N.H. Code Admin. R. Ann. He-E — Bureau of Aging and Adult Services

Chapter He-E 300 Division of Elderly and Adult Services Files

Part He-E 310 Rights of Individuals Receiving Choices for Independence in the Community

N.H. Code Admin. R. Ann. He-E 310.01 Purpose {#sec-he-e-310.01 omnilex-key=us-nh-regs-official--agency-he-e--He-E 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-E 801.03 and who are being served in the community. Participants might have additional rights under RSA 151:21, patients' bill of rights for residents of health care facilities RSA 151:21-b, home care clients’ bill of rights, RSA 151:26 transfer or discharge of patients, and RSA 151:26-a discharge of home health care clients.

History

#14058, eff 8-20-24

N.H. Code Admin. R. Ann. He-E 310.02 Definitions {#sec-he-e-310.02 omnilex-key=us-nh-regs-official--agency-he-e--He-E 310.02}

(a) “Abuse” means “abuse” as defined in RSA 161-F:43, II namely “any one of the following:

(a) "Emotional abuse" means the misuse of power, authority, or both, verbal harassment, or unreasonable confinement which results or could result in the mental anguish or emotional distress of a vulnerable adult.

(b) "Physical abuse" means the use of physical force which results or could result in physical injury to a vulnerable adult.

(c) "Sexual abuse" means contact or interaction of a sexual nature involving a vulnerable adult without his or her informed consent.”

(b) “Adult day facility” means a facility licensed in accordance with He-P 818 and RSA 151:2, I(f).

(c) “Adult family care” means participant housing option for eligible participants under the choices for independence (CFI) waiver program, which includes a combination of personal care, homemaking, and other services that are provided to a participant who is a resident in a certified residence of an unrelated individual or the CFI waiver participant’s relative in accordance with a person-centered plan.

(d) “Applicant” means any person who requests services pursuant to He-E 801.

(e) “Attorney” means a member of the New Hampshire bar association retained, employed, or appointed by a court to represent a participant.

(f) “Authorized representative” means an individual acting on behalf of the casehead in some or all of the aspects of initial and continuing eligibility.

(g) “Case management agency” means an agency licensed pursuant to RSA 151:2-b and He-P 819 and enrolled as a New Hampshire medicaid provider to provide targeted case management services to CFI participants in accordance with He-E 805.

(h) “Coercion” means an act by an employee, contractor, consultant, or volunteer of a service provider which is designed to compel a participant to act in clear opposition to the preference of the participant, excluding requirements otherwise prescribed by law or rule.

(i) “Comprehensive care plan” means an individualized person-centered plan described in He-E 805.05(c) that is:

(1) The result of a person-centered process that identifies the strengths, capacities, preferences, and desired outcomes of the participant;

(2) Developed by the participant’s case manager in collaboration with the participant, the participant’s guardian, and the participant’s legal representative if any;

(3) Written by the case manager; and

(4) Is an integrated plan of all the participant’s services.

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

(k) “Exploitation” means “exploitation” as defined in RSA 161-F:43, IV namely “the illegal use of a vulnerable adult’s person or property for another person’s profit or advantage, or the breach of a fiduciary relationship through the use of a person or person’s property for any purpose not in the proper and lawful execution of a trust, including, but not limited to, situations where a person obtains money, property, or services from a vulnerable adult through the use of undue influence, harassment, duress, deception, or fraud.”

(l) “Grievance” means an expression of dissatisfaction or complaint on behalf of a participant related to the department’s administration of CFI or a provider’s performance of CFI services regardless of whether remedial action is requested.

(m) “Guardian” means a person appointed under RSA 464-A.

(n) “Informed decision” means a choice made voluntarily by a participant receiving services or an applicant for services or, where appropriate, such participant's guardian or legal representative, after all relevant information necessary to making the choice has been provided, when:

(1) The participant understands that the participant is free to choose or refuse any available alternative;

(2) The participant indicates or expresses the participant’s choice; and

(3) The choice is free from all coercion.

(o) “Legal representative” means “legal representative” as defined in RSA 161-F:11, VII namely “any individual, duly appointed or designated in the manner required by law to act on behalf of another individual including:

(a) An attorney.

(b) A guardian or conservator.

(p) “Neglect" means “neglect” as defined in RSA 161-F:43, III, namely “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 and safety of a vulnerable adult.”

(q) “Participant” means an individual receiving CFI services. For the purposes of this part, participant shall include an individual who has applied for CFI services.

(r) “Person-centered” means a process for planning and supporting the participant receiving services that builds upon the participant’s capacity to engage in activities that promote community life, and honors the participant’s preferences, choices, and abilities, and which involves families, friends, and professionals as the participant desires or requires.

(s) “Prescribing practitioner” means a licensed professional with prescriptive authority, including the following:

(1) Physician;

(2) Advance practice registered nurse;

(3) Dentist;

(4) Physician's assistant;

(5) Optometrist; and

(6) Podiatrist.

(t) “Provider” means an individual or entity providing one or more CFI covered services.

(u) “Provider care plan” means a written guide that:

(1) Is developed by the provider in consultation with the participant, the participant’s legal representative, if any, or both, and the participant’s primary care provider, if applicable;

(2) Is developed as a result of an assessment process which includes communication with the participant’s case manager;

(3) Is consistent with and addresses the applicable service needs identified in the participant’s comprehensive care plan; and

(4) Contains specific instructions on providing a defined service to the participant.

(v) “Quality coordinator” means an individual employed by BAAS as a quality coordinator or a designee of the quality coordinator.

(w) “Residential care facility” means “residential care facility” as defined in RSA 151-E:2, VIII namely “a facility, including a supported residential care facility, which provides services to 2 or more individuals, beyond room and board care, in a residential setting, as an alternative to nursing facility care, which offers residents home-like living arrangements, social, health, or medical services, including but not limited to, medical or nursing supervision, or medical care or treatment by appropriately trained or licensed individuals, assistance in daily living, or protective care. “Residential care facility” shall also include a facility certified in accordance with RSA 151:9 VIII.”

(x) “Residential services agreement” means a required agreement between a residential care facility and a participant pursuant to RSA 161-J:4.

(y) “Service” means any evaluation, training, counseling, therapy, habilitation, service coordination, or other type of assistance provided by a provider agency.

(z) “Standard disclosure summary” means information that a residential care facility provides to a prospective resident regarding the costs and services options provided by the residential care facility pursuant to He-E 605.04.

(aa) “Systemic factors” means internal policies and processes that influence the department’s operations and effectiveness, including:

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

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

(3) Practices to assure accurate fiscal management; and

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

(ab) “Treatment” means medical care provided by a prescribing practitioner.

History

#14058, eff 8-20-24

N.H. Code Admin. R. Ann. He-E 310.03 Notice of Rights of Participants and Applicants {#sec-he-e-310.03 omnilex-key=us-nh-regs-official--agency-he-e--He-E 310.03}

(a) Participants shall receive a pamphlet published by the department that explains the participant’s rights under these rules in plain language and form, both verbally and in writing, on an annual basis and provide meaningful access to participants with limited English proficiency.

(b) The notification of rights required pursuant to (a) above shall include, at a minimum, the following measures:

(1) Providers shall inform applicants for services of the applicant’s rights to evaluations and access to treatment and other services;

(2) Providers shall provide meaningful and understandable information about rights to participants who have been adjudicated incapacitated as well as to the participant’s guardian or the participant’s legal representative;

(3) Providers shall provide information outlining the process of how to file a grievance with:

a. The department pursuant to He-E 310.09 below;

b. Adult protective services for grievances involving abuse, neglect, exploitation, or self-neglect of a vulnerable adult;

c. The long term ombudsman established pursuant to RSA 161-F:10 for grievances involving residential care facilities; or

d. The department ombudsman’s office established pursuant to RSA 126-A:4, IV for civil rights issues;

(4) Providers shall advise the participant, the participant’s guardians, or the participant’s legal representative of the participant’s rights upon initial participation in any service, upon any change in provider or community residence, and at least once a year after initial participation;

(5) Every residential care facility and adult family care provider 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 plain language and form; and

(6) Each residential care facility and adult family care provider residence shall have on the premises complete copies of rules pertaining to rights of participants which are available for the participant, the participant’s guardian, the participant’s legal representative, and staff to review.

(c) Each provider shall provide participants meaningful time to review the participant’s rights and encourage the participant or the participant’s guardian, or the participant’s legal representative, to sign a statement acknowledging notification of the participant’s rights.

History

#14058, eff 8-20-24

N.H. Code Admin. R. Ann. He-E 310.04 Fundamental Rights {#sec-he-e-310.04 omnilex-key=us-nh-regs-official--agency-he-e--He-E 310.04}

(a) All participants shall be entitled to any legal right to which all citizens are entitled.

(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 and to vote, if eligible, in public elections and, as provided in 52 USC 10508, the right to receive assistance from the person of the participant’s choice in registering to vote and in voting;

(3) The following civil rights, unless a court has determined that a participant is legally incapacitated pursuant to RSA 464-A and the participant’s guardian or the participant’s legal representative has been appointed to make certain decisions:

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; and

e. The right to make a will;

(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, gender identity, 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 participant;

b. Services which are accessible to participants of limited English proficiency; and

c. Service locations that are accessible and meet the participant’s physical, sensory, intellectual, or emotional needs;

(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; and

(6) The right to receive copies of the participant’s care plans, as defined in He-E 310.02 (i) and (u)

History

#14058, eff 8-20-24

N.H. Code Admin. R. Ann. He-E 310.05 Personal Rights {#sec-he-e-310.05 omnilex-key=us-nh-regs-official--agency-he-e--He-E 310.05}

(a) Participants and applicants shall be treated with dignity and respect at all times.

(b) Participants shall be free from abuse, neglect, and exploitation including, at a minimum, personal or financial exploitation.

(d) Participants shall have the right to be free from coercion.

(e) Any participant who uses or has used CFI provider services shall have the right to confidentiality of all information and records.

(f) Access to records shall be as follows:

(1) Information pertaining to a participant shall be released to the participant and the participant’s guardian or the participant’s legal representative upon request including all information provided by third parties;

(2) Information shall be released to any person or organization that has obtained the written

consent of the participant, the participant’s guardian, or the participant’s legal representative;

(3) In cases where a participant, the participant’s guardian, or the participant’s legal representative of the participant requests copies of the record, such copies shall be made available free of charge; and

(4) Information regarding the medical treatment of a participant shall be released to law enforcement officials or health facility personnel if necessary to address an emergency situation involving danger to the participant's health or safety, but only specific information necessary to the relief of the emergency may be released without the participant's, the participant’s guardian, or the participant’s legal representative’s consent.

(g) In accordance with RSA 329:31, RSA 329-B:29, and RSA 330-A:35, when a participant 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:

(1) Physicians licensed pursuant to RSA 329;

(2) Psychologists licensed pursuant to RSA 329-B; and

(3) Persons licensed pursuant to RSA 330-A and those who work under the supervision of the mental health practitioner.

(h) Participants, the participant’s guardian, and the participant’s legal representative 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.

(i) Any person shall have the right to complain or bring a grievance on behalf of a participant or a group of participants to:

(1) The department pursuant to He-E 310.09 below;

(2) Adult protective services for grievances involving abuse, neglect, exploitation, or self-neglect of a vulnerable adult;

(3) The long term ombudsman established pursuant to RSA 161-F:10 for grievances involving residential care facilities; and

(4) The department’s ombudsman’s office established pursuant to RSA 126-A:4, IV for civil rights issues.

History

#14058, eff 8-20-24

N.H. Code Admin. R. Ann. He-E 310.06 Service Rights {#sec-he-e-310.06 omnilex-key=us-nh-regs-official--agency-he-e--He-E 310.06}

(a) Participants shall have the right to adequate and humane service and treatment, including:

(1) The right to quality services including services provided in accordance with licensing requirements and rules adopted by the department in He-P 800 and other applicable rules of state agencies and services provided in keeping with generally accepted clinical and professional standards;

(2) The right to receive services in the participant’s community that will promote the participant’s full community participation;

(3) The right to a person-centered planning process that:

a. Is directed by the participant to the maximum extent possible;

b. Is intended to identify the strengths, capacities, preferences, needs, and desired outcomes of the participant;

c. Includes individuals freely chosen by the participants;

d. Provides information and support to assist the participant to direct the process and to make informed choices and decisions;

e. Reflects cultural considerations of the participant and is conducted in plain language and form and provides meaningful access to participants with limited English proficiency;

f. Occurs at times and location of convenience to the participant;

g. Includes strategies for solving conflict or disagreement within the process;

h. Offers informed choices to the participant, the participant’s guardian, or legal representative, if applicable, regarding services and supports;

i. Involves the family of the participant or other individuals the participant chooses in enabling and assisting the participant to identify and access a personalized mix of paid and non-paid services and supports that will assist the participant to achieve personally defined outcomes in the most integrated setting appropriate to the needs of the participant;

j. Includes identification of the participant’s planning goals to achieve personal outcomes in collaboration with those whom the participant has identified;

k. Results in a comprehensive care plan that identifies the strengths, capacities, preferences, and desired outcomes of the participant and other services the participant is to receive to achieve those outcomes; and

l. Includes a method for the participant to request changes to the comprehensive care plan;

(4) The right to a comprehensive care plan developed, reviewed, and revised in accordance with He-E 805;

(5) The right to services in accordance with the time frame set in the comprehensive care plan;

(6) The right to services in a setting that is:

a. Based on the participant’s needs and preferences;

b. Chosen by the participant, the participant’s guardian, or the participant’s legal representative from among options that are identified in the comprehensive care plan and include non-disability specific settings; and

c. Integrated in, and supportive of full access of participants 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; and
Live in a private unit in a residential setting, based on personal resources available for room and board;

(7) The right to be informed of all significant risks, benefits, and alternative services and to give consent to any service or referral following an informed decision;

(8) The right to refuse any service;

(9) The right to be fully informed of one's own diagnosis and prognosis by the participant’s health care provider;

(10) The right to voluntary participation in services, as decided by the participant, the participant’s guardian, or the participant’s legal representative, including the right to seek changes in services or providers at any time or to withdraw from any form of service or from a provider;

(11) The right to services which promote independence including services which shall be directed toward:

a. Eliminating or reducing the participant’s need for continued services; and

b. Promoting the ability of the participant to function at the participant’s highest capacity and as independently as possible;

(12) The right to receive or to refuse medical care, medications, and treatment;

(13) The right to consultation and second opinion at the participant’s own expense the consultative services of private physicians, psychologists, dentists, or other health practitioners;

(14) The right to choose, or have the participant’s guardian or the participant’s legal representative choose, one or more person(s) to be present at any person-centered planning meeting or other service planning meeting;

(15) The right to freedom from restraint except when allowed by RSA 151:21; and

(16) 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 telephone calls that do not interfere with other residents;

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 participants to engage in such activities.

(b) Individuals applying for CFI shall have the right to evaluation to determine an the individual’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) Providers may restrict access by participants to various locations to:

(1) Ensure the privacy or safety of participants; or

(2) Comply with provisions of law and orders of court.

(e) These rules shall not require any prescribing practitioner to administer treatment contrary to such professional's clinical judgment.

History

#14058, eff 8-20-24

N.H. Code Admin. R. Ann. He-E 310.07 Termination of Services {#sec-he-e-310.07 omnilex-key=us-nh-regs-official--agency-he-e--He-E 310.07}

(a) Providers shall only terminate services to participants in accordance with RSA 151:26 for residential care facilities or RSA 151:26-a for home health providers.

(b) Residential care facilities and home health providers shall provide written notice to the participant, the participant’s guardian, or the participant’s legal representative of the participant’s right to appeal a discharge or transfer with the department’s administrative appeals unit in accordance with He-C 200.

History

#14058, eff 8-20-24

N.H. Code Admin. R. Ann. He-E 310.08 Rights of Participants in Residential Care Facilities {#sec-he-e-310.08 omnilex-key=us-nh-regs-official--agency-he-e--He-E 310.08}

(a) In addition to the foregoing rights, participants living in residential care facilities 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 participant;

(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 telephone calls that do not interfere with other residents;

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 participants to engage in such activities;

(4) The right to privacy in the participant'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 participant with only appropriate staff having keys to doors;

c. The right to receive visitors of the participant’s choosing at any time;

d. The right to opportunities for personal interaction in a private setting except that any conduct or activity which is illegal shall be prohibited;

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 participant choice, including the following:

a. The right to keep and wear their own clothes;

b. The right to space for personal possessions;

c. The right to keep and to read materials of the participant’s own choosing;

d. The right to keep and spend the participant’s own money;

e. The right to be compensated for any work performed and the right not to work;

f. The right to have a choice of one’s room if multiple rooms are available;

g. The right to have a choice of one’s roommate when bedrooms are shared;

h. The right to furnish and decorate one’s sleeping or living unit within the limits of the lease or other agreement; and

i. The freedom and support to control one’s own activities and schedules, including but not limited to access to food at any time; and

(6) The right to be reimbursed for the loss of any money held in safekeeping by the residential care facility.

(b) Nothing in He-E 310.08 shall require a residential care facility to have policies governing the behavior of the residents.

(c) Participants, the participant’s guardians, and the participant’s legal representatives shall have the right to be informed in writing of any residential care facility policies prior to admission to the residential care facility including a copy of the residential services agreement and standard disclosure summary.

(d) Residents shall have the right to participate in the development and modification of any house policies and be provided the opportunity to review the house policies at least annually.

(e) Residential care facility policies shall be in conformity with He-E 310.

(f) Residential care facility policies shall be reviewed annually for compliance with He-E 310 in connection with department site visits.

(g) Any modification to (a)(4) or (5) above shall be supported by a specific assessed need and documentation described in (h) below.

(h) A residential care facility shall only make modifications pursuant to (g) above by documenting in the provider care plan the following:

(1) The specific and individualized assessed need with a description of the condition that is directly proportionate to the need;

(2) Positive interventions and supports used prior to any modification to the provider care plan;

(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 with established timelines for periodic review to determine whether the modification is still necessary or can be terminated;

(5) Informed consent of the participant, the participant’s guardian, or the participant’s legal representative; and

(6) An assurance that the interventions and supports will not cause harm to the participant.

History

#14058, eff 8-20-24

N.H. Code Admin. R. Ann. He-E 310.09 CFI Grievances {#sec-he-e-310.09 omnilex-key=us-nh-regs-official--agency-he-e--He-E 310.09}

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

(1) A participant;

(2) A participant’s guardian or family member;

(3) An employee, contractor, consultant, or volunteer for the department; or

(4) An employee, contractor, consultant, or volunteer for a CFI provider.

(b) Individuals may file a grievance with the bureau of adult and aging services (BAAS) by:

(1) Emailing the grievance to BAASQualityManagement@dhhs.nh.gov;

(2) Mailing the grievance to: Bureau of Adult and Aging Services, Attn: Quality Coordinator, 105 Pleasant Street, Concord, NH 03301;

(3) By telephone to 603-271-2240; or

(4) By fax to 603-271-4643, Attn: Quality Coordinator.

(d) Reporters shall be informed of changes to the status of the grievance until the complaint is resolved.

(e) BAAS shall resolve each grievance and provide notice as expeditiously as the participant’s health condition requires pursuant to 42 CFR 441.301(c)(7)(v)(A).

(f) BAAS shall provide assistance to individuals filing a grievance including ensuring accessibility to individuals with disabilities and individuals with limited English proficiency.

(g) Anonymous grievances shall be accepted, but follow up information will not be provided to a grievant who fails to provide contact information.

(h) The name and identity of a grievant shall be kept confidential during the resolution of the grievance unless the grievant requests that the grievant’ s name be shared.

(i) Nothing in this section shall affect a participant’s right to file an appeal pursuant to He-C 200.

History

#14058, eff 8-20-24

N.H. Code Admin. R. Ann. He-E 310.10 Grievance Processing {#sec-he-e-310.10 omnilex-key=us-nh-regs-official--agency-he-e--He-E 310.10}

(a) The BAAS quality coordinator shall resolve grievances by one of the following:

(1) An informal grievance resolution where the quality coordinator, the participant, and any other appropriate parties shall meet via telephone, internet video meeting software, or any other agreed upon method to address concerns identified in the grievance;

(2) A formal grievance resolution where the quality coordinator shall investigate the grievance to determine the circumstances of the situation and submit a report to the BAAS bureau chief on the grievance and, if applicable, any systemic factors that played a role in the grievance; or

(3) Make a referral to another agency as appropriate as described in He-E 310.11.

(b) All appropriate parties involved in a grievance resolution shall receive a written summary stating the details of the grievance and the resolution made.

(c) For grievances filed. the participant shall determine whether the quality coordinator proceeds with informal or formal resolution of the grievance

(d) An individual unsatisfied with the outcome of an informal resolution may request a formal resolution by contacting the BAAS quality coordinator within 30 days of the date of the informal resolution summary provided to all appropriate parties pursuant to (b) above.

History

#14058, eff 8-20-24

N.H. Code Admin. R. Ann. He-E 310.11 Grievance Referral {#sec-he-e-310.11 omnilex-key=us-nh-regs-official--agency-he-e--He-E 310.11}

(a) The BAAS quality coordinator shall refer any grievance involving abuse, neglect, or exploitation of a potentially vulnerable adult to adult protective services.

(b) The BAAS quality coordinator shall refer any grievance that alleges criminal conduct of an individual to the appropriate law enforcement agency.

(c) The BAAS quality coordinator shall refer any grievance involving the services of a long-term care facility to the office of long-term care ombudsman.

(d) The BAAS quality coordinator shall refer any grievance regarding a licensed health care provider to DHHS health facilities administration.

(e) After referring a grievance pursuant to (a)-(d) above, the BAAS quality coordinator shall not proceed with attempting to resolve the grievance if the agency or office that received the referral indicates that the agency or office will proceed with an investigation. If the agency or office that received the referral does not indicate that the agency or office will proceed with an investigation within 5 business days of the referral, the quality coordinator shall proceed with either a formal or informal resolution.

(f) If a grievant is unsatisfied with the resolution of a referred entity, the grievant may contact the BAAS quality coordinator, and the BAAS quality coordinator shall proceed with either an informal or formal resolution. The participant shall determine whether the quality coordinator proceeds with informal or formal resolution of the grievance.

History

#14058, eff 8-20-24

N.H. Code Admin. R. Ann. He-E 310.12 Grievance Records {#sec-he-e-310.12 omnilex-key=us-nh-regs-official--agency-he-e--He-E 310.12}

BAAS shall maintain a record of each grievance received which shall include:

(a) A general description of the reason for the grievance;

(b) The date the grievance was received by BAAS;

(d) The resolution of the grievance;

(e) The date of the resolution; and

(f) The name of the participant for whom the grievance was filed.

APPENDIX

Rule

Specific State or Federal Statute or Regulations the Rule Implements

He-E 310

RSA 151-E:12; 42 CFR 441.301(c)(4); RSA 151:19-30; RSA 161-J; 42 CFR 441.301(c)(7)

History

#14058, eff 8-20-24

N.H. Code Admin. R. Ann. He-E 501.01 Purpose and Goals {#sec-he-e-501.01 omnilex-key=us-nh-regs-official--agency-he-e--He-E 501.01}

(a) The purpose of this part is to describe the requirements for services provided by the NH department of health and human services through the social services block grant funded under Title XX of the Social Security Act (Title XX).

(b) Title XX services shall be directed toward one or more of the goals contained in 42 USC 1397.

History

#5584, eff 2-16-93; ss by #5732, eff 10-27-93, EXPIRED: 10-27-99
#9849-A, eff 1-12-11, EXPIRED: 1-12-19
#12720, INTERIM, eff 1-29-19, EXPIRED: 7-29-19
#12936, eff 12-7-19

N.H. Code Admin. R. Ann. He-E 501.02 Definitions {#sec-he-e-501.02 omnilex-key=us-nh-regs-official--agency-he-e--He-E 501.02}

(a) “Activities of daily living (ADL)” means activities such as grooming, toileting, eating, dressing, getting into or out of a bed or chair, walking, and monitoring and supervision of medications.

(b) “Adult” means “adult” as defined in RSA 161-F:1, I, namely “any person 18 years of age or older.”

(c) “Adult day services” means one or more of the following services, provided for fewer than 12 hours a day, to participants 18 years of age or older: supervision, assistance with activities of daily living, nursing care, rehabilitation, recreation, social, cognitive, and physical stimulation, and nutrition.

(d) “Appeal” means a request by a person adversely affected by the NH department of health and humans service’s or a provider’s decision or action to review that decision or action in accordance with the provisions of RSA 126-A:5, VIII.

(e) “Authorized representative” means any adult other than a department staff member or provider representative who is 18 years of age or older and who, with the individual’s permission or under the authority of a guardianship order, acts on behalf of the individual during all aspects of initial or continuing eligibility determination for Title XX services.

(f) “Catchment area” means the geographic area where the provider provides Title XX services, as identified in the provider’s contract or other legal agreement with the department.

(g) “Chronic illness or disability” means that the physical, mental, or emotional ability of a person is such that the individual is unable to manage personal, home, or financial affairs without the support of social services.

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

(i) “Communication access” means, when necessary and appropriate, providing communication assistance to individuals, who are:

(1) Non-English speaking or have limited English proficiency;

(2) Deaf, experiencing a degree of hearing loss, or have auditory processing challenges;

(3) Visually impaired; or

(4) Speech impaired.

(j) “Days” means days on which the department is ordinarily open for business unless otherwise stated.

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

(l) “Elderly” means “elderly” as defined in RSA 161-F:1, V, namely “a person 60 years of age or older.”

(m) “Essential services” means chore, emergency support, and respite services that are needed to maintain an individual’s health or safety, as described in He-E 501.24.

(n) “Homebound” means that an individual is unable to leave home without difficulty because of chronic illness or disability.

(o) “Home-delivered meals” means meals that are prepared and provided to an individual in his or her home, in accordance with He-E 501.25.

(p) “Housecleaning” means duties related to household cleanliness including but not limited to mopping floors, vacuuming, laundry, changing bed linens, dusting, and other tasks related to sanitation within an individual’s living environment.

(q) “Income” means the total amount of money received by the individual on a regular, recurring basis each month, based on the sources of income contained in He-E 501.05.

(r) “Independent living situation” means one of the following living arrangements:

(1) The individual’s own home or apartment;

(2) The home or apartment of a spouse or partner, relative, or friend where the individual also resides;

(3) A motel or hotel; or

(4) A homeless shelter.

(s) “Individual” means the adult applying for or receiving the Title XX social services described in this part.

(t) “In-home care” means services provided to an individual in his or her home including the household maintenance tasks and activities of daily living described in He-E 501.26.

(u) “Instrumental activities of daily living” means activities performed on a regular basis, including, but not limited to, doing laundry, cleaning, managing money, shopping, using transportation, correspondence, making telephone calls, obtaining and keeping appointments, socializing, and recreation.

(v) “Licensed health practitioner” means:

(1) Medical doctor;

(2) Physician assistant (PA);

(3) Advanced practice registered nurse (APRN);

(4) Doctor of osteopathy;

(5) Doctor of naturopathic medicine; or

(6) Any other individual with diagnostic and prescriptive powers licensed by an appropriate NH licensing board.

(w) “Limited English proficiency” means the inability of an individual to speak English as their primary language, and whose skills in listening, speaking, or reading English are such that the individual cannot adequately understand and participate in their care, or in the services provided to them, without language assistance, the provision of communication access services, or communication devices.

(x) “Nursing facility” means a place which provides for 2 or more persons’ basic domiciliary services, including board, room, and laundry, continuing health supervision under competent professional medical and nursing direction, and continuous nursing care as may be individually required.

(y) “Person-centered” means that the individual or his or her authorized representative or caregiver is the center of the system of care, and the individuals’ needs and preferences drive the care and services provided.

(z) “Plan for achieving self- support income (PASS)” means the Supplemental Security income or Social Security income received by an individual, which has been designated by the Social Security Administration to help the individual attain employment.

(aa) “Provider” means the agency under contract with the department or enrolled as a medicaid provider of specific services or a vendor providing Title XX services.

(ab) “Residential care facility” means a licensed assisted living residence-residential care or assisted living-supported residential health care licensed in accordance with RSA 151.

(ac) “Respite care” means care provided on an intermittent basis to the eligible person to relieve the primary caregiver from the demands of home care for a limited period of time.

(ad) “Title XX” means that section of the Social Security Act which describes the services funded through the social services block grant.

(ae) “Vendor” means an individual, business, or organization reimbursed by the department for the cost of providing essential services that are authorized by the department and described in He-E 501.24.

(af) “Wait list” means a list of individuals who have been determined eligible, and are ready to receive, a Title XX service from a provider, but for whom the agency does not have sufficient service units or resources to serve the individuals.

(ag) “Without regard to income” means an eligibility category whereby Title XX services can be provided to an individual without regard to income, and in accordance with He-E 501.05(i).

History

#9849-A, eff 1-12-11, EXPIRED: 1-12-19
#12720, INTERIM, eff 1-29-19, EXPIRED: 7-29-19
#12936, eff 12-7-19

N.H. Code Admin. R. Ann. He-E 501.03 Confidentiality {#sec-he-e-501.03 omnilex-key=us-nh-regs-official--agency-he-e--He-E 501.03}

All information about individuals receiving Title XX services and programs shall be kept confidential, and only persons involved in administering Title XX services and programs shall review an individual’s information, unless the individual signs an authorization to release the information to another individual or organization.

History

#9849-A, eff 1-12-11, EXPIRED: 1-12-19
#12720, INTERIM, eff 1-29-19, EXPIRED: 7-29-19
#12936, eff 12-7-19

N.H. Code Admin. R. Ann. He-E 501.04 Title XX Services {#sec-he-e-501.04 omnilex-key=us-nh-regs-official--agency-he-e--He-E 501.04}

(a) The following Title XX services referenced in (b) below shall be provided to individuals who meet the eligibility requirements contained in He-E 501.05 and subject to the wait list described in He-E 501.15.

(b) Title XX services shall include:

(1) Adult day services;

(2) Essential services;

(3) Home-delivered meals; and

(4) In-home care services.

(c) Providers of adult day services, home-delivered meals, and in-home care shall be contracted with the department and shall provide the services as described in this rule.

(d) Providers of essential services shall be vendors and shall provide services as described in this rule.

(e) Eligibility for services shall be determined by the provider, except for eligibility for essential services, which shall be determined by the department.

History

#9849-A, eff 1-12-11, EXPIRED: 1-12-19
#12720, INTERIM, eff 1-29-19, EXPIRED: 7-29-19
#12936, eff 12-7-19

N.H. Code Admin. R. Ann. He-E 501.05 Eligibility Requirements for Services {#sec-he-e-501.05 omnilex-key=us-nh-regs-official--agency-he-e--He-E 501.05}

(a) In order to be eligible to receive Title XX services an individual shall:

(1) Be an adult as defined by He-E 501.02(b);

(2) Have a chronic illness or disability as defined by He-E 501.02(g);

(3) Reside in or be expected to reside in an independent living situation, as defined by He-E 501.02(r);

(4) Have a monthly income which does not exceed $1,645.80 per month, based on the sources of income specified in (d) and subject to an annual cost of living adjustment as described in (k) below;

(5) Be in need of the requested Title XX service in order to maintain his or her health and safety, as determined by the assessment described in (b) below;

(6) Not already be receiving the same or duplicate services from another program such as services under an approved medicaid waiver program;

(7) Apply for and be found eligible to receive Title XX services as described in He-E 501.05 and 501.06; and

(8) In order to be eligible to receive home-delivered meals, demonstrate that he or she cannot prepare meals, and that the individual is:

a. Homebound; or

b. Temporarily homebound due to recovery from illness or injury.

(b) An individual’s eligibility to receive the requested Title XX services shall be determined through an assessment as follows:

(1) A review of the individual’s application; and

(2) A face-to-face interview with the individual or authorized representative, or both, to obtain information on the individual’s ability to engage in activities of daily living and instrumental activities of daily living.

(c) When determining eligibility for the requested Title XX services, an individual may provide information from his or her licensed health practitioner or other community providers to be considered as a part of the assessment described in (b) above.

(d) When determining eligibility in accordance with He-E 501.05 (a)(4) above, the department or the provider shall review all sources of income including but not limited to the following:

(1) State financial assistance;

(2) Social Security, with the exception of PASS income;

(3) Supplemental Security income;

(4) Veteran’s benefits;

(5) Income received from room and board, rental of buildings or land;

(6) Interest income received from bank accounts, estates, or trusts;

(7) Wages or income from self-employment;

(8) Disability benefits;

(9) Unemployment compensation;

(10) Worker’s compensation; and

(11) Alimony.

(e) When determining eligibility for Title XX services, the income of each individual, including spouses, shall be considered separately.

(f) If the individual receives Social Security income and the cost of his or her Medicare premiums are not deducted from his or her check, the amount paid for the premiums shall be deducted from the individual’s total income for the purposes of determining whether or not the individual meets the income requirements in (a)(4) above.

(g) Income shall be verified for an individual in accordance with He-E 501.06(h).

(h) Priority to receive Title XX services shall be given to individuals who have been determined by the department to be in need of services for protective reasons in accordance with RSA 161-F:42-57.

(i) Title XX services shall be provided without regard to income, if the service(s) are provided during or after a protective investigation conducted by the department in accordance with RSA 161-F:42-57.

(j) Title XX services shall be provided to an adult in an independent living situation.

(k) The income eligibility level in (a)(4) above shall be subject to a cost of living adjustment, when adjusted by the social security administration, each January by the percentage amount of the cost of living increase in the social security benefits on a yearly basis consistent with federal law and regulations.

History

#9849-A, eff 1-12-11, EXPIRED: 1-12-19
#12720, INTERIM, eff 1-29-19, EXPIRED: 7-29-19
#12936, eff 12-7-19

N.H. Code Admin. R. Ann. He-E 501.06 Application Requirements and Process {#sec-he-e-501.06 omnilex-key=us-nh-regs-official--agency-he-e--He-E 501.06}

(a) The applicant, a person assisting the applicant, or an individual acting on the applicant’s behalf shall apply and be deemed eligible to receive Title XX services via an application form provided by the department entitled Form 3000, “Application for Social Services” (June 2025).

(b) An application for Title XX services shall be completed, signed, and dated by the applicant, an individual assisting the applicant, or an individual acting on the applicant’s behalf, and submitted to the department or the contract agency, depending on where the determination of eligibility is being made.

(c) The applicant, the individual assisting the applicant, or the individual acting on the applicant’s behalf shall certify the following:

(1) If the application is signed by the applicant:

“I have read and understood the information on the application, including the Assurances section on the next page, and I agree that the entries I have made on this application are true and accurate to the best of my knowledge.”

“I understand that as part of the administration of Bureau of Adult and Aging Services (BAAS) programs, BAAS, or an agency under contract with BAAS, may verify information I have provided on this application and any other information that would affect my eligibility.”

“My signature below authorizes BAAS and the contract agency to obtain verification and authorized release of such information to BAAS and the contract agency. My authorization to release information remains in effect until the time of my next redetermination of eligibility.”

“I understand that I must report any change in my address or income to the DHHS district office or contract agency where I applied for services, since such changes may affect my eligibility for services.”

(2) If the application is signed by an individual assisting the applicant or by an individual acting on the applicant’s behalf:

“My signature below indicates that I have completed this form on behalf of the applicant, using information provided by the applicant, and that this information is true and complete to the best of my knowledge. I also certify that I have read the signatures section above. The applicant acknowledges that they may be responsible for any errors, omissions or inaccurate information reported to BAAS by me while assisting them.”

(d) If information needed to determine eligibility, as described in He-E 501.05, is incomplete or missing, the provider shall immediately notify the applicant.

(e) The applicant shall provide the missing information to the department or the provider within 10 days of the face-to face interview.

(f) If the applicant does not provide the missing information within the allotted time as stipulated in (e) above, the applicant’s application shall be denied.

(g) An application shall not be required prior to the applicant receiving Title XX services when the department determines services are needed for protective reasons in accordance with RSA 161-F:42-57.

(h) Income shall be verified as described in (i) below and for the following reasons:

(1) There is an indication that the income information provided by the applicant or an individual acting on behalf of the applicant is inaccurate; or

(2) The department performs an audit to verify income for quality control purposes.

(i) At the request of the department or the provider, when determining eligibility, the applicant or an individual acting on behalf of the applicant shall verify income by providing the following information:

(1) Current pay stubs or employer statements, when income includes wages;

(2) Current business records, when the applicant is self-employed;

(3) A copy of the benefit check dated within the last 30 days or the most recent letter from the Social Security administration, when income includes Social Security benefits or Supplemental Security income, or a copy of the most current bank statement showing that the Social Security or Supplemental Security income check has been direct-deposited;

(4) A copy of the benefit check dated within the last 30 days or the most recent correspondence from the agency, business, or union that indicates benefit amounts, when income includes workers’ compensation;

(5) A copy of the pension check dated within the last 30 days or the most recent correspondence from the appropriate agency, business, or union, when income includes a pension;

(6) Bank statements dated within the last 30 days, or the most recent stockholder report when income includes interest from income, dividends, trusts, estates, or royalties;

(7) A copy of a check received from the tenant or boarders dated within the last 30 days or the most current copy of the rental or room and board agreement, when income includes money received from rents, room and board, or rental of land;

(8) A copy of the benefits check dated within the last 30 days or the most recent notice indicating the amount of benefits awarded, when income includes unemployment compensation;

(9) A copy of the most recent court order or a signed statement from the individual making the payment, when income includes alimony; and

(10) A copy of the benefit check dated within the last 30 days or the most recent notice indicating the amount of benefits awarded, when income includes veterans benefits.

(j) If requested by an individual, the department or the provider shall assist the individual with completing the application.

History

#9849-A, eff 1-12-11, (paras (c)-(i)); #9849-B, eff1-12-11, (paras (a) and (b)); (c)-(i) EXPIRED: 1-12-19; ss by #12720, INTERIM, eff 1-29-19, EXPIRED: 7-29-19
#12936, eff 12-7-19; ss by #14298, eff 7-1-25, EXPIRES: 7-1-35

N.H. Code Admin. R. Ann. He-E 501.07 Determination, Notice of Eligibility, and Eligibility Period {#sec-he-e-501.07 omnilex-key=us-nh-regs-official--agency-he-e--He-E 501.07}

(a) An individual shall meet the requirements in He-E 501.05 and 501.06 in order to be deemed eligible to receive Title XX services.

(b) For individuals determined eligible to receive Title XX services, the eligibility period shall be for one year, beginning on the date that eligibility is determined, and ending 364 calendar days later.

(c) A written notice of decision shall be provided by the department or by the provider within 45 calendar days of receipt of an application.

(d) If the eligibility requirements are met, and services are available, the notice shall include:

(1) The services to be provided;

(2) The eligibility period; and

(3) Contact information for the department or provider, depending on which entity is responsible for the eligibility determination.

(e) If eligibility requirements are met, but services are not available, the individual shall be notified that his or her name shall be placed on a wait list in accordance with He-E 501.15.

(f) If the eligibility requirements are not met, the notice shall include:

(1) The reason(s) for the denial;

(2) A statement regarding the right of the individual or his or her authorized representative to request an informal resolution or an administrative hearing, as described in He-E 501.11 501.12 respectively; and

(3) Contact information for the department staff member or provider depending on which entity is responsible for the eligibility determination.

History

#9849-A, eff 1-12-11, EXPIRED: 1-12-19
#12720, INTERIM, eff 1-29-19, EXPIRED: 7-29-19
#12936, eff 12-7-19

N.H. Code Admin. R. Ann. He-E 501.08 Individual’s Responsibility To Report Changes {#sec-he-e-501.08 omnilex-key=us-nh-regs-official--agency-he-e--He-E 501.08}

(a) The individual receiving services or on a wait list shall be responsible for reporting to the department or to the provider any changes in circumstances that could affect his or her eligibility for Title XX services, including changes in:

(1) Address;

(2) Type of living arrangement;

(3) Sources and amounts of income; and

(4) The individual’s level of functioning that would have a direct effect on the need for services.

(b) When the individual reports changes described in (a) above, the department or the provider shall determine whether these changes affect the individual’s eligibility for Title XX services, based on the requirements described in He-E 501.05.

(c) When the individual level of functioning has changed as described in (a)(4) above, the department or the provider shall verify the changes via the redetermination process outlined in He-E 501.09 and, either:

(1) Have a face-to-face meeting with the individual; or

(2) Accept documentation from the individual’s licensed health practitioner describing the change in the individual’s level of functioning.

(d) If it is determined that the reported changes cause the individual to become ineligible for Title XX services:

(1) Services shall be terminated and a notice shall be sent to the individual in accordance with He-E 501.10(c); or

(2) The individual shall be removed from the wait list and provided notice in accordance with He-E 501.15.

History

#9849-A, eff 1-12-11, EXPIRED: 1-12-19
#12720, INTERIM, eff 1-29-19, EXPIRED: 7-29-19
#12936, eff 12-7-19

N.H. Code Admin. R. Ann. He-E 501.09 Redetermination of Service Eligibility {#sec-he-e-501.09 omnilex-key=us-nh-regs-official--agency-he-e--He-E 501.09}

(a) The department or the provider shall provide the application entitled Form 3000 “Application for Social Services” (November 2019) to the individual 60 days prior to the end of the eligibility period.

(b) At least 45 calendar days prior to the end date of the individual’s eligibility period, the individual shall complete and submit the application referenced in (a) above for redetermination of eligibility.

(c) If requested by an individual, the department or provider staff shall assist the individual with completing the application during a scheduled visit.

(d) The department or the provider shall:

(1) Re-determine eligibility in accordance with He-E 501.05; and

(2) Send notice to the individual or his or her authorized representative, as described in He-E 501.07, confirming whether the individual continues to be eligible for Title XX services and:

a. If the individual is determined eligible to continue receiving Title XX services, services shall be authorized in accordance with He-E 501.16; or

b. If the individual is determined ineligible to receive Title XX services, services shall be discontinued in accordance with He-E 501.10.

(e) If an individual does not submit the application prior to the end of their eligibility period services shall be terminated in accordance with He-E 501.10, subject to the right of appeal or informal resolution as described in He-E 501.12, and until such time that the individual re-applies and is found eligible for Title XX services in accordance with He-E 501.06.

History

#9849-A, eff 1-12-11, (paras (c)-(f)); #9849-B, eff 1-12-11, (paras (a) and (b)); (c)-(f) EXPIRED: 1-12-19; ss by #12720, INTERIM, eff 1-29-19, EXPIRED: 7-29-19
#12936, eff 12-7-19

N.H. Code Admin. R. Ann. He-E 501.10 Termination of Services {#sec-he-e-501.10 omnilex-key=us-nh-regs-official--agency-he-e--He-E 501.10}

(a) Title XX services shall be terminated when:

(1) The individual or his or her authorized representative requests that the services be terminated;

(2) The individual no longer meets the eligibility requirements for Title XX services as described in He-E 501.05;

(3) Funding for the service(s) is no longer available;

(4) The individual did not reapply for services in accordance with He-E 501.09;

(5) The individual relocates to a geographic area outside the catchment area area;

(6) The individual relocates to an institutional setting excluding short-term respite care; or

(7) The individual dies.

(b) If a provider wishes to terminate services for an eligible individual because the provider determines that the individual’s behavior or living environment creates a health or safety hazard for the provider’s staff, then:

(1) The provider shall initiate an adult protective report in accordance with RSA 161-F: 46 and He-E 700;

(2) If the provider wishes to terminate Title XX services for the reason described in (b) above, the provider shall:

a. Forward to the department a written notification of the reasons for terminating services, including a summary of the efforts the provider has made to resolve the situation;

b. Consult with department staff for assistance in determining possible remedies other than termination;

c. Following consultation with department staff, document and report to the department the outcome of each additional effort made to resolve the situation;

d. Notify the department of a final decision to terminate prior to distribution of the notice to the individual; and

e. For individuals whose services are terminated in accordance with (a) above, document in the individual’s service record a description of the individual’s behavior(s) or living environment that created a health or safety hazard for the provider’s staff, as well as the provider’s attempts to continue to provide services; and

(3) The provider shall send written notice to an individual as specified in He-E 501.10(c) below, within 5 business days of notifying the department as indicated in He-E 501.10(b)2.d.

(1) The service(s) to be terminated;

(2) The reason(s) for terminating the service or services;

(3) The date upon which the service(s) shall be terminated, which shall be 30 days from the date of the notice;

(4) A statement that the individual has 30 calendar days from the date of the notice to request an administrative hearing with the department as described in He-E 501.11 and in accordance with He-C 200; and

(5) The contact information for the department or provider staff member who completed the notice.

History

#9849-A, eff 1-12-11, EXPIRED: 1-12-19
#12720, INTERIM, eff 1-29-19, EXPIRED: 7-29-19
#12936, eff 12-7-19

N.H. Code Admin. R. Ann. He-E 501.11 Informal Resolution {#sec-he-e-501.11 omnilex-key=us-nh-regs-official--agency-he-e--He-E 501.11}

(a) An individual who disagrees with an eligibility determination, redetermination, or termination of Title XX services may request an informal resolution of the decision, as follows:

(1) The individual or his or her authorized representative, shall submit a written request to the department within 30 calendar days of the eligibility or termination determination; and

(2) The written request shall include:

a. An explanation of the reason why the decision on the eligibility determination, redetermination or termination determination should be changed; and

b. Any supporting documentation.

(b) For individuals currently receiving services, Title XX services shall continue during the informal resolution process until a decision is rendered.

(c) The department shall review the request in (a) above and provide a written notice within 45 days to the individual, or his or her authorized representative, of the decision to maintain or change the original eligibility or termination decision, including the reason therefor. The Department shall make a redetermination based on the same criteria used in the initial determination and shall take into consideration any new information.

(d) If the department or provider’s decision is not upheld:

(1) Services shall be initiated for individuals requesting services; and

(2) Services for individuals currently receiving Title XX services shall continue as long as the Title XX eligibility requirements described in He-E 501.05 are met or until the end of the individual’s eligibility period.

(e) If the department’s or provider’s decision is upheld, services for individuals currently receiving services shall end within 30 calendar days of the decision.

(f) Requesting an informal resolution shall not:

(1) Preclude in any way an individual’s right to appeal a disputed eligibility or termination determination in accordance with He-C 200; or

(2) Change the timeframes established for filing an appeal.

(g) An individual may appeal the decision of the department in accordance with He-C 200 and RSA 541-A:29.

History

#9849-A, eff 1-12-11, EXPIRED: 1-12-19
#12720, INTERIM, eff 1-29-19, EXPIRED: 7-29-19
#12936, eff 12-7-19

N.H. Code Admin. R. Ann. He-E 501.12 Administrative Hearing and Provisions of Services During the Administrative Appeal Process {#sec-he-e-501.12 omnilex-key=us-nh-regs-official--agency-he-e--He-E 501.12}

(a) An individual or his or her authorized representative wishing to appeal a decision made during the service eligibility determination or redetermination may request an administrative hearing within 30 calendar days of receiving the written notice of decision described in He-E 501.07 or He-E 501.10.

(b) The request for an appeal shall be submitted in writing and addressed to:

Department of Health & Human Services

Administrative Appeals Unit

105 Pleasant St., Concord, NH 03301

(d) If the individual or his or her authorized representative requests an administrative hearing for the termination of Title XX services as described in He-E 501.10, Title XX services shall continue until a decision is rendered.

(e) If the department’s or provider’s decision is not upheld, the individual shall continue to receive services as long as the Title XX eligibility requirements described in He-E 501.05 are met or until the end of the individual’s eligibility period.

(f) If services were discontinued in accordance with He-E 501.10(b), and the provider’s decision is not upheld, a provider shall initiate services within 30 days of the date on the notice decision.

(g) If the department’s decision is upheld:

(1) The individual shall be notified in accordance with He-C 200; and

(2) Title XX services shall end within 30 calendar days of the hearing officer’s notice of decision.

History

#9849-A, eff 1-12-11, EXPIRED: 1-12-19
#12720, INTERIM, eff 1-29-19, EXPIRED: 7-29-19
#12936, eff 12-7-19 (formerly He-E 501.11)

N.H. Code Admin. R. Ann. He-E 501.13 Provider Requirements {#sec-he-e-501.13 omnilex-key=us-nh-regs-official--agency-he-e--He-E 501.13}

(a) Providers wishing to provide adult day services, home-delivered meals or in-home care shall be under contract with the department to provide such service(s).

(b) Providers shall:

(1) Comply with all provisions included in the contract with the department;

(2) Comply with and make available upon request any licensing or certification requirements required by applicable federal, state, or local laws or rules, specifically:

a. For providers providing in-home care, be licensed as a home health provider, home care service provider, or other qualified agency in accordance with He-P 809 and He-P 822, respectively; and

b. For providers providing adult day services, be licensed as an adult day program in accordance with He-P 818;

(3) Develop person-centered plans as described in He-E 501.22;

(4) Determine eligibility for applicants and comply with notice requirements as described in these rules;

(5) Maintain the insurance coverage required by applicable state or local laws or rules, and provide written proof of such insurance coverage to the department;

(6) Identify an executive director who will oversee the services being provided;

(7) Identify staff who will complete the responsibilities contained in this rule for the service(s) being provided;

(8) Train and supervise provider staff and volunteers regarding the following:

a. The provider’s policies and procedures;

b. The specific Title XX services the staff or volunteer will be providing; and

c. Any additional training requirements contained in applicable federal or state laws/rules;

(9) Comply with all contract requirements regarding the provision of communication access to individuals who are requesting or receiving services covered under this rule;

(10) Develop protocols for staff responses to emergencies;

(11) Develop protocols for reporting suspected abuse, neglect, self-neglect, or exploitation of incapacitated adults as required by RSA 161-F: 46 of the adult protection law;

(12) Comply with the provisions of RSA 161-F: 49 with regard to checking the names of prospective or current employees, volunteers or subcontractors against the state registry administered by the department’s bureau of adult and aging services (BAAS);

(13) Have an established written complaint and incident process that may be accessed by individuals, family members, or authorized representative when an individual is denied services or dissatisfied with the services provided by the provider, including:

a. The name or position of the provider’s staff member who coordinates the complaint and incident process;

b. The issues that may be addressed through the complaint and incident process;

c. How individuals are informed of their right to file a complaint or incident report;

d. The procedures to be followed by individuals who wish to file a complaint or incident report with the provider;

e. The procedures to be followed by the provider when reviewing complaints or incidents, and for notifying the individual of the outcome of the review; and

f. Information stating that the availability of the complaint and incident process from the provider shall not cancel the right of an individual who is denied Title XX services to request an administrative hearing in accordance with He-E 501.12 and He-C 200;

(14) When requested, provide information to the department regarding individuals receiving services;

(15) Maintain financial records;

(16) Maintain service records in accordance with He-E 501.17 for the specific Title XX service provided per eligibility period;

(17) Submit the fiscal reports required by the department pursuant to the provider contract;

(18) Submit information on the wait list in accordance with He-E 501.15;

(19) Engage in monitoring and evaluating the quality of the services being provided, which shall include:

a. Obtaining feedback from the individual, authorized representative, and family members;

b. Participating in any quality assurance measures implemented by the department; and

c. Making changes as necessary to improve the quality and effectiveness of service delivery; and

(20) When providing home-delivered meals service:

a. Be in compliance with federal, state, and local regulations for food safety, meal preparation and delivery;

b. Employ staff or subcontract with another agency to prepare and deliver meals;

c. Demonstrate on a quarterly basis that meals are in compliance with the nutritional requirements contained in He-E 501.25 by providing the department with sample menus which are signed by a registered dietitian or another professional with comparable expertise;

d. Ensure that meals are delivered only when individuals are at home to receive them;

e. Ensure that the driver who delivers meals has face-to-face contact with each individual; and

f. Keep a record of the number of meals authorized for the individual and the scheduled days of delivery.

History

#9849-A, eff 1-12-11, EXPIRED: 1-12-19
#12720, INTERIM, eff 1-29-19, EXPIRED: 7-29-19
#12936, eff 12-7-19 (formerly He-E 501.20)

N.H. Code Admin. R. Ann. He-E 501.14 Fees for Title XX Services {#sec-he-e-501.14 omnilex-key=us-nh-regs-official--agency-he-e--He-E 501.14}

(a) Providers providing Title XX services may charge fees to individuals receiving these services under the conditions described in this section.

(b) Providers that elect to charge fees shall:

(1) Develop a sliding fee schedule;

(2) Provide the fee schedule to individuals in a letter that describes:

a. The basis for the fee;

b. A description of the program the fee is being applied to;

c. A description of how the fee applies based on the individual’s income;

d. The billing schedule, as applicable; and

e. Whether or not and when services would be discontinued for non-payment; and

(3) Include with the letter to the individual, in (2) above, a copy of the sliding fee schedule.

(1) The type of program(s) the fee is being applied to;

(2) The ability of the individual to pay the fee which includes the income of the individual receiving Title XX services; and

(3) The fee does not exceed the difference between the amount reimbursed by the department to providers and the standard payment charged to individuals paying privately for the full cost of services provided by the provider.

(d) Providers shall:

(1) Communicate the fee schedule verbally and in writing prior to commencing services; and

(2) Make available fee and billing information at any time.

(e) No fees shall be charged to the client receiving Title XX services when the department has determined that services are needed for protective reasons in accordance with RSA 161-F:42-57.

History

#9849-A, eff 1-12-11, EXPIRED: 1-12-19
#12720, INTERIM, eff 1-29-19, EXPIRED: 7-29-19
#12936, eff 12-7-19 (formerly He-E 501.13)

N.H. Code Admin. R. Ann. He-E 501.15 Wait Lists {#sec-he-e-501.15 omnilex-key=us-nh-regs-official--agency-he-e--He-E 501.15}

(a) All services covered by He-E 501 shall be provided to the extent that funds, staff or resources for this purpose are available.

(b) The provider shall maintain a wait list when funding or resources are not available to provide the requested services for:

(1) Individuals who:

a. Are newly eligible; and

b. Are ready to receive services;

(2) Individuals who:

a. Are receiving services; and

b. Requesting additional services; or

(3) Individuals who:

a. Relocate outside of the catchment area for the contact agency providing services; and

b. Are requesting Title XX services from a provider in the new location in accordance with He-E 501.19.

(1) The individual’s full name and date of birth;

(2) The name of the Title XX service being requested;

(3) The date upon which the individual applied for services which shall be the date the application was received by the provider or by the department;

(4) The target date of implementing the services based on the communication between the individual and the department or provider;

(5) The date upon which the individual’s name was placed on the wait list shall be the date of the notice of decision in which the individual was determined eligible for Title XX services;

(6) The individual’s assigned priority on the wait list, determined in accordance with (d) below;

(7) A brief description of the individual’s circumstances and the services he or she needs; and

(8) If the individual is already receiving a Title XX service, the type and amount of the services received.

(d) The provider shall prioritize each individual’s standing on the list by determining the individual’s urgency of need in the following order:

(1) The individual is at risk of being admitted to an institutional setting;

(2) The individual is discharged from an institutional setting;

(3) Declining mental or physical health of the caregiver;

(4) Declining mental or physical health of the individual;

(5) The individual has no respite services while living with a caregiver; and

(6) Length of time on the wait list.

(e) When 2 or more individuals on the wait list have been assigned the same service priority, the individual served first will be the one with the earliest application date.

(f) Individuals with adult protective needs in accordance with RSA 161-F:42-57 shall be exempt from the wait list.

(g) The individual may reserve the right to remove his or her name from the wait list at anytime or apply for Title XX services with another provider.

(h) When an individual is placed on the wait list, the provider shall notify the individual in writing and include the following information:

(1) A statement that Title XX services are not covered because funds, staff, or resources are unavailable;

(2) A brief description of the provider’s wait list process;

(3) The estimated period of time that the provider expects the individual to remain on the wait list;

(4) A statement that notifies the individual of the right to remove his or her name from the wait list and to apply for Title XX services with another provider;

(5) A statement that directs the individual to the specified toll-free telephone number to NH ServiceLink for more information on other providers in the individual’s catchment area that provide the Title XX service being requested;

(6) The contact information for the provider; and

(7) A statement requesting that the individual notify the agency if his or her service needs change or if the individual begins to receive the requested Title XX service from another provider.

(i) Immediately upon becoming aware of availability to provide a Title XX service, the provider shall call and send written notice to the individual requesting Title XX services based on the priority outline in (f) above.

(j) The individual shall respond to the provider within 10 days of the date on the written notice, indicating whether or not her or she still wishes to receive the Title XX services.

(k) If the individual does not respond within 10 business days, the provider shall no longer be obligated to guarantee Title XX services to that individual.

(l) The individual may reapply to receive Title XX services in accordance with He-E 501.05.

(m) If an individual is found ineligible due to a reported change in circumstances as described in He-E 501.08, the department or the provider shall remove the individual from the wait list and provide notice to the individual that includes the following information:

(1) The individual has been removed from the wait list;

(2) The individual has 30 calendar days from the date of the notice to request an administrative hearing as described in He-E 501.12 and in accordance with He-C 200 and RSA 541-A:29 unless the provisions conflict with the Title XX federal requirements ; and

(3) The contact information for the department or provider staff member who completed the notice.

History

#9849-A, eff 1-12-11, (paras (b)-(c));#9849-B, eff 1-12-11, (para (a)); (b)-(c) EXPIRED: 1-12-19; ss by #12720, INTERIM, eff 1-29-19, EXPIRED: 7-29-19
#12936, eff 12-7-19 (formerly He-E 501.14)

N.H. Code Admin. R. Ann. He-E 501.16 Service Authorization {#sec-he-e-501.16 omnilex-key=us-nh-regs-official--agency-he-e--He-E 501.16}

(a) Once an applicant has been determined eligible to receive Title XX services and has completed BAAS Form 3000 “Application for Social Services” (June 2025), one or more of the following services shall be authorized by the provider based on the needs identified in the individual’s person-centered plan:

(1) Adult day services;

(2) Home-delivered meals; and

(3) In-home care services.

(b) The provider shall complete BAAS Form 3502, “Contract Service Authorization-New Authorization” (June 2025) and submit to:

Department of Health and Human Services

Bureau of Data Management

129 Pleasant Street

Concord, NH 03301

History

#9849-A, eff 1-12-11, EXPIRED: 1-12-19
#12720, INTERIM, eff 1-29-19, EXPIRED: 7-29-19
#12936, eff 12-7-19 (formerly He-E 501.15); ss by #14298, eff 7-1-25, EXPIRES: 7-1-35

N.H. Code Admin. R. Ann. He-E 501.17 Service Records {#sec-he-e-501.17 omnilex-key=us-nh-regs-official--agency-he-e--He-E 501.17}

(a) Providers shall maintain service records for all individuals receiving Title XX services.

(b) The service record shall contain:

(1) The individual’s name, address, and telephone number;

(2) The name, address, and telephone number of the individual’s primary caregiver;

(3) The name and telephone number of a person who may be contacted in an emergency;

(4) Documentation of the individual’s communication access needs, including modality, and the name of the communication access provider or type of device utilized, if applicable;

(5) The name and telephone number of the individual’s licensed health practitioner, if applicable;

(6) The name and contact information for the pharmacy used by the individual, if applicable;

(7) The application described in He-E 501.06;

(8) The notice of decision described in He-E 501.07;

(9) The service authorization form required by He-E 501.16;

(10) The person-centered plan as described in He-E 501.22;

(11) Copies of correspondence related to service provision; and

(12) Documentation of the following:

a. The name of the Title XX service being provided, and the type of service activities, based on the service description contained in this rule;

b. The dates of service provision and other related contacts with the individual;

c. Changes in the individual’s health or other circumstances affecting service provision;

d. Any other information or correspondence deemed relevant to service provision; and

e. Documentation of any referrals made to other resources or programs.

(c) Service records shall be kept confidential in accordance with He-E 501.03 and all applicable federal and state laws, rules, or regulations.

(d) Service records shall be retained for a period of 4 years after services have ended or been terminated.

History

#9849-A, eff 1-12-11, EXPIRED: 1-12-19
#12720, INTERIM, eff 1-29-19, EXPIRED: 7-29-19
#12936, eff 12-7-19 (formerly He-E 501.16)

N.H. Code Admin. R. Ann. He-E 501.18 Title XX Services Added During the Eligibility Period {#sec-he-e-501.18 omnilex-key=us-nh-regs-official--agency-he-e--He-E 501.18}

(a) Additional Title XX services may be authorized for an eligible individual at any time within the eligibility period.

(b) If, after the initial service authorization, the individual or his or her authorized representative requests another Title XX service or services in addition to the service(s) previously authorized, the department or provider shall:

(1) Confirm that the individual continues to meet the Title XX eligibility requirements as described in He-E 501.05;

(2) Document on the original application form that another Title XX service(s) is/are being added, and request that the individual initial this note within 30 calendar days in order to confirm that he or she is requesting the service; and

(3) Follow the procedures for service authorization that are described in He-E 501.16.

(c) Additional Title XX services added in accordance with this part shall have the same eligibility period end date as the first service the individual was found eligible to receive.

History

#9849-A, eff 1-12-11, EXPIRED: 1-12-19
#12720, INTERIM, eff 1-29-19, EXPIRED: 7-29-19
#12936, eff 12-7-19 (formerly He-E 501.17)

N.H. Code Admin. R. Ann. He-E 501.19 Relocation and Title XX Services {#sec-he-e-501.19 omnilex-key=us-nh-regs-official--agency-he-e--He-E 501.19}

(a) When an individual receiving Title XX services relocates to a new location outside the provider’s catchment area, the provider shall refer the individual to another provider to make arrangements to receive Title XX services in the new location unless the provider and the individual agree to continue Title XX services after the individual has relocated to another catchment area.

(b) The provider shall transfer the individual’s service record to the provider in the new location.

(c) Within 20 days of an individual’s relocation to another catchment area, a provider shall provide notification to the department that it is no longer providing Title XX services to the individual.

(d) The provider providing Title XX services in the new location shall conduct a record review.

(e) An individual’s eligibility period end date shall not change when an individual relocates to another provider.

History

#9849-A, eff 1-12-11, EXPIRED: 1-12-19
#12720, INTERIM, eff 1-29-19, EXPIRED: 7-29-19
#12936, eff 12-7-19 (formerly He-E 501.18)

N.H. Code Admin. R. Ann. He-E 501.20 Cessation of Title XX Services by a Provider {#sec-he-e-501.20 omnilex-key=us-nh-regs-official--agency-he-e--He-E 501.20}

(a) When a provider decides to stop providing Title XX services, the provider shall provide written notification to the department according to the terms of the contract.

(b) The provider shall notify individuals receiving Title XX services of the date upon which services will cease, and what kind of assistance the agency plans to provide during the transition.

(c) The provider shall also comply with any other provisions contained in its contract with respect to the cessation of Title XX services.

History

#9849-A, eff 1-12-11, EXPIRED: 1-12-19
#12720, INTERIM, eff 1-29-19, EXPIRED: 7-29-19
#12936, eff 12-7-19 (formerly He-E 501.19)

N.H. Code Admin. R. Ann. He-E 501.21 Vendor Requirements {#sec-he-e-501.21 omnilex-key=us-nh-regs-official--agency-he-e--He-E 501.21}

(a) Vendors wishing to provide the essential services described in He-E 501.24 shall:

(1) Comply with any licensing or certification requirements required by applicable federal, state, or local laws , rules or regulations, and provide copies of any current licenses and certificates to the department;

(2) Have a tax identification number;

(3) Obtain any permits, as applicable, prior to the service being rendered;

(4) Have proof of insurance; and

(5) Provide essential services in accordance with the authorization issued in accordance with (b) below.

(b) Essential services shall be authorized by the department and take into consideration the following:

(1) The individual’s needs for the specific essential service being requested; and

(2) The cost of the service being provided by the vendors, based on the vendor’s written estimate.

(c) Vendors offering to provide essential services shall provide a written estimate on the cost thereof, which shall be authorized by the department prior to services being provided.

(d) Vendors providing emergency support shall:

(1) Be reimbursed for no more than the actual costs of the goods purchased and services rendered; and

(2) Include with the invoice a receipt(s) for the goods purchased.

(e) Vendors providing essential services to an individual shall be reimbursed based on the dollar amount authorized by the department which shall not exceed the amounts stipulated in (1)-(3) below:

(1) $500 per individual for chore service during the eligibility period;

(2) $1000 per individual for emergency support provided during the eligibility period; or

(3) $294 per individual for respite care provided during eligibility period.

(f) The vendor shall not bill the individual for any amount for essential services.

History

#9849-A, eff 1-12-11, EXPIRED: 1-12-19
#12720, INTERIM, eff 1-29-19, EXPIRED: 7-29-19
#12936, eff 12-7-19

N.H. Code Admin. R. Ann. He-E 501.22 Person-Centered Plan {#sec-he-e-501.22 omnilex-key=us-nh-regs-official--agency-he-e--He-E 501.22}

(a) Providers providing adult day services, home delivered meals, and in-home care services shall develop with input from each individual or his or her authorized representative a person-centered plan to drive the provision of Title XX services.

(b) The person-centered plan shall be based on the individual’s needs and developed with input from the individual or his or her authorized representative so that services are designed, scheduled, and delivered to best meet the needs and preferences of the individual, and so that the individual is supported as a full participant in the service planning and decision-making process.

(1) Identification of the anticipated needs, goals, and outcomes of service provision from the perspective of the individual;

(2) Written acknowledgement that the person-centered plan was developed with input from the individual or his or her authorized representative;

(3) Written acknowledgement that, as appropriate, reflects the person-centered plan is responsive to the changing needs of the individual; and

(4) Information on the individual’s health condition, medications, allergies, and special nutritional needs as appropriate to the service being provided to assess the individual’s service needs and to coordinate service.

(d) The provider shall provide service to the individual based on the person-centered plan. In addition to the requirements in (c) above, providers of adult day services shall be required to comply with all care plan requirements described in He-P 818.

(e) The person-centered plan shall be updated annually and whenever there is a change in the individual’s living arrangement or health status, or a change requested by the individual and agreed to by the involved parties.

(f) In addition to the requirements in (c) above, for individuals receiving home-delivered meals, the person-centered plan shall include:

(1) The number of meals to be delivered and when the meals are to be delivered;

(2) Documentation of any other special needs or factors that could impact service provision; and

(3) Consideration of the individual’s nutritional needs, including to the extent possible, any special nutritional needs and preferences.

History

#9849-A, eff 1-12-11, EXPIRED: 1-12-19
#12720, INTERIM, eff 1-29-19, EXPIRED: 7-29-19
#12936, eff 12-7-19 (formerly He-E 501.21)

N.H. Code Admin. R. Ann. He-E 501.23 Adult Day Services {#sec-he-e-501.23 omnilex-key=us-nh-regs-official--agency-he-e--He-E 501.23}

(a) Adult day services shall include the following activities, based on the individual’s needs:

(1) Supervision in a protected environment;

(2) The following services, as described in He-P 818.15:

a. Personal care services;

b. Health and safety services;

c. Nutrition services;

d. Nursing services;

e. Social services; and

f. Recreational activities;

(3) Monitoring of the individual’s condition and counseling, as appropriate, on nutrition, hygiene, or other related matters; and

(4) Referrals, as appropriate, to other services and resources that could assist the individual, including any necessary follow-up.

(b) Providers of adult day services shall:

(1) Be licensed and comply with all duties and responsibilities of licensees as required in He-P 818;

(2) Provide the required services described in He-P 818; and

(3) Maintain records as described in He-P 818.

(c) In order for an individual to be eligible to receive adult day services, the individual’s licensed practitioner shall:

(1) Complete a physical examination on the individual within 60 calendar days prior to the request for services; and

(2) Refer the individual for adult day services, because the individual:

a. Has been diagnosed as having an illness or disability; and

b. Requires adult day program services.

(d) Adult day services funded under Title XX shall not be available to anyone:

(1) Who resides in a nursing facility or other licensed or certified facility;

(2) Who receives adult family care services pursuant to He-E 801.14;

(3) Whose needs cannot be met by adult day services; or

(4) Who is primarily seeking services to support needs related to a diagnosis of mental illness or developmental disability.

History

#9849-A, eff 1-12-11, EXPIRED: 1-12-19
#12720, INTERIM, eff 1-29-19, EXPIRED: 7-29-19
#12936, eff 12-7-19 (formerly He-E 501.22)

N.H. Code Admin. R. Ann. He-E 501.24 Essential Services {#sec-he-e-501.24 omnilex-key=us-nh-regs-official--agency-he-e--He-E 501.24}

(a) Essential services shall include one or more of the following components, depending on the individual’s needs as identified by the department in accordance with He-E 501.05:

(1) Chore services, including but not limited to, home maintenance or repairs, heavy cleaning, fumigation, snowplowing, and trash removal;

(2) Emergency support, including but not limited to, payment for food, shelter, clothing, medicine, home heat, or telephone installation; and

(3) Respite care, when the individual needs assistance in the absence of his or her primary caregiver, or when the individual needs interim care while in transition to another living arrangement, and to include one or more of the following based on the individual’s needs:

a. Meal preparation;

b. Personal care; or

c. Light housekeeping.

(b) Respite care may be provided to the individual in the private home or in a licensed residential care or nursing facility.

(c) Vendors shall comply with the authorization described in He-E 501.16, which shall include the amount of funds authorized for chore, emergency support, or respite services based on the requirements contained in He-E 501.21.

(d) Individuals receiving essential services shall receive follow up from the department to:

(1) Confirm that services are being provided as authorized; and

(2) Provide assistance if there are any outstanding issues.

(e) Essential services funding shall not be authorized to supplement services being funded through another Source.

History

#9849-A, eff 1-12-11, EXPIRED: 1-12-19
#12720, INTERIM, eff 1-29-19, EXPIRED: 7-29-19
#12936, eff 12-7-19 (formerly He-E 501.27)

N.H. Code Admin. R. Ann. He-E 501.25 Home-Delivered Meals {#sec-he-e-501.25 omnilex-key=us-nh-regs-official--agency-he-e--He-E 501.25}

(a) Home-delivered meals services shall include:

(1) The delivery of nutritionally balanced meals, based on the requirements contained in (c) and (d) below, to the individual’s home;

(2) The monitoring of the individual and the reporting of emergencies, crises, or potentially harmful situations to emergency personnel;

(3) The distribution of educational materials on nutrition and wellness, including, but not limited to, the following:

a. Printed materials available at no cost from federal, state, or local government sources or from other agencies; or

b. Information provided by the provider through another venue, such as a newsletter; and

(4) Referrals as necessary to other services or programs.

(b) Home-delivered meals shall be provided to individuals who:

(1) Meet the eligibility requirements contained in He-E 501.05;

(2) Can demonstrate that they cannot prepare meals without assistance; and

(3) Are homebound or temporarily homebound due to recovery from illness or injury.

(1) Comply with state and local regulations on the safe and sanitary handling of food, equipment and supplies used in the storage, preparation, service and delivery of meals as described in He-P 2300;

(2) Accommodate, to the extent possible, the special nutritional needs or preferences of the individual, including recommendations from the individuals’ licensed practitioner;

(3) Confirm that the individual is physically present to receive the meal; and

(4) Not be reimbursed for meals that are delivered when the individual is not at home.

(d) Each meal shall:

(1) Include at least one-third of the dietary reference intakes based on age and gender, established by the U. S. Department of Agriculture for dietary reference intakes as specified in the United States Department of Agriculture’s “Dietary Guidelines for Americans 2015-2020” (Eighth Edition), available as noted in Appendix A; and

(2) Meet the U.S. Department of Agriculture recommended Dietary Guidelines for Americans as specified in the United States Department of Agriculture’s “Dietary Guidelines for Americans 2015-2020” (Eighth Edition),b incorporated in (1) above and available as noted in Appendix A.

(e) At least 3 times per year, the provider of home-delivered meals shall distribute to all individuals receiving home-delivered meals educational materials on nutrition and wellness, including, but not limited to, the following:

(1) Printed materials available at no cost from federal, state, or local government sources or from other agencies; or

(2) Information provided by the provider through another venue, such as a newsletter.

(f) As necessary, the provider shall refer individuals to other services or programs.

(g) Providers providing home-delivered meals shall keep a service provision record of all meals delivered that includes:

(1) The date of the meal;

(2) The name of the person the meal was delivered to; and

(3) Comments on any follow-up service provided or referrals to other services.

History

#9849-A, eff 1-12-11, EXPIRED: 1-12-19
#12720, INTERIM, eff 1-29-19, EXPIRED: 7-29-19
#12936, eff 12-7-19

N.H. Code Admin. R. Ann. He-E 501.26 In-Home Care Services {#sec-he-e-501.26 omnilex-key=us-nh-regs-official--agency-he-e--He-E 501.26}

(a) In-home care services, also known as adult in-home care, shall include the following core household maintenance tasks based on the individual’s needs including:

(1) Light housecleaning;

(2) Laundry;

(3) Maintaining a safe environment in areas of the home used by the individual;

(4) Meal preparation for the individual only and not for other members of the household;

(5) Rearranging light-weight furniture to assure the individual can safely ambulate to reach food, water, medication, and other essential items;

(6) Shopping for groceries and performing other errands for the individual receiving services; and

(7) Instructing the individual to perform core household maintenance tasks necessary to maintain the individual’s well-being, safety, and independence.

(b) In-home care services shall also include the following:

(1) Assistance with one or more of the following ADLs or instruction in self-care, based on the individual’s needs:

a. dressing;

b. meal preparation, eating and drinking;

c. grooming;

d. assistance with medication as allowed by He-P 809 and He-P 822; and

e. toileting;

(2) Providing and encouraging socialization; and

(3) Evaluating the individual’s progress and, when necessary, providing information about and referral to other resources.

(1) Home health care providers licensed in accordance with RSA 151:2 and He-P 809; and

(2) Home care providers licensed in accordance with RSA 151:2 and He-P 822.He-E 501.27.

History

#9849-A, eff 1-12-11, EXPIRED: 1-12-19
#12720, INTERIM, eff 1-29-19, EXPIRED: 7-29-19
#12936, eff 12-7-19 (formerly He-E 501.24)

N.H. Code Admin. R. Ann. He-E 501.27 Waivers {#sec-he-e-501.27 omnilex-key=us-nh-regs-official--agency-he-e--He-E 501.27}

(a) A provider may request a waiver of a requirement(s) contained in He-E 501 by sending a letter to the department on the provider’s letterhead, and shall submit the request to the attention of the department by:

(1) Email to BAAS@dhhs.nh.gov; or

(2) Fax to (603) 271-4643; or

(3) Mail to:

The Department of Health & Human Services

Bureau of Adult and Aging Services

105 Pleasant St., Main Building

Concord NH 03301.

(b) The waiver request shall be signed by the provider’s executive director or designee, and shall include:

(1) The specific requirement(s) in He-E 501 that the contract agency requests to have waived;

(2) The reason why the waiver is being sought; and

(3) The alternative proposed by the provider to satisfy the requirements of He-E 501.

(c) The department shall review the request, and within 30 calendar days of the date the request was received, determine whether or not to approve it.

(d) The waiver request shall be approved if the alternative proposed by the provider meets the objective or intent of He-E 501, and, in the opinion of the department, the waiver:

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

(2) Shall not affect the quality of services provided to individuals by the provider; and

(3) Shall not waive any provision or procedure prescribed by statute.

(e) The department shall inform the provider in writing of the decision on the waiver request.

(f) Waivers that are approved shall become effective as of the date of the written notice referred to in (e) above, and shall not expire except as follows:

(1) Those waivers which relate to the health, safety, or welfare of individuals and require periodic reassessment shall be effective for one calendar year only subject to the participant’s continued eligibility; and

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

(g) The contract agency may request a renewal of a waiver from the department, and such a request shall be made at least 90 calendar days prior to the expiration of a current waiver and following the steps described in He-E 501.28(a)-(e).

(h) The request to renew a waiver shall be granted based on the requirements stipulated in He-E 501.23(d).

History

#9849-A, eff 1-12-11, EXPIRED: 1-12-19
#12720, INTERIM, eff 1-29-19, EXPIRED: 7-29-19
#12936, eff 12-7-19

Part He-E 502 Older Americans Act Services: Title Iiib – Supportive Services, Title Iiic1 and C2 – Nutrition Program Policies, and Title Iiid – Disease Prevention and Health Promotion Services

N.H. Code Admin. R. Ann. He-E 502.01 Purpose and Goals {#sec-he-e-502.01 omnilex-key=us-nh-regs-official--agency-he-e--He-E 502.01}

(a) The purpose of the rule is to describe:

(1) The services administered by the NH department of health and human services (DHHS), bureau of adult and elderly services (BAAS) through the Older Americans Act (Title III) to those individuals who meet the eligibility requirements contained in these rules; and

(2) The eligibility requirements for these services.

(b) In accordance with the Older Americans Act, Title III services shall be directed toward one or more of the goals contained in 45 CFR 1321 and 42 U.S.C. 3001, with emphasis placed on serving the following groups of individuals:

(1) Individuals with severe disabilities;

(2) Low income minority older individuals;

(3) Native Americans;

(4) Older individuals in greatest social or economic need;

(5) Older individuals residing in rural areas;

(6) Older individuals with limited English proficiency; and

(7) Older individuals at risk for institutional placement.

History

(See Revision Note at part heading for He-E 502) #10530, eff 2-28-14; ss by #13354, eff 3-19-22

N.H. Code Admin. R. Ann. He-E 502.02 Definitions {#sec-he-e-502.02 omnilex-key=us-nh-regs-official--agency-he-e--He-E 502.02}

(a) “Activities of daily living (ADLs)” means activities such as grooming, toileting, eating, dressing, getting into or out of a bed or chair, walking, and monitoring and supervision of medications.

(b) “Adult” means “adult” as defined in RSA 161-F:1, I, namely “any person 18 years of age or older.”

(c) “Adult protective services (APS) program” means the program which encompasses all the tasks and responsibilities completed in accordance with the adult protection law, RSA 161-F:42-57.

(d) “Appeal” means a request by a person adversely affected by the NH department of health and human service’s or contract agency’s decision or action to review that decision or action in accordance with the provisions of RSA 126-A:5, VIII.

(e) “Authorized representative (AR)” means any adult other than a bureau of adult and aging services representative or contract agency representative who is 18 years of age or older, and who, with the individual’s permission, acts on behalf of the individual during all aspects of initial or continuing eligibility determination for Title III services or under the authority of a guardianship order.

(f) “Bureau of adult and elderly services (BAAS)” means the New Hampshire department of health and human services’ bureau of adult and aging services.

(g) “Catchment area” means the geographic area where the contract agency provides Title III services, as identified in the agency’s contract with BAAS.

(h) “Communication access” means, when necessary and appropriate, providing communication assistance to individuals, who are:

(1) Non-English speaking or have limited English proficiency;

(2) Deaf, experiencing a degree of hearing loss, or have auditory processing challenges;

(3) Visually impaired; or

(4) Speech impaired.

(i) “Contract agency” means the agency under contract with BAAS to provide one or more services or activities as described in this part.

(j) “Donation” means a voluntary contribution made by an individual receiving Title III services that is used to support the cost of these services.

(k) “Evidence-based” means that a program or intervention has been published in a peer-review journal and demonstrated through evaluation to be effective for improving the health and well-being or reducing disease, disability or injury among older individuals.

(l) “Federal poverty guidelines” means the poverty guidelines updated periodically in the Federal Register by the U.S. Department of Health and Human Services under the authority of 42 U.S.C. 9902(2).

(m) “Greatest economic need,” as defined by the Older Americans Act, means the financial need resulting from an income at or below the federal poverty guidelines.

(n) “Greatest social need,” as defined in the Older Americans Act, means the need caused by non-economic factors, which include physical and mental disabilities, language barriers, and cultural, social, or geographical isolation, including isolation caused by racial or ethnic status that restricts the ability of an individual to perform normal daily tasks or threatens the ability of the individual to live independently.

(o) “Group educational service/activity” means an event or meeting during which educational or informational material is presented to a group of 2 or more individuals.

(p) “Housecleaning” means duties related to household cleanliness including, but not limited to, mopping floors, vacuuming, laundry, changing bed linens, dusting, and other tasks related to sanitation within an individual’s living environment.

(q) “Independent living situation” means one of the following living arrangements:

(1) The individual’s own home, apartment, or room;

(2) The home or apartment of a spouse, partner, relative, or friend where the individual also resides;

(3) A motel or hotel; or

(4) A homeless shelter.

(r) “Individual” means the adult requesting or receiving the Title III social services described in He-E 502.05 and He-E 502.06.

(s) “Informal resolution” means the process described in He-E 502.10 that is conducted when an individual, or his or her authorized representative, disagrees with an eligibility or termination determination.

(t) “Licensed practitioner” means a medical doctor, physician’s assistant, advanced practice registered nurse, doctor of osteopathy, doctor of naturopathic medicine, or anyone else with diagnostic and prescriptive powers who is licensed by the appropriate New Hampshire licensing board.

(u) “Limited English proficiency” means the inability of an individual to speak English as their primary language, and whose skills in listening, speaking, or reading English are such that the individual cannot adequately understand and participate in their care, or in the services provided to them, without language assistance, the provision of communication access services, or communication devices.

(v) “Nursing facility” means a licensed nursing facility as defined in RSA 151-E:2, V.

(w) “Older individual” means “older individual” as defined in 42 USC 3002(40), namely “an individual who is 60 years of age or older.” The term includes “elderly” as defined in RSA 161-F:1, V.

(x) “Person-centered” means that the individual or his or her authorized representative or caregiver is the center of the system of care, and the individuals’ needs and preferences drive the care and services provided.

(y) “Protective services” means “protective services” as defined in RSA 161-F:43, I, namely, “services and action which will, through voluntary agreement or through appropriate court action, prevent neglect, abuse or exploitation of incapacitated adults. Such services shall include, but not be limited to, supervision, guidance, counseling and, when necessary, assistance in securing of nonhazardous living accommodations, and mental and physical examinations.”

(z) “ServiceLink Resource Center” means a network of community-based sites with the common purpose of providing information, referrals, and assistance to connect older adults, adults living with disabilities, and their families and caregivers with resources in their communities.

(aa) “Walk-in service” means a session during which a Title III service provider presents educational or informational material to an individual who “drops-in” or “walks-in” to a location, event, or meeting.

(ab) “Wait list” means a list of individuals who have been determined eligible, and are ready to receive, a Title III service from a contract agency, but for whom the agency does not have sufficient service units or resources to serve the individuals.

History

(See Revision Note at part heading for He-E 502) #10530, eff 2-28-14; ss by #13354, eff 3-19-22

N.H. Code Admin. R. Ann. He-E 502.03 Confidentiality {#sec-he-e-502.03 omnilex-key=us-nh-regs-official--agency-he-e--He-E 502.03}

All information on individuals receiving Title III services and programs administered by BAAS or a contract agency shall be kept confidential, and only persons involved in administering Title III services and programs shall review an individual’s information, unless the individual signs an authorization to release the information to another person or organization.

History

(See Revision Note at part heading for He-E 502) #10530, eff 2-28-14; ss by #13354, eff 3-19-22

N.H. Code Admin. R. Ann. He-E 502.04 Title III Services {#sec-he-e-502.04 omnilex-key=us-nh-regs-official--agency-he-e--He-E 502.04}

(a) Contract agencies shall determine eligibility and provide services for all Title III services, except adult in-home care for which eligibility shall be determined by BAAS.

(b) Contract agencies shall provide one or more of the following Title III services:

(1) Adult day program services;

(2) Adult in-home care services;

(3) Alcohol and substance abuse prevention services;

(4) Dental services;

(5) Elder abuse counseling;

(6) Home health aide services;

(7) Homemaker services;

(8) Legal services;

(9) Low vision service;

(10) Nursing services;

(11) Nutrition services: congregate meals;

(12) Nutrition services: home delivered meals;

(13) Prevention services; and

(14) Transportation services.

History

(See Revision Note at part heading for He-E 502) #10530, eff 2-28-14; ss by #13354, eff 3-19-22

N.H. Code Admin. R. Ann. He-E 502.05 Eligibility Requirements for Services {#sec-he-e-502.05 omnilex-key=us-nh-regs-official--agency-he-e--He-E 502.05}

(a) To be eligible to receive Title III services, an individual shall:

(1) Be 60 years of age or older, except as specified in He-E 502.28(e)(1)-(4) Nutrition Services: Congregate Meals and He-E 502.29(d)(1)-(4) Nutrition Services: Home Delivered Meals;

(2) Meet any other requirements for the specific service or services being requested, as described in He-E 502.18 through He-E 502.31;

(3) Reside in an independent living situation, or be expected to transition to an independent living situation prior to the initiation of services, with the exception of legal services; and

(4) Not already be receiving the same or duplicate services from another program such as a Medicaid waiver program.

History

(See Revision Note at part heading for He-E 502) #10530, eff 2-28-14; ss by #13354, eff 3-19-22

N.H. Code Admin. R. Ann. He-E 502.06 Service Requests and Process {#sec-he-e-502.06 omnilex-key=us-nh-regs-official--agency-he-e--He-E 502.06}

(a) An individual or his or her authorized representative may request a Title III service(s) from any contract agency that provides the service(s) being requested, except that adult in-home care shall be requested from BAAS.

(b) Individuals or their authorized representatives requesting Title III services shall be required to self-declare their age.

History

(See Revision Note at part heading for He-E 502) #10530, eff 2-28-14; ss by #13354, eff 3-19-22

N.H. Code Admin. R. Ann. He-E 502.07 Determination, Notice of Eligibility, and Eligibility Period {#sec-he-e-502.07 omnilex-key=us-nh-regs-official--agency-he-e--He-E 502.07}

(a) An individual shall meet the requirements in He-E 502.05 and 502.06 in order to be deemed eligible to receive Title III services.

(b) For individuals determined eligible to receive Title III services, the eligibility period shall be for one year beginning on the date that eligibility is determined and ending 364 calendar days later.

(c) For individuals determined to be eligible to receive Title III services, a written notice of the eligibility decision shall be provided by the contract agency to the individual no later than 45 calendar days from the date of determination for the following services:

(1) Adult day program services;

(2) Adult in-home care services;

(3) Home health aide services;

(4) Homemaker services;

(5) Nursing services; and

(6) Nutrition services: home delivered meals.

(d) If the eligibility requirements are met, and services are available, the notice shall include:

(1) The services to be provided, and when;

(2) The eligibility period; and

(3) Contact information for the contract agency.

(e) If the eligibility requirements are not met, the notice shall include:

(1) The reason(s) for the denial;

(2) A statement regarding the right of the individual or his or her authorized representative to request an informal resolution or appeal of the eligibility determination decision as described in He-E 502.10; and

(3) Contact information for the contract agency.

(f) If eligibility requirements for Title III services are met but services are not available, the individual shall be notified that his or her name shall be placed on a wait list in accordance with He-E 502.13.

(g) For individuals expected to transition to and reside in an independent living situation, Title III services shall not be provided until the individual physically relocates to an independent living situation.

History

(See Revision Note at part heading for He-E 502) #10530, eff 2-28-14; ss by #13354, eff 3-19-22

N.H. Code Admin. R. Ann. He-E 502.08 Redetermination of Service Eligibility {#sec-he-e-502.08 omnilex-key=us-nh-regs-official--agency-he-e--He-E 502.08}

(a) For those individuals determined to be eligible for Title III services, the contract agency shall review the individual’s service record annually, as long as service(s) is being provided. The review shall be completed within 30 calendar days prior to the anniversary date on which eligibility began.

(b) The contract agency shall make a decision to continue or terminate the individual’s Title III services based on the requirements contained in these rules and document the decision by making a notation in the individual’s service record.

History

(See Revision Note at part heading for He-E 502) #10530, eff 2-28-14; ss by #13354, eff 3-19-22

N.H. Code Admin. R. Ann. He-E 502.09 Termination or Significant Alteration of Services {#sec-he-e-502.09 omnilex-key=us-nh-regs-official--agency-he-e--He-E 502.09}

(a) “Significant alteration” means a closure, location change, or other change that restricts access to services.

(b) Title III services shall be terminated when:

(1) The individual no longer meets the eligibility requirements for Title III services as described in He-E 502.05;

(2) Funding for the service(s) is no longer available;

(3) The individual no longer requires the service(s);

(4) The individual or his or her authorized representative requests that the service(s) be terminated;

(5) The individual relocates to a geographical area outside the service delivery area or to an institutional setting;

(6) The contract agency’s contract to provide services is terminated; or

(7) The individual expires.

(c) The individual or his or her authorized representative shall be notified in writing by the contract agency when the following services are terminated pursuant to (a)(1)-(6) above:

(1) Adult day program services;

(2) Adult in-home care services;

(3) Home health aide services;

(4) Homemaker services;

(5) Nursing services; and

(6) Nutrition services: home delivered meals.

(d) The notice of termination shall specify:

(1) The service(s) to be terminated;

(2) The reason(s) for terminating the service(s);

(3) The date upon which the service(s) shall be terminated which shall be 30 calendar days from the date of the notice, unless a request for an informal resolution or appeal has been filed as described in He-E 502.10; and

(4) The contact information for the contract agency staff member who completed the notice.

(e) The contract agency shall keep a copy of the termination in the individual’s service record.

(f) The contract agency shall make a notation in the individual’s service record when the individual or his or her authorized representative elects to terminate services.

(g) The contract agency shall send written notice to BAAS when services are terminated for individuals receiving the following Title III service authorized services:

(1) Adult day program services;

(2) Adult in-home care services;

(3) Home health aide services;

(4) Homemaker services;

(5) Nutrition services: congregate meals, and

(6) Nutrition services: home delivered meals.

(h) The contract agency shall keep a copy of the notice sent in (f) above in the individual’s service record.

(i) If a contract agency wishes to terminate services to an eligible individual who is currently receiving services because the contract agency determines that the individual’s behavior or living environment creates a health or safety hazard for contract agency staff, then:

(1) The contract agency shall:

a. Consult with BAAS staff for assistance in determining possible remedies other than termination;

b. Following consultation with BAAS, document and report to BAAS the outcome of each additional effort made to resolve the situation;

c. Send BAAS written notification of a final decision to terminate including a summary of the efforts the contract agency has made to resolve the situation prior to sending the termination notice to the individual; and

d. Document in the individual’s service record a description of the individual’s behavior(s) or living environment that created a health or safety hazard for contract agency staff, as well as the contract agency’s attempts to continue to provide services; and

(2) The contract agency shall send written notice to an individual within 5 business days of notifying BAAS in (1)d. above.

(3) When an individual’s behavior or living environment presented a perceived imminent danger to contract agency staff or a contract agency volunteer, the contract agency may choose to temporarily suspend service until the requirements in (i)(1) above can be met.

(j) The individual or the individual’s authorized representative shall be notified when the following services are significantly altered:

(1) Adult day program services;

(2) Adult in-home care services;

(3) Home health aide services;

(4) Homemaker services;

(5) Nursing services; and

(6) Nutrition services: home delivered meals.

(k) The notice of significant alteration shall specify:

(1) The service(s) to be significantly altered;

(2) The reason(s) for the significant alteration;

(3) The date upon which the service(s) shall be significantly altered; and

(4) The contact information for the contract agency staff member who completed the notice.

History

(See Revision Note at part heading for He-E 502) #10530, eff 2-28-14; ss by #13354, eff 3-19-22

N.H. Code Admin. R. Ann. He-E 502.10 Informal Resolution {#sec-he-e-502.10 omnilex-key=us-nh-regs-official--agency-he-e--He-E 502.10}

(a) An individual who disagrees with an eligibility or termination determination as described in He-E 502.07 or He-E 502.09 may request an informal resolution of the decision, as follows:

(1) The individual, or their authorized representative, shall submit a written request to the BAAS bureau director, or designee, within 30 calendar days of the eligibility or termination determination; and

(2) The written request shall include an explanation of the reason why the eligibility or termination determination should be changed, including any supporting documentation.

(b) For individuals currently receiving services, Title III services shall continue during the informal resolution process until a decision is rendered.

(c) The BAAS bureau director, or designee, shall review the request in (a) above and provide a written notice to the individual, or their authorized representative, of the decision to maintain or change the original eligibility or termination decision, including the reason therefor.

(d) If the contract agency’s or BAAS’ decision is not upheld:

(1) Services shall be initiated for individuals requesting services; and

(2) Services for individuals currently receiving Title III services shall continue as long as the Title III eligibility requirements described in He-E 502.05 are met or until the end of the individual’s eligibility period.

(e) If the contract agency or BAAS’ decision is upheld, services for individuals currently receiving services shall end within 30 calendar days of the bureau director or designee’s decision.

(f) Requesting an informal resolution shall not:

(1) Preclude in any way an individual’s right to appeal a disputed eligibility or termination determination in accordance with He-C 200; or

(2) Change the timeframes established for filing an appeal.

(g) An individual may appeal the decision of the bureau director or designee in (c) above, in accordance with He-C 200.

History

(See Revision Note at part heading for He-E 502) #10530, eff 2-28-14; ss by #13354, eff 3-19-22

N.H. Code Admin. R. Ann. He-E 502.11 Contract Agency Requirements {#sec-he-e-502.11 omnilex-key=us-nh-regs-official--agency-he-e--He-E 502.11}

(a) Agencies wishing to provide Title III services shall be under contract with BAAS to provide such service(s).

(b) Contract agencies shall:

(1) Comply with all provisions included in the contract with BAAS;

(2) Determine eligibility for individuals requesting service and comply with notification and other documentation requirements as described in these rules;

(3) Target outreach and direct services toward one or more of the goals contained in 45 CFR 1321 and 42 U.S.C. 3001 with emphasis placed on serving the groups of individuals described in He-E 502.01(b)(1)-(7);

(4) Develop person-centered plans as described in He-E 502.17 that encourage the full participation of the individual or his or her authorized representative(s) in the service planning and decision making process;

(5) Coordinate and monitor the provision of services as described in the person-centered plan to ensure there is no duplication of Title III or other services being provided to the individual;

(6) Comply with and make available to BAAS upon request any licensing or certification requirements required by applicable federal, state, or local laws or rules;

(7) Maintain the insurance coverage required by applicable state or local laws or rules, and provide written proof of such insurance coverage to BAAS;

(8) Identify an executive director or designee who will oversee the services provided by the contract agency;

(9) Identify staff who will complete the responsibilities contained in this rule for the service(s) being provided;

(10) Train and supervise contract agency staff and volunteers on the following:

a. The contract agency’s policies and procedures;

b. The specific Title III services the staff or volunteer will be providing; and

c. Any additional training requirements contained in applicable federal or state laws or rules;

(11) Comply with all contract requirements regarding the provision of communication access to individuals who are requesting or receiving services covered under this rule;

(12) Develop procedures for staff responses to emergencies;

(13) Unless otherwise prohibited by law, develop procedures for reporting suspected abuse, neglect, self-neglect, or exploitation of incapacitated adults as required by RSA 161-F:46 of the adult protection law;

(14) Comply with the provisions of RSA 161-F:49 with regard to checking the names of prospective or current employees, volunteers, or subcontractors against the BAAS state registry;

(15) Have an established written complaint and incident process that may be accessed by individuals, family members, or authorized representatives when an individual is denied services or dissatisfied with the services provided by the contract agency, including:

a. The name or position of the contract agency staff member who coordinates the complaint and incident process;

b. The issues that may be addressed through the complaint and incident process;

c. How individuals are informed of their right to file a complaint or incident report;

d. The procedures to be followed by individuals who wish to file a complaint or incident report with the contract agency;

e. The procedures to be followed by the contract agency when reviewing complaints or incidents, and for notifying the individual of the outcome of the review; and

f. Information stating that the availability of the complaint and incident process from the contract agency shall not cancel the right of an individual who is denied Title III services to request an informal resolution or appeal in accordance with He-E 502.10 and He-C 200;

(16) Provide information to BAAS when requested regarding individuals receiving services, except for services provided under He-E 502.25 Legal Services;

(17) Comply with all BAAS service authorization practices and submit claims for payment in accordance with He-E 502.14;

(18) Comply with all BAAS reimbursement practices and maintain financial records to fully support each claim billed for services;

(19) Maintain service records in accordance with He-E 502.15 for the specific Title III service(s) being provided;

(20) Submit fiscal reports to BAAS on a semiannual basis;

(21) Submit information on the wait list in accordance with He-E 502.13;

(22) Engage in monitoring and evaluating the quality of the services being provided, which shall include:

a. Obtaining feedback from the individual or his or her authorized representative or from family members as applicable;

b. Participating in any quality assurance measures implemented by BAAS; and

c. Making changes as necessary to improve the quality and effectiveness of service delivery; and

(23) When providing nutrition services: home-delivered meals:

a. Be in compliance with federal, state, and local regulations for food safety, meal preparation, and delivery;

b. Employ staff or subcontract with another entity to prepare and deliver meals in accordance with the regulations in a. above;

c. Demonstrate on a quarterly basis that meals are in compliance with the dietary requirements contained in He-E 502.29 by providing BAAS with menus which are signed by a registered dietitian or another professional with comparable expertise;

d. Ensure that contract agency staff:

Has direct contemporaneous contact with each individual; and
Reports any observations of unusual circumstances to the designated contract agency supervisor or, in the case of an emergency, calls emergency personnel; and

e. Keep a record of the number of meals authorized for the individual, the scheduled days of delivery, and the number of meals served.

History

(See Revision Note at part heading for He-E 502) #10530, eff 2-28-14; ss by #13354, eff 3-19-22

N.H. Code Admin. R. Ann. He-E 502.12 Voluntary Donations {#sec-he-e-502.12 omnilex-key=us-nh-regs-official--agency-he-e--He-E 502.12}

(a) The contract agency shall not charge fees or bill individuals receiving Title III services.

(b) In accordance with Title III, the contract agency shall provide each individual with an opportunity to voluntarily donate to the cost of the service, as follows:

(1) The contract agency shall clearly inform each individual that there is no obligation to donate, that a donation is purely voluntary, and that the individual shall not be denied services because he or she does not donate; and

(2) The contract agency may suggest an amount for a donation, but shall not use means testing as the basis for the donation or expect the donation to cover the full cost of services.

(1) Protect the privacy and confidentiality of each individual with respect to the individual’s donation or lack of a donation;

(2) Establish appropriate procedures to safeguard and account for all donations; and

(3) Use all donations to support the program for which donations were given.

(d) For individuals with an open APS protective services case as described in He-E 700, the APS program rule, the contract agency shall not attempt to secure additional reimbursement, including donations, of any type from the individual or his or her family members or authorized representative for those services.

History

(See Revision Note at part heading for He-E 502) #10530, eff 2-28-14; ss by #13354, eff 3-19-22

N.H. Code Admin. R. Ann. He-E 502.13 Wait Lists {#sec-he-e-502.13 omnilex-key=us-nh-regs-official--agency-he-e--He-E 502.13}

(a) All services covered by He-E 502 shall be provided to the extent that funds, staff, and resources for this purpose are available.

(b) The contract agency shall maintain a wait list for Title III services when funding or resources are not available to provide the services, except that a wait list for Title III group educational or walk-in services shall not be required.

(1) Who are newly eligible and ready to receive services;

(2) Who are already receiving services and are requesting additional services; and

(3) Who relocate outside of the catchment area for the contract agency providing services and are requesting Title III services from a contract agency in the new location.

(d) Each contract agency shall include the following information on its wait list:

(1) The individual’s full name and date of birth;

(2) The name of the Title III service being requested;

(3) The target date, if known, of implementing the services based on the communication between the individual and the contract agency;

(4) The date upon which the individual’s name was placed on the wait list, which shall be the date of the notice of decision in which the individual was determined eligible for Title III services;

(5) The individual’s assigned priority on the wait list, determined in accordance with (e) below; and

(6) If the individual is already receiving a Title III service, the type and amount of the services received.

(e) The contract agency shall prioritize each individual’s standing on the wait list by determining the individual’s urgency of need in the following order:

(1) Individual has an open APS protective services case;

(2) Individual is not already receiving services through one of DHHS’ Medicaid waiver programs, or who may be eligible for other NH Medicaid services;

(3) Individual is identified by Title III as belonging to one of the following groups, as described in He-E 502.01(b)(1)-(6):

a. Individuals with severe disabilities;

b. Low income minority older individuals;

c. Native Americans;

d. Older individuals in greatest social or economic need;

e. Older individuals residing in rural areas; and

f. Older individuals with limited English proficiency;

(4) Individual is at risk of being admitted to an institutional setting due to:

a. Declining mental or physical health of the caregiver;

b. Declining mental or physical health of the individual; or

c. Individual living with a caregiver who is in need of substitute or respite care due to the temporary incapacity, illness, or unavailability of the regular caregiver;

(5) Length of time on the wait list; and

(6) Individual is transitioning from an institutional setting.

(f) When 2 or more individuals on the wait list have been assigned the same service priority, the individual served first will be the one with the earliest eligibility determination date.

(g) The individual may reserve the right to remove his or her name from the wait list at any time or apply for Title III services with another contract agency.

(h) When an individual is placed on the wait list, the contract agency shall notify the individual in writing and include the following information:

(1) A statement that Title III services are not covered because funds, staff, or resources are unavailable;

(2) A brief description of the contract agency’s wait list process;

(3) The estimated period of time that the contract agency expects the individual to remain on the wait list;

(4) A statement that notifies the individual of the right to remove his or her name from the wait list and to request Title III services with another contract agency;

(5) A statement that directs the individual to the specified NH ServiceLink toll-free telephone number for more information on other contract agencies in the individual’s catchment area that provide the Title III service being requested;

(6) The contact information for the contract agency(ies); and

(7) A statement requesting that the individual notify the contract agency if his or her service needs change or if the individual begins to receive the requested Title III service from another contract agency.

(i) Upon becoming aware of availability to provide a Title III service, the contract agency shall immediately call and send written notice to the individual requesting Title III services based on the priority outline in (e) above and, if appropriate, the assigned APS protective social worker.

(j) The individual shall respond to the contract agency within 10 business days of the date on the written notice, indicating whether or not they still wish to receive the Title III services.

(k) If the individual does not respond within 10 business days, the contract agency shall no longer be obligated to provide Title III services to that individual.

(l) The individual may make another request for Title III services in accordance with He-E 502.06 and 502.07.

History

(See Revision Note at part heading for He-E 502) #10530, eff 2-28-14; ss by #13354, eff 3-19-22

N.H. Code Admin. R. Ann. He-E 502.14 Service Authorization {#sec-he-e-502.14 omnilex-key=us-nh-regs-official--agency-he-e--He-E 502.14}

(a) Once the individual has been determined eligible to receive Title III services, the following Title III services shall be authorized by the contract agency, acting on behalf of BAAS, in order for the individual to receive services funded by Title III:

(1) Adult day program services;

(2) Adult in-home care services;

(3) Home health aide services;

(4) Homemaker services;

(5) Nutrition services: congregate meals; and

(6) Nutrition services: home delivered meals.

(b) Service authorizations shall consist of the specific types of services required to meet the needs identified on the individual’s person-centered plan.

History

(See Revision Note at part heading for He-E 502) #10530, eff 2-28-14; ss by #13354, eff 3-19-22

N.H. Code Admin. R. Ann. He-E 502.15 Service Records {#sec-he-e-502.15 omnilex-key=us-nh-regs-official--agency-he-e--He-E 502.15}

(a) Contract agencies shall maintain a service record for all individuals receiving one or more Title III services except as provided in (h) below.

(b) The service record shall contain:

(1) The individual’s name, address, and telephone number;

(2) A notation that the individual meets the eligibility requirements for services as described in He-E 502.05;

(3) An annual notation of the decision to recertify or terminate services as described in He-E 502.08;

(4) Notation of the following:

a. The name of the Title III service(s) being provided and the type of service activities, based on the service description contained in this rule;

b. The dates of service provision and the number of service units provided;

c. Identification of the individual’s communication access needs, including type and modality, and the name of the communication access provider or type of device utilized, if applicable; and

d. Any other information or correspondence deemed relevant to service provision; and

(5) The service authorization as described in He-E 502.14(a), if applicable.

(1) Adult in-home care services;

(2) Home health aide services;

(3) Homemaker services;

(4) Nursing services; and

(5) Nutrition services: home delivered meals.

(d) The additional documentation specified in (c) above shall include:

(1) A copy of the notice of decision for the provision of service(s) as described in He-E 502.07, as applicable;

(2) The name and telephone number of a person who may be contacted in an emergency;

(3) The name, address, and telephone number of the individual’s primary caregiver, if applicable;

(4) The name and telephone number of the individual’s licensed practitioner, if applicable;

(5) Documentation of changes in the individual’s health or other circumstances affecting service provision;

(6) A copy of any termination notification(s) to the individual and BAAS as described in He-E 502.09, if applicable, or a notation that the individual voluntarily terminated services;

(7) The person-centered plan as described in He-E 502.17;

(8) The dates upon which service(s) will begin and end;

(9) The planned frequency of the service(s);

(10) The total number of service units that will be provided on each date of service, if appropriate; and

(11) Copies of all executed legal directives provided to the contract agency, such as guardianship orders for health care under RSA 464-A, a durable power of attorney or a living will, or any advanced directives under RSA 137-J.

(e) Contract agencies providing adult day program services shall be required to comply with all documentation requirements as described in He-P 818, in addition to the requirements outlined in He-E 502.15(b).

(f) Service records shall be kept confidential in accordance with He-E 502.03 and all applicable federal and state laws and regulations.

(g) Service records shall be retained for a period of 4 years after services have ended or have been terminated.

(h) No service record shall be required for individuals receiving only group educational or walk-in services, or telephone services as described in He-E 502.25 Legal Services.

History

(See Revision Note at part heading for He-E 502) #10530, eff 2-28-14; ss by #13354, eff 3-19-22

N.H. Code Admin. R. Ann. He-E 502.16 Cessation of Title III Services by a Contract Agency {#sec-he-e-502.16 omnilex-key=us-nh-regs-official--agency-he-e--He-E 502.16}

(a) When a contract agency decides to terminate its contract for a Title III service, the agency shall provide written notification to BAAS in accordance with the terms of the contract.

(b) The contract agency shall develop and submit a transition plan for services under the agreement, including, but not limited to, identifying the present and future needs of individuals receiving services under the agreement and establishing a process to meet those needs in accordance with the terms of the contract.

(c) The contract agency shall also comply with any other provisions contained in its contract with respect to the cessation of Title III services.

History

(See Revision Note at part heading for He-E 502) #10530, eff 2-28-14; ss by #13354, eff 3-19-22

N.H. Code Admin. R. Ann. He-E 502.17 Person-Centered Plan {#sec-he-e-502.17 omnilex-key=us-nh-regs-official--agency-he-e--He-E 502.17}

(a) Contract agencies providing the Title III services described in this rule shall develop a person-centered plan for individuals receiving one or more of the following services:

(1) Adult day program services;

(2) Adult in-home care services;

(3) Home health aide services;

(4) Homemaker services;

(5) Nursing services; and

(6) Nutrition services: home-delivered meals.

(b) The person-centered plan shall be based on the individual’s needs and developed with input from the individual or his or her authorized representative so that services are designed, scheduled, and delivered to best meet the needs and preferences of the individual, and the individual is supported as a full participant in the service planning and decision-making process.

(1) Identification of the anticipated needs, goals, and outcomes of service provision from the perspective of the individual;

(2) Documentation that the person-centered plan was developed with input from the individual or his or her authorized representative;

(3) Documentation, as appropriate, to reflect the person-centered plan is responsive to the changing needs of the individual; and

(4) Information on the individual’s health condition, medications, allergies, and special dietary needs as appropriate to the service being provided in order to assess the individual’s service needs and to coordinate service.

(d) The contract agency shall provide service to individuals based on the person-centered plan.

(e) The person-centered plan shall be updated annually or whenever there is a change in the individual’s living arrangement or health status, or a change requested by the individual and agreed to by the parties.

(f) In addition to the requirements in (c) above, contract agencies providing adult day program services shall be required to comply with all care plan requirements described in He-P 818.

(g) In addition to the requirements in (c) above, for individuals receiving home-delivered meals, the person-centered plan shall include:

(1) The number of meals to be delivered and when the meals are to be delivered;

(2) Documentation of any other special needs or factors that could impact service provision; and

(3) Consideration of the individual’s nutritional needs, including to the extent possible, any special dietary needs and preferences.

History

(See Revision Note at part heading for He-E 502) #10530, eff 2-28-14; ss by #13354, eff 3-19-22

N.H. Code Admin. R. Ann. He-E 502.18 Adult Day Program Services {#sec-he-e-502.18 omnilex-key=us-nh-regs-official--agency-he-e--He-E 502.18}

(a) Contract agencies providing adult day program services shall:

(1) Be licensed and comply with all duties and responsibilities of licensees as required in He-P 818;

(2) Provide the required services described in He-P 818; and

(3) Maintain records as described in He-P 818.

(b) In order for an individual to be eligible to receive Title III adult day program services, the individual’s licensed practitioner shall:

(1) Complete a physical examination on the individual within 60 calendar days prior to the request for services; and

(2) Refer the individual for adult day program services, because the individual:

a. Has been diagnosed as having an illness or disability; and

b. Requires adult day program services.

(1) Who resides in a nursing facility or other licensed or certified facility;

(2) Who receives adult family care services pursuant to He-E 801.14;

(3) Whose needs cannot be met by the adult day program; or

(4) Who is primarily seeking services to support needs related to a diagnosis of mental illness or developmental disability.

History

(See Revision Note at part heading for He-E 502) #10530, eff 2-28-14; ss by #13354, eff 3-19-22

N.H. Code Admin. R. Ann. He-E 502.19 Adult In-Home Care Services. {#sec-he-e-502.19 omnilex-key=us-nh-regs-official--agency-he-e--He-E 502.19}

(a) To be eligible for adult in-home care services, the individual shall have an open APS protective services case and be assessed to be in need of adult in-home care services by an adult protective services social worker.

(b) Adult in-home care services shall be provided by employees of:

(1) Home health care providers licensed in accordance with RSA 151:2 and He-P 809;

(2) Home care service providers licensed in accordance with RSA 151:2 and He-P 822; or

(3) Other qualified agencies certified in accordance with RSA 161-I and He-P 601.

(c) Contract agencies providing adult in-home care services shall provide the following core household maintenance tasks based on the individual’s needs including:

(1) Housecleaning;

(2) Laundry;

(3) Maintaining a safe environment in areas of the home used by the individual;

(4) Meal preparation for the individual only and not for other members of the household;

(5) Rearranging light-weight furniture to assure the individual can safely ambulate to reach food, water, medication, and other essential items;

(6) Shopping for groceries and other errands for the individual receiving services only; and

(7) Instructing the individual to perform core household maintenance tasks necessary to maintain the individual’s well-being, safety, and independence.

(d) Contract agencies providing adult in-home care services shall facilitate one or more of the following activities of daily living or instruction in self-care, based on the individual’s needs including:

(1) Bathing;

(2) Dressing;

(3) Eating and drinking;

(4) Grooming;

(5) Taking medication as allowed in He-P 809 and He-P 822; and

(6) Toileting.

(e) Contract agencies providing adult in-home care services shall:

(1) Provide and encourage socialization; and

(2) Evaluate the individual’s progress and when necessary, provide information about, and referral to, other resources.

(f) Contract agencies shall coordinate adult in-home care services to ensure that there is no meal preparation being provided when home delivered meals will be delivered to the individual, and that there is no duplication of additional Title III or other services being provided to the individual.

(g) At least every 3 months the contract agency shall meet with a BAAS adult protective services staff person or communicate by telephone or email in order to assess:

(1) The status of each individual receiving adult in-home care services; and

(2) Whether any changes are needed regarding the type or frequency of service being provided.

(h) If the individual continues to have an open APS protective services case beyond 6 months, the adult protective services social worker shall confer with the appropriate BAAS staff to assess the individual’s appropriateness for the other assistance programs.

History

(See Revision Note at part heading for He-E 502) #10530, eff 2-28-14; ss by #13354, eff 3-19-22

N.H. Code Admin. R. Ann. He-E 502.20 Alcohol and Substance Abuse Prevention Services {#sec-he-e-502.20 omnilex-key=us-nh-regs-official--agency-he-e--He-E 502.20}

(a) A contract agency shall administer alcohol and substance abuse prevention services, as follows:

(1) Within the contract agency, a prevention specialist certified by the Prevention Certification Board of New Hampshire shall oversee the provision of alcohol and substance abuse prevention services; and

(2) The prevention specialist’s certification shall be kept current in accordance with the requirements of the Prevention Certification Board of New Hampshire.

(b) Alcohol and substance abuse prevention services shall include:

(1) Brief intervention and counseling provided by counselors from New Hampshire’s community mental health centers, and as follows:

a. There shall be subcontracts for this purpose between the mental health centers and the contract agency administering alcohol and substance abuse prevention services;

b. Oversight and training of counselors shall be provided by the contract agency administering alcohol and substance abuse prevention services; and

c. A maximum of 5 counseling sessions per individual shall be provided, and for each individual:

Screening shall be completed and documented by the counselor using age-appropriate evidence-based screening tools identified by the contract agency administering alcohol and substance abuse prevention services;
Goals shall be identified and strategies for accomplishing these goals shall be developed, including referrals to other resources as needed; and
A record shall be kept by the counselor of all visits with the individual;

(2) Group educational programs, which shall be held in community-based locations, and address topics such as:

a. Preventing or alleviating the misuse of alcohol, medications, or other drugs;

b. Life changes;

c. Depression or emotional stress;

d. Grief and loss;

e. Opportunities to reduce isolation, improve social interaction, and improve interpersonal relationships; and

f. Other issues that enhance an individual’s ability to live independently, such as home safety and injury prevention; and

(3) Outreach services to encourage individuals to participate in group educational programs.

(1) Provide resource materials that are specific to preventing or alleviating substance misuse among older individuals, and, at the option of the contract agency, resource materials on the other issues identified in (b)(2) above; and

(2) Provide handouts for individuals related to the group educational sessions described in (b)(2) above.

(d) The contract agency administering alcohol and substance abuse prevention services shall keep a log of each group educational activity that includes:

(1) The date of the group educational activity;

(2) The topic of the group educational activity; and

(3) The names of attendees.

(e) The contract agency administering alcohol and substance abuse prevention services shall conduct evaluations on the effectiveness of these services and provide the results of these evaluations annually to BAAS.

(f) The contract agency administering alcohol and substance abuse prevention services shall complete quarterly program reports.

History

(See Revision Note at part heading for He-E 502) #10530, eff 2-28-14; ss by #13354, eff 3-19-22 (formerly He-E 502.21)

N.H. Code Admin. R. Ann. He-E 502.21 Dental Services {#sec-he-e-502.21 omnilex-key=us-nh-regs-official--agency-he-e--He-E 502.21}

(a) Dental services shall include:

(1) Oral exams, including cancer screenings, which are performed to detect and prevent dental diseases and to identify an individual’s dental care needs;

(2) Cleanings;

(3) Restorations;

(4) Prostheses, such as dentures and partial dentures;

(5) Surgical procedures to address infections;

(6) Education regarding dental health; and

(7) When necessary, referrals to other dental or medical services.

(b) Dental services shall be provided by contract agencies or vendors that:

(1) Meet the requirements contained in He-E 502.11 and in any other applicable state laws or rules; and

(2) Employ staff members who are licensed by the NH board of dental examiners in accordance with RSA 317-A.

(c) Contract agencies providing dental services may utilize students enrolled in accredited dental hygiene and dental care programs to assist in the provision of dental care services provided that these students are supervised by contract agency staff that is licensed in accordance with applicable state laws or rules.

(d) For each individual receiving dental services:

(1) An assessment shall be completed and documented;

(2) Goals shall be identified and an individual treatment plan developed; and

(3) Progress notes shall be made by the staff member after each dental visit.

(e) Dental work done only for aesthetic purposes shall not be covered.

History

(See Revision Note at part heading for He-E 502) #10530, eff 2-28-14; ss by #13354, eff 3-19-22 (formerly He-E 502.22)

N.H. Code Admin. R. Ann. He-E 502.22 Elder Abuse Counseling {#sec-he-e-502.22 omnilex-key=us-nh-regs-official--agency-he-e--He-E 502.22}

(a) Elder abuse counseling services shall meet the needs of individuals who require assistance in resolving problems or relieving temporary stresses. Problems addressed may include elder abuse, neglect, self-neglect, exploitation, or physical harm inflicted.

(b) Contract agencies conducting elder abuse counseling shall provide the following services:

(1) Assisting and supporting individuals in resolving problems and relieving stress;

(2) Providing one-on-one or group educational sessions; and

(3) Group educational service programs for individuals on topics concerning the prevention of elder abuse, neglect or self-neglect, and exploitation.

(c) Elder abuse counselors shall be licensed as social workers or mental health practitioners by the State of New Hampshire in accordance with RSA 330-A, and have a working knowledge of effective geriatric assessment tools, mental health issues affecting older individuals, and elder abuse treatment resources.

(d) For each individual receiving elder abuse counseling:

(1) An assessment shall be completed and documented;

(2) Goals shall be identified and an individual treatment plan developed; and

(3) Progress notes shall be made by the counselor following each counseling session.

(e) Contract agencies providing elder abuse counseling services shall keep a service provision log of all group educational activities that includes:

(1) The date of the group educational activity provided;

(2) The type of the group educational activity provided;

(3) The names of the attendees; and

(4) Comment on any follow-up action as needed.

History

(See Revision Note at part heading for He-E 502) #10530, eff 2-28-14; ss by #13354, eff 3-19-22 (formerly He-E 502.23)

N.H. Code Admin. R. Ann. He-E 502.23 Home Health Aide Services {#sec-he-e-502.23 omnilex-key=us-nh-regs-official--agency-he-e--He-E 502.23}

(a) Home health aide services shall be provided by a home health care provider licensed in accordance with RSA 151:2 and He-P 809.

(b) Home health aide services shall be covered when provided by a licensed nursing assistant (LNA) working within the LNA scope of practice, pursuant to Nur 700.

(1) Services allowed within the LNA scope of practice, pursuant to Nur 700; and

(2) Personal care services, as described in He-E 801.22(b), when the individual’s person-centered plan contains documentation that his or her functional or medical condition necessitates the performance of such tasks by an LNA and not an unlicensed provider.

(d) Contract agencies shall coordinate home health aide services to ensure that there is no duplicate provision of services when the individual is also receiving home delivered meals, other Title III services, or services at an adult medical day program, in an assisted living facility, or in an adult family care home.

History

(See Revision Note at part heading for He-E 502) #10530, eff 2-28-14; ss by #13354, eff 3-19-22 (formerly He-E 502.24)

N.H. Code Admin. R. Ann. He-E 502.24 Homemaker Services {#sec-he-e-502.24 omnilex-key=us-nh-regs-official--agency-he-e--He-E 502.24}

(a) Homemaker services shall be provided by employees of:

(1) Home health care providers licensed in accordance with RSA 151:2 and He-P 809;

(2) Home care service providers licensed in accordance with RSA 151:2 and He-P 822; or

(3) Other qualified agencies certified in accordance with RSA 161-I and He-P 601.

(b) Contract agencies providing homemaker services shall provide the following core household maintenance tasks based on the individual’s needs, including:

(1) Housecleaning;

(2) Laundry;

(3) Maintaining a safe environment in areas of the home used by the individual;

(4) Preparation of non-communal meals;

(5) Rearranging light-weight furniture to assure the individual can safely ambulate to reach food, water, medication, and other essential items;

(6) Shopping for groceries and other errands; and

(7) Instructing the individual to perform core household maintenance tasks necessary to maintain the individual’s well-being, safety, and independence.

(c) Contract agencies providing homemaker services shall facilitate one or more of the following activities of daily living or instruction in self-care, based on the individual’s needs including:

(1) Bathing;

(2) Dressing;

(3) Eating and drinking;

(4) Grooming;

(5) Taking medication as allowed in He-P 809 and He-P 822; and

(6) Toileting.

(d) Contract agencies providing homemaker services shall:

(1) Provide and encourage socialization; and

(2) Evaluate the individual’s progress and when necessary, provide information about, and referral to, other resources.

(e) Contract agencies shall coordinate homemaker services to ensure that there is no meal preparation being provided when home delivered meals will be delivered to the individual, and that there is no duplication of additional Title III or other services being provided to the individual.

History

(See Revision Note at part heading for He-E 502) #10530, eff 2-28-14; ss by #13354, eff 3-19-22 (formerly He-E 502.25)

N.H. Code Admin. R. Ann. He-E 502.25 Legal Services {#sec-he-e-502.25 omnilex-key=us-nh-regs-official--agency-he-e--He-E 502.25}

(a) Legal services shall be provided to individuals who are in need of assistance from a paralegal or attorney as described in Title III, and include:

(1) The provision of statewide telephone access through a toll-free number;

(2) Performing community outreach and education, including the provision of written materials to increase awareness of legal rights and legal services; and

(3) The provision of legal advice, counseling, and litigation services by attorneys, or legal assistants working under the supervision of an attorney, in accordance with the administrative rules of the Supreme Court of the State of NH to address civil matters including, but not limited to:

a. Consumer issues relating to debt collection, financial exploitation, and health care services;

b. Family matters;

c. Matters involving public assistance benefits;

d. Matters involving utility shut-off;

e. Nursing facility and assisted living facility issues;

f. Public and private housing matters;

g. The provision of legal representation at hearings or in court; or

h. The provision of referral services to other sources of local assistance.

(b) For each individual receiving counseling and litigation legal services, a case record shall be developed and maintained and case notes be kept as required by He-E 502.15 following each counseling or litigation session.

(c) Contract agencies providing legal services shall keep a service provision log of all telephone, walk-in, and group educational activities which includes:

(1) The date of the telephone call, walk-in, or group educational activity;

(2) The type of interaction provided;

(3) The name of the individual(s) counseled; and

(4) Comment on any follow-up service provided.

History

(See Revision Note at part heading for He-E 502) #10530, eff 2-28-14; ss by #13354, eff 3-19-22 (formerly He-E 502.26)

N.H. Code Admin. R. Ann. He-E 502.26 Low Vision Services {#sec-he-e-502.26 omnilex-key=us-nh-regs-official--agency-he-e--He-E 502.26}

(a) Low vision services shall be provided to individuals who are blind or visually impaired in order to help them perform activities of daily living and attain an optimal level of independence and quality of life.

(b) Contract agencies providing low vision services shall include the following activities, based on the individual’s needs:

(1) Vision rehabilitation, including the evaluation, diagnosis, and management of visual impairment;

(2) Mobility, optical aid, and orientation training;

(3) Counseling on adjustment to vision loss, including referrals to support groups and other appropriate community services; and

(4) The prescription of optical, non-optical, electronic devices, or other treatments.

(d) For each individual receiving low vision services:

(1) An assessment shall be completed and documented;

(2) Goals shall be identified and an individual treatment plan developed; and

(3) Progress notes shall be made by the licensed practitioner following each visit session.

History

(See Revision Note at part heading for He-E 502) #10530, eff 2-28-14; ss by #13354, eff 3-19-22 (formerly He-E 502.27)

N.H. Code Admin. R. Ann. He-E 502.27 Nursing Services {#sec-he-e-502.27 omnilex-key=us-nh-regs-official--agency-he-e--He-E 502.27}

(a) Nursing services shall be provided in an individual’s home by a home health care provider licensed in accordance with RSA 151:2 and He-P 809.

(b) Nursing services shall be covered when provided by a licensed practical nurse (LPN) or registered nurse working within the scope of services allowed under the Nurse Practice Act, RSA 326-B.

(1) Receiving referrals;

(2) Evaluation of the individual’s needs;

(3) Developing a nursing care plan and incorporating this information into the individual’s person-centered plan; and

(4) Providing nursing services in accordance with the individual’s person-centered plan as described in He-E 502.17 and ordered by his or her physician.

(d) Contract agencies shall coordinate nursing services to ensure that there is no duplicate provision of services.

(e) LPN and registered nursing services shall not be covered when provided for the purpose of nursing oversight of authorized LNA services.

History

(See Revision Note at part heading for He-E 502) #10530, eff 2-28-14; ss by #13354, eff 3-19-22 (formerly He-E 502.28)

N.H. Code Admin. R. Ann. He-E 502.28 Nutrition Services: Congregate Meals {#sec-he-e-502.28 omnilex-key=us-nh-regs-official--agency-he-e--He-E 502.28}

(a) Contract agencies providing congregate meals shall:

(1) Provide meals in a congregate setting that affords opportunity for social contact; and

(2) Comply with state and local regulations on the safe and sanitary handling of food, equipment and supplies used in the storage, preparation, service, and delivery of meals as described in He-P 2300.

(b) Congregate meals shall include at least one hot or other appropriate meal per day for 5 or more days per week except in rural areas where such frequency is not feasible and a lesser frequency is approved by BAAS.

(c) Contract agencies approved to provide services at a lesser frequency pursuant to (b) above shall keep the approval on file. Approval of a contract with a lesser frequency shall constitute approval pursuant to (b) above.

(d) Each meal shall:

(1) Include a minimum of 33 1/3 percent of the dietary reference intakes established by the Food and Nutrition Board of the Institute of Medicine, National Academies of Sciences, Engineering, and Medicine and comply with the U.S. Department of Agriculture and the U.S. Department of Health and Human Services “Dietary Guidelines for Americans, 2020-2025” (Ninth Edition), available as noted in Appendix A; and

(2) Accommodate, to the extent possible, the special dietary needs or preference of the individual, including recommendations from the individual’s licensed practitioner, or preferences stemming from the individual’s cultural or religious background.

(e) In addition to offering congregate meals to individuals who meet the eligibility requirements contained in this rule, contract agencies providing this service may also offer a meal, on the same basis as meals provided to eligible older individuals, to:

(1) The spouses of individuals who accompany them to the meal site;

(2) Persons providing volunteer services as part of the meal service, including caregivers during meal hours;

(3) Persons with disabilities under the age of 60 who reside at home with an individual who is receiving Title III services; and

(4) Persons with disabilities under the age of 60 who reside in housing facilities occupied by older individuals where congregate meals are provided.

(f) Contract agencies providing nutrition services: congregate meals shall keep a service provision log of all meals that includes:

(1) The date of the meal;

(2) The name of the person the meal was provided to; and

(3) Comment on any follow-up service provided.

History

(See Revision Note at part heading for He-E 502) #10530, eff 2-28-14; ss by #13354, eff 3-19-22 (formerly He-E 502.29)

N.H. Code Admin. R. Ann. He-E 502.29 Nutrition Services: Home-Delivered Meals {#sec-he-e-502.29 omnilex-key=us-nh-regs-official--agency-he-e--He-E 502.29}

(a) Home-delivered meals shall be provided to individuals who:

(1) Meet the eligibility requirements contained in He-E 502.05; and

(2) Meet one or more of the following requirements:

a. Have limited capacity to prepare meals without assistance;

b. Have limited ability to leave their residence; or

c. Are unable to consume meals at a congregate dining location due to physical, emotional, or mental difficulties or limited desire for social interactions.

(b) Contract agencies providing home-delivered meals shall:

(1) Comply with state and local regulations on the safe and sanitary handling of food, equipment and supplies used in the storage, preparation, service, and delivery of meals as described in He-P 2300; and

(2) Accommodate, to the extent possible, the special dietary needs and preference of the individual, including recommendations from the individual’s licensed practitioner, and preferences stemming from the individual’s cultural or religious background.

(c) Each meal shall include at least a minimum of 33 1/3 percent of the dietary reference intakes established by the Food and Nutrition Board of the Institute of Medicine, National Academy of Sciences, Engineering and Medicine and comply with the U.S. Department of Agriculture and the U.S. Department of Health and Human Services “Dietary Guidelines for Americans, 2020-2025” (Ninth Edition), available as noted in Appendix B.

(d) In addition to offering home-delivered meals to individuals who meet the eligibility requirements contained in this rule, contract agencies providing this service may also offer meals to:

(1) The spouses of individuals;

(2) Persons providing volunteer service through a volunteer service program such as the Retired and Senior Volunteer Program (RSVP) or Senior Companion Program who are working at the recipient’s home during meal hours or volunteering during the service delivery process;

(3) Persons with disabilities who are under the age of 60 who reside at home with an individual who is receiving Title III services; and

(4) Persons with disabilities under the age of 60 who reside in housing facilities occupied primarily by older individuals at which congregate meals are provided.

(e) The contract agency providing home-delivered meals shall at least 3 times per year distribute to all individuals receiving home-delivered meals, educational materials on nutrition and wellness, including, but not limited to, the following:

(1) Printed materials available at no cost from federal, state, or local government sources or from other agencies; or

(2) Information provided by the contract agency through another venue, such as a newsletter.

(f) The contract agency shall provide individuals referrals to other services or programs as necessary.

(g) Contract agencies shall coordinate the provision of home delivered meals to ensure that there is no duplication of services when additional Title III or other services are being provided to the individual, and that the individual is present to receive the meal. Meals that are delivered to an individual’s home when the individual is not at home shall not be reimbursed.

(h) Contract agencies providing home-delivered meals shall keep a service provision log of all meals delivered that includes:

(1) The date of the meal;

(2) The name of the person the meal was delivered to; and

(3) Comment on any follow-up service provided or referrals to other services.

History

(See Revision Note at part heading for He-E 502) #10530, eff 2-28-14; ss by #13354, eff 3-19-22 (formerly He-E 502.30)

N.H. Code Admin. R. Ann. He-E 502.30 Prevention Services {#sec-he-e-502.30 omnilex-key=us-nh-regs-official--agency-he-e--He-E 502.30}

(a) Prevention services shall be covered for individuals who meet the eligibility requirements for Title III services as described in He-E 502.05.

(b) Prevention services shall include, but not be limited to:

(1) Evidence-based health screenings that can detect the presence of, or an individual’s risk for, heart disease, diabetes, cancer, asthma, strokes, vision loss, hearing loss, or other chronic diseases or conditions;

(2) Evidence-based group educational programs or individual counseling on topics such as nutrition, exercise, mobility, medication management, pain management, home safety, the emotional aspects of chronic disease or conditions, or other related topics;

(3) Individual assessments and the development of individual action plans to help prevent injuries or prevent or manage chronic diseases or conditions; and

(4) Referrals to other service providers as necessary, including health care providers who can follow up on further prevention or treatment of chronic diseases or conditions.

(1) An assessment shall be completed and documented;

(2) Goals shall be identified and an individual treatment plan developed; and

(3) Progress notes shall be made by the counselor following each contact or session.

(d) Contract agencies providing prevention services shall keep a service provision log for health screenings, referrals, group educational services, or walk-in service activities that includes:

(1) The date of the activity;

(2) The type of activity or service provided;

(3) The name(s) of the attendee(s) or service recipient(s); and

(4) Comment on any follow-up service provided.

History

(See Revision Note at part heading for He-E 502) #10530, eff 2-28-14 (formerly He-E 502.31)

N.H. Code Admin. R. Ann. He-E 502.31 Transportation {#sec-he-e-502.31 omnilex-key=us-nh-regs-official--agency-he-e--He-E 502.31}

(a) Transportation services shall be covered for the purpose of accessing the following types of services:

(1) Title III services, except home delivered meals;

(2) Medical appointments;

(3) Shopping for groceries and other basic needs; and

(4) Services provided by community facilities and agencies that increase participation in programs, or otherwise promote independent living.

(b) Contract agencies providing transportation services shall comply with provisions included in the contract with regard to routes and reimbursements.

(1) Registered pursuant to Saf-C 500;

(2) Inspected pursuant to Saf-C 3200, and are in good working order; and

(3) Insured for personal liability.

(d) Transportation services shall be provided by individuals who:

(1) Have a current and valid driver’s license; and

(2) Are employees of a Title III service provider or other transportation provider, or volunteers under the supervision of a Title III service provider.

(e) Contract agencies shall document transportation services provided to the individual on an operational schedule or on a service provision log that includes:

(1) The date(s) of service;

(2) The starting and ending locations;

(3) The name(s) of the individual(s);

(4) The reason the transportation services are required;

(5) The name(s) of the driver; and

(6) Comment on any follow-up service provided.

(f) Transportation services for individuals shall not be reimbursed when duplicative of any other program or services, or when included as a core service under the rate paid to the service provider.

History

(See Revision Note at part heading for He-E 502) #10530, eff 2-28-14 (formerly He-E 502.32)

Part He-E 503 Alzheimer's Respite Care Service

N.H. Code Admin. R. Ann. He-E 503.01 Purpose {#sec-he-e-503.01 omnilex-key=us-nh-regs-official--agency-he-e--He-E 503.01}

The purpose of the respite care described in this rule is to provide temporary rest and relief to the primary caregiver from the demands of care provided to a person with Alzheimer’s disease or a related disorder at home.

History

#5584, eff 2-16-93; ss by #5732, eff 10-27-93, EXPIRED: 10-27-99
#7799, eff 12-4-02, EXPIRED: 12-4-10
#9834, INTERIM, eff 12-18-10, EXPIRES: 6-16-11; ss by #9931, eff 5-26-11; ss by #12781, INTERIM, eff 5-21-19, EXPIRED: 11-18-19
#13437, eff 8-19-22

N.H. Code Admin. R. Ann. He-E 503.02 Definitions. {#sec-he-e-503.02 omnilex-key=us-nh-regs-official--agency-he-e--He-E 503.02}

(a) “Adult” means an individual age 18 and older.

(b) “Alzheimer’s disease and related disorders (ADRD),” means “ADRD” as defined in RSA 161-F:66, I.”

(d) “Bureau” means the New Hampshire department of health and human services bureau of elderly and adult services.

(e) “Contract agency” means the agency contracted with the bureau to coordinate ADRD respite care services in accordance with He-E 503.

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

(g) “Eligible person”, pursuant to RSA 161-F:66, II, means an adult who is unable to attend to personal daily needs without the assistance or continuous supervision of a primary caregiver due to ADRD.

(h) “Financial management services agency” means a contract agency that performs human resources and financial functions in accordance with He-E 503.08.

(i) “Home health agency” means agencies licensed to provide home health care pursuant to He-P 809 or He-P 822 or certified as another qualified agency pursuant to He-P 601.

(j) “Nursing facility” means an institution or distinct part of an institution that meets the requirements of Section 1919 of the Social Security Act 42 USC 1396r.

(k) “Person-centered respite care plan” means a plan in which the primary caregiver is the center of the system of care and the primary caregiver’s needs and preferences drive the development and implementation of the respite care services provided.

(l) “Primary caregiver” pursuant to RSA 161-F:66, III, means the family member or other natural person who normally provides the home care and supervision of a victim of ADRD.

(m) “Residential care facility” means a facility providing assistance with personal and social activities at one of the levels of care described in RSA 151:9, VII and VIII, He-P 804, and He-P 805.

(n) “Respite care budget” means the amount of funding that is allocated to a primary caregiver from state general funds allocated to ADRD as part of the state budget.

(o) “Respite care provider” means the entity or the individual chosen by the primary caregiver to provide ADRD respite care services.

(p) “Respite care services” pursuant to RSA 161-F:66, IV means care provided on an intermittent basis to the eligible person to relieve the primary caregiver from the demands of home care for a limited period of time.

(q) “Spending plan” means a plan developed by the contract agency and primary caregiver to ensure the primary caregiver’s needs are met and the entire respite care budget is spent each fiscal year.

(r) “Waitlist” means a list of individuals with ADRD maintained by the contract agency who have been determined eligible, and in need of ADRD respite care services from a contract agency, but the agency does not have sufficient service units or resources to serve these individuals.

History

#5584, eff 2-16-93; ss by #5732, eff 10-27-93, EXPIRED: 10-27-99
#7799, eff 12-4-02, EXPIRED: 12-4-10
#9834, INTERIM, eff 12-18-10, EXPIRES: 6-16-11; ss by #9931, eff 5-26-11; ss by #12781, INTERIM, eff 5-21-19, EXPIRED: 11-18-19
#13437, eff 8-19-22

N.H. Code Admin. R. Ann. He-E 503.03 Eligibility {#sec-he-e-503.03 omnilex-key=us-nh-regs-official--agency-he-e--He-E 503.03}

(a) To be eligible to receive ADRD respite care services, the individual requesting respite services shall be:

(1) The primary caregiver as defined in He-E 503.02(l); and

(2) Providing unpaid care 24 hours per day, 7 days per week to an individual with ADRD.

(b) The individual receiving ADRD respite care services shall be an adult who:

(1) Is unable to attend to his or her daily needs without the assistance or continuous supervision of a primary caregiver due to the impacts of ADRD.

(2) Is not receiving respite services paid through any of the following sources:

a. A medicaid waiver program;

b. The department of veterans affairs; or

c. Any other program.

History

#7799, eff 12-4-02, EXPIRED: 12-4-10
#9834, INTERIM, eff 12-18-10, EXPIRES: 6-16-11; ss by #9931, eff 5-26-11; ss by #12781, INTERIM, eff 5-21-19, EXPIRED: 11-18-19
#13437, eff 8-19-22

N.H. Code Admin. R. Ann. He-E 503.04 Person Centered Respite Care Plan {#sec-he-e-503.04 omnilex-key=us-nh-regs-official--agency-he-e--He-E 503.04}

(a) If the eligibility requirements in He-E 503.03 are met, the primary caregiver and contract agency shall collaborate to complete and develop the following:

(1) An assessment in accordance with (b) below;

(2) A person-centered respite care plan; and

(3) A respite care budget in accordance with (e) and (f) below.

(b) The assessment shall include the following information:

(1) The primary caregiver’s name, address, and telephone number;

(2) The name of the eligible person;

(3) The relationship of the primary caregiver to the eligible person;

(4) Confirmation that the eligible person:

a. Has received a differential diagnosis of Alzheimer’s disease or a similar irreversible dementia; or

b. Demonstrates symptoms of Alzheimer’s disease or a similar irreversible dementia; and

(5) The primary caregiver’s statement of the eligible person’s need for respite services.

(c) If the assessment indicates that the eligibility requirements for ADRD respite service, as described in He-E 503.03, are not met, the contract agency shall assist the primary caregiver to identify and explore other helpful resources, such as the social service block grant or choices for independence programs.

(d) The person-centered respite care plan shall be based on the completed assessment described in (b) above.

(e) The primary caregiver and the contract agency shall work to develop the respite care budget based on the needs identified in (b)(5) above.

(f) To ensure as many primary caregivers as possible receive respite, the respite care budget shall not exceed $2000 per primary caregiver annually.

(g) The contract agency shall review the person-centered respite care plan and respite care budget with the primary caregiver annually to determine the ongoing respite care service needs.

History

#7799, eff 12-4-02, EXPIRED: 12-4-10
#9834, INTERIM, eff 12-18-10, EXPIRES: 6-16-11; ss by #9931, eff 5-26-11; ss by #12781, INTERIM, eff 5-21-19, EXPIRED: 11-18-19
#13437, eff 8-19-22

N.H. Code Admin. R. Ann. He-E 503.05 ADRD Respite Settings {#sec-he-e-503.05 omnilex-key=us-nh-regs-official--agency-he-e--He-E 503.05}

(a) ADRD respite care services shall be provided in the following settings:

(1) A home setting;

(2) A community setting, such as a licensed adult day program; or

(3) A licensed nursing or residential care facility.

(b) ADRD respite care services shall be provided by:

(1) Nursing facilities;

(2) Residential care facilities;

(3) Home health agencies;

(4) Adult day programs; or

(5) Individuals employed by a contracted financial management services agency as described in He- E 503.08(a).

History

#7799, eff 12-4-02, EXPIRED: 12-4-10
#9834, INTERIM, eff 12-18-10, EXPIRES: 6-16-11; ss by #9931, eff 5-26-11; ss by #12781, INTERIM, eff 5-21-19, EXPIRED: 11-18-19
#13437, eff 8-19-22

N.H. Code Admin. R. Ann. He-E 503.06 Contract Agency Requirements {#sec-he-e-503.06 omnilex-key=us-nh-regs-official--agency-he-e--He-E 503.06}

(a) The contract agency shall:

(1) Receive inquiries and determine eligibility for ADRD respite services pursuant to He-E 503.03;

(2) Develop, in collaboration with the primary caregiver:

a. A person centered respite care plan and respite care budget as described in He-E 503.04; and

b. A spending plan in accordance with He-E 503.07 below;

(3) Identify the primary caregiver’s choice for a respite setting as described in He-E 503.05; and

(4) Review and modify the ADRD respite plan and respite care budget with the primary caregiver on an annual basis or more frequently if necessary to meet the primary caregiver’s needs.

History

#7799, eff 12-4-02, EXPIRED: 12-4-10
#9834, INTERIM, eff 12-18-10, EXPIRES: 6-16-11; ss by #9931, eff 5-26-11; ss by #12781, INTERIM, eff 5-21-19, EXPIRED: 11-18-19
#13437, eff 8-19-22

N.H. Code Admin. R. Ann. He-E 503.07 ADRD Spending Plan {#sec-he-e-503.07 omnilex-key=us-nh-regs-official--agency-he-e--He-E 503.07}

(a) ADRD respite services shall be limited to the extent that funds, staff, or other necessary resources are available.

(b) The contract agency shall forward the respite care budget and spending plan to the financial management services agency.

(c) The financial management services agency shall pay invoices in accordance with the respite caregiver and spending plan.

History

#13437, eff 8-19-22

N.H. Code Admin. R. Ann. He-E 503.08 Financial Management Services {#sec-he-e-503.08 omnilex-key=us-nh-regs-official--agency-he-e--He-E 503.08}

(a) The financial management services agency shall perform the following human resources functions for individuals working as respite providers:

(1) Be the employer of record;

(2) Complete tax, labor, and social security documents;

(3) Verify the individual’s citizenship or that the individual is legally authorized to work in the United States;

(4) Request a New Hampshire criminal records background check;

(5) Request a BAAS state registry check in accordance with RSA 161-F:49; and

(6) Manage timesheets.

(b) The financial management services agency shall perform the following financial management functions for individual respite care providers, primary caregivers, and the eligible person:

(1) Manage and pay invoices for each primary caregiver’s respite care budget and spending plan;

(2) Monitor respite care budgets allocated to primary caregivers; and

(3) Provide each contract agency with a monthly statement showing expenditures of ADRD funds by primary caregivers and any remaining balances.

History

#13437, eff 8-19-22

N.H. Code Admin. R. Ann. He-E 503.09 Waitlist {#sec-he-e-503.09 omnilex-key=us-nh-regs-official--agency-he-e--He-E 503.09}

(a) The contract agency shall develop a waitlist of eligible primary caregivers when funding, staff, or other necessary resources are not available to support the provision of respite services.

(b) The contract agency shall prioritize participants on the waitlist using the following criteria:

(1) The declining mental or physical health of the primary caregiver;

(2) The economic need of the primary caregiver or the individual with ADRD; and

(3) An increase in the primary caregiver’s responsibilities.

History

#7799, eff 12-4-02, EXPIRED: 12-4-10
#9834, INTERIM, eff 12-18-10, EXPIRES: 6-16-11; ss by #9931, eff 5-26-11; ss by #12781, INTERIM, eff 5-21-19, EXPIRED: 11-18-19
#13437, eff 8-19-22 (formerly He-E 503.08)

N.H. Code Admin. R. Ann. He-E 503.10 Waivers {#sec-he-e-503.10 omnilex-key=us-nh-regs-official--agency-he-e--He-E 503.10}

(a) Contract agencies who wish to request a waiver of a requirement contained in He-E 503 shall submit a letter to the bureau on the contract agency’s letterhead through one or more of the following means:

(1) E-mail to baas@dhhs.nh.gov;

(2) Fax to (603) 271-4643; or

(3) Mail by postal mail to:

The NH Department of Health and Human Services

Bureau of Adult and Aging Services

105 Pleasant St., Main Building

Concord, NH 03301

(b) The waiver request shall be signed by the contract agency’s executive director or designee and shall include:

(1) The specific requirement in He-E 503 that the contract agency requests be waived;

(2) The reason why the waiver is being requested; and

(3) The alternative proposed by the contract agency to satisfy the requirements of He-E 503.

(c) The department shall review the request, and within 60 calendar days of the date the request was received, inform the contract agency in writing of the decision.

(d) The waiver request shall be approved if the alternative proposed by the contract agency meets the intent of He-E 503 and does not:

(1) Negatively impact the health or safety of the eligible person or the primary caregiver;

(2) Affect the quality of services provided; or

(3) Waive any provision or procedure in statute.

(e) Waivers that are approved shall become effective as of the date of the written approval in accordance with He-E 503.10(c) above.

(f) Waivers that relate to the health, safety, or welfare of eligible persons or primary caregivers shall be effective for the remaining period of the primary caregiver’s eligibility period and subject to the primary caregiver’s continued eligibility.

(g) Contract agencies who wish to request a renewal of a waiver shall request a renewal at least 90 calendar days prior to the expiration of a current waiver by following the steps contained in He-E 503.10 (a) through (e) above.

(h) Any waiver shall end with the closure of the program or applicable service.

History

#13437, eff 8-19-22

Part He-E 605 Standard Disclosure Summary

N.H. Code Admin. R. Ann. He-E 605.01 Purpose {#sec-he-e-605.01 omnilex-key=us-nh-regs-official--agency-he-e--He-E 605.01}

In accordance with RSA 161-J, the purpose of these rules is to describe the “Standard Disclosure Summary” form that enables a prospective resident of an assisted living residence, independent living retirement community, or other housing for older persons to make informed choices and comparisons of the respective or prospective residential options.

History

#13443, eff 9-9-22

N.H. Code Admin. R. Ann. He-E 605.02 Scope {#sec-he-e-605.02 omnilex-key=us-nh-regs-official--agency-he-e--He-E 605.02}

He-E 605 shall apply to assisted living residences, independent living retirement communities, and housing for older persons in accordance with RSA 161-J.

History

#13443, eff 9-9-22

N.H. Code Admin. R. Ann. He-E 605.03 Definitions {#sec-he-e-605.03 omnilex-key=us-nh-regs-official--agency-he-e--He-E 605.03}

(a) “Assisted living residence” means “assisted living residence” as defined in RSA 161-J:2, II.

(b) “Base rate” means the amount charged by a residence to a resident for housing and services included in the residential services agreement as required in RSA 161-J:4, II.

(d) “Independent living retirement community” means “independent living retirement community” as defined in RSA 161-J:2, III-a. This term does not include continuing care communities or condominiums in accordance with RSA 161-J: 3.

(e) “Personal assistance” means “personal assistance” as defined in RSA 161-J:2, IV.

(f) “Representative” means “representative” as defined in RSA 161-J:2, V.

(g) “Residence” means “residence” as defined in RSA 161-J:2, VI.

(h) “Resident” means “resident” as defined in RSA 161-J:2, VII.

(i) “Standard disclosure summary” means information that a residence or independent retirement community provides to a prospective resident regarding the costs and the services options provided by the residence in accordance with RSA 161-J:4, II(j) and RSA 161-J:5.

History

#13443, eff 9-9-22

N.H. Code Admin. R. Ann. He-E 605.04 Completion of the Standard Disclosure Summary {#sec-he-e-605.04 omnilex-key=us-nh-regs-official--agency-he-e--He-E 605.04}

(a) Each resident, prospective resident, or the resident’s representative shall be given a standard disclosure summary by the residence in accordance with RSA 161-J:5 at least 24 hours prior to beginning residency in an assisted living residence, independent living retirement community, or other housing for older persons.

(b) Residences and independent living retirement communities shall utilize form BAAS 3540 entitled “Standard Disclosure Summary,” (12/2024) provided by the department in accordance with RSA 161-J:4, II(j), and:

(1) The standard disclosure summary form shall be the cover sheet for the residential services agreement described in RSA 161-J:4, II(j); and

(2) No alteration or amendment shall be made to the content of the standard disclosure summary form with the exception of the parts of the form that allow insertion of specific information, including the insertion of the name of the residence.

APPENDIX

Rule

Specific State or Federal Statutes or Regulations the Rule Implements

He-E 605.01

RSA 161-J:1

He-E 605.02

RSA 161-J:3; RSA 161-J:4

He-E 605.03 (a)-(h)

RSA 161-J:2

He-E 605.03(i)

RSA 161-J:5

He-E 605.04

RSA 161-J:4, RSA 161-J:5

History

#13443, eff 9-9-22; ss by #14165, EXRF, eff 1-8-25

Chapter He-E 700 Adult Protection Services Program

Part He-E 701 Overview

N.H. Code Admin. R. Ann. He-E 701.01 Purpose {#sec-he-e-701.01 omnilex-key=us-nh-regs-official--agency-he-e--He-E 701.01}

The purpose of the adult protective services program is to:

(a) Receive and investigate reports of abuse, neglect, self-neglect, or exploitation of vulnerable adults;

(b) Provide protective services, if necessary; and

(c) Maintain the department of health and human services, bureau of adult and aging services (BAAS) state registry in accordance with RSA 161-F:49.

History

#5008, eff 11-27-90, EXPIRED: 11-27-96
#6867, eff 10-9-98; ss by #8727, INTERIM, eff 10-9-06, EXPIRED: 4-7-07
#8868, eff 4-19-07; (See Revision Note at Chapter Heading for He-E 700) #10179, eff 9-1-12; ss by #13600, eff 3-24-23

N.H. Code Admin. R. Ann. He-E 701.02 Definitions {#sec-he-e-701.02 omnilex-key=us-nh-regs-official--agency-he-e--He-E 701.02}

(a) “Abuse” as defined in RSA 161-F:43, II, means any one of the following:

(1) ““Emotional abuse” means the misuse of power, authority, or both, verbal harassment, or unreasonable confinement which results or could result in the mental anguish or emotional distress of a vulnerable adult;

(2) “Physical abuse” means the use of physical force which results or could result in physical injury to a vulnerable adult; or

(3) “Sexual abuse” means contact or interaction of a sexual nature involving a vulnerable adult without his or her informed consent”.

(b) “Administrative appeals unit (AAU)” means the unit of the department that receives appeal requests, schedules proceedings, conducts pre-hearing conferences and hearings, and issues decisions for the department.

(c) “Adult protective services program (APS)” means the program which encompasses all the tasks and responsibilities completed in accordance with the adult protection law, RSA 161-F:42-57.

(d) “Adult protective service worker (APSW)” means the individual employed by BAAS and certified by the New Hampshire department of administrative services, division of personnel, to carry out all tasks and responsibilities defined in statute, administrative rule, and program policy as they relate to the adult protective services program.

(e) “Allegation” means an assertion that a vulnerable adult has been abused, neglected, exploited, or has self-neglected.

(f) “Alleged perpetrator” means an individual who is reported to have abused, neglected, or exploited a vulnerable adult for an incident that has not received a founded or unfounded determination.

(g) “Alleged victim” means an adult who is or was vulnerable at the time of the alleged incident who allegedly suffered abuse, neglect, self-neglect, or exploitation.

(h) “Bureau administrator,” for purposes of this rule, means the administrator of BAAS, or the administrator’s designee, appointed by the commissioner of the department of health and human services to carry out the responsibilities described in RSA 161-F:42-57.

(i) “Bureau of adult and aging services (BAAS)” means the New Hampshire department of health and human services bureau of adult and aging services.

(j) “BAAS state registry (state registry)” means a database containing information on founded reports of abuse, neglect, or exploitation of vulnerable adults by a paid or volunteer caregiver, guardian, or agent acting under the authority of any power of attorney (POA) or any durable power of attorney (DPOA) pursuant to RSA 161-F:49.

(k) “Case management” means the tasks associated with the ongoing assessment, person-centered planning, coordination, and monitoring of services provided to an adult protection program client by an APSW.

(l) “Collateral contacts” means individuals who have either witnessed or have information about an alleged situation that could aid the investigator in determining the facts necessary to complete a protective investigation in accordance with RSA 161-F:42-57 and He-E 700.

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

(n) “Date of approval” means the date that the completed protective investigation or disposition is approved by the supervisor.

(o) “Determination” means the finding, following a protective investigation completed pursuant to RSA 161-F:42-57, that the alleged abuse, neglect, self-neglect, or exploitation of a vulnerable adult is either founded or unfounded.

(p) “Disposition” means an administrative classification to indicate that an investigation described in RSA 161-F:42-57 could not be initiated or could not be completed.

(q) “Exploitation” means “exploitation” as defined in RSA 161-F:43, IV, namely “the illegal use of a vulnerable adult’s person or property for another person’s profit or advantage, or the breach of a fiduciary relationship through the use of a person or a person’s property for any purpose not in the proper and lawful execution of a trust, including, but not limited to, situations where a person obtains money, property, or services from a vulnerable adult through the use of undue influence, harassment, duress, deception, or fraud.”

(r) “Facility administrator” means the administrator of a licensed facility described in RSA 151:2 I.

(s) “Founded” means the determination that one or more of the allegations included in a report of alleged abuse, neglect, self-neglect, or exploitation of a vulnerable adult met one or more of the definitions contained in RSA 161-F:43, II (a), (b), (c), III, IV, or VI.

(t) “Guardian” means an individual who has been appointed by the probate court in accordance with RSA 464-A, to have care or custody or manage the estate of another individual adjudicated to be incapacitated.

(u) “Guardianship” means a fiduciary relationship wherein, following a petition, hearing, and other proceedings described in RSA 464-A, an individual is appointed by the probate court to have care and custody of another individual who is adjudged by the court to be incapable of managing personal needs, property, or financial affairs.

(v) “Guardianship hearing” means the hearing on a petition which is held in accordance with RSA 464-A, where the petitioner has the responsibility to establish why the proposed ward, who is the subject of the petition, is in need of a guardian.

(w) “Imminent danger” means that the circumstances of an alleged victim, as described in a protective report, suggest that injury or death could occur immediately.

(x) “Investigator” means a person designated or employed by the department, in accordance with a protocol developed by the department to ensure objectivity, thoroughness, timeliness, and uniformity in methodology and format in the conduct of investigations and investigation reports. An investigator may include an investigator employed by an area agency or community mental health center, if designated by the department.

(y) “Neglect” means “neglect” as defined in RSA 161-F:43, III, 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 a vulnerable adult.”

(z) “Notification” means the processes described in He-E 701.11, by which the parties named in He-E 701.11 are informed as to whether the investigation has resulted in a founded or an unfounded determination, or in a disposition.

(aa) “Perpetrator” means a person who, following a protective investigation completed in accordance with RSA 161-F:42 through RSA 161-F:57 and He-E 700, is found to have abused, neglected, or exploited a vulnerable adult.

(ab) “Protective investigation” means the process by which the investigator inquires into a report of alleged abuse, neglect, self-neglect, or exploitation, pursuant to RSA 161-F:42-57, in order to determine the validity of the allegation(s) and the need for protective services.

(ac) “Protective investigation file” means the individual record that contains all the information related to the protective investigation.

(ad) “Protective investigation summary” means the investigator’s written report that contains information obtained during the protective investigation, except for the identity of the reporter, as well as the determination made at the conclusion of the investigation.

(ae) “Protective report” means a notification to the APS unit that an adult who is, who was, or who is suspected to be vulnerable, has been subjected to abuse, neglect, self-neglect, or exploitation or is living in hazardous conditions.

(af) “Protective services” means “protective services” as defined in RSA 161-F:43, I, namely “services and action which will, through voluntary agreement or through appropriate court action, prevent neglect, abuse, or exploitation of vulnerable adults. Such services shall include, but not be limited to, supervision, guidance, counseling and, when necessary assistance in the securing, of nonhazardous living accommodations, and mental and physical examinations.”

(ag) “Reconsideration” means the process described in He-E 701.13 that is conducted following a founded determination if the reconsideration is requested by a perpetrator who is not registry eligible, or by a founded victim of self-neglect.

(ah) “Registry eligible” means a paid or volunteer caregiver, guardian, or agent acting under the authority of any POA or any DPOA who is a perpetrator and therefore is eligible to be listed on the BAAS state registry in accordance with these rules and pursuant to RSA 161-F:49.

(ai) “Registry eligible alleged perpetrator review” means the process described in He-E 701.09 that is conducted following a recommended founded determination and prior to the date of approval if the review is requested by an alleged perpetrator of abuse, neglect, or exploitation who is registry eligible.

(aj) “Reporter” means the individual who reports in accordance with RSA 161-F:46 that an adult, who is suspected to be vulnerable, at the time of the incident, has been subjected to abuse, neglect, self-neglect, or exploitation.

(ak) “Self-neglect” means self-neglect as defined in RSA 161-F:43, VI, namely “an act or omission by a vulnerable adult which results or could result in the deprivation of essential services or supports necessary to maintain his or her minimum mental, emotional, or physical health and safety.”

(al) “Serious bodily injury” means any harm to the body which causes or could cause severe, permanent, or protracted loss of or impairment to the health or of the function of any part of the body.

(am) “Supervisor” means the individual employed by BAAS and certified by the New Hampshire department of administrative services, division of personnel, who oversees the work of APSWs.

(an) “Unfounded” means the determination that a report of alleged abuse, neglect, self-neglect, or exploitation of a vulnerable adult did not meet the definitions contained in RSA 161-F:43, II(a), (b), (c), III, IV, or VI.

(ao) “Victim” means the vulnerable adult who, following a protective investigation completed in accordance with RSA 161-F:42-57 and He-E 700, is found to have been abused, neglected, exploited, or engaged in self-neglect.

(ap) “Vulnerable” means vulnerable as defined in RSA 161-F:43, VII, namely “the physical, mental, or emotional ability of a person is such that he or she is unable to manage personal, home, or financial affairs, in his or her own best interest, or he or she is unable to act or unable to delegate responsibility to a responsible caretaker or caregiver.”

(aq) “Vulnerable adult” means an individual aged 18 or older who is vulnerable as defined in (ap) above and RSA 161-F:43, VII.

(ar) “Ward” means “ward” as defined in RSA 464-A:2, XVI, namely “a person for whom a guardian of the person and the estate, or the person, or the estate, has been appointed.”

History

#5008, eff 11-27-90, EXPIRED: 11-27-96
#6867, eff 10-9-98; ss by #8727, INTERIM, eff 10-9-06, EXPIRED: 4-7-07
#8868, eff 4-19-07; (See Revision Note at Chapter Heading for He-E 700) #10179, eff 9-1-12; ss by #13600, eff 3-24-23

N.H. Code Admin. R. Ann. He-E 701.03 Protective Reports {#sec-he-e-701.03 omnilex-key=us-nh-regs-official--agency-he-e--He-E 701.03}

(a) When making a report as required by RSA 161-F:46, the reporter may make the report in person, by telephone, by letter, or electronically.

(b) A report may be made anonymously. Individuals shall be encouraged to identify themselves, but anonymous reports shall be accepted.

(d) A person wishing to make a report may contact any district office, the BAAS central office, or the APS central intake office.

(e) After business hours or during weekends or holidays, individuals making reports shall contact the police department of the applicable political subdivision, or the sheriff of the county in which the alleged abuse, neglect, self-neglect, or exploitation occurred, in accordance with RSA 161-F:46, I.

(f) If the report does not meet the criteria for a protective investigation to be initiated pursuant to He-E 701.04, the reporter shall be provided with information regarding community resources.

(g) As soon as possible, but no later than 72 hours following receipt of a protective report, BAAS shall initiate a protective investigation.

(h) In cases of imminent danger, BAAS shall immediately initiate a protective investigation of the allegations detailed in the report and approve the authorization of protective services if necessary to protect the alleged victim.

(i) If the alleged victim has a guardian, BAAS shall contact the guardian to inform the guardian that a protective report has been received, and request a copy of the guardianship order.

(j) If the alleged perpetrator is the guardian of the alleged victim, BAAS shall:

(1) Notify the circuit court – probate division of jurisdiction; and

(2) Notify the supervisor, who shall postpone contact with the guardian if the alleged victim’s safety is in jeopardy.

(k) If the intake contains information that the alleged victim has suffered serious bodily injury that is known or suspected to result from abuse, neglect, or exploitation, or if there is reason to believe that a crime has been committed, BAAS shall notify the appropriate law enforcement agency and the department of justice within 72 hours or as soon as the protective investigation has begun.

(l) Upon taking a protective report, BAAS shall notify the agencies listed in He-E 701.11(a)(3)-(5) as appropriate.

History

#5008, eff 11-27-90, EXPIRED: 11-27-96
#6867, eff 10-9-98; ss by #8727, INTERIM, eff 10-9-06, EXPIRED: 4-7-07
#8868, eff 4-19-07; (See Revision Note at Chapter Heading for He-E 700) #10179, eff 9-1-12; ss by #13600, eff 3-24-23

N.H. Code Admin. R. Ann. He-E 701.04 Protective Investigation Requirements {#sec-he-e-701.04 omnilex-key=us-nh-regs-official--agency-he-e--He-E 701.04}

(a) The department shall conduct a protective investigation on each report received, except as described in (b), (c), or (d) below.

(b) The department shall not conduct or complete a protective investigation when any of the following apply:

(1) The alleged victim does not fall under the reporting requirement described in RSA 161-F:46;

(2) The allegation(s) is determined not to meet any of the definitions of abuse, neglect, exploitation, or self-neglect contained in RSA 161-F:43;

(3) When the alleged victim cannot be located and the department determines that an interview with the alleged victim is necessary to conduct the investigation;

(4) When the alleged victim no longer resides in New Hampshire and adult protective staff has referred or attempted to refer the report to appropriate adult protective services or law enforcement;

(5) When the investigator has made multiple attempts to interview the alleged victim and the alleged victim:

a. Declines to be interviewed;

b. Does not display any indications of having suffered cognitive decline; and

c. Is not in imminent danger;

(6) When the alleged victim cannot be reached for interview and the investigator has:

a. Made at least 3 attempts to contact the alleged victim by phone;

b. Made 3 unannounced home visits to attempt to contact the alleged victim; and

c. Contacted or attempted to contact anyone the investigator suspects may have knowledge of the alleged victim’s whereabouts;

(7) When the report involves an incident or situation of abuse, neglect, or exploitation that allegedly occurred one or more years ago, and there is no current contact with the alleged perpetrator;

(8) When the report does not include sufficient information to allow an investigation to be conducted under RSA 161-F:42-57;

(9) When the alleged perpetrator dies prior to the initiation of the investigation, or after the investigation has been initiated, but before it is completed;

(10) When another DHHS bureau has been or will be conducting an investigation because the alleged perpetrator is living in a certified or licensed facility or residence at the time of the alleged incident;

(11) When the report is determined to be frivolous or without factual basis as described in RSA 161-F:46, III;

(12) For reports of self-neglect when the alleged victim is in or enters into a hospice program and is compliant with a hospice treatment plan; or

(13) When the alleged victim and the alleged perpetrator are both residents of a licensed or certified facility after the report and adult protective staff has referred the report to the appropriate licensing entity.

(c) When the report is criminal in nature, and a criminal investigation will be or has been conducted by law enforcement, the department shall not conduct or complete an investigation unless one or more of the following apply:

(1) The alleged perpetrator is registry eligible;

(2) The investigator has determined that the alleged victim is in need of protective services; or

(3) The alleged perpetrator has ongoing contact with the alleged victim.

(d) When the alleged victim has died, the department shall not conduct or complete an investigation when any of the following apply:

(1) When a report is self-neglect;

(2) When the alleged perpetrator is not registry eligible; or

(3) When the alleged victim has not been interviewed and BAAS determines that an interview with the alleged victim is necessary to the investigation.

History

#5008, eff 11-27-90, EXPIRED: 11-27-96
#6867, eff 10-9-98; ss by #8727, INTERIM, eff 10-9-06, EXPIRED: 4-7-07
#8868, eff 4-19-07; (See Revision Note at Chapter Heading for He-E 700) #10179, eff 9-1-12; ss by #13600, eff 3-24-23

N.H. Code Admin. R. Ann. He-E 701.05 Dispositions {#sec-he-e-701.05 omnilex-key=us-nh-regs-official--agency-he-e--He-E 701.05}

(a) In situations where the supervisor determines that an investigation cannot be conducted, cannot be completed, or is duplicative of a protective investigation completed within the previous 12 months, a report shall result in one of the following dispositions:

(1) No investigation conducted; or

(2) Investigation not completed.

(b) For reports that are duplicative of a protective investigation completed within the last 12 months the report shall be added to the alleged victim’s protective investigation file.

History

#5008, eff 11-27-90, EXPIRED: 11-27-96
#6867, eff 10-9-98; ss by #8727, INTERIM, eff 10-9-06, EXPIRED: 4-7-07
#8868, eff 4-19-07; (See Revision Note at Chapter Heading for He-E 700) #10179, eff 9-1-12; ss by #13600, eff 3-24-23

N.H. Code Admin. R. Ann. He-E 701.06 Interviews {#sec-he-e-701.06 omnilex-key=us-nh-regs-official--agency-he-e--He-E 701.06}

(a) The investigator shall interview the alleged victim in person, regardless of his or her mental or physical condition, even if the alleged victim cannot communicate verbally, unless the circumstances do not allow for an in person interview. If circumstances do not allow an in-person interview, the investigator shall interview the alleged victim via any means that allows contemporaneous communication and protects the privacy of the alleged victim.

(b) During the interview, the investigator shall:

(1) Identify himself or herself and describe BAAS’ responsibility to investigate in accordance with RSA 161-F:42-57;

(2) Inform the alleged victim that a report of abuse, neglect, self-neglect, or exploitation has been received;

(3) Not reveal the reporter’s name, unless the reporter chose to allow disclosure of the reporter’s identity pursuant to He-E 701.03(c);

(4) Explain the role of the investigator and the purpose of the investigation;

(5) Specify the allegation(s) and other concerns contained in the protective report and request the alleged victim’s response;

(6) Obtain information regarding the alleged victim’s safety, functioning, and environment;

(7) Inform the alleged victim that there might be a need to interview other individuals to complete the investigation, and ask for the names of any individuals whom the alleged victim identifies as someone who may have information; and

(8) If the alleged victim has a guardian, inform the alleged victim that at the conclusion of the investigation the guardian will be notified about the investigation results.

(d) If the alleged perpetrator is a minor, the investigator shall:

(1) Contact the alleged perpetrator’s guardian to inform the guardian of the need to interview the minor; and

(2) Offer the guardian the opportunity to be present at the interview, and if the guardian does not choose to do so, obtain written permission to interview the minor without the guardian’s presence.

(e) If the alleged perpetrator has a guardian appointed pursuant to RSA 464-A, the investigator shall contact the guardian to inform the guardian of the need to interview the alleged perpetrator, except under the circumstances described in He-E 701.03(j).

(f) If the alleged perpetrator refuses to be interviewed or cannot be located, the investigator shall send a letter to the alleged perpetrator’s last known address, requesting an interview.

(g) If the alleged perpetrator has a guardian who refuses to allow his or her ward to be interviewed, the investigator shall notify the guardian by letter, sent by United States Postal Service first class mail that a determination shall be made without the alleged perpetrator’s input.

(h) If the alleged perpetrator cannot be located, or can be located but does not consent to be interviewed, the investigator shall proceed with the investigation and make a determination based on information available from the alleged victim, collateral contacts, written reports and records, and other relevant information or documentation.

(i) When interviewing the alleged perpetrator, the investigator shall:

(1) Identify himself or herself and describe the responsibility of BAAS to investigate in accordance with RSA 161-F:42-57;

(2) Inform the alleged perpetrator that a report of abuse, neglect, or exploitation has been received;

(3) Not reveal the reporter’s name;

(4) Explain the role of the investigator and the purpose of the investigation;

(5) Specify the allegation(s) and other concerns contained in the report and request the alleged perpetrator’s response;

(6) Inform the alleged perpetrator that there might be a need to interview other individuals to complete the investigation, and ask for the names of any individuals whom the alleged perpetrator identifies as having information; and

(7) Inform the alleged perpetrator that, at the conclusion of the investigation, the alleged perpetrator and the alleged perpetrator’s guardian, if any, shall be notified about the investigation results, including information about due process and the BAAS state registry if applicable.

(j) The investigator shall interview available collateral contacts who have pertinent information on the reported allegation(s), including, but not limited to, the following:

(1) The individuals whom the alleged victim or the alleged perpetrator have identified as having information; and

(2) Any other individuals who have come to the investigator’s attention as having information regarding the allegations(s).

History

#5008, eff 11-27-90, EXPIRED: 11-27-96
#6867, eff 10-9-98; ss by #8727, INTERIM, eff 10-9-06, EXPIRED4-7-07
#8868, eff 4-19-07; (See Revision Note at Chapter Heading for He-E 700) #10179, eff 9-1-12; ss by #13600, eff 3-24-23

N.H. Code Admin. R. Ann. He-E 701.07 Investigation Responsibilities and the Determination {#sec-he-e-701.07 omnilex-key=us-nh-regs-official--agency-he-e--He-E 701.07}

During the course of the investigation, the investigator shall:

(a) Conduct all interviews as described in He-E 701.06;

(b) As necessary, request protective services to be approved by the supervisor to protect the alleged victim while the investigation is in progress;

(c) Obtain and review relevant written reports, records, photographs, and any other necessary documentation in accordance with RSA 161-F:56;

(d) Consult, as necessary, with other professionals who have expertise regarding the type of report or allegations being investigated;

(e) Review all information collected during the investigation process;

(f) Determine whether or not the allegation(s) is or are substantiated;

(g) Determine whether or not the report is founded or unfounded based on the following:

(1) Statements made by the alleged victim;

(2) Supporting testimony given by collateral contacts;

(3) Supporting written, photographic, audio, or visual documentation; or

(4) Statements made by the alleged perpetrator, if any; and

(h) Complete all required forms, summaries, and letters in order to document the investigation and provide necessary notification(s).

History

#5008, eff 11-27-90, EXPIRED: 11-27-96
#6867, eff 10-9-98; ss by #8727, INTERIM, eff 10-9-06, EXPIRED: 4-7-07
#8868, eff 4-19-07; (See Revision Note at Chapter Heading for He-E 700) #10179, eff 9-1-12; ss by #13600, eff 3-24-23

N.H. Code Admin. R. Ann. He-E 701.08 Purpose of a Review {#sec-he-e-701.08 omnilex-key=us-nh-regs-official--agency-he-e--He-E 701.08}

(a) A registry eligible perpetrator may, in accordance with He-E 701.09 below, request a review by the bureau administrator for the purpose of considering new or additional information, or to dispute the accuracy of the information obtained during the investigation.

(b) With the request for a review, the registry eligible perpetrator shall provide new or additional information to dispute the finding or the accuracy of the information used to make the recommended founded determination.

(c) The bureau administrator shall consider the new or additional information to determine if the recommended founded determination shall be upheld or overturned.

History

#5008, eff 11-27-90, EXPIRED: 11-27-96
#6867, eff 10-9-98; ss by #8727, INTERIM, eff 10-9-06, EXPIRED: 4-7-07
#8868, eff 4-19-07; (See Revision Note at Chapter Heading for He-E 700) #10179, eff 9-1-12; ss by #13600, eff 3-24-23

N.H. Code Admin. R. Ann. He-E 701.09 Registry Eligible Alleged Perpetrator Review Prior to Completion of the Investigation {#sec-he-e-701.09 omnilex-key=us-nh-regs-official--agency-he-e--He-E 701.09}

(a) For a report involving an alleged perpetrator who is registry eligible, upon a recommended founded determination and prior to the date of approval, the investigator shall send written notice to the alleged perpetrator and the alleged perpetrator’s guardian, if any, of the recommended founded determination and the option to request a review prior to completion of the investigation.

(b) The bureau shall notify the registry eligible alleged perpetrator’s parent or guardian if the request for review is received directly from a perpetrator who is under 18 years of age.

(c) The bureau shall notify the registry eligible alleged perpetrator’s guardian if the request for review is received directly from a perpetrator who is 18 years or older and has a guardian appointed by the probate court in accordance with RSA 464-A.

(d) If the alleged perpetrator who is registry eligible wants a review, the alleged perpetrator shall submit a request for review to the bureau administrator within 5 business days of the date of the notice, which may be made via telephone or electronic mail to the phone number or address indicated on the notice.

(e) All requests for a review by a registry eligible alleged perpetrator shall contain:

(1) The full name, address, date of birth, and telephone number of the alleged perpetrator; and

(2) A statement that explains the reason(s) for requesting the review and the additional information the alleged perpetrator wishes to present.

History

#5008, eff 11-27-90, EXPIRED: 11-27-96
#6867, eff 10-9-98; ss by #8727, INTERIM, eff 10-9-06, EXPIRED: 4-7-07
#8868, eff 4-19-07; (See Revision Note at Chapter Heading for He-E 700) #10179, eff 9-1-12; ss by #13600, eff 3-24-23

N.H. Code Admin. R. Ann. He-E 701.10 Notification Following a Request of Review by a Registry Eligible Alleged Perpetrator {#sec-he-e-701.10 omnilex-key=us-nh-regs-official--agency-he-e--He-E 701.10}

(a) Following a request of review by a registry eligible perpetrator, the bureau administrator shall send written notification to the alleged perpetrator and the alleged perpetrator’s guardian, if any, of whether the recommendation of the investigator is approved, overturned, or returned to the investigator for further investigation.

(b) If the recommendation of the investigator is upheld following a review, within 5 business days of the date of the review, a notice to the perpetrator shall be sent in accordance with RSA 161-F:49, II and He-E 701.11.

(c) If the recommendation of the investigator is overturned following a review, within 5 business days of the date of the review, a notice shall be sent to the alleged perpetrator or the alleged perpetrator’s guardian, if any, in accordance with He-E 701.11.

(d) If the report is returned to the investigator for further investigation following a review, notice shall be sent to the alleged perpetrator or the alleged perpetrator’s guardian, if any, within 10 business days of the review.

History

#5008, eff 11-27-90, EXPIRED: 11-27-96
#6867, eff 10-9-98; ss by #8727, INTERIM, eff 10-9-06, EXPIRED: 4-7-07
#8868, eff 4-19-07; (See Revision Note at Chapter Heading for He-E 700) #10179, eff 9-1-12; ss by #13600, eff 3-24-23

N.H. Code Admin. R. Ann. He-E 701.11 Notification Following Investigation {#sec-he-e-701.11 omnilex-key=us-nh-regs-official--agency-he-e--He-E 701.11}

(a) Upon completion of an investigation or investigation not completed disposition pursuant to He-E 701.05, the investigator shall notify the following individuals and agencies:

(1) The alleged victim and the alleged victim’s guardian, if any;

(2) The alleged perpetrator, if any, and the alleged perpetrator’s guardian, if any;

(3) The probate court, if the alleged perpetrator is the guardian of the alleged victim at the time the alleged abuse, neglect, or exploitation occurred;

(4) The department’s office of client and legal services, established in accordance with RSA 171-A:19, if the alleged perpetrator is a public guardian of the alleged victim; and

(5) A home health agency or another agency, if the agency employs or did employ the alleged perpetrator at the time of the alleged abuse, neglect, or exploitation.

(b) All notices sent after the completion of an investigation or an investigation not completed disposition shall:

(1) Be sent by United States Postal Service first class mail, or be hand-delivered; and

(2) State whether the report was founded, unfounded, or resulted in an investigation not completed disposition.

(c) If the investigation resulted in a disposition of investigation not completed, in addition to the information described in (b) above, the notice shall contain the reason for the disposition.

(d) In accordance with RSA 161-F:49, II, if the investigation resulted in a founded determination and the perpetrator is registry eligible, the notice(s) issued in accordance with (a) shall:

(1) Be sent within 5 business days; and

(2) Contain:

a. The identity of the perpetrator;

b. A description of the allegation stated in the report;

c. The reasons for the founded determination, the consequences of such a finding, and that such information is required to be entered on the BAAS state registry in accordance with He-E 701.22 and RSA 161-F:49;

d. Information on the right to appeal as described in He-E 701.15; and

e. Whether services shall be provided, but only in notice(s) sent to the victim and the victim’s guardian.

(e) For reports of self-neglect, abuse, neglect, or exploitation, if the investigation resulted in a founded determination, and the perpetrator is not registry eligible, notice(s) issued in accordance with (a) shall include the following information:

(1) The type and description of the allegations stated in the report;

(2) The reasons for the founded determination;

(3) The procedures by which the perpetrator or victim of self-neglect may request a reconsideration pursuant to He-E 701.14; and

(4) Whether services shall be provided, but only in notice(s) sent to the victim and the victim’s guardian.

History

#5008, eff 11-27-90, EXPIRED: 11-27-96
#6867, eff 10-9-98; ss by #8727, INTERIM, eff 10-9-06, EXPIRED: 4-7-07
#8868, eff 4-19-07; (See Revision Note at Chapter Heading for He-E 700) #10179, eff 9-1-12; ss by #13600, eff 3-24-23 (formerly He-E 701.12)

N.H. Code Admin. R. Ann. He-E 701.12 Purpose of a Reconsideration {#sec-he-e-701.12 omnilex-key=us-nh-regs-official--agency-he-e--He-E 701.12}

The purpose of a reconsideration of a founded determination for a non-registry eligible perpetrator or victim of self-neglect shall be for the bureau administrator to consider new or additional information, or the accuracy of the information obtained during the investigation, or both.

History

#5008, eff 11-27-90, EXPIRED: 11-27-96
#6867, eff 10-9-98; ss by #8727, INTERIM, eff 10-9-06, EXPIRED: 4-7-07
#8868, eff 4-19-07; (See Revision Note at Chapter Heading for He-E 700) #10179, eff 9-1-12; ss by #13600, eff 3-24-23 (formerly He-E 701.13)

N.H. Code Admin. R. Ann. He-E 701.13 Request for Non-Registry Eligible Reconsideration {#sec-he-e-701.13 omnilex-key=us-nh-regs-official--agency-he-e--He-E 701.13}

(a) For founded cases of abuse, neglect, or exploitation, a perpetrator who is not registry eligible, or the perpetrator’s guardian, if any, or the victim of self-neglect, or the guardian of the victim of self-neglect, if any, shall submit a request for reconsideration to the bureau administrator within 10 business days of the date of the notice in He-E 701.11, which may be made via telephone or electronic mail to the phone number or address indicated on the notice, and include the following:

(1) The name, address, and telephone number of the perpetrator or victim of self-neglect; and

(2) A statement that explains the reasons for requesting the reconsideration.

(b) The bureau shall notify the guardian of the perpetrator or the guardian of the victim of self-neglect of the request for a non-registry eligible reconsideration if the request is received directly from one of the following:

(1) A perpetrator who is under 18 years of age; or

(2) A perpetrator or victim of self-neglect who is 18 years or older and has a guardian appointed by the probate court in accordance with RSA 464-A.

History

#5008, eff 11-27-90, EXPIRED: 11-27-96
#6867, eff 10-9-98; ss by #8727, INTERIM, eff 10-9-06, EXPIRED: 4-7-07
#8868, eff 4-19-07; (See Revision Note at Chapter Heading for He-E 700) #10179, eff 9-1-12; ss by #13600, eff 3-24-23 (formerly He-E 701.14)

N.H. Code Admin. R. Ann. He-E 701.14 Notification Following a Non-Registry Eligible Reconsideration {#sec-he-e-701.14 omnilex-key=us-nh-regs-official--agency-he-e--He-E 701.14}

(a) If the original determination of the investigation is upheld, a notice shall:

(1) Be sent within 5 business days of the reconsideration to the perpetrator and the perpetrator’s guardian, if any, or to the victim of self-neglect and the guardian of the victim of self-neglect, if any; and

(2) Contain an explanation of why the determination was upheld.

(b) If the original determination of the investigation is overturned, notice shall be sent within 5 business days of the reconsideration to:

(1) The perpetrator and the perpetrator’s guardian, if any, or to the victim of self-neglect and the guardian of the victim of self-neglect, if any; and

(2) The victim of a founded report of abuse, neglect, or exploitation and the victim’s guardian, if any.

(1) The alleged perpetrator and the alleged perpetrator’s guardian, if any; or

(2) The alleged victim of a founded report of self-neglect and the guardian of the victim of self-neglect, if any.

History

#5008, eff 11-27-90, EXPIRED: 11-27-96
#6867, eff 10-9-98; ss by #8727, INTERIM, eff 10-9-06, EXPIRED: 4-7-07
#8868, eff 4-19-07; (See Revision Note at Chapter Heading for He-E 700) #10179, eff 9-1-12; ss by #13600, eff 3-24-23 (formerly He-E 701.15)

N.H. Code Admin. R. Ann. He-E 701.15 Appeal Rights {#sec-he-e-701.15 omnilex-key=us-nh-regs-official--agency-he-e--He-E 701.15}

(a) Perpetrators who are registry eligible shall have a right to contest the finding by appealing to the AAU within 10 business days of the date of the notice of a founded determination.

(b) Pending the outcome of an appeal requested in (a) above, the perpetrator’s information shall not be entered onto the BAAS state registry.

(c) In accordance with RSA 161-F:49, IV, a perpetrator’s information shall be entered onto the BAAS state registry if the perpetrator appeals the founded determination and it is upheld by the administrative appeals unit, unless contrary to a court order.

(d) Failure to request an appeal within the timeframes identified in (a) above, shall constitute a waiver of the right to an administrative appeal of the department’s founded determination.

(e) Perpetrators who are registry eligible shall have the right to:

(1) Receive a full and fair administrative hearing, including the right to be represented by counsel at the perpetrator’s own expense;

(2) Appeal an adverse decision by the AAU to the probate court in accordance with RSA 161-F:49, V; and

(3) Petition to have the finding expunged from the BAAS state registry pursuant to RSA 161-F:49, X.

History

#5008, eff 11-27-90, EXPIRED: 11-27-96
#6867, eff 10-9-98; ss by #8727, INTERIM, eff 10-9-06, EXPIRED: 4-7-07
#8868, eff 4-19-07; (See Revision Note at Chapter Heading for He-E 700) #10179, eff 9-1-12; ss by #13600, eff 3-24-23 (formerly He-E 701.16)

N.H. Code Admin. R. Ann. He-E 701.16 Opening a Protective Services Program Case {#sec-he-e-701.16 omnilex-key=us-nh-regs-official--agency-he-e--He-E 701.16}

(a) When a protective investigation is concluded, the investigator shall determine that there is a need for protective services if any of the following is true:

(1) The vulnerable adult’s health or safety is in jeopardy and is not being addressed by the service provider or informal support system;

(2) The vulnerable adult’s living arrangement is unsafe; or

(3) The vulnerable adult has functional or cognitive limitations that prevent the necessary performance of personal care activities or household tasks.

(b) Following a protective investigation, the APSW shall open a case in the adult protective services program to provide protective services to, and authorize protective services for a vulnerable adult when the following conditions are met:

(1) There is a need for protective services as determined in (a) above;

(2) The vulnerable adult agrees to accept protective services; and

(3) The vulnerable adult and the vulnerable adult’s guardian, if the vulnerable adult has a guardian, has participated in the development of a protective services program case plan.

History

#5008, eff 11-27-90, EXPIRED: 11-27-96
#6867, eff 10-9-98; ss by #8727, INTERIM, eff 10-9-06, EXPIRED: 4-7-07
#8868, eff 4-19-07; (See Revision Note at Chapter Heading for He-E 700) #10179, eff 9-1-12; ss by #13600, eff 3-24-23 (formerly He-E 701.17)

N.H. Code Admin. R. Ann. He-E 701.17 Protective {#sec-he-e-701.17 omnilex-key=us-nh-regs-official--agency-he-e--He-E 701.17}

Services. Protective services shall consist of any or all of the following:

(a) Case management services provided directly by the APSW;

(b) Services authorized or coordinated by the APSW and provided by other individuals or agencies; and

History

#5008, eff 11-27-90, EXPIRED: 11-27-96
#6867, eff 10-9-98; ss by #8727, INTERIM, eff 10-9-06, EXPIRED: 4-7-07
#8868, eff 4-19-07; (See Revision Note at chapter heading for He-E 700) #10179, eff 9-1-12; ss by #13600, eff 3-24-23 (formerly He-E 701.18)

N.H. Code Admin. R. Ann. He-E 701.18 Role of BAAS in the Guardianship Process {#sec-he-e-701.18 omnilex-key=us-nh-regs-official--agency-he-e--He-E 701.18}

(a) The adult protective services program shall have one of the following roles in the guardianship process described in RSA 464-A:

(1) Providing information about the guardianship process to individuals who are filing for guardianship; or

(2) Petitioning for the appointment of a guardian for a vulnerable adult, pursuant to RSA 161-F:52 and RSA 464-A.

(b) The following criteria shall be met prior to petitioning for the appointment of a guardian for a vulnerable adult:

(1) All other less restrictive options, including the provision of other appropriate protective services, have been exhausted;

(2) A protective investigation has been completed and there is a founded determination;

(3) The bureau administrator has determined that there is a need for protective services;

(4) The vulnerable adult is unable to meet his or her own needs for food, clothing, shelter, health care, or safety, or is unable to manage property or financial matters, as described in RSA 464-A:2, VII;

(5) The vulnerable adult cannot exercise informed judgment, as defined in RSA 464-A:2, XII; and

(6) Family members who have a relationship with the vulnerable adult have been contacted, and have indicated to BAAS that they are unable or unwilling to pursue guardianship.

(c) When the criteria listed in (b)(1) - (6) above are not met, a petition for the appointment of a guardian may still be requested when the bureau administrator determines that without the provision of a guardian, there is a serious likelihood that the vulnerable adult would face a risk of death or serious physical or mental harm to him or herself.

History

#5008, eff 11-27-90, EXPIRED: 11-27-96
#6867, eff 10-9-98; ss by #8727, INTERIM, eff 10-9-06, EXPIRED: 4-7-07
#8868, eff 4-19-07; (See Revision Note at Chapter Heading for He-E 700) #10179, eff 9-1-12; ss by #13600, eff 3-24-23; ss by #13600, eff 3-24-23 (formerly He-E 701.19)

N.H. Code Admin. R. Ann. He-E 701.19 Guardianship Hearing {#sec-he-e-701.19 omnilex-key=us-nh-regs-official--agency-he-e--He-E 701.19}

If BAAS is not the petitioner, adult protection program staff shall attend guardianship hearings only if subpoenaed.

History

#5008, eff 11-27-90, EXPIRED: 11-27-96
#6867, eff 10-9-98; ss by #8727, INTERIM, eff 10-9-06, EXPIRED: 4-7-07
#8868, eff 4-19-07; (See Revision Note at chapter heading for He-E 700) #10179, eff 9-1-12; ss by #13600, eff 3-24-23; ss by #13600, eff 3-24-23 (formerly He-E 701.20)

N.H. Code Admin. R. Ann. He-E 701.20 Releasing Information {#sec-he-e-701.20 omnilex-key=us-nh-regs-official--agency-he-e--He-E 701.20}

Information about the investigation shall be confidential, and shall only be released by BAAS to the parties named in He-E 701.21 below.

History

#5008, eff 11-27-90, EXPIRED: 11-27-96
#6867, eff 10-9-98; ss by #8727, INTERIM, eff 10-9-06, EXPIRED 4-7-07
#8868, eff 4-19-07; (See Revision Note at Chapter Heading for He-E 700) #10179, eff 9-1-12; ss by #13600, eff 3-24-23; ss by #13600, eff 3-24-23 (formerly He-E 701.21)

N.H. Code Admin. R. Ann. He-E 701.21 Who {#sec-he-e-701.21 omnilex-key=us-nh-regs-official--agency-he-e--He-E 701.21}

May Receive Information.

(a) When the investigation is in process, information which has been obtained, or which is in the process of being obtained, shall be released to the following, but only that information which is necessary for the receiving entity to carry out its statutory or regulatory mandates or service provision:

(1) The department of justice, other law enforcement officials, or a court;

(2) The health facilities administration, when the investigation involves an alleged victim residing in a facility overseen by the health facilities administration, except that the reporter’s name shall not be released;

(3) The bureau of behavioral health, when the investigation involves an alleged victim who receives services from a community mental health program or resides at a facility overseen by the bureau of behavioral health, except that the reporter’s name shall not be released;

(4) New Hampshire hospital or Glencliff home when the alleged victim who resides at the facility, except that the reporter’s name shall not be released;

(5) The bureau of developmental services, when the investigation involves an alleged victim who resides in a facility or participates in a program overseen by the bureau of developmental services, except that the reporter’s name shall not be released;

(6) The office of the state long-term care ombudsman, when the investigation involves an alleged victim residing in a licensed nursing facility, licensed assisted living facility, licensed residential care facility, or licensed supported residential care facility, except that the reporter’s name shall not be released;

(7) The board of nursing, when the investigation involves a victim who is alleged to have been abused, neglected, or exploited by an individual licensed by the board, except that the reporter’s name shall not be released; and

(8) Agencies or individuals who provide services to the alleged victim, except that the reporter’s name shall not be released.

(b) When the investigation is completed, and a determination has been made, information shall be released, if requested, to the following agencies and individuals who request it, in accordance with the provisions specified below:

(1) To the victim and the victim’s guardian, if any, or, if the victim is deceased, the executor or administrator of the victim’s will, a copy of the protective investigation summary, except that the reporter’s name shall not be released;

(2) To the perpetrator and the perpetrator’s guardian if any, a copy of the protective investigation summary, but only when a founded determination has been made, except that the reporter’s name shall not be released;

(3) To the department of justice, a court-appointed attorney for the proposed ward or ward, or any other law enforcement officials, a copy of the protective investigation summary or any other requested information, including the reporter’s name if requested;

(4) To a court, a copy of the protective investigation summary or any other requested information, including the reporter’s name if requested;

(5) To the board of nursing and the health facilities administration, a copy of the investigation summary, but only when a founded determination has been made, except that the reporter’s name shall not be released;

(6) To the bureau of behavioral health and the bureau of developmental services, only that information that is needed by those bureaus to carry out their statutory mandates, except that the reporter’s name shall not be released;

(7) To agencies or individuals who are, who were, or who will be, participants in providing services to the victim, only that information needed to provide services, except that the reporter’s name shall not be released;

(8) To a family member or another individual who is petitioning for the appointment of a guardian for a victim, only that information related to the petition for guardianship except that the reporter’s name shall not be released; and

(9) To employers as provided in RSA 161-F:49, VII, a copy of the protective investigation summary, except that the name of the reporter, the last name of the victim and the last name of any individual cited in the summary shall not be released.

(1) The alleged victim and the alleged victim’s guardian, if any, or, if the alleged victim is deceased, the executor or administrator of the alleged victim’s will, if the alleged victim was contacted or interviewed, except that the reporter’s name shall not be released;

(2) The alleged perpetrator and the alleged perpetrator’s guardian, if any, provided that the alleged perpetrator was contacted or interviewed, except that the reporter’s name shall not be released; and

(3) The department of justice, other law enforcement officials, a court-appointed attorney for the proposed ward or ward, or a court, including the reporter’s name, if requested.

History

#5008, eff 11-27-90, EXPIRED: 11-27-96
#6867, eff 10-9-98; ss by #8727, INTERIM, eff 10-9-06, EXPIRED: 4-7-07
#8868, eff 4-19-07; (See Revision Note at Chapter Heading for He-E 700) #10179, eff 9-1-12; ss by #13600, eff 3-24-23 (formerly He-E 701.22)

N.H. Code Admin. R. Ann. He-E 701.22 The BAAS State Registry {#sec-he-e-701.22 omnilex-key=us-nh-regs-official--agency-he-e--He-E 701.22}

BAAS shall maintain a state registry for the purpose of maintaining a record of information on each founded report of abuse, neglect, or exploitation toward an individual by a paid or volunteer caregiver, guardian, or agent acting under the authority of any POA or any DPOA in accordance with RSA 161-F:49.

History

#5008, eff 11-27-90, EXPIRED: 11-27-96
#6867, eff 10-9-98; ss by #8727, INTERIM, eff 10-9-06, EXPIRED: 4-7-07
#8868, eff 4-19-07; (See Revision Note at Chapter Heading for He-E 700) #10179, eff 9-1-12; ss by #13600, eff 3-24-23 (formerly He-E 701.23)

N.H. Code Admin. R. Ann. He-E 701.23 Retention of Protective Investigation Material {#sec-he-e-701.23 omnilex-key=us-nh-regs-official--agency-he-e--He-E 701.23}

(a) For all investigations of self-neglect that are determined to be unfounded, material related to the investigation shall be retained for one year after the date of approval.

(b) For all other investigations that result in an unfounded determination, material related to the investigation shall be retained for 3 years from the date of approval.

(c) For all investigations that result in a founded determination, the material related to the investigation shall be retained for 7 years after the date of approval, or for 7 years after the date the perpetrator’s name is entered onto the registry.

(d) For investigations in which founded determinations are overturned based on either the reconsideration process or on appeal the material related to the investigation shall be retained pursuant to (a) or (b) above from the date of the notice or decision.

(e) For investigations that result in a founded determination, based on the reconsideration process or on appeal, material related to the investigation shall be retained for 7 years from the date of the notice or the decision.

(f) For investigations that result in one of the dispositions described in He-E 701.05, material related to the investigation shall be retained for 6 months from the date of approval.

PARTS He-E 702 – He-E 719 RESERVED

History

#5008, eff 11-27-90, EXPIRED: 11-27-96
#6867, eff 10-9-98; ss by #8727, INTERIM, eff 10-9-06, EXPIRED: 4-7-07
#8868, eff 4-19-07; (See Revision Note at Chapter Heading for He-E 700) #10179, eff 9-1-12; ss by #13600, eff 3-24-23 (formerly He-E 701.11)

Part He-E 720 Bureau of Elderly and Adult Services State Registry

N.H. Code Admin. R. Ann. He-E 720.01 Purpose {#sec-he-e-720.01 omnilex-key=us-nh-regs-official--agency-he-e--He-E 720.01}

The purpose of these rules is to describe:

(a) The process for obtaining a confirmation of whether or not there is a match from the bureau of elderly and adult services (BEAS) state registry;

(b) The confidentiality and expungement of information contained on the BEAS state registry; and

(c) For an employer of a program which is licensed, certified, or funded by the department to provide services to individuals, the process and criteria for granting a waiver to employ a person whose name has been confirmed as a match on the BEAS state registry.

History

#10191, eff 9-27-12; ss by #13602, eff 3-28-23, EXPIRES: 3-28-33

N.H. Code Admin. R. Ann. He-E 720.02 Scope {#sec-he-e-720.02 omnilex-key=us-nh-regs-official--agency-he-e--He-E 720.02}

These rules shall apply to any person or agency seeking a confirmation of whether or not there is a match on the BEAS state registry or seeking a waiver relative to a match on the BEAS state registry pursuant to RSA 161-F:49, VII, and VIII, including:

(a) All employers of programs which are licensed, certified, or funded by the department to provide services to individuals;

(b) Any person considering employing a private citizen to provide personal care services;

(c) Any person considering designating another to serve as his or her agent under a power of attorney or any type of durable power of attorney; and

(d) Any individual, agency, or program which employs staff who provide direct services to individuals.

History

#10191, eff 9-27-12; ss by #13602, eff 3-28-23, EXPIRES: 3-28-33

N.H. Code Admin. R. Ann. He-E 720.03 Definitions {#sec-he-e-720.03 omnilex-key=us-nh-regs-official--agency-he-e--He-E 720.03}

(a) “Abuse” as defined by RSA 161-F:43, II, means any one of the following:

(a) “Emotional abuse” means the misuse of power, authority, or both, verbal harassment, or unreasonable confinement which results or could result in the mental anguish or emotional distress of a vulnerable adult;

(b) “Physical abuse” means the use of physical force which results or could result in physical injury to a vulnerable adult; or

(c) ”Sexual abuse” means contact or interaction of a sexual nature involving a vulnerable adult without his or her informed consent”.

(b) “Applicant” means a prospective employee, contractor, consultant, or volunteer who, through an employer if hired, might be in contact with individuals.

(c) “Bureau of elderly and adult services state registry (state registry)” means a database containing information on founded reports of abuse, neglect, or exploitation of vulnerable adults by a paid or volunteer caregiver, guardian, or agent acting under the authority of any power of attorney or any durable power of attorney pursuant to RSA 161-F:49.

(d) “Commissioner” means the commissioner of the New Hampshire department of health and human services or designee.

(e) “Employer” means a person or agency that is licensed, certified, or funded by the department to provide services to individuals.

(f) “Exploitation” means “exploitation” as defined in RSA 161-F:43, IV namely, “the illegal use of a vulnerable adult’s person or property for another person’s profit or advantage, or the breach of a fiduciary relationship through the use of a person or a person’s property for any purpose not in the proper and lawful execution of a trust, including, but not limited to, situations where a person obtains money, property, or services from a vulnerable adult through the use of undue influence, harassment, duress, deception, or fraud.”

(g) “Expunged” means the removal of information contained on the BEAS state registry that relates to matching a specific perpetrator’s name to a founded report of abuse, neglect, or exploitation.

(h) “Founded report of abuse, neglect, or exploitation” means the determination that one or more of the allegations of abuse, neglect, or exploitation of a vulnerable adult met one or more of the definitions contained in RSA 161-F:43, II (a), (b), (c), III, IV, or VI pursuant to a protective investigation completed in accordance with He-E 700.

(i) “Individual” means a person18 years of age or older, found eligible for or receiving services pursuant to RSA 171-A, RSA 135-C:13 & 14, RSA 161-E & I or programs licensed under RSA 151:2, I(b), (e), or (f) or who is a vulnerable adult.

(j) “Match” means BEAS has identified the name submitted on the consent form in He-E 720.04(a) as a perpetrator in a founded report of abuse, neglect, or exploitation listed on the BEAS state registry.

(k) “Neglect” means “neglect” as defined in RSA 161-F:43, III, 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 a vulnerable adult.”

(l) “Perpetrator” means the individual who, following a protective investigation completed in accordance with RSA 161-F:42-57 and He-E 700, is found to have abused, neglected, or exploited a vulnerable adult.

(m) “Prospective agent” means a person being considered to act under the authority of a power of attorney or any durable power of attorney.

(n) “Vulnerable” means vulnerable as defined in RSA 161-F:43 VII, namely, “the physical, mental, or emotional ability of a person is such that he or she is unable to manage personal, home, or financial affairs in his or her own best interest, or he or she is unable to act or unable to delegate responsibility to a responsible caretaker or caregiver.”

(o) “Vulnerable adult” means a person aged 18 or older who is vulnerable as defined in RSA 161-F:43, VII.

History

#10191, eff 9-27-12; ss by #13602, eff 3-28-23, EXPIRES: 3-28-33

N.H. Code Admin. R. Ann. He-E 720.04 BEAS State Registry {#sec-he-e-720.04 omnilex-key=us-nh-regs-official--agency-he-e--He-E 720.04}

(a) In accordance with these rules, upon request, BEAS shall provide confirmation of whether or not there is a match on the BEAS state registry to the following agencies and persons:

(1) Employers;

(2) Private citizens who:

a. Seek to employ or contract with another private citizen to provide personal care services as defined in RSA 161-I; or

b. Wish to designate a prospective agent;

(3) Persons checking to see if their own names are included on the BEAS state registry;

(4) Courts in accordance with RSA 464-A:4,V(c); and

(5) Any individual, agency, or program providing services to individuals.

(b) The agencies and persons identified in (a)(1)-(3) and (5) above shall complete and submit a consent form entitled “BEAS State Registry Consent Form,” Form 3655 (March 2023) to request the confirmation of whether or not there is a match.

(c) The signature of the applicant, prospective agent, or person completing Form 3655 shall signify authorization for the release of the information in (f) below to the agency or person who is identified on the form.

(d) Confirmation of a match shall be confidential, and notification shall be released in accordance with (f) below with a completed consent form as described in (b) and (c) above.

(e) The information contained on the BEAS state registry shall be retained for a period of 7 years, except upon receipt of an order from the probate division of the circuit court that grants a perpetrator’s request to have the information on the BEAS state registry expunged.

(f) Notification to the agencies or persons identified in (a) above who request BEAS state registry information shall include:

(1) Confirmation of whether or not there is a match; and

(2) If there is a match, information on how to request a waiver for employment.

(g) Third party agencies or persons, such as an employment agency, and agencies not providing services to individuals shall be prohibited from accessing the information contained on the BEAS state registry.

History

#10191, eff 9-27-12; ss by #13602, eff 3-28-23, EXPIRES: 3-28-33

N.H. Code Admin. R. Ann. He-E 720.05 Waiver for Employment {#sec-he-e-720.05 omnilex-key=us-nh-regs-official--agency-he-e--He-E 720.05}

(a) When the applicant applying for employment with a program that is licensed, certified, or funded by the department to provide services to individuals has been confirmed as a match, the employer shall not hire the applicant unless a waiver to hire such a person is requested and obtained from the department.

(b) Upon receipt of a confirmed match, the employer in (a) above may, with the consent of the applicant, request from BEAS a copy of the protective investigation summary, including the supporting documents, to determine whether or not to request a waiver.

(1) Be limited to the protective investigation summary and supporting documents; and

(2) All documents shall be redacted as appropriate for the purposes of maintaining confidentiality.

(d) The employer in (a) above shall submit to the commissioner a written request for a waiver, to include:

(1) The perpetrator’s written acknowledgement of the circumstances that resulted in the founded determination;

(2) Written documentation pertaining to any remedial action the perpetrator has taken subsequent to the founded determination, including but not limited to:

a. A letter of recommendation from a medical professional attesting to the action taken by the perpetrator to address the actions or behaviors which led to the founded determination;

b. Documentation of participation in formalized training related to issues that resulted in the founded determination; and

c. Any other remedial actions taken, such as counseling; and

(3) A written description of the employer’s plan to supervise the perpetrator so that the individuals in the employer’s care shall be safe, to include, at a minimum, the following:

a. A statement attesting that the employer has read the department’s investigation report and is fully informed about the circumstances that led to the perpetrator’s name being placed on the BEAS state registry;

b. A description of the duties and responsibilities that the perpetrator will be hired to do, so that the department can evaluate the potential for risk to the individuals in the employer’s care based upon whether or not there is a likelihood of reoccurrence of the type of behavior that resulted in the perpetrator’s name being placed on the BEAS state registry;

c. A description of an orientation and training plan for the perpetrator regarding the employer’s policies and procedures on the treatment of individuals in the employer’s care, as well as a schedule of subsequent review of such policies and procedures;

d. A description of how the employer shall directly or indirectly supervise the perpetrator; and

e. A description of any other conditions of continued employment.

(e) The commissioner shall approve the waiver request if:

(1) All of the information in (d) above is provided;

(2) The information required by (d) above demonstrates that the employer is fully informed of the circumstances that resulted in the perpetrator’s name being placed on the BEAS state registry; and

(3) After reviewing the employer’s plan in (d)(3) above in relation to the documentation in (d)(1) and (2) above, and the underlying circumstances of the finding against the perpetrator which resulted in the perpetrator’s name being placed on the BEAS state registry, the commissioner determines that the perpetrator does not pose a risk to the safety of the individuals in the employer’s care.

(f) The commissioner shall deny the waiver request if:

(1) Any of the information required in (d) above is not provided;

(2) The information required by (d) above does not demonstrate that the employer is fully informed of the circumstances that resulted in the perpetrator’s name being placed on the BEAS state registry; or

(3) The information provided does not affirmatively demonstrate that the perpetrator does not pose a risk to the safety of individuals in the employer’s care.

(g) If the waiver is approved, the employer shall retain the approved waiver and all of the documents required by (d) above in the employee’s personnel file.

(h) Any waiver granted by the commissioner in accordance with these rules shall not be transferable to any other employer, employee, or position.

History

#10191, eff 9-27-12; ss by #13602, eff 3-28-23, EXPIRES: 3-28-33

N.H. Code Admin. R. Ann. He-E 720.06 Confidentiality and Release of Information {#sec-he-e-720.06 omnilex-key=us-nh-regs-official--agency-he-e--He-E 720.06}

Requests from a perpetrator listed on the BEAS state registry for information contained in the paper file shall be limited to the protective investigation summary and the supporting attachments listed therein.

APPENDIX

Rule

Specific State or Federal Statutes or Regulations the Rule Implements

He-E 701.01

RSA 161-F:46; RSA 161-F:51; RSA-161-F:55

He-E 701.02

RSA 161-F:43; RSA 161-F:55; RSA 541-A:7

He-E 701.03

RSA 161-F:46; RSA 161-F:43, II-V

He-E 701.04

RSA 161-F:46, II; RSA 161-F:51; RSA 161-F:53; RSA 161-F:56

He-E 701.05

RSA 161-F:43, RSA 161-F:46; RSA 161-F:55

He-E 701.06

RSA 161-F:46; RSA 161-F:55; RSA 161-F:56

He-E 701.07

RSA 161-F:46, II; RSA 161-F:51, 53, 55, 56

He-E 701.08

RSA 161-F:55

He-E 701.09

RSA 161-F:49, I(c); RSA 161-F:49, II

He-E 701.10

RSA 161-F:55

He-E 701.11

RSA 161-F:49, II; RSA 161-F:55

He-E 701.12 – 701.13

RSA 161-F:55

He-E 701.14

RSA 161-F:55

He-E 701.15

RSA 161-F:49, II, IV, V

He-E 701.16

RSA 161-F:51, I; RSA 161-F:42

He-E 701.17

RSA 161-F:51; RSA 161-F:42; RSA 161-F:43, I

He-E 701.18 – 701.19

RSA 161-F:52; RSA 161-F:55

He-E 701.20 – 701.21

RSA 161-F:57; RSA 161-F: 55

He-E 701.22

RSA 161-F:49

He-E 701.23

RSA 161-F:49, IX; RSA 161-F:55

He-E 720.01 – He-E 720.06

RSA 161-F:49

History

#10191, eff 9-27-12; ss by #13602, eff 3-28-23, EXPIRES: 3-28-33

Chapter He-E 800 Medical Assistance

Part He-E 801 Choices for Independence Program

N.H. Code Admin. R. Ann. He-E 801.01 Purpose {#sec-he-e-801.01 omnilex-key=us-nh-regs-official--agency-he-e--He-E 801.01}

The purpose of the rules is to describe the requirements for eligibility and the services provided through the Choices for Independence (CFI) home and community based services (HCBS-CFI) medicaid waiver program. The program serves individuals who are financially eligible for medicaid coverage and clinically eligible for long-term-services and supports (LTSS), who choose to receive care in their home or another community setting instead of care in an institutional setting.

History

(See Revision Note at part heading for He-E 801) #9969, eff 8-8-11; ss by #12830, INTERIM, eff 8-7-19, EXPIRED: 2-3-20
#13340, eff 1-29-22

N.H. Code Admin. R. Ann. He-E 801.02 Definitions {#sec-he-e-801.02 omnilex-key=us-nh-regs-official--agency-he-e--He-E 801.02}

(a) “Activities of daily living (ADLs)” means the primary activities necessary to carry out daily self-care activities that include but are not limited to eating, toileting, transferring, bathing, dressing, and continence.

(b) “Adult day services” means one or more of the services delivered by a facility licensed in accordance with He-P 818 and listed in He-E 801.16, provided for fewer than 12 hours a day. This term includes “adult medical day services”.

(c) “Adult family care (AFC)” means participant housing option for eligible participants under the CFI waiver program, which includes a combination of personal care, homemaking, and other services that are provided to a participant who is a resident in a certified residence of an unrelated individual or the CFI waiver participant’s relative in accordance with a person-centered plan.

(d) “Annual aggregate medicaid cost” means the total medicaid costs for nursing home residents, combining both the initial medicaid payments and quarterly supplemental payments.

(e) “Appeal” means a request to review a decision or action made by the department which adversely affected the individual pursuant to RSA 126-A:5, VIII.

(f) “Average aggregate payment” means the value of the annual aggregate medicaid cost of nursing facility services divided by the number of paid medicaid bed days in nursing facilities.

(g) “Authorized representative” means “authorized representative” pursuant to He-W 803.01.

(h) “Provider care plan” means a written guide that:

(1) Is developed and maintained by the service provider in consultation with the participant, his or her legal representative, if any, or both, and the participant’s primary care provider, if applicable;

(2) Is developed as a result of an assessment process which includes communication with the participant’s case manager;

(3) Is consistent with and addresses the applicable service needs identified in the participant’s comprehensive care plan; and

(4) Contains specific instructions on providing a defined service to the participant.

(i) “Case management agency” means an agency licensed under He-P 819 and enrolled as a New Hampshire medicaid provider to provide targeted case management services to CFI participants in accordance with He-E 805.

(j) “Case manager” means an individual employed by, or contracted with, a case management agency who:

(1) Meets the qualifications described in He-E 805.06;

(2) Is responsible for the ongoing assessment, person-centered planning, coordination, and monitoring of the provision of services included in the comprehensive care plan; and

(3) Does not have a conflict of interest.

(k) “Choices for Independence (CFI) waiver program” means a system of long-term services and supports (LTSS) provided under Section 1915(c) of the Social Security Act to participants who meet the eligibility requirements in He-E 801.03 and He-E 801.04.

(l) “Commissioner” means the commissioner of the New Hampshire department of health and human services, or his or her designee.

(m) “Community transition services” means non-recurring services, including case management services to support CFI participants who are transitioning from an institutional setting or another provider-operated living arrangement to a living arrangement in a private residence, in which the participant is directly responsible for his or her own living expenses in accordance with He-E 801.17.

(n) “Comprehensive care plan” means an individualized person-centered plan described in He-E 805.05(c) that is:

(1) The result of a person-centered process that identifies the strengths, capacities, preferences, and desired outcomes of the participant;

(2) Developed by the participant’s case manager; and

(3) Is an integrated plan of all the participant’s services.

(o) “Conflict of interest” means a conflict between the private interests and the official or professional responsibilities of a person, entity, agency, or organization, such as providing other direct services to the participant, being the guardian of the participant, or having a familial or financial relationship with the participant.

(p) “Congregate meals” means the provision of meals to groups of participants in a community setting.

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

(r) “Environmental accessibility services (EAS)” means the installation of ramps, grab bars, widening of doorways, electronic aids to daily living, and other adaptations as authorized by the department, in a participant’s home or vehicle as necessary to support the participants’ health and safety.

(s) “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.

(t) “Financial management services (FMS)” means assisting participants that elect to receive PDMS with the following:

(1) Management and disbursement of funds contained in the participant-directed budget;

(2) Performing fiscal accounting, and budget management;

(3) Creating expenditure reports;

(4) Facilitating the employment of staff, and furnishing orientation; and

(5) Conducting skills training to participants who function as the co-employer of their direct support workers.

(u) “Home-based services” means long-term services and supports provided to a participant either in a private home setting or in a mid-level residential facility, including:

(1) CFI waiver services pursuant to this part; and

(2) The following medicaid state plan services:

a. Targeted case management services pursuant to He-E 805;

b. Personal care attendant;

c. Home health aide;

d. Home health nursing;

e. Physical therapy;

f. Occupational therapy;

g. Speech therapy;

h. Adult medical day; and

i. Private duty nursing.

(v) “Home-delivered meals” means prepared meals that are provided to a participant in his or her home.

(w) “Home health aide services” means services provided by a nursing assistant licensed in accordance with RSA 326-B.

(x) “Homemaker services” means non-hands-on services to support a participant’s household management, including light housecleaning tasks, laundry, preparation of meals and snacks, and errands.

(y) “In-home care” means nonmedical non-hands on care, supervision, and socialization provided to isolated participants to prevent institutionalization. This term includes “adult in-home care”.

(z) “Instrumental Activities of Daily Living” (IADL) means basic tasks that are essential to the ability to live independently, such as light housework, laundry, meal preparation, transportation, grocery shopping, using the telephone, medication management, and money management. IADL also includes other supportive activities as specified in the comprehensive care plan which promote and support health, wellness, dignity, and autonomy within a community setting.

(aa) “Job carving” means the act of analyzing work duties performed in a given job and identifying specific tasks that may be assigned to an employee with disabilities.

(ab) “Legal representative” means one of the following individuals, duly appointed or designated in the manner required by law to act on behalf of another individual, and who is acting within the scope of his or her authority:

(1) An attorney;

(2) A guardian or conservator;

(3) An agent acting under a power of attorney;

(4) An authorized representative acting on behalf of an applicant in some or all of the aspects of initial and continuing eligibility in accordance with He-W 803.01; or

(5) A representative acting on behalf of another individual pursuant to RSA 161-I, Personal Care Services.

(ac) “Legally responsible relative” means the participant’s spouse.

(ad) “Licensed practitioner” means:

(1) Medical doctor;

(2) Physician assistant;

(3) Advanced practice registered nurse;

(4) Doctor of osteopathy;

(5) Doctor of naturopathic medicine;

(6) Physical therapist;

(7) Occupational therapist; or

(8) Anyone with diagnostic and prescriptive powers licensed by the appropriate New Hampshire licensing board.

(ae) “Medicaid bed days” means the total unduplicated number of days of nursing facility care that were paid for by the medicaid program in a 12 month period.

(af) “Non-medical transportation” means transportation provided to enable participants to access the community when personal care services are required to do so as articulated in the comprehensive care plan.

(ag) “Nursing facility” means nursing facility licensed pursuant to RSA 151 that provides for 2 or more persons’ basic domiciliary services, including board, room and laundry, continuing health supervision under competent professional medical and nursing direction, and continuous nursing care as may be individually required.

(ah) “Other qualified agencies” means those entities certified in accordance with RSA 161-I and He-P 601.

(ai) “Participant-directed and managed services (PDMS)” means services that allow CFI waiver participants to direct and manage a menu of any CFI waiver service, except for residential care facility services in accordance with He-E 801.24. PDMS allows the participant to design the services that will be provided, select service providers, decide how authorized funding is to be spent base on the needs identified in the participant’s comprehensive care plan, and perform ongoing oversight of the services provided.

(aj) “Person-centered planning” means a planning process to develop an individual support plan that is directed by the participant, his or her representative, or both, and which identifies his or her preferences, strengths, capacities, needs, and desired outcomes or goals.

(ak) “Personal care services (PCS)” means hands-on assistance with ADLs and IADLs, assisting with self-administration of oral and topical medications, performing light housekeeping, providing cueing with eating or dressing, and accompanying a participant into the community when the assistance of the personal care worker is required by the participant, as provided by staff employed by an agency licensed under He-P 809, He-P 822, or an agency certified under He-P 601.

(al) “Personal emergency response system” means an electronic device that enables participants at high risk of institutionalization and who are alone for periods of time to summon help in an emergency 24-hours per day 7 days per week. It also includes a portable help button to allow for the participant’s mobility.

(am) “Residential care facility” means an assisted living residence-residential care or assisted living-supported residential health care facility licensed in accordance with RSA 151.

(an) “Skilled professional medical personnel” means “skilled professional medical personnel” as defined in RSA 151-E:3.

(ao) “Skilled nursing services” means services listed in the comprehensive plan of care who are within the scope of RSA 326-B and are provided by a registered professional nurse, or licensed practical nurse that are within the scope of RSA 326-B.

(ap) “Specialized medical equipment” means the following:

(1) Devices, controls, or appliances that are specified in the comprehensive care plan which enable a participant to increase his or her ability to perform ADLs or IADLs;

(2) Devices, controls, or appliances that are specified in the comprehensive care plan to perceive, control, or communicate with the environment in which the participant lives;

(3) Items necessary for life support or to address physical conditions along with ancillary supplies and equipment necessary to the proper functioning of such items;

(4) Other durable and non-durable medical equipment not available under the New Hampshire Medicaid state plan that are necessary to address participant functional limitations; and

(5) Necessary medical supplies not available under the New Hampshire medicaid state plan.

(aq) “Supported employment services (SEP)” means individual employment services that help a participant who, because of his or her disabilities, require intensive on-going supports to obtain and maintain competitive employment customized employment or self-employment in an integrated work setting, and includes the following:

(1) Vocational or job-related discovery or assessment and job skill trainings necessary to assist with integration in a job setting;

(2) Job placement;

(3) Job development and negotiation with prospective employers;

(4) Job incentives planning and management;

(5) Transportation to employment; and

(6) Asset development and career advancement services.

(ar) “Supportive housing services” means services provided by a public housing authority licensed as a home health care provider or by a home health care provider contracted with a public housing authority to provide services in apartments located in publicly funded apartment buildings that include the following:

(1) Personal care services, including assistance with ADLs and IADLs;

(2) Supervision;

(3) Medication reminders; and

(4) Other supportive activities as specified in the comprehensive care plan or which promote and support health and wellness, dignity, and autonomy within a community setting.

(as) “Targeted case management” means the collaborative process of assessment, planning, facilitation, advocacy, coordination, and monitoring performed by the case manager that is accomplished with a person-centered program, and which:

(1) Assists participants to gain access to needed CFI waiver services, services contained in the medicaid state plan, and other medical, social, spiritual, vocational, educational, and community supports, regardless of the funding source; and

(2) Provides for coordination of participant service plans from all providers to assure adequacy and appropriateness of care and cost effectiveness of planned services that yield positive outcomes.

History

(See Revision Note at part heading for He-E 801) #9969, eff 8-8-11; ss by #12830, INTERIM, eff 8-7-19, EXPIRED: 2-3-20
#13340, eff 1-29-22

N.H. Code Admin. R. Ann. He-E 801.03 Eligibility {#sec-he-e-801.03 omnilex-key=us-nh-regs-official--agency-he-e--He-E 801.03}

(a) An individual shall be eligible to receive CFI waiver services if he or she meets all of the following requirements:

(1) Submission of a signed and dated application, as defined in He-W 601.01(p), to the department;

(2) Is at least 18 years of age;

(3) Meets the financial and categorical requirements for medicaid;

(4) Meets the clinical eligibility requirements for nursing facility care in RSA 151-E:3, I(a), namely, the person requires 24-hour care for one or more of the following purposes, as determined by skilled professional medical personnel:

a. Medical monitoring and nursing care when the skills of a licensed medical professional are needed to provide safe and effective services;

b. Restorative nursing or rehabilitative care with patient-specific goals;

c. Medication administration by oral, topical, intravenous, intramuscular, or subcutaneous injection, or intravenous feeding for treatment of recent or unstable conditions requiring medical or nursing intervention; or

d. Assistance with 2 or more ADLs;

(5) Requires the provision of at least one of the CFI waiver services pursuant to He-E 801.12, as documented in the identified needs list, and receives at least one of the CFI waiver services monthly; and

(6) Has chosen, or whose legal representative has chosen, by signing the application in (1) above, CFI waiver services as an alternative to institutional care.

(b) Pursuant to 42 CFR 441.301 (b)(1)(iii) and (b)(6), eligibility shall be restricted to individuals who meet the target population criteria approved by the centers for medicare and medicaid services (CMS) for the CFI waiver program and who, without the CFI waiver services, would require the level of care provided in a nursing facility as described in He-E 802.

(c) While receiving care as a resident in a nursing facility, an individual shall not be eligible for coverage of CFI waiver services listed in He-E 801.12 except for targeted case management in accordance with RSA 151-E:17.

(d) An individual shall not be considered to be a resident of a nursing facility in (c) above if he or she is a CFI participant who is admitted to a nursing facility on a temporary basis for treatment or care for an acute episode.

(e) For those CFI participants who are receiving short-term inpatient care in a hospital or nursing facility, the following shall apply:

(1) Services described in He-E 801.12(d) shall not be provided while the participant is in the facility, except for services that have been prior authorized for the purpose of enabling the participant to transition back to his or her community and targeted case management in accordance with RSA 151-E:17; and

(2) The participant’s clinical eligibility shall be maintained until such time that an eligibility redetermination is conducted in accordance with He-E 801.07 and the participant is determined ineligible.

History

(See Revision Note at part heading for He-E 801) #9969, eff 8-8-11; ss by #12830, INTERIM, eff 8-7-19, EXPIRED: 2-3-20
#13340, eff 1-29-22

N.H. Code Admin. R. Ann. He-E 801.04 Initial Clinical Eligibility Determination {#sec-he-e-801.04 omnilex-key=us-nh-regs-official--agency-he-e--He-E 801.04}

(a) The department shall make the clinical eligibility determination of the applicant as follows:

(1) Skilled professional medical personnel shall:

a. Conduct an on-site, face-to-face visit with the applicant;

b. Perform a clinical assessment of the applicant; and

c. Develop the identified needs list with the applicant;

(2) The applicant shall sign the following:

a. A consent for participation in the CFI waiver program, including whether or not he or she has a preference of a case management agency;

b. An authorization for release of information; and

c. An authorization for release of protected health information;

(3) Pursuant to RSA 151-E:3, IV, if the department is unable to determine an applicant’s clinically eligible based on the assessment in (a) above, the department shall send notice to the applicant and the applicant’s licensed practitioner(s), as applicable, requesting additional medical information within 30 calendar days of the notice and stating that the failure to submit the requested information will impede processing of the application and delay service delivery;

(4) Within the 30-day period in (3) above, if the requested information is not received within 20 calendar days, the department shall send a second notice to the applicable licensed practitioner(s), with a copy to the applicant, as a reminder to provide the requested information by the original deadline;

(5) Upon request from the treating licensed practitioner or applicant within the 30-day period in (3) above, the department shall extend the deadline in (3) above for a maximum of 30 days if the practitioner or applicant states that he or she has documentation that supports eligibility and will provide it within that time period; and

(6) If the information required by (3) above is not received by the date specified in the notice, or as extended by the department in accordance with (5) above, the applicant shall be determined to be clinically ineligible.

(b) For each applicant who meets the clinical eligibility requirements, a skilled professional medical personnel shall estimate the costs of the provision of home-based services by identifying the LTSS needed, including units, frequencies, and costs, with consideration of the applicant’s expressed needs as identified in the assessment in (a)(1).

(c) The applicant shall be determined eligible for the CFI waiver program if it is determined that the applicant meets the financial eligibility requirements described in He-W 600 and He-W 800, the clinical eligibility requirements of He-E 801.03(a)(4), and the other eligibility requirements pursuant to He-E 801.03.

(d) Upon a determination of eligibility, the applicant or his or her legal representative shall be sent an approval notice, including:

(1) The name and contact information of the case management agency chosen by the applicant or assigned to the applicant by the department, if available at the time of the notice; and

(2) The eligibility start date.

(e) Upon a determination of ineligibility, because the applicant does not meet the eligibility requirements of He-E 801.03 or because required information is not received pursuant to (a)(6) above, the applicant or his or her legal representative shall be sent a notice of denial, including:

(1) A statement regarding the reason and legal basis for the denial;

(2) Information concerning the applicant’s right of appeal pursuant to He-C 200, including the requirement that the applicant has 30 calendar days from the date of the notice of denial to file such an appeal;

(3) An explanation that an applicant who is denied services and who chooses to appeal this denial pursuant to He-C 200 shall not be entitled to medicaid payments for CFI waiver services pending the appeal hearing decision; and

(4) The medical credentials of the skilled professional medical personnel making the determination of ineligibility.

History

(See Revision Note at part heading for He-E 801) #9969, eff 8-8-11; ss by #12830, INTERIM, eff 8-7-19, EXPIRED: 2-3-20
#13340, eff 1-29-22

N.H. Code Admin. R. Ann. He-E 801.05 Development of the Comprehensive Care Plan {#sec-he-e-801.05 omnilex-key=us-nh-regs-official--agency-he-e--He-E 801.05}

(a) The case manager assigned to the participant shall develop and maintain a comprehensive care plan through a person-centered planning process in accordance with He-E 805.

(b) The participant shall review the identified needs section of the comprehensive assessment, as defined in He-E 805.02(f), indicating his or her agreement or disagreement with the identified needs.

(c) The case manager shall request authorization from the department for coverage of the CFI waiver services contained in the comprehensive care plan, including the specific service providers selected by the participant.

(d) The department shall, within 5 business days of the request for service authorization, request additional information from the case manager, including the comprehensive care plan or the section of the comprehensive care plan as needed to support the authorization.

(e) The case manager shall provide the department with the information requested in (d) above within 5 business days of the request.

History

(See Revision Note at part heading for He-E 801) #9969, eff 8-8-11; ss by #12830, INTERIM, eff 8-7-19, EXPIRED: 2-3-20
#13340, eff 1-29-22

N.H. Code Admin. R. Ann. He-E 801.06 Service Authorization {#sec-he-e-801.06 omnilex-key=us-nh-regs-official--agency-he-e--He-E 801.06}

(a) Upon review of the information provided in He-E 801.05(c) and within 6 business days, the department shall authorize services that meet the needs identified in the clinical assessment in He-E 801.04(a) and other later established needs.

(b) Service authorizations shall include specific types, units, and frequencies of the needed services.

(c) Service authorizations shall be issued to specific service providers identified by the participant and his or her case manager as a result of person-centered planning.

(d) When the service authorization does not include all the services requested, the participant shall be sent a notice, to include:

(1) The requested service;

(2) The authorized service;

(3) A statement regarding the reason and legal basis for the denial;

(4) Information regarding the participant’s option to request reconsideration pursuant to (e) below; and

(5) Information concerning the participant’s right of appeal pursuant to He-C 200, including the requirement that the participant has 30 calendar days from the date of the notice authorizing services to file such an appeal.

(e) A participant who disagrees with a denial of a service authorization may request a reconsideration of the service authorization, as follows:

(1) The participant, or his or her representative, shall submit a written request to the department within 30 days of the service authorization; and

(2) The written request shall include an explanation of the reason why a specific service authorization should be changed, including any supporting documentation.

(f) The department shall review the request in (e) above and provide a written notice to the participant, or his or her representative, of its decision based on the criteria for applicable service authorization to maintain or change the original service authorization, including the reason therefor.

(g) Requesting a service authorization reconsideration shall not:

(1) Preclude in any way a participant’s right to appeal a disputed service authorization in accordance with He-C 200;

(2) Change the timeframes established for filing an appeal; and

(3) Affect the amount or type of services authorized.

History

(See Revision Note at part heading for He-E 801) #9969, eff 8-8-11; ss by #12830, INTERIM, eff 8-7-19, EXPIRED: 2-3-20
#13340, eff 1-29-22

N.H. Code Admin. R. Ann. He-E 801.07 Redetermination of Eligibility and Service Authorization {#sec-he-e-801.07 omnilex-key=us-nh-regs-official--agency-he-e--He-E 801.07}

(a) The eligibility of each participant, as determined in accordance with He-E 801.04, shall be subject to redetermination at least annually.

(b) The redetermination shall be conducted in accordance with He-E 801.04, except that (e)(2)c.2. below shall apply.

(c) The annual redetermination required in (a) above shall not preclude earlier redetermination or reevaluation and subsequent changes to the identified needs list or service authorizations.

(d) Upon a redetermination of eligibility, the department shall review and update, as necessary, the service authorization(s).

(e) If a participant is determined ineligible, or if services are no longer requested by the participant or considered necessary by the department pursuant to He-E 801.03(a) above, the department shall either terminate the participant’s CFI eligibility or reduce the services previously authorized as follows:

(1) Payment for services shall be terminated 30 calendar days from the date of the notice described in (2) below, unless an appeal has been filed within 15 calendar days of the date of the notice; and

(2) A written notice of eligibility termination or the reduction or termination of the services previously authorized, as applicable, shall be sent to the participant, or his or her legal representative, and the participant’s case manager, including:

a. The reason and legal basis for the termination or reduction;

b. The date that service coverage shall be terminated or reduced, absent the filing of an appeal; and

c. Information concerning the participant’s right to appeal pursuant to He-C 200, as follows:

The participant shall have 30 calendar days to file an appeal, otherwise the department’s decision shall be final; and
If the participant files an appeal within 15 calendar days of the date of the notice of service coverage termination or reduction, continued payments for CFI waiver services shall be authorized until 30 calendar days after a hearing decision has been made.

History

(See Revision Note at part heading for He-E 801) #9969, eff 8-8-11; ss by #12830, INTERIM, eff 8-7-19, EXPIRED: 2-3-20
#13340, eff 1-29-22

N.H. Code Admin. R. Ann. He-E 801.08 Request for Clinical Redetermination After Clinical Denial {#sec-he-e-801.08 omnilex-key=us-nh-regs-official--agency-he-e--He-E 801.08}

An applicant or participant may reapply at any time following a denial or termination of services, and eligibility shall be determined in accordance with He-E 801.03 and He-E 801.04.

History

(See Revision Note at part heading for He-E 801) #9969, eff 8-8-11; ss by #12830, INTERIM, eff 8-7-19, EXPIRED: 2-3-20
#13340, eff 1-29-22

N.H. Code Admin. R. Ann. He-E 801.09 Cost Control Methodology {#sec-he-e-801.09 omnilex-key=us-nh-regs-official--agency-he-e--He-E 801.09}

(a) The total cost of a participant’s or applicant’s home-based services shall include the costs of all LTSS services provided under the CFI waiver program.

(b) Costs associated with services rendered for acute care needs, EAS, and community transitions shall not be included in the calculation in (a) above.

(c) The average annual cost for the provision of services to a person in a nursing facility shall be calculated by adding:

(1) The basic medicaid cost, determined by dividing the total annual medicaid cost stated in the nursing facility budget line by the number of paid medicaid bed days for that budget year; and

(2) The average aggregate payment made under the medicaid quality incentive program, through the nursing facility trust fund as described in RSA 151-E:14 and 151-E:15, divided by the number of paid medicaid bed days.

History

(See Revision Note at part heading for He-E 801) #9969, eff 8-8-11; ss by #12830, INTERIM, eff 8-7-19, EXPIRED: 2-3-20
#13340, eff 1-29-22

N.H. Code Admin. R. Ann. He-E 801.10 Post-Eligibility Computation of Cost of Care for CFI Waiver Services {#sec-he-e-801.10 omnilex-key=us-nh-regs-official--agency-he-e--He-E 801.10}

(a) The amount of income that a participant is liable to contribute toward the cost of his or her CFI waiver services shall be computed as follows:

(1) The amount of the participant’s gross earned income as defined in He-W 601.04(o) shall be determined;

(2) The employment expense disregard, as specified in He-W 654.18 for old age assistance (OAA) or aid to the needy blind (ANB) recipients or the earned income disregard, as specified in He-W 854.18 for aid to the permanently and totally disabled (APTD) recipients, shall be subtracted from the participant’s gross earned income to obtain the participant’s net earned income;

(3) The total amount of the participant’s unearned income, as defined in He-W 601.08(k), shall be added to the net earned income to determine the participant’s net income;

(4) The allowable deductions, as defined in He-W 854.20 and He-W 654.21, shall be subtracted from the participant’s net income;

(5) For the maintenance needs of the participant, 300% of the maximum supplemental security income (SSI) benefit for an eligible participant as determined in accordance with 20 CFR 416.410, adjusted by cost of living increases pursuant to 20 CFR 416.405 shall be subtracted from the amount in (4) above;

(6) The cost of the following medical expenses incurred by the participant that are not subject to third-party payment shall be subtracted from the amount in (5) above:

a. Health insurance premiums, including Medicare Part A, Part B, Part C, and Part D, coinsurance payments, and deductibles;

b. Necessary and remedial care that would be covered by medical assistance except that allowable payment limits have been exceeded;

c. Necessary and remedial care that is recognized by state law, but not covered by medical assistance; and

d. Currently obligated, unpaid prior medical debt;

(7) The amount of any continuing SSI benefits, under section 1611 (e) (1) (E) and (G) of the Social Security Act, shall be subtracted from the amount in (6) above;

(8) The veterans affairs aid and attendance allowance shall be added to the amount in (6) or (7) above as required by 42 CFR 435.733 (c); and

(9) The result in (8) above shall be the amount of income for which the individual is liable to remit as payment toward the cost of his or her CFI waiver services.

History

(See Revision Note at part heading for He-E 801) #9969, eff 8-8-11; ss by #12830, INTERIM, eff 8-7-19, EXPIRED: 2-3-20
#13340, eff 1-29-22 (formerly He-E 801.11)

N.H. Code Admin. R. Ann. He-E 801.11 Covered Services and Requirements of Service Provision {#sec-he-e-801.11 omnilex-key=us-nh-regs-official--agency-he-e--He-E 801.11}

(a) CFI waiver services shall be covered for eligible participants when the services:

(1) Are provided as specified in the participant’s comprehensive care plan;

(2) Are provided in accordance with the service descriptions in He-E 801.14 through He-E 801.33; and

(3) Are authorized by the department in accordance with He-E 801.06.

(b) CFI waiver services shall be provided in accordance with the setting standards of 42 CFR 441.301(c)(4).

(c) A participant shall have the right to receive independent targeted case management services in accordance with He-E 805 while residing in a nursing facility, hospital, or rehabilitation hospital.

(d) CFI waiver services shall include one or more of the following services as described in this part:

(1) Adult family care services;

(2) In-home care services;

(3) Adult day services;

(4) EAS;

(5) Home-delivered meals services;

(6) Home health aide services;

(7) Homemaker services;

(8) Non-medical transportation services;

(9) Personal care services;

(10) Personal emergency response system services;

(11) Residential care facility service;

(12) Respite services;

(13) Skilled nursing services;

(14) Specialized medical equipment services;

(15) Supportive housing services;

(16) Community transition services;

(17) Financial management services;

(18) Participant directed and managed services;

(19) Supported employment services; and

(20) Targeted case management services pursuant to He-E 805.

History

(See Revision Note at part heading for He-E 801) #9969, eff 8-8-11; ss by #12830, INTERIM, eff 8-7-19, EXPIRED: 2-3-20
#13340, eff 1-29-22 (formerly He-E 801.12)

N.H. Code Admin. R. Ann. He-E 801.12 Non-Covered Services {#sec-he-e-801.12 omnilex-key=us-nh-regs-official--agency-he-e--He-E 801.12}

(a) No service or item shall be covered though the CFI waiver program if the service or item:

(1) Is covered through the medicaid state plan, and the participant is eligible for that coverage;

(2) Is covered through Medicare or any other insurance, and the participant is eligible for that service;

(3) Is provided as a component of any other covered service;

(4) Duplicates another service being provided to the participant;

(5) Addresses needs being met by another paid or unpaid service;

(6) Is provided by a legally responsible relative;

(7) Is primarily for the purpose of recreation;

(8) Cannot be provided in accordance with the setting requirements of 42 CFR 441.301(c)(4); or

(9) The requested service would result in the department’s inability to obtain federal financial participation.

(b) With the exception of respite care provided in an intermediate care facility or residential care facility, payment for CFI waiver services shall exclude room and board.

History

(See Revision Note at part heading for He-E 801) #9969, eff 8-8-11; ss by #12830, INTERIM, eff 8-7-19, EXPIRED: 2-3-20
#13340, eff 1-29-22 (formerly He-E 801.13)

N.H. Code Admin. R. Ann. He-E 801.13 Adult Family Care {#sec-he-e-801.13 omnilex-key=us-nh-regs-official--agency-he-e--He-E 801.13}

(a) Adult family care, as defined in He-E 801.02(c), shall be covered:

(1) When provided at a private residence in the community that is either:

a. Certified in accordance with RSA 151 and He-P 813; or

b. Not required to be licensed pursuant to RSA 151:2, II(b); and

(2) When the services are organized and managed by an adult family care oversight agency, as defined in He-P 813.03(z), as authorized by the department.

(b) Adult family care shall include the services required by He-P 813.

History

(See Revision Note at part heading for He-E 801) #9969, eff 8-8-11; ss by #12830, INTERIM, eff 8-7-19, EXPIRED: 2-3-20
#13340, eff 1-29-22 (formerly He-E 801.14)

N.H. Code Admin. R. Ann. He-E 801.14 In-Home Care Services {#sec-he-e-801.14 omnilex-key=us-nh-regs-official--agency-he-e--He-E 801.14}

(a) In-home care services, as defined in He-E 801.02(y), shall be covered when provided by an agency licensed in accordance with RSA 151:2 and either He-P 809 or He-P 822, or RSA 161-I and He-P 601.

(b) Covered services shall include socialization and supervision.

(1) Laundering the participant’s personal clothing items, towels, and bedding;

(2) Light cleaning limited to the participant’s bedroom, bathroom, common living spaces, and mobility and medical devices;

(3) Preparing non-communal meals and snacks, unless for multiple CFI participants, including cleaning the food preparation area after the food is served;

(4) Maintaining a safe environment in areas of the home used by the participant;

(5) Rearranging light-weight furniture to assure the participant can safely ambulate to reach food, water, medicine, and other essential items; and

(6) Grocery shopping and other errands for the CFI participant.

(d) In-home care shall not be covered when provided to a participant receiving residential care facility services.

History

(See Revision Note at part heading for He-E 801) #9969, eff 8-8-11; ss by #12830, INTERIM, eff 8-7-19, EXPIRED: 2-3-20
#13340, eff 1-29-22 (formerly He-E 801.15)

N.H. Code Admin. R. Ann. He-E 801.15 Adult Day Services {#sec-he-e-801.15 omnilex-key=us-nh-regs-official--agency-he-e--He-E 801.15}

(a) Adult day services, as defined in He-E 801.02(b) shall be covered for non-acute needs when provided by an adult day program licensed in accordance with RSA 151:2 and He-P 818.

(b) Covered adult day services shall include the following services, based on the participant’s needs in the provider care plan:

(1) Supervision;

(2) Personal care services;

(3) Monitoring of the participant’s condition and counseling, as appropriate, on diet, hygiene, or other related matters;

(4) Referrals, as appropriate, to other services and resources that could assist the participant, including any necessary follow-up; and

(5) The following He-P 818 services:

a. Health and safety services;

b. Dietary services;

c. Nursing services;

d. Social services;

e. Rehabilitative services; and

e. Recreational activities.

(1) Provided to a participant receiving residential care facility services; or

(2) Provided to a participant receiving adult family care services.

(d) Adult day service providers shall comply with the provider and documentation requirements specified in He-E 803 and He-P 818, in addition to the requirements in He-E 801.33.

History

(See Revision Note at part heading for He-E 801) #9969, eff 8-8-11; ss by #12830, INTERIM, eff 8-7-19, EXPIRED: 2-3-20
#13340, eff 1-29-22 (formerly He-E 801.16)

N.H. Code Admin. R. Ann. He-E 801.16 Community Transition Services {#sec-he-e-801.16 omnilex-key=us-nh-regs-official--agency-he-e--He-E 801.16}

(a) Community transition services, as defined in He-E 801.02(m), shall be covered only to the extent that they are reasonable and necessary as determined through the comprehensive care plan development process, and meet the following:

(1) The need for the community transition service is clearly identified in the comprehensive care plan;

(2) The participant is unable to meet the expenses of community transition services; and

(3) The community transition services cannot be obtained from other sources.

(b) The maximum limit for community transition services for a participant shall be $1,500 per transition.

(c) Community transition services shall be one-time services per transition and represent one-time costs as described in this part.

(d) The following shall be coverable expenses under community transition services, subject to the service limit in (c) above:

(1) A security deposit required to obtain a lease on an apartment or house;

(2) Set-up fees or deposits for utility or service access, including telephone, electricity, heat, and water;

(3) Items required to occupy and use a community domicile, such as essential household furnishings, window coverings, household appliances needed for basic food preparation, and bed and bath linens; and

(4) Services necessary for the participant’s health and safety, such as pest eradication, and one-time cleaning done prior to occupancy.

(e) Community transition services shall not include monthly rent or mortgage payments, food, monthly utility expenses, or costs for household appliances or items that are intended for entertainment, recreational or diversional purposes or use.

History

(See Revision Note at part heading for He-E 801) #9969, eff 8-8-11; ss by #12830, INTERIM, eff 8-7-19, EXPIRED: 2-3-20
#13340, eff 1-29-22

N.H. Code Admin. R. Ann. He-E 801.17 Environmental Accessibility Services {#sec-he-e-801.17 omnilex-key=us-nh-regs-official--agency-he-e--He-E 801.17}

(a) EAS, for a participant’s home or vehicle , as defined in He-E 801.02(r) shall be a covered service when:

(1) A NH medicaid-enrolled licensed practitioner has determined the need for one or more of the services in (b) below;

(2) The participant’s case manager has requested prior authorization for the service in accordance with (d) below;

(3) The department has provided the prior authorization for the service;

(4) The service is completed by an EAS provider who is enrolled with the department in accordance with (e) below; and

(5) The services are prior authorized.

(b) The following EAS shall be covered:

(1) Installation of ramps;

(2) Installation of grab bars;

(3) Widening of doorways to accommodate the participant’s wheelchair or other mobility access equipment;

(4) Electronic aids to daily living; and

(5) Other adaptations authorized by the department that are necessary for the health and safety of a participant that are not otherwise covered under the medicaid state plan.

(1) Improvements that are of general utility and do not have direct medical or remedial benefit to the participant;

(2) Adaptations which add to the square footage of the home except when necessary to complete an adaptation such as to improve the entrance or egress to the residence or to configure a bathroom to accommodate the participant’s wheelchair;

(3) Purchase of a motor vehicle;

(4) Electrical or plumbing work that is beyond what is required to support the authorized adaptation;

(5) Electrical or plumbing work, unless the EAS provider states, in writing, that the proposed adaptation can be done within the current electrical or plumbing capacity of the home; and

(6) Adaptations to a residential care facility or other licensed facility, except for adaptations in an adult family care home when approved for a specific participant.

(d) The participant’s case manager shall submit the following when requesting prior authorization for an EAS:

(1) A completed Form 3715, “Choices for Independence Prior Authorization Request Form” (January 2022);

(2) A copy of the evaluation in (a)(1) above that describes:

a. The medical or functional need for the adaptation;

b. The description and measurements required for the adaptation; and

c. The proposed training plan for the participant and as applicable, the caregiver, to ensure safe use of the adaptation;

(3) Proposals from at least 2 EAS providers for proposals that have a total cost more than $5,000, except that one proposal may be submitted with a written explanation of why only one proposal is available or appropriate or when a proposal indicates the total cost is $5,000 or less, including the following, as applicable to the project:

a. A list of supplies and materials;

b. Blueprints or scaled drawings;

c. The name(s) of any subcontractors that will be involved;

d. Written confirmation of whether or not a state or local building permit is required;

e. If electrical or plumbing work is required to support the adaptation, then:

A statement signed by the EAS provider stating that the requested adaptation can be done within the current electrical or plumbing capacity of the residence; and
A copy of the electrician or plumber’s license;

f. A statement signed by the EAS provider affirming knowledge of all applicable building codes and permit requirements, affirming that the work will meet the requirements of RSA 155-A:2, and affirming that any subcontractors involved in the work are appropriately licensed; and

g. An agreement signed by the EAS provider stating that reimbursement for the authorized service through the CFI waiver program shall be considered as payment in full;

(4) If a participant prefers one bid over the other(s), then an explanation of the preference shall be submitted to the case manager; and

(5) A notarized written statement from the property owner granting permission to complete the project if the participant is not the owner of the residence.

(e) In order to be enrolled to perform EAS, the EAS provider shall:

(1) Be licensed if the work to be completed requires licensure, such as plumbing or electrical work;

(2) Be registered with the NH secretary of state to do business in the state of NH;

(3) Be insured with general liability insurance for person and property for a minimum amount of $50,000; and

(4) Have submitted documentation of (1)-(3) above to the department’s fiscal agent.

(f) When there is a discrepancy between the recommended specifications pursuant to (a)(1) above, and the EAS provider’s quote, the case manager shall not request an authorization for the service, and the department shall not authorize the service until the discrepancy is resolved to the recommended specifications.

(g) An initial authorization shall be made for the first 50% of the expense for the modification.

(h) Final authorization for payment for EAS shall not be made until the department receives the following:

(1) A copy of any required state or local building permit(s) and written confirmation from the building inspector that the work was completed as allowed by the permit(s);

(2) A signed statement from the participant, and if the participant is not the owner of the residence, the property owner, stating that the work has been completed according to the approved bid and plans to the satisfaction of the participant and, if applicable, the property owner;

(3) A signed confirmation from the case manager stating that the work was completed; and

(4) A signed confirmation from the participant that he or she was trained as described in the training plan to ensure safe use of the adaption.

(i) Payment for EAS shall not exceed the limit specified in the HCBS-CFI waiver approved by CMS.

(j) If, within 90 days of an EAS installation:

(1) There is a discrepancy between the EAS provider’s quote and the delivered or installed materials for a participant, the EAS provider shall replace the equipment or modification;

(2) The replacement includes a restocking fee that the EAS provider will incur as a result of the needed modification or replacement, the EAS provider may provide a revised quote for the replacement at the same cost and add a restocking fee, and the case manager shall submit the revised quote that includes the restocking fee for authorization to the department. Any restocking fee shall be limited to the actual restocking fee incurred by the EAS provider; and

(3) There is a need to modify the EAS because it did not meet the local or state codes or the EAS provider’s quote, the repair, replacement, or modification shall be made at the EAS provider’s expense.

History

(See Revision Note at part heading for He-E 801) #9969, eff 8-8-11; ss by #12830, INTERIM, eff 8-7-19, EXPIRED: 2-3-20
#13340, eff 1-29-22 (formerly He-E 801.17)

N.H. Code Admin. R. Ann. He-E 801.18 Financial Management Services {#sec-he-e-801.18 omnilex-key=us-nh-regs-official--agency-he-e--He-E 801.18}

(a) FMS, as defined in He-E 801.02(t) shall be provided in accordance with the budget developed by the participant with the case manager as part of the participant’s comprehensive care plan.

(b) The FMS provider shall:

(1) Manage and direct the disbursement of funds in accordance with the PDMS budget and plan;

(2) Facilitate the employment of staff by the family or CFI participant;

(3) Provide orientation and skills training to the participant or the participant’s legal representative who is to act as co-employer of direct support staff about responsibilities as co-employers for the direct support workers employed;

(4) Provide fiscal accounting to include:

a. Disbursements for goods and services approved in the comprehensive care plan and the balance of the participant’s available funds; and

b. Ensuring separation of each participant’s budget and expenses; and

(5) Provide employer functions, including but not limited to:

a. Hiring workers chosen by the participant;

b. Verifying worker citizenship status;

c. Ensuring completion of required background checks and obtaining a waiver if necessary pursuant to He-E 801.37;

d. Processing payroll and issuing payment to employees;

e. Withholding all federal, state, and local taxes and making tax payments to the applicable tax authorities; and

f. Documenting required training.

(c) FMS providers shall enroll with NH medicaid as FMS providers and have the capabilities to perform the required tasks in accordance with 26 USC 3504 and revenue procedure 70-6.

(d) The participant’s budget shall include the following, based on the needs identified by the case manager in the comprehensive care plan:

(1) The specific PDMS components:

(2) The frequency and duration of the required services; and

(3) An itemized cost of the PDMS.

(e) The FMS provider shall prepare a budget worksheet that details how the participant intends to spend the funds allocated in the participant’s budget and the worksheet shall be reviewed monthly by the participant.

(f) Expenses that exceed the limits allowed under a participant’s PDMS budget or that exceed service limits allowed for SME or EAS, or that are not allowed under this program as authorized by CMS, shall not be paid.

(g) All FMS providers shall:

(1) Provide services as described in this part;

(2) Maintain an account for the participant for the purposes of tracking expenditures from the participant’s budget;

(3) Inform participants of procedures for payment requests for goods and services;

(4) Review and submit for payment to the department the items or services that the participant purchases based on his or her budget; and

(5) Provide the participant with a monthly statement to track expenditures and to ensure that the FMS provider is handling the participant’s budget appropriately and accurately.

History

(See Revision Note at part heading for He-E 801) #9969, eff 8-8-11; ss by #12830, INTERIM, eff 8-7-19, EXPIRED: 2-3-20
#13340, eff 1-29-22

N.H. Code Admin. R. Ann. He-E 801.19 Home-Delivered Meals Services {#sec-he-e-801.19 omnilex-key=us-nh-regs-official--agency-he-e--He-E 801.19}

(a) Home-delivered meals, as defined in He-E 801.02(v) and provided as a covered service, shall include:

(1) The delivery of nutritionally balanced meals to the participant’s home; and

(2) Concurrent with meal delivery, monitoring of the participant’s wellbeing, and the reporting of emergencies, crises, or potentially harmful situations shall be made to emergency personnel or the participant’s case manager, as appropriate.

(b) All home-delivered meals shall:

(1) Include at least one-third of the dietary reference intakes r, established by the U. S. Department of Agriculture for dietary reference intakes as specified in the United States Department of Agriculture’s, “Dietary Guidelines for Americans 2020-2025” (Ninth Edition), available as noted in Appendix A; and

(2) Meet the U.S. Department of Agriculture recommended Dietary Guidelines for Americans as specified in the United States Department of Agriculture’s, “Dietary Guidelines for Americans 2020-2025” (Ninth Edition), incorporated in (1) above and available as noted in Appendix A.

(1) Be enrolled and contracted with the department to provide home-delivered meal services to adults;

(2) Ensure that meals are prepared and delivered in compliance with the comprehensive care plan and with any applicable state, federal, or local requirements;

(3) Provide meals that accommodate diabetic or salt restricted diets, or both, as requested by the case manager;

(4) Provide visual verification that the participant is home and that there are no unusual circumstances that may cause someone to suspect harm or potential harm to the participant; and

(5) Report any observations of unusual circumstances to the designated agency supervisor or, in the case of an emergency, call emergency personnel.

(d) Home-delivered meals services shall not be a covered service when the meal is provided at an adult day program, residential care facility, or a congregate meal site.

History

(See Revision Note at part heading for He-E 801) #9969, eff 8-8-11; ss by #12830, INTERIM, eff 8-7-19, EXPIRED: 2-3-20
#13340, eff 1-29-22 (formerly He-E 801.18)

N.H. Code Admin. R. Ann. He-E 801.20 Home Health Aide Services {#sec-he-e-801.20 omnilex-key=us-nh-regs-official--agency-he-e--He-E 801.20}

(a) Home health aide services, as defined in He-E 801.02(w) shall be covered for non-acute needs when provided by a licensed nursing assistant (LNA) licensed in accordance with RSA 326-B and employed by a home health care agency licensed in accordance with RSA 151:2 and He-P 809.

(b) The following home health aide services shall be covered:

(1) Those services allowed within the LNA scope of practice, pursuant to Nur 700 that are not personal care services; and

(2) Personal care services, as described in He-E 801.25, when the participant’s provider care plan contains documentation that his or her medical condition necessitates the performance of such tasks by an LNA and not an unlicensed provider.

(c) Home health aide services shall not be covered separately when provided at an adult day program or at a residential care facility.

History

(See Revision Note at part heading for He-E 801) #9969, eff 8-8-11; ss by #12830, INTERIM, eff 8-7-19, EXPIRED: 2-3-20
#13340, eff 1-29-22 (formerly He-E 801.19)

N.H. Code Admin. R. Ann. He-E 801.21 Homemaker Services {#sec-he-e-801.21 omnilex-key=us-nh-regs-official--agency-he-e--He-E 801.21}

(a) Homemaker services, as defined in He-E 801.02(x), shall be covered when provided by employees of:

(1) Home health care providers licensed in accordance with RSA 151:2 and He-P 809;

(2) Home care service providers licensed in accordance with RSA 151:2 and He-P 822; or

(3) Other qualified agencies certified in accordance with RSA 161-I and He-P 601.

(b) Homemaker services shall be limited to the following non-hands-on general household services:

(1) Laundering the participant’s personal clothing items, towels, and bedding;

(2) Light cleaning limited to the participant’s bedroom, bathroom, and mobility and medical devices and common living spaces;

(3) When the participant lives alone, light cleaning of the kitchen and entry way areas, and common living spaces in order to maintain a safe environment;

(4) Errands for necessary tasks identified in the comprehensive care plan; and

(5) Preparation of non-communal meals and snacks, unless for multiple CFI participants, including cleaning the food preparation area after the food is served.

History

(See Revision Note at part heading for He-E 801) #9969, eff 8-8-11; ss by #12830, INTERIM, eff 8-7-19, EXPIRED: 2-3-20
#13340, eff 1-29-22 (formerly He-E 801.20)

N.H. Code Admin. R. Ann. He-E 801.22 Non-Medical Transportation Services {#sec-he-e-801.22 omnilex-key=us-nh-regs-official--agency-he-e--He-E 801.22}

(a) Non-medical transportation services, as defined in He-E 801.02(ae), provided to enable participants to access the community when personal care services shall do so as articulated in the comprehensive care plan.

(b) The participant’s case manager shall:

(1) Document in the participant’s record what public transportation resources were considered by the case manager and why these resources cannot meet the participant’s needs;

(2) Include in the authorization request the destination where the participant will be transported; and

(3) Be included in the participant’s comprehensive care plan.

(1) Home health care providers licensed in accordance with RSA 151:2 and He-P 809;

(2) Home care service providers licensed in accordance with RSA 151:2 and He-P 822;

(3) Other qualified agencies certified in accordance with RSA 161-I and He-P 601; or

(4) Agencies under contract with the department to provide services, which include the provision of transportation, funded by the Older Americans’ Act or the Social Services Block Grant.

(d) The agencies in (c) above shall ensure that:

(1) Vehicles used for providing non-medical transportation services have a current inspection sticker; and.

(2) Drivers providing non-medical transportation services:

a. Have a current and valid driver’s license;

b. Have automobile insurance that:

Includes uninsured motorist coverage; and
Is for a minimum of $100,000 per passenger per occurrence and $300,000 per occurrence; and

(3) Are 18 years of age or older.

(e) The following services shall not be covered as non-medical transportation:

(1) Transportation provided with the participant’s vehicle;

(2) Transportation to or from medical appointments or services; and

(3) Transportation provided to a participant who resides at a residential care facility or adult family care home.

(f) The prohibition on use of a participant’s vehicle in (f)(1) above, shall not preclude a licensed provider from using a participant’s vehicle in offering another authorized service, such as personal care service pursuant to He-E 801.25.

History

(See Revision Note at part heading for He-E 801) #9969, eff 8-8-11; ss by #12830, INTERIM, eff 8-7-19, EXPIRED: 2-3-20
#13340, eff 1-29-22 (formerly He-E 801.21)

N.H. Code Admin. R. Ann. He-E 801.23 Participant Directed and Managed Services {#sec-he-e-801.23 omnilex-key=us-nh-regs-official--agency-he-e--He-E 801.23}

(a) PDMS, as defined in He-E 801.02(ai), shall:

(1) Be tailored to the participant’s competencies, interest, preferences, and needs;

(2) Promote the health, safety, and emotional wellbeing of the participant;

(3) Be provided in a manner which protects the participant’s rights as described in RSA 151:21-b;

(4) Provide the degree of support a participant needs in order to direct services, increase his or her level of independence, and advocate for himself or herself; and

(5) Allow the participant to serve as co-employer along with an FMS provider for the providers serving the participant.

(b) PDMS shall allow the participant or the participant’s legal representative to define the provider qualifications that reflect sufficient training, expertise, experience and/or education to ensure delivery of safe and effective services, unless otherwise required by state or federal licensing or certification requirements.

History

(See Revision Note at part heading for He-E 801) #9969, eff 8-8-11; ss by #12830, INTERIM, eff 8-7-19, EXPIRED: 2-3-20
#13340, eff 1-29-22

N.H. Code Admin. R. Ann. He-E 801.24 Personal Care Services {#sec-he-e-801.24 omnilex-key=us-nh-regs-official--agency-he-e--He-E 801.24}

(a) PCS shall be documented in the provider care plan and covered when provided for non-acute needs by employees of:

(1) Home health care providers licensed in accordance with RSA 151:2 and He-P 809;

(2) Home care service providers licensed in accordance with RSA 151:2 and He-P 822; or

(3) Other qualified agencies certified in accordance with RSA 161-I and He-P 601.

(b) Covered personal care services shall include the following services:

(1) Hands-on assistance with the ADLs or IADLs or cuing a participant to perform a task;

(2) Assisting the participant with eating;

(3) Under the direction of the participant, assistance with self-administration of oral or topical medication as prescribed, including:

a. Reminding the participant regarding the timing and dosage of the medication, and to take his or her medication as written on the medication container;

b. Placing the medication container within reach of the participant;

c. Assisting the participant with opening the medication container;

d. Assisting the participant by steadying shaking hands; and

e. Observing the participant take the medication and recording the same in the participant’s record;

(4) Accompanying the participant in the community when:

a. The assistance of the personal care worker is required by the participant ; and

b. The need for re-direction or direct assistance, or both, is required;

(5) When non-medical transportation services are authorized, hands-on assistance at the authorized destination when the provider care plan documents that this assistance is required at the destination;

(6) General household tasks, limited to the following:

a. Laundering the participant’s personal clothing items, towels, and bedding;

b. Light cleaning limited to the participant’s bedroom, bathroom, mobility and medical devices, and common living spaces;

c. Light cleaning of the kitchen, entry way areas, and common living spaces, to maintain a safe environment for the participant;

d. Errands for necessary tasks identified in the provider care plan;

e. Preparing meals and snacks for CFI participants including cleaning the food preparation area after the food is served; and

(7) Care, grooming, or feeding of service animals as defined in 28 CFR 35.104, or assistance animals as defined by the U.S Department of Housing & Urban Development’s “Office of Fair Housing & Equal Opportunity Notice: FHEO-2020-01” (January 2020), available as noted in Appendix A.

(1) For the purpose of transportation only, when no other assistance is required;

(2) When provided in any of the following settings:

a. A residential care facility;

b. A hospital;

c. A nursing facility;

d. A rehabilitation facility;

e. An adult family care home; and

f. An adult day care; and

(3) When provided by any of the following individuals:

a. The participant’s personal care services representative, designated in accordance with (d) and (e) below;

b. The participant’s agent acting under a designated power of attorney pursuant to RSA 564-E; or

c. The participant’s legal guardian.

(d) The participant, his or her legal guardian, or a person granted authority under a power of attorney of the participant may designate a PCS representative to act on the participant’s behalf:

(1) To direct the PCS being provided; and

(2) Under the following conditions:

a. The following persons shall not serve as a PCS representative for purposes of directing personal care services:

The personal care worker providing services;
The participant’s case manager; and
Anyone having a financial relationship with any agency providing personal care services or intermediary services, as defined in RSA 161-I:2, VII, to the participant;

b. The PCS representative shall be designated through a written document, stating that:

The PCS representative’s role applies only to decisions made regarding the personal care services described in this section;
The appointment of a PCS representative may be revoked by the participant at any time; and
The responsibilities of the PCS representative shall be to:

(i) At a minimum, have weekly face-to-face contact with the participant and the personal care worker;

(ii) At a minimum, have monthly contact with the participant’s case manager concerning PCS;

(iii) Ensure that the personal care worker is taking the participant’s care preferences into consideration; and

(iv) Communicate concerns or satisfaction to the provider agency that employs that personal care worker; and

c. The written document designating the PCS representative shall be signed by the participant or his or her legal guardian or by the person granted authority under a power of attorney and a witness and be maintained by the provider agency.

(e) When a PCS representative is designated, the participant, his or her guardian, or the person granted authority under a power of attorney shall:

(1) Notify the provider agency in writing of the PCS representative’s name and scope of authority; and

(2) Notify the provider agency in writing of any changes in representation within 30 days of the date that the change occurs.

History

(See Revision Note at part heading for He-E 801) #9969, eff 8-8-11; ss by #12830, INTERIM, eff 8-7-19, EXPIRED: 2-3-20
#13340, eff 1-29-22 (formerly He-E 801.22)

N.H. Code Admin. R. Ann. He-E 801.25 Personal Emergency Response Systems Services {#sec-he-e-801.25 omnilex-key=us-nh-regs-official--agency-he-e--He-E 801.25}

(a) Personal emergency response systems (PERS), as defined in He-E 801.02(al), services shall be a covered service for participants who:

(1) Live alone, live only with someone in poor or failing health, or who are alone at home for 8 hours or more per day, and who are:

a. Ambulatory and at risk of falls as assessed by a physician, registered nurse, or occupational or physical therapist; or

b. Identified as at risk of having a medical emergency as identified in the comprehensive care plan; and

(2) Would require ongoing supervision if the PERS were not provided.

(b) PERS shall not be covered separately when provided to a participant receiving residential care services.

(1) Setting up the PERS in the participant’s home;

(2) Demonstrating to the participant how to use the PERS;

(3) Providing 24/7 monitoring, including the capacity to summon emergency assistance on behalf of the individual as needed; and

(4) Repairing and replacing faulty units.

History

(See Revision Note at part heading for He-E 801) #9969, eff 8-8-11; ss by #12830, INTERIM, eff 8-7-19, EXPIRED: 2-3-20
#13340, eff 1-29-22 (formerly He-E 801.23)

N.H. Code Admin. R. Ann. He-E 801.26 Residential Care Facility Services {#sec-he-e-801.26 omnilex-key=us-nh-regs-official--agency-he-e--He-E 801.26}

(a) The following residential care services shall be covered:

(1) Those services described in He-P 804 or He-P 805; and

(2) Transportation to medical services except when a course of prescribed treatment requires any of the following:

a. Emergency transportation;

b. Transportation more than once per week; or

c. Transportation to a treatment location that is a greater distance from the facility than the participant’s primary care physician.

(b) Residential care facility services shall be covered when provided by facilities licensed in accordance with RSA 151:2 and either He-P 804 or He-P 805.

(c) Reimbursement for all residential care facility services shall be included in one of 3 per diem rates in accordance with (d) below, established by the department in accordance with RSA 161:4, VI(a), and individual services shall not be reimbursed separately when provided in a residential care facility setting.

(d) Residential care facilities licensed under He-P 804 shall be reimbursed at the base residential care facility rate, supported residential care facilities licensed under He-P 805 shall be reimbursed at different rates depending on the needs of the participant in accordance with (e) below.

(e) Supported residential care facilities shall be reimbursed at the base residential care facility rate unless the supported residential care facility has qualified staff assess the needs of the participant using BEAS 3755, “Resident Level of Care Sheet” (January 2022).

(f) Supported residential care facilities that complete BEAS 3755 shall be reimbursed a per diem rate based on the participant’s needs as follows:

(1) The base residential care facility rate for participants with needs assessed 0-8 on BEAS 3755;

(2) Residential Care Dementia Level 1 for participants with needs assessed 9-17 on BEAS 3755; or

(3) Residential Care Dementia Level 2 for participants with needs assessed 18-39 on BEAS 3755.

History

(See Revision Note at part heading for He-E 801) #9969, eff 8-8-11; ss by #12830, INTERIM, eff 8-7-19, EXPIRED: 2-3-20
#13340, eff 1-29-22 (formerly He-E 801.24)

N.H. Code Admin. R. Ann. He-E 801.27 Respite Care Services {#sec-he-e-801.27 omnilex-key=us-nh-regs-official--agency-he-e--He-E 801.27}

(a) Respite care services shall be a covered service when provided by or in one of the following settings:

(1) A medicaid-enrolled nursing facility, licensed in accordance with RSA 151:2 and He-P 813;

(2) A medicaid-enrolled residential care facility licensed in accordance with RSA 151:2 and He-P 804 or He-P 805; or

(3) In the participant’s own residence, by:

a. Home health care providers licensed in accordance with RSA 151:2 and He-P 809;

b. Home care service providers licensed in accordance with RSA 151:2 and He-P 822; or

c. Other qualified agencies certified in accordance with RSA 161-I and He-P 601.

(b) Respite care services shall be:

(1) Provided to the participant on a short-term basis, as described in (2) below, because of the temporary absence or need for relief of those persons normally providing that participant’s care; and

(2) Limited to 30 24-hour days of care per state fiscal year.

History

(See Revision Note at part heading for He-E 801) #9969, eff 8-8-11; ss by #12830, INTERIM, eff 8-7-19, EXPIRED: 2-3-20
#13340, eff 1-29-22 (formerly He-E 801.25)

N.H. Code Admin. R. Ann. He-E 801.28 Skilled Nursing Services {#sec-he-e-801.28 omnilex-key=us-nh-regs-official--agency-he-e--He-E 801.28}

(a) Skilled nursing services, as defined in He-E 801.02(ao), shall be provided by a registered nurse (RN) or by a licensed practical nurse (LPN) who is employed by a home health care provider licensed in accordance with RSA 151:2 and He-P 809.

(b) Skilled nursing services shall be covered for non-acute needs for the provision of chronic long-term care and not short-term care.

(1) On the same day as the participant attends an adult day program if the identified need is within the scope of what would normally be provided by the program;

(2) For the purpose of nursing oversight of authorized LNA services;

(3) At a residential care facility; or

(4) When determined to be needed for the provision of acute needs under the New Hampshire medicaid state plan.

History

(See Revision Note at part heading for He-E 801) #9969, eff 8-8-11; ss by #12830, INTERIM, eff 8-7-19, EXPIRED: 2-3-20
#13340, eff 1-29-22 (formerly He-E 801.26)

N.H. Code Admin. R. Ann. He-E 801.29 Specialized Medical Equipment Services {#sec-he-e-801.29 omnilex-key=us-nh-regs-official--agency-he-e--He-E 801.29}

(a) Specialized medical equipment for non-acute needs shall be a covered service when:

(1) A NH medicaid-enrolled licensed practitioner or physical or occupational therapist has determined the clinical need for one or more of the items in (b) below;

(2) The participant’s case manager has requested prior authorization for the item in accordance with (c) below;

(3) The department has provided the prior authorization for the item; and

(4) The service is completed by a NH enrolled medicaid provider.

(b) Covered specialized medical equipment services shall include the following durable medical equipment items:

(1) Raised toilet seats;

(2) Shower/tub seats and benches;

(3) Tub lifts;

(4) Transfer benches;

(5) Bedside commodes;

(6) Dressing aids and grabbers;

(7) Non-slip grippers to pick up and reach items;

(8) Adaptive utensils;

(9) Transport wheelchairs;

(10) Wheelchair cushions;

(11) Walkers;

(12) Patient lifts;

(13) Slings;

(14) Semi-electric beds;

(15) Bed rails;

(16) Mattress overlay pads;

(17) Electronic communication devices;

(18) Seat lifts, including the chair, or seat lift mechanisms when the following criteria are met:

a. The participant has a severe condition that causes the participant to require assistance to come to a standing position;

b. The participant is completely incapable of standing up from a regular armchair or any chair in their home; and

c. The participant’s attending physician, or a consulting physician treating the participant for the disease or condition resulting in the need for a seat lift, documents that the seat lift mechanism is a part of the physician’s course of treatment to provide support for a condition that is not likely to improve and that may worsen;

(19) Medication dispensing devices, including training on their use, when the following conditions are met:

a. The participant or caregiver is able to use the device;

b. The participant does not live in a licensed facility;

c. When the use of this service is documented to either:

Replace another service of equal or greater cost; or
Avoid the addition of another service; and

d. The type of device is determined by the department’s skilled professional medical personnel to be the least costly device that is appropriate for the participant; and

(20) Other durable medical equipment items that are:

a. Specified in the comprehensive care plan which enable participants to increase their ability to perform activities of daily living;

b. Specified in the comprehensive care plan to help the participant perceive, control, or communicate with the environment in which they live;

c. Necessary for life support or to address physical conditions along with ancillary supplies and equipment necessary to the proper functioning of such items;

d. Not available under the state plan that is necessary to address the participant’s functional limitation; or

e. Necessary medical supplies not available under the state plan.

(c) The participant’s case manager shall submit the following when requesting prior authorization for specialized medical equipment:

(1) A completed Form 3715, “Choices for Independence Prior Authorization Request Form” (January 2022)

(2) A written copy of the determination in (a)(1) above that describes:

a. The medical or functional need for the equipment;

b. Any specifications necessary to meet the participant’s needs; and

c. The proposed training plan for the participant and caregiver to ensure safe use of the equipment;

(3) Proposals from at least 2 medicaid enrolled providers, except that one proposal may be submitted when the equipment costs less than $1,000, already has a set or fixed rate, or with a written explanation of why only one proposal is available or appropriate, including the following, as applicable to the equipment:

a. A list of supplies and materials; and

b. A description of the equipment, including measurements when necessary; and

(4) If a participant prefers one proposal over the other(s), then an explanation of the preference.

(d) Specialized medical equipment services shall not be covered separately for participants receiving residential care facility services if the facility is otherwise required to provide the equipment pursuant to He-P 804, He-P 805, a residential services agreement, or the specialized medical equipment is included in the residential care facility service rate.

(e) Payment for specialized medical equipment shall:

(1) Be for the most cost-effective item, as identified by the department, that would effectively meet the participant’s needs; and

(2) Not exceed the participant limit specified in the HCBs-CFI waiver approved by CMS.

(f) If, within 90 days of delivery of the specialized medical equipment:

(1) There is a discrepancy between the proposal and the delivered or installed equipment for a participant, the specialized equipment provider shall replace the equipment; and

(2) The replacement includes a restocking fee that the specialized medical equipment provider will incur as a result, the provider may submit a revised proposal for the replacement equipment at the same cost and add a restocking fee, and the case manager shall submit the revised proposal that includes the restocking fee for authorization to the department.

History

(See Revision Note at part heading for He-E 801) #9969, eff 8-8-11; ss by #12830, INTERIM, eff 8-7-19, EXPIRED: 2-3-20
#13340, eff 1-29-22 (formerly He-E 801.27)

N.H. Code Admin. R. Ann. He-E 801.30 Supportive Housing Services {#sec-he-e-801.30 omnilex-key=us-nh-regs-official--agency-he-e--He-E 801.30}

(a) Supportive housing services, as defined in He-E 801.02(ar), shall be covered when services are provided by:

(1) A public housing authority licensed as a home health care provider in accordance with RSA 151:2 and He-P 809;

(2) A home health care provider licensed in accordance with RSA 151:2 and He-P 809 that is contracted with a public housing authority to provide services; or

(3) An other qualified agency certified in accordance with RSA 161-I and He-P 601 that is contracted with a public housing authority to provide services.

(b) Supportive housing services shall be provided in federally subsidized individual apartments.

(1) Personal care services, as described in He-E 801.24;

(2) Assistance with ADLs;

(3) Assistance with the IADLs including the following activities:

a. Making telephone calls; and

b. Obtaining and keeping appointments;

(4) Home health aide services as described in He-E 801.20;

(5) Homemaker services, as described in He-E 801.21;

(6) Personal emergency response systems services as described in He-E 801.26; and

(7) Medication reminders and other supportive activities as specified in the comprehensive care plan or which promote and support health and wellness, dignity, and autonomy within a community setting.

(d) Supportive housing services shall be included in a per diem rate, established by the department in accordance with RSA 161:4, VI(a), and shall not be reimbursed as a separately covered service when provided in a supportive housing setting.

History

(See Revision Note at part heading for He-E 801) #9969, eff 8-8-11; ss by #12830, INTERIM, eff 8-7-19, EXPIRED: 2-3-20
#13340, eff 1-29-22 (formerly He-E 801.28)

N.H. Code Admin. R. Ann. He-E 801.31 Supported Employment Services {#sec-he-e-801.31 omnilex-key=us-nh-regs-official--agency-he-e--He-E 801.31}

(a) All supportive employment (SEP) services shall:

(1) Be designed in accordance with the participant’s specific needs, interests, competencies, and learning style, as described in the person-centered comprehensive care plan developed in accordance with He-E 805 and employment profile; and

(2) Assist each participant to assume as much personal responsibility in job seeking and job retention as is possible for that participant.

(b) SEP shall be provided by an employment professional.

(1) Meet one of the following criteria:

a. Have completed, or complete within the first 6 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’s (APSE) “Universal Employment Competencies” (January 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/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.

(d) Payment for SEP shall include:

(1) All supported employment services identified in the provider care plan;

(2) Job opportunity 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 participant 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 participant, as needed to assist the participant to remain successfully employed;

(7) Outreach to employers for building relationships that lead to immediate or future job opportunities for the participant;

(8) Training for direct support staff as it relates to the participant’s employment goals;

(9) Training for employers and co-workers to support the participant by understanding his or her:

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 participant’s employment services and goals;

(12) Accessing work incentives information and work incentives planning services for the participant; and

(13) Any other employment service identified in the participant’s provider care plan.

(e) All SEPs shall be designed to:

(1) Assist the participant to obtain employment or self-employment based on the participant’s employment profile and goals in the provider care plan;

(2) Provide the participant with opportunities to participate in a comprehensive career development process that helps to identify, in a timely manner, the participant’s employment profile;

(3) Support the participant 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 participant to become as independent as possible in his or her 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 participant to:

a. Meet his or her goal for the desired number of hours of work as articulated in the provider care plan; and

b. Earn wages of at least minimum wage or prevailing wage, unless the participant is pursuing income based on self-employment;

c. Assess, cultivate, and utilize natural supports within the workplace to assist the participant to achieve independence to the greatest extent possible;

d. Help the participant to learn about, and develop appropriate social skills to actively participate in, the culture of his or her workplace;

e. Understand, respect, and address the business needs of the participant’s employer, in order to support the participant to meet appropriate workplace standards and goals;

f. Maintain communication with, and provide consultations to, the employer to:

Address employer specific questions or concerns to enable the participant to perform and retain his or her job; and
Explore opportunities for further skill development and advancement for the participant;

g. Help the participant to learn, improve, and maintain a variety of life skills related to employment, such as:

Traveling safely in the community;
Managing personal funds;
Utilizing public transportation; and
Other life skills identified in the person-centered comprehensive care plan related to employment;

h. Promote the participant’s health and safety;

i. Protect the participant’s right to freedom from abuse, neglect, and exploitation; and

j. Provide opportunities for the participant to exercise personal choice and independence.

History

(See Revision Note at part heading for He-E 801) #9969, eff 8-8-11; ss by #12830, INTERIM, eff 8-7-19, EXPIRED: 2-3-20
#13340, eff 1-29-22

N.H. Code Admin. R. Ann. He-E 801.32 Provider Participation {#sec-he-e-801.32 omnilex-key=us-nh-regs-official--agency-he-e--He-E 801.32}

(a) All providers shall:

(1) Be enrolled in NH medicaid as a CFI provider;

(2) Meet the applicable licensing, certification, or other requirements of the specific service being provided; and

(3) Comply with requirements contained in 42 CFR 441.301(c)(4).

(b) All providers shall:

(1) Create and maintain an individual provider care plan for each participant served in accordance with He-E 801.33(a);

(2) Create and maintain other documentation in accordance with He-E 801.33 and as required pursuant to applicable state and federal law;

(3) Submit claims for payment in accordance with He-E 801.34;

(4) Provide services in accordance with this part, 42 CFR 455, 42 CFR 456, 42 CFR 431, and 42 CFR 1001; and

(5) Be subject to monitoring and review by the department upon request.

(c) All providers shall comply with the provisions of RSA 161-F:49 with regard to checking the names of prospective or current employees, volunteers or subcontractors against the state registry maintained by the department’s bureau of elderly and adult services.

(d) All providers shall report to the appropriate departmental authority any participant who is suspected of being abused, neglected, exploited, or self-neglecting, in accordance with the adult protection law, RSA 161-F:46.

History

(See Revision Note at part heading for He-E 801) #9969, eff 8-8-11; ss by #12830, INTERIM, eff 8-7-19, EXPIRED: 2-3-20
#13340, eff 1-29-22 (formerly He-E 801.29)

N.H. Code Admin. R. Ann. He-E 801.33 Required Documentation {#sec-he-e-801.33 omnilex-key=us-nh-regs-official--agency-he-e--He-E 801.33}

(a) All providers, with exceptions noted in (b) below, shall develop, maintain, and implement a written provider care plan and adhere to the following:

(1) The provider shall communicate with the participant’s case manager to ensure the care plan is consistent with and addresses the applicable service needs and the participant’s preferences identified in the comprehensive care plan;

(2) The provider care plan shall contain, at a minimum:

a. A description of the participant’s needs and the scope of services to be provided;

b. The dates upon which services will begin and end;

c. The frequency of the services;

d. The total number of service units authorized and the amount that will be provided on each date of service;

e. Pertinent information on the participant’s health condition, medications, allergies, and special dietary needs; and

f. The anticipated goals and outcomes of service provision;

(3) The provider care plan shall be updated at least annually and as necessary to reflect change in the participant’s need for services; and

(4) The provider shall provide a copy of the provider care plan to the participant’s case manager, upon the completion or revision of the plan, and shall make the provider care plan available to the department upon request.

(b) Providers of the following services shall not be required to develop a provider care plan:

(1) EAS;

(2) Home-delivered meals services;

(3) Non-medical transportation services;

(4) Personal emergency response system services;

(5) Financial management services;

(6) Specialized medical equipment services; and

(1) Maintain documentation in accordance with applicable licensure, certification, and all other applicable federal and state laws and regulations or other requirements;

(2) Maintain any other supporting records in accordance with He-W 520; and

(3) Maintain documentation in their records to fully support each claim billed for services including the specific service provided, the number of service units provided, the name of the employee who provided the service, and the date and time of service provision, as applicable.

(d) Failure to maintain supporting records in accordance with He-W 520 and this part shall entitle the department to recoupment of state and federal medicaid payments pursuant to 42 CFR 455, 42 CFR 447, and 42 CFR 456.

(e) In addition to (c) above, documentation of PCS shall include verification of the PCS worker’s time, including:

(1) When paper timesheets are used, the signature of the participant or PCS representative indicating the reported hours are accurate, the service was provided in accordance with the provider care plan, and the service was to the participant’s satisfaction; or

(2) Certification that the service was provided in accordance with the electronic visit verification requirement of 42 USC 1396b(l) and the provider care plan and the service was to the participant’s satisfaction.

(f) The documentation required by this section shall be made available to the department upon request.

(g) The documentation required by this section shall be maintained for a period of at least 6 years from the date of service or until the resolution of any legal action(s) commenced during the 6 year period, whichever is longer.

History

(See Revision Note at part heading for He-E 801) #9969, eff 8-8-11; ss by #12830, INTERIM, eff 8-7-19, EXPIRED: 2-3-20
#13340, eff 1-29-22 (formerly He-E 801.30)

N.H. Code Admin. R. Ann. He-E 801.34 Payment for Services {#sec-he-e-801.34 omnilex-key=us-nh-regs-official--agency-he-e--He-E 801.34}

(a) Providers shall submit all initial claims to the medicaid fiscal agent, so that the fiscal agent receives the claims no later than one year from the earliest date of service on the claim.

(b) If a provider submitted a claim during the one-year billing period and the claim is subsequently rejected by the fiscal agent, the provider shall resubmit the claim within 15 months from the earliest date of service to receive reimbursement.

(c) If medicaid does not pay a provider for medicaid coverable services, supplies, or equipment due to the billing practices of the provider, the provider shall not bill the participant for the item(s), service(s) or supplies.

(d) Payment to providers of CFI waiver services shall be made in accordance with rates established by the department in accordance with RSA 161:4, VI(a) and RSA 126-A:18-a, as applicable.

History

#12610, eff 8-23-18; ss by #12830, INTERIM, eff 8-07-19, EXPIRED: 2-3-10
#13340, eff 1-29-22 (formerly He-E 801.31)

N.H. Code Admin. R. Ann. He-E 801.35 Utilization Review and Control {#sec-he-e-801.35 omnilex-key=us-nh-regs-official--agency-he-e--He-E 801.35}

The department shall monitor utilization of CFI waiver services to identify, prevent, and correct potential occurrences of fraud, waste, and abuse in accordance with 42 CFR 455, 42 CFR 456, He-W 520, 42 CFR 1001, and He-E 801.

History

#13340, eff 1-29-22 (formerly He-E 801.32)

N.H. Code Admin. R. Ann. He-E 801.36 Third Party Liability {#sec-he-e-801.36 omnilex-key=us-nh-regs-official--agency-he-e--He-E 801.36}

(a) All third party obligations shall be exhausted before medicaid is billed, in accordance with 42 CFR 433.139.

(b) All providers shall determine if third party liability exists and file a claim with the third party before billing medicaid.

(c) If third party liability exists, and the provider is not enrolled with the third party in a manner that allows the provider to submit a claim for service, the provider shall not bill medicaid or the CFI participant.

History

#13340, eff 1-29-22 (formerly He-E 801.33)

N.H. Code Admin. R. Ann. He-E 801.37 Waivers {#sec-he-e-801.37 omnilex-key=us-nh-regs-official--agency-he-e--He-E 801.37}

(a) An applicant, case manager, provider agency, participant, or guardian, may request a waiver of specific procedures outlined in this part using the form titled BEAS 3865 “Choices for Independence Program Waiver Request Form.” (January 2022) The case management agency or provider agency shall submit the request in writing to (c) below.

(b) A completed waiver request form shall be signed by:

(1) The participant or the participant’s legal representative indicating agreement with the request; and

(2) The case manager and provider agency executive director or designee recommending approval of the waiver.

Bureau of Elderly and Adult 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 within 30 calendar days if the alternative proposed by the requesting entity meets the objective or intent of the applicable section of this part, and it:

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

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

(3) All required criminal records checks have been completed no earlier than a year before the date of the waiver request; and

(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 the waiver was sought.

(g) Waivers shall be granted in writing and shall not expire except as in (h) and (i) below.

(h) Those waivers which relate to other issues relative to the health, safety, or welfare of participants that require periodic reassessment shall be effective for one year 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 department. Such request shall be made at least 90 calendar days prior to the expiration of a current waiver and shall be granted in accordance with paragraphs (a) through (f) above.

History

#13340, eff 1-29-22 (formerly He-E 801.34)

Part He-E 802 Nursing Facility Services

N.H. Code Admin. R. Ann. He-E 802.03 Medical Assistance {#sec-he-e-802.03 omnilex-key=us-nh-regs-official--agency-he-e--He-E 802.03}

He-E 802.08

N.H. Code Admin. R. Ann. He-E 802.04 Medical Assistance {#sec-he-e-802.04 omnilex-key=us-nh-regs-official--agency-he-e--He-E 802.04}

He-E 802.09

N.H. Code Admin. R. Ann. He-E 802.05 Medical Assistance {#sec-he-e-802.05 omnilex-key=us-nh-regs-official--agency-he-e--He-E 802.05}

He-E 802.04

N.H. Code Admin. R. Ann. He-E 802.10 Medical Assistance {#sec-he-e-802.10 omnilex-key=us-nh-regs-official--agency-he-e--He-E 802.10}

He-E 802.11

N.H. Code Admin. R. Ann. He-E 802.11 Medical Assistance {#sec-he-e-802.11 omnilex-key=us-nh-regs-official--agency-he-e--He-E 802.11}

He-E 802.12

N.H. Code Admin. R. Ann. He-E 802.12 Medical Assistance {#sec-he-e-802.12 omnilex-key=us-nh-regs-official--agency-he-e--He-E 802.12}

He-E 802.13

N.H. Code Admin. R. Ann. He-E 802.13 Medical Assistance {#sec-he-e-802.13 omnilex-key=us-nh-regs-official--agency-he-e--He-E 802.13}

He-E 802.14

N.H. Code Admin. R. Ann. He-E 802.14 Medical Assistance {#sec-he-e-802.14 omnilex-key=us-nh-regs-official--agency-he-e--He-E 802.14}

He-E 802.15

N.H. Code Admin. R. Ann. He-E 802.15 Medical Assistance {#sec-he-e-802.15 omnilex-key=us-nh-regs-official--agency-he-e--He-E 802.15}

-802.17 He-E 802.16

N.H. Code Admin. R. Ann. He-E 802.18 Medical Assistance {#sec-he-e-802.18 omnilex-key=us-nh-regs-official--agency-he-e--He-E 802.18}

He-E 802.17

N.H. Code Admin. R. Ann. He-E 802.19 Medical Assistance {#sec-he-e-802.19 omnilex-key=us-nh-regs-official--agency-he-e--He-E 802.19}

He-E 802.07

The prior filings affecting the repealed rules He-E 802.06, 802.07 and 802.09 included the following documents:

#7751, effective 8-17-02, EXPIRED 8-17-10

#9786, INTERIM, effective 9-20-10

The prior filings affecting the repealed rule He-E 802.08 included the following documents:

#7751, effective 8-17-02

#8523, effective 1-1-06

The source notes in He-E 802 below which have been renumbered by Document #9888-A include the former rule number, and the documents cited apply to the former rule number.

N.H. Code Admin. R. Ann. He-E 802.01 Definitions {#sec-he-e-802.01 omnilex-key=us-nh-regs-official--agency-he-e--He-E 802.01}

(a) “Activities of daily living (ADLs)” means the primary activities necessary to carry out daily self-care activities involving eating, toileting, transferring, bathing, dressing, and continence.

(b) “Atypical services” means services provided by a nursing facility, or a distinct part of a nursing facility, which possesses the physical characteristics and appropriate staffing for, and devotes its services exclusively to, highly specialized care.

(c) “Bed-hold” means the right of an individual to resume nursing facility residency after he or she has been away from the facility due to hospitalization or therapeutic leave.

(d) “Bureau” means the bureau of adult and aging services (BAAS) within the NH department of health and human services that administers programs that serve elderly and disabled adults.

(e) “Centers for Medicare and Medicaid Services (CMS)” means the federal agency within the U.S. Department of Health and Human Services that administers the Medicare and Medicaid programs.

(f) “Cognitive rehabilitation” means a program for brain-injured individuals that is designed to improve physical and cognitive abilities, decrease the disabling effects, and support behavioral stability, and social reintegration.

(g) “Coma management” means a program provided for brain-injured individuals in order to increase their level of physical ability, maintain optimal health and nutrition, and, where possible, increase cognitive awareness.

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

(i) “Discharge” means “discharge” as defined in RSA 151:19, I-a.

(j) “Division of long term supports and services” means a division within the NH department of health and human services that administers long-term care and home and community based programs that serves chronically ill and disabled persons.

(k) “Extensive specialized care” means specific therapies for the treatment of an individual experiencing an acute episode of behavioral symptoms that necessitates supervision by trained mental health professionals that is directed toward improving the resident’s problematic behavioral symptoms.

(l) “Institution for individuals with intellectual disabilities or persons with related conditions” means “institution for individuals with intellectual disabilities or persons with related conditions” as defined in 42 CFR 435.1010.

(m) “Institution for mental diseases (IMD)” means “institution for mental diseases” as defined in 42 CFR 435.1010.

(n) “Legal representative” means one of the following individuals, duly appointed or designated in the manner required by law to act on behalf of another individual, and who is acting within the scope of his/her authority:

(1) An attorney;

(2) A guardian or conservator;

(3) An agent acting under a power of attorney;

(4) An authorized representative acting on behalf of an applicant in some or all of the aspects of initial and continuing eligibility in accordance with He-W 603.01; or

(5) A representative acting on behalf of another individual pursuant to RSA 161-I, Personal Care Services.

(o) “Licensed practitioner” means:

(1) Medical doctor;

(2) Physician’s assistant;

(3) Advanced practice registered nurse (APRN);

(4) Doctor of osteopathy;

(5) Doctor of naturopathic medicine; or

(6) Anyone else with diagnostic and prescriptive powers licensed by the appropriate New Hampshire licensing board.

(p) “Long-term care” means those health-related services provided in a nursing facility that are above the level of room and board, but below the level of skilled care.

(q) “Medical monitoring and nursing care” means clinical monitoring, provided on a daily basis by a licensed nurse, of disease processes that are currently being treated, including both stable and unstable conditions, in order to assess or supervise a chronic health problem, or assess episodes of acute illness, which might include monitoring of the effects of medication, or both.

(r) “Medication administration” means provision of one or more doses of medication to a resident by a person qualified by law or rule to administer medication.

(s) “Minimum data set (MDS)” means a current version, as specified by CMS, of a minimum set of screening and assessment elements, including common definitions and coding categories that form the foundation of the comprehensive assessment provided to all residents of facilities certified to participate in Medicare or Medicaid.

(t) “Nursing facility (NF)” means an institution or a distinct part of an institution that is:

(1) Participating in the Medicaid program;

(2) Meeting the requirements of Section 1919 of the Social Security Act, 42 USC 1396r;

(3) Not primarily an IMD or an institution for individuals with intellectual disabilities or persons with related conditions; and

(4) Providing one or more of the following:

a. Skilled nursing care and related services for residents who require medical or nursing care;

b. Rehabilitative services for the rehabilitation of injured, disabled or sick individuals; or

c. Health-related care and services to individuals who, because of their mental or physical condition, require care and services that are above the level of room and board, and that can be made available to them only through an institution.

(u) “Rehabilitative services” means nursing interventions that:

(1) Promote the resident’s ability to adapt and adjust to living as independently and safely as possible;

(2) Actively focus on achieving and maintaining optimal physical, mental and, psychosocial functioning; and

(3) Include nursing interventions as set forth in the current version of the MDS.

(v) “Reserved bed day” means a 24-hour period, midnight to midnight, when the resident of a nursing facility is not present during the midnight census at the conclusion of the day, and that is chargeable to Medicaid.

(w) “Resident” means a person residing in a nursing facility.

(x) “Self-administration” means an act whereby an individual administers his or her own medications.

(y) “Skilled professional medical personnel” means “skilled professional medical personnel” as defined in RSA 151-E:3.

(z) “Skilled nursing care” means those health related services, above the level of room and board, which meet the criteria used by the Medicare program for skilled nursing care, per 42 USC 1395i3.

(aa) “Swing-bed” means a bed within a hospital or critical access hospital participating in Medicare that is approved by CMS at a skilled level of care.

(ab) “Therapeutic leave” means one or more days when the resident is absent from the nursing facility for reasons stipulated in the resident’s plan of care, but not for purposes of hospitalization or transfer to another facility.

(ac) “Transfer” means “transfer” as defined in RSA 151:19, VII.

History

#7751, eff 8-17-02, EXPIRED: 8-17-10
#9786, INTERIM, eff 9-20-10; ss by #9888-A, eff, 3-19-11, EXPIRED: 3-19-19
#12741, INTERIM, eff 3-20-19, EXPIRED: 9-16-19
#13130, eff 10-30-20

N.H. Code Admin. R. Ann. He-E 802.02 Provider Participation {#sec-he-e-802.02 omnilex-key=us-nh-regs-official--agency-he-e--He-E 802.02}

(a) All NFs, and all hospitals containing swing beds, shall:

(1) Be licensed pursuant to RSA 151 and He-P 803;

(2) Be enrolled as New Hampshire Medicaid providers; and

(3) Meet the Medicare certification criteria for skilled nursing care.

(b) All NFs shall inform the bureau via a “Change of Status/Transfer/Discharge Form”, incorporated by reference in He-E 802.19(a), of any change in the resident’s status, including:

(1) Source of reimbursement;

(2) Death of the resident;

(3) Transfer to a different facility;

(4) Transition to a community setting; and

(5) Admission to a nursing facility while receiving waiver services.

(c) An individual’s history and a physical shall be submitted with the “Change of Status” form if the form is completed for an individual who is admitted to a facility while receiving waiver services.

(d) The “Change of Status” form in (b) above shall be submitted within 5 business days of the change, except that a transition to a community setting shall require notification no later than 14 days prior to the discharge date from the facility.

History

#7751, eff 8-17-02, EXPIRED: 8-17-10
#9786, INTERIM, eff 9-20-10; ss by #9888-A, eff 3-19-11, EXPIRED: 3-19-19
#12741, INTERIM, eff 3-20-19, EXPIRED: 9-16-19
#13130, eff 10-30-20

N.H. Code Admin. R. Ann. He-E 802.03 Eligibility {#sec-he-e-802.03 omnilex-key=us-nh-regs-official--agency-he-e--He-E 802.03}

(a) An individual shall be eligible to receive NF services if he or she:

(1) Submits a signed and dated application, as defined in He-W 601.01(p), to the department;

(2) Has been determined financially eligible as either categorically needy or medically needy;

(3) Meets the clinical eligibility requirements for nursing facility care in RSA 151-E:3, I(a), namely, the person requires 24-hour care for one or more of the following purposes, as determined by a skilled professional medical personnel appropriately trained to use an assessment instrument and employed by the department, or a designee acting on behalf of the department:

a. Medical monitoring and nursing care when the skills of a licensed medical professional are needed to provide safe and effective services;

b. Restorative nursing or rehabilitative care with patient-specific goals;

d. Assistance with 2 or more ADLs involving eating, toileting, transferring into or out of a bed or chair, bathing, dressing, and continence; and

(4) Has chosen, or whose representative has chosen, by signing the application in (1) above, NF services.

(b) An individual who requires review in accordance with He-M 1302 shall be reviewed in accordance with He-M 1302 prior to an eligibility determination being made pursuant to this rule.

History

(See Revision Note at part heading for He-E 802) #9888-A, eff 3-19-11, EXPIRED: 3-19-19
#12741, INTERIM, eff 3-20-19, EXPIRED: 9-16-19
#13130, eff 10-30-20

N.H. Code Admin. R. Ann. He-E 802.04 Eligibility Criteria for Atypical Services {#sec-he-e-802.04 omnilex-key=us-nh-regs-official--agency-he-e--He-E 802.04}

(a) Services in a skilled nursing care or atypical services unit shall be available to individuals who meet the clinical eligibility requirements in He-E 802.03 and this section, and whose clinical assessment required by He-E 802.05(a)(1)b. includes documentation of the individual’s rehabilitative potential and goals.

(b) Eligibility for atypical services shall not begin prior to the date of the completed nursing assessment instrument pursuant to He-E 802.05(a) below.

(c) Eligibility for short-term skilled nursing care or rehabilitative services shall be determined in accordance with the following criteria:

(1) The individual requires daily skilled nursing care or rehabilitative services, or both; and

(2) The individual has or is one or more of the following:

a. An acquired, non-degenerative brain injury resulting in residual deficits and disability;

b. An injury which occurred within one year of the date of admission to the skilled nursing care or rehabilitation unit, or in the alternative, has an injury older than one year of such admission which is expected to show significant improvement with treatment based on the assessment in (a) above; or

c. Ventilator-dependent or has other specific needs that require extensive nursing or rehabilitative services 24 hours per day.

(d) Eligibility for atypical non-behavioral long-term care services shall be determined in accordance with the following criteria:

(1) The individual requires daily nursing care or rehabilitative services, or both;

(2) The individual requires one of the covered services listed in He-E 802.09; and

(3) The individual has or is one or more of the following:

a. An acquired, non-degenerative brain injury resulting in residual deficits and disability;

b. An injury which occurred within one year of the date of admission to the non-behavioral unit, or in the alternative, has an injury older than one year of such admission which will show significant improvement with treatment based on the assessment in (a) above; or

c. Ventilator-dependent or has other specific needs that require extensive nursing or rehabilitative services 24 hour per day.

(e) Eligibility for atypical behavioral long-term care services shall be determined in accordance with the following criteria:

(1) The individual meets one or both of the following criteria:

a. Has had a psychiatric evaluation completed by a psychiatrist within 30 days prior to admission to the behavioral unit, and the evaluation indicates:

Evidence of current behavioral symptoms; or
Evidence of current and severe manifestations of behavioral problems that interfere with daily living situations; or

b. Has been diagnosed with one or more diseases that:

Have an impact on the individual’s ability to perform ADLs, cognitive status, mood or behavior status, medical treatments, nursing monitoring or risk of death; and
Consist of conditions that are addressed in the current plan of care developed by the NF currently treating the individual or a prospective NF; and

(2) Based on the MDS completed upon admission in accordance with 42 CFR 483.20, has:

a. A combined score that is less than or equal to 2 on the questions relative to:

Ability to understand others;
Short-term memory; and
Cognitive skills for decision making; and

b. An ADL score that is less than or equal to 10.

(f) The following shall apply to eligibility for and authorization for placement in a swing bed:

(1) The bureau shall authorize placement in a swing bed on either a temporary basis or a pending placement basis when there is no NF bed available;

(2) For a temporary placement in a short-term care swing bed:

a. The individual shall meet the eligibility criteria in (b) above; and

b. The bureau shall determine, in consultation with the hospital in which the individual is currently placed, that such temporary placement is appropriate;

(3) For a pending placement in a short-term care swing bed, the individual shall meet the eligibility criteria in (b) above; and

(4) For a pending placement in a long-term care swing bed, the individual shall meet the eligibility criteria in (c) or (d) above.

History

#7751, eff 8-17-02; amd by #8523, eff 1-1-06, amd by #9786, INTERIM, eff 9-20-10; ss and renumbered by #9888-A, eff 3-19-11, EXPIRED: 3-19-19 (formerly He-E 802.05)
#12741, INTERIM, eff 3-20-19, EXPIRED: 9-16-19
#13130, eff 10-30-20

N.H. Code Admin. R. Ann. He-E 802.05 Clinical Eligibility Determination for NF Services {#sec-he-e-802.05 omnilex-key=us-nh-regs-official--agency-he-e--He-E 802.05}

(a) The department shall make the clinical eligibility determination of the applicant as follows:

(1) Skilled professional medical personnel appropriately trained to use the assessment instrument and employed by the department or designated by the department shall:

a. Conduct an on-site, face-to-face visit with the applicant;

b. Perform a clinical assessment of the applicant; and

c. Develop a list of identified needs for the applicant; and

(2) The applicant shall sign the following:

a. A consent for receiving NF services, as applicable;

b. An authorization for release of information, as applicable; and

c. An authorization for release of protected health information, as applicable.

(b) Pursuant to RSA 151-E:3, IV, if the department is unable to determine an applicant clinically eligible based on the assessment in (a) above, the department shall send notice to the applicant and the applicant’s licensed practitioner(s), as applicable, requesting additional clinical information within 30 calendar days of the notice and stating that the failure to submit the requested information will impede processing of the application and delay service delivery.

(c) Within the 30 day period in (b) above, if the requested information is not received within 20 calendar days, the department shall send a second notice to the applicable licensed practitioner(s) with a copy to the applicant requesting the information.

(d) Upon request from the treating licensed practitioner or applicant, the department shall extend the deadline in (b) above for a maximum of 30 days if the practitioner or applicant states that he or she has documentation that supports eligibility and will provide it within that time period.

(e) If the information required by (b) above is not received by the date specified in the notice, or as extended by the department in accordance with (d) above, clinical eligibility shall be denied pursuant to RSA 541-A:29.

(f) The applicant shall be determined clinically eligible if it is determined that the applicant meets the financial eligibility requirements described in He-W 600 and the clinical eligibility requirements of He-E 802.03 and 802.04.

(g) Upon a determination of eligibility, the applicant or his or her representative and the NF shall be sent an approval notice, including:

(1) The type of services approved, based on criteria described in He-E 802.04;

(2) The name of the facility where the individual will be receiving care; and

(3) The eligibility start date and, if applicable, the service end date.

(h) Upon a determination of ineligibility, because the applicant does not meet the eligibility requirements of He-E 802.03 and He-E 802.04 or because required information is not received pursuant to (e) above, the applicant or his or her representative and the NF shall be sent a notice of denial, including:

(1) A statement regarding the reason and legal basis for the denial;

(3) An explanation that an applicant who is denied services and who chooses to appeal this denial pursuant to He-C 200 shall not be entitled to Medicaid payments for NF services pending the appeal hearing decision; and

(4) The medical credentials of the skilled professional medical personnel making the determination of ineligibility.

(i) If an administrative appeal is requested and the result is a reversal of the bureau’s decision, retroactive payment shall be made to the NF or, if the individual is occupying a swing bed, to the hospital where the swing bed is located.

History

(See Revision Note at part heading for He-E 802) #9888-A, eff 3-19-11, EXPIRED: 3-19-19
#12741, INTERIM, eff 3-20-19, EXPIRED: 9-16-19
#13130, eff 10-30-20

N.H. Code Admin. R. Ann. He-E 802.06 Request for Clinical Redetermination After Clinical Denial {#sec-he-e-802.06 omnilex-key=us-nh-regs-official--agency-he-e--He-E 802.06}

An applicant or participant may reapply at any time following a denial, termination of services, or change in level or frequency of services, and eligibility shall be determined in accordance with He-E 802.03, He-E 802.04, and He-E 802.05.

History

(See Revision Note at part heading for He-E 802) #9888-A, eff 3-19-11, EXPIRED: 3-19-19
#12741, INTERIM, eff 3-20-19, EXPIRED: 9-16-19
#13130, eff 10-30-20

N.H. Code Admin. R. Ann. He-E 802.07 Utilization Review {#sec-he-e-802.07 omnilex-key=us-nh-regs-official--agency-he-e--He-E 802.07}

(a) The bureau shall conduct utilization reviews for continued placement as described in this section.

(b) For individuals approved to receive short-term skilled nursing care or rehabilitative services, the following shall apply:

(1) The initial authorization shall be for up to 30 days;

(2) The individual shall be eligible for up to 2 additional 30-day authorization periods, based on a utilization review conducted by the bureau;

(3) The NF shall submit to the bureau a completed “Utilization Review Form”, incorporated by reference in He-E 802.19(b), and any supporting documentation no later than 14 days prior to the end of the current authorization period; and

(4) The bureau shall determine continued placement authorization if, based on the documentation in (3) above, the eligibility criteria in He-E 802.04(b) are met.

(1) The initial authorization shall be for one year;

(2) The individual shall be eligible for additional one-year authorization periods, based on a utilization review conducted by the bureau;

(3) The NF shall submit to the bureau a completed assessment pursuant to He-E 802.05(a)(1)b. and any supporting documentation no later than 14 days prior to the end of the current authorization period; and

(4) The bureau shall determine continued placement authorization if, based on the documentation in (3) above, the eligibility criteria in He-E 802.04(c) are met.

(d) For individuals approved to receive atypical behavioral long-term care services, the following shall apply:

(1) The initial authorization shall be for 6 months;

(2) The individual shall be eligible for an additional 6-month authorization period for a total of one year, after which additional authorization periods shall be for one year, based on a utilization review conducted by the bureau;

(3) The NF shall submit to the bureau, no later than 14 days prior to the end of the current authorization period, a completed “Utilization Review Form”, incorporated by reference in He-E 802.19(b), and the following supporting documentation:

a. A psychological evaluation;

b. A behavioral plan;

c. The bureau’s “Memory and Behavior Checklist”, incorporated by reference in He-E 802.19(c); and

d. A behavior summary which:

Includes the same information as the bureau’s “Behavior Summary Report”, incorporated by reference in He-E 802.19(d); and
Describes the recommended transition plan from the behavioral unit;

(4) The supporting documentation in (3) above shall have been completed no earlier than 30 days prior to its submission;

(5) After one year, in addition to the documentation in (3) above, the facility shall also submit to the bureau a completed assessment pursuant to He-E 802.05(a)(1)b.; and

(6) The bureau shall determine continued placement authorization if, based on the documentation in (3)-(5) above, the eligibility criteria in He-E 802.04(d) are met.

(e) For individuals authorized for placement in a swing bed, the following shall apply:

(1) For residents with a temporary placement, the requirements in (b) above shall apply; and

(2) For residents with a pending placement, the following shall apply:

a. The initial authorization shall be for 30 days;

b. The individual shall be eligible for additional 30-day authorization periods, based on a utilization review conducted by the bureau;

c. The NF shall submit to the bureau a completed “Utilization Review Form”, incorporated by reference in He-E 802.19(b), and any supporting documentation no later than 14 days prior to the end of the current authorization period; and

d. The bureau shall determine continued placement authorization if, based on the documentation in c. above, the eligibility criteria in He-E 802.04(e) are met.

(f) If the NF fails to submit timely utilization review documentation and supporting documentation in accordance with this section, the authorization for services and the payment for services provided shall end.

(g) When, as a result of utilization review, the medical condition of a resident in a specific placement no longer meets the criteria specified in He-E 802.04 for the specific placement, a notice of the determination and the right to request an appeal shall be sent to the resident and the NF, pursuant to He-E 802.05(h).

History

#7751, eff 8-17-02, EXPIRED: 8-17-10
#9786, INTERIM, eff 9-20-10; ss and renumbered by #9888-A, eff 3-19-11, EXPIRED: 3-19-19 (formerly He-E 802.19)
#12741, INTERIM, eff 3-20-19, EXPIRED: 9-16-19
#13130, eff 10-30-20

N.H. Code Admin. R. Ann. He-E 802.08 Covered Services {#sec-he-e-802.08 omnilex-key=us-nh-regs-official--agency-he-e--He-E 802.08}

(a) Pursuant to 42 CFR 483, the following services shall be covered NF services:

(1) Nursing services in accordance with 42 CFR 483.35, including:

a. Services provided to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident, as determined by resident assessments and individual plans of care; and

b. Services provided on a 24-hour basis in accordance with resident care plans;

(2) Food and nutrition services in accordance with 42 CFR 483.60, including:

a. Providing each resident with a nourishing, palatable, well-balanced diet that meets the daily nutritional and special dietary needs of each resident;

b. Employing a qualified dietician either full-time, part-time, or on a consultant basis; and

c. Providing therapeutic diets, as prescribed by the attending physician;

(3) Activities program services in accordance with 42 CFR 483.24(c)(2), including an ongoing program of activities directed by a qualified professional and designed to meet, in accordance with the residents’ assessments, the interests and the physical, mental, and psychosocial well-being of each resident;

(4) Medically related social services, in accordance with 42 CFR 483.40, including:

a. Services provided to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident; and

b. Employing a qualified social worker if the NF has more than 120 beds;

(5) A non-private room;

(6) The provision of routine personal generic or over the counter (OTC) hygiene items and services as required to meet the needs of residents, including, but not limited to the following:

a. Hygiene supplies;

b. Comb;

c. Brush;

d. Bath soap;

e. Disinfecting soaps or specialized cleansing agents when indicated to treat special skin problems or to fight infection;

f. Razor, and shaving cream;

g. Toothbrush, toothpaste, and dental floss;

h. Denture adhesive and denture cleaner;

i. Lotion;

j. Tissues, cotton balls, and cotton swabs;

k. Deodorant;

l. Incontinence care and supplies;

m. Sanitary napkins and related supplies;

n. Towels, washcloths, and hospital gowns;

o. Drugs;

p. Hair and nail hygiene services;

q. Bathing assistance; and

r. Basic personal laundry;

(7) Specialized rehabilitative services in accordance with 42 CFR 483.65, including, but not limited to, physical therapy, speech-language pathology, occupational therapy, respiratory therapy including oxygen, laboratory, radiology, mental health services, and those ancillary services listed in He-E 806.06, and provided by the NF or obtained by the NF from a qualified outside provider;

(8) Dental services in accordance with 42 CFR 483.55, including:

a. Providing or obtaining from an outside providers routine dental services to the extent covered by the New Hampshire Medicaid state plan pursuant to He-W 566;

b. Providing or obtaining from an outside provider emergency dental services; and

c. Assistance with:

Making dental appointments;
Arranging for transportation to and from the dentist’s office; and
Prompt referrals to a dentist for lost or damaged dentures;

(9) Pharmacy services in accordance with 42 CFR 483.45 including:

a. Following procedures that assure the accurate acquiring, receiving, dispensing, and administering of all drugs and biologicals to meet the needs of each resident;

b. Medical supplies, FDA approved pharmaceutical items, and FDA approved non-legend drugs, that is, drugs prescribed by a licensed practitioner that are normally purchased OTC, which are stocked at nursing stations or on the floor in gross supply and distributed individually in small quantities to meet the needs of each resident; and

c. Pharmacy service consultation of a licensed pharmacist;

(10) Physician services in accordance with 42 CFR 483.30;

(11) Specialized services in accordance with 42 CFR 483.120 for residents with an intellectual disability or mental illness; and

(12) Behavioral health services in accordance with 42 CFR 483.40.

(b) The services in (a) above shall be covered to the extent that they are required in each resident’s care plan.

History

#7751, eff 8-17-02, EXPIRED: 8-17-10
#9786, INTERIM, eff 9-20-10; ss and renumbered by #9888-A, eff 3-19-11, EXPIRED: 3-19-19 (formerly He-E 802.03)
#12741, INTERIM, eff 3-20-19, EXPIRED: 9-16-19
#13130, eff 10-30-20

N.H. Code Admin. R. Ann. He-E 802.09 Covered Atypical Services {#sec-he-e-802.09 omnilex-key=us-nh-regs-official--agency-he-e--He-E 802.09}

(a) The following shall be covered in an atypical non-behavioral long-term care unit:

(1) Coma management services;

(2) Cognitive rehabilitation service shall be available and continue for as long as progressive, significant, and measurable improvement is documented by the NF and verified by the bureau in accordance with He-E 802.07;

(3) Care, treatment, and management of residents who are ventilator-dependent;

(4) Care, treatment, and management of residents who require nursing intervention to provide enteral nutrition services; and

(5) Care, treatment, and management of residents who require nursing interventions of a highly specialized nature.

(b) An atypical behavioral long-term care unit shall provide extensive specialized care in behavioral approaches which meet the needs addressed in the resident’s behavior modification plan.

History

#7751, eff 8-17-02, EXPIRED: 8-17-10
#9786, INTERIM, eff 9-20-10; ss and renumbered by #9888-A, eff 3-19-11, EXPIRED: 3-19-19 (formerly He-E 802.04)
#12741, INTERIM, eff 3-20-19, EXPIRED: 9-16-19
#13130, eff 10-30-20

N.H. Code Admin. R. Ann. He-E 802.10 Non-Covered Services {#sec-he-e-802.10 omnilex-key=us-nh-regs-official--agency-he-e--He-E 802.10}

(a) Pursuant to 42 CFR 483.10(f)(11)(ii)(A)-(L), the following items and services shall not be covered:

(1) Utilities to include telephone, internet, and cable;

(2) Television and radio for personal use;

(3) Personal comfort items, including smoking materials, lotions and novelties, and confections;

(4) Cosmetic and grooming items and services in excess of those covered under He-E 802.08(a)(6);

(5) Personal clothing;

(6) Personal reading materials;

(7) Gifts purchased on behalf of a resident;

(8) Flowers and plants;

(9) Social events and entertainment offered outside the scope of the activities program, provided under He-E 802.08(a)(3);

(10) Non-covered special care services such as privately hired nurses or aides;

(11) Private room, except when therapeutically required, for example, isolation for infection control;

(12) Specially prepared or alternative food requested instead of the food generally prepared by the facility, as required by He-E 802.08(a)(2); and

(13) Barber and beauty services.

History

(See Revision Note at part heading for He-E 802) #9888-A, eff 3-19-11, EXPIRED: 3-19-19
#12741, INTERIM, eff 3-20-19, EXPIRED: 9-16-19
#13130, eff 10-30-20

N.H. Code Admin. R. Ann. He-E 802.11 Residents’ Rights {#sec-he-e-802.11 omnilex-key=us-nh-regs-official--agency-he-e--He-E 802.11}

(a) Prior to or upon the resident’s admission to the NF, and annually thereafter, the NF shall inform the resident and his or her legal representative both orally and in writing, and in a language that the resident understands, of his or her rights, including the rights of residents in the event of a proposed transfer or discharge from the NF, in accordance with 42 CFR 483.10 and RSA 151:26, and of all rules and regulations governing resident conduct and responsibilities during the resident’s stay in the NF.

(b) Receipt of the information in (a) above, and any amendments to it, shall be acknowledged in writing by the resident or his or her legal representative.

(c) A NF shall establish and maintain identical policies and practices for all residents, regardless of the payment source, regarding transfers, discharges, and the provision of services.

History

#7751, eff 8-17-02, EXPIRED: 8-17-10
#9786, INTERIM, eff 9-20-10; ss and renumbered by #9888-A, eff 3-19-11, EXPIRED: 3-19-19 (formerly He-E 802.10)
#12741, INTERIM, eff 3-20-19, EXPIRED: 9-16-19
#13130, eff 10-30-20

N.H. Code Admin. R. Ann. He-E 802.12 Planning and Implementation of Care {#sec-he-e-802.12 omnilex-key=us-nh-regs-official--agency-he-e--He-E 802.12}

(a) The NF shall develop and implement a plan of care in accordance with 42 CFR 483.10 (c). The plan of care shall be part of the NF’s permanent resident record. The resident has the right to participate in the development and implementation of his or her plan of care.

(b) The plan of care shall be updated at least every 90 days by the physician and other personnel involved in the care of the resident.

(1) The resident’s:

a. Full name;

b. Address;

c. Gender;

d. Date of birth;

e. Identification number;

f. Admission date; and

g. Any other pertinent identifying information;

(2) Diagnosis, symptoms, complaints, and complications indicating the need for admission or continuing care;

(3) The resident’s life history, significant relationships, and personal preferences;

(4) A description of the resident’s functional level;

(5) Written objectives and approaches by responsible personnel, including the dates when goals are achieved;

(6) Orders for:

a. Medications;

b. Treatments;

c. Restorative and rehabilitative services;

d Therapies;

e. Diet;

f. Activities;

g. Social services; and

h. Special procedures designed to meet these objectives;

(7) Progress notes that shall be written at least every 90 days;

(8) Plans for continuing care, including provisions for review and necessary modifications of the plan; and

(9) Discharge planning initiated within 7 days of admission.

(d) When discharge to the community is planned, the NF shall contact the department to ensure targeted transitional case management assignment pursuant to RSA 151-E:17.

History

#7751, eff 8-17-02, EXPIRED: 8-17-10
#9786, INTERIM, eff 9-20-10; ss and renumbered by #9888-A, eff 3-19-11, EXPIRED: 3-19-19 (formerly He-E 802.11)
#12741, INTERIM, eff 3-20-19, EXPIRED: 9-16-19
#13130, eff 10-30-20

N.H. Code Admin. R. Ann. He-E 802.13 Room Changes Within the Facility {#sec-he-e-802.13 omnilex-key=us-nh-regs-official--agency-he-e--He-E 802.13}

(a) The resident shall reside and receive services in the NF with reasonable accommodation of individual needs and preferences, including choice of room and roommate, pursuant to 42 CFR 483.10(e), except when the health or safety of the resident or other residents would be endangered.

(b) A resident may refuse a transfer to another room within the NF if the purpose of the transfer is one of the following:

(1) To relocate a resident of a skilled NF from the distinct part of the NF that is skilled care to a part of the NF that is not skilled care;

(2) To relocate a resident of a NF from the distinct part of the NF that is not skilled care to a part of the NF that is a skilled NF; or

(3) Solely for the convenience of staff pursuant to 42 CFR 483.10(e)(7) iii.

(c) A NF shall provide a resident with written notification before the resident’s room location is changed or before the resident’s roommate is changed.

History

#7751, eff 8-17-02, EXPIRED: 8-17-10
#9786, INTERIM, eff 9-20-10; ss and renumbered by #9888-A, eff 3-19-11, EXPIRED: 3-19-19 (formerly He-E 802.12)
#12741, INTERIM, eff 3-20-19, EXPIRED: 9-16-19
#13130, eff 10-30-20

N.H. Code Admin. R. Ann. He-E 802.14 Personal Accounts Belonging to Residents {#sec-he-e-802.14 omnilex-key=us-nh-regs-official--agency-he-e--He-E 802.14}

(a) A resident shall handle his or her own personal funds unless a legal representative has been appointed in accordance with state law.

(b) The NF shall not require residents to deposit their personal funds with the NF, but when the resident and his or her legal representative chooses to do this, the NF shall manage the resident’s personal funds in accordance with 42 CFR 483.10, RSA 151:24, and He-E 806.39.

(c) The resident’s personal funds shall not be used to pay or supplement payment for any item or service already included in or coverable by Medicaid reimbursement to the NF.

(d) In the event of a resident’s death, the money in the resident’s personal account shall remain in his or her estate in accordance with RSA 151-A:15.

History

#7751, eff 8-17-02, EXPIRED: 8-17-10
#9786, INTERIM, eff 9-20-10; ss and renumbered by #9888-A, eff 3-19-11, EXPIRED: 3-19-19 (formerly He-E 802.13)
#12741, INTERIM, eff 3-20-19, EXPIRED: 9-16-19
#13130, eff 10-30-20

N.H. Code Admin. R. Ann. He-E 802.15 Temporary Absence from the Nursing Facility {#sec-he-e-802.15 omnilex-key=us-nh-regs-official--agency-he-e--He-E 802.15}

(a) A NF shall establish and follow a written policy regarding bed-hold periods which is consistent with RSA 151:25 and which indicates that when a NF has not received payment for a period of temporary absence or when the absence is longer than 10 days:

(1) The resident shall have the option to return to the NF to the next available bed; and

(2) If more than one person has a right of readmission, vacancies shall be allocated on a first request made, first request honored basis, and without regard to the source of payment.

(b) If a resident leaves the NF for any reason, and there is reason to believe that the resident might be absent during the next midnight census, then the following shall apply:

(1) The NF shall provide to the resident and his or her legal representative the NF’s written policy regarding bed-hold periods;

(2) The NF shall document the notification in the resident’s record, along with the resident’s and legal representative’s written agreement to pay, or rejection of the option to pay, for the bed-hold period;

(3) The NF shall not charge an amount in excess of the Medicaid rate to hold a bed for a resident who is on Medicaid; and

(4) If a NF refuses to readmit a resident following an absence for medical treatment or therapeutic leave then a transfer or discharge shall have been deemed to have occurred and the NF shall follow the transfer discharge requirements found in He-E 802.16.

(c) When a resident leaves the NF for medical treatment, the NF shall communicate with the hospital or facility providing the medical treatment to the extent reasonably necessary in order to plan for the resident’s safe and orderly transition back to the NF.

(d) When a resident is absent from a NF due to therapeutic leave, the NF may bill for reserved bed days pursuant to 42 CFR 447.40, subject to the following conditions:

(1) Such days shall be specified in the resident’s plan of care;

(2) The plan of care shall describe provisions for continuity of care while the resident is out of the NF;

(3) Such days shall not be for hospitalization or for transferring to another facility;

(4) The NF may not bill for more than 30 reserved bed days per resident per state fiscal year; and

(5) When a recipient is on reserved bed day status, the department shall not pay separately for any services covered as part of the NF’s rate pursuant to He-E 806.

History

#7751, eff 8-17-02; amd by #8466, eff 10-28-05; amd by #9786, INTERIM, eff 9-20-10; ss and renumbered by #9888-A, eff 3-19-11, EXPIRED: 3-19-19 (formerly He-E 802.14)
#12741, INTERIM, eff 3-20-19, EXPIRED: 9-16-19
#13130, eff 10-30-20

N.H. Code Admin. R. Ann. He-E 802.16 Transfer or Discharge of Residents {#sec-he-e-802.16 omnilex-key=us-nh-regs-official--agency-he-e--He-E 802.16}

(a) The NF shall not transfer or discharge a resident except as allowed in accordance with 42 CFR 483.10, RSA 151:21, V, and RSA 151:26.

(b) Transfer or discharge of a resident shall be preceded by written notice in accordance with RSA 151:26, II, relative to what shall be included in the notice and to whom the notice shall be sent, including the long-term care ombudsman’s office.

(c) Written notice shall also include information regarding the resident’s right to an administrative hearing pursuant to He-C 200, including:

(1) A statement that the hearing is required to be requested in writing by the resident or his or her representative within 30 days of receiving the notice;

(2) A statement indicating that if a request for a hearing is filed within 20 days of receipt of the notice:

a. The resident shall be allowed to remain in the NF until a final decision is made by the administrative appeals unit, except as may be allowable under the provisions of RSA 151:26, II(b); and

b. That if the resident receives Medicaid, payments to the NF shall continue while the appeal is pending; and

(3) With regard to transfers or discharges involving less than 30 days’ notice, a statement informing the resident of his or her right to an expedited hearing, as described in He-E 802.17(d).

(d) No resident shall be transferred or discharged with less than 30 days’ notice from the date the notice of transfer or discharge is received by the resident except as allowed by RSA 151:26, II(b).

(e) When the written notice is delivered to the resident, NF staff shall:

(1) Communicate orally to the resident, in a language he or she understands, all information contained in the written notice, or, if the resident is hearing-impaired or cannot communicate orally due to a disability, consult with the bureau on how to make reasonable accommodation for communicating with the resident;

(2) Offer to help the resident contact a family member, legal representative, the office of the state long term care ombudsman, or any of the organizations identified in the notice; and

(3) Document the date and time of the notification and offer of assistance in the resident’s record.

(f) At the time of notice, the NF shall provide the resident with written material that describes residents’ rights, including the rights of a resident in the event of a proposed transfer or discharge from the facility, and for residents who are 60 years or older, contact information of the provider(s) of legal services under 42 USC 3058 et. seq.

(g) The NF shall document delivery of the notice to the resident by:

(1) Requesting the signature of the resident on a dated statement of receipt, if the resident is able and willing to sign a receipt;

(2) Recording the date of delivery to the resident in the resident’s record; and

(3) Recording whether and when the notice was mailed to the resident’s legal representative or family members.

(h) If less than 30 days’ notice of a transfer or discharge is given as allowed by RSA 151:26, II(b), the facility, in addition to all other requirements in this section, shall:

(1) Provide verbal notice to the resident and his legal representative and to family members in accordance with any instructions or limitations given by the resident;

(2) As soon as possible, follow the verbal notice with written notice to the above-mentioned parties; and

(3) Document the date and time of the notification in the resident’s record.

(i) The NF shall make, and document in the resident’s record, reasonable efforts to work with the resident, the resident’s legal representative, or the resident’s family to resolve any payment problem prior to transfer or discharge.

(j) No resident shall be transferred or discharged unless there is a written transfer or discharge plan, which includes the following:

(1) The circumstances surrounding the discharge or transfer, including alternative interventions initiated by the NF before the facility proposed the discharge or transfer;

(2) All efforts made to locate the resident to the setting of his or her choice, and if the resident’s wishes could not be accommodated, the reasons why;

(3) The location of the new setting and, if a facility, confirmation that the facility has accepted the resident;

(4) A comprehensive description of the medical, social, and rehabilitative needs of the resident and how the resident’s needs will be met in the new setting;

(5) Documentation of consultation with the resident, family, or other interested parties, if and to the extent that this has been reasonably possible; and

(6) Documentation of consultation with the resident’s personal physician or APRN regarding the transfer or discharge.

(k) A copy of the transfer or discharge plan shall be provided to:

(1) The resident and his or her legal representative; and

(2) The office of the state long term care ombudsman.

History

#7751, eff 8-17-02, EXPIRED: 8-17-10
#9786, INTERIM, eff 9-20-10; ss and renumbered by #9888-A, eff 3-19-11, EXPIRED: 3-19-19 (formerly He-E 802.15-He-E 802.17)
#12741, INTERIM, eff 3-20-19, EXPIRED: 9-16-19
#13130, eff 10-30-20

N.H. Code Admin. R. Ann. He-E 802.17 Appealing Transfers or Discharges {#sec-he-e-802.17 omnilex-key=us-nh-regs-official--agency-he-e--He-E 802.17}

(a) Any resident being transferred or discharged, including any resident who asserts that his or her bed-hold right or right to readmission under He-E 802.15 has been denied, may appeal the transfer or discharge in accordance with the provisions contained in these rules and in He-C 200.

(b) The request for an appeal shall be submitted within 30 days after the resident receives written notice of a proposed transfer or discharge, in compliance with He-E 802.17, or within 30 days of the date the resident learns of the right to appeal if the NF fails to provide the required written notice.

(c) If a resident requests a hearing within 20 days after receiving the notice from the NF, the resident’s transfer or discharge shall be suspended until after the hearing decision is issued, and the resident shall not be transferred or discharged from the NF except as allowed under the provisions of He-E 802.16(d).

(d) In the event of a transfer or discharge with less than 30 days-notice under the provisions of He-E 802.16(d), a resident may request an expedited hearing, subject to the following conditions:

(1) The request for an expedited hearing shall be made within 10 calendar days of the notice of transfer or discharge;

(2) An expedited hearing shall be held within 5 working days of the request for hearing; and

(3) The hearing decision shall be issued:

a. Within 3 working days of the hearing if the resident has been moved out of the NF and the resident requested an expedited hearing; or

b. Within 15 working days of the hearing in all other cases.

(e) A hearing may be requested by a resident, his or her legal representative, or anyone acting on behalf of a resident, including a NF, the department, a family member, or a friend.

(f) Any employee or agent of the NF or the department who becomes aware that a resident has expressed a desire to have his or her transfer or discharge reviewed shall assist the resident in writing and submit his or her request for a hearing, or shall submit the request on behalf of the resident if the resident is not able to do so.

(g) The request for a hearing shall be submitted in writing, with a copy of the NF’s notice of transfer or discharge, to:

NH Department of Health and Human Services

Administrative Appeals Unit

105 Pleasant Street

Concord, NH 03301

(h) The resident and the NF shall be considered parties to any appeal filed by a resident contesting a transfer or discharge pursuant to He-C 200.

(i) When feasible, all hearings shall be conducted at the NF where the resident is located.

(j) The resident and his or her legal representative shall:

(1) Upon an oral or written request, be given access to all records pertaining to the resident, including current clinical records, within 24 hours, excluding weekends and holidays; and

(2) After receipt of his or her records for inspection, be allowed to purchase at a cost not to exceed 25 cents per page, photocopies of the records or any portions of them upon request and after providing advance notice of 2 working days to the NF.

(k) A NF seeking to transfer or discharge a resident shall have the burden of proving by clear and convincing evidence, as described in He-C 203.14, that the transfer complies with the requirements of He-E 802.16.

(l) The following actions shall be taken following the administrative appeal unit’s decision:

(1) If the decision upholds the discharge or transfer, the resident shall be relocated;

(2) If the decision does not uphold the discharge or transfer, the resident shall not be relocated;

(3) If the decision to transfer or discharge a resident who has been transferred or discharged pursuant to the provisions of He-E 802.16 is not upheld, the resident shall be readmitted to the NF’s first available bed; and

(4) If the decision to transfer or discharge a resident is upheld, the NF shall adhere to the discharge plan.

History

#7751, eff 8-17-02, EXPIRED: 8-17-10
#9786, INTERIM, eff 9-20-10; ss and renumbered by #9888-A, eff 3-19-11, EXPIRED: 3-19-19 (formerly He-E 802.18)
#12741, INTERIM, eff 3-20-19, EXPIRED: 9-16-19
#13130, eff 10-30-20

N.H. Code Admin. R. Ann. He-E 802.18 Specialized Rate Requests {#sec-he-e-802.18 omnilex-key=us-nh-regs-official--agency-he-e--He-E 802.18}

(a) General NF rate setting shall be calculated in accordance with He-E 806, and requests for specialized rate setting shall be conducted pursuant to this section.

(b) Each NF presenting a case for consideration, whether for in state or for out of state placement, for a specialized rate, shall complete and submit a “Specialized Service Rate Request Form- Nursing Facility” (September 2020) to the department along with:

(1) The individual’s:

a. History and physical;

b. Therapy notes;

c. Transitional plan; and

d. Plan of care; and

(2) Documentation showing the cost of the individual’s care.

(c) The specialized rate request shall be reviewed by a specialized medical professional employed or contracted by the department for clinical appropriateness pursuant to He-E 802.05 above.

(d) The approved specialized rate shall be subject to a periodic utilization review, as requested on the “Specialized Service Rate Request Form-Nursing Facility Services”, in 30 days, 6 months, or annual increments.

(e) Approved rates shall be communicated to the receiving facility by the department.

History

(See Revision Note at part heading for He-E 802) #9888-B, eff 3-19-11; ss by #12741, INTERIM, eff 3-20-19, EXPIRED: 9-16-19
#13130, eff 10-30-20

N.H. Code Admin. R. Ann. He-E 802.19 Required Forms {#sec-he-e-802.19 omnilex-key=us-nh-regs-official--agency-he-e--He-E 802.19}

(a) Each NF informing the department under He-E 802.02(b) shall complete and submit Form 3820, “Change of Status/Transfer/Discharge Form” (September 2020).

(b) Each NF notifying the department under He-E 802.07(b)(3), (d)(3), and (e)(2)c. shall complete and submit Form 277, “Utilization Review Form” (September 2020).

(c) Each NF notifying the department under He-E 802.07(d)(3)c. shall complete and submit Form 3825, “Memory and Behavior Checklist” (September 2020).

(d) Each NF notifying the department under He-E 802.07(d)(3)d. shall submit a behavior summary which includes the same information as the bureau’s Form 3830, “Behavior Summary Report” (September 2020).

(e) Each NF requesting a specialized rate setting shall complete and submit Form “Specialized Service Rate Request Form-Nursing Facility” (September 2020) to the department.

History

#13130, eff 10-30-20 (formerly He-E 802.18)

Part He-E 803 Adult Medical Day Care Services

N.H. Code Admin. R. Ann. He-E 803.01 Purpose. {#sec-he-e-803.01 omnilex-key=us-nh-regs-official--agency-he-e--He-E 803.01}

The purpose of this rule is to describe the requirements relative to adult medical day services reimbursed under Medicaid, including:

(a) Eligibility requirements for individuals seeking adult medical day services; and

(b) Adult medical day program requirements for providing adult medical day services.

History

#7865, eff 5-1-03; ss by #9914, INTERIM, eff 5-1-11, EXPIRES: 10-28-11; ss by #10010, eff 10-28-11, EXPIRED: 10-28-19

N.H. Code Admin. R. Ann. He-E 803.02 Definitions {#sec-he-e-803.02 omnilex-key=us-nh-regs-official--agency-he-e--He-E 803.02}

(a) “Activities of daily living (ADL)” means basic daily routine tasks such as eating, transferring, toileting, bathing, dressing and self-management of medications.

(b) “Adult medical day program” means a program of service delivery conducted at a facility that is licensed under RSA 151 and He-P 818 as an adult day program and provides adult medical day services under Medicaid in accordance with the requirements contained in this rule.

(c) “Adult medical day services” means those services provided at an adult medical day program that are described in He-E 803.06 and provided to eligible participants in accordance with a care plan.

(d) “Care plan” means a written guide developed by the adult medical day program as a result of the assessment described in He-P 818.16 and for the provision of services, based on the written orders from the participant’s licensed practitioner, and in consultation with personnel, the participant, and the participant’s guardian, agent or personal representative, if any, as a result of the assessment and for the provision of care and services.

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

(f) “Illness or disability” means a long term recurring or short term physical, mental, or emotional condition that results in the inability of an individual to perform activities of daily living without the support of the adult medical day program.

(g) “Independent living situation” means one of the following living arrangements where the individual resides:

(1) A home or apartment;

(2) The home or apartment of a spouse/partner, relative, or friend;

(3) A motel or hotel; or

(4) A homeless shelter.

(h) “Legal representative” means one of the following individuals, duly appointed or designated in the manner required by law to act on behalf of another individual, and who is acting within the scope of his/her authority:

(1) An attorney;

(2) A guardian or conservator;

(3) An agent acting under a power of attorney;

(4) An authorized representative acting on behalf of an applicant in some or all of the aspects of initial and continuing eligibility in accordance with He-W 603.01; or

(5) A person designated in accordance with RSA 151:19.

(i) “Licensed practitioner” means:

(1) Medical doctor;

(2) Physician’s assistant;

(3) Advanced practice registered nurse;

(4) Doctor of osteopathy;

(5) Doctor of naturopathic medicine; or

(6) Any other individual with diagnostic and prescriptive powers licensed by the appropriate New Hampshire licensing board.

(j) “Maintenance level therapies” means any of the following repetitive therapeutic services required to maintain maximum functional capabilities, as assessed and established by a professional therapist and rendered by trained personnel:

(1) Physical therapy;

(2) Occupational therapy;

(3) Speech therapy; and

(4) Other therapeutic services.

(k) “Participant” means the Medicaid-eligible individual who attends the adult medical day program as an alternative to institutionalization, and as recommended by his/her licensed practitioner and who meets the eligibility requirements described in He-E 803.04.

(l) “Specialized transportation,” for purposes of this rule, and described in He-E 803.06(b), means conveying the participant from his or her residence to the adult medical day program location or from the program location back to his or her residence, but does not include ambulance or wheelchair van transport.

History

#7865, eff 5-1-03; ss by #9914, INTERIM, eff 5-1-11, EXPIRES: 10-28-11; ss by #10010, eff 10-28-11, EXPIRED: 10-28-19 (from He-E 803.01)

N.H. Code Admin. R. Ann. He-E 803.03 Adult Medical Day Program Requirements {#sec-he-e-803.03 omnilex-key=us-nh-regs-official--agency-he-e--He-E 803.03}

(a) The adult medical day program shall:

(1) Be licensed pursuant to RSA 151 and He-P 818;

(2) Be enrolled as a New Hampshire Medicaid provider with the department;

(3) Provide adult medical day services pursuant to He-P 818 and as described in He-E 803.06;

(4) Have at least one full-time registered nurse (RN), or a licensed practical nurse (LPN), or both, available at the adult medical day program location whenever one or more participants are present;

(5) Prior to the initiation of adult medical day services, determine whether individuals requesting these services meet the eligibility requirements described in He-E 803.04;

(6) Obtain written orders that include a description of the service and the type and frequency needed, from each participant’s licensed practitioner, to be incorporated into the participant’s care plan;

(7) Ensure participants are transported to and from the adult medical day program location by:

a. Ensuring that the participant has made transportation arrangements;

b. Coordinating the participant’s transportation; or

c. Providing specialized transportation as described in He-E 803.06(b);

(8) Refer the participant as necessary to other health and social services such as maintenance level therapies, included in the licensed practitioner’s written orders for the participant, if these services are not available at the adult medical day program location;

(9) Report suspected abuse, neglect, self-neglect and/or exploitation of incapacitated adults as required by RSA 161-F: 46 of the adult protection law;

(10) Comply with provisions of RSA 161-F:49 with regard to checking the names of prospective or current employees, consultants, contractors, or volunteers who may have direct contact with participants against the bureau of elderly and adult services state registry;

(11) Maintain the records pursuant to He-P 818.16 and as described in He-E 803.07; and

(12) Develop and implement the participant’s care plan in accordance with He-P 818.16 and as follows:

a. Include a description of the type and frequency of services needed;

b. Review and update at least every 90 calendar days, or more frequently if there are significant changes in the participant’s health condition; and

c. Obtain the signature of the participant’s licensed practitioner.

History

#7865, eff 5-1-03; ss by #9914, INTERIM, eff 5-1-11, EXPIRES: 10-28-11; ss by #10010, eff 10-28-11, EXPIRED: 10-28-19

N.H. Code Admin. R. Ann. He-E 803.04 Eligibility Requirements to Receive Adult Medical Day Services {#sec-he-e-803.04 omnilex-key=us-nh-regs-official--agency-he-e--He-E 803.04}

(a) An adult medical day program shall be available to anyone:

(1) Who is age 18 or older;

(2) Who is a Medicaid recipient;

(3) Who resides in an independent living situation;

(4) Whose licensed practitioner has:

a. Completed a physical examination on the individual within 60 days prior to the request for services; and

b. Referred the individual for adult medical day services, because the individual:

Has been diagnosed as having an illness or disability; and
Requires adult medical day services; and

(5) Requires adult medical day services for a minimum of 4 hours per day, on a regularly occurring basis.

(b) Adult medical day services shall not be available to anyone:

(1) Who resides in a nursing facility or other licensed or certified facilities;

(2) Who receives adult family care services pursuant to He-E 801.12;

(3) Whose needs cannot met by the adult medical day program; or

(4) Who is primarily seeking services to address a diagnosis of mental illness or developmental disability.

History

#7865, eff 5-1-03; ss by #9914, INTERIM, eff 5-1-11, EXPIRES: 10-28-11; ss by #10010, eff 10-28-11, EXPIRED: 10-28-19 (from He-E 803.03)

N.H. Code Admin. R. Ann. He-E 803.05 Notice to the Participant {#sec-he-e-803.05 omnilex-key=us-nh-regs-official--agency-he-e--He-E 803.05}

The adult medical day program shall notify the individual or his or her legal representative in writing as to whether or not the individual is eligible to receive adult medical day services.

History

#7865, eff 5-1-03; ss by #9914, INTERIM, eff 5-1-11, EXPIRES: 10-28-11; ss by #10010, eff 10-28-11, EXPIRED: 10-28-19

N.H. Code Admin. R. Ann. He-E 803.06 Adult Medical Day Services {#sec-he-e-803.06 omnilex-key=us-nh-regs-official--agency-he-e--He-E 803.06}

(a) The following adult medical day services shall be provided as required by the participant’s care plan:

(1) The services described in He-P 818.15;

(2) Maintenance level therapies;

(3) Medical supplies which are for general use or first aid purposes; and

(4) Transportation services in accordance with He-E 803.03(a)(7).

(b) Specialized transportation shall:

(1) Be available on all of the days that the adult medical day program operates;

(2) Be provided in a manner that will accommodate each participant’s attendance needs within the adult medical day program location’s operating hours;

(3) Include assistance and supervision as needed and in a manner that maintains support as identified in the care plan, including, but not be limited to, the following:

a. Reminding the participant, prior to leaving his or her residence, to bring items needed for the day, such as eyeglasses, medications and clothing appropriate for the weather;

b. Physically assisting the participant to and from the vehicle;

c. Securing the participant in a seatbelt and stopping to resecure if necessary;

d. Providing reassurance as necessary and stopping to address any personal care needs that arise for the participant during the trip;

e. Physically assisting the participant from the vehicle into the adult medical day program location and back to the vehicle; and

f. Assisting the participant from the vehicle back into his or her residence;

(4) Be provided in vehicles that are:

a. Registered pursuant to Saf-C 500;

b. Inspected pursuant to Saf-C 3200; and

c. Insured for personal liability, and medical payments; and

(5) Be provided by individuals who:

a. Have a current and valid driver’s license;

b. Are employees of the adult medical day program or other transportation provider, or volunteers under the supervision of the adult medical day program;

c. Have been given training by the adult medical day program with regard to their responsibilities; and

d. Are informed about participants’ individual needs and safety concerns including those as described in (3) above.

(c) Adult medical day programs shall inform the transportation provider of any pertinent information at the time of the participant’s pick up from the program.

(d) Adult medical day programs providing specialized transportation shall document the transportation services provided to the participant, including, but not limited to:

(1) The dates of service;

(2) The starting and ending locations;

(3) The name(s) of the drivers; and

(4) For each date of service, the type(s) of assistance provided to each participant.

History

#7865, eff 5-1-03; ss by #9914, INTERIM, eff 5-1-11, EXPIRES: 10-28-11; ss by #10010, eff 10-28-11, EXPIRED: 10-28-19

N.H. Code Admin. R. Ann. He-E 803.07 Required Documentation {#sec-he-e-803.07 omnilex-key=us-nh-regs-official--agency-he-e--He-E 803.07}

The adult medical day program shall:

(a) Comply with the documentation requirements, including confidentiality and retention of records in accordance with He-P 818;

(b) Maintain supporting records in accordance with He-W 520;

(d) Maintain documentation to fully support each claim billed for services.

History

#7865, eff 5-1-03; ss by #9914, INTERIM, eff 5-1-11, EXPIRES: 10-28-11; ss by #10010, eff 10-28-11, EXPIRED: 10-28-19 (from He-E 803.08)

N.H. Code Admin. R. Ann. He-E 803.08 Payment for Services {#sec-he-e-803.08 omnilex-key=us-nh-regs-official--agency-he-e--He-E 803.08}

(a) Adult medical day services described He-E 803.06(a) shall be reimbursed:

(1) At a daily rate for all services provided, except for specialized transportation described in He-E 803.03(a)(7)c. and He-E 803.06(b), which shall be reimbursed in accordance with (b) below; and

(2) Only for days when the participant was in attendance at the adult medical day program for a minimum of 4 hours exclusive of time spent in transit or was receiving services not included in the per diem rate.

(b) Adult medical day programs providing specialized transportation, as described in He-E 803.03(a)(7)c. and He-E 803.06(b), shall be reimbursed at a per-person, per-trip rate.

(c) Rates of payment for services described in (a) and (b) above shall be established by the department in accordance with RSA 161:4, VI(a).

(d) Transportation shall not be reimbursed when it is covered by other Medicaid reimbursement for transportation.

(e) Adult medical day programs shall submit all initial claims to the Medicaid fiscal agent, so that the fiscal agent receives the claims no later than one year from the earliest date of service on the claim.

(f) If an adult medical day program has submitted a claim during the one-year billing period, and the claim is subsequently rejected by the fiscal agent, the adult medical day program shall resubmit the claim within 15 months from the earliest date of service if the adult medical day program still wishes to receive reimbursement.

(g) Adult medical day programs participating in the Medicaid program shall be responsible for timely and accurate billing as required above, and the adult medical day program shall not bill the participant if Medicaid does not pay due to billing practices of the adult medical day program which result in non-payment for a Medicaid item, supply or service.

History

#7865, eff 5-1-03; ss by #9914, INTERIM, eff 5-1-11, EXPIRES: 10-28-11; ss by #10010, eff 10-28-11, EXPIRED: 10-28-19 (from He-E 803.09)

N.H. Code Admin. R. Ann. He-E 803.09 Third Party Liability {#sec-he-e-803.09 omnilex-key=us-nh-regs-official--agency-he-e--He-E 803.09}

All third party obligations shall be exhausted before Medicaid may be billed.

History

#7865, eff 5-1-03; ss by #9914, INTERIM, eff 5-1-11, EXPIRES: 10-28-11; ss by #10010, eff 10-28-11, EXPIRED: 10-28-19 (from He-E 803.10)

N.H. Code Admin. R. Ann. He-E 803.10 Utilization Review {#sec-he-e-803.10 omnilex-key=us-nh-regs-official--agency-he-e--He-E 803.10}

Adult medical day programs shall comply with the quality improvement and financial audit processes conducted by the department regarding adult medical day services.

History

#7865, eff 5-1-03; ss by #9914, INTERIM, eff 5-1-11, EXPIRES: 10-28-11; ss by #10010, eff 10-28-11, EXPIRED: 10-28-19 (formerly He-E 803.11)

Part He-E 804 Licensed Nursing Assistant Training and Medication Nursing Assistant Training Reimbursement

N.H. Code Admin. R. Ann. He-E 804.01 Definitions {#sec-he-e-804.01 omnilex-key=us-nh-regs-official--agency-he-e--He-E 804.01}

(a) “Approved nursing assistant training program (training program)” means a program of study in New Hampshire, which includes training or competency testing, that has been approved by the New Hampshire board of nursing pursuant to RSA 326-B:32.

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

(c) “Licensed nursing assistant (LNA)” means an individual who is licensed by the New Hampshire board of nursing pursuant to RSA 326-B:14 and Nur 301.05.

(d) “Medication nursing assistant (MNA)” means a licensed nursing assistant authorized to administer medication pursuant to RSA 326-B:14, II-a and Nur 301.06.

(e) “Nursing facility (NF)” means an institution or a distinct part of an institution, licensed by the department in accordance with RSA 151 as a nursing facility, that provides one or more of the following as defined in Section 1919(a) of the Social Security Act and is not primarily for the care and treatment of mental diseases:

(1) Skilled nursing care and related services for residents who require medical or nursing care;

(2) Rehabilitation services for the rehabilitation of injured, disabled, or sick individuals; or

(3) On a regular basis, health-related care and services to individuals who because of their mental or physical condition require care and services above the level of room and board which can be made available to them only through an institution.

(f) “Third party” means a person or persons other than the applicant.

History

#7752, eff 8-17-02, EXPIRED: 8-17-10
#9769-A, eff 8-25-10, EXPIRED: 8-25-18
#12717, eff 1-26-19; ss by #13242, eff 7-24-21; ss by #13735, eff 10-1-23; ss by #14057, eff 8-20-24

N.H. Code Admin. R. Ann. He-E 804.02 Requirements, Conditions, and Limitations {#sec-he-e-804.02 omnilex-key=us-nh-regs-official--agency-he-e--He-E 804.02}

The department shall reimburse for the costs of LNA or medication nursing assistants (MNA) training or competency testing subject to the following requirements, conditions, and limitations:

(a) Costs shall have been incurred for a board of nursing approved LNA or MNA training program or competency testing;

(b) Costs shall have been actually paid by the LNA, MNA, or a third party;

(c) Individuals shall have begun employment or received an offer of employment as an LNA or MNA in a licensed nursing facility within 12 months of completing the training program, including passing the competency testing; and

(d) The application requirements in He-E 804.03 shall have been met.

History

#7752, eff 8-17-02, EXPIRED: 8-17-10
#9769-A, eff 8-25-10, EXPIRED: 8-25-18
#12717, eff 1-26-19; ss by #13242, eff 7-24-21; ss by #13735, eff 10-1-23; ss by #14057, eff 8-20-24

N.H. Code Admin. R. Ann. He-E 804.03 Application Requirements {#sec-he-e-804.03 omnilex-key=us-nh-regs-official--agency-he-e--He-E 804.03}

(a) The LNA or MNA shall complete an application, form Bureau of Adult and Aging Services (BAAS) 292 “Application for Reimbursement for Licensed Nursing Assistant or Medication Nursing Assistant Training Program and/or Competency Testing,” (August 2024) in full attesting that the information provided in Section A of the application is accurate and that the LNA or MNA is, has been, or will be employed by the nursing facility named and shall submit the following documentation along with the application:

(1) Legible and itemized receipts from the agency that provided the training or competency testing, or the entity that processed the payment that documents the proof of payment by the LNA or MNA. The receipts shall contain the applicant’s name and, if applicable, the third party payor, the description of the LNA or MNA training program or competency testing taken, and the amount(s) the applicant and third party payor, if applicable, paid for the training program or competency testing; and

(2) An attached certificate from the agency that provided the training or competency testing to the LNA or MNA that shows the date the LNA or MNA successfully completed the training or competency testing.

(b) If a third party is seeking reimbursement for paying for an LNA or MNA’s training or competency testing, the third party shall provide the following on the application:

(1) The amount requested for training program or competency testing reimbursement;

(2) The third party’s dated signature attesting that the information provided in section b of the application is accurate that the third party has paid the amount listed in (b)(1) above for LNA or MNA training or competency testing for the applicant; and

(3) Attach legible and itemized receipts from the agency that provided the training or competency testing, or the entity that processed the payment, that documents proof of payment by the third party. The receipt shall contain the third party’s name, the description of the LNA or MNA training program or competency testing taken, and the amount that the third party paid for the training program or competency testing.

(c) The LNA, MNA, or third party shall submit the application and accompanying documentation required in (a) above or (b) above, or (a) and (b) above if applicable, to the administrator of the employing nursing facility.

(d) The nursing facility administrator shall complete section c on the application.

(e) The nursing facility administrator shall submit the completed application to the department by mailing it to:

The Department of Health and Human Services

Bureau of Adult and Aging Services

Attn: Nursing Assistant Reimbursement105 Pleasant Street

Concord, NH 03301-3857.

(f) The bureau of adult and aging services shall review the application for completeness, accuracy, and to verify that the individual is an LNA or MNA.

History

#7752, eff 8-17-02, EXPIRED: 8-17-10
#9769-B, eff 8-25-10; ss by #12717, eff 1-26-19; ss by #13242, eff 7-24-21; ss by #13735, eff 10-1-23; ss by #14057, eff 8-20-24

N.H. Code Admin. R. Ann. He-E 804.04 Payment {#sec-he-e-804.04 omnilex-key=us-nh-regs-official--agency-he-e--He-E 804.04}

(a) Upon receipt of a completed application and determination that the requirements in He-E 804.02 and He-E 804.03 have been met, the department shall indicate on the application the amount of reimbursement to be made, sign and date the request for reimbursement, and make payment to the LNA, MNA, or third party as follows:

(1) Payment shall be made from the medicaid administrative account in a lump sum, one-time payment;

(2) Payment for expenses paid by the LNA or MNA shall be mailed to the LNA or MNA at the address provided;

(3) Payment for expenses paid by a third party shall be mailed to the third party at the third party’s address; and

(4) Payment shall be limited to the actual costs incurred and for the LNA or MNA training program minus other amounts incurred including, but not limited to, clothing, ancillary items, and criminal record background checks.

(b) The department shall retain a copy of the application and the applicant’s receipt(s), for 3 years from completion date.

(c) If the department determines that the requirements in He-E 804.02 and He-E 804.03 have not been met, the department shall deny payment and notify the applicant in writing of the reason(s) for denial and what steps, if any, the applicant may take to receive reimbursement.

History

#7752, eff 8-17-02, EXPIRED: 8-17-10
#9769-A, eff 8-25-10, EXPIRED: 8-25-18
#12717, eff 1-26-19; ss by #13242, eff 7-24-21; ss by #13735, eff 10-1-23; ss by #14057, eff 8-20-24

Part He-E 805 Targeted Case Management Services

N.H. Code Admin. R. Ann. He-E 805.01 Purpose {#sec-he-e-805.01 omnilex-key=us-nh-regs-official--agency-he-e--He-E 805.01}

The purpose of this rule is to describe the requirements for targeted case management services provided to participants in the home and community based care for the elderly and chronically ill Choices for Independence (CFI) program.

History

#9242, eff 8-26-08; ss by #11167, INTERIM, eff 8-25-16, EXPIRED: 2-21-17
#12115, eff 2-22-17

N.H. Code Admin. R. Ann. He-E 805.02 Definitions {#sec-he-e-805.02 omnilex-key=us-nh-regs-official--agency-he-e--He-E 805.02}

(a) “Activities of daily living” means those activities associated with personal care, including personal hygiene, bathing, eating, dressing, toilet use, walking, transferring from one surface to another, moving between locations, and bed mobility.

(b) “Biopsychosocial history” means information about a participant’s past and present functioning in the areas of:

(1) Physical health;

(2) Psychological health, including emotional/coping ability;

(3) Decision-making ability;

(4) Social environment, including interactive skills, activities and supports;

(5) Family relationships;

(6) Financial considerations;

(7) Employment;

(8) Any vocational interests and activities, including spiritual preferences; and

(9) Any other area of significance in the participant’s life, including, but not limited to, substance abuse or misuse, involvement with the behavioral health care system, developmental disability system, or legal system.

(c) “Case management agency” means an agency that is licensed in accordance with RSA 151:2, I(b), and enrolled as a New Hampshire medicaid provider to provide targeted case management services to CFI participants, and that operates without a conflict of interest. This term includes independent case management agencies.

(d) “Case manager” means an individual employed by, or contracted with, a case management agency who:

(1) Meets the qualifications described in He-E 805.06;

(2) Is responsible for the ongoing assessment, person-centered planning, coordination, and monitoring of the provision of services included in the comprehensive care plan; and

(3) Does not have a conflict of interest.

(e) “Complaint” means:

(1) Any allegation or assertion that a right of a participant has been violated;

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

(3) Any allegation or assertion that the department or a facility, agency, or service provider has acted in an illegal or unjust manner with respect to a participant or category of participants.

(f) “Comprehensive assessment” means a person-centered process of gathering information about a participant’s abilities and needs through a face-to-face interview with the participant, and other methods as needed, which culminates in a written document.

(g) “Comprehensive care plan” means an individualized plan described in He-E 805.05(c) that is the result of a person-centered process that identifies the strengths, capacities, preferences, and desired outcomes of the participant.

(h) “Conflict of interest” means a conflict between the private interests and the official or professional responsibilities of a person, such as providing other direct services to the participant, being the guardian of the participant, or having a familial or financial relationship with the participant.

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

(j) “Home and community-based care for the elderly and chronically ill (Choices for Independence)” means a system of long-term care services provided in non-institutional settings and described in He-E 801, and provided under a waiver of Section 1902(a)(10) and 1915(c) of the Social Security Act for participants who are elderly or adults who have a disability or chronic illness.

(k) “Incident” means an occurrence or event that interrupts normal procedure, including a serious injury or other event threatening the health or safety of a participant or staff.

(l) “Individualized contingency plan” means the person-centered plan that addresses unexpected situations that could jeopardize the participant’s health or welfare, and which:

(1) Identifies alternative staffing resources in the event that normally scheduled care providers are unavailable; and

(2) Addresses special evacuation needs that require notification of the local emergency responders.

(m) “Instrumental activities of daily living” means those activities associated with home management, including grocery shopping, meal preparation, telephone use, and managing finances, and routine housework such as washing dishes, making beds, dusting, and laundry.

(n) “Medical eligibility assessment (MEA)” means an initial assessment and subsequent re-assessments conducted in accordance with RSA 151-E:3, I.

(o) “MEA needs list/support plan” means a document generated by the department that identifies participant needs to be addressed in the comprehensive care plan.

(p) “Participant” means an individual who has been found by the department to be eligible for the CFI program.

(q) “Person-centered” means a process for planning and supporting the participant receiving services that builds upon the participant’s capacity to engage in activities that promote community life and honors the participant’s preferences, choices, and abilities, and which involves families, friends, and professionals as the participant desires or requires.

(r) “Sentinel event” means an unexpected occurrence, including:

(1) The death of a participant from suicide or homicide; or

(2) A serious physical or psychological injury, or risk thereof, resulting from:

a. A sexual assault;

b. An unauthorized departure from a facility;

c. A medication error which results in paralysis, coma, permanent loss of function, or death;

d. A delay in the provision of departmental services resulting in a negative outcome; or

e. Abuse and/or neglect that results in paralysis, coma, permanent loss of function, or death, of a participant who:

Is receiving department funded services;
Has received department funded services within the preceding 30 days; or
Has been evaluated by a contract provider within the preceding 30 days.

(s) “Targeted case management” means the collaborative process of assessment, planning, facilitation, advocacy, coordination, and monitoring that is accomplished with a person-centered process, and which:

(2) Provides for coordination of participant service plans from all providers to assure adequacy and, appropriateness of care and cost effectiveness of planned services that yield positive outcomes.

History

#9242, eff 8-26-08; ss by #11167, INTERIM, eff 8-25-16, EXPIRED: 2-21-17
#12115, eff 2-22-17

N.H. Code Admin. R. Ann. He-E 805.03 Eligibility {#sec-he-e-805.03 omnilex-key=us-nh-regs-official--agency-he-e--He-E 805.03}

(a) Targeted case management services shall be provided to all participants, except those excluded pursuant to the Laws of 2007, Chapter 263:108.

(b) Targeted case management services shall be available to participants who reside in hospitals or nursing facilities licensed in accordance with RSA 151, provided that such services:

(1) Do not exceed a total of 30 cumulative days of services provided prior to discharge to home from an aforementioned facility or combination of facilities; and

(2) Do not duplicate discharge planning services that the facility is normally expected to provide as part of inpatient services.

(c) Notwithstanding (a) above, the commissioner of the department shall grant waivers to allow case management services to be provided to the excluded beneficiaries in (a) above as necessary to protect their health and safety.

History

#9242, eff 8-26-08; ss by #11167, INTERIM, eff 8-25-16, EXPIRED: 2-21-17
#12115, eff 2-22-17

N.H. Code Admin. R. Ann. He-E 805.04 Provider Agency Requirements {#sec-he-e-805.04 omnilex-key=us-nh-regs-official--agency-he-e--He-E 805.04}

(a) Case management agencies shall:

(1) Comply with the requirements contained in He-E 801.29, including the requirement to be enrolled as a medicaid provider; and

(2) Be licensed in accordance with requirements of state law, including RSA 151.

(b) Case management agencies shall employ a full-time administrator responsible for the development and implementation of the policies of the case management agency and for compliance with applicable rules.

(c) Case management agencies shall establish and maintain agency written policies and procedures regarding the following areas, and shall ensure that they are properly followed and enforced:

(1) Completion and documentation of a criminal background check for all employees pursuant to RSA 151:2-d;

(2) A process for confirming that each employee is not on the NH central registry of abuse, neglect or exploitation pursuant to RSA 169-C:35 or BEAS state registry established pursuant to RSA 161-F:49;

(3) Verification of discipline specific licensing for those employees whose profession requires licensing;

(4) The requirements for the mandated reporting of abuse, neglect, or exploitation in accordance with RSA 161-F: 46;

(5) The procedures for reported complaints, incidents, and sentinel events;

(6) Staff orientation including, at a minimum, a review of:

a. The federal and state laws and rules governing the CFI program;

b. The local community service network;

c. The procedures for crisis intervention; and

d. The philosophy governing person-centered planning, as defined in He-E 805.02(q);

(7) Staff development, including procedures for addressing performance or training needs;

(8) Staff performance evaluations, including how performance or training needs will be addressed throughout the case manager’s employment tenure;

(9) A clinical supervision protocol which includes, at a minimum:

a. Monthly meetings between the case manager and his or her supervisor; and

b. As a focus of supervision, the review of participant records to ensure compliance with the requirements described in He-E 805.04(f) and He-E 805.05(b)-(d);

(10) Participant complaints, including how participants are informed about the agency’s policies and procedures;

(11) Evaluation of participant satisfaction with the agency and the case manager, and how a participant may request a change in case manager or case management agency;

(12) Procedures for protection of participant records that govern use of records, storage, removal, conditions for release of information, and compliance with the Health Insurance Portability and Accountability Act (HIPAA); and

(13) Procedures related to quality assurance and quality improvement.

(d) Case management agencies shall accept assignments made, pursuant to He-E 805.07(b), according to the system maintained by the department’s bureau of elderly and adult services (BEAS) unless there is a conflict of interest or the agency has informed BEAS in writing that it must be temporarily removed from the list of available agencies due to staffing shortages.

(e) Case management agencies shall maintain access to a toll free number for all participants served and respond to calls as follows:

(1) Responses to calls received on Monday through Friday shall be made within 24 hours; and

(2) Responses to calls received on Saturdays, Sundays, and holidays shall be made within 48 hours.

(f) Case management agencies shall maintain an individual case record for each participant receiving case management services which includes:

(1) A face sheet describing demographic and other important information, including:

a. The participant’s name, date of birth, and address;

b. The participant’s medicaid identification number; and

c. The name, phone number, and address of the participant’s emergency contact person;

(2) The comprehensive assessment document, described in He-E 805.05(b) below;

(3) The comprehensive care plan, described in He-E 805.05(c) below;

(4) The CFI MEA assessment and MEA needs list or support plan;

(5) Medicaid financial eligibility information, including the cost share described in He-E 801.11;

(6) Release of information forms;

(7) Progress notes that reflect areas contained in the comprehensive care plan;

(8) All contact notes, including those required by He-E 805.05(d)(1) below;

(9) A written record of all monitoring and case management activities;

(10) All pertinent correspondence relating to the participant’s case management; and

(11) Any and all electronic records.

History

#9242, eff 8-26-08; ss by #11167, INTERIM, eff 8-25-16, EXPIRED: 2-21-17
#12115, eff 2-22-17

N.H. Code Admin. R. Ann. He-E 805.05 Required Case Management Services {#sec-he-e-805.05 omnilex-key=us-nh-regs-official--agency-he-e--He-E 805.05}

(a) For each participant who selects or is assigned to a case management agency, the agency shall designate a case manager to provide case management services.

(b) The designated case manager shall conduct a comprehensive assessment of a participant within 15 working days of the date on which the agency receives department notification of the assignment, which shall:

(1) Utilize a formal assessment tool to evaluate the participant’s status based on information gathered at a face-to-face meeting, and through other methods as needed; and

(2) Culminate in a written document that describes the participant’s abilities and needs in the following areas:

a. Biopsychosocial history;

b. Functional ability, including activities of daily living and instrumental activities of daily living;

c. Living environment, including the participant’s in-home mobility, accessibility, and safety;

d. Social environment, including social/informal relationships and supports, activities and interests, such as avocational and spiritual;

e. Self-awareness, or the degree to which the participant is aware of his or her own medical condition(s), treatment(s), and medication regime;

f. Risk, including the potential for abuse, neglect, or exploitation by self or others, as well as health, social or behavioral issues that may indicate a risk;

g. Legal status, including guardianship, legal system involvement, and availability of advance directives, such as durable power of attorney;

h. Community participation, including the participant’s need or expressed desire to access specific resources, such as the library, educational programs, restaurants, shopping, and medical providers; and

i. Any other area identified by the participant as being important to his or her life.

(c) Within 20 working days of the date on which the agency receives BEAS notification of the assignment, the designated case manager shall develop a written comprehensive care plan for the participant, which shall:

(1) Be a person-centered agreement;

(2) Contain measurable objectives and goals, with timelines;

(3) Contain the following, based on the participant’s needs as identified in the comprehensive assessment document and the MED needs list or support plan:

a. Paid services to be provided under medicaid or other funding sources, including:

The needs to be met by paid services;
Service costs;
Service funding source;
Provider names; and
The beginning and ending dates of each service, and the frequency of service provision;

b. Non-paid services or supports, including the needs to be met and the names of those individuals or groups providing such services or support;

c. Unfulfilled needs and gaps in services, including those that pose a risk to the participant’s health and safety;

d. Any existing risks for abuse, neglect or exploitation, as defined in RSA 161-F:43;

e. A plan for mitigating any existing risks; and

f. An individualized contingency plan, as defined in He-E 805.02(l); and

(4) Be updated with written documentation as follows:

a. At least annually for as long as the participant is receiving CFI services;

b. Whenever changes occur in the participant’s medical condition and/or in the participant’s needs and desires; and

c. With progress notes reflecting each case management contact in (e)(1) below.

(d) The designated case manager shall monitor the services provided to a participant, as follows:

(1) Conduct the case management contacts required for each participant, as follows:

a. Case management contacts shall include no less than one monthly telephonic contact and one face-to-face contact every 60 days; and

b. Each case management contact shall be documented in a contact note;

(2) Ensure that services are adequate and appropriate for the participant’s needs, and are being provided, as described in the comprehensive care plan;

(3) Ensure that the participant is actively engaging in the services described in the comprehensive care plan;

(4) Ensure that the participant is satisfied with the comprehensive care plan; and

(5) Identify any changes in the participant’s condition, discuss these changes with the participant in order to determine whether changes to the comprehensive care plan are needed, and make changes to the comprehensive care plan as needed.

History

#9242, eff 8-26-08; ss by #11167, INTERIM, eff 8-25-16, EXPIRED: 2-21-17
#12115, eff 2-22-17

N.H. Code Admin. R. Ann. He-E 805.06 Qualification Requirements for Case Managers {#sec-he-e-805.06 omnilex-key=us-nh-regs-official--agency-he-e--He-E 805.06}

(a) Case managers employed by case management agencies shall have the following minimum requirements:

(1) Have demonstrated knowledge of the local service delivery system and the resources available to participants;

(2) Have demonstrated knowledge of the development and provision of integrated, person-centered services; and

(3) Have a degree in a human-services related field and one year of supervised experience, or a similar combination of training and experience.

(b) Case manager supervisors employed by case management agencies shall have the following minimum requirements:

(1) Have a bachelor’s level degree; or

(2) Be a registered nurse with 2 years of related experience.

(1) Have a felony conviction;

(2) Have been found to have abused, neglected or exploited an individual based on a protective investigation completed by the BEAS in accordance with He-E 700 and an administrative hearing held pursuant to He-C 200, if such a hearing is requested; or

(3) Are listed in the state of NH central registry of abuse, neglect or exploitation pursuant to RSA 169-C:35 or the BEAS state registry pursuant to RSA 161-F:49.

History

#9242, eff 8-26-08; ss by #11167, INTERIM, eff 8-25-16, EXPIRED: 2-21-17
#12115, eff 2-22-17

N.H. Code Admin. R. Ann. He-E 805.07 Participant Selection of Case Management Agency {#sec-he-e-805.07 omnilex-key=us-nh-regs-official--agency-he-e--He-E 805.07}

(a) After being determined eligible for CFI services in accordance with He-E 801, the participant shall select a case management agency from a list provided by BEAS.

(b) If the participant does not choose a case management agency after being determined eligible for CFI services, then the participant shall be assigned to a case management agency through a system maintained by BEAS.

(c) The participant shall be informed that the case manager selected will also be responsible for coordinating mental health and developmental disability-related services if such services are needed by the participant.

(d) The participant shall be informed in writing of the case management agency to which he or she is assigned.

(e) The participant shall be informed in writing and orally of the process to request a change in case management agency:

(1) At the time of eligibility determination and re-determination; and

(2) By the case management agency during the assessment process.

History

#9242, eff 8-26-08; ss by #11167, INTERIM, eff 8-25-16, EXPIRED: 2-21-17
#12115, eff 2-22-17

N.H. Code Admin. R. Ann. He-E 805.08 Payment for Services {#sec-he-e-805.08 omnilex-key=us-nh-regs-official--agency-he-e--He-E 805.08}

(a) Providers shall submit claims for payment to the department’s fiscal agent.

(b) Providers shall meet all NH medicaid provider requirements, including those regarding timely claims submission.

(c) Providers shall not bill the applicant if medicaid does not pay due to billing practices of the provider which result in non-payment for service.

(d) Reimbursement to providers shall be made in accordance with rates established pursuant to RSA 161:4, VI.

History

#9242, eff 8-26-08; ss by #11167, INTERIM, eff 8-25-16, EXPIRED: 2-21-17
#12115, eff 2-22-17

N.H. Code Admin. R. Ann. He-E 805.09 Third Party Liability {#sec-he-e-805.09 omnilex-key=us-nh-regs-official--agency-he-e--He-E 805.09}

All third party obligations shall be exhausted before medicaid may be billed.

History

#9242, eff 8-26-08; ss by #11167, INTERIM, eff 8-25-16, EXPIRED: 2-21-17
#12115, eff 2-22-17

N.H. Code Admin. R. Ann. He-E 805.10 Quality Management {#sec-he-e-805.10 omnilex-key=us-nh-regs-official--agency-he-e--He-E 805.10}

(a) On a quarterly basis, case management agencies shall conduct a participant record review to evaluate the delivery of services identified in the comprehensive care plan to ensure that participants’ needs are being met in the community, and shall document the results of the review in a quarterly quality management report, including:

(1) The number of records reviewed;

(2) A summary of the review results;

(3) A description of any deficiencies identified;

(4) The remedial action taken or planned to address the deficiencies identified in (3) including the dates action was taken or will be taken; and

(5) A summary of unmet service needs.

(b) On a quarterly basis, case management agencies shall conduct a review of all reported complaints, incidents, and sentinel events related to the delivery of services identified in the comprehensive care plan, and shall document the results of the review in a quarterly quality management report, including:

(1) The number of reported complaints, incidents and sentinel events;

(2) A summary of the review results;

(3) A description of the deficiencies identified; and

(4) The remedial action taken or planned to address the deficiencies identified in (3) including the dates action was taken or will be taken.

(c) Case management agencies shall plan and take any remedial action necessary to address deficiencies in service delivery identified in the quarterly quality management reports in (a) and (b) above.

(d) Case management agencies shall retain the quarterly quality management reports in (a) and (b) above for 2 years and make them available to the department upon request.

(e) Case management agencies shall retain clinical records:

(1) To support claims submitted for reimbursement for a period of at least 6 years from the date of service; or

(2) Until resolution of any legal action(s) commenced during the 6-year period.

(f) Case management agencies shall be subject to monitoring visits by BEAS to ensure that services are provided in accordance with He-E 805.

(g) Monitoring visits shall:

(1) Be announced or unannounced;

(2) Occur at least annually;

(3) Include, but not be limited to:

a. A review of participant case records;

b. A review of the portion of employee records pertinent to the provider qualification requirements of He-805; and

c. A review of the quarterly quality management reports in (a) and (b) above and

(4) Be made during the agencies regular business hours.

History

#9242, eff 8-26-08; ss by #11167, INTERIM, eff 8-25-16, EXPIRED: 2-21-17
#12115, eff 2-22-17

Part He-E 806 Nursing Facility Reimbursement

N.H. Code Admin. R. Ann. He-E 806.01 Definitions {#sec-he-e-806.01 omnilex-key=us-nh-regs-official--agency-he-e--He-E 806.01}

(a) “Accrual method of accounting” means revenues are reported in the period when they are earned, regardless of when they are collected, and expenses are reported in the period in which they are incurred, regardless of when they are paid.

(b) “Administration function” means those duties which are necessary to the general supervision and direction of the current operations of the nursing facility.

(c) “Allowances” means the deductions granted for damage, delay, shortage, imperfection, or other causes, excluding discounts and returns.

(d) “Approved educational activities” means formally organized or planned programs of study engaged in by a nursing facility provider and its staff in order to enhance the quality of resident care in a nursing facility or to improve the administration of the nursing facility.

(e) “Arm's length transaction” means a transaction in which one party is not associated with, affiliated with, or controlled by the other party.

(f) “Bad debts” means the amounts considered to be uncollectable from accounts and notes receivable which were created or acquired in providing services.

(g) “Bed day” means any paid day of care at a nursing facility regardless of the payer.

(h) “Centers for Medicare and Medicaid Services (CMS)” means the federal agency responsible for administering the Medicare and medicaid programs, formerly known as the Health Care Financing Administration (HCFA).

(i) “Chain operation” means an organization which consists of a group of 2 or more health care facilities which are owned, leased, or controlled by a home office.

(j) “Charity allowances” means the reductions in charges made by the nursing facility provider of services because of the indigence of the resident.

(k) “Compensation” means the total benefit provided for the services rendered to the nursing facility provider. It includes fees, salaries, wages, payroll taxes, fringe benefits, and other increments paid to, or for the benefit of, those providing the services.

(l) “Cost center” means an organizational unit, generally a department or its subunit, having a common functional purpose for which direct and indirect costs are accumulated, allocated, and apportioned.

(m) “Courtesy allowances” means reductions in charges in the form of allowances to physicians, clergy, members of religious orders, or others as approved by the governing body of the nursing facility, for services received from the nursing facility provider.

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

(o) “Discounts” means reductions in the cost of purchases classified as cash, trade, or quantity discounts.

(p) “Fair market value” means the price that the asset would bring by bona fide bargaining between well-informed buyers and sellers at the date of acquisition.

(q) “Generally accepted accounting principles (GAAP)” means accounting principles approved by the American Institute of Certified Public Accountants or the Institute of Management Accountants.

(r) “Hill-Burton funds” means federal funds made available through the Hill-Burton Act, Title VI of the Public Health Service Act, for building or remodeling.

(s) “Historical cost” means the cost incurred by the present owner in acquiring the asset, subject to the limitations specified in 42 CFR 413.134(j).

(t) “Home office” means the controlling organization of a chain operation which furnishes central management and administrative services such as accounting, purchasing, and personnel services, but is not a nursing facility provider.

(u) “Home office costs” means costs of a home office to furnish services to its related organizations.

(v) “Intermediate care facility for individuals with intellectual disabilities (ICF-IID)” means a nursing facility certified to provide long term care for individuals with intellectual disabilities or individuals with related conditions, such as cerebral palsy.

(w) “Luxurious” means the aspect of any item or service which provides comfort, pleasure, or enjoyment but is not essential for resident care.

(x) “Necessary interest” means interest, other than working capital interest or interest on lines of credit, which are incurred:

(1) On a loan made to satisfy a financial need of the nursing facility provider for a purpose reasonably related to resident care; and

(2) On a loan repaid in payments over a period of time not to exceed the estimated useful life of the asset purchased with the loan.

(y) “Net cost” means the cost of approved activities less any reimbursement from grants, tuition, and specific donations.

(z) “Nursing facility (NF)” means an institution or a distinct part of an institution, including ICF-IIDs, that provide one or more of the following as defined in Section 1919(a) of the Social Security Act and is not primarily for the care and treatment of mental diseases:

(1) Skilled nursing care and related services for residents who require medical or nursing care;

(2) Rehabilitation services for the rehabilitation of injured, disabled, or sick individuals; or

(aa) “Nursing facility (NF) rate” means the medicaid per diem for each certified NF as set by the department.

(ab) “Picture date” means the date on which resident data is gathered from all facilities to be used to calculate the medicaid rate.

(ac) “Proper interest” means that interest is incurred at a rate not in excess of what a prudent borrower would have had to pay in an arm's length transaction at the time the loan was made.

(ad) “Prospective per diem rate” means a per diem amount calculated using a historical cost period as a basis and inflated forward.

(ae) “Quantity discounts” mean reductions from list prices granted because of the size of individual or aggregate purchase transactions.

(af) “Related organizations” means organizations that are associated or affiliated with, have control over, or are controlled by, each other.

(ag) “Related parties” means parties that are associated or affiliated with, have control over, or are controlled by, each other.

(ah) “Reserved bed day” means a 24-hour period, midnight to midnight, when the resident of an NF is not present during the midnight census at the conclusion of the day, and that is chargeable to medicaid.

(ai) “Routine services” means regular room, dietary and nursing services, minor medical and surgical supplies, and the use of equipment and facilities.

(aj) “State owned and operated facilities” means the Glencliff home for the elderly.

(ak) “Straight-line method of depreciation” means that the cost or other basis less its estimated salvage value, if any, is determined first, and then this amount is distributed in equal amounts over the period of the estimated useful life of the asset.

(al) “Trade discounts” mean reductions from list prices granted to a certain class of customers before consideration of credit terms.

History

#8547, eff 1-24-06 (formerly He-W 593.01); ss by #9623, eff 12-24-09, ss by #12440, INTERIM, eff 12-23-17, EXPIRED: 6-21-18
#12566, eff 6-29-18; ss by #14020, eff 7-10-24

N.H. Code Admin. R. Ann. He-E 806.02 Annual Cost Reports {#sec-he-e-806.02 omnilex-key=us-nh-regs-official--agency-he-e--He-E 806.02}

(a) Each nursing facility (NF), with the exception of state-owned and operated facilities, shall submit:

(1) An annual cost report of the costs of their operations utilizing the “Medicaid Annual Cost Report” form 392 described in (b) below;

(2) Financial statements for the reporting period;

(3) Any certifications, opinions, or notes that are a part of (2) above;

(4) Copies of federal income tax statements pertaining to the operation of the NF only if requested by the department of health and human services (department); and

(5) Copies of all signed lease agreements for property, buildings, and equipment unless they have previously been submitted and are unchanged.

(b) Each NF shall submit the following statements and schedules as part of the “Medicaid Annual Cost Report” form 392 referenced in (a)(1) above:

(1) A signed and dated statement certifying that the information provided on the report is true, accurate, complete, and acknowledging that penalties for any false statement or misrepresentation of material fact include a fine or imprisonment;

(2) Resident census statistics including the numbers of residents within each level of care and revenue source for each level of care;

(3) Expenses as described in He-E 806.06 through He-E 806.30 and cost center allocations such as support services, resident care, and capital costs;

(4) Reclassification of expenses, as needed, from one cost center to another;

(5) Adjustments to expenses due to activity such as refunds, discounts, or sale of merchandise or supplies;

(6) Allocation statistics which provide information regarding square footage of the NF, meals served by the NF, pounds of laundry done, and the cost centers relevant to each;

(7) Building and general information including information regarding ownership or rental of the NF;

(8) Fixed assets and depreciation including a listing of land, buildings, major movable equipment, and motor vehicles owned by the NF or related parties, and the depreciation on these assets;

(9) Debt and interest including a listing of NF debt, related party capital debt, and the necessary interest on these debts;

(10) Rental expense detail including rental costs for buildings, fixed equipment, other equipment, and motor vehicles;

(11) Owner and officer compensation including a statement of compensation and other payments to owners, officers, directors, and trustees including their ownership interest, and average hours per week of work provided to the NF;

(12) A financial statement including a balance sheet listing current assets, current liabilities, total equity and changes in equity, cash flow from operating, investing, and financing activities, revenues from inpatient and other operating activities, and a statement of expense and profit or loss;

(13) Funded depreciation detail including a listing of fund income and payments;

(14) Resident fund including a listing of resident funds received and disbursed, interest earned, and remaining balance; and

(15) Staffing pattern including a listing of NF staff, consultants and contract staff, hours worked by position, and total salaries or other compensation paid.

(c) The “Medicaid Annual Cost Report” form 392 and all accompanying documents shall be signed and dated by the NF administrator or owner and paid third party preparer.

(d) A signed and dated copy of the “Medicaid Annual Cost Report” form 392 shall be submitted to:

New Hampshire Department of Health and Human Services

Bureau of Program Integrity

Financial Compliance Unit

Main Building

105 Pleasant Street

Concord, NH 03301-3843

(e) A complete annual cost report shall be submitted:

(1) No later than 3 months after the end of the NF's fiscal year, unless an extension has been granted by the department as described in (p) below. Home office costs shall be documented by the submission to the department of Health Care Financing Administration (HCFA) Form 287-92, or its replacement “Chain Home Office Cost Statement”, no later than 5 months after the end of the home office fiscal year, unless an extension has been granted by the department as described in (p) below; or

(2) By the former owner of the NF within 90 calendar days of the sale of the NF when a change of ownership occurs and a new rate shall be determined by the department in accordance with He-E 806.32(d).

(f) Home office costs shall be documented by the submission of HCFA Form 287-92 or its replacement, “Chain Home Office Cost Statement” and necessary schedules as requested, no later than 5 months after the end of the home office fiscal year, unless an extension has been granted by the department as described in (p) below.

(g) The department shall consider an annual cost report complete unless the cost report is missing information of a material nature so as to render the document unusable for the purpose of determining a per diem rate.

(h) Any NF which submits an incomplete annual cost report shall be subject to penalties described in (q) below, unless an extension has been granted as described in (p) below.

(i) An acceptable cost report shall reflect the most recent desk audit or field audit adjustments made to the previous year’s cost report, if applicable, with the exception of items still under appeal that have not been resolved.

(j) The department shall notify the NF of an incomplete annual cost report within 30 days of receipt of the report.

(k) The time frame for submitting a complete cost report as described in He-E 806.02(e) shall not change due to an incomplete report submitted by an NF.

(l) Failure to submit an annual cost report or a complete annual cost report as required shall result in penalties as stated in (q) below, unless an extension has been granted by the department as described in (o) and (p) below.

(m) NFs which have separate arrangements for caring for residents with different levels of care needs shall segregate their operational costs on the same annual cost report form.

(n) NFs with more than one location shall submit separate balance sheets for each location.

(o) Requests for extensions for filing the annual cost report beyond the prescribed deadline shall:

(1) Be in writing;

(2) Be submitted to the department at least 10 working days prior to the due date of the annual cost report, unless one of the circumstances identified in (p) below occurs during the 10 working days prior to the due date, in which case the request shall be made by telephone within 10 working days of the occurrence;

(3) Clearly explain the necessity for the extension; and

(4) Specify the date on which the report will be submitted.

(p) Approval of extensions shall be made only if it is determined that the delay is caused by circumstances beyond the NF’s control, such as, but not limited to:

(1) Flood;

(2) Fire;

(3) Strikes by employees necessary for the preparation of the cost report;

(4) Earthquakes; or

(5) The death of an owner or administrator.

(q) Failure to submit the annual cost report or a complete report as required shall result in the following penalties, unless an extension has been granted by the department:

(1) The per diem rate currently in effect shall be reduced by 25% effective on the first day of the month following the due date for filing of the completed annual cost report, and for each successive month of delinquency in filing the completed annual cost report;

(2) There shall be no retroactive restoration of penalty payments or reimbursement of related working capital interest costs upon the submission of a completed cost report;

(3) No determination of a new rate for the next payment period shall be made until an acceptable cost report as described in (a) – (e) above is received; and

(4) Reinstatement of the pre-existing rate or the determination of a new rate of payment shall be made subsequent to the receipt of an acceptable annual cost report, but retroactive only to the date of receipt by the department of said report.

(r) The commissioner shall not impose the penalties in (q) above if it is determined that the reason for the NF not meeting the timeframes in (o)(2) above meets the criteria in (p) above.

(s) When a complete annual cost report has been submitted by the NF, the department shall conduct a desk review of the report and shall conduct a field audit if the NF meets one of the conditions for a field audit as described in (t) below.

(t) A field audit shall be conducted as part of the review of the annual cost report in accordance with He-E 806.30 if the NF meets one or more of the following conditions:

(1) The NF has been newly constructed or has had major capital improvements in the past year;

(2) There are items on the annual cost report which need further clarification or investigation as determined by the department; or

(3) A field audit has not been conducted on the NF during the previous 5 state fiscal years.

(u) Based on the desk review or field audit, the department shall determine allowable costs and the compliance of the NF in accordance with the provisions of He-E 806.

(v) The department shall send a notice to the NF of the result of the desk review or field audit including:

(1) A listing of all adjustments to submitted costs on the cost report, if any, as determined by the department as described in (t) above; and

(2) The NF’s right to a reconsideration and an administrative appeal in accordance with He-E 806.40 and He-E 806.41.

(w) The department shall reopen cost reports as a result of field adjustments by department staff or in the case of fraud.

(x) Cost reports shall be reopened at the request of the NF in the case of an error of a material nature until a rate has been set based on that submitted cost report.

(y) For an out-of-state NF or an out-of-state home office, any reopening by the home state or appropriate fiscal agent shall be considered a reopening for the New Hampshire medicaid program.

History

#8547, eff 1-24-06 (formerly He-W 593.03); ss by #9623, eff 12-24-09; ss by #12440, INTERIM, eff 12-23-17, EXPIRED: 6-21-17
#12566, eff 6-29-18; ss by #14020, eff 7-10-24; ss by 14149, eff 12-12-24

N.H. Code Admin. R. Ann. He-E 806.03 Record Keeping Requirements {#sec-he-e-806.03 omnilex-key=us-nh-regs-official--agency-he-e--He-E 806.03}

(a) Each NF shall maintain accurate financial and statistical records, which substantiate the cost reports, for a period of 6 years.

(b) The records of the NF described in (a) above shall include, but not be limited to, information regarding:

(1) NF ownership, organization, operation, fiscal, and other record keeping systems;

(2) Federal and state income tax information related to the operation of the NF;

(3) Asset acquisition, lease, sale, or other action;

(4) Franchise or management arrangement;

(5) Patient service charge schedule;

(6) Information regarding cost of operation and amounts of income received; and

(7) Flow of funds and working capital.

(c) When the department determines that an NF is not maintaining records as required in He-E 806.03 (a) and (b) above, the department shall send a written notice to the NF of its intent to suspend payments in 30 days, together with an explanation of the deficiencies.

(d) If the NF disagrees with the department’s decision, the NF may request an appeal pursuant to He-E 806.41.

(e) Payments shall remain suspended until adequate records are maintained as specified in (a) and (b) above, or until an appeal decision is rendered pursuant to He-E 806.41.

(f) Payments shall be reinstated at the full rate retroactive to the beginning of the suspension period once the NF maintains adequate records in accordance with He-E 806 or if an appeal decision is rendered pursuant to He-E 806.41 in favor of the NF.

(g) NFs shall make the records described in (a) and (b) above available upon request to representatives of the department or the US Department of Health and Human Services, subject to the penalties described in (e) above.

History

#8547, eff 1-24-06 (formerly He-W 593.06); ss by #10474, eff 1-24-14; ss by #14020, eff 7-10-24

N.H. Code Admin. R. Ann. He-E 806.04 Accounting Principles for Annual Cost Reports {#sec-he-e-806.04 omnilex-key=us-nh-regs-official--agency-he-e--He-E 806.04}

The following accounting principles shall apply:

(a) The allowable costs shown in all annual cost reports shall follow the GAAP and the accrual method of accounting; and

(b) If an NF maintains its records on a cash basis, then it shall record such accruals as adjustments.

History

#8547, eff 1-24-06 (formerly He-W 593.05); ss by #10474, eff 1-24-14; ss by #14020, eff 7-10-24

N.H. Code Admin. R. Ann. He-E 806.05 Reimbursement Based on Actual Allowable Costs {#sec-he-e-806.05 omnilex-key=us-nh-regs-official--agency-he-e--He-E 806.05}

The department shall reimburse NFs based on actual allowable costs as follows:

(a) To be allowable, the costs, including compensation, shall be reasonable and necessary for services related to resident care and pertinent to the operation of the NF as described below:

(1) To be reasonable, the compensation shall be such as would ordinarily be paid for comparable services by comparable facilities, for example, facilities of similar size and level of care; and

(2) To be necessary, the service shall be such that had the individual not rendered the services, another person would have had to have been employed to perform the same services;

(b) Allowable costs for services and items directly related to resident care, pursuant to He-E 802, shall be included in the per diem rate unless the service or item is reimbursable under Medicare or covered by the drug rebate program through the department;

(1) Costs that are a result of inefficient operations, such as the hiring of a consultant to assist in daily operations due to management practices which could or did result in the loss of the NF’s license to operate;

(2) Costs resulting from unnecessary or luxurious care, such as purchasing a luxury sedan when a utilitarian sedan would suffice for the transportation of residents;

(3) Costs related to activities not common and accepted in an NF, as determined by the department, in comparison to other facilities, such as purchasing an airplane; and

(4) Costs or financial transactions conceived for the purpose of circumventing the provisions of He-E 806, such as listing an employee with a job title that would be reimbursable under medicaid, but the job duties actually performed by the employee are not reimbursable under medicaid;

(d) To be an allowable cost of compensation, services shall actually be performed by the individual and paid in full to the individual by the NF;

(e) If services are provided on a less than full-time basis, as determined by the NF, allowable compensation shall be based on the percentage of time for which the service is actually provided;

(f) Costs incurred to comply with changes in federal or state laws, rules, or regulations for enhanced direct and indirect resident care services and improved facilities administration shall be considered allowable costs; and

(g) Allowable or non-allowable costs for specific services or items shall be determined as described in He-E 806.06 through He-E 806.30.

History

#8547, eff 1-24-06 (formerly He-W 593.08); ss by #10474, eff 1-24-14; ss by #14020, eff 7-10-24

N.H. Code Admin. R. Ann. He-E 806.06 Routine Services {#sec-he-e-806.06 omnilex-key=us-nh-regs-official--agency-he-e--He-E 806.06}

Allowable costs for routine services and items directly related to resident care shall include but not be limited to:

(a) All general nursing services including, but not limited to, administration of oxygen and related medications, hand feeding, incontinency care, and tray service;

(b) Items furnished routinely and commonly to most or all residents, such as resident gowns, water pitchers, and basins;

(d) Medical supplies, pharmaceutical items, and non-legend drugs, that is, drugs prescribed by a licensed practitioner that are normally purchased over the counter, which are stocked at nursing stations or on the floor in gross supply and distributed individually in small quantities;

(e) Laundry services for routine NF requirements and residents’ personal clothing; and

(f) Routine and emergency dental services defined by the medicaid state plan rendered to NF residents.

History

#8547, eff 1-24-06 (formerly He-W 593.09); ss by #10474, eff 1-24-14; ss by #14020, eff 7-10-24

N.H. Code Admin. R. Ann. He-E 806.07 Physician Services, Psychologist Services, and Pharmacist Consultant Services {#sec-he-e-806.07 omnilex-key=us-nh-regs-official--agency-he-e--He-E 806.07}

(a) The cost of physician or psychologist services performed in rendering direct resident care shall not be allowable in the per diem rate.

(b) The cost of indirect services performed in an administrative or advisory capacity, such as the cost of a medical director or a consultant psychologist, or the cost of a pharmacist consultant rendering administrative services and drug reviews shall be included in the per diem rate.

History

#8547, eff 1-24-06 (formerly He-W 593.22); ss by #10474, eff 1-24-14; ss by #14020, eff 7-10-24

N.H. Code Admin. R. Ann. He-E 806.08 Ancillary Services {#sec-he-e-806.08 omnilex-key=us-nh-regs-official--agency-he-e--He-E 806.08}

(a) The costs of ancillary services provided by the NF, except for prescribed drugs, shall be included in the NF rate determination.

(b) Ancillary services shall include, but not be limited to:

(1) Occupational therapy;

(2) Physical therapy;

(3) Speech therapy;

(4) Inhalation therapy, including oxygen costs;

(5) Laboratory; and

(6) Radiology.

(c) The net cost of medicaid ancillary services not previously reimbursed by another payor source shall be included in the NF rate determination, provided that NFs maintain revenue and cost data of all ancillary services provided to medicaid residents of the NF separately from all other ancillary services and costs.

History

#8547, eff 1-24-06 (formerly He-W 593.27); ss by #10474, eff 1-24-14; ss by #14020, eff 7-10-24

N.H. Code Admin. R. Ann. He-E 806.09 Drugs and Institutional Pharmacy Costs {#sec-he-e-806.09 omnilex-key=us-nh-regs-official--agency-he-e--He-E 806.09}

The cost of operating an institutional pharmacy and the cost or charges of prescribed legend drugs shall not be an allowable cost in the per diem rate as the New Hampshire medicaid program reimburses these costs to the provider of these services through a direct billing process on a fee for service basis in accordance with He-W 570 pharmacy services.

History

#8547, eff 1-24-06 (formerly He-W 593.28); ss by #10474, eff 1-24-14; ss by #14020, eff 7-10-24

N.H. Code Admin. R. Ann. He-E 806.10 Barber and Beauty Services {#sec-he-e-806.10 omnilex-key=us-nh-regs-official--agency-he-e--He-E 806.10}

(a) The direct costs of barber and beauty services shall be non-allowable for purposes of medicaid reimbursement.

(b) The fixed costs for space and equipment related to providing the services described in (a) above shall be allowable.

History

#8547, eff 1-24-06 (formerly He-W 593.31); ss by #10474, eff 1-24-14; ss by #14020, eff 7-10-24

N.H. Code Admin. R. Ann. He-E 806.11 Motor Vehicle Expense {#sec-he-e-806.11 omnilex-key=us-nh-regs-official--agency-he-e--He-E 806.11}

(a) The cost of operating a motor vehicle shall be an allowable cost if the vehicle is used solely for the provision of resident care.

(b) Motor vehicle expenses shall include:

(1) Mileage payments;

(2) Repairs;

(3) Excise taxes; and

(4) Sales taxes and other related expenses, including interest charges, insurance, and depreciation.

History

#8547, eff 1-24-06 (formerly He-W 593.24); ss by #10474, eff 1-24-14; ss by #14020, eff 7-10-24

N.H. Code Admin. R. Ann. He-E 806.12 Depreciation of Equipment and Property {#sec-he-e-806.12 omnilex-key=us-nh-regs-official--agency-he-e--He-E 806.12}

Depreciation of equipment and property which has a purchase price of over $1000 shall be an allowable cost pursuant to the following conditions:

(a) The depreciation shall be:

(1) Identifiable and recorded in the NF’s accounting records;

(2) Based on the historical cost of the asset or fair market value at the time of donation in the case of donated assets; and

(3) Prorated over the estimated useful life of the asset using the straight line method and the guidelines specified in the American Hospital Association’s “Estimated Useful Lives of Depreciable Hospital Assets” (Revised 2023 Edition), available as noted in Appendix A;

(b) Recording of the depreciation pursuant to (a)(1) above shall encompass:

(1) The identification of the depreciable asset in use;

(2) The asset’s historical cost;

(3) The method of depreciation;

(4) The estimated useful life of the asset; and

(5) The asset’s accumulated depreciation; and

History

#8547, eff 1-24-06 (formerly He-W 593.10); ss by #10474, eff 1-24-14; ss by #14020, eff 7-10-24; ss by #14149, eff 12-12-24

N.H. Code Admin. R. Ann. He-E 806.13 Leased Facility and Equipment {#sec-he-e-806.13 omnilex-key=us-nh-regs-official--agency-he-e--He-E 806.13}

Leasing arrangements for property shall be an allowable cost pursuant to the following conditions:

(a) Rent expense on facilities and equipment leased from a related organization shall be limited by substituting the lower of the following:

(1) The actual interest, depreciation, and taxes incurred for the year under review; or

(2) The price of comparable services or facilities purchased elsewhere;

(b) The existence of the following conditions shall establish that a lease is a virtual purchase:

(1) The rental charge exceeds rental charges of comparable equipment in the area;

(2) The term of the lease is less than the useful life of the equipment;

(3) The NF has the option to renew the lease at a reduced rental; and

(4) The NF has the right to purchase the equipment at a price which appears to be less than what the fair market value of the equipment would be at the time of acquisition by the NF is permitted;

(c) When a lease is a virtual purchase, as described in (b) above, allowable costs shall be subject to the following limitations:

(1) The rental charge shall be allowable only to the extent that it does not exceed the amount which would have been an allowable cost had the asset been purchased;

(2) The difference between the amount of rent paid and the amount of rent allowed as rental expense shall be considered as a deferred charge and capitalized as part of the historical costs of the asset when the asset is purchased;

(3) If the asset is returned to the owner, instead of purchased, the deferred charge shall be recorded as an expense in the year the asset is returned; and

(4) If the asset continues to be rented after the due date for the purchase, and rental has been reduced, the deferred charge shall be recorded as an expense to the extent of increasing the reduced rental to a fair market rental value; and

(d) Sale and leaseback agreements for property shall be allowable costs subject to the following conditions:

(1) Rental costs specified in sale and leaseback agreements, incurred by NFs through selling equipment, but not real property, to a purchaser not connected with or related to the NF, and concurrently leasing back the same equipment shall be an allowable cost if the rental charges are as specified in 42 CFR 413.134(h); and

(2) Rental charges in sale and leaseback agreements shall be allowable only to the extent that they do not exceed the amount which would have been an allowable cost had ownership of the asset been retained.

History

#8547, eff 1-24-06 (formerly He-W 593.11); ss by #10474, eff 1-24-14; ss by #14020, eff 7-10-24

N.H. Code Admin. R. Ann. He-E 806.14 Administrator Salaries {#sec-he-e-806.14 omnilex-key=us-nh-regs-official--agency-he-e--He-E 806.14}

For reimbursement purposes, administrators' salaries shall be limited to an amount that is comparable for facilities of similar size and level of care, as determined by the department, in accordance with the provisions of He-E 806.

History

#8547, eff 1-24-06 (formerly He-W 593.19); ss by #10474, eff 1-24-14; ss by #14020, eff 7-10-24

N.H. Code Admin. R. Ann. He-E 806.15 Assistant Administrator Salaries {#sec-he-e-806.15 omnilex-key=us-nh-regs-official--agency-he-e--He-E 806.15}

(a) For facilities of 100 or more beds, assistant administrators' salaries shall be an allowable cost at the rate of one assistant for each 100 beds.

(b) The allowable cost for the salary of the assistant administrator described in (a) above shall not exceed 70% of the allowable salary of the administrator.

History

#8547, eff 1-24-06 (formerly He-W 593.20); ss by #10474, eff 1-24-14; ss by #14020, eff 7-10-24

The cost of a social worker(s) shall be an allowable cost.

History

#8547, eff 1-24-06 (formerly He-W 593.32); ss by #10474, eff 1-24-14; ss by #14020, eff 7-10-24

N.H. Code Admin. R. Ann. He-E 806.17 Owners, Operators, or Their Relatives {#sec-he-e-806.17 omnilex-key=us-nh-regs-official--agency-he-e--He-E 806.17}

(a) For reimbursement purposes, NFs which have a full-time, that is, 40 hours per week minimum, administrator shall not otherwise be allowed compensation for owners, operators, or their relatives except in circumstances specified in (c) below, when the NF has a licensed capacity of more than 99 beds.

(b) Owners shall include:

(1) Any individual or organization with any equity interest in the NF’s operation;

(2) Any member of such individual's family or the individual’s spouse's family;

(3) Partners and all stockholders in the NF's operation; and

(4) All partners and stockholders in organizations which have an equity interest in the operation.

(c) The amount allowable for owner's compensation shall be pursuant to all applicable Medicare policies identified in Section 700 and 900 of the “Provider Reimbursement Manual”, Part I, HCFA-Pub. 15-1 in effect at the time.

History

#8547, eff 1-24-06 (formerly He-W 593.21); ss by #10474, eff 1-24-14; ss by #14020, eff 7-10-24

N.H. Code Admin. R. Ann. He-E 806.18 Non-Paid Workers {#sec-he-e-806.18 omnilex-key=us-nh-regs-official--agency-he-e--He-E 806.18}

If a worker does not receive remuneration for services provided on behalf of the NF, any costs to the employer such as meals and uniforms for the worker, shall be an allowable cost.

History

#8547, eff 1-24-06 (formerly He-W 593.16); ss by #10474, eff 1-24-14; ss by #14020, eff 7-10-24

N.H. Code Admin. R. Ann. He-E 806.19 Administrative Expenses and Administrator Duties {#sec-he-e-806.19 omnilex-key=us-nh-regs-official--agency-he-e--He-E 806.19}

The administration function shall be an allowable cost including, but not limited to, the following:

(a) Hiring and firing of personnel;

(b) Administrative supervision of the nursing, dietary, and other personnel;

(d) Maintenance of payroll, bookkeeping, and other records of the business;

(e) Supervising the maintenance and repairs of the NF; and

(f) Procuring necessary supplies and equipment.

History

#8547, eff 1-24-06 (formerly He-W 593.18); ss by #10474, eff 1-24-14; ss by #14020, eff 7-10-24

N.H. Code Admin. R. Ann. He-E 806.20 General County Government Costs {#sec-he-e-806.20 omnilex-key=us-nh-regs-official--agency-he-e--He-E 806.20}

(a) Indirect costs associated with general county government such as, but not limited to, interest and depreciation, shall not be allowable.

(b) For county-owned and operated nursing facilities, the costs of general county government shall not be allowable costs.

(1) County commissioners;

(2) Treasurers; and

(3) Attorneys and other administrative and support staff.

History

#8547, eff 1-24-06 (formerly He-W 593.29); ss by #10474, eff 1-24-14; ss by #14020, eff 7-10-24

N.H. Code Admin. R. Ann. He-E 806.21 Approved Educational Activities {#sec-he-e-806.21 omnilex-key=us-nh-regs-official--agency-he-e--He-E 806.21}

(a) The net cost of educational activities as approved by the entity, agency, or board having jurisdiction over the activity, shall be an allowable cost.

(b) Orientation, on-the-job training, and in-service programs shall not be considered to be approved educational activities for reporting purposes.

(c) The activities listed in (b) above shall be recognized as allowable costs in accordance with the provisions of He-E 806.

History

#8547, eff 1-24-06 (formerly He-W 593.14); ss by #10474, eff 1-24-14; ss by #14020, eff 7-10-24

N.H. Code Admin. R. Ann. He-E 806.22 Research Costs {#sec-he-e-806.22 omnilex-key=us-nh-regs-official--agency-he-e--He-E 806.22}

Costs incurred for research purposes shall not be included as allowable costs.

History

#8547, eff 1-24-06 (formerly He-W 593.15); ss by #10474, eff 1-24-14; ss by #14020, eff 7-10-24

N.H. Code Admin. R. Ann. He-E 806.23 Advertising Expense {#sec-he-e-806.23 omnilex-key=us-nh-regs-official--agency-he-e--He-E 806.23}

(a) Reasonable and necessary expense of newspaper or other public media advertisement for the purpose of securing necessary employees and volunteers shall be an allowable cost.

(b) Reasonable and necessary expense of newspaper or other public media advertisement required by local, state, and federal government shall be an allowable cost.

History

#8547, eff 1-24-06 (formerly He-W 593.23); ss by #9623, eff 12-24-09; ss by #12440, INTERIM, eff 12-23-17, EXPIRED: 6-21-18
#12566, eff 6-29-18; ss by #14020, eff 7-10-24

N.H. Code Admin. R. Ann. He-E 806.24 Home Office Costs {#sec-he-e-806.24 omnilex-key=us-nh-regs-official--agency-he-e--He-E 806.24}

(a) Home office costs shall include, but not be limited to, the following:

(1) Payroll and benefit services;

(2) Personnel services, including hiring of additional personnel;

(3) Data processing;

(4) Credit and collections;

(5) Accounting; and

(6) Legal services.

(b) Home office costs shall be documented by the submission to the department a copy of HCFA Form 287-92, Chain Home Office Cost Statement, no later than 5 months after the end of the home office fiscal year, unless an extension has been granted by the department as described in He-E 806.02 (p).

(c) If a home office cost report is not submitted or an extension is not granted as in (b) above, then home office costs shall not be allowable costs.

(d) Home office costs for chain operations shall be allowed if:

(1) The costs are reasonable, as defined in He-E 806.05 (a);

(2) The costs are related to resident care; and

(3) The costs meet all reimbursement criteria set forth in He-E 806.

(e) The amount of allowable home office expenses to be included in any year’s administrative costs shall meet the criteria of allowable costs as outlined in He-E 806, and the combination of home office expenses and the expenses of related organizations shall be comparable to NF’s that do not have a home office but are providing the same level of service.

(f) Home office costs shall be limited to the lower of:

(1) The allowable cost if the cost was properly allocated to the NF; or

(2) The price of comparable services, facilities, or supplies that could be purchased elsewhere, taking into consideration the benefits of effective purchasing that would accrue to each member NF in the chain because of aggregate purchasing.

(g) An NF’s “Medicaid Annual Cost Report” shall not include both home office cost expense and management fees.

(h) A home office cost shall not be allowed if the same cost, when incurred by an NF, would not be allowed as a cost pursuant to He-E 806.

History

#8547, eff 1-24-06; ss by #10474, eff 1-24-14; ss by #14020, eff 7-10-24

N.H. Code Admin. R. Ann. He-E 806.25 Services to Individuals Other Than Residents {#sec-he-e-806.25 omnilex-key=us-nh-regs-official--agency-he-e--He-E 806.25}

(a) Employee meals consumed on premises during regular working hours from the NF kitchen or food supply shall be allowable costs.

(b) If individuals other than residents are provided rooms, such services shall not be allowable costs.

History

#8547, eff 1-24-06 (formerly He-W 593.26); ss by #10474, eff 1-24-14; ss by #14020, eff 7-10-24

N.H. Code Admin. R. Ann. He-E 806.26 Other Non-Allowable Costs {#sec-he-e-806.26 omnilex-key=us-nh-regs-official--agency-he-e--He-E 806.26}

(a) The following costs shall not be allowed:

(1) Expenditures made by an NF only for the protection, enhancement, or promotion of the NF's business interests, and not related to the provision of resident care;

(2) Duplicative functions or services;

(3) Expenditures in excess of approved cost controls;

(4) Political contributions or lobbying costs;

(5) Membership costs in social or fraternal organizations; and

(6) Fees and interest charged for untimely payments.

(b) NFs which include any such costs in the expenditure sections of the annual cost report shall exclude them on the appropriate schedules of the annual cost report.

History

#8547, eff 1-24-06 (formerly He-W 593.33); ss by #10474, eff 1-24-14; ss by #14020, eff 7-10-24

N.H. Code Admin. R. Ann. He-E 806.27 Interest Expenses {#sec-he-e-806.27 omnilex-key=us-nh-regs-official--agency-he-e--He-E 806.27}

(a) Interest shall be an allowable cost subject to (b) through (e) below.

(b) Necessary interest and proper interest as defined in He-E 806.01 on both current and capital indebtedness shall be an allowed cost.

(c) To be allowable, interest expense shall be incurred on indebtedness to lenders or lending organizations not related through control, ownership, affiliation, or any personal relationship to the borrower.

(d) Interest expense shall be reduced by interest income.

(e) With respect to loans receivable from an officer, related person, or organization, interest income shall include interest earned on such loan imputed at a rate equal to the highest rate payable on loans payable by the NF.

(f) The imputed interest described in (e) above shall not be calculated on disallowed borrowing.

History

#8547, eff 1-24-06 (formerly He-W 593.12); ss by #10474, eff 1-24-14; ss by #14020, eff 7-10-24

N.H. Code Admin. R. Ann. He-E 806.28 Discounts, Trade Discounts, and Refunds of Expenses {#sec-he-e-806.28 omnilex-key=us-nh-regs-official--agency-he-e--He-E 806.28}

(a) Discounts and allowances received on purchases of goods or services shall be reductions of the cost to which they relate.

(b) If an NF fails to take advantage of available discounts when able to do so, then the amount of the lost discount shall be disallowed.

History

#8547, eff 1-24-06 (formerly He-W 593.17); ss by #10474, eff 1-24-14; ss by #14020, eff 7-10-24

N.H. Code Admin. R. Ann. He-E 806.29 Bad Debts, Charity, and Courtesy Allowances {#sec-he-e-806.29 omnilex-key=us-nh-regs-official--agency-he-e--He-E 806.29}

Bad debts, charity, and courtesy allowances shall not be included as allowable costs.

History

#8547, eff 1-24-06 (formerly He-W 593.13); ss by #10474, eff 1-24-14; ss by #14020, eff 7-10-24

N.H. Code Admin. R. Ann. He-E 806.30 Audit Procedures {#sec-he-e-806.30 omnilex-key=us-nh-regs-official--agency-he-e--He-E 806.30}

The following auditing procedures shall apply:

(a) The department shall conduct on-site audits of the financial and statistical records of participating NFs, pursuant to the requirements of 42 CFR 447.202 and 42 CFR 447.253(g);

(b) The on-site audits as described in (a) above shall be performed to ascertain whether the cost report submitted by the NF meets the requirements as outlined in He-E 806; and

(c) For out-of-state NFs, the department shall accept the audit findings and adjustments of out-of-state medicaid agencies developed in conjunction with their respective cost-related reimbursement plans.

History

#8547, eff 1-24-06 (formerly He-W 593.07); ss by #10474, eff 1-24-14; ss by #14020, eff 7-10-24

N.H. Code Admin. R. Ann. He-E 806.31 Methodology for Determining the Per Diem Rate {#sec-he-e-806.31 omnilex-key=us-nh-regs-official--agency-he-e--He-E 806.31}

(a) A single NF-wide prospective rate shall be paid to each NF and comprised of 5 components of cost determined from NF cost reports submitted to the department.

(b) The 5 components of costs shall be:

(1) Administrative costs incurred in the general management and support of the NF, including the following:

a. Compensation for owners, administrators, and consultants;

b. Management fees;

c. Accounting;

d. Legal;

e. Travel; and

f. Other similar costs;

(2) Other support costs allowable in the support group, except for plant maintenance-related costs, including the following:

a. Housekeeping;

b. Laundry;

c. Dietary;

d. Central supply;

e. Pharmacy;

f. Medical records;

g. Social service; and

h. Recreation;

(3) Plant maintenance costs allowable in the support group related to plant maintenance, including but not limited to:

a. Plant maintenance salaries and benefits;

b. Supplies;

c. Utilities; and

d. Property taxes, as well as other plant maintenance costs;

(4) Capital costs, which are depreciation and interest costs that include, but are not limited to, interest on mortgages and long-term notes and depreciation, of which depreciation and interest costs shall not be inflated; and

(5) Patient care costs, which are costs incurred in the direct care of residents treated and include but are not limited to:

a. Salaries of RNs, LPNs, and aides;

b. Nursing supplies;

c. Ancillaries, and

d. Therapy services.

(c) Therapy service costs included in (b)(5)d. above shall be subject to a ceiling calculated based on the 85th percentile of the combined physical, occupational, and speech therapy portion of the patient care component of NF rates that were effective October 1, 1998, inflated to August 1, 2006.

(d) For each of the components of cost, inflated costs per diem shall be adjusted by a factor to remove costs incurred by residents with atypical needs calculated as follows:

(1) The atypical factor shall be calculated by multiplying the atypical rate in effect by actual atypical days to estimated total atypical costs;

(2) The number of atypical days shall be identified by actual paid claims for atypical individual residents in each NF for the year that corresponds with the NF’s cost report year;

(3) The atypical payments shall then be divided by total medicaid costs for each NF to develop a ratio of atypical costs to total costs; and

(4) Each cost component per diem shall then be reduced by this ratio to remove the costs of treating an atypical resident.

(e) Resident acuity shall be classified using the minimum data set (MDS) version 3.0, the Patient Driven Payment Model (PDPM) nursing component, and the current relative weights as follows:

(1) The assessment types used shall be Centers for Medicare & Medicaid Services (CMS) required MDS assessments, which are the omnibus budget reconciliation act and Prospective Payment System (PPS) assessments, including admission, annual, significant change, quarterlies and PPS-only assessments according to the following:

a. The applicable date on the MDS used to determine inclusion shall be the last day of the 5th month prior to the medicaid rate date;

b. These assessments shall be either an admission assessment with a date of entry, item number A1600, on or before the picture date depending on the adjustment period or the most recent quarterly, annual, or significant change assessment with an assessment reference date no later than 5 days past the picture date;

c. To ensure inclusion in the acuity-based rate, an NF shall transmit all applicable assessments on or before the 20th of the month following the picture date, for inclusion in the data collection process; and

d. Each resident shall then be classified into one of the resident classifications, using the PDPM nursing component, and relative weights assigned as described in (3) below;

(2) The PDPM nursing component shall be described as “State of New Hampshire acuity group classifications;” and

(3) Relative weights used for the PDPM shall be the relative weights used in the federal classification system.

(f) The NF all-payor case mix index for each NF shall be calculated as follows:

(1) By multiplying the number of residents by the relative weight for each of the classifications; and

(2) Dividing the sum of the values across each resident grouping by the total number of residents.

(g) Costs listed in (b)(1), (2), (3), and (5) above shall be calculated by inflating costs in the base year from the midpoint of the cost report to the midpoint of the rate period using the CMS PPS skilled NF input price index by expenses category index.

(h) The all-payor case mix index shall be updated to synchronize the all-payor case mix index with the medicaid cost report year.

(i) The prospective per diem rates-component amounts shall be calculated as follows:

(1) An NF-specific prospective per diem rate shall be calculated by summing 5 rate components:

a. Patient care costs;

b. Administrative costs;

c. Other support costs;

d. Plant maintenance; and

e. Capital; and

(2) Each component’s per diem amount shall be calculated as follows:

a. The patient care cost component shall be based on:

The lower of each NF’s case-mix adjusted direct care cost per diem amount; or
The statewide median value, as calculated below:

(i) The case mix adjusted direct care cost per diem for each NF shall be calculated by dividing total patient care costs including allowed physical, occupational, and speech therapy costs from each NF’s cost report by resident days, based on data included in the most recently desk reviewed or field audited cost reports, inflated to the midpoint of the rate period in order to provide equity among NFs with cost reports with different year end dates;

(ii) The resulting amount shall then be divided by the all payor case-mix index to determine the case-mix adjusted patient care cost component per diem amount; and

(iii) NF-specific amounts shall be arrayed, and the statewide median determined;

b. The administrative cost component of the prospective per diem rate shall be based on the statewide median value, as calculated below:

NF-specific cost per diem amounts shall be calculated by dividing the total administrative costs by resident days, based on data included in the most recently desk reviewed or field audited cost reports, inflated to the midpoint of the rate period in order to provide equity among NFs with cost reports with different year end dates; and
NF-specific amounts shall be arrayed, and the statewide median value determined;

c. The other support cost component of the prospective per diem rate shall be based on the statewide median value, as calculated below:

NF-specific cost per diem amounts shall be calculated by dividing the total other support costs by resident days, based on data included in the most recently desk reviewed or field audited cost reports, inflated to the midpoint of the rate period, in order to provide equity among NFs with cost reports with different year end dates; and
NF-specific amounts shall be arrayed, and the statewide median value determined;

d. The plant maintenance component of the prospective per diem rate shall be based on the statewide median value, as calculated below:

NF-specific cost per diem amounts shall be calculated by dividing the total plant maintenance costs by resident days, based on data included in the most recently desk reviewed or field audited cost reports, inflated to the midpoint of the rate period in order to provide equity among NFs with cost reports with different year end dates; and
NF-specific amounts shall be arrayed, and the statewide median value determined; and

e. The capital cost component of the prospective per diem rate shall be based on the actual NF cost, taken from the most recently desk reviewed or field audited cost reports, subject to an aggregate 85th percentile ceiling.

(j) In addition to the requirements in (i)(2)a. above, the department shall conduct a review of acuity-based rates at least every 6 months, using the most recently available MDS data submitted by the facilities after review validation.

(k) NF-specific per diem rates shall be calculated as follows:

(1) The per diem cost components shall be summed to obtain the total NF rate per diem for each resident in the NF as of a date specified by the department;

(2) The resulting rate shall be paid to the NF until rates are updated with new MDS data after the update to acuity-based rates pursuant to (j) above, at which time the rates for all residents are summed and divided by the total number of residents in the NF; and

(3) These rates shall be reduced by a budget adjustment factor equal to 25% in accordance with the medicaid state plan.

(l) The department shall review rates and rebase NF rates at least every 5 years.

History

#8547, eff 1-24-06 (formerly He-W 593.04); ss by #8769, EMERGENCY RULE, eff 12-1-06, EXPIRES: .5-30-07; ss by #8890, eff 5-25-07; ss by #9623, eff 12-24-09; paras. (e) & (f) amd by #12220, eff 7-1-17; paras. (a)-(d) & (g)-(o) amd by #12440, INTERIM, eff 12-23-17, EXPIRED: 6-21-18 in paras (a)-(d) & (g)-(o); paras (a)-(d) & (g)-(p) amd by #12566, eff 6-29-18; amd by #12688, EMERGENCY RULE, eff 12-7-18, EXPIRED: 6-5-19 (para (k) in #12566 effective again pursuant to RSA 541-A:18, V, I; ss by #14020, eff 7-10-24; ss by #14149, eff 12-12-24

N.H. Code Admin. R. Ann. He-E 806.32 Methodology for Determining the Per Diem Rate for New NFs, When Reconstruction Occurs, and When a Change in Ownership Occurs {#sec-he-e-806.32 omnilex-key=us-nh-regs-official--agency-he-e--He-E 806.32}

The initial prospective per diem rate for new facilities, including existing facilities under new ownership shall be calculated at the average per diem rate for NH facilities until a full year audited cost report is available for inclusion in the per diem rate setting process.

History

#8547, eff 1-24-06 (formerly He-W 593.04); ss by #10474, 1-24-14; ss by #14020, eff 7-10-24; ss by #14149, eff 12-12-24

N.H. Code Admin. R. Ann. He-E 806.33 Per Diem Rates and Payment for Nursing Care {#sec-he-e-806.33 omnilex-key=us-nh-regs-official--agency-he-e--He-E 806.33}

(a) An NF shall be reimbursed for direct and indirect costs as determined by the bed days of care and the NF’s prospective per diem rate.

(b) Payment rates shall be pursuant to the provisions of He-E 806.

History

#8547, eff 1-24-06 (formerly He-W 593.35); ss by #10474, 1-24-14; ss by #14020, eff 7-10-24

N.H. Code Admin. R. Ann. He-E 806.34 Medicare Provider Reimbursement Manual {#sec-he-e-806.34 omnilex-key=us-nh-regs-official--agency-he-e--He-E 806.34}

Decisions governing the allowability of costs not specifically detailed at He-E 806 shall be pursuant to the “Medicare Provider Reimbursement Manual”, Part I, HCFA-Pub 15-1 and Part II, HCFA-Pub 15-2 in effect at the time of such determination.

History

#8547, eff 1-24-06 (formerly He-W 593.34); ss by #10474, 1-24-14; ss by #14020, eff 7-10-24

N.H. Code Admin. R. Ann. He-E 806.35 Rate Setting and Payment Limitations For General Nursing Facility Care {#sec-he-e-806.35 omnilex-key=us-nh-regs-official--agency-he-e--He-E 806.35}

(a) Rate setting and payment limitations for NF care shall be determined as specified in (b) through (f) below.

(b) Each NF's per diem rate shall be reviewed at least annually by the department pursuant to He-E 806 utilizing data submitted on the annual cost report.

(1) The actual days of service rendered, including reserved bed days; or

(2) For the capital component, the greater of the actual days of service rendered or the number of resident days computed at 85% of the certified bed capacity.

(d) In no case shall payment exceed the NF’s customary charges to the general public for such services, or, where applicable, the Medicare rate of reimbursement, whichever is less.

(e) When a medicaid per diem rate is established as a condition for a health services planning and review board approval, pursuant to RSA 151-C, and that rate differs from the medicaid rate established by the department, payment shall be made at the lesser of the 2 rates.

(f) Where a rate limitation is applied as a health services planning and review board condition, an NF may, if aggrieved, appeal such limitation in accordance with He-C 200.

History

#8547, eff 1-24-06 (formerly He-W 593.37); ss by #10474, 1-24-14; ss by #14020, eff 7-10-24

N.H. Code Admin. R. Ann. He-E 806.36 Rate Setting and Payment Limitations for Atypical Nursing Care {#sec-he-e-806.36 omnilex-key=us-nh-regs-official--agency-he-e--He-E 806.36}

(a) Each NF of atypical care shall be an NF or a distinct part of an NF which possesses the physical characteristics and appropriate staffing for, and devotes its services exclusively to, highly specialized care, the nature of which renders that NF or unit incomparable to other NFs for the purpose of calculating and applying cost and occupancy limits.

(b) Examples of such care described in (a) above shall include services for:

(1) Children with severe physical or mental disabilities;

(2) Brain and spinal injured patients;

(3) Ventilator-dependent patients; or

(4) Other specialized services.

(c) The department shall determine the rate of reimbursement utilizing cost documentation submitted by the NF which clearly identifies the cost of the atypical care.

(d) The rate described in (c) above shall:

(1) Include routine care costs, ancillary costs, and capital costs;

(2) Take into consideration any additional amount necessary to assure access to necessary and appropriate services for New Hampshire medicaid residents with specialized care needs; and

(3) Be exempt from comparative cost and occupancy limits.

(e) In order to qualify as an NF of atypical care, the NF shall make application in writing which:

(1) Requests to be considered an NF of atypical care;

(2) Describes the care or services to be provided; and

(3) Documents the costs of such care.

(f) The department shall determine if an NF is qualified to provide and be paid for atypical care based on documentation submitted by the NF, and on whether there is a documented need for these services as determined by the availability of such services in the locality.

(g) Applications for approval of atypical care NFs which have been denied may be appealed pursuant to He-E 806.41.

History

#8547, eff 1-24-06 (formerly He-W 593.38); ss by #10474, 1-24-14; ss by #14020, eff 7-10-24

N.H. Code Admin. R. Ann. He-E 806.37 Reimbursement for Out-of-State Nursing Care {#sec-he-e-806.37 omnilex-key=us-nh-regs-official--agency-he-e--He-E 806.37}

Reimbursement for out-of-state nursing care shall be made as follows:

(a) The department shall base the reimbursement rate on the rate set by the medicaid agency of the state in which the out-of-state NF is located for services at that NF; and

(b) In cases where the out-of-state medicaid rate does not exist or is not sufficient to allow access of New Hampshire residents in need of services, a rate shall be determined by the department as described in He-E 806.

History

#8547, eff 1-24-06 (formerly He-W 593.39); ss by #10474, 1-24-14; ss by #14020, eff 7-10-24

N.H. Code Admin. R. Ann. He-E 806.38 Bed Days {#sec-he-e-806.38 omnilex-key=us-nh-regs-official--agency-he-e--He-E 806.38}

(a) Bed days shall include the day of admission, but not the day of discharge.

(b) If admission and discharge occur on the same day, one bed day shall be allowed.

History

#8547, eff 1-24-06 (formerly He-W 593.36); ss by #10474, 1-24-14; ss by #14020, eff 7-10-24

N.H. Code Admin. R. Ann. He-E 806.39 Maintenance of Resident Funds {#sec-he-e-806.39 omnilex-key=us-nh-regs-official--agency-he-e--He-E 806.39}

(a) NFs shall maintain residents’ personal funds such as, cash account funds and bank accounts.

(b) For cash account funds, pursuant to RSA 151:24, the NF shall determine the balance to be maintained as a source of ready cash for residents.

(d) A receipt shall be obtained for all cash amounts given residents from this fund or any expenditures made on their behalf.

(e) Expenditures not related to residents’ personal needs, such as the cashing of employee checks, shall be prohibited.

(f) All amounts of residents’ personal funds in excess of the cash fund may be maintained in a bank in a variety of ways, such as checking, savings accounts, and certificates of deposit.

(g) Residents’ personal funds shall not be co-mingled with funds maintained for the general operations of the NF.

(h) Interest accumulated by residents’ personal funds accounts shall belong to those residents whose money generates the interest.

(i) Allocation of interest income shall be made at least quarterly.

(j) All disbursements made by the NF on behalf of residents shall be supported by receipts and invoices retained in the resident’s personal needs file.

(k) Authorization by the resident or the resident’s authorized representative shall be obtained for all disbursements described in (j) above.

(l) Upon receipt of monthly bank statements, the residents’ funds shall be reconciled to detail ledgers and equal the checking or savings and cash fund balance.

History

#8547, eff 1-24-06 (formerly He-W 593.40); ss by #10474, 1-24-14; ss by #14020, eff 7-10-24; ss by #14020, eff 7-10-24

N.H. Code Admin. R. Ann. He-E 806.40 Reconsiderations for Cost Report Adjustments {#sec-he-e-806.40 omnilex-key=us-nh-regs-official--agency-he-e--He-E 806.40}

(a) There shall be 2 levels for appeal of cost report adjustments as described in He-E 806.02(s) and (t) as follows:

(1) A reconsideration by the department, through the bureau of program integrity as described in (b) through (e) below; and

(2) An administrative appeal as specified in He-E 806.41.

(b) NFs may use either or both the reconsideration of cost reports adjustment as outlined in (a)(1) and the appeal process as outlined in (a)(2) above.

(c) NFs may request reconsideration of the proposed cost report adjustment(s) within 60 calendar days of the date of notification of the rate adjustments as described in He-E 806.02(v) by submitting a request for reconsideration to:

New Hampshire Department of Health and Human Services

Bureau of Program Integrity

Main Building

105 Pleasant Street

Concord, NH 03301-3843

(d) The NF shall submit a statement as to why the request for reconsideration is being made and may submit any new or additional information that the NF wishes the bureau of program integrity to consider.

(e) At the request of the NF, the reconsideration may be conducted as an informal meeting or as a review of the information described in (f)(1) and (f)(2) below by the bureau of program integrity and the NF.

(f) The bureau of program integrity shall make a decision on the reconsideration based on:

(1) A review of all information submitted by the NF; and

(2) A review of the cost report adjustments proposed by the department to determine the accuracy of the adjustments.

(g) The bureau of program integrity shall send a written decision of the reconsideration to the NF within 10 business days of the meeting.

(h) If the NF disagrees with the decision rendered by the bureau of program integrity, the NF may utilize the administrative appeals process in accordance with He-E 806.41.

History

#8547, eff 1-24-06; ss by #9623, eff 12-24-09; ss by #12440, INTERIM, eff 12-23-17, EXPIRED: 6-21-18
#12566, eff 6-29-18; ss by #14020, eff 7-10-24; ss by #14149, eff 12-12-24

N.H. Code Admin. R. Ann. He-E 806.41 Administrative Appeals {#sec-he-e-806.41 omnilex-key=us-nh-regs-official--agency-he-e--He-E 806.41}

(a) Requests for administrative appeals by NFs, with the exception of state owned and operated facilities, shall be directed to the department with a copy of the appeal sent to bureau of elderly and adult services, rate setting and audit unit.

(b) The written request for an appeal shall be received by the department within 30 calendar days of the date of the notice of the new medicaid NF rates or the date of the bureau of improvement and integrity’s written decision.

(d) Appeals shall be held and heard in accordance with He-C 200.

(e) In accordance with 42 CFR 447.253(e), an NF shall request appeals:

(1) As specified in He-E 806; and

(2) Due to the action or inaction of the department relevant to He-E 806.

(f) An NF may request an appeal regarding a rate set by the department.

(g) An NF shall not request an appeal regarding:

(1) The department’s internal rate setting methodology; or

(2) Federal or state constitutional law.

(h) The hearings officer shall deny any request for an appeal which is not as described in (e) or (f) above.

History

#8547, eff 1-24-06 (formerly He-W 593.41); ss by #10474, 1-24-14; ss by #14020, eff 7-10-24

N.H. Code Admin. R. Ann. He-E 806.42 Incorrect Payments {#sec-he-e-806.42 omnilex-key=us-nh-regs-official--agency-he-e--He-E 806.42}

(a) If an NF was paid incorrectly, interest shall not be paid on underpayments nor collected on overpayments.

(b) If an appeal decision is in favor of the NF, the department shall make the appropriate rate adjustment(s) and payments, including any necessary retroactive payments.

History

#8547, eff 1-24-06 (formerly He-W 593.42); ss by #10474, 1-24-14; ss by #14020, eff 7-10-24

Part He-E 807 Nursing Facility Enforcement Remedies - Expired

N.H. Code Admin. R. Ann. He-E 807.01 Medical Assistance {#sec-he-e-807.01 omnilex-key=us-nh-regs-official--agency-he-e--He-E 807.01}

– He-E 807.18

APPENDIX A: Incorporation by Reference Information

Rule

Title

Publisher; How to Obtain; and Cost

He-E 801.20(b)

United States Department of Agriculture’s “ Dietary Guidelines for Americans 2020-2025” (Ninth Edition)

Publisher: United States Department of Agriculture

Cost: Free to the Public

The incorporated document is available at:

https://www.dietaryguidelines.gov/sites/default/files/2021-03/Dietary_Guidelines_for_Americans-2020-2025.pdf

This publication can also be ordered by calling the U.S. Government Publishing Office (GPO) at (866) 512-1800 and asking for stock number 001-000-04866-0, or by accessing the GPO Online Bookstore at

http://bookstore.gpo.gov.

He-E 801.24(b)(7)

U.S. Department of Housing and Development’s “Office of Fair Housing & Equal Opportunity Notice: FHEO-2020-01” (January 2020)

Publisher: U.S. Department of Housing and Development

Cost: Free to the public

The incorporated document is available at:

https://www.hud.gov/sites/dfiles/PA/documents/HUDAsstAnimalNC1-28-2020.pdf

He-E 801.31(c)(1)a.

Association of People Supporting Employment First’s

“Universal Employment Competencies” (January 2019)

Publisher: Association of People Supporting Employment First

Cost: Free to the public

The incorporated document is available at:

https://apse.org/wp-content/uploads/2019/03/Apse-universal-Comps-FINAL3-15-19.pdf

He-E 806.02(e)(1), 806.02(f), 806.24(b)

“Chain Home Office Cost Statement” Form 287-92

Publisher: Centers for Medicare & Medicaid Services

Available at: https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/R4P231.pdf

Cost: Free

He-E 806.12(a)(3)

American Hospital Association’s “Estimated Useful Lives of Depreciable Hospital Assets” (Revised 2023 Edition)

Publisher: American Hospital Association, 155 North Wacker Drive, Chicago, Illinois 60606. Phone: (312) 422-3000. Web address: http://www.aha.org/.

Available from the publisher’s on-line store at: https://ams.aha.org/EWEB/DynamicPage.aspx?WebCode=ProdDetailAdd&ivd_prc_prd_key=6ccd3a7a-fa36-4806-8102-45d21cd92cea

Cost is: $1313.00 (member); $1545.00 (non-member).

He-E 806.17

“The Provider Reimbursement Manual - Part 1”

Publisher: Centers for Medicare & Medicaid Services

Available at: https://www.cms.gov/regulations-and-guidance/guidance/manuals/paper-based-manuals-items/cms021929

Cost: Free

He-E 806.34

“The Provider Reimbursement Manual - Part 2”

Publisher: Centers for Medicare & Medicaid Services

Available at: https://www.cms.gov/regulations-and-guidance/guidance/manuals/paper-based-manuals-items/cms021935

Cost: Free

APPENDIX B

RULE

SPECIFIC STATE OR FEDERAL STATUTE THE RULE IMPLEMENTS

He-E 801.01

RSA 151-E:1; 42 USC 1396n(c); 42 CFR 440.180; 42 CFR 441 Subpart G

He-E 801.02

RSA 151-E:1, 2; 42 USC 1396n(c); 42 CFR 440.180; 42 CFR 441 Subpart G

He-E 801.03

42 USC 1396n(c)(1) and (2); RSA 151-E:3, 4; 42 CFR 440.180; 42 CFR 441 Subpart G

He-E 801.04

RSA 151-E:3; 42 USC 1396n(c); 42 CFR 440.180; 42 CFR 441.302(c)(1)

He-E 801.05

RSA 151-E:4; 42 USC 1396n(c); 42 CFR 440.180; 42 CFR 441 Subpart G

He-E 801.06

RSA 151-E:1; 42 USC 1396n(c); 42 CFR 440.180; 42 CFR 441 Subpart G

He-E 801.07

RSA 151-E:842 USC 1396n(c); 42 CFR 440.180; 42 CFR 441.302(c)(2)

He-E 801.08

42 USC 1396n(c)(1) and (2); RSA 151-E:3, 4

He-E 801.09

RSA 151-E:11, II-IV; 42 CFR 441.302

He-E 801.10

42 USC 1396n(c); 42 CFR 435.217; 42 CFR 435.735

He-E 801.11

42 USC 1396n(c)(4)(B); RSA 161-I

He-E 801.12

42 USC 1396n(c)(1) ; 42 CFR 433 Subpart D

He-E 801.13 - 801.31

42 USC 1396n(c)(4)(B); RSA 161-I; 42 CFR 440.180

He-E 801.32

42 USC 1396n(c);42 CFR 447.15; 42 CFR 431.107

He-E 801.33

42 USC 1396n(c); 42 CFR 431.107

He-E 801.34

42 USC 1396n(c); 42 CFR 447.50; 42 CFR 447.300; RSA 161:4, VI(a)

He-E 801.35

42 USC 1396n(c); 42 CFR 455; 42 CFR 456

He-E 801.36

42 USC 1396n(c); RSA 167:14-a, III; 42 CFR 433 Subpart D

He-E 801.37

42 USC 1396n(c)

He-E 802.01

RSA 161:4-a, IX and RSA 151

He-E 802.02

42 USC 1396r and RSA 151:2

He-E 802.03

RSA 151-E:3

He-E 802.04

42 USC 1396r; 42 CFR 483.132; RSA 151-E

He-E 802.05

RSA 151-E:3

He-E 802.06

RSA 151-E:3

He-E 802.07

42 USC 1396a and 1396r

He-E 802.08

42 USC 1396r

He-E 802.09

RSA 161:4-a, IX, 42 USC 1396r and RSA 161:4-a, IX

He-E 802.10

42 CFR 483.10(i)(F)

He-E 802.11

42 USC 1396r and RSA 151:21

He-E 802.12

42 USC 1396r

He-E 802.13

42 USC 1396r

He-E 802.14

42 USC 1396r and RSA 151:21

He-E 802.15

42 USC 1396r; 42 CFR 447.40; RSA 151:25

He-E 802.16

42 USC 1396r and RSA 151:26

He-E 802.17

42 USC 1396r and RSA 151:26

He-E 802.18

RSA 541-A:19-b

He-E 802.19

RSA 541-A:19-b

He-E 803.01

RSA 151:2,I(f); RSA 161:4-a, IX

He-E 803.02-803.03

RSA 161:2, XII

He-E 803.04

RSA 161:2, XII and 42 CFR 440.130(c) and (d)

He-E 803.05-803.10

RSA 161:2, XII

He-E 804.01

RSA 161:4-a, IX

He-E 804.02

RSA 161:4-a, IX and 42 USC 1396r

He-E 804.03

RSA 161:4-a, IX and 42 USC 1396r

He-E 804.04

RSA 161:4-a, IX

He-E 805

RSA 151-E; 42 USC 1396n(g)

He-E 806.01

RSA 161:4, VI(a); 1902(a)(13) of the SSA

He-E 806.02

RSA 161:4, VI(a); Section 1902(a)(13) of the SSA; RSA 541-A:21, VIII

He-E 806.12

RSA 161:4, VI(a); Section 1902(a)(13) of the SSA; RSA 541-A:21, VIII

He-E 806.03 – He-E 806.22

RSA 161:4, VI(a); 1902(a)(13) of the SSA; RSA 541-A:21, VIII

He-E 806.23

RSA 161:4, VI(a); Section 1902(a)(13) of the SSA

He-E 806.24 – He-E 806.30

RSA 161:4, VI(a); 1902(a)(13) of the SSA

He-E 806.31

RSA 161:4, VI(a), RSA 161:4-a, X, RSA 541-A:7; Section 1902(a)(13) of the SSA

He-E 806.31(a)-(e) and (h)-(p)

RSA 161:4, VI(a), RSA 541-A:7; Section 1902(a)(13) of the SSA

He-E 806.31(e)-(f)

RSA 161:4-a, X; RSA 541-A:7; Section 1902(a)(13) of the SSA

He-E 806.32 – He-E 806.39

RSA 161:4, VI(a); 1902(a)(13) of the SSA; RSA 541-A:21, VIII

He-E 806.32

RSA 161:4, VI(a); Section 1902(a)(13) of the SSA; RSA 541-A:21, VIII

He-E 806.40

RSA 161:4, VI(a); Section 1902(a)(13) of the SSA

He-E 806.41

RSA 161-F:4; 42 CFR 447.253(e)

He-E 806.42

RSA 161:4, VI(a); 1902(a)(13) of the SSA

He-E 807 - EXPIRED

42 CFR 488.400 - 488.456

History

#8177, eff 9-23-04, EXPIRED: 9-23-12

N.H. Code Admin. R. Ann. He-E — Bureau of Aging and Adult Services

Chapter He-E 300 Division of Elderly and Adult Services Files

Part He-E 310 Rights of Individuals Receiving Choices for Independence in the Community

N.H. Code Admin. R. Ann. He-E 310.01 Purpose {#sec-he-e-310.01 omnilex-key=us-nh-regs-official--agency-he-e--He-E 310.01}

N.H. Code Admin. R. Ann. He-E 310.02 Definitions {#sec-he-e-310.02 omnilex-key=us-nh-regs-official--agency-he-e--He-E 310.02}

N.H. Code Admin. R. Ann. He-E 310.03 Notice of Rights of Participants and Applicants {#sec-he-e-310.03 omnilex-key=us-nh-regs-official--agency-he-e--He-E 310.03}

N.H. Code Admin. R. Ann. He-E 310.04 Fundamental Rights {#sec-he-e-310.04 omnilex-key=us-nh-regs-official--agency-he-e--He-E 310.04}

N.H. Code Admin. R. Ann. He-E 310.05 Personal Rights {#sec-he-e-310.05 omnilex-key=us-nh-regs-official--agency-he-e--He-E 310.05}

N.H. Code Admin. R. Ann. He-E 310.06 Service Rights {#sec-he-e-310.06 omnilex-key=us-nh-regs-official--agency-he-e--He-E 310.06}

N.H. Code Admin. R. Ann. He-E 310.07 Termination of Services {#sec-he-e-310.07 omnilex-key=us-nh-regs-official--agency-he-e--He-E 310.07}

N.H. Code Admin. R. Ann. He-E 310.08 Rights of Participants in Residential Care Facilities {#sec-he-e-310.08 omnilex-key=us-nh-regs-official--agency-he-e--He-E 310.08}

N.H. Code Admin. R. Ann. He-E 310.09 CFI Grievances {#sec-he-e-310.09 omnilex-key=us-nh-regs-official--agency-he-e--He-E 310.09}

N.H. Code Admin. R. Ann. He-E 310.10 Grievance Processing {#sec-he-e-310.10 omnilex-key=us-nh-regs-official--agency-he-e--He-E 310.10}

N.H. Code Admin. R. Ann. He-E 310.11 Grievance Referral {#sec-he-e-310.11 omnilex-key=us-nh-regs-official--agency-he-e--He-E 310.11}

N.H. Code Admin. R. Ann. He-E 310.12 Grievance Records {#sec-he-e-310.12 omnilex-key=us-nh-regs-official--agency-he-e--He-E 310.12}

Chapter He-E 500 Social Services

Part He-E 501 The Social Services Block Grant (title Xx)

N.H. Code Admin. R. Ann. He-E 501.01 Purpose and Goals {#sec-he-e-501.01 omnilex-key=us-nh-regs-official--agency-he-e--He-E 501.01}

N.H. Code Admin. R. Ann. He-E 501.02 Definitions {#sec-he-e-501.02 omnilex-key=us-nh-regs-official--agency-he-e--He-E 501.02}

N.H. Code Admin. R. Ann. He-E 501.03 Confidentiality {#sec-he-e-501.03 omnilex-key=us-nh-regs-official--agency-he-e--He-E 501.03}

N.H. Code Admin. R. Ann. He-E 501.04 Title XX Services {#sec-he-e-501.04 omnilex-key=us-nh-regs-official--agency-he-e--He-E 501.04}

N.H. Code Admin. R. Ann. He-E 501.05 Eligibility Requirements for Services {#sec-he-e-501.05 omnilex-key=us-nh-regs-official--agency-he-e--He-E 501.05}

N.H. Code Admin. R. Ann. He-E 501.06 Application Requirements and Process {#sec-he-e-501.06 omnilex-key=us-nh-regs-official--agency-he-e--He-E 501.06}

N.H. Code Admin. R. Ann. He-E 501.07 Determination, Notice of Eligibility, and Eligibility Period {#sec-he-e-501.07 omnilex-key=us-nh-regs-official--agency-he-e--He-E 501.07}

N.H. Code Admin. R. Ann. He-E 501.08 Individual’s Responsibility To Report Changes {#sec-he-e-501.08 omnilex-key=us-nh-regs-official--agency-he-e--He-E 501.08}

N.H. Code Admin. R. Ann. He-E 501.09 Redetermination of Service Eligibility {#sec-he-e-501.09 omnilex-key=us-nh-regs-official--agency-he-e--He-E 501.09}

N.H. Code Admin. R. Ann. He-E 501.10 Termination of Services {#sec-he-e-501.10 omnilex-key=us-nh-regs-official--agency-he-e--He-E 501.10}

N.H. Code Admin. R. Ann. He-E 501.11 Informal Resolution {#sec-he-e-501.11 omnilex-key=us-nh-regs-official--agency-he-e--He-E 501.11}

N.H. Code Admin. R. Ann. He-E 501.12 Administrative Hearing and Provisions of Services During the Administrative Appeal Process {#sec-he-e-501.12 omnilex-key=us-nh-regs-official--agency-he-e--He-E 501.12}

N.H. Code Admin. R. Ann. He-E 501.13 Provider Requirements {#sec-he-e-501.13 omnilex-key=us-nh-regs-official--agency-he-e--He-E 501.13}

N.H. Code Admin. R. Ann. He-E 501.14 Fees for Title XX Services {#sec-he-e-501.14 omnilex-key=us-nh-regs-official--agency-he-e--He-E 501.14}

N.H. Code Admin. R. Ann. He-E 501.15 Wait Lists {#sec-he-e-501.15 omnilex-key=us-nh-regs-official--agency-he-e--He-E 501.15}

N.H. Code Admin. R. Ann. He-E 501.16 Service Authorization {#sec-he-e-501.16 omnilex-key=us-nh-regs-official--agency-he-e--He-E 501.16}

N.H. Code Admin. R. Ann. He-E 501.17 Service Records {#sec-he-e-501.17 omnilex-key=us-nh-regs-official--agency-he-e--He-E 501.17}

N.H. Code Admin. R. Ann. He-E 501.18 Title XX Services Added During the Eligibility Period {#sec-he-e-501.18 omnilex-key=us-nh-regs-official--agency-he-e--He-E 501.18}

N.H. Code Admin. R. Ann. He-E 501.19 Relocation and Title XX Services {#sec-he-e-501.19 omnilex-key=us-nh-regs-official--agency-he-e--He-E 501.19}

N.H. Code Admin. R. Ann. He-E 501.20 Cessation of Title XX Services by a Provider {#sec-he-e-501.20 omnilex-key=us-nh-regs-official--agency-he-e--He-E 501.20}

N.H. Code Admin. R. Ann. He-E 501.21 Vendor Requirements {#sec-he-e-501.21 omnilex-key=us-nh-regs-official--agency-he-e--He-E 501.21}

N.H. Code Admin. R. Ann. He-E 501.22 Person-Centered Plan {#sec-he-e-501.22 omnilex-key=us-nh-regs-official--agency-he-e--He-E 501.22}

N.H. Code Admin. R. Ann. He-E 501.23 Adult Day Services {#sec-he-e-501.23 omnilex-key=us-nh-regs-official--agency-he-e--He-E 501.23}

N.H. Code Admin. R. Ann. He-E 501.24 Essential Services {#sec-he-e-501.24 omnilex-key=us-nh-regs-official--agency-he-e--He-E 501.24}

N.H. Code Admin. R. Ann. He-E 501.25 Home-Delivered Meals {#sec-he-e-501.25 omnilex-key=us-nh-regs-official--agency-he-e--He-E 501.25}

N.H. Code Admin. R. Ann. He-E 501.26 In-Home Care Services {#sec-he-e-501.26 omnilex-key=us-nh-regs-official--agency-he-e--He-E 501.26}

N.H. Code Admin. R. Ann. He-E 501.27 Waivers {#sec-he-e-501.27 omnilex-key=us-nh-regs-official--agency-he-e--He-E 501.27}

Part He-E 502 Older Americans Act Services: Title Iiib – Supportive Services, Title Iiic1 and C2 – Nutrition Program Policies, and Title Iiid – Disease Prevention and Health Promotion Services

N.H. Code Admin. R. Ann. He-E 502.01 Purpose and Goals {#sec-he-e-502.01 omnilex-key=us-nh-regs-official--agency-he-e--He-E 502.01}

N.H. Code Admin. R. Ann. He-E 502.02 Definitions {#sec-he-e-502.02 omnilex-key=us-nh-regs-official--agency-he-e--He-E 502.02}

N.H. Code Admin. R. Ann. He-E 502.03 Confidentiality {#sec-he-e-502.03 omnilex-key=us-nh-regs-official--agency-he-e--He-E 502.03}

N.H. Code Admin. R. Ann. He-E 502.04 Title III Services {#sec-he-e-502.04 omnilex-key=us-nh-regs-official--agency-he-e--He-E 502.04}

N.H. Code Admin. R. Ann. He-E 502.05 Eligibility Requirements for Services {#sec-he-e-502.05 omnilex-key=us-nh-regs-official--agency-he-e--He-E 502.05}

N.H. Code Admin. R. Ann. He-E 502.06 Service Requests and Process {#sec-he-e-502.06 omnilex-key=us-nh-regs-official--agency-he-e--He-E 502.06}

N.H. Code Admin. R. Ann. He-E 502.07 Determination, Notice of Eligibility, and Eligibility Period {#sec-he-e-502.07 omnilex-key=us-nh-regs-official--agency-he-e--He-E 502.07}

N.H. Code Admin. R. Ann. He-E 502.08 Redetermination of Service Eligibility {#sec-he-e-502.08 omnilex-key=us-nh-regs-official--agency-he-e--He-E 502.08}

N.H. Code Admin. R. Ann. He-E 502.09 Termination or Significant Alteration of Services {#sec-he-e-502.09 omnilex-key=us-nh-regs-official--agency-he-e--He-E 502.09}

N.H. Code Admin. R. Ann. He-E 502.10 Informal Resolution {#sec-he-e-502.10 omnilex-key=us-nh-regs-official--agency-he-e--He-E 502.10}

N.H. Code Admin. R. Ann. He-E 502.11 Contract Agency Requirements {#sec-he-e-502.11 omnilex-key=us-nh-regs-official--agency-he-e--He-E 502.11}

N.H. Code Admin. R. Ann. He-E 502.12 Voluntary Donations {#sec-he-e-502.12 omnilex-key=us-nh-regs-official--agency-he-e--He-E 502.12}

N.H. Code Admin. R. Ann. He-E 502.13 Wait Lists {#sec-he-e-502.13 omnilex-key=us-nh-regs-official--agency-he-e--He-E 502.13}

N.H. Code Admin. R. Ann. He-E 502.14 Service Authorization {#sec-he-e-502.14 omnilex-key=us-nh-regs-official--agency-he-e--He-E 502.14}

N.H. Code Admin. R. Ann. He-E 502.15 Service Records {#sec-he-e-502.15 omnilex-key=us-nh-regs-official--agency-he-e--He-E 502.15}

N.H. Code Admin. R. Ann. He-E 502.16 Cessation of Title III Services by a Contract Agency {#sec-he-e-502.16 omnilex-key=us-nh-regs-official--agency-he-e--He-E 502.16}

N.H. Code Admin. R. Ann. He-E 502.17 Person-Centered Plan {#sec-he-e-502.17 omnilex-key=us-nh-regs-official--agency-he-e--He-E 502.17}

N.H. Code Admin. R. Ann. He-E 502.18 Adult Day Program Services {#sec-he-e-502.18 omnilex-key=us-nh-regs-official--agency-he-e--He-E 502.18}

N.H. Code Admin. R. Ann. He-E 502.19 Adult In-Home Care Services. {#sec-he-e-502.19 omnilex-key=us-nh-regs-official--agency-he-e--He-E 502.19}

N.H. Code Admin. R. Ann. He-E 502.20 Alcohol and Substance Abuse Prevention Services {#sec-he-e-502.20 omnilex-key=us-nh-regs-official--agency-he-e--He-E 502.20}

N.H. Code Admin. R. Ann. He-E 502.21 Dental Services {#sec-he-e-502.21 omnilex-key=us-nh-regs-official--agency-he-e--He-E 502.21}

N.H. Code Admin. R. Ann. He-E 502.22 Elder Abuse Counseling {#sec-he-e-502.22 omnilex-key=us-nh-regs-official--agency-he-e--He-E 502.22}

N.H. Code Admin. R. Ann. He-E 502.23 Home Health Aide Services {#sec-he-e-502.23 omnilex-key=us-nh-regs-official--agency-he-e--He-E 502.23}

N.H. Code Admin. R. Ann. He-E 502.24 Homemaker Services {#sec-he-e-502.24 omnilex-key=us-nh-regs-official--agency-he-e--He-E 502.24}

N.H. Code Admin. R. Ann. He-E 502.25 Legal Services {#sec-he-e-502.25 omnilex-key=us-nh-regs-official--agency-he-e--He-E 502.25}

N.H. Code Admin. R. Ann. He-E 502.26 Low Vision Services {#sec-he-e-502.26 omnilex-key=us-nh-regs-official--agency-he-e--He-E 502.26}

N.H. Code Admin. R. Ann. He-E 502.27 Nursing Services {#sec-he-e-502.27 omnilex-key=us-nh-regs-official--agency-he-e--He-E 502.27}

N.H. Code Admin. R. Ann. He-E 502.28 Nutrition Services: Congregate Meals {#sec-he-e-502.28 omnilex-key=us-nh-regs-official--agency-he-e--He-E 502.28}

N.H. Code Admin. R. Ann. He-E 502.29 Nutrition Services: Home-Delivered Meals {#sec-he-e-502.29 omnilex-key=us-nh-regs-official--agency-he-e--He-E 502.29}

N.H. Code Admin. R. Ann. He-E 502.30 Prevention Services {#sec-he-e-502.30 omnilex-key=us-nh-regs-official--agency-he-e--He-E 502.30}

N.H. Code Admin. R. Ann. He-E 502.31 Transportation {#sec-he-e-502.31 omnilex-key=us-nh-regs-official--agency-he-e--He-E 502.31}

Part He-E 503 Alzheimer's Respite Care Service

N.H. Code Admin. R. Ann. He-E 503.01 Purpose {#sec-he-e-503.01 omnilex-key=us-nh-regs-official--agency-he-e--He-E 503.01}

N.H. Code Admin. R. Ann. He-E 503.02 Definitions. {#sec-he-e-503.02 omnilex-key=us-nh-regs-official--agency-he-e--He-E 503.02}

N.H. Code Admin. R. Ann. He-E 503.03 Eligibility {#sec-he-e-503.03 omnilex-key=us-nh-regs-official--agency-he-e--He-E 503.03}