TABLE OF CONTENTS

 

CHAPTER He-W 400  SUPPORT OF DEPENDENT CHILDREN

          PART He-W 401  DEFINITIONS

                  Section He-W 401.01  Definitions

 

          PART He-W 402  ESTABLISHING PATERNITY - EXPIRED

 

          PART He-W 403  DISTRIBUTION AND DISBURSEMENT OF SUPPORT PAYMENTS

                  Section He-W 403.01  Distribution

                  Section He-W 403.02  Disbursement

                  Section He-W 403.03  Recoupment of Overpayments

                  Section He-W 403.04  Recovery of Payments for Returned Child Support Payment Checks and Reversed Electronic Payments Made by a Payor

                  Section He-W 403.05  Recovery of Payments for Returned Child Support Payment Checks and Reversed Electronic Payments Made by an Employer

                Section He-W 403.06  Recovery of Payments Resulting from an Adjusted Federal Tax Return

                Section He-W 403.07  Appeals and Review Process

 

          PART He-W 404  NEW HAMPSHIRE LOTTERY INTERCEPT FOR COLLECTION OF CHILD SUPPORT ARREARS

                  Section He-W 404.01  Identification, Confirmation, and Interception of Child Support Arrearages

                  Section He-W 404.02  Appeal Process

                  Section He-W 404.03  Distribution of Intercepted Lottery Prizes

                  Section He-W 404.04  Refund of Erroneously Intercepted Lottery Prizes

 

          PART He-W 405  FEES

                  Section He-W 405.01  Annual Fee for Services

                  Section He-W 405.02  Child Support Disbursement Fee – REPEALED

 

          PART He-W 406  MANDATORY WAGE ASSIGNMENT - EXPIRED

 

          PART He-W 407  ADMINISTRATIVE HEARINGS PROCESS - EXPIRED

 

          PART He-W 408  CASE INITIATION - EXPIRED

                  Section He-W 408.01  Prioritization of Child Support Cases

 

          PART He-W 409  CLOSURE OF CHILD SUPPORT CASES - EXPIRED

                  Section He-W 409.01  Criteria for Case Closure

 

          PART He-W 410  APPEALS OF BUREAU OF CHILD SUPPORT SERVICES ACTIONS AND DECISIONS

                  Section He-W 410.01  Appeals of Bureau of Child Support Services Actions and Decisions

 

CHAPTER He-W 500  MEDICAL ASSISTANCE

PART He-W 501  GENERAL MEDICAL ELIGIBILITY – EXPIRED

Section He-W 501.01  Definitions

Section He-W 501.02  Financial Eligibility

Section He-W 501.03  Client or Authorized Representative Responsibilities

Section He-W 501.04  Agency Responsibilities

Section He-W 501.05  Exceptions to Medical Examination Requirement

Section He-W 501.06  Failure or Refusal to Obtain Information

Section He-W 501.07  Refusal of Medical Treatment

Section He-W 501.08  Good Cause Reasons for Refusal of Medical Treatment

Section He-W 501.09  Payment for Medical Evaluations

Section He-W 501.10  Temporary Adjustment Period

Section He-W 501.11  Fair Hearings

Section He-W 501.12  Eligibility Pending a Decision

 

PART He-W 502  AID TO THE NEEDY BLIND PROGRAM

Section He-W 502.01  Definitions

Section He-W 502.02  Recipient Eligibility

Section He-W 502.03  Blindness Evaluation

 

PART He-W 503  AID TO THE PERMANENTLY AND TOTALLY DISABLED (APTD) PROGRAM

Section He-W 503.01  Definitions

Section He-W 503.02  Recipient Eligibility

Section He-W 503.03  Disability Evaluation

Section He-W 503.04  Precedence of Adverse Social Security Disability Determinations

 

PART He-W 504  MEDICAID FOR EMPLOYED ADULTS WITH DISABILITIES

Section He-W 504.01  Definition

Section He-W 504.02  Medical Eligibility

 

PART He-W 505  REPEALED & RESERVED

 

PART He-W 506  MEDICAID CARE MANAGEMENT (MCM)

Section He-W 506.01  Purpose

Section He-W 506.02  Scope

Section He-W 506.03  Definitions

Section He-W 506.04  Covered Services

Section He-W 506.05  Enrollment in Managed Care

Section He-W 506.06  Selection of a Managed Care Organization

Section He-W 506.07  MCO Grievance Process

Section He-W 506.08  MCO Appeal Process

Section He-W 506.09  Department Fair Hearing Process

 

PART He-W 507  MEDICAL ASSISTANCE FOR CHILDREN WITH SEVERE DISABILITIES

Section He-W 507.01  Definitions

Section He-W 507.02  Recipient Eligibility

Section He-W 507.03  Continued Eligibility

Section He-W 507.04  Termination of Medical Eligibility

Section He-W 507.05  Appeals

 

PART He-W 508  MEDICAL ASSISTANCE FOR HOME CARE OF CERTAIN CHILDREN WITH SEVERE DISABILITIES

                  Section He-W 508.01  Purpose

                  Section He-W 508.02  Definitions

                  Section He-W 508.03  Recipient Eligibility

                  Section He-W 508.04  Degree of Care

                  Section He-W 508.05  Medically Appropriate Services

                  Section He-W 508.06  Monitoring and Determination of Cost Effectiveness

                  Section He-W 508.07  Recipient Notification of Cost Effectiveness Monitoring and Determination Results

                  Section He-W 508.08  Cost Reduction Plans

                  Section He-W 508.09  Continued Medical Eligibility for HC-CSD

                  Section He-W 508.10  Denial or Termination of Medical Eligibility for HC-CSD

 

          PART He-W 509  FAMILY PLANNING EXPANSION CATEGORY (FPEC)

                  Section He-W 509.01  Purpose

                  Section He-W 509.02  Definitions

                  Section He-W 509.03  Eligibility

                  Section He-W 509.04  Provider Participation

                  Section He-W 509.05  Service Limits

                  Section He-W 509.06  Covered Services

                  Section He-W 509.07  Non-Covered Services

                  Section He-W 509.08  Transportation

                  Section He-W 509.09  Co-Payments

                  Section He-W 509.10  Utilization Review and Control

                  Section He-W 509.11  Third Party Liability

                  Section He-W 509.12  Payment for Services

 

PARTS He-W 510  RESERVED

 

PART He-W 511  HEALTH INSURANCE PREMIUM PAYMENT PROGRAM (HIPP)

         Section He-W 511.01  Purpose

         Section He-W 511.02  Scope

         Section He-W 511.03  Definitions

         Section He-W 511.04  Recipient Participation

         Section He-W 511.05  Cost Effectiveness Determination

         Section He-W 511.06  Cost Effectiveness Redetermination

         Section He-W 511.07  Wrap Around Coverage

         Section He-W 511.08  Payment of Cost Sharing

         Section He-W 511.09  Loss of Eligibility and Discontinuation of Premium Payments

         Section He-W 511.10  Third Party Liability

         Section He-W 511.11  Utilization Review & Control

 

PART He-W 512  ALTERNATIVE BENEFIT PLAN (ABP) AND PREMIUM ASSISTANCE PROGRAM

         Section He-W 512.01  Purpose

         Section He-W 512.02  Definitions

         Section He-W 512.03  Eligibility

         Section He-W 512.04  Enrollment

         Section He-W 512.05  Covered Services

         Section He-W 512.06  Co-payments

         Section He-W 512.07  Appeals Process for the Premium Assistance Program

         Section He-W 512.08  Utilization Review and Control

         Section He-W 512.09  Third Party Liability

 

PART He-W 513  SUBSTANCE USE DISORDER (SUD) TREATMENT AND RECOVERY SUPPORT SERVICES

         Section He-W 513.01  Purpose

         Section He-W 513.02  Definitions

         Section He-W 513.03  Recipient Eligibility

         Section He-W 513.04  Provider Participation

         Section He-W 513.05  Covered Services

         Section He-W 513.06  Non-Covered Services

         Section He-W 513.07  Utilization Review and Control

         Section He-W 513.08  Third Party Liability

         Section He-W 513.09  Payment for Services

         Section He-W 513.10  Documentation

         Section He-W 513.11  ASAM Level of Care Service Descriptions

         Section He-W 513.12  Waivers

 

PARTS He-W 514 THROUGH 518  RESERVED

 

PART He-W 519  PAYMENTS TO DISPROPORTIONATE SHARE PSYCHIATRIC HOSPITALS - MOVED TO He-M 601

 

PART He-W 520  GENERAL PROGRAM INFORMATION

Section He-W 520.01  Definitions

Section He-W 520.02  Program Administration

Section He-W 520.03  Record Keeping Requirements

Section He-W 520.04  Surveillance and Utilization Review and Control

Section He-W 520.05  Fraud Detection and Investigation

 

PART He-W 521  GENERAL PAYMENT INFORMATION

Section He-W 521.01  Definitions

Section He-W 521.02  Payment Rates

Section He-W 521.03  Payment in Full

Section He-W 521.04  Adjustments to Payments

Section He-W 521.05  Recipient Eligibility

Section He-W 521.06  Prior Authorization

Section He-W 521.07  Third Party Liability

Section He-W 521.08  Accidental Injury

Section He-W 521.09  Medicare Co-insurance and Deductible

Section He-W 521.10  Submission of Claims and Billing Time Limitation

Section He-W 521.11  Exclusion of Medicaid Providers Who Have Been Excluded by Medicare

Section He-W 521.12  Exclusion, Suspension or Termination of Medicaid Providers by Medicaid

 

PART He-W 522  INTERPRETER SERVICES

Section He-W 522.01  Definitions

Section He-W 522.02  Covered Services and Conditions

Section He-W 522.03  Provider Participation

Section He-W 522.04  Payment to Family Members Prohibited

Section He-W 522.05  Payment for Services

 

PART He-W 523 - 528  RESERVED

 

PART He-W 529 - RESERVED

 

PART He-W 530  SERVICE LIMITS, CO-PAYMENTS, AND NON-COVERED SERVICES

Section He-W 530.01  Definitions

Section He-W 530.02  Recipients Subject to Service Limits, Co-Payments, and Non-Covered Services

Section He-W 530.03  Service Limits

Section He-W 530.04  Co-Payments

Section He-W 530.05  Non-Covered Services

Section He-W 530.06  Recipient Responsibility for Payment

Section He-W 530.07  Prior Authorization of Services Which Exceed Service Limits

 

PART He-W 531  PHYSICIAN SERVICES

Section He-W 531.01  Definitions

Section He-W 531.02  Recipient Eligibility

Section He-W 531.03  Provider Participation

Section He-W 531.04  Service Limits

Section He-W 531.05  Covered Services

Section He-W 531.06  Non-covered Services

Section He-W 531.07  Prior Authorization

Section He-W 531.08  Utilization Review and Control

Section He-W 531.09  Third Party Liability

Section He-W 531.10  Payment for Services

 

PART He-W 532  PODIATRY SERVICES

Section He-W 532.01  Definitions

Section He-W 532.02  Recipient Eligibility

Section He-W 532.03  Provider Participation

Section He-W 532.04  Service Limits

Section He-W 532.05  Covered Services

Section He-W 532.06  Non-Covered Services

Section He-W 532.07  Documentation

Section He-W 532.08  Utilization Review and Control

Section He-W 532.09  Third Party Liability

Section He-W 532.10  Payment for Services

 

PART He-W 533  RESERVED

 

PART He-W 534  ADVANCED REGISTERED NURSE PRACTITIONER SERVICES

Section He-W 534.01  Definitions

Section He-W 534.02  Recipient Eligibility

Section He-W 534.03  Provider Participation

Section He-W 534.04  Service Limits

Section He-W 534.05  Covered Services

Section He-W 534.06  Utilization Review & Control

Section He-W 534.07  Third Party Liability

Section He-W 534.08  Payment for Services

 

PART He-W 535  PSYCHOLOGIST SERVICES

Section He-W 535.01  Definitions

Section He-W 535.02  Recipient Eligibility

Section He-W 535.03  Provider Participation

Section He-W 535.04  Service Limits

Section He-W 535.05  Covered Services

Section He-W 535.06  Non-covered Services

Section He-W 535.07  Utilization Review and Control

Section He-W 535.08  Third Party Liability

Section He-W 535.09  Payment for Services

 

PART He-W 536  MEDICAL SERVICES CLINIC

Section He-W 536.01  Definitions

Section He-W 536.02  Recipient Eligibility

Section He-W 536.03  Provider Participation

Section He-W 536.04  Service Limits

Section He-W 536.05  Covered Services

Section He-W 536.06  Utilization Review and Control

Section He-W 536.07  Third Party Liability

Section He-W 536.08  Payment for Services

 

PART He-W 537  RURAL HEALTH CLINICS

Section He-W 537.01  Definitions

Section He-W 537.02  Recipient Eligibility

Section He-W 537.03  Provider Participation

Section He-W 537.04  Service Limits

Section He-W 537.05  Covered Services

Section He-W 537.06  Utilization Review and Control

Section He-W 537.07  Third Party Liability

Section He-W 537.08  Payment for Services

 

PART He-W 538  CERTIFIED MIDWIFE SERVICES

Section He-W 538.01  Definitions

Section He-W 538.02  Recipient Eligibility

Section He-W 538.03  Provider Participation

Section He-W 538.04  Covered Services

Section He-W 538.05  Non-Covered Services

Section He-W 538.06  Utilization Review and Control

Section He-W 538.07  Third Party Liability

Section He-W 538.08  Payment for Services

 

PART He-W 539 - RESERVED

 

PART He-W 540  PRIVATE DUTY NURSING SERVICES

Section He-W 540.01  Definitions

Section He-W 540.02  Recipient Eligibility

Section He-W 540.03  Provider Participation

Section He-W 540.04  Covered Services

Section He-W 540.05  Non-covered Services

Section He-W 540.06  Required Documentation

Section He-W 540.07  Prior Authorization and Review

Section He-W 540.08  Utilization Review and Control

Section He-W 540.09  Third Party Liability

Section He-W 540.10  Payment for Services

 

PART He-W 541  FAMILY PLANNING SERVICES

Section He-W 541.01  Definitions

Section He-W 541.02  Recipient Eligibility

Section He-W 541.03  Provider Participation

Section He-W 541.04  Service Limits

Section He-W 541.05  Covered Services

Section He-W 541.06  Non-Covered Services

Section He-W 541.07  Co-Payments

Section He-W 541.08  Utilization Review and Control

Section He-W 541.09  Third Party Liability

Section He-W 541.10  Payment for Services

 

PART He-W 542  ABORTION SERVICES

Section He-W 542.01  Definitions

Section He-W 542.02  Recipient Eligibility

Section He-W 542.03  Provider Participation

Section He-W 542.04  Covered Services

Section He-W 542.05  Non-Covered Services

Section He-W 542.06  Utilization Review and Control

Section He-W 542.07  Third Party Liability

Section He-W 542.08  Payment for Services

 

PART He-W 543  HOSPITAL SERVICES

Section He-W 543.01  Definitions

Section He-W 543.02  Recipient Eligibility

Section He-W 543.03  Provider Participation

Section He-W 543.04  Prior Authorization

Section He-W 543.05  Covered Services

Section He-W 543.06  Non-Covered Services

Section He-W 543.07  Readmission to Hospital

Section He-W 543.08  Transfer of Recipient

Section He-W 543.09  Split Eligibility

Section He-W 543.10  Medicare Participation

Section He-W 543.11  Utilization Review

Section He-W 543.12  Third Party Liability

Section He-W 543.13  Payment for Services

 

PART He-W 544  HOSPICE SERVICES

Section He-W 544.01  Definitions

Section He-W 544.02  Recipient Eligibility Requirements

Section He-W 544.03  Provider Participation

Section He-W 544.04  Election of Hospice Care

Section He-W 544.05  Hospice Election Periods

Section He-W 544.06  Certification of Terminal Illness

Section He-W 544.07  Change in Designated Hospice Provider

Section He-W 544.08  Revocation of Hospice Care

Section He-W 544.09  Covered Hospice Services

Section He-W 544.10  Documentation of Hospice Services

Section He-W 544.11  Utilization Review and Control

Section He-W 544.12  Third Party Liability

Section He-W 544.13  Payment for Hospice Services

Section He-W 544.14  Hospice Payment Limitations and Adjustments

Section He-W 544.15  Hospice Payment for Recipients in Nursing Facilities

Section He-W 544.16  Payment for Physicians’ Services

Section He-W 544.17  Required Forms

 

PART 545  RESERVED

 

PART He-W 546  EARLY AND PERIODIC SCREENING, DIAGNOSIS AND TREATMENT SERVICES

Section He-W 546.01  Definitions

Section He-W 546.02  Recipient Eligibility

Section He-W 546.03  Provider Participation

Section He-W 546.04  Informing Requirements

Section He-W 546.05  Covered Services

Section He-W 546.06  Prior Authorization for Coverage Based on Medical Necessity

Section He-W 546.07  Support Services

Section He-W 546.08  Non-Covered Services

Section He-W 546.09  Utilization Review and Control

Section He-W 546.10  Third Party Liability

Section He-W 546.11  Payment for Services

 

PART He-W 547  HOME VISIT FOR POSTPARTUM AND NEWBORN ASSESSMENT

Section He-W 547.01  Definitions

Section He-W 547.02  Recipient Eligibility

Section He-W 547.03  Provider Participation

Section He-W 547.04  Covered Services

Section He-W 547.05  Non-Covered Services

Section He-W 547.06  Required Documentation

Section He-W 547.07  Utilization Review and Control

Section He-W 547.08  Third Party Liability

Section He-W 547.09  Payment for Services

 

PART He-W 548  EXTENDED SERVICES TO PREGNANT WOMEN

Section He-W 548.01  Definitions

Section He-W 548.02  Recipient Eligibility

Section He-W 548.03  Provider Participation

Section He-W 548.04  Covered Services

Section He-W 548.05  Non-Covered Services

Section He-W 548.06  Required Documentation

Section He-W 548.07  Utilization Review and Control

Section He-W 548.08  Third Party Liability

Section He-W 548.09  Payment for Services

 

PART He-W 549  HOME VISITING NEW HAMPSHIRE AND CHILD/FAMILY HEALTH CARE SUPPORT SERVICES

Section He-W 549.01  Definitions

Section He-W 549.02  Recipient Eligibility

Section He-W 549.03  Amount of Services

Section He-W 549.04  Provider Participation

Section He-W 549.05  Covered Services

Section He-W 549.06  Non-Covered Services

Section He-W 549.07  Required Documentation

Section He-W 549.08  Utilization Review and Control

Section He-W 549.09  Third Party Liability

Section He-W 549.10  Payment for Services

 

PART He-W 550  ADULT MEDICAL DAY CARE SERVICES - EXPIRED (Now He-E 803)

 

PART He-W 551  RESERVED

 

PART He-W 552  PERSONAL CARE ATTENDANT SERVICES

Section He-W 552.01  Purpose

Section He-W 552.02  Definitions

Section He-W 552.03  Recipient Eligibility

Section He-W 552.04  Provider Participation

Section He-W 552.05  Covered Services

Section He-W 552.06  Non-covered Services

Section He-W 552.07  Training Requirements

Section He-W 552.08  Provider and PCA Responsibilities

Section He-W 552.09  Personal Care Assessments and the Plan of Care

Section He-W 552.10  Utilization Review and Control

Section He-W 552.11  Third Party Liability

Section He-W 552.12  Payment for Services

Section He-W 552.13  Documentation

 

PART He-W 553  HOME HEALTH SERVICES

Section He-W 553.01  Purpose

Section He-W 553.02  Definitions

Section He-W 553.03  Recipient Eligibility

Section He-W 553.04  Provider Participation

Section He-W 553.05  Required Documentation

Section He-W 553.06  Covered Services

Section He-W 553.07  Non-Covered Services

 

PART He-W 554 - 555  RESERVED

 

PART He-W 556  SUPPORTED RESIDENTIAL HEALTH CARE FACILITY SERVICES

Section He-W 556.01  Definitions

Section He-W 556.02  Recipient Eligibility

Section He-W 556.03  Provider Participation

Section He-W 556.04  Covered Services

Section He-W 556.05  Financial Assistance

Section He-W 556.06  Prior Authorization and Review

Section He-W 556.07  Notice of Approval or Denial

Section He-W 556.08  Payment for Services and Rate Setting

Section He-W 556.09  Utilization Review and Control

 

PART He-W 557  RESERVED

 

PART He-W 558  HOME AND COMMUNITY-BASED SERVICES FOR THE ELDERLY AND CHRONICALLY ILL

Section He-W 558.01  Definitions

Section He-W 558.02  Client Eligibility

Section He-W 558.03  Provider Participation

Section He-W 558.04  Plan of Care

Section He-W 558.05  Covered Services

Section He-W 558.06  Initial Level of Care Determinations

Section He-W 558.07  Utilization Review

Section He-W 558.08  Right of Choice

Section He-W 558.09  Payment for Services

 

PART He-W 559  CASE MANAGEMENT OF ADVANCE CARE PLANNING AND DIRECTIVES -EXPIRED

 

PART He-W 560 - 564  RESERVED

 

PART He-W 565  VISION CARE SERVICES

Section He-W 565.01  Definitions

Section He-W 565.02  Recipient Eligibility

Section He-W 565.03  Provider Participation

Section He-W 565.04  Service Limits

Section He-W 565.05  Covered Services

Section He-W 565.06  Non-Covered Services

Section He-W 565.07  Utilization Review and Control

Section He-W 565.08  Third Party Liability

Section He-W 565.09  Payment for Services

 

PART He-W 566  DENTAL SERVICES

Section He-W 566.01  Definitions

Section He-W 566.02  Recipient Eligibility

Section He-W 566.03  Provider Participation

Section He-W 566.04  Covered Services

Section He-W 566.05  Orthodontic Treatment

Section He-W 566.06  Non-Covered Services

Section He-W 566.07  Prior Authorization

Section He-W 566.08  Utilization Review and Control

Section He-W 566.09  Third Party Liability

Section He-W 566.10  Payment for Services

 

PART He-W 567  HEARING AID SERVICES

Section He-W 567.01  Definitions

Section He-W 567.02  Recipient Eligibility

Section He-W 567.03  Provider Participation

Section He-W 567.04  Service Limits

Section He-W 567.05  Covered Services

Section He-W 567.06  Non-Covered Services

Section He-W 567.07  Prior Authorization of Binaural Hearing Aids for Recipients 21 Years of Age or Older

Section He-W 567.08  Documentation

Section He-W 567.09  Utilization Review and Control

Section He-W 567.10  Third Party Liability

Section He-W 567.11  Payment for Services

 

PART He-W 568  PHYSICAL THERAPY, OCCUPATIONAL THERAPY AND SERVICES FOR INDIVIDUALS WITH SPEECH, HEARING AND LANGUAGE DISORDERS

         Section He-W 568.01  Definitions

         Section He-W 568.02  Recipient Eligibility

         Section He-W 568.03  Provider Participation

         Section He-W 568.04  Service Limits

         Section He-W 568.05  Covered Services

         Section He-W 568.06  Prior Authorization

         Section He-W 568.07  Utilization Review and Control

         Section He-W 568.08  Documentation

         Section He-W 568.09  Third Party Liability

         Section He-W 568.10  Payment for Services

 

PART He-W 569  RADIOLOGICAL SERVICES

Section He-W 569.01  Definitions

Section He-W 569.02  Recipient Eligibility

Section He-W 569.03  Provider Participation

Section He-W 569.04  Service Limits

Section He-W 569.05  Covered Services

Section He-W 569.06  Prior Authorization and Review

Section He-W 569.07  Utilization Review and Control

Section He-W 569.08  Third Party Liability

Section He-W 569.09  Payment for Services

 

PART He-W 570  PHARMACEUTICAL SERVICES

Section He-W 570.01  Definitions

Section He-W 570.02  Recipient Eligibility

Section He-W 570.03  Provider Participation

Section He-W 570.04  Covered Items

Section He-W 570.05  Non-Covered Items

Section He-W 570.06  Prior Authorization

Section He-W 570.07  Pharmacy Lock-In Program

Section He-W 570.08  Prescription Drug Dispensing Limitations

Section He-W 570.09  Certification of Prescriptions

Section He-W 570.10  Documentation and Retention

Section He-W 570.11  Utilization Review and Control

Section He-W 570.12  Third Party Liability

Section He-W 570.13  Prescription Co-payment

Section He-W 570.14  Payment for Drugs

 

PART He-W 571  DURABLE MEDICAL EQUIPMENT, PROSTHETIC AND ORTHOTIC DEVICES, AND MEDICAL SUPPLIES

Section He-W 571.01  Definitions

Section He-W 571.02  Recipient Eligibility

Section He-W 571.03  Dispensing Provider Participation

Section He-W 571.04  Covered Services

Section He-W 571.05  Prescription, LMN, and Prior Authorization Requirements

Section He-W 571.06  Non-Covered Services

Section He-W 571.07  Requirements for Maintaining Documentation

Section He-W 571.08  Third Party Liability

Section He-W 571.09  Utilization Review and Control

Section He-W 571.10  Payment for Items

 

PART He-W 572  AMBULANCE SERVICES

Section He-W 572.01  Definitions

Section He-W 572.02  Recipient Eligibility

Section He-W 572.03  Provider Participation

Section He-W 572.04  Covered Services

Section He-W 572.05  Non-Covered Services

Section He-W 572.06  Authorization Requirements for Scheduled and Routine Ambulance Transportation

Section He-W 572.07  Documentation

Section He-W 572.08  Utilization Review and Control

Section He-W 572.09  Third Party Liability

Section He-W 572.10  Payment for Services

 

PART He-W 573  WHEELCHAIR VAN SERVICES

Section He-W 573.01  Definitions

Section He-W 573.02  Recipient Eligibility

Section He-W 573.03  Provider Participation

Section He-W 573.04  Service Limits

Section He-W 573.05  Covered Services

Section He-W 573.06  Non-Covered Services

Section He-W 573.07  Provider Requirements

Section He-W 573.08  Documentation

Section He-W 573.09  Safety Requirements

Section He-W 573.10  Service Limit Override and Review

Section He-W 573.11  Utilization Review and Control

Section He-W 573.12  Third Party Liability

Section He-W 573.13  Payment for Services

 

PART He-W 574  GENERAL MEDICAL TRANSPORTATION

Section He-W 574.01  Definitions

Section He-W 574.02  Recipient Eligibility

Section He-W 574.03  Provider Participation

Section He-W 574.04  Limitations on Covered Services

Section He-W 574.05  Non-Covered Services

Section He-W 574.06  Submission of Claims

Section He-W 574.07  Payment for Services

Section He-W 574.08  Advanced Authorization

Section He-W 574.09  Extenuating Circumstances

Section He-W 574.10  Provider Enrollment System

Section He-W 574.11  Hearings

Section He-W 574.12  Third Party Liability

Section He-W 574.13  Utilization Review and Control

 

PART He-W 575  AUGMENTATIVE AND ALTERNATIVE COMMUNICATION AID SERVICES

Section He-W 575.01  Definitions

Section He-W 575.02  Recipient Eligibility

Section He-W 575.03  Provider Participation

Section He-W 575.04  Covered Services

Section He-W 575.05  Non-Covered Services

Section He-W 575.06  Prior Authorization

Section He-W 575.07  AAC Evaluation

Section He-W 575.08  Documentation

Section He-W 575.09  Third Party Liability

Section He-W 575.10  Utilization Review and Control

Section He-W 575.11  Payment for AAC Aids

 

PART He-W 576  MANAGED CARE ORGANIZATIONS- EXPIRED

 

PART He-W 577  LABORATORY SERVICES

Section He-W 577.01  Definitions

Section He-W 577.02  Recipient Eligibility

Section He-W 577.03  Provider Participation

Section He-W 577.04  Covered Services

Section He-W 577.05  Utilization Review and Control

Section He-W 577.06  Third Party Liability

Section He-W 577.07  Payment for Services

 

PART He-W 578 - 589  RESERVED

 

PART He-W 590  NURSING FACILITY SERVICES

Section He-W 590.01  Definitions - EXPIRED & REPEALED

Section He-W 590.02  Recipient Eligibility

Section He-W 590.03  Services in an Atypical Unit

Section He-W 590.04  Nursing Facility Care in Swing Bed Hospitals

Section He-W 590.05  Change in Period of Authorization

Section He-W 590.06  Provider Participation

Section He-W 590.07  Relocations of Recipient

Section He-W 590.08  Covered Services

Section He-W 590.09  OMS Utilization Review

Section He-W 590.10  OMS Utilization Control and On-Site Inspection

Section He-W 590.11  Certification and Recertification

Section He-W 590.12  Plan of Care

Section He-W 590.13  Denials and Appeals of OMS Decisions

Section He-W 590.14  Recipient Personal Accounts

Section He-W 590.15  Absence from the Facility - REPEALED

Section He-W 590.16  Resident Assessment System - REPEALED

 

PART He-W 591  NURSING FACILITY ENFORCEMENT REMEDIES

Section He-W 591.01  Definitions

Section He-W 591.02  Surveys and Notification of Non-compliance

Section He-W 591.03  Enforcement of Remedies

Section He-W 591.04  Timeframes for Notification of Remedies

Section He-W 591.05  Temporary Management

Section He-W 591.06  Civil Money Penalties; Notice and Hearing Requests

Section He-W 591.07  Collection of Civil Money Penalties

Section He-W 591.08  Disbursement of Civil Money Penalties

Section He-W 591.09  Duration of Remedies

Section He-W 591.10  Documentation of Substantial Compliance

Section He-W 591.11  Hearings

Section He-W 591.12  Timeframes for Requesting Hearings

Section He-W 591.13  Relocation Procedures

Section He-W 591.14  HCFA/State Disagreements

 

PART He-W 592  NURSING ASSISTANT TRAINING REIMBURSEMENT

Section He-W 592.01  Definitions

Section He-W 592.02  Requirements, Conditions and Limitations - REPEALED

Section He-W 592.03  Payment to CAN - REPEALED

 

PART He-W 593  NURSING FACILITY REIMBURSEMENT - EXPIRED (Moved to He-E 806)

 

PART He-W 594 - 599  RESERVED

 

CHAPTER He-W 600  FINANCIAL ASSISTANCE AND ELIGIBILITY FOR MEDICAL CARE

          PART He-W 601  DEFINITIONS

Section He-W 601.01  Definitions A

Section He-W 601.02  Definitions B-C

Section He-W 601.03  Definitions D-E

Section He-W 601.04  Definitions F-H

Section He-W 601.05  Definitions I-N

Section He-W 601.06  Definitions O-Q

Section He-W 601.07  Definitions R-S

Section He-W 601.08  Definitions T-V

 

PART He-W 602  Program Coverages and Limitations

Section He-W 602.01  General Applicability of Rules in This Chapter

Section He-W 602.02  Applicability of Federal Statutes and Regulations

Section He-W 602.03  Telephone Application

Section He-W 602.04  Categorically Needy and Medically Needy Medical Assistance

Section He-W 602.05  60-Month Lifetime Limit on Financial Assistance

Section He-W 602.06  New Hampshire Employment Program (NHEP) and Family Assistance Program (FAP) Financial Assistance

Section He-W 602.07  RESERVED

Section He-W 602.08  Criteria for Extensions to the 60-Month Lifetime Limit

Section He-W 602.09  Duration of Extensions to the 60-Month Time Limit

Section He-W 602.10  Required Verification

Section He-W 602.11  RESERVED

Section He-W 602.12  RESERVED

Section He-W 602.13  RESERVED

Section He-W 602.14  Required Participation in the NHEP Work Program for Families Granted an Extension of FANF Financial Assistance

Section He-W 602.15  Extension Review Process

Section He-W 602.16  Eligibility for Additional Hardship Extensions

Section He-W 602.17  Two-Parent Families

 

PART He-W 603  INDIVIDUAL Rights and Responsibilities

Section He-W 603.01  Authorized Representative

Section He-W 603.02  Individual Responsibility to Supply Accurate Information

Section He-W 603.03  Individual Responsibility to Report Changes

 

PART He-W 604  Case Decisions

Section He-W 604.01  Case Decisions

Section He-W 604.02  Notice of Decision

Section He-W 604.03  Advance Notice Period

Section He-W 604.04  Electronic Notification

Section He-W 604.05  Electronic Account Access

 

          PART He-W 605  RESERVED

 

PART He-W 606  Verification

Section He-W 606.01  General Verification Requirements - All Categories of Financial and Medical Assistance and Low-Income Subsidy Assistance

Section He-W 606.02  Citizenship/Alien Status

Section He-W 606.03-606.09  Reserved

Section He-W 606.10  Residency

Section He-W 606.11  Temporary Absence from N.H.

Section He-W 606.12-606.17  Reserved

Section He-W 606.18  Institutional Residence

Section He-W 606.19  Presence of a Dependent Child

Section He-W 606.20  Deprivation Due to Death

Section He-W 606.21  Deprivation Due to Continued Absence

Section He-W 606.22  Verification of Unemployment Status for the Unemployed Parent

(UP) Medical Assistance Program

Section He-W 606.23  Living with a Specified Relative

Section He-W 606.24  Age

Section He-W 606.25  Reserved

Section He-W 606.26  Strikers

Section He-W 606.27  Reserved

Section He-W 606.28  Proof of Identity

Section He-W 606.29  Reserved

Section He-W 606.30  NHEP Exemption

Section He-W 606.31  Good Cause Reasons for Non-Cooperation with Child Support Requirement Due to Domestic Violence

Section He-W 606.32  NHEP Medical Exemption Review Process

Section He-W 606.33-606.35  RESERVED

Section He-W 606.36  Social Security Numbers (SSN) – FANF Financial Assistance

Section He-W 606.37  Application for Disability Benefits

Section He-W 606.38-606.40  Reserved

Section He-W 606.41  Special Medical Assistance Only Coverage Groups

Section He-W 606.42  OAA Age Requirements

Section He-W 606.43-606.54  Reserved

Section He-W 606.55  Deemed Income

Section He-W 606.56-606.57  Reserved

Section He-W 606.58  Lump Sum Income

Section He-W 606.59  Treatment of Specific Types of Income

Section He-W 606.60  Verification of Educational Income - Adult Categories

Section He-W 606.61  Educational Expenses - Adult Categories

Section He-W 606.62-606.64  Reserved

Section He-W 606.65  PASS Income and Resources

Section He-W 606.66-606.67  Reserved

Section He-W 606.68  Adult OAA and ANB Employment Expense Disregard

Section He-W 606.69  Impairment Related Work Expenses

Section He-W 606.70-606.72  Reserved

Section He-W 606.73  Child Care Costs for All Categories

Section He-W 606.74  Allowable Deductions

Section He-W 606.75  Allocated Income

Section He-W 606.76  Resources - Basic Principles

Section He-W 606.77  Reserved

Section He-W 606.78  Personal Property Resources

Section He-W 606.79-606.82  Reserved

Section He-W 606.83  Verification of Shelter and Living Arrangement

Section He-W 606.84  Adult Category Verification of Shelter and Living Arrangement

Section He-W 606.85-606.88  Reserved

Section He-W 606.89  RESERVED

Section He-W 606.90  Retroactive Medical Assistance

Section He-W 606.91  Reserved

Section He-W 606.92  Telephone Determination

Section He-W 606.93-606.97  RESERVED

Section He-W 606.98  Twelve Month Extended Medical Assistance

Section He-W 606.99  Reserved

Section He-W 606.100  Redetermination of Eligibility

Section He-W 606.101-606.103  RESERVED

Section He-W 606.104  Verification Requirements for Emergency Assistance

 

          PART He-W 607  RESERVED

 

          PART He-W 608  Use of Money Payments

Section He-W 608.01  Use of Money Payments

Section He-W 608.02  Prohibited Use of Money Payments

 

          PART He-W 609 - 615  RESERVED

 

          PART He-W 616  Citizenship/Alien Status

Section He-W 616.01  Sponsored Aliens Who Apply for NHEP/FAP Financial and Medical Assistance

Section He-W 616.02  Eligibility of Qualified Aliens

 

          PART He-W 617  RESERVED

 

          PART He-W 618  Residency

Section He-W 618.01  RESERVED

Section He-W 618.02  Temporary Absence from N.H.

 

          PART He-W 619  PRESUMPTIVE ELIGIBILITY FOR HOME AND COMMUNITY-BASED CARE FOR THE ELDERLY AND CHRONICALLY ILL (HCBC-ECI)

                  Section He-W 619.01  Definitions

                  Section He-W 619.02  Presumptive Eligibility for HCBC-ECI

                  Section He-W 619.03  Qualified Providers

                  Section He-W 619.04  Presumptive Eligibility Determination Process

                  Section He-W 619.05  Termination of Presumptive Eligibility Period

 

          PART He-W 620  aSSET Transfers

Section He-W 620.01  Asset Transfers

 

          PART He-W 621  RESERVED – (Moved to He-W 821)

 

PART He-W 622  Liability of Relatives to Support

Section He-W 622.01  Liability of Relatives to Support

 

          PART He-W 623  RESERVED

 

          PART He-W 624  Institutional Residence

Section He-W 624.01  Institutional Residence

 

          PART He-W 625  Technical Requirements for AFDC, OAA, APTD and ANB

Section He-W 625.01  Application for Social Security Account Numbers

 

          PART He-W 626  TECHNICAL REQUIREMENTS FOR THE FAMILY PLANNING EXPANSION CATEGORY (FPEC) OF MEDICAL ASSISTANCE

                  Section He-W 626.01  Purpose

                  Section He-W 626.02  Family Planning Expansion Category (FPEC)

                  Section He-W 626.03  Presumptive Eligibility Determination

 

          PART He-W 627  TECHNICAL REQUIREMENTS FOR IDP, TAP, AND FWOC CATEGORIES OF FINANCIAL AND MEDICAL ASSISTANCE

                  Section He-W 627.01  Technical Requirements for the Interim Disabled Parent (IDP) Category of Financial Assistance

                  Section He-W 627.02  RESERVED

                  Section He-W 627.03  Technical Requirements for Families with Older Children (FWOC) Category of Financial and Medical Assistance

                  Section He-W 627.04  General Requirements for IDP, TAP, and FWOC Financial Assistance

                  Section He-W 627.05  RESERVED

 

          PART He-W 628  DEPRIVATION OF PARENTAL SUPPORT OR CARE FOR FANF FINANCIAL ASSISTANCE

Section He-W 628.01  Deprivation Due to Continued Absence

Section He-W 628.02  Deprivation Due to Incapacity

Section He-W 628.03  Unemployed Parent (UP) Medical Assistance Program

 

PART He-W 629  RESERVED

 

PART He-W 630  Living with a Specified Relative

Section He-W 630.01  Living with a Specified Relative

 

PART He-W 631  UNWED MINOR PARENTS

Section He-W 631.01  Unwed Minor Parent Requirements

 

PART He-W 632  Age

Section He-W 632.01  NHEP/FAP Age Requirements

 

PART He-W 633  RESERVED

 

PART He-W 634  Strikers

Section He-W 634.01  Strikers and Eligibility for NHEP/FAP Financial Assistance

 

          PART He-W 635  RESERVED

 

          PART He-W 636  TECHNICAL REQUIREMENTS FOR NHEP/FAP FINANCIAL AND MEDICAL ASSISTANCE

Section He-W 636.01  Personal Interview

Section He-W 636.02  Verification of Identity

Section He-W 636.03  School Attendance

Section He-W 636.04-636.07  RESERVED

Section He-W 636.08  Disclosure of Paternity Information

Section He-W 636.09  Good Cause for Failure to Cooperate

Section He-W 636.10  Sanction for Failure to Cooperate

 

          PART He-W 637  THE NEW HAMPSHIRE EMPLOYMENT PROGRAM (NHEP)

Section He-W 637.01  Definitions

Section He-W 637.02  NHEP Orientation

Section He-W 637.03  NHEP Employment Activities Participation Requirements

Section He-W 637.04  Exemptions

Section He-W 637.05  Compliance

Section He-W 637.06  Failure to Participate/Comply

Section He-W 637.07  Good Cause

Section He-W 637.08  Sanctions

Section He-W 637.09  Initial Assessment

Section He-W 637.10  RESERVED

Section He-W 637.11  RESERVED

Section He-W 637.12  Employability Plan

Section He-W 637.13  Applicability of Existing Employability Plans

Section He-W 637.14  RESERVED

Section He-W 637.15  Single Course Authorization

Section He-W 637.16  RESERVED

Section He-W 637.17  Basic Education Activity

Section He-W 637.18  Interim Activities

Section He-W 637.19  RESERVED

Section He-W 637.20  On-the-Job-Training (OJT)

Section He-W 637.21  Work Experience and Community Service Program (WECSP)

Section He-W 637.22  Vocational Educational Training

Section He-W 637.23  Post Secondary Education

Section He-W 637.24  RESERVED

Section He-W 637.25  RESERVED

Section He-W 637.26  RESERVED

Section He-W 637.27  RESERVED

Section He-W 637.28  RESERVED

 

PART He-W 638  HOMECARE WORKS

Section He-W 638.01  Purpose

Section He-W 638.02  HomeCare Works Program

 

PART He-W 639  GRANITE WORKFORCE

       Section He-W 639.01  Purpose

       Section He-W 639.02  Subject to Available Funding

       Section He-W 639.03  Definitions

       Section He-W 639.04  Participant Eligibility

       Section He-W 639.05  Initial Assessment

       Section He-W 639.06  Activities and Services

       Section He-W 639.07  Employment Support Services

       Section He-W 639.08  Employer Subsidies

       Section He-W 639.09  Termination of GWPP

 

PART He-W 640  RESERVED

 

PART He-W 641  Special Medical Assistance Only Coverage Groups

Section He-W 641.01  Children Up to 20 Years of Age

Section He-W 641.02  Qualified Pregnant Women/60 Day Extended MA

Section He-W 641.03  Medicaid for Employed Adults with Disabilities (MEAD)

Section He-W 641.04  Severely Disabled Children

Section He-W 641.05  Presumptive Eligibility Determinations

Section He-W 641.06  Medical Coverage for Pregnant Women

Section He-W 641.07  Medical Coverage for Low Income Children under Healthy-Kids Gold

Section He-W 641.08  RESERVED

Section He-W 641.09  Breast and Cervical Cancer Program

 

PART He-W 642  Categorical Requirements - Adult Financial and Medical Assistance

Section He-W 642.01  Reserved

Section He-W 642.02  OAA Categorical Requirements

Section He-W 642.03  APTD Categorical Requirements

Section He-W 642.04  ANB Categorical Requirements

 

          PART He-W 643  RESERVED

 

PART He-W 644  Technical Requirements for Adult Financial and Medical Assistance

Section He-W 644.01  Personal Interview

 

          PART He-W 645 - 647  RESERVED

 

PART He-W 648  Residential Care Facilities and Community Residences

Section He-W 648.01  Reserved

Section He-W 648.02  Residential Care Facilities

Section He-W 648.03  Community Residences

 

          PART He-W 649 - 651  RESERVED

 

PART He-W 652  Income - Basic Principles

Section He-W 652.01  Reserved

Section He-W 652.02  Availability of Funds

Section He-W 652.03  Deemed Income For Financial and Medical Assistance

Section He-W 652.04  Reserved

Section He-W 652.05  Conversion to Monthly Amounts

Section He-W 652.06  Fluctuating Income

Section He-W 652.07  Developing Potential Sources of Income

 

          PART He-W 653  RESERVED

 

PART He-W 654  Evaluation and Treatment of Income

Section He-W 654.01  Evaluation and Treatment of Income

Section He-W 654.02  Income Computation

Section He-W 654.03  Lump Sum Income - NHEP/FAP Financial Assistance

Section He-W 654.04  Treatment of Specific Types of Income

Section He-W 654.05  Educational Income - Adult Categories

Section He-W 654.06  Educational Expenses - Adult Categories

Section He-W 654.07  Income-In-Kind

Section He-W 654.08  Provided Shelter

Section He-W 654.09  Treatment of Assigned Support

Section He-W 654.10  Deemed Income from a Non-citizen’s Sponsor

Section He-W 654.11  Federally Mandated Excluded Income

Section He-W 654.12  Other Excluded Income

Section He-W 654.13  Earned Income Disregard (EID) and Employment Expense Disregard (EED) for Financial Assistance to Needy Families (FANF)

Section He-W 654.14  Child/Dependent Care Disregard

Section He-W 654.15  Adult Category Earned Income Disregard

Section He-W 654.16  Adult Standard Disregard

Section He-W 654.17  Post-Eligibility Computation of Cost of Care for Nursing Facility Care

Section He-W 654.18  Adult Employment Expense Disregard

Section He-W 654.19  Child Care Costs

Section He-W 654.20  Allowable Deductions

Section He-W 654.21  Allocated Income

 

PART He-W 655  Purchased Services for Employment Support Services

Section He-W 655.01  Definitions

Section He-W 655.02  Availability of Funds

Section He-W 655.03  Eligibility for Child Care

Section He-W 655.04  Methods of Payment

Section He-W 655.05  Fees and Supplies

Section He-W 655.06  Transportation Assistance

Section He-W 655.07  Tuition Assistance

 

PART He-W 656  Resources

Section He-W 656.01  Resources - Basic Principles

Section He-W 656.02  Treatment of Specific Types of Resources

Section He-W 656.03  Jointly Owned Resources

Section He-W 656.04  Personal Property Resources

Section He-W 656.05  Real Property Resources

Section He-W 656.06  Resource Limits

 

          PART He-W 657  RESERVED

 

PART He-W 658  Standard of Need

Section He-W 658.01  Financial Assistance to Needy Families (FANF) Standard of Need

Section He-W 658.02  Financial Assistance to Needy Families Payment Standard

Section He-W 658.03  Adult Category Standard of Need

Section He-W 658.04  RESERVED

Section He-W 658.05  RESERVED

Section He-W 658.06  RESERVED

 

Section He-W 658.07  REPEALED

 

          PART He-W 659 - 661  RESERVED

 

          PART He-W 662  RESERVED

 

          PART He-W 663  RESERVED

 

          PART He-W 664  SEPARATE MEDICAL ASSISTANCE GROUP

Section He-W 664.01  RESERVED

Section He-W 664.02  FANF Medical Assistance Only Case – MOVED TO He-W 864.02

 

          PART He-W 665 - 669  RESERVED

 

PART He-W 670  Determination of Financial Eligibility and the Amount of Assistance

Section He-W 670.01-670.02  Reserved

Section He-W 670.03  Determination of the Grant

Section He-W 670.04  Determination of the Assistance Payment

 

          PART He-W 671  ISSUANCE OF ASSISTANCE PAYMENTS

Section He-W 671.01  Electronic Benefit Transfer (EBT)

Section He-W 671.02  Electronic Funds Transfer (EFT)

Section He-W 671.03  Adjustment to an Electronic Benefit Transfer (EBT) Account

Section He-W 671.04  Paper Checks

 

PART He-W 672  Initiation of Financial Assistance

Section He-W 672.01  Initiation of FANF Category Financial Assistance

Section He-W 672.02  Initiation of Adult Category Financial Assistance

 

          PART He-W 673  RESERVED

 

          PART He-W 674  Termination of Financial Assistance

Section He-W 674.01  Termination of Financial Assistance

 

          PART He-W 675  RESERVED

 

          PART He-W 676  Nursing Facilities

Section He-W 676.01  Financial Eligibility for Nursing Facilities

 

          PART He-W 677  RESERVED

 

          PART He-W 678  RESERVED

 

          PART He-W 679  RESERVED

 

PART He-W 680  Initiation of Medical Assistance

Section He-W 680.01  Initiation of Medical Assistance

Section He-W 680.02  Retroactive Medical Assistance

 

          PART He-W 681  RESERVED

 

PART He-W 682  Termination of Medical Assistance

Section He-W 682.01  Termination of Medical Assistance

Section He-W 682.02-682.05  Reserved

 

          PART He-W 683  RESERVED

 

PART He-W 684  Redetermination of Eligibility

Section He-W 684.01  Redeterminations - General

Section He-W 684.02  Regularly Scheduled Redeterminations

 

PART He-W 685  Additional Eligibility Requirements

Section He-W 685.01  Special Reviews of Eligibility

 

PART He-W 686  PROTECTIVE AND VENDOR PAYMENTS

Section He-W 686.01  Protective and Vendor Payments

 

          PART He-W 687  RESERVED

 

PART He-W 688  Corrective Payments

Section He-W 688.01  Corrective Payments

 

          PART He-W 689  RESERVED

 

PART He-W 690  Reimbursement

Section He-W 690.01  Reimbursement

 

          PART He-W 691  RESERVED

 

PART He-W 692  Recoupment

Section He-W 692.01  Reserved

Section He-W 692.02  Erroneously Paid Financial Assistance

Section He-W 692.03  Erroneously Paid Medical Assistance

 

PART He-W 693  FANF INTENTIONAL PROGRAM VIOLATIONS

Section He-W 693.01  Applicability

Section He-W 693.02  Intentional Program Violation

Section He-W 693.03  Administrative Disqualification Hearing Procedures

Section He-W 693.04  Waiver of the Administrative Disqualification Hearing

Section He-W 693.05  Court Actions on Consent Agreements

Section He-W 693.06  Disqualification Penalties

 

PART He-W 694  Funeral and Burial Expenses

Section He-W 694.01  Funeral and Burial Expenses

 

PART He-W 695 - reserved

 

PART He-W 696  NUTRITIONAL SUPPLEMENT FOR WORKING FAMILIES (NSWF)

       Section He-W 696.01  Purpose

       Section He-W 696.02  Nutritional Supplement for Working Families (NSWF)

 

PART He-W 697  RESERVED

 

PART He-W 698  Buy In of Medicare Part B

Section He-W 698.01  Buy-In of Medicare Part B

 

PART He-W 699  Special Payment Situations

Section He-W 699.01  Reserved

Section He-W 699.02  Post Office Boxes and General Delivery Mailing Addresses

Section He-W 699.03  RESERVED

Section He-W 699.04  Deceased Recipients

Section He-W 699.05  Emergency Assistance

Section He-W 699.06  Special Needs Payments for OAA, ANB, and APTD Financial Assistance Recipients

 

CHAPTER He-W 700  FOOD STAMPS

          PART He-W 701  DEFINITIONS

                  Section He-W 701.01  Able Bodied Adult Without Dependents (ABAWD)

                  Section He-W 701.02  RESERVED

                  Section He-W 701.03  Educational Income

                  Section He-W 701.04  Electronic Benefit Transfer (EBT)

                  Section He-W 701.05  Food Stamp Account

                  Section He-W 701.06  Personal Identification Number (PIN)

                  Section He-W 701.07  Questionable

                  Section He-W 701.08  EXPIRED

                  Section He-W 701.09  EXPIRED

                  Section He-W 701.10  Verification

 

          PART He-W 702  FOOD STAMP BENEFIT ISSUANCE

                  Section He-W 702.01  Method of Issuance

                  Section He-W 702.02  RESERVED

                  Section He-W 702.03  Telephone Application

 

          PART He-W 703  RESERVED

 

          PART He-W 704  CASE DECISIONS

                  Section He-W 704.01-704.03  RESERVED

                  Section He-W 704.04  Electronic Notification

                  Section He-W 704.05  Electronic Account Access

                  Section He-W 704.05  Electronic Account Access

 

          PARTS He-W 705 through He-W 707 - RESERVED

 

          PART He-W 708  CLAIMS AGAINST HOUSEHOLDS

                  Section He-W 708.01  Collection Action on Claims

 

PART He-W 709  ADMINISTRATIVE DISQUALIFICATION HEARINGS ON INTENTIONAL PROGRAM VIOLATION

                  Section He-W 709.01  RESERVED

                  Section He-W 709.02  Waived Hearings

                  Section He-W 709.03  Timeframe for Signing Waivers

 

          PARTS He-W 710 through He-W 721 - RESERVED

 

          PART He-W 722  INTERVIEWING HOUSEHOLDS

                  Section He-W 722.01  Interview Requirements

 

          PART He-W 723 - RESERVED

 

          PART He-W 724  VERIFICATION REQUIREMENTS

                  Section He-W 724.01  Required Verification

 

          PARTS He-W 725 through He-W 731 - RESERVED

 

          PART He-W 732  SOCIAL SECURITY ENUMERATION

                  Section He-W 732.01  Social Security Enumeration Requirements

 

          PART He-W 733 - RESERVED

 

          PART He-W 734  DISQUALIFICATIONS

                  Section He-W 734.01  Disqualifications for Voluntary Quit

                  Section He-W 734.02  RESERVED

                  Section He-W 734.03  Child Support

                  Section He-W 734.04  Work Requirements

 

          PARTS He-W 735 through He-W 739 - RESERVED

 

          PART He-W 740  INCOME

                  Section He-W 740.01  Excluded Income

 

          PART He-W 741  RESOURCES

                  Section He-W 741.01  Excluded Resources

 

          PART He-W 742  ALLOWABLE INCOME DEDUCTIONS

                  Section He-W 742.01  Mileage for Medical Travel

                  Section He-W 742.02  Utility Expenses Incurred Separately

 

          PART He-W 743 - RESERVED

 

          PART He-W 744  DETERMINATION OF MONTHLY FOOD STAMP INCOME AND DEDUCTIONS AND HOUSEHOLD ELIGIBILITY

                  Section He-W 744.01  Averaging Income

                  Section He-W 744.02  Ineligible Alien Income and Financial Resources

                  Section He-W 744.03  Fluctuating Income

 

          PART He-W 745 - RESERVED

 

          PART He-W 746  ACTIONS ON ELIGIBLE HOUSEHOLDS

                  Section He-W 746.01  Determination of the Monthly Allotment

                  Section He-W 746.02  Establishing Certification Periods

                  Section He-W 746.03  Withdrawal of Fair Hearing Requests

 

          PART He-W 747 - RESERVED

 

          PART He-W 748  EMPLOYMENT AND TRAINING REQUIREMENTS

                  Section He-W 748.01  Reimbursement for Mileage

                  Section He-W 748.02  RESERVED

                  Section He-W 748.03  RESERVED

 

          PART He-W 749 - RESERVED

 

          PART He-W 750  ACTIONS BECAUSE OF DELAYED ELIGIBILITY DETERMINATIONS

                  Section He-W 750.01  Actions Because of Delayed Eligibility Determinations

 

          PART He-W 751 REPORTING REQUIREMENTS

                  Section He-W 751.01 Change Reporting Requirements

 

          PART He-W 752  NOTICES TO CLIENTS

                  Section He-W 752.01  Change Report Form

 

          PARTS He-W 753 through He-W 755 - RESERVED

 

          PART He-W 756  DETERMINATION OF ELIGIBILITY FOR SPECIAL SITUATION HOUSEHOLDS

                  Section He-W 756.01  Households with Shared Custody of Children

                  Section He-W 756.02  Households Receiving or Paying Child Support

                  Section He-W 756.03  Households in Community Residences

                  Section He-W 756.04  Self-employment

                  Section He-W 756.05  Adopted Children Age 18 up to Age 22 Residing with a Birthparent Who Has Relinquished Parental Rights

                  Section He-W 756.06  Public Assistance Households

                  Section He-W 756.07  Households with an Individual Development Account

 

          PART He-W 757 - RESERVED

 

          PART He-W 758  TARGET POPULATION - ELDERLY AND DISABLED INDIVIDUALS

                  Section He-W 758.01  Medical Expenses of Target Population Members

 

          PARTS He-W 759 through He-W 765 - RESERVED

 

          PART He-W 766  RECERTIFICATION OF ELIGIBILITY

                  Section He-W 766.01  Recertification of Eligibility

                  Section He-W 766.02  Telephone Redetermination

 

          PARTS He-W 767 through He-W 774 - RESERVED

 

          PART He-W 775 - PROGRAM OPTIONS - RESERVED

 

CHAPTER He-W 800  ELIGIBILITY FOR MEDICAL ASSISTANCE

          PART He-W 801  RESERVED

 

          PART He-W 802  PROGRAM COVERAGES AND LIMITATIONS

                  Section He-W 802.03  Telephone Application

 

          PART He-W 803  INDIVIDUAL RIGHTS AND RESPONSIBILITIES

                  Section He-W 803.01  Authorized Representative

                  Section He-W 803.02  Individual Responsibility to Supply Accurate Information

                  Section He-W 803.03  Individual Responsibility to Report Changes

 

          PART He-W 804  CASE DECISIONS

                  Section He-W 804.01-804.03  RESERVED

                  Section He-W 804.04  Electronic Notification

                  Section He-W 804.05  Electronic Account Access

 

                 PART He-W 805  RESERVED

 

          PART He-W 806  VERIFICATION

                  Section He-W 806.01-806.36  RESERVED

                  Section He-W 806.18  Institutional Residence

                  Section He-W 806.37  Applications for Disability Benefits

                  Section He-W 806.38 - 806.59  RESERVED

                  Section He-W 806.60  Verification of Educational Income – Adult Categories

                  Section He-W 806.61-806.67  RESERVED

                  Section He-W 806.68  Adult OAA, APTD, and ANB Employment Expense Disregard

                  Section He-W 806.69  Impairment Related Work Expenses

                  Section He-W 806.70-806.73  RESERVED

                  Section He-W 806.74  Allowable Deductions

                  Section He-W 806.75-806.77  RESERVED

                  Section He-W 806.78  Personal Property Resources

                  Section He-W 806.79-806.88  RESERVED

                  Section He-W 806.89  Verification Requirements for In and Out Medically Needy Medical Assistance

                  Section He-W 806.90-806.91  RESERVED

                  Section He-W 806.92  Telephone Redetermination

 

          PART He-W 807 – 819  RESERVED

 

          PART He-W 820  ASSET TRANSFERS

          Section He-W 820.01  Purpose

          Section He-W 820.02  Definitions

          Section He-W 820.03  Asset Transfers

 

          PART 821 He-W 821  TECHNICAL REQUIREMENTS FOR NURSING FACILITY (NF) AND HOME AND COMMUNITY BASED CARE (HCBC) SERVICES

          Section He-W 821.01  Asset Transfer Penalty Undue Hardship Waiver

          Section He-W 821.02  Hardship Waiver for Individuals with Substantial Home Equity

          Section He-W 821.03  Administrative Appeals

 

          PARTS He-W 822-823  RESERVED

 

          PART He-W 824  INSTITUTIONAL RESIDENCE

                  Section He-W 824.01  Institutional Residence

 

                  PARTS He-W 825 through He-W 836  RESERVED

 

          PART He-W 837 GRANITE ADVANTAGE HEALTH CARE PROGRAM

                  Section He-W 837.01  Definitions

                  Section He-W 837.02  Community Engagement Requirement

                  Section He-W 837.03  Exemptions

                  Section He-W 837.04  Request for Exemption; Duration of Exemptions

                  Section He-W 837.05  Qualifying Activities

                  Section He-W 837.06  Reporting of Community Engagement Activities and Crediting of Hours

                  Section He-W 837.07  Beneficiaries with Disabilities: Reasonable Modification

                  Section He-W 837.08  Opportunity to Cure

                  Section He-W 837.09  Suspension

                  Section He-W 837.10  Good Cause

                  Section He-W 837.11  Crediting a Finding of Good Cause

                  Section He-W 837.12  Limitation on the Repeated Consecutive Use of Curing to Meet the Community Engagement Requirement

                  Section He-W 837.13  Extra Hours

                  Section He-W 837.14  Disenrollment and Reconsideration

                  Section He-W 837.15  Re-Application

                  Section He-W 837.16  Screening for Other Bases of Medicaid Eligibility Prior to Suspension, Termination, Disenrollment or Denial of Eligibility

                  Section He-W 837.17  Appeals

                  Section He-W 837.18  Other Department Obligations

 

          PARTS He-W 838 through 843  RESERVED

 

          PART He-W 844  Technical Requirements for Adult Medical Assistance

                  Section He-W 844.01  Personal Interview

 

          PARTS He-W 845 through 847  RESERVED

 

          PART He-W 848  RESIDENTIAL CARE FACILITIES AND COMMUNITY RESIDENCES

                  Section He-W 848.01  RESERVED

                  Section He-W 848.02  Residential Care Facilities

                  Section He-W 848.03  Community Residences

 

          PARTS He-W 849 – 851  RESERVED

 

          PART He-W 852  INCOME – BASIC PRINCIPALS

                  Section He-W 852.06  Fluctuating Income

 

          PART He-W 853  RESERVED

 

          PART He-W 854  EVALUATION AND TREATMENT OF INCOME

                  Section He-W 854.02  Income Computation

                  Section He-W 854.16  Adult Standard Disregard

                  Section He-W 854.17  Post-Eligibility Computation of Cost of Care for Nursing Facility Care

                  Section He-W 854.18  Adult Employment Expense Disregard

                  Section He-W 854.20  Allowable Deductions

 

          PARTS He-W 855  RESERVED

 

          PART He-W 856  RESOURCES

                  Section He-W 856.01  Resources – Basic Principles

                  Section He-W 856.02  Reserved

                  Section He-W 856.03  Jointly Owned Resources

                  Section He-W 856.04  RESERVED

                  Section He-W 856.05  Real Property Resources

                  Section He-W 856.06  Resource Limits

 

          PARTS He-W 857- RESERVED

 

          PART He-W 858  STANDARD OF NEED

                  Section He-W 858.01 – 858.03  RESERVED

                  Section He-W 858.04  Protected Income Level

                  Section He-W 858.05  Eligibility for Adult Category Medical Assistance Nursing Care

                  Section He-W 858.06  Eligibility for Adult Category Medical Assistance for Home and Community-Based Care Choices for Independence (HCBC0CFI), Home and Community-Based Care for the Developmentally Disabled (HCBC-DD), Home and Community-Based Care for Individuals with an Acquired Brain Disorder (HCBC-ABD), and Home and Community-Based Care for In-Home Supports (HCBC-HIS)

 

          PARTS He-W 859 through He-W 863 & PARTS He-W 865 through He-W 875  RESERVED

 

          PART He-W 864 MEDICALLY NEEDY MEDICAL ASSISTANCE

                  Section He-W 864.01  RESERVED

                  Section He-W 864.02  Parents and Other Caretaker Relatives Medically Needy Medical Assistance

 

          PART He-W 876  NURSING FACILITIES

                  Section He-W 876.01  Financial Eligibility for Nursing Facilities

 

          PART He-W 877  RESERVED

 

          PART He-W 878  IN AND OUT MEDICALLY NEEDY MEDICAL ASSISTANCE

                  Section He-W 878.01  In and Out Medically Needy Medical Assistance

 

          PARTS He-W 879-881

 

          PART He-W 882  TERMINATION OF MEDICAL ASSISTANCE

                  Sections He-W 882.01 - 882.03  Reserved

                  Section He-W 882.04  Four Month Extended Medical Assistance Due to New or Increased Spousal Support

                  Section He-W 882.05  Twelve Month Extended Medical Assistance

 

          PARTS He-W 883 - 894  RESERVED

 

          PART He-W 895  UNDUE HARDSHIP

                  Section He-W 895.01  Purpose

                  Section He-W 895.02  Definitions

                  Section He-W 895.03  Waiver of Recovery

                  Section He-W 895.04  Criteria for Determination of Undue Hardship

                  Section He-W 895.05  Request for Undue Hardship

                  Section He-W 895.06  Undue Hardship Request Review

                  Section He-W 895.07  Reduction from Claim Against Non-Probate Assets

                  Section He-W 895.08  Administrative Hearings

 

PARTS He-W 896 - 898  RESERVED

 

          PART He-W 899  SPECIAL PAYMENT SITUATIONS

                  Section He-W 899.01  RESERVED

                  Section He-W 899.02  Post Office Boxes and General Delivery Mailing Addresses

 

CHAPTER He-W 900  OTHER PROGRAMS ADMINISTERED BY THE DEPARTMENT OF HEALTH AND HUMAN SERVICES

 

        PART He-W 910  EXPANDED HEALTH CARE COVERAGE FOR CERTAIN LOW-INCOME CHILDREN - REPEALED

 

        PART He-W 950  COMPREHENSIVE HEALTH CARE INFORMATION SYSTEM PROCEDURES FOR THE RELEASE OF CLAIMS DATA SETS FOR PUBLIC AND RESEARCH PURPOSES

                  Section He-W 950.01  Purpose

                  Section He-W 950.02  Scope

                  Section He-W 950.03  Definitions

                  Section He-W 950.04  Release of Public Use Data Sets

                  Section He-W 950.05  Release of Limited Use Data Sets

                  Section He-W 950.06  Claims Data Release Advisory Committee

                  Section He-W 950.07  Fees

                  Section He-W 950.08  Exemption from Rule

                  Section He-W 950.09  General Limitation