. Gallen State Office Park

105 Pleasant Street, Main Building

Concord, NH 03301

(d) No provision or procedure prescribed by statute shall be waived.

(1) Does not negatively impact the health or safety of the individual(s); and

(2) Does not affect the quality of services to individuals.

(g) Waivers shall be granted in writing for the minimum period necessary to accommodate the waiver request, with a specific duration not to exceed 5 years except as in (h)-(i) below.

(h) Those waivers which relate to other issues relative to the health, safety, or welfare of individuals that require periodic reassessment shall be effective for the current certification period only.

(i) Any waiver shall end with the closure of the related program or service.

(j) A requesting entity may request a renewal of a waiver from the bureau. Such request shall be made at least 90 days prior to the expiration of a current waiver.

History

#8424, eff 9-1-05 (from He-M 517.10); ss by #10454, eff 10-31-13; ss by #13988, eff 5-30-24 (formerly He-M 517.11)

Part He-M 518 Employment Services

N.H. Code Admin. R. Ann. He-M 518.01 Purpose {#sec-he-m-518.01 omnilex-key=us-nh-regs-official--agency-he-m--He-M 518.01}

The purpose of these rules is to:

(a) Establish the requirements for employment services for individuals with developmental disabilities and acquired brain disorders served within the service delivery system who have an expressed interest in working;

(b) Provide access to comprehensive employment services by staff qualified pursuant to He-M 518.10; and

(1) Employment opportunities;

(2) Training and educational opportunities; and

(3) The use of co-worker supports and generic resources, to the maximum extent possible.

History

#4593, eff 4-1-89; EXPIRED: 4-1-95
#6569, eff 8-22-97; ss by #8406, eff 8-22-05; ss by #10397, INTERIM, eff 8-22-13, EXPIRES: 2-18-14; ss by #10493, eff 2-18-14; ss by #14040, eff 8-1-24

N.H. Code Admin. R. Ann. He-M 518.02 Definitions {#sec-he-m-518.02 omnilex-key=us-nh-regs-official--agency-he-m--He-M 518.02}

(a) “Acquired brain disorder” means a disruption in brain functioning that:

(1) Is not congenital or caused by birth trauma;

(2) Presents a severe and life-long disabling condition which significantly impairs a person’s ability to function in society;

(3) Occurs prior to age 60;

(4) Is attributable to one or more of the following reasons:

a. External trauma to the brain as a result of:

A motor vehicle incident;
A fall;
An assault; or
Another related traumatic incident or occurrence;

b. Anoxic or hypoxic injury to the brain such as from:

Cardiopulmonary arrest;
Carbon monoxide poisoning;
Airway obstruction;
Hemorrhage; or
Near drowning;

c. Infectious diseases such as encephalitis and meningitis;

d. Brain tumor;

e. Intracranial surgery;

f. Cerebrovascular disruption such as a stroke;

g. Toxic exposure; or

(5) Is manifested by one or more of the following:

a. Significant decline in cognitive functioning and ability; or

b. Deterioration in:

Personality;
Impulse control;
Judgment;
Modulation of mood; or
Awareness of deficits.

(b) “Area agency” means “area agency” as defined in RSA 171-A:2, I-b.

(d) “Bureau of vocational rehabilitation” means the New Hampshire department of education, bureau of vocational rehabilitation.

(e) “Career exploration” means as part of the career planning process, selection by an individual of a job, training, or educational path that fits their interests, skills, and abilities.

(f) “Career planning” means a time-limited, person-centered, comprehensive, employment planning process that assists an individual to identify a career direction and results in a plan for achieving employment at or above minimum wage.

(g) “Career portfolio” means a tool used to organize and document training, education, work experiences, skills, contributions, and accomplishments.

(h) “Customized employment” means the individualizing of the employment relationship between employees and employers in ways that meet the needs of both. It is based on an individualized determination of the strengths, needs, and interests of the individual, and is also designed to meet the specific needs of the employer.

(i) “Days” means calendar days unless otherwise specified.

(j) “Developmental disability” means “developmental disability” as defined in RSA 171‑A:2, V, namely, “a disability:

(k) “Employee” means an individual who receives wages in exchange for work rendered in an integrated setting.

(l) “Employment” means working for at least minimum wage in an integrated setting or being self-employed.

(m) “Employment professional” means a provider who meets the criteria in He-M 518.10 (e)(1) and (2).

(n) “Employment profile” means a summary of an individual’s vocationally-related:

(1) Competencies;

(2) Interests;

(3) Preferences;

(4) Learning style;

(5) Environmental considerations; and

(6) Supports.

(o) “Fading plan” means a specific plan that is developed to assist an individual to achieve maximum independence on the job through a variety of activities including cultivating natural supports.

(p) “Hard skills” means the essential skills required to perform a job such as, but not limited to:

(1) Operating machinery;

(2) Using a computer;

(3) Providing customer service; and

(4) Typing.

(q) “Individual” means any person who has a developmental disability or acquired brain disorder.

(r) “Integrated setting” means a workplace where people with disabilities work alongside other employees who do not have disabilities and where they have the same opportunities to participate in all activities in which other employees participate.

(s) “Job coaching” means the training of an employee through structured intervention techniques to help the employee learn to perform job tasks to the employer’s specifications and to learn the interpersonal skills necessary to be accepted as a worker at the job site and in related community contacts.

(t) “Job development” means contacting and connecting with employers to identify, develop, or customize jobs suited to individuals’ skills and interests.

(u) “National core indicators” means standard measures compiled by the National Association of State Directors of Developmental Disabilities Services and the Human Services Research Institute and used across states to assess the outcomes of services provided to individuals and families. Indicators address key areas of concern including employment, rights, service planning, community inclusion, choice, and health and safety. National core indicators are published as annual reports, state reports, and consumer outcomes reports, and are available at http://www.nationalcoreindicators.org/.

(v) “Natural support” means support wherein a community business provides direct training, supervision, or assistance to an employee.

(w) “Person-centered service planning” is an individual-directed, positive approach to the planning and coordination of a person’s services and other supports based on the individual’s aspirations, needs, preferences, and goals.

(x) “Provider” means a person receiving any form of remuneration for the provision of services to an individual.

(y) “Provider agency” means an agency or independent provider that is established to provide services to individuals and meets the criteria in He-M 504.

(z) “Safeguards” means specific measures taken to protect the individual from harm or loss.

(aa) “Service agreement” means a written agreement between the individual, guardian, or representative, and provider agency that is prepared as a result of the person-centered service planning process and that describes the services that an individual will receive and constitutes an individual service agreement as defined in RSA 171-A:2, X and developed pursuant to He-M 503.10 or He-M 522.11.

(ab) “Service coordinator” means a provider who meets the criteria in He-M 503.08 or He-M 522.09 and is chosen by an individual and their guardian or representative to organize, facilitate, and document service planning and to negotiate and monitor the provision of the individual’s services.

(ac) “Soft skills” means the interpersonal skills required to be successful in a job, such as:

(1) Effective communication;

(2) Managing emotions;

(3) Conflict resolution;

(4) Creative problem solving;

(5) Critical thinking; and

(6) Team building.

(ad) “Staff” means a person employed by a provider agency, subcontract agency, or other employer.

(ae) “Work incentives” means special regulations developed by the Social Security Administration making it possible for people with disabilities receiving Social Security or Supplemental Security Income (SSI) to work and still receive monthly payments and Medicare or Medicaid, including:

(1) Trial work period, 20 CFR 404.1592;

(2) Impairment related work expenses, 20 CFR 404.1576;

(3) Extended period of eligibility, 20 CFR 404,1592a;

(4) Extended Medicare coverage for Social Security Disability Insurance, 42 CFR 406.12(e);

(5) Earned income exclusion, 20 CFR 418.3325;

(6) Continued Medicaid eligibility, section 1619(b) of the Social Security Act;

(7) Plan to achieve self-support, 20 CFR 416.1225;

(8) Ticket to work program, 20 CFR part 411, subpart B;

(9) Impairment-related work expenses, 20 CFR 404.1576;

(10) Expedited reinstatement, 20 CFR 416.999;

(11) Unsuccessful work attempt, 20 CFR 416.974; and

(12) Medicaid for employed adults with disabilities (MEAD), pursuant to He-W 504.

(af) “Work incentives planning” means specific planning around earning income, managing public benefits, and accessing work incentives.

History

#4593, eff 4-1-89; EXPIRED: 4-1-95
#6569, eff 8-22-97; ss by #8406, eff 8-22-05; ss by #10397, INTERIM, eff 8-22-13, EXPIRES: 2-18-14; ss by #10493, eff 2-18-14; ss by #14040, eff 8-1-24

N.H. Code Admin. R. Ann. He-M 518.03 Service Principles {#sec-he-m-518.03 omnilex-key=us-nh-regs-official--agency-he-m--He-M 518.03}

(a) All employment services shall be designed to:

(1) Assist the individual to obtain employment or self-employment that is based on the individual’s employment profile and goals as outlined in the service agreement;

(2) Provide the individual with opportunities to participate in a comprehensive career development process that helps to identify, in a timely manner, the individual’s employment profile;

(3) Support the individual to develop appropriate skills for job searching, including:

a. Creating a resume and employment portfolio;

b. Practicing job interviews; and

c. Learning soft skills that are essential for succeeding in the workplace;

(4) Assist the individual to become as independent as possible in their employment, internships, and education and training opportunities by:

a. Developing accommodations;

b. Utilizing assistive technology; and

c. Creating and implementing a fading plan;

(5) Help the individual to:

a. Meet their goal for the desired number of hours of work as outlined in the service agreement; and

b. Earn wages of at least minimum wage or prevailing wage, unless the individual is pursuing income based on self-employment;

(6) Assess, cultivate, and utilize natural supports within the workplace to assist the individual to achieve independence to the greatest extent possible;

(7) Help the individual to learn about, and develop appropriate social skills to actively participate in, the culture of their workplace;

(8) Understand, respect, and address the business needs of the individual’s employer, in order to support the individual to meet appropriate workplace standards and goals;

(9) Maintain communication with, and provide consultations to, the employer to:

a. Address employer specific questions or concerns to enable the individual to perform and retain their job; and

b. Explore opportunities for further skill development and advancement for the individual;

(10) Help the individual to learn, improve, and maintain a variety of life skills related to employment, such as:

a. Traveling safely in the community;

b. Managing personal funds;

c. Utilizing public transportation; and

d. Other life skills identified in the service agreement related to employment;

(11) Promote the individual’s health and safety;

(12) Protect the individual’s right to freedom from abuse, neglect, and exploitation;

(13) Protect the individual’s rights in accordance with He-M 310; and

(14) Provide opportunities for the individual to exercise personal choice and independence within the bounds of reasonable risks.

(b) An individual, guardian, or representative may select any available provider that is qualified pursuant to He-M 504.03, He-M 504.04, and He-M 504.11, to deliver the employment services identified in the individual’s service agreement in accordance with He-M 518.05 and He-M 518.10.

(1) Comply with applicable rules, the 1915(c) home and community-based waiver service authority and any other federal laws, rules, and regulations, when applicable;

(2) Meet the provisions specified within the individual’s service agreement; and

(3) Meet the needs of the individual while taking into account the interests and obligations of the employer.

History

#4593, eff 4-1-89; EXPIRED: 4-1-95
#6569, eff 8-22-97; ss by #8406, eff 8-22-05; ss by #10397, INTERIM, eff 8-22-13, EXPIRES: 2-18-14; ss by #10493, eff 2-18-14; ss by #14040, eff 8-1-24

N.H. Code Admin. R. Ann. He-M 518.04 Eligibility For Employment Services {#sec-he-m-518.04 omnilex-key=us-nh-regs-official--agency-he-m--He-M 518.04}

(a) Employment services shall be available to any individual who:

(1) Has been referred to the bureau of vocational rehabilitation at the start of the employment planning process to first assess if the service the individual needs is provided and available by vocational rehabilitation, and it has been determined that the individual requires employment supports in excess of the vocational rehabilitation services available to the individual;

(2) Is found to be eligible for Home and Community Based waiver services (HCBS services) in accordance with He-M 503.05 or He-M 522.05;

(3) Has a service agreement that includes the goals and desired outcomes that will be addressed through the provision of employment services; and

(4) Has a prior authorization requested by the agency intending to provide employment services through the Medicaid program using the procedure outlined in He-M 517.11.

(b) The determination or confirmation that the individual has an employment goal and desires services shall occur at or by:

(1) The preliminary recommendations for services process under He-M 503.05 or He-M 522.05;

(2) The service planning required by He-M 503.09 or He-M 522.10;

(3) The transition process described in Ed 1109.01 (a)(10) for individuals beginning at age 14 or younger, as applicable who are in school; or

(4) Any other informal or formal means by which the individual expresses a desire to work.

History

#4593, eff 4-1-89; EXPIRED: 4-1-95
#6569, eff 8-22-97; ss by #8406, eff 8-22-05; ss by #10397, INTERIM, eff 8-22-13, EXPIRES: 2-18-14; ss by #10493, eff 2-18-14 (from He-M 518.03); ss by #14040, eff 8-1-24

N.H. Code Admin. R. Ann. He-M 518.05 The Individual Employment Planning Process {#sec-he-m-518.05 omnilex-key=us-nh-regs-official--agency-he-m--He-M 518.05}

(a) As part of the person-centered service planning process, the individual’s service coordinator shall include employment planning for each individual seeking or receiving employment services.

(b) The employment planning process shall:

(1) Be led by an employment professional qualified pursuant to He-M 518.10(e); and

(2) Include:

a. A vocational evaluation or an assessment of employment interests and capacities;

b. Development of an employment profile to include:

Learning style;
Environmental needs;
Medical needs;
Physical needs; and
Safety needs;

c. Career exploration;

d. Goal setting;

e. Development of soft skills;

f. Development of hard skills through:

Internships;
Sector-based training;
Continuing education;
On-the-job training; and
Unpaid work experiences;

g. Development of strategies for achieving employment;

h. Transportation planning and training to independently use transportation options;

i. Community safety skills training; and

j. Work incentives planning.

(1) An employment profile of the individual;

(2) A resume and employment portfolio;

(3) Employment goal(s) and strategies with specific timeframes for achieving the goal(s) that include:

a. Skills training;

b. Increased responsibilities;

c. Career advancement;

d. Increased wages;

e. Increased hours worked;

f. Change in employment; and

g. Any other identified goals;

(4) Referral to the bureau of vocational rehabilitation;

(5) Identification of the roles and responsibilities of team members in implementing the goal(s) and service(s); and

(6) Identification of any of the services listed in He-M 518.07 to achieve the goal(s).

History

#4593, eff 4-1-89; EXPIRED: 4-1-95
#6569, eff 8-22-97; ss and moved by #8406, eff8-22-05 (from He-M 518.06); ss by #10397, INTERIM, eff 8-22-13, EXPIRES: 2-18-14; ss by #10493, eff 2-18-14 (from He-M 518.04); ss by #14040, eff 8-1-24

N.H. Code Admin. R. Ann. He-M 518.06 Wages {#sec-he-m-518.06 omnilex-key=us-nh-regs-official--agency-he-m--He-M 518.06}

(a) All wages shall be paid to employees in accordance with the Fair Labor Standards Act as specified in 29 U.S.C. 201 et seq., and any other applicable state and federal statutes, rules, and regulations.

(b) Whenever possible, wages shall be in the form of payment made directly to the employee by the employer.

(c) In those situations when payments are made to the employee by the provider agency, wages shall be set based on the minimum wage pursuant RSA 279:21.

(d) In no event shall Medicaid or bureau funds be used to pay or subsidize wages otherwise earned by employees.

History

#4593, eff 4-1-89; EXPIRED: 4-1-95
#6569, eff 8-22-97; ss and moved by #8406, eff8-22-05 (from He-M 518.07); ss by #10397, INTERIM, eff 8-22-13, EXPIRES: 2-18-14; ss by #10493, eff 2-18-14 (from He-M 518.05); ss by #14040, eff 8-1-24

N.H. Code Admin. R. Ann. He-M 518.07 Covered Services {#sec-he-m-518.07 omnilex-key=us-nh-regs-official--agency-he-m--He-M 518.07}

(a) All employment services shall be:

(1) Designed in accordance with the individual’s specific needs, interests, competencies, and learning style, as described in the individual’s service agreement and employment profile as outlined in He-M 503.10 or He-M 522.11;

(2) To assist each individual to assume as much personal responsibility in job seeking and job retention as is possible for that individual;

(3) Responsive to the individual’s changing needs and choices within the limitations of federal and state laws, rules, and regulations;

(4) Provided only after the informed consent of the individual or their guardian or representative;

(5) Free from conflict in accordance with He-M 503.08 or He-M 522.09;

(6) Delivered by any willing and qualified provider agency or provider that is freely chosen by the individual or individual’s guardian or representative and who meets the criteria in He-M 504; and

(7) Provided in accordance with He-M 310.

(b) Payments for employment services shall cover:

(1) All services identified in He-M 518.05;

(2) Job development;

(3) Assistance, as needed, with employment including:

a. Job applications;

b. Resume-writing;

c. Obtaining references;

d. Development of a career portfolio;

e. Interview preparation; and

f. All other activities related to obtaining and maintaining employment except as described in (10) below;

(4) Training for the individual to learn the responsibilities and expectations of employment, including:

a. Acquiring or developing acceptable work standards and workplace behavior;

b. Adjusting to the job site and work culture; and

c. Using accommodations, including any customized modifications made to perform the job;

(5) Implementation of the fading plan;

(6) Consultations or contacts with the businesses and the individual, as needed, to assist the individual to remain successfully employed;

(7) Outreach to employers for building relationships that lead to immediate or future job opportunities for the individual;

(8) Training for direct support staff as it relates to the individual’s employment goals;

(9) Training for employers and co-workers to support the individual by understanding their:

a. Learning style;

b. Environmental needs;

c. Medical needs;

d. Physical needs; and

e. Safety needs;

(10) When combined with another employment service, transportation and training in accessing transportation, as appropriate, to and from work;

(11) Referral, evaluation, and consultation for adaptive equipment, environmental modifications, communications technology or other forms of assistive technology, and educational opportunities related to the individual’s employment services and goals;

(12) Accessing work incentives information and work incentives planning services for the individual; and

(13) Any other employment service identified in the individual’s service agreement.

History

#4593, eff 4-1-89; EXPIRED: 4-1-95
#6569, eff 8-22-97; ss and moved by #8406,eff 8-22-05 (from He-M 518.09); ss by #10397, INTERIM, eff 8-22-13, EXPIRES: 2-18-14; ss by #10493, eff 2-18-14 (from He-M 518.06); ss by #14040, eff 8-1-24

N.H. Code Admin. R. Ann. He-M 518.08 Employment Planning for Individuals in School {#sec-he-m-518.08 omnilex-key=us-nh-regs-official--agency-he-m--He-M 518.08}

(a) Beginning at age 14, or younger if applicable, the individual and their family and school personnel shall be given information by the area agency staff regarding:

(1) The employment services that are available within the adult service system;

(2) The importance of planning ahead for achieving successful employment outcomes in the future;

(3) Work incentives planning; and

(4) The bureau of vocational rehabilitation as a source of assistance regarding employment opportunities.

(b) In their communications with the individual, family, and schools, area agency staff shall continuously reinforce the importance of employment opportunities and facilitate as applicable, their development.

History

#4593, eff 4-1-89; EXPIRED: 4-1-95
#6569, eff 8-22-97; ss and moved by #8406, eff8-22-05 (from He-M 518.10); ss by #10397, INTERIM, eff 8-22-13, EXPIRES: 2-18-14; ss by #10493, eff 2-18-14; ss by #14040, eff 8-1-24

N.H. Code Admin. R. Ann. He-M 518.09 Records and Reporting {#sec-he-m-518.09 omnilex-key=us-nh-regs-official--agency-he-m--He-M 518.09}

Each provider agency shall:

(a) Maintain records and provide documentation as outlined in He-M 504.03 and He-M 504.04 and He-M 517.10 for all individuals receiving services pursuant to He-M 518.05 and He-M 518.07; and

(b) At least annually, assess the employment service through interviews with employers, individuals, and guardians.

History

#4593, eff 4-1-89; EXPIRED: 4-1-95
#6569, eff 8-22-97; ss and moved by #8406, eff8-22-05 (from He-M 518.11) ); ss by #10397, INTERIM, eff 8-22-13, EXPIRES: 2-18-14; ss by #10493, eff 2-18-14 (from He-M 518.07); ss by #14040, eff 8-1-24

N.H. Code Admin. R. Ann. He-M 518.10 Staff Qualifications and Responsibilities {#sec-he-m-518.10 omnilex-key=us-nh-regs-official--agency-he-m--He-M 518.10}

(a) Each provider agency shall have:

(1) Personnel qualified pursuant to (b) and (c) below, available to meet the individual and collective employment-related needs of each individual served; and

(2) Staff who meet the requirements of (e) or (f) below.

(b) Prior to a person providing employment services to individuals, the provider agency, with the consent of the person, shall complete the necessary registration, criminal background, and office of the inspector general exclusion list checks in accordance with He-M 504.03

(1) Obtain at least 2 references for the person; and

(2) Complete a motor vehicles record check to ensure that the person has a valid driver’s license if such provider will be transporting individuals.

(d) Provider agencies shall provide initial and ongoing training as required in He-M 506.05 and as required to implement services in He-M 518.05 and He-M 518.07.

(e) Employment professionals shall:

(1) Meet one of the following criteria:

a. Have completed, or complete within the first 12 months of becoming an employment professional, training that meets the national competencies for job development and job coaching, as established by the Association of People Supporting Employment First (APSE) in “APSE Universal Employment Competencies” (Revision 2019), available as noted in Appendix A; or

b. Have obtained the designation as a Certified Employment Services Professional through the Employment Services Professional Certification Commission (ESPCC), an affiliate of APSE; and

(2) Obtain 12 hours of continuing education annually in subject areas pertinent to employment professionals including, at a minimum:

a. Employment;

b. Customized employment;

c. Task analysis or systematic instruction;

d. Marketing and job development;

e. Discovery;

f. Person-centered employment planning;

g. Work incentives for individuals and employers;

h. Job accommodations;

i. Assistive technology;

j. Vocational evaluation;

k. Personal career profile development;

l. Situational assessments;

m. Writing meaningful vocational objectives;

n. Writing effective resumes and cover letters;

o. Understanding workplace culture;

p. Job carving;

q. Understanding laws, rules, and regulations;

r. Developing effective on the job training and supports;

s. Developing a fading plan and natural supports;

t. Self-employment; and

u. School to work transition.

(f) At a minimum, job coaching staff shall be trained on all of the following prior to supporting an individual in employment:

(1) Understanding and respecting the business culture and business needs;

(2) Task analysis;

(3) Systematic instruction;

(4) How to build natural supports;

(5) Implementation of the fading plan;

(6) Effective communication with all involved;

(7) Methods to maximize the independence of the individual on the job site; and

(8) Understanding individual specific health-related requirements including but not limited to any special, cognitive, mental health, or behavioral needs.

(g) Supervisors of employment professionals shall ensure employment professionals and job coaches meet the criteria outlined in (e) and (f) above.

History

#10493, eff 2-18-14 (from He-M 518.08); ss by #14040, eff 8-1-24

N.H. Code Admin. R. Ann. He-M 518.11 Oversight and Quality Improvement {#sec-he-m-518.11 omnilex-key=us-nh-regs-official--agency-he-m--He-M 518.11}

(a) The director of employment services shall:

(1) Be responsible for providing oversight; and

(2) Evaluate, facilitate, and improve the quality of services being delivered and outcomes achieved.

(b) Each individual’s service coordinator shall provide oversight regarding the employment service arrangement and review and facilitate the effectiveness of the employment services being provided and outcomes achieved.

(c) In fulfilling the responsibilities cited in (a) and (b) above, the director of employment services and service coordinator shall consider whether the following criteria are being met:

(1) Services are customized and meet the interests, goals, and desired outcomes of the individual, as defined in the service agreement;

(2) Goals reflect the individual’s growth and evolving interests and are revised accordingly;

(3) The goals and desired outcomes identified in the service agreement are being achieved;

(4) Staff are knowledgeable of the individual’s service agreement as it pertains to employment services and are assisting in meeting the desired goals and outcomes;

(5) Services occur in integrated settings;

(6) Methods or strategies for achieving the individual’s employment services goals and desired outcomes are evident and documented; and

(7) Individuals, and guardians if applicable, are satisfied with services.

(d) The bureau shall develop and maintain an employment services leadership committee consisting of representation of employment professionals from area agencies, provider agencies, and the bureau of vocational rehabilitation.

(e) The employment services leadership committee shall:

(1) Review quarterly employment data reports, identify trends, and establish statewide employment benchmarks;

(2) Identify and ensure relevant employment training is available for individuals served, families, employment professionals, service coordinators, and other agency personnel;

(3) Annually review the memorandum of understanding between the bureau of developmental services and the bureau of vocational rehabilitation;

(4) Provide an annual report to the developmental services quality council, established pursuant to RSA 171-A:33, at the end of each fiscal year;

(5) Review national core indicators and other relevant data to measure individual and family satisfaction with employment services; and

(6) Support efforts to collaborate with business and industry.

History

#10493, eff 2-18-14; ss by #14040, eff 8-1-24

N.H. Code Admin. R. Ann. He-M 518.12 Waivers {#sec-he-m-518.12 omnilex-key=us-nh-regs-official--agency-he-m--He-M 518.12}

(a) An applicant, area agency, provider agency, individual, guardian, or provider may request a waiver of specific procedures outlined in He-M 518 by completing and submitting the form titled “NH bureau of developmental services waiver request” (October 2023 edition). The waiver request shall be submitted in writing to the bureau administrator.

(b) A completed waiver request form shall be signed by:

(1) The individual or guardian indicating agreement with the request; and

(2) The area agency or provider agency’s executive director or designee recommending approval of the waiver, when the waiver is requested by an area agency or a provider agency.

(1) Email at bds.dhhs.nh.gov; or

(2) By mail to:

The Bureau of Developmental Services

Hugh J. Gallen State Office Park

105 Pleasant Street, Main Building

Concord, NH 03301

(d) No provision or procedure prescribed by statute shall be waived.

(1) Does not negatively impact the health or safety of the individual(s); and

(2) Does not affect the quality of services to individuals.

(g) Waivers shall be granted in writing for the minimum period necessary to accommodate the waiver request, with the specific duration not to exceed 5 years except as in (h) and (i) below.

(h) Any waiver shall end with the closure of the related program or service.

(i) A requesting entity may request a renewal of a waiver from the bureau. Such request shall be made at least 90 days prior to the expiration of a current waiver.

History

#10493, eff 2-18-14 (from He-M 518.09); ss by #14040, eff 8-1-24

Part He-M 519 Family Support Services

N.H. Code Admin. R. Ann. He-M 519.01 Purpose {#sec-he-m-519.01 omnilex-key=us-nh-regs-official--agency-he-m--He-M 519.01}

The purpose of this part is:

(a) To establish a framework for the provision of supports and services to care-giving families with an individual member who:

(1) Has a developmental disability or acquired brain disorder; or

(2) Is eligible for family-centered early supports and services pursuant to He-M 510.06;

(b) To describe the structure, roles, and responsibilities of regional family support councils in advising and collaborating with their local area agencies; and

(c) To describe the structure, roles, and responsibilities of the state family support council in supporting regional councils and in advising the bureau.

History

#5929, eff 12-1-94, EXPIRED: 12-1-00
#7830, eff 2-13-03, EXPIRED: 2-13-11
#9879-A, eff 2-26-11; ss by #12784, eff 5-21-19

N.H. Code Admin. R. Ann. He-M 519.02 Definitions {#sec-he-m-519.02 omnilex-key=us-nh-regs-official--agency-he-m--He-M 519.02}

(a) “Acquired brain disorder” means a disruption in brain functioning that:

(1) Is not congenital or caused by birth trauma;

(2) Presents a severe and life-long disabling condition which significantly impairs a person’s ability to function in society;

(3) Occurs prior to age 60;

(4) Is attributable to one or more of the following reasons:

a. External trauma to the brain as a result of:

A motor vehicle incident;
A fall;
An assault; or
Another related traumatic incident or occurrence;

b. Anoxic or hypoxic injury to the brain such as from:

Cardiopulmonary arrest;
Carbon monoxide poisoning;
Airway obstruction;
Hemorrhage; or
Near drowning;

c. Infectious diseases such as encephalitis and meningitis;

d. Brain tumor;

e. Intracranial surgery;

f. Cerebrovascular disruption such as a stroke;

g. Toxic exposure; or

h. Other neurologic disorders such as Huntington’s disease or multiple sclerosis which predominantly affect the central nervous system; and

(5) Is manifested by:

a. Significant decline in cognitive functioning and ability; or

b. Deterioration in:

Personality;
Impulse control;
Judgment;
Modulation of mood; or
Awareness of deficits.

(b) “Area agency” means “area agency” as defined in RSA 171-A:2, I-b.

(d) “Bureau administrator” means the chief administrator of the bureau of developmental services.

(e) “Commissioner” means the commissioner of the department of health and human services.

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

(g) “Developmental disability” means “developmental disability” as defined in RSA 171:A:2, V, namely “a disability:

(a) Which is attributable to intellectual disability, cerebral palsy, epilepsy, autism, or a specific learning disability, or any other condition of an individual found to be closely related to intellectual disability as it refers to general intellectual functioning or impairment in adaptive behavior or requires treatment similar to that required for persons with an intellectual disability; and

(h) “Family” means a group of 2 or more persons that:

(1) Is related by ancestry, marriage, or other legal arrangement;

(2) Has one member who is the primary caregiver of the individual in (3) below; ; and

(3) Has at least one member who is an individual as defined in (j) below.

(i) “Family support” means those services, activities, and interventions, enumerated in He-M 519.04 (c), that are identified by a family to assist that family to remain the primary caregiver of an individual.

(j) “Individual” means a person with a developmental disability or acquired brain disorder who is eligible or conditionally eligible pursuant to He-M 503.03 or He-M 522.03 or a child, through age 2, who is eligible for family-centered early supports and services pursuant to He-M 510.06.

(k) “Partners in Health (PIH)” means “partners in health” as defined in He-M 523, namely “a New Hampshire community-based program of family support for young adults and families”.

(l) “Region” means “area” as defined in RSA 171-A:2, I-a, namely “a geographic region established by rules adopted by the commissioner for the purpose of providing services to developmentally disabled persons”.

(m) “Respite” means the provision of short-term care, in accordance with He-M 513, for an individual, in or out of the individual’s home, for the temporary relief and support of the family with whom the individual lives.

(n) “Special medical services (SMS)” means “special medical services” as defined in He-M 520 namely, “the administrative section of the bureau of developmental services that operates the Title V program for children and youth with special health care needs”.

(o) “Supports and services” means a wide range of activities that assist families in developing and maximizing the families’ abilities to care for individuals and meet their needs in a flexible manner.

History

#5929, eff 12-1-94, EXPIRED: 12-1-00
#7830, eff 2-13-03, EXPIRED: 2-13-11
#9879-A, eff 2-26-11; ss by #12784, eff 5-21-19

N.H. Code Admin. R. Ann. He-M 519.03 Eligibility {#sec-he-m-519.03 omnilex-key=us-nh-regs-official--agency-he-m--He-M 519.03}

A family shall be eligible for family support services if such family has:

(a) An individual member from birth through age 2 who is eligible for family-centered early supports and services pursuant to He-M 510.06; or

(b) An individual member age 3 or older who has a developmental disability or an acquired brain disorder pursuant to He-M 503.03 or He-M 522.03.

History

#5929, eff 12-1-94, EXPIRED: 12-1-00
#7830, eff 2-13-03, EXPIRED: 2-13-11
#9879-A, eff 2-26-11; ss by #12784, eff 5-21-19

N.H. Code Admin. R. Ann. He-M 519.04 Supports and Services {#sec-he-m-519.04 omnilex-key=us-nh-regs-official--agency-he-m--He-M 519.04}

(a) Family support services shall:

(1) Focus on the entire family;

(2) Recognize and value the family’s strengths and competencies;

(3) Respect the family’s approach to making decisions regarding provision of supports and services;

(4) Create and emphasize opportunities for families to build relationships in their communities;

(5) Maximize the family’s control over the provision of supports and services;

(6) Identify resources and supports and services that are flexible, individualized, and responsive to the changing needs of the family;

(7) Respect the family’s cultural and ethnic beliefs, traditions, personal values, and lifestyles;

(8) Empower families through educational opportunities and wide dissemination of information; and

(9) Promote family involvement in all levels of planning, policy-making, and monitoring of the service system.

(b) In addition to offering area agency programs or funds to provide supports and services, family support staff shall explore, identify, and assist families to access community resources, both formal and informal, as available.

(1) Information and referral;

(2) Assistance to identify and assess the family’s own strengths, needs, and goals;

(3) Identification of, and assistance to access, community resources and supports;

(4) Assistance with transition in and out of services;

(5) Crisis intervention and emotional support;

(6) Advocacy for accessing supports and services;

(7) Opportunities for family networking;

(8) Assistance to access respite care;

(9) Assistance to access environmental modifications of the family’s home and the family’s vehicle;

(10) Promotion of inclusive social and recreational opportunities;

(11) Conferences and workshops in response to families’ requests;

(12) Community outreach, education, and development to promote understanding and support for families as well as individuals with disabilities;

(13) Financial assistance provided that this assistance is:

a. Related to supporting a family to care for an individual member in the family home; and

b. Consistent with the established policies of the area agency and, if applicable, the regional family support council as required by He-M 519.05(c)(5); and

(14) Other supports and services that assist a family in providing care for an individual member in the family home.

History

#5929, eff 12-1-94, EXPIRED: 12-1-00
#7830, eff 2-13-03, EXPIRED: 2-13-11
#9879-A, eff 2-26-11; ss by #12784, eff 5-21-19

N.H. Code Admin. R. Ann. He-M 519.05 Regional Family Support Council {#sec-he-m-519.05 omnilex-key=us-nh-regs-official--agency-he-m--He-M 519.05}

(a) Each region shall have a family support council that shall act as an advisory body to the area agency.

(b) A regional family support council shall:

(1) Be composed of a minimum of 5 voting members;

(2) Have members who are either family members or individuals;

(3) Have no voting member who is an employee of either the area agency or the family support council; and

(4) Have membership that is representative of the various ages, and geographical locations, and overall diversity of the individuals and families served in the region.

(1) Membership, recruitment, rotation, and term limits on the council;

(2) A process for determining the chairperson, the state council delegate, the council representative to the area agency board of directors, and any other positions;

(3) Orientation and mentoring of all council members;

(4) A formal written agreement between the council and the area agency that identifies:

a. The parties’ relationship, roles, and responsibilities;

b. The process to be used in resolving any conflicts which might arise between the parties;

c. The involvement of the council in the selection and evaluation of the performance of the family support staff;

d. The family support representative on the area agency management team and the mechanism for direct communication between this person and the council;

e. The family support council’s obligation to comply with all confidentiality requirements as set by federal authorities, the department, or the area agency; and

f. The process for sharing contact information for families in the region with the family support council for the purpose of outreach, advocacy, or information.

(5) Processes used to distribute family support council funds and other resources, and the processes shall include ensuring family privacy in the application and fund allocation process; and

(6) A mechanism for the council to be involved in the area agency monitoring of supports and services provided to families.

(d) The regional family support councils shall coordinate their efforts with other local public and private entities that serve children, adults, and families, including but not limited to early supports and services providers, PIH, and SMS.

History

#5929, eff 12-1-94, EXPIRED: 12-1-00
#7830, eff 2-13-03, EXPIRED: 2-13-11
#9879-A, eff 2-26-11; ss by #12784, eff 5-21-19

N.H. Code Admin. R. Ann. He-M 519.06 Family Support Staff {#sec-he-m-519.06 omnilex-key=us-nh-regs-official--agency-he-m--He-M 519.06}

(a) Each area agency shall designate not less than one full-time position as the family support coordinator or director.

(b) The qualifications and duties of the staff person designated pursuant to (a) above shall be identified by a job description designed jointly by the regional family support council and the area agency.

(1) Representing the ideas and concerns of families and of family support staff to the area agency executive director and at management team meetings;

(2) Promoting the values of family support as listed in He-M 519.04 (a) in area agency activities and initiatives;

(3) Acting as the primary liaison with the council and regularly attending council meetings;

(4) Providing information to the council regarding family support activities so that the council:

a. Understands families’ needs;

b. Can act on families’ needs; and

c. Is involved in the area agency monitoring of regional supports and services;

(5) Ensuring that an individual or family has accessed all other available funding and community resources prior to requesting funding for family supports from the council;

(6) Facilitating the distribution of family support funds approved for distribution by the family support council;

(7) Providing information or referral to PIH if requested by the PIH family support coordinator, or the individual, or family; and

(8) Providing feedback to other family support staff from the council and the management team.

(d) Family support staff shall:

(1) Provide, or assist families in accessing, family supports and services;

(2) Solicit support for families from community groups, foundations, and other sources as needed;

(3) Plan and develop agreements with each family that document the supports in He-M 519.04 (c) that will be provided;

(4) Maintain records regarding the supports and services provided to each individual or family;

(5) Maintain data that specifies the type and frequency of family supports and services provided; and

(6) Report data collected pursuant to (4) and (5) above to the bureau on a quarterly basis.

History

#5929, eff 12-1-94, EXPIRED: 12-1-00
#7830, eff 2-13-03, EXPIRED: 2-13-11
#9879-A, eff 2-26-11; ss by #12784, eff 5-21-19

N.H. Code Admin. R. Ann. He-M 519.07 Regional Family Support Plan {#sec-he-m-519.07 omnilex-key=us-nh-regs-official--agency-he-m--He-M 519.07}

(a) Each regional family support council shall contribute to the development of the area plan prepared pursuant to He-M 505.03 (t)-(u).

(b) To satisfy the requirements of He-M 505.03 (u)(2), the regional family support council’s contribution pursuant to (a) above shall consider:

(1) The priorities of families residing throughout the region for supports and services; and

(2) Strategies to address these priorities.

History

#5929, eff 12-1-94, EXPIRED: 12-1-00
#7830, eff 2-13-03, EXPIRED: 2-13-11
#9879-A, eff 2-26-11; ss by #12784, eff 5-21-19

N.H. Code Admin. R. Ann. He-M 519.08 State Family Support Council {#sec-he-m-519.08 omnilex-key=us-nh-regs-official--agency-he-m--He-M 519.08}

The state family support council shall:

(a) Be comprised of one voting delegate appointed by each of the 10 regional family support councils;

(b) Be assisted by the family support administrator or designee and bureau support staff;

(d) Hold meetings every other month to discuss agenda items formulated by members of the council;

(e) Be a forum for exchanging, sharing, and distributing information to each regional council;

(f) Be an avenue for arbitration and mediation of conflict resolution between area agencies and regional councils when requested by both parties and after processes identified pursuant to He-M 519.05(c)(4)b. have been exhausted; and

(g) Provide information and feedback on issues and concerns of regional councils to the bureau.

History

#5929, eff 12-1-94, EXPIRED: 12-1-00
#7830, eff 2-13-03, EXPIRED: 2-13-11
#9879-A, eff 2-26-11; ss by #12784, eff 5-21-19

N.H. Code Admin. R. Ann. He-M 519.09 Waivers {#sec-he-m-519.09 omnilex-key=us-nh-regs-official--agency-he-m--He-M 519.09}

(a) An area agency or regional family support council may request a waiver of specific procedures outlined in He-M 519 by completing and submitting to the department the form entitled “NH Bureau of Developmental Services Waiver Request” (January 2018 edition).

(b) A completed waiver request form shall include signatures by the family support council chairperson or designee indicating agreement with the request and the area agency’s executive director or designee recommending approval of the waiver.

Department of Health and Human Services

Bureau of Developmental Services

Hugh J. Gallen State Office Park

105 Pleasant Street, Main Building

Concord, NH 03301

(d) All information entered on the forms described in (a) above shall be typewritten or otherwise legibly written.

(e) No provision or procedure prescribed by statute shall be waived.

(f) The request for a waiver shall be granted by the commissioner or his or her designee within 30 days if the alternative proposed by the requesting entity meets the objective or intent of the rule and it:

(1) Does not negatively impact the health or safety of the individual(s); and

(2) Does not affect the quality of services to individuals.

(g) Upon receipt of approval of a waiver request, the requesting entity’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.

(h) Waivers shall be granted in writing for a specific duration not to exceed 5 years except as in (i) below.

(i) A requesting entity may request a renewal of a waiver from the bureau. Such request shall be made at least 90 days prior to the expiration of a current waiver.

(j) A request for renewal of a waiver shall be approved in accordance with the criteria specified in (f) above.

History

#5929, eff 12-1-94, EXPIRED: 12-1-00
#7830, eff 2-13-03, EXPIRED: 2-13-11
#9879-A, eff 2-26-11, (paras (a) & (d)-(j)); #9879-B, eff 2-26-11, (paras (b)-(c)); ss by #12784, eff 5-21-19

Part He-M 520 Children’s Special Medical Services

N.H. Code Admin. R. Ann. He-M 520.01 Definitions {#sec-he-m-520.01 omnilex-key=us-nh-regs-official--agency-he-m--He-M 520.01}

(a) “Administrator” means the person who oversees the bureau of special medical services and its contractors.

(b) “Allowable deduction” means the amount subtracted from a household’s annual gross income, which represents expenses paid by a household member whose income is counted when determining financial eligibility, and is limited to:

(1) Monthly court-ordered alimony payments;

(2) Monthly court-ordered child support payments;

(3) Monthly household child care expenses when both parents are employed or when one parent is employed and the other parent is functionally unable to care for the child;

(4) Monthly private health and or dental insurance premiums;

(5) Monthly food deduction for a household member with a specialty diet recommended by a licensed clinician, not to exceed $400 per month;

(6) Annual deduction of $1,000 for each additional current recipient in the household, not to exceed $3,000 per household; and

(7) Annual single head of household deduction not to exceed $1,000.

(1) Including, but not limited to:

a. Wages, salaries, tips, and commissions before deductions;

b. Net earnings or Schedule C income from self-employment, partnership, or business;

c. Net rental income;

d. Dividends;

e. Interest;

f. Annuities;

g. Pensions;

h. Royalties;

i. Government- or state-issued benefits, such as:

Public assistance;
State financial grants;
Social security benefits;
Unemployment compensation;
Workers compensation; and
Veterans Administration benefits;

j. Alimony or child support received;

k. One-time insurance payments or compensation for injury or death received;

l. Medical settlements, and

m. Non-medical trusts established for the applicant or any household member; and

(2) Excluding income from sale of property, tax refunds, gifts, scholarships, trainings, or stipends.

(d) “Applicant” means the person for whom the application is made and who, if determined to be eligible, becomes the recipient.

(e) “Bureau” means the bureau of special medical services within the department of health and human services.

(f) “Children with special health care needs” means “children with special health care needs” as defined in RSA 132:13, II, namely “children who have or are at risk for chronic physical, developmental, behavioral, or emotional conditions and who also require health and related services of a type or amount beyond that required by children generally.”

(g) “Chronic medical condition” means an ongoing physical, developmental, behavioral, or emotional illness or disability, which:

(1) Is expected to last one year or longer;

(2) Requires extended sequential, medical, surgical, or rehabilitative intervention as determined by a diagnostic evaluation performed by a licensed clinician who is board eligible or board certified;

(3) Is one of the following:

a. Genetic condition;

b. Inborn error of metabolism;

c. Pulmonary or respiratory condition;

d. Genitourinary disorder;

e. Musculoskeletal condition;

f. Blindness as defined by 42 USC 416 (i)(1);

g. Deafness as defined by 34 CFR 300.7 (c)(3);

h. Congenital anomaly;

i. Developmental delay from birth to 6 years of age;

j. Limb deficiency, including post amputation;

k. Cranial facial anomaly;

l. Neurologic condition;

m. Digestive system condition;

n. Endocrine abnormality, excluding conditions noted in (4) b. below;

o. Cardiovascular condition;

p. Neuromotor disorder;

q. Spinal cord injury;

r. Hematological disorder;

s. Immunological disorder;

t. Malignant neoplastic disease; or

u. Skin disorder as listed in 20 CFR 404, Subpart P, Appendix 1; and

(4) Is not one of the following:

a. An acute or recurrent condition encompassing the area of routine medical care;

b. A hormonal condition for which long-term replacement therapy is required, such as short stature; and

c. A dental or orthodontic condition except as related to conditions in (3)h. or (3)k. above.

(h) “Date of application” means the date stamped on the SMS application as indication that the application was received by SMS.

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

(j) “Durable medical equipment” means a non-disposable device that:

(1) Can withstand repeated use;

(2) Is appropriate for in-home use for the treatment of an acute or chronic medically diagnosed health condition, illness, or injury; and

(3) Is not useful to a person in the absence of an acute or chronic medically diagnosed health condition, illness, or injury.

(k) “Federal poverty guidelines” means the annual revision of the poverty income guidelines for the United States Department of Health and Human Services as published in the Federal Register (74 FR 4199).

(l) “Financial assistance” means a payment made by SMS in whole or in part for health-related services.

(m) “Health-related service” means a service related to the treatment of a recipient’s chronic medical condition, such as, but not limited to:

(1) Therapies;

(2) Medications;

(3) Hospitalizations; and

(4) Durable medical equipment or medical supplies.

(n) “Household” means one or more children under the age of 21 and the adults who are directly related to them by blood, by marriage, or by adoption or who assist in the personal care and rearing of an applicant, all of whom reside in the same home.

(o) “Household income” means the annual gross income of the applicant and the adults included in the household.

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

(q) “Medical liability” means a household’s accrued medically related debt or medical expenses paid within the past 12 months that are not covered by third party liability insurance (TPL), including, but not limited to:

(1) Office visit or prescription co-payments;

(2) Emergency department visits;

(3) Insurance or COBRA payments;

(4) TPL required deductibles; and

(5) Other non-covered medical services.

(r) “Medically necessary” means health care services and items 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;

(2) Consistent with the established diagnosis or treatment of the recipient’s illness, injury, disease, or its symptoms;

(3) Not primarily for the convenience of the recipient or the recipient’s family, caregiver, or health care provider;

(4) Not costlier 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;

(5) Not experimental, investigative, cosmetic, or considered alternative by current medical practices;

(6) Not duplicative in nature; and

(7) Proven to be safe and effective, as documented in medical peer review literature.

(s) “Medical supplies” means consumable or disposable items appropriate for in-home use for relief or treatment of a specific medically diagnosed health condition, illness, or injury.

(t) “Net income” means the household’s annual gross income minus any allowable deductions, defined in (b) above.

(u) “Provider” means an individual who provides a medical, therapeutic, or other direct care service within his or her office, agency, practice, or during a home visit.

(v) “Recipient” means a child with special health care needs who has met the established criteria as described in He-M 520.02.

(w) “Resource(s)” means any funds, available to the household, with the exception of Achieving a Better Life Experience (ABLE) Act/STABLE accounts, minus any penalties for withdrawal, including, but not limited to:

(1) Checking accounts;

(2) Savings accounts;

(3) Certificates of deposit;

(4) Investments, such as mutual funds, stocks, and bonds; and

(5) Trust funds.

(x) “Special medical services (SMS)” means the bureau of special medical services that operates the Title V program for children and youth with special health care needs.

(y) “Spend down” means the amount of a household’s net income which exceeds 185% of that household’s federal poverty guideline amount.

(z) “Third party” means any private insurer, health maintenance organization, hospital service organization, medical service or health services corporation, governmental agency, or any individual, organization, entity, or agency which is authorized or under legal obligation to pay for medical services for a recipient.

(aa) “Title V” means the program described in Title V of the Social Security Act. SMS administers the NH children with special health care needs component of Title V as part of the Health Resources and Services Administration, United States Department of Health and Human Services.

(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.

History

#9748-A, eff 7-1-10; amd by #10138, eff 7-1-12; ss by #12558, INTERIM, eff 6-26-18, EXPIRED: 12-24-18
#12699, eff 12-28-18

N.H. Code Admin. R. Ann. He-M 520.02 Application Procedure {#sec-he-m-520.02 omnilex-key=us-nh-regs-official--agency-he-m--He-M 520.02}

(a) In order to be determined eligible to receive program services or financial assistance, a signed, dated, and completed application, entitled “Bureau for Family Centered Services (BFCS),” (July 2023) shall be submitted to SMS for each applicant.

(b) The following documentation shall accompany the submitted application in (a) above:

(1) Supporting documentation of income and resources, as applicable;

(2) Supporting documentation regarding the applicant’s health diagnosis;

(3) A signed release of personal health information, which complies with current Health Insurance Portability and Accountability Act (HIPPA) policies as defined in 45 CFR 160.103 and 45 CFR 164.501; and

(4) Documentation of guardianship of an applicant or foster parent status, as applicable.

(1) Accept and review all applications for program or financial eligibility, in accordance with He-M 520.03 and He-M 520.05;

(2) Notify the applicant in writing of the applicant’s eligibility status and the services for which the applicant is eligible; and

(3) Have the applicable Program Coordinator(s) initiate phone contact to discuss the SMS program(s) for which the applicant has been found eligible.

(d) SMS’s notice of decision shall include:

(1) For eligibility approvals:

a. The beginning and ending dates of SMS eligibility;

b. The approved SMS services;

c. The name and phone number of an SMS contact person;

d. Financial eligibility determination, including the spend down amount, as applicable; and

e. Notice that the recipient shall report to SMS any change in the recipient’s medical insurance coverage, including Medicaid or TPL changes, within 30 days of the change; and

(2) For eligibility denials:

a. The reason(s) for denial;

b. Information about the applicant’s right to an appeal in accordance with He-M 202 and He-C 200; and

c. Alternate support services information as available.

(e) For an applicant who is determined to be eligible, eligibility shall be effective for 12 months from the applicant’s application date, except when any household changes affect the recipient’s eligibility status.

(f) SMS shall notify a recipient in writing 30 calendar days prior to the date that eligibility will close, for such reasons as the 12-month eligibility period is expiring, the recipient is turning 21, services provided are no longer available, or there is a household change which affects eligibility status.

(g) A new application shall be submitted in accordance with (a) and (b) above prior to the expiration of current eligibility.

(h) An applicant or recipient shall have the right to reapply at any time after eligibility has been denied.

(i) An applicant who submits false or misleading information shall be subject to the provisions of RSA 132:15 and RSA 638:15.

History

#9748-A, eff 7-1-10, para (c)-(h), intro., & (i)(1), (4), & (5), and (j); #9748-B, eff 7-1-10, paras (a), (b), and (i)(3); amd by #10138, eff 7-1-12; ss by #12558, INTERIM, eff 6-26-18, EXPIRED: 12-24-18
#12699, eff 12-28-18; (see also Revision Note at part heading for He-M 520)

N.H. Code Admin. R. Ann. He-M 520.03 Program Eligibility Requirements {#sec-he-m-520.03 omnilex-key=us-nh-regs-official--agency-he-m--He-M 520.03}

To be eligible for services provided under He-M 520.04, an applicant shall:

(a) Be a child with special health care needs;

(b) Be a resident of the State of New Hampshire and not have residency in another state;

(d) Be under the age of 21.

History

#9748-A, eff 7-1-10, para (c)-(h), intro., & (i)(1), (4), & (5), and (j); #9748-B, eff 7-1-10, paras (a), (b), and (i)(3); amd by #10138, eff 7-1-12; ss by #12558, INTERIM, eff 6-26-18, EXPIRED: 12-24-18
#12699, eff 12-28-18; (see also Revision Note at part heading for He-M 520)

N.H. Code Admin. R. Ann. He-M 520.04 Services Provided {#sec-he-m-520.04 omnilex-key=us-nh-regs-official--agency-he-m--He-M 520.04}

(a) Services provided to recipients by SMS or agencies under current service contract obligation with SMS shall include:

(1) SMS care coordination services to:

a. Assist the household in developing and implementing a health care plan for the recipient; and

b. Provide information about available types of third-party assistance;

(2) SMS nutrition services;

(3) SMS feeding and swallowing services;

(4) SMS consultation services;

(5) SMS specialty services provided through attendance at child development clinics sponsored by SMS;

(6) SMS specialty services provided through attendance at complex care clinics sponsored by SMS; and

(7) SMS specialty services provided through attendance at neuromotor clinics sponsored by SMS.

(b) A recipient shall be limited to the services listed in (a)(4)-(6) above if his or her primary diagnosis is one of the following:

(1) Attention deficit disorder;

(2) Autism spectrum disorder; or

(3) Another emotional or behavioral disorder.

History

#9748-A, eff 7-1-10; ss by #12558, INTERIM, eff 6-26-18, EXPIRED: 12-24-18
#12699, eff 12-28-18

N.H. Code Admin. R. Ann. He-M 520.05 Financial Eligibility Requirements {#sec-he-m-520.05 omnilex-key=us-nh-regs-official--agency-he-m--He-M 520.05}

(a) To be eligible for financial assistance, a recipient shall:

(1) Meet the program eligibility requirements in He-M 520.03;

(2) Have a documented chronic medical condition; and

(3) Meet the financial eligibility requirements in (b) through (h) below.

(b) A recipient shall be eligible for financial assistance for health-related services related to the recipient’s chronic medical condition if:

(1) The recipient resides in a household with a net income less than or equal to 185% of that household’s federal poverty guideline amount and with resources of $10,000 or less; or

(2) The recipient resides in a household with a net income greater than 185% of that household’s federal poverty guideline amount and the household’s medical liability is enough to reduce the household’s spend down amount by 100% prior to receiving financial assistance.

(1) SMS shall determine a household’s medical liability, each time eligibility for financial assistance is reviewed;

(2) A household’s medical liability shall be used to reduce the spend down amount;

(3) A household’s medical liability that is used to reduce the spend down amount in one year shall not be used to reduce the spend down amount in any subsequent year;

(4) Medical liability used to reduce the spend down amount shall not be eligible for payment through financial assistance; and

(5) SMS shall notify recipients in writing of current spend down amounts.

(d) If a household requests payment for services that would otherwise be covered under Medicaid and the household’s income would allow it to be eligible for Medicaid, the household shall be encouraged to apply for such Medicaid services within 3 months of requesting financial assistance.

(e) Households that do not apply for Medicaid eligibility for the applicant pursuant to (d) above, shall not be eligible for financial assistance under He-M 520.05 and He-M 520.06.

(f) For purposes of determining financial eligibility, a recipient who meets any of the following criteria shall be considered to be the only individual in the household:

(1) The recipient is an emancipated minor;

(2) The recipient is aged 18 to 21;

(3) The recipient is a foster child; or

(4) The recipient has a court appointed guardian.

(g) A recipient’s adult siblings who are 18 or older and share the recipient’s residence shall be excluded as household members when the siblings:

(1) Are employed or have a source of income;

(2) Are married; or

(3) Have their own children.

(h) For a child residing with a parent and one or more unrelated adult, the income of the unrelated adult shall be included in the household income if the unrelated adult is a parent of an applicant’s sibling.

(i) When a household member reports to SMS and supplies supporting documentation of a change in household net income, SMS shall then reassess financial eligibility.

History

#9748-A, eff 7-1-10; amd by #10138, eff 7-1-12; ss by #12558, INTERIM, eff 6-26-18, EXPIRED: 12-24-18
#12699, eff 12-28-18

(a) SMS shall approve a recipient’s request for payment for a health-related service when all the following are true:

(1) The recipient has been determined to be financially eligible in accordance with He-W 520.05;

(2) The health-related service is:

a. Determined to be medically necessary;

b. Related to the recipient’s chronic medical condition; and

c. Supported by the recipient’s SMS health care plan;

(3) All third party resources, including the recipient’s hospital, surgical, or medical insurance plans, have been exhausted, except as allowed by (f) below; and

(4) A bill or invoice for a health-related service is submitted to SMS:

a. Which is itemized and dated; and

b. For which the service date is:

Not more than 12 months prior to the submission date;
Not prior to the recipient’s application date; and
Not a date when the recipient was not eligible for financial assistance.

(b) Payments for health-related services shall be paid at the lowest of:

(1) The provider’s usual and customary charge to the public, as defined in RSA 126-A:3, III(b);

(2) The lowest amount accepted from any other third party payors; or

(3) The Medicaid rate established by the department in accordance with RSA 161:4, VI(a).

(1) Include both inpatient and outpatient services; and

(2) Have a maximum of $3,000 per event.

(d) Payment for diagnostic procedures shall have a maximum of $3,000 per procedure.

(e) Notwithstanding (b) above:

(1) Over-the-counter medication and non-prescription medication items shall be paid as submitted if no current Medicaid rate is available; and

(2) The administrator shall approve reimbursement for health-related services over Medicaid rates when:

a. SMS has negotiated a higher payment rate(s) with the provider; or

b. Medicaid reimbursement is less than what was paid out of pocket by the recipient.

(f) The administrator shall approve reimbursement for health-related services not submitted for Medicaid or third-party reimbursement when:

(1) A Medicaid or TPL precedent has been set for denial of equivalent services;

(2) A crisis situation exists that jeopardizes the safety or health of the recipient; or

(3) The volume of service is over Medicaid or TPL allowable limits.

(g) With respect to Title XIX, Medicare, or any medical insurance program or policy, SMS shall be the payor of last resort. Nothing contained in these rules shall require SMS to provide payment for medications, supplies, or services.

History

#9748-A, eff 7-1-10; ss by #12558, INTERIM, eff 6-26-18, EXPIRED: 12-24-18
#12699, eff 12-28-18

N.H. Code Admin. R. Ann. He-M 520.07 Limitation of Services {#sec-he-m-520.07 omnilex-key=us-nh-regs-official--agency-he-m--He-M 520.07}

Financial assistance provided under these rules shall be provided to the extent that funds for this purpose are appropriated and made available to the bureau by the Legislature and not otherwise reduced or restricted by legislative fiscal committee action.

History

#9748-A, eff 7-1-10; ss by #12558, INTERIM, eff 6-26-18, EXPIRED: 12-24-18
#12699, eff 12-28-18

N.H. Code Admin. R. Ann. He-M 520.08 Appeals {#sec-he-m-520.08 omnilex-key=us-nh-regs-official--agency-he-m--He-M 520.08}

(a) Pursuant to He-M 202, an applicant, recipient, parent, or guardian may request to informally resolve any disagreement with SMS, or, within 30 business days of an SMS decision, she or he may choose to file a formal appeal. Any determination, action, or inaction by SMS may be appealed.

(b) If informal resolution is requested, the administrator shall meet and review with the applicant, recipient, parent, or guardian the financial status or medical condition of the applicant or recipient that pertains to the applicant’s or recipient’s eligibility.

(c) SMS shall notify the applicant, recipient, parent, or guardian of the findings of the review, in writing, within 15 business days of a case review conference.

(d) Formal appeals shall be submitted, in writing, to the bureau administrator in care of the bureau’s office of client and legal services. An exception shall be that appeals may be filed verbally if the individual is unable to convey the appeal in writing.

(e) If a hearing is requested, the following actions shall occur:

(1) Services and payments shall be continued as a consequence of a request for a hearing until a decision has been made; and

(2) If SMS’s decision is upheld, funding shall cease 60 days from the date of the denial letter or 30 days from the hearing decision, whichever is later.

History

#9748-A, eff 7-1-10; ss by #12558, INTERIM, eff 6-26-18, EXPIRED: 12-24-18
#12699, eff 12-28-18

N.H. Code Admin. R. Ann. He-M 520.09 Waivers {#sec-he-m-520.09 omnilex-key=us-nh-regs-official--agency-he-m--He-M 520.09}

(a) An applicant, parent, or guardian may request a waiver of specific services as outlined in He-M 520 by completing and submitting to the department, bureau of special medical services form titled “Department of Health and Human Services, Bureau of Special Medical Services Waiver for Services” ( December 2018)”.

(b) A completed waiver request form shall be signed by the applicant, parent, guardian, or provider indicating agreement with the request.

(1) The alternative proposed by the applicant, recipient, parent, or guardian meets the objective or intent of the rule;

(2) The alternative proposed does not negatively impact the health or safety of the household or recipient;

(3) The alternative proposed does not affect the quality of services to a recipient; and

(4) All other TPL service requests have been exhausted or denied.

(d) A waiver request shall be submitted to:

Department of Health and Human Services

Office of Special Medical Services

State Office Park South

129 Pleasant Street, Thayer Building

Concord, NH 03301

(e) No provision or procedure prescribed by statute shall be waived.

(f) The determination on the request for a waiver shall be made within 30 days of the receipt of the request.

(g) Waivers shall be granted in writing and remain in effect for the duration of the recipient’s current eligibility.

(h) Waivers shall end with the closure of the related program or service.

History

#9748-A, eff 7-1-10; ss by #12558, INTERIM, eff 6-26-18, EXPIRED: 12-24-18
#12699, eff 12-28-18

Part He-M 521 Certification of Residential Services or Combined Residential and Community Participation Services Provided in the Family Home

N.H. Code Admin. R. Ann. He-M 521.01 Purpose {#sec-he-m-521.01 omnilex-key=us-nh-regs-official--agency-he-m--He-M 521.01}

The purpose of these rules is to provide minimum standards for residential services or combined community participation and residential services for individuals with developmental disabilities or acquired brain disorders who reside in their families’ homes. These rules shall not apply to individuals who receive services under He-M 524, in-home supports.

History

#5791, eff 3-1-94, EXPIRED: 3-1-00
#7227, INTERIM, eff 3-31-00, EXPIRED: 7-29-00
#7494, eff 5-22-01; ss by #9013, eff 10-27-07; ss by #9475, eff 5-22-09; ss by #12340, eff 7-25-17

N.H. Code Admin. R. Ann. He-M 521.02 Definitions {#sec-he-m-521.02 omnilex-key=us-nh-regs-official--agency-he-m--He-M 521.02}

(a) “Acquired brain disorder” means a disruption in brain functioning that:

(1) Is not congenital or caused by birth trauma;

(2) Presents a severe and life-long disabling condition which significantly impairs a person’s ability to function in society;

(3) Occurs prior to age 60; and

(4) Is attributable to one or more of the following reasons:

a. External trauma to the brain as a result of:

A motor vehicle incident;
A fall;
An assault; or
Another related traumatic incident or occurrence;

b. Anoxic or hypoxic injury to the brain such as from:

Cardiopulmonary arrest;
Carbon monoxide poisoning;
Airway obstruction;
Hemorrhage; or
Near drowning;

c. Infectious diseases, such as encephalitis and meningitis;

d. Brain tumor;

e. Intracranial surgery;

f. Cerebrovascular disruption such as a stroke;

g. Toxic exposure; and

h. Other neurological disorders such as Huntington’s disease or multiple sclerosis which predominantly affect the central nervous system; and

(5) Is manifested by one or more of the following:

a. Significant decline in cognitive functioning and ability; or

b. Deterioration in:

Personality;
Impulse control;
Judgment;
Modulation of mood; or
Awareness of deficits.

(b) “Area agency” means “area agency” as defined in RSA 171-A:2, I-b.

(d) “Bureau administrator” means the chief administrator of the bureau of developmental services.

(e) “Commissioner” means the commissioner of the department of health and human services or his or her designee.

(f) “Community participation services” referred to elsewhere in He-M 500 and He-M 1001 as “day services”, means habilitation, assistance, and instruction provided to individuals that:

(1) Improve or maintain their performance of basic living skills;

(2) Offer vocational and community activities, or both;

(3) Enhance their social and personal development;

(5) At a minimum, meet the needs and achieve the desired goals and outcomes of each individual as specified in the service agreement.

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

(h) “Developmental disability” means “developmental disability” as defined in RSA 171-A:2, V, namely, “a disability:

(i) “Family” means a group of 2 or more persons related by ancestry, marriage, or other legal arrangement that has at least one member who has a developmental disability.

(j) “Guardian” means a person appointed pursuant to RSA 464-A or a parent of an individual under the age of 18 whose parental rights have not been terminated or limited by law in such a way as to remove the person’s right to make decisions pursuant to RSA 171-A on behalf of the individual..

(k) “Individual” means a person with a developmental disability or acquired brain disorder who is eligible to receive services pursuant to He-M 503 or He-M 522.

(l) “Provider” means a person receiving any form of remuneration for the provision of services to an individual.

(m) “Provider agency” means an area agency or another entity under contract with an area agency to provide services.

(n) “Representative” means:

(1) The parent or guardian of an individual under the age of 18;

(2) The guardian of an individual 18 or over; or

(3) A person who has power of attorney for the individual.

(o) “Service” means any paid assistance to an individual in meeting his or her own needs provided through the area agency.

(p) “Service agreement” means a written agreement between an individual or his or her guardian or representative and an area agency that is prepared in accordance with He-M 503 or He-M 522 and that describes the services that an individual will receive and constitutes an individual service agreement as defined in RSA 171-A:2,X.

(q) “Service coordinator” means a person who is chosen or approved by an individual and his or her guardian or representative to organize, facilitate and document service planning and to negotiate and monitor the provision of the individual’s services.

(r) “Staff” means a person employed by an area agency or provider agency.

History

#5791, eff 3-1-94, EXPIRED: 3-1-00
#7227, INTERIM, eff 3-31-00, EXPIRED: 7-29-00
#7494, eff 5-22-01; amd by #9013, eff 10-27-07; ss by #9475, eff 5-22-09; ss by #12340, eff 7-25-17

N.H. Code Admin. R. Ann. He-M 521.03 Services {#sec-he-m-521.03 omnilex-key=us-nh-regs-official--agency-he-m--He-M 521.03}

(a) All services shall be specifically tailored to the competencies, interests, preferences, needs, and lifestyle of the individual served.

(b) Services shall include assistance and instruction to improve and maintain an individual’s skills in basic daily living, personal development, and community activities, such as, but not limited to:

(1) Making personal choices;

(2) Promoting and maintaining safety;

(3) Enhancing communication;

(4) Participating in community activities;

(5) Developing and maintaining personal relationships;

(6) Finding and maintaining employment;

(7) Pursuing avocations in areas of personal interest;

(8) Improving and maintaining social skills;

(9) Achieving and maintaining physical well-being;

(10) Improving and/or maintaining mobility and physical functioning;

(11) Shopping and managing money;

(12) Attending to personal hygiene and appearance;

(13) Doing household chores;

(14) Participating in meal preparation;

(15) Accessing and using assistive technology;

(16) Accessing and using transportation; and

(17) Other similar services as indicated in the individual’s service agreement.

History

#5791, eff 3-1-94, EXPIRED: 3-1-00
#7227, INTERIM, eff 3-31-00, EXPIRED: 7-29-00
#7494, eff 5-22-01; ss by #9475, eff 5-22-09; ss by #12340, eff 7-25-17

N.H. Code Admin. R. Ann. He-M 521.04 Eligibility {#sec-he-m-521.04 omnilex-key=us-nh-regs-official--agency-he-m--He-M 521.04}

(a) Any individual who resides at home with his or her family shall be eligible for services identified in He-M 521.03, except as provided in (b) below.

(b) An individual who resides in a foster home licensed by the division of children, youth, and families shall not be eligible for services identified in He-M 521.03.

History

#5791, eff 3-1-94; ss by #6002, eff 4-1-95; ss by #7494, eff 5-22-01; ss by #9475, eff 5-22-09; ss by #12340, eff 7-25-17

N.H. Code Admin. R. Ann. He-M 521.05 Administrative Requirements {#sec-he-m-521.05 omnilex-key=us-nh-regs-official--agency-he-m--He-M 521.05}

(a) Once a family expresses interest regarding He-M 521 services but before services are provided under He-M 521, the area agency shall:

(1) Ensure that the proposed service arrangement:

a. Meets the individual’s expressed interests, preferences, needs, and lifestyle;

b. Is consistent with the goals and services identified in the individual’s service agreement; and

c. Meets the individual’s environmental and personal safety needs; and

(2) Explain and discuss the following with the individual, guardian, representative, and family members:

a. Area agency oversight of services provided under He-M 521;

b. If applicable, the process of having staff or providers coming into the home environment;

c. If the individual is taking medication, the supports available or needed to administer the medication safely;

d. That modifications might be necessary in the service agreement if and when the individual’s needs or preferences change;

e. If applicable, receiving payments for the provision of services;

f. If applicable, the relationship between the area agency and the family member as a provider or subcontractor;

g. The requirements regarding certification of services, including, for all people who are being considered for a position of staff or provider:

Performing criminal background checks; and
Checking the state registry of abuse, neglect, and exploitation reports as established by RSA 161-F:49; and

h. The conditions warranting the suspension or revocation of certification.

(b) In those situations where a family member is to be reimbursed as a provider or subcontractor, the area agency or provider agency shall, in consultation with the individual, guardian, representative, and family, develop a contract that:

(1) Identifies the responsibilities of the area agency, provider agency, if applicable, and the family member as a provider or subcontractor;

(2) Describes the provision of supports needed to administer medication safely;

(3) Includes provision for time off and identifying the area agency or provider agency responsibility in assisting the family to secure substitute providers when the family member is the provider;

(4) Includes a provision for either party to dissolve the contract with notice;

(5) Allows for review and revision as deemed necessary by either party; and

(6) Is signed by all parties.

(1) Have, at a minimum, quarterly contacts with the family to provide information and support to ensure that services are provided in accordance with the service agreement and He-M 521; and

(2) Ensure that the service arrangement is in compliance with He-M 503.10 or He-M 522.

History

#5791, eff 3-1-94; ss by #6002, eff 4-1-95; ss by #7494, eff 5-22-01; amd by #9013, eff 10-27-07; ss by #9475, eff 5-22-09; ss by #12340, eff 7-25-17

N.H. Code Admin. R. Ann. He-M 521.06 Medication Administration {#sec-he-m-521.06 omnilex-key=us-nh-regs-official--agency-he-m--He-M 521.06}

When an individual living with his or her family is in need of medication administration, such administration shall:

(a) Comply with He-M 1201 when administered by area agency, provider agency staff, home providers, or other providers contracted by the area agency;

(b) Comply with Nur 404 when a nurse identified in Nur 404.04 delegates the task of medication administration to providers who are neither family members nor under contract with an area agency or provider agency, except in situations where the individuals are living with their families and receiving respite arranged by the family; or

(c) When performed by family members paid under He-M 521, include discussion between the area agency or provider agency and the family about any concerns the family might have regarding medication administration.

History

#5791, eff 3-1-94, EXPIRED: 3-1-00
#7242, INTERIM, eff 4-27-00, EXPIRED: 8-25-00
#7494, eff 5-22-01; ss by #9475, eff 5-22-09; ss by #12340, eff 7-25-17

N.H. Code Admin. R. Ann. He-M 521.07 Quality Assessment {#sec-he-m-521.07 omnilex-key=us-nh-regs-official--agency-he-m--He-M 521.07}

(a) An area agency shall monitor services provided pursuant to He-M 521.

(b) All services shall be monitored by a service coordinator, who:

(1) Meets the criteria in He-M 503.08 9(e)-(f);

(2) Is an area agency service coordinator, family support coordinator or any other area agency or provider agency employee;

(3) Is a member of the individual’s family;

(4) Is a friend of the individual; or

(5) Another person chosen to represent the individual.

(c) On at least a monthly basis, the service coordinator shall visit or have verbal contact with the individual or persons responsible for services to review progress on achieving the goals in the service agreement, inquire about other service needs, and document such visit or contact.

(d) The service coordinator shall visit the individual at home and contact the guardian or representative, if any, at least quarterly, or more frequently if so specified in the individual’s service agreement, to determine and document whether services:

(1) Match the interests, needs, preferences and lifestyle of the individual;

(2) Meet with the individual’s satisfaction;

(3) Meet the individual’s environmental and personal safety needs; and

(4) Meet the terms of the service agreement; and

(e) If applicable, reviews of medication administration related activities shall be conducted as required in He-M 1201.09(b) and (c).

History

#5791, eff 3-1-94, EXPIRED: 3-1-00
#7242, INTERIM, eff 4-27-00, EXPIRED: 8-25-00
#7494, eff 5-22-01; ss by #9475, eff 5-22-09; ss by #12340, eff 7-25-17

N.H. Code Admin. R. Ann. He-M 521.08 Documentation {#sec-he-m-521.08 omnilex-key=us-nh-regs-official--agency-he-m--He-M 521.08}

Individual records shall:

(a) Be maintained by the provider or staff; and

(b) Include:

(1) The service agreement;

(2) Provider or staff progress notes written at least monthly, or more frequently if so specified in the service agreement, including the dates services are provided and reports on progress toward achieving desired outcomes;

(3) For community participation services, a weekly personal schedule or calendar that:

a. Identifies the days, times, and locations of the individual’s community activities such as recreation or paid or volunteer work; or

b. Includes brief, daily notations that document responses to people and activities and any changes in the individual's schedule; and

(4) Any other documentation required by the area agency.

History

#5791, eff 3-1-94, EXPIRED: 3-1-00
#7242, INTERIM, eff 4-27-00, EXPIRED: 8-25-00
#7494, eff 5-22-01; ss by #9013, eff 10-27-07; ss by #9475, eff 5-22-09; ss by #12340, eff 7-25-17

N.H. Code Admin. R. Ann. He-M 521.09 Certification {#sec-he-m-521.09 omnilex-key=us-nh-regs-official--agency-he-m--He-M 521.09}

(a) Residential services and combined residential and community participation services provided under He-M 521 shall be certified by the bureau.

(b) To initiate the certification process, the area agency shall:

(1) Review the service arrangement and documentation to confirm that all applicable requirements identified in He-M 521.05 and He-M 521.06 are being met; and

(2) At least 30 days prior to the start of services, forward to the bureau:

a. The individual’s service agreement and proposed budget; and

b. The area agency’s recommendation for certification.

(1) Review the service arrangement and documentation to confirm that all applicable requirements identified in He-M 521.05 through He-M 521.08 are being met; and

(2) At least 30 days prior to the expiration of the current services, forward to the bureau:

a. The individual’s service agreement and budget; and

b. The area agency’s recommendation for recertification.

(d) Within 14 days of receiving the area agency recommendation pursuant to (b) or (c) above, the bureau shall issue a certification if the applicable requirements are being met.

(e) All certifications granted by the bureau under (d) above shall be effective for no more than 24 months.

History

#5791, eff 3-1-94, EXPIRED: 3-1-00
#7242, INTERIM, eff 4-27-00, EXPIRED: 8-25-00
#7494, eff 5-22-01; amd by #9013, eff 10-27-07; ss by #9475, eff 5-22-09; ss by #12340, eff 7-25-17

N.H. Code Admin. R. Ann. He-M 521.10 Denial and Revocation of Certification {#sec-he-m-521.10 omnilex-key=us-nh-regs-official--agency-he-m--He-M 521.10}

(a) In the event of the denial or revocation of certification of services pursuant to (c) below, the individual’s service coordinator shall assist him or her to continue receiving alternative services that meet his or her needs.

(b) The bureau shall deny an application for certification or revoke certification of services, following written notice pursuant to (d) below and opportunity for a hearing pursuant to He-C 200, due to:

(1) Failure of a staff member, provider, provider agency, or area agency to comply with He-M 521 or any other applicable rule adopted by the department;

(2) Hiring of persons below the age of 18 as staff or providers;

(3) Submission of materially false or misleading information to the department or failure to provide information requested by the department and required pursuant to He-M 521;

(4) The staff, provider, provider agency, or area agency preventing or interfering with any review or investigation by the department;

(5) The staff, provider, provider agency, or area agency failing to provide required documents to the department;

(6) Any reported abuse, neglect, or exploitation of an individual by a provider, staff member, or person living in an individual’s residence, if

a. Such abuse, neglect, or exploitation is reported on the state registry of abuse, neglect, and exploitation in accordance with RSA 161:F-49;

b. Such person(s) continues to have contact with the individual; and

c. Such finding has not been overturned on appeal, been annulled, or received a waiver pursuant to He-M 521.14;

(7) Failure by a provider agency or area agency to perform criminal background checks on all persons paid to provide services under He-M 521 who begin to provide such services on or after the effective date of He-M 521, or any person living in an individual’s residence;

(8) A misdemeanor conviction of any staff or provider or any person living in an individual’s residence that involves:

a. Physical or sexual assault;

b. Violence or exploitation;

c. Child pornography;

d. Threatening or reckless conduct;

e. Theft;

f. Driving under the influence of drugs or alcohol; or

g. Any other conduct that represents evidence of behavior that could endanger the well-being of an individual;

(9) A felony conviction of any staff or provider or any person living in an individual’s residence; or

(10) Evidence that any provider or staff working directly with individuals has an illness or behavior that, as evidenced by the documentation obtained and the observations made by the department, would endanger the well-being of the individuals or impair the ability of the provider or staff to comply with department rules.

(c) If the department determines that services meet any of the criteria for denial or revocation listed in (b)(1)-(10) above, the department shall deny or revoke the certification of the services.

(d) Certification shall be denied or revoked upon the written notice by the department to the family and provider, provider agency, or area agency stating the specific rule(s) with which the service does not comply.

(e) Any certificate holder aggrieved by the denial or revocation of the certification may request an adjudicative proceeding in accordance with He-M 521.12 and the denial or revocation shall not become final until the period for requesting an adjudicative proceeding has expired or, if the certificate holder requests an adjudicative proceeding, until such time as the administrative appeals unit issues a decision upholding the department’s action.

(f) Pending compliance with all requirements for certification specified in the written notice made pursuant to (d) above, a provider, provider agency, or area agency shall not provide additional services if a notice of revocation has been issued concerning a violation that presents potential danger to the health or safety of the individuals being served.

History

#5791, eff 3-1-94, EXPIRED: 3-1-00
#7242, INTERIM, eff 4-27-00, EXPIRED: 8-25-00
#7494, eff 5-22-01; ss by #9475, eff 5-22-09; ss by #12340, eff 7-25-17

N.H. Code Admin. R. Ann. He-M 521.11 Immediate Suspension of Certification {#sec-he-m-521.11 omnilex-key=us-nh-regs-official--agency-he-m--He-M 521.11}

(a) In the event that a violation poses an immediate and serious threat to the health or safety of an individual, the bureau administrator shall suspend a service’s certification immediately upon issuance of written notice specifying the reasons for the action.

(b) The bureau administrator or his or her designee shall schedule and hold a hearing within 10 working days of the suspension for the purpose of determining whether to revoke or reinstate the certification. The hearing shall provide opportunity for the provider, provider agency, or area agency whose certification has been suspended to demonstrate that it has been, or is, in compliance with the specified requirements.

History

#7494, eff 5-22-01; ss by #9475, eff 5-22-09; ss by #12340, eff 7-25-17

N.H. Code Admin. R. Ann. He-M 521.12 Appeals {#sec-he-m-521.12 omnilex-key=us-nh-regs-official--agency-he-m--He-M 521.12}

(a) Pursuant to He-C 200, an individual, guardian, or representative may within 30 business days of the area agency decision, she or he may choose to file a formal appeal. Any determination, action, or inaction by an area agency may be appealed by an individual, guardian, or representative.

(b) An applicant for certification, provider, provider agency, or area agency may request a hearing regarding a proposed revocation or denial of certification, except as provided in He-M 521.11 above.

(c) Appeals shall be submitted, in writing, to the bureau administrator in care of the department’s office of client and legal services within 10 days following the date of the notification of denial or revocation of certification. An exception shall be that appeals may be filed verbally if the individual is unable to convey the appeal in writing.

(d) The bureau administrator shall immediately forward the appeal to the department’s administrative appeals unit which shall assign a presiding officer to conduct a hearing or independent review, as provided in He-C 200. The burden shall be as provided by He-C 203.14.

(e) If a hearing is requested, the following actions shall occur:

(1) Services and payments shall be continued as a consequence of an appeal for a hearing until a decision has been made; and

(2) If the bureau’s decision is upheld, funding shall cease 60 days from the date of the denial letter or 30 days from the hearing decision, whichever is later.

History

#7494, eff 5-22-01; ss by#9475, eff 5-22-09; ss by #12340, eff 7-25-17

N.H. Code Admin. R. Ann. He-M 521.13 Payment {#sec-he-m-521.13 omnilex-key=us-nh-regs-official--agency-he-m--He-M 521.13}

(a) In order to receive funding under He-M 521, services shall be certified by the bureau in accordance with He-M 521.09.

(b) Community‑based care providers shall submit claims for covered community‑based care services on to:

Xerox Provider Services

ATTN: Claims Administration

P.O. Box 2003

Concord, NH 03302-2003

(c) Payment for community‑based care services shall only be made if prior authorization has been obtained from the bureau.

(d) Requests for prior authorization shall be made in writing to:

Xerox Provider Services ATTN: Claims Administration

PO Box 2003

Concord, NH 03302-2003

(e) For those individuals whose net income exceeds the appropriate standard of need, Medicaid claims payment will reflect a reduction in reimbursement equal to the cost of care amount..

(f) In those situations where cost of care is subtracted from the Medicaid billings, the area agency shall recover the cost from individuals unless they qualify for Medicaid for employed adults with disabilities (MEAD) pursuant to He-W 641.03.

(g) Payment for services shall not be available to any service provider who:

(1) Is a person under age 18; or

(2) Is the spouse of an individual receiving services.

History

#9475, eff 5-22-09; ss by #12340, eff 7-25-17

N.H. Code Admin. R. Ann. He-M 521.14 Waivers {#sec-he-m-521.14 omnilex-key=us-nh-regs-official--agency-he-m--He-M 521.14}

(a) An area agency, provider agency, individual, guardian, representative, or provider may request a waiver of specific procedures outlined in He-M 521 by completing and submitting the form titled “NH Bureau of Developmental Services Waiver Request” (September 2013 edition). The area agency shall submit the request in writing to the bureau administrator.

(b) A completed waiver request form shall be signed by:

(1) The individual, guardian(s), or representative(s) indicating agreement with the request; and

(2) The area agency’s executive director or designee recommending approval of the waiver.

Department of Health and Human Services

Office of Client and Legal Services

Hugh J. Gallen State Office Park

105 Pleasant Street, Main Building

Concord, NH 03301

(d) No provision or procedure prescribed by statute shall be waived.

(1) Does not negatively impact the health or safety of the individual(s); and

(2) Does not affect the quality of services to individuals.

(g) Waivers shall be granted in writing for a specific duration not to exceed 5 years except as in (h) below.

(h) Any waiver shall end with the closure of the related program or service.

(i) A requesting entity may request a renewal of a waiver from the bureau. Such request shall be made at least 90 days prior to the expiration of a current waiver.

History

#9475, eff 5-22-09 (from He-M 521.12); ss by #12340, eff 7-25-17

Part He-M 522 Eligibility and the Process of Providing Services for Individuals with an Acquired Brain Disorder

N.H. Code Admin. R. Ann. He-M 522.01 Purpose {#sec-he-m-522.01 omnilex-key=us-nh-regs-official--agency-he-m--He-M 522.01}

The purpose of these rules is to establish standards and procedures for the determination of eligibility, the development of service agreements, and the provision and monitoring of services that maximize the ability and informed decision-making authority of individuals with acquired brain disorder, and that promote the individual’s personal development, independence, and quality of life in a manner that is determined by the individual.

History

#7120, eff 10-20-99; ss by #8974, INTERIM, eff 10-6-07, EXPIRED: 4-3-08
#9734, eff 6-25-10; ss by #12683, eff 11-30-18; ss by #14253, eff 5-22-25, EXPIRES: 5-22-35

N.H. Code Admin. R. Ann. He-M 522.02 Definitions {#sec-he-m-522.02 omnilex-key=us-nh-regs-official--agency-he-m--He-M 522.02}

(a) “Acquired brain disorder” means a disruption in brain functioning that:

(1) Is not congenital or caused by birth trauma;

(2) Presents a severe and life-long disabling condition which significantly impairs a person’s ability to function in society;

(3) Occurs prior to age 60;

(4) Is attributable to one or more of the following reasons:

a. External trauma to the brain as a result of:

A motor vehicle incident;
A fall;
An assault; or
Another related traumatic incident or occurrence;

b. Anoxic or hypoxic injury to the brain such as from:

Cardiopulmonary arrest;
Carbon monoxide poisoning;
Airway obstruction;
Hemorrhage; or
Near drowning;

c. Infectious diseases such as encephalitis and meningitis;

d. Brain tumor;

e. Intracranial surgery;

f. Cerebrovascular disruption such as a stroke;

g. Toxic exposure; or

(5) Is manifested by one or more of the following:

a. Significant decline in cognitive functioning and ability; or

b. Deterioration in:

Personality;
Impulse control;
Judgment;
Modulation of mood; or
Awareness of deficits.

(b) “Amendment” means any change to the personal profile, provider agency, or provision of services, including the amount, scope, type, frequency, or duration, within a service agreement.

(d) “Area” means “area” as defined in RSA 171-A:2, I-a, namely, “a geographic region established by rules adopted by the commissioner for the purpose of providing services to developmentally disabled persons.” This term includes “region”.

(e) “Area agency” means “area agency” as defined in RSA 171-A:2, I-b.

(f) “Area agency director” means that person who is appointed as executive director or acting executive director of an area agency by the area agency’s board of directors.

(g) “Assistive technology” means technology designed to be utilized in an “assistive technology device” as defined in 29 U.S.C. section 3002(4) or “assistive technology service” as defined in 29 U.S.C. section 3002(5).

(h) “Brain injury community supports” means services administered through the Brain Injury Association of New Hampshire that:

(1) Are provided to persons with an acquired brain disorder who are eligible for services pursuant to He-M 522.03(a) but do not meet the eligibility criteria in He-M 517.03(a) for home and community-based care; and

(2) Include, at a minimum the following services when such services are not reimbursable by medicaid or other insurance:

a. Home modification;

b. Respite service;

c. Assistive technology;

d. Specialized equipment;

e. Transportation;

f. Short-term financial assistance, such as for utilities or rent;

g. Therapeutic evaluations; and

h. Other similar limited or nonrecurring services necessary for an individual to live as safely and independently as possible in their community.

(i) “Bureau” means the bureau of developmental services of the department of health and human services.

(j) “Bureau administrator” means the chief administrator of the bureau of developmental services.

(k) “Commissioner” means the commissioner of the department of health and human services or their designee.

(l) “Comprehensive risk assessment” means an evaluation administered pursuant to He-M 522.10 (m)(11) using evidence-based tools to evaluate an individual’s behaviors and determine the potential risks to the individual or others posed by said behaviors.

(m) “Days” means calendar days unless otherwise specified.

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

(o) “Developmental disability” means “developmental disability” as defined in RSA 171-A:2, V, namely, a disability:

(1) “Which is attributable to an intellectual disability, cerebral palsy, epilepsy, autism, or a specific learning disability, or any other condition of an individual found to be closely related to an intellectual disability as it refers to general intellectual functioning or impairment in adaptive behavior or requires treatment similar to that required for persons with an intellectual disability”; and

(2) “Which originates before such individual attains age 22, has continued or can be expected to continue indefinitely, and constitutes a severe disability to such individual’s ability to function normally in society.”

(p) “Guardian” means a person appointed pursuant to RSA 463 or RSA 464-A, or the parent of an individual under the age of 18 whose parental rights have not been terminated or limited by law.

(q) “Health Risk Screening Tool (HRST)” means the 2015 edition of the Health Risk Screening Tool, available as noted in Appendix A, which is a web-based rating instrument used for performing health risk screenings on individuals in order to:

(1) Determine an individual’s vulnerability regarding potential health risks; and

(2) Enable the early identification of health issues and monitoring of health needs.

(r) “Home and community-based waiver services (waiver services)” means the services defined and funded pursuant to New Hampshire’s agreement with the federal government, known as the Acquired Brain Disorder Waiver, pursuant to the authority of section 1915(c) of the Social Security Act, which allows the federal funding of long-term care services in non-institutional settings for persons who have an acquired brain disorder.

(s) “Individual” means a person with an acquired brain disorder.

(t) "Informed consent" means a decision made voluntarily by an individual or applicant for services or, where appropriate, such person's legal guardian or representative, after all relevant information necessary to making the choice has been provided, when the person understands that they are free to choose or refuse any available alternative, when the person clearly indicates or expresses their choice, and when the choice is free from all coercion.

(u) “Intellectual disability” means “intellectual disability” as defined in RSA 171-A:2, XI-a, namely, “significantly subaverage general intellectual functioning existing concurrently with deficits in adaptive behavior, and manifested during the developmental period. A person with an intellectual disability may be considered mentally ill provided that no person with an intellectual disability shall be considered mentally ill solely by virtue of his or her intellectual disability.”

(v) “Participant directed and managed services” means a method of service delivery provided pursuant to He-M 525.

(x) “Personal profile” means a narrative description that includes a personal statement from the individual and those who know them best that summarizes the individual’s strengths and capacities, communication and learning style, challenges, needs, interests, and any health concerns, as well as the individual’s hopes and dreams.

(y) “Provider” means a person receiving any form of remuneration for the provision of services to an individual.

(z) “Provider agency” means an agency or an independent provider that is established to provide services to individuals and meets the criteria in He-M 504.

(aa) “Representative” means:

(1) The parent or guardian of an individual under the age of 18;

(2) The guardian of an individual 18 or over; or

(3) A person who has power of attorney for the individual.

(ab) “Service” means any paid assistance to the individual in meeting their own needs provided through the developmental services system.

(ac) “Service agreement” means a written agreement between the individual, guardian, or representative and provider agencies, developed pursuant to He-M 522, that is prepared as a result of the person-centered service planning process and that describes the services that an individual will receive and constitutes an individual service agreement as defined in RSA 171-A:2, X.

(ad) “Service coordination agency” means a provider agency providing service coordination services to individuals, that meets the criteria in He-M 504.

(ae) “Service coordinator” means a provider who meets the criteria in He-M 522.09(b)-(d) and is chosen by an individual and their guardian or representative to organize, facilitate, and document service planning and to negotiate and monitor the provision of the individual’s services.

(af) “Service planning meeting” means a gathering of 2 or more people, one of whom is the individual who receives services unless they choose not to attend, held to develop, review, add to, delete from, or otherwise change a service agreement.

(ag) “State of residence” means the “state of residence” as defined in 42 CFR 435.403.

(ah) “Supported decision-making” means “supported decision-making” as defined in RSA 464-D:4, VI.

(ai) “Supports intensity scale adult version ® (SIS-A ®)” means the 2023 edition of the Supports Intensity Scale, available as noted in Appendix A, which is an assessment tool intended to assist in service planning by measuring the individual’s support needs in the areas of home living, community living, lifelong learning, employment, health and safety, social activities, protection, and advocacy. The tool uses a formal rating scale to identify the type of supports needed, frequency of supports needed, and daily support time.

(aj) “Termination” means the cessation of a service by an area agency director with or without the informed consent of the individual or their guardian or representative.

(ak) “Withdrawal” means the choice of an individual or their guardian or representative to discontinue that individual’s participation in a service.

History

#7120, eff 10-20-99; ss by #8974, INTERIM, eff 10-6-07, EXPIRED: 4-3-08
#9734, eff 6-25-10; ss by #12683, eff 11-30-18; ss by #14253, eff 5-22-25, EXPIRES: 5-22-35

N.H. Code Admin. R. Ann. He-M 522.03 Eligibility for Services {#sec-he-m-522.03 omnilex-key=us-nh-regs-official--agency-he-m--He-M 522.03}

(a) As referenced in He-M 522.02(a) and (ag), any person whose state of residence is New Hampshire and who has an acquired brain disorder shall be eligible for service coordination and community support.

(b) Individuals described in (a) above shall also be eligible for waiver services if they meet the requirements of He-M 517.03(a).

(c) Any applicant for services whose suspected acquired brain disorder occurred prior to age 22 shall be evaluated pursuant to He-M 503.05 to determine whether they have a brain injury that meets the criteria for developmental disability. If the applicant has a developmental disability, they shall be provided services pursuant to He-M 503.09 and He-M 503.10. If the applicant is determined not to have a developmental disability, they shall be evaluated for eligibility pursuant to He-M 522.05.

(d) Eligibility for services shall be reviewed pursuant to He-M 522.07.

History

#7120, eff 10-20-99; ss by #8974, INTERIM, eff 10-6-07, EXPIRED: 4-3-08
#9734, eff 6-25-10; ss by #12683, eff 11-30-18; ss by #14253, eff 5-22-25, EXPIRES: 5-22-35

N.H. Code Admin. R. Ann. He-M 522.04 Application for Services {#sec-he-m-522.04 omnilex-key=us-nh-regs-official--agency-he-m--He-M 522.04}

(a) Application for services shall be made by:

(1) The applicant;

(2) A guardian of an applicant under the age of 18;

(3) A guardian of an applicant age 18 or over if a guardian of the person has been appointed by the probate court pursuant to RSA 464-A; or

(4) A representative of the applicant authorized to make such application.

(b) An application for services shall be made in writing to the area agency in the applicant’s region of residence.

(c) An area agency shall explain the eligibility process and offer assistance to the applicant, guardian, or representative in making application for services.

(d) The area agency shall inform the applicant, guardian, or representative of its roles and responsibilities and provide information about:

(1) The types of evaluations, assessments, and screenings needed to assist in the development of the service agreement;

(2) Eligibility determination;

(3) Service coordination;

(4) Service agreement development and review;

(5) Services provided by the area agency and the assistance available to identify the services that are required;

(6) Service provision;

(7) Service monitoring; and

(8) Advocacy supports.

(e) To aid in the provision of comprehensive, efficient, and coordinated services, the area agency shall undertake a review of the public and private benefits and resources that are available to the applicant and inform the applicant of all such benefits and resources.

(f) An area agency shall request each applicant to authorize the release of information to permit the area agency to access relevant current and historical records and information for the determination of eligibility pursuant to He-M 522.03 regarding the applicant’s:

(1) Acquired brain disorder;

(2) Personal, family, social, educational, neuropsychological, medical, and rehabilitation status; and

(3) Functional abilities, interests, and aptitudes.

(g) Authorization to release information shall specify:

(1) The name of the applicant and the information to be released;

(2) The name of the person or organization being authorized to release the information;

(3) The name of the person or organization to whom the information is to be released; and

(4) The time period for which the authorization is given, which shall not exceed one year.

History

#7120, eff 10-20-99; ss by #8974, INTERIM, eff 10-6-07, EXPIRED: 4-3-08
#9734, eff 6-25-10; ss by #12683, eff 11-30-18; ss by #14253, eff 5-22-25, EXPIRES: 5-22-35

N.H. Code Admin. R. Ann. He-M 522.05 Determination of Eligibility as a Person with an Acquired Brain Disorder {#sec-he-m-522.05 omnilex-key=us-nh-regs-official--agency-he-m--He-M 522.05}

(a) To determine the existence of an applicant’s acquired brain disorder, the area agency shall perform a comprehensive screening evaluation consisting of:

(1) Reviewing available information, including, but not limited to:

a. Current physical, intellectual, cognitive, and behavioral evaluations;

b. An age-appropriate standardized functional assessment; and

c. As applicable, additional specialty medical, health, or clinical evaluations, such as communication, functional behavior, psychological, or psychopharmacological assessments, assistive technology, and personal safety or comprehensive risk assessments; and

(2) Gathering additional information and preforming the additional evaluations among those listed in (1) above that are necessary to complete the determination, if the information available is not adequate to make a determination of eligibility.

(b) The results of the comprehensive screening evaluation pursuant to (a) above and any other information concerning the applicant’s disability shall be the basis for determination of eligibility pursuant to He-M 522.03(a) and assist in the identification of needs and provision of services.

(d) An area agency shall review the information it has received regarding an applicant and, within 15 business days after the receipt of the completed application, make and communicate one of the following decisions on the eligibility of the applicant in accordance with He-M 522.03(a) to the applicant, guardian, or representative:

(1) Eligible; or

(2) Ineligible.

(g) Decisions by the bureau in (f) above shall be made within 5 business days.

(i) A written denial of eligibility pursuant to (d)(2) above shall describe the specific legal and factual basis for the denial, including specific citation of the applicable law or department rule, and advise the applicant of their right to appeal pursuant to He-M 522.17.

(j) Following a denial of eligibility, the applicant, guardian, or representative, as applicable, may reapply for services if new information regarding the diagnosis, age of onset, or severity of the disability or functional impairment related to the acquired brain disorder becomes available.

(k) Communication of approval of eligibility in accordance with (d)(1) above shall include a contact person at the area agency.

(l) Preliminary planning to determine the services needed shall occur with the individual and guardian or representative at the time of intake or during subsequent discussions. Preliminary evaluations shall be completed and preliminary recommendations for services shall be made within 21 days of a completed application for service.

(m) Within 3 days of the determination of the applicant’s eligibility under He-M 522.05(d)(1), the area agency shall review 1915(c) of the Social Security Act, waiver services, with the applicant, guardian, or representative in order to make a decision.

(n) If the individual, guardian, or representative is interested in pursuing waiver services within the next 12 months, within 5 business days of the individual’s decision pursuant to (m) above, the area agency shall submit an application for waiver level of care eligibility pursuant to He-M 517.03 to the bureau.

(o) In an emergency situation, temporary service arrangements may be made prior to the completion of the evaluation in (a) above if the bureau administrator, or designee, first determines that the individual meets one of the following:

(1) Is a victim of abuse or neglect pursuant to He-E 700;

(2) Is abandoned and homeless;

(3) Is without a caregiver due to death or incapacitation;

(4) Is at significant risk of physical or psychological harm due to decline in their medical or behavioral status; or

(5) Is presenting a significant risk to community safety.

(p) The determination of eligibility pursuant to He-M 522.03(a) by one area agency shall be accepted by every other area agency in the state.

History

#7120, eff 10-20-99; ss by #8974, INTERIM, eff 10-6-07, EXPIRED: 4-3-08
#9734, eff 6-25-10; ss by #12683, eff 11-30-18; ss by #14253, eff 5-22-25, EXPIRES: 5-22-35

N.H. Code Admin. R. Ann. He-M 522.06 Determination of Eligibility for Medicaid Home and Community-Based Waiver Services {#sec-he-m-522.06 omnilex-key=us-nh-regs-official--agency-he-m--He-M 522.06}

(a) For those persons found eligible under He-M 522.03(a), and who wish to pursue waiver services within the next 12 months, the bureau shall review the application submitted pursuant to He-M 522.05(n) and make a decision within 15 business days of receipt of the application.

(b) Within 3 days of the decision, the bureau shall communicate the decision to the area agency and the individual, guardian, or representative in writing.

(c) If there is not sufficient information to determine the individual’s level of care, a request for additional information shall be sent by the bureau to the submitting entity to allow an additional 10 days to provide information sufficient to determine level of care.

(d) If information to determine is not provided, the bureau shall deny the level of care application. However, if new information becomes available after such denial, a new application may be submitted.

(e) If the bureau determines the individual is not eligible for services in He-M 517, the notice shall include the specific legal and factual basis for the determination, including a specific citation to the applicable law or department rule, and the bureau shall advise the individual, guardian, or representative in writing of their right to appeal pursuant to He-M 517.12.

History

#7120, eff 10-20-99; ss by #8974, INTERIM, eff 10-6-07, EXPIRED: 4-3-08
#9734, eff 6-25-10; ss by #12683, eff 11-30-18; ss by #14253, eff 5-22-25, EXPIRES: 5-22-35

N.H. Code Admin. R. Ann. He-M 522.07 Periodic Review of Eligibility {#sec-he-m-522.07 omnilex-key=us-nh-regs-official--agency-he-m--He-M 522.07}

(a) If there is reason to believe that the individual’s level of cognitive functioning or adaptive behavior has changed and the individual no longer has an acquired brain disorder as defined in He-M 522.02(a), or a need for services pursuant to He-M 517.03(a)(3)b., the area agency shall notify the individual receiving services and the representative or guardian if the individual has one, and arrange for a reassessment of eligibility.

(b) In the event of a review pursuant to (a) above, the individual, representative, or guardian shall have the right to submit additional evaluations, letters, or other information regarding continued eligibility which shall be considered by the area agency or bureau prior to issuing a decision.

(c) If the results of the above reassessment demonstrate that the individual no longer meets the criteria for eligibility in He-M 522.03(a) the area agency shall inform the individual and representative or guardian in writing of the determination and phase out the relevant services over the 12 months following the date of notice. The phase plan shall be outlined through a service agreement.

(d) In each instance where the reassessment leads to a denial of eligibility, the area agency shall, in writing:

(1) Inform the applicant, guardian, or representative of the determination;

(2) Describe the specific legal and factual basis for the denial, including specific citation of the applicable law or department rule; and

(3) Advise the applicant, representative, or guardian of their right to appeal pursuant to He-M 522.17.

(e) An applicant, guardian, or representative may appeal a denial of eligibility based on the reassessment pursuant to He-M 522.17 and He-C 200.

History

#7120, eff 10-20-99; ss by #8974, INTERIM, eff 10-6-07, EXPIRED: 4-3-08
#9734, eff 6-25-10 (from He-M 522.06); ss by #12683, eff 11-30-18; ss by #14253, eff 5-22-25, EXPIRES: 5-22-35

N.H. Code Admin. R. Ann. He-M 522.08 Service Guarantees {#sec-he-m-522.08 omnilex-key=us-nh-regs-official--agency-he-m--He-M 522.08}

(a) All services shall:

(1) Be voluntary;

(2) Be provided only after the informed consent of the individual, guardian, or representative;

(3) Comply with the rights of the individual established under He-M 310 and federal laws and rules; and

(4) Maximize as much as possible the individual’s ability to determine and direct the services they will receive in accordance with federal and state laws and rules.

(b) All services shall be designed to:

(1) Promote the individual’s personal development and quality of life in a manner that is determined by the individual;

(2) Meet the individual’s needs in life skills to promote independent living:

a. Including educational activities with the purpose of assisting the individual in attaining or enhancing community living skills or adaptive skill development to assist the individual in residing in the most appropriate setting for their needs; and

b. Not including post-secondary education regardless of whether it leads to a degree or private tutoring;

(3) Promote the individual’s health and safety within the bounds of reasonable risk;

(4) Protect the individual’s right to freedom from abuse, neglect, and exploitation;

(5) Increase the individual’s participation in a variety of integrated activities and settings;

(6) Provide opportunities for the individual to exercise personal choice, independence, and autonomy within the bounds of reasonable risks;

(7) Enhance the individual’s ability to perform personally meaningful or functional activities;

(9) Be provided in such a way that the individual is seen as a valued, contributing member of their community; and

(10) Meet the individual’s needs in accordance with He-M 522.10(m).

(c) The environment or setting in which an individual receives services shall be the least restrictive, most integrated setting that promotes that individual’s:

(1) Freedom of movement;

(2) Ability to make informed decisions;

(3) Self-determination;

(4) Participation in the community in accordance with 42 CFR 441.301; and

(5) Rights in accordance with He-M 310.

(e) All provider agencies and providers shall comply with the rules and terms of the waiver when applicable, pertaining to the service(s) offered and meet the provisions specified within the individual’s service agreement.

(f) The area agency shall notify each individual, annually, that they have a right to choose their service coordinator in accordance with He-M 522.09(a).

(h) Area agencies and provider agencies shall inform individuals and applicants of their rights under these rules in clearly understandable language and form.

(i) For individuals who require a positive behavior support plan, emergency physical restraint shall only be approved for safely responding to situations in which the individual presents with imminent credible risk of significant harm to self or others by providers who are trained and certified in recognized intervention modalities.

History

#7120, eff 10-20-99; ss by #8974, INTERIM, eff 10-6-07, EXPIRED: 4-3-08
#9734, eff 6-25-10 (from He-M 522.07); ss by #12683, eff 11-30-18 (formerly He-M 522.09); ss by #14253, eff 5-22-25, EXPIRES: 5-22-35

N.H. Code Admin. R. Ann. He-M 522.09 Service Coordination {#sec-he-m-522.09 omnilex-key=us-nh-regs-official--agency-he-m--He-M 522.09}

(a) The service coordinator shall be a person chosen by the individual, guardian, or representative who meets the criteria in He-M 504, He-M 506, and He-M 522.09(b)-(d) below.

(b) For those individuals not eligible for waiver services pursuant to He-M 517, the service coordinator shall:

(1) Hold a person-centered service planning session to identify service needs and goals and appropriate community resources;

(2) Make appropriate referrals to community agencies; and

(3) Advocate on behalf of the individual for services to be provided in accordance with He-M 522.

(1) Advocate on behalf of individuals for services to be provided in accordance with the service guarantees in He-M 522.08(b);

(2) Coordinate the service planning process in accordance with He-M 522.08, He-M 522.10, and He-M 522.11;

(3) Describe to the individual, guardian, or representative service delivery options including participant directed and managed services;

(4) Monitor and document services provided to the individual in accordance with He-M 522.11 below and He-M 517 for waiver services;

(5) Ensure continuity and quality of services provided in the amount, scope, frequency, and duration as outlined in the service agreement;

(6) Monitor and document quality of services provided in accordance with He-M 522.11 below and He-M 517 for waiver services;

(7) Provide crisis and critical incident coordination and planning;

(8) Ensure that service documentation is maintained pursuant to He-M 522.11(c) and (i)(2)-(3) and He-M 517 for waiver services;

(10) Convene person-centered service planning meetings at least annually and whenever:

a. The individual, guardian, or representative is not satisfied with the services received;

b. There is no progress on the goals after follow-up interventions;

c. The individual’s needs change;

d. There is a need for a new provider agency; or

e. The individual, guardian, or representative requests a meeting;

(11) Document service coordination visits and contacts pursuant to He-M 522.10(u) and He-M 522.11(i)(2)-(4);

(12) No less than 45 days in advance of the annual person-centered service planning meeting:

b. Identify risk factors and plans to minimize them;

c. Assess the individual’s interest in, or satisfaction with, employment; and

d. Discuss and assess the individual’s progress on goals and preparing for the development of new goals to be included in the new service agreement;

(13) Assist the individual, guardian, or representative to maintain the individual’s public benefits; and

(14) Participate in risk management activities by:

a. Making referrals to the applicable area agency’s local risk management committee for individuals exhibiting behaviors including but not limited to violent aggression, problematic sexual behaviors, or fire-setting behaviors for evaluations or planning activities initially and ongoing;

c. Attending risk management training activities; and

d. Attending clinically specialized trainings, based on assessed needs of the individuals supported, that enable successful completion of and participation in risk management activities.

(d) A service coordinator shall not:

(1) Be a guardian or representative of the individual whose services they are coordinating; or

(e) A provider agency that provides direct services to the individual and seeks to also provide service coordination, shall be determined the only willing and qualified service coordination agency and permitted to provide service coordination services and direct services if the following criteria are met:

(1) There is a lack of another qualified service coordination agency willing to provide services to the individual as outlines in their service agreement;

(2) The individual, guardian, or representative agrees that the same agency shall provide both service coordination services and direct services;

(3) The agency ensures that service coordination services and direct services are located in different departments and different physical locations within the organization, and report to separate and equal organizational leadership; and

(4) The direct services department shall not develop or have any influence on developing the individual’s service agreement.

(f) A provider agency requesting determination to serve as the only willing and qualified service coordination agency in accordance with (e) above shall complete and submit the form entitled “NH Bureau of Developmental Services Exemption Request” (May 2025) along with the following documentation:

(1) Documentation that the criteria outlined in He-M 522.09(e)(1)-(4) above has been met;

(2) Such agency’s plan to develop or recruit service coordination agencies;

(3) Documentation of service coordinator orientation and training that outlines the role of the service coordinator as a neutral facilitator and how to offer choice to individuals;

(4) Documentation of how such agency ensures all individuals, guardians, and representatives have accurate and accessible information relative to service providers; and

(5) Documentation to demonstrate how such agency monitors that choice is given to individuals, guardians, and representatives.

(g) Upon review of the form and documentation submitted pursuant to (f) above, the bureau shall approve such a request if all the requirements are met.

(h) The approval of being the only willing and qualified service coordination agency shall be for one year.

(i) After approval of an initial exemption request, the agency in (f) above shall resubmit to the department a “NH Bureau of Developmental Services Exemption Request” form (December 2023) annually.

(j) The documentation required in (f)(1)-(5) shall only be required with the initial request.

(k) Subsequent requests shall not require the described documentation provided that the only willing and qualified service coordination agency certifies that there have been no changes to the original documentation submitted.

(l) Once an only willing and qualified service coordination agency request has been approved in accordance with (g) or (k) above, the bureau shall conduct ongoing quarterly monitoring regarding the criteria in (e)(1) above.

History

#7120, eff 10-20-99; ss by #8974, INTERIM, eff 10-6-07, EXPIRED: 4-3-08
#9734, eff 6-25-10 (from He-M 522.08); ss by #12683, eff 11-30-18 (formerly He-M 522.10); ); ss by #14253, eff 5-22-25, EXPIRES: 5-22-35

N.H. Code Admin. R. Ann. He-M 522.10 Service Planning {#sec-he-m-522.10 omnilex-key=us-nh-regs-official--agency-he-m--He-M 522.10}

(a) Preliminary planning for services shall be done in accordance with He-M 522.05(l).

(b) Within 15 days of an individual’s eligibility pursuant to He-M 522.05(d)(1), or level of care approval pursuant to He-M 522.06(a) for those for whom an application for waiver services has been submitted pursuant to He-M 522.05(n), the area agency shall assist the individual, guardian, or representative with resources to select a service coordinator.

(c) In instances when an individual has been determined eligible pursuant to He-M 522.05(d)(1), and declines services available pursuant to He-M 522.03(a) and waiver services, the area agency shall assign a service coordinator within 30 days.

(f) The service coordinator shall document that they have maximized the extent to which an individual participates in and directs their person-centered service planning process by:

(2) Explaining to the individual their rights and responsibilities pursuant to He-M 310;

(4) Determining with the individual issues to be discussed during all person-centered service planning meetings; and

(5) Explaining to the individual the limits of the decision-making authority of the guardian or representative, if applicable, and the individual’s right to make all other decisions related to services.

(h) Service coordinators shall facilitate service planning to develop service agreements in accordance with He-M 522.11. Service agreements shall be prepared initially according to the timeframe specified in He-M 522.11(c) and annually thereafter, as required by He-M 522.09(c)(10).

(i) The individual, guardian, or representative may determine the following elements of the person-centered service planning process:

(1) The number and length of meetings;

(2) The location, date, and time of meetings;

(3) The meeting participants; and

(4) Topics to be discussed.

(j) Copies of relevant evaluations and reports shall be sent to the individual and guardian or representative at least 5 business days before person-centered service planning meetings.

(l) The service coordinator shall contact all persons who have been identified to provide a service to the individual and confirm arrangements for providing such services.

(m) All service planning shall occur through a person-centered service planning process that:

(1) Maximizes the decision-making of the individual;

(2) Is directed by the individual or the individual’s guardian or representative, if applicable;

(3) Facilitates personal choice by providing information and support to assist the individual to direct the process, including information describing:

a. The array of services and provider agencies available; and

b. Options regarding self-direction of services;

(4) Includes participants freely chosen by the individual;

(5) Reflects cultural considerations of the individual and is conducted in clearly understandable language and form;

(6) Occurs at a time and location of convenience to the individual, guardian, or representative;

(7) Includes strategies for solving conflict or disagreement within the process, including clear conflict of interest guidelines for all planning participants;

(8) Is consistent with an individual’s rights to privacy, dignity, respect, and freedom from coercion and restraint;

(9) Includes the process for the individual, guardian, or representative to request amendments to the service agreement;

(10) Records the alternative home and community-based settings that were considered by the individual, guardian, or representative;

(11) Includes information related to risk by:

a. Incorporating information obtained through a comprehensive risk assessment, which shall be administered:

Initially, at the beginning of service planning, or as needed to each individual with a history of, or exhibiting signs of, behaviors that pose a potentially serious likelihood of danger to self or others, or a serious threat of substantial damage to real property, such as, but not limited to, the following:

(i) Problematic sexual behavior;

(ii) Violent aggression;

(iii) Fire-setting behaviors; or

(iv) Other similar violent or dangerous behaviors or events;

Prior to any significant change in the level of the individual’s treatment or supervision;
At any time an individual who previously has not had a comprehensive risk assessment begins to engage in behaviors referenced in 1. above; and
By an evaluator with specialized experience, training, and expertise in the treatment of the types of behaviors referenced in a.1. above;

c. Ensuring documentation of activities and progress in treatment relative to management of risk for an individual to help inform development of person-centered service plans;

d. Making referrals for individuals associated with high-risk incidents to participate in evaluations or planning activities initially and ongoing;

e. Processing and analyzing incidents related to violent aggression, problematic sexual behavior, or fire-setting behaviors; and

f. Making referrals for individuals associated with high-risk incidents to evaluations or planning activities initially and ongoing;

(13) Includes strategies to address co-occurring severe mental illness or behavioral challenges which are interfering with the individual’s functioning, including positive behavior plans or other strategies based on functional behavior or other evaluations or referrals to behavioral health services;

(15) Includes individualized backup plans and strategies;

(16) Includes strategies for solving disagreements;

(17) Uses a strengths-based approach to identify the positive attributes of the individual;

(18) Includes the provision of auxiliary aids and services when needed for effective communication, including low literacy materials and interpreters;

(19) Addresses the individual’s concerns about current or contemplated guardianship or other legal assignment of rights;

(20) Explores housing and employment in integrated settings, and develops plans consistent with the individual’s goals and preferences;

(21) Includes a review of the past year that:

a. Includes the individual’s:

Personal achievements;
Relationships;
Degree of community involvement;
Challenging issues or behavior;
Health status and any changes in health; and
Safety considerations during the year;

b. Addresses the previous year’s goals with level of success and, if applicable, identifies any obstacles encountered;

c. Identifies the individual’s personal goals and the supports that will aid in achieving their goals;

d. Identifies the type and amount of services the individual receives and the support services provided under each service category;

e. Identifies the individual’s health needs;

f. Identifies the individual’s safety needs;

g. Identifies any follow-up action needed on concerns and the persons responsible for the follow-up; and

h. Includes a statement of the individual’s and guardian or representative’s satisfaction with services;

(22) Includes the individual’s paid employment and volunteer positions, as applicable;

(23) Considers historical information about the individual’s experiences; and

(n) The information outlined in (m)(1)-(24) above shall be entered into the service agreement outlined in He-M 522.11 when the individual, guardian, representative, or planning team determine that such information is necessary for successful participation in the services and supports outlined in the service agreement.

(o) All planning for waiver services shall include information from the following assessments:

(1) The American Association on Intellectual and Developmental Disabilities’, “SIS-A ®”, (2023 edition), available as noted in Appendix A, which shall be administered:

a. Initially, within 60 days of the determination of eligibility for waiver services pursuant to He-M 522.06(a) for each individual;

b. Upon a significant change as defined under SIS-A ® protocols;

c. Five years following each prior administration; and

d. To individuals who have moved to New Hampshire and are requesting waiver services in the next 12 months. If the individual previously had a SIS-A ® completed in another state within the last 5 years, however, then they may provide the out-of-state SIS-A ® results in place of taking a new SIS-A ®;

(2) Information obtained through the HRST (2015 edition), available as noted in Appendix A, which shall be administered:

a. Initially, upon determination of eligibility for waiver services pursuant to He-M 522.06(a) for each individual; and

b. Annually or upon significant change in an individual’s status; and

(3) For residential services, includes information from personal safety assessments pursuant to He-M 1001.

(1) Include the individual and other persons involved in their life;

(2) Are facilitated by a service coordinator; and

(3) Are focused on the individual’s abilities, health, interests, and achievements.

(q) Service agreements shall be reviewed by the service coordinator with the individual, guardian, or representative at least once during the first 6 months of service and as needed. The annual review required by He-M 522.09(c)(10) shall include a service planning meeting.

(r) The reviews required in (q) above shall include, at a minimum, the following:

(1) A thorough clinical examination including an annual health assessment;

(2) An assessment of the individual’s capacity to make informed decisions; and

(3) Consideration of less restrictive alternatives for service.

(u) The service coordinator shall be responsible for monitoring services identified in the service agreement pursuant to He-M 522.11 and for assessing individual, guardian, or representative satisfaction at least annually for non-waiver services and quarterly for waiver services.

(v) If an individual has a residency agreement and there is notification of intended termination, the service coordinator shall convene a person-centered service planning meeting as follows:

(1) Within 10 days of receipt of notification of the intended termination; or

(2) Within 24 hours of receipt of the notification if the intended termination is within 72 hours due to the threat of serious bodily injury by or to the resident.

(w) An area agency, service coordinator, provider agency, provider, individual, guardian, or representative shall have the authority to request a person-centered service planning meeting at any time.

(x) Service agreement amendments may be proposed at any time.

(y) If the individual, guardian, representative, or provider agency disapproves of the service agreement, or a service agreement amendment, the dispute shall be resolved:

(1) Through informal discussions between the individual, guardian, or representative and service coordinator;

(2) By reconvening a service planning meeting; or

(3) By the individual, guardian, or representative filing an appeal to the department pursuant to He-C 200.

History

#7120, eff 10-20-99; ss by #8974, INTERIM, eff 10-6-07, EXPIRED: 4-3-08
#9734, eff 6-25-10 (from He-M 522.09); ss by #12683, eff 11-30-18 (formerly He-M 522.11); ss by #14253, eff 5-22-25, EXPIRES: 5-22-35

N.H. Code Admin. R. Ann. He-M 522.11 Service Agreements {#sec-he-m-522.11 omnilex-key=us-nh-regs-official--agency-he-m--He-M 522.11}

(a) The service coordinator shall create service agreements for all individuals in accordance with (b)-(j) below.

(b) All service agreements shall:

(1) Be understandable to the individual, guardian, or representative and all provider agencies and providers responsible for service provision;

(2) Be written in plain language and in a manner accessible and understandable to individuals with disabilities and persons who have limited proficiency in English;

(3) Be finalized and agreed to in writing by the individual, guardian, or representative and signed by all provider agencies responsible for the implementation of the service agreement;

(4) Be entered into the electronic platform, IntellectAbility, at https://nhbds.hrstapp.com/ and then NHEasy at https://nheasy.nh.gov/#/ when IntellectAbility sunsets; and

(5) Be distributed to the individual, guardian, or representative, area agency, and all provider agencies and providers who are responsible for the implementation or monitoring of the service agreement.

(c) Within 14 days of the initial person-centered service planning meeting pursuant to He-M 522.10(e), the service coordinator shall develop a service agreement, that includes, but is not limited to, the following:

(1) A statement of the nature of the specific strengths, interests, capacities, disabilities, and specific needs of the individual;

(2) A description of intermediate and long-range habilitation and treatment goals chosen by the individual and their guardian or representative with a projected timetable for their attainment;

(3) A statement of specific waiver services to be provided and the amount, scope, frequency, and duration of each service;

(4) Specification of the provider agencies to furnish each service identified in the service agreement;

(5) Criteria for transfer to less restrictive settings for habilitation, including criteria for termination of service and a projected date for termination of service;

(6) Demographic information;

(7) A personal profile;

(8) The specific services to be furnished based on the support needs identified in (1) above and how the services selected will support the individual’s goals;

(9) Guardianship, supported decision making, and representative payee information;

(10) Service documentation requirements sufficient to track outcomes;

(11) Identification of the persons and entities responsible for monitoring the services in the service agreement;

(12) Documentation that all settings where the individual receives services meet the criteria of 42 CFR 441.301, are chosen by the individual, guardian, or representative, and support full access to the greater community, including opportunities to seek employment and work in competitive integrated settings, engage in community life, control personal resources, and receive services in the community to the same degree of access as people not receiving services;