CHAPTER He-M
500 DEVELOPMENTAL SERVICES
PART He-M 501 RESERVED
Statutory
Authority: RSA 171-A:31
PART He-M 502 RECORDS STANDARDS FOR INDIVIDUALS SERVED -
DEVELOPMENTAL SERVICES
Statutory
Authority: RSA 171-A:3: 18, IV
REVISION NOTE:
Document #5046,
effective 1-18-91, made extensive changes to the wording, format, structure,
and numbering of rules in Part He-M 502.
Document #5046 supersedes all prior filings for the sections in this
chapter. He-M 502.04, 502.05, 502.06,
and 502.07 were new with Document #5046.
The prior filings affecting rules in former Part He-M 502 include the
following documents:
#2746, eff 6-14-84
He-M 502.01 – 502.09 - EXPIRED
Source. (See Revision Note at part heading for He-M
502) #5046, eff 1-18-91, EXPIRED: 1-18-97
New. #6646, eff 12-2-97, EXPIRED: 12-2-05
PART He-M 503 ELIGIBILITY AND THE PROCESS OF PROVIDING
SERVICES
Statutory Authority: RSA 171-A:3; 18, IV
He-M
503.01 Purpose. The purpose of these rules is to
establish standards and procedures for the determination of eligibility, the
development of service agreements, and the provision and monitoring of services
which maximize the ability and informed decision-making authority of
individuals with developmental disabilities and which promote the individual’s
personal development, independence, and quality of life in a manner that is
determined by the individual.
Source. #1969, eff 2-25-82; ss by #2615, eff 2-6-84;
ss by #2962, eff 1-22-85; ss by #5211, eff 8-28-91; EXPIRED:
8-28-97
New. #6581, INTERIM, eff 9-19-97, EXPIRED: 1-17-98
New. #6932, eff 1-27-99; ss by #8805, eff 1-27-07;
ss by #10774, INTERIM, eff 1-27-15, EXPIRES: 7-27-15; ss by #10900, eff 7-25-15;
ss by #13841, eff 12-29-23
He-M 503.02 Definitions.
(a) “Amendment” means any change to the personal
profile, provider agency, or provision of services, including the amount, scope, type, frequency, or duration, within a service
agreement.
(b) “Applicant”
means any person who requests services under RSA l71-A.
(c) “Area”
means “area” as defined in RSA 171-A:2, I-a, namely,
“a geographic region established by rules adopted by the commissioner for the
purpose of providing services to developmentally disabled persons.” This term
includes “region”.
(d) “Area
agency” means “area agency” as defined in RSA 171-A:2, I-b.
(e) “Area
agency director” means that person who is appointed as executive director or
acting executive director of an area agency by the
area agency’s board of directors.
(f) “Assistive
technology” means technology designed to be utilized in an “assistive
technology device” as defined in 29 U.S.C. section 3002(4) or “assistive
technology service” as defined in 29 U.S.C. section 3002(5).
(g) “Autism,” also called “autism spectrum disorder” means a
developmental disorder of brain function that presents with:
(1) Persistent
deficits in social communication and social interaction across multiple
contexts, as manifested by the following, currently or by history:
a. Deficits
in social-emotional reciprocity;
b. Deficits in nonverbal communicative behaviors used for social
interaction; and
c. Deficits in developing, maintaining, and understanding relationships;
(2) Restricted, repetitive patterns of behavior, interests, or
activities, as manifested by at least 2 of the following, currently or by
history:
a. Stereotyped or repetitive motor movements, use of objects, or speech;
b. Insistence on sameness, inflexible adherence to routines, or
ritualized patterns of verbal or nonverbal behavior;
c. Highly restricted, fixated interests that are
abnormal in intensity or focus; or
d. Hyper- or
hyporeactivity to sensory input or unusual interests in sensory aspects of the
environment;
(3) Symptoms
that are present in the early developmental period, but might not become fully manifested until social demands exceed limited capacities, or might
be masked by learned strategies in later life;
(4) Symptoms that cause clinically significant impairment in social,
occupational, or other important areas of current functioning; and
(5) Disturbances that are not better explained by intellectual disability
or global developmental delay.
(h) “Bureau”
means the bureau of developmental services of the department of health and
human services.
(i) “Bureau administrator” means the chief administrator of the bureau
of developmental services.
(j) “Cerebral
palsy” means a condition resulting from brain damage occurring in utero or
during infancy or childhood and characterized by permanent motor impairment
that constitutes a severe disability to such individual’s ability to function normally
in society.
(k) “Commissioner” means the commissioner of the department of health and
human services or their designee.
(l) “Comprehensive risk assessment” means an
evaluation administered pursuant to He-M 503.09(m)(11) using evidence-based tools to evaluate an individual’s behaviors and
determine the potential risks to the individual or others posed by said
behaviors.
(m) “Conditional
eligibility” means a category of eligibility where a person under the age of 22
is determined to have a developmental disability only provisionally because
either the diagnostic information is inconclusive or it cannot yet be determined whether the disability will continue
indefinitely.
(n) “Days” means
calendar days unless otherwise specified.
(o) “Department” means the New Hampshire department of health
and human services.
(p) “Developmental disability” means “developmental disability” as defined in
RSA 171-A:2, V, namely, “a disability:
(1) Which
is attributable to an intellectual disability, cerebral palsy, epilepsy,
autism, or a specific learning disability, or any other condition of an individual found to be closely related to an intellectual disability as it refers to general intellectual
functioning or impairment in adaptive behavior or requires treatment similar to
that required for persons with an intellectual disability; and
(2) Which
originates before such individual attains age 22, has continued or can be
expected to continue indefinitely, and
constitutes a severe disability to such individual’s ability to function
normally in society.”
(q) “Epilepsy”
means a neurological condition characterized by recurrent seizures which might
be accompanied by loss of consciousness, convulsive movements, or disturbances
of feeling, thought, or behavior and constitutes a severe disability to such
individual’s ability to function normally in society.
(r) “Guardian”
means a person appointed pursuant to RSA 463 or RSA 464-A or the parent of an
individual under the age of 18 whose parental rights have not been terminated
or limited by law.
(s) “Health Risk Screening
Tool (HRST)” means the 2015 edition of the Health Risk Screening Tool,
available as noted in Appendix A, which is a web-based rating instrument used
for performing health risk screenings on individuals in order to:
(1) Determine an individual’s vulnerability regarding potential health
risks; and
(2) Enable
the early identification of health issues and monitoring of
health needs.
(t) “Home
and community-based waiver services (“waiver services”) ” means the services
defined and funded pursuant to New Hampshire’s agreement with the federal
government, known as the Developmental Disabilities Waiver, pursuant to the
authority of section 1915(c) of the Social Security Act which allows the
federal funding of long-term care services in non-institutional settings for
persons who are developmentally disabled.
(u) “Individual”
means a person who has a developmental disability.
(v) “Informed
consent” means a decision made voluntarily by an individual or applicant for
services or, where appropriate, such person's legal guardian or representative,
after all relevant information necessary to making the choice has been provided,
when the person understands that they are free to choose or refuse any
available alternative, when the person clearly indicates or expresses their
choice, and when the choice is free from all coercion.
(w) “Intellectual
disability” means “intellectual disability” as defined in RSA 171-A:2, XI-a,
namely, “significantly subaverage general intellectual functioning existing
concurrently with deficits in adaptive behavior, and manifested during the
developmental period. A person with an intellectual disability may
be considered mentally ill provided that no person with an intellectual
disability shall be considered mentally ill solely by virtue of his or her
intellectual disability.”
(x) “Local
education agency (LEA)” means “local education agency” as defined in 34
CFR 300.28. This term includes “school district” as defined in Ed 1102.03(n).
(y) “Participant
directed and managed services” means a method of service delivery provided
pursuant to He-M 525.
(z) “Person-centered service planning” is an
individual-directed, positive approach to the planning and coordination of a
person’s services and other supports based on the individual’s aspirations,
needs, preferences, and goals.
(aa) “Personal
profile” means a narrative description that includes a personal statement from
the individual and those who know them best that summarizes the individual’s
strengths and capacities, communication and learning style, challenges, needs,
interests, and any health concerns, as well as the individual’s hopes and
dreams.
(ab) “Provider”
means a person receiving any form of remuneration for the provision of services
to an individual.
(ac) “Provider
agency” means an agency or an independent provider that is established to
provide services to individuals and meets the criteria in He-M 504.
(ad) “Representative”
means:
(1) The parent or guardian of an individual under the age of 18;
(2) The
guardian of an individual 18 or over; or
(3) A
person who has power of attorney for the individual.
(ae) “Service”
means any paid assistance to an individual in meeting their own needs provided
through the developmental services system.
(af) “Service
agreement” means a written agreement between the individual, guardian, or
representative and provider agencies that is prepared as a result of the
person-centered service planning process and that describes the services that
an individual will receive and constitutes an individual service agreement as
defined in RSA 171-A:2, X and developed pursuant to He-M 503.10.
(ag) “Service coordination agency” means a
provider agency providing service coordination services to individuals, that
meets the criteria in He-M 504.
(ah) “Service
coordinator” means a provider who meets the criteria in He-M 503.08 (b)
and(c) and is chosen by an individual and their guardian or representative
to organize, facilitate and document service planning and to negotiate and
monitor the provision of the individual’s services.
(ai) “Service planning meeting” means a gathering of
2 or more people, one of whom is the individual who receives services unless
they choose not to attend, called to
develop, review, add to, delete from, or otherwise change a service agreement.
(aj) “Specific learning disability” means a
chronic condition of presumed neurological origin that selectively interferes
with the development, integration, or demonstration of verbal or non-verbal
abilities, and constitutes a severe disability to such individual’s ability to
function normally in society. The term includes such conditions as
perceptual handicaps, brain injury, dyslexia, and developmental
aphasia. The term does not include individuals who have learning problems
which are primarily the result of visual, hearing, or motor handicaps,
intellectual disability, emotional disturbance, or environmental, cultural, or
economic disadvantage.
(ak) “State of residence”
means state of residence as defined in 42 CFR 435.403.
(al) “Supported decision-making” means
“supported-decision making” as defined in RSA 464-D: 4, VI.
(am) “Supports Intensity Scale-Adult Version ®
(SIS-A ®)” means the 2023 edition of the Supports Intensity Scale, available as
noted in Appendix A, which is an assessment tool intended to assist in service
planning by measuring the individual’s support needs in the areas of home
living, community living, lifelong learning, employment, health and safety,
social activities, and protection and advocacy. The tool uses a formal rating
scale to identify the type of supports needed, frequency of supports needed, and
daily support time.
(an) “Termination”
means the cessation of a service by an area agency director with or without the
informed consent of the individual or their guardian or representative.
(ao) “Withdrawal”
means the choice of an individual or their guardian to discontinue that
individual’s participation in a service.
Source. #1969, eff 2-25-82; ss by #2615, eff 2-6-84;
ss by #2962, eff 1-22-85; ss by #5211, eff 8-28-91; EXPIRED:
8-28-97
New. #6581, INTERIM, eff 9-19-97, EXPIRED: 1-17-98
New. #6932, eff 1-27-99; ss by #8805, eff 1-27-07;
ss by #10774, INTERIM, eff 1-27-15, EXPIRES: 7-27-15; ss by #10900, eff 7-25-15;
ss by #13841, eff 12-29-23
He-M
503.03 Eligibility for Services.
(a) Pursuant
to RSA 171-A, and as referenced in He-M 503.02 (ak) and (o), any person whose
state of residence is New Hampshire and who has a developmental disability
shall be eligible for services as described in (b) through (h) below.
(b) Individuals
who meet the requirements of (a) above, shall be eligible under He-M 503 to
receive the following services:
(1) Service coordination;
(2) Family support services pursuant to He-M 519;
(3) Respite services pursuant to He-M 513; and
(4) Other
applicable services available pursuant to He-M 500 that are needed as
determined in accordance with He-M 503.05, except those that are the legal
responsibility of the local education agency (LEA) pursuant to the Interagency
Agreement in accordance with RSA 186-C:7-a, the department’s division for
children, youth and families (DCYF), or another state agency to provide.
(c) Individuals
described in (a) above shall also be eligible for home and community-based
waiver services if they meet the requirements of He-M 517.03.
(d) Individuals
described in (a), from birth through 21 who have not graduated or exited the
school system and who live at home shall be eligible for in-home support
services if the requirements of He-M 524.03 are met.
(e) Individuals
described in (a) above who are under age 3 shall also be eligible for
family-centered early supports and services if the requirements of He-M 510.06
are met.
(f) An
applicant under the age of 18 who has a developmental disability cited in He-M
503.02 (o) at the time of application shall be found conditionally eligible for
services if either the diagnostic information is inconclusive or it cannot be
determined whether the disability will continue indefinitely.
(g) When
the eligibility of an individual has been determined to be conditional, the
eligibility for services shall be periodically reviewed pursuant to He-M 503.06
so that the area agency can reach a conclusive decision before the individual turns
age 18.
Source. #1969, eff 2-25-82; ss by #2615, eff 2-6-84;
ss by #2962, eff 1-22-85; ss by #5211, eff 8-28-91; EXPIRED:
8-28-97
New. #6581, INTERIM, eff 9-19-97, EXPIRED: 1-17-98
New. #6932, eff 1-27-99; ss by #8805, eff 1-27-07;
ss by #10774, INTERIM, eff 1-27-15, EXPIRES: 7-27-15; ss by #10900, eff 7-25-15;
ss by #13841, eff 12-29-23
He-M
503.04 Application for Services.
(a) Application for
services shall be made by:
(1) The
applicant;
(2) A
guardian of an applicant under the age of 18;
(3) A
guardian of an applicant age 18 or over if a guardian of the person
has been appointed by the probate court per RSA 464-A; or
(4) A
representative of the applicant authorized to make such application.
(b) An
application for services shall be made in writing to the area agency in
the applicant’s region of residence.
(c) An
area agency shall explain the eligibility process and offer assistance to the
applicant, guardian, or representative in making application for services.
(d) The
area agency shall inform the applicant, guardian, or representative of its
roles and responsibilities and provide information about:
(1) The
types of evaluations, assessments, and screenings needed to assist in
development of the service agreement;
(2) Eligibility determination;
(3) Service coordination;
(4) Service agreement development and review;
(5) Services provided by the area agency and the assistance available
to identify the services that are needed;
(6) Service provision;
(7) Service monitoring; and
(8) Advocacy
supports.
(e
) To aid in the provision of comprehensive, efficient, and coordinated
services, the area agency shall undertake a review of the public and private
benefits and resources that are available to the applicant and inform the
applicant of all such benefits and resources.
(f) To
receive services beyond age 3, the eligibility of a child served in
family-centered early supports and services shall be determined by the area
agency pursuant to He-M 503.03 and He-M 503.05 prior to the date the child
turns age 3, without the need of the family reapplying for
services. The eligibility determination process shall be initiated
by the area agency at least 90 days prior to the child’s third birthday.
(g) An
area agency shall request each applicant to authorize the release of
information to permit the area agency to access relevant current and historical
records and information for determination of eligibility pursuant to He-M
503.03 regarding the applicant’s:
(1) Developmental disabilities;
(2) Personal, family, social, educational, psychological, and medical
status; and
(3) Functional abilities, interests, and aptitudes.
(h) Authorization to
release information shall specify:
(1) The
name of the applicant and the information to be released;
(2) The
name of the person or organization being authorized to release
the information;
(3) The
name of the person or organization to whom the information is
to be released; and
(4) The
time period for which the authorization is given, which shall not exceed one
year.
Source. #1969, eff 2-25-82; ss by #2615, eff 2-6-84;
ss by #2962, eff 1-22-85; ss by #5211, eff 8-28-91; EXPIRED:
8-28-97
New. #6581, INTERIM, eff 9-19-97, EXPIRED: 1-17-98
New. #6932, eff 1-27-99; ss by #8805, eff 1-27-07;
ss by #10774, INTERIM, eff 1-27-15, EXPIRES: 7-27-15; ss by #10900, eff 7-25-15;
ss by #13841, eff 12-29-23
He-M
503.05 Determination of Eligibility.
(a) To
determine the existence of an applicant’s developmental disability, the area
agency shall perform a comprehensive screening evaluation consisting of:
(1) Reviewing
available information, including, but not limited to:
a. Birth, developmental, and educational histories;
b. Current
physical, intellectual, cognitive, and behavioral evaluations;
c. An age-appropriate standardized functional assessment; and
d.
As applicable, additional specialty medical, health, or clinical evaluations,
such as communication, functional behavior, psychological,
or psychopharmacological assessments, assistive technology, and personal safety
or comprehensive risk assessments; and
(2) Gathering
additional information and performing the additional evaluations among those
listed in (1) above that are necessary to complete the determination, if the
information available is not adequate to make a determination of eligibility.
(b) The
results of the comprehensive screening evaluation pursuant to (a) above and any
other information concerning the applicant’s disability shall be the basis for
determination of eligibility pursuant to He-M 503.03 and assist in the identification
of needs and provision of services.
(c) To
the extent possible, the area agency shall utilize generic resources to pay for
an applicant’s comprehensive screening evaluation. Such resources
shall, with the applicant’s consent, include private and public insurance.
(d) An
area agency shall review the information it has received regarding an applicant
and, within 15 business days after the receipt of the completed application,
make and communicate one of the following decisions on the eligibility of the applicant
in accordance with He-M 503.03 to the applicant, guardian, or
representative:
(1) Eligible;
(2) Conditionally eligible pursuant to He-M
503.02(l); or
(3) Ineligible.
(e) If an area agency determines additional
information is necessary in order to make a determination in accordance with
(d) above, a communication detailing the additional information necessary shall
be provided to the applicant, guardian, or representative, and the application
shall not be determined complete until all necessary information has been
received by the area agency.
(f) In
cases where the information on eligibility is inconclusive, the area agency may
consult with the bureau regarding determination of eligibility prior to making
a decision in accordance with (d) above.
(g) Decisions by the bureau in (f) above shall be
made within 5 business days.
(h) In instances where consultations in (f) above
would cause the area agency’s decision pursuant to (d) above to exceed 15
business days, an additional 7 business days shall be allowed to make such
decision.
(i) A written denial of eligibility pursuant to
(d)(3) above, shall describe the specific legal and factual basis for the
denial, including specific citation of the applicable law or department rule,
and advise the applicant of the appeal rights under He-M 503.16.
(j) Following denial of eligibility, the
applicant, guardian, or representative, as applicable, may reapply for services
if new information regarding the diagnosis, age of onset, or severity of the
disability becomes available.
(k) Communication of approval or conditional
eligibility in accordance with (d)(1) or (2) above shall include a contact
person at the area agency.
(l) Preliminary planning to determine the
services needed shall occur with the individual and guardian, or representative
at the time of intake or during subsequent discussions. Preliminary evaluations shall be completed
and preliminary recommendations for services shall be made within 21 days of a
completed application for service.
(m) Within
3 days of the determination of an applicant’s eligibility under He-M 503.05
(d)(1) or (2), an area agency shall review 1915(c) of the Social Security Act,
home and community-based waiver services with the individual, guardian, or representative
in order to make a decision.
(n) If the individual, guardian, or
representative is interested in pursuing home and community-based waiver
services within the next 12 months, within 5 business days of the individual’s
decision pursuant to (m) above, the area agency shall submit an application for
waiver level of care eligibility pursuant to He-M 517.03 to the bureau.
(o) The
bureau shall review an application submitted pursuant to (n) above and make a
decision within 15 business days of receipt of the application.
(p) Within 3 days of the decision, the bureau
shall communicate the decision to the area agency and the individual, guardian,
or representative in writing.
(q) If the bureau determines the individual is
not eligible for services in He-M 517, the notice shall include the specific
legal and factual basis for the determination, including a specific citation to
the applicable law or department rule, and the bureau shall advise the
individual, guardian, or representative in writing of the appeal rights under
He-M 517.09.
(r) If there is not sufficient information to
determine the individual’s level of care, a request for additional information
shall be sent by the bureau to the submitting entity to allow an additional 10
days to provide information sufficient to determine level of care.
(s) If information to determine is not provided,
the bureau shall deny the level of care application, however, if new
information becomes available after such denial, a new application may be
submitted.
(t) Pursuant to RSA 171-A:6, IV, in an emergency
situation, temporary service arrangements may be made prior to the completion
of the evaluation in (a) above if the bureau administrator, or designee, first
determines that the individual meets one of the following:
(1) Is a victim of abuse or neglect pursuant to
He-E 700;
(2) Is abandoned and homeless;
(3) Is without a caregiver due to death or
incapacitation;
(4) Is at significant risk of physical or
psychological harm due to decline in their medical or behavioral status; or
(5) Is presenting a significant risk to community
safety.
(u) The determination of
eligibility by one area agency, pursuant to He-M 503.05(d), shall be accepted
by every other area agency in the state.
Source. #1969, eff 2-25-82; ss by #2615, eff 2-6-84;
ss by #2962, eff 1-22-85; ss by #5211, eff 8-28-91; EXPIRED:
8-28-97; ss by #10774, INTERIM, eff 1-29-15, EXPIRES:
7-27-15
New. #6581, INTERIM, eff 9-19-97, EXPIRED: 1-17-98
New. #6932, eff 1-27-99; ss by #8805, eff 1-27-07;
ss by #10774, INTERIM, eff 1-27-15, EXPIRES: 7-27-15; ss by #10900, eff 7-25-15;
ss by #13841, eff 12-29-23
He-M
503.06 Periodic Review of Conditional Eligibility.
(a) Subsequent
to finding an individual to be conditionally eligible for services pursuant to
He-M 503.03 (f), the area agency shall render a definitive decision on
eligibility before the individual reaches the age of 18.
(b) To
determine whether the applicant is eligible, the area agency shall, at minimum,
arrange for reevaluations:
(1) Anytime
during the ages of 7 through 9;
(2) Anytime
during the ages of 12 through 14; and
(3) Not
later than the individual’s 18th birthday.
(c) If
any of the reevaluations pursuant to (b) above, or any other information
obtained subsequent to finding an applicant conditionally eligible,
demonstrates to the area agency that a person is eligible for services pursuant
to He-M 503.03 (a), any subsequent required reevaluations to determine
eligibility shall not be performed.
(d) If
the results of any of the reevaluations, or any other information obtained
subsequent to finding an applicant conditionally eligible, demonstrate to the
area agency that the applicant’s disability will continue indefinitely or the
diagnosis is conclusive as defined in He-M 503.02 (o), the area agency shall
determine them eligible for services and so inform the applicant, guardian, or
representative in writing.
(e) If
the results of any of the reevaluations demonstrate that the applicant does not
meet the criteria as defined in He-M 503.02 (o), the area agency shall inform
the applicant, guardian, or representative in writing no more than 3 business days
from the determination of ineligibility and phase out services over the 12
months following the date of notice. The
phase plan shall be outlined through a service agreement.
(f) In
each instance where the reevaluation leads to a denial of eligibility, the area
agency shall, in writing:
(1) Inform
the applicant, guardian, or representative of the determination;
(2) Describe
the specific legal and factual basis for the denial, including specific
citation of the applicable law or department rule; and
(3) Advise
the applicant of the appeal rights under He-M 503.16.
(g) An
applicant, guardian, or representative may appeal a denial of eligibility based
on the reevaluation pursuant to He-M 503.16 and He-C 200.
Source. #1969, eff 2-25-82; ss by #2615, eff 2-6-84;
ss by #2962, eff 1-22-85; ss by #5211, eff 8-28-91; EXPIRED:
8-28-97
New. #6581, INTERIM, eff 9-19-97, EXPIRED: 1-17-98
New. #6932, eff 1-27-99; ss by #8805, eff 1-27-07;
ss by #10774, INTERIM, eff 1-27-15, EXPIRES: 7-27-15; ss by #10900, eff 7-25-15;
ss by #13841, eff 12-29-23
He-M
503.07 Service Guarantees.
(a) Except
as provided by RSA 171-B, all services shall:
(1) Be
voluntary;
(2) Be
provided only after the informed consent of the individual, guardian, or
representative;
(3) Comply
with the rights of the individual established under RSA 171-A:13-14, He-M 310,
and federal laws and rules; and
(4) Maximize
as much as possible the individual’s ability to determine and direct the
services they will receive, in accordance with federal and state laws and
rules.
(b) All
services shall be designed to:
(1) Promote
the individual’s personal development and quality of life in a manner that is
determined by the individual;
(2) Meet
the individual’s needs in life skills to promote independent living:
a. Including
educational activities with the purpose of assisting the individual in
attaining or enhancing community living skills, or adaptive skill development to assist the
individual in residing in the most appropriate setting for their needs; and
b. Not
including post-secondary education, regardless of whether it leads to a degree,
or private tutoring;
(3) Promote
the individual’s health and safety within the bounds of reasonable risk;
(4) Protect
the individual’s right to freedom from abuse, neglect, and exploitation;
(5) Increase
the individual’s participation in a variety of integrated activities and
settings;
(6) Provide
opportunities for the individual to exercise personal choice, independence, and
autonomy within the bounds of reasonable risks;
(7) Enhance
the individual’s ability to perform personally meaningful or functional
activities;
(8) Assist
the individual to acquire and maintain life skills, such as, managing a
personal budget, participating in meal preparation, or traveling safely in the
community, including accessing community transportation;
(9) Be
provided in such a way that the individual is seen as a valued, contributing
member of their community; and
(10) Meet the individual’s needs in accordance
with He-M 503.09(m).
(c) The
environment or setting in which an individual receives services shall be the
least restrictive, most integrated setting that promotes that individual’s:
(1) Freedom
of movement;
(2) Ability
to make informed decisions;
(3) Self-determination;
(4) Participation
in the community in accordance with 42 CFR 441.301; and
(5)
Rights in accordance with He-M 310.
(d) An
individual, guardian, or representative may select any available provider that
is qualified pursuant to He-M 504, to deliver one or more of the services
identified in the individual’s service agreement. All provider
agencies and providers shall comply with the administrative rules and terms of
the waiver when applicable, pertaining to the service(s) offered and meet the
provisions specified within the individual’s service agreement.
(e) The area agency shall notify each individual,
annually, that they have a right to choose their service coordinator who meets
the requirements in He-M 503.08(a).
(f) No
one shall be denied an opportunity for services on the basis of the severity of
their developmental disability.
(g) An
area agency shall monitor timeliness of the completion of annual service
agreements by the service coordinator for all individuals, with the exception
of those individuals or families who request only information and referral.
(h) Area agencies and provider agencies shall
inform individuals and applicants of their rights under these rules in clearly
understandable language and form.
(i) For individuals who require a positive
behavior plan, emergency physical restraint shall only be approved for safely
responding to situations in which the individual presents with imminent
credible risk of significant harm to self or others by providers who are
trained and certified in recognized intervention modalities.
Source. #1969, eff 2-25-82; ss by #2615, eff 2-6-84;
ss by #2962, eff 1-22-85; ss by #5211, eff 8-28-91; EXPIRED:
8-28-97
New. #6581, INTERIM, eff 9-19-97, EXPIRED: 1-17-98
New. #6932, eff 1-27-99; ss by #8805, eff 1-27-07;
ss by #10774, INTERIM, eff 1-27-15, EXPIRES: 7-27-15; ss by #10900, eff 7-25-15
(from He-M 503.08); ss by #13841, eff 12-29-23
He-M
503.08 Service Coordination.
(a) The
service coordinator shall be a person chosen by the individual, guardian, or
representative who meets the criteria in He-M 504, He-M 506, and He-M
503.08 (b)-(c) below.
(b) The
service coordinator shall:
(1) Advocate
on behalf of individuals for services to be provided in accordance with the
service guarantees in He-M 503.07 (b);
(2) Coordinate
the service planning process in accordance with He-M 503.07, He-M 503.09, and
He-M 503.10;
(3) Describe
to the individual, guardian, or representative service delivery options
including participant directed and managed services;
(4) Monitor
and document services provided to the individual in accordance with He-M 503.10
below and He-M 517 for home and community-based waiver services;
(5) Ensure
continuity and quality of services provided in the amount, scope, frequency, and
duration as outlined in the service agreement;
(6) Monitor
and document quality of services provided in accordance with He-M 503.10 below
and He-M 517 for home and community-based waiver services;
(7)
Provide crisis and critical incident coordination and planning;
(8) Ensure
that service documentation is maintained pursuant to He-M 503.10 (c) and
(l)(2)-(3) and He-M 517 for home and community-based waiver services;
(9) Determine
and implement necessary action and document resolution when goals are not being
addressed, support services are not being provided in accordance with the
service agreement, or when health or safety issues have arisen;
(10) Convene
person-centered service planning meetings at least annually and whenever:
a. The individual, guardian, or representative is not satisfied with the
services received;
b. There is no progress on the goals after follow-up interventions;
c. The individual’s needs change;
d. There is a need for a new provider agency; or
e. The individual, guardian, or representative requests a meeting;
(11) Document
service coordination visits and contacts pursuant to He-M 503.09 (u) and He-M
503.10 (l) (2)-(4);
(12) No
less than 45 days in advance of the annual person-centered service planning
meeting:
a. Ensure
that all needed evaluations, screenings, or assessments, such as the SIS-A ®,
HRST, assistive technology evaluation, comprehensive risk assessments, positive
behavior plans, and other clinical or health evaluations are updated and, if
necessary, performed and that information from said evaluations, screenings,
and assessments is discussed and shared with the individual, guardian, or
representative;
b. Identify risk factors and plans to minimize them;
c. Assess the individual’s interest in, or satisfaction with,
employment; and
d. Discuss and assess the individual’s progress on goals and preparing
for the development of new goals to be included in the new service agreement;
(13) Assist
the individual, guardian, or representative to maintain the individual’s public
benefits; and
(14) Participate in risk management activities by:
a. Making referrals to the applicable area
agency’s local risk management committee for individual’s exhibiting behaviors including but not limited to violent aggression,
problematic sexual behaviors, or fire-setting behaviors for evaluations or
planning activities initially and ongoing;
b. Participating in and presenting to committees
and other groups related to risk management including, but not limited to,
local human rights committees, statewide and local risk management committees,
and community of practice to determine application of assessment
recommendations received;
c. Attending risk
management training activities; and
d. Attending clinically specialized trainings,
based on assessed needs of the individuals supported, that
enable successful completion of and participation in risk management
activities.
(c) A
service coordinator shall not:
(1) Be
a guardian or representative of the individual whose services they are
coordinating; or
(2) Have
a conflict of interest concerning the individual, such as providing, or being
employed by the provider agency that also provides other direct services to the
individual, except in accordance with He-M 503.08(d) and (e) below.
(d) A provider agency that provides direct
services to the individual and seeks to also provide service coordination,
shall be determined the only willing and qualified service coordination agency
and permitted to provide service coordination and direct services if the
following criteria are met:
(1) There is a lack of another qualified service
coordination agency willing to provide services to the individual as outlined
in their service agreement;
(2) The individual, guardian, or representative
agrees that the same agency shall provide both service coordination and direct
services;
(3) The agency ensures that service coordination
and direct services are located in different departments and different physical
locations within the organization, and report to separate and equal
organizational leadership; and
(4) The direct services department shall not
develop or have any influence on developing the individual’s service agreement.
(e)
A provider agency requesting determination to serve as the only willing
and qualified service coordination agency in accordance with (d) above shall
complete and submit the form entitled “NH Bureau of Developmental Services
Exemption Request” (December 2023) along with the following documentation:
(1) Documentation
that the criteria outlined in He-M 503.08(d)(1) through (4) above has
been met;
(2) Such agency’s plan to develop or recruit
service coordination agencies;
(3) Documentation of service coordinator
orientation and training that outlines the role of the service coordinator as a
neutral facilitator and how to offer choice to individuals;
(4) Documentation of how such agency ensures all
individuals, guardians, and representatives have accurate and accessible
information relative to service providers; and
(5) Documentation to demonstrate how such agency
monitors that choice is given to individuals, guardians, and representatives.
(f) Upon review of the form submitted pursuant to
(e) above, the bureau shall approve such a request if all the requirements are
met.
(g) The approval of being the only willing and
qualified service coordination agency shall be for one year.
(h) After approval of an initial exemption
request, the agency in (e) above shall resubmit to the department a “NH Bureau
of Developmental Services Exemption Request” form (December 2023) annually.
(i) The documentation required in (e)(1)-(4)
shall only be required with the initial request.
(j) Subsequent requests shall not require the
described documentation provided that the only willing and qualified service
coordination agency certifies that there have been no changes to the original
documentation submitted.
(k) Once an only willing and qualified service
coordination agency request has been approved in accordance with (f) or (j)
above, the bureau shall conduct ongoing quarterly monitoring regarding the
criteria in (d)(1) above.
Source. #1969, eff 2-25-82; ss by #2615, eff 2-6-84;
ss by #2962, eff 1-22-85; ss by #5211, eff 8-28-91; EXPIRED:
8-28-97
New. #6581, INTERIM, eff 9-19-97, EXPIRED: 1-17-98
New. #6932, eff 1-27-99; ss by #8805, eff 1-27-07;
ss by #10774, INTERIM, eff 1-27-15, EXPIRES: 7-27-15; ss by #10900, eff 7-25-15
(from He-M 503.09); ss by #13841, eff 12-29-23
He-M
503.09 Service Planning.
(a) Preliminary
planning for services shall be done in accordance with He-M 503.05(l).
(b) Within 15 days of an
individual’s eligibility or conditional eligibility pursuant to He-M 503.05(d)
or level of care approval pursuant to He-M 503.05(o), for those for whom an
application for home and community-based waiver services has been submitted
pursuant to He-M 503.05(n), the area agency shall assist the individual,
guardian, or representative with resources to select a service coordinator.
(c) In instances when an individual has been
determined eligible pursuant to He-M 503.05(d), and declines services available
pursuant to He-M 503.05(l) and (m), the area agency shall assign a service
coordinator within 30 days.
(d) In instances when a service coordinator
has been assigned pursuant to (c) above, the service coordinator shall, at
minimum, contact the individual annually to discuss ongoing needs and determine
if service planning is desired.
(e) The
service coordinator shall hold an initial person-centered service planning
meeting to determine the individual’s goals and service needs in meeting those
goals with the individual, the individual’s guardian or representative, and any
other person chosen by the individual within 15 business days of the selection
of and acceptance by, a service coordination agency.
(f) The service coordinator shall document that
they have maximized the extent to which an individual participates in and directs their
person-centered service planning process by:
(1) Explaining to the individual the
person-centered service planning process and providing the information and support necessary to ensure that the
individual directs the process to the maximum extent possible;
(2) Explaining
to the individual their rights and responsibilities pursuant to He-M 310;
(3) Eliciting information from the individual
regarding their goals, personal preferences, and service needs, including any health concerns, that shall be
a focus of person-centered service planning meetings;
(4) Determining
with the individual issues to be discussed during all person-centered service
planning meetings; and
(5) Explaining
to the individual the limits of the decision-making authority of the guardian,
if applicable, and the individual’s right to make all other decisions related
to services.
(g) The person-centered service planning process
shall include a discussion regarding whether or not there is a need for a
limited or full guardianship, conservatorship, representative payee for social
security benefits, durable power of attorney, durable power of attorney for
healthcare, supported-decision making, or other less restrictive alternatives
to guardianship. The discussion and any recommendations from the team shall be
incorporated into the service agreement.
(h) Service
coordinators shall facilitate service planning to develop service agreements in
accordance with He-M 503.10. Service agreements shall be prepared
initially according to the timeframe specified in He-M 503.10 (c) and annually
thereafter, as required by He-M 503.08 (b)(10).
(i) The individual, guardian, or representative
may determine the following elements of the person-centered service planning process:
(1) The number
and length of meetings;
(2) The location,
date, and time of meetings;
(3) The meeting
participants; and
(4) Topics to be discussed.
(j) Copies
of relevant evaluations and reports shall be sent to the individual and
guardian at least 5 business days before person-centered service
planning meetings.
(k) If
people who provide services to the individual are not selected by the
individual to participate in a person-centered service planning meeting, and
the individual determines that the provider would have information beneficial
to service planning, the service coordinator shall contact such persons prior
to the meeting so that their input can be considered.
(l) The
service coordinator shall contact all persons who have been identified to
provide a service to the individual and confirm arrangements for providing such
services.
(m) All
service planning shall occur through a person-centered service planning process
that:
(1) Maximizes
the decision-making of the individual;
(2) Is
directed by the individual or the individual’s guardian or representative, if
applicable;
(3) Facilitates
personal choice by providing information and support to assist the individual
to direct the process, including information describing:
a. The array
of services and provider agencies available; and
b. Options regarding self-direction of services;
(4) Includes
participants freely chosen by the individual;
(5) Reflects
cultural considerations of the individual and is conducted in clearly
understandable language and form;
(6) Occurs
at times and a location of convenience to the individual, guardian, or
representative;
(7) Includes
strategies for solving conflict or disagreement within the process, including
clear conflict of interest guidelines for all planning participants;
(8) Is
consistent with an individual’s rights to privacy, dignity, respect, and
freedom from coercion and restraint;
(9) Includes
the process for the individual, guardian, or representative to request
amendments to the service agreement;
(10) Records
the alternative home- and community-based settings that were considered by the
individual, guardian, or representative;
(11) Includes
information related to risk by:
a. Incorporating
information obtained through a comprehensive risk assessment, which shall be administered:
1. Initially,
at the beginning of service planning, or as needed to each individual with a
history of, or exhibiting signs of, behaviors that pose a potentially
serious likelihood of danger to self or others, or a serious threat of
substantial damage to real property, such as, but not limited to, the
following:
(i) Problematic sexual behavior;
(ii) Violent aggression;
(iii) Fire-setting behaviors; or
(iv) Other similar violent
or dangerous behaviors or events;
2. Prior
to any significant change in the level of the individual’s treatment or supervision;
3. At
any time an individual who previously has not had a comprehensive risk
assessment begins to engage in behaviors referenced in 1. above; and
4. By
an evaluator with specialized experience, training, and expertise in the
treatment of the types of behaviors referenced in 1. above;
b. Ensuring
that plans created pursuant to He-M 505 are reviewed with evaluators to
consider ongoing appropriateness and opportunities for modification of
restrictions following initiation of risk management related strategies. Such considerations may be made
through reassessment or through a consultative review of other documentation
and updated data related to the individual’s progress;
c. Ensuring
documentation of activities and progress in treatment relative to management of
risk for an individual to help inform development of person-centered service
plans;
d. Making referrals for individuals associated with high-risk incidents to participate in
evaluations or planning activities initially and ongoing;
e. Processing
and analyzing incidents related to violent aggression, problematic sexual
behavior, or fire-setting behaviors; and
f.
Making referrals for individuals associated with high-risk incidents to
evaluations or planning activities initially and ongoing;
(12) Includes
information from specialty medical and health assessments and clinical
assessments as needed, including, at a minimum, communication, assistive
technology, and functional behavior assessments, as applicable;
(13) Includes
strategies to address co-occurring severe mental illness or behavioral
challenges which are interfering with the person’s functioning, including
positive behavior plans or other strategies based on functional behavior or
other evaluations or referrals to behavioral health services;
(14) Provides the individual with information regarding
the services and provider agencies available to enable the individual to make
informed decisions as to whom they would like to provide services;
(15) Includes
individualized backup plans and strategies;
(16) Includes
strategies for solving disagreements;
(17) Uses
a strengths-based approach to identify the positive attributes of the
individual;
(18)
Includes the provision of auxiliary aids and services when needed for effective
communication, including low literacy materials and interpreters;
(19) Addresses
the individual’s concerns about current or contemplated guardianship or other
legal assignment of rights;
(20) Explores
housing and employment in integrated settings, and develops plans consistent
with the individual’s goals and preferences;
(21) Includes
a review of the past year that:
a. Includes the individual’s:
1. Personal
achievements;
2. Relationships;
3. Degree
of community involvement;
4. Challenging
issues or behavior;
5. Health
status and any changes in health; and
6. Safety
considerations during the year;
b. Addresses
the previous year’s goals with level of success and, if applicable, identifies
any obstacles encountered;
c. Identifies the individual’s personal goals and the supports that will
aid in achieving their goals;
d. Identifies
the type and amount of services the individual receives and the support
services provided under each service category;
e. Identifies the individual’s health needs;
f. Identifies the individual’s safety needs;
g. Identifies
any follow-up action needed on concerns and the persons responsible for the
follow-up; and
h. Includes a statement of the individual’s and guardian’s
satisfaction with services;
(22) Includes
the individual’s paid employment and volunteer positions, as applicable;
(23) Considers
historical information about the individual’s experiences; and
(24) Includes a discussion of the need for
assistive technology that could be utilized to support all services and
activities identified in the proposed service agreement without regard to the
individual’s current use of assistive technology.
(n) The information outlined in (m)(1)-(24) above
shall be entered into the service agreement outlined in He-M 503.10 when the
individual, guardian, or planning team determine that such information is
necessary for successful participation in the services and supports outlined in
the service agreement.
(o) All planning for home and community-based
waiver services shall include information from the following assessments:
(1) The American Association on Intellectual and
Developmental Disabilities’, “SIS-A ®”, (2023 edition), available as noted in
Appendix A, for individuals aged 16 or older, which shall be administered:
a. Initially, within 60 days of the
determination of eligibility for waiver services pursuant to He-M 503.05(o) for each individual;
b. For individual’s receiving In Home Supports
home and community-based waiver services within 60 days of when the individual reaches age 16;
c. Upon a significant
change as defined under SIS-A ® protocols;
d. Five years following
each prior administration; and
e. To individuals who have moved to New
Hampshire and are requesting home and community-based
waiver services in the next 12 months. If the individual has previously had
a SIS-A ® completed in another state
within the last 5 years, however, then they may provide the out-of-state SIS-A
® results in place of taking a new SIS-A ®; and
(2) Information obtained through the HRST (2015
edition), available as noted in Appendix A, which shall be administered:
a. Initially, upon
determination of eligibility for waiver services pursuant to He-M 503.05(o) or
He-M 524 for each individual; and
b. Annually or upon
significant change in an individual’s status; and
(3) For residential services, includes
information from personal safety assessments pursuant to He-M 1001.
(p) In
order to develop or revise a service agreement to the satisfaction of the
individual, guardian, or representative, the person-centered service planning
process shall consist of periodic and ongoing discussions regarding elements
identified in He-M 503.07(b) that:
(1) Include
the individual and other persons involved in their life;
(2) Are
facilitated by a service coordinator; and
(3) Are
focused on the individual’s abilities, health, interests, and achievements.
(q) Service
agreements shall be reviewed by the service coordinator with the individual,
guardian, or representative at least once during the first 6 months of service
and as needed. The annual review required by He-M 503.08 (b)(10)
shall include a service planning meeting.
(r) Pursuant
to RSA 171-A:11, the reviews required in (q) above shall include, at a minimum,
the following:
(1) A
thorough clinical examination including an annual health assessment;
(2) An
assessment of the individual’s capacity to make informed decisions; and
(3) Consideration
of less restrictive alternatives for service.
(s) The
individual, guardian, or representative may request, in writing, a delay in an
initial or annual service agreement planning meeting. The area agency and
provider agencies shall honor this request.
(t) In the event an individual, guardian, or
representative requests an extension of the service agreement meeting, the
extension shall be documented and not exceed 60 days after the expiration of
the current service agreement.
(u) The
service coordinator shall be responsible for monitoring services identified in
the service agreement pursuant to He-M 503.10(l) and for assessing individual,
family, or guardian satisfaction at least annually for non-waiver services and
quarterly for waiver services.
(v) If an individual has a residency agreement
and there is notification of intended termination, the service coordinator
shall convene a person-centered service planning meeting as follows:
(1) Within 10 days of receipt of notification of
the intended termination; or
(2) Within 24 hours of receipt of the
notification if the intended termination is within 72 hours due to the threat
of serious bodily injury by or to the resident.
(w) An
area agency, service coordinator, provider agency, provider, individual,
guardian, or representative shall have the authority to request a
person-centered service planning meeting at any time.
(x) Service
agreement amendments may be proposed at any time.
(y) If
the individual, guardian, or provider agency disapproves of the service
agreement, or a service agreement amendment, the dispute shall be resolved:
(1) Through
informal discussions between the individual, guardian, or representative and
service coordinator;
(2) By
reconvening a person-centered service planning meeting; or
(3) By
the individual, guardian, or representative filing an appeal to the bureau
pursuant to He-C 200.
Source. #1969, eff 2-25-82; ss by #2615, eff 2-6-84;
ss by #2962, eff 1-22-85; ss by #5211, eff 8-28-91; EXPIRED: 8-28-97
New. #6581, INTERIM, eff 9-19-97, EXPIRED: 1-17-98
New. #6932, eff 1-27-99; ss by #8805, eff 1-27-07;
ss by #10774, INTERIM, eff 1-27-15, EXPIRES: 7-27-15; ss by #10900, eff 7-25-15
(from He-M 503.10); ss by #13841, eff 12-29-23
He-M
503.10 Service Agreements.
(a) The
service coordinator shall create service agreements for all individuals in
accordance with (b)-(f) below.
(b) All
service agreements shall:
(1) Be
understandable to the individual, guardian, or representative and all provider
agencies and providers responsible for service provision;
(2) At
a minimum, be written in plain language and in a manner accessible to
individuals with disabilities and persons who have limited proficiency in
English;
(3) Be
finalized and agreed to in writing by the individual, guardian, or
representative and signed by all provider agencies responsible for the
implementation of the service agreement;
(4) Be
entered into the electronic platform, IntellectAbility at https://nhbds.hrstapp.com/ , and
then NH Easy at https://nheasy.nh.gov/#/ , when IntellectAbility sunsets; and
(5) Be
distributed to the individual, guardian or representative, area agency, and all
provider agencies and providers who are responsible for the implementation or
monitoring of the service agreement.
(c) Within
14 days of the initial person-centered service planning meeting pursuant to
He-M 503.09 (e), the service coordinator shall develop a service agreement that
includes, but is not limited to, the following:
(1) A statement of the nature of the specific
strengths, interests, capacities, disabilities, and specific needs of the
individual;
(2) A description of intermediate and long-range
habilitation and treatment goals chosen by the individual and their guardian
with a projected timetable for their attainment;
(3) A statement of specific services to be
provided and the amount, scope, frequency, and duration of each service;
(4) Specification of the provider agencies to
furnish each service identified in the service agreement;
(5) Criteria for transfer to less restrictive
settings for habilitation, including criteria for termination of service, and a
projected date for termination of service;
(6) Demographic information;
(7) A personal profile;
(8) The
specific services to be furnished based on the support needs identified in (1)
above and how the services selected will support the individual’s goals;
(9) Guardianship,
supported decision-making, and representative payee information;
(10) Service
documentation requirements sufficient to track outcomes;
(11) Identification
of the persons and entities responsible for monitoring the services in the
service agreement;
(12) Documentation
that all settings where the individual receives services meet the criteria of
42 CFR 441.301, are chosen by the individual or representative, and support
full access to the greater community, including opportunities to seek employment
and work in competitive integrated settings, engage in community life, control
personal resources, and receive services in the community to the same degree of
access as people not receiving services;
(13) Documentation
that the setting is selected by the individual from among setting options,
including non-disability specific settings and an option for a private unit in
a residential setting, and that the settings options are identified and based
on the individual’s needs, and preferences;
(14) Documentation
that any restriction on the right of an individual is justified by:
a. An identified specific and individualized need that the modification is
based on;
b. The positive
interventions and supports used prior to any modifications to the individual’s
rights;
c. The less
intrusive methods of meeting the need that were tried but did not work;
d. A clear description of the condition that is directly proportionate to the
specific assessed need;
e. The regular collection and review of data to measure the ongoing
effectiveness of the modification;
f. Established time limits for periodic reviews of the necessity of the
modification;
g. The informed consent of the individual, guardian, or representative;
and
h. An assurance that the modification will not cause harm to the
individual;
(15) Services needed but not currently available;
and
(16) If applicable, risk factors and the measures
required to be in place to minimize them, including backup plans and
strategies.
(d) For
individuals receiving waiver services, the information provided below shall be
added to the service agreement:
(1) The
specific waiver services to be provided including the amount, scope, frequency,
and duration;
(2) The results of the SIS-A ® and the HRST;
(3) Service
documentation requirements sufficient to describe progress on goals and the
services received; and
(4) If
applicable, reporting mechanisms under self-directed services regarding budget
updates and individual and guardian satisfaction with services.
(e) For
individuals who reside in a provider owned or controlled residential setting,
the service agreement shall document any modifications of the individual’s
rights in said setting to:
(1) Privacy
in their sleeping or living unit, including doors lockable by the individual
with only appropriate providers having keys to doors as needed;
(2) Freedom
and support to control their own schedule and activities;
(3) Access
to food at any time;
(4) Having
visitors of their choosing at any time; and
(5) Freedom
to furnish and decorate sleeping or living units.
(f) A
provider agency shall only make modifications pursuant to (e) above by
documenting in the service agreement the following:
(1) An
identified specific and individualized assessed need that the modifications are
based on;
(2) The
positive interventions and supports used prior to any modifications to the
service agreement;
(3) The
less intrusive methods of meeting the need that have been tried but did not
work;
(4) A
clear description of the condition that is directly proportionate to the
specific assessed need;
(5) The
regular collection and review of data to measure the ongoing effectiveness of
the modification;
(6) Established
time limits for periodic reviews to determine if the modification is still
necessary or can be terminated;
(7) The
informed consent of the individual or representative; and
(8) An
assurance that the interventions and support will not cause harm to the
individual.
(g) Within
5 business days of completion of a service agreement, or service agreement
amendment, the service coordinator shall provide the individual and guardian,
or representative the following:
(1)
The service agreement, signed by the service coordinator, and all provider
agencies identified in the service agreement;
(2) The
name, address, email, and phone number of all provider agencies; and
(3) A
description of the procedures for challenging the proposed service agreement
pursuant to He-M 503.16 for those situations where the individual, guardian, or
representative disapproves of the service agreement.
(h) The
individual, guardian, or representative shall have 10 business days from the
date of receipt of the service agreement, or the service agreement amendment,
to respond in writing, indicating approval or disapproval of the service
agreement or amendment. Unless otherwise arranged between the individual,
guardian, or representative and the service coordinator, failure to respond
within the time allowed shall constitute approval of the service agreement or
amendment.
(i) When
a service agreement has been approved by the individual, guardian, or
representative and service coordinator, the services shall be implemented and
monitored as follows:
(1) A
person responsible for implementing any part of a service agreement, shall
collect and record information about services provided and how they have
impacted progress on the individual’s goals, in a timeframe outlined in the
service agreement or, at a minimum, monthly;
(2) On
at least a monthly basis, the service coordinator shall visit or have verbal or
written contact, as determined by the individual or persons responsible for
implementing a service agreement, and document these contacts;
(3) The
service coordinator shall visit the individual and contact the guardian, if
any, at least quarterly, or more frequently if so specified in the individual’s
service agreement, to determine and document:
a. Whether services match the interests and needs of the individual;
b. Individual
and guardian satisfaction with services; and
c. Progress
on the goals in the expanded service agreement; and
(4) If
the individual receives services under He-M 1001, or residential services under
He-M 521, He-M 524, or He-M 525, all of the service coordinator’s quarterly
visits with the individual shall be in the home where the individual resides.
Source. #1969, eff 2-25-82; ss by #2615, eff 2-6-84;
ss by #2962, eff 1-22-85; ss by #5211, eff 8-28-91; EXPIRED: 8-28-97
New. #6581, INTERIM, eff 9-19-97, EXPIRED: 1-17-98
New. #6932, eff 1-27-99; ss by #8805, eff 1-27-07;
ss by #10774, INTERIM, eff 1-27-15, EXPIRES: 7-27-15; ss by #10900, eff 7-25-15
(from He-M 503.11); ss by #13841, eff 12-29-23
He-M
503.11 Record Requirements for Area Agencies and Provider
Agencies.
(a) Area
agencies, service coordinators, and other provider agencies, or their designees
shall maintain a separate record for each individual who receives services and
ensure the confidentiality of information pertaining to the individual, including:
(1) Maintaining
the confidentiality of any personal data in the records;
(2) Storing
and disposing of records in a manner that preserves confidentiality; and
(3) Obtaining
a release of information pursuant to He-M 503.04 (h) prior to release of any
part of a record to a third party.
(b) An
individual’s record shall include, as applicable:
(1) Personal
and identifying information including the individual’s:
a. Name;
b. Address;
c. Date of
birth; and
d. Telephone number;
(2) All
information used to determine eligibility for services pursuant to He-M 503.05
and He-M 503.06;
(3) Information
about the individual that would be essential in case of an emergency,
including:
a. Name,
address, and telephone number of legal guardian, representative, or next of kin
or other person to be notified;
b. Name, address, and telephone number of current providers; and
c. Medical information as applicable, including:
1. Diagnosis(es);
2. Health
history;
3. Allergies;
4. Do
not resuscitate (DNR) orders, as appropriate;
5. Advance
directives, as determined by the individual;
6. Current medications; and
7. Any correspondence related to medical
information relevant to the individual;
(4) A
copy of the individual’s current service agreement;
(5) Copies
of all service agreement amendments;
(6) Progress
notes on goals and support services provided as identified in the service
agreement;
(7) All
service coordination contact notes and quarterly assessments pursuant to He-M
503.10(i)(2)-(4);
(8) Copies
of evaluations and reviews by providers and professionals;
(9) Copies
of correspondence within the past year with the individual and guardian, area
agency, provider agencies, providers, physicians, attorneys, state and federal
agencies, family members, and others in the individual’s life;
(10) Other
correspondence or memoranda concerning any significant events in the
individual’s life;
(11) Information
about transfer or termination of services, as appropriate; and
(12) Proof that the individual was given choice of
provider agencies.
(c) All
entries made into an individual record shall be legible and dated and have the
author identified by name and position.
(d) In
addition to the documentation requirements identified in He-M 503, each area
agency, service coordinator, provider agency, and provider shall comply with
all applicable documentation requirements of other department rules.
(e) Each
billing entity shall:
(1) Retain
records supporting each Medicaid bill for a period of not less than 6 years;
and
(2)
Retain an individual’s social history, medical history, evaluations, and any
court-related documentation for a period of not less than 6 years after
termination of services.
Source. #1969, eff 2-25-82; ss by #2615, eff 2-6-84;
ss by #2962, eff 1-22-85; ss by #5211, eff 8-28-91; EXPIRED: 8-28-97
New. #6581, INTERIM, eff 9-19-97, EXPIRED: 1-17-98
New. #6932, eff 1-27-99; ss by #8805, eff 1-27-07;
ss by #10774, INTERIM, eff 1-27-15, EXPIRES: 7-27-15; ss by #10900, eff 7-25-15
(from He-M 503.12); ss by #13841, eff 12-29-23
He-M
503.12 Service Funding.
(a) Pursuant
to RSA 171-A:1-a, I, services shall be funded in such a manner that:
(1) For
individuals in school and already eligible for services from the area agencies,
funds shall be allocated to them 90 days prior to their graduating or exiting
the school system or earlier so that any new or modified services needed are available
and provided upon such school graduation or exit;
(2) For
newly found eligible adults, the period between the time of completion of a
service agreement and the allocation by the department of the funds needed to
carry out the services required by the service agreement shall not exceed 90
days; and
(3) For
individuals already receiving services who experience significant life changes,
such as a significant change in their medical conditions, the period of time
for initiation of new services shall not exceed 90 days from the amendment of the
service agreement except by mutual agreement between the area agency and the
individual specifying a time limited extension.
(b) Service
funding needs for (a)(1)-(2) shall be documented by the area agency into NH
Easy at
https://nheasy.nh.gov/#/.
(c) Service funding needs for (a)(3) shall be documented by the
service coordinator into NH Easy at https://nheasy.nh.gov/#/.
(d)
The bureau shall make the final determination on the cost effectiveness of
proposed services for all funding requests.
Source. #1969, eff 2-25-82; ss by #2615, eff 2-6-84;
ss by #2962, eff 1-22-85; ss by #5211, eff 8-28-91; EXPIRED: 8-28-97
New. #6581, INTERIM, eff 9-19-97, EXPIRED: 1-17-98
New. #6932, eff 1-27-99; ss by #8805, eff 1-27-07;
ss by #10774, INTERIM, eff 1-27-15, EXPIRES: 7-27-15; ss by #10900, eff 7-25-15
(from He-M 503.14); amd by #12948, eff 12-20-19; ss by #13841, eff 12-29-23
He-M
503.13 Transfers Across Regions.
(a) If
an individual, guardian, or representative plans to relocate where
the individual lives and wishes to transfer
the individual’s area agency affiliation to that region, the
individual, guardian, or representative shall notify, in writing, the area
agency in the current region and the area agency in the proposed region
that the individual is moving and wishes to transfer services to that
region.
(b) The
current area agency shall send to the proposed area agency all information
contained within the individual’s file as outlined in He-M 503.11.
(c) Service
coordinators shall assist with the coordination when an individual transfers so
that benefits obtained from third party resources such as Medicaid, community
mental health center services, and the division of vocational rehabilitation
services shall not be lost or delayed during the transition from one region to
another.
Source. #1969, eff 2-25-82; ss by #2615, eff 2-6-84;
ss by #2962, eff 1-22-85; ss by #5211, eff 8-28-91; EXPIRED: 8-28-97
New. #6581, INTERIM, eff 9-19-97, EXPIRED: 1-17-98
New.
#6932, eff 1-27-99; ss by #8805, eff 1-27-07; ss by #10372, eff 7-1-13;
ss by #10900, eff 7-25-15 (from He-M 503.15); ss by #13841, eff 12-29-23
(formerly He-M 503.14)
He-M
503.14 Termination of Services.
(a) If
termination of services is being considered by the area agency, service
coordinator, individual, guardian, representative, or provider agency, then the
service coordinator shall meet with either the individual or their guardian or
representative, or both to discuss the reasons for the recommended termination.
(b) Any
recommendation for termination shall be made in writing to the area agency
director and be based on one or both of the following:
(1) The
individual can function without such service; or
(2) Services
are no longer necessary because they have been replaced by other supports or
services.
(c) Within
10 business days of receipt of a recommendation for termination of services, an
area agency director shall call a meeting with the service coordinator, either
the individual or their guardian or representative, if applicable, and the
provider agencies to be convened to review the request. The purpose of the
meeting shall be to determine if the criteria listed in (b) above applies to
the individual.
(d) Based
on the information presented and determinations made at the meeting, the
service coordinator shall prepare a written report for the area agency director
which sets forth one of the following:
(1) A
statement of concurrence with the recommendation for termination;
(2) A
recommendation for continuance; or
(3) Changes
to the individual’s service agreement.
(e) The
area agency director shall make the final decision regarding termination based
on the criteria listed in (b) above.
(f) If
a decision is made to terminate services pursuant to (b) above, the area agency
director shall send a termination notice to the individual, guardian, or
representative at least 30 days prior to the proposed termination
date. Services may be terminated sooner than 30 days with the consent of
the individual, guardian, or representative. The individual,
guardian, or representative may appeal the termination decision in accordance
with He-C 200.
(g) In
each termination notice the area agency shall provide information on the reason
for termination, the right to appeal, and the process for appealing the
decision, including the names, addresses, and phone numbers of the office of
client and legal services of the bureau and advocacy organizations, such as the
Disability Rights Center-NH, which the individual, guardian, or representative
may contact for assistance in appealing the decision.
(h) An
individual whose services have been terminated may request resumption of
services if they believe that the
reasons for the termination of services no longer apply. Such a
request shall be made by the individual, guardian, or representative, in
writing, to the area agency director.
(i) Upon
request of the individual, guardian, or representative, the area agency
director shall resume services to the individual if the criteria in (b) above
no longer apply and if funding is available.
Source. #1969, eff 2-25-82; ss by #2615, eff 2-6-84;
ss by #2962, eff 1-22-85; ss by #5211, eff 8-28-91; EXPIRED: 8-28-97
New. #6581, INTERIM, eff 9-19-97, EXPIRED: 1-17-98
New. #6932, eff 1-27-99; ss by #8805, eff 1-27-07;
ss by #10774, INTERIM, eff 1-27-15, EXPIRES: 7-27-15; ss by #10900, eff 7-25-15
(from He-M 503.16); ss by #13841, eff 12-29-23 (formerly He-M 503.15)
He-M
503.15 Voluntary Withdrawal from Services.
(a) An
individual, guardian, or representative may withdraw voluntarily from any
service(s) at any time, except as provided by RSA 171-B.
(b) The
administrator of the service from which withdrawal is made shall notify the
area agency in writing of the withdrawal and so indicate in the individual’s
record.
(c) If
any provider determines that withdrawal from a service might constitute abuse,
neglect, or exploitation on the part of a guardian or representative, the
provider or service coordinator shall report such abuse, neglect, or
exploitation as required by law.
(d) If
an individual does not have a guardian or representative and their service
coordinator or any other person believes that the individual is not making an
informed decision to withdraw from services and might suffer harm as a result
of abuse, neglect, or exploitation, the area agency shall pursue the least
restrictive protective means including, as appropriate, guardianship to address
the situation.
(e) An
individual who has withdrawn from services may request resumption of services
at any time. Such a request shall be made by the individual,
guardian, or representative, in writing, to the area agency director.
(f) Upon
request of the individual, guardian, or representative, the area agency
director shall resume services to the individual if funding is available.
Source. #1969, eff 2-25-82; ss by #2615, eff 2-6-84;
ss by #2962, eff 1-22-85; ss by #5211, eff 8-28-91; EXPIRED: 8-28-97
New. #6581, INTERIM, eff 9-19-97, EXPIRED: 1-17-98
New. #6932, eff 1-27-99; ss by #8805, eff 1-27-07
(from He-M 503.13); ss by #10774, INTERIM, eff 1-27-15, EXPIRES: 7-27-15; ss by
#10900, eff 7-25-15 (from He-M 503.17); ss by #13841, eff 12-29-23 (formerly He-M 503.16)
He-M
503.16 Challenges and Appeals.
(a) Any
determination, action, or inaction by the bureau, a service coordination
agency, provider agency, or area agency may be appealed by an individual,
guardian, or representative.
(b) An
individual, guardian, or representative may choose to pursue formal or informal
resolution to resolve any disagreement with the bureau, a service coordination
agency, provider agency, or an area agency. If informal resolution
is sought, at any time during the process or within 30 business days of the
bureau, service coordination agency, provider agency, or area agency decision,
the individual may choose to file a formal appeal pursuant to (e)-(g)
below. All formal appeals shall be filed within 30 days of the
bureau, area agency, provider agency, or service coordination agency
determination, action, or inaction.
(c) The
following actions shall be subject to the notification requirements of (d)
below:
(1) Adverse
eligibility actions under He-M 503.05(i) and (q) and He-M 503.06(e) and (f);
(2)
Proposed service agreements or service agreement amendments if the individual,
guardian, or representative disapproves pursuant to He-M 503.10(h); and
(3) A
determination to terminate services under He-M 503.14(f).
(d) The
bureau, area agency, provider agency, or service coordination agency, as
applicable, shall provide written notice to the applicant, individual, and
guardian or representative of the actions specified in (c) above, including:
(1) The
specific rules that support, or the federal or state law that requires, the
action;
(2) Notice
of the individual’s right to appeal in accordance with He-C 200 within 30
business days and the process for filing an appeal, including the contact
information to initiate the appeal with the bureau’s administrator;
(3) Notice
of the individual’s continued right to services pending appeal, when
applicable, pursuant to (g) below;
(4) Notice
of the right to have representation with an appeal by:
a. Legal counsel;
b. A relative;
c. A friend; or
d. Another spokesperson;
(5) Notice
that neither the area agency, provider agency, service coordination agency, nor
the bureau is responsible for the cost of representation; and
(6) Notice
of organizations with their addresses and phone numbers that might be available
to provide pro bono or reduced fee legal assistance and advocacy, including the
Disability Rights Center-NH.
(e) Appeals
shall be forwarded, in writing, to the bureau administrator in care of the
department’s office of client and legal services. An exception shall be
that appeals may be filed verbally if the individual is unable to convey the appeal
in writing.
(f) The
bureau administrator shall immediately forward the appeal to the department’s
administrative appeals unit which shall assign a presiding officer to conduct a
hearing, as provided in He-C 200. The burden shall be as provided by
He-C 204.12.
(g) If
a hearing is requested, the following actions shall occur:
(1) For
current recipients, services and payments shall be continued as a consequence
of an appeal for a hearing until a decision has been made; and
(2) If
the bureau, service coordination agency, provider agency, or area agency
decision is upheld:
a. Benefits
shall cease 60 days from the date of the denial letter or 30 days from the
hearing decision, whichever is later; or
b. In the
instance of termination of services, services shall cease one year after the
initial decision to terminate services or 30 days from the hearing decision, whichever
is later.
Source. #8805, eff 1-27-07 (from He-M 503.14); ss by
#10774, INTERIM, eff 1-27-15, EXPIRES: 7-27-15; ss by #10900, eff 7-25-15 (from
He-M 503.18); ss by #13841, eff 12-29-23 (formerly He-M 503.17)
He-M
503.17 Waivers.
(a) An
applicant, area agency, service coordination agency, provider agency,
individual, guardian, representative, or provider may request
a waiver of specific procedures outlined in He-M 503 by completing and
submitting the form titled “NH Bureau of Developmental Services Waiver Request”
(October 2023). The request shall be sent in writing to the bureau
administrator.
(b) A
completed waiver request form shall be signed by:
(1) The
individual, guardian, or representative indicating agreement with the request;
and
(2) If
applicable, the area agency, service coordination agency, or provider agency’s
executive director or designee recommending approval of the waiver.
(c) A
waiver request shall be submitted to the department via:
(1) Email at bds@dhhs.nh.gov; or
(2) By mail to:
Bureau of
Developmental Services
Hugh J. Gallen State Office
Park
105 Pleasant Street, Main Building
Concord, NH 03301
(d) No
provision or procedure prescribed by statute shall be waived.
(e) The
request for a waiver shall be granted by the commissioner or their designee
within 30 days if the alternative proposed by the requesting entity meets the
objective or intent of the rule and it:
(1) Does
not negatively impact the health or safety of the individual(s); and
(2) Does
not affect the quality of services to individuals.
(f) Upon
receipt of approval of a waiver request, the requesting entity’s subsequent
compliance with the alternative provisions or procedures approved in the waiver
shall be considered compliance with the rule for which waiver was sought.
(g) Waivers
shall be granted in writing for the minimum period necessary to accommodate the
waiver request, with a specific duration not to exceed 5 years except as in
(h)-(i) below.
(h) Any
waiver shall end with the closure of the related program or service.
(i) A
requesting entity may request a renewal of a waiver from the
bureau. Such request shall be made at least 30 days prior to the
expiration of a current waiver.
Source. #8805, eff 1-27-07 (from He-M 503.15); ss by
#10774, INTERIM, eff 1-27-15, EXPIRES: 7-27-15; ss by #10900, eff 7-25-15
(formerly He-M 503.19); ss by #13841, eff 12-29-23(formerly He-M 503.18)
PART He-M 504 PROVIDER AND PROVIDER AGENCY OPERATIONS
Statutory
Authority: RSA 171-A:3, 18, IV
REVISION NOTE:
Document
#13679, effective 6-28-23, adopted He-M 504 as an emergency rule, and the “NH
Bureau of Developmental Services Waiver Request” form (July 2019) was
incorporated by reference in He-M 504.14(a).
Document #13788, effective 10-21-23, readopted the form with amendments
pursuant to the expedited revisions to agency forms process in RSA 541-A:19-c,
updating the revision date of the form from July 2019 to October 2023. Document #13788 contained only the updated
form, giving the form a new effective date, while leaving the effective date of
the rule He-M 504.14 under Document #13679 as 6-28-23.
The
emergency rule in Document #13679 would normally have expired 12-25-23, but
before the rule expired, Document #13807, effective 11-17-23, readopted with
amendment He-M 504, including the “NH Bureau of Developmental Services Waiver
Request” form incorporated by reference with a revision date of October 2023 in
He-M 504.14(a).
He-M 504.01 Purpose. The purpose of these rules is to define the
expectations for all providers and provider agencies seeking payment from the
department for the provision of authorized services to eligible individuals
with developmental disabilities and acquired brain disorders.
Source. #13679,
EMERGENCY RULE, eff 6-28-23; ss by #13807, eff 11-17-23
He-M 504.02 Definitions. The words and phrases used in these rules
shall mean the following, except where a different meaning is clearly intended
from the context:
(a)
“Acquired brain disorder” means a disruption
in brain functioning that:
(1) Is
not congenital or caused by birth trauma;
(2) Presents a severe and life-long disabling condition which
significantly impairs a person’s ability to
function in society;
(3) Occurs
prior to age 60;
(4) Is attributable to one or
more of the following reasons:
a. External trauma to the brain as a result of:
1. A
motor vehicle incident;
2. A
fall;
3. An
assault; or
4. Another
related traumatic incident or occurrence;
b. Anoxic or hypoxic injury to the brain such as from:
1. Cardiopulmonary
arrest;
2. Carbon
monoxide poisoning;
3. Airway
obstruction;
4. Hemorrhage;
or
5. Near
drowning;
c. Infectious diseases such as encephalitis and meningitis;
d. Brain tumor;
e. Intracranial surgery;
f. Cerebrovascular disruption such as a stroke;
g. Toxic
exposure; or
h. Other
neurological disorders such as Huntington’s disease or multiple sclerosis which
predominantly affect the central nervous system resulting in diminished
cognitive functioning and ability; and
(5) Is
manifested by one or more of the following:
a. Significant decline in cognitive functioning and ability; or
b. Deterioration in:
1. Personality;
2. Impulse
control;
3. Judgment;
4. Modulation
of mood; or
5. Awareness
of deficits;
(b) "Area agency" means “area agency”
as defined in RSA 171-A:2, I-b.
(c)
“Bureau” means the bureau of developmental services of the department of
health and human services;
(d)
“Commissioner” means the commissioner of the department of health and
human services or designee;
(e) “Cost of care” means the amount of income that
eligible individuals receiving home and community based waiver services are
liable to contribute toward the cost of their services as specified in He-M
517;
(f)
“Critical incident” means an
alleged, suspected, or actual occurrence of:
(1) Abuse including physical, sexual, verbal, and
psychological abuse;
(2) Neglect;
(3) Exploitation;
(4) Serious injury;
(5) Death other than by natural causes; and
(6) Other events that threaten the health or
safety of an individual such as hospitalizations, administration of the wrong
medication, failure to administer medication, or use of restraints or
behavioral interventions that are not included in an approved behavior change
program;
(g) “Days” means calendar days unless otherwise
specified;
(h) “Department” means the New Hampshire department of health and human
services;
(i)
"Developmental disability" means “developmental disability” as
defined in RSA 171-A:2, V, namely, "a disability:
(1) Which is attributable to an intellectual
disability, cerebral palsy, epilepsy, autism, or a specific learning
disability, or any other condition of an individual found to be closely related
to an intellectual disability as it refers to general intellectual functioning
or impairment in adaptive behavior or requires treatment similar to that
required for persons with an intellectual disability; and
(2) Which originates before such individual
attains age 22, has continued or can be expected to continue indefinitely, and
constitutes a severe disability to such individual's ability to function
normally in society.";
(j)
“Enrolled provider” means a provider agency or independent provider that
the department has determined is eligible to provide Home and Community Based
1915 (c) waiver services and receive payment therefore;
(k)
“Guardian” means a person appointed pursuant to RSA 463 or RSA 464-A or
the parent of an individual under the age of 18 whose parental rights have not
been terminated or limited by law;
(l)
“Home and community based waiver services” means the services defined
and funded pursuant to New Hampshire’s agreement with the federal government,
known as the Developmental Disabilities Waiver, In-Home Supports Waiver, and
the Acquired Brain Disorder Waiver, pursuant to the authority section of
1915(c) of the Social Security Act which allows the federal funding of
long-term care services in non-institutional settings for persons who are
developmentally disabled or who have an acquired brain disorder;
(m)
“Individual” means a person who has a developmental disability or
acquired brain disorder;
(n) “Medicaid” means the Title XIX and Title XXI programs administered
by the department, which makes medical assistance and services available to
eligible individuals;
(o) “Medicaid management information
system (MMIS)” means the general system for
mechanized claims processing and information retrieval recommended by the
Centers for Medicare and Medicaid Services (CMS) for the implementation of the
requirements of state fiscal administration pursuant to 42 CFR 433, Subpart C;
(p)
“Organized health care delivery system
(OHCDS)” means an
area agency, designated pursuant to He-M 505, that directly provides at least
one home and community based waiver service;
(q)
“Pass-through billing” means an arrangement, pursuant to 42 CFR
447.10(g)(3), whereby the OHCDS is the enrolled provider of home and community
based waiver services for the purposes of billing and subcontracting for the
service provision and has authorization from the department to do so;
(r)
“Person-centered service planning” is an individual-directed, positive
approach to the planning and coordination of a person’s services and other
supports based on the individual’s aspirations, needs, preferences, and goals;
(s)
“Problematic sexual behavior” means non-consensual touching or attempting to
touch another person’s body in a sexualized manner, unsolicited sexualized
statements, public exposure, and illegal sexual conduct whether in person or
online.
(t)
“Provider” means a person receiving any form of remuneration for the
provision of services to an individual;
(u)
“Provider agency” means an agency or an independent provider that is
established to provide services to individuals;
(v) “Provider
applicant” means a provider agency who is undergoing the enrollment or
re-enrollment process to become a New Hampshire Medicaid provider;
(w) “Provider enrollment ID” means a unique
identification number assigned to provider agencies who are enrolled in the
state’s Medicaid program and authorized to provide services to Medicaid
beneficiaries;
(x) “Room and board” means shelter
type expenses, including all property-related costs such as rental or purchase
of real estate and furnishings, maintenance, utilities, and related
administrative services, and 3 meals a day or any other full nutritional
regimen;
(y)
“Sentinel event” means an unexpected occurrence involving death or
serious physical or psychological injury, or risk thereof. Serious injury
specifically includes loss of limb or function. Categories of reportable
sentinel events are individual-centered events, in which the individual is
either a victim or perpetrator, including, but are not limited to:
(1) Any sudden, unanticipated, or accidental
death, not including homicide or suicide, and not related to the natural course
of an individual’s illness or underlying condition;
(2) Permanent loss of function, not related to
the natural course of an individual’s illness or underlying condition,
resulting from such causes including but not limited to:
a. A medication error;
b. An unauthorized departure or abduction from a
facility providing care; or
c. A delay or failure to
provide requested or medically necessary services due to waitlists,
availability, insurance coverage, or resource limits;
(3) Homicide;
(4) Suicide;
(5) Suicide attempt, such as
self-injurious behavior with a non-fatal outcome, with explicit or implicit
evidence that the person intended to die and medical intervention was needed;
(6) Rape or any other sexual
assault;
(7) Serious physical injury;
(8) Serious psychological
injury that jeopardizes the person’s health that is associated with the
planning and delivery of care; or
(9) Injuries due to physical or
mechanical restraints;
(10) High profile or high risk event, such as:
a. Media coverage; or
b. Police involvement leading to an arrest;
(z)
“Service” means any paid assistance to an individual in meeting their
own needs provided through the developmental services system;
(aa)
“Service coordinator” means a provider who meets the criteria in He-M
503 or He-M 522 and is chosen by an individual and their guardian or
representative to organize, facilitate, and document service planning and to
negotiate and monitor the provision of the individual’s services;
(ab)
“Service coordination agency” means a provider agency providing service
coordination services to individuals and licensed pursuant to He-P 819;
(ac)
“Staff” means a person employed by a provider agency, subcontract
agency, or other employer; and
(ad) “Utilization
review and control” means the monitoring of medicaid program services
pursuant to 42 CFR 455 and 42 CFR 456.
Source. #13679,
EMERGENCY RULE, eff 6-28-23; ss by #13807, eff 11-17-23
He-M 504.03 Roles and Responsibilities of Providers
and Provider Agencies.
(a)
All provider agencies shall obtain and maintain certifications for
community residences, enhanced family care shared living residential
habilitation services, and adult day community participation services in accordance
with He-M 507 or He-M 1001, as applicable.
(b) All providers and provider agencies shall be
responsible for the following:
(1) Participating in person-centered service
planning in accordance with He-M 503, He-M 522, and He-M 524;
(2) Ensuring service delivery is led by the
individual and family, if chosen by the individual, and promotes community
involvement, relationship development, independence, societal contribution,
enhancement of individual communications, and aligns with an individual’s
service agreement and in accordance with RSA 171-A;
(3) Reviewing the service agreement to ensure:
a. That all provider agencies review and sign
the service agreement in accordance with He-M 503, He-M 522, and He-M 524, as
applicable, to indicate that they agree to provide services in the amount,
scope, frequency and duration, as outlined; and
b. That all
providers review the service agreement relative to the service that they will
be providing prior to service provision;
(4) Ensuring that all services and supports are
provided in accordance with He-M 310, He-M 503, He-M 517, He-M 522, He-M 524,
and He-M 1201, as applicable;
(5) Creating and maintaining documentation in
accordance with He-M 503, He-M 517, He-M 522, He-M 524, and He-M 1201, as
applicable;
(6) Providing documentation of service planning,
monitoring, and billing related to the service being provided, within 30 days
of the request from the following entities, unless otherwise stated in rule, as
follows:
a. To the department;
b. To area agencies, regarding information that
is necessary for area agencies to complete their responsibilities pursuant to
He-M 505; and
c. To service coordinators, regarding information
that is necessary for the service coordination provider agency and service
coordinator to complete their responsibilities pursuant to He-M 500;
(7) Providing documentation in (6) above within 3
business days in circumstances when the information is needed to support crisis
planning;
(8) Participating
in activities with the area agency that are necessary to complete its
responsibilities pursuant to He-M 505;
(9) Participating
in crisis mitigation and management which includes, but is not limited to,
identifying alternative placement options, sharing information with other
provider agencies and providers, and participating in crisis management
meetings;
(10) Documenting and submitting to service
coordination agencies and notifying guardians, if applicable, incident reports
regarding critical incidents;
(11) Documenting and submitting to area agencies
incident reports regarding critical incidents when the service coordination
agency is the reporting entity; and
(12) Managing responses to areas of risk, in
accordance with He-M 503, He-M 522, and He-M 524 and by:
a. Reviewing and
analyzing incidents related to violent aggression, problematic sexual
behaviors, or fire-setting behaviors as they pertain to service planning and
provision;
b. Notifying
service coordinators of the presentation of incidents in accordance with (a)
above;
c. Presenting to committees and other groups
related to risk management, when invited by the service
coordinator, including, but not limited to, local human rights committees,
statewide and local risk management committees, and community of practice to
determine application of assessment recommendations received, when the provider
agency participated in the plan development;
d. Ensuring documentation of activities and
progress in treatment relative to management of risk for an individual to help inform the person-centered
development of plans;
e. Ensuring that agency personnel and contractors
receive clinically specialized trainings, based on assessed
needs of the individuals supported, that enable these personnel to successfully
complete risk management activities;
f. Ensuring participation
in risk management training activities; and
g. Ensuring that plans are reviewed regularly
with individuals and their treatment team to consider ongoing appropriateness
and, in the event that potential changes are indicated, seeking additional consultation with providers qualified to
conduct and author assessments, whether they created the initial plans or are
new, to discuss opportunities for modification of restrictions by sharing data
regarding the individual’s updated progress in treatment.
(c) In addition to the requirements in He-M
504.03(b)(9) for response to management of risk, service coordination provider
agencies and service coordination providers shall:
(1) Make referrals, as applicable, to the
appropriate area agency’s local risk management committee
for individuals exhibiting violent aggression, problematic sexual behaviors, or
fire-setting behaviors for evaluations or planning activities initially and
ongoing;
(2) Arrange for
assessments or evaluations resulting from local human rights committee
recommendations; and
(3) Participate in and present to committees and other
groups related to risk management including, but not limited to, local human
rights committees, statewide and local risk management committees and
communities of practice to determine application of assessment recommendations
received.
(d) All service coordination agencies
shall document sentinel events and submit reports to the applicable area agency
for finalization in accordance with RSA 126-A:4.
(e) All provider agencies shall be
able to be contacted during their published hours of business, as indicated in
the medicaid provider enrollment process.
(f) In addition to (e) above, all home and
community based waiver community residence and enhanced family care shared
living residential habilitation provider agencies and service coordination
provider agencies shall be accessible 24/7 and have an on-call system for
emergency access outside of regular business hours to ensure response within 30
minutes by a representative with decision-making authority.
(g) Each provider agency must complete a New
Hampshire criminal records check no more than 30 days prior to hire and prior
to working with any individual, and every other year thereafter, for all of its
providers, staff, contractors, and volunteers who will have direct contact with
individuals or families and:
(1) If the applicable provider, staff, contractor
or volunteer’s primary residence is out of state, a criminal records check for
their state of residence shall be completed prior to working with any
individual, and every other year thereafter; or
(2) If the applicable provider, staff, contractor
or volunteer has resided in New Hampshire for less than one year, a criminal
records check for their previous state(s) of residence shall be completed prior
to working with any individual.
(h) Each provider agency shall complete a check
of the division of children, youth and families (DCYF) state registry, pursuant to RSA 169-C:35 for all of its
providers, staff, contractors, and volunteers who will have direct contact with
individuals or families, prior to working with any individual and every other
year thereafter.
(i) Each provider agency shall complete a check
of the registry of founded reports of abuse, neglect, and exploitation pursuant to RSA 161-F:49 for all of its providers, staff,
contractors, and volunteers who will have direct contact with individuals and
families prior to working with any individual and every other year thereafter.
(j) Each provider agency shall obtain an
attestation from all of its providers, staff, contractors, and volunteers who will have direct contact with individuals or families in
the year in between the checks required pursuant to (g)-(i) above that they
have not:
(1) Been convicted of a felony or misdemeanor in
this or any other state; and
(2) Had a finding by the department or any
administrative agency in this or any other state for assault, fraud, abuse,
neglect, or exploitation of any person.
(k) Except
as allowed in (l) and (m) below, a provider agency shall not hire a person, or
permit them to volunteer:
(1) Who
has a:
a. Felony
conviction; or
b. Any
misdemeanor conviction involving:
1. Physical or
sexual assault;
2. Violence;
3. Exploitation;
4. Child pornography;
5. Threatening or
reckless conduct;
6. Theft;
7. Driving under
the influence of drugs or alcohol; or
8. Any other
conduct that represents evidence of behavior that could endanger the well-being
of an individual; or
(2) Whose
name is on either of the state registries of founded abuse, neglect, and
exploitation as established by RSA 161-F:49 and RSA 169-C:35.
(l) A
provider agency may hire a person, or permit the person to volunteer, with a
criminal record listed in (k)(1) a. or b. above for a single offense that
occurred 10 or more years ago in accordance with (m) and (n)
below. In such instances, the individual, their guardian if
applicable, and the provider agency shall review the person’s history prior to
approving the person’s employment.
(m) Employment of a person pursuant to (l) above shall only occur if such
employment:
(1) Is
approved by the individual, their guardian, if applicable, and the
provider agency;
(2) Does not
negatively impact the health or safety of the individual; and
(3) Does not
affect the quality of services to the individual.
(n) Upon hiring or permitting a person to volunteer
pursuant to (l) and (m) above, the provider agency shall document and retain
the following information in the individual’s record:
(1) The date(s)
of the approvals in (l) above;
(2) The
name of the individual for whom the person will provide services;
(3) The
name of the person hired or permitted to volunteer;
(4) Description of
the person’s criminal offense;
(5) The type of service the person is hired
or volunteering to provide;
(6) The provider agency’s name and address;
(7) A
full explanation of why the provider agency is hiring or allowing the person to
volunteer despite the person’s criminal record;
(8) Signature
of the individual, or of the legal guardian(s) if applicable, indicating
agreement
with the employment and date signed;
(9) Signature of the provider agency staff
person who obtained the individual or guardian’s signature and
date signed;
(10) Signature of the provider agency’s executive
director or designee approving the
employment;
and
(11) The
signature and phone number of the person being hired or permitted to volunteer.
(o) In instances when obtaining the checks
required in (g)-(h) would delay a provider agency’s ability to have a provider, staff, contractor, or volunteer provide services, the
provider agency shall obtain a self-attestation from the prospective provider,
staff, contractor, or volunteer to attest that they have not:
(1) Committed a felony or misdemeanor in this or
any other state; and
(2) Had a finding by the department or any
administrative agency in this or any other state for assault, fraud, abuse,
neglect, or exploitation of any person.
(p) Self-attestations obtained in accordance with
(o) above shall be accepted while the provider agency is awaiting the results of the checks required in (g)-(h) above, but shall
not be valid for more than 90 days once signed. Individual and guardian
approval shall be obtained if a provider, staff, contractor or volunteer will
work directly with an individual and not under the supervision of a provider,
staff, contractor or volunteer with completed checks pursuant to (g)-(h) above.
(q) Each provider
agency shall check the office of the inspector general exclusion list prior to
hire and monthly thereafter with regard to checking names of prospective or
current providers, staff, and contractors.
(r) Each provider agency shall ensure all
providers, staff, contractors, and volunteers who drive individuals, in their
own vehicle or agency vehicle, have a valid driver’s license.
(s) Each provider agency, provider, staff,
contractor, and volunteer is a mandated reporter and shall report to the
appropriate department authority any individual who is suspected of being
abused, neglected, exploited, or self-neglecting,
in accordance with, RSA 161-F:46 and RSA 169-C:35, and pursuant to He-M 202,
any individual who is suspected of being abused, neglected, exploited, or
having had their service rights violated, in accordance with He-M 310.
(t) Each provider agency
shall report instances of restraint and seclusion to each individual’s area
agency not less than quarterly.
(u) Provider agencies shall collect any applicable
room and board payments.
(v) Provider
agencies shall collect any applicable cost of care payments.
Source. #13679,
EMERGENCY RULE, eff 6-28-23; ss by #13807, eff 11-17-23
He-M 504.04 Provider and Provider Agency Participation.
(a) Each
provider
agency who seeks to be enrolled to provide and receive reimbursement for home
and community based waiver services shall:
(1) Complete an
application for enrollment via the MMIS portal at: https://nhmmis.nh.gov/portals/wps/portal/ProviderLogin in order to apply to
be and operate as a New Hampshire Medicaid enrolled provider in
accordance with 42 CFR 455.410 and He-W 520.06, unless they choose to contract
with an OHCDS for pass-through billing, pursuant to He-M 504.06;
(2) Contact the
bureau to request a screening in accordance with (b) below:
a. Following initiation of an application in
accordance with (1) above; or
b. Not less than 120 days prior to expiration of
the current enrollment period when the provider agency
intends to submit an application for re-enrollment;
(3) Meet the applicable licensing, certification,
or other requirements of the specific service they provide, such as but not limited to, criteria required in New Hampshire
RSA 151, RSA 171-A, 42 CFR 441.301, or a contract with the bureau or OHCDS; and
(4) Have an executed Medicaid provider
participation agreement with the department in order to obtain Medicaid agency
identification numbers from the department for the specific services for which
the provider agency is enrolling.
(b) Each provider applicant shall participate in a
department screening upon enrollment and re-enrollment to review the following:
(1) Mission and vision statements, as applicable;
(2) Training practices, such as but not limited
to, requirements per specific position, purchased training platforms, and
continuing education hours requirements;
(3) Service-specific competencies, as related to
developmental services defined in chapter He-M 500;
(4) Three references that illustrate the provider
applicant’s ability to meet their service obligations in accordance with their
mission and vision statement;
(5) Financial indicators of fiscal integrity,
including but not limited to;
a. Financial statements identifying current
portion of long-term debt payments
including principal and interest; and
b. A measure of total current assets available to
cover the cost of current liabilities;
(6) Liability protections;
(7) Policies and practices regarding restraint and
seclusion;
(8) Attestation that criminal background and
appropriate registry checks were completed pursuant to He-M 504.03(g)-(h); and
(9) Attestation that office of inspector general
checks were completed in accordance with He-M 504.03(n).
(c) The screening in (b) above shall occur within
90 days of application for enrollment and within 120 days for reenrollment.
(d)
A provider applicant shall not be enrolled pursuant to (a)(4) above
until the department has completed the screening in (b) above and has
communicated this to the department’s program integrity office.
(e)
In addition to the reasons set forth in He-W 520.06, the department
shall deny an application for provider agency enrollment or re-enrollment, as
applicable, due to any of the following reasons:
(1) Failure to
complete the screening required in (b) above;
(2) Any reported abuse, neglect, or exploitation
of an individual by an applicant, provider, provider agency, or contractor, if
such abuse, neglect, or exploitation is reported on the state registry of
abuse, neglect, and exploitation in accordance with RSA 161-F:49 or RSA
169-C:35 and the provider agency failed to take appropriate action;
(3) A provider agency fails to ensure that its
providers, staff, and contractors meet the training requirements in chapter
He-M 500, He-M 1001, He-M 1201, or Nur 404;
(4) A provider agency, provider, staff, or
contractor has an illness or behavior that, as evidenced by documentation
obtained or the observations made by the department, would endanger the
well-being of the individuals or impair the ability of the provider agency to
comply with department rules and the provider agency failed to take appropriate
action to address and respond;
(5) A provider agency, or any of its providers,
staff, contractors, or any representative thereof, knowingly provides
materially false or misleading information to the department;
(6) A provider agency, or any of its providers,
staff, contractors, or any representative thereof, fails to permit or
interferes with any inspection or investigation by the department;
(7) A provider agency, or any of its providers,
staff, contractors, or representatives thereof, fails to provide required
documents to the department or entities acting on its behalf;
(8) Federal or state laws, regulations, or
guidelines are modified in such a way that either providing the services under
the medicaid provider participation agreement is prohibited or the department
is prohibited from paying for such services from the planned funding source; or
(9) The provider agency, provider, or contractor
no longer holds a required license, certification, or other credential to
qualify as a provider of services.
(f)
Enrollment or re-enrollment shall be denied upon the written notice by
the department to the provider agency stating the specific rule(s) with which
the provider agency does not comply.
(g)
A provider agency may request an appeal, in accordance with He-C 200,
regarding a proposed denial of enrollment or re-enrollment within 30 business
days of the decision.
(h) The provider agency’s enrollment status shall
be suspended until the appeal determination is adjudicated.
(i) The denial shall not become final until the
period for requesting an appeal has expired, or, if the provider agency
requests an appeal, until such time as the administrative appeals unit issues a
decision upholding the department’s decision.
(j)
If the department’s decision is not upheld, the denial would be
ineffective, and the provider shall continue to provide services.
(k)
Appeals shall be submitted in writing, to the bureau administrator in
care of the department’s office of client and legal services.
(l) Each enrolled provider shall:
(1) Submit
claims for payment in accordance with He-M 504.05; and
(2) Be subject to
monitoring by the department or entities acting on its behalf, in accordance
with the requirements of He-M 504.09, He-M 500, and He-M 1201.
(m) An enrolled provider or applicant shall update
MMIS and notify the department, in writing to the bureau chief, or designee, of
any material change in any status or condition of any element on their
application within 30 days of the change occurring for changes such as, but not
limited to:
(1) Business affiliation;
(2) Ownership and control information;
(3) Federal tax identification number;
(4) Criminal convictions;
(5) Addition to the bureau of elderly and adult
services (BEAS) or DCYF state registries; and
(6) The types of services that are offered.
(n)
An enrolled provider shall notify any applicable service coordination
agency if any change results in a change to the provider agency’s ability to
deliver services to an individual as outlined in that individual’s service
agreement within 2 business days.
(o)
An enrolled provider or provider applicant shall notify any applicable
area agency or service coordination agency if any change impacts their status
as a provider agency within 2 business days.
(p)
An enrolled provider shall immediately notify, in writing, the
department, any applicable area agencies, any applicable service coordination
agencies, and any individuals receiving services from the provider agency, in
accordance with He-M 504.13 of their decision to terminate their status as an
enrolled provider and update the MMIS at least 90 days prior to the termination
date.
(q)
Enrolled providers terminating in accordance with (n) above shall ensure
each individual’s full service file and any other pertinent documentation is
transferred to their respective service coordination agency within 2 business
days of the notification.
(r) Documentation of services provided between the
date of notice and the last date of service provision shall be transferred to
the respective service coordination entity no more than 2 business days after
the end of service provision.
(s)
Claims submitted by, or payments made to, enrolled provider agencies who
have not timely furnished the notification of changes or have not submitted any
of the items that are required due to a change, in accordance with (n)-(q)
above, shall be denied payment or be subject to recovery.
He-M 504.05 Payment for Services.
(a) Provider agencies shall submit all initial claims to the MMIS, so
that the claims are received within 90 days after the date of service on the
claim.
(b) If a
provider agency has submitted a claim in compliance with (a) above and it is
denied, the provider agency shall resubmit the claim within 15 months from the
earliest date of service if the provider agency still wishes to receive reimbursement.
(c) Submission of claims in accordance with (a)
and (b) above shall constitute the provider agency’s assurance that:
(1) The service was delivered in compliance with
all applicable federal and state rules and requirements in effect on the date
the service(s) was provided, including but not limited to, the home and
community based waiver services, chapter He-M 500, He-W 520, He-W 521, and CFR
455.410;
(2) The provider agency has created and
maintained all records necessary in accordance with He-M 503, He-M 517, He-M
522, and He-M 524;
(3) The provider agency is prepared to share
records with the department or the department’s designee, including area
agencies, within 30 days as requested; and
(4) The information included within the claim is
accurate and complete.
(d) Provider
agencies shall not bill the individual for medicaid covered services, even if
medicaid denies the claim, when the individual
is eligible for medicaid and approved for the service provided.
(e) Claims submitted by, or payments made to,
provider agencies who have not timely billed pursuant to this part shall be
subject to denied payment or recovery.
Source. #13679,
EMERGENCY RULE, eff 6-28-23; ss by #13807, eff 11-17-23
He-M 504.06 Pass-Through Billing.
(a)
Pass-through billing shall be permissible for the following home and
community based waiver services:
(1) Assistive technology;
(2) Environmental
and vehicle modification services;
(3) Individual goods and services;
(4) Non-medical transportation;
(5) Personal emergency response system;
(6) Community integration services;
(7) Respite;
(8) Wellness coaching; and
(9) Specialty services for assessments,
consultations, and evaluations.
(b) An OHCDS that provides pass-through billing
shall:
(1) Establish itself as the enrolled provider for
the home and community based waiver
service(s) in (a)
above for which pass-through billing will be done;
(2) Hold a contract or other agreement with a
provider or provider agency for service provision, except that provision of
goods, other than environmental or vehicle modifications, shall not require a
contract or agreement;
(3) Ensure that the providers and provider
agencies with whom it contracts, or has agreements with, meet:
a. The service and provider qualification
standards under the applicable home and community based services waiver, He-M
504 and He-M 506 to provide the services pursuant to (1) above;
b. Medicaid requirements and are free from
sanctions or exclusions or are otherwise not excluded from receiving medicaid
reimbursement;
c. Medicaid office of inspector general screening
requirements prior to service delivery and monthly thereafter;
d. All federal and
state rules and requirements; and
e. All applicable
regulatory and industry standards and maintains good standing as a provider
agency;
(4) Submit claims to MMIS for rendered services
and goods and ensure that records are maintained to verify that such services
and goods were provided in the amount, scope, and frequency that was claimed;
(5) Reimburse subcontractors;
(6) Submit to the bureau
within 30 days of the close of the state fiscal year, in addition to all other
required reports and statements, an aggregate annual summary delineating OHCDS
activities, including subcontractor names, amounts paid per subcontractor,
nature of services, and number of individuals served by each subcontractor;
(7) Ensure that it maintains detailed records,
available for the department, its
designee, or respective individual, at request
for review at any time, to verify the purchase of services and goods outlined
in (a) above; and
(8) Ensure that
policies and practices do not:
a. Restrict any home and community-based waiver
services provider agency or provider to participate only through an OHCDS and
that such arrangements are voluntary; and
b. Restrict individuals into securing services
exclusively through an OHCDS.
Source. #13679,
EMERGENCY RULE, eff 6-28-23; ss by #13807, eff 11-17-23
He-M
504.07 Third Party Liability. All third party
obligations shall be exhausted before medicaid may be billed, in
accordance with 42 CFR 433.139.
Source. #13679,
EMERGENCY RULE, eff 6-28-23; ss by #13807, eff 11-17-23
He-M 504.08 Monitoring and Determination of Cost
Effectiveness.
(a) Each provider agency shall submit to the
department annually, cost reporting information, which includes, but is not
limited to, the following:
(1) A signed statement certifying that the
information provided is true, accurate, and complete and acknowledging that
penalties for any false statement or misrepresentation of material fact include
fine or imprisonment;
(2) Financial
statements and schedules for the reporting period;
(3) Expenses,
including all personnel related expenses; and
(4) Information
reflective of the most recent desk audit or field audit adjustments made to the
previous cost report, if applicable,
with the exception of items still under appeal that have not been resolved.
(b)
Complete cost information shall be submitted:
(1) No later than
120 days after the end of the state fiscal year, unless an extension has been
granted by the department, pursuant to (g)-(h) below; or
(2) By the former
owner of the organization within 90 days of the sale of the entity when a
change in ownership occurs.
(c)
The department shall consider annual cost information reported to be
incomplete if it is not provided in accordance with (a) above.
(d)
The department shall audit the cost information reported not less than
every 3 years.
(e)
Any provider agency that submits incomplete cost reporting information
shall be subject to penalties described in (i) below, unless an extension has
been granted pursuant to (g)-(h) below.
(f)
The department shall notify the provider agency of incomplete cost
reporting information within 30 days of receipt of information and the
timeframe for submitting complete cost reporting information as described in
(b)(1)-(2) shall not change due to an incomplete report submitted by a provider
agency.
(g) Requests for extensions for submitting cost
reporting beyond the prescribed deadline shall:
(1) Be in writing;
(2) Be submitted to the department at least 10
business days prior to the due date, unless one of the circumstances identified
in (h)(1)-(4) below occurs during the 10 business day prior to the due date, in
which case the request shall be made by telephone within 10 business days of
the occurrence;
(3) Clearly explain the necessity for the
extension; and
(4) Specify the date on which the report shall be
submitted.
(h) Approval of extensions shall be made only if
it is determined that the delay is caused by circumstances beyond the provider
agency’s control, such as, but not limited to:
(1) Natural or manmade disasters;
(2) Strikes by
employees;
(3) The death of
an owner or senior management; or
(4) Any other
instances where the agency can demonstrate a critical impact to operations.
(i)
Failure to submit the required cost information shall result in delayed
or reduced payments effective on the first day of the month following the due
date for filing of cost information, and for each successive month of
delinquency in filing the completed cost information.
Source. #13679,
EMERGENCY RULE, eff 6-28-23; ss by #13807, eff 11-17-23
He-M 504.09 Utilization
Review and Control. The department’s program integrity unit
shall monitor utilization of home and community-based
waiver services to identify, prevent, and correct potential occurrences of
fraud, waste, and abuse in accordance with in accordance with He-W 520, 42 CFR
455, and 42 CFR 456.
Source. #13679,
EMERGENCY RULE, eff 6-28-23; ss by #13807, eff 11-17-23
He-M 504.10 Fraud Detection
and Investigation.
(a) In accordance with 42
CFR 455.14, the department’s program integrity unit shall address complaints of
medicaid fraud, waste, or abuse from any source or the identification of
any questionable practices after analysis of paid claim history by conducting a
preliminary investigation.
(b) Cases where potential
fraud has been detected as a result of a preliminary investigation pursuant to
(a) above, shall be referred for a full investigation to the appropriate
agency, in accordance with 42 CFR 455.15.
(c) A full investigation and resolution shall be
conducted in accordance with 42 CFR 455.16.
(d) The department shall
recoup state and federal medicaid payments as permitted by 42 CFR 455, 42 CFR
447, and 42 CFR 456 for a provider agency’s failure to maintain supporting
records in accordance He-W 520 and He-M 504.
Source. #13679,
EMERGENCY RULE, eff 6-28-23; ss by #13807, eff 11-17-23
He-M 504.11 Provider and Provider Agency Staff
Requirements.
(a)
All providers shall meet the applicable provider training requirements
in He-M 506.
(b)
All provider agency staff, providers, and contractors who have direct
contact with individuals and families shall participate in a person-centered
thinking program and demonstrate competencies by March of 2025 and every 5
years thereafter.
(c)
All provider agency staff, providers, and contractors who have direct
contact with individuals and families shall participate in at least one
person-centered thinking course per year.
(d)
Person-centered trainings and programs for (b)-(c) above shall consist
of nationally recognized models and best practices as identified by the National Center on
Advancing Person-Centered Practices and Systems (NCAPPS) or the National
Alliance for Direct Support Professionals NADSP.
(e)
Providers of the following services shall not be subject to the
requirements in (b)-(c) above:
(1) Assistive technology;
(2) Environmental and vehicle modification
services;
(3) Individual goods and services;
(4) Non-medical transportation;
(5) Personal emergency response services;
(6) Community integration services;
(7) Respite;
(8) Wellness coaching; and
(9) Specialty services for assessments,
consultations, and evaluations.
(f)
Providers who offer services listed in (e) above and any additional
services shall be subject to the requirements of (b)-(c) above.
(g)
Providers who are also family members shall be subject to (b)-(c) at the
discretion of the individual and guardian.
Source. #13679,
EMERGENCY RULE, eff 6-28-23; ss by #13807, eff 11-17-23
He-M 504.12 Suspension and
Revocation of Provider Enrollment.
(a)
If the department finds at any time that an enrolled provider repeatedly
fails to meet their participation, information sharing and billing obligations, or that their continued operations
endanger the health, safety, or welfare of individuals, or the public, the
department shall order the suspension or revocation of the enrolled provider.
(b)
Suspension shall include receiving notice from the department of its
intent to suspend payment of any claims submitted or the provider enrollment ID
for the specific service location associated with the violation or, if the
violation is specific to all sites, the provider enrollment ID’s for that
provider agency.
(c)
Revocation shall include receiving notice from the department of its
intent to revoke the provider enrollment ID for the specific service location
associated with the violation or, if the violation is specific to all sites,
the provider enrollment ID’s for that provider agency.
(d)
When a claim or provider enrollment suspension is issued, pursuant to
(b) above, a plan of correction shall be issued by the department which shall
outline the conditions necessary for reinstatement including if the provider
agency shall be permitted to continue to provide services during a claim
suspension period.
(e)
If the provider agency is permitted to continue providing services
during the suspension period, the processing and payment of claims shall be
suspended until the provider has met the requirements of the corrective action
plan.
(f)
If a provider agency is not permitted to continue providing services
during the suspension period, the department shall deny claims for payment or
other reimbursement requests for dates of service during the suspension period.
(g)
Provider agencies shall remain under suspension until specified
conditions for reinstatement as outlined in a corrective action plan issued
pursuant to (d) above, are met and approved by the department.
(h)
If the provider agency does not meet the conditions for reinstatement,
as outlined in a corrective action plan, a recommendation shall be made for
enrollment termination to the department’s program integrity unit.
(i)
A provider agency may request an appeal, in accordance with He-C 200,
regarding a proposed suspension or revocation of enrollment within 30 business
days of the decision.
(j) The provider’s enrollment status shall be
suspended until the appeal determination is adjudicated.
(k) The revocation shall not become final until
the period for requesting an appeal has expired, or, if the provider agency
requests an appeal, until such time as the administrative appeals unit issues a
decision upholding the department’s decision.
(l)
If the department’s decision is not upheld, the denial would be
ineffective, and the provider shall continue to provide services.
(m)
Appeals shall be submitted in writing, to the bureau administrator in
care of the department’s office of client and legal services.
Source. #13679,
EMERGENCY RULE, eff 6-28-23; ss by #13807, eff 11-17-23
He-M 504.13 Discontinuation of Services by Provider or
Provider Agency.
(a)
A provider agency that is not delivering services in conjunction with a
residency agreement, in accordance with He-M 310.10(c), shall immediately
provide the individual, guardian, and service coordinator, with a written
90-day notice that clearly describes the basis for the provider agency’s
decision to discontinue service provision and all reasonable efforts made by
the provider agency to work with the participant and guardian to maintain such
service provision.
(b) When written notice is issued in accordance
with (a), services shall not end before the 90-day notice period except by
mutual agreement of the individual, guardian, and provider agency.
(c) A provider agency that is delivering services in
conjunction with a residency agreement, in accordance with He-M 310.10(c),
shall follow the procedures for notification outlined in He-M 310.
(d) If a notice to discontinue services is issued in accordance with (a)
above, the following actions shall occur:
(1) The provider agency shall transfer a copy of
the individual’s full service file to their service coordination agency within
2 business days;
(2)
The service coordinator shall conduct service planning for any necessary
transitions, in accordance with He-M 503, He-M 522, or He-M 524 within 5
business days; and
(3)
The provider and provider agency shall participate in service planning
and provision based on developments resulting from (2) above during the notice
period outlined in (a) above or the transition period to a new provider agency.
(e)
If a notice is issued in accordance with (b) above, the following shall
occur:
(1) The provider agency shall transfer a copy of
the individual’s full service file to their service coordination agency within
2 business days;
(2) The service coordinator shall conduct service
planning for any necessary transitions in accordance with He-M 310.10; and
(3) The provider agency shall provide the service
coordinator with alternative residential options, if applicable, or demonstrate
a good faith effort to provide this information.
(f) An individual or guardian may request an
appeal of a notice provided in accordance with (a) above, unless the reason for
discontinuation of services is due to the provider agency’s cessation of
services.
(g) Appeals shall be filed, in writing, to the
bureau administrator in care of the department’s office of client and legal
services within 30 days following the date of notification of service
discontinuation, in accordance with (a) above and He-C 200.
(h) If an
appeal is requested, the following actions shall occur:
(1)
Services and payments shall be continued as a consequence of an appeal for a
hearing until a decision has been made; and
(2) If
the provider agency’s decision is upheld, services shall cease 60 days from the
date of the denial letter or 30 days from the hearing decision, whichever is
later.
Source. #13679,
EMERGENCY RULE, eff 6-28-23; ss by #13807, eff 11-17-23
He-M 504.14 Waivers.
(a)
A provider applicant, area agency, provider agency, individual,
guardian, or provider may request a waiver of specific procedures outlined in
He-M 504 by completing and submitting the form titled “NH Bureau of Developmental
Services Waiver Request” (October 2023 edition) in accordance with (b) and (c)
below.
(b)
A completed waiver request form shall be signed by the provider agency’s
executive director or designee recommending approval of the waiver.
(c)
A waiver request shall be submitted to the department via:
(1) Email at bds@dhhs.nh.gov;
or
(2) By mail to:
Bureau of
Developmental Services
Hugh J. Gallen
State Office Park
105 Pleasant
Street, Main Building
Concord, NH 03301
(d)
No provision of procedure prescribed by statue shall be waived.
(e)
The request for a waiver shall be granted by the commissioner or
designee within 30 days if the alternative proposed by the requesting entity
meets the objective or intent of the rule and it:
(1) Does not negatively impact the health or
safety of the individual(s); and
(2) Does not affect the quality of services to
individuals.
(f)
Upon receipt of approval of a waiver request, the requesting entity’s
subsequent compliance with the alternative provisions or procedures approved in
the waiver shall be considered compliance with the rule for which waiver was
sought.
(g)
Waivers shall be granted in writing for the minimum period necessary to
accommodate the waiver request, with a specific duration not to exceed 5 years
except as in (h)-(i) below.
(h)
Any waiver shall end with the closure, termination, revocation, or
suspension of the related program or service.
(i)
A requesting entity may request a renewal of a waiver from the
bureau. Such request shall be made at
least 30 days prior to the expiration of a current waiver.
Source. #13679,
EMERGENCY RULE, eff 6-28-23; ss by #13807, eff 11-17-23; (see also Revision
Note at part heading for He-M 504)
PART
He-M 505 ESTABLISHMENT AND OPERATION OF
AREA AGENCIES
Statutory Authority:
RSA 171-A:3; 171-A:18, I, IV
He-M
505.01 Purpose. The purpose of these rules is to define the
procedures and criteria for the establishment, designation, and redesignation
of area agencies, and to define their role and responsibilities.
Source. #1647, eff 10-14-80; ss by #2020, eff
5-11-82; ss by #2678, eff 4-18-84; ss by #4667, eff 8-25-89; ss by #4729, eff
1-15-90, EXPIRED: 1-15-96
New. #6871, eff 10-21-98; ss by #8728, INTERIM, eff
10-21-06, EXPIRED: 4-19-07
New. #8928, eff 6-30-07; ss by #10916, eff 8-26-15;
ss by #13842, eff 12-29-23
(a)
“Acquired brain disorder” means a disruption in brain functioning that:
(1) Is not congenital or caused by birth trauma;
(2) Presents a severe and life-long disabling
condition which significantly impairs a person’s ability to function in
society;
(3) Occurs prior to age 60;
(4) Is attributable to one or more of the
following reasons:
a. External trauma to the brain as a result of:
1. A motor vehicle incident;
2. A fall;
3. An assault; or
4. Another related traumatic incident or
occurrence;
b. Anoxic or hypoxic injury to the brain such as
from:
1. Cardiopulmonary arrest;
2. Carbon monoxide poisoning;
3. Airway obstruction;
4. Hemorrhage; or
5. Near drowning;
c. Infectious diseases such as encephalitis and
meningitis;
d. Brain tumor;
e. Intracranial surgery;
f. Cerebrovascular disruption such as a stroke;
g. Toxic exposure; or
h. Other neurological disorders such as
Huntington’s disease or multiple sclerosis which predominantly affect the
central nervous system; and
(5) Is manifested by one or more of the
following:
a. Significant decline in cognitive functioning
and ability; or
b. Deterioration in:
1. Personality;
2. Impulse control;
3. Judgment;
4. Modulation of mood; or
5. Awareness of deficits;
(b)
“Applicant group” means a group of area citizens that has submitted the
required materials to the bureau for consideration for designation as an area
agency;
(c)
“Area” means “area” as defined in RSA 171-A:2, I-a, namely “a geographic
region established by rules adopted by the commissioner for the purpose of
providing services to developmentally disabled persons.”;
(d)
“Area agency” means “area agency” as defined in RSA 171-A:2, I-b;
(e)
“Area board” means “area board” as defined in RSA 171-A:2, I-c, namely
“the governing body or board of directors of an area agency.”;
(f)
“Area plan” means a document prepared by the area agency that outlines
that agency’s goals, objectives, and activities pursuant to He-M 505.04(p) and
RSA 171-A:18;
(g)
“Bureau” means the bureau of developmental services of the department of
health and human services;
(h)
"Bureau administrator" means the chief administrator of the
bureau of developmental services;
(i)
“Commissioner” means the commissioner of the department of health and
human services, or their designee;
(j)
“Conditional redesignation” means a written ruling by the commissioner
pursuant to He-M 505.10 that an area agency has partially complied with the
redesignation criteria listed in He-M 505.09 and that continued designation is
contingent upon fulfilling the requirements established by He-M 505;
(k)
“Critical incident” means an alleged, suspected, or actual occurrence
of:
(1) Abuse, including physical, sexual, verbal,
and psychological abuse;
(2) Neglect;
(3) Exploitation;
(4) Serious injury;
(5) Death other than by natural causes; and
(6) Other events that threaten the health or
safety of an individual such as hospitalizations, administration of the wrong
medication, failure to administer medication, or use of restraints or
behavioral interventions that are not included in an approved behavior change
program;
(l)
“Designation” means a written ruling by the commissioner that an
applicant group has been determined to be in compliance with the eligibility
requirements set forth in He-M 505.06 and has been approved as the area agency
for the area;
(m)
“Developmental disability” means “developmental disability” as defined
in RSA 171-A:2, V, namely, “a disability:
(a) Which is attributable to an intellectual
disability, cerebral palsy, epilepsy, autism, or a specific learning
disability, or any other condition of an individual found to be closely related
to intellectual disability as it refers to general intellectual functioning or
impairment in adaptive behavior or requires treatment similar to that required
for persons with an intellectual disability; and
(b) Which originates before such individual
attains age 22, has continued or can be expected to continue indefinitely, and
constitutes a severe disability to such individual's ability to function
normally in society.”;
(n)
“Financial management services” means fiscal intermediary services
available to individuals who elect to direct and manage their services,
pursuant to He-M 524 and He-M 525;
(o)
“Generic services” means services available to the general population
that are not specifically designed for individuals;
(p)
“Governance review” means an announced review to monitor annual
compliance of area agency operations including, but not limited to, services,
programs, functions, and finances, whether operated directly by the area agency
or through contracts with persons or organizations;
(q)
“Guardian” means a person appointed pursuant to RSA 463 or RSA 464-A or
the parent of an individual under the age of 18 whose parental rights have not
been terminated or limited by law;
(r)
“Individual” means a person who has a developmental disability or
acquired brain disorder;
(s) “Integrated activity” means
personal interaction between persons with and without developmental
disabilities or acquired brain disorders that occurs within community settings;
(t)
“Integrated setting” means a setting where the majority of persons are
without developmental disabilities and the primary activity is neither
bureau-funded nor designed primarily for individuals;
(u)
“Interim designation” means a written ruling by the commissioner
pursuant to He-M 505.06 (e)(8) that an applicant group or other organization
has been approved as the interim area agency until a final designation is made
by the commissioner;
(v)
“Mission” means the stated goals of the service system as established by
the bureau or area agencies;
(w) “Problematic sexual behavior” means
non-consensual touching or attempting to touch another person’s body in a
sexualized manner, unsolicited sexualized statements, public exposure, and
illegal sexual conduct whether in person or online;
(x) “Provider” means a person receiving any form
of remuneration for the provision of services to an individual;
(y) “Provider agency” means an agency or an
independent provider that is established to provide services to individuals;
(z)
“Region” means, when followed by a Roman numeral, the area agency in the
area corresponding to the identified numeral;
(aa)
“Registry” means the list maintained in the department’s electronic
database which itemizes identified service needs for individuals in the
following 5 years;
(ab)
“Sentinel event” means an unexpected occurrence involving death or
serious physical or psychological injury, or risk thereof. Serious injury
specifically includes loss of limb or function. Categories of reportable
sentinel events are individual-centered events, in which the individual is
either a victim or perpetrator, including, but are not limited to:
(1) Any sudden, unanticipated, or accidental
death, not including homicide or suicide, and not related to the natural course
of an individual’s illness or underlying condition;
(2) Permanent loss of function, not related to
the natural course of an individual’s illness or underlying condition,
resulting from such causes including but not limited to:
a. A medication error;
b. An unauthorized departure or abduction from a
facility providing care; or
c. A delay or failure to provide requested or
medically necessary services due to waitlists, availability, insurance
coverage, or resource limits;
(3) Homicide;
(4) Suicide;
(5) Suicide attempt, such as self-injurious
behavior with a non-fatal outcome, with explicit or implicit evidence that the
person intended to die and medical intervention was needed;
(6) Rape or any other sexual assault;
(7) Serious physical injury;
(8) Serious psychological injury that jeopardizes
the person’s health that is associated with the planning and delivery of care;
(9) Injuries due to physical or mechanical
restraints; and
(10) High profile or high risk event, such as:
a. Media coverage; and
b. Police involvement leading to an arrest;
(ac)
“Service coordination agency” means a provider agency providing service
coordination services to individuals that meets the criteria in He-M 504; and
(ad) “Service
coordinator” means a provider who meets the criteria in He-M 503 or He-M 522
and is chosen by an individual and their guardian or representative to
organize, facilitate, and document service planning and to negotiate and
monitor the provision of the individual’s services.
Source. #1647, eff 10-14-80; ss by #2020, eff
5-11-82; ss by #2678, eff 4-18-84; ss by #4667, eff 8-25-89; ss by #4729, eff
1-15-90, EXPIRED: 1-15-96
New. #6871, eff 10-21-98; ss by #8728, INTERIM,
eff
10-21-06, EXPIRED: 4-19-07
New. #8928, eff 6-30-07; ss by #10916, eff 8-26-15;
ss by #13842, eff 12-29-23
He-M 505.03 Role and
Responsibilities of the Area Agency.
(a) The primary responsibility of an area agency, designated in
accordance with He-M 505, shall be to plan, establish, or maintain
comprehensive service access and delivery for all individuals who are residing
in the area, in accordance with RSA 171-A and the rules promulgated thereunder,
by:
(1) Maintaining a current
contract with the department to serve as an area agency;
(2) Managing and providing
family support services in accordance with He-M 519;
(3) Managing and providing
family centered early supports and services in accordance with He-M 510;
(4) Providing or supporting the
arrangement of financial management services for individuals who choose to
direct and manage their waiver services;
(5) Managing and completing
intake and eligibility activities for individuals in order to determine access
to the developmental services system in accordance with He-M 503 and He-M 522
and to facilitate and assist individuals in applying for and maintaining
Medicaid benefits;
(6) Developing and managing
initial service planning and access to supports for individuals found to be
eligible for services pursuant He-M 503, He-M 522, or He-M 524;
(7) Providing oversight and
management of the provider network by:
a. Coordinating and monitoring
the provider network to support the needs of the catchment region as outlined
in the agency’s area plan, developed pursuant to He-M 505.04 (p);
b. Communicating relevant
service delivery system updates to provider agencies and provide training as
needed;
c. Monitoring current service
capacity using data from the bureau to identify risk and solutions;
d. Reporting to the bureau
quarterly, the results from monitoring in c. above and follow up on actions
taken pursuant to f. below, to support provider network management;
e. Promoting the establishment
of new provider agencies to increase service capacity as determined by the
bureau based on the data provided in d. above; and
f. Providing follow-up to the
bureau on actions taken in accordance with e. above;
(8) Providing information,
education, and referrals to the service delivery system, as defined in RSA
171-A:2, XVI, by:
a. Providing objective
information and assistance that empowers people to make informed decisions
about their services and supports; and
b. Networking and partnering
with community organizations with the goal of supporting inclusive community
life, leveraging natural resources, services, and supports, and in improving
the community’s understanding of the service delivery system;
(9) Managing registry
documentation by:
a. Assisting individuals in the
determination of and documentation of need for services to be provided,
pursuant to He-M 503, within 5 years from the date of initial eligibility; and
b. Reviewing and updating the
registry as early as practicable anytime a need for services in the next 5
years is identified;
(10) Submitting level of care
submissions to the bureau in accordance with He-M 517 and He-M 524 for initial
level of care determinations as well as level of care determinations for
transfers between home and community based services waivers;
(11) Initiating waiver services
in accordance with He-M 503, He-M 522, and He-M 524 including:
a. Facilitating the scheduling
of an individual’s initial supports intensity scale assessment for individuals
who do not have a service coordinator;
b. Providing resources to an
individual regarding service coordination agencies so the individual can select
a service coordination provider; and
c. Following bureau approval of
level of care in accordance with He-M 503.05, submission of the individual’s
selection in accordance with b. above to NH Easy for provider review and
acceptance;
(12) Maintaining and updating records in the electronic database NH
Easy at https://nheasy.nh.gov/#/
;
(13) Completing service utilization and quality oversight by:
a. Managing service agreement
development through monthly monitoring of annual service agreement renewals;
b. Reviewing service agreements
quarterly and communicating any identified needs to applicable service provider
agencies;
c. Managing and overseeing
submission of out-of-state service provision requests to the bureau;
d. Monitoring provision of
services as prescribed in the service agreement by:
1. Completing annual service
and post-payment audits using a tool provided by the bureau within 60 days of
request by the bureau; and
2. Providing results of the
audits completed in accordance with (1) above to include raw data, aggregated
data, and analysis of findings;
e. Assessing annual
satisfaction with quality of services, and reviewing and continuously improving
quality of services by:
1. Soliciting feedback from individuals and families within the
agency’s geographic region; and
2. Providing results of the
feedback received in accordance with (1) above to include raw data, aggregated
data, and analysis of findings;
f. Completing inquiry and
review at the request of the bureau related to service concerns, complaints, or
grievances;
g. Ensuring training and
education dissemination related to identified trends of sentinel events,
restraint and seclusion, and mortality. Area agencies shall ensure that at
least one training per state fiscal year quarter is offered and provided to
those who register;
h. Collaborating with the
community mental health center that serves the region to support coordinated service planning and delivery for
individuals accessing or wishing to access services from both service systems;
and
i. Collaborating with the
regional public health network that serves the region to support emergency planning processes in order to
develop and execute response and recovery plans;
(14) Increasing access to employment by:
a. Acting on employment trends,
as identified by the bureau; and
b. Participating in the
employment leadership committee pursuant to He-M 518;
(15) Providing critical
incident management by:
a. Collecting restraint and
seclusion data and providing such data to the bureau quarterly with analysis of
findings on a tool approved by the bureau;
b. Finalizing mortality
notifications and reviews received from provider agencies and submitting these
reviews to the bureau;
c. Finalizing sentinel event
reports and submitting these reports to the bureau;
d. Reviewing reports of
incidents to determine if a sentinel event report is needed;
e. Monitoring follow-up related to findings from formal complaint
investigations conducted pursuant to He-M 202;
f. Providing coordination,
logistical support, and subject matter expertise to service coordinators
regarding crisis mitigation situations;
g. Providing crisis data to the
bureau quarterly with analysis of any observed findings on a tool approved by
the bureau;
h. Ensuring area agency availability 24/7 in order to provide critical
incident coordination, logistical support, and subject matter expertise;
i. Completing expedited intake and eligibility supports to individuals
who are experiencing a critical incident but have not sought eligibility for
services through the developmental services system; and
j. Facilitating strategy
development and coordination meetings in collaboration with the bureau;
(16) Monitoring, maintaining, safeguarding, and promoting human rights
by:
a. Maintaining and facilitating
a human rights committee, whose duties pursuant to RSA 171-A:17 for all
individuals working with the committee, shall be;
1. Monitoring and approving all
positive behavior change programs created pursuant to He-M 310.11;
2. Ensuring emergency physical
restraint shall only be approved for safely responding to situations in which
the individual presents with an imminent credible risk of significant harm to
self or others by staff who are trained and certified in recognized
intervention modalities;
3. Evaluating the treatment and
habilitation provided to individuals;
4. Regularly monitoring the
implementation of individual service agreements;
5. Monitoring the use of
restrictive or intrusive interventions designed to address challenging behavior
pursuant to He-M 310.11; and
6. Promoting advocacy programs
on behalf of individuals;
b. Offering and providing to
those who register, 2 trainings per year on advocacy and individual rights;
c. Maintaining and distributing
a list of current advocacy groups within the catchment area; and
d. Completing informal
investigations pursuant to He-M 202.05;
(17) Managing catchment region risk by:
a. Coordinating and
facilitating a local risk management committee whose duties shall be:
1. Reviewing and analyzing
referrals from service coordinators related to violent aggression, problematic
sexual behavior, or fire-setting behaviors;
2. Making assessment or evaluation referral recommendations to service
coordinators for individuals exhibiting behaviors including but not limited to
violent aggression, problematic sexual behaviors, or fire-setting behaviors;
3. Reviewing assessment and
evaluation results completed for individuals for whom a referral was submitted
in accordance with 2. above to determine whether a need is identified for a
plan to manage risk;
4. Providing consultation to
service coordinators in identifying providers to create plans to manage risk
who have expertise in the areas identified in 1. above;
5. Reviewing plans to manage
risk created when a recommendation for such a plan was made pursuant to 4 above
to ensure it appropriately applies assessment or evaluation recommendations
received pursuant to 3. above;
6. Participating in committees and other groups related to risk
management including, but not limited to, statewide risk management committees,
and communities of practice to determine application of assessment or
evaluation recommendations received pursuant to 2. above;
7. Reviewing documentation from
service coordinators and provider agencies on an ongoing basis to determine the
impact of such data relative to management of risk for an individual and
related plans;
8. Ensuring that plans to
manage risk created when a recommendation for such a plan was made pursuant to
4 above are reviewed regularly with individuals and their treatment team to
consider ongoing appropriateness and, in the event that potential changes are
indicated, seeking additional consultation with providers qualified to conduct
and author assessments, whether they created the initial plans or are new, to
discuss opportunities for modification of restrictions by sharing data
regarding the individual’s progress in treatment. Such considerations shall be
made through reassessment or through a consultative review of other
documentation and updated data related to the individual’s progress;
9. Offering recommendations to
the area agency for training for the service system;
10. Offering recommendations,
as applicable, to service coordinators for individual-specific training needs;
11. Conducting training related
to risk management activities, as requested by the area agency;
12. Ensuring that provider
agencies and providers are trained in risk management plans;
13. Ensuring that relevant area
agency personnel, provider agencies, and providers receive recommendations for
clinically specialized trainings, based on assessed needs of the individuals
supported, that enable these personnel to successfully complete risk management
activities; and
14. Ensuring monthly
representation in the statewide risk management committees; and
b. Collaborate with all area
agencies to co-facilitate and convene a statewide risk management committee;
(18) Managing Health Risk Screening Tool (HRST) IntellectAbility
accounts and data at https://nhbds.hrstapp.com/ by:
a. Providing administrative
support for HRST account management; and
b. Completing a clinical review
for individuals with a score greater than or equal to 3;
(19) Managing New Hampshire
Easy (NH Easy) accounts and data by:
a. Ensuring that appropriate
staff receive and maintain access to NH Easy in order to carry out duties;
b. Ensuring that the area
agency’s NH Easy account remains in good standing; and
c. Notifying NH Easy support of
any noted system issues;
(20) Completing the request for
the funding of a public guardian if the individual does not have a service
coordinator;
(21) Participating in
medication administration planning by:
a. Attending the state
medication committee meeting as defined in He-M 1201.11;
b. Reviewing the 6-month
medication error reports described in He-M 1201.11(c)-(e); and
c. Offering and providing to
those who register, training to provider agencies and providers about
medication administration trends as determined by the state medication
committee and confirmed by the bureau;
(22) Completing information
gathering via survey by:
a. Disseminating and
coordinating the annual national core indicator satisfaction surveys;
b. Reviewing survey results to
identify areas of quality improvement; and
c. In partnership with the
bureau, distributing and reviewing survey results to ensure continuous quality
improvement of the service delivery system;
(23) Maintaining records
pursuant to He-M 503, He-M 510, He-M 517, He-M 519, and He-M 522, as
applicable; and
(24) Managing transitions
between regions.
(b) Failure of a
provider agency to comply with the requirements in He-M 504 with respect to
providing an area agency with necessary information or participating in
activities in order for an area agency to carry out its responsibilities in (a)
above shall not be considered noncompliance by an area agency.
(c) In instances of
a provider agency failure as reflected in (b) above, the area agency shall
notify the bureau within 15 days.
(d) For items
(a)(4)–(24), Medicaid administrative reimbursement may be claimed by the
designated and contracted area agency for activities completed each month on
behalf of individuals in the area who are eligible for or seeking eligibility
for Medicaid.
(e) Pursuant to RSA
171-A:18, I, the area agency shall be the primary recipient of these funds
provided by the bureau for use in establishing, operating, and administering
supports and services and coordinating these with existing generic services on
behalf of individuals in the area. The area agency may receive funds
from sources other than the bureau to assist it in carrying out its
responsibilities.
(f) In order to collect
Medicaid administrative reimbursement, pursuant to (d) above, the area agency
shall:
(1) Ensure that records are
maintained to support that the services in (a)(4)-(24) above were provided in
the manner that was claimed;
(2) Ensure that records
pursuant to (1) above are made available to the bureau or any state or federal
auditing entity; and
(3) Provide information
regarding services, supports, and costs, as requested by the department not
less than every 5 years.
(g) When possible, the area agency shall utilize
community based, integrated services, rather than establish separate services
for people with developmental disabilities or acquired brain disorders.
Source. #1647, eff 10-14-80; ss by #2020, eff
5-11-82; ss by #2678, eff 4-18-84; ss by #4667, eff 8-25-89; ss by #4729, eff
1-15-90, EXPIRED: 1-15-96
New. #6871, eff 10-21-98; amd by #8443, eff 1-1-06;
amd by #8728, INTERIM, eff 10-21-06, EXPIRED: 4-19-07
New. #8928, eff 6-30-07; ss by #10916, eff 8-26-15;
ss by #13842, eff 12-29-23
He-M 505.04 Governance and
Composition of the Area Agency Board.
(a) Each area agency board shall establish
policies and procedures for the governance and administration of the area
agency and those policies and procedures shall:
(1) Be developed to ensure
efficient and effective operation of the local service delivery system;
(2) Be developed to adhere to
the requirements of state and federal funding sources, the area plans, and the
rules and contracts established by the department; and
(3) Be developed to ensure that
the area agency avoids any conflict of interest and any appearance of conflict
of interest in its business relationships.
(b) The department shall assist area agencies in
the establishment and provision of services through contract establishment,
contract monitoring, consultation, technical assistance, guidance regarding
service reviews, staff and board training, coordination with other service
systems, and other means.
(c) The area agency shall be incorporated and
have an established plan for governance in accordance with He-M 505.04 (d)-(p)
below.
(d) The area agency board shall have
responsibility for the entire management and control of the property and
affairs of the corporation and have the powers usually vested in the board of
directors of a not-for-profit corporation, except as regulated herein. This shall be stated in a set of bylaws
maintained and updated by the area board.
(e) The area board shall include in its articles
of incorporation and its bylaws a statement that, in the event of dissolution
of the area agency or in the event that the agency is no longer designated as
an area agency, disposal of all debts and obligations shall be provided for.
(f) Each area agency board shall include in its
bylaws:
(1) A provision requiring rotation of area board membership so that
1/4 of the members’ terms expire each year.
Said rotation shall not result in all terms of individuals, guardians,
or family members expiring in the same year;
(2) A provision that the maximum consecutive period during which a
board member may serve as an officer of the board shall not exceed 6 years; and
(3) A procedure by which
inactive members are removed from the area board.
(g) The size and composition of the area agency
board shall be as follows:
(1) In all cases, the board of
directors shall be composed of an uneven number of persons;
(2) The number of persons
serving as members shall be no fewer than 9 and no more than 25;
(3) Individuals, guardians, and
family members shall comprise at least 1/3 of the membership of the area agency
board;
(4) Members shall be
representative of the agency’s individuals supported, their family members, and
the entire area; and
(5) Membership shall be open to
persons who reside in the area except for those excluded as follows:
a. Persons or the spouses of
persons who are under financial contract with the area agency or any
organization that is a subsidiary or affiliate of the area agency shall not be
eligible for membership on the area board;
b. Employees or the spouses of
employees of agencies that are under financial contract with the area agency
shall not be eligible for membership on the area board;
c. Employees or the spouses of
employees of the area agency shall not be eligible for membership on the area
board;
d. Employees of the New
Hampshire department of health and human services or their spouses shall not be
eligible for membership on the area board; and
e. Volunteer board members or
the spouses of volunteer board members of agencies or programs under contract
with the area agency shall be eligible for membership on the area board but
shall comprise no more than 1/3 of the board.
(h) All area agency board
members shall participate in at least one nationally recognized person-centered
thinking training when they begin their first term of board membership and
every 5 years thereafter.
(i) The area board shall fill vacancies by
soliciting interested persons to submit applications to the area board. Such
solicitation shall be by conducting public meetings, placing public
announcements in local media, and by any other means.
(j) Pursuant to RSA 171-A:18, III, the area board
shall appoint an executive director of the area agency. The executive director shall serve at the
pleasure of the area board and as a full-time employee of the agency.
(k) The executive director shall be selected,
employed, and supervised by the area board in accordance with a published job
description and a competitive application procedure pursuant to the area
agency’s personnel policies.
(l) The executive director shall have the
following experience qualifications, at a minimum:
(1) Five years of
administrative experience in human services; and
(2) Four years of experience in
developmental services programs, which may be done all or in part in the above
administrative capacity.
(m) The executive director shall demonstrate
extensive knowledge of all aspects of the fields of developmental disabilities
and acquired brain disorders, including knowledge of:
(1) Administration;
(2) Planning;
(3) Community networking;
(4) Business management; and
(5) Financial and social
resources.
(n) The executive director’s performance shall be
evaluated annually by the area board to ensure that services are provided in
accordance with the agency mission, area plan, contract provisions, and mission
as well as federal and state laws and rules.
(o) Pursuant to RSA 171-A:18, V, the area agency
board shall prepare and submit to the department an area plan for the provision
of programs and services to individuals in the area for a 5-year period that
coincides with the redesignation cycle identified in Table 505-2.
(p) The area plan shall:
(1) Clearly identify the extent
to which the area agency has involved its individuals and families, the area
family support council established pursuant to RSA 126-G:4, the general public
residing in the area, and generic service agencies in the planning and
provision of services for individuals;
(2) Demonstrate that services
and supports for which the agency is responsible, as outlined in He-M
505.03(a), are intended to establish and maintain a comprehensive service
delivery system that is:
a. Based on the nature and
extent of the service needs of individuals and their care-giving families;
b. Consistent with RSA 171-A
and the agency’s and bureau’s mission statements and priorities;
c. Responsive to the priorities
of the individuals and families in the area agency’s catchment region; and
d. Free from conflict in
accordance with 42 CFR 441.301;
(3) Be submitted to the bureau
administrator for approval pursuant to (q) below; and
(4) Be reviewed by the area
board every 2 years and may be amended by the area board at any time, with such
amendments submitted to the bureau administrator for approval if:
a. The area board proposes to
change, discontinue, or expand services to individuals and their care-giving
families; or
b. Amendment is necessary to
reflect changes in area-wide individual and family needs, legislation, or area
demographics, vendors, or funding.
(q) The bureau administrator, commissioner, or
the commissioner’s designee shall review area plans and amendments to area
plans submitted for approval pursuant to (p)(3) and (4) above and approve those
plans or amendments that are determined to comply with the agency mission and
department rules and other applicable state and federal laws, regulations, and
rules.
(r) The area agency shall utilize all applicable
federal, third party, and other public and private sources of funds to carry
out its mission and responsibilities.
(s) The area agency shall not enter any merger,
sale, affiliation, or other substantial change in its corporate identity
without the prior approval of the bureau administrator, with notice being
provided to the bureau no less than 6 months before the change.
(t) The bureau administrator shall review any proposed merger, sale,
affiliation, or other substantial change in the corporate identity of an area
agency.
(u) The bureau administrator shall assess the potential impact on the
developmental services system stability and approve such proposed changes if
they determine that the developmental services system stability can be
maintained adequately by the resulting organization’s compliance with
department rules and other applicable state and federal laws, regulations, and
rules, and that such changes are in the best interest of individuals residing
in the area.
(v) The services, programs, and functions for
which the area agency is responsible to oversee may be provided directly by the
area agency or the area agency may, pursuant to RSA 171-A:18, II, enter into
agreements with persons and organizations for the provision of designated
services. The area agency shall not
delegate its financial management responsibility to any person or organization.
(w) An area agency planning to enter into
agreements pursuant to He-M 505.04 (v) shall:
(1) Obtain written permission from the commissioner pursuant to RSA
171-A:18; and
(2) Include in said notice a
description of services to be provided, payment schedules, and reporting
requirements, and assurances that the participants in the agreements agree to
comply with all pertinent state and federal requirements.
(x) The area agency shall be responsible and
accountable for all area agency services, programs, and functions whether
administered directly by the area agency or provided under contracts with
persons or organizations.
(y) Monitoring and evaluation of all area agency services, whether
administered directly or by contract, shall be conducted by the area agency
with its findings and any remedial action taken reported to the area agency
board.
(z) Area agency services, programs, and functions
shall be operated in compliance with applicable state and federal laws and
rules and contract requirements established by the department and comply with
the goals and priorities of the approved area plan.
(aa) The department shall conduct annual
governance reviews, announced or unannounced reviews of area agencies, and
audit area agencies at least every 5 years, including all or part of any
services, programs, functions, finances, operations, or contract requirements
of the area agency, whether operated directly by the area agency or through
contracts with persons or organizations.
(ab) The results of the review conducted in
accordance with He-M 505.04(aa) above, and any resulting trends in performance,
shall be considered during the redesignation process.
Source. #1647, eff 10-14-80; ss by #2020, eff
5-11-82; ss by #2678, eff 4-18-84; ss by #4667, eff 8-25-89; ss by #4729, eff
1-15-90, EXPIRED: 1-15-96
New. #6871, eff 10-21-98; ss by #8443, eff 1-1-06;
ss by #8928, eff 6-30-07; ss by #10916, eff 8-26-15; ss by #13842, eff 12-29-23
He-M 505.05 Designation of
Area Boundaries. Areas designated
for the purpose of providing services to individuals shall be the developmental
services areas specified in table 505-1, which sets forth the numerical
designation of the areas and lists towns by area:
Table 505-1, INCORPORATED TOWNS AND CITIES BY AREA
Area I
|
Albany |
Easton |
Lisbon |
Stark |
|
Bartlett |
Eaton |
Littleton |
Stewartstown |
|
Benton |
Effingham |
Lyman |
Stratford |
|
Berlin |
Errol |
Madison |
Sugar Hill |
|
Bethlehem |
Franconia |
Milan |
Tamworth |
|
Brookfield |
Freedom |
Monroe |
Tuftonboro |
|
Carroll |
Gorham |
Moultonborough |
Wakefield |
|
Chatham |
Hart's Location |
Northumberland |
Warren |
|
Clarksville |
Haverhill |
Ossipee |
Waterville Valley |
|
Colebrook |
Jackson |
Piermont |
Whitefield |
|
Columbia |
Jefferson |
Pittsburg |
Wolfeboro |
|
Conway |
Lancaster |
Randolph |
Woodstock |
|
Dalton |
Landaff |
Sandwich |
|
|
Dummer |
Lincoln |
Shelburne |
|
Area II
|
Acworth |
Dorchester |
Langdon |
Orford |
|
Canaan |
Enfield |
Lebanon |
Plainfield |
|
Charlestown |
Goshen |
Lempster |
Springfield |
|
Claremont |
Grafton |
Lyme |
Sunapee |
|
Cornish |
Grantham |
Newport |
Unity |
|
Croydon |
Hanover |
Orange |
Washington |
Area III
|
Alexandria |
Bristol |
Groton |
Plymouth |
|
Alton |
Campton |
Hebron |
Rumney |
|
Ashland |
Center Harbor |
Holderness |
Sanbornton |
|
Barnstead |
Ellsworth |
Laconia |
Thornton |
|
Belmont |
Gilford |
Meredith |
Tilton |
|
Bridgewater |
Gilmanton |
New Hampton |
Wentworth |
Area IV
|
Allenstown |
Danbury |
Hopkinton |
Sutton |
|
Andover |
Deering |
Loudon |
Warner |
|
Boscawen |
Dunbarton |
Newbury |
Weare |
|
Bow |
Epsom |
New London |
Webster |
|
Bradford |
Franklin |
Northfield |
Wilmot |
|
Canterbury |
Henniker |
Pembroke |
Windsor |
|
Chichester |
Hill |
Pittsfield |
|
|
Concord |
Hillsborough |
Salisbury |
|
Area V
|
Alstead |
Greenville |
Nelson |
Surry |
|
Antrim |
Hancock |
New Ipswich |
Swanzey |
|
Bennington |
Harrisville |
Peterborough |
Temple |
|
Chesterfield |
Hinsdale |
Richmond |
Troy |
|
Dublin |
Jaffrey |
Rindge |
Walpole |
|
Fitzwilliam |
Keene |
Roxbury |
Westmoreland |
|
Francestown |
Lyndeborough |
Sharon |
Winchester |
|
Gilsum |
Marlborough |
Stoddard |
|
|
Greenfield |
Marlow |
Sullivan |
|
Area VI
|
Amherst |
Hudson |
Merrimack |
Nashua |
|
Brookline |
Litchfield |
Milford |
Wilton |
|
Hollis |
Mason |
Mont Vernon |
|
Area VII
|
Auburn |
Candia |
Hooksett |
Manchester |
|
Bedford |
Goffstown |
Londonderry |
New Boston |
Area VIII
|
Brentwood |
Greenland |
Newfields |
Portsmouth |
|
Deerfield |
Hampton |
Newington |
Raymond |
|
East Kingston |
Hampton Falls |
Newmarket |
Rye |
|
Epping |
Kensington |
North Hampton |
Seabrook |
|
Exeter |
Kingston |
Northwood |
South Hampton |
|
Fremont |
New Castle |
Nottingham |
Stratham |
Area IX
|
Barrington |
Lee |
New Durham |
Strafford |
|
Dover |
Madbury |
Rochester |
|
|
Durham |
Middleton |
Rollinsford |
|
|
Farmington |
Milton |
Somersworth |
|
Area X
|
Atkinson |
Derry |
Pelham |
Sandown |
|
Chester |
Hampstead |
Plaistow |
Windham |
|
Danville |
Newton |
Salem |
|
Source. #1647, eff 10-14-80; ss by #2020, eff
5-11-82; ss by #2678, eff 4-18-84; ss by #4667, eff 8-25-89; ss by #4729, eff
1-15-90, EXPIRED: 1-15-96
New. #6871, eff 10-21-98; ss by #8443, eff 1-1-06;
ss by #8928, eff 6-30-07; ss by #10916, eff 8-26-15; ss by #13842, eff 12-29-23
He-M 505.06 Area Agency
Designation Procedures and Criteria.
(a) The bureau shall initiate the area agency
designation process by publishing a notice in a newspaper or newspapers of
area-wide distribution to convey information about:
(1) The role and
responsibilities of the area agency;
(2) Membership on the area
board; and
(3) The area agency application
and designation process, including the closing date for submission of
application materials required by (c) below.
(b) Existing boards of private, non-profit
agencies, including community mental health programs approved pursuant to RSA
135-C:10, may apply for designation as an area agency provided that the
requirements under RSA 171-A:18, He-M 505.04(g), and (d) below have been met.
(c) An applicant group shall submit the following
area agency application materials to the bureau:
(1) The name of the applicant
group’s contact person;
(2) Written assurances of
adherence to these rules and applicable federal and state laws and rules;
(3) A personal data summary for
each member of the applicant group, which shall:
a. Contain information
documenting the person's experience and knowledge as required by (d) below; and
b. Demonstrate that the person
is not excluded from board membership pursuant to He-M 505.04(g)(5);
(4) A description of the unmet
service needs of individuals and how the applicant group proposes to meet those
service needs; and
(5) A written proposal which
shall include a line item budget and a description of all services to be
provided.
(d) The members of the applicant group shall
collectively demonstrate, through the submission of personal data summaries as
required in (c)(3) above, experience in development and provision of services
as well as knowledge of the fiscal, legal, and management issues of services
and of the needs and abilities of individuals. The members of the applicant
group shall have a demonstrated commitment to community-based, individual
-directed services and have the capacity to meet the needs of individuals and
families.
(e) The designation process shall be as follows:
(1) The commissioner shall
solicit and consider comments from individuals, their families, and other
stakeholders, such as local human services, educational, or advocacy
organizations, in the area as to the ability of the applicant group(s) to carry
out its responsibilities as stated in He-M 505.03 and He-M 505.04;
(2) The commissioner shall
review the materials submitted by each applicant group as specified in (c)
above and such information as is obtained from comments as provided in (e) (1)
above;
(3) The commissioner shall
select for site review the applicant group(s) that appear to be able to comply
with all applicable state and federal laws and rules;
(4) The applicant group that is
determined to be able to best comply with applicable deferral and state laws
and rules shall receive designation as the area agency within 75 days following
the date of the application deadline by the commissioner;
(5) Designation shall be for a
5-year term, unless revoked or suspended pursuant to He-M 505.07 or He-M 505.08
or unless an agency applies for redesignation in accordance with He-M 505.09;
(6) The commissioner shall
notify each applicant group that does not receive designation of the reason why
the applicant group was not designated;
(7) If there is no applicant
group selected for designation in the area, the commissioner shall notify each
applicant group and request that a second submission of application materials
occur within 30 days following notification by the commissioner;
(8) If no applicant group in
the area receives designation following the second submission of area agency
application materials, the commissioner shall reinitiate the application
procedure for designation of an area agency and either appoint an interim area
agency to operate in the area or designate department staff to temporarily
operate area agency services until a new area agency can be designated; and
(9) An applicant group denied
designation by the commissioner shall have the right to appeal pursuant to He-M
505.12.
(f) An agency that has had its status as an area
agency revoked in accordance with He-M 505.07,
shall not be eligible to apply for designation as a successor area
agency for 5 years following the date of the revocation.
(g) In cases where 2 or more areas are
consolidated as a result of amendment of He-M 505.05, the commissioner shall
select one area agency as the designated area agency for the new consolidated
area using the criteria identified in He-M 505.09 (f)-(g). The area agency selected shall be one of the
area agencies previously designated to serve the areas being consolidated.
Source. #1647, eff 10-14-80; ss by #2020, eff
5-11-82; ss by #2678, eff 4-18-84; ss by #4667, eff 8-25-89; ss by #4729, eff
1-15-90, EXPIRED: 1-15-96
New. #6871, eff 10-21-98; ss by #8728, INTERIM,
eff
10-21-06, EXPIRED: 4-19-07
New. #8928, eff 6-30-07; ss by #10916, eff 8-26-15;
ss by #13842, eff 12-29-23 (formerly He-M 505.05)
He-M
505.07 Revocation of Designation.
(a) The bureau administrator shall monitor:
(1) The contract requirements, services, programs, and functions
provided by the area agency to assure that area agency services are operated in
accordance with the department rules and other applicable statutes, and federal
laws, regulations, and rules, contract provisions, and mission statement, and
the area plan in accordance with 505.04 (o)-(p); and
(2) The fiscal integrity, in accordance with contract requirements, of
the area agencies.
(b) In the event that the bureau administrator determines that the
area agency is not providing such services programs, supports, and functions in
accordance with said laws, rules, contract, plan, mission, or that the area
agency has not maintained fiscal integrity pursuant to contract requirements,
the bureau administrator shall send a written notice to the area agency and
area board specifying the nature of the deficiencies and the remedial action
that is requested.
(c) Notices issued pursuant to
(b) above shall specify when the remedial action shall be completed.
(d) In the event that the commissioner determines
that the area agency has not complied with the remedial action requested
pursuant to (b) above, the commissioner shall revoke the area agency’s
designation.
(e) The commissioner shall issue written notice
of revocation that specifies the reasons for the decision and its effective
date. The effective date of the decision shall be at least 90 days from the
date of said revocation notice.
(f) An area agency may request a revocation
hearing in accordance with He-M 505.12.
(g) In the event that the decision to revoke
designation is upheld following a revocation hearing, the commissioner shall
initiate the process to select a successor area agency according to He-M
505.06.
Source. #1647, eff 10-14-80; ss by #2020, eff
5-11-82; ss by #2678, eff 4-18-84; ss by #4667, eff 8-25-89; ss by #4729, eff
1-15-90, EXPIRED: 1-15-96
New. #6871, eff 10-21-98; ss by #8728, INTERIM,
eff
10-21-06, EXPIRED: 4-19-07
New. #8928, eff 6-30-07; ss by #10916, eff 8-26-15;
ss by #13842, eff 12-29-23 (formerly He-M 505.06)
He-M 505.08 Suspension.
(a) If the commissioner finds at any time that
the health, safety, or welfare of individuals or the public is endangered by
the continued operation of services by an area agency, the commissioner shall
order the immediate suspension of the area agency’s designation.
(b) The commissioner or their designee shall
conduct a hearing on the suspension within 10 days of its issue. Such a hearing
shall be conducted pursuant to RSA 541-A:31-36 and He-C 200, except as provided
in (f) below.
(c) The department shall send a notice to the
area agency specifying the reasons for the suspension and the time and place of
the hearing scheduled pursuant to (b) above.
(d) Within 10 days of the hearing, the
commissioner shall either revoke or reinstate the area agency’s designation.
(e) The area agency may appeal the commissioner’s
decision to a court of competent jurisdiction.
(f) In the event that the area agency waives its
right to a hearing on a decision to suspend designation, or that such decision
is upheld following a hearing, the commissioner shall initiate the process to
designate a successor area agency pursuant to He-M 505.06.
Source. #1647, eff 10-14-80; ss by #2020, eff
5-11-82; ss by #2678, eff 4-18-84; ss by #4667, eff 8-25-89; ss by #4729, eff
1-15-90, EXPIRED: 1-15-96
New. #6871, eff 10-21-98; amd by #8443, eff 1-1-06;
ss by #8728, INTERIM, eff 10-21-06, EXPIRED: 4-19-07
New. #8928, eff 6-30-07; ss by #10916, eff 8-26-15; ss by #13842, eff 12-29-23 (formerly He-M 505.07)
He-M 505.09 Redesignation.
(a) Each area agency shall notify the bureau
administrator of its intent to be redesignated every 5 years, in accordance
with Table 505-2.
(b) Submission of notification
of the area agency’s intention to be redesignated shall cause the area agency’s
current designation to be effective until the bureau administrator issues a
decision pursuant to (i) below.
(c) If an area agency’s current designation is
due to expire earlier than the scheduled redesignation in Table 505-2, the
current designation shall be extended to remain effective until the scheduled
redesignation review is completed.
(d) Area agencies shall submit a comprehensive
self-assessment with the notification of intent to be redesignated, to outline
the area agency’s performance, within 180 days, but not less than 150 days,
prior to the expiration of its current redesignation according to Table 505-2
below:
Table 505-2, Redesignation Schedule
|
2024 and 2029 |
2025 and 2030 |
2026 and 2031 |
2027 and 2032 |
2028 and 2033 |
|
Region II |
Region III |
Region VII |
Region IV |
Region I |
|
Region V |
Region VI |
Region X |
Region IX |
Region VIII |
(e) The bureau
administrator shall review the agency’s self-assessment, department materials,
and feedback from provider agencies, providers, individuals, family members,
area citizens, advocacy and self-advocacy groups, and community groups regarding
the area agency’s past performance and current ability to coordinate access to
a comprehensive service delivery system.
(f) The bureau administrator shall consider the
area agency’s past and current performance in providing services, programs, and
functions to individuals and their families, including reviewing results and
trends identified from the annual governance reviews conducted pursuant to He-M
505.04(aa).
(g) An area agency shall be considered successful
and operating efficiently when it annually:
(1) Demonstrates, through its
services, programs, and functions, a commitment to a mission that embraces and
emphasizes active community membership and inclusion for persons with
disabilities;
(2) Demonstrates, through multiple means, its commitment to individual
rights, health promotion, and safety;
(3) Provides individuals and
families with information and supports to design and direct their services in
accordance with their needs, preferences, and capacities and to decide who will
provide them;
(4) Involves those who use its
services in area planning, system design, and development;
(5) Assesses and continuously
improves the quality of its services, and ensures that the recipients of
services are satisfied with the services that they receive;
(6) Demonstrates, through its
board of directors and management team, effective governance, administration,
and oversight of the area agency staff, provider agencies, and, if applicable,
subcontract agencies;
(7) Is fiscally sound, manages
resources effectively to support its mission, and utilizes generic community
resources and proactive supports in assisting people;
(8) Complies, along with its
subcontractors, if applicable, with all contract requirements and state and
federal requirements; and
(9) Achieves the goals
identified in its area plan and implements the recommendations made in its
previous redesignation report from the department, if applicable.
(h) Approval of an area agency’s request for
redesignation shall be granted if, based on the following information, the area
agency is found to be in compliance with (f)(1)-(9) above:
(1) Materials
collected as part of the redesignation process, which shall include, at a
minimum, the following:
a. Comments
solicited from individuals, family members, area citizens, provider agencies,
providers, advocacy and self-advocacy groups, and community groups
demonstrating the area agency’s ability to coordinate access to comprehensive
services and provide leadership in addressing the needs of individuals within
its catchment region; and
b. Information
to demonstrate that the area agency has complied with the requirements of He-M
202 with respect to implementation of recommendations;
and
(2) Other
available documents which shall demonstrate:
a. Compliance with all department rules and other
applicable statutes and federal laws, regulations, and rules, and contract
requirements;
b. The results of the annual
governance reviews and any other announced or unannounced reviews;
c. Compliance with performing and documenting
Medicaid administration functions and claiming in accordance with 505.03; and
d. Corrective
action taken in response to any
department’s quality assurance review.
(i) The bureau administrator shall issue a report
redesignating or conditionally redesignating an area agency.
(j) An area agency shall respond to any
corrective action request included in a letter of redesignation.
Source. #1647, eff 10-14-80; ss by #2020, eff
5-11-82; ss by #2678, eff 4-18-84; ss by #4667, eff 8-25-89; ss by #4729, eff
1-15-90, EXPIRED: 1-15-96
New. #6871, eff 10-21-98; ss by #8728, INTERIM,
eff
10-21-06, EXPIRED: 4-19-07
New. #8928, eff 6-30-07; ss by #10916, eff 8-26-15;
ss by #13842, eff 12-29-23 (formerly He-M 505.08)
He-M 505.10 Conditional
Redesignation.
(a) If the area agency fails to meet the
redesignation criteria specified in He-M 505.09, the commissioner shall
redesignate the area agency on a conditional basis for a period of time not to
exceed l80 days.
(b) The commissioner shall specify, in writing,
conditions and time frames that shall be met by the area agency in order to be
eligible for redesignation.
(c) Department staff designated by the bureau
administrator shall review and issue a report regarding the area agency’s
progress toward compliance with the conditions identified pursuant to He-M
505.10 (b).
(d) At least 2 weeks prior to the expiration of
the conditional redesignation, the commissioner shall:
(l) Approve the application for
redesignation, effective as of the date of conditional redesignation, if all
conditions have been met within the required time frame; or
(2) Deny the application for
redesignation if all conditions have not been met within the required time
frame.
(e) Any corrective action not fully completed at
the time an application for redesignation is approved in accordance with (d)(1)
above shall be incorporated in the next area plan developed by the area agency
after the redesignation review.
Source. #1647, eff 10-14-80; ss by #2020, eff
5-11-82; ss by #2678, eff 4-18-84; ss by #4667, eff 8-25-89; ss by #4729, eff
1-15-90, EXPIRED: 1-15-96
New. #6871, eff 10-21-98; ss by #8728, INTERIM,
eff
10-21-06, EXPIRED: 4-19-07
New. #8928, eff 6-30-07; ss by #10916, eff 8-26-15;
ss by #13842, eff 12-29-23 (formerly He-M 505.09)
He-M 505.11 Denial of Redesignation.
(a) In those cases where the commissioner denies
an application for redesignation, the commissioner shall notify the area agency
in writing of the decision.
(b) Such a notice
described in (a) above, shall specify the reasons for the decision and its
effective date.
(c) The effective date
of the decision shall be at least 90 days from the date of the notice of
denial.
(d) The area agency
shall have 20 days following the date of the notice to request a hearing on the
denial in accordance with He-M 505.12.
(e) In the event that a hearing request is not
made or the denial is upheld following a hearing, the commissioner shall
initiate the process to designate a successor area agency as outlined in He-M
505.06.
Source. #1647, eff 10-14-80; ss by #2020, eff
5-11-82; ss by #2678, eff 4-18-84; ss by #4667, eff 8-25-89; ss by #4729, eff
1-15-90, EXPIRED: 1-15-96
New. #6871, eff 10-21-98; ss by #8728, INTERIM,
eff
10-21-06, EXPIRED: 4-19-07
New. #8928, eff 6-30-07; ss by #10916, eff 8-26-15;
ss by #13842, eff 12-29-23 (formerly He-M 505.10)
He-M
505.12 Hearings.
(a) An area agency may request a hearing
regarding a denial of designation or redesignation or revocation of
designation.
(b) A request for hearing shall be submitted to
the commissioner in writing within 20 days following the date of the
notification of denial or revocation.
(c) The commissioner or their designee shall
conduct a hearing in accordance with the procedures set forth in He-C 200
within 30 days of receipt of a request.
(d) Within 10 days of the hearing, the
commissioner shall grant or deny an application for designation or
redesignation or revoke or reinstate an area agency’s designation.
(e) The area agency may appeal the commissioner’s
decision to a court of competent jurisdiction.
Source. #1647, eff 10-14-80; ss by #2020, eff
5-11-82; ss by #2678, eff 4-18-84; ss by #4667, eff 8-25-89; ss by #4729, eff
1-15-90, EXPIRED: 1-15-96
New. #6871, eff 10-21-98; ss by #8728, INTERIM,
eff
10-21-06, EXPIRED: 4-19-07
New. #8928, eff 6-30-07; ss by #10916, eff 8-26-15;
ss by #13842, eff 12-29-23 (formerly He-M 505.11)
He-M 505.13 Designation of Successor Area Agency.
(a) If the commissioner or designee upholds the
denial of designation or redesignation, suspension of designation, or
revocation, the commissioner shall initiate the process described in He-M
505.06 to designate a successor area agency.
(b) Pursuant to RSA 171-A:18, VII, the department
shall assume all or any part of the responsibilities of the area agency at any
time during which an area agency is not designated.
(c) Following the revocation of an area agency’s
designation, the department shall operate the services directly, enter a
contract with the agency for provision of certain services, or enter into
contracts with other area agencies to ensure the needs of individuals are met
by service providers that have the capacity to provide high quality services
pending the selection of a successor area agency.
Source. #6871, eff 10-21-98; ss by #8728, INTERIM,
eff
10-21-06, EXPIRED: 4-19-07
New. #8928, eff 6-30-07; ss by #10916, eff 8-26-15;
ss by #13842, eff 12-29-23 (formerly He-M 505.12)
He-M 505.14 Waivers.
(a) An applicant, area agency, provider agency,
individual, guardian, or provider may request a waiver of specific procedures
outlined in He-M 505 by completing and submitting the form titled “NH Bureau of
Developmental Services Waiver Request” (October 2023) in accordance with
(b) and (c) below.
(b) A completed waiver request form shall be
signed by the individual or guardian, if applicable, and the area
agency’s executive director or designee recommending approval of the waiver.
(c) A waiver request shall be
submitted to the department via:
(1) Email at bds@dhhs.nh.gov; or
(2) By mail to:
Bureau of Developmental Services
Hugh J. Gallen State Office Park
105 Pleasant Street, Main Building
Concord, NH 03301
(d) No provision or procedure
prescribed by statute shall be waived.
(e) The request for a waiver
shall be granted by the commissioner or their designee within 30 days if the
alternative proposed by the requesting entity meets the objective or intent of
the rule and it:
(1) Does not negatively impact
the health or safety of the individual(s); and
(2) Does not affect the quality
of services to individuals.
(f) Upon receipt of approval of
a waiver request, the requesting entity’s subsequent compliance with the
alternative provisions or procedures approved in the waiver shall be considered
compliance with the rule for which waiver was sought.
(g) Waivers shall be granted in
writing for the minimum period necessary to accommodate the waiver request,
with a specific duration not to exceed 5 years except as in (h) and (j) below.
(h) Those waivers which relate
to other issues relative to the health, safety, or welfare of individuals that
require periodic reassessment shall be effective for the current designation
period only.
(i) Any waiver shall end with
the closure of the related program or service.
(j) A requesting entity may
request a renewal of a waiver from the bureau.
Such request shall be made at least 90 days prior to the expiration of a
current waiver.
Source. #6871, eff 10-21-98; ss by #8728, INTERIM,
eff
10-21-06, EXPIRED: 4-19-07
New. #8928, eff 6-30-07; ss by #10916, eff 8-26-15;
ss by #13842, eff 12-29-23; ss by #13842, eff 12-29-23 (formerly He-M 505.13)
PART He-M 506 PROVIDER, STAFF,
AND CONTRACTOR QUALIFICATIONS AND DEVELOPMENT REQUIREMENTS FOR DEVELOPMENTAL
SERVICE AGENCIES
Statutory
Authority: New Hampshire RSA 171-A:3;
18, IV; 137-K:3, IV
He-M 506.01 Purpose. The purpose of
these rules is to outline the minimum qualifications and training requirements
of providers and staff.
Source. #2033, eff 6-7-82; ss by #2679, eff 4-18-84;
ss by #5047, eff 1-18-91, EXPIRED: 1-18-97
New. #6645, eff 12-2-97, EXPIRED: 12-2-05
New. #8604, eff 4-11-06; ss by #10528, eff 3-1-14;
ss by #14039, eff 8-1-24
He-M 506.02 Definitions.
(a) “Acquired
brain disorder” means a disruption in brain functioning that:
(1) Is not congenital or caused by birth trauma;
(2) Presents a severe and life-long disabling condition
which significantly impairs a person's ability to function in society;
(3) Occurs prior to age 60;
(4) Is attributable to one or more of the following
reasons:
a. External trauma to the brain as a result of:
1. A
motor vehicle incident;
2. A
fall;
3. An
assault; or
4. Another
related traumatic incident or occurrence;
b. Anoxic or hypoxic injury to the brain such as from:
1. Cardiopulmonary
arrest;
2. Carbon
monoxide poisoning;
3. Airway
obstruction;
4. Hemorrhage;
or
5. Near
drowning;
c. Infectious diseases such as encephalitis and meningitis;
d. Brain tumor;
e. Intracranial surgery;
f. Cerebrovascular disruption such as a stroke;
g. Toxic exposure; or
h. Other neurological disorders such as Huntington's
disease or multiple sclerosis which predominantly affect the central nervous
system resulting in diminished cognitive functioning and ability; and
(5) Is manifested by one or more of the following:
a. Significant decline in cognitive functioning and
ability; or
b. Deterioration in:
1. Personality;
2. Impulse
control;
3. Judgment;
4. Modulation
of mood; or
5. Awareness
of deficits.
(b) “Area
agency” means “area agency” as defined under RSA 171-A:2, I-b.
(c) “Bureau”
means the bureau of developmental services of the department of health and
human services.
(d) “Days” means calendar days unless otherwise
specified.
(e) “Developmental
disability” means “developmental disability” as defined in RSA 171‑A:2,
V, namely, “a disability:
(a) Which is attributable to an intellectual disability,
cerebral palsy, epilepsy, autism or a specific learning disability or any other
condition of an individual found to be closely related to an intellectual
disability as it refers to general intellectual functioning or impairment in
adaptive behavior or requires treatment similar to that required for persons
with an intellectual disability; and
(b) Which originates before such individual attains age 22,
has continued or can be expected to continue indefinitely, and constitutes a
severe disability to such individual's ability to function normally in
society.”
(f) “Family”
means a group of 2 or more persons that:
(1) Are related by ancestry,
marriage, or other legal arrangement;
(2) Are living in the same
household; and
(3) Have at least one member
who is an individual as defined in (i) below.
(g) “Health
Risk Screening Tool (HRST)” means the 2015 edition of the Health Risk Screening
Tool, available as noted in Appendix A, which is a web-based rating instrument
used for performing health risk screenings on individuals in order to:
(1) Determine an individual’s vulnerability regarding
potential health risks; and
(2) Enable the early identification of health issues and
monitoring of health needs.
(h) “Home and community based waiver services (HCBS waiver services)” means
the services defined and funded pursuant to New Hampshire’s agreement with the
federal government, known as the “Disabilities Waiver” and the “Acquired Brain
Disorder Waiver", pursuant to the authority section of 1915(c) of the
Social Security Act which allows the federal funding of long-term care services
in non-institutional settings for persons who are developmentally disabled or
who have an acquired brain disorder.
(i) “Individual”
means any person with a developmental disability or acquired brain disorder.
(j) “Provider” means a
person receiving any form of remuneration for the provision of services to an
individual.
(k) “Provider
agency” means an agency or an independent provider that is established to
provide services to individuals and who meets the criteria in He-M 504.
(l) “Staff”
means a person employed by a provider agency, subcontract agency, or other
employer.
(m) “Supports
Intensity Scale-Adult Version ® (SIS-A ®)” means the 2023 edition of the
Supports Intensity Scale, available as noted in Appendix A, which is an
assessment tool intended to assist in service planning by measuring the
individual’s support needs in the areas of home living, community living,
lifelong learning, employment, health and safety, social activities, and
protection and advocacy. The tool uses a formal rating scale to
identify the type of supports needed, frequency of supports needed, and daily
support time.
Source. #2033, eff 6-7-82; ss by #2679, eff 4-18-84;
ss by #5047, eff 1-18-91, EXPIRED: 1-18-97
New. #6645, eff 12-2-97, EXPIRED: 12-2-05
New. #8604, eff 4-11-06; ss by #10528, eff 3-1-14;
ss by #14039, eff 8-1-24
He-M 506.03 Minimum
Provider, Staff, and Contractor Qualifications.
(a) Providers,
staff, and contractors shall meet the qualifications and requirements for
providing HCBS waiver services identified in He-M 503, He-M 504, He-M 507, He-M
510, He-M 513, He-M 518, He-M 521, He-M 524, He-M 1001, and He-M 1201.
(b) All
providers, staff, and contractors shall be at least 18 years of age, except as
permitted in He-M 524.22 and He-M 525.12.
(c) Prior to
a person working directly with individuals, the provider agency, with the
consent of the person, shall complete the necessary registry, criminal
background, and office of the inspector general exclusion list checks in
accordance with He-M 504.03.
(d) Records,
including information relating to providers, staff, and contractors shall be
maintained by the provider agency for a period of 6 years after that provider,
staff, or contractor no longer provides HCBS waiver services to individuals or
is no longer employed by the provider agency.
Source. #2033, eff 6-7-82; ss by #2679, eff 4-18-84;
ss by #5047, eff 1-18-91, EXPIRED: 1-18-97
New. #6645, eff 12-2-97, EXPIRED: 12-2-05
New. #8604, eff 4-11-06; ss by #10528, eff 3-1-14;
ss by #14039, eff 8-1-24
He-M
506.04 Policy and Procedure
Requirements. Each provider agency shall establish and implement written
policies which shall specifically address the following:
(a) Non-discrimination
on the basis of:
(1) Race;
(2) Color;
(3) Sex;
(4) Creed;
(5) National origin;
(6) Age;
(7) Marital status;
(8) Familial status;
(9) Sexual orientation; or
(10) Physical or mental disability; and
(b) Knowledge,
skills, and abilities relative to providing HCBS waiver services.
Source. #2033, eff 6-7-82; ss by #2679, eff 4-18-84;
ss by #5047, eff 1-18-91; amd by #5322, eff 1-31-92; ss by #6645, eff 12-2-97;
EXPIRE: 12-2-05
New. #8604, eff 4-11-06; ss by #10528, eff 3-1-14;
ss by #14039, eff 8-1-24
He-M 506.05 Provider, Staff,
and Contractor Development Requirements.
(a) Within
the first month of providing HCBS waiver services, a provider agency shall
train each provider, staff, and contractor in:
(1) An overview of the rights of persons who receive
services, as described in He-M 202 and He-M 310; and
(2) Developing an understanding of the stigmas, negative
labels, and common life experiences of people with disabilities including how
individuals utilize behavior as communication.
(b) All provider agency providers, staff, and
contractors who have direct contact with individuals and families shall meet
the applicable requirements in He-M 504.11.
(c) All provider agency providers, staff, and
contractors who have direct contact with individuals or are hired after March
31,2025 shall participate in a person-centered thinking program and demonstrate
competencies within the first 3 months of providing HCBS waiver services and
every 5 years thereafter.
(d) Person-centered programs for (c) above shall
consist of nationally recognized models and best practices as identified by the
National Center on Advancing Person-Centered Practices and Systems (NCAPPS) or
the National Alliance for Direct Support Professionals (NADSP).
(e) Prior to
working directly with an individual, providers, staff, and contractors shall be
trained in the following information regarding the individual:
(1) Personal profile;
(2) Goals;
(3) Specific health-related requirements, including:
a. All current medical conditions, medical history, and
routine and emergency protocols;
b. Any special nutrition, hydration, elimination, personal
hygiene, oral health, or ambulation needs; and
c. Any special, cognitive, mental health, or behavioral
needs;
(4) Information the family, and guardian if applicable,
believe would be helpful to the service provision process;
(5) Emergency contact information;
(6) Safety plan;
(7) Behavior or risk management plan;
(8) HRST information pertinent to supporting the
individual;
(9) SIS information pertinent to supporting the individual;
(10) Any other information needed to ensure the
individual’s health and safety needs are understood; and
(11) Any information in the service agreement not specified
in (1)-(10) above.
(f) Staff
with no prior experience providing services directly to individuals shall be
assigned to work with an experienced staff member, for not less than 16 hours
during their orientation.
(g) Prior to
staff working directly with an individual and annually thereafter, supervisors
shall ask each staff to demonstrate, through examples, their understanding of
the information presented pursuant to (e) above.
(h) At least
monthly, supervisors or their designees shall conduct unannounced visits to
staff at community locations while they are providing services for
individuals. The purpose of the visits shall be to assure that
services are provided in accordance with each individual's service agreement.
(i) Providers,
staff, and contractors shall be re-trained annually in an overview of the
rights of individuals, as described in He-M 202 and He-M
310. Provider agencies shall re-train providers, staff, and
contractors and the re-training shall include examples of rights violations.
(j) A
provider agency shall train providers, staff, and contractors in the following
areas within the first 6 months of providing HCBS waiver services:
(1) An overview of developmental disabilities and acquired
brain disorders, which shall include:
a. An overview of the different types of developmental
disabilities and acquired brain disorders and their causes;
b. An overview of the local and state service delivery
system; and
c. An overview of professional services and technologies
including therapies, assistive technologies,
and environmental modifications necessary to achieve individuals'
goals at home, in the community, in the workplace and in recreation or leisure
activities;
(2) An overview of conditions promoting or detracting from
the quality of life that individuals enjoy, which shall provide providers,
staff, and contractors the competencies necessary to:
a. Support individuals to obtain and maintain valued social
roles;
b. Support individuals to build relationships with their
families, neighbors, co-workers, and other community members;
c. Create and enhance opportunities for individuals to:
1. Increase
their presence in the life of their local communities; and
2. Increase
the ways in which they contribute to their communities;
d. Support individuals to have as much control as possible
over their own lives;
e. Build individuals’ skills, strengths, and interests that
are functional and meaningful in natural community environments;
f. Create supports that enable individuals to explore and
participate in a wide variety of community activities and experiences in
settings that are available to the general public; and
g. Support individuals to gain as much independence as
possible;
(3) Methods to assist individuals with challenging
behaviors utilizing positive behavioral supports as described in He-M 1001.07
(d);
(4) Understanding, and assisting individuals to manage
behavior that derives from neurological compromises or limitations;
(5) Techniques to:
a. Facilitate social relationships;
b. Enhance skills that improve everyday living and promote
independence; and
c. Teach, coach, and mentor individuals to learn skills
that maximize independence;
(6) Basic health and safety practices related to:
a. Personal wellness;
b. Success in living, working, and recreating in the
community; and
c. An understanding of the importance of common signs and
symptoms of illness;
(7) Training relative to supporting individuals in
employment pursuant to He-M 518, as appropriate;
(8) Skills necessary to support individuals and their
families to:
a. Make their own decisions;
b. Advocate for themselves; and
c. Create their own social networks;
(9) Any trainings specified in an individual’s service
agreement; and
(10) Training in orienting individuals to fire safety and
emergency evacuation procedures.
Source. #2033, eff 6-7-82; ss by #2679, eff 4-18-84;
ss by #5047, eff 1-18-91, EXPIRED: 1-18-97
New. #6645, eff 12-2-97, EXPIRED: 12-2-05
New. #8604, eff 4-11-06; ss by #10528, eff 3-1-14;
ss by #14039, eff 8-1-24
He-M 506.06 Waivers.
(a) A
provider agency, individual, guardian, or provider may request a waiver of
specific procedures outlined in He-M 506 using the form titled “NH Bureau of
Developmental Services Waiver Request” (October 2023 edition).
(b) A completed waiver
request form shall be signed by:
(1) The individual or guardian
indicating agreement with the request, if applicable; and
(2) The provider agency’s
executive director or designee recommending approval of the waiver.
(c) A waiver request
shall be submitted to the department via:
(1) Email at bds@dhhs.nh.gov;
or
(2) By mail to:
Department of Health and Human Services
Bureau of Developmental Services
Hugh J. Gallen State Office Park
105 Pleasant Street, Main Building
Concord, NH 03301
(d) No
provision or procedure prescribed by statute shall be waived.
(e) The
request for a waiver shall be granted by the commissioner or their designee
within 30 days if the alternative proposed by the requesting entity meets the
objective or intent of the rule and it:
(1) Does not negatively impact the health or safety of the
individual(s); and
(2) Does not affect the quality of services to individuals.
(f) Upon
receipt of approval of a waiver request, the requesting entity’s subsequent
compliance with the alternative provisions or procedures approved in the waiver
shall be considered compliance with the rule for which waiver was sought.
(g) Waivers
shall be granted in writing for the minimum period necessary to accommodate the
waiver request, with a specific duration not to exceed 5 years except as in (h)
and (i) below.
(h) Any
waiver shall end with the closure of the related program or service.
(i) A
requesting entity may request a renewal of a waiver from the
bureau. Such request shall be made at least 90 days prior to the
expiration of a current waiver.
Source. #6645, eff 12-2-97, EXPIRED: 12-2-05
New. #8604, eff 4-11-06; ss by #10528, eff 3-1-14;
ss by #14039, eff 8-1-24
PART He-M 507 COMMUNITY PARTICIPATION SERVICES
Statutory
Authority: New Hampshire RSA 171-A:3;
171-A:18, IV; 137-K:3, IV
He-M 507.01 Purpose. The purpose of these rules is to establish
standards for certified community participation services as part of a
comprehensive array of community-based services for persons with developmental
disabilities or acquired brain disorders that:
(a)
Assist the individual to attain, improve, and maintain a variety of life
skills, including vocational skills;
(b)
Emphasize, maintain and broaden the individual’s opportunities for
community participation and relationships;
(c)
Support the individual to achieve and maintain valued social roles, such
as of an employee or community volunteer;
(d)
Promote personal choice and control in all aspects of the individual’s
life and services, including the involvement of the individual, to the extent
he or she is able, in the selection, hiring, training, and ongoing evaluation
of his or her primary staff and in determining the quality of services; and
(e)
Are provided in accordance with the individual’s service agreement and
goals and desired outcomes.
Source. #2269, eff 1-10-83; ss by #2963, eff 1-22-85;
ss by #4314, eff 9-27-87; ss by #4659, eff
8-4-89; EXPIRED: 8-4-95
New. #6285, eff 7-12-96, EXPIRED: 7-12-04
New. #8142, INTERIM, eff 8-21-04, EXPIRED: 2-17-05
New. #8324, eff 4-16-05, EXPIRED: 4-16-13
New. #10320, INTERIM, eff 4-25-13, EXPIRES:
10-22-13; ss by #10426, eff 10-1-13
He-M 507.02 Definitions. The words and phrases used in these rules
shall mean the following:
(a)
“Acquired brain disorder” means a disruption in brain functioning that:
(1) Is not congenital or caused by birth trauma;
(2) Presents a severe and life-long disabling
condition which significantly impairs a person’s ability to function in
society;
(3) Occurs prior to age 60;
(4) Is attributable to one or more of the
following reasons:
a. External trauma to the brain as a result of:
1. A motor vehicle incident;
2. A fall;
3. An assault; or
4. Another related traumatic incident or
occurrence;
b. Anoxic or hypoxic injury to the brain such as
from:
1. Cardiopulmonary arrest;
2. Carbon monoxide poisoning;
3. Airway obstruction;
4. Hemorrhage; or
5. Near drowning;
c. Infectious diseases such as encephalitis and
meningitis;
d. Brain tumor;
e. Intracranial surgery;
f. Cerebrovascular disruption such as a stroke;
g. Toxic exposure; or
h. Other neurological disorders such as
Huntington's disease or multiple sclerosis which predominantly affect the
central nervous system; and
(5) Is manifested by one or more of the
following:
a. Significant decline in cognitive functioning
and ability; and
b. Deterioration in:
1. Personality;
2. Impulse control;
3. Judgment;
4. Modulation of mood; or
5. Awareness of deficits.
(b) “Area agency” means “area agency” as defined
under RSA 171-A:2, I-b, namely, “an entity established as a nonprofit
corporation in the state of New Hampshire which is established by rules adopted
by the commissioner to provide services to developmentally disabled persons in
the area.”
(c)
“Basic living skills” means activities accomplished each day to acquire,
improve, or maintain independence in daily life.
(d)
“Bureau” means the bureau of developmental services of the department of
health and human services.
(e)
“Centralized service site” means a location operated by a provider
agency where individuals receive community participation services for more than
one hour per day.
(f)
“Certification” means the written approval by the bureau of health
facilities administration for the operation of community participation services
in accordance with the requirements set forth in He-M 507.
(g)
“Community participation services”, also called “day services” elsewhere
in He-M 500 and He-M 1001, means habilitation, assistance, and instruction
provided to individuals that:
(1) Improve or maintain their performance of
basic living skills;
(2) Offer vocational and community activities, or
both;
(3) Enhance their social and personal
development;
(4) Include consultation services, in response to
individuals’ needs, and as specified in service agreements, to improve or
maintain communication, mobility, and physical and psychological health; and
(5) At a minimum, meet the needs and achieve the
desired goals and outcomes of each individual as specified in the service
agreement.
(h)
“Covered services” means community participation services described
pursuant to He-M 507.04 as reimbursable under the Medicaid program or through
grants from the bureau.
(i)
“Department” means the department of health and human services.
(j)
“Developmental disability” means “developmental disability” as defined
in RSA 171‑A:2, V, namely, “a disability:
(a) Which is attributable to an intellectual
disability, cerebral palsy, epilepsy, autism or a specific learning disability,
or any other condition of an individual found to be closely related to an
intellectual disability as it refers to general intellectual functioning or
impairment in adaptive behavior or requires treatment similar to that required
for persons with an intellectual disability; and
(b) Which originates before such individual
attains age 22, has continued or can be expected to continue indefinitely, and
constitutes a severe handicap to such individual's ability to function normally
in society.”
(k)
“Exploitation” means “exploitation” as defined in RSA 161-F:43, IV.
(l)
“Family” means a group of 2 or more persons related by ancestry,
marriage, or other legal arrangement.
(m)
“Health assessment” means an evaluation of an individual’s health status
done by a physician or other licensed practitioner for the purpose of making
recommendations regarding strategies for promoting and maintaining optimum
health.
(n)
“Health Risk Screening Tool (HRST) (2009 edition)”, available as noted
in Appendix A, means a web-based rating instrument used for performing health
risk screenings on individuals in order to:
(1) Determine an individual’s vulnerability
regarding potential health risks; and
(2) Enable the early identification of health
issues and monitoring of health needs.
(o)
“Home and community‑based care waiver” means the waiver of
sections 1902 (a) (10) and 1915 (c) of the Social Security Act which allows the
federal Medicaid funding of long‑term services for persons in non‑institutional
settings who are elderly, disabled, or chronically ill.
(p)
“Individual” means any person with a developmental disability or
acquired brain disorder who receives, or has been found eligible to receive,
area agency services.
(q)
“Personal development” means supporting or increasing an individual's
capacity to make choices, to communicate interests and preferences, and to have
sufficient opportunities for exploring and meeting those interests.
(r)
“Personal profile” means a narrative description prepared pursuant to
He-M 503.11 (f)(1) a. 1. that includes:
(1) A personal statement from the individual and
those who know him or her best that summarizes the individual’s strengths and
capacities, communication and learning style, challenges, needs, interests, and
any health concerns, as well as the individual’s hopes and dreams;
(2) A personal history covering significant life
events, relationships, living arrangements, health, use of assistive
technology, and results of evaluations which contribute to an understanding of
the individual’s needs;
(3) A review of the past year that:
a. Summarizes
the individual’s:
1. Personal achievements;
2. Relationships;
3. Degree of community involvement;
4. Challenging issues or behavior;
5. Health status and any changes in health; and
6. Safety considerations during the year;
b. Addresses
the previous year’s desired goals and outcomes with level of success and, if
applicable, identifies any obstacles encountered;
c. Identifies
the desired goals and outcomes of the individual for the coming year;
d. Identifies
the type and amount of services the individual receives and the support
services provided under each service category;
e. Identifies
the individual’s health needs;
f. Identifies
the individual’s safety needs;
g. Identifies
any follow-up action needed on concerns and the persons responsible for the
follow-up; and
h. Includes a
statement of the individual’s and guardian’s satisfaction with services;
(4) An attached work history of the individual’s
paid employment and volunteer positions, as applicable, that includes:
a. Dates of
employment;
b. Type of
work;
c. Hours worked
per week; and
d. Reason for
leaving, if applicable; and
(5) A reference to sensitive historical
information in other sections of the record when the individual or guardian, as
applicable, prefers not to have this included in the profile.
(s)
“Primary staff” means staff who are regularly assigned to provide
services to specific individuals.
(t)
“Provider” means a person receiving any form of remuneration for the
provision of services to an individual.
(u)
“Provider agency” means an area agency or an entity under contract with
an area agency that is responsible for providing community participation
services to individuals.
(v)
“Risk management plan” means a person-centered document that describes
the services, supports, approaches and guidelines to be utilized to meet the
individual’s needs and mitigate risks to community safety and which is
consistent with the service guarantees and protections articulated in He-M 503.
(w)
“Service agreement” means a written agreement between an individual or
guardian and the area agency that describes the services that the individual
will receive and constitutes an individual service agreement as defined in RSA
171-A:2, X. The term includes a basic
service agreement for all individuals who receive services and an expanded
service agreement for those who receive more complex services pursuant to He-M
503.11.
(x)
“Service coordinator” means a person who is chosen or approved by an
individual and his or her guardian and designated by the area agency to
organize, facilitate and document service planning and to negotiate and monitor
the provision of the individual’s services and who is:
(1) An area agency service coordinator, family
support coordinator, or any other area agency or provider agency employee;
(2) A member of the individual’s family;
(3) A friend of the individual; or
(4) Another person chosen to represent the
individual.
(y)
“Sheltered workshop” means a program that provides a segregated service
environment where the contract objectives of the provider agency are the
primary focus and goal.
(z)
“Supports Intensity Scale (2004 edition)”, available as noted in
Appendix A, means an assessment tool intended to assist in service planning by
measuring the individual’s support needs in the areas of home living, community
living, lifelong learning, employment, health and safety, social activities,
and protection and advocacy. The tool uses a formal rating scale to identify
the type of supports needed, frequency of supports needed, and daily support
time.
(aa)
“Systematic, therapeutic, assessment, respite and treatment (START)”
means the model of service supports that is intended to optimize independence,
treatment, and community living for individuals with developmental disabilities
and mental health needs.
Source. #2269, eff 1-10-83; ss by #2963, eff 1-22-85;
ss by #4314, eff 9-27-87; ss by #4659, eff 8-4-89; EXPIRED:
8-4-95
New. #6285, eff 7-12-96, EXPIRED: 7-12-04
New. #8142, INTERIM, eff 8-21-04, EXPIRED: 2-17-05
New. #8324, eff 4-16-05, EXPIRED: 4-16-13
New. #10320, INTERIM, eff 4-25-13, EXPIRES:
10-22-13; ss by #10426, eff 10-1-13
He-M 507.03 Service Principles.
(a) All community participation services shall be
designed to:
(1) Support the individual’s participation in a
variety of integrated community activities and settings;
(2) Assist the individual to be a contributing
and valued member of his or her community through vocational and volunteer
opportunities;
(3) Meet the individual’s needs, goals, and
desired outcomes, as identified in his or her service agreement, related to
community opportunities for volunteerism, employment, personal development,
socialization, recreation, communication, mobility, and personal care;
(4) Help the individual to achieve more
independence in all aspects of his or her life by learning, improving, or
maintaining a variety of life skills, such as:
a. Traveling safely in the community;
b. Managing personal funds;
c. Participating in community activities; and
d. Other life skills identified in the service
agreement;
(5) Promote the individual’s health and safety;
(6) Protect the individual’s right to freedom
from abuse, neglect, and exploitation; and
(7) Provide opportunities for the individual to
exercise personal choice and independence within the bounds of reasonable
risks.
(b) Community participation services shall be
primarily provided in community settings outside of the home where the
individual lives.
(c) An individual or guardian may select any
person, any provider agency, or another area agency as a provider to deliver
the community participation services identified in the individual’s service
agreement.
(d) All providers shall:
(1) Comply with the rules pertaining to community
participation services;
(2) Enter into a contractual agreement with the
area agency; and
(3) Operate within the limits of funding
authorized by the agreement.
Source. #2269, eff 1-10-83; ss by #2963, eff 1-22-85;
ss by #4314, eff 9-27-87; ss by #4659, eff 8-4-89; EXPIRED:
8-4-95
New. #6285, eff 7-12-96, EXPIRED: 7-12-04
New. #8142, INTERIM, eff 8-21-04, EXPIRED: 2-17-05
New. #8324, eff 4-16-05; amd by #8545, eff 1-24-06;
paras (a)-(g) and (i)-(q) expired on 4-16-13; ss by #10320, INTERIM, eff
4-25-13, EXPIRES: 10-22-13; ss by #10426, eff 10-1-13
He-M 507.04 Covered Services.
(a)
All community participation services shall be designed and provided in
accordance with the individual’s specific needs, interests, competencies, and
learning style, as described in the individual’s service agreement and personal
profile.
(b)
The following services shall be covered:
(1) Instruction and assistance to learn, improve,
or maintain:
a. Social and safety skills in different
community settings;
b. Decision-making regarding choice of and
participation in community activities;
c. Life skills as applied to community-based
activities, such as purchasing items and managing personal funds;
d. Good nutrition and healthy lifestyle;
e. Self-advocacy and rights and responsibilities
as citizens; and
f. Any other skill identified by the individual
or guardian during service planning and related to the individual’s
participation in, or contribution to, his or her community;
(2) Supports to identify and develop the
individual’s interests and capacities related to securing employment
opportunities, including internships;
(3) Services related to job development and
on-the-job training;
(4) Assistance in finding and maintaining
volunteer positions;
(5) Supports related to enabling the individual
to explore, and participate in, a wide variety of community activities and
experiences in settings that are available to the general public;
(6) Consultation services as specified in the
service agreement to improve or maintain the individual’s communication,
mobility, and physical and psychological health and well-being; and
(7) Transportation that is:
a. Related to community
participation services, including travel from the individual’s residence to
locations where the community participation service activities are taking
place; or
b. Travel from the individual’s residence to
employment or volunteer positions described in He-M 507.05 (a)(3) below.
Source. #2269, eff 1-10-83; ss by #2963, eff 1-22-85;
ss by #4314, eff 9-27-87; ss by #4659, eff 8-4-89; EXPIRED:
8-4-95
New. #6285, eff 7-12-96, EXPIRED: 7-12-04
New. #8142, INTERIM, eff 8-21-04, EXPIRED: 2-17-05
New. #8324, eff 4-16-05, EXPIRED: 4-16-13
New. #10320, INTERIM, eff 4-25-13, EXPIRES:
10-22-13; ss by #10426, eff 10-1-13
He-M 507.05 Non‑Covered Services.
(a)
The following services shall not be covered by community participation
services funding provided by the bureau or the Medicaid home- and community‑based
care waiver:
(1) Custodial care programs provided only to
maintain an individual’s basic welfare;
(2) Sheltered workshops;
(3) Employment or volunteer positions where the
individual is:
a. Being solely supported by persons who are not
providers; and
b. Not receiving any services from a provider
agency at those locations; and
(4) Educational services or education programs
for individuals under 21 years of age for which school districts are
responsible.
(b) When the
community participation services for an individual are phased out at a
volunteer or job site and the individual begins to be supported by non-paid
persons exclusively, as described in (a)(3) above, the provider agency may
include such an arrangement as a part of its billable community participation
service for a maximum of another 120 days.
The staffing resources freed up from such an arrangement may be used to
support the individual in other activities or need areas identified in the
individual’s service agreement.
Source. #2269, eff 1-10-83; ss by #2963, eff 1-22-85;
ss by #4314, eff 9-27-87; ss by #4659, eff 8-4-89; amd by #5864, eff 7-1-94; EXPIRED: 8-4-95
New. #6285, eff 7-12-96, EXPIRED: 7-12-04
New. #8142, INTERIM, eff 8-21-04, EXPIRED: 2-17-05
New. #8324, eff 4-16-05, EXPIRED: 4-16-13
New. #10320, INTERIM, eff 4-25-13, EXPIRES:
10-22-13; ss by #10426, eff 10-1-13
He-M 507.06 Certification.
(a)
To be eligible for reimbursement by the bureau or by Medicaid for
community participation services provided to individuals, community
participation services shall be certified by the department.
(b)
If a provider agency wishes to furnish community participation services
to 3 or more persons who have not been found eligible for area agency services,
the provider agency shall be licensed as an adult day program in accordance
with RSA 151 and He-P 818.
(c)
An entity seeking certification or recertification to provide community
participation services shall submit an application to:
Bureau
of Health Facilities Administration (BHFA)
Hugh J. Gallen State Office Park
129 Pleasant Street, Brown Building
Concord, NH 03301
(d)
Application materials shall include the following:
(1) A completed “Request for Certification of
Community Residence and/or Individual Community Participation Services
Provider” application (September 2013 edition);
(2) A written description of the proposed
staffing pattern necessary to provide services pursuant to He-M 507.04;
(3) The names, titles, qualifications and
relevant experience of all staff members, in accordance with He-M 506.03 and
He-M 507.10;
(4) Written administrative policies and
procedures, which shall comply with He-M 507.08(b); and
(5) If the community participation services are
provided in a centralized service site, a copy of a life safety report which
shall:
a. Have been completed no more than 90 days
prior to submission; and
b. Include:
1. The name and address of the provider agency;
2. The date of
inspection and certification by the local fire inspector that the centralized
service site, if applicable, complies with local fire safety codes;
3. The maximum number of individuals authorized
to receive services; and
4. The signature, title, and professional
affiliation of the local fire inspector.
(e)
For a provider agency requesting initial certification, certification
shall be granted for 90 days from the date the department receives all required
information if the provider agency meets the requirements of, or demonstrates
the capacity to meet the requirements of, He-M 507.04, He-M 507.08 (b), and
He-M 507.10.
(f)
An initial certification review shall be conducted at the provider
agency location by BHFA within 90 days of the effective date of the initial
certificate for the purposes of determining whether or not the community
participation services are in compliance with these rules.
(g)
Initial certification shall be granted from the effective date of the
initial certificate until the last day of the twelfth month following
certification when the provider agency verifies that:
(1) Any necessary corrective action has been
taken; and
(2) The services conform with all applicable
rules adopted by the commissioner.
(h)
For community participation services that are applying for
recertification, BHFA shall conduct a certification review prior to the
expiration date of the certificate. The
current certification shall be effective until recertification has been granted
or denied or unless the current certification is revoked.
(i)
A community participation service program applying for recertification
shall submit a completed application 60 days prior to the expiration of the
certificate.
(j)
The renewal period for certificates shall be one year from the
expiration date of the previous certificate for:
(1) Community participation service programs
certified for 51 or more individuals; and
(2) Community participation service programs
certified for 50 or fewer individuals with 3 or more deficiencies.
(k)
The renewal period for certificates shall be 2 years from the expiration
date of the previous certificate for community participation service programs
certified for 50 or fewer individuals with 2 or fewer deficiencies.
(l)
When a renewal certificate is issued for a period of 2 years, the
provider agency holding the certificate shall conduct a quality assurance
review one year following the issuance to ensure that the community participation
service program remains in compliance with all applicable rules.
(m)
When BHFA staff conduct the 2-year certification review:
(1) If the community participation service
program has documentation of a review pursuant to (l) above, BHFA staff shall:
a. Review such documentation;
b. Cite any deficiency noted during the
agency-conducted quality assurance review that has not been addressed; and
c. Review the community participation service
program’s compliance for the previous year; or
(2) If the community participation service
program lacks documentation of a review pursuant to (l) above, BHFA staff
shall:
a. Cite this as a deficiency; and
b. Hold the entire 2-year period subject to
review.
(n)
Notwithstanding (m) (1) above, any documentation maintained by a
community participation service program during its most recent 2-year
certification period shall be open to review by BHFA staff for compliance with
applicable department rules.
(o)
If deficiencies were cited in the inspection
report, within 21 days of the date of issuance of the report the community
participation service program shall submit a written
plan of correction or submit information demonstrating that the deficiency(ies)
did not exist. The department shall
evaluate any submitted information on its merits and render a written decision
on whether a written plan of correction is necessary.
(p)
The department shall, within 45 days:
(1) Accept a plan of correction or other
information submitted pursuant to (o) above if:
a. The plan:
1. Addresses each identified deficiency in a
manner which achieves full compliance with rules cited in the inspection
report;
2. Does not create
another violation of statute or rule as the result of its implementation;
3. States a completion date; and
4. Identifies a plan for how each deficiency
will be prevented in the future; or
b. The information submitted proves that the
deficiency was cited erroneously; or
(2) Reject a plan of correction or other
information submitted pursuant to (o) above that fails to meet the criteria in
(1) above.
(q)
If the proposed plan of correction is rejected, the department shall
notify the provider agency in writing of the reason(s) for rejection.
(r)
Within 10 business days of the date of the written notice under (q)
above, the provider agency shall submit a revised plan of correction that
includes proposed alternatives that address the reason(s) for rejection.
(s)
The department shall either accept or reject the revised plan in
accordance with (p) above. If the
revised plan of correction is rejected, the department shall deny the certification
request. The provider agency may appeal
the denial pursuant to He-M 507.15.
(t)
The department shall renew a certificate if it determines that:
(1) No deficiencies exist; or
(2) The plan of correction complies with (p) (1)
a. above.
Source. #2269, eff 1-10-83; ss by #2963, eff 1-22-85;
ss by #4314, eff 9-27-87; ss by #4659, eff 8-4-89; EXPIRED:
8-4-95
New. #6285, eff 7-12-96, EXPIRED: 7-12-04
New. #8142, INTERIM, eff 8-21-04, EXPIRED: 2-17-05
New. #8324, eff 4-16-05, EXPIRED: 4-16-13
New. #10320, INTERIM, eff 4-25-13, EXPIRES:
10-22-13; ss by #10426, eff 10-1-13 (from He-M 507.03)
He-M 507.07 Operating Requirements.
(a)
Each individual shall have a written service agreement that includes
goals and desired outcomes and activities specific to his or her community
participation services. Each service
agreement shall meet the requirements of He-M 503.11.
(b)
For each individual receiving community participation services, the
annual service planning meeting shall include a discussion of employment and
volunteer opportunities.
(c)
Individual community participation services shall be designed in
accordance with He-M 503.08 and He-M 503.11.
(d)
Review of each individual’s progress with respect to goals and outcomes
shall be conducted and documented as specified in the service agreement, but
not less than quarterly.
(e)
Participation in all community participation services shall be
voluntary.
(f)
Any person may make a recommendation for termination of services in
accordance with He-M 503.16.
Source. #2269, eff 1-10-83; ss by #2963, eff 1-22-85;
ss by #4314, eff 9-27-87; ss by #4659, eff 8-4-89; EXPIRED:
8-4-95
New. #6285, eff 7-12-96, EXPIRED: 7-12-04
New. #8142, INTERIM, eff 8-21-04, EXPIRED: 2-17-05
New. #8324, eff 4-16-05; amd by #8545, eff 1-24-06;
paras (a)-(d) and (f) expired on 4-16-13; ss by #10320, INTERIM, eff 4-25-13,
EXPIRES: 10-22-13; ss by #10426, eff 10-1-13 (from He-M 507.06)
He-M 507.08 Organization and Administration.
(a) The community participation
services director shall be responsible for the administration of community participation services and the hiring, training, and
supervision of community participation services staff.
(b)
Provider agencies shall have written policies and procedures that
address the following:
(1) The provision of covered services;
(2) Emergency plans, which shall minimally
include:
a. Procedures to follow while at a service site,
in a vehicle, or in the community in case of:
1. Behavioral or medical emergencies of an
individual; or
2. Fire or severe weather; and
b. If individuals gather at a centralized
service site to receive services, an emergency evacuation plan including
provisions in compliance with the following:
1. Each individual shall be oriented to
evacuation procedures upon starting services;
2. If the service site has been evacuated in 3
minutes or less during each of 6 consecutive monthly drills, the provider
agency shall thereafter conduct a drill at least once quarterly;
3. If the service site has not been evacuated in
3 minutes or less during each of 6 consecutive monthly drills, the provider
agency shall conduct monthly drills;
4. For each individual unable to evacuate in 3
minutes or less, the provider agency shall implement a specific evacuation
plan;
5. Evacuation drills shall be held at varied
times of the day;
6. A written record of each drill shall be kept
on file by the provider agency;
7. Staff shall be trained in all aspects of
evacuation procedures; and
8. Staff who conduct training pursuant to 7.
above shall document such training;
(3) A policy for the administration of
medication, which shall comply with the requirements of He-M 1201;
(4) A policy on individual rights in accordance
with He-M 202 and He-M 310; and
(5) If individuals gather at a centralized
service site to receive services, a policy which ensures compliance with
applicable local and state health, zoning, building, and fire codes and
requires documentation of compliance with fire codes.
(c)
Record keeping shall be as follows:
(1) Records shall comply with the requirements of
He-M 310, rights of individuals receiving developmental services in the
community, and He-M 503.10–503.11, service planning and service agreements;
(2) The provider agency shall maintain a separate
record for each individual and records regarding administration of services;
(3) Each individual’s record shall have an
administrative and a service component as described in (d) and (e) below; and
(4) Attendance records, either individual or
collective, shall be kept at the administrative offices of the provider agency
and at the area agency.
(d)
The administrative component of each individual’s record shall include,
for that individual, at least the following:
(1) Personal and identifying information,
including:
a. Name;
b. Address;
c. Phone number;
d. Photo or physical description;
e. Date of birth;
f. Primary language, if other than English, or
communication means and level;
g. Emergency contact;
h. Parent or next of kin;
i. Guardian, if applicable;
j. Home provider, if applicable;
k. Service coordinator; and
l. Health insurance, if any; and
(2) A current health assessment.
(e)
The service component of each individual’s record shall include at least
the following:
(1) A copy of the current service agreement
containing:
a. Goals and desired outcomes specific to the
individual’s participation in community participation services; and
b. The methods or strategies for achieving the
individual’s community participation services’ goals and desired outcomes;
(2) As a guide for planning activities, an
individual, week-long, personal schedule or calendar that is created at the
time of the annual service planning meeting and, if applicable, identifies:
a. The days, times, and locations of the
individual’s:
1. Paid employment;
2. Community activities, volunteerism, or
internship; and
3. Other regularly recurring activities, such as
therapeutic activities related to communication, mobility, and personal care;
and
b. The days and approximate times of unspecified
community activities, which shall not exceed 20% of the total community
participation service hours the individual receives per week;
(3) A record of daily community participation
services activities maintained by the provider agency, including:
a. The name(s) of individual(s) served and names
of staff supporting them;
b. The dates on which services were provided;
and
c. Activities that took place and the locations
of the activities;
(4) Narrative progress notes, and other service
documentation as specified in the service agreement, recorded at least monthly,
and addressing:
a. The individual’s community participation
services goals and actual outcomes; and
b. Other
activities related to the individual’s support services, health, interests,
achievements, and relationships;
(5) The individual’s medical status, including
current medications, known allergies, and other pertinent health care
information;
(6) Results of any screenings or evaluations that
have been conducted, including:
a. The Supports Intensity Scale (2004 edition),
available as noted in Appendix A;
b. Vocational assessments;
c. Results of any assistive technology
assessments;
d. The Health Risk Screening Tool (HRST) (2009
edition), available as noted in Appendix A;
e. START in-depth assessments and crisis plans;
and
f. Risk management plans; and
(7) For each individual for whom medications are
administered during community participation services, medication log
documentation pursuant to He-M 1201.07.
(f)
Records of service operations shall include the following:
(1) A register of current and prior individuals
who received community participation services, including termination dates when
applicable;
(2) A daily census;
(3) Documentation of all incident reports as
defined in He-M 202.02 (o);
(4) Evacuation drill records, if there is a
centralized service site; and
(5) Copies of emergency plans.
(g)
Provider agencies shall have personal injury liability insurance for the
staff and providers and for vehicles used to transport individuals. Proof of insurance shall be on file at the
provider agency premises.
Source. #2269, eff 1-10-83; ss by #2963, eff 1-22-85;
ss by #4314, eff 9-27-87; ss by #4659, eff 8-4-89; EXPIRED:
8-4-95
New. #6285, eff 7-12-96, EXPIRED: 7-12-04
New. #8142, INTERIM, eff 8-21-04, EXPIRED: 2-17-05
New. #8324, eff 4-16-05, EXPIRED: 4-16-13
New. #10320, INTERIM, eff 4-25-13, EXPIRES:
10-22-13; ss by #10426, eff 10-1-13; (from He-M 507.07)
He-M 507.09 Oversight and Quality Improvement.
(a)
The community participation services director shall:
(1) Be responsible for providing oversight; and
(2) Evaluate, facilitate, and improve the quality
of services being delivered and outcomes achieved.
(b)
Each individual’s service coordinator shall provide oversight regarding
the community participation service arrangement and review and facilitate the
effectiveness of the community participation services being provided and
outcomes achieved.
(c)
In fulfilling the responsibilities cited in (a) and (b) above, the
community participation services director and service coordinator shall
determine whether the following criteria are being met and, if not, take
appropriate action:
(1) Services are customized and meet the
interests, goals, and desired outcomes of the individual, as defined in the
service agreement;
(2) Goals reflect the individual’s growth and
evolving interests and are revised accordingly;
(3) The goals and desired outcomes identified in
the service agreement are being achieved;
(4) Staff are knowledgeable of the individual’s
service agreement as it pertains to community participation services and are
assisting in meeting the desired goals and outcomes;
(5) Services occur in integrated settings;
(6) Methods or strategies for achieving the
individual’s community participation services goals and desired outcomes are
evident and documented;
(7) An individual week-long personal schedule or
calendar is present; and
(8) Individuals, and guardians if applicable, are
satisfied with services.
Source. #4659, eff 8-4-89; EXPIRED: 8-4-95
New. #6285, eff 7-12-96, EXPIRED: 7-12-04
New. #8142, INTERIM, eff 8-21-04, EXPIRED: 2-17-05
New. #8324, eff
4-16-05 (formerly He-M 507.08), EXPIRED: 4-16-13
New. #10320, INTERIM, eff 4-25-13, EXPIRES:
10-22-13; ss by #10426, eff 10-1-13 (from He-M 507.08)
He-M 507.10 Staff and Provider Qualifications.
(a)
Community participation services staff, contracted providers, and
consultants shall collectively possess professional backgrounds and
competencies such that the needs of the individuals who receive community participation
services can be met.
(b)
Community participation services shall be provided, in accordance with
each individual’s service agreement, by:
(1) Direct service staff;
(2) Contracted providers;
(3) Consultants;
(4) Professional staff;
(5) Non-professional staff; or
(6) Volunteers.
(c) All personnel identified in (b) above shall
be supervised by professional staff or by the director of community
participation services or his or her designee.
(d) If clinical consultants are
used, they shall be licensed or certified as required by New Hampshire law.
(e) All persons who provide community
participation services shall be at least 18 years of age.
(f) Prior to a person providing community
participation services to individuals, the provider agency, with the consent of
the person, shall:
(1) Obtain at least 2 references for the person;
(2) Complete, at a minimum, a New Hampshire
criminal records check;
(3) If a person’s primary residence is out of
state, complete a criminal records check for their state of residence;
(4) If a person has resided in New Hampshire for
less than one year, complete a criminal records check for their previous state
of residence; and
(5) Complete a motor vehicles record check to
ensure that the person has a valid driver’s license.
(g) Except as allowed in (h)-(i) below, the
provider agency shall not hire a person:
(1) Who has a:
a. Felony conviction; or
b. Any misdemeanor conviction involving:
1. Physical or sexual assault;
2. Violence;
3. Exploitation;
4. Child pornography;
5. Threatening or reckless conduct;
6. Theft;
7. Driving under the influence of drugs or
alcohol; or
8. Any other conduct that represents evidence of
behavior that could endanger the well being of an individual; or
(2) Whose name is on the registry of founded
reports of abuse, neglect, and exploitation pursuant to RSA 161-F:49.
(h)
A provider agency may hire a person with a criminal record listed in
(g)(1)a. or b. above for a single offense that occurred 10 or more years ago in
accordance with (i) and (j) below. In
such instances, the individual, his or her guardian, and the area agency shall
review the person’s history prior to approving the person’s employment.
(i)
Employment of a person pursuant to (h) above shall only occur if such
employment:
(1) Is approved by the individual, his or her
guardian and the area agency;
(2) Does not negatively impact the health or
safety of the individual(s); and
(3) Does not affect the quality of services to
individuals.
(j)
Upon hiring a person pursuant to (h) above, the provider agency shall
document and retain the following information in the individual’s record:
(1) Identification of the region, according to
He-M 505.04, in which the provider agency is located;
(2) The date(s) of the approvals in (h) above;
(3) The name of the individual or individuals for
whom the person will provide services;
(4) The name of the person hired;
(5) Description of the person’s criminal offense;
(6) The type of service the person is hired to
provide;
(7) The provider agency’s name and address;
(8) The certification number and expiration date
of the certified program, if applicable;
(9) A full explanation of why the provider agency
is hiring the person despite the person’s criminal record;
(10) Signature of
the individual(s) or legal guardian(s) indicating agreement with the employment
and date signed;
(11) Signature of the staff person who obtained
the individual’s or guardian’s signature and date signed;
(12) Signature of the area
agency’s executive director or designee approving the employment; and
(13) The signature and phone number of the person
being hired.
Source. #4659, eff 8-4-89; EXPIRED: 8-4-95
New. #6285, eff 7-12-96, EXPIRED: 7-12-04
New. #8142, INTERIM, eff 8-21-04, EXPIRED: 2-17-05
New. #8324, eff 4-16-05 (formerly He-M 507.09),
EXPIRED: 4-16-13
New. #10320, INTERIM, eff 4-25-13, EXPIRES:
10-22-13; ss by #10426, eff 10-1-13
He-M 507.11 Staff and Provider Training.
(a)
Prior to delivering community participation services to an individual,
the provider agency shall orient staff, contracted providers, and consultants
to the needs and interests of the specific individuals they serve, in the
following areas:
(1) Rights and safety;
(2) Health-related requirements including those
related to:
a. Current medical conditions, medical history,
and routine and emergency protocols; and
b. Any special nutrition, dietary, hydration,
elimination, or ambulation needs;
(3) Any communication needs;
(4) Any behavioral supports;
(5) The individuals’ service agreements,
including all goals and desired outcomes and methods or strategies to achieve
the goals and desired outcomes; and
(6) The community participation services’
evacuation procedures, if applicable.
(b)
Provider agencies shall:
(1) Assign staff to work with an experienced
staff member during their orientation if they have had no prior experience
providing services to individuals;
(2) Train staff in accordance with (c) below
within the first 6 months of employment; and
(3) Provide staff with training in accordance
with their annual individual staff development plans.
(c)
A provider agency shall train staff in the following areas within the
first 6 months of employment:
(1) An overview of developmental disabilities and
acquired brain disorders, which shall include:
a. An overview of the different types of
disabilities and their causes;
b. An overview of the local and state service
delivery system; and
c. An overview of professional services and
technologies including therapies, assistive technologies, and environmental
modifications necessary to achieve individuals' goals in the community, in the
workplace, in recreation or leisure activities, and at home;
(2) An overview of conditions promoting or
detracting from the quality of life that individuals enjoy, which shall:
a. Aid staff to develop an understanding of the
stigmas, negative labels and common life experiences of people with
disabilities; and
b. Aid staff to gain the competencies necessary
to:
1. Support individuals to obtain and maintain
valued social roles;
2. Support individuals to build relationships
with their families, neighbors, co-workers and other community members;
3. Create and enhance opportunities for
individuals to:
(i) Increase their presence in the life of their
local communities; and
(ii) Increase the ways in which they contribute to
their communities;
4. Support individuals to have as much control
as possible over their own life;
5. Build individuals’ skills, strengths and
interests that are functional and meaningful in natural community environments;
and
6. Create conditions that provide opportunities
for individuals to experience and participate in a wide range of community
organizations and resources;
(3) Methods to assist individuals with
challenging behaviors utilizing positive behavioral supports;
(4) Techniques to:
a. Facilitate social relationships; and
b. Enhance skills that improve everyday living
and promote independence;
(5) Basic health and safety practices related to:
a. Personal wellness;
b. Success in living, working, and recreating in
the community; and
c. An understanding of the importance of common
signs and symptoms of illness; and
(6) Skills necessary to support individuals to:
a. Make their own decisions;
b. Advocate for themselves; and
c. Create their own social networks.
Source. #2269, eff 1-10-83; ss by #2963, eff 1-22-85;
ss by #4314, eff 9-27-87; ss by #4659, eff 8-4-89; EXPIRED:
8-4-95
New. #6285, eff 7-12-96, EXPIRED: 7-12-04
New. #8142, INTERIM, eff 8-21-04, EXPIRED: 2-17-05
New. #8324, eff
4-16-05 (formerly He-M 507.10), EXPIRED: 4-16-13
New. #10320, INTERIM, eff 4-25-13, EXPIRES:
10-22-13; ss by #10426, eff 10-1-13 (from He-M 507.09)
He-M 507.12 Prior Authorization of Community
Participation Services.
(a)
In order to receive community participation services, an individual
shall have a developmental disability or acquired brain disorder and a written
service agreement that includes one or more goals and desired outcomes for
community participation services.
(b)
An agency intending to provide community participation services to an
individual through the Medicaid program shall request prior authorization using
the procedure outlined in He-M 517.08 (b).
Source. #4659, eff 8-4-89; EXPIRED: 8-4-95
New. #6285, eff 7-12-96, EXPIRED: 7-12-04
New. #8142, INTERIM, eff 8-21-04, EXPIRED: 2-17-05
New. #8324, eff 4-16-05 (formerly He-M 50711),
EXPIRED: 4-16-13
New. #10320, INTERIM, eff 4-25-13, EXPIRES:
10-22-13; ss by #10426, eff 10-1-13
He-M 507.13 Denial or Revocation of Certification.
(a)
The department shall deny an application for certification or issue a
notice of intent to revoke certification, following written notice pursuant to
(b) below and opportunity for a hearing pursuant to He-C 200, due to any of the
following reasons:
(1) Any reported abuse, neglect, or exploitation
of an individual by an applicant, provider, provider agency, or community
participation services staff, if:
a. Such abuse, neglect, or exploitation is
reported on the state registry of abuse, neglect, and exploitation in
accordance with RSA 161-F:49;
b. Such person(s) continues to have contact with
the individual; and
c. A waiver has not been received pursuant to
He-E 720.05;
(2) Except as provided in He-M 507.10(g)-(h), any
applicant, provider, provider agency, or community participation services staff
for whom He-M 507.10(f)(1) or (2) is true;
(3) A provider agency or area agency fails to
conduct criminal records check on all persons who are paid to provide services
under He-M 507;
(4) An applicant, provider, provider agency, or
community participation services staff has an illness or behavior that, as
evidenced by the documentation obtained or the observations made by the
department, would endanger the well-being of the individuals or impair the
ability of the provider agency to comply with department rules;
(5) An applicant or provider agency, or any
representative or employee thereof, knowingly provides materially false or
misleading information to the department;
(6) An applicant or provider agency, or any
representative or employee thereof, fails to permit or interferes with any
inspection or investigation by the department;
(7) An applicant or provider agency, or any
representative or employee thereof, fails to provide required documents to the
department;
(8) At an inspection the applicant or provider
agency is not in compliance with RSA 171-A or He-M 507 or other applicable
rules; or
(9) As a result of certification review, the
applicant or provider agency or certificate holder is not in compliance with
RSA 171-A or He-M 507 or other applicable rules and:
a. The applicant or provider agency failed to
fully implement and continue to comply with a plan of correction that has been
accepted by the department in accordance with He-M 507.06 (p); or
b. The applicant or provider agency has
submitted a revised plan of correction that has been rejected by the department
in accordance with He-M 507.06 (s).
(b)
Certification shall be denied or revoked upon the written notice by the
department to the applicant or provider agency stating the specific rule(s)
with which the provider agency does not comply.
(c)
Any applicant or provider agency aggrieved by the denial or revocation
of certification may request an adjudicative proceeding in accordance with He-M
507.15. The denial or revocation shall
not become final until the period for requesting an adjudicative proceeding has
expired or, if the applicant or provider agency requests an adjudicative
proceeding, until such time as the administrative appeals unit issues a
decision upholding the department’s action.
(d)
Pending compliance with all requirements for certification specified in
the written notice made pursuant to (b) above, a provider agency shall not
accept additional individuals if a notice of revocation has been issued
concerning a violation which presents potential danger to the health or safety
of the individuals being served.
(e)
If certification has been revoked, the provider agency shall transfer
all individuals to another appropriately certified community participation
service program within 10 days of certificate revocation becoming final in
accordance with (c) above
Source. #6285, eff 7-12-96, EXPIRED: 7-12-04
New. #8142, INTERIM, eff 8-21-04, EXPIRED: 2-17-05
New. #8324, eff 4-16-05, EXPIRED: 4-16-13
New. #10320, INTERIM, eff 4-25-13, EXPIRES:
10-22-13; ss by #10426, eff 10-1-13 (from He-M 507.11)
He-M 507.14 Immediate Suspension of Certification.
(a)
Notwithstanding the provision of He-M 507.13(c), in the event that a
violation poses an immediate and serious threat to the health or safety of an
individual, the department shall, in accordance with RSA 541-A:30, III, suspend
a provider agency’s certification immediately upon issuance of written notice
specifying the reasons for the action.
(b)
The department shall schedule and hold a hearing within 10 working days
of the suspension for the purpose of determining whether to revoke or reinstate
the provider agency’s certification. The
hearing shall provide opportunity for the provider agency whose certification
has been suspended to demonstrate that it has been, or is, in compliance with
the specified requirements.
Source. #6285, eff 7-12-96, EXPIRED: 7-12-04
New. #8142, INTERIM, eff 8-21-04, EXPIRED: 2-17-05
New. #8324, eff
4-16-05 (formerly He-M 507.13), EXPIRED: 4-16-13
New. #10320, INTERIM, eff 4-25-13, EXPIRES:
10-22-13; ss by #10426, eff 10-1-13 (from He-M 507.12)
He-M 507.15 Appeals.
(a)
An applicant for certification, provider, provider agency, or area
agency may request a hearing regarding a proposed revocation or denial of
certification, except as provided in He‑M 507.14 above.
(b)
Appeals shall be submitted, in writing, to the bureau administrator in
care of the department’s office of client and legal services within 10 days
following the date of the notification of denial or revocation of
certification.
(c)
The bureau administrator or his or her designee shall immediately
forward the appeal to the department’s administrative appeals unit which shall
assign a presiding officer to conduct a hearing or independent review, as
provided in He-C 200. The burden of
proof shall be as required in He-C 203.14.
Source. #8324, eff 4-16-05 (formerly He-M 507.14),
EXPIRED: 4-16-13
New. #10320, INTERIM, eff 4-25-13, EXPIRES:
10-22-13; ss by #10426, eff 10-1-13 (from He-M 507.13)
He-M 507.16 Prior Authorization and Payment.
(a)
In order to receive Medicaid reimbursement for community participation
services, area agencies, as the enrolled providers of home and community‑based
care services, shall submit claims for payment to:
ACS Xerox
250 Commercial
Street, #1
Manchester, NH
03101
(b)
Payment for Medicaid waiver services shall only be made if prior
authorization has been obtained from the bureau pursuant to He-M 517.08.
(c)
Requests for prior authorization shall be made in writing to:
Division of
Community Based Care Services
Bureau of
Developmental Services
State Office Park
South
105 Pleasant
Street
Concord, NH 03301
Source. #10426, eff 10-1-13
He-M 507.17 Waivers.
(a) An applicant,
area agency, provider agency, individual, guardian, or provider may request a
waiver of specific procedures outlined in He-M 507 using the form titled “NH
bureau of developmental services waiver request” (September 2013
edition). The
area agency shall submit the request in writing to the bureau administrator.
(b) A completed waiver
request form shall be signed by:
(1) The individual or guardian indicating
agreement with the request; and
(2) The area agency’s executive director or
designee recommending approval of the waiver.
(c) A waiver request shall be submitted to:
Office of Client and Legal Services
Hugh J. Gallen State Office Park
105 Pleasant Street, Main Building
Concord, NH 03301
(d)
No provision or procedure prescribed by statute shall be waived.
(e)
The request for a waiver shall be granted by the commissioner or his or
her designee within 30 days if the alternative proposed by the requesting
entity meets the objective or intent of the rule and it:
(1) Does not negatively impact the health or
safety of the individual(s); and
(2) Does not affect the quality of services to
individuals.
(f)
Upon receipt of approval of a waiver request, the requesting entity’s
subsequent compliance with the alternative provisions or procedures approved in
the waiver shall be considered compliance with the rule for which waiver was
sought.
(g)
Waivers shall be granted in writing for a specific duration not to
exceed 5 years except as in (h) and (j) below.
(h)
Those waivers which relate to other issues relative to the health,
safety or welfare of individuals that require periodic reassessment shall be
effective for the current certification period only.
(i)
Any waiver shall end with the closure of the related program or service.
(j)
A requesting entity may request a renewal of a waiver from the
bureau. Such request shall be made at
least 90 days prior to the expiration of a current waiver.
Source. #10426, eff 10-1-13 (from He-M 507.15)
PART He-M 508 -
RESERVED
PART He-M 509 -
RESERVED
PART He-M 510 FAMILY-CENTERED EARLY SUPPORTS AND SERVICES
Statutory
Authority: RSA 171-A:18, IV; Part C of
Public Law 108-446, Individuals with Disabilities Education Improvement Act
(IDIEA) of 2004 (20 U.S.C. 1400 et seq.)
REVISION NOTE:
Document #5745, effective 12-1-93,
made extensive changes to the wording, format, structure, and numbering of
rules in Part He-M 510. Document #5745
supersedes all prior filings for the sections in this part. The prior filings for former Part 510 include
the following documents:
#2117, eff 8-1-82
#2663, eff 3-30-84
#2780, eff 7-24-84
EXPIRED 7-24-90
He-M
510.01 Purpose. In its role as designated lead
agency for the implementation of federally mandated Part C of Public Law
108-446 Individuals with Disabilities Education Improvement Act (IDEIA) of
2004, 20 U.S.C. 1400 et seq., the department establishes these minimum
standards for family-centered early supports and services
(FCESS). These services are provided in natural environments as part
of a comprehensive array of supports and services for families and their
children, as defined in He-M 510.02 (g), residing throughout New Hampshire.
Source. (See Revision Note at part heading for He-M
510) #5745, eff 12-1-93, EXPIRED: 12-1-99
New. #7234, eff 4-22-00; ss by #9135, INTERIM, eff
4-22-08, EXPIRED: 10-19-08
New. #9594, eff 11-11-09; ss by #10325, eff
4-26-13; ss by #13753, eff 9-27-23
He-M
510.02 Definitions. The words and phrases used in
these rules shall have the following meanings:
(a) “Applicant”
means any person under the age of 3 whose parent requests services pursuant to
He-M 510.06;
(b) “Area
agency” means “area agency” as defined in RSA 171-A:2, I-b, namely, “an entity
established as a nonprofit corporation in the state of New Hampshire which is
established by rules adopted by the commissioner to provide services to
developmentally disabled persons in the area in accordance with 42 CFR
441.301.”;
(c) “Assessment”
means the procedures used by personnel, as identified in He-M 510.11 (b)(1),
throughout the period of a child’s application and
eligibility under this part to identify the child’s unique strengths and needs
and the services appropriate to meet those needs, and includes:
(1) A
review of the multidisciplinary evaluation described in He-M 510.06
(k);
(2) Personal
observations of the child; and
(3) The
identification of the child’s needs in each of the following areas:
a. Physical development, including vision, hearing, or both;
b. Cognitive development;
c. Communication development;
d. Social
or emotional development; and
e. Adaptive
development;
(d) “Assistive technology
device” means any item, piece of equipment or product, whether acquired
commercially “off the shelf”, modified, or customized, that is used to
increase, maintain, or improve the functional capabilities of a child. The
term does not include medical devices that are surgically implanted, or the
optimization, such as mapping, maintenance, or replacement of such devices.
(e)
“At risk for substantial developmental delay” means a child is a
substance-exposed newborn, or experiences 3 or more of the following, as reported by the family and documented by
personnel listed in He-M 510.11 (b)(1):
(1) Documented
conditions, events, or circumstances affecting the child including:
a. Birth
weight less than 4 pounds;
b. Respiratory distress syndrome;
c. Gestational
age less than 27 weeks or more than 44 weeks;
d. Asphyxia;
e. Infection;
f. History
of abuse or neglect;
g. Prenatal
drug exposure due to mother’s substance abuse or withdrawal;
h. Prenatal
alcohol exposure due to mother’s substance abuse or withdrawal;
i. Nutritional problems that interfere with growth and development;
j. Intracranial hemorrhage grade III or IV; or
k. Homelessness; or
(2) Documented
conditions, events, or circumstances affecting a parent, including:
a. Developmental
disability;
b. Psychiatric
disorder;
c. Family
history of lack of stable housing;
d. Education less
than 10th grade;
e. Social
isolation;
f. Substance
misuse or abuse;
g. Age
of either parent less than 18 years;
h. Parent
and child interactional disturbances; or
i. Founded
child abuse or neglect as determined by a district court pursuant to RSA
169-C:21;
(f) “Atypical
behavior” means behavior reported by the family and documented by personnel
listed in He-M 510.11 (b)(1) that includes one or more of the following:
(1) Extreme
fearfulness or other modes of distress that do not respond to comforting by
caregivers;
(2) Self-injurious
or extremely aggressive behaviors;
(3) Extreme
apathy;
(4)
Unusual and persistent patterns of inconsolable crying, chronic sleep
disturbances, regressions in functioning, absence of pleasurable interest in
adults and peers, or inability to communicate emotional needs; or
(5) Persistent
failure to initiate or respond to most social situations;
(g) “Child” means an infant or toddler with a disability who is under
3 years of age and:
(1) Is
at risk for or has a developmental delay;
(2) Exhibits
atypical behavior; or
(3) Has
an established condition;
(h) “Commissioner”
means the commissioner of the New Hampshire department of health and
human services or their designee;
(i) “Consent” means that:
(1) The
parent has been fully informed, in the parent’s native language or other mode
of communication, of all information relevant to the activity for which
approval is sought;
(2) The
parent understands and agrees to, in writing, the carrying out of the activity
for which the parent’s approval is sought;
(3) The
written approval describes the approved activity and lists the records, if any,
that will be released and to whom; and
(4) The
parent understands that the granting of approval is voluntary on the part of
the parent, can be revoked at any time, and that revocation of approval is not
retroactive;
(j)
“Department” means the New Hampshire department of health
and human services;
(k) “Developmental delay” means that a child has a 33% delay in one or more
of the following areas as determined through completion of the
multidisciplinary evaluation pursuant to He-M 510.06 (k):
(1) Physical
development, including vision, hearing, or both;
(2) Cognitive
development;
(3) Communication
development;
(4) Social
or emotional development; or
(5) Adaptive
development;
(l) “Division for Children, Youth and Families (DCYF)” means the
organizational unit of the department of health and human services that
provides services to children and youth referred by courts pursuant to RSA
169-A, RSA 169-B, RSA 169-C, RSA 169-D, and RSA 463;
(m) “Early intervention specialist”
means an individual certified by the bureau in accordance with the criteria in
He-M 510.11 (k)-(m);
(n) “Established condition” means that a child has a diagnosed physical or
mental condition that has a high probability of resulting in a developmental
delay, even if no delay exists at the time of referral, as documented by the
family and personnel listed in He-M 510.11 (b)(1), including, at a minimum,
conditions such as:
(1) Chromosomal
anomaly or genetic disorder;
(2) Inborn errors of
metabolism;
(3) A
congenital malformation;
(4) A
severe infectious disease;
(5) A
neurological disorder;
(6) A
sensory impairment;
(7) A
severe attachment disorder;
(8) Fetal
alcohol spectrum disorder;
(9) Lead
poisoning; or
(10) Toxic
exposure;
(o) “Family-centered
early supports and services (FCESS)” means a wide range of activities and
assistance, based on peer-reviewed research to the extent practicable, that
develops and maximizes the family’s and other caregivers’
ability to care for the child and to meet the child’s needs in a flexible
manner;
(q) “Family-centered
early supports and services (FCESS) program” means a program under contract
with the department to provide FCESS as defined in these rules;
(r) “Family
support council” means the regional council established pursuant
to RSA 126-G:4;
(s) “Foster
parent” means a person with whom a child lives and who is
licensed pursuant to He-C 6446 and certified pursuant to He-C 6347;
(t) “Frequency and intensity” means the number of days or sessions a
service will be provided and whether the service will be provided on an individual or group basis;
(u) “Homeless children” means children under the age of 3 years who meet
the definition given the term “homeless children and youths” in section 725 (42
U.S.C. 11434a) of the McKinney-Vento Homeless Assistance Act, as amended, 42
U.S.C. 11431 et seq;
(v) “Individualized
family support plan (IFSP)” means a written plan developed in accordance with
He-M 510.07 for providing supports and services to an eligible child and family;
(w) “Informed clinical opinion” means the conclusion of a professional
identified pursuant to He-M 510.11 (b)(1) based on:
(1) Parent
observations of the child as reported to the professional;
(2) Parent
reports of the child’s developmental history;
(3) The
professional’s multiple and direct observations of the child at home or in
other community settings;
(4) The
professional’s review of pertinent records related to the child’s current
health status and medical history; and
(5) Formal
measures of the child’s activities and interactions with others;
(x) “Length” means the period of time the service is provided during
each session of that service;
(y) “Local
education agency (LEA)” means “local education agency” as defined in
Ed 1102.03 (n);
(z) “Medical home” means a model of delivering primary care that is
accessible, continuous, comprehensive, family-centered, coordinated,
compassionate, and culturally effective;
(aa) “Method”
means how a service is provided;
(ab) “Multidisciplinary” means the involvement of 2 or more individuals from
separate disciplines or professions;
(ac) “Native language” means:
(1) The
language normally used by the parent of the child in the home; or
(2) For
a child with deafness or blindness, or for a family with no written language,
the mode of communication normally used by the child and family such as sign
language, Braille, or oral communication;
(ad) “Natural
environment” means places and situations where the child’s age peers without
disabilities live, play, and grow;
(ae) “Natural supports” means people including but not limited to
family, relatives, friends, neighbors,
childcare providers, clergy, and social groups such as religious
organizations, co-workers, and social clubs, available to provide assistance as
part of everyday living as well as during critical events;
(af)
“Notification” means referral of a child to the LEA and the NH
department of education;
(ag) “Parent” means:
(1) A
biological or adoptive parent of a child; or
(2) As
identified in a judicial decree or when the biological or adoptive parent does
not have legal authority to make educational or FCESS decisions on behalf of
the child:
a. A
guardian authorized to act as the child’s parent, or authorized to make early
intervention, educational, health, or developmental decisions for the child,
but not the state if the child is in the custody of the New Hampshire division
for children, youth, and families;
b. A
foster parent as defined in (s) above;
c. An individual
acting in the place of a biological or adoptive parent, including a
grandparent, stepparent, or other relative with whom the child lives;
d. A
surrogate parent as defined in (aq) below; or
e. Any other individual who is legally responsible for the
child’s welfare;
(ah) “Personally identifiable information” means:
(1) The
name of the parent(s);
(2) The
name of the child or other family members;
(3) The
address of the child;
(4) A
personal identifier such as the parent or child’s social security number; or
(5) A
list of personal characteristics, or other information that would make it
possible to identify the child or family with reasonable certainty;
(ai) “Potentially eligible” means that an estimation has been made by the
IFSP team, as described in He-M 510.07 (c), that a child might be eligible to
receive preschool special education services from the child’s LEA;
(aj) “Provider” means a person receiving any form of remuneration for the
provision of services to a child or family applying for or receiving FCESS
under He-M 510;
(ak) “Record” means, in accordance with the Family Educational Rights
and Privacy Act (FERPA) and 34 CFR 99.3, any information recorded in any way
including, but not limited to:
(1) Handwriting;
(2) Print;
(3) Computer
media;
(4) Video
or audio tape;
(5) Email;
(6) Text
message; and
(7) Any
other electronically stored information;
(al) “Region” means a geographic area designated pursuant to He-M
505.04 for the purpose of providing services to individuals with developmental
disabilities and their families;
(am) “Scientifically-based research” means “scientifically-based research” as
defined in the Elementary and Secondary Education Act (ESEA), Title IX, Part A,
section 9101(37) and 20 U.S.C. 7801(37);
(an) “Service coordinator” means a person who:
(1) Is
chosen or approved by the parent of the child;
(2) Is
identified in He-M 510.11(b);
(3) Together
with the family has the responsibility of planning, accessing, coordinating,
and monitoring the delivery of services for an eligible child’s and family; and
(4) Possesses
experience relevant to carrying out applicable responsibilities for the child
and family’s needs under He-M 510;
(ao) “Setting” means the
actual place(s) the services will be provided;
(ap)
“Substance-exposed newborn” means “substance-exposed newborn” as defined
in RSA 171-A:18-a, namely, “a newborn who was exposed to
alcohol, or other drugs in utero, which may have adverse effects, whether or
not this exposure is detected at birth through a drug screen or withdrawal
symptoms.”; and
(aq) “Surrogate parent” means a person who:
(1) Is
appointed by the lead agency;
(2) Is
trained by the lead agency regarding FCESS; and
(3) Acts
as a child’s advocate in the FCESS decision-making process, including the
transition to art B services, in place of the child’s:
a. Biological
parents;
b. Adoptive
parents; or
c. Guardian.
Source. (See Revision Note at part heading for He-M
510) #5745, eff 12-1-93, EXPIRED: 12-1-99
New. #7234, eff 4-22-00; amd by #7822, eff 2-8-03;
ss by #9135, INTERIM, eff 4-22-08, EXPIRED: 10-19-08
New. #9594, eff 11-11-09; ss by #10325, eff 4-26-13;
ss by #13753, eff 9-27-23
He-M
510.03 Family-Centered Support and Service
Categories.
(a) Assistive
technology services shall directly assist a child in the selection,
acquisition, or use of an assistive technology
device, including:
(1) The
evaluation of the needs of a child, including a functional evaluation of the
child in the child’s customary environment;
(2) Purchasing,
leasing, or otherwise providing for the acquisition of assistive technology
devices by the family;
(3) Selecting,
designing, fitting, customizing, adapting, applying, maintaining, repairing, or
replacing assistive technology devices;
(4) Coordinating
and using other therapies, interventions, supports, or services with assistive
technology devices, such as those associated with existing IFSPs;
(5) Training
or technical assistance for a child or, if appropriate, that child’s family;
and
(6) Training
or technical assistance for professionals, including persons providing FCESS
and other persons who provide services to, or are otherwise substantially
involved in the major life functions of, children.
(b) Audiology services shall include:
(1) Identification
of children with auditory impairments, using at risk criteria and appropriate
audiologic screening techniques;
(2) Determination
of the range, nature, and degree of hearing loss and communication functions,
by use of audiological evaluation procedures;
(3) Referral
for medical and other services necessary for the habilitation or rehabilitation
of children with auditory impairment;
(4) Provision
of auditory training, aural rehabilitation, speech reading, and listening
device orientation and training, and other services;
(5) Provision
of services for prevention of hearing loss; and
(6) Determination
of the child’s need for individual amplification, including selecting, fitting,
and dispensing appropriate listening and vibrotactile devices, and evaluating
the effectiveness of those devices.
(c) Family
training, counseling, and home visits shall include assistance to the family in
understanding the special needs and building on the
interests of the child and enhancing the child’s development.
(d) Health services shall include services necessary to enable a
child to benefit from the other FCESS under He-M 510 during the time that the
child is eligible to receive other FCESS, including:
(1) Such
services as clean intermittent catheterization, tracheotomy care, tube feeding,
the changing of dressings or colostomy collection bags, and other health
services; and
(2) Consultation
by physicians with other FCESS providers concerning the special health care
needs of children that will need to be addressed in the course of providing
other FCESS.
(e) Health
services shall not include:
(1) Services
that are surgical in nature, such as cleft palate surgery, surgery for club
foot, or the shunting of hydrocephalus;
(2) Services
that are purely medical in nature, such as hospitalization for management of
congenital heart ailments or the prescribing of medicine or drugs for any
purpose;
(3) Services
related to the implementation, maintenance, replacement, or optimization, such
as mapping, of a medical device that is surgically implanted, including
cochlear implants;
(4) Devices
such as heart monitors, respirators and oxygen, and gastrointestinal feeding
tubes and pumps necessary to control or treat a medical condition; or
(5) Medical-health
services, such as immunizations and regular “well baby” care, that are
routinely recommended for all children.
(f) Nothing in He-M 510 shall:
(1) Limit
the right of a child who has a surgically implanted device, such as a cochlear
implant, to receive the early supports and services that are identified in the
child’s IFSP as necessary to meet the child’s developmental outcomes; or
(2) Prevent
the provider from routinely checking that either the hearing aid or the
external components of a surgically implanted device, such as a cochlear
implant, of a child are functioning properly.
(g) Medical services shall include services provided by a licensed
physician for diagnostic or evaluation purposes to determine a child’s
developmental status and need for FCESS.
(h) Nursing
services shall include:
(1) The
assessment of a child’s health status for the purpose of providing nursing
care, including the identification of patterns of human response to actual or
potential health problems;
(2) Provision
of nursing care to prevent health problems, restore or improve functioning, and
promote optimal health and development; and
(3) The
administration of medications, treatments, and regimens prescribed by a
licensed physician or an advanced practice registered nurse (APRN) in
accordance with RSA 326-B:11, III.
(i) Nutrition services shall include:
(1) Conducting
individual assessments in:
a. Nutritional
history and dietary intake;
b. Anthropometric,
biochemical, and clinical variables;
c. Feeding
skills and feeding problems; and
d. Food
habits and preferences;
(2) Developing
and monitoring appropriate plans to address the nutritional needs of children
based on the findings in (i)(1) above; and
(3) Making
referrals to appropriate community resources to carry out nutrition goals.
(j) Occupational therapy shall be services that:
(1) Address
the functional needs of a child related to adaptive development, adaptive
behavior and play, and sensory, motor, and postural development;
(2) Are
designed to improve the child’s functional ability to perform tasks in home,
school, and community settings; and
(3) Include:
a. Identification,
assessment, and provision of needed supports and services;
b. Adaptation
of the environment and selection, design, and fabrication of assistive and
orthotic devices to facilitate development and promote the acquisition of
functional skills; and
c. Prevention
or minimization of the impact of initial or future impairment, delay in
development, or loss of functional ability.
(k) Physical therapy shall be services that:
(1) Address
the promotion of sensorimotor function through enhancement of:
a. Musculoskeletal
status;
b. Neurobehavioral
organization;
c. Perceptual
and motor development;
d. Cardiopulmonary
status; and
e. Effective
environmental adaptation; and
(2) Include:
a. Screening,
evaluation, and assessment of children to identify movement dysfunction;
b. Obtaining,
interpreting, and integrating information to prevent, alleviate, or compensate
for movement dysfunction and related functional problems; and
c. Providing
individual and group services to prevent, alleviate, or compensate for movement dysfunction and related functional problems.
(l) Preventative
and diagnostic services shall be early and periodic screening, diagnosis, and
treatment services as specified in He-W 546.05 (a)
and (b).
(m) Psychological
services shall include:
(1) Administering
psychological and developmental tests and other assessment procedures;
(2) Interpreting
assessment results;
(3) Obtaining,
integrating, and interpreting information about child behavior and child and
family conditions related to learning, mental health, and development; and
(4) Planning
and managing a program of psychological services, including:
a. Psychological
counseling for children and parents;
b. Family
counseling;
c. Consultation
on child development;
d. Parent
training; and
e. Education
programs.
(n) Service coordination shall:
(1) Be
services provided by a service coordinator to assist and enable a child and the
child’s family to receive the services and rights, including procedural
safeguards, required under this part, He-M 203, and He-M 310;
(2) Be
an active, ongoing process that involves:
a. Assisting
parents of children in gaining access to, and coordinating the provision of,
the FCESS required under this part; and
b. Coordinating
the other services identified in the IFSP that are needed by, or are being
provided to, the child and that child’s family; and
(3) Include:
a. Coordinating
all services required under this part across agency lines;
b. Serving
as the single point of contact for carrying out the activities described in c.
– l. below;
c. Assisting
parents of children in obtaining access to needed supports and services and
other services identified in the IFSP, including making referrals to providers
for needed services and scheduling appointments for children and their families;
d. Coordinating
the provision of FCESS and other services, such as educational, social, and
medical services that are not provided for diagnostic or evaluative purposes,
that the child needs or are being provided;
e. Coordinating
evaluations and assessments;
f. Facilitating and participating in the development, review, and
evaluation of IFSPs;
g. Conducting
referral and other activities to assist families in identifying available
providers;
h. Coordinating,
facilitating, and monitoring the delivery of services required under this part
to ensure that the services are provided in a timely manner;
i. Conducting
follow-up activities to determine that appropriate services are being provided;
j. Informing
families of their rights and procedural safeguards, as set forth in He-M 203
and He-M 310, and related resources, including organizations with their
addresses and telephone numbers that might be available to provide legal
assistance and advocacy, such as the Disabilities Rights Center, Inc. and NH
Legal Assistance;
k. Coordinating
the funding sources for services required under this part; and
l. Facilitating
the development of a transition plan to preschool, school, or, if appropriate,
to other services.
(o) Use
of the term “service coordination” or “service coordination services” by an
FCESS program or provider shall not preclude characterization of the services
as case management or any other service that is covered by another payor of
last resort, such as Title XIX of the Social Security Act—Medicaid, for
purposes of claims in compliance with the requirements of 34 CFR 303.501 through 303.521.
(p) Sign
language and cued language services shall include:
(1) Teaching
sign language, cued language, and auditory and oral language;
(2) Providing
oral transliteration services, such as amplification; and
(3) Providing
sign and cued language interpretation.
(q) Social
work services shall include:
(1) Home
visits to evaluate a child’s living conditions and patterns of parent-child
interaction;
(2) Preparing
a social or emotional developmental assessment of the child within the family
context;
(3) Providing
individual and family counseling with parents and other family members and
appropriate social skill building activities with the child and parents;
(4) Working
with the family to resolve problems in the family’s living situation, home, or
community that affect the child’s and family’s maximum utilization of FCESS;
and
(5) Identifying,
mobilizing, and coordinating community resources and services to enable the
child and family to receive maximum benefit from
FCESS.
(r) Special instruction shall include:
(1) Designing
learning environments and activities that promote the child’s acquisition of
skills in a variety of developmental areas, including cognitive processes and
social interaction;
(2) Curriculum
planning, including the planned interaction of personnel, materials, and time
and space, that leads to achieving the outcomes in the IFSP;
(3) Providing
families with information, skills, and support related to enhancing the skill
development of the child; and
(4) Working
with the child to enhance the child’s development.
(s) Speech-language
pathology services shall include:
(1) Identification
of children with communicative or language disorders and delays in development
of communication skills, including the diagnosis and appraisal of specific
disorders and delays in those skills;
(2) Referral
for medical or other professional services necessary for the habilitation or
rehabilitation of children with communicative or language disorders and delays
in development of communication skills; and
(3) Provision
of services for the habilitation, rehabilitation, or prevention of
communication or language disorders and delays in development of communication
skills.
(t) Transportation
services shall include reimbursing the family for the cost of travel such as
mileage, or travel by taxi, common carrier, or other means, and other related
costs such as tolls and parking expenses, that are necessary to enable an
eligible child and the child’s family to receive FCESS.
(u) Vision services shall include:
(1) Evaluation
and assessment of visual functioning, including the diagnosis and appraisal of
specific visual disorders, delays, and abilities that affect early childhood
development;
(2) Referral
for medical or other professional services necessary for the habilitation or
rehabilitation of visual functioning disorders, or both; and
(3) Communication
skills training, orientation and mobility training for all environments, visual
training, independent living skills training, and additional training necessary
to activate visual motor abilities.
(v) The
services and personnel identified and defined in (a)-(u) above shall not
comprise exhaustive lists of the types of services that may constitute FCESS or
the types of qualified personnel that may provide FCESS. Nothing in
this section shall prohibit the identification in the IFSP of another type of
service as an FCESS provided that the service meets the criteria in He-M 510.04.
(w) Children
and families who qualify for services under He-M 510 may have access to respite
services under He-M 513 and He-M 519 as well as other services authorized by
the department that meet the intent and purpose and are consistent with
evidence-based nationally recognized treatment standards.
Source. (See Revision Note at part heading for He-M
510) #5745, eff 12-1-93, EXPIRED: 12-1-99
New. #7234, eff 4-22-00; amd by #7822, eff 2-8-03;
ss by #9135, INTERIM, eff 4-22-08, EXPIRED: 10-19-08
New. #9594, eff 11-11-09; ss by #10325, eff
4-26-13; ss by #13753, eff 9-27-23
He-M
510.04 Provision of Supports and Services.
(a) FCESS shall:
(1) Be
selected in collaboration with parents and provided under public supervision by
personnel qualified pursuant to He-M 510.11;
(2) Be
provided under the system of payment described in He-M 510.14;
(3) Include
those of the services listed in He-M 510.03 (a)-(u), and other services
provided by personnel identified in He-M 510.11 (b), that meet the
developmental needs of the child and family and enhance the child’s
development;
(4) Comply
with state laws regulating the professional practice of persons providing
services, as well as the requirements of Part C of the IDEIA;
(5) To
the maximum extent appropriate, be provided in natural environments; and
(6) Be
provided in conformity with an IFSP.
(b) FCESS
shall be provided in a variety of natural environments where children and
families of the community gather, such as:
(1) The
family’s own home;
(2) Neighborhood
playgrounds;
(3) Child
care settings;
(4) Foster
placements;
(5) Relatives’
or friends’ homes;
(6) Libraries;
(7) Recreational
programs;
(8) Places
of worship;
(9) Grocery
stores;
(10) Shopping
malls; and
(11) Other
similar settings.
(c) FCESS shall incorporate the concerns, priorities, and resources
of the family to:
(1) Identify
and promote the use of natural supports as a principal way of assisting in the
development of the child, including supports from:
a. Relatives;
b. Fiends;
c. Neighbors;
d. Co-workers;
and
e. Cultural,
ethnic, or religious organizations;
(2) Foster
the family’s capacity to make decisions and provide care and learning
opportunities for their child;
(3) Respect
the cultural and ethnic beliefs and traditions, and the personal values and
lifestyle of the family;
(4) Respond
to the changing needs of the family and to critical transition points in the
family’s life; and
(5) Facilitate
access to community resources to support families and link them with other
families with similar concerns and interests.
(d) FCESS
shall include training, support, evaluation, special
instruction, and therapeutic services that maximize the family’s and other
caregivers’ ability to understand and care for the child’s developmental,
functional, medical, and behavioral needs at home as well as in settings
described in (b) above.
(e) FCESS
to the child and family and other caregivers shall be founded on
scientifically-based research to the extent practicable, and include assistance
in the following areas as identified in the family’s IFSP:
(1) Understanding
the child’s special needs;
(2) Support
and counseling for families;
(3) Management
and coordination of health and medical issues in collaboration with the primary
physician or medical home;
(4) Enhancement
of the cognitive, social interactive, and play competencies of the child at
home and in community settings;
(5) Enhancement
of the ability of the child to develop age-appropriate fine and gross motor
skills and overall sensory and physical awareness and development;
(6) Enhancement
of the ability of the child to develop functional communication methods and
expressive and receptive language skills;
(7) Guidance
and management of a child with very active, inappropriate, or life-threatening
behaviors;
(8) Consultation
regarding appropriate diet and the child’s eating and oral motor skills to
insure proper nutrition;
(9) Linkage
with assistive technology services that might enhance the child’s growth and
development; and
(10) Assessments
conducted throughout the period of the child’s eligibility.
(f) FCESS
shall promote local and statewide prevention efforts to reduce and, where
possible, eliminate the causes of disabling
conditions.
Source. (See Revision Note at part heading for He-M
510) #5745, eff 12-1-93, EXPIRED: 12-1-99
New. #7234, eff 4-22-00; ss by #9135, INTERIM, eff
4-22-08, EXPIRED: 10-19-08
New. #9594, eff 11-11-09; ss by #10325, eff
4-26-13; ss by #13753, eff 9-27-23
He-M
510.05 Parents’ Right to Written Prior Notice.
(a) FCESS programs shall give written notice to families before
proposing, refusing to initiate, or changing the eligibility for, evaluation
regarding, or provision of FCESS.
(b) The
written notice referenced in (a) above shall be provided, at a minimum, prior
to:
(1) Eligibility
evaluations;
(2) IFSP
development;
(3) IFSP
reviews;
(4) Changes
in IFSP services;
(5) The
transition planning conference; and
(6) Notification
pursuant to He-M 510.09 (f), (g), and (j).
(c) The written notice referenced in (a) above shall contain the
following information:
(1) The
proposed date and time of the action;
(2) The
action that is being proposed or refused;
(3) The
reasons for taking the action;
(4) All
procedural safeguards that are available under He-M 510, He-M 203, and He-M
310; and
(5) A
summary of the FCESS complaint resolution procedures set forth in He-M 203,
including a description of how to file a state administrative complaint and due
process complaint and the timelines under these procedures.
(d) The proposed date and time of the action in (c) above shall be
timely and convenient to the family.
(e) The notice shall be written in language that is understandable
to the general public and in the family’s native language or other mode of
communication used by the parent, unless it is clearly not feasible to do
so.
(f) If
the native language or the other mode of communication of the parent is not a
written language, the area agency or FCESS program
shall take steps to ensure:
(1) The
notice is translated orally, or by other means to the parent in the parent’s
native language, or other mode of communication;
(2) The
parent understands the notice; and
(3) There
is written evidence that the requirements of (1)-(2) above have been met.
Source. (See Revision Note at part heading for He-M
510) #5745, eff 12-1-93, EXPIRED: 12-1-99
New. #7234, eff 4-22-00; amd by #7822, eff 2-8-03;
ss by #9135, INTERIM, eff 4-22-08, EXPIRED 10-19-08
New. #9594, eff 11-11-09; ss by #10325, eff
4-26-13; ss by #13753, eff 9-27-23
He-M
510.06 Referral and Eligibility Determination.
(a) A
child as defined in He-M 510.02(g), who is a resident of New
Hampshire shall be eligible for FCESS.
(b) Any person may make a referral to FCESS.
(c) When a referral is made by someone other than the parent, the
FCESS program shall notify the parent immediately both verbally and in writing.
(d) Participation in FCESS shall be voluntary.
(e) The point of contact for referral to FCESS shall be the area
agency.
(f) An
area agency shall designate an intake coordinator to make initial contact with
families who are referred for FCESS.
(g) The
intake coordinator shall:
(1) Have
at least 2 years’ experience with children and their families;
(2) Demonstrate
the capacity to develop rapport with families;
(3) Have
knowledge of resources available in the community; and
(4) Act
as an interim service coordinator for families applying for FCESS until
eligibility is determined and a service coordinator identified.
(h) The
intake coordinator shall:
(1) Document
the date the referral was received;
(2) Provide
information relative to FCESS and other community services;
(3) Inform
the family of the process for the initiation of FCESS, including the family’s
rights under He-M 510 and He-M 310 and procedural safeguards under He-M 203;
(4) If
the family decides to seek a determination of eligibility for FCESS:
a. Obtain
parental consent for the initial evaluation and, if the applicant is eligible,
IFSP development;
b. Request
a release to obtain the applicant’s medical records and a physician’s referral
for evaluation;
c. Request
information about the applicant’s insurance, including public and private
insurance; and
d. Request
consent to utilize private insurance pursuant to He-M 510.14 (b)-(f); and
(5) If
the family decides not to seek a determination of eligibility for FCESS, make
reasonable efforts to ensure the parent:
a. Is
fully aware of the nature of the evaluation, the assessment, and the services
that would be available; and
b. Understands
that the applicant will not be able to receive the evaluation, the assessment,
or other services unless consent is given pursuant to
(4)a. above.
(i) If
a family decides to seek a determination of eligibility for FCESS,
the area agency shall conduct a multidisciplinary evaluation pursuant to (k)
below and a family directed assessment.
(j) The
purpose of the multidisciplinary evaluation shall be:
(1) To
determine if the applicant is eligible for FCESS according to (a) above and
He-M 510.02 (g); and
(2) To
provide information that will form the basis of the IFSP if the applicant is
eligible for FCESS.
(k) The
multidisciplinary evaluation shall:
(1) Be
based on informed clinical opinion;
(2) Be
conducted by an evaluation team composed of the family, other persons requested
by the family, and professionals from 2 or more different disciplines
identified in He-M 510.11 (b)(1);
(3) Be
conducted by professionals whose expertise most closely relates to the needs of
the applicant and family;
(4) Be
carried out in a setting that is convenient to the family;
(5) Include
the completion of the IDA Institute’s “Infant-Toddler Developmental
Assessment-2 (IDA-2)”, (Second Edition) or Shine Early Learning’s “Hawaii Early
Learning Profile (HELP) Strands 0–3” (1992–2013), available as noted in
Appendix A;
(6) Include
the components of the assessment as defined in He-M 510.02 (c);
(7) Include
the applicant’s medical and developmental history;
(8) Include
information from others sources such as family members, other caregivers,
medical providers, social workers, and educators, if necessary;
(9) Include
a review of the applicant’s medical, educational, or other records;
(10) Include
an evaluation of the applicant’s level of functioning in each of the following
developmental domains:
a. Physical
development, including vision, hearing, or both;
b. Cognitive
development;
c. Communication
development;
d. Social
or emotional development; and
e. Adaptive
development;
(11) Determined
through the use of an assessment tool and a voluntary family-directed personal
interview, include identification of:
a. The
family’s resources, priorities, and concerns; and
b. The supports
and services necessary to enhance the family’s capacity to meet the
developmental needs of the applicant;
(12) Be
conducted to:
a. Determine
an applicant’s eligibility or a child’s progress;
b. Define
or redefine services and expected outcomes; or
c. Plan
for future needs;
(13) Be
conducted in the applicant’s, child’s, or family’s native language if
determined by qualified personnel conducting the evaluation to be
developmentally appropriate, given the applicant’s or child’s age and
communication skills; and
(14) Be
selected and administered so as not to be racially or culturally
discriminatory.
(l) An
applicant’s medical and other records may be used to establish eligibility
prior to conducting a multidisciplinary evaluation if those records contain
information regarding the applicant’s level of functioning in the developmental
areas identified in (k)(10) above.
(m) Based
on the results of the multidisciplinary evaluation pursuant to (k) above or
medical records in (l) above, the evaluation team
shall determine whether the applicant is a child as defined in He-M 510.02 (g)
and is eligible for FCESS pursuant to (a) above.
(n) If
the applicant is found eligible for FCESS, the area agency shall, in
writing, advise the family of its eligibility status within 3 business days and
include the name of, and contact information for, the service
coordinator.
(o) If
the applicant is found eligible based upon medical records in (l) above,
the area agency shall do an assessment of the child and a family assessment as
described in (k)(11) above.
(p) If
the applicant is found not eligible for FCESS, the area agency shall, in
writing, advise the family within 3 business days from date of eligibility
determination pursuant to He-M 510.05 of the following:
(1) The
findings of the evaluation and recommendations;
(2) Other
specific supports and services that meet the needs of the family, including
parent-to-parent networks, and an explanation of how to access those supports
and services;
(3) The
family’s right to file a complaint pursuant to He-M 203; and
(4) The
names, addresses, and telephone numbers of advocacy organizations, such as the
Disabilities Rights Center, Inc., that the family can contact for assistance in
challenging the determination.
(q) In
the event of exceptional family circumstances that make it impossible to
complete the initial evaluation and develop the IFSP
within 45 calendar days of the referral, the FCESS program shall:
(1) Document
the specific circumstances of the delay;
(2) Complete
the multidisciplinary evaluation as soon as family circumstances allow;
(3) Proceed
pursuant to (m)-(p) above; and
(4) Develop
and implement an interim IFSP, to the extent appropriate and consistent with
He-M 510.07 (a) and (g).
(r) Continued
eligibility shall be determined as noted in He-M 510.08 (e) and (f).
Source. (See Revision Note at part heading for He-M
510) #5745, eff 12-1-93, EXPIRED: 12-1-99
New. #7234, eff 4-22-00; amd by #7822, eff 2-8-03;
amd by #8065, eff 3-25-04; ss by #9135, INTERIM, eff 4-22-08, EXPIRED 10-19-08
New. #9594, eff 11-11-09 (from He-M 510.05); ss by
#10325, eff 4-26-13; ss by #13753, eff 9-27-23
He-M 510.07 Initial and Annual IFSP
Development.
(a) With
parental consent, FCESS may begin prior to the completion of the
multidisciplinary evaluation if an interim IFSP is in place
that contains the name of the service provider responsible for the interim
services and a description of the services needed immediately and the elements
described in (h) below. Such an interim IFSP shall not preclude the
requirement in (b) below of completing the multidisciplinary evaluation and
developing a full IFSP within 45 calendar days from the initial date of the
referral.
(b) For
a child who has been evaluated for the first time and determined
to be eligible, a meeting to complete the initial IFSP shall be conducted
within 45 calendar days from the initial date of referral received by the IFSP
team, described in (c) below.
(c) The
IFSP team shall be multidisciplinary and include the following participants:
(1) The
parent(s);
(2) The
service coordinator;
(3) The
person or persons directly involved in conducting the evaluation or assessment;
(4) Providers,
as appropriate; and
(5) As
requested by the parent:
a. Other
family members; and
b. An
advocate, or person outside the family.
(d) The
initial IFSP meeting shall be held at a time and place mutually agreed upon by
the IFSP team and convenient for the family.
(e) At
all IFSP team meetings, including reviews required pursuant to He- M 510.08(d),
if the person or persons identified in (c)(3) above is unable to attend, the FCESS program
shall make arrangements for their involvement through other means including:
(1) Participating
in telephone or virtual conference call;
(2) Having
a knowledgeable authorized representative attend the meeting; or
(3) Making
pertinent records available at the meeting.
(f) All
IFSP team meetings shall be conducted in the native language of the
family or other mode of communication used by the family, unless it is clearly
not feasible to do so.
(g) The
IFSP shall be based on the results of the multidisciplinary
evaluation.
(h) The
IFSP shall include:
(1) Information
about the child’s status in the domains noted in He-M 510.06 (k)(10);
(2) To
the extent the family agrees, a statement of the family’s concerns, priorities,
and resources related to enhancing the family’s capacity to meet the
developmental needs of the child;
(3) A
statement of the measurable results or measurable outcomes expected to be
achieved for the child and family, including pre-literacy and language skills
as developmentally appropriate for the child;
(4) The
criteria, procedures, and timelines used to determine the degree to which
progress toward achieving the outcomes is being made and whether modifications
or revisions of the expected results, outcomes, or services are necessary;
(5) A
detailed statement of the specific FCESS that are necessary to meet the unique
needs of the child and family to achieve the outcomes identified in the IFSP;
(6) The
length, frequency, intensity, anticipated duration, method of delivery,
location, and payment arrangement, if any, for each support and service;
(7) A
statement that each FCESS is provided in the natural environment for that child
to the maximum extent appropriate;
(8) Identification
of the natural environments in which the FCESS will be provided;
(9) A
justification of the extent, if any, as to why a support or service cannot be
provided in a natural environment, including:
a. An
explanation of why the supports or services cannot be provided satisfactorily
for the child in a natural environment;
b. A
plan of action that identifies how supports and services can be provided in a
natural environment in the future; and
c. A
time frame in which this plan will be implemented;
(10) A
summary of the documented medical services such as hospitalization, surgery,
medication, and other supports that the child needs or is receiving through
other sources but that are neither required nor funded under He-M 510;
(11) For
services described in (10) above that are not currently being provided, a
description of the steps the service coordinator or family can take to assist
the child and family in securing and funding those other services;
(12) The
name(s) and credentials of the person(s) responsible for implementing the
supports and services;
(13) The
earliest possible projected start date for each support and service as agreed
upon by the IFSP team, including the family;
(14) The
name, telephone number, agency, and location of the service coordinator;
(15) The
names of the members of the IFSP team participating in the development of the
plan;
(16) The
steps to be taken to support the transition described in He-M 510.09,
including:
a. Discussions
with, and training of, parents, as appropriate, regarding future placements and
other matters related to the child’s transition;
b. Procedures to
prepare the child for changes in service delivery, including steps to help the
child adjust to, and function in, a new setting;
c. Confirmation
that child find system information, in accordance with 34 CFR 303.115, 303.302,
and 303.303, about the child has been transmitted to the LEA or other relevant
agency in accordance with He-M 510.09 (f) and (g); and
d. Identification
of transition services and other activities that the IFSP team determines are
necessary to support the transition of the child; and
(17) Services
to be provided to support the smooth transition of the child in accordance with
He-M 510.09 to:
a. Preschool
special education services to the extent that those services are appropriate;
or
b. Other
appropriate services.
(i) The
steps and services referred to in (h)(16)-(17) above shall be listed
in a document called a transition plan as described in He-M 510.09 (a).
(j) Through
discussion, all IFSP team members shall consider the advantages and
disadvantages of each FCESS suggested during the development of the IFSP.
(k) The
FCESS program shall explain the contents of the IFSP to the family prior
to the family consenting to the document.
(l) Parents
may elect to provide consent with respect to some FCESS and withhold
consent for others.
(m) Parents
may withdraw consent for some services without jeopardizing other
FCESS.
(n) The
IFSP shall be considered complete when the family has given consent by signing the
IFSP.
(o) The
following services shall be provided to each child at public expense at no cost
to the parent:
(1) Implementing
child find system requirements in accordance with 34 CFR Part 303.115, 303.302,
and 303.303;
(2) Evaluation
and assessment;
(3) Service
coordination;
(4) Development,
review, and evaluation of IFSPs; and
(5) Implementation
of procedural safeguards available under He-M 203 and Part C of Public Law
102-119, Individuals with Disabilities Education Act, 20 U.S.C. 1400 et seq.
(p) A meeting shall be conducted by the IFSP team,
described in (c) above, on at least an annual basis to evaluate and revise, as
appropriate, the IFSP for the child and the child’s family, according to the
following:
(1) The
annual IFSP meeting shall be held at a time and place mutually agreed upon by
the IFSP team and convenient for the family; and
(2) The
results of any current evaluations or current assessments of the child shall be
used in determining the early intervention services that are needed or
provided.
Source. (See Revision Note at part heading for He-M
510) #5745, eff 12-1-93, EXPIRED: 12-1-99
New. #7234, eff 4-22-00; amd by #7822, eff 2-8-03;
ss by #9135, INTERIM, eff 4-22-08, EXPIRED 10-19-08
New. #9594, eff 11-11-09; ss by #10325, eff
4-26-13; ss by #13753, eff 9-27-23
He-M 510.08 Implementation of the IFSP.
(a) FCESS shall be delivered as agreed upon in the IFSP.
(b) In
addition to arranging direct supports and services for the child
and parents or primary caregivers, the service coordinator shall link the child
and family with community resources identified in the IFSP.
(c) Each
IFSP shall be reviewed periodically at least once every 6 months, or more
frequently if a provider proposes adding or discontinuing a support or service
or if requested by the family.
(d) Such
a review shall:
(1) Include:
a. The
parent(s);
b. The
service coordinator;
c. If
requested, other family members, advocates, and persons outside the family; and
d. Other
members of the IFSP team as described in He-M 510.07 (c) and (e) if changes to
increase or reduce services in the IFSP are proposed;
(2) Be
arranged at a mutually agreed upon time and location; and
(3) Employ
a process that is convenient to the family.
(e) The
review pursuant to (c)-(d) above shall:
(1) Assess
progress toward achieving outcomes;
(2) Determine
if the FCESS in the IFSP continue to be appropriate;
(3) Determine
whether revisions or additions are needed to the IFSP; and
(4) Discuss continued eligibility for FCESS.
(f) At
the review, if the IFSP team is in disagreement regarding the child’s continued
eligibility, the FCESS program shall conduct a multidisciplinary evaluation following the
process described in He-M 510.06 (k).
(g) At
any time, the IFSP team, including the family, may request a multidisciplinary
evaluation or an assessment to determine progress review eligibility, redefine
services and outcomes, or plan for future needs.
(h) Before
implementation of any revision, deletion, or addition to the IFSP, the family
shall give consent and sign the revised
IFSP. If the family does not give consent, the IFSP shall remain
unchanged.
(i) If
the family has any concerns with the implementation of the IFSP, the family or
the service coordinator may request a
meeting. Such a meeting shall be held as soon as possible at a
mutually determined time and location that is convenient to the family and
include the family, the service coordinator, and others as requested who are
involved in providing supports and services to the family and child.
(j) If
the family’s concerns are not being addressed to the family’s satisfaction, the
procedural safeguards for FCESS identified in He-M
203 shall be made available.
Source. (See Revision Note at part heading for He-M
510) #5745, eff 12-1-93, EXPIRED: 12-1-99
New. #7234, eff 4-22-00; ss by #9135, INTERIM, eff
4-22-08, EXPIRED 10-19-08
New. #9594, eff 11-11-09 (from He-M 510.07); ss by
#10325, eff 4-26-13; ss by #13753, eff 9-27-23
He-M 510.09 Transition to Special Education Preschool
and Other Services.
(a) For
all children found eligible for FCESS prior to 33 months of age, the service
coordinator shall convene the IFSP team when the child is between 27 and 32
months to develop a transition plan for the child to exit the program that:
(1) Reviews
the child’s program options for the period from the child’s 3rd birthday
through the remainder of the school year;
(2) Identifies
steps for the child and the child’s family to exit the FCESS program;
(3) Identifies
any transition services needed by the child and family;
(4) Includes,
with parental consent, referrals to the area agency and other community
resources; and
(5) Determines
if the child is potentially eligible for preschool special education.
(b) If
the child is determined to not be potentially eligible for preschool special
education services, the service coordinator
shall convene a transition conference and make reasonable efforts to include
providers of other services to discuss appropriate services the child might
receive.
(c) If the child is determined to be potentially eligible for
preschool special education services, the service coordinator shall provide
parents information describing the notification requirement in (f) and (g)
below and their right to object, in (d) below, to information about their child
being provided to the responsible LEA and the NH department of education.
(d) If
a parent informs the FCESS program in writing within 7 calendar days of
receiving the information described in (c) above that they object to the
notification, the service coordinator shall not provide notification to the
responsible LEA and NH department of education.
(e) If
the parent objects to notification, the service coordinator shall convene a
transition conference and make reasonable efforts to include providers of other
services to discuss alternative ways of meeting the child’s needs.
(f) If
the parent does not inform the FCESS program within 7 calendar days, as
specified in (d) above, that they object, the FCESS program shall refer the child by notifying the responsible
LEA and NH department of education as soon as possible but not less than 90
calendar days before the child reaches their 3rd birthday that a child who is
potentially eligible for special education is receiving FCESS.
(g) Information provided with the notification and referral described in
(f) above shall include:
(1) The
child’s name;
(2) The
child’s date of birth;
(3) The
parents’ names;
(4) The
parents’ contact information including addresses and telephone numbers; and
(5) Additional
information with parental consent including a copy of the most recent
evaluation and assessments of the child and the most recent IFSP.
(h) After
the LEA and NH department of education have been notified that a child is
potentially eligible for services, the service
coordinator shall convene a transition conference that:
(1) Includes
the family, other persons requested by the family, the service coordinator, and
relevant providers;
(2) Is
conducted not less than 90 calendar days but not more than 9 months prior to
the child’s 3rd birthday; and
(3) Includes
the LEA representative.
(i) The
purpose of the transition conference shall be to:
(1) Review
the results of the IFSP team meeting held pursuant to (a) above;
(2) Update
the transition plan with input from the LEA representative and other providers;
and
(3) Discuss
the child’s program options for the period from the child’s 3rd birthday
through the remainder of the school year, if applicable, including any services
the child might be eligible to receive under Part B of IDEIA.
(j) For
a child who is determined eligible for FCESS more than 45 calendar days but
less than 90 calendar days before the child’s 3rd birthday, the FCESS program,
as soon as possible if the parent does not object, shall notify the LEA and NH department of education that the child will reach the
age for eligibility for Part B services.
(k) For
a child referred fewer than 45 calendar days before the child’s
3rd birthday, the FCESS program, following parental consent, shall refer the
child to the NH department of education and LEA as soon as
possible. The FCESS program shall not be required to conduct a
multidisciplinary evaluation or initial IFSP meeting.
(l) For
children exiting the program prior to 27 months of age or found no longer
eligible for FCESS, the service coordinator shall develop a transition plan
with the family that includes:
(1) Service
options for the family to explore based on future needs;
(2) Activities
as necessary to prepare the child for exiting the program;
(3) Information
about parent training and resources; and
(4) Referrals
to other community resources.
Source. (See Revision Note at part heading for He-M
510) #5745, eff 12-1-93, EXPIRED: 12-1-99
New. #7234, eff 4-22-00; ss by #9135, INTERIM, eff
4-22-08, EXPIRED 10-19-08
New. #9594, eff 11-11-09; ss by #10325, eff
4-26-13; ss by #13753, eff 9-27-23
He-M 510.10 Administration.
(a) Each
area agency shall develop an agreement with FCESS programs and the family
support council within the region to detail their
mutual responsibilities in supporting families who are participating in FCESS.
(b) The
agreement in (a) above shall:
(1) Describe
the process of referral, eligibility determination, and initiation of supports
and services in the area agency system;
(2) Provide
for streamlined mechanisms to enable families to easily access family support
services from the area agency pursuant to He-M 519;
(3) Provide
for ongoing contacts between staff of the area agency and the FCESS program to
ensure open communication and effective collaboration; and
(4) Provide
for procedures to address issues of common concern in the region.
(c) The
area agency shall develop a written agreement with the LEA that describes:
(1) Practices
that will enable FCESS and LEA personnel to collaborate effectively;
(2) When
and how information will be shared, including a statement of confidentiality;
(3) A
process to facilitate involvement of families, FCESS staff, and LEA staff in
transition conference planning activities and meetings; and
(4) Transition
activities that will take place such as home and program visits, observations,
and evaluations.
(d) Each
area agency, in cooperation with its family support council and FCESS programs,
shall document evidence of coordination with other local agencies that serve
children and their families, such as:
(1) The
regional offices of the New Hampshire division of public health
services;
(2) Local
education agencies;
(3) Visiting
nurse associations;
(4) Local
hospitals and medical clinics;
(5) Child
care providers;
(6) Family resource centers; and
(7) DCYF.
(e) Documentation
pursuant to (d) above shall include agreements, minutes of meetings, or
memoranda that demonstrate efforts to maximize the use of community resources
and prevent duplication of services for families.
(f) Each
area agency, in cooperation with the FCESS program, shall document evidence of
outreach to local agencies and providers serving children and their families to
identify children who might be eligible for FCESS.
(g) Area
agencies and FCESS programs shall comply with applicable state and federal
rules and regulations.
(h) FCESS
programs shall annually conduct and document quality assurance activities,
including, at a minimum:
(1) Constituent
surveys;
(2) Record
reviews;
(3) Performance
data measurements;
(4)
Participation in lead agency monitoring; and
(5) Development
and implementation of a corrective action plan if appropriate based on (1)-(4)
above.
(i) Area
agencies and FCESS programs shall enter the information identified below into
the lead agency’s statewide data system based on the following schedule:
(1) Immediately upon referral of a child, the following
information:
a. The child’s
name;
b. The child’s
date of birth;
c. The child’s
gender;
d. Date of
referral; and
e. Referral
source;
(2) Once contact with the
family is established the following information shall be entered:
a. Parent
or guardian contact information;
b. The
child’s race and ethnicity;
c. Primary
language;
d. Date of intake;
e. Diagnosis
and reason for referral;
f. Insurance status, as one of the following types:
1. Public;
2. Private;
3. Both
public and private; or
4. None;
and
g. FCESS program name;
(3) Upon
eligibility determination:
a. Eligibility
status; and
b. Eligibility
category;
(4) Following
preparation of the IFSP:
a. The
date of parent or guardian consent;
b. IFSP
services to be provided;
c. The delivery method of the services to be
provided;
d. The frequency of the services to be provided;
e. The length, in minutes, of the services to be
provided;
f. The provider;
g. The environment, including a justification
statement if the environment is not a natural environment as defined in He-M
510.02(ad);
h. The projected start date of the services to
be provided;
i. Circumstances
regarding non-timely services;
j. Actual 6 month review date; and
k. Transition
plan activities;
(4) On
a monthly basis:
a. Updated
insurance status;
b. Services,
including evaluations, that have been provided; and
c. The
child’s updated diagnosis or eligibility status;
(5) Within
30 calendar days of the child exiting the program:
a. Child
outcome data required by 34 CFR 303.702; and
b. The
reason for exiting and date of exit; and
(6) As
they occur, notifications as required by He-M 510.09 (f), (g), and (k).
(j) Each
FCESS program shall have a designated program director who shall be responsible
for the overall administration of the supports and services and personnel
training and supervision. The director may be involved in the
provision of direct supports and services.
(k) FCESS
programs shall offer and provide a full array of FCESS to families throughout
the calendar year.
(l) FCESS
programs shall coordinate personnel schedules so that staff have opportunities
to share information and strategies across disciplines on a regular basis.
(m) The
area agency shall initiate a referral for a surrogate parent to the NH lead
agency in accordance with He-M 510.18 when:
(1) No
parent can be identified;
(2) A
child is under legal guardianship of the division for children, youth and
families; or
(3) A
court has issued a written order for a surrogate parent.
Source. (See Revision Note at part heading for He-M
510) #5745, eff 12-1-93, EXPIRED: 12-1-99
New. #7234, eff 4-22-00; ss by #9135, INTERIM, eff
4-22-08, EXPIRED 10-19-08
New. #9594, eff 11-11-09; ss by #10325, eff
4-26-13 (from He-M 510.11); ; ss by #13753, eff 9-27-23
He-M
510.11 Personnel.
(a) All
personnel shall have specific training and experience in child development and
knowledge of family support.
(b) Personnel
shall be drawn from the following categories:
(1) New
Hampshire licensed, department of education certified, or bureau of
developmental services certified professionals, including, at a minimum:
a. Advanced
practice registered nurse;
b. Audiologist;
c. Clinical
mental health counselor;
d. Clinical
social worker;
e. Dietitian
registered;
f. Early
childhood educator;
g. Early
childhood special educator;
h. Early
intervention specialist;
i. Marriage
and family therapist;
j. Occupational
therapist;
k. Orientation
and mobility specialist;
l. Pastoral
psychotherapist;
m. Physician;
n. Physician
assistant;
o. Psychologist;
p. Physical
therapist;
q. Registered
nurse;
r. Speech
language pathologist;
s. Speech-language
specialist;
t. Special
education teacher;
u. Special
education teacher in the area of blind and vision disabilities;
v. Special
education teacher in the area of deaf and hearing disabilities;
w. Special
education teacher in the area of emotional and behavioral disabilities;
x. Special
education teacher in the area of intellectual and developmental disabilities;
y. Special
education teacher in the area of physical and health disabilities;
z. Special
education teacher in area of specific learning disabilities; and
aa. Vision
specialist including ophthalmologists and optometrists;
(2) New
Hampshire licensed or certified professional assistants, including:
a. Licensed
physical therapy assistant;
b. Licensed
occupational therapy assistant; and
c. Certified
speech and language assistant; and
(3) Unlicensed
or uncertified personnel, including personnel who have education, training, or
experience relevant to the provision of FCESS.
(c) All
personnel shall utilize support strategies, assessment procedures, and
treatment techniques considered to be best practice in working with a child and
family applying for or receiving FCESS.
(d) All
personnel shall ensure the effective provision of FCESS, via a minimum of the
following:
(1) Consulting
with parents, other providers, and representatives of appropriate community
agencies;
(2) Participating
in the child’s multidisciplinary evaluation and the development of service
outcomes for the IFSP; and
(3) Coaching
parents and other persons chosen by the family regarding the provision of the
services.
(e) Personnel
identified in (b)(1) above shall:
(1) Conduct
multidisciplinary evaluations;
(2) Conduct
assessments;
(3) Develop
or amend IFSPs;
(4) Supervise,
when appropriate, licensed assistants and unlicensed personnel; and
(5) Provide
service coordination.
(f) Personnel
identified in (b)(2) above shall:
(1) Contribute
to the multidisciplinary evaluation;
(2) Contribute
to assessments;
(3) Contribute
to the development or amendment of IFSPs;
(4) Be
supervised, as required by their license or certification; and
(5) Provide
service coordination.
(g) Personnel
identified in (b)(3) above shall:
(1) Contribute
to the multidisciplinary evaluation;
(2) Contribute
to the assessment;
(3) Contribute
to the development or amendment of IFSPs;
(4) Be
supervised by one of the providers described in (b)(1) above at least once a
month in the setting where FCESS is provided, with additional supervision as
needed; and
(5) Provide
service coordination.
(h) All
FCESS personnel, including program directors and consultants, shall
meet New Hampshire requirements for certification, licensing,
continuing competence, or other comparable requirements.
(i) An
FCESS program director shall:
(1) Be
a licensed or certified professional pursuant to (b)(1) above;
(2) Have
3 years of professional experience providing FCESS; and
(3) Have
one year of professional experience in a management or administrative role.
(j) A
service coordinator shall:
(1) Have
completed the orientation program outlined in He-M 510.12 (b); and
(2) Together
with the family and other IFSP team member(s), be responsible for accessing,
coordinating, and monitoring the delivery of services identified in the child’s
IFSP, including transition services and coordination with other agencies and
persons.
(k) An
individual who wishes to obtain certification as an early intervention
specialist shall submit information to the bureau documenting:
(1) Possession
of a minimum, in addition to the requirements in (2) below, of a bachelor’s
degree in:
a. Human
services;
b. Family
studies;
c. Psychology;
d. Child
development;
e. Communication;
f. Child
life;
g. Education;
h. Behavior
analysis; or
i. Early
intervention;
(2) A
minimum of one year experience in an FCESS program for degrees listed in (1) a.
- h. above;
(3) A
minimum of 6 months’ experience in an FCESS program for the degree listed in
(1) i. above;
(4) Possession
of a minimum, in addition to the requirements in (5) below, of an associate’s
degree or minor of studies in:
a. Physical
therapy assistant;
b. Occupational
therapy assistant;
c. Speech
and language assistant;
d. Child
development;
e. Child
life;
f. Education;
or
g. Early
intervention;
(5)
A minimum of 2 years’ experience in an FCESS program for degrees listed in (4)
a. - g. above;
(6) Completion
of the orientation program outlined in He-M 510.12 (b); and
(7) Training and experience in the subject matter
in (e)(1)-(3) and (5) above.
(l) Upon
completion of (k) above, the bureau shall certify the individual as an early
intervention specialist.
(m) To
continue to be certified as an early intervention specialist, individuals
identified in (k) above shall demonstrate ongoing professional development as
described in He-M 510.12 (e).
Source. (See Revision Note at part heading for He-M
510) #5745, eff 12-1-93, EXPIRED: 12-1-99
New. #7234, eff 4-22-00; ss by #9135, INTERIM, eff
4-22-08, EXPIRED 10-19-08
New. #9594, eff 11-11-09 (from He-M 510.08); ss by
#10325,e ff 4-26-13; ss by #10325, eff 4-26-13 (from He-M 510.12); ss by
#13753, eff 9-27-23
He-M
510.12 Personnel Development.
(a) All
new personnel who provide service coordination or work directly with families,
including personnel involved with intake activities, shall participate in an
orientation program pursuant to (b) below within 6 months from the date of
hire.
(b) The
lead agency orientation program shall consist of training and include
information about:
(1) The
history and philosophy of FCESS;
(2) Provision
of service coordination;
(3) Eligibility
evaluation and ongoing assessment;
(4) Procedural
safeguards pursuant to He-M 203;
(5) Scientifically
based research practices in FCESS evaluations, provision of supports, and
service delivery;
(6) Funding
for FCESS;
(7) IFSP
development and implementation; and
(8) Transition
from FCESS to community services such as special education.
(c) Each
employee involved in the provision of FCESS to families shall have an annual
personnel development plan approved by the FCESS program
director. The purpose of the personnel development plan shall be to
sustain and improve the relevant skills and knowledge of the employees such
that the requirements of He-M 510.11 (d) and (h) have been
met. Successful achievement of professional development goals shall
be included in the criteria for annual review of performance.
(d) Personnel
development plans for FCESS program directors shall be developed with, and
monitored by, the director’s supervisor.
(e) As
a part of their annual personnel development plan an early intervention
specialist shall acquire at least 24 hours of continuing education credit in
subject matter relevant to their job description, as determined by the program
director.
(f)
The area agency shall provide all program staff who work directly with
families, annual training in procedural safeguards pursuant to He-M 203.
(g) The lead agency shall provide
training on child outcome summary and outcome development to all program staff
who directly work with families within 6 months of hire.
(h) The lead agency shall provide
training on ensuring culturally competent services and adult learning
strategies to all program staff who directly
work with families within one year of hire.
Source. (See Revision Note at part heading for He-M
510) #5745, eff 12-1-93, EXPIRED: 12-1-99
New. #7234, eff 4-22-00; amd by #7822, eff 2-8-03;
ss by #9135, INTERIM, eff 4-22-08, EXPIRED 10-19-08
New. #9594, eff 11-11-09 (from He-M 510.09); ss by
#10325, eff 4-26-13 (from He-M 510.13); ss by #13753, eff 9-27-23
He-M
510.13 Record keeping.
(a) Each
program shall maintain individual family records that contain, at a minimum,
the following:
(1) Personal
information that shall include:
a. Identifying
information including:
1.
The child’s name, family name(s), address(es), telephone number(s), and
email(s); and
2. The
child’s birth date;
b. The
name of the service coordinator;
c. The
name, address, and telephone number of the child’s primary health care
provider; and
d. Health
insurance information;
(2) Medical
information that shall include:
a. A
record of a physical examination conducted within the past year;
b. Documentation
by qualified medical personnel of any established condition(s), as identified
in He-M 510.02 (n), including diagnosis;
c. A
record of immunizations;
d. A
list of any required prescriptions; and
e. Other
pertinent medical records;
(3) The
current multidisciplinary evaluation of the child and family pursuant to He-M
510.06 (k);
(4) The
current IFSP signed by the parent;
(5) Written
documentation of each contact with the child and family by the provider,
including:
a. A
description of the service provided;
b. A
description of the child’s and family’s response;
c. The
date, location, and duration of the contact; and
d. The
name and credentials of the provider;
(6) Reviews
of progress once every 6 months or more frequently;
(7) Copies
of any letters or notifications written to, or on behalf of, the family;
(8) Information
obtained from other agencies or programs that the family believes is important
in developing or providing FCESS; and
(9) Releases
of information providing consent obtained from the family for evaluation and
for the exchange of information among agencies and providers.
(b) Each
FCESS program shall have a standard release or exchange of information form,
compliant with all state and federal laws, which shall be valid for no longer
than one year.
(c) All
release or exchange of information forms shall include:
(1) The
child’s name and birth date;
(2) The
information to be released or obtained;
(3) The
purpose of obtaining or releasing the information;
(4) The
name of the person or organization being authorized to release the information;
(5) The
name of the person or organization to whom the information is to be released;
and
(6) The
time period for which the authorization is given, if less than one year.
(d) Each
FCESS program shall maintain a log of access and disclosures of information
that includes:
(1) The
information accessed or disclosed;
(2) The
date of access or disclosure;
(3) The
name of the recipient of the information; and
(4)
The purpose for which the party is authorized to use the FCESS records.
(e) Each
provider and FCESS program shall maintain the confidentiality of a child’s and
family’s records and protect the child’s and family’s personally identifiable
information at the collection, storage, disclosure, and destruction stages in
accordance with FERPA.
(f) Each
FCESS program shall designate a staff member responsible for ensuring the
confidentiality of any personally identifiable information, in compliance with
federal law.
(g) Each
FCESS program shall have policies for the training of all personnel in the
collection or use of personally identifiable information and compliance with
IDIEA and FERPA.
(h) Parents
shall have the following rights with regard to FCESS records for their
children:
(1) The
right to inspect and review FCESS records at any time;
(2) The
right to make requests for explanations and interpretations of the records and
to receive a response to these requests within 3 business days;
(3) The
right to receive, upon request, copies of records in accordance with (k) and
(l) below; and
(4) The
right to have a representative of the parent inspect, review, and receive
copies of the records.
(i) FCESS
programs shall give each family a list of the types and locations of records
collected, maintained, or used by FCESS personnel. All parents shall
have the right to access such records unless a particular parent does not have
this authority under state law.
(j) Information
shall be made available only:
(1) To
those persons or agencies for whom the parent or guardian has given written
consent;
(2) To
FCESS personnel;
(3) To
the department or other funding, licensing, or accrediting agencies as
necessary for determining eligibility for funding or for assisting in
accrediting, monitoring, or evaluating supports and services delivery; or
(4) As
otherwise required by law.
(k) Each
FCESS program shall make copies of records available to parents free of charge
for the first 25 pages and not more than 10 cents per page
thereafter. The fee shall not effectively prevent the parents from
exercising their right to inspect and review those records. A fee
shall not be charged for searching for or retrieving information.
(l) Copies
of the following documents shall be provided at no cost to the family as soon
as possible after each IFSP meeting:
(1) Evaluations;
(2) Assessments
of the child and family; and
(3) The
IFSP.
(m) FCESS
programs shall advise families of their right to request that records be
corrected or amended if they believe the information collected, maintained, or
used is inaccurate or misleading or violates the privacy or other rights of the
child or family.
(n) The
FCESS program shall take steps to accommodate any request pursuant to (m)
above.
(o) If
the FCESS program refuses to amend the information as requested, the program
director shall inform the parent of the refusal, why the request to amend the
information was refused, and advise the parent of the right to complain
pursuant to He-M 203.
(p) If,
as a result of a complaint resolution it
is decided, pursuant to He-M 203, that the information contained in the records
is inaccurate, misleading, or otherwise in violation of privacy or other rights
of the child, the FCESS program shall amend the information accordingly and so
inform the parent(s) in writing.
(q) If,
as a result of a complaint resolution it is decided, pursuant to He-M 203, that
the information contained in the records is not inaccurate, misleading, or
otherwise in violation of privacy or other rights of the child, the FCESS
program shall inform the parent(s) of the right to place in the records a
statement commenting on the information or setting forth any reasons for
disagreeing with the decision of the FCESS program.
(r) Any
explanation placed in the records of the child shall be maintained by the FCESS
program as part of the records of the child as long as the record, or the
contested portion of a record, is maintained by the program.
(s) If
the record, or the contested portion of a record, is disclosed by the FCESS
program to any party, the explanation shall be disclosed to the party.
(t) The
FCESS program shall inform the parent(s) when personally identifiable
information collected, maintained, or used is no longer needed to provide
supports and services to the child.
(u) Personally
identifiable information that is no longer needed by an FCESS program shall be
destroyed at the request of the parent(s).
(v) Notwithstanding
(u) above, a permanent record of the following shall be maintained without a
time limitation:
(1) The
child’s name and date of birth;
(2) The
parents’ contact information including address and telephone number;
(3) The
name of the service coordinator(s) and early supports and services provider(s);
and
(4) Exit
data including the year and child’s age and any programs entered into upon
exiting.
(w) Records
that parents have not requested to be destroyed shall be retained for at least
6 years following termination of service.
(x) All
evaluations and assessments, notices of eligibility for services, IFSPs,
notices of meetings, information regarding procedural safeguards, progress
reports, and consent forms shall be written in language understandable to the
general public and provided to the family in their native language or primary
mode of communication unless it is unfeasible to do so. If the family’s
native language or means of communication is not a written language, the FCESS
program shall take steps to ensure that the information is translated orally or
by the mode of communication the family typically uses so that the information
is meaningful and useful.
Source. (See Revision Note at part heading for He-M
510) #5745, eff 12-1-93, EXPIRED: 12-1-99
New. #7234, eff 4-22-00; ss by #9135, INTERIM, eff
4-22-08, EXPIRED 10-19-08
New. #9594, eff 11-11-09; ss by #10325, eff 4-26-13
(from He-M 510.14); ss by #13753, eff 9-27-23
He-M
510.14 Utilization of Public and Private Insurance.
(a) When
a child is covered by private insurance or enrolled in Medicaid, the FCESS
program shall use these benefits to pay for FCESS in accordance with (b) – (k)
below.
(b) The
FCESS program shall not use the private insurance of a parent or child to pay
for FCESS unless the parent provides parental consent. This includes the
use of private insurance when such use is a prerequisite for the use of
Medicaid.
(c) When
an FCESS program uses a child’s private insurance, the program shall not
collect costs associated with the use of private insurance from the child’s
family, including the cost of deductibles, coinsurance and co-pays.
(d) When
private insurance is used to pay for FCESS, the FCESS program shall obtain
parental consent at the following times:
(1) When
an FCESS program seeks to use the child’s private insurance to pay for the
initial provision of an FCESS identified in the IFSP; and
(2) Each
time there is an increase in the provision of services and a related change in
the child’s IFSP.
(e) When
obtaining consent under (d) above or initially using benefits under a private
insurance policy, an FCESS program shall provide to the child’s parents:
(1) A
copy of the system of payments described in He-M 510.14; and
(2) Notice
of the potential costs to the parent when private insurance is used to pay for
early intervention services, including premiums or other long-term costs
associated with annual or lifetime health insurance coverage caps.
(f) An
FCESS program shall not delay or deny the provision of any services in the IFSP
when a parent does not provide consent to use private insurance.
(g)
If a parent does not provide consent to use private insurance, an FCESS
program shall utilize funds available in contract with the department,
including federal funds available pursuant to 34 CFR 303.510(a), for the
provision of any services in the IFSP.
(h)
If funds are utilized pursuant to (g) above, the parent shall not be
required to reimburse any such funds.
(i) When
Medicaid benefits are used to pay for FCESS, the FCESS program shall provide
written notice to the child’s parents that includes:
(1) A
statement of the no-cost protection provisions in 34 C.F.R. §303.520(a)(2);
(2) Pursuant
to (k) below, a statement that a parent’s refusal to enroll in Medicaid shall
not delay or cause to be denied the provision of any services in the child’s
IFSP; and
(3) A
description of the general categories of costs that the parent would incur as a
result of participating in Medicaid, including the required use of private
insurance as the primary insurance.
(j) An
FCESS program shall not require a parent to sign up for or enroll in Medicaid
as a condition of receiving FCESS.
(k) An
FCESS program shall not delay or deny the provision of any services in the
child’s IFSP if a parent does not enroll in Medicaid.
(l) The
FCESS program shall maintain up to date insurance
coverage information for each child.
Source. #9594, eff 11-11-09 (from He-M 510.11); ss by
#10325, eff 4-26-13 (from He-M 510.15); ss by #13753,
eff 9-27-23
He-M 510.15 Interagency
Coordinating Council. The purpose of the interagency
coordinating council shall be to provide advice to the lead agency regarding
the FCESS program. The interagency coordinating council shall be
established and operated pursuant to 34 CFR Part 303, Subpart G.
Source. #9594, eff 11-11-09; ss by #10325, eff
4-26-13 (from He-M 510.16); ss by #13753, eff 9-27-23
He-M
510.16 Central Directory.
(a) The purpose of the
central directory shall be to provide information about:
(1) Public
and private early
intervention services, resources, and experts
available in the state including professionals and other groups that provide
assistance to children; and
(2) Research
and demonstration projects related to children.
(b) The central directory
shall be maintained and operated pursuant to 34 CFR Part 303.117.
Source. #9594, eff 11-11-09; ss by #10325, eff
4-26-13 (from He-M 510.17); ss by #13753, eff 9-27-23
He-M
510.17 Waivers.
(a) An area agency, FCESS
program, parent, or provider may request a waiver of specific procedures
outlined in He-M 510.
(b) The
entity requesting a waiver shall:
(1) Complete
the form entitled “NH Bureau of Developmental Services Waiver Request” (July
2019 edition); and
(2) Include
a signature from the parent(s) or legal guardian(s) indicating agreement with
the request and the area agency’s executive director or designee recommending
approval of the waiver.
(c) No
provision or procedure prescribed by statute or federal regulation shall be
waived.
(d) The
request for a waiver shall be granted by the commissioner or the commissioner’s
designee within 30 calendar days if the alternative proposed by the requesting
entity meets the objective or intent of the rule and it:
(1) Does
not negatively impact the health or safety of the child; and
(2) Does
not affect the quality of services to the child.
(e) The
determination on the request for a waiver shall be made within 30 calendar days
of the receipt of the request.
(f) Upon
receipt of approval of a waiver request, the requesting entity’s subsequent
compliance with the alternative provisions or procedures approved in the waiver
shall be considered compliance with the rule for which waiver was sought.
(g) Waivers
shall be granted in writing for a specific duration not to exceed 5 years
except as in (i) below.
(h) Any
waiver shall end with the closure of the related program or service.
(i) The
requesting entity may request a renewal of a waiver from the
department. Such request shall be made at least 90 calendar days
prior to the expiration of a current waiver.
Source. #9594, eff 11-11-09; ss by #10325, eff
4-26-13 (from He-M 510.18); ss by #13753, eff 9-27-23
He-M 510.18 Surrogate Parent.
(a) A surrogate
parent shall be appointed by the lead agency in the following circumstances:
(1) No parent
as defined in He-M 510.02(ag) can be identified;
(2) The lead agency, area agency, or
FCESS program, after reasonable efforts, including, but not limited to telephone calls and e-mails with documentation of
the dates and times of the attempts, cannot locate a parent;
(3) The
child is in the custody of DCYF and the court overseeing the case has not
appointed a surrogate parent meeting the requirements of (f) below; or
(4) When a court has issued a written order for a
surrogate parent.
(b) An application for appointment of
a surrogate parent shall be submitted to the
lead agency by an area agency or FCESS program if any of the criteria in (a) above are present.
(c) Within 30 days of
the receipt of a completed application pursuant to (b) above, the lead agency
shall determine whether the child needs a surrogate parent, and if necessary,
assign a surrogate parent.
(d)
In order to determine whether a child needs a surrogate parent, the lead
agency shall obtain information that demonstrates
one of the following:
(1) A parent cannot be
identified because there is no written record of the existence of such a person
available to the area agency, FCESS program, or lead agency;
(2) A parent is not able to be located by the FCESS program or area agency as
evidenced through documentation of efforts including but not limited to,
telephone calls and emails and the date, time of attempts to contact parent.
(3) The FCESS program or area agency has contacted DCYF for assistance; or
(4) The absence of a court order
appointing a surrogate parent for a child in the custody of DCYF.
(e) For children in the custody of DCYF, the lead agency must collaborate with DCYF to
obtain necessary information for the appointment of a surrogate parent.
(f) The lead
agency shall select individuals to be available to serve as surrogate parents
provided such individuals:
(1) Have volunteered to serve as a
surrogate parent;
(2) Have satisfactorily completed training to serve as a surrogate parent provided by the lead
agency or designee;
(3) Are 21 years of age or over;
(4) Have agreed in writing to serve
as a surrogate parent from the date of appointment;
(5) Have no interest that conflicts personally or
professionally with the interest of the child they represents;
(6) Are not employees of the lead agency, area agency, or
FCESS program responsible for the services, education, care, or any other services to the child or any family member of the
child, or the school district of liability related to the transition process;
and
(7) Have provided consent to a
check of state registries of founded reports of abuse, neglect, exploitation, as established by RSA 161-F:49 and RSA 169-C:35, and their names do not
appear on said registries.
(g) A surrogate parent assigned by the lead agency shall
have the same rights and responsibilities as a parent defined in He-M
510.02(ag) for purposes of this chapter.
(h) The lead agency shall terminate the appointment of a surrogate parent when:
(1) A parent becomes known, is located, or rescinds their request or consent to have a
surrogate parent appointed and will assume educational decision-making;
(2) The child ceases to be under
legal custody of DCYF or guardianship of DCYF per RSA 463;
(3) The child is placed within a relative foster
placement;
(4) The child is
adopted; or
(5) When the assigned surrogate parent provides 30 days’ notice to the lead agency of the
desire to end the surrogate parent relationship.
Source. #13753, eff 9-27-23
PART He-M 511 -
RESERVED
REVISION NOTE:
Document #5048, effective 1-18-91,
made extensive changes to the wording, format, structure, and numbering of
rules in Part He-M 511. Document #5048
supersedes all prior filings for the sections in this part. The prior filings for former Part He-M 511
include the following documents:
#2032, eff 6-7-82
#2680, eff 4-18-84
EXPIRED 4-18-90
Source. (See Revision Note at part heading for He-M
511) #5048, eff 1-18-91, EXPIRED: 1-18-97
PART He-M 512 -
RESERVED
PART He-M 513 RESPITE SERVICES
Statutory
Authority: New Hampshire RSA 171-A:3;
171-A:18, IV
REVISION NOTE:
Document #4495, effective 9-23-88,
made extensive changes to the wording, format, structure, and numbering of
rules in Part He-M 513. Document #4495
supersedes all prior filings for the sections in this part. The prior filings for former Part He-M 513
include the following documents:
#2747, eff 6-14-84 EXPIRED 6-14-90
He-M 513.01 Purpose. The purpose of these rules is to establish
standards for respite services as part of a system of community based services
and supports responsive to the changing needs of individuals with developmental
disabilities or acquired brain disorders
and their families. These rules also
apply to children, birth through age 2, and their families who are eligible for
family-centered early supports and
services.
Source. (See Revision Note at part heading for He-M
513) #4495, eff 9-23-88; EXPIRED: 9-23-94
New.
#6155, eff 12-29-95; ss by #8016, eff 12-29-03; ss by #10030, eff
12-1-11, EXPIRED: 12-1-19
New. #12944, INTERIM, eff 12-20-19, EXPIRED:
6-17-20
New. #13263, eff 9-22-21
He-M 513.02 Definitions.
(a) “Acquired brain disorder” means a disruption
in brain functioning that:
(1) Is not congenital or caused by birth trauma;
(2) Presents a severe and life-long disabling
condition which significantly impairs a person’s ability to function in
society;
(3) Occurs prior to age 60;
(4) Is attributable to one or more of the
following reasons:
a. External trauma to the brain as a result of:
1. A motor vehicle incident;
2. A fall;
3. An assault; or
4. Another related traumatic incident or
occurrence;
b. Anoxic or hypoxic injury to the brain such as
from:
1. Cardiopulmonary arrest;
2. Carbon monoxide poisoning;
3. Airway obstruction;
4. Hemorrhage; or
5. Near drowning;
c. Infectious diseases such as encephalitis and
meningitis;
d. Brain tumor;
e. Intracranial surgery;
f. Cerebrovascular disruption such as a stroke;
g. Toxic exposure; or
h. Other neurologic disorders, such as
Huntington’s disease or multiple sclerosis, which predominantly affect the
central nervous system; and
(5) Is manifested by one of the following:
a. Significant decline in cognitive functioning
and ability; or
b. Deterioration in:
1. Personality;
2. Impulse control;
3. Judgment;
4. Modulation of mood; or
5. Awareness of deficits.
(b)
“Area agency” means “area agency” as defined in RSA 171-A:2,I-b.
(c)
“Bureau” means the bureau of developmental services of the department of
health and human services.
(d)
“Bureau administrator” means the chief administrator of the bureau of
developmental services.
(e)
“Developmental disability” means “developmental disability” as defined
in RSA 171‑A:2, V, namely "a disability:
(1) Which is attributable to an intellectual
disability, cerebral palsy, epilepsy, autism, or a specific learning
disability, or any other condition of an individual found to be closely related
to intellectual disability as it refers to general intellectual functioning or
impairment in adaptive behavior or requires treatment similar to that required
for persons with an intellectual disability; and
(2) Which originates before such individual
attains age 22, has continued or can be expected to continue indefinitely, and
constitutes a severe disability to such individual's ability to function
normally in society."
(f)
“Family” means a group of 2 or more persons that:
(1) Is related by marriage, ancestry, or other
legal arrangement;
(2) Is living in the same household; and
(3) Has at least one member who is an individual
as defined in (h) below.
(g)
“Home and community‑based care waiver (HCBC-DD)” means that waiver
of sections 1902(a)(10) and 1915(c) of the Social Security Act which allows the
federal funding of long‑term care services in non-institutional settings
for persons who are elderly, disabled, or chronically ill.
(h)
“Individual” means a person with a developmental disability or acquired
brain disorder or a child, birth through age 2, who is eligible for
family-centered early supports and services pursuant to He-M 510.06(a).
(i)
“Respite service provider” means a person or agency that delivers
respite services to an individual and his or her family who are eligible for
area agency services and supports.
(j)
“Respite services” means the provision of short‑term care for an
individual, in or out of the individual's home, for the temporary relief and
support of the family with whom the individual lives.
Source. (See Revision Note at part heading for He-M
513) #4495, eff 9-23-88; EXPIRED: 9-23-94
New. #6155, eff 12-29-95; ss by #8016, eff
12-29-03; ss by #10030, eff 12-1-11, EXPIRED: 12-1-19
New. #12944, INTERIM, eff 12-20-19, EXPIRED:
6-17-20
New. #13263, eff
9-22-21
He-M 513.03 Eligibility and Application for Respite
Services.
(a)
Any family that has a member who is eligible for respite services
provided through an area agency in accordance with He‑M 503.03(a)‑(d)
or He-M 510.06(a) shall be eligible for respite services.
(b)
A family applying for respite services and no other service through the
developmental services system shall not be required to go through the complete
application process described in He‑M 503.04 and He-M 503.05 or He-M
510.06. The application process shall be
as set forth in (c) below.
(c) A family applying for respite services shall
submit:
(1) Documentation to enable the area agency to
determine whether the applicant has a developmental disability or acquired
brain disorder or is a child as defined in He-M 510.02(f);
(2) An explanation of the needs of the applicant
and family; and
(3) A description of the respite services
requested.
(d) Agency staff shall:
(1) Describe respite services to the applicant;
(2) Discuss with the applicant the needs of the
individual and family;
(3) Determine with the family the respite
services required and the amount of respite services to be allocated; and
(4) Assist the family in the selection of area agency or family arranged respite
services.
(e)
Prior to providing respite services, the area agency shall obtain the
following information from families and individuals requesting respite
services:
(1) The family's name, address, and telephone
number;
(2) The name, age, gender, and disability of the
individual;
(3) A description of respite services needs
identified by the family, such as location, dates, and times;
(4) Relevant medical information regarding the
individual, as applicable, including:
a. Prescribed medication;
b. Allergies;
c. Limitations on activities;
d. Special diets;
e. Assistive technology devices; and
f. Any other specific health or safety needs;
(5) The name and telephone number of at least one person to contact in an emergency; and
(6) The name and telephone number of the
individual's family physician or health care provider.
(f)
If an emergency circumstance prevents a family from being able to care
for an individual, the family may request respite services beyond the amount
determined under (d) above. In such
cases, the area agency shall approve respite services based on availability of
funds.
(g)
Providers who operate residences certified under He-M 1001.11, He-M
1001.12, or He-M 1001.13 shall not be eligible for respite services under He-M
513. Such providers may make
arrangements for provider time off through the area agency.
Source. (See Revision Note at part heading for He-M
513) #4495, eff 9-23-88; EXPIRED: 9-23-94
New. #6155, eff 12-29-95; ss by #8016, eff
12-29-03; ss by #10030, eff 12-1-11, EXPIRED: 12-1-19
New. #12944, INTERIM, eff 12-20-19, EXPIRED:
6-17-20
New. #13263, eff
9-22-21
He-M 513.04 Agency Arranged Respite Services.
(a)
When respite services are provided by employees of an area agency or a
subcontractor of an area agency, the area agency or the subcontractor shall, at
a minimum:
(1) Discuss with the family their current respite
services needs;
(2) Encourage the family to use extended family,
neighbors, or other people known to the family as respite service providers,
whenever possible;
(3) At the request of the family, identify
potential respite service providers;
(4) Match respite service providers with eligible
individuals and families based on the individuals' and families' needs and
preferences and the skills and interests of the respite service providers;
(5) Arrange for a meeting with the individual,
the individual's family member or guardian, and the respite service provider
prior to the provision of respite services, whenever possible; and
(6) Assist the family to make the final
determination regarding respite service providers and where and when respite
services are to be provided.
(b)
Persons interested in providing respite services arranged by the area
agency shall apply to the area agency.
(c)
An application to be a respite service provider shall include:
(1) The
applicant’s:
a. Name;
b. Address;
c. Telephone number; and
d. Occupation;
(2) A photocopy of the applicant’s driver’s
license;
(3) The applicant’s training and experience in
the area of developmental disabilities;
(4) The time(s) and duration(s) of availability;
(5) The location(s) where respite services can be
provided;
(6) Any specific ability or inability of the
applicant to serve an individual with a particular type of disability; and
(7) The names, addresses, and telephone numbers
of 2 references unrelated to the applicant.
(d)
The area agency shall:
(1) Interview each applicant who submits a
completed application pursuant to (c) above;
(2) Request, verify, document, if necessary, and
retain 2 written or telephone references; and
(3) With the consent of the applicant:
a.
Submit the person’s name for review against the registry of founded
reports of abuse, neglect, and exploitation to ensure that the person is not on
the registry pursuant to RSA 161-F:49; and
b. Complete a criminal record check in New
Hampshire, in the applicant’s state of residence if not New Hampshire, and in
the applicants previous state of residence if he or she has lived in New
Hampshire for less than one year, ensure
that the applicant has no history of fraud, felony, or misdemeanor
conviction.
(e) An area agency may hire a
person with a criminal record listed in (d)(3)b. above for a single offense
that occurred 10 or more years ago in accordance with (h) and (i) below. In such instances, the individual, his or her
guardian if applicable, and the area agency shall review the person’s history
prior to approving the person’s employment.
(f) Unless a waiver is granted
pursuant to (g) below, a provider agency shall not hire a person with a
criminal record, other than as specified in (e) above.
(g) The department shall grant
a waiver of (f) above if, after reviewing the underlying circumstances, it
determines that the person does not pose a threat to the health, safety, or
well-being of individuals.
(h) Employment of a person
pursuant to (e) above shall only occur if:
(1) Such employment is approved
in writing by the individual, or his or her guardian, if applicable;
(2) Such employment is approved
in writing by the area agency executive director or designee;
(3) The signature and phone
number of the person being hired are obtained;
(4) The employment does not
negatively impact the health or safety of the individual(s); and
(5) The employment does not
affect the quality of services to individuals.
(i) Upon hiring a person
pursuant to (e) above, the provider agency shall document and retain the
following information in the individual’s record:
(1) Identification of the
region, according to He-M 505.04, in which the provider agency is located;
(2) The date(s) of the
approvals in (e) above;
(3) The name of the individual
or individuals for whom the person will provide services;
(4) The name of the person
hired;
(5) Description of the person’s
criminal offense;
(6) The type of service the
person is hired to provide;
(7) The provider agency’s name
and address; and
(8) A full explanation of why
the agency is hiring the person despite the person’s criminal record;
(l) All personnel shall sign a
statement annually, which is maintained in the personnel file, stating that
since the time of hire they:
(1) Have not been convicted of
a felony or misdemeanor in this or any other state, and
(2) Have not had a finding by
the department or any administrative agency in this or any other state for
assault, fraud, abuse, neglect, or exploitation of any person.
(m)
For agency-arranged respite services, an applicant shall be denied
employment who:
(1) Is listed on the registry pursuant to RSA
161-F:49; or
(2) Refuses to consent to checks pursuant to
(d)(3) above.
(n)
If the respite services are to be delivered in the respite service
provider’s home, the home shall be visited by a staff member from the area
agency prior to the delivery of respite services.
(o)
The staff member who visited the respite service provider’s home shall
complete a report of the visit that includes a statement of acceptability of
the following conditions using criteria established by the area agency:
(1) The general cleanliness;
(2) Any safety hazards;
(3) Any architectural barriers for the
individual(s) to be served; and
(4) The adequacy of the following:
a. Lighting;
b. Ventilation;
c. Hot and cold water;
d. Plumbing;
e. Electricity;
f. Heat;
g. Furniture, including beds; and
h. Sleeping arrangements.
(p)
The following criteria shall apply to area agency-arranged respite
services:
(1) Respite service providers shall be able to
meet the day-to-day requirements of the person(s) served, including all of the
requirements listed in (v) below;
(2) Respite service providers giving care in
their own homes shall serve no more than 2 persons at one time; and
(3) Respite service providers shall contact the
area agency in the event that the provider is unable to meet the respite
service needs of the individual or comply with these rules.
(q)
Within 30 days, an area agency shall notify an applicant to be a respite
service provider of the status of the application based on compliance with (c),
(o), and (p) above.
(r) Each area agency shall arrange for training
of respite service providers in the following areas:
(1) The value and importance of respite services
to a family;
(2) The area agency mission statement and the
importance of family-centered supports and services as described in He-M
519.04(a);
(3) Basic health and safety practices including
emergency first aid;
(4) An overview of developmental disabilities and
acquired brain disorders;
(5) Understanding behavior as communication and
facilitating positive behaviors; and
(6) Other specialized skills as determined by the
area agency in consultation with the family.
(s)
If respite is to be provided in a residence certified under He‑M
1001.11, He-M 1001.12, He-M 1001.13, or He‑M 521.09, the respite service
provider shall be authorized to administer medication pursuant to He‑M
1201.
(t)
The area agency shall maintain a file on each respite service provider
that includes:
(1) Items and documentation described under
(c)-(o) and (s) above;
(2) Record of any training related to the
provision of respite services and provided subsequent to that shown on the
application;
(3) Dates and location(s) of service, individuals
served, and fees paid; and
(4) Evaluations by
the family, described in (v)-(w) below, of each service provided, or cross‑references
to individuals’ files where such evaluations are located.
(u)
The area agency shall provide or arrange for respite services and
provider training such that:
(1) Any special health, behavioral, or
communication needs of individuals can be met during the period of respite
services;
(2) Respite services to be provided are
appropriate to the individual’s needs and family-directed; and
(3) Activities normally engaged in by the
individual are included as part of the respite services.
(v)
Within one week following provision of area agency arranged respite
services by a respite service provider to a new family, area agency staff shall
contact the family in person, by telephone, or by questionnaire to review the
respite services provided.
(w)
The information collected as a result of the family contact shall:
(1) Be documented in writing and maintained at
the area agency;
(2) Minimally, address those service requirements
listed in (v) above; and
(3) Report the family's satisfaction or
dissatisfaction with the respite services provided.
Source. (See Revision Note at part heading for He-M
513) #4495, eff 9-23-88; EXPIRED: 9-23-94
New. #6155, eff 12-29-95; ss by #8016, eff
12-29-03; ss by #10030, eff 12-1-11, EXPIRED: 12-1-19
New. #12944, INTERIM, eff 12-20-19, EXPIRED:
6-17-20
New. #13263, eff 9-22-21
He-M 513.05 Family Arranged Respite Services.
(a) Any family approved by the area agency to
receive respite services may make its own arrangements for respite services
through the use of extended family, neighbors, or other people known to the
family.
(b) In circumstances where the family arranges
for respite services, all arrangements shall be at the discretion of, and be
the responsibility of, the family except as noted in (d) below.
(c) The area agency and family shall discuss the
available funds and establish compensation amounts and procedures for family
arranged respite services.
(d) If respite services are to be provided in a
residence certified under He-M 1001.11, He-M 1001.12, He-M 1001.13, or He-M
521.09, the respite service provider shall be trained in medication
administration pursuant to He-M 1201.
(e) The person primarily responsible for an
individual’s day-to-day care shall not provide and be reimbursed for respite
services for that individual.
Source. (See Revision Note at part heading for He-M
513) #4495, eff 9-23-88; EXPIRED: 9-23-94
New. #6155, eff 12-29-95; ss by #8016, eff
12-29-03; ss by #10030, eff 12-1-11, EXPIRED: 12-1-19
New. #12944, INTERIM, eff 12-20-19, EXPIRED:
6-17-20
New. #13263, eff 9-22-21
He-M 513.06 Role of Regional Family Support Councils.
(a)
Each area agency shall enter into an agreement with the regional family
support council, as described in He-M 519.05(c)(4), which details the regional
family support council's role in planning for the provision of respite services
within the region.
(b)
The regional family support council shall, at a minimum, make
recommendations to the area agency regarding the development and implementation
of the area plan, pursuant to He-M 505.03 (u), as it pertains to monitoring the
quality of, access to, and methods of providing respite services.
Source. (See Revision Note at part heading for He-M
513) #4495, eff 9-23-88; EXPIRED: 9-23-94
New. #6155, eff 12-29-95; ss by #8016, eff
12-29-03; ss by #10030, eff 12-1-11, EXPIRED: 12-1-19
New. #12944, INTERIM, eff 12-20-19, EXPIRED:
6-17-20
New. #13263, eff
9-22-21
He-M
513.07 Payment for Area Agency
Arranged and Family Arranged Respite Services.
(a) Area agencies may develop and use sliding
scale fees to determine the amount of the family’s payment, if any, for respite
services.
(b) A sliding fee scale pursuant to (a) above
shall:
(1) Be based on
family income; and
(2) Only apply
to families of individuals who are under the age of 18.
(c) Compensation shall be made by the area
agency, the family, or both to respite service providers for each hour or each
day that respite services are provided.
(d) Payment for respite services funded under the
HCBC‑DD waiver shall be in accordance with
He-M 517.10, medicaid covered home and community-based care services for
persons with developmental disabilities.
Source. (See Revision Note at part heading for He-M
513) #4495, eff 9-23-88; EXPIRED: 9-23-94
New. #6155, eff 12-29-95; ss by #8016, eff
12-29-03; ss by #10030, eff 12-1-11, EXPIRED: 12-1-19
New. #12944, INTERIM, eff 12-20-19, EXPIRED:
6-17-20
New. #13263, eff
9-22-21
He-M 513.08 Waivers.
(a)
An area agency, family member, respite service provider, or individual
may request a waiver of specific procedures outlined in He-M 513.
(b)
The entity requesting a waiver shall:
(1) Complete the
form entitled “NH Bureau of Developmental Services Waiver Request” (July 2019
edition); and
(2) Include a signature from the individual(s) or
legal guardian(s) indicating agreement with the request and the area agency’s
executive director or designee recommending approval of the waiver.
(c)
All information entered on the form described in (b) above shall be
typewritten or otherwise legibly written.
(d)
No provision or procedure prescribed by statute shall be waived.
(e)
The request for a waiver shall be granted by the commissioner or his or
her designee within 30 days if the alternative proposed by the requesting
entity meets the objective or intent of the rule and it:
(1) Does not negatively impact the health or
safety of the individual(s); and
(2) Does not affect the quality of services to
individuals.
(f)
The determination on the request for a waiver shall be made within 30
days of the receipt of the request.
(g)
Upon receipt of approval of a waiver request, the grantee’s subsequent
compliance with the alternative provisions or procedures approved in the waiver
shall be considered essential compliance with the rule for which the waiver was
sought.
(h)
Waivers shall be granted in writing for the minimum period necessary to
accomplish the waiver request’s purpose, with the specific duration not to exceed 5 years.
(i)
Any waiver shall end with the closure of the related program or service.
(j)
An area agency, family member, respite service provider, or individual
may request a renewal of a waiver from the bureau. Such request shall be made at least 90 days
prior to the expiration of a current waiver.
(k)
A request for renewal of a waiver shall be approved in accordance with
the criteria specified in (e) above.
Source. (See Revision Note at part heading for He-M
513) #4495, eff 9-23-88; EXPIRED: 9-23-94
New. #6155, eff 12-29-95; ss by #8016, eff
12-29-03; ss by #10030, eff 12-1-11, EXPIRED: 12-1-19
New. #12944, INTERIM, eff 12-20-19, EXPIRED:
6-17-20
New. #13263, eff 9-22-21
PART He-M 514 -
RESERVED
PART He-M 515 STANDARDS FOR INDIVIDUAL SKILLS TRAINING AND
PAYMENT - EXPIRED
Statutory
Authority: RSA 171-A:3; 4
REVISION NOTE:
Document #5131, effective 5-1-91, made
extensive changes to the wording, format, structure, and numbering of rules in
Part He-M 515. Document #5131 supersedes
all prior filings for the sections in this chapter. The prior filings for former Part He-M 515
include the following documents:
#2284, eff
12-29-82
#2819, eff 8-16-84
EXPIRED 8-16-90
He-M 515.01 - 515.10 - EXPIRED
Source. (See Revision Note at part heading for He-M
515) #5131, eff 5-1-91, EXPIRED: 5-1-97
PART He-M 516 -
RESERVED
Statutory
Authority: RSA 171-A:3; 4
REVISION NOTE:
Document #5049, effective 1-18-91,
made extensive changes to the wording, format, structure, and numbering of
rules in Part He-M 516. Document #5049
supersedes all prior filings for the sections in this chapter. The prior filings for former Part He-M 516
include the following documents:
#2662, eff 3-30-84
EXPIRED 3-30-90
Source. (See Revision Note at part heading for He-M
516) #5049, eff 1-18-91, EXPIRED: 1-18-97
PART He-M 517 MEDICAID-COVERED HOME AND COMMUNITY-BASED
CARE SERVICES FOR PERSONS WITH DEVELOPMENTAL DISABILITIES AND ACQUIRED BRAIN
DISORDERS
Statutory
Authority: RSA 171-A:3; 171-A:4; 171-A:18, IV; RSA 137-K:3, I,
II,-IV
He-M
517.01 Purpose. The purpose of these rules is to
define the requirements and procedures for medicaid-covered home and community-based care waiver services for persons with developmental
disabilities and acquired brain disorders where such services are provided
pursuant to He-M 503, He-M 504, He-M 507, He-M 513, He-M 518, He-M 521, He-M
522, He-M 525, and He-M 1001.
Source. #4315, eff 9-25-87; EXPIRED: 9-25-93
New. #6360, eff 10-23-96, EXPIRED: 10-23-04
New. #8195, INTERIM, eff 10-29-04, EXPIRED:
4-27-05
New. #8424, eff 9-1-05; ss by #10454, eff 10-31-13;
ss by #13988, eff 5-30-24
He-M
517.02 Definitions. The
words and phrases in this chapter shall have the following meanings:
(a) “Acquired
brain disorder” means a disruption in brain functioning that:
(1) Is
not congenital or caused by birth trauma;
(2) Presents a severe and life-long disabling condition which
significantly impairs a person’s ability to function in society;
(3) Occurs
prior to age 60;
(4) Is
attributable to one or more of the following reasons:
a. External trauma to the brain as a result of:
1. A
motor vehicle incident;
2. A
fall;
3. An
assault; or
4. Another
related traumatic incident or occurrence;
b. Anoxic or
hypoxic injury to the brain such as from:
1. Cardiopulmonary arrest;
2. Carbon
monoxide poisoning;
3. Airway
obstruction;
4. Hemorrhage; or
5. Near
drowning;
c. Infectious
diseases such as encephalitis and meningitis;
d. Brain tumor;
e. Intracranial surgery;
f. Cerebrovascular disruption such as a stroke;
g. Toxic exposure; or
h. Other neurological
disorders, such as Huntington’s disease or multiple sclerosis, which
predominantly affect the central nervous system resulting in diminished
cognitive functioning and ability; and
(5) Is
manifested by one or more of the following:
a. Significant decline in cognitive functioning and ability; or
b. Deterioration in:
1. Personality;
2. Impulse control;
3. Judgment;
4. Modulation of mood; or
5. Awareness of deficits;
(b) “Agency
residence” means a community residence operated by staff of a
provider agency;
(c) “Area
agency” means “area agency” as defined under RSA 171-A:2, I-b;
(d) “Basic living skills” means activities
accomplished each day to acquire, improve, or maintain independence
in daily life;
(e) “Bureau”
means the bureau of developmental services of the department of
health and human services;
(f) “Bureau
administrator” means the chief administrator of the bureau of
developmental services or their designee;
(g) “Centralized
service site” means a location operated by a provider agency where individuals
receive community participation services for more than one hour per day;
(h) “Commissioner” means the commissioner of the department of health and
human services, or their designee;
(i) “Community
integration” means:
(1) Participation
in a wide variety of experiences in settings that are available to and used by
the general public;
(2) Participation in natural relationships with one’s family, friends,
neighbors, and co-workers; and
(3) Expansion of one’s personal network of friends to include
individuals who do not have disabilities;
(j) “Community
residence” means either an agency residence or family residence exclusive of
any independent living arrangement that:
(1) Provides
residential services for at least one individual with a developmental
disability, in accordance with He-M 503, or acquired brain
disorder in accordance with He-M 522;
(2) Provides services and supervision for an individual on a daily and
ongoing basis, both in the home and in the community, unless the individual’s
service agreement states that the individual may be without supervision for
specified periods of time;
(3) Serves
individuals whose services are funded by the department; and
(4) Is
certified pursuant to He-M 1001, except as allowed in He-M 517.05(e)(7);
(k) “Cost of care” means the amount that an individual pays to a
provider agency because the individual’s net income is above the applicable
standard of need established in He-W 658.03;
(l) “Days” means calendar days unless otherwise
specified;
(m) “Department” means the New Hampshire department of health and human
services;
(n) “Developmental disability” means “developmental disability” as defined in
RSA 171‑A:2, V, namely, “a disability:
(a) Which
is attributable to an intellectual disability, cerebral palsy, epilepsy,
autism, or a specific learning disability, or any other condition of an
individual found to be closely related to an intellectual disability as it
refers to general intellectual functioning or impairment in adaptive behavior
or requires treatment similar to that required for persons with an intellectual
disability; and
(b) Which
originates before such individual attains age 22, has continued or can be
expected to continue indefinitely, and constitutes a severe disability to such
individual’s ability to function normally in society.”;
(o) “Family”
means a group of 2 or more persons that:
(1) Is
related by marriage, ancestry, or other legal arrangement;
(2) Is
living in the same household; and
(3) Has
at least one member who is an individual as defined in (r) below;
(p) “Family residence” means a community residence that is:
(1) Operated
by a person or family residing therein;
(2) Under
contract with a provider agency; and
(3) Certified
pursuant to He-M 1001;
(q) “Home
and community-based waiver services (HCBS waiver services)” means the services defined and funded
pursuant to New Hampshire’s agreement with the federal government, known as the
“Developmental Disabilities Waiver”, and the “Acquired Brain Disorder Waiver”,
pursuant to the authority section of 1915(c) of the Social Security Act which
allows the federal funding of long-term care services in non-institutional
settings for persons who are developmentally disabled or who have an acquired
brain disorder;
(r) “Individual”
means a person who has a developmental disability or an acquired brain
disorder;
(s) “Natural
supports” means people such as family, relatives, friends, neighbors, and
clergy, and social groups such as religious organizations, co-workers, and
social clubs, available to provide comfort and help as part of everyday living
as well as during critical events;
(t) “Organized health care delivery system
(OHCDS)” means an area agency, designated pursuant to He-M
505, that directly provides at least one home and community-based waiver
service;
(u) “Participant directed and managed services (PDMS)” means services
provided pursuant to He-M 525;
(v) “Pass-through billing” means an arrangement, pursuant to 42 CFR 447.10(g)(3),
whereby the OHCDS is the enrolled provider of home and community-based waiver
services for the purposes of billing and subcontracting for the service
provision and has authorization from the department to do so;
(w) “Personal
development” means supporting or increasing an individual’s capacity to make
choices, to communicate interests and preferences, and to have sufficient opportunities for
exploring and meeting those interests;
(x) “Provider” means
a person receiving any form of remuneration for the provision of services to an
individual;
(y) “Provider agency” means an agency or an independent provider that is
established to provide services to individuals pursuant to He-M 517.05 and
meets the criteria in He-M 504;
(z) “Representative” means:
(1) The
parent or guardian of an individual under the age of 18;
(2) The
legal guardian of an individual 18 or over; or
(3) A
person who has power of attorney for the individual;
(aa) “Service” means any paid assistance to an individual in meeting
their own needs provided through the developmental services system;
(ab) “Service
agreement” means a written agreement between the individual, guardian, or
representative, and the provider agency that is prepared as a result of the person-centered
service planning process and that describes the services that the individual
will receive and constitutes an individual service agreement as defined in RSA
171-A:2, X and developed pursuant to He-M 503.10 or He-M 522.11;
(ac) “Service coordinator” means a provider who meets the criteria in
He-M 503.08 or He-M 522.09 and is chosen by an individual and their guardian or
representative to organize, facilitate, and document service planning and to
negotiate and monitor the provision of the individual’s services;
(ad) “Sheltered
workshop” means a program that provides a segregated environment
where the contract objectives of the provider agency are the primary focus and
goal; and
(ae) “Skilled
nursing or skilled rehabilitative services” means those services
that:
(1) Require
the skills of a licensed or certified health professional including, but not
limited to:
a. Registered nurse;
b. Licensed practical nurse;
c. Physical therapist;
d. Occupational therapist;
e. Speech pathologist;
f. Audiologist; or
g. Other
similar health-related professional; and
(2) Are
provided directly by or under the general supervision of such professionals to
assure the safety of the individual and to achieve the medically desired
result.
Source. #4315, eff 9-25-87; EXPIRED: 9-25-93
New. #6360, eff 10-23-96, EXPIRED: 10-23-04
New. #8195, INTERIM, eff 10-29-04, EXPIRED:
4-27-05
New. #8424, eff 9-1-05; ss by #10454, eff 10-31-13;
ss by #13988, eff 5-30-24
He-M
517.03 Eligibility.
(a) Based on availability of funds, HCBS waiver services shall be
available to any individual who:
(1) Is
found to be eligible for services by an area agency pursuant to He-M 503 or
He-M 522;
(2) Is
found to be eligible for medicaid by the department pursuant to He-W
600 and He-W 800, as applicable;
(3) Meets
institutional level of care criteria as demonstrated by one of the following:
a. A developmental disability that requires at least one of the following:
1. Services on a daily basis for:
(i) Performance
of basic living skills;
(ii) Intellectual,
physical, or psychological development and well-being;
(iii) Medication
administration and instruction in, or supervision of, self-medication by a
licensed medical professional; or
(iv) Medical
monitoring or nursing care by a licensed professional person;
2. Services on
a less than daily basis as part of a planned transition to more independence; or
3. Services
on a less than daily basis but with continued availability of services to
prevent circumstances that could necessitate more intrusive and
costly services; or
b. An acquired brain disorder that requires a skilled nursing facility
level of care, which means requiring skilled
nursing or skilled rehabilitative services on a daily basis; and
(4) Agrees
to make the appropriate payment toward the cost of care, as specified in He-M
517.13(c).
(b) To
request initial determination of level of care as described in in He-M 517.03(a)(3) above, a “NH bureau of developmental services functional screen for waiver services” electronic
form shall be submitted by the area agency via NH Easy, via https://nheasy.nh.gov/#/,
within 5 business days of an individual’s decision to seek eligibility for HCBS
waiver services.
(c) Individuals
shall undergo an annual redetermination of the level of care criteria in He-M
517.03(a)(3) above.
(d) To request a
redetermination of the level of care in He-M 517.03(a)(3) above, a “NH bureau
of developmental services functional screen for waiver services” electronic
form shall be submitted by the service coordinator via NH Easy, https://nheasy.nh.gov/#/ , not
less than 30 days but not more than 45 days prior to expiration of the current
level of care determination.
(e) The
bureau shall send notification of the level of care determination in accordance
with He-M 503.05 or He-M 522.06.
(f) The
bureau shall deny services through the home and community-based
waiver if it determines that the provision of services will result in the loss
of federal financial participation for such services.
Source. #4315, eff 9-25-87; EXPIRED: 9-25-93
New. #6360, eff 10-23-96, EXPIRED: 10-23-04
New. #8195, INTERIM, eff 10-29-04, EXPIRED:
4-27-05
New. #8424, eff 9-1-05; ss by #9370, eff 1-24-09;
ss by #10454, eff 10-31-13; ss by #13988, eff 5-30-24
He-M
517.04 Provider and Provider Agency Participation.
(a) Every
OHCDS and provider agency shall be enrolled with the New Hampshire
medicaid program and comply with all requirements
set forth in He-M 504 in order to receive reimbursement for the provision of
HCBS waiver services.
(b) An
OHCDS or provider agency shall allow the department or area
agency to examine its service and financial records at any time for the
purposes of audit or review in accordance with He-M 504.
Source. #4315, eff 9-25-87; EXPIRED: 9-25-93
New. #6360, eff 10-23-96, EXPIRED: 10-23-04
New. #8195, INTERIM, eff 10-29-04, EXPIRED:
4-27-05
New. #8424, eff 9-1-05; ss by #10454, eff 10-31-13;
ss by #13988, eff 5-30-24
He-M
517.05 Covered Services.
(a) All
HCBS waiver services provided shall be specifically tailored
to, and provided in accordance with, the individual’s needs, interests,
competencies, and lifestyle as described in the individual’s service agreement.
(b) Services
provided pursuant to He-M 517 shall be:
(1) Designed to maintain and enhance each
individual’s natural supports;
(2) Responsive to the individual’s changing needs
and choices within the limitations of federal and state laws and rules and the
HCBS waiver;
(3) Provided only after the informed consent of
the individual or their guardian or representative;
(4) Free from conflict in accordance with He-M
503 or He-M 522;
(5) Delivered by any willing and qualified
provider agency or provider that is freely chosen by the individual or
individual’s guardian or representative and who meets the criteria in He-M
504.03, He-M 504.04, and He-M 504.11; and
(6) Provided in accordance with He-M 310.
(c) The
services identified in (d)-(s) below shall be fundable in
accordance with the HCBS waiver services if such services are identified within
an individual’s service agreement.
(d) Service coordination services shall:
(1) Be
provided pursuant to He-M 503 or He-M 522;
(2) Include
the following:
a. Coordination and facilitation to assist individuals in gaining access
to needed services and resources, as well as needed medical, social,
educational, and other services, regardless of funding source, as delineated in
the service agreement, including:
1.
System navigation including identifying, providing information about, and
assisting families to access available services as well as community resources;
2. Person-centered
service planning including coordination and facilitation of services and the
development of a service agreement pursuant to He-M 503.09 and He-M 503.10 or
He-M 522.10 and He-M 522.11;
3. Monitoring and ongoing review of services and
individual outcomes, in accordance with He-M 503.10 or He-M 522.11 to include
assessing and reassessing service needs, goals and, outcomes;
4. Monitoring of
services for quality in accordance with He-M 503.10 or He-M 522.11;
5. Monitoring to
ensure health and welfare in accordance with He-M 503.10 or He-M 522.11; and
6. Assistance in
identifying available provider agencies and providers;
b. Referral
to the bureau for the redetermination of the individual’s continued need for
HCBS waiver services pursuant to He-M 503 or He-M 522 and He-M 517.03;
c. Twenty-four hour
access, 7 days a week pursuant to He-M 504.03;
d. Monitoring to ensure that documentation is maintained to demonstrate
service coordination service provisions;
e. Gathering of
documentation from provider agencies to aid in person-centered service planning
and in creating an individual’s service agreement in accordance with He-M
503.10 or He-M 522.11;
f. Participating in
transition planning; and
g. Providing
advocacy education and skill development to the individual, their family, and
their representative or guardian; and
(3) Be
reimbursed at a monthly rate.
(e) Residential habilitation
services shall:
(1) Be
provided pursuant to He-M 1001, He-M 525, or He-M 521, as applicable;
(2) Include
individually tailored supports to assist with the acquisition, retention, or
improvement of community-based living skills including but not limited to:
a. Meal preparation;
b. Eating;
c. Bathing;
d. Dressing;
e. Personal
hygiene;
f. Medication
management;
g. Community inclusion;
h. Transportation;
i. Social and leisure skills; and
j. Adaptive skill
development;
(3) Include assistance to the individual to
enable them to reside in the least restrictive setting most appropriate to
their needs;
(4) Be provided in the home or outside of the
home;
(5) Be
reimbursed at a daily rate;
(6) Be
certified pursuant to He-M 1001, except as allowed by (7) below.
(7) Be
licensed by the bureau of health facilities administration in accordance with
RSA 151:2, I, (e) and He-P 814, in addition to being certified pursuant to He-M
1001, if a community residence serves 4 or more people;
(8) Not
be required to be certified as a community residence pursuant to He-M 1001 when
the residence is funded under the home and community-based care waiver,
provides services to persons with acquired brain disorders, and is licensed as
a supported residential care facility or a residential treatment and
rehabilitation facility under RSA 151:2, I, (e);
(9) Be
certified pursuant to He-M 521.09 when residential habilitation services are
provided in the family home of an individual who is 18 years of age or older,
as described in He-M 521.03; and
(10) Be
certified pursuant to He-M 525 for services provided through a participant
directed and managed services method of delivery.
(f) Community participation services shall:
(1) Be
provided in accordance with He-M 507;
(2) Include
the following as outlined in the individual’s service agreement:
a. Instruction and assistance to learn, attain, improve, or maintain:
1. Social
and safety skills in different community settings;
2. Decision-making
regarding choice of and participation in community activities;
3. Life
skills as applied to community-based activities, such as purchasing items and
managing personal funds;
4. Good
nutrition and healthy lifestyle;
5. Self-advocacy and rights and responsibilities as citizens; and
6. Any
other skill identified by the individual or guardian during service
planning and related to the individual’s participation in, or contribution to,
their community;
b. Supports to identify and develop the individual’s interests and
capacities related to securing employment opportunities, including internships;
c. Services related to job development and on-the-job training;
d. Assistance in finding and maintaining volunteer positions;
e. Supports related to enabling the individual to explore, and
participate in, a wide variety of community
activities and experiences in settings that are available to the general
public; and
f. Transportation
related to community participation services, including travel from the individual’s residence to locations where the community participation
service activities are taking place;
(3) Exclude
employment or volunteer positions where the individual is:
a. Being solely supported by persons who are not providers; and
b. Not receiving any services from a provider agency at those locations;
and
(4) Be
reimbursed at a quarter hour rate.
(g) Supported employment services shall:
(1) Be
provided in accordance with He-M 518;
(2) Be
available to any individual who:
a. Has a goal or desired outcome related to employment; and
b. Is not authorized
and funded by the NH department’ of education’s bureau of vocational
rehabilitation for the same supported employment service;
(3) Consist
of assistance provided to individuals to:
a. Improve or maintain their skills in employment activities; or
b. Enhance
their social and personal development or well-being within the context of vocational goals;
(4) Include
referral, evaluation, and consultation for adaptive equipment, environmental
modifications, communications technology or other forms of assistive
technology, and educational opportunities related to the individual’s
employment services and goals;
(5) When
combined with another employment service, transportation and training in
accessing transportation, as appropriate, to and from work; and
(6) Be
reimbursed at a quarter hour rate.
(h) Respite
care services shall:
(1) Be
provided pursuant to He-M 513;
(2) Consist
of the provision of short-term assistance and care for individuals unable to
care for themselves because of the absence or need for relief of the family who
lives with and normally provides care for the individual;
(3) Be provided in or out of an individual’s
home;
(4) Not exceed 20% of an individual’s total
funding for services when provided through a participant directed and managed
program as outlined in He-M 517.07 below and He-M 525;
(5) Be authorized by the bureau in excess of the limitation in
(4) above upon written request which shall include documentation supporting the
need and the correlation of the request to the individual’s
service agreement; and
(6) Be
reimbursed at a quarter hour rate.
(i) Environmental and vehicle modification services shall:
(1) Include
modifications or adaptations and maintenance thereof to the individual’s home
environment including:
a. Installation of
ramps;
b. Installation of grab
bars;
c. Widening of doorways
to accommodate the participant’s wheelchair or other mobility access equipment;
and
d. Other adaptations
authorized by the bureau that are necessary to ensure the health and
safety of the individual or that are needed to
accommodate the medical equipment and supplies that are necessary for the
welfare of the individual;
(2) Include
modifications or adaptations and maintenance thereof to the vehicle used by the
individual in order to enable them to:
a. Travel in
greater safety;
b. Access
the community; and
c. Carry out
activities of daily living;
(3) Comply
with applicable state and local building and vehicle codes;
(4) Not exceed $2500 when used for outdoor
fencing to support individuals with unsafe wandering or running behaviors; and
(5) Be authorized by the bureau in excess of the limitation in
(4) above upon written request which shall include documentation supporting the
need and the correlation of the request to the individual’s
service agreement.
(j) Environmental and vehicle modification services shall not cover:
(1) Improvements that are of general utility and do not have direct or medical
remedial benefit to the individual;
(2) Adaptations which add to the square footage of the home except when necessary to
complete an adaptation;
(3) The purchase or lease of a vehicle;
(4) Regularly scheduled upkeep and maintenance of a vehicle;
(5) Electrical or plumbing work that is beyond what is
required to support the authorized adaptation; and
(6) Electrical or plumbing work for which the proposed contractor is unable to
state, in writing, that the proposed adaptation can be done within the current
electrical or plumbing capacity of the home.
(k) Crisis
response services shall:
(1) Consist
of direct consultation, clinical evaluation, or support to an individual who is
experiencing a behavioral, emotional, or medical crisis in order to reduce the
likelihood of harm to the person or others and to assist the individual to
return to their pre-crisis status;
(2) Include
training and staff development related to the needs of the individual;
(3) Include
on-call staff for the direct support of the individual in crisis;
(4) Be
authorized for a period of up to 6 months;
(5) Be
reimbursed at a quarter hour rate; and
(6) Be authorized by the bureau in excess of the
limitation in (4) above upon written request which shall include documentation
supporting the need and the correlation of the request to the individual’s
service agreement.
(l) Community support services shall:
(1) Be
available for an individual who has developed, or is trying to develop, skills
to live independently within the community;
(2) Consist
of assistance, excluding room and board, provided to an individual to:
a. Improve or maintain their skills in basic daily living and
community integration; and
b. Enhance their personal development and well-being;
(3) Not exceed 30 hours per week;
(4) Be provided for up to 24 consecutive months
while an individual is residing with their family;
(5) Be authorized by the
bureau in excess of the limitation in (3) and (4) above upon written request
which shall include documentation supporting the need and the
correlation of the request to the individual’s
service agreement; and
(6)
Be reimbursed at a quarter hour rate.
(m) Assistive technology shall:
(1) Include an item,
piece of equipment, certification and training of service animal, or product
system, used to increase, maintain, or improve functional capabilities of an
individual, including, but not limited to, the following:
a. Devices, controls, or appliances, specified in the individual service
agreement that enable the individual to
increase their ability to perform activities of daily living, or perceive,
control, or communicate with the environment in which they live;;
b. The evaluation of
the assistive technology needs of an individual, including a functional
evaluation of the impact of the provision of appropriate assistive technology
and appropriate services to the individual;
c. Purchasing,
leasing, or otherwise providing for the acquisition of assistive technology or
devices;
d. Selecting,
designing, fitting, customizing, adapting, applying, maintaining, repairing, or
replacing assistive technology devices;
e. Coordination
and use of necessary therapies, interventions, or services associated with
other services in the service agreement;
f. Training or
technical assistance for the individual or the individual’s family members,
guardians, advocates, or authorized representatives;
g. Training or
technical assistance for professional or other individuals who provide services
to, employ, or are otherwise substantially involved in the major life functions
of an individual; and
h. Training and certification of a service
animal, defined in federal regulations implementing the Americans with
Disabilities Act, 28 C.F.R. § 36.104 as “service animal means any dog that is individually trained to
do work or perform tasks for the benefit of an individual with a disability, including a
physical, sensory, psychiatric, intellectual, or other mental disability. Other species of animals, whether
wild or domestic, trained or untrained, are not service animals for the
purposes of this definition. The work or tasks performed by a service animal must be directly related to the
individual's disability.";
(2) Include adaptive equipment which shall be items of durable
and non-durable medical equipment necessary to address the individual’s
functional limitations;
(3) Not exceed $10,000 over the
course of 5 years; and
(4) Be authorized by the bureau in excess of the limitation in (3) above upon written
request which shall include documentation supporting the need and the
correlation of the request to the individual’s
service agreement.
(n) Specialty services shall:
(1) Be
available to individuals whose medical, behavioral, therapeutic, health, or
personal needs require services that are particularly designed to address the
unique conditions and aspects of their developmental disabilities or acquired
brain disorders;
(2) Consist
of one or more of the following:
a. Assessment;
b. Consultation;
c. Design,
development, and provision of services;
d. Training
and supervision of staff and providers; and
e. Evaluation
of service outcomes; and
(3) Be
reimbursed at a quarter hour rate or at cost when for a consultation.
(o) Community
integration services shall:
(1) Be services designed to
support, enhance, or enable an individual’s level of functioning,
independence, and life activities, to promote health and
wellness as well as reduce or eliminate the activity limitations and
restrictions to participation in life situations caused by a disability shall
include, but not be limited to the following:
a. Water safety training;
b. Community based camperships; and
c. A pass or membership for admission to
community-based activities only when needed to address assessed needs;
(2) When including community-based activity passes, be
purchased as day passes or monthly passes, whichever is the most cost
effective;
(3) Not exceed $8,000 annually;
(4) Be authorized by the bureau in excess of the limitation in
(3) above upon written request which shall include documentation supporting the
need and the correlation of the request to the individual’s
service agreement; and
(5) Require a licensed healthcare practitioner’s recommendation when any single
community integration service, other than a campership, is over $2,000.
(p) Individual goods and services shall:
(1) Include equipment or supplies that address an identified need in
the service agreement, and meet at least one of the following requirements:
a. The good or service decreases the need for other
Medicaid services;
b. The good or service promotes inclusion in the
community; or
c. The good or service increases the individual's
safety in the home environment;
(2) Include payment through the home and
community-based services waiver if:
a. The individual does not have the funds to
purchase the item or service; or
b. The item or service is not covered through other
sources;
(3) Not exceed $1,500 annually;
(4) Be authorized by the bureau
in excess of the limitation in (3) above upon written request
which shall include documentation supporting the need and the
correlation of the request to the individual’s service agreement;
(5) Have an anticipated finite period of time to
be utilized; and
(6) Include a
determination on the frequency of purchase of individual goods and services in
accordance with the documented continued need of the item and the ability of
the item to continue to meet that need.
(q) Non-medical transportation shall:
(1) Be services designed specifically to
improve the individual’s and the caregiver's ability to access community
activities within their own community in response to needs
identified through the individual's service agreement, including, but not
limited to:
a. Orientation service using other services or
supports for safe movement from one place to another;
b. Travel training such as supporting the
individual and family in learning how to access and use informal and public transport for independence and community
integration;
c. Transportation service provided by different
modalities, including public and community transportation, taxi services,
transportation specific to prepaid transportation cards, mileage reimbursement,
volunteer transportation, and non-traditional transportation providers; and
d. Prepaid transportation vouchers and cards;
(2) Be limited to:
a. $5,000 annually; or
b. $10,000 annually for individuals who require
specialized transportation such as a vehicle that:
1. Can accommodate a wheelchair or similar;
2. Has lift capabilities; or
3. Allows for the individual to
not be within reach of the driver;
(3) Be authorized by the bureau in excess of the limitations in (2)(a)-(b)
above upon written request which shall include
documentation supporting the need and the correlation of the request to the individual’s service agreement;
(4) Be limited
to transportation needed:
a. To access a HCBS waiver service that is
included in the individual’s service agreement; or
b. To access other activities and resources
identified in the individual’s service agreement; and
(5) Not be available to individuals under the age
of 16 for public transportation expenses.
(r) Personal emergency response services (PERS) shall:
(1) Consist of smart technology devices that enable individuals to
summon help in an emergency including but not limited to:
a. Wearable or
portable devices that allow for safe mobility;
b. Response systems that are connected to the
individual’s telephone and programmed to signal a response center when
activated;
c. Staffed and
monitored response systems that operate 24 hours a day, 7 days a week;
d. Any device
that informs of elopement; and
e. Monthly
expenses that are affiliated with maintenance contracts or agreements to
maintain the operations of the device or item;
(2) Include non-smart technology items, such as seatbelt release covers,
ID bracelets, and GPS devices;
(3) Not exceed $2,000 annually;
(4) Be authorized by the bureau
in excess of the limitation in (3) above upon written request which shall
include documentation supporting the need and
the correlation of the request to the individual’s service agreement; and
(5) Be authorized as part of a
positive behavior plan pursuant to He-M 310 when the device is restrictive.
(s) Wellness coaching shall:
(1) Include planning, directing, coaching, and mentoring individuals
with disabilities in community based, inclusive exercise activities in
accordance with the recommendations of a licensed recreational therapist or a
certified personal trainer;
(2) Include specific goals in
the individual’s service agreement which are developed by a wellness coach,
including activities that are carried over into the individual’s home and
community;
(3) Consist of demonstration by
a wellness coach on exercise techniques and form to include observation of individuals and explanation to them of corrective
measures necessary to improve their skills;
(4) Include collaboration between a wellness coach and the
individual, their family and other caregivers, and with other health and wellness professionals as needed;
(5) Not exceed $5,000 annually;
and
(6) Be authorized by the bureau
for amount in excess of the limitation in (5) above by written request, which shall include the
recommendation of a licensed professional and documentation supporting the need
and the correlation of the request to the individual’s service agreement.
(t) Removable prosthodontic services shall:
(1) Assist individuals as a
means to prevent functional limitations in order to support community
integration and avoid isolation or
institutionalization and when, if not otherwise provided:
a. The individual’s health would be compromised
through reduced food options and result in restrictive nutritional intake,
impacting overall health; or
b. When considerations interfere with supported
employment or social development;
(2) Include:
a. Complete dentures, including immediate
prosthetic appliances and routine post-delivery care;
b.
P artial dentures, including immediate prosthetic appliances and routine
post-delivery care;
c. Adjustments to dentures;
d. Repairs to complete and partial dentures;
e. Denture rebase procedures; and
f. Denture reline procedures;
(3) Be included
in the individual’s service agreement;
(4) Not exceed $1,500 annually;
(5) Not cover dentures more than once in a 5 year period;
(6) Not be available to
individuals under the age of 21 that are not otherwise covered by the Medicaid state plan;
(7) Be authorized by the
department in excess of the limitation in (4) and (5) above due to medical
necessity through written request, which shall
include documentation to support the
identified need and how it correlates the individual’s service agreement; and
(8) Be overseen
by New Hampshire’s prepaid ambulatory health plan as defined in 42 CFR §438.2.
Source. #4315, eff 9-25-87; EXPIRED: 9-25-93
New. #6360, eff 10-23-96, EXPIRED: 10-23-04
New. #8195, INTERIM, eff 10-29-04, EXPIRED:
4-27-05
New. #8424, eff 9-1-05; amd by #9370, eff 1-24-09;
ss by #10454, eff 10-31-13; ss by #13988, eff 5-30-24
He-M 517.06 Acute and Remote Setting
Services.
(a) Upon request, services in
(f) below shall be provided in an acute care hospital when each service is:
(1) Identified
in an individual’s service agreement;
(2) Provided
to meet needs of the individual that are not met through the provision of
hospital services;
(3) Not a substitute for services that the hospital is
obligated to provide through its conditions of participation or under federal
or state law, or under another applicable requirement; and
(4) Designed to ensure smooth
transitions between acute care settings and home and community-based settings,
and to preserve the individual’s functional abilities.
(b) If services in (e) are
provided pursuant to (c) below, then those services shall be reviewed by the
team at the quarterly meeting to ensure this method of service delivery
continues to meet the individual’s needs.
(c) Upon request, services in
(e) below shall be provided remotely under the following conditions:
(1) This method of service delivery meets the assessed needs
of the individual;
(2) The individual, guardian, or representative chose this method of
service delivery;
(3) This method of service delivery is reviewed by the team
at the quarterly meeting to ensure that it continues to meet the individual’s
needs; and
(4) The chosen remote platform for delivery of services is in
compliance with the Health Insurance Portability and Accountability Act of
1996, as applicable.
(d) If an individual, guardian,
or representative no longer chooses to receive a service in (e) below through a
remote method of service delivery, the provider agency shall continue providing
services in the same amount, type, scope, frequency, and duration during the
time in which services are changed to an in-person method of delivery.
(e) Services that may be
provided through a remote method of service delivery pursuant to (c) above
shall include:
(1) Community
participation services;
(2) Residential
habilitation;
(3) Service coordination,
except home visits pursuant to He-M 503.10 or He-M 522.11 for residential
services;
(4) Supported
employment;
(5) Assistive technology;
(6) Community
integration services;
(7) Community
support services;
(8) Crisis response services;
(9) Individual goods and services;
(10) Specialty services; and
(11) Wellness coaching.
(f) Services that may be
provided in an acute care hospital pursuant to (a) above shall include:
(1) Community
participation services;
(2) Residential
habilitation;
(3) Respite;
(4) Service coordination;
(5) Supported
employment;
(6) Assistive
technology;
(7) Community
support services;
(8) Crisis response services;
(9) Environmental
and vehicle modification services;
(10) Individual
goods and services;
(11) Personal
emergency response services;
(12) Removable
prosthodontic services;
(13) Specialty
services; and
(14) Wellness
coaching.
Source. #4315, eff 9-25-87; EXPIRED: 9-25-93
New. #6360, eff 10-23-96, EXPIRED: 10-23-04
New. #8195, INTERIM, eff 10-29-04, EXPIRED:
4-27-05
New. #8424, eff 9-1-05; ss by #10454, eff 10-31-13;
ss by #13988, eff 5-30-24
He-M
517.07 Out of State Service Provision.
(a) Services outlined in (c) below shall be
provided outside of New Hampshire as follows:
(1) When the only
safe and accessible setting is outside of New Hampshire;
(2) Only until a
safe and accessible setting is available in New Hampshire or in their community
in accordance with (d) below;
(3) The services are
approved by the bureau in accordance with (b) below; and
(4) The services are
outlined in the individual’s service agreement to reflect the amount, scope,
duration, and frequency of the service and the oversight and monitoring of the
service agreement.
(b) Out-of-state service provisions shall be
requested via written request to the bureau and include:
(1) A transition plan
with a timeframe for return to New Hampshire;
(2) Verification that the provider agency meets
criteria in accordance with He-M 504, He-M 506, He-M 507, and He-M 518, as applicable;
(3) Demonstration that the provider is in good
standing through licensing or certification reports from the previous 5 years, or the maximum number available
for providers established within the previous 5 years, from any in-state or
out-of-state entity, including deficiency reports and compliance records;
(4) A plan articulated in
the service agreement to demonstrate how an individual will access acute care
as well as ongoing medical and clinical needs that are not covered by the home
and community-based waiver; and
(5) A plan
articulated in the service agreement for oversight and monitoring of the
service plan in accordance with He-M 503 or He-M 522.
(c)
Services that may be provided out-of-state pursuant to (a)-(b) shall include:
(1) Community
participation services;
(2) Residential
habilitation;
(3) Supported
employment;
(4) Assistive
technology;
(5) Community
integration services;
(6) Community
support services;
(7) Crisis response services;
(8) Environmental
and vehicle modification services;
(9) Individual
goods and services;
(10) Non-medical transportation;
(11) Personal emergency
response services;
(12) Removable
prosthodontic services;
(13) Specialty services; and
(14) Wellness coaching.
(d) The provisions outlined in (a)-(b) shall not
apply when an individual is requesting services in a town outside of New
Hampshire that is not more than a 30 minute drive.
Source. #4315, eff 9-25-87; EXPIRED: 9-25-93
New. #6360, eff 10-23-96, EXPIRED: 10-23-04
New. #8195, INTERIM, eff 10-29-04, EXPIRED:
4-27-05
New. #8424, eff 9-1-05; amd by #9370, eff 1-24-09;
ss by #10454, eff 10-31-13; ss by #13988, eff 5-30-24
He-M
517.08 Participant Directed and Managed Services.
(a) Services that are accessed through the
participant directed and managed method of service delivery shall:
(1) Be
provided
pursuant to He-M 525;
(2) Be
available for
individuals and their families in order to improve or maintain each
individual’s health and their experiences and opportunities in work and
community life;
(3) Consist of assistance and resources within a
flexible process that allows the family and individual to control, to the
extent desired, the service provision, including, for each service:
a. The type;
b. The
amount;
c. The location;
d. The duration; and
e. The service provider agency and provider;
(4) Be
based on an
individual service agreement that includes:
a. A description of the services to be provided that also specifies the
expenditures to be made;
b. A line-item budget; and
c. A process
for measuring the individual’s degree of satisfaction with the services
provided;
(5) Not
be provided by the spouse of an individual, except as provided in He-M
517.10(g) below, or the parent of an individual where the individual is a minor
child;
(6) Be
provided by persons qualified pursuant to He-M 504.03, He-M 504.04, He-M
504.11, He-M 525.05, and He-M 525.06, as
applicable; and
(7) Be
reimbursed in
accordance with the process for each service provided as outlined in He-M
517.05.
(b) Participant directed and managed services
documentation shall include:
(1) Individual records, including:
a. Information
about the individual that would be essential in case of an emergency, including
that information specified in He-M
517.09 (b)(1);
b. The portion of the individual’s service agreement pertaining to participant
directed and managed services, with any revisions;
c. Monthly
progress notes;
d. Monthly notes describing the family’s satisfaction with the services; and
e. Monthly financial statements provided to the individual and family by the service
coordinator; and
(2) Detailed description of all services provided,
including:
a. The date;
b. The
activity or type of service;
c. The location;
d. The duration;
e. The provider agency and provider; and
f. Documentation
required for the services provided as outlined in He-M 517.10.
Source. #4315, eff 9-25-87; EXPIRED: 9-25-93
New. #6360, eff 10-23-96, EXPIRED: 10-23-04
New. #8195, INTERIM, eff 10-29-04, EXPIRED:
4-27-05
New. #8424, eff 9-1-05; amd by #9370, eff 1-24-09;
ss by #10454, eff 10-31-13; ss by #13988, eff 5-30-24
He-M
517.09 Non-Covered Services. The following
services shall not be fundable under home and community-based care waivers:
(a) Educational
services or education programs for individuals who are under 22 years of age
that are the responsibility of the local education authority;
(b) Post-secondary
education, regardless of whether it leads to a degree;
(c) Sheltered
workshop services;
(d) Custodial
care programs provided only to maintain an individual’s basic welfare;
(e) Services that are recreational or diversional
in nature;
(f) Services which are
available under the medicaid state plan; and
(g) Experimental or prohibited treatments.
Source. #4315, eff 9-25-87; EXPIRED: 9-25-93
New. #6360, eff 10-23-96, EXPIRED: 10-23-04
New. #8195, INTERIM, eff 10-29-04, EXPIRED:
4-27-05
New. #8424, eff 9-1-05; ss by #10454, eff 10-31-13;
ss by #13988, eff 5-30-24 (formerly He-M 517.06)
He-M
517.10 Documentation.
(a) Provider
agencies of home and community‑based care for individuals with
developmental disabilities or acquired brain disorders shall maintain the
documentation described in (b)-(r) below at the sites where services are
provided.
(b) Service
coordination records shall include:
(1) Information about the individual that
would be essential in case of an emergency, including:
a. Name, address, and telephone number of legal guardian, representative,
or next of kin; and
b. Medical information, including:
1. Diagnosis(es);
2. Health
history;
3. Medications, including dose, frequency, and route;
4. Allergies;
5. Do
not resuscitate (DNR) status;
6. Advance directives created in accordance with RSA 137-J; and
7. Any correspondence
related to medical information relevant to the individual;
(2) A
copy of each individual’s
service agreement;
(3) Copies
of all service agreement
revisions approved by the individual or their guardian;
(4) Documentation of service agreement
monitoring pursuant to He-M 503 or He-M 522 including:
a. Progress notes on goals for which the service
coordinator has primary responsibility;
b. Monthly
documentation by the service coordinator of service coordination activities,
including activities promoting community participation and integration; and
c. At least quarterly documentation of face-to-face visits, inclusive of
those that occur in the individual’s home, assessing progress on goals and
identifying whether the services:
1. Match
the interests and needs of the individual;
2. Met
with the individual’s and guardian’s satisfaction; and
3. Meet
the terms of the service agreement;
(5) Copies of all evaluations and reviews by
providers and professionals;
(6) Copies of correspondence within the past year
with the individual or guardian, providers, physicians, attorneys, state and
federal agencies, family members, and others in the individual’s life with
whom the service coordinator has corresponded; and
(7) Other
correspondence or
memoranda concerning any significant events in the individual’s life.
(c) For
residential habilitation services provided in a community residence pursuant to
He-M 1001, services documentation shall
include:
(1) Individual records, which shall include:
a. Information
about the individual that would be essential in case of an emergency, including
that information specified in (b)(1) above;
b. The
portion of the service agreement pertaining to residential services, with any
revisions; and
c. Monthly
progress notes;
(2) Community
residence daily service provision records, which shall:
a. Be
completed by the provider agency;
b. Include
the date;
c. Indicate
each individual’s daily presence or absence;
d. If the
individual is not present, indicate the date and time of the individual’s
departure and return, and include the reason for the absence;
e. For those
community residences where supervision is less than 24 hours a day, indicate
the days in which services were provided; and
f. Be on
file at both the community residence and the provider agency; and
(3) A
daily medication log, which shall be completed at the residence pursuant to
He-M 1201.07.
(d) For
services provided in a family home pursuant to He-M 521, documentation shall
include:
(1) Individual records, which shall include:
a. Information
about the individual that would be essential in case of an emergency, including
that information specified in (b)(1) above;
b. The
portion of the service agreement pertaining to residential services with any
revisions; and
c. Monthly
progress notes; and
(2) Daily service
provision records, which shall:
a. Be
completed by the provider agency;
b. Include
the date; and
c. Indicate
days that services were provided.
(e) For
community participation services pursuant to He-M 507, individual records shall
include:
(1) A
copy of the current service
agreement containing:
a. Goals and
desired outcomes specific to the individual’s participation in community
participation services; and
b. The
methods or strategies for achieving the individual’s community participation
services’ goals and desired outcomes;
(2) As
a guide for planning activities, an individual, week-long, personal schedule or
calendar that is created at the time of the annual service planning meeting
and, if applicable, identifies:
a. The days,
times, and locations of the individual’s:
1. Paid
employment;
2. Community activities, volunteerism, or internship; and
3.
Other regularly recurring activities, such as therapeutic activities
related to communication, mobility, and personal care; and
b. The days
and approximate times of unspecified community activities, which shall not
exceed 20% of the total day service hours the individual receives per week;
(3) A
record of
daily community participation services activities maintained by the provider
agency, which shall include the following:
a. The
name(s) of individual(s) served and names of staff supporting them;
b. The dates
on which services were provided; and
c. Activities
that took place and the locations of the activities;
(4) Narrative progress notes, and other service
documentation as specified in the service agreement, recorded at least monthly,
and addressing:
a. The
individual’s community participation services goals and actual outcomes; and
b. Other activities related to the individual’s
support services, health, interests, achievements, and relationships;
(5) The
individual’s
medical status, including current medications, known allergies, and other
pertinent health care information;
(6) Results
of any screenings or
evaluations including, if applicable:
a. The
Supports Intensity Scale, SIS-A ® (2023 edition), available as noted in
Appendix A;
b. Vocational
assessments;
c. Results
of any assistive technology assessments;
d. The
Health Risk Screening Tool (HRST) (2015 edition), available as noted in
Appendix A;
e. Systematic, therapeutic, assessment, respite
and treatment (START) in-depth assessments and crisis plans; and
f. Risk
management plans for individuals who are deemed to pose a risk to community
safety; and
(7) For
each individual for whom
medications are administered during community participation services,
medication log documentation pursuant to He-M 1201.07.
(f) Individual
records for supported employment services shall include:
(1) Information about the individual that
would be essential in case of an emergency, including that information
specified in (b)(1) above;
(2) The
portion of the service agreement pertaining to employment services, with any
revisions;
(3) Quarterly progress notes regarding services
provided and progress toward goals identified in the service agreement;
(4) Weekly work schedules; and
(5) If
there is a
provider agency staff person with the individual or individuals at the job
site:
a. Service
provision records, including documentation of the individual’s attendance at
work; and
b. As
needed, notation of any employment-related events apart from each individual’s
expected work routine.
(g) Respite
service records shall include attendance records indicating the dates and
duration of the services provided.
(h) Environmental
and vehicle modification services documentation shall include:
(1) A
specific
description of the modifications and estimate(s) of cost, in accordance with
He-M 517.08;
(2) A
rationale as to
why the requested modification is specifically related to the individual’s
disability;
(3) The
section of the individual’s service agreement that outlines the need for the
modifications; and
(4) The date of completion.
(i) Crisis
response services documentation shall include:
(1) A
brief description of the crisis in the service agreement written by the service
coordinator;
(2) A
summary of
the crisis response services proposed;
(3) Monthly progress notes, including a description
of the services provided and the individual’s response to services; and
(4) Service provision records indicating the units of
services provided.
(j) Community
support services documentation shall include:
(1) Individual records, which shall include:
a. Information
about the individual that would be essential in case of an emergency, including
that information specified in (b)(1) above;
b. A service
agreement with all approved revisions; and
c. Monthly
progress notes; and
(2) Service provision records indicating the units of
services provided.
(k) Assistive
technology documentation shall include:
(1) A
brief statement in the service agreement describing:
a. The item or service;
b. The name of the healthcare practitioner
recommending the item or service;
c. An evaluation or assessment regarding the
appropriateness of the item;
d. A goal related to the use of the item;
e. The anticipated environment in which any item
will be used; and
f. Current modifications to the item or product
and anticipated future modifications and anticipated cost;
(2) Records indicating the dates and services
provided; and
(3) For
lease of assistive technology equipment, a written proposal for the cost of the
lease.
(l) Specialty services shall include:
(1) Documentation in the service agreement of:
a. The service;
b. An evaluation or assessment regarding the
need for the services; and
c. The nature of the service, date, and number
of units; and
(2) Records
indicating the dates, units and services provided.
(m) Community integration services shall include:
(1) Documentation in
the service agreement of:
a. The service;
b. The name of the healthcare practitioner
recommending the service when a single service exceeds $2,000 except when such
service is a community-based campership;
c. An evaluation or assessment regarding the
appropriateness of the services; and
d. The individual’s goal(s) that will be
supported through the use of the service; and
(2) Records
indicating the dates, costs and services provided.
(n) Individual goods and services documentation
shall include:
(1) A summary in the service agreement to
include:
a. The service;
b. The duration of any service to include a
finite end-date;
c. An evaluation or assessment regarding the
appropriateness of the services; and
d. A goal related to the use of the service;
(2) Monthly documentation, pursuant to He-M
503.10, related to the use of the item or service to include:
a. The frequency of purchase; and
b. That the item continues to meet the
individual’s identified need; and
(3)
Records indicating the dates, costs, and services provided.
(o) Non-medical transportation shall include:
(1) Documentation in
the service agreement of:
a. The service; and
b. How the service will be utilized; and
(2) Records
indicating the dates and costs of services provided.
(p) Personal emergency response system shall
include:
(1)
Documentation in the service agreement of:
a. The service; and
b. An evaluation or assessment regarding the
need for the services; and
(2) Records
indicating the dates, costs, and services provided.
(q) Wellness coaching shall include:
(1) Documentation in the service agreement of:
a. The service;
b. An evaluation or assessment regarding the
need for the services; and
c. The desired wellness goals and outcomes for
the individual over the coming year; and
(2) Records
indicating the dates, costs, and services provided.
(r) Removable prosthodontic services
documentation shall include:
(1) Documentation in
the service agreement of the need for the service;
(2) Treatment
notes;
(3) Radiographic
images;
(4) Laboratory
prescriptions; and
(5) Laboratory
invoices.
(s) Each
provider agency shall retain individual records for a period of 6 years
following the termination of services to an individual.
Source. #4315, eff 9-25-87; EXPIRED: 9-25-93
New. #6360, eff 10-23-96, EXPIRED: 10-23-04
New. #8195, INTERIM, eff 10-29-04, EXPIRED:
4-27-05
New. #8424, eff 9-1-05 (from He-M 517.09) ; ss by
#10454, eff 10-31-13; ss by #13988, eff 5-30-24 (formerly He-M 517.07)
He-M
517.11 Utilization Control.
(a) Requests
for prior service authorization shall be made to the bureau electronically
utilizing NH Easy via https://nheasy.nh.gov/#/, and
shall include the service, amount, scope, frequency, and duration.
(b) To
request prior service authorization of a change in covered services within a
current authorization period, the service coordinator shall complete and
submit, via NH Easy at https://nheasy.nh.gov/#/,
updated information to reflect the change in the service, amount, scope,
frequency, or duration.
(c) The bureau shall approve or deny requests for
prior service authorization following determination and approval of the need
for services pursuant to He‑M 517.03 and development of a service
agreement pursuant to He-M 503.10 or He-M 522.11.
(d) If
information submitted pursuant to (b) or (c) above, or similar information
obtained at any other time by the bureau, indicates that an individual might no
longer meet the criteria for home and community-based care specified in He-M
517.03(a)(3) a. or b., the bureau shall redetermine the individual’s
eligibility pursuant to He-M 517.03(a)(3).
(e) Any
request for an environmental or vehicle
modification shall include:
(1) Two cost estimates when the
modification is in excess of $7,500 to include the following, as applicable to
the modification:
a.
A breakdown of costs between labor and
materials;
b.
A list of supplies and materials;
c. Blueprints or scaled drawings, if applicable;
d. The name(s) of any
subcontractors that will be involved;
e. Written confirmation of whether or not a building
permit is required;
f.
A written statement if the individual
or guardian, if applicable, prefers the more expensive bid over the other, to
include an explanation of the preference;
(2) If electrical or plumbing work
is required to support the modification, then:
a.
A statement signed by the selected plumber or electrician stating that
the requested modification can be done within
the current electrical or plumbing capacity of the residence; and
b.
A copy of the selected electrician or
plumber’s license;
(3) A statement signed by the selected provider agency affirming
knowledge of all applicable building codes and permitting requirements and
affirming that any subcontractors involved in the work are appropriately
licensed;
(4) An agreement signed by the selected provider agency stating that
reimbursement for the authorized service through the bureau shall be payment in
full; and
(5) A notarized written statement
from the property owner granting permission to complete the project if the
individual is not the owner of the residence.
(f) The
bureau shall deny services through the HCBS waiver services if it determines
that the provision of services will result in the loss of federal financial
participation for such services.
(g) In
every case of denial of a request for prior service authorization, the bureau
shall notify the service coordinator, individual, guardian, or representative,
in writing, of the decision and the reasons for the denial.
(h) Notification pursuant to
(g) above shall include:
(1) The
specific rules
that support, or the federal or state law that requires, the action;
(2) An
explanation of the individual’s right to request an appeal and the procedure
and timelines set forth in He-M 517.12;
(3) Notice
that the individual has the right to have representation with an appeal by:
a. Legal
counsel;
b. A
relative;
c. A friend;
or
d. Another
spokesperson;
(4) Notice
that neither the area agency, service coordination agency, nor the bureau is
responsible for the cost of representation; and
(5) Notice of organizations that might offer
assistance or representation to the individual, including pro bono or reduced
fee assistance.
Source. #8424, eff 9-1-05 (from He-M 517.10); ss by
#10454, eff 10-31-13; ss by #13988, eff 5-30-24 (formerly He-M 517.08)
He-M
517.12 Appeals.
(a) Within
30 working days of receipt of a final decision as described in He-M 517.03 or
pursuant to He-M 517.11(g), the individual or guardian may appeal in accordance
with He-C 200.
(b) Appeals
shall be forwarded to the bureau administrator, in writing, in care of the
department’s office of client and legal services.
(c) The
bureau administrator shall immediately forward the appeal to the department’s
administrative appeals unit which shall assign a presiding officer to conduct a
hearing or independent review, as provided in He-C 200. The burden
shall be as provided by He-C 203.14.
(d) If
a hearing is requested, the following actions shall occur:
(1) For
current recipients, services and payments shall be continued as a consequence
of an appeal for a hearing until
a decision has been made; and
(2) If
the bureau’s decision is upheld, benefits shall cease 60 days from the date of
the denial letter or 30 days from the hearing
decision, whichever is later.
Source. #4315, eff 9-25-87; EXPIRED: 9-25-93
New. #6360, eff 10-23-96, EXPIRED: 10-23-04
New. #8195, INTERIM, eff 10-29-04, EXPIRED:
4-27-05
New. #8424, eff 9-1-05; ss by #10454, eff 10-31-13;
ss by #13988, eff 5-30-24 (formerly He-M 517.09)
He-M
517.13 Payment.
(a)
Provider agencies shall submit claims for covered HCBS waiver services pursuant
to He-M 504.05:
(b) Payment
for HCBS waiver services shall only be made if prior service authorization has
been obtained from the bureau pursuant to He-M 517.11.
(c) For
those individuals whose net income exceeds the appropriate standard of
need, medicaid claims payment shall reflect a reduction in
reimbursement equal to the cost of care amount.
(d) Payment for environmental or vehicle
modification services shall not be made until the bureau receives the
following, as applicable to the modification:
(1) A
copy of any required building permit and written confirmation from the building
inspector that the work was completed as allowed by the permit;
(2) A
signed statement from the individual or guardian, if applicable, stating that
the work has been completed according to the
approved bid and plans and to the satisfaction of the individual; and
(3) A signed confirmation from the service coordinator stating
that the work was completed.
(e) Payment
for HCBS waiver services shall not be available to any provider who:
(1) Is
the parent of an individual under age 18;
(2) Is
a person under
age 18, except as permitted in He-M 525; or
(3) Is
the spouse of an
individual receiving services, except as provided in (g) below.
(f) Payment for provision of residential
habilitation services to a person who is receiving services for an acquired
brain disorder shall be available to a spouse when:
(1) The individual, or
guardian, if applicable, choses the individual's spouse to provide the service;
(2) It is determined that
this is in the best interest of the individual;
(3) At least one of the following applies:
1. The individual’s level of dependency in
performing activities of daily living, including the need for assistance with
toileting, eating, or mobility, exceeds that of the individual’s peers with an
acquired brain disorder;
2. The individual requires support for a complex
medical condition, including airway management, enteral feeding,
catheterization, or other similar procedures; or
3. The individual’s need for behavioral
management or cognitive supports exceeds that of the individual’s peers with an
acquired brain disorder;
(4) The spouse meets all applicable provider
qualifications in accordance with He-M 504.03, He-M 504.04, and He-M 504.11;
(5) The spouse does not provide more than 40
hours per week of residential habilitation services; and
(6) The service coordinator conducts service
monitoring in accordance with He-M 522.09.
Source. #4315, eff 9-25-87; EXPIRED: 9-25-93
New. #6360, eff 10-23-96, EXPIRED: 10-23-04
New. #8195, INTERIM, eff 10-29-04, EXPIRED:
4-27-05
New. #8424, eff 9-1-05 (from He-M 517.09) ; ss by
#10454, eff 10-31-13; ss by #13988, eff 5-30-24 (formerly He-M 517.10)
He-M
517.14 Waivers.
(a) An applicant,
area agency, provider agency, individual, guardian, or provider may request a
waiver of specific procedures outlined in He-M 517 using the form titled “NH
Bureau of Developmental Services Waiver Request” (October 2023).
(b) A completed waiver
request form shall be signed by:
(1) The
individual or guardian indicating agreement with the request, if applicable;
and
(2) The
provider agency’s executive director or designee recommending approval of the
waiver, when the waiver is requested by a provider agency.
(c) A waiver request
shall be submitted via:
(1) Email to bds@dhhs.nh.gov; or
(2) Mail to:
Department of Health
and Human Services
Bureau of Developmental Services
Hugh J. Gallen State Office Park
105 Pleasant
Street, Main Building
Concord, NH 03301
(d) No
provision or procedure prescribed by statute shall be waived.
(e) The
request for a waiver shall be granted by the commissioner or their designee
within 30 days if the alternative proposed by the requesting entity meets the
objective or intent of the rule and it:
(1) Does
not negatively
impact the health or safety of the individual(s); and
(2) Does
not affect the
quality of services to individuals.
(f) Upon
receipt of approval of a waiver request, the requesting entity’s subsequent
compliance with the alternative provisions or procedures approved in the waiver
shall be considered compliance with the rule for which waiver was sought.
(g) Waivers
shall be granted in writing for the
minimum period necessary to accommodate the waiver request, with a
specific duration not to exceed 5 years except as in (h)-(i) below.
(h) Those
waivers which relate to other issues relative to the health, safety, or welfare
of individuals that require periodic reassessment shall be effective for the
current certification period only.
(i) Any
waiver shall end with the closure of the related program or service.
(j) A
requesting entity may request a renewal of a waiver from the
bureau. Such request shall be made at least 90 days prior to the
expiration of a current waiver.
Source. #8424, eff 9-1-05 (from He-M 517.10); ss by
#10454, eff 10-31-13; ss by #13988, eff 5-30-24 (formerly He-M 517.11)
PART He-M 518 EMPLOYMENT SERVICES
Statutory
Authority: RSA 171-A:3; 171-A:18, IV;
137-K:3, IV
He-M 518.01 Purpose. The purpose of these rules is to:
(a) Establish the requirements for employment
services for individuals with developmental disabilities and acquired brain
disorders served within the service delivery system who have an expressed
interest in working;
(b) Provide access to comprehensive employment
services by staff qualified pursuant to He-M 518.10; and
(c) Make available, based upon individual needs
and interests:
(1) Employment opportunities;
(2) Training and educational opportunities; and
(3) The use of co-worker supports and generic
resources, to the maximum extent possible.
Source. #4593, eff 4-1-89; EXPIRED: 4-1-95
New. #6569, eff 8-22-97; ss by #8406, eff 8-22-05;
ss by #10397, INTERIM, eff 8-22-13, EXPIRES: 2-18-14; ss by #10493, eff
2-18-14; ss by #14040, eff 8-1-24
He-M
518.02 Definitions.
(a) “Acquired brain disorder” means a disruption
in brain functioning that:
(1) Is not congenital or caused by birth trauma;
(2) Presents a severe and life-long disabling
condition which significantly impairs a person’s ability to function in
society;
(3) Occurs prior to age 60;
(4) Is attributable to one or more of the
following reasons:
a. External trauma to the brain as a result of:
1. A motor vehicle incident;
2. A fall;
3. An assault; or
4. Another related traumatic incident or
occurrence;
b. Anoxic or hypoxic injury to the brain such as
from:
1. Cardiopulmonary arrest;
2. Carbon monoxide poisoning;
3. Airway obstruction;
4. Hemorrhage; or
5. Near drowning;
c. Infectious diseases such as encephalitis and
meningitis;
d. Brain tumor;
e. Intracranial surgery;
f. Cerebrovascular disruption such as a stroke;
g. Toxic exposure; or
h. Other neurological disorders such as
Huntington’s disease or multiple sclerosis which predominantly affect the
central nervous system resulting in diminished cognitive functioning and
ability; and
(5) Is manifested by one or more of the
following:
a. Significant decline in cognitive functioning
and ability; or
b. Deterioration in:
1. Personality;
2. Impulse control;
3. Judgment;
4. Modulation of mood; or
5. Awareness of deficits.
(b) “Area agency” means “area agency” as defined
in RSA 171-A:2, I-b.
(c) “Bureau” means the bureau of developmental
services of the department of health and human services.
(d) “Bureau of vocational rehabilitation” means
the New Hampshire department of education, bureau of vocational rehabilitation.
(e) “Career exploration” means as part of the
career planning process, selection by an individual of a job, training, or
educational path that fits their interests, skills, and abilities.
(f) “Career planning” means a time-limited,
person-centered, comprehensive, employment planning process that assists an
individual to identify a career direction and results in a plan for achieving
employment at or above minimum wage.
(g) “Career portfolio” means a tool used to
organize and document training, education, work experiences, skills,
contributions, and accomplishments.
(h) “Customized employment”
means the individualizing of the employment
relationship between employees and employers in ways that meet the needs of
both. It is based on an individualized determination of the strengths, needs,
and interests of the individual, and is also designed to meet the specific
needs of the employer.
(i)
“Days” means calendar days unless otherwise specified.
(j) “Developmental disability” means
“developmental disability” as defined in RSA 171‑A:2, V, namely, “a
disability:
(a) Which is attributable to an intellectual
disability, cerebral palsy, epilepsy, autism or a specific learning disability,
or any other condition of an individual found to be closely related to an
intellectual disability as it refers to general intellectual functioning or
impairment in adaptive behavior or requires treatment similar to that required
for persons with an intellectual disability; and
(b) Which originates before such individual
attains age 22, has continued or can be expected to continue indefinitely, and
constitutes a severe disability to such individual’s ability to function
normally in society.”
(k) “Employee” means an individual who receives
wages in exchange for work rendered in an integrated setting.
(l) “Employment” means working for at least
minimum wage in an integrated setting or being self-employed.
(m)
“Employment professional” means a provider who meets the criteria in
He-M 518.10 (e)(1) and (2).
(n) “Employment profile” means a summary of an
individual’s vocationally-related:
(1) Competencies;
(2) Interests;
(3) Preferences;
(4) Learning style;
(5) Environmental considerations; and
(6) Supports.
(o) “Fading plan” means a specific plan that is
developed to assist an individual to achieve maximum independence on the job
through a variety of activities including cultivating natural supports.
(p) “Hard skills” means the essential skills
required to perform a job such as, but not limited to:
(1) Operating machinery;
(2) Using a computer;
(3) Providing customer service; and
(4) Typing.
(q) “Individual” means any person who has a developmental disability or acquired brain
disorder.
(r) “Integrated setting” means a workplace where
people with disabilities work alongside other employees who do not have
disabilities and where they have the same opportunities to participate in all
activities in which other employees participate.
(s) “Job coaching” means the training of an employee through
structured intervention techniques to help the employee learn to perform job
tasks to the employer’s specifications and to learn the interpersonal skills
necessary to be accepted as a worker at the job site and in related community
contacts.
(t)
“Job development” means contacting and connecting with employers to
identify, develop, or customize jobs suited to individuals’ skills and
interests.
(u)
“National core indicators” means standard measures compiled by the
National Association of State Directors of Developmental Disabilities Services
and the Human Services Research Institute and used across states to assess the
outcomes of services provided to individuals and families. Indicators address
key areas of concern including employment, rights, service planning, community
inclusion, choice, and health and safety.
National core indicators are published as annual reports, state reports,
and consumer outcomes reports, and are available at http://www.nationalcoreindicators.org/.
(v)
“Natural support” means support wherein a community business provides
direct training, supervision, or assistance to an employee.
(w)
“Person-centered service planning” is an individual-directed, positive
approach to the planning and coordination of a person’s services and other
supports based on the individual’s aspirations, needs, preferences, and goals.
(x)
“Provider” means a person receiving any form of remuneration for the
provision of services to an individual.
(y)
“Provider agency” means an agency or independent provider that is
established to provide services to individuals and meets the criteria in He-M
504.
(z)
“Safeguards” means specific measures taken to protect the individual
from harm or loss.
(aa) “Service agreement” means a written agreement
between the individual, guardian, or representative, and provider
agency that is prepared as a result of the person-centered service planning
process and that describes the services that an
individual will receive and constitutes an individual service agreement
as defined in RSA 171-A:2, X and developed pursuant to He-M 503.10 or He-M
522.11.
(ab) “Service coordinator” means a provider who
meets the criteria in He-M 503.08 or He-M 522.09 and is chosen by an individual
and their guardian or representative to organize, facilitate, and document
service planning and to negotiate and monitor the provision of the individual’s
services.
(ac) “Soft skills” means the interpersonal skills
required to be successful in a job, such as:
(1) Effective communication;
(2) Managing emotions;
(3) Conflict resolution;
(4) Creative problem solving;
(5) Critical thinking; and
(6) Team building.
(ad) “Staff” means a person employed by a provider
agency, subcontract agency, or other employer.
(ae) “Work incentives” means special regulations
developed by the Social Security Administration making it possible for people
with disabilities receiving Social Security or Supplemental Security Income
(SSI) to work and still receive monthly payments and Medicare or Medicaid,
including:
(1) Trial work period, 20 CFR 404.1592;
(2) Impairment related work expenses, 20 CFR
404.1576;
(3) Extended period of eligibility, 20 CFR
404,1592a;
(4) Extended Medicare coverage for Social
Security Disability Insurance, 42 CFR 406.12(e);
(5) Earned income exclusion, 20 CFR 418.3325;
(6) Continued Medicaid eligibility, section
1619(b) of the Social Security Act;
(7) Plan to achieve self-support, 20 CFR
416.1225;
(8) Ticket to work program, 20 CFR part 411,
subpart B;
(9) Impairment-related work expenses, 20 CFR
404.1576;
(10) Expedited reinstatement, 20 CFR 416.999;
(11) Unsuccessful work attempt, 20 CFR 416.974; and
(12) Medicaid for employed adults with
disabilities (MEAD), pursuant to He-W 504.
(af) “Work incentives planning” means specific
planning around earning income, managing public benefits, and accessing work
incentives.
Source. #4593, eff 4-1-89; EXPIRED: 4-1-95
New. #6569, eff 8-22-97; ss by #8406, eff 8-22-05;
ss by #10397, INTERIM, eff 8-22-13, EXPIRES: 2-18-14; ss by #10493, eff
2-18-14; ss by #14040, eff 8-1-24
He-M
518.03 Service Principles.
(a) All employment services shall be designed to:
(1) Assist the individual to obtain employment or
self-employment that is based on the individual’s employment profile and goals
as outlined in the service agreement;
(2) Provide the individual with opportunities to
participate in a comprehensive career development process that helps to
identify, in a timely manner, the individual’s employment profile;
(3) Support the individual to develop appropriate
skills for job searching, including:
a. Creating a resume and employment portfolio;
b. Practicing job interviews; and
c. Learning soft skills that are essential for
succeeding in the workplace;
(4) Assist the individual to become as
independent as possible in their employment, internships, and education and
training opportunities by:
a. Developing accommodations;
b. Utilizing assistive technology; and
c. Creating and implementing a fading plan;
(5) Help the individual to:
a. Meet their goal for the desired number of
hours of work as outlined in the service
agreement; and
b. Earn wages of at least minimum wage or
prevailing wage, unless the individual is pursuing income based on
self-employment;
(6) Assess, cultivate, and utilize natural
supports within the workplace to assist the individual to achieve independence
to the greatest extent possible;
(7) Help the individual to learn about, and
develop appropriate social skills to actively participate in, the culture of
their workplace;
(8) Understand, respect, and address the business
needs of the individual’s employer, in order to support the individual to meet
appropriate workplace standards and goals;
(9) Maintain communication with, and provide
consultations to, the employer to:
a. Address employer specific questions or
concerns to enable the individual to perform and retain their job; and
b. Explore
opportunities for further skill development and advancement for the individual;
(10) Help the individual to learn, improve, and
maintain a variety of life skills related to employment, such as:
a. Traveling safely in the community;
b. Managing personal funds;
c. Utilizing public transportation; and
d. Other life skills identified in the service
agreement related to employment;
(11) Promote the individual’s health and safety;
(12) Protect the individual’s right to freedom
from abuse, neglect, and exploitation;
(13) Protect the individual’s rights in accordance
with He-M 310; and
(14) Provide opportunities for the individual to
exercise personal choice and independence within the bounds of reasonable
risks.
(b)
An individual, guardian, or representative may select any available
provider that is qualified pursuant to He-M 504.03, He-M 504.04, and He-M
504.11, to deliver the employment services identified in the individual’s
service agreement in accordance with He-M 518.05 and He-M 518.10.
(c)
All provider agencies and providers of employment services shall:
(1) Comply with applicable rules, the 1915(c)
home and community-based waiver service authority and any other federal laws,
rules, and regulations, when applicable;
(2) Meet the provisions specified within the
individual’s service agreement; and
(3) Meet the needs of the individual while taking
into account the interests and obligations of the employer.
Source. #4593, eff 4-1-89; EXPIRED: 4-1-95
New. #6569, eff 8-22-97; ss by #8406, eff 8-22-05;
ss by #10397, INTERIM, eff 8-22-13, EXPIRES: 2-18-14; ss by #10493, eff
2-18-14; ss by #14040, eff 8-1-24
He-M 518.04 Eligibility For Employment Services.
(a)
Employment services shall be available to any individual who:
(1) Has been referred to the bureau of vocational
rehabilitation at the start of the employment planning process to first assess
if the service the individual needs is provided and available by vocational
rehabilitation, and it has been determined that the individual requires
employment supports in excess of the vocational rehabilitation services
available to the individual;
(2) Is found to be eligible for Home and
Community Based waiver services (HCBS services) in accordance with He-M 503.05
or He-M 522.05;
(3)
Has a service agreement that includes the goals and desired outcomes that will
be addressed through the provision of employment services; and
(4)
Has a prior authorization requested by the agency intending to provide
employment services through the Medicaid program using the procedure outlined
in He-M 517.11.
(b)
The determination or confirmation that the individual has an employment
goal and desires services shall occur at or by:
(1) The preliminary recommendations for services
process under He-M 503.05 or He-M 522.05;
(2) The service planning required by He-M 503.09
or He-M 522.10;
(3) The transition process described in Ed
1109.01 (a)(10) for individuals beginning at age 14 or younger, as applicable
who are in school; or
(4) Any other informal or formal means by which
the individual expresses a desire to work.
Source. #4593, eff 4-1-89; EXPIRED: 4-1-95
New. #6569, eff 8-22-97; ss by #8406, eff 8-22-05;
ss by #10397, INTERIM, eff 8-22-13, EXPIRES: 2-18-14; ss by #10493, eff 2-18-14
(from He-M 518.03); ss by #14040, eff 8-1-24
He-M 518.05 The Individual Employment Planning Process.
(a) As part of the person-centered service
planning process, the individual’s service coordinator shall include employment
planning for each individual seeking or receiving employment services.
(b) The employment planning process shall:
(1) Be led by an employment professional
qualified pursuant to He-M 518.10(e); and
(2) Include:
a. A vocational evaluation or an assessment of
employment interests and capacities;
b. Development of an employment profile to
include:
1. Learning style;
2. Environmental needs;
3. Medical needs;
4. Physical needs; and
5. Safety needs;
c. Career exploration;
d. Goal setting;
e. Development of soft skills;
f. Development of hard skills through:
1. Internships;
2. Sector-based training;
3. Continuing education;
4. On-the-job training; and
5. Unpaid work experiences;
g. Development of strategies for achieving
employment;
h. Transportation planning and training to
independently use transportation options;
i. Community safety skills training; and
j. Work incentives planning.
(c) The service agreement for each individual who
receives employment services shall include:
(1) An employment profile of the individual;
(2) A resume and employment portfolio;
(3) Employment goal(s) and strategies with
specific timeframes for achieving the goal(s) that include:
a. Skills training;
b. Increased responsibilities;
c. Career advancement;
d. Increased wages;
e. Increased hours worked;
f. Change in employment; and
g. Any other identified goals;
(4) Referral to the bureau of vocational
rehabilitation;
(5) Identification of the roles and
responsibilities of team members in implementing the goal(s) and service(s);
and
(6) Identification of any of the services listed
in He-M 518.07 to achieve the goal(s).
Source. #4593, eff 4-1-89; EXPIRED: 4-1-95
New. #6569, eff 8-22-97; ss and moved by #8406,
eff8-22-05 (from He-M 518.06); ss by #10397, INTERIM, eff 8-22-13, EXPIRES:
2-18-14; ss by #10493, eff 2-18-14 (from He-M 518.04); ss by #14040, eff 8-1-24
He-M 518.06 Wages.
(a)
All wages shall be paid to employees in accordance with the Fair Labor
Standards Act as specified in 29 U.S.C. 201 et seq., and any other applicable
state and federal statutes, rules, and regulations.
(b)
Whenever possible, wages shall be in the form of payment made directly
to the employee by the employer.
(c)
In those situations when payments are made to the employee by the
provider agency, wages shall be set based on the minimum wage pursuant RSA
279:21.
(d)
In no event shall Medicaid or bureau funds be used to pay or subsidize
wages otherwise earned by employees.
Source. #4593, eff 4-1-89; EXPIRED: 4-1-95
New. #6569, eff 8-22-97; ss and moved by #8406,
eff8-22-05 (from He-M 518.07); ss by #10397, INTERIM, eff 8-22-13, EXPIRES:
2-18-14; ss by #10493, eff 2-18-14 (from He-M 518.05); ss by #14040, eff 8-1-24
He-M 518.07 Covered Services.
(a)
All employment services shall be:
(1) Designed in accordance with the individual’s
specific needs, interests, competencies, and learning style, as described in
the individual’s service agreement and employment profile as outlined in He-M
503.10 or He-M 522.11;
(2) To assist each individual to assume as much
personal responsibility in job seeking and job retention as is possible for
that individual;
(3) Responsive to the individual’s changing needs
and choices within the limitations of federal and state laws, rules, and
regulations;
(4)
Provided only after the informed consent of the individual or their guardian or
representative;
(5) Free from conflict in accordance with He-M
503.08 or He-M 522.09;
(6) Delivered by any willing and qualified
provider agency or provider that is freely chosen by the individual or
individual’s guardian or representative and who meets the criteria in He-M 504;
and
(7) Provided in accordance with He-M 310.
(b) Payments for employment services shall cover:
(1) All services identified in He-M 518.05;
(2) Job development;
(3) Assistance, as needed, with employment
including:
a. Job applications;
b. Resume-writing;
c. Obtaining references;
d. Development of a career portfolio;
e. Interview preparation; and
f. All other activities related to obtaining and
maintaining employment except as described in (10) below;
(4) Training for the individual to learn the
responsibilities and expectations of employment, including:
a. Acquiring or developing acceptable work
standards and workplace behavior;
b. Adjusting to the job site and work culture;
and
c. Using accommodations, including any
customized modifications made to perform the job;
(5) Implementation of the fading plan;
(6) Consultations or contacts with the businesses
and the individual, as needed, to assist the individual to remain successfully
employed;
(7) Outreach to employers for building
relationships that lead to immediate or future job opportunities for the
individual;
(8) Training for direct support staff as it
relates to the individual’s employment goals;
(9) Training for employers and co-workers to
support the individual by understanding their:
a. Learning style;
b. Environmental needs;
c. Medical needs;
d. Physical needs; and
e. Safety needs;
(10) When combined with another employment
service, transportation and training in accessing transportation, as
appropriate, to and from work;
(11)
Referral, evaluation, and consultation for adaptive equipment, environmental
modifications, communications technology or other forms of assistive
technology, and educational opportunities related to the individual’s
employment services and goals;
(12) Accessing work incentives information and
work incentives planning services for the individual; and
(13) Any other employment service identified in
the individual’s service agreement.
Source. #4593, eff 4-1-89; EXPIRED: 4-1-95
New.
#6569, eff 8-22-97; ss and moved by #8406,eff 8-22-05 (from He-M 518.09); ss by
#10397, INTERIM, eff 8-22-13, EXPIRES: 2-18-14; ss by #10493, eff 2-18-14 (from
He-M 518.06); ss by #14040, eff 8-1-24
He-M 518.08 Employment Planning for Individuals in
School.
(a)
Beginning at age 14, or younger if applicable, the individual and their
family and school personnel shall be given information by the area agency staff
regarding:
(1) The employment services that are available
within the adult service system;
(2) The importance of planning ahead for
achieving successful employment outcomes in the future;
(3) Work incentives planning; and
(4) The bureau of vocational rehabilitation as a
source of assistance regarding employment opportunities.
(b)
In their communications with the individual, family, and schools, area
agency staff shall continuously reinforce the importance of employment
opportunities and facilitate as applicable, their development.
Source. #4593, eff 4-1-89; EXPIRED: 4-1-95
New. #6569, eff 8-22-97; ss and moved by #8406,
eff8-22-05 (from He-M 518.10); ss by #10397, INTERIM, eff 8-22-13, EXPIRES:
2-18-14; ss by #10493, eff 2-18-14; ss by #14040, eff 8-1-24
He-M 518.09 Records and Reporting. Each provider agency shall:
(a)
Maintain records and provide documentation as outlined in He-M 504.03
and He-M 504.04 and He-M 517.10 for all individuals receiving services pursuant
to He-M 518.05 and He-M 518.07; and
(b)
At least annually, assess the employment service through interviews with
employers, individuals, and guardians.
Source. #4593, eff 4-1-89; EXPIRED: 4-1-95
New. #6569, eff 8-22-97; ss and moved by #8406,
eff8-22-05 (from He-M 518.11) ); ss by #10397, INTERIM, eff 8-22-13, EXPIRES:
2-18-14; ss by #10493, eff 2-18-14 (from He-M 518.07); ss by #14040, eff 8-1-24
He-M 518.10 Staff Qualifications and Responsibilities.
(a)
Each provider agency shall have:
(1) Personnel qualified pursuant to (b) and (c)
below, available to meet the individual and collective employment-related needs
of each individual served; and
(2) Staff who meet the requirements of (e) or (f)
below.
(b) Prior to a person providing employment
services to individuals, the provider agency, with the consent of the person,
shall complete the necessary registration, criminal background, and office of
the inspector general exclusion list checks in accordance with He-M 504.03
(c) Prior to providing employment services to
individuals, the provider agency, with the consent of the person, shall:
(1) Obtain at least 2 references for the person;
and
(2) Complete a motor vehicles record check to
ensure that the person has a valid driver’s license if such provider will be
transporting individuals.
(d)
Provider agencies shall provide initial and ongoing training as required
in He-M 506.05 and as required to implement services in He-M 518.05 and He-M
518.07.
(e) Employment professionals shall:
(1) Meet one of the following criteria:
a. Have completed, or complete within the first
12 months of becoming an employment professional, training that meets the
national competencies for job development and job coaching, as established by
the Association of People Supporting Employment First (APSE) in “APSE Universal Employment Competencies”
(Revision 2019), available as noted in Appendix A; or
b.
Have obtained the designation as a Certified Employment Services Professional
through the Employment Services Professional Certification Commission (ESPCC),
an affiliate of APSE; and
(2) Obtain 12 hours of continuing education
annually in subject areas pertinent to employment professionals including, at a
minimum:
a. Employment;
b. Customized employment;
c. Task analysis or systematic instruction;
d. Marketing and job development;
e. Discovery;
f. Person-centered employment planning;
g. Work incentives for individuals and
employers;
h. Job accommodations;
i. Assistive technology;
j. Vocational evaluation;
k. Personal career profile development;
l. Situational assessments;
m. Writing meaningful vocational objectives;
n. Writing effective resumes and cover letters;
o. Understanding workplace culture;
p. Job carving;
q. Understanding laws, rules, and regulations;
r. Developing effective on the job training and
supports;
s. Developing a fading plan and natural
supports;
t. Self-employment; and
u. School to work transition.
(f)
At a minimum, job coaching staff shall be trained on all of the
following prior to supporting an individual in employment:
(1) Understanding and respecting the business
culture and business needs;
(2) Task analysis;
(3) Systematic instruction;
(4) How to build natural supports;
(5) Implementation of the fading plan;
(6) Effective communication with all involved;
(7) Methods to maximize the independence of the
individual on the job site; and
(8) Understanding individual specific
health-related requirements including but not limited to any special,
cognitive, mental health, or behavioral needs.
(g)
Supervisors of employment professionals shall ensure employment
professionals and job coaches meet the criteria outlined in (e) and (f) above.
Source. #10493, eff 2-18-14 (from He-M 518.08); ss
by #14040, eff 8-1-24
He-M
518.11 Oversight and Quality
Improvement.
(a) The director of employment services shall:
(1) Be responsible for providing oversight; and
(2) Evaluate, facilitate, and improve the quality
of services being delivered and outcomes achieved.
(b) Each individual’s service coordinator shall
provide oversight regarding the employment service arrangement and review and
facilitate the effectiveness of the employment services being provided and
outcomes achieved.
(c) In fulfilling the responsibilities cited in
(a) and (b) above, the director of employment services and service coordinator
shall consider whether the following criteria are being met:
(1) Services are customized and meet the
interests, goals, and desired outcomes of the individual, as defined in the
service agreement;
(2) Goals reflect the individual’s growth and
evolving interests and are revised accordingly;
(3) The goals and desired outcomes identified in
the service agreement are being achieved;
(4) Staff are knowledgeable of the individual’s
service agreement as it pertains to employment services and are assisting in
meeting the desired goals and outcomes;
(5) Services occur in integrated settings;
(6) Methods or strategies for achieving the
individual’s employment services goals and desired outcomes are evident and
documented; and
(7) Individuals, and guardians if applicable, are
satisfied with services.
(d)
The bureau shall develop and maintain an employment services leadership
committee consisting of representation of employment professionals from area
agencies, provider agencies, and the bureau of vocational rehabilitation.
(e)
The employment services leadership committee shall:
(1) Review quarterly employment data reports,
identify trends, and establish statewide employment benchmarks;
(2) Identify and ensure relevant employment
training is available for individuals served, families, employment
professionals, service coordinators, and other agency personnel;
(3) Annually review the memorandum of
understanding between the bureau of developmental services and the bureau of
vocational rehabilitation;
(4) Provide an annual report to the developmental
services quality council, established pursuant to RSA 171-A:33, at the end of
each fiscal year;
(5) Review national core indicators and other
relevant data to measure individual and family satisfaction with employment
services; and
(6) Support efforts to collaborate with business
and industry.
Source. #10493, eff 2-18-14; ss
by #14040, eff 8-1-24
He-M 518.12 Waivers.
(a) An applicant, area agency, provider agency, individual,
guardian, or provider may request a waiver of specific procedures outlined in
He-M 518 by completing and submitting the form titled “NH bureau of
developmental services waiver request” (October 2023 edition). The waiver request
shall be submitted in writing to the bureau administrator.
(b) A completed waiver request form shall be signed by:
(1) The individual or guardian indicating
agreement with the request; and
(2) The area agency or provider agency’s
executive director or designee recommending approval of the waiver, when the
waiver is requested by an area agency or a provider agency.
(c) A waiver request shall be submitted to the department via:
(1) Email at bds.dhhs.nh.gov; or
(2) By mail to:
The
Bureau of Developmental Services
Hugh
J. Gallen State Office Park
105
Pleasant Street, Main Building
Concord,
NH 03301
(d)
No provision or procedure prescribed by statute shall be waived.
(e)
The request for a waiver shall be granted by the commissioner or their
designee within 30 days if the alternative proposed by the requesting entity
meets the objective or intent of the rule and it:
(1) Does not negatively impact the health or
safety of the individual(s); and
(2) Does not affect the quality of services to
individuals.
(f)
Upon receipt of approval of a waiver request, the requesting entity’s
subsequent compliance with the alternative provisions or procedures approved in
the waiver shall be considered compliance with the rule for which waiver was
sought.
(g)
Waivers shall be granted in writing for the minimum period necessary to
accommodate the waiver request, with the specific duration not to exceed 5
years except as in (h) and (i) below.
(h)
Any waiver shall end with the closure of the related program or service.
(i)
A requesting entity may request a renewal of a waiver from the
bureau. Such request shall be made at
least 90 days prior to the expiration of a current waiver.
Source. #10493, eff 2-18-14 (from He-M 518.09); ss
by #14040, eff 8-1-24
PART He-M 519 FAMILY SUPPORT SERVICES
He-M 519.01 Purpose. The purpose of this part is:
(a)
To establish a framework for the provision of supports and services to
care-giving families with an individual member who:
(1) Has a developmental disability or acquired
brain disorder; or
(2) Is eligible for family-centered early
supports and services pursuant to He-M 510.06;
(b)
To describe the structure, roles, and responsibilities of regional
family support councils in advising and collaborating with their local area
agencies; and
(c) To describe the structure, roles,
and responsibilities of the state family support council in supporting regional
councils and in advising the bureau.
Source. #5929, eff 12-1-94, EXPIRED: 12-1-00
New. #7830, eff 2-13-03, EXPIRED: 2-13-11
New. #9879-A, eff 2-26-11; ss by #12784, eff
5-21-19
He-M 519.02 Definitions.
(a)
“Acquired brain disorder” means a disruption in brain functioning that:
(1) Is not congenital or caused by birth trauma;
(2) Presents a
severe and life-long disabling condition which significantly impairs a person’s
ability to function in society;
(3) Occurs prior to age 60;
(4) Is attributable to one or more of the
following reasons:
a. External trauma to the brain as a result of:
1. A motor vehicle incident;
2. A fall;
3. An assault; or
4. Another related traumatic incident or
occurrence;
b. Anoxic or hypoxic injury to the brain such as
from:
1. Cardiopulmonary arrest;
2. Carbon monoxide poisoning;
3. Airway obstruction;
4. Hemorrhage; or
5. Near drowning;
c. Infectious diseases such as encephalitis and
meningitis;
d. Brain tumor;
e. Intracranial surgery;
f. Cerebrovascular disruption such as a stroke;
g. Toxic exposure; or
h. Other neurologic disorders such as
Huntington’s disease or multiple sclerosis which predominantly affect the
central nervous system; and
(5) Is manifested by:
a. Significant decline in cognitive functioning
and ability; or
b. Deterioration in:
1. Personality;
2. Impulse control;
3. Judgment;
4. Modulation of mood; or
5. Awareness of deficits.
(b)
“Area agency” means “area agency” as defined in RSA 171-A:2, I-b.
(c)
“Bureau” means the bureau of developmental services of the department of
health and human services.
(d)
“Bureau administrator” means the chief administrator of the bureau of
developmental services.
(e)
“Commissioner” means the commissioner of the department of health and
human services.
(f)
“Department” means the New Hampshire department of health and human
services.
(g)
“Developmental disability” means “developmental disability” as defined
in RSA 171:A:2, V, namely “a disability:
(a) Which is attributable to intellectual
disability, cerebral palsy, epilepsy, autism, or a specific learning
disability, or any other condition of an individual found to be closely related
to intellectual disability as it refers to general intellectual functioning or
impairment in adaptive behavior or requires treatment similar to that required
for persons with an intellectual disability; and
(b) Which originates before such individual
attains age 22, has continued or can be expected to continue indefinitely, and
constitutes a severe disability to such individual’s ability to function
normally in society.”
(h)
“Family” means a group of 2 or more persons that:
(1) Is related by ancestry, marriage, or other
legal arrangement;
(2) Has one member who is the primary caregiver
of the individual in (3) below; ; and
(3) Has at least one member who is an individual
as defined in (j) below.
(i)
“Family support” means those services, activities, and interventions,
enumerated in He-M 519.04 (c), that are identified by a family to assist that
family to remain the primary caregiver of an individual.
(j) “Individual” means a person with a
developmental disability or acquired brain disorder who is eligible or
conditionally eligible pursuant to He-M 503.03 or He-M 522.03 or a child,
through age 2, who is eligible for family-centered early supports and services
pursuant to He-M 510.06.
(k)
“Partners in Health (PIH)” means “partners in health” as defined in He-M
523, namely “a New Hampshire
community-based program of family support for young adults and families”.
(l)
“Region” means “area” as defined in RSA 171-A:2, I-a, namely “a
geographic region established by rules adopted by the commissioner for the
purpose of providing services to developmentally disabled persons”.
(m)
“Respite” means the provision of short-term care, in accordance with
He-M 513, for an individual, in or out
of the individual’s home, for the temporary relief and support of the family
with whom the individual lives.
(n)
“Special medical services (SMS)” means “special medical services” as
defined in He-M 520 namely, “the administrative section of the bureau of
developmental services that operates the
Title V program for children and youth with special health care needs”.
(o)
“Supports and services” means a wide range of activities that assist
families in developing and maximizing the families’ abilities to care for
individuals and meet their needs in a flexible manner.
Source. #5929, eff 12-1-94, EXPIRED: 12-1-00
New. #7830, eff 2-13-03, EXPIRED: 2-13-11
New. #9879-A, eff 2-26-11; ss by #12784, eff
5-21-19
He-M 519.03 Eligibility. A family shall be eligible for family support
services if such family has:
(a)
An individual member from birth through age 2 who is eligible for
family-centered early supports and services pursuant to He-M 510.06; or
(b)
An individual member age 3 or older who has a developmental disability
or an acquired brain disorder pursuant to He-M 503.03 or He-M 522.03.
Source. #5929, eff 12-1-94, EXPIRED: 12-1-00
New. #7830, eff 2-13-03, EXPIRED: 2-13-11
New. #9879-A, eff
2-26-11; ss by #12784, eff 5-21-19
He-M 519.04 Supports and Services.
(a)
Family support services shall:
(1) Focus on the entire family;
(2) Recognize and value the family’s strengths
and competencies;
(3) Respect the
family’s approach to making decisions regarding provision of supports and
services;
(4) Create and emphasize opportunities for
families to build relationships in their communities;
(5) Maximize the family’s control over the
provision of supports and services;
(6) Identify
resources and supports and services that are flexible, individualized, and
responsive to the changing needs of the family;
(7) Respect the family’s cultural and ethnic
beliefs, traditions, personal values, and lifestyles;
(8) Empower
families through educational opportunities and wide dissemination of
information; and
(9) Promote family involvement in all levels of
planning, policy-making, and monitoring of the service system.
(b)
In addition to offering area agency programs or funds to provide
supports and services, family support staff shall explore, identify, and assist
families to access community resources, both formal and informal, as available.
(c)
Family support shall include the following:
(1) Information and referral;
(2) Assistance to identify and assess the
family’s own strengths, needs, and goals;
(3) Identification of, and assistance to access,
community resources and supports;
(4) Assistance with transition in and out of
services;
(5) Crisis intervention and emotional support;
(6) Advocacy for accessing supports and services;
(7) Opportunities for family networking;
(8) Assistance to access respite care;
(9) Assistance to access environmental
modifications of the family’s home and the family’s vehicle;
(10) Promotion of inclusive social and
recreational opportunities;
(11) Conferences and workshops in response to
families’ requests;
(12) Community outreach, education, and
development to promote understanding and support for families as well as
individuals with disabilities;
(13) Financial
assistance provided that this assistance is:
a. Related to supporting a family to care for an
individual member in the family home; and
b. Consistent
with the established policies of the area agency and, if applicable, the
regional family support council as required by He-M 519.05(c)(5); and
(14) Other supports and services that assist a
family in providing care for an individual member in the family home.
Source. #5929, eff 12-1-94, EXPIRED: 12-1-00
New. #7830, eff 2-13-03, EXPIRED: 2-13-11
New. #9879-A, eff 2-26-11;
ss by #12784, eff 5-21-19
He-M 519.05 Regional Family Support Council.
(a)
Each region shall have a family support council that shall act as an
advisory body to the area agency.
(b)
A regional family support council shall:
(1) Be composed of a minimum of 5 voting members;
(2) Have members who are either family members or
individuals;
(3) Have no voting member who is an employee of
either the area agency or the family support council; and
(4) Have membership that is representative of the
various ages, and geographical locations, and overall diversity of the
individuals and families served in the region.
(c)
Regional family support councils shall establish and maintain policies
that address, at a minimum, the following:
(1) Membership, recruitment, rotation, and term
limits on the council;
(2) A process for determining the chairperson,
the state council delegate, the council representative to the area agency board
of directors, and any other positions;
(3) Orientation and mentoring of all council
members;
(4) A formal written agreement between the
council and the area agency that identifies:
a. The parties’ relationship, roles, and
responsibilities;
b. The process to be used in resolving any
conflicts which might arise between the parties;
c. The involvement of the council in the
selection and evaluation of the performance of the family support staff;
d. The family
support representative on the area agency management team and the mechanism for
direct communication between this person and the council;
e. The family
support council’s obligation to comply with all confidentiality requirements as
set by federal authorities, the department, or the area agency; and
f. The process for sharing contact information
for families in the region with the family support council for the purpose of
outreach, advocacy, or information.
(5) Processes used to distribute family support
council funds and other resources, and the processes shall include ensuring
family privacy in the application and fund allocation process; and
(6) A mechanism for the council to be involved in
the area agency monitoring of supports and services provided to families.
(d)
The regional family support councils shall coordinate their efforts with
other local public and private entities that serve children, adults, and
families, including but not limited to early supports and services providers,
PIH, and SMS.
Source. #5929, eff 12-1-94, EXPIRED: 12-1-00
New. #7830, eff 2-13-03, EXPIRED: 2-13-11
New. #9879-A, eff
2-26-11; ss by #12784, eff 5-21-19
He-M 519.06 Family Support Staff.
(a) Each area agency shall designate
not less than one full-time position as the family support coordinator or
director.
(b)
The qualifications and duties of the staff person designated pursuant to
(a) above shall be identified by a job description designed jointly by the
regional family support council and the area agency.
(c)
The designated staff person shall perform all duties in his or her job
description including, at a minimum:
(1) Representing the ideas and concerns of
families and of family support staff to the area agency executive director and
at management team meetings;
(2) Promoting the values of family support as
listed in He-M 519.04 (a) in area agency activities and initiatives;
(3) Acting as the primary liaison with the
council and regularly attending council meetings;
(4) Providing information to the council
regarding family support activities so that the council:
a. Understands families’ needs;
b. Can act on families’ needs; and
c. Is involved in the area agency monitoring of
regional supports and services;
(5) Ensuring that
an individual or family has accessed all other available funding and community
resources prior to requesting funding for family supports from the council;
(6) Facilitating the distribution of family
support funds approved for distribution by the family support council;
(7) Providing information or referral to PIH if
requested by the PIH family support coordinator, or the individual, or family;
and
(8) Providing feedback to other family support
staff from the council and the management team.
(d)
Family support staff shall:
(1) Provide, or assist families in accessing,
family supports and services;
(2) Solicit
support for families from community groups, foundations, and other sources as
needed;
(3) Plan and develop agreements with each family
that document the supports in He-M 519.04 (c) that will be provided;
(4) Maintain records regarding the supports and
services provided to each individual or family;
(5) Maintain data that specifies the type and
frequency of family supports and services provided; and
(6) Report data collected pursuant to (4) and (5)
above to the bureau on a quarterly basis.
Source. #5929, eff 12-1-94, EXPIRED: 12-1-00
New. #7830, eff 2-13-03, EXPIRED: 2-13-11
New. #9879-A, eff 2-26-11; ss by #12784, eff
5-21-19
He-M 519.07 Regional Family Support Plan.
(a)
Each regional family support council shall contribute to the development
of the area plan prepared pursuant to He-M 505.03 (t)-(u).
(b) To satisfy the requirements of
He-M 505.03 (u)(2), the regional family support council’s contribution pursuant
to (a) above shall consider:
(1) The priorities of families residing
throughout the region for supports and services; and
(2) Strategies to address these priorities.
Source. #5929, eff 12-1-94, EXPIRED: 12-1-00
New. #7830, eff 2-13-03, EXPIRED: 2-13-11
New. #9879-A, eff
2-26-11; ss by #12784, eff 5-21-19
He-M 519.08 State Family Support Council. The state family support council shall:
(a)
Be comprised of one voting delegate appointed by each of the 10 regional
family support councils;
(b)
Be assisted by the family support administrator or designee and bureau
support staff;
(c)
Elect a new chairperson at least every 2 years;
(d)
Hold meetings every other month to discuss agenda items formulated by
members of the council;
(e)
Be a forum for exchanging, sharing, and distributing information to each
regional council;
(f) Be an avenue for arbitration and
mediation of conflict resolution between area agencies and regional councils
when requested by both parties and after processes identified pursuant to He-M
519.05(c)(4)b. have been exhausted; and
(g)
Provide information and feedback on issues and concerns of regional
councils to the bureau.
Source. #5929, eff 12-1-94, EXPIRED: 12-1-00
New. #7830, eff 2-13-03, EXPIRED: 2-13-11
New. #9879-A, eff 2-26-11; ss by #12784, eff
5-21-19
(a) An area agency or regional family support
council may request a waiver of specific procedures outlined in He-M 519 by
completing and submitting to the department the form entitled “NH Bureau of
Developmental Services Waiver Request” (January 2018 edition).
(b) A completed waiver request form shall include
signatures by the family support council chairperson or designee indicating
agreement with the request and the area agency’s executive director or designee
recommending approval of the waiver.
(c) A waiver request shall be submitted to:
Department of Health and Human Services
Bureau of Developmental Services
Hugh J. Gallen State Office Park
105 Pleasant Street, Main Building
Concord, NH 03301
(d)
All information entered on the forms described in (a) above shall be
typewritten or otherwise legibly written.
(e) No provision or procedure prescribed by
statute shall be waived.
(f) The request for a waiver shall be granted by
the commissioner or his or her designee within 30 days if the alternative
proposed by the requesting entity meets the objective or intent of the rule and
it:
(1) Does not
negatively impact the health or safety of the individual(s); and
(2) Does not
affect the quality of services to individuals.
(g) Upon receipt of approval of a waiver request,
the requesting entity’s subsequent compliance with the alternative provisions
or procedures approved in the waiver shall be considered compliance with the
rule for which waiver was sought.
(h) Waivers shall be granted in writing for a
specific duration not to exceed 5 years except as in (i) below.
(i) A requesting entity may request a renewal of
a waiver from the bureau. Such request
shall be made at least 90 days prior to the expiration of a current waiver.
(j) A request for renewal of a waiver shall be
approved in accordance with the criteria specified in (f) above.
Source. #5929, eff 12-1-94, EXPIRED: 12-1-00
New. #7830, eff 2-13-03, EXPIRED: 2-13-11
New. #9879-A, eff 2-26-11, (paras (a) & (d)-(j));
#9879-B, eff 2-26-11, (paras (b)-(c));
ss by #12784, eff 5-21-19
PART He-M 520 CHILDREN’S SPECIAL MEDICAL SERVICES
Statutory
Authority: RSA 132:10-b, IV
PART He-M 520 CHILDREN’S SPECIAL MEDICAL SERVICES
Statutory
Authority: RSA 132:10-b, IV
REVISION NOTE:
Document #13370, effective 4-20-22,
readopted with amendments the form “Special Medical Services (SMS)—Application
for All Services” and re-named the form “Bureau for Family Centered Services
(BFCS)—Application for Services” pursuant to the expedited revisions to agency
forms process in RSA 541-A:19-c. Document #13370 updated the revision date on the form from
“(December 2018)” to “(4/2022)”. The
form is incorporated by reference in He-M 520.02(a) and He-M 523.04(a)(1). Document #13370 contained only the amended
form, giving it a new effective date of 4-20-22. The prior filing
affecting rule He-M 520.02 was Document #12699, effective 12-28-18, and the
prior filing affecting rule He-M 523.04 was Document #12700, effective
12-28-18, although the revision date for the form in the rules was “(August,
2018).” The effective date of the rules
remained unchanged by Document #13370.
Document #13696, effective 7-22-23,
readopted with amendments the form “Bureau for Family Centered Services
(BFCS)—Application for Services” pursuant to the expedited revisions to agency
forms process in RSA 541-A:19-c.
Document #13696 updated the revision date on the form from “(4/2022)” to
“(July 2023)”. The form is still
incorporated by reference in He-M 520.02(a) and He-M 523.04(a)(1). Document #13696 contained only the amended
form, giving it a new effective date of 7-22-23. Since Document #13696 updated the revision
date on the form from “(4/2022)” to “(July 2023)”, the revision date was
subsequently updated editorially in He-M 520.02(a) and He-M 523.04(a)(1) from
“(August 2018)” to “(July 2023)”. The
effective date of the rules remained unchanged by Document #13696.
He-M 520.01 Definitions.
(a)
“Administrator” means the person who oversees the bureau of special
medical services and its contractors.
(b)
“Allowable deduction” means the amount subtracted from a household’s
annual gross income, which represents expenses paid by a household member whose
income is counted when determining financial eligibility, and is limited to:
(1) Monthly court-ordered alimony payments;
(2) Monthly court-ordered child support payments;
(3) Monthly household child care expenses when
both parents are employed or when one parent is employed and the other parent
is functionally unable to care for the child;
(4) Monthly private health and or dental
insurance premiums;
(5) Monthly food deduction for a household member
with a specialty diet recommended by a licensed clinician, not to exceed $400
per month;
(6) Annual deduction of $1,000 for each
additional current recipient in the household, not to exceed $3,000 per
household; and
(7) Annual single head of household deduction not
to exceed $1,000.
(c)
“Annual gross income” means the sum of all income received by the
household as listed below:
(1) Including, but not limited to:
a.
Wages, salaries, tips, and commissions before deductions;
b.
Net earnings or Schedule C income from self-employment, partnership, or
business;
c.
Net rental income;
d.
Dividends;
e.
Interest;
f.
Annuities;
g.
Pensions;
h.
Royalties;
i.
Government- or state-issued benefits, such as:
1. Public assistance;
2. State financial grants;
3. Social security benefits;
4. Unemployment compensation;
5. Workers compensation; and
6. Veterans Administration benefits;
j.
Alimony or child support received;
k.
One-time insurance payments or compensation for injury or death
received;
l.
Medical settlements, and
m.
Non-medical trusts established for the applicant or any household
member; and
(2) Excluding income from sale of property, tax
refunds, gifts, scholarships, trainings, or stipends.
(d)
“Applicant” means the person for whom the application is made and who,
if determined to be eligible, becomes the recipient.
(e)
“Bureau” means the bureau of
special medical services within the department of health and human
services.
(f) “Children with special health care needs”
means “children with special health care needs” as defined in RSA 132:13, II,
namely “children who have or are at risk for chronic physical, developmental,
behavioral, or emotional conditions and who also require health and related
services of a type or amount beyond that required by children generally.”
(g)
“Chronic medical condition” means an ongoing physical, developmental,
behavioral, or emotional illness or disability, which:
(1) Is expected to last one year or longer;
(2) Requires extended sequential, medical,
surgical, or rehabilitative intervention as determined by a diagnostic
evaluation performed by a licensed clinician who is board eligible or board
certified;
(3) Is one of the following:
a.
Genetic condition;
b.
Inborn error of metabolism;
c.
Pulmonary or respiratory condition;
d.
Genitourinary disorder;
e.
Musculoskeletal condition;
f.
Blindness as defined by 42 USC 416 (i)(1);
g.
Deafness as defined by 34 CFR 300.7 (c)(3);
h.
Congenital anomaly;
i.
Developmental delay from birth to 6 years of age;
j.
Limb deficiency, including post amputation;
k.
Cranial facial anomaly;
l.
Neurologic condition;
m.
Digestive system condition;
n.
Endocrine abnormality, excluding conditions noted in (4) b. below;
o.
Cardiovascular condition;
p.
Neuromotor disorder;
q.
Spinal cord injury;
r.
Hematological disorder;
s.
Immunological disorder;
t.
Malignant neoplastic disease; or
u.
Skin disorder as listed in 20 CFR 404, Subpart P, Appendix 1; and
(4) Is not one of the following:
a.
An acute or recurrent condition encompassing the area of routine medical
care;
b.
A hormonal condition for which long-term replacement therapy is
required, such as short stature; and
c.
A dental or orthodontic condition except as related to conditions in
(3)h. or (3)k. above.
(h)
“Date of application” means the date stamped on the SMS application as
indication that the application was received by SMS.
(i)
“Department” means the New Hampshire department of health and human
services.
(j)
“Durable medical equipment” means a non-disposable device that:
(1) Can withstand repeated use;
(2) Is appropriate for in-home use for the
treatment of an acute or chronic medically diagnosed health condition, illness,
or injury; and
(3) Is not useful to a person in the absence of
an acute or chronic medically diagnosed health condition, illness, or injury.
(k)
“Federal poverty guidelines” means the annual revision of the poverty
income guidelines for the United States Department of Health and Human Services
as published in the Federal Register (74 FR 4199).
(l)
“Financial assistance” means a payment made by SMS in whole or in part
for health-related services.
(m)
“Health-related service” means a service related to the treatment of a
recipient’s chronic medical condition, such as, but not limited to:
(1) Therapies;
(2) Medications;
(3) Hospitalizations; and
(4) Durable medical equipment or medical
supplies.
(n)
“Household” means one or more children under the age of 21 and the
adults who are directly related to them by blood, by marriage, or by adoption
or who assist in the personal care and rearing of an applicant, all of whom
reside in the same home.
(o)
“Household income” means the annual gross income of the applicant and
the adults included in the household.
(p)
“Medicaid” means the Title XIX and Title XXI programs administered by
the department that makes medical assistance available to eligible individuals.
(q)
“Medical liability” means a household’s accrued medically related debt
or medical expenses paid within the past 12 months that are not covered by
third party liability insurance (TPL), including, but not limited to:
(1) Office visit or prescription co-payments;
(2) Emergency department visits;
(3) Insurance or COBRA payments;
(4) TPL required deductibles; and
(5) Other non-covered medical services.
(r)
“Medically necessary” means health care services and items that a
licensed health care provider, exercising prudent clinical judgment, would
provide, in accordance with generally accepted standards of medical practice,
to a recipient for the purpose of evaluating, diagnosing, preventing, or
treating an acute or chronic illness, injury, disease, or its symptoms, and
that are:
(1) Clinically appropriate in terms of type,
frequency of use, extent, site, and duration;
(2) Consistent with the established diagnosis or
treatment of the recipient’s illness, injury, disease, or its symptoms;
(3) Not primarily
for the convenience of the recipient or the recipient’s family, caregiver, or
health care provider;
(4) Not costlier
than other items or services which would produce equivalent diagnostic,
therapeutic, or treatment results as related to the recipient’s illness,
injury, disease, or its symptoms;
(5) Not
experimental, investigative, cosmetic, or considered alternative by current
medical practices;
(6) Not duplicative in nature; and
(7) Proven to be safe and effective, as
documented in medical peer review literature.
(s)
“Medical supplies” means consumable or disposable items appropriate for
in-home use for relief or treatment of a specific medically diagnosed health
condition, illness, or injury.
(t)
“Net income” means the household’s annual gross income minus any
allowable deductions, defined in (b) above.
(u)
“Provider” means an individual who provides a medical, therapeutic, or
other direct care service within his or her office, agency, practice, or during
a home visit.
(v)
“Recipient” means a child with special health care needs who has met the
established criteria as described in He-M 520.02.
(w) “Resource(s)” means any funds, available to
the household, with the exception of Achieving a Better Life Experience (ABLE)
Act/STABLE accounts, minus any penalties for withdrawal, including, but not
limited to:
(1) Checking accounts;
(2) Savings accounts;
(3) Certificates of deposit;
(4) Investments, such as mutual funds, stocks,
and bonds; and
(5) Trust funds.
(x)
“Special medical services (SMS)” means the bureau of special medical
services that operates the Title V program for children and youth with special
health care needs.
(y)
“Spend down” means the amount of a household’s net income which exceeds 185% of
that household’s federal poverty guideline amount.
(z)
“Third party” means any private insurer, health maintenance organization,
hospital service organization, medical service or health services corporation,
governmental agency, or any individual, organization, entity, or agency which
is authorized or under legal obligation to pay for medical services for a
recipient.
(aa) “Title V” means the program described in
Title V of the Social Security Act. SMS
administers the NH children with special health care needs component of Title V
as part of the Health Resources and Services Administration, United States
Department of Health and Human Services.
(ab)
“Title XIX” means the joint federal-state program described in Title XIX
of the Social Security Act and administered in New Hampshire by the department
under the Medicaid program.
(ac)
“Title XXI” means the joint federal-state program described in Title XXI
of the Social Security Act and administered in New Hampshire by the department
under the Medicaid program.
Source. #9748-A, eff 7-1-10; amd by #10138, eff
7-1-12; ss by #12558, INTERIM, eff 6-26-18, EXPIRED: 12-24-18
New. #12699, eff 12-28-18
He-M 520.02 Application Procedure.
(a)
In order to be determined eligible to receive program services or
financial assistance, a signed, dated, and completed application, entitled “Bureau
for Family Centered Services (BFCS),” (July 2023) shall be submitted to SMS for
each applicant.
(b)
The following documentation shall accompany the submitted application in
(a) above:
(1) Supporting documentation of income and
resources, as applicable;
(2) Supporting documentation regarding the
applicant’s health diagnosis;
(3) A signed
release of personal health information, which complies with current Health
Insurance Portability and Accountability Act (HIPPA) policies as defined in 45
CFR 160.103 and 45 CFR 164.501; and
(4) Documentation of guardianship of an applicant
or foster parent status, as applicable.
(c)
Within 60 days of the date of application, SMS shall:
(1) Accept and review all applications for
program or financial eligibility, in accordance with He-M 520.03 and He-M
520.05;
(2) Notify the applicant in writing of the
applicant’s eligibility status and the services for which the applicant is
eligible; and
(3) Have the
applicable Program Coordinator(s) initiate phone contact to discuss the SMS
program(s) for which the applicant has been found eligible.
(d)
SMS’s notice of decision shall include:
(1) For eligibility approvals:
a. The beginning and ending dates of SMS
eligibility;
b. The approved SMS services;
c. The name and phone number of an SMS contact
person;
d. Financial eligibility determination,
including the spend down amount, as applicable; and
e. Notice that the
recipient shall report to SMS any change in the recipient’s medical insurance
coverage, including Medicaid or TPL changes, within 30 days of the change; and
(2) For eligibility denials:
a. The reason(s) for denial;
b. Information about the applicant’s right to an
appeal in accordance with He-M 202 and He-C 200; and
c. Alternate support services information as
available.
(e)
For an applicant who is determined to be eligible, eligibility shall be
effective for 12 months from the applicant’s application date, except when any
household changes affect the recipient’s eligibility status.
(f)
SMS shall notify a recipient in writing 30 calendar days prior to the
date that eligibility will close, for such reasons as the 12-month eligibility
period is expiring, the recipient is turning 21, services provided are no
longer available, or there is a household change which affects eligibility
status.
(g)
A new application shall be submitted in accordance with (a) and (b)
above prior to the expiration of current eligibility.
(h)
An applicant or recipient shall have the right to reapply at any time
after eligibility has been denied.
(i)
An applicant who submits false or misleading information shall be
subject to the provisions of RSA 132:15 and RSA 638:15.
Source. #9748-A, eff 7-1-10, para (c)-(h), intro.,
& (i)(1), (4), & (5), and (j); #9748-B,
eff 7-1-10, paras (a), (b), and
(i)(3); amd by #10138, eff 7-1-12; ss by #12558, INTERIM,
eff 6-26-18, EXPIRED: 12-24-18
New. #12699, eff 12-28-18; (see also Revision Note
at part heading for He-M 520)
He-M 520.03 Program Eligibility Requirements. To be eligible for services provided under
He-M 520.04, an applicant shall:
(a)
Be a child with special health care needs;
(b)
Be a resident of the State of New Hampshire and not have residency in
another state;
(c)
Be, or have a parent or guardian who is, a United States citizen or a
legal resident alien; and
(d)
Be under the age of 21.
Source. #9748-A, eff 7-1-10, para (c)-(h), intro.,
& (i)(1), (4), & (5), and (j); #9748-B,
eff 7-1-10, paras (a), (b), and
(i)(3); amd by #10138, eff 7-1-12; ss by #12558, INTERIM,
eff 6-26-18, EXPIRED: 12-24-18
New. #12699, eff 12-28-18; (see also Revision Note
at part heading for He-M 520)
He-M 520.04 Services Provided.
(a)
Services provided to recipients by SMS or agencies under current service
contract obligation with SMS shall include:
(1) SMS care coordination services to:
a.
Assist the household in developing and implementing a health care plan
for the recipient; and
b.
Provide information about available types of third-party assistance;
(2) SMS nutrition services;
(3) SMS feeding and swallowing services;
(4) SMS consultation services;
(5) SMS specialty
services provided through attendance at child development clinics sponsored by
SMS;
(6) SMS specialty services provided through
attendance at complex care clinics sponsored by SMS; and
(7) SMS specialty services provided through
attendance at neuromotor clinics sponsored by SMS.
(b)
A recipient shall be limited to the services listed in (a)(4)-(6) above
if his or her primary diagnosis is one of the following:
(1) Attention deficit disorder;
(2) Autism spectrum disorder; or
(3) Another emotional or behavioral disorder.
Source. #9748-A, eff 7-1-10; ss by #12558, INTERIM,
eff 6-26-18, EXPIRED: 12-24-18
New.
#12699, eff 12-28-18
He-M 520.05 Financial Eligibility Requirements.
(a)
To be eligible for financial assistance, a recipient shall:
(1) Meet the program eligibility requirements in
He-M 520.03;
(2) Have a documented chronic medical condition;
and
(3) Meet the financial eligibility requirements
in (b) through (h) below.
(b)
A recipient shall be eligible for financial assistance for
health-related services related to the recipient’s chronic medical condition
if:
(1) The recipient resides in a household with a
net income less than or equal to 185% of that household’s federal poverty
guideline amount and with resources of $10,000 or less; or
(2) The recipient resides in a household with a
net income greater than 185% of that household’s federal poverty guideline
amount and the household’s medical liability is enough to reduce the
household’s spend down amount by 100% prior to receiving financial assistance.
(c)
The following shall apply to a household’s medical liability and spend
down amount:
(1) SMS shall determine a household’s medical
liability, each time eligibility for financial assistance is reviewed;
(2) A household’s medical liability shall be used
to reduce the spend down amount;
(3) A household’s medical liability that is used
to reduce the spend down amount in one year shall not be used to reduce the
spend down amount in any subsequent year;
(4) Medical liability used to reduce the spend
down amount shall not be eligible for payment through financial assistance; and
(5) SMS shall notify recipients in writing of
current spend down amounts.
(d)
If a household requests payment for services that would otherwise be
covered under Medicaid and the household’s income would allow it to be eligible
for Medicaid, the household shall be encouraged to apply for such Medicaid
services within 3 months of requesting financial assistance.
(e)
Households that do not apply for Medicaid eligibility for the applicant
pursuant to (d) above, shall not be eligible for financial assistance under
He-M 520.05 and He-M 520.06.
(f)
For purposes of determining financial eligibility, a recipient who meets
any of the following criteria shall be considered to be the only individual in
the household:
(1) The recipient is an emancipated minor;
(2) The recipient is aged 18 to 21;
(3) The recipient is a foster child; or
(4) The recipient has a court appointed guardian.
(g)
A recipient’s adult siblings who are 18 or older and share the
recipient’s residence shall be excluded as household members when the siblings:
(1) Are employed or have a source of income;
(2) Are married; or
(3) Have their own children.
(h)
For a child residing with a parent and one or more unrelated adult, the
income of the unrelated adult shall be included in the household income if the
unrelated adult is a parent of an applicant’s sibling.
(i)
When a household member reports to SMS and supplies supporting
documentation of a change in household net income, SMS shall then reassess
financial eligibility.
Source. #9748-A, eff 7-1-10; amd by #10138, eff
7-1-12; ss by #12558, INTERIM, eff 6-26-18, EXPIRED: 12-24-18
New.
#12699, eff 12-28-18
He-M 520.06 Payment for Health-Related Services.
(a)
SMS shall approve a recipient’s request for payment for a health-related
service when all the following are true:
(1) The recipient has been determined to be
financially eligible in accordance with He-W 520.05;
(2) The health-related service is:
a. Determined to be medically necessary;
b. Related to the recipient’s chronic medical
condition; and
c. Supported by the recipient’s SMS health care
plan;
(3) All third party resources, including the
recipient’s hospital, surgical, or medical insurance plans, have been
exhausted, except as allowed by (f) below; and
(4) A bill or invoice for a health-related
service is submitted to SMS:
a. Which is itemized and dated; and
b. For which the service date is:
1. Not more than 12 months prior to the
submission date;
2. Not prior to the recipient’s application
date; and
3. Not a date when the recipient was not
eligible for financial assistance.
(b)
Payments for health-related services shall be paid at the lowest of:
(1) The provider’s usual and customary charge to
the public, as defined in RSA 126-A:3, III(b);
(2) The lowest amount accepted from any other
third party payors; or
(3) The Medicaid rate established by the
department in accordance with RSA 161:4, VI(a).
(c)
Payment for hospital charges shall:
(1) Include both inpatient and outpatient
services; and
(2) Have a maximum of $3,000 per event.
(d)
Payment for diagnostic procedures shall have a maximum of $3,000 per
procedure.
(e)
Notwithstanding (b) above:
(1) Over-the-counter medication and
non-prescription medication items shall be paid as submitted if no current
Medicaid rate is available; and
(2) The administrator shall approve reimbursement
for health-related services over Medicaid rates when:
a. SMS has negotiated a higher payment rate(s)
with the provider; or
b. Medicaid reimbursement is less than what was
paid out of pocket by the recipient.
(f) The administrator shall approve
reimbursement for health-related services not submitted for Medicaid or
third-party reimbursement when:
(1) A Medicaid or TPL precedent has been set for
denial of equivalent services;
(2) A crisis situation exists that jeopardizes
the safety or health of the recipient; or
(3) The volume of service is over Medicaid or TPL
allowable limits.
(g)
With respect to Title XIX, Medicare, or any medical insurance program or
policy, SMS shall be the payor of last resort.
Nothing contained in these rules shall require SMS to provide payment
for medications, supplies, or services.
Source. #9748-A, eff 7-1-10; ss by #12558, INTERIM, eff
6-26-18, EXPIRED: 12-24-18
New.
#12699, eff 12-28-18
He-M 520.07 Limitation of Services. Financial assistance provided under these
rules shall be provided to the extent that funds for this purpose are
appropriated and made available to the bureau by the Legislature and not
otherwise reduced or restricted by legislative fiscal committee action.
Source. #9748-A, eff 7-1-10; ss by #12558, INTERIM,
eff 6-26-18, EXPIRED: 12-24-18
New.
#12699, eff 12-28-18
He-M 520.08 Appeals.
(a)
Pursuant to He-M 202, an applicant, recipient, parent, or guardian may
request to informally resolve any disagreement with SMS, or, within 30 business
days of an SMS decision, she or he may choose to file a formal appeal. Any determination, action, or inaction by SMS
may be appealed.
(b)
If informal resolution is requested, the administrator shall meet and
review with the applicant, recipient, parent, or guardian the financial status
or medical condition of the applicant or recipient that pertains to the
applicant’s or recipient’s eligibility.
(c)
SMS shall notify the applicant, recipient, parent, or guardian of the
findings of the review, in writing, within 15 business days of a case review
conference.
(d) Formal appeals shall be submitted, in
writing, to the bureau administrator in care of the bureau’s office of client
and legal services. An exception shall
be that appeals may be filed verbally if the individual is unable to convey the
appeal in writing.
(e)
If a hearing is requested, the following actions shall occur:
(1) Services and payments shall be continued as a
consequence of a request for a hearing until a decision has been made; and
(2) If SMS’s decision is upheld, funding shall
cease 60 days from the date of the denial letter or 30 days from the hearing
decision, whichever is later.
Source. #9748-A, eff 7-1-10; ss by #12558, INTERIM,
eff 6-26-18, EXPIRED: 12-24-18
New. #12699, eff 12-28-18
He-M 520.09 Waivers.
(a)
An applicant, parent, or guardian may request a waiver of specific
services as outlined in He-M 520 by completing and submitting to the
department, bureau of special medical services form titled “Department of Health
and Human Services, Bureau of Special Medical Services Waiver for Services” (
December 2018)”.
(b)
A completed waiver request form shall be signed by the applicant,
parent, guardian, or provider indicating agreement with the request.
(c) The request for a waiver shall be granted by
the commissioner or his or her designee within 30 days if:
(1) The alternative proposed by the applicant,
recipient, parent, or guardian meets the objective or intent of the rule;
(2) The alternative proposed does not negatively
impact the health or safety of the household or recipient;
(3) The alternative proposed does not affect the
quality of services to a recipient; and
(4) All other TPL service requests have been
exhausted or denied.
(d)
A waiver request shall be submitted to:
Department of
Health and Human Services
Office of Special
Medical Services
State Office Park
South
129 Pleasant
Street, Thayer Building
Concord, NH 03301
(e)
No provision or procedure prescribed by statute shall be waived.
(f)
The determination on the request for a waiver shall be made within 30
days of the receipt of the request.
(g)
Waivers shall be granted in writing and remain in effect for the
duration of the recipient’s current eligibility.
(h)
Waivers shall end with the closure of the related program or service.
Source. #9748-A, eff 7-1-10; ss by #12558, INTERIM,
eff 6-26-18, EXPIRED: 12-24-18
New.
#12699, eff 12-28-18
PART He-M 521 CERTIFICATION OF RESIDENTIAL SERVICES OR
COMBINED RESIDENTIAL AND COMMUNITY PARTICIPATION SERVICES PROVIDED IN THE
FAMILY HOME
Statutory
Authority: RSA 171-A:3; 18, IV; 137-K:3
He-M 521.01 Purpose. The purpose of these rules is to provide
minimum standards for residential services or combined community participation
and residential services for individuals with developmental disabilities or
acquired brain disorders who reside in their families’ homes. These rules shall not apply to individuals
who receive services under He-M 524, in-home supports.
Source. #5791, eff 3-1-94, EXPIRED: 3-1-00
New. #7227, INTERIM, eff 3-31-00, EXPIRED: 7-29-00
New. #7494, eff 5-22-01; ss by #9013, eff 10-27-07;
ss by #9475, eff 5-22-09; ss by #12340, eff 7-25-17
He-M 521.02 Definitions.
(a)
“Acquired brain disorder” means a disruption in brain functioning that:
(1) Is not congenital or caused by birth trauma;
(2) Presents a severe and life-long disabling
condition which significantly impairs a person’s ability to function in
society;
(3) Occurs prior to age 60; and
(4) Is attributable to one or more of the
following reasons:
a. External trauma to the brain as a result of:
1. A motor vehicle incident;
2. A fall;
3. An assault; or
4. Another related traumatic incident or
occurrence;
b. Anoxic or hypoxic injury to the brain such as
from:
1. Cardiopulmonary arrest;
2. Carbon monoxide poisoning;
3. Airway obstruction;
4. Hemorrhage; or
5. Near drowning;
c. Infectious diseases, such as encephalitis and
meningitis;
d. Brain tumor;
e. Intracranial surgery;
f. Cerebrovascular disruption such as a stroke;
g. Toxic exposure; and
h. Other neurological disorders such as
Huntington’s disease or multiple sclerosis which predominantly affect the
central nervous system; and
(5) Is manifested by one or more of the
following:
a. Significant decline in cognitive functioning
and ability; or
b. Deterioration in:
1. Personality;
2. Impulse control;
3. Judgment;
4. Modulation of mood; or
5. Awareness of deficits.
(b)
“Area agency” means “area agency” as defined in RSA 171-A:2, I-b.
(c)
“Bureau” means the bureau of developmental services of the department of
health and human services.
(d)
“Bureau administrator” means the chief administrator of the bureau of
developmental services.
(e)
“Commissioner” means the commissioner of the department of health and
human services or his or her designee.
(f)
“Community participation services” referred to elsewhere in He-M 500 and
He-M 1001 as “day services”, means habilitation, assistance, and instruction
provided to individuals that:
(1) Improve or maintain their performance of
basic living skills;
(2) Offer vocational and community activities, or
both;
(3) Enhance their social and personal
development;
(4) Include consultation services, in response to
individuals’ needs, and as specified in service agreements, to improve or
maintain communication, mobility, and physical and psychological health; and
(5) At a minimum, meet the needs and achieve the
desired goals and outcomes of each individual as specified in the service
agreement.
(g)
“Department” means the New Hampshire department of health and human
services.
(h)
“Developmental disability” means “developmental disability” as defined
in RSA 171-A:2, V, namely, “a disability:
(a) Which is attributable to an intellectual
disability, cerebral palsy, epilepsy, autism or a specific learning disability,
or any other condition of an individual found to be closely related to an
intellectual disability as it refers to general intellectual functioning or
impairment in adaptive behavior or requires treatment similar to that required
for persons with an intellectual disability; and
(b) Which originates before such individual
attains age 22, has continued or can be expected to continue indefinitely, and
constitutes a severe disability to such individual’s ability to function
normally in society.”
(i)
“Family” means a group of 2 or more persons related by ancestry,
marriage, or other legal arrangement that has at least one member who has a
developmental disability.
(j)
“Guardian” means a person appointed pursuant to RSA 464-A or a parent of
an individual under the age of 18 whose parental rights have not been
terminated or limited by law in such a way as to
remove the person’s right to make decisions pursuant to RSA 171-A on behalf of
the individual..
(k)
“Individual” means a person with a developmental disability or acquired
brain disorder who is eligible to receive services pursuant to He-M 503 or He-M
522.
(l)
“Provider” means a person receiving any form of remuneration for the
provision of services to an individual.
(m)
“Provider agency” means an area agency or another entity under contract
with an area agency to provide services.
(n)
“Representative” means:
(1) The parent or guardian of an individual under
the age of 18;
(2) The guardian of an individual 18 or over; or
(3) A person who has power of attorney for the
individual.
(o)
“Service” means any paid assistance to an individual in meeting his or
her own needs provided through the area agency.
(p)
“Service agreement” means a written agreement between an individual or
his or her guardian or representative and an area agency that is prepared in accordance with He-M 503 or He-M 522 and that describes the
services that an individual will receive and constitutes an individual service
agreement as defined in RSA 171-A:2,X.
(q)
“Service coordinator” means a person who is chosen or approved by an
individual and his or her guardian or representative to organize, facilitate
and document service planning and to negotiate and monitor the provision of the
individual’s services.
(r)
“Staff” means a person employed by an area agency or provider agency.
Source. #5791, eff 3-1-94, EXPIRED: 3-1-00
New. #7227, INTERIM, eff 3-31-00, EXPIRED: 7-29-00
New. #7494, eff 5-22-01; amd by #9013, eff
10-27-07; ss by #9475, eff 5-22-09; ss by #12340, eff 7-25-17
He-M 521.03 Services.
(a)
All services shall be specifically tailored to the competencies,
interests, preferences, needs, and lifestyle of the individual served.
(b)
Services shall include assistance and instruction to improve and
maintain an individual’s skills in basic daily living, personal development,
and community activities, such as, but not limited to:
(1) Making personal choices;
(2) Promoting and maintaining safety;
(3) Enhancing communication;
(4) Participating in community activities;
(5) Developing and maintaining personal
relationships;
(6) Finding and maintaining employment;
(7) Pursuing avocations in areas of personal
interest;
(8) Improving and maintaining social skills;
(9) Achieving and maintaining physical
well-being;
(10) Improving and/or maintaining mobility and
physical functioning;
(11) Shopping and managing money;
(12) Attending to personal hygiene and appearance;
(13) Doing household chores;
(14) Participating in meal preparation;
(15) Accessing and using assistive technology;
(16) Accessing and using transportation; and
(17) Other similar services as indicated in the
individual’s service agreement.
Source. #5791, eff 3-1-94, EXPIRED: 3-1-00
New. #7227, INTERIM, eff 3-31-00, EXPIRED: 7-29-00
New. #7494, eff 5-22-01; ss by #9475, eff 5-22-09;
ss by #12340, eff 7-25-17
He-M 521.04 Eligibility.
(a)
Any individual who resides at home with his or her family shall be
eligible for services identified in He-M 521.03, except as provided in (b)
below.
(b)
An individual who resides in a foster home licensed by the division of
children, youth, and families shall not be eligible for services identified in
He-M 521.03.
Source. #5791, eff 3-1-94; ss by #6002, eff 4-1-95;
ss by #7494, eff 5-22-01; ss by #9475, eff 5-22-09; ss by #12340, eff 7-25-17
He-M 521.05 Administrative Requirements.
(a)
Once a family expresses interest regarding He-M 521 services but before
services are provided under He-M 521, the area agency shall:
(1) Ensure that the proposed service arrangement:
a. Meets the individual’s expressed interests,
preferences, needs, and lifestyle;
b. Is consistent with the goals and services
identified in the individual’s service agreement; and
c. Meets the individual’s environmental and
personal safety needs; and
(2) Explain and discuss the following with the
individual, guardian, representative, and family members:
a. Area agency oversight of services provided
under He-M 521;
b. If applicable, the process of having staff or providers coming into
the home environment;
c. If the individual is taking medication, the supports available or needed to
administer the medication safely;
d. That modifications might be
necessary in the service agreement if and when the individual’s needs or
preferences change;
e. If applicable, receiving payments for the
provision of services;
f. If applicable, the relationship between the
area agency and the family member as a provider or subcontractor;
g. The requirements regarding certification of
services, including, for all people who are being considered for a position of
staff or provider:
1. Performing criminal background checks; and
2. Checking the state registry of abuse,
neglect, and exploitation reports as established by RSA 161-F:49; and
h. The conditions warranting the suspension or
revocation of certification.
(b)
In those situations where a family member is to be reimbursed as a
provider or subcontractor, the area agency or provider agency shall, in
consultation with the individual, guardian, representative, and family, develop
a contract that:
(1) Identifies the responsibilities of the area
agency, provider agency, if applicable, and the family member as a provider or
subcontractor;
(2) Describes the provision of supports needed to
administer medication safely;
(3)
Includes provision for time off and identifying the area agency or provider
agency responsibility in assisting the family to secure substitute providers
when the family member is the provider;
(4) Includes a provision for either party to
dissolve the contract with notice;
(5) Allows for review and revision as deemed
necessary by either party; and
(6) Is signed by all parties.
(c)
When services are being provided under He-M 521, the area agency shall:
(1) Have, at a minimum, quarterly contacts with
the family to provide information and support to ensure that services are
provided in accordance with the service agreement and He-M 521; and
(2) Ensure that the service arrangement is in
compliance with He-M 503.10 or He-M 522.
Source. #5791, eff 3-1-94; ss by #6002, eff 4-1-95;
ss by #7494, eff 5-22-01; amd by #9013, eff 10-27-07; ss by #9475, eff 5-22-09;
ss by #12340, eff 7-25-17
He-M 521.06 Medication Administration. When an individual living with his or her
family is in need of medication administration, such administration shall:
(a)
Comply with He-M 1201 when administered by area agency, provider agency staff, home providers, or other providers contracted
by the area agency;
(b)
Comply with Nur 404 when a nurse identified in Nur 404.04 delegates the
task of medication administration to providers who are neither family members
nor under contract with an area agency or provider agency, except in situations
where the individuals are living with their families and receiving respite
arranged by the family; or
(c)
When performed by family members paid under He-M 521, include discussion
between the area agency or provider agency and the family about any concerns
the family might have regarding medication administration.
Source. #5791, eff 3-1-94, EXPIRED: 3-1-00
New. #7242, INTERIM, eff 4-27-00, EXPIRED: 8-25-00
New. #7494, eff 5-22-01; ss by #9475, eff 5-22-09;
ss by #12340, eff 7-25-17
He-M 521.07 Quality Assessment.
(a) An area agency shall monitor services
provided pursuant to He-M 521.
(b) All services shall be monitored by a service
coordinator, who:
(1) Meets the criteria in He-M 503.08 9(e)-(f);
(2) Is an area agency service coordinator, family
support coordinator or any other area agency or provider agency employee;
(3) Is a member of the individual’s family;
(4) Is a friend of the individual; or
(5) Another person chosen to represent the
individual.
(c)
On at least a monthly basis, the service coordinator shall visit or have
verbal contact with the individual or persons responsible for services to
review progress on achieving the goals in the service agreement, inquire about
other service needs, and document such visit or contact.
(d)
The service coordinator shall visit the individual at home and contact
the guardian or representative, if any, at least quarterly, or more frequently
if so specified in the individual’s service agreement, to determine and
document whether services:
(1) Match the interests, needs, preferences and
lifestyle of the individual;
(2) Meet with the individual’s satisfaction;
(3) Meet the individual’s environmental and
personal safety needs; and
(4) Meet the terms of the service agreement; and
(e)
If applicable, reviews of medication administration related activities
shall be conducted as required in He-M 1201.09(b) and (c).
Source. #5791, eff 3-1-94, EXPIRED: 3-1-00
New. #7242, INTERIM, eff 4-27-00, EXPIRED: 8-25-00
New. #7494, eff 5-22-01; ss by #9475, eff 5-22-09;
ss by #12340, eff 7-25-17
He-M 521.08 Documentation. Individual records shall:
(a) Be maintained by the provider or staff; and
(b) Include:
(1) The service agreement;
(2) Provider or staff progress notes written at
least monthly, or more frequently if so specified in the service agreement,
including the dates services are provided and reports on progress toward
achieving desired outcomes;
(3) For community participation services, a
weekly personal schedule or calendar that:
a. Identifies the days, times, and locations of
the individual’s community activities such as recreation or paid or volunteer
work; or
b. Includes brief, daily notations that document
responses to people and activities and any changes in the individual's
schedule; and
(4) Any other documentation required by the area
agency.
Source. #5791, eff 3-1-94, EXPIRED: 3-1-00
New. #7242, INTERIM, eff 4-27-00, EXPIRED: 8-25-00
New. #7494, eff 5-22-01; ss by #9013, eff 10-27-07;
ss by #9475, eff 5-22-09; ss by #12340, eff 7-25-17
He-M 521.09 Certification.
(a)
Residential services and combined residential and community
participation services provided under He-M 521 shall be certified by the
bureau.
(b)
To initiate the certification process, the area agency shall:
(1) Review the service arrangement and
documentation to confirm that all applicable requirements identified in He-M
521.05 and He-M 521.06 are being met; and
(2) At least 30 days prior to the start of
services, forward to the bureau:
a. The individual’s service agreement and
proposed budget; and
b. The area agency’s recommendation for
certification.
(c)
To renew certification of services under He-M 521, the area agency
shall:
(1)
Review the service arrangement and documentation to confirm that all applicable
requirements identified in He-M 521.05 through He-M 521.08 are being met; and
(2) At least 30 days prior to the expiration of
the current services, forward to the bureau:
a. The individual’s service agreement and
budget; and
b. The area agency’s recommendation for
recertification.
(d)
Within 14 days of receiving the area agency recommendation pursuant to
(b) or (c) above, the bureau shall issue a certification if the applicable
requirements are being met.
(e)
All certifications granted by the bureau under (d) above shall be
effective for no more than 24 months.
Source. #5791, eff 3-1-94, EXPIRED: 3-1-00
New. #7242, INTERIM, eff 4-27-00, EXPIRED: 8-25-00
New. #7494, eff 5-22-01; amd by #9013, eff
10-27-07; ss by #9475, eff 5-22-09; ss by #12340, eff 7-25-17
He-M 521.10 Denial and Revocation of Certification.
(a)
In the event of the denial or revocation of certification of services
pursuant to (c) below, the individual’s service coordinator shall assist him or
her to continue receiving alternative services that meet his or her needs.
(b)
The bureau shall deny an application for certification or revoke
certification of services, following written notice pursuant to (d) below and
opportunity for a hearing pursuant to He-C 200, due to:
(1) Failure of a staff member, provider, provider
agency, or area agency to comply with He-M 521 or any other applicable rule
adopted by the department;
(2) Hiring of persons below the age of 18 as
staff or providers;
(3) Submission of materially false or misleading
information to the department or failure to provide information requested by
the department and required pursuant to He-M 521;
(4) The staff, provider, provider agency, or area
agency preventing or interfering with any review or investigation by the
department;
(5) The staff, provider, provider agency, or area
agency failing to provide required documents to the department;
(6) Any reported abuse, neglect, or exploitation
of an individual by a provider, staff member, or person living in an
individual’s residence, if
a. Such abuse, neglect, or exploitation is
reported on the state registry of abuse, neglect, and exploitation in
accordance with RSA 161:F-49;
b. Such person(s) continues to have contact with
the individual; and
c. Such finding has not been overturned on
appeal, been annulled, or received a waiver pursuant to He-M 521.14;
(7) Failure by a provider agency or area agency
to perform criminal background checks on all persons paid to provide services
under He-M 521 who begin to provide such services on or after the effective
date of He-M 521, or any person living in an individual’s residence;
(8) A misdemeanor conviction of any staff or
provider or any person living in an individual’s residence that involves:
a. Physical or sexual assault;
b. Violence or exploitation;
c. Child pornography;
d. Threatening or reckless conduct;
e. Theft;
f. Driving under the influence of drugs or
alcohol; or
g. Any other conduct that represents evidence of
behavior that could endanger the well-being of an individual;
(9) A felony conviction of any staff or provider
or any person living in an individual’s residence; or
(10) Evidence that any provider or staff working
directly with individuals has an illness or behavior that, as evidenced by the
documentation obtained and the observations made by the department, would
endanger the well-being of the individuals or impair the ability of the
provider or staff to comply with department rules.
(c)
If the department determines that services meet any of the criteria for
denial or revocation listed in (b)(1)-(10) above, the department shall deny or
revoke the certification of the services.
(d)
Certification shall be denied or revoked upon the written notice by the
department to the family and provider, provider agency, or area agency stating
the specific rule(s) with which the service does not comply.
(e)
Any certificate holder aggrieved by the denial or revocation of the
certification may request an adjudicative proceeding in accordance with He-M
521.12 and the denial or revocation shall not become final until the period for
requesting an adjudicative proceeding has expired or, if the certificate holder
requests an adjudicative proceeding, until such time as the administrative
appeals unit issues a decision upholding the department’s action.
(f)
Pending compliance with all requirements for certification specified in
the written notice made pursuant to (d) above, a provider, provider agency, or
area agency shall not provide additional services if a notice of revocation has
been issued concerning a violation that presents potential danger to the health
or safety of the individuals being served.
Source. #5791, eff 3-1-94, EXPIRED: 3-1-00
New. #7242, INTERIM, eff 4-27-00, EXPIRED: 8-25-00
New. #7494, eff 5-22-01; ss by #9475, eff 5-22-09;
ss by #12340, eff 7-25-17
He-M 521.11 Immediate Suspension of Certification.
(a)
In the event that a violation poses an immediate and serious threat to
the health or safety of an individual, the bureau administrator shall suspend a
service’s certification immediately upon issuance of written notice specifying
the reasons for the action.
(b)
The bureau administrator or his or her designee shall schedule and hold
a hearing within 10 working days of the suspension for the purpose of
determining whether to revoke or reinstate the certification. The hearing shall provide opportunity for the
provider, provider agency, or area agency whose certification has been
suspended to demonstrate that it has been, or is, in compliance with the
specified requirements.
Source. #7494, eff 5-22-01; ss by #9475, eff 5-22-09;
ss by #12340, eff 7-25-17
He-M 521.12 Appeals.
(a)
Pursuant to He-C 200, an individual, guardian, or representative may
within 30 business days of the area agency decision, she or he may choose to
file a formal appeal. Any determination,
action, or inaction by an area agency may be appealed by an individual,
guardian, or representative.
(b)
An applicant for certification, provider, provider agency, or area
agency may request a hearing regarding a proposed revocation or denial of
certification, except as provided in He-M 521.11 above.
(c)
Appeals shall be submitted, in writing, to the bureau administrator in
care of the department’s office of client and legal services within 10 days
following the date of the notification of denial or revocation of
certification. An exception shall be
that appeals may be filed verbally if the individual is unable to convey the
appeal in writing.
(d)
The bureau administrator shall immediately forward the appeal to the
department’s administrative appeals unit which shall assign a presiding officer
to conduct a hearing or independent review, as provided in He-C 200. The burden shall be as provided by He-C
203.14.
(e)
If a hearing is requested, the following actions shall occur:
(1) Services and payments shall be continued as a
consequence of an appeal for a hearing until a decision has been made; and
(2) If the bureau’s decision is upheld, funding
shall cease 60 days from the date of the denial letter or 30 days from the
hearing decision, whichever is later.
Source. #7494, eff 5-22-01; ss by#9475, eff 5-22-09;
ss by #12340, eff 7-25-17
He-M 521.13 Payment.
(a)
In order to receive funding under He-M 521, services shall be certified
by the bureau in accordance with He-M 521.09.
(b)
Community‑based care providers shall submit claims for covered
community‑based care services on to:
Xerox Provider
Services
ATTN: Claims Administration
P.O. Box 2003
Concord, NH 03302-2003
(c)
Payment for community‑based care services shall only be made if
prior authorization has been obtained from the bureau.
(d)
Requests for prior authorization shall be made in writing to:
Xerox Provider
Services ATTN: Claims Administration
PO Box 2003
Concord, NH 03302-2003
(e)
For those individuals whose net income exceeds the appropriate standard
of need, Medicaid claims payment will reflect a reduction in reimbursement
equal to the cost of care amount..
(f)
In those situations where cost of care is subtracted from the Medicaid
billings, the area agency shall recover the cost from individuals unless they
qualify for Medicaid for employed adults with disabilities (MEAD) pursuant to
He-W 641.03.
(g) Payment for services shall not be available
to any service provider who:
(1) Is a person under age 18; or
(2) Is the spouse of an individual receiving
services.
Source. #9475, eff 5-22-09; ss by #12340, eff 7-25-17
He-M 521.14 Waivers.
(a)
An area agency, provider agency, individual, guardian, representative,
or provider may request a waiver of specific procedures outlined in He-M 521 by
completing and submitting the form titled “NH Bureau of Developmental Services
Waiver Request” (September 2013 edition).
The area agency shall submit the request in writing to the bureau
administrator.
(b)
A completed waiver request form shall be signed by:
(1) The individual, guardian(s), or
representative(s) indicating agreement with the request; and
(2) The area agency’s executive director or
designee recommending approval of the waiver.
(c)
A waiver request shall be submitted to:
Department of
Health and Human Services
Office of Client
and Legal Services
Hugh J. Gallen
State Office Park
105 Pleasant
Street, Main Building
Concord, NH 03301
(d)
No provision or procedure prescribed by statute shall be waived.
(e)
The request for a waiver shall be granted by the commissioner or his or
her designee within 30 days if the alternative proposed by the requesting
entity meets the objective or intent of the rule and it:
(1) Does not negatively impact the health or
safety of the individual(s); and
(2) Does not affect the quality of services to
individuals.
(f)
Upon receipt of approval of a waiver request, the requesting entity’s
subsequent compliance with the alternative provisions or procedures approved in
the waiver shall be considered compliance with the rule for which waiver was
sought.
(g)
Waivers shall be granted in writing for a specific duration not to
exceed 5 years except as in (h) below.
(h)
Any waiver shall end with the closure of the related program or service.
(i)
A requesting entity may request a renewal of a waiver from the
bureau. Such request shall be made at
least 90 days prior to the expiration of a current waiver.
Source. #9475, eff 5-22-09 (from He-M 521.12); ss by
#12340, eff 7-25-17
PART He-M 522 ELIGIBILITY AND THE PROCESS OF
PROVIDING SERVICES FOR
INDIVIDUALS WITH AN ACQUIRED BRAIN DISORDER
Statutory
Authority: RSA 137-K:3
He-M 522.01 Purpose. The
purpose of these rules is to establish standards and procedures for the
determination of eligibility, the development of service
agreements, and the provision and monitoring of
services that maximize the ability and informed decision-making
authority of individuals with acquired brain disorder, and that
promote the individual’s personal development, independence, and quality of
life in a manner that is determined by the individual.
Source. #7120, eff 10-20-99; ss by #8974, INTERIM,
eff 10-6-07, EXPIRED: 4-3-08
New. #9734, eff 6-25-10; ss by #12683, eff
11-30-18; ss by #14253, eff 5-22-25, EXPIRES: 5-22-35
He-M 522.02 Definitions.
(a) “Acquired brain disorder” means a disruption in brain functioning
that:
(1) Is
not congenital or caused by
birth trauma;
(2)
Presents a severe and life-long disabling condition which significantly impairs
a person’s ability to function in society;
(3)
Occurs prior to age 60;
(4) Is
attributable to one or more of the following reasons:
a. External trauma to the brain as a
result of:
1. A motor vehicle
incident;
2. A fall;
3. An assault; or
4. Another related
traumatic incident or occurrence;
b.
Anoxic or hypoxic injury to the
brain such as from:
1. Cardiopulmonary
arrest;
2. Carbon monoxide poisoning;
3. Airway obstruction;
4. Hemorrhage; or
5. Near drowning;
c. Infectious diseases such as
encephalitis and meningitis;
d.
Brain tumor;
e. Intracranial surgery;
f. Cerebrovascular disruption such as a
stroke;
g.
Toxic exposure; or
h.
Other neurological disorders, such as Huntington’s disease or multiple
sclerosis, which predominantly
affect the central nervous system resulting in diminished cognitive functioning
and ability; and
(5) Is
manifested by one or more of the
following:
a.
Significant decline in cognitive functioning and ability; or
b. Deterioration in:
1. Personality;
2. Impulse control;
3. Judgment;
4. Modulation of
mood; or
5. Awareness of
deficits.
(b) “Amendment”
means any change to the personal profile, provider agency, or provision of
services, including the amount, scope, type, frequency, or duration, within a
service agreement.
(c) “Applicant”
means any person who requests services pursuant to He-M 522.04.
(d) “Area” means “area” as defined in
RSA 171-A:2, I-a, namely, “a geographic region established by rules adopted by the commissioner for the purpose of providing services
to developmentally disabled persons.” This term includes “region”.
(e) “Area agency” means “area
agency” as defined in RSA 171-A:2, I-b.
(f) “Area agency director” means that
person who is appointed as executive director or acting executive director of
an area agency by the area agency’s board of directors.
(g) “Assistive technology” means
technology designed to be utilized in an “assistive technology device” as
defined in 29 U.S.C. section 3002(4) or “assistive technology service”
as defined in 29 U.S.C. section 3002(5).
(h) “Brain
injury community supports” means services administered through the Brain
Injury Association of New Hampshire that:
(1)
Are provided to persons with an acquired brain disorder who are eligible for
services pursuant to He-M 522.03(a)
but do not meet the eligibility criteria in He-M 517.03(a) for home and
community-based care; and
(2)
Include, at a minimum the following services when such services are not
reimbursable by medicaid or other insurance:
a.
Home modification;
b. Respite service;
c. Assistive technology;
d. Specialized equipment;
e. Transportation;
f.
Short-term financial assistance, such as for utilities or rent;
g. Therapeutic evaluations; and
h.
Other similar limited or nonrecurring services necessary for an individual to
live as safely and independently
as possible in their community.
(i) “Bureau” means the bureau of
developmental services of the department of health and human services.
(j) “Bureau
administrator” means the chief administrator of the bureau of developmental
services.
(k) “Commissioner” means the commissioner of the department of health and human services
or their designee.
(l) “Comprehensive risk assessment”
means an evaluation administered pursuant to He-M 522.10 (m)(11) using
evidence-based tools to evaluate an individual’s behaviors and determine the
potential risks to the individual or others posed by said behaviors.
(m) “Days” means calendar days unless otherwise specified.
(n) “Department”
means the New Hampshire department of health and human services.
(o) “Developmental disability” means “developmental disability” as defined in
RSA 171-A:2, V, namely, a disability:
(1)
“Which is attributable to an intellectual disability, cerebral palsy, epilepsy,
autism, or a specific learning disability, or any other condition of an
individual found to be closely related to an intellectual disability as it refers to general
intellectual functioning or impairment in adaptive behavior or requires
treatment similar to that required for persons with an intellectual
disability”; and
(2)
“Which originates before such individual attains age 22, has continued or can
be expected to continue indefinitely,
and constitutes a severe disability to such individual’s ability to function
normally in society.”
(p) “Guardian” means a person
appointed pursuant to RSA 463 or RSA 464-A, or the parent of an individual
under the age of 18 whose parental rights have not been terminated
or limited by law.
(q) “Health Risk Screening Tool
(HRST)” means the 2015 edition of the Health Risk Screening Tool, available as
noted in Appendix A, which is a web-based rating instrument used for performing
health risk screenings on individuals in order to:
(1) Determine an individual’s
vulnerability regarding potential health risks; and
(2)
Enable the early identification
of health issues and monitoring of health needs.
(r) “Home and community-based waiver
services (waiver services)” means the services defined and funded pursuant to New Hampshire’s agreement with the federal government,
known as the Acquired Brain Disorder Waiver, pursuant to the authority of
section 1915(c) of the Social Security Act, which allows the federal funding of
long-term care services in non-institutional settings for persons who have an
acquired brain disorder.
(s) “Individual”
means a person with an acquired brain disorder.
(t) "Informed
consent" means a decision made voluntarily by an individual or
applicant for services or, where appropriate,
such person's legal guardian or representative, after all relevant information
necessary to making the choice has been provided, when the person understands
that they are free to choose or refuse any available alternative, when the
person clearly indicates or expresses their choice, and when the choice is free
from all coercion.
(u) “Intellectual disability” means
“intellectual disability” as defined in RSA 171-A:2, XI-a, namely,
“significantly subaverage general intellectual functioning existing
concurrently with deficits in adaptive behavior, and manifested during the
developmental period. A person with an intellectual disability may be
considered mentally ill provided that no person with an intellectual disability
shall be considered mentally ill solely by virtue of his or her intellectual
disability.”
(v) “Participant
directed and managed services” means a method of service delivery provided
pursuant to He-M 525.
(w) “Person-centered service planning”
is an individual-directed, positive approach to the planning and coordination
of a person’s services and other supports based on the individual’s
aspirations, needs, preferences, and goals.
(x) “Personal profile” means a
narrative description that includes a personal statement from the individual
and those who know them best that summarizes the individual’s strengths and
capacities, communication and learning style, challenges, needs, interests, and
any health concerns, as well as the individual’s hopes and dreams.
(y) “Provider”
means a person receiving any form of remuneration for the provision of services
to an individual.
(z) “Provider agency” means an agency
or an independent provider that is established to provide services to
individuals and meets the criteria in He-M 504.
(aa) “Representative” means:
(1)
The parent or guardian of an
individual under the age of 18;
(2)
The guardian of an individual 18
or over; or
(3) A person who has power of attorney for
the individual.
(ab) “Service” means any paid
assistance to the individual in meeting their own needs provided through the
developmental services system.
(ac) “Service agreement” means a
written agreement between the individual, guardian, or representative and
provider agencies, developed pursuant to He-M 522, that is prepared as a result
of the person-centered service planning process and that describes the services
that an individual will receive and constitutes an individual service agreement
as defined in RSA 171-A:2, X.
(ad) “Service coordination agency”
means a provider agency providing service coordination services to individuals,
that meets the criteria in He-M 504.
(ae) “Service
coordinator” means a provider who meets the criteria in He-M 522.09(b)-(d)
and is chosen by an individual and their guardian or representative to
organize, facilitate, and document service planning and to negotiate and
monitor the provision of the individual’s services.
(af) “Service planning meeting” means
a gathering of 2 or more people, one of whom is the individual who receives services unless they choose not to attend, held to develop, review,
add to, delete from, or otherwise change a service agreement.
(ag) “State of
residence” means the “state of residence” as defined in 42 CFR 435.403.
(ah) “Supported
decision-making” means “supported decision-making” as defined in RSA 464-D:4,
VI.
(ai) “Supports intensity scale adult
version ® (SIS-A ®)” means the 2023 edition of the Supports Intensity Scale,
available as noted in Appendix A, which is an assessment tool intended to
assist in service planning by measuring the individual’s
support needs in the areas of home living, community living, lifelong learning,
employment, health and safety, social activities, protection, and advocacy. The
tool uses a formal rating scale to identify the type of supports needed,
frequency of supports needed, and daily support time.
(aj) “Termination” means the cessation
of a service by an area agency director with or without the informed consent of the individual or their guardian or representative.
(ak) “Withdrawal”
means the choice of an individual or their guardian or representative to
discontinue that individual’s participation in a service.
Source. #7120, eff 10-20-99; ss by #8974, INTERIM,
eff 10-6-07, EXPIRED: 4-3-08
New. #9734, eff 6-25-10; ss by #12683, eff
11-30-18; ss by #14253, eff 5-22-25, EXPIRES: 5-22-35
He-M 522.03 Eligibility for
Services.
(a) As referenced in He-M 522.02(a)
and (ag), any person whose state of residence is New Hampshire and who
has an acquired brain disorder shall be eligible
for service coordination and community support.
(b) Individuals described
in (a) above shall also be eligible for waiver services if they meet the
requirements of He-M 517.03(a).
(c) Any applicant for
services whose suspected acquired brain disorder occurred prior
to age 22 shall be evaluated pursuant to He-M 503.05 to
determine whether they have a brain injury that meets the criteria for
developmental disability. If the applicant has
a developmental disability, they shall be provided services pursuant
to He-M 503.09 and He-M 503.10. If the applicant is determined not to
have a developmental disability, they shall be evaluated
for eligibility pursuant to He-M 522.05.
(d) Eligibility
for services shall be reviewed pursuant to He-M 522.07.
Source. #7120, eff 10-20-99; ss by #8974, INTERIM,
eff 10-6-07, EXPIRED: 4-3-08
New. #9734, eff 6-25-10; ss by #12683, eff
11-30-18; ss by #14253, eff 5-22-25, EXPIRES: 5-22-35
He-M 522.04 Application
for Services.
(a) Application
for services shall be made by:
(1)
The applicant;
(2) A guardian of an applicant under the age
of 18;
(3) A
guardian of an applicant age 18 or over if a guardian of the person has been
appointed by the probate court pursuant to RSA 464-A; or
(4) A representative of the applicant
authorized to make such application.
(b) An application
for services shall be made in writing to the area agency in
the applicant’s region of residence.
(c) An area
agency shall explain the eligibility process and offer assistance to the
applicant, guardian, or representative in making application for services.
(d) The area agency shall inform the
applicant, guardian, or representative of its roles and responsibilities and
provide information about:
(1)
The types of evaluations,
assessments, and screenings needed to assist in the development of the service
agreement;
(2)
Eligibility determination;
(3)
Service coordination;
(4)
Service agreement development
and review;
(5)
Services provided by the area agency and the assistance available to identify
the services that are required;
(6)
Service provision;
(7)
Service monitoring; and
(8)
Advocacy supports.
(e) To aid in the provision of
comprehensive, efficient, and coordinated services, the area agency shall
undertake a review of the public and private benefits and resources that are
available to the applicant and inform the applicant of all such benefits and
resources.
(f) An area agency shall request each
applicant to authorize the release of information to permit the area agency to access relevant current and historical records and information
for the determination of eligibility pursuant to He-M 522.03 regarding
the applicant’s:
(1) Acquired brain disorder;
(2)
Personal, family, social,
educational, neuropsychological, medical, and
rehabilitation status; and
(3) Functional abilities, interests, and
aptitudes.
(g) Authorization to release information shall specify:
(1)
The name of the applicant and
the information to be released;
(2)
The name of the person or organization being authorized to release the
information;
(3)
The name of the person or
organization to whom the information is to be released; and
(4) The time period for which the authorization is given, which
shall not exceed one year.
Source. #7120, eff 10-20-99; ss by #8974, INTERIM,
eff 10-6-07, EXPIRED: 4-3-08
New. #9734, eff 6-25-10; ss by #12683, eff
11-30-18; ss by #14253, eff 5-22-25, EXPIRES: 5-22-35
He-M 522.05 Determination of Eligibility as a Person with an
Acquired Brain Disorder.
(a) To determine
the existence of an applicant’s acquired brain disorder, the area agency shall
perform a comprehensive screening evaluation consisting of:
(1) Reviewing
available information, including, but not limited to:
a. Current physical, intellectual,
cognitive, and behavioral evaluations;
b. An
age-appropriate standardized functional assessment; and
c. As
applicable, additional specialty medical, health, or clinical evaluations, such
as communication, functional behavior, psychological, or psychopharmacological
assessments, assistive technology, and personal safety or comprehensive risk
assessments; and
(2) Gathering additional information and
preforming the additional evaluations among those listed in (1) above that are necessary to complete the
determination, if the information available is not adequate to make a
determination of eligibility.
(b) The results of the comprehensive
screening evaluation pursuant to (a) above and any other information concerning
the applicant’s disability shall be the basis for determination of eligibility
pursuant to He-M 522.03(a) and assist in the identification of needs and
provision of services.
(c) To the extent possible, the area
agency shall utilize generic resources to pay for an applicant’s comprehensive
screening evaluation. Such resources shall, with the applicant’s consent,
include private and public insurance.
(d) An area agency shall review
the information it has received regarding an applicant and, within 15 business days after the receipt of the completed application, make and
communicate one of the following decisions on the eligibility of the applicant
in accordance with He-M 522.03(a) to the applicant, guardian, or
representative:
(1) Eligible; or
(2) Ineligible.
(e)
If an area agency determines additional information is necessary in order to
make a determination in accordance with (d) above, a communication detailing the additional information
necessary shall be provided to the applicant, guardian, or representative, and
the application shall not be determined complete until all necessary
information has been received by the area agency.
(f) In cases
where the information on eligibility is inconclusive, the area agency may
consult with the bureau regarding determination of eligibility prior to making
a decision in accordance with (d) above.
(g) Decisions
by the bureau in (f) above shall be made within 5 business days.
(h) In instances
where consultations in (f) above would cause the area agency’s decision
pursuant to (d) above to exceed 15 business days, an additional 7 business days
shall be allowed to make such decisions.
(i) A written denial of eligibility
pursuant to (d)(2) above shall describe the specific legal and factual basis
for the denial, including specific citation of the applicable law or department
rule, and advise the applicant of their right to appeal pursuant to He-M
522.17.
(j) Following a denial of eligibility,
the applicant, guardian, or representative, as applicable, may reapply for
services if new information regarding the diagnosis, age of onset, or severity
of the disability or functional impairment related to the acquired brain
disorder becomes available.
(k) Communication of approval of
eligibility in accordance with (d)(1) above shall include a contact person at
the area agency.
(l) Preliminary planning to determine
the services needed shall occur with the individual and guardian or
representative at the time of intake or during subsequent discussions.
Preliminary evaluations shall be completed and preliminary recommendations for
services shall be made within 21 days of a completed application for service.
(m)
Within 3 days of the determination of the applicant’s eligibility
under He-M 522.05(d)(1), the area agency shall review 1915(c) of the Social
Security Act, waiver services, with the applicant, guardian, or representative
in order to make a decision.
(n) If the individual, guardian, or
representative is interested in pursuing waiver services within the next 12
months, within 5 business days of the individual’s decision pursuant to
(m) above, the area agency shall submit an application for waiver level of care
eligibility pursuant to He-M 517.03 to the bureau.
(o) In an emergency situation,
temporary service arrangements may be made prior to the completion of the
evaluation in (a) above if the bureau administrator, or designee, first
determines that the individual meets one of the following:
(1) Is
a victim of abuse or neglect pursuant to He-E 700;
(2) Is abandoned and homeless;
(3) Is
without a caregiver due to death
or incapacitation;
(4) Is
at significant risk of physical
or psychological harm due to decline in their medical or behavioral status; or
(5) Is
presenting a significant risk to
community safety.
(p) The determination of eligibility
pursuant to He-M 522.03(a) by one area agency shall be accepted by every other area agency in the state.
Source. #7120, eff 10-20-99; ss by #8974, INTERIM,
eff 10-6-07, EXPIRED: 4-3-08
New. #9734, eff 6-25-10; ss by #12683, eff
11-30-18; ss by #14253, eff 5-22-25, EXPIRES: 5-22-35
He-M 522.06 Determination
of Eligibility for Medicaid Home and Community-Based Waiver Services.
(a) For those
persons found eligible under He-M 522.03(a), and who wish to pursue waiver
services within the next 12 months, the bureau shall review the application
submitted pursuant to He-M 522.05(n) and make a decision within 15 business
days of receipt of the application.
(b) Within 3 days of the decision, the
bureau shall communicate the decision to the area agency and the individual,
guardian, or representative in writing.
(c)
If there is not sufficient information to determine the individual’s level of
care, a request for additional information shall be sent by the bureau to the submitting entity to allow an additional 10
days to provide information sufficient to determine level of care.
(d)
If information to determine is not provided, the bureau shall deny the level of
care application. However, if new information becomes available after such
denial, a new application may be submitted.
(e)
If the bureau determines the individual is not eligible for services in He-M
517, the notice shall include the specific legal and factual basis for the determination, including a specific citation
to the applicable law or department rule, and the bureau shall advise the
individual, guardian, or representative in writing of their right to appeal
pursuant to He-M 517.12.
Source. #7120, eff 10-20-99; ss by #8974, INTERIM,
eff
10-6-07, EXPIRED: 4-3-08
New. #9734, eff 6-25-10; ss by #12683, eff
11-30-18; ss by #14253, eff 5-22-25, EXPIRES: 5-22-35
He-M 522.07 Periodic Review of
Eligibility.
(a) If there is reason to believe that
the individual’s level of cognitive functioning or adaptive behavior has
changed and the individual no longer has an acquired brain disorder as defined
in He-M 522.02(a), or a need for services pursuant to He-M 517.03(a)(3)b., the
area agency shall notify the individual receiving services and the
representative or guardian if the individual has one, and arrange for a
reassessment of eligibility.
(b) In the event of a review pursuant
to (a) above, the individual, representative, or guardian shall have the right
to submit additional evaluations, letters, or other information regarding
continued eligibility which shall be considered by the area agency or bureau
prior to issuing a decision.
(c) If the results of the above
reassessment demonstrate that the individual no longer meets the criteria for
eligibility in He-M 522.03(a) the area agency shall inform the individual and
representative or guardian in writing of the determination and phase out the
relevant services over the 12 months following the date of notice. The phase
plan shall be outlined through a service agreement.
(d) In each instance where the
reassessment leads to a denial of eligibility, the area agency shall, in
writing:
(1)
Inform the applicant, guardian,
or representative of the determination;
(2) Describe the specific legal and
factual basis for the denial, including specific citation of the applicable law
or department rule; and
(3) Advise the applicant, representative,
or guardian of their right to appeal pursuant to He-M 522.17.
(e) An applicant, guardian, or
representative may appeal a denial of eligibility based on the reassessment
pursuant to He-M 522.17 and He-C 200.
Source. #7120, eff 10-20-99; ss by #8974, INTERIM,
eff
10-6-07, EXPIRED: 4-3-08
New. #9734, eff 6-25-10 (from He-M 522.06); ss by
#12683, eff 11-30-18; ss by #14253, eff 5-22-25, EXPIRES: 5-22-35
He-M 522.08 Service Guarantees.
(a) All services shall:
(1) Be
voluntary;
(2) Be
provided only after the informed consent of the individual, guardian, or
representative;
(3)
Comply with the rights of the individual established under He-M 310 and federal
laws and rules; and
(4)
Maximize as much as possible the individual’s ability to determine and direct
the services they will receive in accordance with federal and state laws and
rules.
(b) All services shall be designed to:
(1)
Promote the individual’s personal development and quality of life in a manner
that is determined by the individual;
(2)
Meet the individual’s needs in life skills to promote independent living:
a.
Including educational activities with the purpose of assisting the individual
in attaining or enhancing community living skills or adaptive skill development
to assist the individual in residing in the most appropriate setting for their
needs; and
b. Not
including post-secondary
education regardless of whether it leads to a degree or private tutoring;
(3)
Promote the individual’s health and safety within the bounds of reasonable
risk;
(4)
Protect the individual’s right to freedom from abuse, neglect, and
exploitation;
(5)
Increase the individual’s participation in a variety of integrated activities
and settings;
(6)
Provide opportunities for the individual to exercise personal choice,
independence, and autonomy within the bounds of reasonable risks;
(7)
Enhance the individual’s ability to perform personally meaningful or functional
activities;
(8)
Assist the individual to acquire and maintain life skills, such as, managing a
personal budget, participating in meal preparation, or traveling safely in the
community, including accessing community transportation;
(9) Be
provided in such a way that the individual is seen as a valued, contributing
member of their community; and
(10) Meet the individual’s needs in accordance with He-M
522.10(m).
(c) The environment
or setting in which an individual receives services shall be the least
restrictive, most integrated setting that promotes that individual’s:
(1)
Freedom of movement;
(2)
Ability to make informed decisions;
(3)
Self-determination;
(4)
Participation in the community in accordance with 42 CFR 441.301; and
(5)
Rights in accordance with He-M 310.
(d) An individual, guardian, or
representative may select any available provider that is qualified pursuant to
He-M 504, to deliver one or more of the services identified in the individual’s
service agreement.
(e) All
provider agencies and providers shall comply with the rules and terms of the
waiver when applicable, pertaining to the service(s) offered and meet the
provisions specified within the individual’s service agreement.
(f) The area agency shall notify each
individual, annually, that they have a right to choose their service
coordinator in accordance with He-M 522.09(a).
(g) An area
agency shall monitor timeliness of the completion of
annual service agreements by the service coordinator for all
individuals, with the exception of those individuals or families who request
only information and referral.
(h) Area agencies and provider agencies shall inform individuals and
applicants of their rights under these rules in clearly understandable language
and form.
(i) For individuals
who require a positive behavior support plan, emergency physical restraint
shall only be approved for safely responding to situations in which the
individual presents with imminent credible risk of significant harm to self or
others by providers who are trained and certified in recognized intervention
modalities.
Source. #7120, eff 10-20-99; ss by #8974, INTERIM,
eff
10-6-07, EXPIRED: 4-3-08
New. #9734, eff 6-25-10 (from He-M 522.07); ss by
#12683, eff 11-30-18 (formerly He-M 522.09); ss by #14253, eff 5-22-25,
EXPIRES: 5-22-35
He-M 522.09 Service Coordination.
(a) The service coordinator shall be a
person chosen by the individual, guardian, or representative who meets the criteria in He-M 504, He-M 506, and He-M 522.09(b)-(d) below.
(b) For those
individuals not eligible for waiver services pursuant to He-M 517, the service
coordinator shall:
(1)
Hold a person-centered service planning session to identify service needs and
goals and appropriate community resources;
(2)
Make appropriate referrals to community agencies; and
(3)
Advocate on behalf of the individual for services to be provided in accordance
with He-M 522.
(c) For those
individuals eligible for waiver services pursuant to He-M
517.03, the service coordinator shall:
(1)
Advocate on behalf of individuals for services to be provided in accordance
with the service guarantees in He-M 522.08(b);
(2)
Coordinate the service planning process in accordance with He-M 522.08,
He-M 522.10, and He-M 522.11;
(3)
Describe to the individual, guardian, or representative service delivery
options including participant directed and managed services;
(4)
Monitor and document services provided to the individual in accordance with
He-M 522.11 below and He-M 517 for waiver services;
(5)
Ensure continuity and quality of services provided in the amount, scope,
frequency, and duration as outlined in the service agreement;
(6)
Monitor and document quality of services provided in accordance with He-M
522.11 below and He-M 517 for waiver services;
(7)
Provide crisis and critical incident coordination and planning;
(8)
Ensure that service documentation is maintained pursuant to He-M 522.11(c)
and (i)(2)-(3) and He-M 517 for waiver services;
(9)
Determine and implement necessary action and document resolution when goals are
not being addressed, support services are not being provided in accordance with
the service agreement, or health or safety issues have arisen;
(10)
Convene person-centered service planning meetings at least annually and
whenever:
a. The
individual, guardian, or
representative is not satisfied with the services received;
b.
There is no progress on the goals after follow-up interventions;
c. The
individual’s needs change;
d.
There is a need for a new provider agency; or
e. The
individual, guardian, or
representative requests a meeting;
(11)
Document service coordination visits and contacts pursuant to
He-M 522.10(u) and He-M 522.11(i)(2)-(4);
(12) No less than 45 days in advance of the annual
person-centered service planning meeting:
a.
Ensure that all needed evaluations, screenings, or assessments, such as the
SIS-A ®, HRST, assistive
technology evaluation, comprehensive risk assessments, positive behavior plans,
and other clinical or health evaluations are updated and, if necessary,
performed and that information from said evaluations, screenings, and
assessments is discussed and shared with the individual, guardian, or
representative;
b.
Identify risk factors and plans to minimize them;
c.
Assess the individual’s interest in, or satisfaction with, employment; and
d.
Discuss and assess the
individual’s progress on goals and preparing for the development of new goals
to be included in the new service agreement;
(13)
Assist the individual, guardian, or representative to maintain the individual’s
public benefits; and
(14)
Participate in risk management activities by:
a. Making referrals to the applicable area agency’s local risk management
committee for individuals exhibiting behaviors including but not limited to violent aggression,
problematic sexual behaviors, or fire-setting behaviors for evaluations or
planning activities initially and ongoing;
b.
Participating in and presenting to committees and other groups related to risk
management including, but not limited to, local human rights committees,
statewide and local risk management committees, and community of practice to
determine application of assessment recommendations received;
c. Attending risk management training
activities; and
d. Attending clinically specialized
trainings, based on assessed needs of the individuals supported, that enable
successful completion of and participation in risk management activities.
(d) A service coordinator shall not:
(1) Be
a guardian or representative of the individual whose services they are
coordinating; or
(2)
Have a conflict of interest concerning the individual, such as providing, or
being employed by the provider agency that also provides other direct services
to the individual, except in accordance with He-M 522.10(e) and (f) below.
(e) A
provider agency that provides direct services to the individual and seeks to
also provide service coordination, shall be determined the only willing and
qualified service coordination agency and permitted to provide service
coordination services and direct services if the following criteria are met:
(1) There is a lack of another qualified service coordination agency willing to
provide services to the individual as outlines in their service agreement;
(2) The individual, guardian, or representative agrees that the
same agency shall provide both service coordination services and direct
services;
(3) The agency ensures that service coordination services and direct services are
located in different departments and different physical locations within the
organization, and report to separate and equal organizational leadership; and
(4) The direct services department shall not develop
or have any influence on developing the individual’s service agreement.
(f) A
provider agency requesting determination to serve as the only willing and
qualified service coordination agency in accordance with (e) above shall complete and submit the form entitled
“NH Bureau of Developmental Services Exemption Request” (May 2025) along with
the following documentation:
(1) Documentation that the criteria outlined in He-M 522.09(e)(1)-(4) above has been met;
(2) Such agency’s plan to develop or recruit service
coordination agencies;
(3) Documentation of service coordinator orientation
and training that outlines the role of the service coordinator as a neutral facilitator and how to offer
choice to individuals;
(4) Documentation of how such agency ensures all
individuals, guardians, and representatives have accurate and accessible information relative to service providers;
and
(5) Documentation to demonstrate how such agency monitors that choice is given to
individuals, guardians, and representatives.
(g)
Upon review of the form and documentation submitted pursuant to (f) above, the
bureau shall approve such a request if all the requirements are met.
(h) The approval of being the only
willing and qualified service coordination agency shall be for one year.
(i) After approval of an initial exemption
request, the agency in (f) above shall resubmit to the department a “NH Bureau
of Developmental Services Exemption Request” form (December 2023) annually.
(j)
The documentation required in (f)(1)-(5) shall only be required with the
initial request.
(k) Subsequent requests shall not require the
described documentation provided that the only willing and qualified service
coordination agency certifies that there have been no changes to the original
documentation submitted.
(l)
Once an only willing and qualified service coordination agency request has been
approved in accordance with (g) or (k) above, the bureau
shall conduct ongoing quarterly monitoring regarding the criteria in (e)(1)
above.
Source. #7120, eff 10-20-99; ss by #8974, INTERIM,
eff
10-6-07, EXPIRED: 4-3-08
New. #9734, eff 6-25-10 (from He-M 522.08); ss by
#12683, eff 11-30-18 (formerly He-M 522.10); ); ss by #14253, eff 5-22-25,
EXPIRES: 5-22-35
H-M 522.10 Service
Planning.
(a) Preliminary
planning for services shall be done in accordance with He-M 522.05(l).
(b) Within 15
days of an individual’s eligibility pursuant to He-M 522.05(d)(1), or level of
care approval pursuant to He-M 522.06(a) for those for whom an application for
waiver services has been submitted pursuant to He-M 522.05(n), the area agency
shall assist the individual, guardian, or representative with resources to
select a service coordinator.
(c) In instances when an individual has been
determined eligible pursuant to He-M 522.05(d)(1), and declines services
available pursuant to He-M 522.03(a) and waiver services, the area agency shall
assign a service coordinator within 30 days.
(d) In instances when a service
coordinator has been assigned pursuant to (c) above, the service coordinator
shall, at minimum, contact the individual annually to discuss ongoing needs and
determine if service planning is desired.
(e) The service coordinator shall hold
an initial person-centered service planning meeting to determine the
individual’s goals and service needs in meeting those goals with the
individual, the individual’s guardian or representative, and any other person
chosen by the individual within 15 business days of the acceptance by a service
coordination agency.
(f) The service coordinator shall document
that they have maximized the extent to which an individual participates in and
directs their person-centered service planning process by:
(1) Explaining to
the individual the person-centered service planning process and providing the
information and support necessary to ensure that the individual directs the
process to the maximum extent possible;
(2) Explaining to the individual their rights and
responsibilities pursuant to He-M 310;
(3) Eliciting
information from the individual regarding their goals, personal preferences,
and service needs, including any health concerns, that shall be a focus of
person-centered service planning meetings;
(4) Determining
with the individual issues to be discussed during all person-centered service
planning meetings; and
(5) Explaining to
the individual the limits of the decision-making authority of the guardian or
representative, if applicable, and the individual’s right to make all other
decisions related to services.
(g) The person-centered service
planning process shall include a discussion regarding whether or not there is a
need for a limited or full guardianship, conservatorship, representative payee
for social security benefits, durable power of attorney, durable power of
attorney for healthcare, supported-decision making, or other less restrictive
alternatives to guardianship. The discussion and any recommendations from the
team shall be incorporated into the service agreement.
(h) Service
coordinators shall facilitate service planning to develop service agreements in
accordance with He-M 522.11. Service agreements shall be prepared initially
according to the timeframe specified in He-M 522.11(c) and annually thereafter,
as required by He-M 522.09(c)(10).
(i) The individual, guardian, or
representative may determine the following elements of the person-centered
service planning process:
(1) The number and
length of meetings;
(2) The location,
date, and time of meetings;
(3) The meeting
participants; and
(4) Topics to be
discussed.
(j) Copies of relevant evaluations and
reports shall be sent to the individual and guardian or representative at least
5 business days before person-centered service planning meetings.
(k) If people who provide services to
the individual are not selected by the individual to participate in a
person-centered service planning meeting, and the individual determines that
the provider would have information beneficial to
service planning, the service coordinator shall contact such persons prior to
the meeting so that their input can be considered.
(l) The service coordinator shall
contact all persons who have been identified to provide a service to the
individual and confirm arrangements for providing such services.
(m) All
service planning shall occur through a person-centered service planning process
that:
(1)
Maximizes the decision-making of the individual;
(2) Is
directed by the individual or the individual’s guardian or
representative, if applicable;
(3)
Facilitates personal choice by providing information and support to assist the
individual to direct the process, including information describing:
a. The
array of services and provider agencies available; and
b.
Options regarding self-direction of services;
(4)
Includes participants freely chosen by the individual;
(5) Reflects cultural considerations of the individual and is conducted
in clearly understandable language and form;
(6)
Occurs at a time and location of convenience to the individual,
guardian, or representative;
(7)
Includes strategies for solving conflict or disagreement within the process,
including clear conflict of interest guidelines for all planning participants;
(8) Is
consistent with an individual’s rights to privacy, dignity, respect,
and freedom from coercion and restraint;
(9)
Includes the process for the individual, guardian, or representative to
request amendments to the service agreement;
(10)
Records the alternative home and community-based settings that were considered
by the individual, guardian, or representative;
(11) Includes information related to risk by:
a.
Incorporating information obtained through a comprehensive risk assessment,
which shall be administered:
1. Initially, at the beginning of service
planning, or as needed to each individual with a history of, or exhibiting
signs of, behaviors that pose a potentially serious likelihood of danger to
self or others, or a serious threat of substantial damage to real property,
such as, but not limited to, the following:
(i) Problematic sexual behavior;
(ii) Violent aggression;
(iii) Fire-setting behaviors; or
(iv) Other similar violent or dangerous behaviors or events;
2. Prior to any
significant change in the level of the individual’s treatment or supervision;
3. At any time an
individual who previously has not had a comprehensive risk assessment begins to
engage in behaviors referenced in 1. above; and
4. By an evaluator with specialized experience, training, and
expertise in the treatment of the types of behaviors referenced in a.1. above;
b. Ensuring that plans created pursuant to He-M 505 are reviewed with
evaluators to consider ongoing appropriateness and opportunities for modification of restrictions following
initiation of risk management related strategies. Such considerations may be
made through reassessment or through a consultative review of other
documentation and updated data related to the individual’s progress;
c. Ensuring documentation of activities and progress in treatment
relative to management of risk for an individual to help inform development of person-centered service
plans;
d. Making referrals for individuals associated with high-risk
incidents to participate in evaluations or planning activities initially and
ongoing;
e. Processing and analyzing incidents related to violent aggression,
problematic sexual behavior, or
fire-setting behaviors; and
f. Making referrals for individuals associated with high-risk
incidents to evaluations or planning activities initially and ongoing;
(12)
Includes information from specialty medical and health assessments and clinical
assessments as needed, including, at a minimum, communication, assistive technology, and
functional behavior assessments, as applicable;
(13)
Includes strategies to address co-occurring severe mental illness or behavioral
challenges which are interfering with the individual’s functioning, including positive
behavior plans or other strategies based on functional behavior or other
evaluations or referrals to behavioral health services;
(14) Provides the individual with information regarding the
services and provider agencies available to enable the individual to make
informed decisions as to whom they would like to provide services;
(15) Includes individualized backup plans and strategies;
(16) Includes strategies for solving disagreements;
(17)
Uses a strengths-based approach to identify the positive attributes of the
individual;
(18) Includes the provision of auxiliary aids and services when needed
for effective communication, including low literacy materials and interpreters;
(19) Addresses the individual’s concerns about current or contemplated
guardianship or other legal assignment of rights;
(20)
Explores housing and employment in integrated settings, and develops plans
consistent with the individual’s goals and preferences;
(21)
Includes a review of the past year that:
a.
Includes the individual’s:
1. Personal
achievements;
2. Relationships;
3. Degree of community involvement;
4. Challenging
issues or behavior;
5. Health status
and any changes in health; and
6. Safety considerations
during the year;
b. Addresses
the previous year’s goals with level of success and, if applicable, identifies any
obstacles encountered;
c. Identifies
the individual’s personal goals and the supports that will aid in achieving
their goals;
d. Identifies
the type and amount of services the individual receives and the support
services provided under each service category;
e. Identifies
the individual’s health needs;
f. Identifies
the individual’s safety needs;
g. Identifies
any follow-up action needed on concerns and the persons responsible for the
follow-up; and
h. Includes
a statement of the individual’s and guardian or representative’s satisfaction
with services;
(22) Includes the individual’s paid employment and volunteer positions,
as applicable;
(23) Considers historical information about the individual’s experiences;
and
(24)
Includes a discussion of the need for assistive technology that could be
utilized to support all services and activities
identified in the proposed service agreement without regard to the individual’s
current use of assistive technology.
(n) The information outlined in
(m)(1)-(24) above shall be entered into the service agreement outlined in He-M
522.11 when the individual, guardian, representative, or planning team
determine that such information is necessary for
successful participation in the services and supports outlined in the service
agreement.
(o) All planning for waiver services
shall include information from the following assessments:
(1)
The American Association on Intellectual and Developmental
Disabilities’, “SIS-A ®”, (2023 edition), available as noted in Appendix A,
which shall be administered:
a.
Initially, within 60 days of the determination of eligibility for waiver
services pursuant to He-M 522.06(a) for each individual;
b.
Upon a significant change as defined under SIS-A ® protocols;
c.
Five years following each prior administration; and
d. To
individuals who have moved to New Hampshire and are requesting waiver services
in the next 12 months. If the individual previously had a SIS-A ® completed in
another state within the last 5 years, however, then they may provide the
out-of-state SIS-A ® results in place of taking a new SIS-A ®;
(2) Information obtained through the HRST (2015 edition), available as
noted in Appendix A, which shall be administered:
a.
Initially, upon determination of eligibility for waiver services pursuant to
He-M 522.06(a) for each individual; and
b.
Annually or upon significant change in an individual’s status; and
(3)
For residential services, includes information from personal safety
assessments pursuant to He-M 1001.
(p) In order to develop or revise a
service agreement to the satisfaction of the individual, guardian, or
representative, the person-centered service planning process shall consist of
periodic and ongoing discussions regarding elements identified in He-M
522.08(b) that shall:
(1) Include the individual and other persons involved in their life;
(2)
Are facilitated by a service coordinator; and
(3)
Are focused on the individual’s abilities, health, interests, and
achievements.
(q) Service
agreements shall be reviewed by the service coordinator with the individual,
guardian, or representative at least once during the first 6 months of service
and as needed. The annual review required by He-M 522.09(c)(10) shall
include a service planning meeting.
(r) The reviews required in (q) above shall include, at a minimum,
the following:
(1) A thorough clinical examination including an annual health
assessment;
(2) An
assessment of the individual’s capacity to make informed decisions;
and
(3) Consideration of less restrictive alternatives for service.
(s) The individual, guardian, or
representative may request, in writing, a delay in an initial or annual service
agreement planning meeting. The area agency and provider agencies
shall honor this request.
(t) In the event an individual,
guardian, or representative requests an extension of the service agreement
meeting, the extension shall be documented and not exceed 60 days after
the expiration of the current service agreement.
(u) The service coordinator shall be
responsible for monitoring services identified in the service agreement
pursuant to He-M 522.11 and for assessing individual, guardian, or
representative satisfaction at least annually for non-waiver services and quarterly
for waiver services.
(v) If an
individual has a residency agreement and there is notification of intended
termination, the service coordinator shall convene a person-centered service
planning meeting as follows:
(1)
Within 10 days of receipt of notification of the intended termination; or
(2)
Within 24 hours of receipt of the notification if the intended termination is
within 72 hours due to the threat of serious bodily injury by or to the
resident.
(w) An area agency, service
coordinator, provider agency, provider, individual, guardian, or representative
shall have the authority to request a person-centered service
planning meeting at any time.
(x) Service
agreement amendments may be proposed at any time.
(y) If the individual, guardian,
representative, or provider agency disapproves of the service agreement, or a
service agreement amendment, the dispute shall be resolved:
(1) Through informal discussions between the individual, guardian, or
representative and service coordinator;
(2) By
reconvening a service planning meeting; or
(3) By
the individual, guardian, or representative filing an appeal to the department
pursuant to He-C 200.
Source. #7120, eff 10-20-99; ss by #8974, INTERIM,
eff
10-6-07, EXPIRED: 4-3-08
New. #9734, eff 6-25-10 (from He-M 522.09); ss by
#12683, eff 11-30-18 (formerly He-M 522.11); ss by #14253, eff 5-22-25,
EXPIRES: 5-22-35
He-M 522.11 Service
Agreements.
(a) The service coordinator shall
create service agreements for all individuals in accordance with (b)-(j) below.
(b) All
service agreements shall:
(1) Be
understandable to the individual, guardian, or representative and all provider
agencies and providers responsible for service provision;
(2) Be written in plain language and in a manner
accessible and understandable to individuals with disabilities and persons who
have limited proficiency in English;
(3) Be
finalized and agreed to in writing by the individual, guardian, or
representative and signed by all provider agencies responsible for the
implementation of the service agreement;
(4) Be
entered into the electronic platform, IntellectAbility, at https://nhbds.hrstapp.com/ and
then NHEasy at https://nheasy.nh.gov/#/ when
IntellectAbility sunsets; and
(5) Be
distributed to the individual, guardian, or representative, area agency, and
all provider agencies and providers who are responsible for the implementation
or monitoring of the service agreement.
(c) Within 14 days of the initial
person-centered service planning meeting pursuant to He-M 522.10(e), the
service coordinator shall develop a service agreement, that includes, but is
not limited to, the following:
(1) A
statement of the nature of the specific strengths, interests, capacities,
disabilities, and specific needs of the individual;
(2) A
description of intermediate and long-range habilitation and treatment goals
chosen by the individual and their guardian or representative with a projected
timetable for their attainment;
(3) A
statement of specific waiver services to be provided and the amount, scope,
frequency, and duration of each service;
(4)
Specification of the provider agencies to furnish each service identified in
the service agreement;
(5)
Criteria for transfer to less restrictive settings for habilitation, including
criteria for termination of service and a projected date for termination of
service;
(6)
Demographic information;
(7) A
personal profile;
(8)
The specific services to be furnished based on the support needs identified in
(1) above and how the services selected will support the individual’s goals;
(9)
Guardianship, supported decision making, and representative payee information;
(10)
Service documentation requirements sufficient to track outcomes;
(11)
Identification of the persons and entities responsible for monitoring the
services in the service agreement;
(12)
Documentation that all settings where the individual receives services meet the
criteria of 42 CFR 441.301, are chosen by the individual, guardian, or
representative, and support full access to the greater community, including
opportunities to seek employment and work in competitive integrated settings,
engage in community life, control personal resources, and receive services in
the community to the same degree of access as people not receiving services;
(13)
Documentation that the setting is selected by the individual from among setting
options, including non-disability specific settings and an option for a private
unit in a residential setting, and that the settings options are identified and
based on the individual’s needs, and preferences;
(14)
Documentation that any restriction on the right of an individual is justified
by:
a. An
identified specific and individualized need that the modification is based on;
b. The
positive interventions and supports used prior to any modifications to the
individual’s rights;
c. The
less intrusive methods of meeting the need that were tried but did not work;
d. A
clear description of the condition that is directly proportionate to the
specific assessed need;
e. The
regular collection and review of data to measure the ongoing effectiveness of
the modification;
f.
Established time limits for periodic reviews of the necessity of the
modification;
g. The
informed consent of the individual, guardian, or representative; and
h. An
assurance that the modification will not cause harm to the individual;
(15)
Services needed but not currently available; and
(16)
If applicable, risk factors and the measures required to be in place to
minimize them, including backup plans and strategies.
(d) For individuals receiving waiver
services, the information provided below shall be added to the service
agreement:
(1)
The specific waiver services to be provided including the amount, scope,
frequency, and duration;
(2)
The results of the SIS-A ® and the HRST;
(3)
Service documentation requirements sufficient to describe progress on goals and
the services received; and
(4) If
applicable, reporting mechanisms under self-directed services regarding budget
updates and individual and guardian or representative satisfaction with
services.
(e) For individuals who reside in a
provider owned or controlled residential setting, the service agreement shall
document any modifications of the individual’s rights in the residential
setting to include:
(1)
Privacy in their sleeping or living unit, including doors lockable by the
individual with only appropriate providers having keys to doors as needed;
(2)
Freedom and support to control their own schedule and activities;
(3)
Access to food at any time;
(4)
Having visitors of their choosing at any time; and
(5)
Freedom to furnish and decorate sleeping or living units.
(f) A provider agency shall only make
modifications pursuant to (e) above by documenting in the service agreement the
following:
(1) An
identified specific and individualized assessed need that the modifications are
based on;
(2)
The positive interventions and supports used prior to any modifications to the
service agreement;
(3)
The less intrusive methods used to attempt to meet the need but was
unsuccessful;
(4) A
clear description of the condition that is directly proportionate to the
specific assessed need;
(5)
The regular collection and review of data to measure the ongoing effectiveness
of the modification;
(6)
Established time limits for periodic reviews to determine if the modification
is still necessary or can be terminated;
(7)
The informed consent of the individual or representative; and
(8) An
assurance that the interventions and support will not cause harm to the
individual.
(g) Within 5 business days of
completion of a service agreement, or service agreement amendment, the service
coordinator shall provide the individual, guardian, or representative, the
following:
(1)
The service agreement, signed by the service coordinator, and all provider
agencies identified in the service agreement;
(2)
The name, address, email, and phone number of all provider agencies; and
(3) A
description of the procedures for challenging the proposed service agreement
pursuant to He-M 522.17 for those situations where the individual,
guardian, or representative disapproves of the service agreement.
(h) The individual, guardian, or
representative shall have 10 business days from the date of receipt of the
service agreement, or service agreement amendment, to respond in writing,
indicating approval or disapproval of the service agreement or amendment.
Unless otherwise arranged between the individual, guardian, or representative
and the service coordinator, failure to respond within the time allowed shall
constitute approval of the service agreement or amendment.
(i) When a service agreement has been
approved by the individual, guardian, or representative and service
coordinator, the services shall be implemented and monitored as follows:
(1) A
person responsible for implementing any part of a service agreement shall
collect and record information about services provided and how they have
impacted progress on the individual’s goals, in a timeframe outlined in the
service agreement or, at a minimum, monthly;
(2) On
at least a monthly basis, the service coordinator shall visit or have verbal or
written contact as determined by the individual or persons responsible for
implementing a service agreement, and document these contacts;
(3)
The service coordinator shall visit the individual and contact the guardian or
representative, if any, at least quarterly, or more frequently if so specified
in the individual’s expanded service agreement, to determine and document:
a.
Whether services match the interests and needs of the individual;
b. The
individual’s and guardian’s or representative’s satisfaction with services; and
c.
Progress on the goals in the service agreement; and
(4) If
the individual receives services under He-M 1001 or residential services under
He-M 521 or He-M 525, all of the service coordinator’s quarterly visits with
the individual shall be in the home where the individual resides.
Source. #7120, eff 10-20-99; ss by #8974, INTERIM,
eff
10-6-07, EXPIRED: 4-3-08
New. #9734, eff 6-25-10); ss by #12683, eff
11-30-18 (formerly He-M 522.12); ss by #14253, eff 5-22-25, EXPIRES: 5-22-35
He-M 522.12 Record
Requirements for Area Agencies and Provider Agencies.
(a) Area agencies, service
coordinators, and other provider agencies, or their designees shall maintain a
separate record for each individual who receives services and ensure the
confidentiality of information pertaining to the individual, including:
(1)
Maintaining the confidentiality of any personal data in the records;
(2)
Storing and disposing of records in a manner that preserves confidentiality;
and
(3)
Obtaining a release of information pursuant to He-M 522.04(f) prior to
release of any part of a record to a third party.
(b) An individual’s record shall
include, as applicable:
(1)
Personal and identifying information including the individual’s:
a.
Name;
b.
Address;
c.
Date of birth; and
d.
Telephone number;
(2)
All information used to determine eligibility for services pursuant to
He-M 522.05, He-M 522.06, and He-M 522.07;
(3)
Information about the individual that would be essential in case of an
emergency, including:
a.
Name, address, and telephone number of the legal guardian,
representative, next of kin, or other person to be notified;
b.
Name, addresses, and telephone numbers of current service providers; and
c.
Medical information, including:
1. Diagnosis(es);
2. Health history;
3. Allergies;
4. Do
not resuscitate (DNR) orders;
5. Advance directives, as determined by
the individual;
6.
Current medications; and
7. Any
correspondence related to
medical information relevant to the individual;
(4) A
copy of the individual’s current service agreement;
(5)
Copies of all service agreement amendments;
(6)
Progress notes on goals and support services provided as identified in the
service agreement;
(7)
All service coordination contact notes and quarterly assessments pursuant to
He-M 522.11(i)(2)-(4);
(8)
Copies of evaluations and reviews by providers and professionals;
(9)
Copies of correspondence within the past year with the individual and guardian
or representative, area agency,
provider agencies, providers, physicians, attorneys, state and federal
agencies, family members, and others in the individual’s life;
(10)
Other correspondence or memoranda concerning any significant events in the
individual’s life;
(11)
Information about transfer or termination of services, as appropriate; and
(12)
Proof that the individual was given choice of provider agencies.
(c) All entries made into an
individual record shall be legible and dated and have the author identified by
name and position.
(d) In addition to the documentation
requirements identified in He-M 522, each area agency, service
coordinator, provider agency, and provider shall comply with all applicable
documentation requirements of other department rules.
(e) Each billing entity shall:
(1)
Retain records supporting each medicaid bill for a period of not less than 6
years; and
(2)
Retain an individual’s social history, medical history, evaluations, and
any court-related documentation for a period of not less than 6 years after
termination of services.
Source. #7120, eff 10-20-99; ss by #8974, INTERIM,
eff
10-6-07, EXPIRED: 4-3-08
New. #9734, eff 6-25-10; ss by #12683, eff
11-30-18; ss by #12683, eff 11-30-18 (formerly He-M 522.13); ss by 14253, eff
5-22-25, EXPIRES: 5-22-35
He-M 522.13 Service Funding.
(a) For newly found eligible
adults, the period between the time of completion of a service agreement and
the allocation by the department of the funds needed to carry out the services
required by the service agreement shall not exceed 90 days.
(b) For individuals already
receiving waiver services who experience significant life changes, such as
a significant change in their medical conditions, the period of time for
initiation of new services shall not exceed 90 days from the amendment of the
service agreement except by mutual agreement between the area agency and the
individual specifying a time limited extension.
(c) Service funding needs for (a)
above shall be documented by the area agency into NH Easy at https://nheasy.nh.gov/#/.
(d) Service funding needs for (b)
above shall be documented by the service coordinator into NH Easy at https://nheasy.nh.gov/#/.
(e)
The bureau shall make the final determination on the cost effectiveness
of proposed services for all funding requests.
Source. #7120, eff 10-20-99; ss by #8974, INTERIM,
eff
10-6-07, EXPIRED: 4-3-08
New. #9734, eff 6-25-10; ss by #12683, eff
11-30-18 (formerly He-M 522.14); ss by 14253, eff 5-22-25, EXPIRES: 5-22-35
He-M 522.14 Transfers Across
Regions.
(a) If an individual, guardian, or
representative plans to relocate where the individual lives and
wishes to transfer the individual’s area agency affiliation to that
region, the individual, guardian, or representative shall notify, in writing,
the area agency in the current region and the area agency in the proposed
region that the individual is moving and wishes to transfer services
to that region.
(b) The current area agency shall send
to the proposed area agency all information contained within the individual’s
file as outlined in He-M 522.12.
(c) Service coordinators shall assist
with the coordination when an individual transfers so that benefits obtained
from third party resources such as medicaid, community mental health center
services, and the division of vocational rehabilitation services shall not be
lost or delayed during the transition from one region to another.
Source. #7120, eff 10-20-99; ss by #8974, INTERIM,
eff
10-6-07, EXPIRED: 4-3-08
New. #9734, eff 6-25-10; ss by #12683, eff
11-30-18 (formerly He-M 522.15); ss by 14253, eff 5-22-25, EXPIRES: 5-22-35
He-M 522.15 Termination of
Services.
(a) If termination of services is
being considered by the area agency, service coordinator, individual, guardian,
representative, or provider agency, then the service coordinator shall meet
with either the individual or their guardian or representative, or
both, to discuss the reasons for the recommended termination.
(b) Any recommendation for
termination shall be made in writing to the area agency director and be based
on at least one of the following:
(1)
The individual can function without service(s); or
(2)
Services are no longer necessary because they have been replaced by other
supports or services.
(c) Within 10 business days of receipt
of a recommendation for termination of services, an area agency director shall
call a meeting with the service coordinator, either the individual or their
guardian or representative, and the provider agencies to be convened to review
the request. The purpose of the meeting shall be to determine if the
criteria listed in (b) above applies to the individual.
(d) Based on the information presented
and determinations made at the meeting, the service coordinator shall prepare a
written report for the area agency director which sets forth one of the
following:
(1) A
statement of concurrence with the recommendation for termination;
(2) A
recommendation for continuance; or
(3)
Changes to the individual’s service agreement.
(e) The area agency director shall
make the final decision regarding termination based on the criteria listed in
(b) above.
(f) If a decision is made to terminate
services pursuant to (b) above, the area agency director shall send a
termination notice to the individual, guardian, or representative at least 30
days prior to the proposed termination date. Service may be terminated sooner
than 30 days with the consent of the individual, guardian, or representative.
The individual, guardian, or representative may appeal the termination decision
in accordance with He-C 200.
(g) In each termination notice the
area agency shall provide information on the reason for termination, the right
to appeal, and the process for appealing the decision, including the names,
addresses, and phone numbers of the department and advocacy organizations, such
as the disability rights center-NH, which the individual, guardian, or
representative may contact for assistance in appealing the decision.
(h) An individual whose services have
been terminated may request resumption of services if they believe that the
reasons for the termination of services no longer apply. Such a request shall
be made by the individual, guardian, or representative, in writing, to the area
agency director.
(i) Upon request of the individual,
guardian, or representative, the area agency director shall resume services to
the individual if the criteria in (b) above no longer apply and if funding is
available.
Source. #7120, eff 10-20-99; ss by #8974, INTERIM,
eff
10-6-07, EXPIRED: 4-3-08
New. #9734, eff 6-25-10; ss by #12683, eff
11-30-18 (formerly He-M 522.16); ss by 14253, eff 5-22-25, EXPIRES: 5-22-35
He-M 522.16 Voluntary Withdrawal
from Services.
(a) An individual, guardian, or
representative may withdraw voluntarily from any service(s) at any time.
(b) The administrator of the service
from which withdrawal is made shall notify the area agency in writing of the
withdrawal and so indicate in the individual’s record.
(c) If any provider determines that
withdrawal from a service might constitute abuse, neglect, or exploitation
on the part of a guardian or representative, the provider or service
coordinator shall report such abuse, neglect, or exploitation as required
by law.
(d) If an individual does not have a
guardian or representative and their service coordinator or any other person
believes that the individual is not making an informed decision to withdraw
from services and might suffer harm as a result of abuse, neglect, or
exploitation, the area agency shall pursue the least restrictive protective
means including, as appropriate, guardianship to address the situation.
(e) An individual who has withdrawn
from services may request resumption of services at any time. Such a request
shall be made by the individual, guardian, or representative, in writing, to
the area agency director.
(f) Upon request of the individual,
guardian, or representative, the area agency director shall resume services to
the individual if funding is available.
Source. #7120, eff 10-20-99; ss by #8974, INTERIM,
eff
10-6-07, EXPIRED: 4-3-08
New. #9734, eff 6-25-10; ss by #12683, eff
11-30-18 (formerly He-M 522.17); ss by 14253, eff 5-22-25, EXPIRES: 5-22-35
He-M 522.17 Challenges and Appeals.
(a) Any determination, action, or
inaction by the bureau, a service coordination agency, provider agency, or an
area agency may be appealed by an individual, guardian, or representative.
(b) An individual, guardian, or
representative may choose to pursue formal or informal resolution to resolve
any disagreement with the bureau, a service coordination agency, provider
agency, or an area agency. If informal resolution is sought, at any time during
the process or within 30 business days of the bureau, service coordination
agency, provider agency, or area agency decision, the individual may choose to
file a formal appeal pursuant to (e)-(g) below. All formal appeals shall be
filed within 30 business days of the bureau, service coordination agency,
provider agency, or area agency determination, action, or inaction.
(c) The following actions shall be
subject to the notification requirements of (d) below:
(1)
Adverse eligibility actions under He-M 522.05(d) and (m), He-M
522.06(a), and He-M 522.07(c);
(2)
Proposed service agreements or service agreement amendments if the individual,
guardian, or representative disapproves pursuant to He-M 522.11(g); and
(3) A
determination to terminate services under He-M 522.15(e).
(d) The bureau, service coordination
agency, provider agency, or area agency, as applicable, shall provide written
notice to the applicant, individual, and guardian or representative of the
actions specified in (c) above, including:
(1)
The specific facts and rules that support, or the federal or state law that
requires, the action;
(2)
Notice of the individual’s right to appeal in accordance with He-C 200 within
30 business days and the process for filing an appeal, including the contact
information to initiate the appeal with the department;
(3)
Notice of the individual’s continued right to services pending appeal, when
applicable, pursuant to (g) below;
(4)
Notice of the right to have representation with an appeal by:
a.
Legal counsel;
b. A
relative;
c. A
friend; or
d.
Another spokesperson;
(5) Notice that neither the area agency, provider agency, service coordination agency, nor the
bureau is responsible for the cost of representation; and
(6)
Notice of organizations with their addresses and phone numbers that might be
available to provide pro bono or reduced fee legal assistance and advocacy,
including the disability rights center-NH.
(e) Appeals shall be forwarded, in
writing, to the bureau administrator in care of the department’s office of
client and legal services. An exception shall be that appeals may be filed
verbally if the individual is unable to convey the appeal in writing.
(f) The bureau administrator shall
immediately forward the appeal to the department’s administrative appeals unit
which shall assign a presiding officer to conduct a hearing, as provided in
He-C 200. The burden shall be as provided by He-C 203.14.
(g) If a hearing is requested, the
following actions shall occur:
(1)
Current recipients, services, and payments shall be continued as a consequence
of an appeal for a hearing until a decision has been made; and
(2) If
the bureau, service coordination agency, provider agency, or area agency’s
decision is upheld:
a.
Benefits shall cease 60 days from the date of the denial letter or 30 days from
the hearing decision, whichever is later; or
b. In
the instance of termination of services, services shall cease one year after
the initial decision to terminate services or 30 days from the hearing
decision, whichever is later.
Source. #9734, eff 6-25-10 (from He-M 522.13); ss by #12683,
eff 11-30-18(formerly He-M 522.18); ss by 14253, eff 5-22-25, EXPIRES: 5-22-35
He‑M 522.18 Waivers.
(a) An applicant, area agency, service
coordination agency, provider agency, individual, guardian, representative, or
provider may request a waiver of specific procedures outlined in
He-M 522 by completing and submitting the form titled “NH Bureau of
Developmental Services Waiver Request” (October 2023 edition). The request
shall be sent in writing to the bureau administrator.
(b) A completed waiver request form
shall be signed by:
(1)
The individual, guardian, or representative indicating agreement with the
request; and
(2) If
applicable, the area agency, service coordination agency, or provider agency’s
executive director or designee recommending approval of the waiver.
(c) A waiver request shall be
submitted to the department via:
(1)
Email at bds@dhhs.nh.gov; or
(2)
Mail to:
Bureau
of Developmental Services
Hugh
J. Gallen State Office Park
105
Pleasant Street, Main Building
Concord,
NH 03301
(d) No provision or procedure
prescribed by statute shall be waived.
(e) The request for a waiver shall be
granted by the commissioner or their designee within 30 days if the alternative
proposed by the requesting entity meets the objective or intent of the rule and
it:
(1)
Does not negatively impact the health or safety of the individual(s); and
(2)
Does not affect the quality of services to individuals.
(f) Upon receipt of approval of a
waiver request, the requesting entity’s subsequent compliance with the
alternative provisions or procedures approved in the waiver shall be considered
compliance with the rule for which waiver was sought.
(g) Waivers shall be granted in
writing for the
minimum period necessary to accommodate the waiver request, with a specific duration not to exceed 5 years except as in
(h)-(i) below.
(h) Any waiver shall end with the
closure of the related program or service.
(i) A requesting entity may request a
renewal of a waiver from the department. Such request shall be made at
least 30 days prior to the expiration of a current waiver.
Source. #9734, eff 6-25-10 (from He-M 522.14); ss by
#12683, eff 11-30-18 (formerly He-M 522.19); ); ss by 14253, eff 5-22-25,
EXPIRES: 5-22-35 (formerly He-M 522.19)
PART He-M 523 FAMILY SUPPORT SERVICES TO CHILDREN AND YOUNG
ADULTS WITH CHRONIC HEALTH CONDITIONS
Statutory
Authority: RSA 161:4-a, IX
REVISION NOTE:
Document #13370, effective 4-20-22,
readopted with amendments the form “Special Medical Services (SMS)—Application
for All Services” and re-named the form “Bureau for
Family Centered Services (BFCS)—Application for Services” pursuant to the
expedited revisions to agency forms process in RSA 541-A:19-c. Document #13370 updated the revision date on
the form from “(December 2018)” to “(4/2022)”.
The form is incorporated by reference in He-M 520.02(a) and He-M
523.04(a)(1). Document #13370 contained
only the amended form, giving it a new effective date of 4-20-22. The prior filing affecting rule He-M 520.02
was Document #12699, effective 12-28-18, and the prior filing affecting rule
He-M 523.04 was Document #12700, effective 12-28-18, although the revision date
for the form in the rules was “(August, 2018).”
The effective date of the rules remained unchanged by Document #13370.
Document #13696, effective 7-22-23,
readopted with amendments the form “Bureau for Family Centered Services
(BFCS)—Application for Services” pursuant to the expedited revisions to agency
forms process in RSA 541-A:19-c.
Document #13696 updated the revision date on the form from “(4/2022)” to
“(July 2023)”. The form is still
incorporated by reference in He-M 520.02(a) and He-M 523.04(a)(1). Document #13696 contained only the amended
form, giving it a new effective date of 7-22-23. Since Document #13696 updated the revision
date on the form from “(4/2022)” to “(July 2023)”, the revision date was
subsequently updated editorially in He-M 520.02(a) and He-M 523.04(a)(1) from
“(August 2018)” to “(July 2023)”. The
effective date of the rules remained unchanged by Document #13696.
He-M 523.01 Purpose.
(a)
The purpose of these rules is to establish a framework that provides
supports for the needs of young adults and families who have a child with a
chronic health condition. This framework
will allow decisions regarding family support services to be made with
consideration for the unique needs and characteristics of each young adult and
family.
(b)
As each young adult’s and family’s circumstances and needs vary, the
purpose of family support services is to assist young adults and families of
children with chronic health conditions to advocate, access resources, navigate
systems, and build competence to manage their own or their children’s chronic
illnesses through family directed education, support, and encouragement.
Source. #7713, eff 6-21-02; ss by #9728, eff 6-18-10;
ss by #12559, INTERIM, eff 6-26-18, EXPIRED: 12-24-18
New. #12700, eff 12-28-18
He-M 523.02 Definitions.
(a)
“Action plan” means a written plan for providing supports and services
to an eligible young adult or family.
(b)
“Applicant” means the person for whom the application is made.
(c)
“Bureau” means the bureau of
special medical services of the department of health and human services.
(d) “Bureau administrator” means the chief
administrator of the bureau of special
medical services.
(e)
“Chronic health condition” means a physical condition that:
(1) Will last or is expected to last for 12
months or longer;
(2) Meets one or both of the following criteria:
a. Consistently affects the individual’s ability
to function on a daily basis:
1.
In the areas of emotional, social, or physical development; or
2.
In his or her family, school, or community; or
b. Requires more intensive medical care from
primary care and specialty providers than is typically required for well child
and acute illness visits; and
(3)
Is not excluded
pursuant to He-M 523.03 (c).
(f)
“Department” means the New Hampshire department of health and human
services.
(g)
“Family” means the biological, adoptive, or foster parents, or legal
guardians of a child aged 0 through 20 who has a chronic health condition.
(h)
“Family support services” means those activities and interventions that:
(1) Are identified by a young adult or family in
the action plan;
(2)
Are provided for, or on behalf of, that young adult or family through
the PIH family council, the PIH coordinator, SMS, or the lead agency; and
(3) Assist that young adult or family as primary
caregiver of a child with a chronic health condition.
(i)
“Lead agency” means an entity awarded a contract by special medical
services to provide Partners in Health services to young adults and families
living in a designated region.
(j) “Partners in Health” (PIH) means a
New Hampshire community-based program of family support for young adults and
families.
(k) “Special medical services (SMS)”
means the bureau of special medical services that administers Partners In
Health.
(l)
“Young adult” means a person who has a chronic health condition and is
eligible for services described in He-M 523.05, and is:
(1) 18 through 20 years of age; or
(2) A minor who has been legally emancipated.
Source. #7713, eff 6-21-02; ss by #9728, eff 6-18-10;
ss by #12559, INTERIM, eff 6-26-18, EXPIRED: 12-24-18
New. #12700, eff 12-28-18
He-M 523.03 Eligibility.
(a)
An applicant shall be eligible for services described in He-M 523.06 if
the applicant is a family as defined in He-M 523.02(g) or a young adult as
defined in He-M 523.02(l).
(b)
For the purposes of establishing eligibility, an applicant shall provide
documentation from a licensed physician, advanced practice registered nurse, or
doctor of osteopathy indicating that the person’s chronic health condition
meets the specific criteria in He-M 523.02(e).
(c) An applicant who meets the criteria of a
chronic health condition as defined in He-M 523.02(e) shall not be eligible to
receive services under He-M 523 if the condition is:
(1) A developmental disability when:
a. The
disability meets the definition in RSA 171-A:2, V; and
b. The person would be or has been found
eligible for services pursuant to He-M 503.03 through He-M 503.18;
(2) A mental illness when the illness:
a. Meets the definition in RSA 135-C:2, X; or
b. Meets the definition of serious emotional
disturbance in He-M 401.02 (u);
(3) A dental condition; or
(4) Obesity, which means a body mass index equal
to or greater than the gender- and age-specific 95th percentile from the
Centers for Disease Control and Prevention growth charts.
(d) A young adult or
family shall receive family support services from the region in which they
reside.
Source. #7713, eff 6-21-02; ss by #9728, eff 6-18-10;
ss by #12559, INTERIM, eff 6-26-18, EXPIRED: 12-24-18
New. #12700, eff 12-28-18
He-M 523.04 Application Procedure.
(a)
An application for services shall include:
(1) A fully
completed and signed “Special Medical Services (SMS) – Application for All
Services” (July 2023 Edition); and
(2) A fully executed release to obtain medical
records from the applicant’s physician, to confirm a chronic health condition.
(b)
Within 60 days of the date of
application, PIH shall:
(1) Accept and review all applications for
program eligibility, in accordance with He-M 523.05;
(2) Notify the applicant in writing of the
applicant’s eligibility status and the services for which the applicant is
eligible; and
(3) Have the applicable Family Support
Coordinator initiate phone contact to discuss the PIH program for which the
applicant has been found eligible.
(c)
PIH’s notice of decision shall include:
(1) For eligibility approvals:
a. The beginning
and ending dates of PIH eligibility;
b. The name and phone number of a PIH contact
person; and
c. Notice that
the recipient shall report to PIH any change in the recipient’s medical
insurance coverage, including Medicaid or TPL changes, within 30 days of the
change; and
(2) For eligibility denials:
a. The reason(s) for denial;
b. Information about the applicant’s right to an
appeal in accordance with He-M 202 and He-C 200; and
c. Alternate
support services information as available.
(d)
For an applicant who is determined to be eligible, eligibility shall be
effective for 12 months from the applicant’s application date, except when any
changes affect the recipient’s eligibility status.
(e)
PIH shall notify a recipient in writing 30 calendar days prior to the
date that eligibility will close, for such reasons as the 12-month eligibility
period is expiring, the recipient is turning 21, services provided are no
longer available, or there is a change which affects eligibility status.
(f)
A new application shall be submitted in accordance with (a) above prior
to the expiration of current eligibility.
(g)
An applicant or recipient shall have the right to reapply at any time
after eligibility has been denied.
(h)
An applicant who submits false or misleading information shall be
subject to the provisions of RSA 132:15 and RSA 638:15.
Source. #7713, eff 6-21-02; ss by #9728, eff 6-18-10;
ss by #12559, INTERIM, eff 6-26-18, EXPIRED: 12-24-18
New. #12700, eff 12-28-18
He-M 523. 05 Determination of Eligibility.
(a)
The medical documentation provided pursuant to He-M 523.03 (b), and any
other information provided by the applicant concerning the applicant’s
unconfirmed chronic health condition, shall be the basis for determination of
eligibility for services.
(b)
A PIH coordinator shall review the medical documentation received
regarding an applicant and, within 15 business days after the receipt of the
documentation, confirm the applicant has a chronic health condition as defined
by He-M 523.02(e).
(c)
In cases where the information regarding eligibility is inconclusive, a
SMS clinician shall make the determination of an applicant’s eligibility.
(d)
If the information required to determine eligibility cannot be obtained
or it is anticipated that the person will not be determined eligible in
consultation with SMS within the timelines stated in (b) above, the PIH
coordinator shall:
(1) Request an extension from the applicant, in
writing, stating the reason for the delay; and
(2) Obtain the approval in writing from the
applicant.
(e) Extensions approved in writing by the
applicant in (d) above shall not exceed 30 business days after the receipt of
the documentation.
(f)
If the PIH coordinator’s request for an extension pursuant to (d) above
is denied by the applicant, the PIH coordinator shall determine the applicant
to be ineligible for services. The young
adult or family may reapply for services pursuant to (k) below.
(g) The PIH coordinator shall
authorize services to be provided prior to the completion of the eligibility
determination process if such services are necessary to protect the health or
safety of an applicant who the PIH coordinator believes is likely to be
eligible, based upon available information.
(h)
Within 5 business days of the determination of a family’s or a young
adult’s eligibility, a PIH coordinator shall send notice to each applicant that
includes the determination of eligibility.
(i)
Preliminary planning to determine the services needed shall occur with
the young adult or family when the application is submitted or no later than 5
business days from the notification of eligibility.
(j)
Within 5 business days of determination of an applicant’s ineligibility,
a PIH coordinator shall convey to the applicant a written decision that
describes the specific legal and factual basis for the denial, including
specific citation of the applicable law or department rule, and advise the
applicant in writing and verbally of the appeal rights under He-M 523.13.
(k)
Following denial of eligibility, the individual or family, as
applicable, may reapply for services if new information regarding the diagnosis
or about the health condition becomes available or if the timelines are not met
in accordance with (f) above.
(l)
The determination of eligibility by one PIH coordinator shall be
accepted by every lead agency of the state.
(m)
On an annual basis, the PIH coordinator shall re-determine the
eligibility of a young adult or family through the review of the young adult’s
or family’s action plan.
(n)
Young adults and families shall make the necessary medical and other
forms of documentation concerning the chronic health condition available upon
request from the PIH coordinator, SMS or the lead agency.
Source. #7713, eff 6-21-02; ss by #9728, eff 6-18-10;
ss by #12559, INTERIM, eff 6-26-18, EXPIRED: 12-24-18
New. #12700, eff 12-28-18 (formerly He-M 523.04)
He-M 523.06 Family Support Services.
(a)
Family support services shall:
(1) Assist young adults to identify and assess
their own strengths, needs, and goals;
(2) Assist families to identify and assess the
care of their children who have chronic health conditions;
(3) Aid young adults to care for their chronic
health conditions;
(4) Aid families to care for their children who
have chronic health conditions;
(5) Assist young adults to access the financial,
educational, training, and other resources and services needed to monitor,
assess, and respond to their own health care needs;
(6) Assist families to access the financial,
educational, training, and other resources and services needed to monitor,
assess, and respond to their children’s chronic health condition; and
(7) Assist young adults and families in obtaining
services such as applying for grants and locating donations of goods.
(b)
Family support services shall include financial assistance based on the
young adult’s or family’s needs and the availability of funds.
(c)
The PIH family council shall establish the method of provision of
financial assistance, including limits on the use of PIH family support
services funding, in accordance with He-M 523.08.
Source. #7713, eff 6-21-02; ss by #97278, eff
6-18-10; ss by #12559, INTERIM, eff 6-26-18, EXPIRED: 12-24-18
New. #12700, eff 12-28-18 (formerly He-M 523.05)
He-M 523.07 Responsibilities of Lead Agency.
(a)
Each lead agency shall:
(1) Have a contract with SMS to provide PIH
services within a designated region(s);
(2) Provide community outreach and education to
promote PIH throughout the region(s);
(3) Review PIH services to ensure that services
are provided to a young adult or family in home and community settings and are
based on a young adult’s or family’s needs, interest, competencies, and
lifestyles; and
(4) Designate, with input from the family
council, a PIH coordinator(s) for each designated region, but a person may
serve as a coordinator for more than one region.
(b)
The lead agency shall comply with SMS quality assurance activities,
including:
(1) Conducting and reviewing member satisfaction
surveys;
(2) Reviewing personnel files of any staff funded
through the contract for completeness; and
(3) Participating in quality improvement reviews
conducted by the SMS including:
a. Reviewing the records of young adults and
families; and
b. Reviewing the lead agency’s compliance with
this section.
Source. #7713, eff 6-21-02; ss by #9728, eff 6-18-10;
ss by #12559, INTERIM, eff 6-26-18, EXPIRED: 12-24-18
New. #12700, eff 12-28-18 (formerly He-M 523.06)
He-M 523.08 PIH Family Council.
(a)
Each region shall have a PIH family council that shall act as an
advisory body to the lead agency.
(b)
A regional PIH family council shall:
(1) Be composed of a minimum of 5 members;
(2) Have members who are, or have been, young
adults or family members enrolled in PIH; and
(3) Neither the Family Support Coordinator nor
the Lead Agency Supervisor may be a voting member of the council.
(c)
Each regional PIH family council shall establish and maintain policies
that address, at a minimum, the following:
(1) Membership, recruitment, rotation, and term
limits for service on the council;
(2) A process for determining the chairperson and
other officers;
(3) Providing all PIH family council members
orientation, training, and mentorship; and
(4) Processes used to determine the utilization
of funds and other resources identified for family council activities.
Source. #7713, eff 6-21-02; ss by #9728, eff 6-18-10;
ss by #12559, INTERIM, eff 6-26-18, EXPIRES: 12-24-18
New. #12700, eff 12-28-18 (formerly He-M 523.07)
He-M 523.09 Collaboration Between Lead Agencies and
PIH Family Councils.
(a)
Lead agencies and PIH family councils shall work together to support the
mission of the PIH program by coordinating planning activities with one
another, and with other community agencies, to maximize supports, services, and
funding.
(b)
Specifically, lead agencies and PIH family councils shall work
collaboratively to:
(1) Determine and agree upon the 2 parties’
relationship, roles, and responsibilities;
(2) Develop and agree upon a method of conflict
resolution, including the provision that in cases of without resolution SMS
shall be the final arbiter regarding He-M 523 applicability; and
(3) Develop and implement a biennial regional
family support plan.
(c)
At a minimum, the regional family support plan for each region shall:
(1) Specify the methods used to identify needs of
young adults and families in the region;
(2) Identify the needs of young adults and
families residing in the region;
(3) Identify the resources available to support
young adults and families in the region;
(4) Identify
community agencies that serve children and young adults with chronic health
conditions;
(5) Prioritize identified needs based on the
information obtained in (1) through (4) above; and
(6) Develop strategies to address priorities.
Source. #7713, eff 6-21-02; ss by #9728, eff 6-18-10;
ss by #12559, INTERIM, eff 6-26-18, EXPIRED: 12-24-18
New. #12700, eff 12-28-18 (formerly He-M 523.08)
He-M 523.10 PIH Coordinator Duties and Qualifications.
(a)
Each lead agency shall have at least one person designated as a PIH
coordinator.
(b)
A PIH coordinator’s duties and qualifications shall be identified by a
job description designed jointly by the PIH family council and lead agency and
in accordance with (c) and (d) below.
(c)
A PIH coordinator shall have at least an associate's degree from an
accredited program in a field of study related to health or social services
with at least one year's corresponding experience.
(d)
A PIH coordinator shall:
(1) Review and communicate eligibility for
services to applicants as specified in He-M 523.03 and He-M 523.04;
(2) Provide, or assist young adults and families
in acquiring, family support services;
(3) Coordinate the establishment and operations
of the PIH family council;
(4) Provide information to the PIH family council
regarding family supports to assist the council to:
a. Understand young adults’ and families’ needs;
b. Act on those needs; and
c. Monitor the services and supports provided;
(5) Provide information
and referral consultation to those staff providing family support under He-M
519, upon request of the area agency family support coordinator, or the
young adult or family;
(6) When distributing funds, ensure that a young
adult or family has accessed all other available funding and community
resources prior to receiving family support services funding, and consider the
following:
a. The unique needs of each young adult or
family related to their chronic health condition;
b. Maintenance of sufficient funds in a given
budget cycle; and
c. The needs within the region, as established
by the regional family support plan in He-M 523.09(c);
(7) Solicit financial support for young adults
and families from community groups, foundations, and other sources to augment
state funding as needed;
(8) Develop an action plan with each young adult
and family that includes:
a. A young adult or family profile; and
b. A prioritization of needs and goals to be
addressed, including:
1. Timelines;
2. Methods for achieving goals; and
3. Criteria for completion; and
c. Planning for health care transitions;
(9) Maintain records regarding supports and
services provided for young adults and families; and
(10) Facilitate the distribution of family support
funds under the direction of the PIH family council.
(e)
Family support services provided by the PIH coordinator shall:
(1) Be initiated through an action plan;
(2) Include the following:
a. Documentation of all contacts with the child,
his or her family, or the young adult; and
b. Determination of the young adult’s or the
family’s satisfaction with services; and
(3) Involve coordination and monitoring of family
support services.
(f) A PIH coordinator shall assist a young adult
and family to access other appropriate and available community resources prior
to using PIH family support services funds.
Source. #7713, eff 6-21-02; ss by #9728, eff 6-18-10
(from He-M 523.11); ss by #12559, INTERIM, eff 6-26-18, EXPIRES: 12-24-18
New. #12700, eff 12-28-18 (formerly He-M 523.09)
He-M 523.11 Voluntary Withdrawal from Services.
(a)
A young adult or family may withdraw voluntarily from services at any
time.
(b)
The PIH coordinator shall document the withdrawal in the record.
(c)
A young adult or family who has withdrawn from services may reapply for
services at any time.
Source. #7713, eff 6-21-02; ss by #9728, eff 6-18-10);
ss by #12559, INTERIM, eff 6-26-18, EXPIRED: 12-24-18
New. #12700, eff 12-28-18 (formerly He-M 523.10)
He-M 523.12 Designation of Region Boundaries.
(a)
An eligible young adult or family may request to SMS to receive services
from a region other than the one in which they reside.
(b) A lead agency
may request from SMS, with the approval of the eligible young adult or family,
that the young adult or family receive services from another region other than
the one in which they reside.
(c)
Requests made in (a) and (b) above shall be submitted in writing to SMS
and include supporting information that explains why the family is better
served by another region.
(d)
A lead agency shall be awarded a contract to service one or more of the
regions listed in Table 523-1:
Table 523-1, TOWNS
AND CITIES BY REGION
|
Region I |
|||
|
|
|
|
|
|
Albany |
Easton |
Livermore |
Stratford |
|
Bartlett |
Eaton |
Lyman |
Sugar
Hill |
|
Bath |
Effingham |
Madison |
Tamworth |
|
Benton |
Errol |
Milan |
Tuftonboro |
|
Berlin |
Franconia |
Millsfield |
Union |
|
Bethlehem |
Freedom |
Monroe
|
Wakefield |
|
Brookfield |
Gorham |
Moultonboro |
Warren |
|
Carroll |
Groveton |
Northumberland |
Waterville |
|
Chatham |
Hart's Location |
Ossipee |
Wentworth |
|
Clarksville |
Haverhill |
Piermont |
Whitefield |
|
Colebrook |
Jackson |
Pittsburg |
Wolfeboro |
|
Columbia |
Jefferson |
Randolph |
Woodstock |
|
Conway |
Lancaster |
Sanbornville |
Woodsville |
|
Dalton |
Landaff |
Sandwich |
|
|
Dixville |
Lincoln |
Shelburne |
|
|
Dummer |
Lisbon |
Stark |
|
|
|
Littleton |
Stewartstown |
|
|
|
|
|
|
|
Region II |
|||
|
|
|
|
|
|
Acworth |
Dorchester |
Langdon |
Orford |
|
Canaan |
Enfield |
Lebanon |
Plainfield |
|
Charlestown |
Goshen |
Lempster |
Springfield |
|
Claremont |
Grafton |
Lyme |
Sunapee |
|
Cornish |
Grantham |
Newport |
Unity |
|
Croydon |
Hanover |
Orange |
Washington |
|
|
|
|
|
|
Region
III |
|||
|
|
|
|
|
|
Alexandria |
Bristol |
Groton |
Plymouth |
|
Alton |
Campton |
Hebron |
Rumney |
|
Ashland |
Center Harbor |
Holderness |
Sanbornton |
|
Barnstead |
Ellsworth |
Laconia |
Thornton |
|
Belmont |
Gilford |
Meredith |
Tilton |
|
Bridgewater |
Gilmanton |
New Hampton |
|
|
Region
IV |
|||
|
|
|
|
|
|
Allenstown |
Dunbarton |
Hopkinton |
Sutton |
|
Andover |
Danbury |
Loudon |
Warner |
|
Boscawen |
Deering |
Newbury |
Weare |
|
Bow |
Epsom |
New London |
Webster |
|
Bradford |
Franklin |
Northfield |
Wilmot |
|
Canterbury |
Henniker |
Pembroke |
Windsor |
|
Chichester |
Hill |
Pittsfield |
|
|
Concord |
Hillsboro |
Salisbury |
|
|
|
|
|
|
|
Region V |
|||
|
|
|
|
|
|
Alstead |
Greenville |
Nelson |
Surry |
|
Antrim |
Hancock |
New Ipswich |
Swanzey |
|
Bennington |
Harrisville |
Peterborough |
Temple |
|
Chesterfield |
Hinsdale |
Richmond |
Troy |
|
Dublin |
Jaffrey |
Rindge |
Walpole |
|
Fitzwilliam |
Keene |
Roxbury |
Westmoreland |
|
Francestown |
Lyndeborough |
Sharon |
Winchester |
|
Gilsum |
Marlborough |
Stoddard |
|
|
Greenfield |
Marlow |
Sullivan |
|
|
|
|
|
|
|
Region VI |
|||
|
|
|
|
|
|
Amherst |
Hudson |
Merrimack |
Nashua |
|
Brookline |
Litchfield |
Milford |
Wilton |
|
Hollis |
Mason |
Mont Vernon |
|
|
|
|
|
|
|
Region
VII |
|||
|
|
|
|
|
|
Auburn |
Candia |
Hooksett |
Manchester |
|
Bedford |
Goffstown |
Londonderry |
New Boston |
|
|
|
|
|
|
Region
VIII |
|||
|
|
|
|
|
|
Brentwood |
Greenland |
Newfields |
Portsmouth |
|
Deerfield |
Hampton |
Newington |
Raymond |
|
East Kingston |
Hampton Falls |
Newmarket |
Rye |
|
Epping |
Kensington |
North Hampton |
Seabrook |
|
Exeter |
Kingston |
Northwood |
South Hampton |
|
Fremont |
New Castle |
Nottingham |
Stratham |
|
|
|
|
|
|
Region
IX |
|||
|
|
|
|
|
|
Barrington |
Lee |
New Durham |
Strafford |
|
Dover |
Madbury |
Rochester |
|
|
Durham |
Middleton |
Rollinsford |
|
|
Farmington |
Milton |
Somersworth |
|
|
|
|
|
|
|
Region X |
|||
|
|
|
|
|
|
Atkinson |
Derry |
Pelham |
Sandown |
|
Chester |
Hampstead |
Plaistow |
Windham |
|
Danville |
Newton |
Salem |
|
Source. #7713, eff 6-21-02; ss by #9728, eff 6-18-10;
ss by #12559, INTERIM, eff 6-26-18, EXPIRED: 12-24-18
New. #12700, eff 12-28-18 (formerly He-M 523.11)
He-M 523.13 Appeals.
(a)
Pursuant to He-M 202 or He-C 200, a young adult or family may choose to
pursue informal resolution to resolve any disagreement with a lead agency or,
within 30 business days of a lead agency decision, may choose to file an
appeal.
(b) A young adult
or family may appeal any determination, action, or inaction by a lead agency.
(c) Appeals shall be submitted, in writing, to
the bureau administrator in care of the department’s office of client and legal
services.
(d) Appeals may be filed verbally, if the family
or young adult is unable to convey the appeal in writing.
(e)
The young adult or family may choose to participate in a hearing or
independent review, as provided in He-C 200.
The burden shall be as provided by He-C 203.14.
(f)
If a hearing is requested, the following actions shall occur:
(1) If the young adult or family is currently
receiving supports and services, those supports and services shall be continued
until a decision has been made;
(2) If the bureau’s decision is upheld, funding
shall cease 60 days from the date of the decision;
(3) If the young adult or family member is
appealing a denial of eligibility for supports and services, no family support
services shall be provided until a decision is made to reverse the denial; and
(4)
If the bureau’s decision if reversed, family support services shall commence as
soon as practicable.
Source. #9728, eff 6-18-10; ss by #12559, INTERIM,
eff 6-26-18, EXPIRED: 12-24-18
New. #12700, eff 12-28 18 (formerly He-M 523.12)
He‑M 523.14 Waivers.
(a)
A lead agency, PIH family council, family, or young adult may request a
waiver of specific procedures outlined in He-M 503 by completing and submitting
to the department, bureau of special medical services the form titled
“Department of Health and Human Services, Bureau of Special Medical Services
Waiver for Services (December 2018).”
(b)
A completed waiver request form shall be signed by the requester - young
adult, family, lead agency, or PIH family council representative.
(c)
The request for waiver shall be reviewed and granted by the commissioner
of the department or his or her designee, within 30 days of receipt of the
request, if the alternative proposed by the lead agency, PIH family council,
family, or young adult, meets the objective or intent of the rule and it:
(1) Does not negatively impact the health or
safety of the family or young adult(s); and
(2) Does not affect the quality of services to a
family or young adult.
(d) A waiver request shall be submitted to:
Department of
Health and Human Services
Special Medical
Services
State Office Park
South
129 Pleasant
Street, Thayer Building
Concord, NH 03301
(e)
No provision or procedure prescribed by statute shall be waived.
(f)
The determination on the request for a waiver shall be made within 30
days of the receipt of the request.
(g)
Waivers shall be granted in writing and remain in effect for the
duration of the service.
(h)
Any waiver shall end with the closure of the related program or service.
Source. #12700, eff 12-28 18 (formerly He-M 523.13)
PART He-M 524 IN-HOME SUPPORTS
Statutory
Authority: RSA 161-I:7; 171-A:3; 18, IV
He-M 524.01 Purpose. The purpose of these rules is to establish
minimum standards for the provision of Medicaid-covered home- and
community-based in home residential habilitation, including personal care and
other related supports and services that promote greater independence and skill
development for a child, adolescent, or young adult who:
(a)
Has a developmental disability;
(b)
Has significant medical or behavioral challenges as determined pursuant
to He-M 524.03 (a)(4) and (5) a.; and
(c)
Lives at home with his or her family.
Source. #7891, eff 5-20-03; ss by #9927, INTERIM, eff
5-21-11, EXPIRES: 11-17-11; ss by #10027, eff 11-17-11; ss by #13397, eff
6-18-22
(a)
“Area agency” means “area agency” as defined under RSA 171-A: 2,
I-b, namely, “an entity established as a nonprofit corporation in the state of
New Hampshire which is established by rules adopted by the commissioner to
provide services to developmentally disabled persons in the area.”
(b)
“Bureau” means the bureau of developmental services of the
department of health and human services.
(c)
“Bureau administrator” means the chief administrator of the bureau
of developmental services.
(d)
“Cultural competence” means the knowledge, attitudes, and interpersonal
skills applied to a provider’s practice methods that allow the provider to understand, appreciate,
and work effectively with individuals from cultures other than his or her own.
(e)
“Department” means the New Hampshire department of health
and human services.
(f)
“Developmental disability” means “developmental disability” as defined
in RSA 171-A: 2, V, namely, “a disability:
(1) Which is attributable to intellectual
disability, cerebral palsy, epilepsy, autism or a specific learning disability or any other
condition of an individual found to be closely related to an intellectual
disability as it refers to general intellectual functioning or impairment in
adaptive behavior or requires treatment similar to that required for persons
with an intellectual disability; and
(2) Which originates before such individual
attains age 22, has continued or can be expected to continue indefinitely, and
constitutes a severe disability to such individual’s ability to function
normally in society.”
(g)
“Direct and manage” means to be actively involved in all chosen aspects
of the service arrangement, including but not limited to:
(1) Designing the services;
(2) Selecting the service providers;
(3) Deciding how the authorized funding is to be
spent based on the needs identified in the individual’s service
agreement; and
(4) Performing ongoing oversight of the services provided.
(h)
“Employer” means an area agency, subcontract agency, or person that
handles legally defined and other employer-related functions such as, but not
limited to:
(1) Paying employer taxes;
(2) Withholding employee taxes;
(3) Performing other payroll functions, including issuing paychecks;
(4) Providing workers’ benefits; and
(5) Obtaining workers’ compensation and liability insurance.
(i)
“Family” means a group of 2 or more persons related by ancestry,
marriage, or other legal arrangement, including foster care as defined in 45
C.F.R. § 1355.20, that has at least one member who has a developmental disability.
(j)“Guardian” means a person appointed
pursuant to RSA 547-B, RSA 463, or RSA 464-A or the parent of a child under the
age of 18 whose parental rights have not been terminated or limited by law.
(k)
“Home- and community-based care waiver” means a waiver pursuant
to the authority of section 1915 (c) of the Social Security Act which allows
the federal funding of long-term care services in non-institutional settings
for persons who are elderly, disabled, or chronically ill.
(l)
“In-home supports” means an array of home and community-based care
waiver services provided to an individual and his or her family in the home and
in the community to enhance the family’s and other caregivers’ ability to care for the
individual and to provide the individual with opportunities to develop a
variety of life skills as listed in He-M 524.05.
(m)
“Individual” means a child, adolescent, or young adult with a
developmental disability who is eligible to receive services pursuant to He-M
503.03 if aged 3 to 21 or pursuant to He-M 510 if under the age of 3.
(n)
“Individualized family support plan (IFSP)” means a written plan for
providing services and supports to a child and his or her family who are eligible for family-centered
early supports and services under He-M 510.06.
(o)
“Informed decision” means “informed decision” as defined in RSA 171-A:2,
XI, namely, “a choice made by a client or potential client or, where appropriate, his legal
guardian that is reasonably certain to have been made subsequent to a rational
consideration on his part of the advantages and disadvantages of each course of
action open to him.”
(p)
“Medicaid” means the federal medical assistance program established
pursuant to Title XIX of the Social Security Act.
(q)
“Nursing-related tasks” means those services that are delegated by
a licensed nurse to unlicensed personnel in accordance with RSA 326-B and Nur
Part 404.
(r)
“Parent” means an individual’s:
(1) Mother;
(2) Father;
(3) Adoptive mother;
(4) Adoptive father; or
(5) Legal guardian(s).
(s)
“Provider” means a person receiving any form of remuneration for the
provision of services to an individual.
(t)
“Representative” means, where applicable:
(1) The parent or legal guardian of an individual under the age of 18;
(2) The legal guardian of an individual 18 or over;
(3) A person who has power of attorney for the individual; or
(4) The division of children youth and families (DCYF) in cases where DCYF
has responsibility for the placement and care of an individual.
(u)
“Respite services” means the provision of short-term care, in accordance
with He-M 513, for an individual in or out of the individual’s home for the
temporary relief and support of the individual’s family.
(v)
“Service” means any paid assistance to the individual and his or
her family.
(w)
“Service agreement” means “individual service agreement” as defined in
RSA 171-A:2, X, namely, “a written document for a client's services and
supports which is specifically tailored to meet the needs of each client.”
(x)
“Service coordinator” means a person who meets the criteria in He-M
503.08(e) – (f) and is chosen or approved by an individual and his or her
guardian or representative, if applicable, and designated to organize,
facilitate, and document service planning and to negotiate and monitor the
provision of the individual’s services and who is:
(1) An area agency service coordinator, family
support coordinator, or any other area agency or subcontract agency employee;
(2) A friend of the individual; or
(3) Any other person chosen by the individual or representative who is
not a spouse, parent, relative, or guardian of the individual.
(y)
“Staff” means a person employed by an area agency, subcontract
agency, or other employer.
(z)
“Subcontract agency” means an entity that is under contract with any
area agency to provide services to individuals who have a
developmental disability.
(aa)
“Team” means the group of people that participates in service planning
meetings and includes the individual and his or her service coordinator and
representative, if applicable, and others invited by the individual.
Source. #7891, eff 5-20-03; amd by #9122, eff 4-3-08;
amd by #9927, INTERIM, eff 5-21-11, EXPIRES: 11-17-11; ss by #10027, eff 11-17-11;
ss by #13397, eff 6-18-22
He-M 524.03 Eligibility.
(a) In-home supports
shall be available to any individual birth through the age of 21 who lives at
home with his or her family, and who:
(1) Is found eligible for
services by an area agency pursuant to:
a. He-M 503.05 for individuals aged 3 to 21; or
b. He-M 510 for
individuals under the age of 3;
(2) Is found eligible for Medicaid
by the department pursuant to applicable rules in He-W 600 and He-W 800;
(3) Has not graduated or
exited the school system;
(4) Has 2 or more factors
specific to the individual or a combination of at least one factor specific to
the individual and one factor specific to the parent which complicate care of
the individual or impede the ability of the care-giving parent to provide care,
including:
a. The following
factors specific to the individual:
1. Lack of age
appropriate awareness of safety issues so that constant supervision is
required;
2. Destructive or
injurious behavior to self or others;
3. Inconsistent
sleeping patterns or sleeping less than 6 hours per night and requiring
supervision when awake; or
4. Any other condition
that impedes the ability of the:
(i) Care-giving parent to
provide care; or
(ii) Individual to
participate in local community childcare or activity programs without
support(s); or
b. The following
factors specific to the parent:
1. Care
responsibilities for other family members with disabilities or health problems;
2. Age of either parent being less than 18 years
or above 59;
3. Physical or
mental health condition which impedes the ability of the care-giving parent to
provide care;
4 Founded child
neglect or abuse as determined by a district court pursuant to RSA 169-C:21; or
5. Availability of only one parent for
care-giving; and
(5) Is determined by the
department to meet institutional level of care as demonstrated by requiring one
of the following:
a. Services on a
daily basis for:
1. Performance of
basic living skills;
2. Intellectual, communicative, behavioral,
physical, sensory motor, psychosocial, or emotional development and well-being;
3. Medication administration; or
4. Medical monitoring or
nursing care by a licensed professional person such as:
(i) A registered nurse;
(ii) A licensed practical nurse;
(iii) A physical therapist;
(iv) An occupational therapist;
(v) A speech pathologist;
or
(vi) An audiologist; or
b. Services on a less than daily basis as part
of a planned transition to more independence or to prevent circumstances that could necessitate more intrusive and costly services.
(b) To obtain
determination of home and community based services waiver eligibility, in
addition to the eligibility letter pursuant to He-M 503.05 or 510, the area
agency shall complete and submit to the bureau a “NH Bureau
of Developmental Services Functional Screen for Waiver Services” form (May
2013) and a “Bureau of Developmental Services In-Home
Supports Waiver Individual/Parent Factors Form” (April 2022) within 3 business
days of the eligibility determination made in accordance with He-M 524.03(a)(1)-(4)
above.
(c) A person shall
not be eligible for services under He-M 524 if he or she is:
(1) Not living with his or
her family; or
(2) Receiving services
under another home and community based Medicaid waiver.
(d) The bureau shall
deny in-home supports if it determines that the provision of services will
result in the loss of federal financial participation for such services.
Source. #7891, eff 5-20-03; ss by #9927, INTERIM, eff
5-21-11, EXPIRES: 11-17-11; ss by #10027, eff 11-17-11; ss by #13397, eff
6-18-22
He-M 524.04 Provisions
Applicable to All Services.
(a) All in-home
supports shall be directed and managed by the individual or the individual’s
representative.
(b) In-home supports
shall be:
(1) Specifically tailored
to the competencies, interests, preferences, and needs of the individual and
his or her family and respectful of the cultural and ethnic beliefs,
traditions, personal values, and lifestyle of the family;
(2) Designed to facilitate,
maintain, and enhance supports from family members, friends, neighbors, child
care organizations, religious organizations, and community programs;
(3) Responsive to the
individual’s and family’s changing needs and choices within the limitations of
federal and state laws and rules;
(4) Specified in the
individual’s service agreement, or individual family support plan (IFSP);
(5) Provided only after the
informed consent of the individual or representative;
(6) In compliance with the
rights of the individual established under RSA 171-A:14 and He-M 310;
(7) Supportive of the
individual’s or representative’s efforts to direct and manage the services to
be provided; and
(8) Delivered in
collaboration with other related support plans when applicable, and consistent
with other services provided in additional environments such as the community,
school, and work.
(c) The individual
and the individual’s representative shall have free choice of any willing
provider meeting the qualifications of this part.
Source. #7891, eff 5-20-03; ss by #9927, INTERIM, eff
5-21-11, EXPIRES: 11-17-11; ss by #10027, eff 11-17-11; ss by #13397, eff
6-18-22
He-M 524.05 In Home Residential Habilitation. In home residential habilitation services are
services that assist an individual with the acquisition, retention, or
improvement of skills related to living in the community, personal care,
activities of daily living (ADL), assistance with ADL’s, and community
inclusion, including, but not limited to, instruction and skill building to
develop greater independence in:
(a) Performing basic
living skills such as, but not limited to, eating, drinking, toileting,
personal hygiene, and dressing;
(b) Improving and
maintaining mobility and physical functioning;
(c) Maintaining
health and personal safety;
(d) Carrying out
household chores and preparation of snacks and meals;
(e) Communicating;
(f) Learning to make
choices, to show preferences, and to utilize opportunities for satisfying those
interests;
(g) Developing and
maintaining personal relationships;
(h) Participating in
community experiences and activities;
(i) Pursuing
interests and enhancing competencies in leisure and avocational activities; and
(j) Addressing
behavioral challenges.
Source. #7891, eff 5-20-03; ss by #9927, INTERIM, eff
5-21-11, EXPIRES: 11-17-11; ss by #10027, eff 11-17-11; ss by #13397, eff
6-18-22
He-M 524.06 Service Coordination.
(a) Service
coordination services shall be services that assist individuals in gaining
access to needed waiver and or Medicaid State Plan services, as well as needed
medical, social, educational, and other services, regardless of funding source.
(b) Service
coordination services shall include the following:
(1) Coordinating,
facilitating, and monitoring services provided under He-M 524;
(2) Assessing and
re-assessing service needs, goals and outcomes;
(3) Facilitating
development, review, and modification of service agreements;
(4) Assisting with
recruiting, screening, hiring, and training providers;
(5) Identifying, providing
information about, and assisting families to access community resources;
(6) Providing counseling
and support;
(7) Providing advocacy
education and skill development to the individual, family, or his or her
representative;
(8) Initiating,
collaborating, and facilitating the development of a transition plan so that:
a. When the individual turns age 3, he or she
can access school services as described in He-M 510; and
b. When the individual graduates or exits the
school system, he or she can access adult supports, services, and community
resources with planning to start no later than age 16, or earlier if determined
necessary by the team in collaboration with the school district;
(9) Assisting in accessing
the registry of available providers and staff;
(10) Reviewing the actual
expenditures and revenues in the individualized budget and assisting the
individual or representative and providers in managing the authorized funds;
and
(11) Monitoring individual,
family, and representative satisfaction with services provided.
Source. #7891, eff 5-20-03; ss by #9927, INTERIM, eff
5-21-11, EXPIRES: 11-17-11; ss by #10027, eff 11-17-11; ss by #13397, eff
6-18-22
He-M 524.07 Consultative
Services.
(a) Consultative
services shall include any of the following services that are not otherwise
available under the Medicaid state plan, including but not limited to, Early
and Periodic Screening, Diagnostic and Treatment (EPSDT) under He-W 546,
benefits or services under the Rehabilitation Act of 1973, or the Individuals
with Disabilities Education Act:
(1) Evaluation, training,
mentoring, and special instruction to improve the ability of the service
provider, family, and other caregivers to understand and care for the
individual’s developmental, functional, health, and behavioral needs; and
(2) Support and counseling
regarding diagnosis and treatment of the individual to families for whom the
day-to-day responsibilities of caregiving have become overwhelming and
stressful.
(b) Consultative
services shall be limited to 100 hours per calendar year.
(c) The bureau
shall authorize consultative services exceeding 100 hours upon the written
recommendation of a licensed professional, the recommendation of the area
agency, and the availability of funds.
Source. #7891, eff 5-20-03; ss by #9927, INTERIM, eff
5-21-11, EXPIRES: 11-17-11; ss by #10027, eff 11-17-11; ss by #13397, eff
6-18-22
He-M 524.08 Respite
Services.
(a) Respite services
shall be:
(1) The provision of short
term assistance, in or out of an individual’s home, for the temporary relief
and support of the family; and
(2) Provided pursuant to
He-M 513.
(b) Respite
services shall be limited to no more than 20% of an individual’s total budget.
(c) The cost of
training respite providers shall be outside of the total funds available for
respite.
Source. #7891, eff 5-20-03; ss by #9927, INTERIM, eff
5-21-11, EXPIRES: 11-17-11; ss by #10027, eff 11-17-11; ss by #13397, eff
6-18-22
He-M 524.09 Environmental
and Vehicle Modification Services.
(a) Environmental
and vehicle modification services shall consist of physical adaptations to the
home environment of the individual or vehicle that is the primary means of
transportation of the individual that are necessary to ensure the health,
welfare, and safety of the individual or enable the individual to function with
greater independence in the home and community, and without which the
individual would require institutionalization.
(b) Adaptations to
the home environment shall include, but are not limited to the following:
(1) Installation of ramps
and grab-bars;
(2) Widening of doorways:
(3) Modification of
bathroom facilities; or
(4) Installation of specialized electric and plumbing systems,
which are necessary to accommodate the medical equipment and supplies, which
are necessary for the welfare of the individual.
(c) The following
shall not be included as environmental modifications:
(1) Adaptations or improvements to the home which are of general
utility and not of direct medical or remedial benefit to the individual, such
as, but not limited to, carpeting, roof repair, or central air conditioning;
and
(2) Adaptations that add to the total square footage of the home,
except when necessary to complete an adaption.
(d) The following
shall not be included as vehicle modifications:
(1) Adaptations that are of
general utility and not of direct medical or remedial benefit to the
individual;
(2) The purchase or lease
of a vehicle; and
(3) Regularly scheduled
upkeep and maintenance, unless it is upkeep and maintenance of the
modification.
(e) All
modifications shall be included in the individual’s service agreement.
(f) All home
modifications shall be made in accordance with all applicable State or local
building codes.
(g) For individuals
with unsafe wandering and running behaviors, outdoor fencing may be provided
under this waiver.
(h) Waiver funds
allocated toward the cost of the fence in (g) above shall not exceed $2,500
which can provide approximately 3,500 square feet of a safe play area.
Source. #7891, eff 5-20-03; ss by #9927, INTERIM, eff
5-21-11, EXPIRES: 11-17-11; ss by #10027, eff 11-17-11; ss by #13397, eff
6-18-22
He-M 524.10 Assistive
Technology.
(a) “Assistive
technology” means an item, piece of equipment, certification and training of
service animal, or product system, used to increase, maintain, or improve
functional capabilities of an individual, including, but not limited to, the
following:
(1) Devices, controls, or appliances, specified
in the individual service agreement that enable the individual
to increase their ability to perform activities of daily living, or perceive,
control, or communicate with the environment in which they live;
(2) The
evaluation of the assistive technology needs of an individual, including a
functional evaluation of the impact of the provision of appropriate assistive
technology and appropriate services to the individual;
(3) Purchasing,
leasing, or otherwise providing for the acquisition of assistive technology or
devices;
(4) Selecting,
designing, fitting, customizing, adapting, applying, maintaining, repairing, or
replacing assistive technology devices;
(5) Coordination
and use of necessary therapies, interventions, or services associated with
other services in the service agreement;
(6) Training or
technical assistance for the individual or the individual’s family members,
guardians, advocates, or authorized representatives;
(7) Training or
technical assistance for professional or other individuals who provide services
to, employ, or are otherwise substantially involved in the major life functions
of an individual; and
(8) Training and certification of a service
animal, defined in federal regulations implementing the Americans with Disabilities Act, 28 C.F.R. § 36.104 as
“service animal means any dog that
is individually trained to do work or perform tasks for the benefit of an individual with a disability, including a
physical, sensory, psychiatric, intellectual, or other mental disability. Other species of animals, whether wild or domestic, trained
or untrained, are not service animals for the purposes of this definition.
The work or
tasks performed by a service animal must be directly related to the
individual's disability."
(b) “Adaptive
equipment” means items of durable and non-durable medical equipment necessary
to address the individual’s functional limitations.
(c) Adaptive
equipment shall not be covered if used for recreational purposes.
(d)
Payment for assistive technology shall be limited to $10,000 over the
course of 5 years.
(e)
The bureau shall authorize assistive technology in excess of the limitation in
(d) above upon written request which shall include documentation supporting the
need and the correlation of the request to the individual’s
service agreement.
(f) Assistive technology provided through the
home and community based services waiver shall be in addition to, and not
duplicative of, assistive technology which is available under the Medicaid
state plan, or that is the obligation of the individual's employer.
(g) In order to
obtain prior authorization for payment for assistive technology, the individual
service agreement (ISA) shall specify the following:
(1) The item;
(2) The name of the healthcare practitioner
recommending the item;
(3) An evaluation
or assessment regarding the appropriateness of the item;
(4) A goal related
to the use of the item;
(5) The anticipated
environment that the item will be used; and
(6) Current modifications to the item or product
and anticipated future modifications and anticipated cost.
Source. #7891, eff 5-20-03; ss by #9927, INTERIM, eff
5-21-11, EXPIRES: 11-17-11; ss by #10027, eff 11-17-11; ss by #13397, eff
6-18-22
He-M 524.11
Community Integration Services.
(a)
Community integration services shall be services designed to support and
enhance an individual’s level of functioning,
independence and life activities, to promote health and wellness as well as
reduce or eliminate the activity limitations and restrictions to participation
in life situations caused by a disability shall include, but not be limited to
the following:
(1) Water safety training;
(2) Community
based camperships; and
(3) A pass or membership for admission to
community based activities only when needed to address assessed needs.
(b)
Community
based activity passes shall be purchased as day passes or monthly passes,
whichever is the most cost effective.
(c) Community integration services, inclusive of
therapeutic services and camperships, shall be capped annually at $8,000.
(d) Any single community integration service,
other than a campership, over $2,000 shall require a licensed healthcare
practitioner’s recommendation.
Source. #7891, eff 5-20-03; ss by #9927, INTERIM, eff
5-21-11, EXPIRES: 11-17-11; ss by #10027, eff 11-17-11; ss by #13397, eff
6-18-22
He-M
524.12 Individual Goods and Services.
(a) Individual goods
and services shall include equipment or supplies that address an identified
need in the ISA, and meet at least one of the following requirements:
(1) The good or service
decreases the need for other Medicaid services;
(2) The good or service
promotes inclusion in the community; or
(3) The good or service
increases the individual's safety in the home environment.
(b) Payment for
individual goods and services shall be made through the home and community
based services waiver if:
(1) The individual and
their family do not have the funds to purchase the item or service;
(2) The item or service is
not covered under the Medicaid State Plan; or
(3) The item or service is
not available through other sources.
(c) Payment for
experimental or prohibited treatments shall be prohibited.
(d) Payment for
individual goods and services shall not exceed $1,500 annually for an
individual.
(e) The bureau shall authorize individual goods
and services in excess of the limitation in (d) above upon written request which shall include documentation supporting
the need and the correlation of the request to the individual’s service
agreement.
(f) Documentation
related to the use of the item shall be maintained in monthly progress notes in
accordance with He-M 524.24.
(g) Individual goods
and services shall have an anticipated finite period of time to be utilized.
(h) The frequency of
purchase of individual goods and services shall be determined in accordance
with the documented continued need of the item and the ability of the item to
continue to meet that need.
Source. #7891, eff 5-20-03; ss by #9927, INTERIM, eff
5-21-11, EXPIRES: 11-17-11; ss by #10027, eff 11-17-11; ss by #13397, eff
6-18-22
He-M 524.13 Non-Medical Transportation.
(a)
Non-medical transportation services shall be services designed
specifically to improve the individual’s and the family caregiver's ability to
access community activities within their own community in response to needs identified through the individual's service agreement, including, but
not limited to:
(1) Orientation service using other services or supports for safe movement from one
place to another;
(2)
Travel training such as supporting the individual and family in learning
how to access and use informal and public transport for independence and
community integration;
(3)
Transportation service provided by different modalities, including
public and community transportation, taxi services,
transportation specific to prepaid transportation cards, mileage reimbursement,
volunteer transportation, and non-traditional transportation providers; and
(4) Prepaid transportation vouchers and cards.
(b) Payment for non-medical transportation shall be limited to $5,000 annually.
(c) If a family is transporting an individual,
payment shall only be made for transportation that is directly related to the child's disability or specific to a provider of transportation to
activities determined in the individual service agreement that are not
otherwise covered by the NH Medicaid state plan, including early periodic
screening, development, and training (EPSDT), and local education authority
(LEA).
(d) Youth under the age of 16 shall not be
reimbursed for public transportation expenses.
Source. #7891, eff 5-20-03; ss by #9927, INTERIM, eff
5-21-11, EXPIRES: 11-17-11; ss by #10027, eff 11-17-11; ss by #13397, eff
6-18-22
He-M 524.14 Personal Emergency Response Services
(PERS).
(a) “Personal emergency response services (PERS)” means smart technology devices
that enable individuals to summon help in an emergency including but not
limited to:
(1) Wearable or portable devices that allow for safe mobility;
(2)
Response systems that are connected to the individual’s telephone and
programmed to signal a response center when activated;
(3) Staffed and monitored response systems that operate 24 hours a day, seven
days a week;
(4) Any device that informs of elopement; and
(5) Monthly expenses that are affiliated with maintenance contracts or agreements
to maintain the operations of the device or item.
(b)
PERS shall also include non-smart technology items, such as seatbelt
release covers, ID bracelets, and GPS devices.
(c)
Payment for PERS shall not exceed $2,000
annually for an individual.
(d)
The bureau shall authorize PERS in excess of the limitation in (c) above
upon written request which shall include documentation supporting the need and the correlation of the request to the
individual’s service agreement.
Source. #7891, eff 5-20-03; ss by #9122, eff 4-3-08;
ss by #10027, eff 11-17-11; ss by #13397, eff 6-18-22
He-M 524.15 Wellness Coaching.
(a) “Wellness
coaching” means planning, directing, coaching, and mentoring individuals with
disabilities in community based, inclusive exercise activities in
accordance with the recommendations of a licensed recreational therapist or a
certified personal trainer.
(b)
A wellness coach shall develop specific goals for the individual’s
service agreement, including activities that are carried over into the
individual’s home and community.
(c)
A wellness coach shall demonstrate exercise techniques
and form, observe individuals, and explain to them corrective measures
necessary to improve their skills.
(d)
A wellness coach shall collaborate with the individual, his or her
family and other caregivers, and with other health and wellness professionals as needed.
(e)
Wellness coaching provided through the home and community based
services waiver shall be in addition to, and not duplicative of, wellness
coaching which is available under the Medicaid state plan.
(f)
Coverage for wellness coaching shall be limited to 100 hours per
year.
(g)
The bureau shall authorize payment for hours in excess of the limitation
in (f) above by written request, which shall include the recommendation of a licensed professional and documentation
supporting the need and the correlation of the request to the individual’s
service agreement.
Source. #7891, eff 5-20-03; ss by #9927, INTERIM, eff
5-21-11, EXPIRES: 11-17-11; ss by #10027, eff 11-17-11; ss by #13397, eff
6-18-22
He-M 524.16 Acute and Remote Setting Services.
(a)
Upon request, services in (d) and (e) below shall be provided in an
acute care hospital, only when the parent or guardian is not available and
under the following conditions:
(1)
Identified in an individual’s person-centered service agreement;
(2)
Provided to meet needs of the individual that are not met through the
provision of hospital services;
(3) Not
a substitute for services that the hospital is obligated to provide through its
conditions of participation or under federal or state law, or under another
applicable requirement; and
(4)
Designed to ensure smooth transitions between acute care settings and
home and community-based settings, and to preserve the individual’s functional
abilities.
(b) If services in (d) are provided
pursuant to (c)below, then those services shall be reviewed by the team at the
quarterly meeting to ensure this method of service delivery continues to meet
the individual’s needs.
(c)
Upon request, services in (d) below shall be provided remotely under the
following conditions:
(1)
This method of service delivery meets the assessed needs of the
individual;
(2) The
individual, guardian, or representative chose this method of service delivery;
and
(3)
This method of service delivery is reviewed by the team at the quarterly
meeting to ensure that it continues to meet the individual’s needs.
(d)
Services that may be provided in an acute care
hospital pursuant to (a) above or remote setting pursuant to (c) above shall
include:
(1) In
home residential habilitation;
(2)
Service coordination; and
(3)
Consultative services.
(e)
Services that may be provided in an acute care
hospital pursuant to (a) above shall include:
(1)
Assistive technology;
(2)
Environmental and vehicle modifications;
(3)
Respite services; and
(4)
PERS.
Source. #13397, eff 6-18-22
He-M 524.17 Non-Covered Services. The
following services shall not be funded under He-M 524:
(a) Educational services provided pursuant to
the Individuals with Disabilities Education Improvement Act (IDEIA) of 2004, 20
U.S.C. 1400 et seq.;
(b) Vocational or employment services provided
pursuant to IDEIA;
(c) Room and board;
(d) Custodial care programs;
(e) Services available to individuals birth
through 21 years of age under He-W 546, including early and periodic screening,
diagnosis, and treatment services;
(f) Services
available to individuals birth through 21 years of age under Title IV-E for
foster care ; and
(g) All other Medicaid state plan
services.
Source. #13397, eff 6-18-22 (formerly He-M 524.05)
He-M
524.18 Orienting Families to In-Home Supports. Before
services are delivered to an individual or a family, the area agency staff
shall meet with the individual, family, and representative and provide and
review a participant directed and managed services (PDMS) manual as an overview
of the supports available and available methods of service delivery, and inform
them of the following:
(a) The
services and supports available to the individual and family through He-M 524;
(b) Services
available outside of He-M 524, including other departmental services, community
resources, and institutional alternatives that might be pertinent to the
individual’s and family’s specific situation;
(c) The
benefits and applicable service limits of (a) and (b) above relative to the
family’s needs;
(d) The
features under He-M 524, including:
(1) That services are
directed and managed by the individual or representative;
(2) That a service
agreement is developed to include components listed in He-M 524.20 (a)(3);
(3) Area agency oversight of services provided;
(4) The completion of
criminal background checks on all prospective service providers;
(5) Responsibilities of providers, family members, and
the individual or representative in the provision of services and supports under each method of PDMS;
(6) The flexibility offered to identify possible
providers, including people known to the family such as extended family,
neighbors, or others in the local community; and
(7) The process of
having providers coming into the home environment;
(e) If
applicable, an explanation of alternative approaches to behavioral
intervention, including a description of the theory, practice, strengths, and
expected outcomes of the methods; and
(f) If
applicable, medication administration requirements under He-M 524.21(a)(7).
Source. #13397, eff 6-18-22 (formerly He-M 524.06)
He-M
524.19 Coordination of In-Home Supports.
(a) Once
an individual, family, and representative, choose to participate and the
individual is authorized pursuant to He-M 524.03 to receive services, a service
coordinator shall be chosen or approved by the individual or representative.
(b) Within
30 business days of being chosen by the individual or representative the
service coordinator shall hold the service planning meeting to create a service
agreement in accordance with He-M 524.20.
(c) The serv ice
coordinator shall:
(1) Maximize the
extent to which an individual, family, and representative participate in the
service planning process by:
a. Explaining the individual’s rights;
b. Explaining the service planning process;
c. Eliciting information regarding the
preferences, goals, and service needs of the individual and his or her family;
d. Reviewing
issues to be discussed during service planning meetings; and
e. Inviting
and assisting the family, representative, and individual, if age appropriate,
to determine the following elements in the service planning process:
1. The number and length of meetings;
2. The location and time of meetings;
3. The meeting participants; and
4. The topics to be discussed;
(2) Facilitate the service agreement meeting if the
individual or representative is unable to or chooses not
to select the facilitator of the meeting; and
(3) Document the
service agreement.
(d) If the individual or representative selects
a service coordinator who is not employed by the area agency or a subcontract
agency, the service coordinator and area agency shall enter into an agreement
which describes:
(1) The specific
responsibilities of the service coordinator;
(2) The reimbursement to
the service coordinator; and
(3) The oversight
activities to be provided by the area agency.
Source. #13397, eff 6-18-22 (formerly He-M 524.07)
He-M
524.20 In-Home Supports Service Agreement.
(a) The
service agreement describing services provided pursuant to He-M 524 shall:
(1) Be
developed in accordance with He-M 524.19(b), He-M 503.10, excluding He-M
503.10(c)-(e), and unless otherwise listed below;
(2) Be developed jointly by the
individual, family, representative, providers, service coordinator, and
consultants in accordance with the individual’s interests, preferences, and
needs and the family’s and individual’s or representative’s priorities;
(3) Include the
following:
a. A
list of specific activities to be carried out, including those regarding
safety;
b. The
specific schedule for the provision of services;
c. Name(s)
of the person(s) responsible for providing the services;
d. Specific
documentation requirements;
e. Specific
contingency plans for assuring provision of service when the usual providers
are not available;
f. Emergency
contact information; and
g. An
individualized budget which specifies:
1. Service components;
2. Duration and frequency of services required; and
3. Itemized cost of services;
(4) Be amended at any time by the individual, family,
representative, service providers, service coordinator, and
others involved in the care of the individual through joint discussion, written
revision, and with indication of consent as shown by the signature of the
individual or representative; and
(5) Be reviewed, and if necessary, amended, as required
under (4) above, but at least annually, with:
a. Formal
discussion of the individual’s progress in developing greater independence and
life skills;
b. Documentation
of the family’s, representative’s, and individual’s satisfaction with the
service provision; and
c. Provision
and review of information regarding personal rights and the complaint process.
(b) Within
5 business days of completion of the service agreement, the area agency shall
send the individual, guardian, or representative the following:
(1) A copy of the expanded service agreement signed by
the area agency executive director or designee;
(2) The name, address, and phone number of the service
coordinator or service provider(s) who may be contacted to respond to questions
or concerns; and
(3) A description of
the procedures for challenging the proposed expanded service agreement pursuant
to He-M 524.25 for those situations where the individual, guardian, or
representative disapproves of the expanded service agreement.
(c)
The individual, guardian, or representative shall have 10 business days
from the date of receipt of the expanded service agreement to respond in writing, indicating
approval or disapproval of the service agreement. Unless otherwise
arranged between the individual, guardian, or representative and the area
agency, failure to respond within the time allowed shall constitute approval of
the service agreement.
(d) The
signature page of the service agreement shall document the individual’s or
representative’s informed consent and
that the individual or representative has been fully informed of community and
institutional service alternatives and of the right to a hearing, as defined in
He-C 201.02 (i), to dispute any component of the service agreement.
(e) If
either the individual or representative, or area agency executive director, or
designee, disapproves of the service agreement or an amendment proposed
pursuant to (a)(4) above, the dispute shall be resolved:
(1) Through informal discussions among
the individual, family, representative, service coordinator, and area agency
executive director;
(2) By reconvening a
service planning meeting;
(3) By the
individual or representative filing a complaint pursuant to He-M 202; or
(4) By filing a formal appeal pursuant to
He-M 524.25.
(f) When the service agreement has been approved by the
individual, guardian, or representative and area agency director, the services
shall be implemented and monitored as follows:
(1) A person
responsible for implementing any part of an expanded service agreement,
including goals and support services, shall collect and record information
about services provided and summarize progress as required by the service
agreement or, at a minimum, monthly;
(2) On at least a
monthly basis, the service coordinator shall visit or have verbal or video call
contact with the individual or persons responsible for implementing an expanded
service agreement and document these contacts;
(3) The service
coordinator shall visit the individual and contact the guardian, if any, in
person or through a video call at least quarterly, or more frequently
if so specified in the individual’s expanded service agreement, to
determine and document:
a. Whether
services match the interests and needs of the individual;
b. Individual
and guardian satisfaction with services;
c. Progress
on the goals in the expanded service agreement; and
d. The utilization of allocated funds.
(4) At least
2 of the service coordinator’s quarterly visits with the individual shall be
conducted in person in the home where the individual resides.
Source. #13397, eff 6-18-22 (formerly He-M 524.08)
He-M
524.21 Administrative Requirements.
(a) When
in-home supports are provided, the area agency shall, in collaboration with the
individual or representative and family and, if applicable, the subcontract
agency, specify the roles of the area agency, family, individual or
representative, and subcontract agency in service planning, service provision,
and oversight including:
(1) Implementation of
the service agreement;
(2) Specific
training and supervision requirements for service providers;
(3) Compensation
amounts and procedures for paying providers;
(4) Oversight of
the service provision, as required by the service agreement;
(5) Documentation of
compliance with He-M 524.21 through He-M 524.24;
(6) Employer
services provided by the area agency, subcontract agency, or other person or
entity to facilitate the delivery of in-home supports;
(7) Compliance with applicable laws and rules, including
delegation of medication administration and other nursing-related tasks by a nurse to unlicensed providers pursuant to Nur
404 or He-M 1201;
(8) The provision of service coordination; and
(9) Procedures for
review and revision of the service agreement as deemed necessary by any of the
parties.
(b) When
an individual or representative chooses in-home supports to be provided by an
entity other than the area agency or subcontract agency, the area agency shall:
(1) Discuss items specified under (a) above with the
individual, representative, and family to enable them to
make an informed decision regarding the roles and responsibilities of the
family and providers; and
(2) Establish a contract with the individual or
representative that specifies the parties responsible for the items under (a) above.
(c) The
individual or representative and the area agency shall develop an
individualized budget that includes:
(1) The
specific service components;
(2) The frequency and duration of the services
required;
(3) An itemized cost
of services; and
(4) The frequency at which budget reports pursuant to (e) below
will be provided by the area agency or subcontractor to the individual or
representative.
(d) The
individual or representative and the area agency shall develop a job
description for providers that outlines the expectations and responsibilities
of the provider.
(e) As
a part of the service provision, the area agency or subcontract agency shall
establish a budget reporting mechanism, detailing expenditures to date and the
amount remaining in the budget, to assist the individual or representative to
manage the individual’s budget.
Source. #13397, eff 6-18-22 (formerly He-M 524.09)
He-M
524.22 Qualifications and Training.
(a) Providers
who are not a member of the individual’s family shall:
(1) With respect to qualifications and training, meet
the requirements specified in the service agreement and,
if applicable, medication administration requirements under He-M 524.21 (a)(7);
(2) Meet the
educational qualifications, or the equivalent combination of education and
experience, identified in the job description;
(3) Supply at
least one reference;
(4) Meet
certification and licensure requirements of the position, if any; and
(5) Be either:
a. A minimum of 18 years of age; or
b. With the agreement of the individual or
representative, and area agency, ages 15 through 17.
(b) All
providers, including providers who are family members, shall, prior to a final
hiring decision, be required by the employer to consent to:
(1) A New Hampshire
criminal records check no more than 30 days prior to hire;
(2) If the provider’s primary residence is out of state, a criminal
records check for their state of residence;
(3) If the provider has resided in New
Hampshire for less than one year, a criminal records check for their previous
state of residence; and
(4) A check of the state
registries of founded reports of abuse, neglect, and exploitation, as
established by RSA 161-F:49 and RSA 169-C:35.
(c) Except as
allowed in (d) and (e) below, an employer shall not hire a person:
(1) Who has a:
a. Felony
conviction; or
b. Any
misdemeanor conviction involving:
1. Physical or sexual assault;
2. Violence;
3. Exploitation;
4. Child pornography;
5. Threatening or reckless conduct;
6. Theft;
7. Driving under the influence of drugs or alcohol; or
8. Any other conduct that represents evidence of behavior that
could endanger the well-being of an individual; or
(2) Whose name is on either of the state registries of
founded abuse, neglect, and exploitation as established by RSA 161-F:49 and RSA
169-C:35.
(d) An employer may hire a person with a
criminal record listed in (c)(1)a. or b. above for a single offense that
occurred 10 or more years ago in accordance with (e) and (f)
below. In such instances, the individual, his or her guardian if
applicable, and the area agency shall review the person’s history prior to
approving the person’s employment.
(e) Employment of a
person pursuant to (d) above shall only occur if such employment:
(1) Is approved by the individual, his or her guardian
if applicable, and the area agency;
(2) Does not
negatively impact the health or safety of the individual; and
(3) Does not
affect the quality of services to the individual.
(f) Upon hiring a person pursuant to (d) and (e)
above, the employer shall document and retain the following information in the
individual’s record:
(1) The date(s) of
the approvals in (e) above;
(2) The name of the individual for whom the person will
provide services;
(3) The name of the person hired;
(4) Description of
the person’s criminal offense;
(5) The type of
service the person is hired to provide;
(6) The employer’s name
and address;
(7) A full explanation of why the employer is hiring
the person despite the person’s criminal record;
(8) Signature of the individual, or of the legal
guardian(s) if applicable, indicating agreement with the employment and date signed;
(9) Signature of
the staff person who obtained the individual’s or guardian’s signature and
date signed;
(10) Signature of
the area agency’s executive director or designee approving the employment; and
(11) The signature and phone number of the person being
hired.
(g) For
the purposes of (b) above, the area agency shall be the employer for parents
paid to provide in-home residential habilitation.
(h) The
employer shall provide information regarding the staff development elements
identified in He-M 506.05 to assist the individual or representative in making
informed decisions with respect to orientation and training of non-family staff
and providers.
(i) Subsequent
to (h) above, and consistent with the area agency or subcontract agency’s
personnel policies, the employer shall ensure that non-family staff and
providers receive the orientation and training selected by the individual or
representative.
(j) The
service coordinator shall:
(1) For individuals aged
3 and over, comply with He-M 503.08(e) and (f); or
(2) For individuals under
age 3, comply with He-M 510.02 (ak) and He-M 510.11(j).
(k) When
an individual or representative chooses in-home supports to be provided by a
family member, the employer shall require the individual or representative to
submit documentation describing any orientation and training provided to the
family member.
(l) Providers of assistive technology, in accordance with
He-M 524.10, shall have specialized training relative to the specific item of
assistive technology.
(m) Providers of
consultative services, in accordance with He-M 524.07, shall meet one of the
following qualifications:
(1) Be
a psychiatrist, psychologist, or other provider that requires a license and
hold a valid license issued by the appropriate licensing board;
(2) For
other disability professionals who do not require professional licensure as
specified in (1) above, have specialized knowledge in the subject matter they
are providing consultative services for; or
(3) A master’s level clinical degree with
expertise and experience to provide supports to individuals with developmental
disabilities who are at risk for unsafe sexual behaviors or arson.
(n) Providers of
environmental or vehicle modifications in accordance with He-M 524.09
shall have any license,
certificate, or permit as required by state law or local ordinance for the
particular modification provider.
(o) Providers of non-medical transportation in accordance with He-M 524.13 shall:
(1) Have a current driver’s license;
(2) Consent to a New Hampshire driving record
check completed by the employer within 30 days or providing transportation; and
(3) Provide proof of automobile
insurance.
Source. #13397, eff 6-18-22 (formerly He-M 524.10)
He-M
524.23 Quality
Assessment.
(a) The
service coordinator shall conduct visits and contacts as established in the
service agreement pursuant to 524.20 (f) and document the individual’s, family’s,
and representative’s satisfaction with:
(1) Staff and
providers such as their availability, compatibility, and adherence to the
provisions of the service agreement;
(2) Progress on
achieving the outcomes specified in the service agreement;
(3) Communication
among the individual, family, area agency, and providers;
(4) The individual’s health and safety supports as
identified in the service agreement; and
(5) The utilization of
allocated funds.
(b) The
bureau shall assess compliance with He-M 524 by reviewing documentation at the
area agency of the provision of in-home supports
during redesignation of area agencies pursuant to He-M 505.08.
Source. #13397, eff 6-18-22 (formerly He-M 524.11)
He-M
524.24 Documentation. For
each individual served, the provider, staff, or family member shall document
and maintain at the area agency a record containing the following:
(a) A
weekly schedule indicating the type
and duration of specific in-home supports provided;
(b) The
service agreement, in accordance He-M
524.20;
(c) The
individualized budget;
(d) Provider
or staff progress notes written at least monthly, or more frequently if so
specified in the service agreement;
(e) The
applicable contract as specified in He-M 524.21 (b)(2);
(f) Relevant evaluations including the health risk screening tool (HRST), supports
intensity scale for individuals over the age of 16, and a current
individualized education plan (IEP); and
(g) Any other documentation required by the area agency or individual or
representative and specified in the service agreement.
Source. #13397, eff 6-18-22 (formerly He-M 524.12)
He-M
524.25 Appeals.
(a) An
individual or representative may choose to pursue informal resolution
to resolve any disagreement with an area agency, or, within 30 business days of
the area agency decision, she or he may choose to file a formal appeal pursuant
to (e) below. Any determination, action, or inaction by an area
agency may be appealed by an individual or representative.
(b) The following actions
shall be subject to the notification requirements of (c) below:
(1) Adverse
eligibility actions under He-M 524.03;
(2) Area agency disapproval of service agreements or proposed
amendments to service agreements pursuant to He-M 524.20 (b); and
(3) Denial of services by
the bureau pursuant to He-M 524.26 (c).
(c) The bureau or an area agency shall provide written and verbal notice
to the applicant and representative of the actions specified in (b) above,
including:
(1) The specific rules that support, or the federal or
state law that requires, the action;
(2) Notice of the
individual’s right to appeal in accordance with He-C 200 within 30 days and the
process for filing an appeal, including the contact information to initiate the
appeal with the bureau administrator;
(3) Notice of the individual’s continued
right to services pending appeal, when applicable, pursuant to (g) below;
(4) Notice of
the right to have representation with an appeal by:
a. Legal counsel;
b. A relative;
c. A friend; or
d. Another spokesperson;
(5) Notice that neither the area agency nor the bureau
is responsible for the cost of representation;
(6) Notice of
organizations with their addresses and phone numbers that might be
available to provide legal assistance and advocacy, including the Disabilities
Rights Center and pro bono or reduced fee assistance; and
(7) Notice of individual’s right to request a second
formal risk assessment from a qualified evaluator.
(d) Appeals shall be submitted, in writing, to the bureau administrator in
care of the department’s office of client and legal services within 30 days
following the date of the notification of an area agency’s
decision. An exception shall be that appeals may be filed verbally
if the individual is unable to convey the appeal in writing.
(e) The
office of client and legal services
shall immediately forward the appeal to the department’s administrative appeals
unit which shall assign a presiding officer to conduct a hearing, as provided
in He-C 200. The burden shall be as provided by He-C 203.14.
(g) If
a hearing is requested, the following
actions shall occur:
(1) For current recipients, services and payments shall
be continued as a consequence of an appeal for a hearing until a decision has
been made; and
(2) If the bureau’s or area agency’s decision is
upheld, benefits shall cease 60 days from the date of the denial letter or 30 days from the hearing decision, whichever is later.
Source. #13397, eff 6-18-22 (formerly He-M 524.13)
He-M
524.26 Funding and Payment.
(a) Area
agencies shall submit to the bureau a proposed individualized budget for each
individual requesting services under He-M 524. The
proposed budget shall contain detailed line item information regarding all
services to be requested.
(b) The
bureau shall review the proposed budget and issue a response within 10 business
days from the date of request.
(c) For
each request an area agency makes for funding individual services under He-M
524, the bureau shall make the final
determination on the cost effectiveness of requested services.
(d) Based on an individualized budget approved by the bureau and service
agreement approved by the individual or representative, the area
agency shall request a prior authorization from the bureau.
(e) Requests for prior authorization shall include the documentation in
(d) above and be submitted to:
Bureau
of Developmental Services
Hugh J. Gallen State Office
Park
105
Pleasant Street
Concord, NH 03301
(f)
If information submitted pursuant to (e) above, or similar information
obtained at any other time by the bureau, indicates that an individual might no
longer meet the criteria for home and community-based care specified in He-M
524.03 the bureau shall re-determine the individual’s eligibility pursuant to
He-M 524.03 above.
(g) Once an area agency obtains a prior authorization from the bureau, it
shall submit claims for in-home supports electronically to the Medicaid
Management Information System.
(h) Payment for in-home supports shall only be made if prior authorization
has been obtained from the bureau.
(i)
The bureau shall approve requests for prior authorization that meet the
criteria in (j)-(k) below.
(j) Payment for in-home supports shall not be available to any service
provider who:
(1) Is a person under
age 18, except as specified in He-M 524.22(b)(2); or
(2) Is the
spouse of an individual receiving services.
(k) Payment
for provision of in-home residential habilitation shall be available to the
parent of an individual receiving in-home supports when the
following apply:
(1) The individual has
at least one of the following factors:
a. The
individual’s level of dependency in performing activities of daily living,
including the need for assistance with toileting, eating, or mobility, exceeds
that of his or her developmentally disabled peers as determined by a nationally
recognized standardized functional assessment tool;
b. The
individual requires support for a complex medical condition, including airway
management, enteral feeding, catheterization, or other similar procedures; or
c. The
individual’s need for behavioral management exceeds that of his or her
developmentally disabled peers, as determined by a nationally recognized
standardized behavioral assessment tool, and the child’s destructive or
injurious behavior represents a risk for serious injury or death;
(2) The
parent has at least one of the following factors:
a. The
parent has exhausted all options for obtaining in-home support assistance due
to the lack of availability of qualified providers, as exemplified in (l)
below; or
b. The
child’s need for care has an imminent, negative effect on a parent’s ability to
maintain paid employment; and
(3) The
parent meets all applicable provider qualifications pursuant to He-M 524.22 and
all documentation requirements of He-M 524.24.
(l) Examples of lack of availability of qualified providers shall include the
following:
(1) A family lives
in a rural or remote area and cannot secure providers;
(2) The extensive medical or behavioral needs of the
child prevent the recruiting and maintaining of providers;
(3) A family whose
cultural background is different from the culture of the overall pool of
providers cannot secure providers who demonstrate cultural competence;
(4) A family’s work
schedule requires that providers be available during evening, overnight,
weekend, and holiday hours, thus making it difficult to retain providers;
(5) A family’s needs
are such that no provider agency can be identified or is available to provide
the required service; and
(6) Any other
circumstance or condition of a parent or child or of local provider agencies
that results in a family being unable to obtain in-home support assistance.
(m) The
area agency shall administer payments to parents for in home residential
habilitation and submit requests for parent payment
to BDS for prior authorization.
(n) Payments to
parents under (k) above shall apply solely to the provision of in home
residential habilitation services.
(o) When
a parent is paid to provide in-home residential habilitation, the number of
hours for which a parent will receive
payment shall be specified in the service agreement.
Source. #13397, eff 6-18-22 (formerly He-M 524.14)
He-M 524.27 Waivers.
(a) An
area agency, subcontract agency, individual, representative, or provider may
request a waiver of specific procedures outlined in He-M 524 using the form
titled “NH Bureau of Developmental Services Waiver Request” (July
2019). The area agency shall submit the request in writing to the
bureau administrator.
(b) A completed waiver
request form shall be signed by:
(1) The
individual or representative indicating agreement with the request; and
(2) The area
agency’s executive director or designee recommending approval of the waiver.
(c) A waiver request shall be submitted to:
Bureau
of Developmental Services
Hugh J. Gallen State Office
Park
105
Pleasant Street, Main Building
Concord, NH 03301
(d) No provision or procedure prescribed by statute shall be
waived.
(e) The request for
a waiver shall be granted by the commissioner or his or her designee within 30
days if the alternative proposed by the area agency, subcontract agency, individual,
representative, or provider meets the objective or intent of the rule and it:
(1) Does not negatively impact the health or safety of
the individual(s); and
(2) Does not affect the quality of services to
individuals.
(f) The determination on the request for a waiver
shall be made within 30 days of the receipt of the request.
(g) Upon receipt
of approval of a waiver request, the grantee’s subsequent compliance with the
alternative provisions or procedures approved in the waiver shall be considered
compliance with the rule for which waiver was sought.
(h) Waivers shall be granted in writing for a specific duration not to
exceed 5 years except as in (i) below.
(i) Those
waivers which relate to issues relative to the health, safety, or welfare of
individuals that require periodic reassessment shall be
effective for a one-year period only.
(j) Any
waiver shall end with the closure of
the related program or service.
(k) An
area agency, subcontract agency,
individual, representative, or provider may request a renewal of a waiver from
the department. Such request shall be made at least 90 days prior to
the expiration of a current waiver.
Source. #13397, eff 6-18-22 (formerly He-M 524.15)
PART He-M 525 PARTICIPANT DIRECTED AND MANAGED SERVICES
Statutory Authority: New
Hampshire RSA 171-A:3; RSA 171-A:18, IV; RSA 137-K:3, IV
He-M 525.01 Purpose and Scope.
(a)
The purpose of these rules is to establish minimum standards for
participant directed and managed services for individuals who have a
developmental disability or acquired brain disorder.
(b)
Participant directed and managed services (PDMS) enable individuals who
have a developmental disability or acquired brain disorder to direct their
services and to experience, to the greatest extent possible, independence,
community inclusion, employment, and a fulfilling home life, while promoting
personal growth, responsibility, health, and safety.
(c)
These rules shall not apply to individuals who receive services under
He-M 524, in-home supports.
(d)
Nothing in these rules shall supersede the provisions of He-M 503.08
regarding service guarantees for persons with developmental disabilities.
Source. #9391, eff 2-21-09; ss by #9890-A, eff
3-22-11; ss by #12859, eff 8-28-19
He-M
525.02 Definitions.
(a)
“Area agency” means “area agency” as defined under RSA 171-A:2, I-b.
(b)
“Area agency director” means that person who is appointed as executive
director or acting executive director of an area agency by the area agency’s
board of directors.
(c)
“Bureau” means the bureau of developmental services of the department of
health and human services.
(d)
“Bureau administrator” means the chief administrator of the bureau of
developmental services.
(e)
“Department” means the New Hampshire department of health and human
services.
(f)
“Developmental disability” means “developmental disability” as defined
in RSA 171-A:2,V, namely, “a disability:
(a) Which is attributable to intellectual
disability, cerebral palsy, epilepsy, autism or a specific learning disability
or any other condition of an individual found to be closely related to an
intellectual disability as it refers to general intellectual functioning or
impairment in adaptive behavior or requires treatment similar to that required
for persons with an intellectual disability; and
(b) Which originates before such individual
attains age 22, has continued or can be expected to continue indefinitely, and
constitutes a severe disability to such individual’s ability to function
normally in society.”
(g)
“Direct and manage” means to be actively involved in all aspects of the
service arrangement, including:
(1) Designing the services;
(2) Selecting the service providers;
(3) Deciding how the authorized funding is to be
spent based on the needs identified in the individual’s service agreement; and
(4) Performing ongoing oversight of the services
provided.
(h)
“Employer” means an area agency or subcontract agency or person that
handles legally defined and other employer-related functions such as, but not
limited to:
(1) Paying employer taxes;
(2) Withholding employee taxes;
(3) Performing other payroll functions, including
issuing paychecks;
(4) Providing workers’ benefits; and
(5) Obtaining workers’ compensation and liability
insurance.
(i)
“Family” means a group of 2 or more persons related by ancestry,
marriage, or other legal arrangement that has at least one member who has a
developmental disability or acquired brain disorder.
(j)
“Guardian” means a person appointed pursuant to RSA 547-B, RSA 463, or
RSA 464-A or the parent of a child under the age of 18 whose parental rights
have not been terminated or limited by law.
(k)
“Home provider” means a person who is under contract with the area
agency, a subcontract agency, or another entity and who is responsible for
providing services to an individual in the provider’s home.
(l)
“Individual” means a person who is eligible for developmental services
or services for acquired brain disorder pursuant to He-M 503 or He-M 522.
(m)
“Informed decision” means “informed decision” as defined in RSA 171-A:2,
XI.
(n)
“Nursing-related tasks” means those nursing services that are delegated
to unlicensed personnel and:
(1) That are routine in nature;
(2) That do not require nursing judgment;
(3) That pose little risk to the individual if
done inappropriately or incorrectly; and
(4) Whose outcomes are stable and predictable.
(o)
“Participant directed and managed services (PDMS)” means services
provided pursuant to He-M 525 whereby the individual or representative, if
applicable, directs and manages the services as defined in (g) above. Services include assistance and resources to
individuals in order to maintain or improve their skills and experiences in
living, working, socializing, and recreating.
(p)
“Provider” means a person receiving any form of remuneration for the
provision of services to an individual.
(q)
“Representative” means:
(1) The parent or guardian of an individual under
the age of 18;
(2) The legal guardian of an individual 18 or
over; or
(3) A person who has power of attorney for the
individual.
(r)
“Respite” means the provision of short-term care, in accordance with
He-M 513, for an individual in or out of the individual’s home for the
temporary relief and support of the family with whom the individual lives.
(s)
“Service coordinator” means a person who meets the criteria in He-M
503.08(e) – (f) and is chosen or approved by an individual and his or her
guardian or representative and designated to organize, facilitate, and document
service planning and to negotiate and monitor the provision of the individual’s
services and who is:
(1) An area agency service coordinator, family
support coordinator, or any other area agency or subcontract agency employee;
(2) A member of the individual’s family;
(3) A friend of the individual; or
(4) Any other person chosen by the individual.
(t)
“Sheltered workshop” means a program run by an area agency or a
subcontract agency, person, or entity that provides a segregated work
environment.
(u)
“Staff” means a person employed by an area agency, subcontract agency,
or other employer.
(v)
“Staffed home” means a residence owned or leased by an area agency or
subcontract agency exclusive of any independent living arrangement where
supports are provided to the individual.
(w)
“Subcontract agency” means an entity that is under contract with any
area agency to provide services to individuals who have a developmental
disability or acquired brain disorder.
(x)
“Team” means that group that participates in service planning and review
meetings and includes the individual and his or her service coordinator and
representative and others invited by the individual.
Source. #9391, eff 2-21-09; ss by #9890-A, eff
3-22-11; ss by #12859, eff 8-28-19
He-M 525.03 Eligibility.
(a)
PDMS shall be open to any individual who:
(1) Is eligible and has funding for services
pursuant to He-M 503 or He-M 522; and
(2) Wishes to direct, or whose representative
wishes to direct, his or her services.
(b)
PDMS shall not be used in congregate service arrangements or programs
where individuals, families, or guardians do not direct and manage the services
and approved funding pursuant to He-M 525.02 (g) and there is a per diem
payment made to the provider rather than a budget that is available to the
individual, family, or guardian to manage.
(c)
Individuals who receive services under He-M 524 shall not be eligible
for services under this part.
(d)
A person shall not be eligible to receive payment for providing services
under He-M 525 if he or she is the spouse of the individual.
(e) PDMS shall not be available for an individual
with the following:
(1) Incident(s) of behaviors that pose a risk to
community safety with or without police or court involvement, or a history of
civil commitment under RSA 171-B;
(2) A formal risk assessment conducted within the
past year by a N.H. licensed psychologist or psychiatrist that finds the
individual poses a moderate or high risk to community safety and includes
recommendations on the level of security, services, and treatment necessary for
the individual; and
(3) Concurrence from the area agency’s human
rights committee, established pursuant to RSA 171-A:17, I, that services under
He-M 525 would not provide the degree of security, services, or treatment
needed by the individual.
(f)
Upon a positive finding pursuant to (e)(2) above, the individual may
obtain a second opinion from a New Hampshire licensed psychologist or
psychiatrist.
(g)
The human rights committee shall consider the findings of the assessment
conducted in (f) above.
(h)
If a human rights committee convenes pursuant to (e)(3) or (g) above,
the committee shall meet, if requested, with the individual and the
individual’s representative.
Source. #9391, eff 2-21-09; ss by #9890-A, eff
3-22-11; ss by #12859, eff 8-28-19
He-M 525.04 Non-Covered
Services. The following services
shall not be fundable under this part:
(a) Custodial care programs provided only to
maintain the individual’s basic welfare;
(b) Educational services or education programs
for individuals under 21 years of age for which school districts are
responsible;
(c) Sheltered workshops; and
(d) Services not related to supports required
because of an individual’s developmental disability or acquired brain disorder.
Source. #9391, eff 2-21-09; ss by #9890-A, eff
3-22-11; ss by #12859, eff 8-28-19
He-M 525.05 Service Principles.
(a)
PDMS shall promote the individual’s and his or her representative’s
involvement, choice, and control in all levels of planning, provision, and
monitoring of services.
(b)
Individuals who are involved in PDMS may identify others of their choice
to assist them in directing their services.
(c)
PDMS shall:
(1) Be tailored to the individual’s competencies,
interests, preferences, and needs;
(2) Promote the health, safety, and emotional
well-being of the individual;
(3) Be provided in a manner which protects the
individual’s rights as described in He-M 202 and He-M 310; and
(4) Provide the degree of support an individual
needs to direct services, increase his or her level of independence, and
advocate for himself or herself.
(d)
PDMS that support families who are caring for their family members
shall:
(1) Respect each family’s values, beliefs, and
traditions; and
(2) Recognize and draw on each family’s strengths
and competencies.
(e)
For an individual who is 21 years of age or older, PDMS shall include
supports identified in the service agreement, such as:
(1) Personal care, employment supports, adult
basic education, and avocational and leisure activities;
(2) Adaptations through environmental and vehicle
modifications and assistive technology;
(3) Services that assist the individual to
acquire and maintain life skills in such areas as personal safety, meal
preparation, and budgeting;
(4) Services that, based on the individual’s
preferences, broaden his or her life experiences through social, artistic, and
spiritual expression;
(5) Respite and family support services that meet
the needs of individuals living with their families;
(6) Provider training including, at a minimum:
a. Individual rights; and
b. Universal precautions and other
nursing-related tasks;
(7) Consultations and assessments; and
(8) Services needed, but not currently available.
(f)
For an individual who is under the age of 21, PDMS shall include
supports identified in the service agreement for the individual and his or her
family, such as:
(1) Respite;
(2) Environmental and vehicle modifications, and
assistive technology;
(3) Provider training including, at a minimum:
a. Individual rights; and
b. Universal precautions and other
nursing-related tasks;
(4) Consultations and assessments; and
(5) The following, to the extent that they are
not the responsibility of the school district to provide:
a. Transition planning;
b. After school supports; and
c. Acquisition and maintenance of life skills,
such as:
1. Preparing meals;
2. Budgeting;
3. Obtaining and maintaining employment;
4. Socializing; and
5. Maintaining personal safety.
(g)
The area agency or subcontract agency shall discuss options for service
provision with the individual and representative.
(h)
The individual or representative shall select the provider and staff to
deliver PDMS based on the discussion of options required in (g) above.
(i)
When the individual or representative opts for services that are to be
provided by a person or an entity other than the area agency or a subcontract
agency:
(1) The area agency shall hire the person or
contract with the person or entity, consistent with the area agency’s or
subcontract agency’s personnel policies; or
(2) The individual or representative may choose
to hire or contract with the person or entity.
(j)
If the individual or representative chooses to hire or contract with the
person or entity:
(1) The area agency shall:
a. Approve the identified person or entity;
b. Discuss with the individual and
representative each party’s responsibilities regarding service planning,
provision, and oversight; and
c. Establish a contract with the individual or
representative regarding service planning, provision, and oversight; and
(2) The individual or representative shall give
to the area agency a copy of any contract established with a contractor
pursuant to (i)(2) above.
(k)
In those situations where the area agency does not approve the
individual’s or representative’s selection of a person or entity, the area
agency shall:
(1) Provide, in writing, the reasons why the area
agency will not hire, contract with, or approve the person or entity;
(2) Advise the individual or representative in
writing and verbally of his or her appeal rights under He-M 525.11; and
(3) Assist the individual or representative in
selecting another person or entity to provide the services, as needed.
Source. #9391, eff 2-21-09; ss by #9890-A, eff
3-22-11; ss by #12859, eff 8-28-19
He-M 525.06 Administrative, Service, and Personnel
Requirements.
(a)
Service planning shall be conducted in accordance with He-M 503.09.
(b)
The service coordinator shall assist the individual and representative
and other persons chosen by the individual to develop a written service
agreement in accordance with the principles outlined in He-M 525.05, signed by
the individual or representative and the area agency director or designee, that
includes the following:
(1) A brief description of the individual’s
strengths, needs, and interests, as applicable;
(2) The individual’s clinical and support needs
as identified through current evaluations and assessment;
(3) The specific services to be furnished and the
goal associated with each service;
(4) The amount, frequency, duration, and desired
outcome of each service;
(5) Timelines for initiation of services;
(6) The provider to furnish the services;
(7) The individual’s need for guardianship, if
any;
(8) Service documentation requirements for
tracking outcomes and service provision, including the type of documentation;
(9) Identification of the person or entity
responsible for monitoring the plan;
(10) The frequency of service coordinator visits
with the individual and contact with the representative pursuant to He-M 525.08
(a) and (b);
(11) An individualized budget pursuant to (g)
below; and
(12) If medication is administered, provision for
compliance with (k)(5) below.
(d)
Requirements for documentation of service provision shall be specified
in the service agreement and include, at minimum:
(1) The
dates services are provided; and
(2) Reports on progress toward achieving desired
outcomes.
(e)
Service agreements shall be renewed at least annually and include a
review of guardianship.
(f)
Amendments to the service agreement may be made at any time. Amendments shall be documented by the service
coordinator with the approval of the individual or representative and the area
agency director or designee.
(g)
The individual or representative and the area agency shall develop an
individualized budget that includes:
(1) The specific service components;
(2) The frequency and duration of the services
required;
(3) An itemized cost of services; and
(4) The frequency at which budget reports will be
provided by the area agency or subcontractor to the individual or
representative pursuant to (h) below.
(h)
In providing services, the area agency or subcontract agency shall
establish a budget reporting mechanism, detailing expenditures to date and the
amount remaining in the budget, to assist the individual -and representative to
manage his or her budget.
(i)
When PDMS are to be provided by a subcontract agency of the area agency,
one of the following shall apply:
(1) The individual or representative shall
establish an agreement with the subcontract agency; or
(2) The area agency shall establish a contract
with the subcontract agency for service provision and oversight.
(j)
Agencies providing PDMS shall have policies regarding:
(1) Administration of medication, pursuant to
(k)(5) below; and
(2) Individual rights in accordance with He-M 202
and He-M 310.
(k)
For individuals who are 21 years of age or older, the following shall
apply:
(1) Unless otherwise requested by the individual
or representative the area agency or a subcontract agency shall be the
employer;
(2) When the individual or representative
requests to be the employer or designates an entity to perform that function
that is not a subcontractor of an area agency, the area agency shall identify
and review with the individual and representative the responsibilities
referenced in (3) below;
(3) Prior to hiring or contracting with a staff
or provider, the individual, representative, or area agency or subcontract
agency that intends to contract with a provider, shall:
a. Submit the name of the person and all other
persons residing in the home of a non-family provider for review against the
registry of founded reports of abuse, neglect, and exploitation to ensure that
the person is not on the registry pursuant to RSA 169-C:35 or RSA 161-F:49;
b. Complete a criminal records check in New
Hampshire, no more than 30 days prior to contracting with the person to ensure
that he or she and all other persons residing in the home of a non-family
provider have no history of fraud, felony, or misdemeanor conviction;
c. Complete a criminal records check for the
person’s state of residence if it is not New Hampshire to ensure that the
person and all other persons residing in the home of a non-family provider have
no history of fraud, felony, or misdemeanor conviction;
d. Complete a criminal records check for the
person’s previous state of residence if he or she has resided in New Hampshire
for less than one year to ensure that the person and all other persons residing
in the home of a non-family provider have no history of fraud, felony, or
misdemeanor conviction;
e. Provide information obtained pursuant to (3)
a. above to the area agency;
f. Obtain at a minimum one reference on each
prospective staff or non-family provider;
g.
Provide proof of insurance coverage, including general liability and workers’
compensation, to the area agency; and
h. Comply, as applicable, with all
employer-employee legal requirements such as wage reporting and tax
withholding;
(4) An individual, representative, area agency,
or subcontract agency may hire a person with a criminal record listed in (3)
b.-d. above for a single offense that
occurred 10 or more years ago in accordance with (5) and (6) below. In such instances, the individual, his or her
guardian, if applicable, the area agency, and the subcontract agency, if
applicable, shall review the person’s history prior to approving the person’s
employment;
(5) Unless a waiver is granted pursuant to (6)
below, an individual, representative, area agency, or subcontract agency shall
not hire a person with a criminal record, other than as specified in (4) above;
(6) The department may grant a waiver of (5)
above if, after reviewing the underlying circumstances, it determines that the
person does not pose a threat to the health, safety, or well-being of
individuals;
(7) Employment of a person pursuant to (4) above
shall only occur if such employment:
a. Is approved by the individual, his or her
guardian if applicable, the area agency, and the subcontract agency if
applicable;
b. Does not negatively impact the health or
safety of the individual(s); and
c. Does not affect the quality of services to
individuals;
(8) Upon the hiring of a person pursuant to (4)
above, the area agency shall document and retain the following information in
the individual’s record:
a. The dates of the approval in (4) above;
b. The name of the person hired;
c. The description of the person’s criminal
offense;
d. The type of service the person is hired to
provide;
e. The subcontract agency’s name and address, if
applicable;
f. A full explanation as to why the individual,
representative, or agency is hiring the person despite the person’s criminal
record;
g. The signature of the individual, guardian, or
representative indicating agreement with the employment and the date signed;
h. The signature of the area agency
representative approving the employment; and
i. The signature and phone number of the person
being hired;
(9)
All personnel shall sign a statement annually, which shall be maintained
in the personnel file, stating that since the time of hire they:
a. Have not been convicted of a felony or
misdemeanor in this or any other state; and
b. Have not had a finding by the department or
any administrative agency in this or any other state for assault, fraud, abuse,
neglect, or exploitation of any person;
(10) Medication administration shall:
a. Comply with He-M 1201 or Nur 404 except in
situations where the individuals are living with their families and receiving
respite arranged by the family; or
b.
When performed by family members paid under He-M 525, include discussion
between the area agency or subcontract agency and the family about any concerns
the family might have regarding medication administration;
(11) Provision of nursing-related tasks shall:
a.
Comply with Nur 404 except in situations where individuals are living
with their families and receiving respite arranged by the family; or
b.
When performed by family members paid under He-M 525, include discussion
between the area agency or subcontract agency and the family about concerns the
family might have regarding the provision of nursing-related tasks;
(12) Staff and providers who are not family
members shall:
a.
Meet the educational qualifications, or the equivalent combination of
education and experience, identified in the job description;
b.
Meet the certification and licensing requirements of the position, if
any; and
c.
Be 18 years of age or older;
(13) The employer, when not the individual or
representative, shall provide information to the individual and representative
regarding the staff development elements identified in He-M 506.05 to assist
him or her in making informed decisions with respect to orientation and
training of staff and providers; and
(14) Subsequent to (13) above and consistent with
the area agency’s or subcontract agency’s personnel policies, the employer
shall ensure that the staff and providers receive the orientation and training
selected by the individual or representative.
(l)
In addition to complying with (k) above, when an individual is 21 years
of age or older and lives in a staffed home:
(1) The home shall comply with applicable local
and state health, zoning, building, and fire codes;
(2) The physical layout and environment of the
home shall meet the health and safety needs of the individual;
(3) A signed statement from the local fire
official shall be obtained before the individual moves into the home:
a.
Verifying that the home complies with all state and local fire codes;
and
b.
Specifying the number of beds that can safely be occupied by individuals
living in the home; and
(4) Quarterly fire drills in the home shall be
conducted and documented such that:
a.
One drill per year shall be conducted during sleep hours; and
b.
The first drill shall be conducted no more than 5 days after the
individual has moved into the home.
(m)
In addition to complying with (k) above, when an individual is 21 years
of age or older and lives with a home provider who is not a family member, the
home shall have:
(1) An integrated fire alarm system with a
functioning smoke detector in each bedroom and on each level of the home
including the basement and attic, if the attic is used as living or storage
space;
(2) A functioning septic or other sewage disposal
system;
(3) A source of potable water for drinking and
food preparation, such that, if the water for drinking and food preparation is
not from a public water supply:
a. At the time of the initial certification
there shall be well water test results less than 2 years old that indicate the
water is potable; or
b. There shall be documentation that bottled
water is used; and
(4) Two means of egress.
(n)
If the home in which supports are provided is not owned by a family
member, a fire safety assessment shall be conducted by staff in a staffed home
or a home provider, when not a family member, to address the individual’s
following risk factors:
(1) Response to alarm;
(2) Response to instructions;
(3) Vision and hearing difficulties;
(4) Impaired judgment;
(5) Mobility problems; and
(6) Resistance to evacuation.
(o)
Based on the findings of the fire safety assessment, the individual and
other members of his or her team shall develop a fire safety plan that
addresses fire drill frequencies, procedures to achieve evacuation within 3
minutes, and other fire safety related strategies determined by the team to be
applicable.
(p)
When an individual’s service agreement specifies unsupervised time and
the provider is not a family member, the staff in a staffed home or the home
provider shall conduct a personal safety assessment that identifies the
individual’s ability to demonstrate the following safety skills:
(1) Responding to a fire, including exiting
safely and seeking assistance;
(2) Caring for personal health, including
understanding health issues, taking medication, seeking assistance for health
needs and applying basic first aid;
(3) Seeking safety if victimized or sexually
exploited;
(4) Negotiating one’s community, including
finding one’s way, riding in vehicles safely, handling money safely, and
interacting with strangers appropriately;
(5) Responding appropriately in severe weather
and other natural disasters, including storms and extreme temperature; and
(6) Maintaining a safe home, including:
a. Operating heating, cooking, and other
appliances; and
b. Responding to common household problems such
as a blocked toilet, power failure or gas odors.
(q)
Based on the findings of the personal safety assessment, the individual
and other members of his or her team shall develop a personal safety plan that:
(1) Identifies any supports necessary for an
individual to respond to each of the contingencies listed in (p) above;
(2) Indicates who will provide the needed
supports;
(3) Describes how the supports will be activated
in an emergency;
(4) Indicates approval of the individual or legal
guardian, provider, residential coordinator, and service coordinator;
(5) Is reviewed by the provider or staff at the
time of the individual’s service agreement; and
(6) Is revised whenever there is a change in the
individual’s residence or ability to respond to the contingencies listed in the
plan.
Source. #9391, eff 2-21-09; ss by #9890-A, eff
3-22-11; ss by #12859, eff 8-28-19
He-M 525.07 Certification.
(a)
PDMS provided in the home to individuals who are 21 years or older shall
be certified by the bureau, except for respite care or in those situations
where the individual is living independently.
(b)
To facilitate the certification process, the area agency shall:
(1) Review the service arrangement and
documentation to confirm that all applicable requirements identified in He-M
525.06 are being met; and
(2) Forward to the bureau, 30 days prior to the
initiation of services, the individual’s proposed service agreement and
proposed individualized budget and the area agency’s recommendation for
certification.
(c)
Within 14 days of receiving the area agency recommendation, the bureau
shall issue a certification if the requirements in He-M 525.06 are being met.
(d)
All certifications granted by the bureau under (c) above shall be
effective for no more than 24 months.
(e)
To renew a PDMS certification, the area agency shall:
(1) Review the service arrangement and
documentation to confirm that all applicable requirements identified in He-M
525.06 are being met; and
(2) Forward to the bureau the individualized
budget, the service agreement, and the area agency’s recommendation for
re-certification 30 days prior to the expiration of the current services.
(f)
Within 14 days of receiving the area agency recommendation, the bureau
shall renew a certification if the requirements in He-M 525.06 and He-M 525.12
(b) are being met.
(g)
Upon request by the area agency, the bureau shall issue a 60-day
emergency certification to enable an individual to relocate to a staffed or
provider home if the area agency executive director, or his or her designee,
submits to the bureau a signed statement documenting that the individual’s
safety has been addressed.
(h)
Within 5 business days of an individual’s relocation pursuant to (g)
above, a service coordinator and licensed nurse shall visit the individual in
the home to determine if the transition has resulted in adverse changes in the
health or behavioral status of the individual.
(i)
A service coordinator shall document the visit described in (h) above in
the individual’s record.
Source. #9391, eff 2-21-09; ss by #9890-A, eff
3-22-11; ss by #12859, eff 8-28-19
He-M 525.08 Quality Review.
(a)
When an individual receives services in a staffed home or with a home
provider, the service coordinator shall contact the representative and visit
with the individual at least twice a year in the home where the individual
resides, or more frequently if specified in the service agreement.
(b)
When an individual lives with his or her family or in his or her own
home, the individual or representative and service coordinator shall establish
within the service agreement the minimum number of:
(1) Service coordinator visits per year with the
individual in the home; and
(2) Contacts with the representative per year.
(c)
Based on the frequency identified in the service agreement, the service
coordinator shall visit with the individual and contact the representative and
document their satisfaction with:
(1) Staff or providers such as their
availability, compatibility, and adherence to the provisions of the service
agreement;
(2) Progress on achieving the outcomes specified
in the service agreement;
(3) Communication among the individual, the
representative, the area agency, and the providers;
(4) The individual’s health and safety supports
as identified in the service agreement; and
(5) The utilization of allocated funds.
(d)
The bureau shall conduct yearly reviews of PDMS to ensure compliance
with this part by reviewing documentation at the area agency of, at minimum,
10% of participant directed and managed service arrangements.
Source. #9391, eff 2-21-09; ss by #9890-A, eff
3-22-11; ss by #12859, eff 8-28-19
He-M 525.09 Denial and Revocation of Certification.
(a)
In the event of the denial or revocation of certification of PDMS, the
individual’s service coordinator shall assist him or her to continue receiving
alternative services that meet his or her needs.
(b)
The bureau shall deny an application for certification or revoke
certification of PDMS, following written notice pursuant to (d) below and
opportunity for a hearing pursuant to He-C 200, due to:
(1) Failure of a staff, provider, subcontract
agency, or area agency to comply with this part or any other applicable rule
adopted by the department;
(2) Hiring of persons below the age of 18 as
staff or non-family providers;
(3) Knowing submission of materially false or
misleading information to the department or failure to provide information
requested by the department and required pursuant to He-M 500;
(4) The staff, provider, subcontract agency, or
area agency preventing or interfering with any review or investigation by the
department;
(5) The staff, provider, subcontract agency, or
area agency failing to provide required documents to the department;
(6) Any abuse, neglect, or exploitation by a
provider, staff, or person living in a non-family provider’s home, as reported
on the state registry in accordance with RSA 161-F: 49, I (a), if such finding
has not been overturned on appeal, been annulled, or received a waiver pursuant
to He-M 525.13;
(7) Failure by the employer to perform criminal
background checks on all persons paid to provide services under He-M 525 who
begin to provide such services on or after the effective date of He-M 525;
(8) Except as allowed in He-M 525.06(k)(4), any
staff, provider, or person living in a non-family provider’s home has been
found guilty of fraud, a felony, or a misdemeanor against a person in this or
any other state by a court of law, unless a waiver has been obtained pursuant
to He-M 525.13; or
(9) Evidence that any provider or staff, working
directly with individuals, has an illness or behavior that, as evidenced by the
documentation obtained or the observations made by the department, would
endanger the well-being of the individuals or impair the ability of the
provider to comply with department rules, except in cases where such personnel
have been reassigned and the well-being of all individuals and the provider’s
ability to comply with these rules are no longer at risk.
(c)
If the department determines that services meet any of the criteria for
denial or revocation listed in (b) above, the department shall deny or revoke
the certification of the PDMS.
(d)
Certification shall be denied or revoked upon the written notice by the
department to the provider, subcontract agency, or area agency stating the
specific rule(s) with which the service does not comply.
(e)
Any certificate holder aggrieved by the denial or revocation of the
certificate may request an adjudicative proceeding in accordance with He-M
525.11. The denial or revocation shall
not become final until the period for requesting an adjudicative proceeding has
expired or, if the certificate holder requests an adjudicative proceeding,
until such time as the administrative appeals unit issues a decision upholding
the department’s action.
(f)
Pending compliance with all requirements for certification specified in
the written notice made pursuant to (d) above, a provider, subcontract agency,
or area agency shall not provide additional PDMS if a notice of revocation has
been issued concerning a violation that presents potential danger to the health
or safety of the individuals being served.
Source. #9391, eff 2-21-09; ss by #9890-A, eff
3-22-11; ss by #12859, eff 8-28-19
He-M 525.10 Immediate Suspension of Certification.
(a)
Notwithstanding the provision of He-M 525.09 (e), in the event that a
violation poses an immediate and serious threat to the health or safety of the
individuals, the bureau administrator shall, in accordance with RSA 541-A:30,
III, suspend a service’s certification immediately upon issuance of written
notice specifying the reasons for the action.
(b)
The bureau administrator or his or her designee shall schedule and hold
a hearing within 10 working days of the suspension for the purpose of
determining whether to revoke or reinstate the certification. The hearing shall provide opportunity for the
provider, subcontract agency, or area agency whose certification has been
suspended to demonstrate that it has been, or is, in compliance with the
specified requirements.
Source. #9391, eff 2-21-09; ss by #9890-A, eff
3-22-11; ss by #12859, eff 8-28-19
He-M 525.11 Appeals.
(a)
An individual or guardian may choose to pursue informal resolution to
resolve any disagreement with an area agency, or, within 30 business days of
the area agency decision, she or he may choose to file a formal appeal pursuant
to (e) below. Any determination, action,
or inaction by an area agency may be appealed by an individual or guardian.
(b)
An applicant for certification, provider, subcontract agency, or area
agency may request a hearing regarding a proposed revocation or denial of
certification, except as provided in He-M 525.10 above.
(c) The following actions shall be subject to the
notification requirements of (d) below:
(1) Adverse
eligibility actions under He-M 525.03;
(2) Area
agency determinations regarding an individual’s or guardian’s selection of a
provider under He-M 525.05 (h) or removal of a provider under He-M 525.05 (k);
(3) Area
agency determinations regarding provider certification under He-M 525.09;
(4) Area
agency determinations regarding the removal of a service coordinator selected
by an individual or guardian under He-M 503.08(f) (2) and (3); and
(5) A
determination to terminate services under He-M 503.15 (f).
(d)
An area agency shall provide written and verbal notice to the applicant
and guardian of the actions specified in (c) above, including:
(1) The
specific rules that support, or the federal or state law that requires, the
action;
(2) Notice of the individual’s
right to appeal in accordance with He-C 200 within 30 business days and the
process for filing an appeal, including the contact information to initiate the
appeal with the bureau administrator;
(3) Notice of the individual’s
continued right to services pending appeal, when applicable, pursuant to (f)
below;
(4) Notice of the right to have representation
with an appeal by:
a. Legal counsel;
b. A relative;
c. A friend; or
d. Another spokesperson;
(5) Notice that neither the area agency nor the
bureau is responsible for the cost of representation;
(6) Notice of organizations with their addresses and phone numbers that
might be available to provide legal assistance and advocacy, including the
Disabilities Rights Center and pro bono or reduced fee assistance; and
(7) Notice of individual’s right
to request a second formal risk assessment from a qualified evaluator.
(e)
Appeals shall be submitted, in writing, to the bureau administrator in
care of the department’s office of client and legal services within 30 business
days following the date of the notification of an area agency’s decision or the
bureau’s denial or revocation of certification.
An exception shall be that appeals may be filed verbally if the
individual is unable to convey the appeal in writing.
(f)
The bureau administrator shall immediately forward the appeal to the
department’s administrative appeals unit which shall assign a presiding officer
to conduct a hearing or independent review, as provided in He-C 200. The burden shall be as provided by He-C
203.14.
(g)
If a hearing is requested, the following actions shall occur:
(1) For current recipients, services and payments
shall be continued as a consequence of an appeal for a hearing until a decision
has been made; and
(2) If the bureau’s decision is upheld, benefits
shall cease 60 days from the date of the denial letter or 30 days from the
hearing decision, whichever is later.
Source. #9391, eff 2-21-09; ss by #9890-A, eff
3-22-11; ss by #12859, eff 8-28-19
He-M 525.12 Funding and Payment.
(a)
Area agencies shall submit to the bureau a proposed individualized
budget for each individual requesting initial provision of services under He-M
525, which contains detailed line item information regarding all services to be
provided.
(b)
The bureau shall review the proposed budget and issue a response within
10 business days from the date of request.
(c)
For each request an area agency makes for funding individual services
under He-M 525, the bureau shall make the final determination on the cost
effectiveness of the budget and proposed services.
(d)
Based on an approved individualized budget, service agreement and, if
applicable, certification issued pursuant to He-M 525.07 (c), the area agency
shall request a prior authorization from the bureau.
(e)
Requests for prior authorization shall be made in writing to:
Bureau of
Developmental Services
Hugh J. Gallen
State Office Park
105 Pleasant
Street
Concord, NH 03301
(f)
Once an area agency obtains a prior authorization from the bureau it
shall submit claims for Medicaid waiver PDMS to:
Conduent
2 Pillsbury
Street, Suite 200
Concord, NH 03301
(g)
Payment for medicaid waiver PDMS shall only be made if prior
authorization has been obtained from the bureau.
(h)
For those individuals whose net income exceeds the nursing facility cap
as established in He-W 658.05, area agencies shall subtract the cost of care
from the medicaid billings for the individuals unless they qualify for medicaid
for employed adults with disabilities (MEAD) pursuant to He-W 641.03.
(i)
In those situations where cost of care is subtracted from the medicaid
billings, the area agency shall recover the cost from individuals.
(j)
Payment for PDMS shall not be available to any service provider who:
(1) Is the parent of the individual under age
18;
(2) Is a person under age 18 if the individual is
21 years or older; or
(3) Is the spouse of an individual receiving
services.
Source. #9391, eff 2-21-09; ss by #9890-A, eff
3-22-11; ss by #12859, eff 8-28-19
He-M 525.13 Waivers.
(a) An area agency, subcontract agency,
individual, representative, or provider may request a waiver of specific
procedures outlined in He-M 525 by completing and submitting the department’s
form entitled “NH Bureau of Developmental Services Waiver Request” (July 2019).
The area agency shall submit the request in writing to the bureau
administrator.
(b)
If the waiver request is of He-M 525.09 (b) (8) or (9), the entity
requesting a waiver shall include a copy of the relevant criminal record check.
(c)
A completed waiver
request form shall be signed by:
(1) The individual, guardian, or representative
indicating agreement with the request; and
(2) The area agency’s executive director or
designee recommending approval of the waiver.
(d)
A waiver request shall be submitted to:
Bureau of
Developmental Services
Hugh J. Gallen
State Office Park
105 Pleasant Street, Main Building
Concord, NH 03301
(e)
All information entered on the forms described in (a) above shall be
typewritten or otherwise legibly written.
(f)
No provision or procedure prescribed by statute shall be waived.
(g)
The request for a waiver shall be granted by the commissioner or his or
her designee within 30 days if the alternative proposed by the requesting
entity meets the objective or intent of the rule and it:
(1) Does not negatively impact the health or
safety of the individual(s); and
(2) Does not affect the quality of services to
individuals.
(h)
Upon receipt of approval of a waiver request, the requesting entity’s
subsequent compliance with the alternative
provisions or procedures approved in the waiver shall be considered compliance
with the rule for which waiver was sought.
(i)
Waivers shall be granted in writing for the minimum period necessary to
accomplish the waiver request’s purpose with the specific duration not to
exceed 5 years except as in (j)-(k) below.
(j)
Those waivers which relate to the following shall be effective for the
current certification period only:
(1) Fire safety; or
(2) Other issues relative to the health, safety
or welfare of individuals that require periodic reassessment.
(k)
Any waiver shall end with the closure of the related program or service.
(l)
An area agency, subcontract agency, individual, representative, or
provider may request a renewal of a waiver from the bureau. Such request shall be made at least 90 days prior
to the expiration of a current waiver.
(m)
A request for renewal of a waiver shall be approved in accordance with
the criteria specified in (g) above.
Source. #9391, eff 2-21-09; amd by #9890-A, eff
3-22-11, (paras (a) & (d)-(l)); amd by #9890-B,
eff 3-22-11, (paras (b) & (c)) ; ss by #12859, eff 8-28-19
PART
He-M 526 DESIGNATION OF RECEIVING
FACILITIES FOR DEVELOPMENTAL SERVICES
Statutory
Authority: RSA 171-A:20
He-M 526.01 Purpose. The purpose of these rules is to outline
standards and procedures for the designation and operation of receiving
facilities for voluntary and involuntary treatment of persons with
developmental disabilities.
Source. #6213, eff 3-30-96, EXPIRED: 12-31-98
New. #7089, eff 8-31-99, EXPIRED: 8-31-07
New. #9059, eff 1-3-08; ss by #11009, INTERIM, eff
1-3-16, EXPIRES: 7-1-16; ss by #11125, eff 7-1-16
He-M 526.02 Definitions.
(a)
“Applicant” means that legal entity which requests designation as a
receiving facility.
(b)
“Commissioner” means the commissioner of the department of health and
human services, or his or her designee.
(c)
“Department” means the New Hampshire department of health and human
services.
(d)
“Designated receiving facility (DRF)” means a residential treatment
program designated by the commissioner pursuant to RSA 171-A:20 and He-M 526 to
provide care, custody, and treatment to persons voluntarily and involuntarily
admitted to the state developmental services system.
(e)
“Designation” means a decision by the commissioner that a facility that
has not been operating as a DRF immediately prior to its application is
approved to operate as a DRF pursuant to He-M 526.
(f)
“Individual” means a person who is receiving the services of a DRF and:
(1) Receives services from a department-funded
developmental services program; or
(2) Receives the services of a DRF pursuant to
involuntary admission.
(g)
“Individual treatment plan” means a plan developed by the individual’s
treatment team to address the individual’s clinical needs and the behavior or
condition that creates a potential danger for others.
(h)
“Involuntary admission” means admission of a person to a DRF on an
involuntary basis per order of a probate court pursuant to RSA 171-B:12.
(i)
“Redesignation” means a decision by the commissioner that a DRF whose
designation is effective and that has applied for redesignation is approved to
continue to operate as a DRF pursuant to He-M 526.
(j)
“Region” means a geographic area designated pursuant to He-M 505.04 for
the purpose of providing services to individuals with developmental
disabilities.
(k)
“Risk assessment” means an evaluation administered pursuant to He-M
503.09 (d)(13) using evidence-based tools to evaluate an individual’s behaviors
and determine the potential risks to the individual or others posed by said
behaviors.
(l)
“Risk management plan” means a person-centered document that describes
the services, supports, approaches and guidelines to be utilized to meet the
individual’s needs and mitigate risks to community safety and which is
consistent with the service guarantees and protections articulated in He-M 503.
Source. #6213, eff 3-30-96, EXPIRED: 12-31-98
New. #7089, eff 8-31-99, EXPIRED: 8-31-07
New. #9059, eff 1-3-08; ss by #11009, INTERIM, eff
1-3-16, EXPIRES: 7-1-16; ss by #11125, eff 7-1-16
He-M 526.03 Designation Requirements.
(a)
Pursuant to RSA 171-A:20, a DRF shall be designated for one or more of
the following purposes:
(1) To receive persons for involuntary admission
directly pursuant to a court order; and
(2) To receive involuntarily admitted persons by
transfer with the approval of the commissioner.
(b)
In addition to the purposes identified in (a) above, a DRF may receive
persons by voluntary admission if the DRF has the capacity to meet those
persons’ needs.
(c)
A DRF shall comply with all requirements of these rules and He-M 310,
He-M 503, He-M 507, He-M 522, He-M 1001, He-M 1201 and any other applicable
rules adopted by the commissioner.
(d)
A DRF shall:
(1) Provide services to clients regardless of
their ability to pay; and
(2) Assure that all services are provided in the
same manner and are of the same quality as services provided to other clients
pursuant to He-M 526.07.
Source. #6213, eff 3-30-96, EXPIRED: 12-31-98
New. #7089, eff 8-31-99, EXPIRED: 8-31-07
New. #9059, eff 1-3-08; ss by #11009, INTERIM, eff
1-3-16, EXPIRES: 7-1-16; ss by #11125, eff 7-1-16
He-M 526.04 Establishment of a State DRF. If the commissioner establishes a
state-operated program as a DRF that has the administrative supports, clinical
services, and security measures to meet the needs of individuals served in the
facility, such DRF shall comply with the applicable provisions of He-M 526
through He-M 529.
Source. #6213, eff 3-30-96, EXPIRED: 12-31-98
New. #7089, eff 8-31-99, EXPIRED: 8-31-07
New. #9059, eff 1-3-08, EXPIRED: 1-3-16
New. #11125, eff 7-1-16
He-M 526.05 Designation and Redesignation Process for
a Community DRF.
(a)
Application for designation or redesignation as a community DRF shall be
made in writing to the commissioner by an area agency or subcontractor of an
area agency, or through a request for proposals process established by the
department, and include the following:
(1) The name and address of the applicant;
(2) The physical location of the DRF;
(3) A statement
describing the capacity of the applicant to provide services pursuant to this
chapter;
(4) A description
of staffing patterns and staff qualifications, including clinical staff, that
demonstrates compliance with He-M 526.06;
(5) A description of all programs and services
operated by the applicant, including services to be available through the
proposed DRF; and
(6) A description of unmet service needs that the
proposed DRF would address.
(b)
An application for designation or redesignation shall include
documentation demonstrating that the DRF is eligible for licensure by the
department in accordance with RSA 151 and certification as a community residence
pursuant to He-M 1001, as applicable.
(c)
Application for redesignation shall be submitted by a community DRF to
request redesignation or to alter the service capacity or type of services a
DRF is designated to provide.
(d)
Application to request redesignation shall be submitted to the
commissioner at least 2 months prior to the expiration date of the DRF’s
designation.
(e)
Submission of an application pursuant to (d) above shall cause the DRF’s
current designation to be effective until the commissioner issues a decision
pursuant to (h) below.
(f)
The commissioner shall assign staff to review the application materials
and conduct a site visit of a program proposed for designation or
redesignation.
(g)
The review and site visit pursuant to (f) above shall be completed
within 60 days of the date of receipt of application and shall result in a
determination of the compliance or non-compliance of the DRF with He-M 526,
He-M 310, He-M 503, He-M 507, He-M 522, He-M 1001, He-M 1201, and all other
applicable department rules.
(h)
Within 10 days of completion of a review and site visit pursuant to (f)
and (g) above, the commissioner shall:
(1) Designate or redesignate as a DRF those
facilities that have been determined to be in compliance with He-M 526 and all
other applicable rules; or
(2) Deny designation or redesignation as a DRF to
those facilities that have been determined not to comply with He-M 526 or any
other applicable rules.
(i)
The commissioner shall notify an applicant in writing upon approval or
denial of application for designation or redesignation.
(j)
Designation or redesignation shall be effective for one year from the
date that notification is sent.
(k)
A DRF shall be designated or redesignated to provide only those services
described by the applicant pursuant to (a) above and those required pursuant to
He-M 526.07.
(l)
Notification of a decision to deny designation or redesignation shall
occur pursuant to He-M 526.09(a).
Source. #6213, eff 3-30-96, EXPIRED: 12-31-98
New. #7089, eff 8-31-99, EXPIRED: 8-31-07
New. #9059, eff 1-3-08, EXPIRED: 1-3-16
New. #11125, eff 7-1-16
He-M 526.06 Staffing.
(a)
Staff of a DRF shall include:
(1) A DRF administrator who shall be responsible
for the overall operation of the DRF;
(2) A clinical director who shall be responsible
for all services provided to individuals admitted to the DRF; and
(3) Such clinicians as are necessary to meet the
treatment needs of the individuals served.
(b)
Clinicians working at a DRF may be employed on a full-time, part-time,
or consultant basis.
(c)
Professional staff of a DRF who provide psychotherapy shall meet the
requirements of He-M 426.08.
Source. #6213, eff 3-30-96, EXPIRED: 12-31-98
New. #7089, eff 8-31-99, EXPIRED: 8-31-07
New. #9059, eff 1-3-08; ss by #11009, INTERIM, eff
1-3-16, EXPIRES: 7-1-16; ss by #11125,
eff 7-1-16
He-M 526.07 Services to be Provided.
(a)
The following shall be basic services available to all individuals
served at a DRF:
(1) Psychological and other clinical evaluations,
including alcohol or substance abuse evaluations, as determined necessary by an
individual’s treating clinicians;
(2) Medical monitoring and medication
administration in accordance with He-M 1201;
(3) Individual and group therapeutic services
directed toward addressing each individual’s problem behaviors;
(4) Case coordination provided by DRF staff,
including individual evaluation, individual treatment planning, discharge
planning, and linkage with appropriate community services;
(5) Case management provided by area agency
staff;
(6) A functional assessment of each individual’s
community and independent living skills; and
(7) Instruction in
community and independent living skills to prepare each individual for
discharge, as specified in the individual’s treatment plan.
(b)
A DRF shall have adequate facilities to:
(1) Meet the treatment needs of the individuals
served, including provision of specialized evaluation and treatment;
(2) Afford all individuals access to all
programs, services, and physical facilities of the DRF in accordance with the
Americans with Disabilities Act; and
(3) Provide services such that language barriers
are overcome.
(c)
A DRF shall have an interagency agreement with the area agency in the
individual’s region of origin or other area agency as agreed to in the service
planning process. Such an agreement
shall address the responsibilities of the DRF and the area agency including, at
a minimum:
(1) Treatment planning in accordance with He-M
503;
(2) Risk assessment administration;
(3) Risk management plan development; and
(4) Discharge planning responsibilities of the
area agency and DRF.
(d)
A risk assessment shall be administered for each individual immediately
prior to, or within 30 days after, admission to a DRF, and a risk management
plan shall be developed by the area agency based on the risk assessment.
(e)
A DRF shall adopt policies and procedures governing seclusion and
restraint that shall be consistent with He-M 310.
(f)
A DRF shall adopt policies and procedures for a multi-level review for
the development of recommendations for absolute and conditional
discharges. Such policies and procedures
shall specify the nature and extent of participation by clinical staff in the
multi-level reviews.
(g)
A DRF shall provide ongoing contact with individuals on conditional
discharge status from the DRF and assist the area agency responsible for
supporting the individual on conditional discharge to facilitate the success of
the discharge plan.
Source. #6213, eff 3-30-96, EXPIRED: 12-31-98
New. #7089, eff 8-31-99, EXPIRED: 8-31-07
New. #9059, eff 1-3-08; ss by #11009, INTERIM, eff
1-3-16, EXPIRES: 7-1-16; ss by #11125,
eff 7-1-16
He-M 526.08 Safety Procedures.
(a)
A DRF shall have written procedures:
(1) Regarding supervision levels and the
monitoring of individuals, including the use of electronic or other security
devices;
(2) For accessing police and fire
department and emergency medical technician (EMT) services; and
(3) For the investigation, review, and
remediation of accidents, injuries, and safety hazards.
(b)
A DRF shall have an emergency evacuation plan that ensures the rapid
evacuation of the facility in the event of fire or other life threatening
emergencies.
(c)
A DRF shall house non-ambulatory individuals in wheelchair-accessible
areas only, consistent with the Americans with Disabilities Act.
(d)
A community DRF shall have comprehensive liability insurance against all
claims of bodily injury, death, or property damage in amounts not less than
$250,000 per claim and $2,000,000 per incident.
Source. #6213, eff 3-30-96, EXPIRED: 12-31-98
New. #7089, eff 8-31-99, EXPIRED: 8-31-07
New. #9059, eff 1-3-08; ss by #11009, INTERIM, eff
1-3-16, EXPIRES: 7-1-16; ss by #11125,
eff 7-1-16
He-M 526.09 Denial and Revocation of Designation.
(a)
Application for designation shall be denied or designation shall be
revoked, following written notice and opportunity for a hearing pursuant to
He-M 526.11, due to:
(1) Failure to maintain the necessary license or
certification pursuant to RSA 151 or He-M 1001;
(2) Failure to comply with these rules or any
applicable department rule;
(3) The DRF
administrator or applicant failing to provide information requested by the
department or knowingly giving false or misleading information to the
department;
(4) Refusal by DRF staff to admit any employee of
the department of health and human services authorized to monitor or inspect
the facility in accordance with He-M 1001.14;
(5) Any reported abuse, neglect, or exploitation
of individuals by DRF personnel, if:
a. Such personnel have not been prevented from
having individual contact; and
b. Such abuse,
neglect, or exploitation is founded based on a protective investigation
performed by the department in accordance with He-E 700 and an administrative
hearing held pursuant to He-C 200, if such a hearing is requested;
(6) Felony conviction of any staff member of the
DRF;
(7) Misdemeanor conviction of any staff member of
the DRF involving:
a. Physical or sexual assault;
b. Violence;
c. Exploitation;
d. Child pornography;
e. Threatening or reckless conduct;
f. Driving under the influence of drugs or
alcohol;
g. Theft; or
h. Any other conduct that represents evidence of
behavior that could endanger the well-being of an individual; or
(8) Any illness or behavior of an applicant or
program staff member that, as evidenced by the documentation obtained and the
observations made by the department, would endanger the individuals’ well-being
or prohibit the DRF from complying with He-M 526 or other applicable rules,
except in cases where such program staff have been re-assigned and the
individuals’ well-being and the DRF’s ability to comply with these rules are no
longer at risk.
(b)
Revocation shall only occur following:
(1) Provision of 30 days’ written notice by the
commissioner to the DRF of the specific rule(s) with which that DRF does not
comply; and
(2) Opportunity, pursuant to He-M 526.11, for the
DRF to show compliance.
(c)
If, after notice and opportunity for hearing, the commissioner
determines that a DRF meets any of the criteria for revocation listed in
(a)(1)-(8) above, the commissioner shall revoke the designation of that program.
(d)
The commissioner shall withdraw a notice of revocation if, within the
notice period, the DRF complies with the specified rule(s).
(e)
Pending compliance with all requirements for designation specified in
written notice made pursuant to (b)(1) above, a DRF shall not accept additional
individuals if a notice of revocation has been issued concerning a violation
that poses potential danger to the health or safety of the individuals.
Source. #6213, eff 3-30-96, EXPIRED: 12-31-98
New. #7089, eff 8-31-99, EXPIRED: 8-31-07
New. #9059, eff 1-3-08; ss by #11009, INTERIM, eff
1-3-16, EXPIRES: 7-1-16; ss by #11125,
eff 7-1-16
He-M 526.10 Emergency Suspension of Designation.
(a)
If the commissioner finds at any time that the health, safety, or
welfare of individuals or the public is endangered by the continued operation
of a community DRF, the commissioner shall suspend that facility’s designation
immediately upon written notice specifying the reasons for the action.
(b)
A suspension shall be effective upon issuance.
(c)
At the time that the commissioner suspends the designation of a DRF, the
commissioner shall schedule, and give the DRF written notice of, a hearing to
be held within 10 working days.
(d)
The purpose of the hearing referenced in (c) above shall be to determine
whether the DRF in fact posed an immediate and serious threat to the health and
safety of the individuals residing in the DRF at the time its designation was
suspended.
(e)
The DRF shall also be afforded the opportunity to show that since the
time that its designation was suspended it has come into compliance with all
applicable rules adopted by the commissioner and no longer poses an immediate
and serious threat to the health or safety of the individuals residing in the
DRF.
Source. #6213, eff 3-30-96, EXPIRED: 12-31-98
New. #7089, eff 8-31-99, EXPIRED: 8-31-07
New. #9059, eff 1-3-08; ss by #11009, INTERIM, eff
1-3-16, EXPIRES: 7-1-16; ss by #11125,
eff 7-1-16
He-M 526.11 Hearings.
(a)
An applicant or DRF shall have the right to request a hearing regarding
a proposed revocation or denial of designation, except that hearings on
emergency suspension of designation shall be mandatory.
(b)
Hearings shall be held in accordance with RSA 541-A and He-C 200.
Source. #6213, eff 3-30-96, EXPIRED: 12-31-98
New. #7089, eff 8-31-99, EXPIRED: 8-31-07
New. #9059, eff 1-3-08; ss by #11009, INTERIM, eff
1-3-16, EXPIRES: 7-1-16; ss by #11125,
eff 7-1-16
He-M 526.12 Waivers.
(a)
An applicant or DRF may request a waiver of specific procedures outlined
in He-M 526 by working with the area agency to complete and submit the form
titled “NH Bureau of Developmental Services Waiver Request” (September 2013
edition).
(b) A completed waiver request form submitted by
an applicant or DRF shall be signed by:
(1) The individual, guardian, or representative
indicating agreement with the request; and
(2) The area agency’s executive director or
designee recommending approval of the waiver.
(c) A waiver request shall be submitted to:
Office of Client
and Legal Services
State Office Park
South
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 if the
alternative proposed by the applicant or DRF meets the objective or intent of
the rule and it:
(1) Does not negatively impact the health or
safety of the individual(s); and
(2) Does not negatively affect the quality of
services to individuals.
(f)
The determination on the request for a waiver shall be made within 30
days of the receipt of the request.
(g)
Upon receipt of approval of a waiver request, the applicant’s or DRF’s
subsequent compliance with the alternative provisions or procedures approved in
the waiver shall be considered compliance with the rule for which waiver was
sought.
(h)
Waivers shall be granted in writing for a specific duration not to
exceed 5 years except as in (i) below.
(i)
Any waiver shall end with the closure of the related program or service.
(j)
An applicant or DRF may request a renewal of a waiver from the
department in accordance with (a) through (c) above. Such request shall be made at least 90 days
prior to the expiration of a current waiver.
Source. #6213, eff 3-30-96, EXPIRED: 12-31-98
New. #7089, eff 8-31-99, EXPIRED: 8-31-07
New. #9059, eff 1-3-08; ss by #11009, INTERIM, eff
1-3-16, EXPIRES: 7-1-16; ss by #11125,
eff 7-1-16
PART He-M 527 ADMISSION TO AND DISCHARGE FROM A
DEVELOPMENTAL SERVICES DESIGNATED RECEIVING FACILITY
Statutory
Authority: New Hampshire RSA 171-A:3,
RSA 171-A:8-a
He-M 527.01 Purpose. The purpose of these rules is to establish
criteria and procedures for admission to and discharge from a developmental
services designated receiving facility (DRF).
Source. #6214, eff 3-30-96, EXPIRED: 12-31-98
New. #7062, eff 7-24-99, EXPIRED: 7-24-07
New. #9060, eff 1-3-08; ss by #11009, INTERIM, eff
1-3-16, EXPIRES: 7-1-16; ss by #11125,
eff 7-1-16
He-M 527.02 Definitions.
(a)
“Bureau administrator” means the chief administrator of the bureau of
developmental services.
(b)
“Commissioner” means the commissioner of the department of health and
human services or his or her designee.
(c)
“Conditional discharge” means the release of a person from a designated
receiving facility (DRF) during a period of court-ordered involuntary admission
on the condition that the person complies with specific provisions of
community-based treatment or is subject to readmission to the DRF.
(d)
“Department” means the New Hampshire department of health and human
services.
(e)
“Designated receiving facility (DRF)” means a residential treatment
program designated by the commissioner pursuant to RSA 171-A:20 and He-M 526 to
provide care, custody, and treatment to persons voluntarily and involuntarily
admitted to the state developmental services system.
(f)
“DRF administrator” means the staff member responsible for the overall
operation of a designated receiving facility, or his or her designee.
(g)
“Individual” means a person who is receiving the services of a DRF and:
(1) Receives services from a department-funded
developmental services program; or
(2) Receives the services of a DRF pursuant to
involuntary admission.
(h)
“Involuntary admission” means admission of a person to a DRF on an
involuntary basis per order of the probate court pursuant to RSA 171-B:12.
(i)
“Least restrictive alternative” means the program or service which least
inhibits a person’s freedom of movement and participation in the community and
accommodates the person’s informed decision-making while achieving the purposes
of treatment.
(j)
“Physician” means a medical doctor licensed to practice in New
Hampshire.
(k)
“Probate court” means the state court which has authority to preside
over civil commitment and guardianship proceedings.
(l)
“Voluntary admission” means admission to a DRF subsequent to the
documented consent of the person being admitted or his or her legal guardian.
Source. #6214, eff 3-30-96, EXPIRED: 12-31-98
New. #7062, eff 7-24-99, EXPIRED: 7-24-07
New. #9060, eff 1-3-08; ss by #11009, INTERIM, eff
1-3-16, EXPIRES: 7-1-16; ss by #11125,
eff 7-1-16
He-M 527.03 Admission to a DRF.
(a)
Pursuant to RSA 171-B:2, a person shall be involuntarily admitted when:
(1) The person has been charged with a felony
involving serious bodily injury or the use of a deadly weapon, or with
aggravated felonious sexual assault other than pursuant to RSA 632-A:2, I(h),
or with felonious sexual assault, or with arson pursuant to RSA 634:1, II or
III;
(2) A district court, superior court, or grand
jury has found that probable cause exists that the person committed a felony as
set forth in (1) above;
(3) The person is determined to be not competent
to stand trial;
(4) The person has an intellectual disability, as
defined in the most current edition of the Diagnostic Manual-Intellectual
Disability developed by the National Association for the Dually Diagnosed in
association with the American Psychiatric Association; and
(5) The person has a condition or behavior as a
result of which the person poses a potentially serious likelihood of danger to
others or a potentially serious threat of engaging in acts which would
constitute arson as evidenced by a specific act or actions which may include
such act or actions giving rise to the felony charge according to RSA 171-B:2,
I.
(b)
Involuntary admissions shall not occur unless ordered by a probate court
pursuant to RSA 171-B:12.
(c)
A DRF shall not refuse admission of a person sent to such DRF pursuant
to RSA 171-B.
(d)
A person may be admitted to a DRF on a voluntary basis provided that:
(1) The person receives services through an area
agency;
(2) The person or his or her guardian has
provided a written document agreeing to the person’s placement at the DRF;
(3) The DRF has the capacity to meet the person’s
needs; and
(4) The DRF is the least restrictive, most
appropriate setting to meet the person’s needs and the placement has been
approved by the individual’s area agency human rights committee.
Source. #6214, eff 3-30-96, EXPIRED: 12-31-98
New. #7062, eff 7-24-99, EXPIRED: 7-24-07
New. #9060, eff 1-3-08; ss by #11009, INTERIM, eff
1-3-16, EXPIRES: 7-1-16; ss by #11125,
eff 7-1-16
He-M 527.04 Transfers to or from a DRF.
(a)
A DRF may accept the transfer of a person who is admitted to the secure
psychiatric unit pursuant to RSA 171-B, in accordance with RSA 622:48, I(b).
(b)
A DRF may transfer a person admitted to the DRF pursuant to RSA 171-B,
to the secure psychiatric unit pursuant to RSA 171-B:15, I, RSA 622:45, and
He-M 611.
(c)
Transfers from one DRF to another shall be conducted in accordance with
He-M 529.
(d)
Transfers from a DRF for medical treatment or security reasons shall be
conducted in accordance with He-M 529.
Source. #6214, eff 3-30-96, EXPIRED: 12-31-98
New. #7062, eff 7-24-99, EXPIRED: 7-24-07
New. #9060, eff 1-3-08; ss by #11009, INTERIM, eff
1-3-16, EXPIRES: 7-1-16; ss by #11125,
eff 7-1-16
He-M 527.05 Discharge of a Person Voluntarily Admitted.
(a) If a person is at a DRF on a voluntary basis,
he or she, or his or her legal guardian may request withdrawal from the DRF
whether or not such withdrawal is made against the advice of the DRF treatment
staff.
(b)
A person or legal guardian of a person who wishes to withdraw shall
state such intent in writing to staff of the DRF.
(c)
The time and date of receipt of a notice of intent to withdraw shall be
indicated on the notice, if applicable, and in the person’s medical record.
(d)
A person who has requested withdrawal or whose legal guardian has
requested withdrawal shall be discharged by a DRF within 24 hours of receipt of
such request, excluding weekends and holidays.
(e)
A person admitted to the DRF on a voluntary basis may be discharged
without requesting it if the staff of the DRF determine that the person’s needs
can be met in a less restrictive setting.
Source. #6214, eff 3-30-96, EXPIRED: 12-31-98
New. #7062, eff 7-24-99, EXPIRED: 7-24-07
New. #9060, eff 1-3-08 (from He-M 527.04); ss by
#11009, INTERIM, eff 1-3-16, EXPIRES: 7-1-16; ss by #11125, eff 7-1-16
He-M 527.06 Discharge of a Person Involuntarily
Admitted.
(a)
If a person is admitted to a DRF subsequent to an involuntary admission,
such involuntary admission shall not continue beyond the time allowed by the
probate court order.
(b)
Pursuant to RSA 171-A:21, any person involuntarily admitted to a DRF
pursuant to RSA 171-B, or conditionally discharged pursuant to RSA 171-B, may
be granted absolute discharge by the DRF administrator most recently providing
services if the bureau administrator, or his or her designee:
(1) After reviewing the person’s situation, has
consented to the discharge; and
(2) Has determined that an absolute discharge
will not create a potentially serious likelihood of danger to others or
substantial damage to real property.
(c)
Upon the absolute discharge of any person from a DRF pursuant to He-M
527.06(b), the DRF administrator shall immediately, and in writing, notify the
person’s legal guardian, if any, the probate court entering the original order
of commitment, and the attorney general that an absolute discharge has been
granted to the person.
(d)
Any person who has been involuntarily admitted to a DRF may be
conditionally discharged under the conditions specified in He-M 528.
Source. #6214, eff 3-30-96, EXPIRED: 12-31-98
New. #7062, eff 7-24-99, EXPIRED: 7-24-07
New. #9060, eff 1-3-08 (from He-M 527.05); ss by
#11009, INTERIM, eff 1-3-16, EXPIRES: 7-1-16; ss by #11125, eff 7-1-16
He-M 527.07 Waivers.
(a)
A DRF may request a waiver of specific procedures outlined in He-M 527
by working with the area agency to complete and submit the form titled “NH
Bureau of Developmental Services Waiver Request” (September 2013 edition).
(b) A completed
waiver request form submitted by an applicant or DRF shall be signed by:
(1) The individual, guardian, or representative
indicating agreement with the request; and
(2) The area agency’s executive director or
designee recommending approval of the waiver.
(c)
A waiver request shall be submitted to:
Office of Client
and Legal Services
State Office Park
South
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 if the
alternative proposed by the DRF meets the objective or intent of the rule and
it:
(1) Does not negatively impact the health or
safety of the individual(s); and
(2) Does not negatively affect the quality of
services to individuals.
(f)
The determination on the request for a waiver shall be made within 30
days of the receipt of the request.
(g)
Upon receipt of approval of a waiver request, the DRF’s subsequent
compliance with the alternative provisions or procedures approved in the waiver
shall be considered compliance with the rule for which waiver was sought.
(h) Waivers shall be granted in writing for a
specific duration not to exceed 5 years except as in (i) below.
(i)
Any waiver shall end with the closure of the related program or service.
(j)
A DRF may request a renewal of a waiver from the department in
accordance with (a) through (c) above.
Such request shall be made at least 90 days prior to the expiration of a
current waiver.
Source. #9060, eff 1-3-08 (from He-M 527.06) ); ss by
#11009, INTERIM, eff 1-3-16, EXPIRES: 7-1-16; ss by #11125, eff 7-1-16
PART He-M 528 CONDITIONAL DISCHARGE FROM A DESIGNATED
RECEIVING FACILITY FOR DEVELOPMENTAL SERVICES
Statutory
Authority: RSA l71-A:21-24
He-M 528.01 Purpose. The purpose of these rules is to define the
criteria and procedures for conditional discharge of a person involuntarily
admitted to a designated receiving facility (DRF) and for the revision and
revocation of the conditional discharge.
Source. #6215, eff 3-30-96, EXPIRED: 12-31-98
New. #7063, eff 7-24-99, EXPIRED: 7-24-07
New. #9061, eff 1-3-08; ss by #11009, INTERIM, eff
1-3-16, EXPIRES: 7-1-16; ss by #11125, eff 7-1-16
He-M 528.02 Definitions.
(a)
“Bureau administrator” means the chief administrator of the bureau of
developmental services.
(b)
“Commissioner” means the commissioner of the department of health and
human services or his or her designee.
(c)
“Conditional discharge” means the release of a person from a designated
receiving facility (DRF) during a period of court ordered involuntary admission
on the condition that the person comply with specific provisions of
community-based treatment or be subject to readmission to the DRF.
(d)
“Department” means the New Hampshire department of health and human
services.
(e)
“Designated receiving facility (DRF)” means a residential treatment
program designated as a receiving facility by the commissioner pursuant to RSA
171-A:20 and He-M 526 to provide care, custody, and treatment to persons
voluntarily and involuntarily admitted to the state developmental services
system.
(f)
“DRF administrator” means the staff member responsible for the overall
operation of a designated receiving facility, or his or her designee.
(g)
“Individual” means a person who is receiving the services of a DRF and:
(1) Receives services from a department-funded
developmental services program; or
(2) Receives the services of a DRF pursuant to
involuntary admission.
(h)
“Informed decision” means a choice made voluntarily by a resident of a
DRF or, where appropriate, such person’s legal guardian, after all relevant
information necessary to making the choice has been provided, when:
(1) The person understands that he or she is free
to choose or refuse any available alternative;
(2) The person clearly indicates or expresses his
or her choice; and
(3) The choice is free from all coercion.
(i)
“Involuntary admission” means admission of a person to a DRF on an
involuntary basis per order of a probate court pursuant to RSA l71-B:12.
(j)
“Law enforcement officer” means “officer” as defined in RSA 594:1, III.
(k)
“Treatment team member” means a person who shares ongoing responsibility
for the care and treatment of an individual.
Source. #6215, eff 3-30-96, EXPIRED: 12-31-98
New. #7063, eff 7-24-99, EXPIRED: 7-24-07
New. #9061, eff 1-3-08; ss by #11009, INTERIM, eff
1-3-16, EXPIRES: 7-1-16; ss by #11125, eff 7-1-16
He-M 528.03 Grant of Conditional Discharge.
(a)
A recommendation for conditional discharge of a person shall be made by
the DRF administrator to the bureau administrator only after the following
actions have been taken:
(l) A multi-level review has occurred that:
a. Incorporates:
1. Clinical input;
2. Individual input; and
3. With the consent of the individual or his or
her guardian, the individual’s family’s input; and
b. Involves DRF staff and the staff of the
accepting area agency;
(2) The DRF staff and accepting area agency
concur that the supervision, treatment, and other services that the individual
needs can be provided by the accepting area agency; and
(3) The executive director of the area agency
where the individual will reside following conditional discharge has certified
that the supervision, treatment, and other services that the individual
requires will be provided.
(b)
The DRF administrator shall, with the prior approval of the bureau
administrator, grant a conditional discharge to a person who has been
involuntarily admitted to the DRF pursuant to RSA l71-B:12 when the following
criteria have been met:
(l) The person’s potential for danger to others
can be adequately mitigated through provision of ongoing care including
environmental modifications and staff supervision;
(2) A recommendation for conditional discharge of
the person has been made in accordance with the procedures in (a) above; and
(3) The person makes an informed decision to
agree to the conditions and terms of conditional discharge, including any
requirement for participation in continuing treatment in the community, and
agrees to be subject to the provisions of RSA 171-A:23 and He-M 528.
(c) Prior approval shall be given verbally or in
writing, after consideration of the facts upon which the conditional discharge
was based, if the bureau administrator determines that the criteria identified
in (b) above have been met.
(d)
The DRF administrator shall:
(1) Inform the person and his or her guardian, if
any, orally and in writing, in clear and understandable language, of:
a. The terms and conditions of discharge; and
b. The criteria and process for revocation of
conditional discharge; and
(2) Document the person’s consent to the elements
discussed pursuant to (1) above.
(e) The term of conditional discharge of a person
from a DRF granted under He-M 528 shall not exceed the period of time remaining
on the person’s order of involuntary admission made pursuant to RSA l71-B:12.
(f)
A conditional discharge may be:
(1) Made absolute in accordance with He-M 528.04;
(2) Revised in accordance with the provisions of
He-M 528.06; or
(3) Revoked in accordance with He-M 528.07.
Source. #6215, eff 3-30-96, EXPIRED: 12-31-98
New. #7063, eff 7-24-99, EXPIRED: 7-24-07
New. #9061, eff 1-3-08; ss by #11009, INTERIM, eff
1-3-16, EXPIRES: 7-1-16; ss by #11125, eff 7-1-16
He-M 528.04 Grant of Absolute Discharge.
(a)
The administrator of a DRF from which a person has been conditionally
discharged shall grant to such person an absolute discharge:
(1) At the end of the term of the conditional
discharge unless:
a. The discharge has been revoked previously in
accordance with RSA 171-A:23 and He-M 528.07; or
b. Another order of involuntary admission of the
person has been made pursuant to RSA l71-B:12; or
(2) When the bureau administrator has reviewed
the situation and determined that an absolute discharge will not create a
potentially serious likelihood of danger to others or a potentially serious
likelihood of substantial damage to real property.
(b)
A notice of absolute discharge shall be given verbally or in writing,
after consideration of the facts upon which the absolute discharge was based,
if the bureau administrator determines that the criteria identified in (a)(1)
or (2) above have been met.
(c)
The DRF administrator shall, in writing, immediately notify the court
that made the original order of involuntary admission pursuant to RSA l71-B:12
and the attorney general that the person has been granted an absolute
discharge.
Source. #6215, eff 3-30-96, EXPIRED: 12-31-98
New. #7063, eff 7-24-99, EXPIRED: 7-24-07
New. #9061, eff 1-3-08; ss by #11009, INTERIM, eff
1-3-16, EXPIRES: 7-1-16; ss by #11125, eff 7-1-16
He-M 528.05 Transfer to Another DRF. A person who so consents may be transferred
from one DRF to another for the purpose of being conditionally discharged. Such a transfer shall be in accordance with
He-M 529 and RSA 171-B:15, II.
Source. #6215, eff 3-30-96, EXPIRED: 12-31-98
New. #7063, eff 7-24-99, EXPIRED: 7-24-07
New. #9061, eff 1-3-08; ss by #11009, INTERIM, eff
1-3-16, EXPIRES: 7-1-16; ss by #11125, eff 7-1-16
He-M 528.06 Revision of Conditions of Discharge from a
DRF. The term and conditions of a
conditional discharge granted pursuant to He-M 528.03 may be revised at any
time in accordance with the following procedures:
(a)
The revisions shall be proposed by the area agency serving the person
conditionally discharged, the person conditionally discharged, or the DRF from
which the person was conditionally discharged by forwarding a written request
from the proposing party to the other parties;
(b)
The DRF administrator shall immediately inform the bureau administrator
of any proposed revisions of the discharge conditions;
(c)
The person’s treatment team shall meet to consider and make a
recommendation regarding the proposed revisions;
(d)
Any proposed revisions shall be in writing and be signed by:
(1) The person subject to the conditional
discharge;
(2) The guardian, if any;
(3) The DRF administrator; and
(4) The area agency executive director or
designee;
(e)
The bureau administrator shall approve the revision after consideration
of the facts upon which the revisions were based if he or she determines that
the criteria identified in He-M 528.03 (b)(1) and (3) and (c)–(d) above have
been met;
(f)
Upon approval by the bureau administrator, the revised conditions shall
become effective until such time as:
(1) The order of involuntary admission expires;
(2) The conditional discharge is revoked or
revised; or
(3) The individual is absolutely discharged; and
(g)
Copies of the revised conditions shall be filed in the person’s clinical
record at the area agency and provided to:
(1) The person;
(2) The guardian, if any; and
(3) The DRF from which the person was
conditionally discharged.
Source. #6215, eff 3-30-96, EXPIRED: 12-31-98
New. #7063, eff 7-24-99, EXPIRED: 7-24-07
New. #9061, eff 1-3-08; ss by #11009, INTERIM, eff
1-3-16, EXPIRES: 7-1-16; ss by #11125, eff 7-1-16
He-M 528.07 Revocation of Conditional Discharge.
(a)
An executive director or designee of an area agency providing continuing
treatment to a person conditionally discharged pursuant to He-M 528.03 shall,
after the review conducted pursuant to He-M 528.07 (b) and (c) below,
temporarily revoke a person’s conditional discharge if it is determined that:
(1) The person has violated a condition of the
discharge; and
(2) A condition or behavior exists as a result of
which the person might pose a potentially serious likelihood of danger to
others or a potentially serious threat of substantial damage to real property.
(b)
Before temporarily revoking a conditional discharge pursuant to He-M
528.07 (a), the area agency executive director or designee shall conduct a
review of the acts, behavior, or condition of the person to determine if one of
the criteria set forth in He-M 528.07 (a) is met.
(c)
Prior to the review, the person shall be given written and oral notice
of the claim, and the specific reasons therefor, that a violation of a
condition of the discharge has occurred or that a condition or behavior exists
as a result of which the person might pose a potentially serious likelihood of
danger to others or a potentially serious threat of substantial damage to real
property.
(d)
If the person refuses to consent to the review authorized by He-M 528.07
(b), the executive director or other representative of the area agency may sign
a complaint to compel review.
(e)
Upon issuance of a complaint pursuant to (d) above, any law enforcement
officer shall be authorized and directed, pursuant to RSA 171-A:23, IV, to take
custody of the person and immediately deliver him or her to the place for
review specified in the complaint.
(f)
Following the review conducted pursuant to (b) above, the executive
director shall:
(1) Temporarily revoke the conditional discharge
if he or she finds that a violation of a condition of the discharge has
occurred or that a condition or behavior exists as a result of which the person
might pose a potentially serious likelihood of danger to others or a
potentially serious threat of substantial damage to real property;
(2) Identify the DRF to which the person is to be
delivered;
(3) Inform the person in writing of the specific
reasons for the revocation and the receiving facility to which the person is to
be delivered;
(4) Direct a law enforcement officer to take
custody of the person and deliver the person to the identified receiving
facility; and
(5) Notify the DRF administrator immediately by
telephone of the temporary revocation.
(g)
The law enforcement officer who takes custody of the person whose
conditional discharge has been temporarily revoked shall, pursuant to RSA
171-A:23, IV, deliver the person, together with a copy of the notice of, and
reasons for, the temporary revocation of the conditional discharge, to the DRF
identified in accordance with (f) above.
(h)
Within 48 hours of the arrival at a DRF identified in accordance with
(f) above of a person whose conditional discharge has been temporarily revoked,
the area agency shall deliver or cause to be delivered to the DRF a copy of the
court order of involuntary admission and a copy of the terms of the conditional
discharge.
(i)
The administrator, or clinical director if designated by the
administrator, of the DRF to which a person has been returned shall:
(1) Review the reasons for
temporary revocation of the conditional discharge with the individual; and
(2) Revoke absolutely the conditional discharge
if the temporary revocation documents that:
a. The person has violated a condition of the
discharge; or
b. A condition or behavior exists as a result of
which the person might pose a potentially serious likelihood of danger to
others or a potentially serious threat of substantial damage to real property.
(j)
Within 72 hours, excluding holidays, of delivery of a person to a DRF
pursuant to (g) above:
(1) A review pursuant to (i)(1) above shall be
completed; and
(2) An administrator’s decision pursuant to
(i)(2) above shall be made.
(k)
The DRF administrator shall immediately provide written notice of the
following to a person whose conditional discharge has been absolutely revoked:
(1) The reason for the revocation; and
(2) The person’s right to appeal and right to
legal counsel as set forth in He-M 528.08.
(l)
Immediately upon absolute revocation, the DRF shall notify the attorney
designated by the department pursuant to He-M 528.08 (e) to provide counsel to
the individual regarding his or her right to appeal and his or her right to be
represented by an attorney.
(m)
The person whose conditional discharge has been absolutely revoked shall
be admitted to the DRF identified in accordance with (f) above and be subject
to the terms and conditions of the order of involuntary admission made pursuant
to RSA 171-B:12 as if such conditional discharge had not been granted.
(n)
Following the revocation of a conditional discharge, the treatment team
shall reconvene to consider revised terms or alternative supports, services,
and treatment that might allow for a subsequent conditional discharge.
(o)
Following a review pursuant to (b) above, an examination and review
pursuant to (i)(1) above, or an appeal pursuant to He-M 528.08, if it is
determined that the conditions for temporary revocation of conditional
discharge identified in (a)(2) or (i)(2) above do not apply, the person shall:
(1) Promptly be returned by the DRF to the
location where he or she was taken into custody; and
(2) Be subject to the term and provisions of
conditional discharge that were in effect prior to the temporary revocation of
the conditional discharge.
Source. #6215, eff 3-30-96, EXPIRED: 12-31-98
New. #7063, eff 7-24-99, EXPIRED: 7-24-07
New. #9061, eff 1-3-08; ss by #11009, INTERIM, eff
1-3-16, EXPIRES: 7-1-16; ss by #11125, eff 7-1-16
He-M 528.08 Appeal of Revocation.
(a)
A person whose conditional discharge has been absolutely revoked
pursuant to He-M 528.07 (i) may appeal the decision to the bureau
administrator, notwithstanding the consent of the person’s guardian, if any. The person may request assistance from the
DRF in effecting the appeal.
(b)
The appeal request shall:
(l) Be in writing;
(2) State whether or not assistance of legal
counsel is requested at such a hearing;
(3) State whether or not the person is able to
pay for legal counsel if the assistance of counsel is requested; and
(4) Include such information related to the basis
for the appeal as the person, at the time, elects to offer.
(c)
The DRF shall submit the appeal to the bureau administrator together
with copies of all notices provided to the person pursuant to He-M 528.07 and
any other information relevant to the reasons for absolute revocation of the
conditional discharge.
(d)
If a hearing is requested, the hearing shall be conducted in accordance
with He-M 202.08 and He-C 200, and shall occur within 5 days, excluding
weekends and holidays, of the receipt of the request for hearing.
(e)
The bureau administrator shall obtain legal counsel for any person who
requests a hearing on the appeal and requests legal counsel.
(f)
Following a hearing, the bureau administrator shall, within 3 working
days, decide if the person either has violated a condition of the discharge or
if a condition or behavior exists as a result of which the person might pose a
potentially serious likelihood of danger to others or a potentially serious
threat of substantial damage to real property.
(g)
In reaching a decision, the bureau administrator shall only consider
evidence presented at the hearing.
(h)
The burden shall be upon the administrator of the DRF who absolutely
revoked the conditional discharge to establish that the criteria for absolute
revocation of the conditional discharge are met by clear and convincing
evidence.
(i)
The decision made by the bureau administrator shall be in writing, state
the reasons for the decision, and be sent promptly to the person appealing, his
or her legal counsel, if any, and the DRF and area agency that initiated the
process to revoke the conditional discharge of the person.
Source. #6215, eff 3-30-96, EXPIRED: 12-31-98
New. #7063, eff 7-24-99, EXPIRED: 7-24-07
New. #9061, eff 1-3-08; ss by #11009, INTERIM, eff
1-3-16, EXPIRES: 7-1-16; ss by #11125, eff 7-1-16
He-M 528.09 Waivers.
(a)
A DRF may request a waiver of specific procedures outlined in He-M 528
by working with the area agency to complete and submit the form titled “NH
Bureau of Developmental Services Waiver Request” (September 2013 edition).
(b) A completed waiver request form submitted by
an applicant or DRF shall be signed by:
(1) The individual, guardian, or representative
indicating agreement with the request; and
(2) The area agency’s executive director or
designee recommending approval of the waiver.
(c)
A waiver request shall be submitted to:
Office of Client
and Legal Services
State Office Park
South
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 if the
alternative proposed by the DRF meets the objective or intent of the rule and
it:
(1) Does not negatively impact the health or
safety of the individual(s); and
(2) Does not negatively affect the quality of
services to individuals.
(f)
The determination on the request for a waiver shall be made within 30
days of the receipt of the request.
(g)
Upon receipt of approval of a waiver request, the DRF’s subsequent
compliance with the alternative provisions or procedures approved in the waiver
shall be considered compliance with the rule for which waiver was sought.
(h)
Waivers shall be granted in writing for a specific duration not to
exceed 5 years except as in (i) below.
(i)
Any waiver shall end with the closure of the related program or service.
(j)
A DRF may request a renewal of a waiver from the department in
accordance with (a) through (c) above.
Such request shall be made at least 90 days prior to the expiration of a
current waiver.
Source. #6215, eff 3-30-96, EXPIRED: 12-31-98
New. #7063, eff 7-24-99, EXPIRED: 7-24-07
New. #9061, eff 1-3-08; ss by #11009, INTERIM, eff
1-3-16, EXPIRES: 7-1-16; ss by #11125, eff 7-1-16
PART He-M 529 TRANSFERS BETWEEN DESIGNATED RECEIVING
FACILITIES IN THE DEVELOPMENTAL SERVICES SYSTEM
Statutory
Authority: RSA 171-A:8-a, I
He-M 529.01 Purpose. The purpose of these rules is to establish
the criteria and procedures for transfers of involuntarily admitted persons
between designated receiving facilities in the developmental services system.
Source. #6216, eff 3-30-96, EXPIRED: 12-31-98
New. #7090, eff 8-31-99, EXPIRED: 8-31-07
New. #9062, eff 1-3-08; ss by #11009, INTERIM, eff
1-3-16, EXPIRES: 7-1-16; ss by #11125, eff 7-1-16
He-M 529.02 Definitions.
(a)
“Attorney” means a lawyer retained, employed, or appointed by a court to
represent an individual.
(b)
“Bureau administrator” means the chief administrator of the bureau of
developmental services.
(c)
“Commissioner” means the commissioner of the department of health and
human services or designee.
(d)
“Department” means the New Hampshire department of health and human
services.
(e) “Designated receiving facility
(DRF)” means a residential treatment program designated as a receiving facility
by the commissioner pursuant to RSA 171-A:20 and He-M 526 to provide care,
custody, and treatment to persons voluntarily and involuntarily admitted to the
state developmental services system.
(f)
“DRF administrator” means the staff member responsible for the overall
operation of a designated receiving facility, or his or her designee.
(g)
“Guardian” means a person who is appointed by the court to make
decisions regarding the person or property, or both, of another person pursuant
to RSA 464-A.
(h)
“Individual” means a person who is receiving the services of a DRF and:
(1) Receives services from a department-funded
developmental services program; or
(2) Receives the services of a DRF pursuant to
involuntary admission.
(i)
“Involuntary admission” means admission of a person to a DRF on an
involuntary basis per order of a probate court pursuant to RSA 171-B:12.
Source. #6216, eff 3-30-96, EXPIRED: 12-31-98
New. #7090, eff 8-31-99, EXPIRED: 8-31-07
New. #9062, eff 1-3-08; ss by #11009, INTERIM, eff
1-3-16, EXPIRES: 7-1-16; ss by #11125, eff 7-1-16
He-M 529.03 Treatment and Security Transfers.
(a)
Whenever a DRF has custody of a person for a period of involuntary
admission, the DRF administrator or the administrator’s designee shall order
the transfer of the person to another DRF under the circumstances and
procedures identified in (b)–(k) below.
(b)
Transfers for treatment purposes shall be ordered if a person’s
condition is such that the DRF that has custody cannot reasonably provide the
treatment required to stabilize or ameliorate the person’s condition.
(c)
Transfers pursuant to (b) above shall only occur after the DRF
administrator consults with the administrator of the proposed receiving DRF and
determines that it can provide the treatment the person requires.
(d)
Transfers for medical treatment at an acute care hospital shall be made
if the following conditions apply:
(1) The person has medical needs requiring
treatment that cannot be provided at the DRF;
(2) The hospital to which the person is to be
transferred can provide the treatment that the person requires; and
(3) One of the following conditions applies:
a. The person, or the person’s legal guardian if
the guardian has been granted decision-making authority regarding medical care,
has approved the transfer; or
b. A personal safety emergency exists pursuant
to He-M 305.03.
(e)
A person who is transferred for medical treatment shall remain under the
protective custody of the admitting DRF pursuant to the authority under which
the person was involuntarily admitted.
(f)
Transfers for security purposes shall be ordered if:
(1) A person’s behavior is such that the DRF that
has custody cannot reasonably provide the supervision and control necessary to
prevent the person from causing bodily harm to self or others or significant
damage to property; and
(2) The DRF administrator has determined that the
DRF to which the person is to be transferred can provide the supervision and
control the person requires.
(g)
No transfer shall occur under He-M 529.03 without the prior approval of
the bureau administrator.
(h)
Prior approval shall be given verbally or in writing, after
consideration of the facts upon which the transfer order was based, if the
bureau administrator determines that the criteria identified in (f) above have
been met.
(i)
When a transfer is to be made for treatment or security purposes, the
DRF administrator shall sign a transfer order stating the reasons for the
transfer and identifying the DRF to which the person is to be transferred.
(j)
The DRF administrator shall:
(1) Give to the person to be transferred:
a. A copy of the transfer order; and
b. A verbal explanation of the order, the
transfer procedures, and the right to object to the transfer; and
(2) Send a copy of the order to the person’s
guardian and attorney, if any, within 24 hours of issuance.
(k)
Within 48 hours of receipt of a transfer order, the bureau administrator
shall either approve the transfer if it is determined that the criteria
identified in (f) above have been met or disapprove the transfer.
(l)
Once transferred, a person shall be subject to RSA 171-B as if
originally placed in the custody of the DRF to which the person was
transferred, except as provided in (e) above.
(m)
Transportation of a person under this section shall be arranged by the
DRF making the transfer, as follows:
(1) The person may be transported by staff of the
DRF from which or to which the person is being transferred; or
(2) The person may be transported by any law
enforcement officer empowered to transport under RSA 171-A:27.
Source. #6216, eff 3-30-96, EXPIRED: 12-31-98
New. #7090, eff 8-31-99, EXPIRED: 8-31-07
New. #9062, eff 1-3-08; ss by #11009, INTERIM, eff
1-3-16, EXPIRES: 7-1-16; ss by #11125, eff 7-1-16
He-M 529.04 Transfers to Less Restrictive Settings.
(a)
Whenever a DRF has custody of a person for a period of involuntary
admission, the DRF administrator shall order the transfer of the person to
another DRF if:
(1) The DRF to which the person will be
transferred can provide an environment that is less restrictive of the person’s
freedom of movement than the DRF having custody of the person; and
(2) The DRF to which the person will be
transferred can provide the care, treatment, and security required for the
person.
(b)
When a transfer is being made to a DRF with a less restrictive setting,
the administrator of the transferring DRF shall sign an order of transfer.
(c)
The transfer order shall state the reason for the transfer and identify
the DRF to which the person is to be transferred.
(d)
The person to be transferred shall be given a copy of the transfer order
and a verbal explanation of the order, the transfer procedures, and the right
to object to the transfer.
(e)
A copy of the order shall also be sent to the person’s guardian or
attorney, if any.
(f)
Any transfer under He-M 529.04 shall require:
(1) Prior approval by the bureau administrator,
based upon a determination that the transfer criteria specified in (a) above
have been met; and
(2) Prior approval by the administrator of the
DRF to which the person is being transferred.
(g)
If a person being transferred under He-M 529.04 objects to the transfer,
the challenge shall be treated as an appeal in accordance with He-C 200,
notwithstanding the consent of the person’s guardian, if any.
(h)
Once transferred, a person shall be subject to RSA 171-B as if
originally placed in the custody of the DRF to which the person was
transferred.
(i)
Transportation of a person under this section shall be arranged by the
DRF making the transfer, as follows:
(1) The person may be transported by staff of the
DRF from which or to which the person is being transferred; or
(2) The person may be transported by any law
enforcement officer empowered to transport under RSA 171-A:27.
Source. #6216, eff 3-30-96, EXPIRED: 12-31-98
New. #7090, eff 8-31-99, EXPIRED: 8-31-07
New. #9062, eff 1-3-08; ss by #11009, INTERIM, eff
1-3-16, EXPIRES: 7-1-16; ss by #11125, eff 7-1-16
He-M 529.05 Emergency Transfers.
(a)
A person who has been admitted to a DRF by an involuntary admission
pursuant to RSA 171-B:12 shall, in the event that an emergency is determined to
exist pursuant to (b) below, be transferred to another DRF by the DRF
administrator without the prior approval of the bureau administrator.
(b)
A DRF administrator shall determine that an emergency exists when there
is serious likelihood of danger to the person or to others or a serious
likelihood of substantial damage to property if the transfer is not made and an
immediate transfer is necessary in order to protect the person or others.
(c)
The determination of a serious likelihood of danger shall be based upon
the behavior(s) of the person to be transferred or other circumstances that
create a strong probability that the person will cause or attempt to cause harm
to self or others, or will cause or attempt to cause substantial damage to
property and the DRF cannot reasonably provide the degree of safety and
security necessary to prevent the harm or the damage.
(d)
Prior to the emergency transfer of the person, the DRF administrator or
his or her designee shall:
(1) Inform the person verbally and in writing of
the transfer and reasons therefor; and
(2) Give the person an opportunity to consent to
the transfer.
(e)
The commissioner shall, within 24 hours, excluding Saturdays, Sundays
and holidays, of an emergency approve the transfer of the person if the
criteria identified in (b) above have been met.
(f)
If the approval referenced in (e) above is not granted within 24 hours
after the transfer, the person shall be immediately returned to the DRF from
which he or she was transferred.
(g)
If the commissioner approves the emergency transfer and the person
transferred has consented to the transfer, no further action shall be necessary
and the person will then be in the care and custody of the DRF to which he or
she has been transferred.
(h)
If the person being transferred objects to the transfer, the challenge
shall be treated as an appeal in accordance with He-C 200, notwithstanding the
consent of the person’s guardian, if any.
(i)
A hearing shall be conducted in accordance with the procedures set forth
in He-M 202.08 and He-C 200 within 72 hours, excluding Saturdays, Sundays and
holidays, after the transfer has been approved.
The review or hearing may occur following the transfer.
(j)
Following a hearing, the person shall promptly be returned to the DRF
from which he or she was transferred if the commissioner finds that an
emergency pursuant to (b) above did not exist.
Source. #6216, eff 3-30-96, EXPIRED: 12-31-98
New. #7090, eff 8-31-99, EXPIRED: 8-31-07
New. #9062, eff 1-3-08; ss by #11009, INTERIM, eff
1-3-16, EXPIRES: 7-1-16; ss by #11125, eff 7-1-16
He-M 529.06 Waivers.
(a)
A DRF may request a waiver of specific procedures outlined in He-M 528
by working with the area agency to complete and submit the form titled “NH
Bureau of Developmental Services Waiver Request” (September 2013 edition).
(b) A completed waiver request form submitted by
an applicant or DRF shall be signed by:
(1) The individual, guardian, or representative
indicating agreement with the request; and
(2) The area agency’s executive director or
designee recommending approval of the waiver.
(c)
A waiver request shall be submitted to:
Office of Client
and Legal Services
State Office Park
South
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 if the
alternative proposed by the DRF meets the objective or intent of the rule and
it:
(1) Does not negatively impact the health or
safety of the individual(s); and
(2) Does not negatively affect the quality of
services to individuals.
(f)
The determination on the request for a waiver shall be made within 30
days of the receipt of the request.
(g)
Upon receipt of approval of a waiver request, the DRF’s subsequent
compliance with the alternative provisions or procedures approved in the waiver
shall be considered compliance with the rule for which waiver was sought.
(h)
Waivers shall be granted in writing for a specific duration not to
exceed 5 years except as in (i) below.
(i)
Any waiver shall end with the closure of the related program or service.
(j)
A DRF may request a renewal of a waiver from the department in
accordance with (a) through (c) above.
Such request shall be made at least 90 days prior to the expiration of a
current waiver.
Source. #6216, eff 3-30-96, EXPIRED: 12-31-98
New. #7090, eff 8-31-99, EXPIRED: 8-31-07
New. #9062, eff 1-3-08; ss by #11009, INTERIM, eff
1-3-16, EXPIRES: 7-1-16; ss by #11125, eff 7-1-16
APPENDIX A: Incorporation by Reference Information
|
Rule |
Title |
Publisher; How to Obtain; and Cost |
|
He-M 503.02(r), He-M 503.08(b)(12)a., and He-M
503.09(o)(2) |
Health Risk Screening Tool (HRST) (2015 edition) |
Publisher: IntellectAbility Cost: 1–100 consumers = $699.00 each; 1–200
consumers = $899.00 each; 1–1000 consumers = $999.00 each The incorporated
document is available at https://replacingrisk.com/ |
|
He-M 503.02(t), 503.08(d)(10)a., 503.09(d)(12) |
Health Risk Screening Tool (HRST) (2015 edition) |
DTECH Computerists, Inc. PO Box 480942. Tulsa, OK
74148-0942. Voice: (918) 585-9988 x110. Toll free: (800) 800-4278 x110. Website: www.dtechgroup.com. Email: HRSTinfo@dtechgroup.com. Cost: 1–100 consumers = $699.00 each; 1–200
consumers = $899.00 each; 1–1000 consumers = $999.00 each |
|
He-M 503.02(am), He-M 503.08(b)(12)a., and He-M
503.09(o)(1) intro, c., and e. |
Supports Intensity Scale- Adult Version (SIS-A)
(2023 edition) |
Publisher: American Association on Intellectual and
Developmental Disabilities (AAIDD) Cost: $115 The incorporated document is available at:
https://www.aaidd.org/sis |
|
He-M
506.02(g) |
Health
Risk Screening Tool (HRST) (2015 edition) |
Publisher:
IntellectAbility Cost:
1–100 consumers = $699.00 each; 1–200 consumers = $899.00 each; 1–1000
consumers = $999.00 each The
incorporated document is available at https://replacingrisk.com/
|
|
He-M
506.02(m) |
Supports
Intensity Scale- Adult Version (SIS-A) (2023 edition) |
Publisher:
American Association on Intellectual and Developmental Disabilities (AAIDD) Cost:
$115 The
incorporated document is available at: https://www.aaidd.org/sis |
|
He-M 506.03(b)(5) |
Centers for Disease Control and Prevention,
“Guidelines for Preventing the Transmission of Tuberculosis in Health
Facilities/Settings, 2005” |
Publisher: US
Department of Health and Human Services, Centers for Disease Control and
Prevention. Available free of charge from the CDC website at www.cdc.gov, and more specifically: http://www.cdc.gov/mmwr/pdf/rr/rr5417.pdf
. |
|
He-M |
Health Risk Screening Tool (HRST) (2009 edition) |
DTECH Computerists, Inc. PO Box 480942. Tulsa, OK
74148-0942. Voice: (918) 585-9988 x110. Toll free: (800) 800-4278 x110. Website: www.dtechgroup.com. Email: HRSTinfo@dtechgroup.com. Cost: 1–100
consumers = $699.00 each; 1–200 consumers = $899.00 each; 1–1000 consumers =
$999.00 each |
|
He-M |
Supports Intensity Scale (2004 edition) |
American Association on Intellectual and
Developmental Disabilities. 501 3rd St., NW, Suite 200. Washington, D.C.
20001 Phone: 800-424-3688. Cost: $115 |
|
He-M 510.06(k)(5) |
The IDA Institute’s, “Infant-Toddler Developmental
Assessment-2 (IDA-2)” (Second Edition) |
Publisher: The
IDA Institute Cost: $90 for
packs of 25 The incorporated
document is available at: https://ida2.org/collections/ida-2-manuals-and-forms
|
|
He-M 510.06(k)(5) |
Shine Early Learning’s, “The Hawaii Early Learning
Profile (HELP) Strands 0-3” (1992-2013) |
Publisher: Shine
Early Learning Cost: $4.95
single booklet/ $106.25 pack of 25 booklets The incorporated
document is available at: https://shineearly.store/products/help-strands-0-3 |
|
He-M |
Supports Intensity Scale (2004 edition) |
American
Association on Intellectual and Developmental Disabilities. 501 3rd St., NW,
Suite 200. Washington, D.C. 20001 Phone:
800-424-3688. Cost: $115 |
|
He-M |
Health Risk Screening Tool (HRST) (2009 edition) |
DTECH
Computerists, Inc. PO Box 480942. Tulsa, OK 74148-0942. Voice: (918) 585-9988
x110. Toll free: (800) 800-4278 x110.
Website: www.dtechgroup.com. Email: HRSTinfo@dtechgroup.com. Cost: 1–100
consumers = $699.00 each; 1–200 consumers = $899.00 each; 1–1000 consumers =
$999.00 each |
|
He-M
517.10(e)(6)a. |
Supports
Intensity Scale Adult Version ® (2023 edition) |
Publisher: American Association on
Intellectual and Developmental Disabilities (AAIDD) Cost: $115 The incorporated document is available at: https://www.aaidd.org/sis |
|
He-M
517.10(e)(6)d. |
Health Risk
Screening Tool (HRST) (2015 edition) |
Publisher: IntellectAbility Cost: 1–100 consumers = $699.00 each; 1–200
consumers = $899.00 each; 1–1000 consumers = $999.00 each The incorporated document is available at https://replacingrisk.com/ |
|
He-M 518.10(h)(1)a. |
APSE Supported Employment Competencies (Revision
2010) |
Publisher: Association of People Supporting Employment
First (APSE). Available online
at no cost: http://www.apse.org/docs/APSE%20Supported%20Employment%20Competencies[1]1.pdf |
|
He-M 518.10(e)(1)a. |
Association of
People Supporting Employment First, “APSE Universal Employment Competencies”
(2019 Revision) |
Publisher: Association
of People Supporting Employment First Cost: Free of Charge The incorporated
document is available at: https://apse.org/wp-content/uploads/2019/03/Apse-universal-Comps-FINAL3-15-19.pdf
|
|
He-M 522.02(q) and He-M 522.10(o)(2) |
Health Risk
Screening Tool (HRST) (2015 edition) |
Publisher: IntellectAbility Cost: Tier 1 (up to 99 people): $375/month;
Tier 2 (100-499 people): $3.75 per person/month; Tier 3 (500+ people): $3.50
per person/month; State and Local Government: Please contact directly. There is an additional one time $500
activation fee per tier. The incorporated document is available at https://replacingrisk.com/ |
|
He-M 522.02(s) |
Health Risk
Screening Tool (2015 edition) |
Available from
the publisher, http://hrstonline.com The cost of this
software is based on a “per individual” pricing model and is determined by
the number of individuals being rated. |
|
He-M 522.02(ai) and He-M 522.10(o)(1) |
Supports Intensity Scale Adult Version ® (2023 edition) |
Publisher: American Association on
Intellectual and Developmental Disabilities (AAIDD) Cost: $115 The incorporated document is available at: https://www.aaidd.org/sis |
|
He-M 522.02(an) |
Supports Intensity Scale (January 2004 edition), |
Available from
the publisher, American Association on Intellectual and Developmental
Disabilities (https://aaidd.org/sis/)
Cost is $120.00. |
APPENDIX B
|
RULE |
SPECIFIC STATE
STATUTES WHICH THE RULE IMPLEMENTS |
|
He-M
501 |
Reserved |
|
He-M 503.01 |
RSA 171-A:4-8; 11-13; 18, I |
|
He-M 503.02 |
RSA 171-A:4-8; 11-13; 18, I |
|
He-M 503.03 |
RSA 171-A:4 |
|
He-M 503.04 |
RSA 171-A:5; 6, I |
|
He-M 503.05 |
RSA 171-A:6, II, III, IV |
|
He-M 503.06 |
RSA 171-A:6, II; 11 |
|
He-M 503.07 |
RSA 171-A:13; 14 |
|
He-M 503.08 |
RSA 171-A:11, I-II; 18; I |
|
He-M 503.09 |
RSA 171-A:11; 12; 42 CFR § 441.301(c)(1) |
|
He-M 503.10 |
RSA 171-A:11; 12; 42 CFR §441.301(c)(2) & (c)(4) |
|
He-M 503.11 |
RSA 171-A:11; 12; 18, I |
|
He-M 503.12 |
RSA 171-A:18, II |
|
He-M 503.13(a) intro & (a)(1) |
RSA 171-A:1-a |
|
He-M 503.14 |
RSA 171-A:6, I |
|
He-M 503.15 |
RSA 171-A:8 |
|
He-M 503.16 |
RSA 171-A:7 |
|
He-M 503.17 |
RSA 171-A:6, V |
|
He-M 503.18 |
RSA 171-A:3; 541-A:22, IV |
|
He-M 504.01 – 504.03 |
RSA 171-A:3; 18, IV |
|
He-M 504.04 |
RSA 171-A:3; 18, IV; 42 CFR § 455.410; 42 CFR § 447.10 |
|
He-M 504.05 |
RSA 171-A:3; 18, IV |
|
He-M 504.06 |
RSA 171-A:3, 18, IV; 42 CFR § 447.10 |
|
He-M 504.07 |
RSA 171-A:3; 42 CFR § 433.139 |
|
He-M 504.08 |
RSA 171-A:3; 18, IV |
|
He-M 504.09 |
RSA 171-A:3; 42 CFR § 455; 42 CFR § 456 |
|
He-M 504.10 |
RSA 171-A:3; 42 CFR § 455.14 |
|
He-M 504.11-504.14 |
RSA 171-A:3; 18, IV |
|
He-M 505.01 |
RSA 171-A:18; I, II; IV |
|
He-M 505.02 |
RSA 171-A:18; I, II; IV |
|
He-M 505.03 (Specific paragraphs implementing specific statutes are listed below) |
RSA 171-A:18; I, II; IV |
|
He-M 505.03 |
RSA 171-A:18; I, II; IV; 42 CFR 441.301; 42 CFR 447.10 |
|
He-M 505.03(a)-(ac) |
RSA 171-A:18; I, II; IV |
|
He-M 505.03 (o)-(s) |
RSA 171-A:18; III, IV |
|
He-M 505.03 (t)-(v) |
RSA 171-A:18; V |
|
He-M 505.04 |
RSA 171-A:18; I, III; IV; V, VI |
|
He-M 505.05 (Specific paragraphs implementing specific statutes are listed below) |
RSA 171-A:18; I, II; IV |
|
He-M 505.05 |
RSA 171-A:18, I, II; IV |
|
He-M 505.05(a)-(e)(3), (e)(5)-(8) |
RSA 171-A:18; I, II; IV |
|
He-M 505.05(e)(8) |
RSA 171-A:18; VII |
|
He-M 505.05 (e)(4), (f) & (g) |
RSA 171-A:18; I, II; IV |
|
He-M 505.06 (Specific paragraphs implementing specific statutes are listed below) |
RSA 171-A:18; I, II; IV |
|
He-M 505.06 |
RSA 171-A:18; I, II; IV |
|
He-M 505.06(a)-(e)(3), (e)(5)-(8) |
RSA 171-A:18; I, II; IV |
|
He-M 505.06(e)(8) |
RSA 171-A:18; VII |
|
He-M 505.06 (e)(4), (f) & (g) |
RSA 171-A:18; I, II; IV |
|
He-M 505.07 |
RSA 171-A:18; I, II; IV |
|
He-M 505.08 |
RSA 171-A:18; I, II; IV |
|
He-M 505.09 |
RSA 171-A:18; I, II; IV |
|
He-M 505.10 |
RSA 171-A:18; I, II; IV |
|
He-M 505.11 |
RSA 171-A:18; I, II; IV |
|
He-M 505.12 |
RSA 171-A:18; I, II; IV |
|
He-M 505.13 |
RSA 171-A:18; I, II; IV |
|
He-M 505.14 |
RSA 171-A:18; I, II; IV |
|
He-M 506.01 – 506.05 |
RSA 171-A:18; I, II; RSA 137-K:9 |
|
He-M 506.06 |
RSA 171-A:18; I, II; RSA 541-A:22, IV; RSA 137-K:9 |
|
He-M 507.01 – 507.12 |
RSA 171-A:18; I, II; RSA 137-K:9 |
|
He-M 507.08 |
RSA 171-A:18; I, II; RSA 137-K:9; RSA 161:4-a, XI |
|
He-M 507.09 – 507.12 |
RSA 171-A:18; I, II; RSA 137-K:9 |
|
He-M 507.13 |
RSA 171-A:18; I, II; RSA 541-A:29, 30, II; RSA
137-K:9 |
|
He-M 507.14 |
RSA 171-A:18; I, II; RSA 541-A:30, III; RSA 137-K:9 |
|
He-M 507.15 |
RSA 171-A:18; I, II; RSA 541-A:31, III; RSA 137-K:9 |
|
He-M 507.16 |
RSA 171-A:18; I, II; RSA 137-K:9 |
|
He-M 507.17 |
RSA 171-A:18; I, II; RSA 541-A:22, IV; RSA 137-K:9 |
|
He-M 510 All sections |
RSA 171-A:14, V (Specific provisions implementing
specific federal regulations are listed below) |
|
He-M 510.01 |
34 CFR Part 303.1-3 9/28/11, IDEIA, Part C |
|
He-M 510.02 |
34 CFR Part 303.4-37 9/28/11; IDEIA, Part C |
|
He-M 510.03 |
34 CFR Part 303.12-13 9/28/11, IDEIA, Part C |
|
He-M 510.04 |
34 CFR Part 303.13 9/28/11, IDEIA, Part C |
|
He-M 510.05 |
34 CFR Part 303.421 9/28/11, IDEIA, Part C |
|
He-M 510.06 |
34 CFR Part 303.303. 303.320-.322 9/28/11, IDEIA,
Part C; |
|
He-M 510.07 |
34 CFR Part 303.340-345, 9/28/11, IDEIA, Part
C; RSA 171-A:12 |
|
He-M 510.08 |
34 CFR Part 303.342 - 303.346, 9/28/11, IDEIA, Part
C; RSA 171-A:11 |
|
He-M 510.09 |
34 CFR Part 303.209 9/28/11, IDEIA, Part C |
|
He-M 510.10 |
RSA 171-A:18 IV; 34 CFR Part 303.401-417 303.209,
303.702, 303.720-724 9/28/11, IDEIA, Part C |
|
He-M 510.11 |
34 CFR Part 303.119 9/28/11; IDEIA, Part C |
|
He-M 510.12 |
34 CFR Part 303.118, 9/28/11; IDEIA, Part C |
|
He-M 510.13 |
34 CFR Part 303.401-417, 9/28/11; IDEIA, Part C |
|
He-M 510.14 |
34 CFR Part 303.510-511, 303.520-521; 9/28/11,
IDEIA, Part C |
|
He-M 510.15 |
34 CFR Part 303.600-605, 9/28/11, IDEIA, Part C |
|
He-M 510.16 |
34 CFR Part 303.117, 9/28/11, IDEIA, Part C |
|
He-M 510.17 |
RSA 541-A:22, IV |
|
He-M 510.18 |
34 CFR Part 303.422 |
|
He-M 513.01 |
RSA 171-A:18; I, II |
|
He-M 513.02 |
RSA 171-A:18; I, II; Sect. 1902(a)(10) and 1915(c)
SSA |
|
He-M 513.03 |
RSA 171-A:18; I, II |
|
He-M 513.04 |
RSA 171-A:18; I, II |
|
He-M 513.05 |
RSA 171-A:18; I, II |
|
He-M 513.06 |
RSA 171-A:18; V; RSA 126-G:4 |
|
He-M 513.07 |
RSA 171-A:18; I, II |
|
He-M 513.08 |
RSA 541-A:22, IV |
|
He-M 517 (all sections) |
RSA 171-A:18, IV; RSA 137-K:3 |
|
He-M 518.01 – He-M 518.11 |
RSA 171-A:18; I, II; RSA 137-K:9 |
|
He-M 518.12 |
RSA 171-A:18; I, II; RSA
541-A:22, IV; RSA 137-K:9 |
|
He-M 519.01 - 519.04 |
RSA 126-G:3 |
|
He-M 519.05 - 519.07 |
RSA 126-G:4 |
|
He-M 519.08 - 519.09 |
RSA 126-G:3 |
|
He-M 520.01 -
520.09 |
RSA 132:2, X;
RSA 132:13 |
|
He-M 521.01 -
521.14 |
RSA 171-A:4; 18,
I and II |
|
He-M 522.01 – He-M
522.18 |
RSA 137-K:1 |
|
He-M 522.02 |
RSA 137-K:3, I, IV |
|
He-M 522.03 – He-M
522.07 |
RSA 137-K:3, IV |
|
He-M 522.08 |
RSA 137-K:3, I, IV; 42 CFR 441.301 |
|
He-M 522.09 |
RSA 137-K:3, I, IV; 42 CFR 441.301(c)(1) |
|
He-M 522.10 |
RSA 137-K:3, I, IV; 42 CFR 441.301(c)(2) &
(c)(4) |
|
He-M 522.11 and He-M 522.12 |
RSA 137-K:3, I, IV; 42 CFR 441.301 |
|
He-M 522.13 |
RSA 137-K:3, I, IV, RSA 171-A:1-a |
|
He-M 522.14 – He-M 522.16 |
RSA 137-K:3, I, IV |
|
He-M 522.17 and He-M 522.18 |
RSA 137-K:3, IX |
|
He-M 523.01 - 523.06 |
RSA 126-G:3; 161:2, I |
|
He-M 523.07 - 523.09 |
RSA 126-G:4; 161:2, I |
|
He-M 523.10 - 523.14 |
RSA 126-G:3; 161:2, I |
|
He-M 524.01 and He-M 524.02 |
RSA 161-I-1; RSA 171-A:I |
|
He-M 524.03 |
RSA 161-I:2, IV; RSA 171-A:4 |
|
He-M 524.04 - He-M 524.06 |
RSA 161-I:1; RSA 171-A:4 |
|
He-M 524.07 - He-M 524.16 |
RSA 171-A:3,4 |
|
He-M 524.17 |
RSA 161-I:1; RSA 171-A:3,4 |
|
He-M 524.18 |
RSA 161-I:1; RSA 171-A:4 |
|
He-M 524.19 - He-M 524.25 |
RSA 171-A:4 |
|
He-M 524.26 |
RSA 171-A:18, II; RSA 161-I:3-a |
|
He-M 524.27 |
RSA 171-A:3 |
|
He-M 525.01 |
171-A:1; 4-8; 11-13; 18, I |
|
He-M 525.02 |
171-A:4-8; 11-13; 18, I |
|
He-M 525.03 |
RSA 171-A:4 |
|
He-M 525.04 |
RSA 171-A:4; 12 |
|
He-M 525.05 |
RSA 171-A:13; 14 |
|
He-M 525.06 |
RSA 171-A:11; 12; 13 |
|
He-M 525.07 |
RSA 171-A:18, I, II |
|
He-M 525.08 |
RSA 171-A:11; 13 |
|
He-M 525.09 |
RSA 171-A:18, I, II |
|
He-M 525.10 |
RSA 171-A:1, V; 18, I, II |
|
He-M 525.11 |
RSA 171-A:6, V |
|
He-M 525.12 |
RSA 171-A:18, I, II |
|
He-M 525.13 |
RSA 171-A:3; RSA 541-A:22, IV |
|
He-M 526.01 – He-M 526.12 |
RSA 171-A:20 |
|
He-M 527.01 |
RSA 171-A:3 |
|
He-M 527.02 |
RSA 171-A:3 |
|
He-M 527.03 |
RSA 171-B:2 |
|
He-M 527.03(a)(4) |
RSA 171-B:2, IV |
|
He-M 527.04 |
RSA 171-A:8-a |
|
He-M 527.05 |
RSA 171-A:21 |
|
He-M 527.06 |
RSA 171-A:21 |
|
He-M 527.07 |
RSA 171-A:3 |
|
He-M 528.01 |
RSA 171-A:3 |
|
He-M 528.02 |
RSA 171-A:3 |
|
He-M 528.03 |
RSA 171-A:22 |
|
He-M 528.04 |
RSA 171-A:21, I |
|
He-M 528.05 |
RSA 171-A:8-a, I |
|
He-M 528.06 |
RSA 171-A:22 |
|
He-M 528.07 |
RSA 171-A:23 |
|
He-M 528.08 |
RSA 171-A:24 |
|
He-M 528.09 |
RSA 171-A:3 |
|
He-M 529.01 – 529.06 |
RSA 171-A:8-a; 171-B:15 |