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

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

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

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

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

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

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

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

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

(3) Visually impaired; or

(4) Speech impaired.

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

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

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

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

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

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

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

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

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

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

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

(3) A motel or hotel; or

(4) A homeless shelter.

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

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

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

(v) “Licensed health practitioner” means:

(1) Medical doctor;

(2) Physician assistant (PA);

(3) Advanced practice registered nurse (APRN);

(4) Doctor of osteopathy;

(5) Doctor of naturopathic medicine; or

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

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

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

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

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

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

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

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

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

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

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

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

Source. #9849-A, eff 1-12-11, EXPIRED: 1-12-19

New. #12720, INTERIM, eff 1-29-19, EXPIRED: 7-29-19

New. #12936, eff 12-7-19

He-E 501.03 Confidentiality. All information about individuals receiving Title XX services and programs shall be kept confidential, and only persons involved in administering Title XX services and programs shall review an individual’s information, unless the individual signs an authorization to release the information to another individual or organization.

Source. #9849-A, eff 1-12-11, EXPIRED: 1-12-19

New. #12720, INTERIM, eff 1-29-19, EXPIRED: 7-29-19

New. #12936, eff 12-7-19

He-E 501.04 Title XX Services.

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

(b) Title XX services shall include:

(1) Adult day services;

(2) Essential services;

(3) Home-delivered meals; and

(4) In-home care services.

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

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

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

Source. #9849-A, eff 1-12-11, EXPIRED: 1-12-19

New. #12720, INTERIM, eff 1-29-19, EXPIRED: 7-29-19

New. #12936, eff 12-7-19

He-E 501.05 Eligibility Requirements for Services.

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

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

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

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

(4) Have a monthly income which does not exceed $1,512.80 per month, based on the sources of income specified in (d) and subject to an annual cost of living adjustment as described in (k) below;

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

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

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

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

a. Homebound; or

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

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

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

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

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

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

(1) State financial assistance;

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

(3) Supplemental Security income;

(4) Veteran’s benefits;

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

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

(7) Wages or income from self-employment;

(8) Disability benefits;

(9) Unemployment compensation;

(10) Worker’s compensation; and

(11) Alimony.

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

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

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

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

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

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

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

Source. #9849-A, eff 1-12-11, EXPIRED: 1-12-19

New. #12720, INTERIM, eff 1-29-19, EXPIRED: 7-29-19

New. #12936, eff 12-7-19

He-E 501.06 Application Requirements and Process.

(a) An individual or their authorized representative shall apply to receive Title XX services via an application form provided by the department entitled Form 3000, “Application for Social Services” (November 2019).

(b) The individual or the authorized representative shall submit to the department or the provider depending on where the determination of eligibility is being made, a completed Form 3000, “Application for Social Services” certifying the following:

(1) If the individual:

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

“I understand that as part of the administration of the department programs, the department or provider may verify information I have provided on this application and any other information that would affect my eligibility.”

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

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

(2) If the authorized representative:

“My signature below indicates that I have completed this form on behalf of the applicant, using information provided by the applicant, and that this information is true and complete to the best of my knowledge. I have the applicant’s permission to act on his or her behalf during all aspects of initial or continuing eligibility for services, including compliance with the provisions described above, and have agreed to accept the responsibilities designated to me. I have read and understood the provisions described above and the Assurances section on the next page. The applicant acknowledges that he/she may be responsible for any errors, omissions or inaccurate information reported to BEAS by me acting as the authorized representative.”

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

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

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

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

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

(1) There is an indication that the income information provided by the individual is inaccurate; or

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

(h) At the request of the department or the provider, when determining eligibility, the individual or authorized representative shall verify income by providing the following information:

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

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

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

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

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

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

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

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

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

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

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

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

New. #12936, eff 12-7-19

He-E 501.07 Determination, Notice of Eligibility, and Eligibility Period.

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

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

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

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

(1) The services to be provided;

(2) The eligibility period; and

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

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

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

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

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

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

Source. #9849-A, eff 1-12-11, EXPIRED: 1-12-19

New. #12720, INTERIM, eff 1-29-19, EXPIRED: 7-29-19

New. #12936, eff 12-7-19

He-E 501.08 Individual’s Responsibility To Report Changes.

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

(1) Address;

(2) Type of living arrangement;

(3) Sources and amounts of income; and

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

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

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

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

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

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

(1) Services shall be terminated and a notice shall be sent to the individual in accordance with He-E 501.10(c); or (2) The individual shall be removed from the wait list and provided notice in accordance with He-E 501.15.

Source. #9849-A, eff 1-12-11, EXPIRED: 1-12-19

New. #12720, INTERIM, eff 1-29-19, EXPIRED: 7-29-19

New. #12936, eff 12-7-19

He-E 501.09 Redetermination of Service Eligibility.

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

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

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

(d) The department or the provider shall:

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

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

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

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

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

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

New. #12936, eff 12-7-19

He-E 501.10 Termination of Services.

(a) Title XX services shall be terminated when:

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

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

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

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

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

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

(7) The individual dies.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Source. #9849-A, eff 1-12-11, EXPIRED: 1-12-19

New. #12720, INTERIM, eff 1-29-19, EXPIRED: 7-29-19

New. #12936, eff 12-7-19

He-E 501.11 Informal Resolution.

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

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

(2) The written request shall include:

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

b. Any supporting documentation.

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

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

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

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

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

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

(f) Requesting an informal resolution shall not:

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

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

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

Source. #9849-A, eff 1-12-11, EXPIRED: 1-12-19

New. #12720, INTERIM, eff 1-29-19, EXPIRED: 7-29-19

New. #12936, eff 12-7-19

He-E 501.12 Administrative Hearing and Provisions of Services During the Administrative Appeal Process.

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

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

Department of Health & Human Services

Administrative Appeals Unit

105 Pleasant St., Concord, NH 03301

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

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

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

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

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

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

Source. #9849-A, eff 1-12-11, EXPIRED: 1-12-19

New. #12720, INTERIM, eff 1-29-19, EXPIRED: 7-29-19

New. #12936, eff 12-7-19 (formerly He-E 501.11)

He-E 501.13 Provider Requirements.

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

(b) Providers shall:

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

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

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

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

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

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

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

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

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

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

a. The provider’s policies and procedures;

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

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

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

(10) Develop protocols for staff responses to emergencies;

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

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

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

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

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

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

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

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

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

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

(15) Maintain financial records;

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

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

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

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

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

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

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

(20) When providing home-delivered meals service:

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

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

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

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

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

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

Source. #9849-A, eff 1-12-11, EXPIRED: 1-12-19

New. #12720, INTERIM, eff 1-29-19, EXPIRED: 7-29-19

New. #12936, eff 12-7-19 (formerly He-E 501.20)

He-E 501.14 Fees for Title XX Services.

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

(b) Providers that elect to charge fees shall:

(1) Develop a sliding fee schedule;

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

a. The basis for the fee;

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

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

d. The billing schedule, as applicable; and

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

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

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

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

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

(d) Providers shall:

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

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

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

Source. #9849-A, eff 1-12-11, EXPIRED: 1-12-19

New. #12720, INTERIM, eff 1-29-19, EXPIRED: 7-29-19

New. #12936, eff 12-7-19 (formerly He-E 501.13)

He-E 501.15 Wait Lists.

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

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

(1) Individuals who:

a. Are newly eligible; and

b. Are ready to receive services;

(2) Individuals who:

a. Are receiving services; and

b. Requesting additional services; or

(3) Individuals who:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

(6) Length of time on the wait list.

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

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

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

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

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

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

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

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

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

(6) The contact information for the provider; and

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

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

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

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

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

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

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

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

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

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

New. #12936, eff 12-7-19 (formerly He-E 501.14)

He-E 501.16 Service Authorization.

(a) Once an applicant has been determined eligible to receive Title XX services, one or more of the following services shall be authorized by the provider based on the needs identified in the individual’s person-centered plan:

(1) Adult day services;

(2) Home-delivered meals; and

(3) In-home care services.

(b) The provider shall complete Form 3502, “Contract Service Authorization-New Authorization” (November 2019) and submit to:

Department of Health and Human Services

Bureau of Data Management

129 Pleasant Street

Concord, NH 03301

(c) Payment shall not be made to the provider unless Form 3502, “Contract Service Authorization” (September 2014) is submitted to data management as indicated above.

Source. #9849-A, eff 1-12-11, EXPIRED: 1-12-19

New. #12720, INTERIM, eff 1-29-19, EXPIRED: 7-29-19

New. #12936, eff 12-7-19 (formerly He-E 501.15)

He-E 501.17 Service Records.

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

(b) The service record shall contain:

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

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

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

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

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

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

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

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

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

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

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

(12) Documentation of the following:

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

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

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

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

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

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

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

Source. #9849-A, eff 1-12-11, EXPIRED: 1-12-19

New. #12720, INTERIM, eff 1-29-19, EXPIRED: 7-29-19

New. #12936, eff 12-7-19 (formerly He-E 501.16)

He-E 501.18 Title XX Services Added During the Eligibility Period.

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

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

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

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

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

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

Source. #9849-A, eff 1-12-11, EXPIRED: 1-12-19

New. #12720, INTERIM, eff 1-29-19, EXPIRED: 7-29-19

New. #12936, eff 12-7-19 (formerly He-E 501.17)

He-E 501.19 Relocation and Title XX Services.

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

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

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

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

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

Source. #9849-A, eff 1-12-11, EXPIRED: 1-12-19

New. #12720, INTERIM, eff 1-29-19, EXPIRED: 7-29-19

New. #12936, eff 12-7-19 (formerly He-E 501.18)

He-E 501.20 Cessation of Title XX Services by a Provider.

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

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

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

Source. #9849-A, eff 1-12-11, EXPIRED: 1-12-19

New. #12720, INTERIM, eff 1-29-19, EXPIRED: 7-29-19

New. #12936, eff 12-7-19 (formerly He-E 501.19)

He-E 501.21 Vendor Requirements.

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

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

(2) Have a tax identification number;

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

(4) Have proof of insurance; and

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

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

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

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

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

(d) Vendors providing emergency support shall:

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

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

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

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

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

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

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

Source. #9849-A, eff 1-12-11, EXPIRED: 1-12-19

New. #12720, INTERIM, eff 1-29-19, EXPIRED: 7-29-19

New. #12936, eff 12-7-19

He-E 501.22 Person-Centered Plan.

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

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

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

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

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

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

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

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

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

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

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

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

Source. #9849-A, eff 1-12-11, EXPIRED: 1-12-19

New. #12720, INTERIM, eff 1-29-19, EXPIRED: 7-29-19

New. #12936, eff 12-7-19 (formerly He-E 501.21)

He-E 501.23 Adult Day Services.

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

(1) Supervision in a protected environment;

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

a. Personal care services;

b. Health and safety services;

c. Nutrition services;

d. Nursing services;

e. Social services; and

f. Recreational activities;

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

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

(b) Providers of adult day services shall:

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

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

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

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

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

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

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

b. Requires adult day program services.

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

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

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

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

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

Source. #9849-A, eff 1-12-11, EXPIRED: 1-12-19

New. #12720, INTERIM, eff 1-29-19, EXPIRED: 7-29-19

New. #12936, eff 12-7-19 (formerly He-E 501.22)

He-E 501.24 Essential Services.

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

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

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

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

a. Meal preparation;

b. Personal care; or

c. Light housekeeping.

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

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

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

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

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

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

Source. #9849-A, eff 1-12-11, EXPIRED: 1-12-19

New. #12720, INTERIM, eff 1-29-19, EXPIRED: 7-29-19

New. #12936, eff 12-7-19 (formerly He-E 501.27)

He-E 501.25 Home-Delivered Meals.

(a) Home-delivered meals services shall include:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

(d) Each meal shall:

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

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

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

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

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

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

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

(1) The date of the meal;

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

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

Source. #9849-A, eff 1-12-11, EXPIRED: 1-12-19

New. #12720, INTERIM, eff 1-29-19, EXPIRED: 7-29-19

New. #12936, eff 12-7-19

He-E 501.26 In-Home Care Services.

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

(1) Light housecleaning;

(2) Laundry;

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

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

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

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

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

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

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

a. dressing;

b. meal preparation, eating and drinking;

c. grooming;

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

e. toileting;

(2) Providing and encouraging socialization; and

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

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

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

Source. #9849-A, eff 1-12-11, EXPIRED: 1-12-19

New. #12720, INTERIM, eff 1-29-19, EXPIRED: 7-29-19

New. #12936, eff 12-7-19 (formerly He-E 501.24)

He-E 501.27 Waivers.

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

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

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

(3) Mail to:

The Department of Health & Human Services

Bureau of Elderly and Adult Services

105 Pleasant St., Main Building

Concord NH 03301.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Source. #9849-A, eff 1-12-11, EXPIRED: 1-12-19

New. #12720, INTERIM, eff 1-29-19, EXPIRED: 7-29-19

New. #12936, eff 12-7-19

PART He-E 502 OLDER AMERICANS ACT SERVICES: TITLE IIIB – SUPPORTIVE SERVICES, TITLE IIIC1 AND C2 – NUTRITION PROGRAM POLICIES, AND TITLE IIID – DISEASE PREVENTION AND HEALTH PROMOTION SERVICES

REVISION NOTE:

Document #10530, effective 2-28-14, adopted He-E 502 titled “Older Americans Act Services: Title IIIB-Supportive Services, Title IIIC1 and C2-Nutrition Program Policies, and Title IIID-Disease Prevention and Health Promotion Services.” He-E 502 had formerly been titled “Definitions” for Chapter He-E 500 on social services. The former He-E 502 had originally been filed under Document #5584, effective 2-16-93, had been superseded by rules filed under Document #5732, effective 10-27-93, and had expired 10-27-99.

He-E 502.01 Purpose and Goals.

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

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

(2) The eligibility requirements for these services.

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

(1) Individuals with severe disabilities;

(2) Low income minority older individuals;

(3) Native Americans;

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

(5) Older individuals residing in rural areas;

(6) Older individuals with limited English proficiency; and

(7) Older individuals at risk for institutional placement.

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

He-E 502.02 Definitions.

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

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

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

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

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

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

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

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

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

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

(3) Visually impaired; or

(4) Speech impaired.

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

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

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

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

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

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

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

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

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

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

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

(3) A motel or hotel; or

(4) A homeless shelter.

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

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

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

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

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

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

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

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

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

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

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

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

He-E 502.03 Confidentiality. All information on individuals receiving Title III services and programs administered by BEAS or a contract agency shall be kept confidential, and only persons involved in administering Title III services and programs shall review an individual’s information, unless the individual signs an authorization to release the information to another person or organization.

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

He-E 502.04 Title III Services.

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

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

(1) Adult day program services;

(2) Adult in-home care services;

(3) Alcohol and substance abuse prevention services;

(4) Dental services;

(5) Elder abuse counseling;

(6) Home health aide services;

(7) Homemaker services;

(8) Legal services;

(9) Low vision service;

(10) Nursing services;

(11) Nutrition services: congregate meals;

(12) Nutrition services: home delivered meals;

(13) Prevention services; and

(14) Transportation services.

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

He-E 502.05 Eligibility Requirements for Services.

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

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

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

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

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

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

He-E 502.06 Service Requests and Process.

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

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

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

He-E 502.07 Determination, Notice of Eligibility, and Eligibility Period.

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

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

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

(1) Adult day program services;

(2) Adult in-home care services;

(3) Home health aide services;

(4) Homemaker services;

(5) Nursing services; and

(6) Nutrition services: home delivered meals.

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

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

(2) The eligibility period; and

(3) Contact information for the contract agency.

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

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

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

(3) Contact information for the contract agency.

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

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

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

He-E 502.08 Redetermination of Service Eligibility.

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

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

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

He-E 502.09 Termination or Significant Alteration of Services.

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

(b) Title III services shall be terminated when:

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

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

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

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

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

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

(7) The individual expires.

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

(1) Adult day program services;

(2) Adult in-home care services;

(3) Home health aide services;

(4) Homemaker services;

(5) Nursing services; and

(6) Nutrition services: home delivered meals.

(d) The notice of termination shall specify:

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

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

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

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

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

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

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

(1) Adult day program services;

(2) Adult in-home care services;

(3) Home health aide services;

(4) Homemaker services;

(5) Nutrition services: congregate meals, and

(6) Nutrition services: home delivered meals.

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

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

(1) The contract agency shall:

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

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

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

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

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

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

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

(1) Adult day program services;

(2) Adult in-home care services;

(3) Home health aide services;

(4) Homemaker services;

(5) Nursing services; and

(6) Nutrition services: home delivered meals.

(k) The notice of significant alteration shall specify:

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

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

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

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

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

He-E 502.10 Informal Resolution.

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

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

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

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

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

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

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

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

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

(f) Requesting an informal resolution shall not:

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

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

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

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

He-E 502.11 Contract Agency Requirements.

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

(b) Contract agencies shall:

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

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

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

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

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

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

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

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

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

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

a. The contract agency’s policies and procedures;

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

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

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

(12) Develop procedures for staff responses to emergencies;

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

d. Ensure that contract agency staff:

1. Has direct contemporaneous contact with each individual; and

2. Reports any observations of unusual circumstances to the designated contract agency supervisor or, in the case of an emergency, calls emergency personnel; and

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

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

He-E 502.12 Voluntary Donations.

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

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

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

(2) The contract agency may suggest an amount for a donation, but shall not use means testing as the basis for the donation or expect the donation to cover the full cost of services.

(1) Protect the privacy and confidentiality of each individual with respect to the individual’s donation or lack of a donation;

(2) Establish appropriate procedures to safeguard and account for all donations; and

(3) Use all donations to support the program for which donations were given.

(d) For individuals with an open APS protective services case as described in He-E 700, the APS program rule, the contract agency shall not attempt to secure additional reimbursement, including donations, of any type from the individual or his or her family members or authorized representative for those services.

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

He-E 502.13 Wait Lists.

(a) All services covered by He-E 502 shall be provided to the extent that funds, staff, and resources for this purpose are available.

(b) The contract agency shall maintain a wait list for Title III services when funding or resources are not available to provide the services, except that a wait list for Title III group educational or walk-in services shall not be required.

(1) Who are newly eligible and ready to receive services;

(2) Who are already receiving services and are requesting additional services; and

(3) Who relocate outside of the catchment area for the contract agency providing services and are requesting Title III services from a contract agency in the new location.

(d) Each contract agency shall include the following information on its wait list:

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

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

(3) The target date, if known, of implementing the services based on the communication between the individual and the contract agency;

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

(5) The individual’s assigned priority on the wait list, determined in accordance with (e) below; and

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

(e) The contract agency shall prioritize each individual’s standing on the wait list by determining the individual’s urgency of need in the following order:

(1) Individual has an open APS protective services case;

(2) Individual is not already receiving services through one of DHHS’ Medicaid waiver programs, or who may be eligible for other NH Medicaid services;

(3) Individual is identified by Title III as belonging to one of the following groups, as described in He-E 502.01(b)(1)-(6):

a. Individuals with severe disabilities;

b. Low income minority older individuals;

c. Native Americans;

d. Older individuals in greatest social or economic need;

e. Older individuals residing in rural areas; and

f. Older individuals with limited English proficiency;

(4) Individual is at risk of being admitted to an institutional setting due to:

a. Declining mental or physical health of the caregiver;

b. Declining mental or physical health of the individual; or

c. Individual living with a caregiver who is in need of substitute or respite care due to the temporary incapacity, illness, or unavailability of the regular caregiver;

(5) Length of time on the wait list; and

(6) Individual is transitioning from an institutional setting.

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

(g) The individual may reserve the right to remove his or her name from the wait list at any time or apply for Title III services with another contract agency.

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

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

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

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

(4) A statement that notifies the individual of the right to remove his or her name from the wait list and to request Title III services with another contract agency;

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

(6) The contact information for the contract agency(ies); and

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

(i) Upon becoming aware of availability to provide a Title III service, the contract agency shall immediately call and send written notice to the individual requesting Title III services based on the priority outline in (e) above and, if appropriate, the assigned APS protective social worker.

(j) The individual shall respond to the contract agency within 10 business days of the date on the written notice, indicating whether or not they still wish to receive the Title III services.

(k) If the individual does not respond within 10 business days, the contract agency shall no longer be obligated to provide Title III services to that individual.

(l) The individual may make another request for Title III services in accordance with He-E 502.06 and 502.07.

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

He-E 502.14 Service Authorization.

(a) Once the individual has been determined eligible to receive Title III services, the following Title III services shall be authorized by the contract agency, acting on behalf of BEAS, in order for the individual to receive services funded by Title III:

(1) Adult day program services;

(2) Adult in-home care services;

(3) Home health aide services;

(4) Homemaker services;

(5) Nutrition services: congregate meals; and

(6) Nutrition services: home delivered meals.

(b) Service authorizations shall consist of the specific types of services required to meet the needs identified on the individual’s person-centered plan.

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

He-E 502.15 Service Records.

(a) Contract agencies shall maintain a service record for all individuals receiving one or more Title III services except as provided in (h) below.

(b) The service record shall contain:

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

(2) A notation that the individual meets the eligibility requirements for services as described in He-E 502.05;

(3) An annual notation of the decision to recertify or terminate services as described in He-E 502.08;

(4) Notation of the following:

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

b. The dates of service provision and the number of service units provided;

c. Identification of the individual’s communication access needs, including type and modality, and the name of the communication access provider or type of device utilized, if applicable; and

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

(5) The service authorization as described in He-E 502.14(a), if applicable.

(1) Adult in-home care services;

(2) Home health aide services;

(3) Homemaker services;

(4) Nursing services; and

(5) Nutrition services: home delivered meals.

(d) The additional documentation specified in (c) above shall include:

(1) A copy of the notice of decision for the provision of service(s) as described in He-E 502.07, as applicable;

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

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

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

(5) Documentation of changes in the individual’s health or other circumstances affecting service provision;

(6) A copy of any termination notification(s) to the individual and BEAS as described in He-E 502.09, if applicable, or a notation that the individual voluntarily terminated services;

(7) The person-centered plan as described in He-E 502.17;

(8) The dates upon which service(s) will begin and end;

(9) The planned frequency of the service(s);

(10) The total number of service units that will be provided on each date of service, if appropriate; and

(11) Copies of all executed legal directives provided to the contract agency, such as guardianship orders for health care under RSA 464-A, a durable power of attorney or a living will, or any advanced directives under RSA 137-J.

(e) Contract agencies providing adult day program services shall be required to comply with all documentation requirements as described in He-P 818, in addition to the requirements outlined in He-E 502.15(b).

(f) Service records shall be kept confidential in accordance with He-E 502.03 and all applicable federal and state laws and regulations.

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

(h) No service record shall be required for individuals receiving only group educational or walk-in services, or telephone services as described in He-E 502.25 Legal Services.

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

He-E 502.16 Cessation of Title III Services by a Contract Agency.

(a) When a contract agency decides to terminate its contract for a Title III service, the agency shall provide written notification to BEAS in accordance with the terms of the contract.

(b) The contract agency shall develop and submit a transition plan for services under the agreement, including, but not limited to, identifying the present and future needs of individuals receiving services under the agreement and establishing a process to meet those needs in accordance with the terms of the contract.

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

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

He-E 502.17 Person-Centered Plan.

(a) Contract agencies providing the Title III services described in this rule shall develop a person-centered plan for individuals receiving one or more of the following services:

(1) Adult day program services;

(2) Adult in-home care services;

(3) Home health aide services;

(4) Homemaker services;

(5) Nursing services; and

(6) Nutrition services: home-delivered meals.

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

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

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

(3) Documentation, as appropriate, to reflect the person-centered plan is responsive to the changing needs of the individual; and

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

(d) The contract agency shall provide service to individuals based on the person-centered plan.

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

(f) In addition to the requirements in (c) above, contract agencies providing adult day program services shall be required to comply with all care plan requirements described in He-P 818.

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

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

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

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

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

He-E 502.18 Adult Day Program Services.

(a) Contract agencies providing adult day program services shall:

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

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

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

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

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

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

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

b. Requires adult day program services.

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

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

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

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

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

He-E 502.19 Adult In-Home Care Services.

(a) To be eligible for adult in-home care services, the individual shall have an open APS protective services case and be assessed to be in need of adult in-home care services by an adult protective services social worker.

(b) Adult in-home care services shall be provided by employees of:

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

(2) Home care service providers licensed in accordance with RSA 151:2 and He-P 822; or

(3) Other qualified agencies certified in accordance with RSA 161-I and He-P 601.

(c) Contract agencies providing adult in-home care services shall provide the following core household maintenance tasks based on the individual’s needs including:

(1) Housecleaning;

(2) Laundry;

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

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

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

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

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

(d) Contract agencies providing adult in-home care services shall facilitate one or more of the following activities of daily living or instruction in self-care, based on the individual’s needs including:

(1) Bathing;

(2) Dressing;

(3) Eating and drinking;

(4) Grooming;

(5) Taking medication as allowed in He-P 809 and He-P 822; and

(6) Toileting.

(e) Contract agencies providing adult in-home care services shall:

(1) Provide and encourage socialization; and

(2) Evaluate the individual’s progress and when necessary, provide information about, and referral to, other resources.

(f) Contract agencies shall coordinate adult in-home care services to ensure that there is no meal preparation being provided when home delivered meals will be delivered to the individual, and that there is no duplication of additional Title III or other services being provided to the individual.

(g) At least every 3 months the contract agency shall meet with a BEAS adult protective services staff person or communicate by telephone or email in order to assess:

(1) The status of each individual receiving adult in-home care services; and

(2) Whether any changes are needed regarding the type or frequency of service being provided.

(h) If the individual continues to have an open APS protective services case beyond 6 months, the adult protective services social worker shall confer with the appropriate BEAS staff to assess the individual’s appropriateness for the other assistance programs.

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

He-E 502.20 Alcohol and Substance Abuse Prevention Services.

(a) A contract agency shall administer alcohol and substance abuse prevention services, as follows:

(1) Within the contract agency, a prevention specialist certified by the Prevention Certification Board of New Hampshire shall oversee the provision of alcohol and substance abuse prevention services; and

(2) The prevention specialist’s certification shall be kept current in accordance with the requirements of the Prevention Certification Board of New Hampshire.

(b) Alcohol and substance abuse prevention services shall include:

(1) Brief intervention and counseling provided by counselors from New Hampshire’s community mental health centers, and as follows:

a. There shall be subcontracts for this purpose between the mental health centers and the contract agency administering alcohol and substance abuse prevention services;

b. Oversight and training of counselors shall be provided by the contract agency administering alcohol and substance abuse prevention services; and

c. A maximum of 5 counseling sessions per individual shall be provided, and for each individual:

1. Screening shall be completed and documented by the counselor using age-appropriate evidence-based screening tools identified by the contract agency administering alcohol and substance abuse prevention services;

2. Goals shall be identified and strategies for accomplishing these goals shall be developed, including referrals to other resources as needed; and

3. A record shall be kept by the counselor of all visits with the individual;

(2) Group educational programs, which shall be held in community-based locations, and address topics such as:

a. Preventing or alleviating the misuse of alcohol, medications, or other drugs;

b. Life changes;

c. Depression or emotional stress;

d. Grief and loss;

e. Opportunities to reduce isolation, improve social interaction, and improve interpersonal relationships; and

f. Other issues that enhance an individual’s ability to live independently, such as home safety and injury prevention; and

(3) Outreach services to encourage individuals to participate in group educational programs.

(1) Provide resource materials that are specific to preventing or alleviating substance misuse among older individuals, and, at the option of the contract agency, resource materials on the other issues identified in (b)(2) above; and

(2) Provide handouts for individuals related to the group educational sessions described in (b)(2) above.

(d) The contract agency administering alcohol and substance abuse prevention services shall keep a log of each group educational activity that includes:

(1) The date of the group educational activity;

(2) The topic of the group educational activity; and

(3) The names of attendees.

(e) The contract agency administering alcohol and substance abuse prevention services shall conduct evaluations on the effectiveness of these services and provide the results of these evaluations annually to BEAS.

(f) The contract agency administering alcohol and substance abuse prevention services shall complete quarterly program reports.

Source. (See Revision Note at part heading for He-E 502) #10530, eff 2-28-14; ss by #13354, eff 3-19-22 (formerly
He-E 502.21)

He-E 502.21 Dental Services.

(a) Dental services shall include:

(1) Oral exams, including cancer screenings, which are performed to detect and prevent dental diseases and to identify an individual’s dental care needs;

(2) Cleanings;

(3) Restorations;

(4) Prostheses, such as dentures and partial dentures;

(5) Surgical procedures to address infections;

(6) Education regarding dental health; and

(7) When necessary, referrals to other dental or medical services.

(b) Dental services shall be provided by contract agencies or vendors that:

(1) Meet the requirements contained in He-E 502.11 and in any other applicable state laws or rules; and

(2) Employ staff members who are licensed by the NH board of dental examiners in accordance with RSA 317-A.

(c) Contract agencies providing dental services may utilize students enrolled in accredited dental hygiene and dental care programs to assist in the provision of dental care services provided that these students are supervised by contract agency staff that is licensed in accordance with applicable state laws or rules.

(d) For each individual receiving dental services:

(1) An assessment shall be completed and documented;

(2) Goals shall be identified and an individual treatment plan developed; and

(3) Progress notes shall be made by the staff member after each dental visit.

(e) Dental work done only for aesthetic purposes shall not be covered.

Source. (See Revision Note at part heading for He-E 502) #10530, eff 2-28-14; ss by #13354, eff 3-19-22 (formerly
He-E 502.22)

He-E 502.22 Elder Abuse Counseling.

(a) Elder abuse counseling services shall meet the needs of individuals who require assistance in resolving problems or relieving temporary stresses. Problems addressed may include elder abuse, neglect, self-neglect, exploitation, or physical harm inflicted.

(b) Contract agencies conducting elder abuse counseling shall provide the following services:

(1) Assisting and supporting individuals in resolving problems and relieving stress;

(2) Providing one-on-one or group educational sessions; and

(3) Group educational service programs for individuals on topics concerning the prevention of elder abuse, neglect or self-neglect, and exploitation.

(c) Elder abuse counselors shall be licensed as social workers or mental health practitioners by the State of New Hampshire in accordance with RSA 330-A, and have a working knowledge of effective geriatric assessment tools, mental health issues affecting older individuals, and elder abuse treatment resources.

(d) For each individual receiving elder abuse counseling:

(1) An assessment shall be completed and documented;

(2) Goals shall be identified and an individual treatment plan developed; and

(3) Progress notes shall be made by the counselor following each counseling session.

(e) Contract agencies providing elder abuse counseling services shall keep a service provision log of all group educational activities that includes:

(1) The date of the group educational activity provided;

(2) The type of the group educational activity provided;

(3) The names of the attendees; and

(4) Comment on any follow-up action as needed.

Source. (See Revision Note at part heading for He-E 502) #10530, eff 2-28-14; ss by #13354, eff 3-19-22 (formerly
He-E 502.23)

He-E 502.23 Home Health Aide Services.

(a) Home health aide services shall be provided by a home health care provider licensed in accordance with RSA 151:2 and He-P 809.

(b) Home health aide services shall be covered when provided by a licensed nursing assistant (LNA) working within the LNA scope of practice, pursuant to Nur 700.

(1) Services allowed within the LNA scope of practice, pursuant to Nur 700; and

(2) Personal care services, as described in He-E 801.22(b), when the individual’s person-centered plan contains documentation that his or her functional or medical condition necessitates the performance of such tasks by an LNA and not an unlicensed provider.

(d) Contract agencies shall coordinate home health aide services to ensure that there is no duplicate provision of services when the individual is also receiving home delivered meals, other Title III services, or services at an adult medical day program, in an assisted living facility, or in an adult family care home.

Source. (See Revision Note at part heading for He-E 502) #10530, eff 2-28-14; ss by #13354, eff 3-19-22 (formerly
He-E 502.24)

He-E 502.24 Homemaker Services.

(a) Homemaker services shall be provided by employees of:

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

(2) Home care service providers licensed in accordance with RSA 151:2 and He-P 822; or

(3) Other qualified agencies certified in accordance with RSA 161-I and He-P 601.

(b) Contract agencies providing homemaker services shall provide the following core household maintenance tasks based on the individual’s needs, including:

(1) Housecleaning;

(2) Laundry;

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

(4) Preparation of non-communal meals;

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

(6) Shopping for groceries and other errands; and

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

(c) Contract agencies providing homemaker services shall facilitate one or more of the following activities of daily living or instruction in self-care, based on the individual’s needs including:

(1) Bathing;

(2) Dressing;

(3) Eating and drinking;

(4) Grooming;

(5) Taking medication as allowed in He-P 809 and He-P 822; and

(6) Toileting.

(d) Contract agencies providing homemaker services shall:

(1) Provide and encourage socialization; and

(2) Evaluate the individual’s progress and when necessary, provide information about, and referral to, other resources.

(e) Contract agencies shall coordinate homemaker services to ensure that there is no meal preparation being provided when home delivered meals will be delivered to the individual, and that there is no duplication of additional Title III or other services being provided to the individual.

Source. (See Revision Note at part heading for He-E 502) #10530, eff 2-28-14; ss by #13354, eff 3-19-22 (formerly
He-E 502.25)

He-E 502.25 Legal Services.

(a) Legal services shall be provided to individuals who are in need of assistance from a paralegal or attorney as described in Title III, and include:

(1) The provision of statewide telephone access through a toll-free number;

(2) Performing community outreach and education, including the provision of written materials to increase awareness of legal rights and legal services; and

(3) The provision of legal advice, counseling, and litigation services by attorneys, or legal assistants working under the supervision of an attorney, in accordance with the administrative rules of the Supreme Court of the State of NH to address civil matters including, but not limited to:

a. Consumer issues relating to debt collection, financial exploitation, and health care services;

b. Family matters;

c. Matters involving public assistance benefits;

d. Matters involving utility shut-off;

e. Nursing facility and assisted living facility issues;

f. Public and private housing matters;

g. The provision of legal representation at hearings or in court; or

h. The provision of referral services to other sources of local assistance.

(b) For each individual receiving counseling and litigation legal services, a case record shall be developed and maintained and case notes be kept as required by He-E 502.15 following each counseling or litigation session.

(c) Contract agencies providing legal services shall keep a service provision log of all telephone, walk-in, and group educational activities which includes:

(1) The date of the telephone call, walk-in, or group educational activity;

(2) The type of interaction provided;

(3) The name of the individual(s) counseled; and

(4) Comment on any follow-up service provided.

Source. (See Revision Note at part heading for He-E 502) #10530, eff 2-28-14; ss by #13354, eff 3-19-22 (formerly
He-E 502.26)

He-E 502.26 Low Vision Services.

(a) Low vision services shall be provided to individuals who are blind or visually impaired in order to help them perform activities of daily living and attain an optimal level of independence and quality of life.

(b) Contract agencies providing low vision services shall include the following activities, based on the individual’s needs:

(1) Vision rehabilitation, including the evaluation, diagnosis, and management of visual impairment;

(2) Mobility, optical aid, and orientation training;

(3) Counseling on adjustment to vision loss, including referrals to support groups and other appropriate community services; and

(4) The prescription of optical, non-optical, electronic devices, or other treatments.

(d) For each individual receiving low vision services:

(1) An assessment shall be completed and documented;

(2) Goals shall be identified and an individual treatment plan developed; and

(3) Progress notes shall be made by the licensed practitioner following each visit session.

Source. (See Revision Note at part heading for He-E 502) #10530, eff 2-28-14; ss by #13354, eff 3-19-22 (formerly
He-E 502.27)

He-E 502.27 Nursing Services.

(a) Nursing services shall be provided in an individual’s home by a home health care provider licensed in accordance with RSA 151:2 and He-P 809.

(b) Nursing services shall be covered when provided by a licensed practical nurse (LPN) or registered nurse working within the scope of services allowed under the Nurse Practice Act, RSA 326-B.

(1) Receiving referrals;

(2) Evaluation of the individual’s needs;

(3) Developing a nursing care plan and incorporating this information into the individual’s person-centered plan; and

(4) Providing nursing services in accordance with the individual’s person-centered plan as described in He-E 502.17 and ordered by his or her physician.

(d) Contract agencies shall coordinate nursing services to ensure that there is no duplicate provision of services.

(e) LPN and registered nursing services shall not be covered when provided for the purpose of nursing oversight of authorized LNA services.

Source. (See Revision Note at part heading for He-E 502) #10530, eff 2-28-14; ss by #13354, eff 3-19-22 (formerly
He-E 502.28)

He-E 502.28 Nutrition Services: Congregate Meals.

(a) Contract agencies providing congregate meals shall:

(1) Provide meals in a congregate setting that affords opportunity for social contact; and

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

(b) Congregate meals shall include at least one hot or other appropriate meal per day for 5 or more days per week except in rural areas where such frequency is not feasible and a lesser frequency is approved by BEAS.

(c) Contract agencies approved to provide services at a lesser frequency pursuant to (b) above shall keep the approval on file. Approval of a contract with a lesser frequency shall constitute approval pursuant to (b) above.

(d) Each meal shall:

(1) Include a minimum of 33 1/3 percent of the dietary reference intakes established by the Food and Nutrition Board of the Institute of Medicine, National Academies of Sciences, Engineering, and Medicine and comply with the U.S. Department of Agriculture and the U.S. Department of Health and Human Services “Dietary Guidelines for Americans, 2020-2025” (Ninth Edition), available as noted in Appendix A; and

(2) Accommodate, to the extent possible, the special dietary needs or preference of the individual, including recommendations from the individual’s licensed practitioner, or preferences stemming from the individual’s cultural or religious background.

(e) In addition to offering congregate meals to individuals who meet the eligibility requirements contained in this rule, contract agencies providing this service may also offer a meal, on the same basis as meals provided to eligible older individuals, to:

(1) The spouses of individuals who accompany them to the meal site;

(2) Persons providing volunteer services as part of the meal service, including caregivers during meal hours;

(3) Persons with disabilities under the age of 60 who reside at home with an individual who is receiving Title III services; and

(4) Persons with disabilities under the age of 60 who reside in housing facilities occupied by older individuals where congregate meals are provided.

(f) Contract agencies providing nutrition services: congregate meals shall keep a service provision log of all meals that includes:

(1) The date of the meal;

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

(3) Comment on any follow-up service provided.

Source. (See Revision Note at part heading for He-E 502) #10530, eff 2-28-14; ss by #13354, eff 3-19-22 (formerly
He-E 502.29)

He-E 502.29 Nutrition Services: Home-Delivered Meals.

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

(1) Meet the eligibility requirements contained in He-E 502.05; and

(2) Meet one or more of the following requirements:

a. Have limited capacity to prepare meals without assistance;

b. Have limited ability to leave their residence; or

c. Are unable to consume meals at a congregate dining location due to physical, emotional, or mental difficulties or limited desire for social interactions.

(b) Contract agencies providing home-delivered meals shall:

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

(2) Accommodate, to the extent possible, the special dietary needs and preference of the individual, including recommendations from the individual’s licensed practitioner, and preferences stemming from the individual’s cultural or religious background.

(c) Each meal shall include at least a minimum of 33 1/3 percent of the dietary reference intakes established by the Food and Nutrition Board of the Institute of Medicine, National Academy of Sciences, Engineering and Medicine and comply with the U.S. Department of Agriculture and the U.S. Department of Health and Human Services “Dietary Guidelines for Americans, 2020-2025” (Ninth Edition), available as noted in Appendix B.

(d) In addition to offering home-delivered meals to individuals who meet the eligibility requirements contained in this rule, contract agencies providing this service may also offer meals to:

(1) The spouses of individuals;

(2) Persons providing volunteer service through a volunteer service program such as the Retired and Senior Volunteer Program (RSVP) or Senior Companion Program who are working at the recipient’s home during meal hours or volunteering during the service delivery process;

(3) Persons with disabilities who are under the age of 60 who reside at home with an individual who is receiving Title III services; and

(4) Persons with disabilities under the age of 60 who reside in housing facilities occupied primarily by older individuals at which congregate meals are provided.

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

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

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

(f) The contract agency shall provide individuals referrals to other services or programs as necessary.

(g) Contract agencies shall coordinate the provision of home delivered meals to ensure that there is no duplication of services when additional Title III or other services are being provided to the individual, and that the individual is present to receive the meal. Meals that are delivered to an individual’s home when the individual is not at home shall not be reimbursed.

(h) Contract agencies providing home-delivered meals shall keep a service provision log of all meals delivered that includes:

(1) The date of the meal;

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

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

Source. (See Revision Note at part heading for He-E 502) #10530, eff 2-28-14; ss by #13354, eff 3-19-22 (formerly
He-E 502.30)

He-E 502.30 Prevention Services.

(a) Prevention services shall be covered for individuals who meet the eligibility requirements for Title III services as described in He-E 502.05.

(b) Prevention services shall include, but not be limited to:

(1) Evidence-based health screenings that can detect the presence of, or an individual’s risk for, heart disease, diabetes, cancer, asthma, strokes, vision loss, hearing loss, or other chronic diseases or conditions;

(2) Evidence-based group educational programs or individual counseling on topics such as nutrition, exercise, mobility, medication management, pain management, home safety, the emotional aspects of chronic disease or conditions, or other related topics;

(3) Individual assessments and the development of individual action plans to help prevent injuries or prevent or manage chronic diseases or conditions; and

(4) Referrals to other service providers as necessary, including health care providers who can follow up on further prevention or treatment of chronic diseases or conditions.

(1) An assessment shall be completed and documented;

(2) Goals shall be identified and an individual treatment plan developed; and

(3) Progress notes shall be made by the counselor following each contact or session.

(d) Contract agencies providing prevention services shall keep a service provision log for health screenings, referrals, group educational services, or walk-in service activities that includes:

(1) The date of the activity;

(2) The type of activity or service provided;

(3) The name(s) of the attendee(s) or service recipient(s); and

(4) Comment on any follow-up service provided.

Source. (See Revision Note at part heading for He-E 502) #10530, eff 2-28-14 (formerly He-E 502.31)

He-E 502.31 Transportation.

(a) Transportation services shall be covered for the purpose of accessing the following types of services:

(1) Title III services, except home delivered meals;

(2) Medical appointments;

(3) Shopping for groceries and other basic needs; and

(4) Services provided by community facilities and agencies that increase participation in programs, or otherwise promote independent living.

(b) Contract agencies providing transportation services shall comply with provisions included in the contract with regard to routes and reimbursements.

(1) Registered pursuant to Saf-C 500;

(2) Inspected pursuant to Saf-C 3200, and are in good working order; and

(3) Insured for personal liability.

(d) Transportation services shall be provided by individuals who:

(1) Have a current and valid driver’s license; and

(2) Are employees of a Title III service provider or other transportation provider, or volunteers under the supervision of a Title III service provider.

(e) Contract agencies shall document transportation services provided to the individual on an operational schedule or on a service provision log that includes:

(1) The date(s) of service;

(2) The starting and ending locations;

(3) The name(s) of the individual(s);

(4) The reason the transportation services are required;

(5) The name(s) of the driver; and

(6) Comment on any follow-up service provided.

(f) Transportation services for individuals shall not be reimbursed when duplicative of any other program or services, or when included as a core service under the rate paid to the service provider.

Source. (See Revision Note at part heading for He-E 502) #10530, eff 2-28-14 (formerly He-E 502.32)

PART He-E 503 ALZHEIMER'S RESPITE CARE SERVICE

Statutory Authority: RSA 161-F:67

He-E 503.01 Purpose. The purpose of the respite care described in this rule is to provide temporary rest and relief to the primary caregiver from the demands of care provided to a person with Alzheimer’s disease or a related disorder at home.

Source. #5584, eff 2-16-93; ss by #5732, eff 10-27-93, EXPIRED: 10-27-99

New. #7799, eff 12-4-02, EXPIRED: 12-4-10

New. #9834, INTERIM, eff 12-18-10, EXPIRES: 6-16-11; ss by #9931, eff 5-26-11; ss by #12781, INTERIM, eff 5-21-19, EXPIRED: 11-18-19

New. #13437, eff 8-19-22

He-E 503.02 Definitions.

(a) “Adult” means an individual age 18 and older.

(b) “Alzheimer’s disease and related disorders (ADRD),” means “ADRD” as defined in RSA 161-F:66, I.”

(d) “Bureau” means the New Hampshire department of health and human services bureau of elderly and adult services.

(e) “Contract agency” means the agency contracted with the bureau to coordinate ADRD respite care services in accordance with He-E 503.

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

(g) “Eligible person”, pursuant to RSA 161-F:66, II, means an adult who is unable to attend to personal daily needs without the assistance or continuous supervision of a primary caregiver due to ADRD.

(h) “Financial management services agency” means a contract agency that performs human resources and financial functions in accordance with He-E 503.08.

(i) “Home health agency” means agencies licensed to provide home health care pursuant to He-P 809 or He-P 822 or certified as another qualified agency pursuant to He-P 601.

(j) “Nursing facility” means an institution or distinct part of an institution that meets the requirements of Section 1919 of the Social Security Act 42 USC 1396r.

(k) “Person-centered respite care plan” means a plan in which the primary caregiver is the center of the system of care and the primary caregiver’s needs and preferences drive the development and implementation of the respite care services provided.

(l) “Primary caregiver” pursuant to RSA 161-F:66, III, means the family member or other natural person who normally provides the home care and supervision of a victim of ADRD.

(m) “Residential care facility” means a facility providing assistance with personal and social activities at one of the levels of care described in RSA 151:9, VII and VIII, He-P 804, and He-P 805.

(n) “Respite care budget” means the amount of funding that is allocated to a primary caregiver from state general funds allocated to ADRD as part of the state budget.

(o) “Respite care provider” means the entity or the individual chosen by the primary caregiver to provide ADRD respite care services.

(p) “Respite care services” pursuant to RSA 161-F:66, IV means care provided on an intermittent basis to the eligible person to relieve the primary caregiver from the demands of home care for a limited period of time.

(q) “Spending plan” means a plan developed by the contract agency and primary caregiver to ensure the primary caregiver’s needs are met and the entire respite care budget is spent each fiscal year.

(r) “Waitlist” means a list of individuals with ADRD maintained by the contract agency who have been determined eligible, and in need of ADRD respite care services from a contract agency, but the agency does not have sufficient service units or resources to serve these individuals.

Source. #5584, eff 2-16-93; ss by #5732, eff 10-27-93, EXPIRED: 10-27-99

New. #7799, eff 12-4-02, EXPIRED: 12-4-10

New. #9834, INTERIM, eff 12-18-10, EXPIRES: 6-16-11; ss by #9931, eff 5-26-11; ss by #12781, INTERIM, eff 5-21-19, EXPIRED: 11-18-19

New. #13437, eff 8-19-22

He-E 503.03 Eligibility.

(a) To be eligible to receive ADRD respite care services, the individual requesting respite services shall be:

(1) The primary caregiver as defined in He-E 503.02(l); and

(2) Providing unpaid care 24 hours per day, 7 days per week to an individual with ADRD.

(b) The individual receiving ADRD respite care services shall be an adult who:

(1) Is unable to attend to his or her daily needs without the assistance or continuous supervision of a primary caregiver due to the impacts of ADRD.

(2) Is not receiving respite services paid through any of the following sources:

a. A medicaid waiver program;

b. The department of veterans affairs; or

c. Any other program.

Source. #7799, eff 12-4-02, EXPIRED: 12-4-10

New. #9834, INTERIM, eff 12-18-10, EXPIRES: 6-16-11; ss by #9931, eff 5-26-11; ss by #12781, INTERIM, eff 5-21-19, EXPIRED: 11-18-19

New. #13437, eff 8-19-22

He-E 503.04 Person Centered Respite Care Plan.

(a) If the eligibility requirements in He-E 503.03 are met, the primary caregiver and contract agency shall collaborate to complete and develop the following:

(1) An assessment in accordance with (b) below;

(2) A person-centered respite care plan; and

(3) A respite care budget in accordance with (e) and (f) below.

(b) The assessment shall include the following information:

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

(2) The name of the eligible person;

(3) The relationship of the primary caregiver to the eligible person;

(4) Confirmation that the eligible person:

a. Has received a differential diagnosis of Alzheimer’s disease or a similar irreversible dementia; or

b. Demonstrates symptoms of Alzheimer’s disease or a similar irreversible dementia; and

(5) The primary caregiver’s statement of the eligible person’s need for respite services.

(c) If the assessment indicates that the eligibility requirements for ADRD respite service, as described in He-E 503.03, are not met, the contract agency shall assist the primary caregiver to identify and explore other helpful resources, such as the social service block grant or choices for independence programs.

(d) The person-centered respite care plan shall be based on the completed assessment described in (b) above.

(e) The primary caregiver and the contract agency shall work to develop the respite care budget based on the needs identified in (b)(5) above.

(f) To ensure as many primary caregivers as possible receive respite, the respite care budget shall not exceed $2000 per primary caregiver annually.

(g) The contract agency shall review the person-centered respite care plan and respite care budget with the primary caregiver annually to determine the ongoing respite care service needs.

Source. #7799, eff 12-4-02, EXPIRED: 12-4-10

New. #9834, INTERIM, eff 12-18-10, EXPIRES: 6-16-11; ss by #9931, eff 5-26-11; ss by #12781, INTERIM, eff 5-21-19, EXPIRED: 11-18-19

New. #13437, eff 8-19-22

He-E 503.05 ADRD Respite Settings.

(a) ADRD respite care services shall be provided in the following settings:

(1) A home setting;

(2) A community setting, such as a licensed adult day program; or

(3) A licensed nursing or residential care facility.

(b) ADRD respite care services shall be provided by:

(1) Nursing facilities;

(2) Residential care facilities;

(3) Home health agencies;

(4) Adult day programs; or

(5) Individuals employed by a contracted financial management services agency as described in He- E 503.08(a).

Source. #7799, eff 12-4-02, EXPIRED: 12-4-10

New. #9834, INTERIM, eff 12-18-10, EXPIRES: 6-16-11; ss by #9931, eff 5-26-11; ss by #12781, INTERIM, eff 5-21-19, EXPIRED: 11-18-19

New. #13437, eff 8-19-22

He-E 503.06 Contract Agency Requirements.

(a) The contract agency shall:

(1) Receive inquiries and determine eligibility for ADRD respite services pursuant to He-E 503.03;

(2) Develop, in collaboration with the primary caregiver:

a. A person centered respite care plan and respite care budget as described in He-E 503.04; and

b. A spending plan in accordance with He-E 503.07 below;

(3) Identify the primary caregiver’s choice for a respite setting as described in He-E 503.05; and

(4) Review and modify the ADRD respite plan and respite care budget with the primary caregiver on an annual basis or more frequently if necessary to meet the primary caregiver’s needs.

Source. #7799, eff 12-4-02, EXPIRED: 12-4-10

New. #9834, INTERIM, eff 12-18-10, EXPIRES: 6-16-11; ss by #9931, eff 5-26-11; ss by #12781, INTERIM, eff 5-21-19, EXPIRED: 11-18-19

New. #13437, eff 8-19-22

He-E 503.07 ADRD Spending Plan.

(a) ADRD respite services shall be limited to the extent that funds, staff, or other necessary resources are available.

(b) The contract agency shall forward the respite care budget and spending plan to the financial management services agency.

(c) The financial management services agency shall pay invoices in accordance with the respite caregiver and spending plan.

Source. #13437, eff 8-19-22

He-E 503.08 Financial Management Services.

(a) The financial management services agency shall perform the following human resources functions for individuals working as respite providers:

(1) Be the employer of record;

(2) Complete tax, labor, and social security documents;

(3) Verify the individual’s citizenship or that the individual is legally authorized to work in the United States;

(4) Request a New Hampshire criminal records background check;

(5) Request a BEAS state registry check in accordance with RSA 161-F:49; and

(6) Manage timesheets.

(b) The financial management services agency shall perform the following financial management functions for individual respite care providers, primary caregivers, and the eligible person:

(1) Manage and pay invoices for each primary caregiver’s respite care budget and spending plan;

(2) Monitor respite care budgets allocated to primary caregivers; and

(3) Provide each contract agency with a monthly statement showing expenditures of ADRD funds by primary caregivers and any remaining balances.

Source. #13437, eff 8-19

He-E 503.09 Waitlist.

(a) The contract agency shall develop a waitlist of eligible primary caregivers when funding, staff, or other necessary resources are not available to support the provision of respite services.

(b) The contract agency shall prioritize participants on the waitlist using the following criteria:

(1) The declining mental or physical health of the primary caregiver;

(2) The economic need of the primary caregiver or the individual with ADRD; and

(3) An increase in the primary caregiver’s responsibilities.

Source. #7799, eff 12-4-02, EXPIRED: 12-4-10

New. #9834, INTERIM, eff 12-18-10, EXPIRES: 6-16-11; ss by #9931, eff 5-26-11; ss by #12781, INTERIM, eff 5-21-19, EXPIRED: 11-18-19

New. #13437, eff 8-19-22 (formerly He-E 503.08)

He-E 503.10 Waivers.

(a) Contract agencies who wish to request a waiver of a requirement contained in He-E 503 shall submit a letter to the bureau on the contract agency’s letterhead through one or more of the following means:

(1) E-mail to beas@dhhs.nh.gov;

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

(3) Mail by postal mail to:

The NH Department of Health and Human Services

Bureau of Elderly and Adult Services

105 Pleasant St., Main Building

Concord, NH 03301

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

(1) The specific requirement in He-E 503 that the contract agency requests be waived;

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

(3) The alternative proposed by the contract agency to satisfy the requirements of He-E 503.

(c) The department shall review the request, and within 60 calendar days of the date the request was received, inform the contract agency in writing of the decision.

(d) The waiver request shall be approved if the alternative proposed by the contract agency meets the intent of He-E 503 and does not:

(1) Negatively impact the health or safety of the eligible person or the primary caregiver;

(2) Affect the quality of services provided; or

(3) Waive any provision or procedure in statute.

(e) Waivers that are approved shall become effective as of the date of the written approval in accordance with He-E 503.10(c) above.

(f) Waivers that relate to the health, safety, or welfare of eligible persons or primary caregivers shall be effective for the remaining period of the primary caregiver’s eligibility period and subject to the primary caregiver’s continued eligibility.

(g) Contract agencies who wish to request a renewal of a waiver shall request a renewal at least 90 calendar days prior to the expiration of a current waiver by following the steps contained in He-E 503.10 (a) through (e) above.

(h) Any waiver shall end with the closure of the program or applicable service.

Source. #13437

PART He-E 504 METHOD OF SERVICE PROVISION - EXPIRED

Source. #5584, eff 2-16-93; ss by #5732, eff 10-27-93, EXPIRED: 10-27-99

PART He-E 505 PAYMENT FOR SERVICES

Source. #5584, eff 2-16-93; ss by #5732, eff 10-27-93, EXPIRED: 10-27-99

PART He-E 506 APPLICATION PROCESS

Source. #5584, eff 2-16-93; ss by #5732, eff 10-27-93, EXPIRED: 10-27-99

PART He-E 507 SERVICE AGREEMENT

Source. #5584, eff 2-16-93; ss by #5732, eff 10-27-93, EXPIRED: 10-27-99

PART He-E 508 PLAN OF CARE

Source. #5584, eff 2-16-93; ss by #5732, eff 10-27-93, EXPIRED: 10-27-99

PART He-E 509 SERVICE RECORD

Source. #5584, eff 2-16-93; ss by #5732, eff 10-27-93, EXPIRED: 10-27-99

PART He-E 510 MODES OF SERVICE

Source. #5584, eff 2-16-93; ss by #5732, eff 10-27-93, EXPIRED: 10-27-99

PART He-E 511 EVALUATION AND MONITORING OF SERVICE PROVISION

Source. #5584, eff 2-16-93; ss by #5732, eff 10-27-93, EXPIRED: 10-27-99

PART He-E 512 REDETERMINATION OF ELIGIBILITY FOR ADRD RESPITE CARE SERVICE

Source. #5584, eff 2-16-93; ss by #5732, eff 10-27-93, EXPIRED: 10-27-99

PART He-E 513 TRAINING

Source. #5584, eff 2-16-93; ss by #5732, eff 10-27-93, EXPIRED: 10-27-99

APPENDIX

Rule	Specific State Statute the Rule Implements

He-E 501.01-501.27	RSA 161-F:4; 42 USC 1397

He-E 502.01-He-E 502.32	RSA 161-F:4; 42 USC 3001 et. seq.

He-E 503 (Specific Rules implementing specific statutes are listed below)	RSA 161-F:65 and RSA 161-F:67
He-E 503.01	RSA 161-F:65
He-E 503.02	RSA 161-F:66
He-E 503.03	RSA 161-F:70,II
He-E 503.04	RSA 161-F:70,V,VI
He-E 503.05	RSA 161-F:65-70
He-E 503.06	RSA 161-F:69; RSA 161-F:67; RSA 161-F:70, VII
He-E 503.07	RSA 161-F: 67
He-E 503.08	RSA 161-F:70, VII

APPENDIX B: Incorporation by Reference Information

Rule	Title	Publisher; How to Obtain; and Cost
He-E 501.25(d)(1)	United States Department of Agriculture’s “ Dietary Guidelines for Americans 2015-2020” (Eighth Edition)	Publisher: United States Department of Agriculture Cost: Free to the Public The incorporated document is available at: https://health.gov/dietaryguidelines/2015/resources/2015-2020_Dietary_Guidelines.pdf
He-E 502.29(c)(1) & He-E 502.30(c)	US Departments of Agriculture & Health and Human Services “Dietary Guidelines for Americans, 2010.”	Available free of charge at http://www.health.gov/dietaryguidelines/. This publication can also be ordered by calling the U.S. Government Printing Office (GPO) at (866) 512-1800 and asking for stock number 001-000-04719-1, or by accessing the GPO Online Bookstore at http://bookstore.gpo.gov.
He-E 502.29(d)(1) & He-E 502.30(c)	US Department of Agriculture & Health and Human Services “Dietary Guidelines for Americans, 2020-2025.” (Ninth Edition)	Publisher: U.S. Department of Agriculture